Research curricula in critical care fellowships--a survey

OBJECTIVES: To determine curriculum requirements and educational methods used by Critical Care fellowship training programs in fulfilling Residency Review Committee requirements for a research experience during Critical Care subspecialty training. DATA SOURCE: Responses from 163 (67%) of the 245 directors of accredited Anesthesiology, Medicine, Pediatric, and Surgical Critical Care fellowship training programs listed in the American Medical Association Graduate Medical Education Directory. DATA EXTRACTION: Survey information accepted as valid for each program was tabulated to answer study questions. DATA SYNTHESIS: Most (89%) Critical Care programs with 2- or 3-yr curricula meet Residency Review Committee requirements and provide nonclinical time for research. Only 63% of 1-yr curricula from Anesthesiology and Medicine provide a required research experience. Formal instruction in research topics is provided by lecture, journal club, or research conference in approximately 90% of fellowships. Academic productivity from fellowship programs is high, but not correlated with a program's requirement for research. CONCLUSION: Compliance with current Residency Review Committee requirements for active participation in research is poor for 1-yr fellowship curricula. Reasons for this failure are discussed and a modified requirement is proposed.     

A randomized study of a pH sensor feeding tube vs a standard feeding tube in patients requiring enteral nutrition

RATIONALE AND OBJECTIVES: A survey of chief residents of academic radiology programs is conducted annually on behalf of the American Association of Academic Chief Residents in Radiology (A3CR2). Data are obtained to improve the training of diagnostic radiology residents and to increase the understanding of radiologists and their associates about issues of interest to radiologists in training. METHODS: Questionnaires were mailed to 133 accredited programs in the United States and Canada. A wide variety of demographic and common interest questions were asked. The analysis took into account geographic location of the responders and the size of the residency program. Comparisons were made to the data from prior years. RESULTS: Completed surveys from 93 programs (70%) were returned. The percentage of women residents is increasing. Important regional and size variations exist in several areas including salary, workload, prior clinical training, resident/fellow ratios, post residency plans, and call schedules. Although many chief residents feel knowledgeable about the health care system, opinions about the future of radiology and medical care are tentative. CONCLUSIONS: This survey provides important demographic information about academic radiology residency programs. The summary information regarding plans for fellowship training, resident call schedules, and opinions about socioeconomic issues may be useful for chief residents, program directors, and departmental chairmen.     

Training in projective testing: Survey of clinical training directors and internship directors.

Eighty-nine percent of directors of doctoral programs in clinical psychology accredited by the American Psychological Association (APA) and 84% of directors of APA-accredited internships responded to similar surveys on expectations, attitudes, and practices in the instruction of projective techniques. Directors of internship programs appeared to value projective techniques more than did directors of doctoral programs, and they expected students to have more experience with these techniques than is typically provided in doctoral programs. The two groups also differed significantly in where they believed the responsibility for correcting this imbalance should lie. In addition, 15% of directors of doctoral programs did not believe that training in projective techniques should be required, whereas only 4% of directors of internship programs expressed this view. This study documents the disparity between the average amount of training in projectives provided to students in doctoral programs and the proficiency expected of those students in their internships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early tracheostomy in trauma patients

The purpose of this study was to determine the current level of psychiatric training in internal medicine residencies, satisfaction with this training, and perceived need, if any, for more training. Surveys were mailed to all training directors of accredited primary care (N = 178) and categorical (N = 410) internal medicine residencies in the United States; 110 primary care (62%) and 238 categorical (58%) training directors returned the surveys. Seventy-five percent of categorical and 66% of primary care training directors thought their program should spend more time on psychiatric disorders. For all categories of psychiatric disorder, training intensity was greater and satisfaction with training higher in the primary care programs, but less than half of the directors were satisfied with their current level of training, e.g., 33% of categorical and 47% of primary care directors were satisfied with their residents training concerning depression. Training in somatoform disorders, psychotropic drugs, and office psychotherapy were most frequently identified as deficient. The most favored additions to the curriculum were psychiatric consultants in medical clinics and on medical wards. Although most outpatient care for psychiatric disorders is given by primary care physicians, internal medicine training directors perceive current levels of training in their residencies as inadequate. Innovative collaborations between medicine and psychiatry departments will be necessary if treatment of psychiatric disorders in primary care is to be improved.     

Licensure, use, and training of paramedical personnel to perform screening flexible sigmoidoscopy

BACKGROUND: The purpose of this study was to assess the state board of nursing guidelines about the performance of flexible sigmoidoscopy by nurses and to determine the current use and training of paramedical personnel in flexible sigmoidoscopy at gastroenterology fellowship programs in the United States. METHODS: Separate one-page questionnaires were sent to state boards of nursing and directors of endoscopy at gastroenterology fellowship programs in the United States. RESULTS: Twenty percent (10 of 50) of state boards of nursing explicitly approve the performance of sigmoidoscopy by registered nurses, and 50% (25 of 50) explicitly approve the practice by nurse practitioners. Forty-six percent (23 of 50) of state boards of nursing have no written policy but allow nurses to use a "decision making model" to determine whether the performance of sigmoidoscopy is allowed. Fifteen percent (24 of 164) of gastroenterology fellowship programs in the United States use paramedical personnel to perform flexible sigmoidoscopy. Sixty-three percent (15 of 24) of these programs started since 1995, and 67% (16 of 24) require that the paramedical personnel perform 50 or more supervised sigmoidoscopies during their training. Forty-five percent (5 of 11) of programs with physician assistants/nurse practitioners use these personnel to perform colonoscopy or endoscopy. CONCLUSIONS: Nurses are allowed to perform flexible sigmoidoscopy in most states based on current state board of nursing guidelines. The use of paramedical personnel to perform endoscopic procedures is increasing rapidly.     

National survey of psychology internship directors regarding education for prevention of psychologist–patient sexual exploitation.

All directors of psychology internships accredited by the American Psychological Association (N?=?410) were surveyed about the status of internship education related to prevention of psychologist–patient sexual exploitation. Virtually all responding directors (99% of 230) reported that their program provides at least 1 session on this topic, and the same number indicated that such education should be part of the mandatory internship curriculum. Ninety-four percent of responding programs had instituted the reported training within the prior 10 years and 60% had done so within 4 years. A national mandate requiring education for prevention of psychologist–patient sexual exploitation can consolidate the apparent trend toward greater inclusion of this topic in training programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Getting in and getting money: A comparative analysis of admission standards, acceptance rates, and financial assistance across the research–practice continuum in clinical psychology programs.

The diversification and proliferation of doctoral programs in clinical psychology call for their periodic comparative analysis to inform prospective applicants, their advisors, and the entire field. The authors surveyed directors of the 232 American Psychological Association (APA)–accredited doctoral programs in clinical psychology (98% response) regarding application numbers, acceptance rates, financial assistance, and credentials of incoming students. Results are summarized for all clinical programs and then separately for 6 types of programs along the practice–research continuum: freestanding PsyD, university professional school PsyD, university department PsyD, practice-oriented PhD, equal-emphasis PhD, and research-oriented PhD. Lower acceptance rates and higher Graduate Record Examination scores were strongly associated with programs oriented toward more research training; for example, research-oriented PhD programs admitted far fewer applicants (7% vs. 50%) than did freestanding PsyD programs. Freestanding PsyD programs awarded significantly less full financial assistance to incoming students (1% vs. 89%) and required 1 less year to complete than did PhD programs. Overall, PhD-level students were more likely to secure an APA or Association of Psychology Postdoctoral and Internship Centers internship than were PsyD students. The authors conclude with observations about the historical changes and heightened differentiation of doctoral training in clinical psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Character and Fitness Requirements for Professional Psychologists: Training Directors' Perspectives.

Do directors of psychology training programs consider whether program applicants and students possess essential moral character and psychological fitness characteristics? A survey revealed that directors of clinical training (DCTs) in clinical and counseling psychology training programs are very concerned about both character and fitness. DCTs reported that evidence accrued during interviews and from undergraduate references is most salient preadmission and that behavior in the program and in clinical situations is most meaningful postadmission. The authors highlight the practices and perspectives of DCTs when it comes to evaluating character and fitness and conclude with several recommendations for training programs, licensing boards, and psychology training organizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of a diabetes electronic management system on the care of patients seen in a subspecialty diabetes clinic

Journal clubs are a time-honored method of teaching literature appraisal skills in many residency programs. A questionnaire was completed by 57 hand surgery fellowship directors and 91 hand fellows to define the role of the journal club in hand fellowship training. We sought to identify definitive characteristics of hand surgery journal clubs and assess their strengths and weaknesses. One hundred forty-eight of 164 (90%) directors and fellows responded, yielding information on 57 of 58 accredited hand fellowships. Forty-nine of 57 (86%) responding fellowships have a journal club. The majority of clubs meet monthly for 1 to 2 hours, usually within the hospital. The primary purpose is to familiarize both fellows and attendings with the current literature. Most often, fellows choose the articles, which are most commonly original research and review articles. Usually, faculty presides, and residents and fellows present. Increased faculty participation was the most frequently suggested improvement. The great majority of those surveyed felt that their journal club was successful and was an important part of the fellowship training. We conclude that journal clubs have a high perceived value by participants, and recommend the journal club to all hand surgery communities, with or without fellowship involvement.     

Training and supervision practices in clinical, counseling, and school psychology programs.

This study surveyed the training directors of counseling, clinical, and school psychology programs accredited by the American Psychological Association on training and supervisory practices and perceptions of various modalities of supervision. Response rates were 74%, 56%, and 45%, respectively. Clinical and counseling psychology training directors reported that videotape review was the most used modality of supervision; school psychology training directors reported that self-report only was the most frequently used. The amount of time involved in conducting live supervision and cotherapy as supervision was seen as a moderate barrier to their use. Cotherapy as supervision was rated as having the most strengths by all program directors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Orthopedic residents' perceptions of the content and adequacy of their residency training

The content and adequacy of orthopedic surgery residency training can be evaluated by several means. The Accreditation Council for Graduate Medical Education and the Residency Review Committee set standards with which residency programs must comply in order to be accredited. Residents' perceptions of the content and adequacy of their training is another means of evaluating orthopedic residency training. A questionnaire was sent to all graduating orthopedic residents in the United States, Canada, and Puerto Rico. The questionnaire provided program and individual resident demographics, as well as the residents' rating of specific areas of residency training on a 5-point scale (1=superior, 2=above average, 3=average, 4=below average, 5=inadequate). Completed surveys were received from 454 of the 698 graduating orthopedic surgery residents listed by the American Academy of Orthopaedic Surgeons; the response rate was therefore 65.0%. Our respondents were representative of the entire population in terms of geographic and sex distribution. Respondents rated their general orthopedic training at 1.9. The areas of training that had the best ratings included trauma/fracture (1.8), adult reconstruction (1.9), and pediatrics (1.9). The worst rating was reported for training in foot and ankle (2.7). Factors related to better ratings for general orthopedic training included male sex of residents, programs with more full-time faculty, programs with more hours of weekly teaching conferences, programs with one or more faculty present at all teaching conferences and programs in which residents first operate independently at or before postgraduate year 4. Sixty-six percent of all respondents were planning to hold a fellowship immediately after graduation. The most common fellowships taken included sports medicine (20.5% of all respondents), hand (12.1%), and spine (9.5%). Younger graduating residents, those from larger programs (more residents per year), and those from the Mideast (U.S.), and New England regions were most likely to enter a fellowship after graduation.     

Multi-institutional survey of graduates of pediatric anesthesia fellowship: assessment of training and current professional activities

We surveyed all the graduates of four fellowship programs in pediatric anesthesia between 1985 and 1993 to assess their current professional activities, their evaluation of fellowship training, and their opinions on future directions of such training. One-hundred ninety-one (62%) of the graduates responded. Nearly all of the respondents had sought fellowship training for pediatric anesthesia and thought that the training was worthwhile. At the time of the survey, 40% worked in a children's hospital, 72% had university or affiliate positions, and 54% had a practice that was > 50% pediatric. Those with > or = 12 mo fellowship and/or board certification in pediatrics were the most likely to have a pediatric-dedicated practice. Seventy percent of the respondents thought that fellowship training should be for 12 mo, and the proportion of respondents who recommended inclusion of training in pain management and clinical research was greater than the number who had actually received such training. Fifty-eight percent of respondents supported restriction of fellowship positions in the future, but 83% did not support a mandatory 2-yr fellowship with research training. We conclude that fellowships in pediatric anesthesia seem to be successful in providing training that is not only satisfying to the trainees, but that is also followed by active involvement in the care of children and in the training of residents and fellows in anesthesia. Additional information should be gathered to assess the impact of this training on pediatric care, to formulate a standardized curriculum, and to justify support for such training in the future. Implications: We surveyed graduates of four fellowship programs in pediatric anesthesia (1985-1993) to assess current professional activities, fellowship training, and future directions of such training. Fellowships in pediatric anesthesia seem to provide training that is satisfying to trainees and that is followed by active involvement in the care of children.     

A profile of European ICU nursing

OBJECTIVE: To evaluate major similarities and major differences between Western European countries in intensive care unit (ICU) nurse staffing, education, training, responsibilities, and initiative. DESIGN: A questionnaire was sent to Western European doctor members of the European Society of Intensive Care Medicine, to be passed on to the nurse-in-charge of their ICU. RESULTS: 156 completed questionnaires were analyzed: 49% were from university hospitals, 26% from university-affiliated hospitals, and 25% from community hospitals; 42% of the hospitals had more than 700 beds, 67% of the ICUs had between 6 and 12 beds, and 54% were mixed medical-surgical units. Among British units, 79% had more than three full-time nursing equivalents (FTE) per ICU bed, while in Sweden 75% of units had less than two FTE/ICU bed. University hospitals had more nursing staff per bed than community hospitals. As regards training, 33% of nurses followed a training course before starting work on the ICU and 64% after starting on the unit, and 85% had easy access to continuing education, particularly in the university hospitals. In an emergency, more than 70% of nurses regularly initiated oxygen administration, mask ventilation, or cardiac massage. In Sweden 100% of nurses and in Switzerland 91% of nurses regularly inserted peripheral intravenous catheters, but only 7% of German nurses did. No German nurses and only 12% of British nurses regularly performed arterial puncture, but in Sweden 75% of nurses regularly did. CONCLUSION: Even though the number of participants were limited, our questionnaire revealed variations in nurse staffing patterns among European countries and in their systems of training and education. Nurse autonomy also varies widely between countries.     

The intensive care units in greater Athens: needs and resources

The purpose of this study was to investigate the availability of intensive care unit (ICU) beds and the number of requests, the number and categories of nursing staff, the nursing care required, and the time spent in various nursing activities. METHODS: 19 district general hospitals were studied. The characteristics of the units and their nursing personnel were recorded. The availability of ICU beds, the frequency of bed requests, and the way of patient admission in the ICUs were studied retrospectively for 1 year and prospectively for 2 weeks. The staffing level of direct care for 36 patients was studied to determine the time required for direct nursing care. RESULTS: the distribution of intensive care beds was: GICU 108, CICU 114, PSICU 30. During 1991, 12363 patients were admitted and 12172 of them were discharged; 3 628 patients stayed less than 2 days while the average length of stay was 12.5 days. In 1992, during the 2-week period, there were 303 requests for an admission to ICUs and of these 150 requests could not be met because of lack of ICU beds. The mean staffing level was 2.3 nurses per bed (to cover the three shifts). The mean nursing time required for direct nursing care of each patient per shift was found to be 6 hours for GICU patients, 5.3 for CICU, and 6.0 for PSICU patients.     

Critical care in Japan and Korea. The market of excellence

Medical services in general are well advanced in Japan and Korea. However, intensive and critical care medicine is still on its way to further developments. One particular problem in both countries is the shortage of positions for intensive care physicians and nurses. Although they are well equipped with therapeutic and monitoring devices, there are a limited number of ICU beds. In Korea, the estimated number of ICUs is 122 or more. In Japan, the number of ICUs is estimated to be between 229 and 944.     

Fellowship training in infectious diseases: a report from the regional and national meetings of infectious diseases division chiefs and program directors

During the 2-year period April 1995 to April 1997, six regional meetings and one national meeting of division chiefs and program directors of adult infectious diseases programs in the United States were held to review fellowship training. Herein, we report data on job availability and job selection for recently graduated fellows. We summarize discussions on decreasing the number of fellows in training, and we outline suggested components of a core clinical curriculum and of three training tracks--clinician track, clinical investigator track, and basic investigator track.     

The management of bereavement on intensive care units

OBJECTIVE: To investigate the management of the bereaved on Intensive Care Units (ICU) throughout the United Kingdom, and to identify inadequacies that may exist either in the provision of staff training in dealing with bereavement or in the facilities or support available for the bereaved. DESIGN: Questionnaires were sent to the senior nurse and senior doctor in all general ICUs with more than four beds nationwide. The questions asked about nursing and medical practice around the time of a patient's death, as well as about staff attitudes towards, and training in, dealing with bereavement and the support they received for this role. RESULTS: We obtained a 68% (293/430) response rate. Most ICUs had facilities for relatives, but little for the specific needs of the bereaved. Only 6% of doctors and 21% of nurses had training in dealing with bereavement and grieving. A staff support group was available in 23% of ICUs, and 75% of the remainder thought it would be useful to have one. Lack of staff training and poor facilities for relatives were identified as the major concerns of ICU staff. CONCLUSION: Many doctors and nurses working in Intensive Care Units feel inadequately trained to deal confidently with the bereaved. A minority of ICUs have support mechanisms available for their staff, inspite of the perceived need for them. Furthermore, many ICU staff feel the facilities they are able to offer the bereaved are inadequate. We have identified the major inadequacies and the needs of ICU staff for improved training. Meeting these needs would play a significant role not only in reducing staff stress but also minimising the morbidity in surviving relatives.