Program requirements for residency/fellowship education in neuroendovascular surgery/interventional neuroradiology: a special report on graduate medical education.
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BACKGROUND AND PURPOSE: Neuroendovascular surgery/interventional neuroradiology is a relatively new subspecialty that has been evolving since the mid-1970s. During the past 2 decades, significant advances have been made in this field of minimally invasive therapy for the treatment of intracranial cerebral aneurysms; acute stroke therapy intervention; cerebral arteriovenous malformations; carotid cavernous sinus fistulas; head, neck, and spinal cord vascular lesions; and other complex cerebrovascular diseases. Advanced postresidency fellowship programs have now been established in North America, Europe, and Japan, specifically for training in this new subspecialty. METHODS: From 1986 to the present, an ad hoc committee of senior executive committee members from the American Society of Interventional and Therapeutic Neuroradiology, the Joint Section of Cerebrovascular Neurosurgery, and the American Society of Neuroradiology met to establish, by consensus, general guidelines for training physicians in this field. RESULTS: In April 1999, the Executive Committee of the Joint Section of Cerebrovascular Neurosurgery voted unanimously to endorse these training standard guidelines. In May 1999, the Executive Committee of the American Society of Interventional and Therapeutic Neuroradiology and the American Society of Neuroradiology also unanimously voted to endorse these guidelines. In June 1999, the Executive Council of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons unanimously voted to endorse these guidelines. CONCLUSION: The following guidelines for residency/fellowship education have now been endorsed by the parent organization of both the interventional and diagnostic neuroradiology community, as well as both senior organizations representing neurosurgery in North America. These guidelines for training should be used as a reference and guide to any institution establishing a training program in neuroendovascular surgery/interventional neuroradiology. (+info)
Confidence of academic general internists and family physicians to teach ambulatory procedures.
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OBJECTIVE: To evaluate and compare the readiness of academic general internal medicine physicians and academic family medicine physicians to perform and teach 13 common ambulatory procedures. DESIGN: Mailed survey. SETTING: Internal medicine and family medicine residency training programs associated with 35 medical schools in 9 eastern states. PARTICIPANTS: Convenience sample of full-time teaching faculty. MEASUREMENTS AND MAIN RESULTS: A total of 331 general internists and 271 family physicians returned completed questionnaires, with response rates of 57% and 65%, respectively. Academic generalists ranked most of the ambulatory procedures as important for primary care physicians to perform; however, they infrequently performed or taught many of the procedures. Overall, compared with family physicians, general internists performed and taught fewer procedures, received less training, and were less confident in their ability to teach these procedures. Physicians' confidence to teach a procedure was strongly associated with training to perform the procedure and performing or precepting a procedure at least 10 times per year. CONCLUSIONS: Many academic general internists do not perform or precept common adult ambulatory procedures. To ensure that residents have the opportunity to learn routine ambulatory procedures, training programs may need to recruit qualified faculty, train current faculty, or arrange for academic specialists or community physicians to teach these skills. (+info)
Confidence of graduating internal medicine residents to perform ambulatory procedures.
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OBJECTIVE: To evaluate the training of graduating internal medicine residents to perform 13 common ambulatory procedures, 3 inpatient procedures, and 3 screening examinations. DESIGN: Self-administered descriptive survey. SETTING: Internal medicine training programs associated with 9 medical schools in the eastern United States. PARTICIPANTS: Graduating residents (N = 128); response rate, 60%. MEASUREMENTS AND MAIN RESULTS: The total number of procedures performed during residency, importance for primary care physicians to perform these procedures, confidence to perform these procedures, and helpfulness of rotations for learning procedures were assessed. The majority of residents performed only 2 of 13 outpatient procedures 10 or more times during residency: simple spirometry and minor wound suturing. For all other procedures, the median number performed was 5 or fewer. The percentage of residents attributing high importance to a procedure was significantly greater than the percentage reporting high confidence for 8 of 13 ambulatory procedures; for all inpatient procedures, residents reported significantly higher confidence than importance. Continuity clinic and block ambulatory rotations were not considered helpful for learning ambulatory procedures. CONCLUSIONS: Though residents in this sample considered most ambulatory procedures important for primary care physicians, they performed them infrequently, if at all, during residency and did not consider their continuity clinic experience helpful for learning these skills. Training programs need to address this deficiency by modifying the curriculum to ensure that these skills are taught to residents who anticipate a career in primary care medicine. (+info)
Procedural skills training. Canadian family practice residency programs.
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OBJECTIVE: To survey Canadian family practice residency programs to discover which procedural skills residents are expected to learn. DESIGN: Cross-sectional eight-item questionnaire. SETTING AND PARTICIPANTS: The survey was sent to all 92 program directors and site or unit directors of family practice residency programs across Canada. MAIN OUTCOME MEASURES: Information on procedural skills lists was solicited. We sought date of creation, date of most recent revision, and who was involved in creating the list. A copy of the most recent list available was requested. RESULTS: We received 65 responses, for a 71% return rate. Surveys were received from all provinces and from all Canadian universities offering family practice residency programs. We received 24 unique lists of procedural skills: the shortest listed only 10 procedural skills; the longest, 75 skills; and the average, 36 skills. Only five procedural skills were found on more than 80% of the lists; 30 skills were listed on half or more of the lists. CONCLUSIONS: Canadian family practice residency programs have widely varying expectations of procedural skills for their residents. This survey is a first step in examining the whole issue of procedural skills training in Canadian family medicine programs. (+info)
Postgraduate training positions. Follow-up survey of third-year residents in family medicine.
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OBJECTIVE: To survey all family medicine programs in Canada to determine how many positions for third-year training were available. DESIGN: The survey instrument contained questions to determine how many second-year positions and how many third-year positions each program had. Descriptions of third-year positions were requested. One survey question asked about the percentage of people with third-year training who initially went into rural or small-town practice. Last, each program director was asked for an opinion on how many third-year positions should be available for further training. SETTING: The survey was administered to the program directors of all 16 family medicine programs in Canada. PARTICIPANTS: Program directors of departments of family medicine. RESULTS: The survey indicated that the number of third-year positions was 18% of the number of second-year positions currently available (an increase over the 10% determined in Busing's study in 1989). The largest proportion of third-year training was in emergency medicine, and approximately 30% of third-year positions were primarily reserved for physicians intending to go into rural practice. Academic family physicians and residents are in fairly close agreement that third-year positions should represent 40% of second-year positions. CONCLUSION: A survey of Canadian family medicine programs during the 1996-1997 academic years indicated that third-year positions available for family medicine residents have almost doubled since Busing's original survey in 1989. (+info)
The effect of accredited rural training tracks on physician placement.
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Accredited family practice rural training tracks are placing graduates in rural settings at notably high rates: 76 percent overall and 88 percent among programs implemented in the past 10 years. Favorable, immediate results could be expected from their continuation and expansion, permitted by adjustments in the Balanced Budget Act of 1997. (+info)
Effects of the revised HCFA evaluation and management guidelines on inpatient teaching.
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OBJECTIVE: In 1996, the Health Care Financing Administration (HCFA) introduced new evaluation and management (E&M) guidelines mandating more intensive supervision and documentation by attending physicians. We assessed the effects of the guidelines on inpatient teaching. DESIGN: Pretest-posttest, nonequivalent control group design. SETTING: A university hospital and an affiliated county hospital where the guidelines were implemented and an affiliated VA medical center where they were not. PARTICIPANTS: Sixty-one full-time faculty who had attended on the general medical wards for at least 1 month for 2 of 3 consecutive years prior to July 1996 and for at least 1 month during the 18 following months. MEASUREMENTS AND MAIN RESULTS: We evaluated standardized, confidential evaluations of attending physicians that are routinely completed by residents and students after clinical rotations at all three sites. Comparing 863 evaluations completed before July 1, 1996 and 497 completed after that date, there were no significant differences at any of the hospitals on any items assessed. There were also no differences between the university and county hospitals as compared with the VA. Eighty-seven percent of 39 university and county attending physicians returned a survey about their perceptions of inpatient teaching activities before and after July 1, 1996. They reported highly significant increases in time devoted to attending responsibilities but diminished time spent on teaching activities. CONCLUSIONS: Physicians reported a dramatic increase in overall time spent attending but a decrease in time spent teaching following implementation of the revised E&M guidelines. Yet, evaluations of their teaching effectiveness did not change. (+info)
Supporting the moral development of medical students.
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Philosophers who studied moral development have found that individuals normally progress rapidly in early adulthood from a conventional stage in which they base behavior on the norms and values of those around them to a more principled stage where they identify and attempt to live by personal moral values. Available data suggest that many medical students, who should be in this transition, show little change in their moral development. Possibly, this relates to perceived pressures to conform to the informal culture of the medical wards. Many students experience considerable internal dissidence as they struggle to accommodate personal values related to empathy, care, and compassion to their clinical training. Educational interventions that positively influence this process have established regular opportunities for critical reflection by the students in small groups. Other interventions include faculty development to enhance role modeling and feedback by clinical faculty. The author espouses more widespread adoption of these educational interventions. (+info)