A Geriatric Dental Resident Training Program

The exponential increase in the size of the U.S. population 75 years and older places new demands on the health care delivery system. Primary among these is the need to train professional manpower in the attitudinal, cognitive, and clinical skills essential to the management and treatment of medically compromised and functionally dependent elderly patients. The university-affiliated skilled nursing facility with a rehabilitation-oriented interdisciplinary staff offers an ideal setting for these educational objectives. The rationale, organization, and experience of a unique geriatric/general practice dental resident training program in such a teaching nursing home is delineated in this presentation.     

Educating Internists in Emergency Medicine

The education of internists in emergency medicine needs to be thoughtfully planned by those involved in their education. Objectives for their emergency medicine rotation include the recognition and initial treatment of true medical and surgical emergencies, clinical experience with and knowledge of common acute primary care problems, the ability to handle several patients with problems having different degrees of urgency, effective use of consultants in the follow-up and management of difficult patients and a knowledge of and clinical experience with the prehospital care system. A curriculum should be designed to give the resident a core of didactic material in addition to supervised clinical experience. The rotation should be evaluated by both residents and faculty from internal medicine and emergency medicine to determine if it is accomplishing the objectives set forth.     

Establishing a multidisciplinary academic cosmetic center

The demand for cosmetic services has risen rapidly in recent years, but has slowed down with the current economic downturn. Managed care organizations and Medicare have been steadily reducing their reimbursements for physician services. The payment for reconstructive surgical procedures has been decreasing and is likely to worsen with healthcare reform, and many plastic surgery residency programs are facing fiscal challenges. An adequate volume of patients needing cosmetic services is necessary to recruit and train the best candidates to the residency programs. Self-pay patients will help ensure the fiscal viability of plastic surgery residency programs. Attracting patients to an academic healthcare center will become more difficult in a recession without the appropriate facilities, programs, and pricing strategies. Setting up a modern cosmetic services program at an academic center has some unique challenges, including funding, academic politics, and turf. The authors opened a free-standing academic multidisciplinary center at their medical school 3 years ago. The center is an off-site, 13,000-sq ft facility that includes faculty from plastic surgery, ear, nose, and throat, dermatology, and vascular surgery. In this article, the authors discuss the process of developing and executing a plan for starting an aesthetic services center in an academic setting. The financing of the center and factors in pricing services are discussed. The authors show the impact of the center on their cosmetic surgery patient volumes, resident education, and finances. They expect that their experience will be helpful to other plastic surgery programs at academic medical centers.     

Evolving residency requirements for ambulatory care training for five medical specialties, 1961 to 1989.

Recent changes in the patient population of teaching hospitals, spurred by technologic advances and economic forces, have jeopardized the traditional hospital-based model of residency training. In consequence, there has been increasing attention paid to the need for ambulatory care experience. A primary force in shaping the content of postgraduate medical education is "The Essentials of Accredited Residencies," published in the Directory of Graduate Medical Education Programs. We reviewed recommendations and requirements for ambulatory settings and outpatient experience as specified in the Directory during the years 1961 to 1988 and investigated pending changes in requirements for five major specialties: internal medicine, pediatrics, family practice, general surgery, and obstetrics and gynecology. Increases in the amount of time residents spend in ambulatory care training recently have been mandated in internal medicine and are under consideration in two other specialties, indicating probable major shifts in the locus of postgraduate medical training.     

The academic base for general practice: the case for change.

University departments of general practice and the postgraduate education system for general practice have developed separately over the past 30 years. This separation is now impeding the academic development of the discipline and causes difficulties with recruitment and career progression. These problems could be eased by the creation of integrated departments. This would establish a critical mass for research and educational development, allow human and other resources to be used more flexibly and effectively, and provide a strong base for undergraduate education, vocational training, higher professional training, and continuing education. It could encourage collaborative ventures with other disciplines and also lead to higher standards of patient care.     

The Practical Application of Narrative Medicine at Mayo Clinic: Imagining the Scaffold of a Worthy House

American health care institutions increasingly recognize narrative medicine as a means to developing quality patient care. More commonly applied in health care professional development settings, narrative medicine is less overtly employed with patient populations. In this article, we describe the application of various narrative practices in the patient care and medical education programs of a major health care center in Minnesota. We discuss the impact of these programs on their participants in relation to the evidence based in current scholarship. Further, we examine narrative externalization of illness in Katherine Butler Hathaway’s disability memoir “The Little Locksmith,” a text which implicates the work of metaphor-making as a transformative step in healing. While several reports demonstrate that patients can find creative writing during times of illness to be therapeutic, there are many for whom the practice is problematic or unattractive, obstacles to practice implementation that the authors discuss. However, based on the experience of our institution, for health care institutions seeking to build a legacy of leadership in empathic patient care, narrative—employed in mentoring physicians in training and in establishing strong, dialogic relationships with patients and colleagues—should serve as a central strategy, or scaffold.     

Using immersive healthcare simulation for physiology education: initial experience in high school, college, and graduate school curricula

In the natural world, learning emerges from the joy of play, experimentation, and inquiry as part of everyday life. However, this kind of informal learning is often difficult to integrate within structured educational curricula. This report describes an educational program that embeds naturalistic learning into formal high school, college, and graduate school science class work. Our experience is based on work with hundreds of high school, college, and graduate students enrolled in traditional science classes in which mannequin simulators were used to teach physiological principles. Specific case scenarios were integrated into the curriculum as problem-solving exercises chosen to accentuate the basic science objectives of the course. This report also highlights the historic and theoretical basis for the use of mannequin simulators as an important physiology education tool and outlines how the authors' experience in healthcare education has been effectively translated to nonclinical student populations. Particular areas of focus include critical-thinking and problem-solving behaviors and student reflections on the impact of the teaching approach.     

Undergraduate geriatric education through community service learning

doi: 10.1111/j.1741‐2358.2010.00444.x Undergraduate geriatric education through community service learning Introduction: Despite the exponential growth of the elderly population worldwide, geriatric education has been a formal component of only a few dental schools’ curricula. Objective: To describe the geriatric community service learning (CSL) component of the professionalism and community service (PACS) module, and to explore a CSL project carried out by a group of first year dental students at a long‐term care facility. Methods: A literature review was performed to present and describe the CSL component of the PACS module. Students’ personal reflections were used to illustrate some of the joys and challenges of experiencing a long‐term care facility environment. Results: The newly developed PACS module combines community service learning with the long‐term care experience. Students develop, apply and evaluate an educational health promotion activity in a long‐term care facility. Conclusions: The PACS module has encouraged students to acquire comprehensive knowledge and awareness of the needs and dynamics of a long‐term care as they collaboratively interacted with personnel from the facility to develop their projects. The authors would like to engage other schools in discussing the need to integrate community‐based geriatric education into their dental curricula.     

Improving the quality of care via maintenance of certification and the Web: an early status report

Few question the need for continuous professional development throughout a physician's career, but rapid changes in health care are creating demand for physicians to acquire new knowledge, skills, and attitudes to implement quality improvement in clinical practice. The Internet and World Wide Web are technologies that have the potential to facilitate deep change in physician practice and lifelong learning. This paper describes how the American Board of Internal Medicine (ABIM) has utilized the Web and the Internet to engage physicians in the competencies of practice-based learning and improvement and systems-based practice. Specifically, we describe how the ABIM developed and implemented Web-based practice improvement modules (PIMs) to help physicians measure and improve their clinical practice.     

General anesthesia in an office-based plastic surgical facility: a report on more than 23,000 consecutive office-based procedures under general anesthesia with no significant anesthetic complications

The popularity of elective office-based plastic surgery has increased significantly over the past two decades. The continuing demand for improved aesthetic results has stimulated the development of ever more complex plastic surgical techniques. These techniques may require extended periods of operative time spent under anesthesia. Patients have come to expect an almost perfect anesthetic and surgical experience, with safety and comfort being their foremost concerns. Because of increasingly complex and lengthy operations, the authors believe that intravenous sedation, used for many years in their plastic surgery practice, is now suboptimal for most longer and complex surgical procedures. In their experience, under most circumstances, general anesthesia provides the optimal anesthetic experience for the patient, anesthesiologist, and surgeon. The authors present a consecutive 18-year study of general anesthesia in more than 23,000 procedures in an accredited, office-based plastic surgical facility that offers a very safe and uniformly pleasant anesthesia experience for patients. There were no intraoperative or postoperative deaths and no significant complications. The authors' experience differs from the common perception that general anesthesia is too risky for aesthetic surgery procedures.     

Oral care training in the basic education of care professionals

doi:10.1111/j.1741‐2358.2009.00304.x
Oral care training in the basic education of care professionals Objective: To investigate the quantity and quality of oral care training in the basic education of future long‐term care (LTC) professionals in Norway. Background: The level of oral hygiene has often proved inadequate in LTC facilities. It has been maintained that this could be due to insufficient knowledge of oral care among care professionals. Materials and methods: A self‐administered questionnaire was sent to all 270 schools in Norway which offered basic education of LTC personnel in 2004/05. Information on theoretical and practical oral care training, scope of oral care in teaching material and curriculum, educational background of the teaching staff and schools opinion regarding adequacy of their training programme was collected. Results: Of the 203 respondents (75% response rate), 188 (participants) included oral care in their educational programme. Approximately two‐thirds of the participating schools provided 3 h or more of oral care training and many of the important themes were presented in the textbooks that were recommended. Moreover, the practical exercises performed in practice placement supplemented the knowledge. Conclusion: The results could not confirm that LTC professional’s basic education concerning oral care was inadequate. There may therefore be other explanations for the poor oral hygiene in many LTC facilities.     

Medical education in an era of health-care reform

Medical educators are facing a challenge today that is quite analogous to that addressed by Abraham Flexner, namely how to transform a legacy system of education that is no longer preparing future physicians adequately to meet contemporary expectations and responsibilities. In facing up this challenge, however, today's educators not only must equip students to deal effectively with the rapidly changing paradigms in health care and medical practice, they also must adapt their curricula and pedagogical methods to the demanding new paradigms of medical education. Their success in addressing these dual imperatives will determine whether the educational transformations currently underway will have as momentous an effect on the public's health as did those stimulated by Flexner a century ago.     

自然保护地自然教育资源分类与评价——以神农架国家公园为例

自然教育是生态文明建设的有力抓手及重要内容。自然保护地具有良好的自然资源禀赋,为自然教育实践提供活动场地及教育资源基础。在界定分析自然教育相关概念及内涵基础上,提出自然保护地自然教育资源分类方案,包括自然事物、场地设施、自然文化3项主类,9个亚类、48种基本类型;综合运用层次分析法和德尔菲法构建包括教育价值、资源质量、开发条件3层要素、10项指标的自然教育资源评价体系;以神农架国家公园为例进行自然教育资源分类及评价的实证分析。结果表明,构建的自然教育资源分类方案及评价体系具有科学性、普适性与可操作性,可在自然保护地自然教育资源的调查、分类与评价中推广,为自然保护地的自然教育开发利用提供科学参考。     

遗传学课程思政教育的探索与实践

课程思政对高校落实立德树人、实现人才培养目标具有重要的意义。在专业课中进行课程思政改革有助于探究高校专业课程中育人功能的发挥。遗传学是生命科学专业重要的基础课程,在生命科学知识体系的构建中具有重要作用。立足内蒙古农业大学示范课程改革的教学实践,我们重塑了教学目标,改革教学方法,挖掘遗传学课程中蕴含的思政元素,使德育教育深入教师心、学生心,贯穿于教学、教评全过程,使知识传授、能力培养与价值引领同向同行,以提升学生的综合素质。     

Career evaluation and the decision process for plastic surgery graduates

National experience shows that 50 percent of physicians change positions within the first 2 years of practice. Because of market pressures, medicine in general and plastic surgery in particular are shifting away from solo practice. The authors examine the primary reasons for turnover and discuss job search priorities for recent plastic surgery graduates and established surgeons in job transition, with a current analysis of the different job opportunities available, ranging from government to private practice. The advantages and disadvantages of different positions are compared and income data are presented. Academic income is close to that of private practice at a mean of $366,141 annually but requires more work as measured by an overall higher relative value unit of productivity. The concept of creating a personal inventory before seeking the best job match is introduced.     

Biomechanics - Review of approaches for performance training in spinal manipulation

Motor skills development is an inherent part of clinical training in health disciplines. The conscious use of educational theory to ground learning is receiving increasing attention across health care education. There are three distinct, yet overlapping, stages of motor skill learning; the cognitive, the integrative or associative, and the autonomous; in which a contextual framework for learning content may be structured. The learning is associated with a mapping of changes within the central nervous system by the interactive mechanisms of adaptation, use-dependent plasticity and operant reinforcement. Successful skill learning requires a sufficient amount of practice and the implementation of relevant feedback strategies in the form of knowledge of performance (KP) or knowledge of results (KR). There is a natural maturation of skills that may be accelerated by feedback. Several factors contribute to stronger skills development. "Mixture-of-experts" models systematically sequence tasks into logical blocks of theory, practice and student reflection on performance. Feedback should involve both KP and KR that compares performance to a tangible standard. Rehearsals should balance use of simulators and volunteer simulated patients to provide the full range of safe and effective learning opportunities prior to students accepting a role as care givers to the public in any clinical setting.     

Residency training in plastic surgery: a survey of educational goals

With the advent of integrative plastic surgical training programs, requirements for earlier specialization decisions, and an increasing subspecialization within the practice of plastic surgery, the educational goals of residency training may have changed. The duration and extent of training required are also currently being questioned. This study was performed to better understand the necessary roles of plastic surgery residencies and to determine how these demands might optimally be met. Of 151 practicing plastic surgeons in the Ontario, Canada, region, 81 (53.6 percent) responded to a survey. General agreement was that 2 years was an optimal length of time for core surgical training, which should then be followed by at least 3 years of plastic surgical training. Opinions on the ideal length of time training in specific medical and surgical disciplines are discussed. Overall, respondents thought that two thirds of training should occur in tertiary care centers, with the remaining time spent at smaller community centers and private clinics. Nearly half of respondents thought that research training should be a mandatory part of the residency, although the amount of protected time for this activity varied substantially. Most thought that unrestricted elective time should also be available. Academic plastic surgeons rated the importance of research training (p < 0.01), critical appraisal skills (p < 0.05), and teaching skills (p < 0.05) as significantly more important than did their nonacademic colleagues. The authors present results from the Ontario region and a template for determining optimal characteristics for training programs. Further investigation may be of timely importance during a foreseeable future transition from traditional to integrative plastic surgery residency training.     

Maintenance of Certification, maintenance of public trust

The Maintenance of Certification program has been well received by many physicians but has faced significant opposition from others who complain that it is overly tedious, costly, and irrelevant to their practice. This article offers a consolidated and concise history of the program and a summary of what plastic surgeons need to know to successfully complete the American Board of Plastic Surgery's own Maintenance of Certification requirements. The authors have justified each step of the board's Maintenance of Certification process in terms of how it improves the quality of care delivered to plastic surgery patients. Finally, a summary of research is presented that demonstrates both that the public supports the maintenance of certification process for all physicians and that continuing education and formal assessment and improvement initiatives have been linked in multiple studies to a better and more evidence-based medical practice.     

Sustainable Livelihoods and Ecosystem Health: Exploring Methodological Relations as a Source of Synergy

Using ecohealth as a transdisciplinary lens to explore the connections among overlapping domains of inquiry, this article examines methodological relations between Sustainable Livelihoods and Ecosystem Health, two approaches for improving rural health and well-being. The experience of working on a project tasked with developing an integrated, systems-based approach for understanding the nature of rural livelihoods and ecosystems provides the base for analysis. Several key insights are discussed: The overarching goals of health and sustainability facilitate collaboration among disciplines; differences arise from how each approach operationalizes systems as variables and indicators; the dependent variables for one approach can be used as the independent variables for the other. In summary, while broad concepts like health and sustainability help transcend differences across disciplines and scales of analysis, variables and indicators cannot, as they are bound to how an observed system is operationalized. An advantage of using an ecohealth lens is that it creates conceptual and analytical spaces in which differences can be reconciled and used as sources of synergy. A source of synergy revealed in this article is the interdependence of variables used by each approach.