A new educational role for plastic surgery in the fourth year of medical school

At most medical schools, students are offered limited or sporadic experiences in plastic surgery. This is unfortunate because all physicians need to possess the knowledge and skills to evaluate skin lesions and participate in wound management. Also, students who are considering a career in plastic surgery do not have adequate information to make informed decisions. With the restructuring of plastic surgery training programs, career decisions of individuals interested in plastic surgery are being made earlier than ever before in the education continuum, and the aforementioned problem assumes greater magnitude both for the students and the faculty. At MCP-Hahnemann School of Medicine, basic plastic surgery experiences have been integrated into the third-year surgery clerkship as a requirement for all students, and a Plastic Surgery Pathway has been designed in conjunction with the school's pathway system for fourth-year students. The Pathway provides a framework for the student to select a combination of rotations that will best provide an appropriate broad-based education in preparation for training in plastic surgery, and it provides extensive guidance by faculty members in the discipline to assist with career decisions, rotation selection, and preparations for the residency application process. Students in the Plastic Surgery Pathway are required to take rotations in medicine, neurology, and plastic surgery. The remaining rotations are selected from a list of options based on the student's individual learning needs, interests, and career aspirations. Early experience with the Plastic Surgery Pathway has shown that it has been well received by students and faculty, has assisted students with their career decisions, and has led to an increased student awareness of the importance and relevance of the specialty.     

新形势下神经内科研究生专业特色培养的模式探索

：新形势下我国医学教育提出了培养高素质创新人才的要求,医学研究生的培养是医学生培养的最高层次。随着神经病学及其亚专业的迅猛发展,不仅对研究生的临床和科研水平提出了严峻的挑战,而且要求研究生在某一专业领域有较高的造诣。因此,对研究生进行专业特色培养是值得探索的新课题。本研究对我校神经内科研究生专业特色培养的系列探索与实践进行了总结。实践表明,我校神经内科研究生专业特色培养教学改革已取得明显成效：探索出一套行之有效的研究生专业特色培养的新模式,建立并完善了研究生培养中高素质专业人才的质量保障体系,强化了研究生的专业特色。为国内高等医学院校研究生培养模式提供了有价值的参考。     

Career and training patterns of students entering Canadian medical schools in 1965.

This paper follows the careers of the 1128 students who entered Canadian medical schools in 1965, most of whom graduated in 1969. The type of career pursued (whether general or specialty practice or some combination thereof), the type of specialty undertaken, the place of internship and residency training and the 1973 practice location of the graduates are examined. The wide variation in careers followed by the 12 schools'' graduates provides the major focus of the paper.     

Medical students as medical educators: opportunities for skill development in the absence of formal training programs

All physicians, at some point in their career, are responsible for the education of their peers and junior colleagues. Although medical students are expected to develop clinical and research skills in preparation for residency, it is becoming clear that a student should also be expected to develop abilities as a teacher. A handful of institutions have student-as-teacher programs to train medical students in education, but most students graduate from medical school without formal training in this area. When such a program does not exist, medical students can gain experience in education through participation in peer teaching, course design, educational committees, and medical education scholarship. In doing so, they attain important skills in the development, implementation, and evaluation of educational programs. These skills will serve them in their capacity as medical educators as they advance in their careers and gain increasing teaching responsibility as residents, fellows, and attending physicians.     

Establishment of a General Medicine Residency Training Program in Rural West Africa

Ghana, a developing country in West Africa, has major medical burdens in taking care of a large population with limited resources. Its three medical schools produce more than 200 graduates per year, but most emigrate to developed lands after training. Ghana is working to educate and retain locally trained physicians, but it is difficult to get them to work in rural settings where the need is greatest. This article details the establishment of a General Medicine residency at a 150-bed hospital in rural Ghana. Early training comprises 6 months each in Medicine, Surgery, OB/GYN, and Pediatrics; the hospital in Techiman also has a Surgery residency. House officers choose the program for more hands-on experience than they can get in larger centers. They perform many tasks, including surgery, sooner and more independently than do residents in developed countries. The training program includes a morning report, clinical teaching rounds, and rotations on in-patient wards and in the Emergency Department and clinics. Teaching focuses on history, physical examination, good communication, and proper follow-up, with rigorous training in the OR and some clinical research projects pertinent to Ghana. Trainees work hard and learn from one another, from a dedicated faculty, and by evaluating and treating very sick patients. Ghana’s rural residencies offer rigorous and attractive training, but it is too soon to tell whether this will help stem the “brain drain” of young physicians out of West Africa.     

The Class of 1989 and post-MD training

BACKGROUND: "The Class of 1989" is a longitudinal study of 1722 people who were awarded an MD degree by a Canadian university in 1989. This paper reports on the details of their post-MD training up to spring 1996. METHODS: Several medical professional and educational associations in Canada and the United States provided year-by-year information on field and location of post-MD training, certification achieved, whether in practice and location of practice through to spring 1996. Information from all sources was linked to a list of 1989 medical school graduates. RESULTS: Of the 1722 graduates 57 (3.3%) never entered post-MD training in Canada; 147 (8.5%) did 1 or more years of training in the United States. A total of 222 graduates (12.9%) took a break of at least 1 year from training, and 301 (17.5%) changed their choice of field or specialty after starting training. Substantial numbers took 1 or more years longer to complete training than would be expected based on the prescribed length of the training program chosen. The field or specialty choices of the cohort produced a generalist:specialist ratio of 58:42. The final numbers in several fields depended heavily on trainees changing their initial career choice. INTERPRETATION: The data point out widely differing and often very long lead times from start to completion of training. Since 1993, changes to licensure requirements have reduced opportunities for recent graduating cohorts to delay final career choices, take a break in training, prolong training or change initial career choices. Rigidities in the post-1993 training environment point to the emergence of a number of serious problems, such as dissatisfaction and high anxiety levels among residents, licensing authorities being faced with people who have not completed a training program to certification, and insufficient provision of positions for post-MD training because of underestimates of the time needed to complete training programs. The insights gained from this study lead to the recognition that planning the specialty distribution of the physician workforce is highly complex and difficult.     

Postgraduate clinical education — the Canadian experience

To obtain a quantitative measure of the extent to which graduate education and qualification for specialty practice have become an integral part of the total educational experience, samples of the graduating classes of 1960, 1964, 1968 and 1970 of Canadian medical schools were tracked through postgraduate educational training and into specialty certification. From the 1960 cohort 65% chose a career recognized by special certifying exams in Canada and/or the United States, entered a residency, completed it and achieved certification of special competence. From the 1970 cohort, by the end of 1972 approximately 50% had entered a recognized specialty training program leading to certification. The diminishing trend toward specialty practice is demonstrated by reviewing the comparative figures in the 1964 and 1968 cohorts. Evidence garnered in this study indicates a continuing strong motivation for specialty practice although family medicine and/or general practice appear increasingly attractive as career choices. Strong provincial educational forces as well as social and other forces will probably continue to modify career selection and may lead an increasing number of Canadian medical graduates into family practice.     

Undergraduate and postgraduate medical education in Canada

An overview of medical education at both the undergraduate and postgraduate levels in Canadian faculties of medicine is provided. Particular attention is focused on changes that have occurred in the 1990s and their effect on medical students and on educational programs. Also considered are the effects of reductions in the number of entry-level positions for residency training and the changes in educational requirements for licensure on senior medical students.     

Little room for error in Canada's postgraduate training system

Although the majority of physicians entering residency training in Canada will enjoy fulfilling careers in their chosen specialty, today''s postgraduate training system has its critics. Among them are the new graduates who are not satisfied with the residency positions offered to them and practising physicians who would like to re-enter the system to train in a new specialty but find themselves locked out.     

Pediatric resident staff follow-up, 1958 to 1972: their present place of practice and activities.

Of 174 medical graduates who had undertaken residency training in pediatrics at the Health Centre for Children, Vancouver between 1958 and 1972, 156 replied to a questionnaire designed to determine their present activity. Excluding those still in training 58.4% are currently practising pediatrics, 28% are in family practice and 12.8% are in other areas of professional activity; 49% obtained a specialty degree in pediatrics and 5.4% obtained certification of the Royal College of Physicians and Surgeons of Canada in another specialty. Of the total, 69% have remaind in Canada; of the Canadian graduates 83% have remained in this country, compared with 63.8% of graduates from other countries. Estimation of pediatric manpower requirements should take into account the anticipated increase in population, the pediatrician attrition rate, the contribution one province may provide for the rest of the country, and the fact that only approximately 60% of pediatric trainees will ultimately practise this specialty.     

Perceptions of family medicine and career choice among first year medical students: a cross-sectional survey in a Turkish medical school

Public attitudes to family medicine in Turkey have lagged behind its rapid academic development. The effect of undergraduate training in primary care on medical students' attitudes to family medicine has not been assessed. Objectives of this study were to assess the attitudes of first year medical students at Uludag University School of Medicine in Bursa, Turkey to family medicine and to determine their career aspirations. The study was a survey of the first year medical class in 2003-2004. The response rate was 95% (248/261 students). Students were positive about their choice of medicine as a career but had negative opinions of general practice. Female students were more positive in this respect. Initial preference was for specialization in fields other than general practice with little knowledge of the academic specialty of family medicine. Greater undergraduate exposure to family medicine is needed in order to increase knowledge of the field and influence student career choices.     

EDWIN L. BRUCK,M.D

The progressive fall in the status and numbers of general practitioners has produced a dangerous void in the field of comprehensive medical care. The Millis Commission and other national study committees have recommended that family practice be made a board-certified specialty in order to restore the status and numbers of family physicians. The scope of family practice that is envisioned, however, would be so restricted in depth as to raise serious doubts that sufficient medical graduates would be attracted to careers in this new specialty. Better training in broadly-based general or family practice—rather than a specialty board, per se—is the only realistic way to elevate status and attract more medical students to this field.     

An international basic science and clinical research summer program for medical students

An important part of training the next generation of physicians is ensuring that they are exposed to the integral role that research plays in improving medical treatment. However, medical students often do not have sufficient time to be trained to carry out any projects in biomedical and clinical research. Many medical students also fail to understand and grasp translational research as an important concept today. In addition, since medical training is often an international affair whereby a medical student/resident/fellow will likely train in many different countries during his/her early training years, it is important to provide a learning environment whereby a young medical student experiences the unique challenges and value of an international educational experience. This article describes a program that bridges the gap between the basic and clinical research concepts in a unique international educational experience. After completing two semester curricula at Alfaisal University in Riyadh, Kingdom of Saudi Arabia, six medical students undertook a summer program at St. Boniface Hospital Research Centre, in Winnipeg, MB, Canada. The program lasted for 2 mo and addressed advanced training in basic science research topics in medicine such as cell isolation, functional assessment, and molecular techniques of analysis and manipulation as well as sessions on the conduct of clinical research trials, ethics, and intellectual property management. Programs such as these are essential to provide a base from which medical students can decide if research is an attractive career choice for them during their clinical practice in subsequent years. An innovative international summer research course for medical students is necessary to cater to the needs of the medical students in the 21st century.     

Competencies required for the practice of geriatric medicine as a consultant physician.

Geriatric medicine in Canada is now being viewed not merely as an academic specialty but, rather, more broadly as a service specialty providing consulting support to other physicians. Any redesigning of training programs will have to be done with this fact in mind. We drew up a list of competencies required for consultant practice in the field and presented them to other practitioners of geriatric medicine and members of the Canadian Society of Geriatric Medicine for feedback. We believe that the resulting list of competencies can be used as a starting point for redesigning training programs in geriatric medicine.     

Characteristics of medical students who choose primary care as a career: the McMaster experience.

We examined the relation between demographic characteristics and the career choices of medical students who entered McMaster University medical school between 1969 and 1975. In contrast to earlier work, this study found no significant differences in sex, age, marital status at the time of entry into medical school, undergraduate major, whether prerequisite premedical courses had been taken, undergraduate grade point average and academic performance between the graduates who chose primary care and those who chose a specialty. This suggests that many medical school graduates in the 1970s entered primary care by choice rather than by default.     

五年制临床医学专业防原医学课程标准的制定与探索

防原医学是为五年制临床医学专业开设的一门必修的军事医学课程,理解和掌握防原医学知识,是成为具有全面技能的军事医学人才的基础。为了通过本门课程的学习,更好地培养高素质的新型军事医学人才,本文结合第四军医大学五年制临床医学专业学员的培养目标和实际情况,对课程标准的内容制定和实施进行思考,探索课程标准下的防原医学教学模式与方法,旨在进一步提升教学效果,造就新时期军事变革条件下的优秀人民军医。     

A University/Community Hospital Family Practice Residency Program

A residency program associated with a major university has many obvious advantages. On the other hand, a residency program located in an area of health manpower shortage is a major advantage to that community. This paper describes the development of a university affiliated family practice residency in the Mojave Desert of Southern California. It reports that it is possible to form a successful alliance between a medical center and a rural community, bringing increased primary care to the community, upgrading the quality of medicine practiced in the community and augmenting the staff of the local hospital without sacrificing training for the family practice residents. Furthermore, the residency program can become financially self-sufficient.     

Dietary Patterns,Metabolic Markers and Subjective Sleep Measures in Resident Physicians

Shiftwork is common in medical training and is necessary for 24-h hospital coverage. Shiftwork poses difficulties not only because of the loss of actual sleep hours but also because it can affect other factors related to lifestyle, such as food intake, physical activity level, and, therefore, metabolic patterns. However, few studies have investigated the nutritional and metabolic profiles of medical personnel receiving training who are participating in shiftwork. The aim of the present study was to identify the possible negative effects of food intake, anthropometric variables, and metabolic and sleep patterns of resident physicians and establish the differences between genders. The study included 72 resident physicians (52 women and 20 men) who underwent the following assessments: nutritional assessment (3-day dietary recall evaluated by the Adapted Healthy Eating Index), anthropometric variables (height, weight, body mass index, and waist circumference), fasting metabolism (lipids, cortisol, high-sensitivity C-reactive protein [hs-CRP], glucose, and insulin), physical activity level (Baecke questionnaire), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and sleepiness (Epworth Sleepiness Scale; ESS). We observed a high frequency of residents who were overweight or obese (65% for men and 21% for women; p?=?0.004). Men displayed significantly greater body mass index (BMI) values (p?=?0.002) and self-reported weight gain after the beginning of residency (p?=?0.008) than women. Poor diet was observed for both genders, including the low intake of vegetables and fruits and the high intake of sweets, saturated fat, cholesterol, and caffeine. The PSQI global scores indicated significant differences between genders (5.9 vs. 7.5 for women and men, respectively; p?=?0.01). Women had significantly higher mean high-density lipoprotein cholesterol (HDL-C; p?<?0.005), hs-CRP (p?=?0.04), and cortisol (p?=?0.009) values than men. The elevated prevalence of hypertriglyceridemia and abnormal values of low-density lipoprotein cholesterol (LDL-C; >100?mg/dL) were observed in most individuals. Higher than recommended hs-CRP levels were observed in 66% of the examined resident physicians. Based on current recommendations, a high prevalence of low sleep quality and excessive daytime sleepiness was identified. These observations indicate the need to monitor health status and develop actions to reassess the workload of medical residency and the need for permission to perform extra night shifts for medical residents to avoid worsening health problems in these individuals.     

Imagerie hybride,TEP-TDM et TEMP-TDM. En quoi peut-elle influencer la formation et la pratique en médecine nucléaire en France ?

To define the policy of our specialty with a consensus opinion, a questionnaire entitled “hybrid imaging” was sent to practicing nuclear medicine specialist physicians in France to obtain their opinion on the impact of this recent method in training and in the practice of nuclear medicine and on the relations between nuclear medicine specialists and other medical imaging specialists. This questionnaire, written by the office of the French Society of Nuclear Medicine (FSNM) and molecular imaging , was divided into four parts: Profile and experience in hybrid imaging, Relations with radiologists, Practice of CT scans with hybrid equipment, and the Future of the specialty and of training in nuclear medicine. The response rate was 60%, i.e. 374 completed questionnaires. Overall, the responses were uniform, whatever the respondent's experience, type and place of practice. Regular participation in hybrid imaging practice was the reply provided by the majority of respondents. In terms of relations with radiologists, such contacts existed in over 85% of cases and are considered as being of high quality in over 90% of cases. The vast majority of practitioners believe that hybrid imaging will become the standard. Opinions on the diagnostic use of CT scans are divided, as well as their interpretation by a radiologist, a nuclear medicine specialist or by both. In the opinion of the vast majority, hybrid equipment systems should be managed by nuclear medicine specialists. With regard to the future, nuclear medicine should remain an independent specialty with enhanced training in morphological imaging and a residency training program whose length should be increased to 5 years.