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Declining pediatric subspecialty training and rising educational debt

JOURNAL OF PEDIATRICS 2001年第1期138卷 149-151页

作者： Hardie, WD Jaskiewicz, JA Childrens Hosp Med Ctr Cincinnati OH 45229 USA

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Comparison of pain and time of procedures with two first-trimester abortion techniques performed by residents and faculty

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 2001年第7期184卷 1564-1567页

作者： Edelman, A Nichols, MD Jensen, J Oregon Hlth Sci Univ Dept Obstet & Gynecol Portland OR 97201 USA

OBJECTIVES: We compared pain perception and procedure time in abortions performed by residents and faculty using a manual vacuum aspirator and electric vacuum curettage devices. STUDY DESIGN: We conducted a randomized trial of 114 women undergoing first-trimester abortions. Patients assessed the level of pain with visual analog scales. RESULTS: The mean procedure times were 5.7 and 6.9 minutes, respectively, with electric vacuum curettage and manual vacuum aspirator. Faculty took less time than residents to perform both procedures. Patients reported a higher pain level with cervical dilatation before resident electric vacuum curettage procedures. Patients undergoing electric vacuum curettage thought that the procedure noise increased their pain. CONCLUSIONS: First-trimester abortion procedures can be performed more quickly by experienced surgeons. The procedure time for the manual vacuum aspirator is greater than that for the electric vacuum curettage. Patient pain perception with aspiration by these two techniques is not different. The level of pain after aspiration did not vary significantly in patients who had abortions performed by residents or faculty.

关键词：流产人工/副作用流产人工/方法刮除术院校全体教工实习医师和住院医师职务疼痛/病因学疼痛/病理生理学妊娠初期抽吸时间因素真空成年人女(雌)性人类妊娠

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Re: Malpractice occurrence in emergency medicine: Does residency training make a difference?

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JOURNAL OF EMERGENCY MEDICINE 2001年第1期21卷 75-76页

作者： Schorin, MJ Cambridge Hosp Cambridge MA 02139 USA

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写给初为医者

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中国卫生 2001年第2期 31-32页

作者：张永琇北京友谊医院宣教科

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Enriching the resident-faculty relationship

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ANNALS OF EMERGENCY MEDICINE 2001年第3期38卷 336-338页

作者： Stack, SJ Watson, MJ Ohio State Univ Med Ctr Dept Emergency Med Columbus OH 43210 USA Geisinger Med Ctr Dept Emergency Med Danville PA 17822 USA

[Stack SJ, Watson MJ. Enriching the resident-faculty relationship. Ann Emerg Med. September 2001;38:336-338.]

关键词：课程急救医学/教育全体教工医学院校阶层社会实习医师和住院医师职务人际关系职业间关系美国人类

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Restricted contact with drug company representatives influences future physicians

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2001年第24期58卷 2366-2366页

作者： [Anonymous]

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Knowledge of Centers for Disease Control and Prevention guidelines for the use of vancomycin at a large tertiary care children's hospital

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JOURNAL OF PEDIATRICS 2000年第5期137卷 694-700页

作者： Lin, PL Oram, RJ Lauderdale, DS Dean, R Daum, RS Univ Chicago Childrens Hosp Pharm Dept Pediat Chicago IL 60637 USA Univ Chicago Childrens Hosp Pharm Dept Hlth Studies Chicago IL 60637 USA

Objective: In 1994, the Centers for Disease Control and Prevention (CDC) published guidelines to encourage prudent use of vancomycin. We sought to determine whether physicians could demonstrate knowledge consistent with the guidelines. Design: Survey consisting of 18 clinical vignettes based on the CDC guidelines. Participants: hll residents, fellows, and attending physicians involved in pediatric inpatient services. Setting: Tertiary care children's hospital providing service to an inner-city population and community referral base. Main outcome measures: Comparison of sun ey scores and individual responses among respondents. Results: Survey scores did not vary with level of training or whether the respondent was a pediatrician or non-pediatrician. Average scores of attending physicians, fellows, and residents were 74.1% (SD = 13.1), 77.2% (SD = 11.5), and 73.4% (SD = 10.5), respectively, and did not differ significantly. Questions incorrectly answered by more than 30% of respondents concerned the use of vancomycin as: (1) first-line treatment of Clostridium difficile colitis, (2) a topical solution for wound infection, (3) initial, empiric treatment of patients with fel er and neutropenia, (4) peri-operative prophylaxis, (5) a preferred agent over beta -lactam antimicrobial agents. Conclusion: Deficits in knowledge regarding appropriate vancomycin use can be localized to certain clinical settings. This observation lends optimism to the notion that targeted educational intervention may improve the appropriate use of vancomycin.

关键词：美国疾病控治中心数据收集坚持准则健康知识态度实践医院儿科实习医师和住院医师职务医师诊疗准则(主题) 美国青少年儿童儿童学龄前人类婴儿婴儿新生

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Consultation-liaison psychiatry training and supervision results in fewer recommendations for constant observation

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GENERAL HOSPITAL PSYCHIATRY 2000年第5期22卷 359-364页

作者： Jin, C Novik, S Saravay, S Long Isl Jewish Med Ctr Albert Einstein Coll Med Dept Consultat Liaison Psychiat N Shore Long Isl Jewish Hlth Syst New Hyde Park NY 11040 USA

In this study, we tested two hypotheses. First, that consultation-liaison (C-L)-trained psychiatry residents would order constant observation (CO) less frequently than psychiatry residents untrained in C-L. Second, we predicted that CO would be ordered less frequently under circumstances when experienced C-L psychiatry attending and fellows would be available to supervise psychiatry residents training in C-L. We reviewed a total of 138 consultations during a 6-month period. Constant observation was recommended in 31 cases (22.5%). Consultations were done by residents who had received training in C-L psychiatry (n=34) and by residents who were not trained in C-L (n=34). Residents not trained in C-L had a significantly higher percentage of CO orders (44.1%) compared to those trained in C-L (15.4%) (chi(2)=22.1, df=1, P<0.001). Because C-L-trained residents provided regular-hour and after-hour consults while residents without C-L training provided only after-hour consults, we also separately analyzed data from the 102 after-hour cases. We again found that residents with C-L training had a significantly lower rate of ordering CO (22.1%) than those who had not yet received C-L psychiatry training(44.1%) (chi(2)=5.31, df=1, P<0.05). We also found that C-L-trained residents ordered CO less frequently during regular hour consults (2.8%) when experienced staff are available in supervision compared to after hours (22.1%) (chi(2)=6.72, df-1, P<0.01). Our findings suggest that training in C-L psychiatry has a significant impact on the use of constant observation for patients in the general hospital thereby reducing the cost of care. (C) 2000 Elsevier Science Inc.

关键词：医院综合实习医师和住院医师职务病案纽约观察精神病科医院/组织和管理精神病学/教育转诊和会诊回顾性研究成年人女(雌)性人类男(雄)性

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Do picture archiving and communication systems improve report turnaround times?

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JOURNAL OF DIGITAL IMAGING 2000年第2期13卷 105-107页

作者： Mehta, A Dreyer, K Boland, G Frank, M Harvard Univ Sch Med Massachusetts Gen Hosp Dept Radiol Boston MA 02114 USA

Radiology departments are beginning to embrace new technologies to decrease operating budgets and improve services. One of these technologies is the picture archiving and communication system (PACS). PACS, through immediate availability of images to the radiologist, promises to decrease turnaround times of reports to the clinician. The purpose of this study was to determine if this technology actually decreases the time for referring clinicians to receive reports generated by the radiologist. The time to provide a preliminary report by a resident and time to finalize this report by a board-certified radiologist was retrospectively obtained for 6,022 abdominal and pelvic computed tomography (CT) scans over two 1-year periods from March 1, 1997 to March 1, 1998 and from March 1, 1998 to March 1, 1999. During the first year, interpretation was conducted using hard-copy film and during the second using PACS. In both 1-year periods, MedSpeak voice recognition software (IBM, White Plains, NY) was employed for dictation. The average time for a preliminary report for a abdominal and pelvic CT, dictated by a resident or fellow, to be available in alphanumeric form on the hospital information system using hard-copy film was 3.73 days. The installation of a PACS system decreased this turnaround time to 0.56 days, representing an 85.0% improvement. The time to availability of final reports, ie, signed by board-certified staff radiologists, was 5.49 days in the hard-copy interpretation subset and 5.97 days in the PACS subset. The addition of PACS into an academic gastrointestinal radiology division improves availability of alphanumeric preliminary reports of abdominal and pelvic CTs on the hospital information system (HIS), dictated by a resident or fellow, by 85.0%. There was no impact with a PACS on the time to final sign reports by a staff board certified radiologist as signing patterns remained relatively constant over the two interpretation formats. Copyright (C) 2000 by W.

关键词：数据显示效率实习医师和住院医师职务病案系统计算机化骨盆/诊断显像放射摄影术腹部放射学/教育放射学信息系统作业完成和分析时间和运动研究体层摄影术 X线计算机人类

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Development of an objective structured assessment of technical skills for obstetric and gynecology residents

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OBSTETRICS AND GYNECOLOGY 2000年第1期96卷 146-150页

作者： Goff, BA Lentz, GM Lee, D Houmard, B Mandel, LS Univ Washington Sch Med Dept Obstet & Gynecol Seattle WA 98195 USA

Objective: To develop an objective structured assessment for evaluating surgical skills of obstetrics and gynecology residents and to evaluate the reliability and validity of the assessment. Methods: A seven-station, objective, structured assessment of technical skills was administered to 24 residents. The test included laparoscopic procedures (port placement, salpingostomy, suturing, vessel ligation) and open abdominal procedures (hypogastric ligation, repair of enterotomy, salpingo-oophorectomy.) All surgical tasks were done on pigs. Residents were timed and assessed at each station using three methods of scoring, a task-specific checklist, global rating scale, and pass-fail grade. Results: Assessment of construct validity (the ability of the test to discriminate among residency levels) found significant differences on the checklist and the global rating scale by residency level. Reliability indices calculated with Cronbach's alpha were 0.89 for the global rating scale and 0.89-0.95 for the individual skills checklists. Interrater reliability was 0.87 for the global rating scale and 0.78-0.98 for the checklists. Conclusion: Objective, structured assessment of technical skills can assess residents' surgical skills with high reliability and validity. These assessments have possible application for identifying residents who need additional training and might provide a mechanism to ensure competence of surgical skills. (Obstet Gynecol 2000;96:146-50. (C) 2000 by The American College of Obstetricians and Gynecologists.).

关键词：临床工作能力妇科学/教育实习医师和住院医师职务产科学/教育结果可重复性院校医学华盛顿成年人人类

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