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Why are internal medicine residents at university medical centers not pursuing fellowship training in gastroenterology? A survey analysis

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第3期95卷 777-783页

作者： Benya, RV Univ Illinois Sect Digest & Liver Dis Chicago IL 60612 USA

OBJECTIVE: The decrease in available GI fellowship positions appears to be associated with a disproportionate decrease in the quality of applicants. Thus, the aims of this study were: 1) to determine the current interest in advanced training of nonprimary care internal medicine residents at university medical centers, and 2) to identify the reasons why fellowship-bound residents an not pursuing GI. METHODS: Postage prepaid survey cards were distributed directly to the campus mailboxes of 1862 internal medicine residents at 61 university medical centers at the beginning of their second postgraduate year of training. E-mail questionnaires were then sent to 144 residents planning fellowship training and careers in academia other than in GI/hepatology. RESULTS: A total of 592 residents (32% response) returned completed survey cards. Overall, 392 (66%) indicated that they will pursue fellowship training and similar to 60% wanted to remain in academia. However, <10% indicated an interest in GI/hepatology. E-mail replies were then obtained from 122 residents (87% response) planning academic careers but not in GI. The major reasons for disinterest in GI/hepatology include the perception that jobs are not widely available, that the held is intellectually unchallenging, as well as that is too procedure-oriented. CONCLUSIONS: The majority of residents at university training programs plan advanced training and want to pursue careers in academia, but not in GI/hepatology. Efforts to attract highly qualified residents to GI must emphasize the improved job market, especially as it exists in academia;must advertise research opportunities;and must de-emphasize the procedural nature of this subspecialty. (Am J Gastroenterol 2000,95:777-783. (C) 2000 by Am. Coll. of Gastroenterology).

关键词：医学科学研究中心医务工作者的态度职业选择助学金和奖学金胃肠病学/教育内科学/教育实习医师和住院医师职务专门化美国成年人女(雌)性人类男(雄)性

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Survey of internal medicine residents' use of the fecal occult blood test and their understanding of colorectal cancer screening and surveillance

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第8期95卷 2068-2073页

作者： Sharma, VK Corder, FA Raufman, JP Sharma, P Fennerty, MB Howden, CW Univ Arkansas Med Sci Div Digest Dis Little Rock AR 72205 USA Univ Kansas Kansas City MO USA Oregon Hlth Sci Univ Portland OR 97201 USA Rush Presbyterian St Lukes Med Ctr Chicago IL 60612 USA

OBJECTIVE: Primary care physicians have imperfect understanding of current colorectal cancer screening guidelines and recommendations. Furthermore, compliance with colorectal cancer screening by internal medicine residents has been demonstrated to be poor. We sought to identify whether current trainees in internal medicine had adequate understanding of colorectal cancer screening and surveillance and test utilization. METHODS: We applied a structured questionnaire about colorectal cancer screening and the use of fecal occult blood tests to 168 internal medicine residents at four accredited programs in the U.S. They were also asked for recommendations about six hypothetical patients who may have been candidates for screening or surveillance. RESULTS: Seventy-one percent identified 50 yr as the currently recommended age to commence screening in an average-risk individual;64.3% would begin screening with fecal occult blood testing and flexible sigmoidoscopy and 4.8% with colonoscopy. Most perform fecal occult blood testing on stool obtained at digital rectal exam and without prior dietary restrictions. Many use fecal occult blood testing for indications other than colorectal cancer screening. Only 29% recommended colonoscopy to evaluate a positive fecal occult blood test. Most residents plan to be screened for colorectal neoplasia at the appropriate age;significantly more opted for colonoscopy than recommended it for their patients. CONCLUSIONS: Internal medicine residents have many misperceptions regarding colorectal cancer screening and the utility of the Fecal occult blood test. Educational efforts should be directed at internal medicine residents, many of whom plan careers in primary care, where most colorectal cancer screening is currently performed. (C) 2000 by Am. Cell. of Gastroenterology.

关键词：结肠镜检查结直肠肿瘤/诊断数据收集内科学/教育实习医师和住院医师职务潜血人群监测问卷调查成年人女(雌)性人类男(雄)性中年人

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European neurosurgical education - The next generation

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ACTA NEUROCHIRURGICA 2000年第10期142卷 1081-1087页

作者： Brennum, J Rigshosp Univ Clin Dept Neurosurg DK-2100 Copenhagen Denmark

Questionnaires regarding neurosurgical training were sent to all participants of the EANS-training course in Barcelona 1999 and to all national neurosurgical societies of EANS. The completed questionnaires show a significant variation in 1) the demands for education prior to obtaining a neurosurgical training position, 2) in the theoretical training programme and 3) in the surgical experience obtained within the training period. The trainees express a need for improvement of the neurosurgical training programmes. The need for common guidelines for European neurosurgical training as well as regular evaluation of the training programmes are discussed.

关键词：课程数据收集教育医学/发展趋势欧洲实习医师和住院医师职务神经外科手术/方法专业能力成年人女(雌)性人类男(雄)性

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Clinical forensic medicine

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ANNALS OF EMERGENCY MEDICINE 2000年第3期36卷 271-273页

作者： Ryan, MT Univ Louisville Sch Med Dept Emergency Med Louisville KY 40292 USA

[Ryan MT. Clinical forensic medicine . Ann Emerg Med. September 2000;36:271-273.]

关键词：咬伤人/诊断衣物文献工作急救医学/教育法医学/教育实习医师和住院医师职务病史记录模式识别视觉体格检查暴力创伤和损伤/诊断创伤和损伤/治疗人类

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Survey of resident training in beating heart operations

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ANNALS OF THORACIC SURGERY 2000年第2期70卷 479-482页

作者： Ricci, M Karamanoukian, H D'Ancona, G DeLaRosa, J Karamanoukian, RL Choi, S Bergsland, J Salerno, TA Buffalo Gen Hosp Div Cardiothorac Surg Buffalo NY 14203 USA Buffalo Gen Hosp Ctr Minimally Invas Cardiac Surg Buffalo NY 14203 USA SUNY Buffalo Buffalo NY 14260 USA Univ Calif San Diego Dept Surg San Diego CA 92103 USA

Background. "Off-pump" coronary artery operations are done with increasing frequency in the treatment of coronary artery disease. As a result, residents in thoracic surgery have been confronted with the necessity of gaining experience in this innovative approach to coronary surgery. The aim of this study was to assess the importance of training in minimally invasive coronary revascularization as it was perceived by thoracic surgery residents. Methods. A postal, multiple-choice survey questionnaire was sent to all cardiothoracic surgery residents (n = 327) of accredited training programs in the United States. Responses were tabulated and analyzed. Results. The overall response rate was 68% (222 of 327 residents). The attending staff was very interested (37%), or had some interest (63%), in beating heart coronary revascularization. Ninety-eight percent of the programs had at least one surgeon performing off-pump procedures. Although 88% of the responding residents showed some interest in off-pump coronary operations, only 22% of them had performed more than 20 off-pump cases, and even less (12%) had performed more than 20 cases of off-pump complete revascularization, or off-pump circumflex revascularization (4%). Sixteen percent of them had no clinical experience with these techniques. Regarding career intentions, 88% of the residents indicated that off-pump coronary operations were expected to be part of the practice, and 58% of them were interested in pursuing additional training in less invasive heart procedures. Conclusions. The results of this survey suggest that training in off-pump coronary revascularization is variable across training programs, and that the majority of residents may not reach proficiency in coronary procedures on the beating heart during their residency. This may adversely affect their future expectations, as 88% of them would like to practice off-pump coronary surgery once the training is completed. (C) 2000 by The Society of Thoracic Surgeon

关键词：心肺转流术临床工作能力实习医师和住院医师职务心肌血管重建术/方法外科手术微创性胸外科学/教育美国人类

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Assessment of a surgery clerkship's performance evaluation system

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AMERICAN JOURNAL OF SURGERY 2000年第2期179卷 145-149页

作者： DaRosa, DA Niehaus, AH Markwell, SJ Northwestern Univ Sch Med Dept Surg Chicago IL 60611 USA So Illinois Univ Sch Med Dept Surg Springfield IL 62794 USA So Illinois Univ Sch Med Dept Stat & Res Consulting Springfield IL USA

BACKGROUND: This study was designed to examine the validity of a surgery clerkship's performance evaluation system. The study also assessed faculty members' confidence in how clerks are evaluated and promotion decisions made. METHODS: Student files from five classes (n = 339) were analyzed. A 25-item published survey designed to study faculty perceptions of a student evaluation system was distributed. Chi-square tests of independence and descriptive statistics were used. RESULTS: Faculty survey results showed faculty perceptions of strengths and weaknesses in the evaluation system. Significant relationships were found with prior performance indicators and clerkship performance yielding evidence of concurrent and predictive validity. CONCLUSIONS: Findings provide guidance for enhancing how clerks are evaluated as well as specific profiles of students who may need special attention or additional challenges during the surgery clerkship. This study provides a model for other clerkships to assess their student evaluations systems. Am J Surg. 2000;179:145-149. (C) 2000 by Excerpta Medica, Inc.

关键词：成就麻醉学/教育医务工作者的态度卡方分布临床实习/标准课程决策教育考核/方法全体教工医学院校妇科学/教育内科学/教育实习医师和住院医师职务模型教育产科学/教育儿科学/教育精神病学/教育补习教学可重复性结果学生医科人类

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Investigating pathology utilisation by junior medical staff in a teaching hospital: a qualitative study

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 2000年第2期30卷 261-263页

作者： Enno, A Mondy, P Kerridge, I Pearson, S Hunter Area Pathol Serv Div Haematol Hunter NSW 2310 Australia Univ Newcastle Fac Med & Hlth Sci Newcastle NSW 2308 Australia

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Practice factors that influence antibiotic prescribing in general practice in Tayside

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 2000年第3期46卷 509-512页

作者： Steinke, DT Bain, DJG MacDonald, TM Davey, PG Ninewells Hosp Med Monitoring Unit Dundee DD1 9SY Scotland Ninewells Hosp Tayside Ctr Gen Practice Dundee DD1 9SY Scotland

A cohort design was used to evaluate antibiotic prescribing in relation to patient and general practice characteristics. The study included prescribing to all subjects resident in Tayside, from January to December 1994 and found 215217 antibiotic prescriptions dispensed to 118596 people. Training status of general practitioners (GPs) was found to be the characteristic most associated with prescribing, Adjusting for other GP characteristics had little effect on these results. Training practice status was the dominant factor associated with significant differences in rates of antibiotic prescribing, in class of antibiotic prescribed and in performance indicators of antibiotic prescribing.

关键词：抗菌药/治疗应用队列研究数据库事实型药物处方药物利用评审家庭医学感染/药物疗法实习医师和住院医师职务苏格兰人类

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A structured curriculum for improved resident education in statistics

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AMERICAN SURGEON 2000年第6期66卷 585-588页

作者： Cheatham, ML Orlando Reg Med Ctr Dept Surg Educ Orlando FL 32608 USA

Many resident physicians do not receive sufficient education in statistical theory and study design to allow them to effectively interpret and apply the medical literature to patient care. A survey of 62 surgical residency programs identified that only 33 per cent include formal statistics teaching in their curricula. A structured curriculum was formulated to introduce surgical residents to basic statistical theory, common statistical tests, and study design. Lectures were integrated into an existing monthly journal club in which manuscripts reviewed were used to illustrate the statistical concepts taught. Knowledge improvement was determined using a multiple choice test given before and after completion of the curriculum. Mean test scores increased significantly as a result of the curriculum (P < 0.004), Formal statistics education using a structured curriculum significantly improves resident physician knowledge of statistical theory and study design. Such teaching can be easily integrated into a residency program's existing curriculum.

关键词：课程实习医师和住院医师职务统计数据/教育外科学/教育美国人类

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The stress of being a doctor: Steroid excretion rates in internal medicine residents on and off duty

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AMERICAN JOURNAL OF MEDICINE 2000年第6期109卷 492-494页

作者： Vierhapper, H Nowotny, P Univ Vienna Clin Internal Med 3 Clin Div Endocrinol & Metab A-1090 Vienna Austria

Emotional and physical stress is an intrinsic part of medical practice (1). This may be intensified by sleep deprivation, resulting in fatigue and impaired mental and physical performance (2–4). However, little is known about the effects of prolonged working hours on hormonal and metabolic parameters in physicians (4). We therefore studied urinary excretion rates of several steroid metabolites in a group of internal medicine residents during a 24-hour working period.

关键词：肾上腺皮质激素类/尿雄酮/尿病例对照研究表雄酮/尿糖皮质激素类/尿内科学/教育实习医师和住院医师职务孕烷三醇/尿应激/尿学生医科四氢皮质醇/尿四氢可的松/尿成年人人类男(雄)性

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