Additional Postgraduate Training Research Articles

An Argument for Reducing Family Medicine Training to 2 Years

A residency program director supports a shortened 2-year family medicine residency program that emphasizes primary care in the ambulatory setting and also allows family physicians to receive additional postgraduate training in their specialty areas of interest. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Utilization of Preoperative Urodynamic Studies by Canadian Gynaecologists

Objectives: (1) To determine the proportion of Canadian gynaecologists who have urodynamic studies (UDS) readily available; (2) to assess the preoperative UDS utilization patterns of Canadian gynaecologists in various clinical scenarios of stress urinary incontinence (SUI).Methods: A mail survey was sent to all 1266 obstetrician/gynaecologist members of the Society of Obstetricians and Gynaecologists of Canada (SOGC), as part of an international survey with the U.K., U.S.A., New Zealand, and Australia. Survey questions included geographic availability of UDS and specific types of urodynamics testing available. Utilization of urodynamics prior to anti-incontinence surgery was assessed in four clinical scenarios: (A) a history of uncomplicated primary stress urinary incontinence, (B) a history of mixed stress and urgency incontinence, (C) stress incontinence with a history of straining to void, and (D) recurrent stress incontinence.Results: Of the 1266 surveys mailed, 230 (18%) were returned. Forty-four of the respondents did not manage incontinent women. Of the 186 respondents who did, 27% reported a special interest or additional postgraduate training in urogynaecology, and 73% were general gynaecologists. UDS were available in the same centre or city to 79% of respondents. For uncomplicated primary stress incontinence, 47% would always obtain preoperative UDS, 42% would not, and 11 % would only if UDS were readily available. For the total group of respondents, in scenario A 47% would always obtain preoperative UDS, 42% would not, and 11% would only if UDS were readily available. Among general gynaecologists, in scenario A, if UDS were available in their city or centre of practice, 54% would always obtain preoperative UDS, as compared to 5% by general gynaecologists who did not have UDS available in their city or centre of practice.Conclusion: The data collected in this survey are compromised because of the low response rate. However, most 79% of the respondents who manage women with urinary incontinence had access to urodynamics in the same centre or city. The utilization of urodynamics prior to surgical treatment of uncomplicated primary pure stress incontinence varies depending on the availability of such testing. An uncomplicated history of primary SUI and decreased availability of testing were two factors seen to have an effect of decreasing utilization of preoperative UDS. Hospital management did not always comply with SOGC guidelines for preoperative testing for SUI. Updating and dissemination of these guidelines is necessary to ensure “best” Practice and highest quality of care for all women with SUI in Canada.

Postgraduate Training in Breast Surgery

Dramatic changes have taken place in the field of breast surgery within the past ten years. Much of the change in practice is due to the advent of less invasive surgical procedures and increased technology such as the evolution of sentinel node biopsies. Many surgeons choose to undergo additional postgraduate training to gain an increased proficiency in the diagnosis and surgical treatment of benign and malignant disorders of the breast.

Uncertainty in Computational Fluid Dynamics

The Annual EPSRC/IMechE Expert Meeting brought together some 44 experts to consider sources of uncertainty in computational fluid dynamics (CFD). Presentations and discussions covered modelling, numerical solution techniques, boundary conditions, evaluation protocols and QA (quality assurance) procedures. The principal conclusions to emerge were: (a) the need for additional collaborative validation studies; (b) the desirability of introducing appropriate QA procedures, possibly based on the CFD Community Club initiative; (c) the need for additional postgraduate training, possibly based on the IGDS principle; (d) the value of continuing work in modelling and error estimation techniques for numerical schemes.

Maxillofacial prosthetics: Vital signs

A maxillofacial prosthetics survey was designed to record the response rate of prosthodontists regarding the frequency of maxillofacial procedures and insurance coverage in 1991. The survey explored variability with respect to membership in professional organizations, region, education, primary activity, and age of the prosthodontist. A total of 342 survey instruments were received from a total of 690 mailed. A total of 18,410 maxillofacial procedures were performed by the survey population. Members of the American Academy of Maxillofacial Prosthetics performed procedures at a significantly higher rate than did the members of the American College of Prosthodontists. A greater procedure rate was observed for prosthodontists in the South Midwest and Southwestern regions; the hospital setting; with 2 plus 1 year additional postgraduate maxillofacial training; and the 45- to 54-year age group. Insurance covered most maxillofacial procedures, but was not uniformly distributed within predictor variables nor between procedures.

The approaches to learning of specialist physicians

Recent studies have provided information about the approaches to studying and learning used by medical students. However, no published work is available on the approaches of practising doctors. The Adelaide Diagnostic Learning Inventory for Medical Students (ADLIMS) was modified and administered to a random sample of 308 physicians (internists). Generally speaking, physicians seem to have lower scores on surface approach and higher scores on deep approach than students. Level of clinical experience did not appear to influence this finding. However, marked differences were apparent between the approaches adopted by physicians with additional postgraduate academic training and those without. The former had a much stronger tendency to use the more desirable deep approach. The latter seemed to rely more on the less desirable surface approach. Further longitudinal studies will be required to determine whether this difference is attributable to self-selection of those who have already developed a deep approach or is causally related to a training in research. Although these findings must be interpreted with caution, some implications are clear. Physicians should become more aware of the way they learn and about the way they teach. Inappropriate patterns of learning may be entrenched during the undergraduate and immediate postgraduate years. If validated, these findings may provide support for the inclusion of research projects in medical school and during specialist training.

Instituto nacional de enfermedades Neoplásicas: Past and present

The Instituto Nacional de Enfermedades Neoplásicas was established by the government of Peru as an institution for the treatment of cancer patients in 1939; it has existed under different names until the current title was adopted in 1952. Between 1980 and 1987, attendance increased by 70% and a new and larger facility came into use at the beginning of 1988. This institution has national responsibility for cancer prevention, detection, treatment, education, and research and is currently organizing satellite treatment centers in other parts of the country. More than 80% of the medical staff has been trained in the institute's residency program, the majority of whom received additional postgraduate training in the United States and Europe; 90% of the medical staff hold academic appointments in medical schools. In 1952 the Institute became the first hospital in Peru with a formal postgraduate training system for various medical disciplines, including surgical oncology and medical oncology. So far we have trained about 500 surgical oncologists who are working in all parts of Peru. The Maes-Heller Institute for Cancer Research forms part of the National Cancer Institute complex. Research will be directed mainly toward new diagnostic and therapeutic approaches, multidisciplinary tumor therapy, and large-scale cancer screening. The Institute focuses on early detection and prevention of cancer and is active in breast self-examination education and antismoking campaigns. It enjoys community support evidenced in the women's organization, Adainen, involved in fundraising; 460 women volunteers give at least 4 hr service per week to the Institute. The Institute has grown from 9,000 patients seen per year in its early days to 215,000 attendances in 1986.