Medicine Education Programs Research Articles

Capturing the Diagnosis: An Internal Medicine Education Program to Improve Documentation

BackgroundSpecific and accurate documentation of patient diagnoses and comorbidities in the medical record is critical to drive quality improvement and to ensure accuracy of publicly reported data. Unfortunately, inpatient documentation is taught to internal medicine trainees and practitioners sporadically, if at all. At Harbor-UCLA Medical Center, a public, tertiary care, academic medical center, we implemented an educational program to enhance documentation of diagnoses and comorbidities by internal medicine resident and attending physicians. MethodsThe program consisted of a series of lectures and the creation of a pocket card. These were designed to guide providers in accurate documentation of common diagnoses that group to different levels of disease severity, achieved by capturing Centers for Medicare and Medicaid Services complication codes and major complication codes. We started the educational program in January 2010 and used a pre-post design to compare outcomes. The program's impact on complication codes and major complication codes capture rates, mortality index, and case mix index was evaluated using the University Health Consortium database. ResultsThe median quarterly complication codes and major complication codes capture rate for inpatients on the internal medicine service was 42% before the intervention versus 48% after (P = .003). Observed mortality did not change but expected mortality increased, resulting in a 30% decline in median quarterly mortality index (P = .001). The median quarterly case mix index increased from 1.27 to 1.36 (P = .004). ConclusionsThus, implementation of an internal medicine documentation curriculum improved accuracy in documenting diagnoses and comorbidities, resulting in improved capture of complication codes.

Factors affecting the current status of transfusion medicine education in South Africa

Education in transfusion medicine, aimed at clinical transfusion practice, is limited in most South African pre- and postgraduate medical training programs. A number of local and global factors impact on the need for and provision of transfusion medicine education programs in South Africa, which are discussed in this paper. A perspective is provided on the effects of issues such as global versus local training need, blood safety, appropriate use of blood in resource-restrained environments, the presence or absence of national blood policies, standardization of training, medical migration and workforce diversity. Harnessing support for the development of training programs for medical doctors and new opportunities for developing a career in transfusion medicine are discussed. Commentary is also provided on online learning, social networking and integration of modern paradigms of learning, such as screencasting and online learning, into teaching programs. This article should provide anyone in medical education or program development, in particular in the field of transfusion medicine, with an indication of the factors that should be considered when embarking on such an endeavor.

“Educating the Educators” Guidelines for Education in Radiation Medicine: A Pragmatic Approach at International Atomic Energy Agency

Drawing on the experience of the Division of Human Health within the Department of Nuclear Sciences and Applications, we explore "educating the educators" guidelines for planning, developing, implementing, and evaluating education and training programs in radiation medicine for the International Atomic Energy Agency's Member States. The guidelines are based on a pragmatic approach to strengthen an internal quality-assurance framework. This article is based on the consultants' meetings and reports, participatory observations, bi monthly capacity-building sessions, and informal communication with staff members of the Division of Human Health, held between December 2009 and August 2012. This article contributes to the theoretical and practical applications of "educating the educators" philosophy as continuously cultivated in an international organization that transforms itself as a learning organization.

Outpatient Palliative Care: Plan or Expand More Successfully Using New Tools From IPAL-OP and CAPC (SA520)

3. Identify strategies to actively engage medical student participation in the design and leadership of palliative medicine educational programs. Since the Liaison Committee on Medical Education published requirements in 2000, the amount of end-of-life care and palliative medicine content in medical school curricula has greatly increased. However, there are currently no accepted standards for undergraduate training in palliative medicine, resulting in wide variability in curriculum content, time commitment, target audience, and evaluation methods. Palliative medicine educators are in the process of developing a set of standard minimum competencies to guide in designing, implementing, and evaluating curricular content. The role of medical students is an essential component of this process as we anticipate a critical change in the way medical schools deliver palliative medicine education over the next several years. This unique session brings a student perspective to understanding the current state of palliative care education by featuring medical students who will give an overview of current palliative care curricula at United States medical schools and then speak individually about their own active participation with such programs at their institutions. The speakers represent a diversity of program design, setting, and challenges faced. Specifically, three key topics will be discussed: (a) a literature review of medical students’ experience in caring for patients with advanced illness, including the evidence base of effective teaching methods and growth of curricular content over the past 10 years, (b) challenges and opportunities faced when implementing a palliative medicine curriculum, including recruiting interested faculty, fitting the program into an existing medical school infrastructure, and developing educational partnerships (i.e. with community hospices); and (c) exploration of methods to engage students as leaders and active participants in curriculum development and implementation into medical schools. Each student will cover one objective for 10 minutes, with the remaining 5 minutes reserved for personal experiences. We will close with a group exercise with the audience reflecting on their institutions’ challenges and opportunities and questions for the students. Interdisciplinary Cases (SA519)

Mechanical Ventilation Practices of Turkish Emergency Physicians: A National Survey

Introduction: Our objective is to ascertain the mechanical ventilation management skill perception levels of EPs and infrastructural condition of EDs in respect of mechanical ventilation, in Turkey. Materials and Methods: In Turkey, a survey aimed at all EPs was conducted. The contents of the survey form were consisted of 4 main titles. Socio-demographic characteristics, situation of the personnel and technical infra-structure in the ED, Emergency Medicine Training Program and post graduate trainings and solution suggestions. Their perception level was evaluated with a 10 cm Visual Analogue Scale. Results: 400 emergency physicians participated in the study (response rate = 70.5%). The mean of emergency physicians’ perception on whether or not the personnel and technical infrastructure for mechanical ventilation management are adequate, in the institutions where they work was found out to be, respectively, 3.2±2.4 cm and 3.4±2.4 cm. It was determined that %75.5 of the participants had no education on mechanical ventilation management during their emergency medicine education program. The mean value of perception levels on the number of mechanical ventilation practice adequacy during emergency medicine education program was established to be 4.6±2.2 cm and the mean value of perception levels on knowledge and skills about mechanical ventilation management was established to be 5.4±2 cm. It was determined that, during mechanical ventilation, 29.5% of EPs not used any one of sedative agents and 30.2% of them not used any one of paralyzing agents. It was also determined that, frequently midazolam (30.7%) was used for sedation, fentanyl (50.7%) for analgesia and vecuronium (27%) as neuromuscular blocker. Conclusion: The skill perception level of emergency physicians on mechanical ventilation management is low. Mechanical ventilation management educations in emergency medicine education programs and infrastructural conditions of emergency departments in respect of mechanical ventilation were both considered as inadequate by emergency physicians.

Emergency thoracotomies: Two center study

Introduction and Aim:Emergency thoracotomy is performed either immediately at the scene of injury, in the emergency department or in the operating room. It aims to evacuate the pericardial tamponade, control the haemorrhage, to ease the open cardiac massage and to cross-clamp the descending thoracic aorta to redistribute blood flow and maybe to limit sub-diaphragmatic haemorrhage, bleeding and iatrogenic injury are the common risk factors. We aimed to review our experience in the field of emergency thoracotomies, identify the predictors of death, analyze the early results, detect the risk factors and asses the mortalities and their risk factors.Patients and Methods:Our hospital records of 197 patients who underwent emergency thoracotomy were reviewed. We retrospectively analyzed a piece of the extensive experience of the Mansoura University Hospitals and Mansoura Emergency Hospital; Egypt and Saudi German Hospitals; Jeddah in the last 12 years in the management of trauma cases for whom emergency thoracotomy. The aim was to analyse the early results of such cases and to detect the risk factors of dismal prognosis.Results:Our series included 197 cases of emergency thoractomies in Mansoura; Egypt and SGH; Jeddah; KSA in the last 12 years. The mean age of the victims was 28 years and ranged between 5 and 62 years. Of the 197 patients with emergency thoracotomy, the indications were both penetrating and blunt chest trauma, iatrogenic and postoperative hemodynamito a surgical cause. The commonest indication was stab heart followed by traumatic diaphragmatic ruptures.Conclusion:The results of emergency thoracotomy in our series were cooping with the results of other reports, mainly due to our aggressive measures to achieve rapid stabilization of the hemodynamic condition. We emphasize the importance of emergency medicine education programs on rapid diagnosis of traumatic injuries with early intervention, and adequate hemodynamic and respiratory support. Emergency thoracotomy has an important role in emergency big volume hospitals and can save a lot of lives. Outcome can be improved by increasing the learning curve and the integrated cooperation of the emergency and surgical teams.

Sleep Disordered Breathing, Insomnia Symptoms, and Sleep Quality in a Clinical Cohort of US Hispanics in South Florida

There is a paucity of information on the epidemiology of sleep disorders among US Hispanics. This study describes the frequency of sleep disordered breathing (SDB) risk, insomnia complaints, poor sleep quality, and daytime somnolence in a clinical cohort of ethnically diverse US Hispanics living in South Florida. We explored the presence of sleep disorders in a cohort of Hispanics seen at primary care, pulmonary, and sleep clinics at the University of Miami and Miami Veterans Affair Medical Center. Participants completed validated questionnaires, evaluating risk of SDB, presence of insomnia symptoms, sleep quality, and daytime sleepiness. Polysomnography was completed on the majority of the sleep clinic participants. Participants (N = 282; 62% male; mean age 54 ± 15 years; mean BMI 31 ± 6 kg/m(2)) included Hispanics of Cuban, Puerto Rican, Central/South American, and Caribbean heritage. Excessive daytime sleepiness was noted by 45% of participants. Poor sleep quality was reported by 49%; 76% screened high risk for SDB, and 68% had insomnia symptoms. Sleep disorders were more commonly reported in sleep clinic participants; however, 54% of non-sleep clinic participants were high risk for SDB, 35% had insomnia complaints, 28% had poor sleep quality, and 18% reported daytime sleepiness. Sleep disorders (including SDB) are common in clinical samples of Hispanics in South Florida. These findings highlight the urgent need for linguistically relevant and culturally responsive screening, awareness and education programs in clinical sleep medicine among US Hispanics. Shafazand S; Wallace DM; Vargas SS; Del Toro Y; Dib S; Abreu AR; Ramos A; Nolan B; Baldwin CM; Fleming L. Sleep disordered breathing, insomnia symptoms, and sleep quality in a clinical cohort of US Hispanics in South Florida. J Clin Sleep Med 2012;8(5):507-514.

Impact of the Parkinson's disease medication protocol program on nurses' knowledge and management of Parkinson's disease medicines in acute and aged care settings

To determine the impact of a Parkinson's medicine education program on nurses' knowledge and practices in two settings where people with Parkinson's disease are cared for: hospitals and residential aged care facilities. The Parkinson's Disease Medication Protocol Program aimed to increase nurse knowledge of Parkinson's medication administration and safety in care management in order to improve health outcomes, function and well-being for the person with Parkinson's. The ageing demographic of the developed world is concomitant with an increase in chronic disease, with Parkinson's disease being one of the most debilitating and costly. Individually complex medication regimens and unique spectrums of symptoms require disease-specific knowledge in nurses. People with Parkinson's disease admitted to hospitals and/or living in residential aged care facilities often have multiple co-morbidities, rendering care more complex still. Nurse ignorance of Parkinson's disease medicines, their uses, side effects and administration regimens, and safe care practices, can cause unnecessary distress and dysfunction for the person. The two pilot studies employed an eighteen month pre/post-test/follow up design at different time frames, using a questionnaire developed by the study team and an expert panel to evaluate nurses' self-assessed 'perceived' knowledge and actual knowledge of Parkinson's disease, Parkinson's medicines and safe care practices, and satisfaction with the targeted Parkinson's education program. Nurses in the hospital pilot (2006/8) revealed deficits in pre-test perceived and actual knowledge levels, which increased significantly at post-test and follow-up. In contrast, in the residential aged care pilot (2008/10) the nurses had higher perceived and actual (correct) knowledge relevant to experience at pre-test and these levels increased at follow-up. Both pilot study cohorts were very satisfied with the PDMPP as an education and support vehicle in Parkinson's management. These study results concur with the international literature which identifies that without targeted clinical education nurses do not necessarily have sufficient knowledge to effectively manage Parkinson's medicines and avoid unnecessary negative outcomes arising from delays, errors and omissions, nor do they know how to provide safe and effective care for persons with Parkinson's. A well-developed and resourced Parkinson's medicine education program, such as the PDMPP, has the potential to improve deficits in clinical practice.

The Complementary Medicine Education and Outcomes (CAMEO) program: A foundation for patient and health professional education and decision support programs

ObjectiveThis paper describes the background, design and evaluation of a theory-informed education and decision support program for cancer patients considering complementary medicine (CM). MethodsThe program was informed by the Shared Decision Making theory, the Ottawa Decision Support Framework and the Supportive Care Framework. Previous empirical evidence and baseline research were used to identify patients’ and health professionals’ (HPs) information and decision support needs related to CM. ResultsTo address the continuum of CM needs, a variety of education and decision support interventions were developed, including basic CM information and resources for patients and HPs, a group education program and one-on-one decision support coaching for patients, and an on-line education module for HPs. Evaluation of the program and individual interventions is underway. ConclusionsThis education and decision support program addresses a significant gap in care and offers an evidence-informed framework in which to translate CM evidence to conventional care settings and promote communication about CM. Practice implicationsEvidence-informed CM education and decision support interventions are needed to shift the culture around CM within conventional care settings and promote open communication that will lead to CM therapies being safely integrated into care.

Complementary, Holistic, and Integrative Medicine: Therapies for Learning Disabilities

1. Elaine Z. Galicia-Connolly, MD* 2. Larissa Shamseer, MSc† 3. Sunita Vohra, MD† 1. *Former Clinical Fellow, University of Alberta, Stollery Children's Hospital CARE Program, Edmonton, Alberta, Canada. 2. †Complementary and Alternative Medicine Research and Education (CARE) Program, Department of Pediatrics, Faculty of Medicine, University of Alberta on behalf of the American Academy of Pediatrics Section on Complementary and Integrative Medicine. Between 5% and 10% of schoolchildren have learning disabilities (LD), and up to 80% of such children have some form of dyslexia. (1) The diagnosis is based on significantly lower academic achievement than the intelligence quotient (IQ) would suggest. (2) Although disorders of learning and attention frequently occur together, this review specifically examines the effectiveness of complementary and alternative medicine (CAM) interventions for children who have LD. The studies might include children who have comorbid conditions such as attention-deficit/hyperactivity disorder (ADHD). Existing interventions for LD focus on remedial teaching in the early years and offering compensatory mechanisms and lifestyle adjustments at later ages. The most robust predictive factors correlating with the success of LD interventions are attention and behavior, general verbal ability, prior level of component reading skills, and total IQ. (1) In a survey of 148 schoolchildren who had dyslexia, Bull found that 55.4% had used CAM for dyslexia, most commonly nutritional supplements or special diets, homeopathy, and osteopathy or chiropractic manipulation. (3) We conducted a search for articles related to learning disabilities and CAM therapies on MEDLINE, Embase, AMED, PsycInfo, the Cochrane Database of Systematic Reviews, and Cochrane's Central Register of Controlled Trials. Search terms were: (learning disorders OR learning disabilities) AND (complementary therapies), with terms varying by database and no limits on language or date. Studies were included if they examined a strictly pediatric population (0 to 18 years) of individuals who had LD and who experienced CAM as the intervention. Eleven articles were relevant …

Universidad Central del Caribe School of Medicine

Universidad Central del Caribe School of Medicine

Engendered Roles in Physical Therapist Education: A Feminist Vision for Scholarship in Clinical Education

Background and Purpose. Although professional education programs, including physical therapist education, require unique roles and qualifications of faculty, academic rank and promotion typically follow traditional university structure. Expectations that all physical therapist academic faculty members, including the director of clinical education (DCE), have a defined, ongoing scholarly agenda can perpetuate a traditional university construction of academic roles unless scholarship is extended to divergent ways of knowing. A feminist understanding of scholarship values connectivity of knowledge through direct community involvement and intensive student engagement. This article, a feminist critique of the DCE role, informs the scholarly potential of the DCE within a context of a more broadly defined and reconstructed definition of scholarship. Position and Rationale. Current academic roles in physical therapist education programs are aligned with engendered definitions of traditional academic structures which can lead to academic devaluation of the DCE. A social constructionist analysis of the DCE position in light of higher education feminist literature provides an alternative perspective of scholarship. Discussion and Conclusion. Academic structures ideally support realization of all faculty potential; however, a paternalistic metric determines faculty promotion with administration, management, and specialized research at the top of the hierarchy. A feminized metric would value those roles inherent to the DCE: student and community engagement, counseling, organization, and content integration. Acceptance and embrace of the feminized nature of the DCE position serves students and professional community more than have attempts to realign the DCE position to traditional masculine academic roles. Key Words: Clinical education, Feminist critique, Director of clinical education, Scholarship. BACKGROUND AND PURPOSE Physical therapist education program faculty comprises an academic administrator, a director of clinical education, academic faculty, clinical education faculty, and adjunct faculty. While all of these members serve integral roles in successful physical therapist academic programs, the director of clinical education (DCE) serves in a tenuous position in terms of academic definitions and traditional academic structures of promotion.1 The inherent qualifications and responsibilities associated with this position can make academic career advancement challenging. This position requires broad clinical perspectives and intensive and direct contact with practicing physical therapists and students through advising, counseling, and teaching. Organizational skills and information management are essential to the position. These responsibilities are not of high academic value in terms of academic promotion, which often situates the DCE as junior faculty or as an assistant professor within traditional academic structures. Rather than accept the prevailing rank of the DCE, the purpose of this article is to challenge the traditional academic status of the DCE and offer an alternative vision for this position based on feminist critique and critical social theory. Feminist perspective has been extended to higher education programs in medicine, nursing, business, engineering, basic sciences, the humanities, and economics to evaluate work distribution, promotional structures, and characteristics of leadership.2 As with these fields, physical therapy academic roles do not exist in isolation but are socially constructed and interpreted within the context of accepted norms, values, and shared beliefs. POSITION This article will present an evaluation of the DCE position as it is socially constructed. That is, the interpretation is developed from the unique viewpoint of the DCE and informed by a higher education and feminist literature. A social constructionist approach accepts multiple realities, as all individuals form knowledge and make meaning of experience contextually and through social understandings. …

An Evaluation of the Evidence in “Evidence-Based” Integrative Medicine Programs

Alternative therapies are popular, and information about them should be included in the curricula of health profession schools. During 2000 to 2003, the National Institutes of Health National Center for Complementary and Alternative Medicine awarded five-year education grants to 14 health professions schools in the United States and to the American Medical Students Association Foundation. The purpose of the grants was to integrate evidence-based information about complementary and alternative medicine (CAM) into the curriculum. The authors reviewed the educational material concerning four popular CAM therapies-herbal remedies, chiropractic, acupuncture, and homeopathy-posted on the integrative medicine Web sites of the grant recipients and compared it with the best evidence available. The curricula on the integrative medicine sites were strongly biased in favor of CAM, many of the references were to poor-quality clinical trials, and they were five to six years out of date. These "evidence-based CAM" curricula, which are used all over the country, fail to meet the generally accepted standards of evidence-based medicine. By tolerating this situation, health professions schools are not meeting their educational and ethical obligations to learners, patients, or society. Because integrative medicine programs have failed to uphold educational standards, medical and nursing schools need to assume responsibility for their oversight. The authors suggest (1) appointing faculty committees to review the educational materials and therapies provided by integrative medicine programs, (2) holding integrative medicine programs' education about CAM to the same standard of evidence used for conventional treatments, and (3) providing ongoing oversight of integrative medicine education programs.

National Disaster Life Support Programs—A Model for Standardized, All-Hazards Disaster Medicine Training

Introduction: The development of the [US] National Disaster Life Support (NDLS) programs (Advanced, Basic, and Core Disaster Life Support) began prior to 11 September 2001, but in its aftermath, the NDLS programs have become a leading all-hazards disaster medicine training program in the US. The NDLS programs are taught through a training center model. The curriculum is revised via the National Disaster Life Support Education Consortium (NDLSEC), a multi-disciplinary, multi-specialty consortium. Methods: The National Disaster Life Support Foundation (NDLSF) is a not-for-profit organization developed by the academic medical centers and partners that developed the NDLS programs. The founding institutions are the Medical College of Georgia, die University of Georgia, the University of Texas Southwestern, the University of Texas-Houston, and the American Medical Association. The NDLSF has die responsibility to oversee, certify, and monitor a network of training centers. The NDLSEC consist of individual members and 75 representative stakeholder organizations. Results: The training center network overseen by the NDLSF consists of 70 training centers in the US and 10 developing international training centers. The NDLSEC has >150 members with representatives from virtually every medical discipline and specialty. More than 70,000 individuals have been trained. Conclusions: The NDLS programs have employed a training center network model to deploy standardized, all-hazards disaster educational programs. The NDLS programs have been successful in bridging die gap in disaster medicine education programs in the US and may represent a useful model for other countries to provide disaster medicine education.

Development and Evaluation of Fundamental Education about Kampo Medicine Adopting an Experimental Program in Clinical Pharmacy Using Team-based Format

A model core curriculum was proposed by the government in 2001 that outlined the core structure for undergraduate medical education, in which a Kampo medicine educational program was established. The following year, it was introduced in pharmacy as well as medicine. For fourth-year students at Tokai Medical University, a lecture on Kampo herbal medicine, focusing on clinical pharmacy, was given using team- based learning. Students learned the fundamental mechanism of Kampo medicine through team discussions about their subjective assessment of herbal medicine "Keishito" using their sensory organs and comparing objective analysis data of the main ingredients of Cinnamomi Cortex. They found that knowledge about Kampo medicine can come not only from clinical trials but also from objective observation. Through this educational program, almost all had an increased interest in the possible therapeutic value of herbal medicine. The results of examinations on Kampo herbal medicine showed that this program motivated students, especially those who had less or little interest in Kampo medicine before the lecture. The lecture-style team-based format could also facilitate a mutually supportive atmosphere, because negative feelings and concerns regarding initial traditional medicine can freely be expressed. In future, pharmacists as medical staff will provide preventive and curative primary care; since, for example, the Japanese government is pressing forward to prevent metabolic syndrome, which is related to lifestyle, this project could not have been completed without the cooperation of health professionals such as pharmacists. The present educational program in Kampo medicine may also be recommended for clinical pharmacy education.

Substance Users Get Creative to Fool Drug Tests

Substance Users Get Creative to Fool Drug Tests

Introduction to Wilderness Medicine Education in the City: A New Paradigm

Wilderness medicine programs are proliferating for several reasons: more and more people (including those with medical problems or disabilities) are engaging in wilderness recreation; medical students who participate in a wilderness medicine elective often rate it as the best course they ever took1.McGraw D. Gluckman S.J. The perceived benefits of a medical school course in wilderness medicine.Wilderness Environ Med. 2005; 16: 106-110Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar; wilderness medicine skills apply to many other situations, such as disaster responses, foreign travel, and rural emergency medical services (EMS) with long or chancy transport to hospitals; urban hospitals deal with many problems that people bring back from the wilderness; and outdoor recreation programs are natural partners for wilderness medicine programs, which encourages them to pool their resources and faculty. Moreover, wilderness medicine has long been taught to lay people as well as physicians, because physicians are almost never available in outdoor emergencies. Most of these themes run through the present article. For example, the collaboration of medical faculty with outdoor instructors, which the fortuitous existence of an outdoor program at Cornell University made possible for the authors’ program, is standard practice in European Mountain Medicine courses for physicians.2.Peters P. Mountaineering and climbing techniques in the curriculum of mountain medicine education programs: a survey of the European courses for mountain medicine.Wilderness Environ Med. 2002; 13: 59-65Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar This combination of medical and outdoor skills training has been featured at Wilderness Medical Society conferences as well, because in order to take care of other people in wilderness situations, you must first be able to take care of yourself. Making a modified wilderness medicine curriculum available to Cornell undergraduates also reminds us of the growing demand for realistic emergency care training from people who do outdoor recreation, which has caused courses for lay people to multiply. Some of these courses, pioneered many years ago by groups like The Mountaineers in Seattle, teach techniques (such as reducing dislocations) that even paramedics are not allowed to do in urban situations. Another collaboration described by the authors is with their hospital's Hazardous Materials Team and their EMS Special Operations Team, which reminds us that major disaster scenes are (from a medical perspective) wilderness situations and that many people involved in disaster response, as well as emergency medical technicians and nurses, are taking wilderness medicine courses. The authors also mention that these collaborations have created opportunities for relevant research. All of these themes have one thing in common—the recognition by more and more people that wilderness medicine is relevant to their lives and (in many cases) necessary to their occupations. In a way, this is a reversal of the trend for medicine to become more and more specialized and compartmentalized, which has isolated it from the lives and educations of people outside the profession. In previous centuries, when doctors were scarce, there were many medical guides written for lay people. Perhaps the earliest example in North America was Every Man His Own Doctor: Or, The Poor Planter's Physician.3.Tennent J. Every Man His Own Doctor: Or, The Poor Planter's Physician. William Parks, Williamsburg, VA1736Google Scholar By the early 20th century, these guides had grown into massive tomes containing much of what was in the contemporary medical curriculum (one example being owned by this writer's paternal grandfather). Then, with the expansion of medical training and hospital facilities, followed by the development of the EMS system in the 1970s, the boundary between medical practice and first aid training for lay people was more and more sharply drawn. But now that boundary is shifting, as people realize that for wilderness emergencies or disaster situations, they will need training in wilderness medicine to take care of anyone who is injured.

A correlation between characteristics and students’ perception with the last score of field experience study at community based medicine

Field experience study (FES) is one of the Community Based Medicine Education Programs that has done in Faculty of Medicine University of Malahayati. The aims of this study were to identify several factors related to final FES score. The questionnaires were given for all field study participants. It consisted of students’ characteristics and perception on field study. This FES was conducted on 3 September 2007. Cox regression was used to analyze data using STATA version 9.0. Gender, previous GPA, time of taking FES was dominant risk factors related to risk of FES score. The students who had higher cumulative Grade Point Average (GPA) had 72% higher on final FES score [adjusted relative risk (RRα) = 1.72; 95% Confidence interval (CI) = 1.22-2.43). Female than male students had 39% higher final FES score (RRα = 1.39; 95% CI = 0.93-2.09; P = 0.111), and the students who took than who did not take FES on recommended year of study had 29% higher final FES score (RR = 1.29; 95% CI = 0.96-1.73; P = 0.088). While conducting FES, special attention should be given to students who had previous GPA in order to increase their final FES score. (Med J Indones 2008; 17: 64-7) Keywords: community-based medicine, field experience study, student’s performance

Entering-Class Enrollments in Educational Programs in Radiography, Radiation Therapy, and Nuclear Medicine Technology, 1999 to 2006

To track entering-class enrollments in primary programs in radiography, nuclear medicine technology, and radiation therapy and to anticipate trends in numbers entering those disciplines. The American Society of Radiologic Technologists' annual Enrollment Snapshot of Radiography, Radiation Therapy, and Nuclear Medicine Educational Programs has surveyed program directors in these 3 disciplines every fall since 2001, obtaining information on entering-class enrollments, retention rates, and program viability. These survey results, together with American Registry of Radiologic Technologists statistics on the number of first-time certification examinees (which they foreshadow by about 2 years) show that the number of radiologic technologists entering these 3 disciplines declined steadily from 1995 to 2000, then increased steadily from 2000 to 2005. However, since 2005, entering-class enrollments have begun to level off, especially in radiation therapy and radiography. Entering-class enrollments provide an "early warning system" with respect to trends in the supply of radiographers, nuclear medicine technologists, and radiation therapists. Given the recent stabilization of entering-class enrollments in radiography and radiation therapy, we can anticipate a similar leveling off of the number of entrants into those 2 disciplines over the next 2 years.

Getting “Beyond the Barriers” in Reforming Osteopathic Medical Education

As the healthcare needs of the United States change, some leaders at colleges of osteopathic medicine and osteopathic graduate medical education programs have embraced one very important and timeless goal: to prepare future physicians to meet society's health needs. These medical educators have made significant strides toward moving "beyond the barriers" to effect curricular reform and quality improvement at their institutions. Some of the barriers to osteopathic medical education reform are addressed in this article, which recommends allowing curricular evolution and faculty development; expanding clinical learning and teaching; breaking down departmental walls; integrating osteopathic principles and practice; reevaluating admission requirements of colleges of osteopathic medicine; and eradicating the unspoken and, ironically, often detrimental culture of medicine, which can be contrary to compassionate patient care and healing.