Minimum Training Standards Research Articles

Ultrasound Training for Medical and Surgical Specialties

An increasing number of medical and surgical specialties are undertaking their own ultrasound scans. This brings challenges to those wishing to perform ultrasound to ensure that they are competent and for those who provide training to be adequately resourced to do this. In the United Kingdom it is proposed that ultrasound training becomes an integral part of the Urology Specialist Registrar (SpR) training programme. The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) have defined three levels of minimum training standards and this concept has been embraced by the Royal College of Radiologists in a publication which outlines recommended syllabuses for 10 difference specialties.

The status of vascular surgery as an independent specialty in Europe: are the relationships with general and cardiothoracic surgery a problem?

Vascular surgery has established a clear clinical and scientific profile in Europe over the last decade, but it presents a highly complex, disorganized, and unplanned pattern. It is a specialty in the majority of the present member states of the European Union (EU), but in the United Kingdom, Germany, the Netherlands, and Sweden this is not the case. With the current expansion of the EU with 13 countries, mainly from the former Eastern Bloc, it will be even more necessary to ensure at least some level of convergence in the standards of training, certification, quality assured practice, continuing medical education, recertification, access to and quality of care, etc, because free migration of doctors, and patients, is a derivative of the cornerstones of the EU treaties, namely free movement of the citizens (and capital). The profession has been successful in creating a simple and coherent system for organization within the European Union of Medical Specialists with a board of vascular surgery, for a (voluntary) European proficiency test for specialists (the EBSQ-Vasc), and for European continuing medical education, all in close collaboration with the premier scientific society, the European Society for Vascular Surgery. The fantastic reductions in working hours for young doctors in the EU represent a serious threat to standards of training and, ultimately, to the patients. This, in connection with increased litigation and compensation demands for incompetence and negligence, makes it even more necessary to establish European minimum standards for training, professional competence, and an obligatory European specialist examination. A key element in this difficult process is the establishment of vascular surgery as a specialty in all member states. Day-to-day collaboration with radiologic interventionalists has developed pragmatically at the local level in most places, but only when the administrative structures mature and vascular surgery becomes a specialty in all countries will the necessary tools be available for the avoidance of professional conflicts with colleagues from other specialties.

Epilepsy Surgery

Epilepsy Surgery

Exercise for treating fibromyalgia syndrome.

Fibromyalgia (FMS) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services. Exercise training is commonly recommended as a treatment. The objective of this systematic review was to examine the efficacy of exercise training as an treatment for FMS. We searched 6 electronic bibliographies for studies of exercise training in FMS: MEDLINE (1966-12/2000), CINAHL (1982-12/2000), HealthSTAR (1990-12/2000), Sports Discus (1975-05/2000), EMBASE (1974-05/2000) and the Cochrane Controlled Trials Register (2000, issue 4). We also reviewed the reference lists from identified articles including reviews and meta-analyses of treatment studies. Randomized trials focused on cardiorespiratory endurance, muscle strength and/or flexibility as treatment for FMS were selected. Two reviewers independently identified trials meeting inclusion criteria, rated the methodologic quality using 2 standardized validated instruments, evaluated the adequacy of the exercise training stimulus using the American College of Sports Medicine (ACSM) criteria and evaluated the results. Disagreements were resolved through active discussion and consensus. High quality training studies had scores of 50% or greater on van Tulder methodologic criteria and met the minimum training standards of ACSM. Outcome variables were grouped into 7 constructs: pain, tender points, physical function, global well being, self efficacy, fatigue & sleep, and psychological function. Two reviewers independently extracted data on study characteristics, results and point estimates for selected variables, and used consensus to address discrepancies. Sixteen trials involving a total of 724 participants were assigned at random to: exercise intervention groups (n=379), control groups (n=277), or groups receiving an alternate treatment (n=68). Seven studies were high quality training studies: 4 aerobic training, 1 a mixture of aerobic, strength and flexibility training, 1 strength training and 2 with exercise training as part of a composite treatment. Flexibility protocols were never described in sufficient detail to allow evaluation. The four high quality aerobic training studies reported significantly greater improvements in the exercise groups versus control groups in aerobic performance (17.1% increase in aerobic performance with exercise versus 0.5% increase in the control groups), tender point pain pressure threshold (28.1% increase versus 7.0% decrease) and improvements in pain (11.4% decrease in pain versus 1.6% increase). Poor description of exercise protocols was common, with insufficient information on intensity, duration, frequency and mode of exercise. Adverse events were also poorly reported. Supervised aerobic exercise training has beneficial effects on physical capacity and FMS symptoms. Strength training may also have benefits on some FMS symptoms. Further studies on muscle strengthening and flexibility are needed. Research on the long-term benefit of exercise for FMS is needed.

Survey of arthroscopy performed by rheumatologists.

To determine the international distribution and practice of arthroscopy performed by rheumatologists and to evaluate proposed guidelines on minimum standards for training in arthroscopy in the context of current clinical practice. A questionnaire was sent to all rheumatology centres identified as practising arthroscopy, by (i) searching Medline from 1966 to 1999, (ii) searching the abstract books of the annual general meetings of ACR, BSR and EULAR from 1980 to 1999, and (iii) correspondence with all the centres identified. Thirty-six rheumatology centres were confirmed as performing arthroscopy (24 in Europe, 10 in USA and two in Australia) and 33 (92%) centres completed the questionnaire. Twenty-five (76%) of the 33 centres performing arthroscopy had started to perform it since 1990 and 72 rheumatologists are now trained in arthroscopy. A total of 16532 arthroscopies had been performed (median=220 arthroscopies/centre, range 20-5000); 50.5% of the arthroscopies had a primary clinical indication and 49.5% had a primary research indication. Most centres fulfilled the minimum standards for arthroscopic facilities and the proposed minimum standards in training were acceptable to 76% of respondents. Complication rates were calculated for 15682 arthroscopies where routine follow-up data were available [joint infection, 16 (0.1%); wound infection, 17 (0.1%); haemarthrosis, 141 (0.9%); deep venous thrombosis, 31 (0.2%); neurological damage, 3 (0.02%), thrombophlebitis, 12 (0.08%), other, 8 (0.06%)]. Irrigation volume correlated with wound infection rate (r=0.41, P=0.03) and centres performing cartilage biopsy had a higher rate of haemarthrosis (P=0.007). The last decade has seen rapid growth in arthroscopy performed by rheumatologists in an out-patient setting under local and regional anaesthesia. Proposed minimum standards for training in rheumatological arthroscopy reflect current practice accurately and are acceptable to the majority of arthroscopists. Complication rates of rheumatological arthroscopy are similar to those reported in the orthopaedic literature.

Application of regulations to cosmetic lasers in privatepractice

Recent years have seen a growth in the number of non-NHS premises, forexample beauty salons, offering cosmetic laser treatments such as laserhair removal. By law, such practices are subject to registration andmonitoring by Health Authorities. However, a national consensus onappropriate standards is urgently required, particularly on interpretationof the legal requirements for medical direction and operator training, inorder to ensure consistency of standards in private practice with lasersacross the country.This paper outlines the difficulties experienced in the inspection andregistration process, and makes recommendations on appropriate interimstandards, pending formal guidance from professional bodies and thepromulgation of revised regulations. Until such guidance is in place, itmay be wise for Health Authorities to include within their inspectionprotocols a requirement that applicants for laser registrations produce astatement as to the exact form which medical direction of laser treatmentwill take, to enable the Health Authority to consider and take advice onits suitability. Similarly a requirement that laser operators arestate-registered health professionals will ensure that these potentiallyhazardous devices are only used by properly qualified operators, whilstprofessional bodies work towards a consensus on minimum training standards.

Adherence to Physician Training Guidelines for Pediatric Transesophageal Echocardiography Affects the Outcome of Patients Undergoing Repair of Congenital Cardiac Defects

Intraoperative echocardiography is widely accepted as being useful during a variety of cardiac surgical procedures. Several applications have been reported during the repair of congenital cardiac defects. National organizations, including the Society of Pediatric Echocardiography and the American Society of Echocardiography, have published guidelines for the provision of at least minimum standards of training and quality for a variety of cardiac ultrasonography procedures. Few data exist concerning whether adherence to such guidelines affects the performance of ultrasonography studies or patient outcome. This study is an outcome-based analysis of intraoperative transesophageal echocardiography performed during repair of congenital cardiac defects during 5-month periods in 2 different years. In year 1, examinations were performed by physicians who met the guidelines for pediatric transesophageal echocardiography published by the American Society of Echocardiography. Those performing examinations in year 2 did not meet those guidelines. Significant differences between the years were found for adequacy of echocardiographic recordings, return to bypass for further surgery based on echocardiographic results, and prevalence and detection of significant residual problems by intraoperative echocardiography. It is concluded that patient outcome is affected beneficially when intraoperative transesophageal echocardiography is performed by physicians who meet the published guidelines, and whose sole responsibility is the performance of echocardiography. (J Am Soc Echocardiogr 1999;12:165-72.)

The problem of pediatric malignancies in the developing world.

In industralized countries, 70 to 80% of children with cancer can be cured by expensive interdisciplinary teamwork and by cooperation on the national or international level. As a result of poor socio-economic conditions, worldwide, less than 20% of the approximately 185,000 children developing cancer each year get adequate treatment. This is also true for 14 to 15 million children dying each year of diarrhea and infections, but while this number is decreasing, the number of children with cancer is increasing. In "middle income" developing countries, cancer is now a leading cause of death for children between 5 and 15 years of age. The "geography" of pediatric cancer reveals complex interactions between environment, lifestyle, and carcinogenesis. The "mapping" of pediatric cancer is far from complete, and the investigation of carcinogenetic interactions has barely started. A great challenge is the planning of pediatric oncology in developing countries. The goals are to improve the access to treatment and treatment results. Even if pediatric oncology has a low priority, the institution, in each country or large province, of at least one pediatric cancer unit may improve not only cancer treatment but medical care in general. By promoting education, organizing meetings, and setting minimum standards for training and care, international organizations can contribute to the development of pediatric oncology worldwide.

Accreditation of vascular training programs and certification of vascular surgeons

Accreditation of vascular training programs and certification of vascular surgeons

A model curriculum for training in psycho‐oncology

AbstractThe increased awareness of the cancer patient's psychosocial needs in the past few years has led to the development of training programs for health professionals working in oncology. Given the diversity of training goals, professionals involved in the care of patients, institutional resources and local needs, there is a lack of uniform criteria to train specialists in the field of psycho‐oncology. This paper describes a model for a one‐year curriculum the objective of which is to establish minimal standards of training to become a professional who is subspecialized in adult or child and adolescent psycho‐oncology. The curriculum primarily consists of a didactic and a skills development components. Selection of trainees and faculty as well as teaching tools and evaluation of the curriculum are described. The second part of the model curriculum contains specific recommendations that address the particular educational needs of specific oncological disciplines (oncologists, nurses, social workers) and volunteers. In addition, the need for multidisciplinary teams in oncology settings is emphasized. Defining minimum standards for training across institutions and even nations will not only improve patient care but will also contribute to define psycho‐oncology as a discipline.

A survey of obstetric anaesthesia practice in British Columbia.

Hospitals and anaesthetists in British Columbia were surveyed by means of questionnaires to assess patterns of obstetric anaesthesia practice, qualifications and numbers of obstetric anaesthesia personnel, hospital obstetric facilities and facilities and protocols for neonatal resuscitation. It was apparent that a large proportion of the obstetric anaesthesia service in this province was being provided by physicians who were not trained, nor certified, as anaesthesia specialists. Preanaesthetic assessment in the obstetric units differed in attitude and practice from the standards expected in the general operating rooms. There was also in community hospitals a significant incidence of failure to follow certain accepted safe practices (in obstetric patients), such as preinduction hydration and oxygenation, cricoid pressure during intubation and prevention of aortocaval compression. However, administration of general anaesthesia without endotracheal intubation, was rare in this survey. Post-anaesthetic recovery facilities in obstetric units were conspicuously deficient, even in the larger hospitals. The majority of community hospitals lacked written protocols for neonatal resuscitation; and the number of institutions reporting that the neonatal heart rates and temperatures were not routinely monitored is of concern. It is recommended that minimum standards for training in obstetric anaesthesia should be clearly defined; and provision should be made for revision and upgrading of knowledge and skills for physicians practicing anaesthesia in smaller community hospitals.

Minimum Standards for Training: A consumer viewpoint.

Minimum Standards for Training: A consumer viewpoint.

Minimum standards for training. Selecting general practitioner trainers.

Minimum standards for training. Selecting general practitioner trainers.

Doctoral Level Internships in Counseling: Should APGA Accredit Them?

If one accepts the assumption that accreditation indicates at least minimum standards of training and competency, then it seems appropriate for APGA to begin accrediting internship training sites. This article argues in favor of such accreditation.

The Personnel Manager and His Educational Preparation

The purpose of this article is to evaluate the principles, needs, and objectives of the education of the personnel manager. An appropriate place to start is with consideration of whether the field of industrial and labor relations is a profession, even though this can be, and doubtless should be, regarded as simply a matter of definition and usage. Clearly, in the classical sense (or at least in what lawyers and physicians think of as the classical sense), it is not. A recent study suggested these four criteria for defining a profession: 1. A profession should rest on a systematic body of knowledge of substantial intellectual content and on the development of personal skill in the application of this knowledge to specific cases. 2. It must set up standards of professional conduct, which take precedence over the goal of personal gain. 3. It should have an association of members, among whose functions are the enforcement of standards and the advancement and dissemination of knowledge. 4. It should prescribe ways--controlled in some degree by the members of the professional association--of entering the profession by meeting certain minimum standards of training and competence. Industrial and labor relations fails to qualify by this definition on counts 2, 3, and 4. (Author's abstract courtesy EBSCO.)