Certification Rates Research Articles

Realising the health benefits of safe work - a continuing professional education for primary care practitioners

Background: General Practitioners complete around 91% of compensable certificates, and play a significant role in promoting the awareness of the health benefits of work. The Australasian Consensus Statement on the Health Benefits of Work developed by the Australasian Faculty of Occupational and Environmental Medicine (AFOEM) has been endorsed by 100 organisations including the Royal Australian College of General Practitioners (RACGP). The Victorian WorkCover Authority and TAC has undertaken a program of work focussing on the delivery of a general practice education and awareness raising program.Objectives: The objectives of the program were to; engage Medicare Locals to undertake a general practice education and awareness raising program, develop training materials for Medicare Local staff to undertake practice liaison visits, recruit and train General Practice peer educators to deliver in-practice education and develop and deliver content for continuing professional development events in selected Medicare Locals.Methods: A suite of educational resources were developed and tailored to suit delivery in a General Practice setting. The Medicare Locals were targeted if they had high certification rates, the educational events were delivered in-practice settings and Principal findings The practice target was reached in all Medicare Locals, a total of 457 general practices across the five Medicare Locals were visited. The program was successful in raising awareness of the health benefits of work amongst GPs and practice staff.Discussion: The education has given general practitioners the impetus to talk to patients early about the health benefits of work and has the potential for GPs to be more confident in their clinical management of compensable patients.Conclusion: That the educational program continue with the Victorian WorkCover Authority and TAC working with key peak bodies and medical colleges to ensure education about the Health Benefits of Safe Work become a mandatory component of all GP postgraduate training.

Trends in Sickness Certification of Injured Workers by General Practitioners in Victoria, Australia

General practitioners (GPs) play a critical role in facilitating injured workers return to work via their ability to certify capacity to return to employment. However, little is known about the sickness certification patterns of GPs in the context of workers' compensation claims. To determine if GPs' sickness certification behaviour has changed between 2003 and 2010 in Victoria, Australia. Retrospective population-based cohort study of all injured workers with an accepted compensation claim. Sickness certification rates per 1,000 working population per annum were calculated. General regression models adjusted for workers' age and annual claim number were fitted to summarize changes in count and duration (expressed as incidence rate ratios or IRRs) of unfit for work (UFW) versus alternate duties (ALT) certificates within six categories of work-related injury and disease. 92,134 UFW and 28,293 ALT certificates were identified. A significant decrease in the unadjusted annual certification rates per 1,000 working population was observed. However, after adjusting for the annual number of claims and age, the IRRs of certificates increased over time. The rate of injuries and IRRs of certificates varied across affliction categories, IRRs being higher in mental health conditions in women than in men (IRR: 0.40, 95 % CI 0.38-0.41 vs. IRR: 0.17, 95 % CI 0.16-0.18). The duration of certificates remained stable, with the ALT being longer than UFW certificates in all claimants. Our findings indicate that GPs in Victoria issue an increasing number of UFW sickness certificates each year. Further research is required to investigate the reasons for such practises.

Pancreatoduodenectomy—current status of surgical and perioperative techniques in Germany

Pancreatoduodenectomy in Germany is performed by a broad range of hospitals. A diversity of operative techniques is employed as no guidelines exist for intra- and perioperative management. We carried out a national survey to determine the de facto German standards for pancreatoduodenectomy, assess quality assurance measures, and identify relevant issues for further investigation. A questionnaire evaluating major outcome variables, case load, preferred surgical procedures, and perioperative management during pancreatoduodenectomy was developed and sent to 211 German hospitals performing >12 pancreatoduodenectomies per year (requirement for certification as a pancreas center). Statistical analysis was carried out using the Fisher Exact, Mann-Whitney U, and Spearman tests. The final response rate was 86 % (182/211). The preferred technique and de facto German standard for pancreatoduodenectomy was pylorus-preserving pancreatoduodenectomy with pancreatojejunostomy carried out via duct-to-mucosa anastomosis with interrupted sutures using PDS 4.0. The minority of German pancreas centers were certified (18-48 %). The certification rate increased with higher capacity levels and case load (P < 0.05); however, significant correlations between the fistula rate and hospital case load, hospital capacity level, or hospital certification status were not seen. This study revealed a distinct variety of management strategies for pancreatic surgery and available evidence-based data was not necessarily translated into clinical practice. The limited certification rate represented a shortcoming of quality assurance. The data emphasize the need for further trials to answer the questions whether hospital certifications and omission of drains improve outcome after pancreatoduodenectomy and for the establishment of guidelines for pancreatoduodenectomy.

Not the Last Word: Harvard Beats Yale and Other Fallacies

Not the Last Word: Harvard Beats Yale and Other Fallacies

Theoretical System Dynamics Modeling for Taiwan Pediatric Workforce in an Era of National Health Insurance and Low Birth Rates

In an era of declining birth rates and a single-payer health care system, the pediatric workforce might overreact to its demands. System dynamics (SD) were therefore applied to establish models to predict the future need and demand for the pediatric workforce. Data of population and workforce were extracted from national databases and models developed using Vensim software. In the past decade, the child-to-pediatrician ratio correlated with infant mortality in Taiwan (p<0.001, r(2)=0.88, child-to-pediatrician ratio=146+354×infant mortality/1000 live births). Currently, the child-to-pediatrician ratio is 1742:1. Using the Millennium Development Goals (2.437/1000 live births) for infant mortality, the child-to-pediatrician ratio was estimated as 1009:1. The pediatric population model incorporated the birth and mortality rates in each age category, accurately predicted population changes between 1974 and 2010, and projected a decreasing trend until 2017. The pediatric workforce model, which considered rates of enrollment, completion, certification, and retention, predicted a decrease in the supply of pediatricians in the mid-2010s that could be delayed by policy incentives. When targeting the base scenario, the model indicated that discrepancies between demands and supply of pediatricians would occur in the late 2010s toward 2020. When targeting the Millennium Development Goals scenario, however, the discrepancies would be consistent. Effective SD models were developed for the population and health care workforce. The strengths of the SD models are derived from simulation, which is subject to influence from new policies. Policies can, therefore, be examined and intervened in a timely manner.

Comparison of Academic and Practice Outcomes of Rural and Traditional Track Graduates of a Family Medicine Residency Program

The Marshall University Family Medicine Residency (MUFMR) implemented its rural track (RT) in 1994 to help achieve its mission of producing primary care physicians for practice in rural areas and West Virginia. This study examined the impact of the RT on the program's training outcomes and assessed the academic equivalence of the RT and traditional track (TT) curricula. The authors analyzed academic outcomes (in-training examination [ITE] scores, board certification rates) and practice outcomes (location and type following graduation) for the 174 MUFMR graduates who entered the program from 1984 through 2006. They compared RT and TT graduates who entered after RT implementation (1994-2006) with each other and with graduates who entered during the decade before implementation (1984-1993). There were differences between the 12 RT and 94 TT graduates in rural practice upon graduation (RT: 83% versus TT: 40%; P<.01) and practice in West Virginia (RT 83% versus TT 68%; P=.34). RT and TT graduates had similar mean increases in ITE scores and board certification rates. The 106 post-implementation graduates had a significantly higher rate of West Virginia practice than did the 68 pre-implementation graduates (70% versus 52%; P=.02). RT development was associated with a substantial increase in MUFMR graduates practicing in West Virginia. RT graduates were more likely than TT graduates to practice in rural areas and in the state upon graduation. RT graduates seem to advance academically as well as their TT counterparts.

Integrating building information modelling with sustainability to design building projects at the conceptual stage

Lately the construction industry has become more interested in designing and constructing environmentally friendly buildings (e.g. sustainable buildings) that can provide both high performance and monetary savings. In general, sustainability integrates the following three related components: (1) environmental, (2) economic, (3) social well-being. Incorporating these components at the conceptual stage is achieved by using sustainable design, through which designers must identify associated materials and systems based on any selected certification (rating) system. The use of building information modelling (BIM) concepts helps engineers design digital models that allow owners to visualize the building before the physical implementation takes place. To apply BIM concepts, designers use tools to create 3D models of buildings where the design materials and systems are selected from the built-in database of these tools. Designers will not be able to quantify the environmental impacts of these materials to support the decisions needed to design sustainable buildings due to the following reasons: (1) a lack of information about the sustainable materials that are stored in the database, (2) a lack of interoperability between the design and analysis tools that enable full life cycle assessments (LCAs) of buildings. This paper presents a methodology that integrates BIM and LCA tools with a database for designing sustainable building projects. The methodology describes the development and implementation of a model that incorporates a database in which information about sustainable materials is stored and linked to a BIM (3D) module along with an LCA module and a certification and cost module. The goal of this model is to simplify the process of creating sustainable designs and to evaluate the environmental impacts (EI) of newly designed buildings at the conceptual stage of their life. An actual building project is presented in order to illustrate the usefulness and capabilities of the developed model.

Evaluating Curricular Influence on Preparation for Practice, Career Outcomes, and Job Satisfaction: Results From an Alumni Survey of a 40-Year Rehabilitation and Mental Health Counseling Program

Alumni of a Council on Rehabilitation Education (CORE)–accredited graduate rehabilitation counselor education (RCE) program were surveyed to evaluate career outcomes, job satisfaction, licensure and certification rates, client populations served, and RCE program satisfaction and effectiveness. Results indicate a high level of satisfaction with the program and career outcomes and confirm the program’s effectiveness in meeting the education and career needs of its graduates. Information obtained provides valuable insight for other RCE programs that aspire to improve and grow to meet the needs of their students and the field.

Analysis of some Portuguese thermal regulation parameters

Due to the high energy consumption associated with the building sector, several legal documents with the aim of promoting energy efficiency have emerged in recent years, e.g. the Directive 2002/91/EC on the energy performance of buildings (EPBD) and its recast on 19 May 2010, Directive 2010/31/EU. The EPBD led many countries to adjust their own building energy-related regulations. The Portuguese thermal regulation for residential buildings, “Regulamento das Características do Comportamento Térmico de Edifícios (RCCTE)”, is a part of the transposition of the EPBD to Portuguese law.The main objective of this paper is to analyse the RCCTE in order to study the influence of some parameters considered important to the energy efficiency of buildings on energy performance and on the final energy certification rating.

A Longitudinal Analysis of Nursing Specialty Certification by Magnet® Status and Patient Unit Type

The objective of this study was to examine nursing specialty certification trends by Magnet® status and unit type. Research exploring organizational and unit attributes associated with higher specialty certification rates is timely given the beginning evidence that certification is associated with lower patient adverse events. The sample included 6047 units in 1249 National Database of Nursing Quality Indicators hospitals. Hierarchical linear modeling was used to predict growth in percentage of specialty-certified RNs within each unit type and Magnet status. Data (Bayesian Information Criteria = 224 583.30) demonstrated significant growth in specialty certification rates over time (P < .0001). Magnet-designated organizations had significantly different starting certification rates (P = .0002) and rates of change (P = .0002). Unit types also had significantly different starting certification rates (P < .0001) and different rates of change (P < .0001). Magnet recognition is associated with increases in specialty certification rates. Certification rates have risen faster in unit types such as pediatric critical care than in unit types such as adult step-down and adult surgical.

Confronting the Elephant in the Room: Can We Transcend Medical Graduate Stereotypes?

As a US medical graduate, I was not exposed to the travails of international medical graduates until 1993. That year, having just completed critical care training at the University of Chicago, I joined the faculty of a program where international medical graduates made up most of the trainees. I made this choice because I sensed an opportunity to have a positive impact on education and a community's health outcomes. At the time, some admonished me that I would be throwing away my career on “missionary work.” While this elitist comment sealed the deal, my choice was also prescient. My impact in a place that had not had formal critical care education and team coordination was instant and substantial.1 Eventually, I became program director of internal medicine and was charged with the task of building a top-tier residency. This journey has been simultaneously edifying, frustrating, and inspiring. Demographics of 21st Century Graduate Medical Education Data compiled by the National Resident Matching Program (NRMP)2 show that the percentage of international medical graduate (IMG) residents has remained relatively stable during the past decade at 17% to 20% overall and 28% to 36% for internal medicine programs (figure). While the NRMP publishes national specialty-specific match results, it excludes positions offered outside the match, which are often filled by IMGs. Thus, the number of IMGs in residency programs is unknown. Despite the sizeable proportion of IMGs who fill training programs, relatively little scholarly work has examined their demographics, distribution, and performance compared to US medical graduates (USMGs). A few studies and anecdotal data suggest that university programs train a greater percentage of USMGs, and community hospitals may have a higher percentage IMGs.3,4 A single large study of internal medicine residents examined aggregate examination scores over time finding that medical knowledge scores of IMGs compared favorably to those of USMGs.5 Between 1995 and 2000, IMGs “scored higher than graduates of US medical schools on every internal medicine in-training examination at every PGY level.”5 Although overall rates of internal medicine board certification are less in US-born international medical graduates (US-IMGs) than in non–US-IMGs and USMGs,6 no study has reported pass rates for first-time test takers in medicine or other disciplines. FIGURE NRMP Statistics Describing Percentage of IMGs Matching to All Residencies and Internal Medicine Residencies.

Where are They Now? USU School of Medicine Graduates After Their Military Obligation is Complete

The Uniformed Services University's (USU) F. Edward Hébert School of Medicine was chartered in 1972, with the goal of providing high-quality physicians for the Uniformed Services. In exchange for their education, USU graduates incur an active duty service obligation, after which they may choose to stay on active duty or transition to civilian practice. The purpose of this study is to describe the practice characteristics of USU graduates after this obligation has been completed in order to determine the societal benefits during this phase of their careers. To accomplish this purpose, we performed a retrospective cohort study of the first 20 years of USU graduates (1980-1999). We used the American Medical Association Physician Masterfile to determine the graduates' current practice location and characteristics, as well as their board certification status. Of these 2,760 graduates, nearly all (91%) were involved in active clinical practice in over 100 self-declared specialties, the vast majority (89%) practiced in locations other than the immediate vicinity of the medical school (i.e., Maryland and the District of Columbia), and most still worked for the federal government (71%). Finally, USU graduates in full-time clinical practice had a board certification rate of 93%, which was better than the average of all other graduates of U.S. Medical Schools (88%) in the same time period. Thus, it seems USU is attaining its goal of producing high-quality physicians who continue to benefit the nation after their service obligation has been completed, with many still in federal service.

Medical education accreditation in Mexico and the Philippines: impact on student outcomes

Accreditation of medical education programmes is becoming increasingly prevalent worldwide, but beyond the face validity of these quality assurance methods, data linking accreditation to improved student outcomes are limited. Mexico and the Philippines both have voluntary systems of medical education accreditation and large numbers of students who voluntarily take components of the United States Medical Licensing Examination (USMLE). We investigated the examination performance of Mexican and Philippine citizens who attended medical schools in their home countries by medical school accreditation status. The sample included 5045 individuals (1238 from Mexico, 3807 from the Philippines) who took at least one of the three USMLE components required for Educational Commission for Foreign Medical Graduates (ECFMG) certification. We also separately studied 2702 individuals who took all three examinations (589 from Mexico, 2113 from the Philippines). The chi-squared statistic was used to determine whether the associations between outcomes (first attempt pass rate on USMLE components and rate of ECFMG certification) and medical school accreditation (yes/no) were statistically significant. For the sample of registrants who took at least one USMLE component, first attempt pass rates on all USMLE components were higher for individuals attending accredited schools, although there were differences in pass rates among the components and between the two countries. The distinction was greatest for USMLE Step 1, for which attending an accredited school was associated with increases in first attempt pass rates of 15.9% for Mexican citizens and 29.2% for Philippine citizens. In registrants from the Philippines who took all three examinations, attending an accredited medical school was also associated with increased success in obtaining ECFMG certification. These findings support the value and usefulness of accreditation in Mexico and the Philippines by linking accreditation to improved student outcomes.

Mortality From Cancer and Other Causes in an Italian Cohort of Male Rubber Tire Workers

To investigate mortality among workers of an Italian rubber tire factory employed between 1954 and 2008. This cohort study included 6246 men, totaling 190,512 man-years of observation. Employment data were obtained from personnel records, whereas vital status and causes of death were ascertained from local authorities. We computed standardized mortality ratios (SMRs) using national and regional death certification rates. Mortality was significantly lower than expected for all cancers (SMR = 79) and all causes (SMR = 85). The SMRs were 99 for cancer of stomach, 78 for lung, 121 for urinary bladder, 116 for lymphoma, and 89 for leukemia, none being significant. Decreased mortality emerged for cancers of the oral cavity and pharynx (SMR = 45), esophagus (SMR = 29), colorectum (SMR = 71), liver (SMR = 57), and kidney (SMR = 33). This study shows no excess cancer risk among male rubber tire workers employed after 1954.

Geographical variation in certification rates of blindness and sight impairment in England, 2008–2009

ObjectivesTo examine and interpret the variation in the incidence of blindness and sight impairment in England by PCT, as reported by the Certificate of Vision Impairment (CVI).DesignAnalysis of national certification...

Pediatric Residents' Learning Styles and Temperaments and Their Relationships to Standardized Test Scores

Board certification is an important professional qualification and a prerequisite for credentialing, and the Accreditation Council for Graduate Medical Education (ACGME) assesses board certification rates as a component of residency program effectiveness. To date, research has shown that preresidency measures, including National Board of Medical Examiners scores, Alpha Omega Alpha Honor Medical Society membership, or medical school grades poorly predict postresidency board examination scores. However, learning styles and temperament have been identified as factors that 5 affect test-taking performance. The purpose of this study is to characterize the learning styles and temperaments of pediatric residents and to evaluate their relationships to yearly in-service and postresidency board examination scores. This cross-sectional study analyzed the learning styles and temperaments of current and past pediatric residents by administration of 3 validated tools: the Kolb Learning Style Inventory, the Keirsey Temperament Sorter, and the Felder-Silverman Learning Style test. These results were compared with known, normative, general and medical population data and evaluated for correlation to in-service examination and postresidency board examination scores. The predominant learning style for pediatric residents was converging 44% (33 of 75 residents) and the predominant temperament was guardian 61% (34 of 56 residents). The learning style and temperament distribution of the residents was significantly different from published population data (P = .002 and .04, respectively). Learning styles, with one exception, were found to be unrelated to standardized test scores. The predominant learning style and temperament of pediatric residents is significantly different than that of the populations of general and medical trainees. However, learning styles and temperament do not predict outcomes on standardized in-service and board examinations in pediatric residents.

Research on Hydrocarbon Emission Regularity of Passenger Car

To analyse and research the idle hydrocarbon emission regularity of passenger car gasoline engine, based on large sample detected data of different type cars, parameter estimation and hypothesis test are carried on by statistical tools and neans, and the optimum distribution parameters of idle hydrocarbon emission of different type engines are also got. Then the optimum distribution models of these engines are established. The calculating result shows that the maximum error between model calculating and sample detecting certification rates is only 0.526 8%, and the established models have very high calculating precision and practical value. On the other hand, the research also shows that the inspect and maintenance program should be strengthen in order to control vehicle emission pollution effectively.

등급판정 관련 특성이 장기요양 인정률에 미치는 영향

This study is to investigate the factors affecting the regional rate of certification for long-term care insurance benefits. Analyzed data were the 253,935 certified beneficiaries (equivalent to 4.9% of total elderly population) as long-term care degree (LTC degree) 1~3 extracted from the applicants for long-term care in the beginning stage of the system from April 15 2008 to July 1 2009. Although the data were collected from individuals, after restructured into regional data and then analysed in the unit of 225 administrative regions for the Korean Long-term Care Insurance. The rate of certification was operated as the percentage of people of LTC degree 1~3 to the elderly population in each region. The average rate of certification among regions was 4.91%, and ranged from 2.20% to 8.32%. In the analysing regression models, most socio-demographic variables, applicants` disease characteristics, regional service infrastructure, and the certification interviewer`s characteristics were included. The most influencing variables were the disease factors of applicants, especially dementia or cerebrovascular disease rather than arthritis, osteoporosis, or fracture patients were strong factors for the regional rate of certification. However, advanced studies adding more explainable factors on the regional variance of certification rate would be necessary to provide political agenda and measures for evidence-based certification process with high reliability and validity for a sustainable LTC system in Korea.

Apprenticeship in Canada: where’s the crisis?

Unique features of the 2006 census, as well as 33 employer interviews, provide an opportunity to test key assumptions in Canadian apprenticeship policy. Apprenticeship is widely understood to be a crucial contributor to the national skills supply, but also an institution critically vulnerable to market failures, mainly due to the insecurity of private contracts for training. The census data reveal a low overall incidence of apprenticeship certification among trades workers, revealing a trades labour market substantially dependent on uncertified labour. Strong inter-occupational differences in the certification rate make it unlikely that participation is impeded by a uniform set of contracting problems. At the firm level, the interviews reveal substantial diversity in employers’ training practices, levels of investment, and modes of engagement with the apprenticeship system. Consistent with recent literature in the political economy of skills, the present findings support a view of apprenticeship as an institution centred on collective action rather than private contract. They suggest that current Canadian apprenticeship policies offer indiscriminate subsidies with negligible and potentially negative effects on private skill formation.

Assessing Internet Health Information on Female Pelvic Floor Disorders

While health information on the Internet on female pelvic floor disorders is abundant, to our knowledge there has been no comprehensive evaluation of the quality of this material. We assessed health information on the Internet using Health on the Net Foundation principles as they pertain to female pelvic floor disorders. Web sites were searched using the key words urinary incontinence, vaginal, uterine or pelvic organ prolapse and overactive bladder. The first 150 websites identified for each female pelvic disorder were assessed for Health on the Net Foundation certification using an automated toolbar function. The specific sponsorship of each web site was also recorded. All searched domains for female pelvic floor disorders revealed that most websites were not certified. The certification rate for urinary incontinence, pelvic organ prolapse and overactive bladder was 29%, 27% and 27%, respectively. Overall websites were sponsored by for profit commercial entities (44%), urologist/specialty societies (30%), government/educational organizations (16%), nonprofit organizations (9%) and law firms (1%). Nonprofit organizations (40%) and government/educational organization (38%) sponsored websites were more likely to be certified than those sponsored by commercial entities (25%) and urologist/specialty societies (23%) (p=0.036). The Internet has become a heavily used resource for the distribution and acquisition of health information. Availability notwithstanding, certification and validation are lacking for most sites related to information on female pelvic floor disorders. As we move forward, improvement in the quality of information on the Internet is imperative along with proper guidance to patients using the Internet as a reference.