University-affiliated Programs Research Articles

Altering the career choice: Can we attract more women to vascular surgery?

Vascular surgery has relied upon the pool of general surgical residents for candidates for residency. This has significantly limited the pool of applicants. With the advent of new primary certificate training paradigms, we investigated factors that might alter the career choices for women medical students. A Web-based survey was conducted of third-year and fourth-year medical students at three university-affiliated programs. A total of 140 students completed the survey, which identified the third year of medical school as the primary year when students committed to a final career choice. Lifestyle issues were the primary deterrents, with long work hours and lack of time to see family negatively influencing students' interest in surgery. Eliminating the need for 5 years of general surgery and the opportunity for part-time training were cited as factors that would alter students' decisions to pursue vascular surgery. Ultimately, a positive rotation experience, lifestyle issues, and mentors impacted on final career decisions. To attract the best applicants to the field, we need to continue to be active in mentoring students and exploring alternative training paths and eventual career practices.

Inclusion in Early Childhood Services: Ongoing Challenges

Inclusion for children with disabilities is well-established in Australia and receives commonwealth and state government funding. The international literature describes potential service models for which there is mounting empirical evidence. Typically these models are developed in university affiliated programs, which have access to funding and personnel not generally available in the Australian context. This paper provides a brief report of a project in which the aim was to identify the challenges for early childhood services in NSW, including children with disabilities.

Faculty in the Middle

This study was designed to explore how organizational life in university-affiliated graduate social work education programs in the United States is affected by the stress of heightened caregiving roles. Analysis of data from 69 schools demonstrated deleterious effects of caregiving stress on organizational effectiveness, including missed obligations, feeling overwhelmed, and distracting others by seeking social support for specific problems. The authors identify two variables that provided partial amelioration of caregiver stress and appeared to contribute to increased organizational effectiveness: larger faculty size and on-site child care.

The prevention research initiative and the peer review process at CDC.

basic biomedical research. Yet, we fall behind many developed countries in life expectancy and other measures of health quality.1 Prevention research, one of the highest priorities of the Centers for Disease Control and Preven tion (CDC), is a multidisciplinary approach to discovering new ways to prolong the health, well-being, and self-sufficiency of all Americans. Prevention research focuses on preventing disease, injury, and disabil ity. Researchers work with communities to identify health needs; they determine, select, and implement effective strategies for disease preven tion and encourage healthy living. Results from prevention research will help communities discover the programs that work, how well they work, and at what cost. Americans are interested not only in protecting their own health status, but in learning how to promote and enhance the health of their families and communities. However, many questions that have been raised about the relationships among lifestyles, environment, and health remain unanswered because research emphasis has not been suffi cient to determine best practices in community preventive services.2,3 The Prevention Research Initiative (PRI), which began in FY99, pro vides CDC an expanding opportunity to maximize public health impact by leveraging research to address high-priority and crosscutting topics. Such topics include evaluation of community interventions that address multi ple health domains in communities; the impact of legislative, regulatory, and other policy changes on morbidity and mortality; methods to strengthen public health infrastructure and develop public-private part nerships for public health; and factors that facilitate or hinder adoption of effective prevention practices. The PRI is organized to complement exist ing public health research programs and to strengthen partnerships between the public health practice community and academia. In FY 1999, $12.5 million funded 50 research projects at academic health cen ters, research centers and university affiliated programs (in schools of public health, medicine, nursing, and engineering) across the country. The awards covered a range of subjects, from prevention of sexually trans mitted diseases and asthma to home, workplace, and recreational injuries.

Self-Advocacy Group Advisor Activities and Their Impact/Relation to Self-Advocacy Group Development

The purpose of this study was to identify self-advocacy group advisor activities, to examine advisor activities as they are linked to self-advocacy group development, and to examine how advisor activities change over time. A telephone survey was administered to 118 advisors randomly selected from a directory of self-advocacy groups (Longhurst, 1994). A total of 90 telephone surveys were completed representing a response rate of 76%. Major findings reveal a wide array of advisor activities, but perhaps most importantly, information on how advisors see their activities changing as the group changes. The results of this investigation provide important baseline information for individuals affiliated with the self-advocacy movement, university affiliated programs, developmental disability councils, and professionals in the field of intellectual impairment/developmental disabilities. The results can be used to help better meet the needs of advisors, self-advocacy group members, and to help readers to better understand how to support a self-advocacy group as it is evolving.

Freedom, Support, Authority, and Responsibility

The professional direction of the lives of individuals with developmental disabilities is giving way to self-determination. This values-based movement relies on philosophical, managerial, and personal commitment to inclusive policy making, independent support brokerage, and the shifting of resource control to individually managed budgets. The Robert Wood Johnson Foundation (RWJF) National Program in Self-Determination is facilitating change through the support of "learning community" grants to self-advocacy organizations, to Arc, and to others (e.g., University Affiliated Programs). Multiyear implementation grants have been made to 29 states, and a longitudinal evaluation is underway. Local implementation is demonstrating creativity in establishing new tools for self-directed management of resources, listening to people, and reinvesting in communities.

Joining University Affiliated Programs and Schools of Social Work

Schools of social work vary widely in their ability and commitment to prepare students for practice with individuals with disabilities. Given their teaching and training expertise and resources, University Affiliated Programs (UAPs) are uniquely positioned to partner with schools of social work to remedy this situation. This article describes a model of collaboration to develop and actively promote specialized curriculum and training opportunities in the field of mental retardation and developmental disabilities. The model builds on the “best practices” of existing collaborative efforts between UAPs and social work programs.

Physical diagnosis skills of physicians in training: a focused assessment.

To assess the proficiency of emergency medicine (EM) trainees in the recognition of physical findings pertinent to the care of the critically ill patient. Fourteen medical students, 63 internal medicine (IM) residents, and 47 EM residents from three university-affiliated programs in Philadelphia were tested. Proficiency in physical diagnosis was assessed by a multimedia questionnaire targeting findings useful in emergencies or related to diseases frequently encountered in the ED. Attitudes toward diagnosis not based on technology, teaching practices of physical examination during EM training, and self-motivated learning of physical diagnosis also were assessed for all the EM trainees. With the exception of ophthalmology, the EM trainees were never significantly better than the senior students or the IM residents. They were less proficient than the IM residents in cardiology, and not significantly different from the IM residents in all other areas. For no organ system tested, however, did they achieve less than a 42.9% error rate (range: 42.9-72.3%, median = 54.8%). There was no significant improvement in proficiency over the three years of customary EM training. The EM residents who had received supervised teaching in physical diagnosis during training achieved a significantly higher cumulative score. The EM residents attributed great clinical importance to physical diagnosis and wished for more time devoted to its teaching. These data confirm the recently reported deficiencies of physical diagnosis skills among physicians in training. The results are particularly disturbing because they relate to EM trainees and concern skills useful in the ED. Physical diagnosis should gain more attention in both medical schools and residency programs.

Bedside science reduces laboratory art. Appropriate use of physical findings to reduce reliance on sophisticated and expensive methods.

During recent decades, we have witnessed the steady downgrading of bedside cardiology as it is constantly being replaced by modern technology. Many, if not most, cardiological diagnoses could be made by use of patient history and the physical examination, supplemented by simple noninvasive procedures, such as the ECG and chest roentgenogram. Newer, increasingly complex techniques become indispensable only when the simpler methods fail or when physicians fail to use them appropriately owing to ignorance, lack of training, or atrophy of previously acquired skills. Access to more sophisticated technologies accelerates these trends in contemporary practice. Newer diagnostic technologies expanded our ability to define anatomic and physiological abnormalities. Our clinical acumen was first sharpened by the correlation between bedside cardiology and cardiac catheterization. Newer, noninvasive confirmatory techniques, such as nuclear medicine, ultrasonography, computed tomography, and magnetic resonance imaging should have further extended and honed our clinical capabilities. Yet these impressive opportunities ultimately weakened transmission and acquisition of physical diagnostic skills. In 300 randomized subjects autopsied in 1960, 1970, and 1980, Harvard investigators reported that 20 years of sonography, scintigraphy, and computed tomography had not reduced the frequency of misdiagnosis.1 A nationwide investigation of trainees in internal medicine and cardiology and third-year medical students demonstrated that the proficiency of bedside cardiac auscultation was seriously degraded.2 Programs with structured teaching in auscultation existed in only 27% of medicine and 37% of cardiology programs.3 Correct answers at the end of an academic year ranged from 0% to 56% for cardiology fellows (median, 21.9%) and from 2% to 36.8% for medical residents (median, 19.3%); these performances equalled those of the third-year medical students. In another survey, 124 internal medicine residents, 11 pulmonary fellows, and 63 medical students in six university-affiliated programs were never exposed to structured teaching of pulmonary auscultation. The auscultatory performance …

Work Hours of Residents in Seven Anesthesiology Training Programs

Medical educators and credentialing organizations recently have called attention to the long hours that some house staff are required to spend in the hospital during training. To determine the average duration of in-hospital work hours of anesthesiology residents, 148 residents at seven, university-affiliated training programs kept daily logs of their activities for one week. Residents in clinical anesthesia years 1, 2, and 3 spent an average of 66, 65, and 64 hours per week, respectively, in the hospital with a range of 43 to 104 hours per week. Although there was not a difference in in-hospital work time among years of training, there was a statistical difference between two of the seven programs studied. The largest portion of the in-hospital time was devoted to patient care activities in the operating room. Residents had time for educational activities, conferences, and reading while in the hospital. The overall work hours of the residents in the anesthesiology training programs included in this survey appeared to be within current guidelines.

Lecture Practices in United States Anesthesiology Residencies

We obtained data on lecture practices from 100 of the 110 university-affiliated anesthesiology residency programs certified in the United States in 1988. Of these residency programs, 36% had a majority of their lectures before the operating room schedule began, 57% had no lectures at all in this early time slot, and 78% had morning lectures at least once a week in conjunction with a delayed operating room start. Seventy-one percent of programs had one or more afternoon lectures each week. An attendance of more than 80% was reported in 66% of the programs for morning lectures and in 50% of the programs for afternoon lectures, which is a significant difference. Aggregate pass rates on the American Board of Anesthesiology written examinations in 1987 and 1988 correlated significantly with morning-lecture attendance, but not with afternoon-lecture attendance, number of lecture days per week, or mandatory lecture attendance. These findings suggest the need for further study and definition of the role of lectures in resident education in anesthesiology.

An in Vivo Evaluation of the Use of Data-Based Rules to Guide Instructional Decisions

A program evaluation of the benefits of utilizing systematic procedures for data review to make instructional decisions was conducted with teachers in two university-affiliated programs who had been using a standard method of data summary and evaluation with school-aged children and with adults for 1 to 2 years prior to our study. During a 6-month period, the teachers' ongoing decision making was evaluated through measures of decisions to change or continue instruction that were based on rules for various data patterns and the effect of these decisions on subsequent student progress. Some support was found for the benefit of rule following on student progress. Suggestions for designing research to further evaluate the benefits of systematic data-based decisions are described.

A survey of program evaluation in University affiliated programs

A survey of program evaluation in University affiliated programs

Public school satisfaction with interdisciplinary services.

Representatives from local, regional, and state educational agencies throughout the country were surveyed to determine their satisfaction with services provided by University Affiliated Programs (UAPs). Sixty-eight respondents from 26 states and the District of Columbia returned questionnaires indicating their assessment of UAP services. Overall results showed highly positive ratings regarding access to UAP services, interdisciplinary evaluations, comprehensiveness, and relevancy of written reports and in-service training activities.

Evaluation of pediatric residents and their training programs

Theoretic objectives in the evaluation of the training of pediatricians are presented, with an assessment of the extent to which the current procedures of the American Board of Pediatrics are able to measure the success of such training. An introspective analysis of the Board's written examination is detailed. The relative inability of Board procedures to measure a candidate's physical skills and professional attitudes is recognized. In order to aid in the evaluation of the quality of individual educational programs, the performances of candidates from university-affiliated programs and those from nonuniversity ones in the written examination from 1968 through 1970 have been analyzed. Although the number of programs in each category is about equal, about 75 per cent of the Board candidates are trained in university programs. The mean scores of these candidates are higher than those from nonuniversity programs. Reasons for these differences are discussed.