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"Humans"

Nutrition education among residents in training is at a critical juncture. There is a general lack of a unified curriculum, a lack of nutrition physician mentors, and a failure to properly train physicians about nutrition. In surveys, residents in training have acknowledged their minimal nutrition education. Published data and training experiences suggest the importance of creating physician mentors in nutrition who are embedded in residency training programs. The development of recurrent short-term nutrition credentialing courses and online nutrition tool kits is also thought to be important in future residency training. Copyright © 2010 American Society for Parenteral and Enteral Nutrition.

Objective: To determine if selecting rural background students into the Monash Bachelor of Medicine and Bachelor of Surgery (MBBS) program affects vocational training location and intended practice location after training. Design: Retrospective cohort mail survey. Setting: Australia. Participants: Rural-background students at Monash 1992-1994 (n = 24/40) and 1995-1999 (n = 59/120) and urban background students (n = 36/93 and 104/300, respectively). Overall study population: 62% female, average age of 28 years; 79% Australian-born; and 60% married/partnered.Interventions: Rural or urban background, rural undergraduate exposure. Main outcome measures: Intent towards rural medical practice, vocational training location and subsequent practice location. Results: There was a positive and significant (P ≤ 0.05) association between rural background and rural practice intent when respondents began (10-times higher than urban graduates) and completed (three times higher) their MBBS course. Rural practice intent increased fourfold in urban background graduates. There was a positive and significant association between rural background and preferred place of practice in 5-10 years in a Rural, Remote and Metropolitan Area (RRMA) 3-7 community (three times higher). There was a positive, but non-significant association between rural background and RRMA 3-7 community as their current location and first place of practice once vocationally qualified.Conclusions: Interest in rural practice is not fully reflected in location during or after vocational training. The beneficial effects of rural undergraduate exposure might be lost if internship and vocational training programs provide insufficient rural clinical experiences and curriculum content. Continuation of the rural pathway might be needed to maintain rural practice intent. © 2010 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

Background: Surgical trainees' operating theatre (OT) experiences significantly influence their ability to attain key professional competencies. A measure of trainees' satisfaction with this learning environment would allow recognition of characteristics of highly successful teaching venues and threats to trainee development. Our study aimed to validate the Surgical Theatre Educational Environment Measure (STEEM) and use it to explore Australasian surgical trainees' satisfaction with OT learning.Methods: In a cross-sectional study, the STEEM was distributed electronically to all 1500 Royal Australasian College of Surgeons trainees in Australia and New Zealand. Trainee satisfaction was gauged using Likert-type items, an overall satisfaction measure and content analysis of free-text comments. The STEEM's psychometric properties were evaluated using exploratory factor analysis.Results: Three hundred fifty-six responses were received. The STEEM's original subscales were not supported by the data; empirically grounded subscales were identified for further analysis. Most trainees were satisfied with their OT environment and satisfaction was higher in senior than junior trainees. Trainees' relationship with their supervisor correlated most strongly with overall satisfaction. Less positively, only half of trainees report discussing their operative role with their supervisor prior to surgery.Conclusions: The a priori STEEM subscales could not be replicated by factor analysis. We developed an empirically grounded instrument capable of identifying areas of trainee concern. The majority of trainees reported high levels of satisfaction. The revised instrument has potential to complement other sources of information to facilitate surgical supervisors' difficult task of optimizing trainees' compatibility with their OT learning environments. © 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.

In a world undergoing constant change, in the era of globalisation, the training of medical professionals should be under constant review so that it can be tailored to meet the needs of this society in transition. This is all the more true at times of economic uncertainty, such as the current conditions, which have a direct impact on health services. Professionals need new Competencies for new times. Over the last decade initiatives have emerged in various Anglo-Saxon countries which have defined a framework of basic Competencies that all medical specialists should demonstrate in their professional practice. In addition to this, we must respond to the creation of the European Higher Education Area which has implications for specialised training. In Spain, training for medical specialists was in need of an overhaul and the recently passed law (Real Decreto 183/2008) will allow us to move forward and implement, in medical education, initiatives and innovations required in our medical centres, to respond to the new society and bring us in line with international professional education and practice. The way forward is a Competency-based model for medical education with assessment of these Competencies using simple instruments, validated and accepted by all the stakeholders. The institutions involved (hospitals, medical centres and other health care services) should trial different approaches within the general framework established by the current legislation and be conscious of the duty they have to society as accredited training organisations. Accordingly, they should consolidate their teaching and learning structures and the various different educational roles (Director of Studies, Tutors, and other teaching positions), showing the leadership necessary to allow proper implementation of their training programmes. For this, the Spanish Autonomous Regions must develop their own legislation regulating Medical Specialty Training. So, medical professionals should receive training, based on ethical values, behaviours and attitudes that considers humanistic, scientific and technical factors, developing an understanding of the scientific method and ability to put it into practice; skills to manage complexity and uncertainty; a command of scientific, technical and IT terminology, to facilitate independent learning; and a capacity for initiative and teamwork, as well as skills for personal activities and for making an effective, democratic contribution both within health organisations and in the wider society. © 2010 Revista Nefrología.

The humanities offer great potential for enhancing professional and humanistic development in medical education. Yet, although many students report benefit from exposure to the humanities in their medical education, they also offer consistent complaints and skepticism. The authors offer a pedagogical definition of the medical humanities, linking it to medicine as a practice profession. They then explore three student critiques of medical humanities curricula: (1) the content critique, examining issues of perceived relevance and intellectual bait-and-switch, (2) the teaching critique, which examines instructor trustworthiness and perceived personal intrusiveness, and (3) the structural/placement critique, or how and when medical humanities appear in the curriculum. Next, ways are suggested to tailor medical humanities to better acknowledge and reframe the needs of medical students. These include ongoing cross-disciplinary reflective practices in which intellectual tools of the humanities are incorporated into educational activities to help students examine and, at times, contest the process, values, and goals of medical practice. This systematic, pervasive reflection will organically lead to meaningful contributions from the medical humanities in three specific areas of great interest to medical educators: professionalism, "narrativity," and educational competencies. Regarding pedagogy, the implications of this approach are an integrated required curriculum and innovative concepts such as "applied humanities scholars." In turn, systematic integration of humanities perspectives and ways of thinking into clinical training will usefully expand the range of metaphors and narratives available to reflect on medical practice and offer possibilities for deepening and strengthening professional education. © 2009 Association of American Medical Colleges.

The pharmaceutical consultation offered to liver transplant patients is one of the components of therapeutic education. The content of this consultation has been designed on the basis of research results led in the field of health communication. This research has highlighted the need to clarify to the patient the aims and format of the consultation, to obtain patient approval, and to elicit patient participation in the elaboration of the treatment plan. Studying and taking into account patient representations of transplantation, of transplant treatment and rejection is indispensable to the design of an efficient communication plan. Setting up this consultation requires initial training or continuing vocational training of the pharmacist - this training will address issues in psychology, cognitive science and health communication. No such training is currently available in universities and needs to be set up. It should be followed by practice and training during internships in hospitals and community pharmacies. © 2008 Elsevier Masson SAS. All rights reserved.

Those who educate medical students and physicians work in a world suffused with the concept of competency. This article examines the intellectual origins and hidden assumptions of this concept and argues that it is an inadequate, and even harmful, concept to use as a guiding motif for professional education. The competency model-which tends to be top-down and prescriptive-does not provide the framework for objective educational assessment that it claims to provide. The alternative apprenticeship model is more appropriate for professional education and is more consistent with what psychological research has shown about the acquisition of expertise. © 2009 by The Johns Hopkins University Press.

Although there is evidence to support implementing interprofessional education (IPE) in the health sciences, widespread implementation in health professions education is not yet a reality. Challenges include the diversity in location and settings of schools and colleges, ie, many are not located within an academic health center. Faculty members may not have the necessary skill set for teaching in an IPE environment. Certain topics or themes in a pharmacy curriculum may be more appropriate than others for teaching in an IPE setting. This paper offers solutions to teaching IPE in diverse settings, the construct for implementing a faculty development program for IPE, and suggested curricular topics with their associated learning objectives, potential teaching methods, and timelines for implementation.

David Stern argues that some basic features of the American high school must be modified if it is to serve all students successfully. He notes, for example, that only three-quarters of U.S. high school students graduate four years after beginning ninth grade and that the National Assessment of Educational Progress found no improvement in reading or mathematics for seventeen-year-olds between 1971 and 2004. The nation's system for educating teenagers, says Stern, seems to be stuck, despite the constant efforts of teachers and repeated waves of reform.Citing two widely accepted public purposes of educating teenagers-preparation for civic participation and for economic self-sufficiency-Stern proposes four new strategies to achieve those goals. He draws on empirical evidence suggesting that these are promising directions for research and policy, but acknowledges that existing studies provide only limited guidance. First, he says, schools should continue the current trend toward integrating educational options to provide young people with skills and experiences that pave the way to both college and careers. Second, states and districts should tie education funding not simply to the number of students attending school, but also to what young people learn, whether they graduate, and whether they find jobs or enroll in postsecondary education. Such a move, he argues, would encourage teaching and learning formats that use students' time more effectively. Third, more adults in addition to classroom teachers should be involved in educating teenagers. Other adults acting as academic advisers, learning coaches, student advocates, internship supervisors, mentors, and college counselors could help guide the education of teenagers inside and outside of school and provide some relief for the chronic shortage of teachers. Fourth, schools should expand the options for educating teenagers outside of geographically fixed schools. Combining improved Internet-based curriculum with internships and civic engagement projects, for example, may produce better results for many young people and also may promote academic achievement for teenagers who do not thrive in conventional classrooms and for those who face academic and social challenges when they move from one place to another. Stern argues that the limited success of today's high schools makes such new initiatives well worth trying and evaluating.

INTRODUCTION: Australian medical education is increasingly influenced by rural workforce policy. Therefore, understanding the influences on medical graduates' practice location and specialty choice is crucial for medical educators and medical workforce planners. The South Australian Flinders University Parallel Rural Community Curriculum (PRCC) was funded by the Australian Government to help address the rural doctor workforce shortage. The PRCC was the first community based medical education program in Australia to teach a full academic year of medicine in South Australian rural general practices. The aim of this research was to identify what factors influence the career choices of PRCC graduates. METHODS: A retrospective survey of all contactable graduates of the PRCC was undertaken. Quantitative data were analysed using SPSS 14.0 for Windows. Qualitative data were entered into NVIVO 7 software for coding, and analysed using content analysis. RESULTS: Usable data were collected from 46 of the 86 contactable graduates (53%). More than half of the respondents (54%) reported being on a rural career path. A significant relationship exists between being on a rural career pathway and making the decision prior to or during medical school (p = 0.027), and between graduates in vocational training who are on an urban career path and making a decision on career specialty after graduation from medical school (p = .004). Graduates in a general practice vocational training program are more likely to be on a rural career pathway than graduates in a specialty other than general practice (p = .003). A key influence on graduates' practice location is geographic location prior to entering medical school. Key influences on graduates choosing a rural career pathway are: having a spouse/partner with a rural background; clinical teachers and mentors; the extended rural based undergraduate learning experience; and a specialty preference for general practice. A lack of rural based internships and specialist training places is influencing both urban- and rural-origin graduates to practise in urban locations. Further analysis of graduates' career pathway choices (rural or urban) and geographic background (rural or urban) was conducted. This resulted in the development of a new model, 'The Four Qs Model'. This model consists of four quadrants derived from the variables career pathway choice (rural or urban) and geographic background (rural or urban). Clustering of consistent demographic and qualitative trends unique to each quadrant was demonstrated. The distinctive clustering that emerged from the data resulted in the quadrants being renamed 'The True Believers', 'The Convertibles' 'The Frustrated' and 'The Metro Docs'. CONCLUSIONS: The PRCC is influencing graduates to choose a rural career path. The PRCC program affirms the career preferences of rural origin students while graduates with little rural exposure prior to the PRCC report being positively influenced to pursue a rural career path. The Four Qs Model is a useful model in that it demonstrates consistent themes in the characteristics of PRCC graduates and assists understanding of why they choose a rural medical career. This could be relevant to the selection of medical students into rural medical education programs and in the construction of rural curricula. The model also offers a useful framework for further research in this field.