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An interview with psychiatrist and author Ronald W. Pies, MD is presented in 2023. When asked on the current status in realizing psychiatry as a humanistic science, he observes that translational psychiatry is not yet fully achieved. Pies states that U.S. psychiatric care is marked by poor integration with dual diagnosis, and that homeless individuals have comorbid psychiatric/substance abuse disorders. He notes that psychiatrists need to be diversified and pluralistic in their work approach.

Aims: To determine the effect of adding structured simulation to a traditional classroom lecture format on students' knowledge acquisition and their evaluation of faculty teaching effectiveness, compared to traditional classroom lectures alone. Background: There is a critical lack of high‐quality clinical placements/experiences in nursing education, particularly in clinical specialty populations, such as paediatrics. Simulation has been shown to help students practice in a safe environment. However, less is known about the outcomes of embedding simulation in didactic class sessions or classroom lectures. Additionally, data on the impact of simulation as a teaching pedagogy on faculty teaching effectiveness is limited. Design: Post‐test, nonequivalent control group quasi‐experimental study. Methods: Students in two prelicensure nursing programs participated in a 10‐week term paediatric nursing course taught by the same faculty member on two different campuses. The students at one campus, designated as the control group (n = 43), received four hours of traditional, lecture‐only, instructions. The group at a second campus, the intervention group (n = 44), received the same lectures with added structured simulations. Students' knowledge acquisition and their evaluation of faculty teaching effectiveness were measured in both groups using the same standardised assessment measures. The CONSORT checklist was followed. Results: Students' knowledge acquisition scores and their evaluation scores of faculty teaching effectiveness were significantly higher in the intervention (simulation) group compared to the control group. A significantly higher number of students in the simulation group scored above the national average Nursing Care of Children score as compared to students in the control group. Conclusions: Integrating simulation with didactic instruction enhanced students' knowledge acquisition and improved their opinion of faculty teaching effectiveness. Relevance to clinical practice: Augmenting lecture with simulation may provide students with learning experiences that they may not have during clinical rotation due to a lack of paediatric clinical placement sites and differences between sites. [ABSTRACT FROM AUTHOR]

Objective: We explored the impact of TeKnO T1D, an online, case‐based, spaced education curriculum about insulin pump and continuous glucose monitor (CGM) use in pediatric type 1 diabetes management. Methods: Pediatric endocrinology fellows (n = 64) were randomized to receive an educational curriculum focused on either insulin pumps or CGMs. Fellows received interactive questions twice weekly via email or mobile app. Median time to completion was 76.5 days. The primary outcome was change in knowledge as measured by performance on multiple‐choice questions (MCQ) from the pre‐test to the post‐test. Results: Forty‐eight of 64 (75%) learners completed the curriculum and assessments. The pump group improved from 35.0 ± 15% on the pre‐test MCQs to 61.1 ± 17% on the post‐test, a 12.2 absolute percentage point greater improvement on pump‐specific items than the CGM group (P =.03). The CGM group improved from 30.3 ± 15% on the pre‐test MCQs to 61.4 ± 21% on the post‐test, a 28.7 absolute percentage point greater improvement on CGM‐specific items than the pump group (P <.001). Both groups were more likely to report an appropriate level of understanding of their respective technologies after completing the corresponding curriculum. In thematic analysis of qualitative data, fellows indicated that knowledge gains led to improved patient care. There was universal agreement about enjoyment and effectiveness of the curricula. Conclusions: TeKnO T1D proved to be an engaging, effective way to improve endocrinology fellows' knowledge and confidence about insulin pumps and CGM use in the management of pediatric type 1 diabetes. [ABSTRACT FROM AUTHOR]

Purpose To describe the development of a collaborative community–academic postgraduate year 1 pharmacy residency program in San Diego that provides a hybrid experience of opportunities in community practice, ambulatory care, and teaching. Summary Residency training programs are being developed to better match the evolving role of the community pharmacist. In 2016, the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences partnered with Ralphs Pharmacy, a division of the Kroger Co. to launch a 1-year community residency to develop community-based pharmacists with diverse patient care, leadership, and education skills. Learning experiences include pharmacy operations, clinical services focusing on chronic disease management and education, teaching, and practice-based research. Training settings include community pharmacy, corporate pharmacy, ambulatory care, and academia. Graduates are prepared to work in these settings as well as capitalize on advanced training opportunities, including postgraduate year 2 residencies and professional certifications. The program has been successfully accredited, and graduates have completed the program: one completed a postgraduate year 2 residency, and both have obtained a management or clinical pharmacist position. Conclusion An innovative community—academic residency program preparing postgraduate year 1 learners for careers in community-based pharmacy, corporate, ambulatory care, and academic settings was developed, with positive preliminary outcomes. [ABSTRACT FROM AUTHOR]

Balancing resident education with operating room (OR) efficiency, while accommodating different styles of surgical educators and learners, is a challenging task. We sought to evaluate variability in operative time for breast surgery cases. Accreditation Council for Graduate Medical Education case logs of breast operations from 2011 to 2017 for current surgical residents at Loma Linda University were correlated with patient records. The main outcome measure was operative time. Breast cases were assessed as these operations are performed during all postgraduate years (PGY). Breast procedures were grouped according to similarity. Variables analyzed included attending surgeon, PGY level, procedure type, month of operation, and American Society of Anesthesiologists class. Of 606 breast cases reviewed, median overall operative time was 150 minutes (interquartile range 187-927). One-way analysis of covariance demonstrated statistically significant variation in operative time by attending surgeon controlling for covariates (PGY level, procedure, American Society of Anesthesiologists class, and month) (P = 0.04). With institutional OR costs of $30 per minute, the average difference between slowest and fastest surgeon was $2400 per case [(218-138) minutes × $30/min]. Minimizing variability for common procedures performed by surgical educators may enhance OR efficiency. However, the impact of case length on surgical resident training requires careful consideration. [ABSTRACT FROM AUTHOR]

Surgical trainees are expected to demonstrate family-centered care. However, it is unclear if residents know how to address psychosocial issues of pediatric patients and their families. Our aim was to evaluate surgical trainees' knowledge of family dynamics. Over a six-month period, trainees (n = 16) were surveyed regarding their comfort and familiarity with the psychosocial aspects of patient care and family dynamics. Residents recorded their comfort level with managing various behaviors using a Likert scale, and indicated which family issues they felt least prepared to handle. Most trainees lacked knowledge of family adjustment phases (50%), relational triangles (78%), developmental stages of families (40%), ambiguous loss (75%), ABCX model of family stress (100%), and the SPIKES model (88%). Excluding anxiety and sadness, almost half of residents felt unprepared for dealing with a variety of challenging behaviors. Finally, trainees were least comfortable with breaking bad news. A Family Dynamics curriculum could potentially increase resident management skills and improve patient care. [ABSTRACT FROM AUTHOR]

Objectives: To describe the process and cost of establishing clinical pharmacy services with prescribing privileges in a federally qualified health center (FQHC) primary care clinic. Setting: The primary care clinic was located in a low-income area of Southern California and served patients with Medicaid and Medicare. The primary care clinic had preventive medicine and family medicine physicians, a family medicine residency program, behavioral health services, and a registered dietician. Practice Innovation: New clinical pharmacy services were established at this FQHC primary care clinic. The medication assistance program was a stepping stone to establish rapport with the physicians. Credentialing and privileging was implemented for clinical pharmacists. An open protocol collaborative practice agreement was developed to allow clinical pharmacists to manage ambulatory patients. Results: From August 2014 to June 2015, the clinical pharmacist interacted with 392 patients and spent 336 hours educating patients and providing disease state management. The pharmacist also provided consults to residents and providers. Diabetic patients made up 76% of all clinical pharmacy encounters. There were 86 face-to-face clinical pharmacy appointments with the pharmacist. The average time for clinical pharmacy appointments was 77 minutes. Conclusion: By describing ways to develop rapport with providers, how to credential and privilege pharmacists, and explain resources and costs of setting up a service, the hope is that more clinical pharmacists will be able to incorporate into independent or FQHC primary care clinics for improved management of ambulatory patients. [ABSTRACT FROM AUTHOR]

Single-site robotic cholecystectomy (SSRC) accounts for most of the robotic surgery cases performed by general surgeons at our institution since acquiring the da Vinci Si Surgical SystemTM (Intuitive Surgical, Inc., Sunnyvale, CA) in 2014. We sought to determine whether a SSRC program is safe to start in a public teaching hospital and to determine whether resident participation in this procedure is feasible. Data on age, gender, race, BMI, total operative time, length of stay, comorbidities, and conversion from laparoscopic to open surgery were examined for elective SSRC and laparoscopic cholecystectomies (LCs) performed by two faculty surgeons between February 2015 and August 2015. Thirty-eight patients underwent elective SSRC, whereas 27 patients underwent LC. Residents participated as operating surgeons for some portion of the case in 15 SSRC cases and in all LC cases. There were no significant differences in operative time, length of stay, or 30-day readmission rates, regardless of resident involvement. Patients in the SSRC group had a significantly lower BMI (25.8 vs 33.7, P = 0.008). This study suggests that resident participation does not increase complications or total operative time and that SSRC is a safe procedure to start in a public teaching hospital after proper faculty and resident training. [ABSTRACT FROM AUTHOR]

A call to implement 21st-century change drivers within teacher preparation is evidenced within policy and research. The use of technology-enhanced methods of supervision where virtual observations of pre-service or in-service teachers are performed by university supervisors or mentors has an established and growing research base that demonstrates improvements in pre- and in-service teacher competencies, as well as programmatic benefits, such as time and cost savings and the ability to supervise remotely. To answer this call, the researcher investigated the strategic implementation of an asynchronous video-based remote supervision model within a university-based teacher preparation program from the perspective of education specialist teacher candidates and their cooperating teachers. Results suggest a video-based remote supervision method is feasible and equally effective or preferred over traditional face-to-face observations by teacher candidates and cooperating teachers for self-reflection, professional growth, and convenience. Time and cost savings resulting from reduced travel for the supervisor are analyzed and discussed. The model and methods presented in this study may be replicated to enable strategic scaling of video-based remote supervision within other teacher preparation programs, particularly those serving candidates in remote or rural areas. [ABSTRACT FROM AUTHOR]

Quality Issue: Implementing quality improvement (QI) education during clinical training is challenging due to time constraints and inadequate faculty development in these areas.Initial Assessment: Quiz-based reinforcement systems show promise in fostering active engagement, collaboration, healthy competition and real-time formative feedback, although further research on their effectiveness is required.Choice Of Solution: An online quiz-based reinforcement system to increase resident and faculty knowledge in QI, patient safety and care transitions.Implementation: Experts in QI and educational assessment at the 5 University of California medical campuses developed a course comprised of 3 quizzes on Introduction to QI, Patient Safety and Care Transitions. Each quiz contained 20 questions and utilized an online educational quiz-based reinforcement system that leveraged spaced learning.Evaluation: Approximately 500 learners completed the course (completion rate 66-86%). Knowledge acquisition scores for all quizzes increased after completion: Introduction to QI (35-73%), Patient Safety (58-95%), and Care Transitions (66-90%). Learners reported that the quiz-based system was an effective teaching modality and preferred this type of education to classroom-based lectures. Suggestions for improvement included reducing frequency of presentation of questions and utilizing more questions that test learners on application of knowledge instead of knowledge acquisition.Lessons Learned: A multi-campus online quiz-based reinforcement system to train residents in QI, patient safety and care transitions was feasible, acceptable, and increased knowledge. The course may be best utilized to supplement classroom-based and experiential curricula, along with increased attention to optimizing frequency of presentation of questions and enhancing application skills. [ABSTRACT FROM AUTHOR]

Having an oncology specific nurse residency program is crucial to supporting new nurses transition ing to practice. In 2015 staff nurses noticed a need for additional education and encouragement and development of emotional resiliency of new graduate oncology nurses. Nursing Professional Development created a 6month program to meet this need. The program was redesigned in 2018 to incorporate the Vizient transition to practice model. After initiation the program leadership recognized a need for more oncology specific topics and adapted the program to address these shortcomings. In 2021 the program was accredited with distinction as a practice transition program by the ANCC. The purpose of this project was to develop and provide expanded knowledge of the oncology nursing practice to support oncology nurses as they transition to practice. All new hired nurses with less than 1 year of experience are enrolled in the program. They are required to meet monthly in four-hour increments for 12 months. Topics include oncologic emergencies, ethics, end-of-life care, symptom management, disease specific topics, self-care and resiliency, delegation, and prioritization, and are required to submit an evidence-based practice project at graduation. The residency program has demonstrated improvements in nursing satisfaction, nursing retention, and eased the transition to practice for new nurses. Based on resident monthly evaluations the program leadership recognized a need for redesign to incorporate more oncology topics and develop part of the program to include resiliency as the compassion fatigue was becoming increasingly evident. Feedback from previous and current resident cohorts, including oncology specific education into their transition to practice program has increased emotional resiliency and elevated their comfort in caring for this specialized scope of nursing. This program is specialized to meet the needs of new graduate oncology nurses and stands out from other transition to practice programs. The support and education continue to grow and develop monthly in line with evidence-based practice and nursing oncology research. [ABSTRACT FROM AUTHOR]

With the future of healthcare shifting to the ambulatory setting, ensuring new graduate nurses are thoroughly prepared is essential. Most students are advised to begin their nursing career on an inpatient unit where any needed resource is easily available. Ambulatory nursing is a key aspect of healthcare where the nurse must be autonomous, have good judgement, and trust their clinical knowledge/skills. Providing an opportunity for graduating undergraduate students to be immersed in an ambulatory setting assists in determining where the new graduate may prefer to work. In 2019 two advanced practice nurses, in a DNP program, developed an Ambulatory Care Clinical Immersion Course as their project to be implemented at our NCI-Designated, comprehensive cancer center. Oncology nursing leadership was tasked, in partnership with the college of nursing, to ensure this program continued on each semester within the infusion nursing units. To initiate and sustain an ambulatory care clinical immersion program for nursing students in their final semester on an oncology infusion unit. Nursing students were provided the opportunity to apply for this immersion program during their Ambulatory Care course. Once selected, these students were paired up with a preceptor who had attended a preceptor education course. Before starting the two week program, the students were provided with relevant policies and procedures within the organization. The students shadowed their preceptor during all aspects of patient care and were able to see the process of a patient undergoing chemotherapy in the ambulatory setting. To date we have had 13 students go through the immersion program. Unfortunately, due to Covid-19 while the course still continued, we did not have students for the immersion piece in the spring of 2020; the program picked back up again fall 2020. Three students were hired, as new graduate nurses, within our organization. Currently, only experienced nurses are hired into the ambulatory infusion center. Hiring new graduate nurses would be a culture change for all involved and additional support will be needed, not only for these new graduate nurses but also for their preceptors. The nurse residency program, currently in place at our organization, is required for all new graduate nurses. Adding an ambulatory oncology focus to the nurse residency program will ensure these new graduate nurses succeed in the ambulatory setting. [ABSTRACT FROM AUTHOR]

Background: Each application cycle, emergency medicine (EM) residency programs attempt to predict which applicants will be most successful in residency and rank them accordingly on their program's Rank Order List (ROL).Objective: Determine if ROL position, participation in a medical student rotation at their respective program, or United States Medical Licensing Examination (USMLE) Step 1 rank within a class is predictive of residency performance.Methods: All full-time EM faculty at Los Angeles County + University of Southern California (LAC + USC), Harbor-UCLA (Harbor), Alameda Health System-Highland (Highland), and the University of California-Irvine (UCI) ranked each resident in the classes of 2013 and 2014 at time of graduation. From these anonymous surveys, a graduation ROL was created, and using Spearman's rho, was compared with the program's adjusted ROL, USMLE Step 1 rank, and whether the resident participated in a medical student rotation.Results: A total of 93 residents were evaluated. Graduation ROL position did not correlate with adjusted ROL position (Rho = 0.14, p = 0.19) or USMLE Step 1 rank (Rho = 0.15, p = 0.14). Interestingly, among the subgroup of residents who rotated as medical students, adjusted ROL position demonstrated significant correlation with final ranking on graduation ROL (Rho = 0.31, p = 0.03).Conclusions: USMLE Step 1 score rank and adjusted ROL position did not predict resident performance at time of graduation. However, adjusted ROL position was predictive of future residency success in the subgroup of residents who had completed a sub-internship at their respective programs. These findings should guide the future selection of EM residents. [ABSTRACT FROM AUTHOR]

The American Society of Colon and Rectal Surgeons rectal cancer checklist describes a set of best practices for rectal cancer surgery. The objective of this study was to assess the quality of operative reports for rectal cancer surgery based on the intraoperative American Society of Colon and Rectal Surgeons checklist items. Patients undergoing rectal cancer surgery at two public teaching hospitals from 2009 to 2015 were included. A total of 12 intraoperative checklist items were assessed. One hundred and fifty-eight operative reports were reviewed. Overall adherence to checklist items was 55 per cent, and was significantly higher in attending versus resident dictated reports (67% vs 51%, P < 0.01). Senior residents had significantly higher adherence to checklist items than junior residents (55% vs 44%, P < 0.01). However, overall adherence to rectal cancer checklist items was low. This represents an opportunity to improve the quality of operative documentation in rectal cancer surgery, which could also impact the technical quality of the operation itself. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition that physician wellness is critical; it not only benefits the provider, but also influences quality and patient care outcomes. Despite this, resident physicians suffer from a high rate of burnout and personal distress. Individuals with higher emotional intelligence (EI) are thought to perceive, process, and regulate emotions more effectively, which can lead to enhanced well-being and less emotional disturbance. This study sought to understand the relationship between EI and wellness among surgical residents.Study Design: Residents in a single general surgery residency program were surveyed on a voluntary basis. Emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire-Short Form. Resident wellness was assessed with the Dupuy Psychological General Well-Being Index, Maslach Burnout Inventory, and Beck Depression Inventory-Short Form. Emotional intelligence and wellness parameters were correlated using Pearson coefficients. Multivariate analysis was performed to identify factors predictive of well-being.Results: Seventy-three residents participated in the survey (response rate 63%). Emotional intelligence scores correlated positively with psychological well-being (r = 0.74; p < 0.001) and inversely with depression (r = -0.69, p < 0.001) and 2 burnout parameters, emotional exhaustion (r = -0.69; p < 0.001) and depersonalization (r = -0.59; p < 0.001). In regression analyses controlling for demographic factors such as sex, age, and relationship status, EI was strongly predictive of well-being (β = 0.76; p < 0.001), emotional exhaustion (β = -0.63; p < 0.001), depersonalization (β = -0.48; p = 0.002), and depression (β = -0.60; p < 0.001).Conclusions: Emotional intelligence is a strong predictor of resident well-being. Prospectively measuring EI can identify those who are most likely to thrive in surgical residency. Interventions to increase EI can be effective at optimizing the wellness of residents. [ABSTRACT FROM AUTHOR]

The article focuses on a study regarding medical education recommend creating for individualized learning pathways during medical training, so that learners can experience professional roles beyond patient care. It mentions the Primary Care Medicine Education (PRIME) research pathway for internal medicine residents at the University of California San Francisco (UCSF). It also mentions that clinical skills supports career development within medicine residency programs.

Creating new norms is essential for success as acute care leaders seek to redesign care delivery. Through the structures of the registered nurse (RN) residency and utilizing a quality improvement process, new graduate RNs demonstrated success in creating a centralized float pool resource. [ABSTRACT FROM AUTHOR]

Advances in endovascular surgery have resulted in a decline in major open arterial reconstructions nationwide. Our objective is to investigate the effect of endovascular surgery on general surgery resident experience with open vascular surgery. Between 2004 and 2014, 112 residents graduated from two academic institutions in Southern California. Residents were separated into those who graduated in 2004 to 2008 (period 1) and in 2009 to 2014 (period 2). Case volumes of vascular procedures were compared using two-sample t test. A total of 43 residents were in period 1 and 59 residents were in period 2. In aggregate, there was no significant difference in open cases recorded between the two periods (84 vs 87, P = 0.194). Subgroup analysis showed period 2 recorded significantly fewer cases of open aneurysm repair (5 vs 3, P < 0.001), cerebrovascular (14 vs 10, P = 0.007), and peripheral obstructive procedures (16 vs 13, P = 0.017). Dialysis access procedures constituted the largest group of procedures and remained similar between the two periods (35 vs 42, P = 0.582). General surgery residents experienced a significant decline in several index open major arterial reconstruction cases. This decline was offset by maintenance of dialysis access procedures. If the trend continues, future general surgeons will not be proficient in open vascular procedures. [ABSTRACT FROM AUTHOR]

Little has been written addressing ethical considerations in the training of custody evaluators and mediators. This article summarizes the ethical principles involved in training new evaluators and in providing ongoing training to experienced evaluators. Model programs for both types of training are presented. [ABSTRACT FROM AUTHOR]

Objectives Given the calls for earlier student engagement in clinical experiences, educators are challenged to define roles for pre-clerkship students that enable legitimate participation in clinical practice. This study aimed to determine the student roles and activities, as well as the clinic characteristics, that allow early student engagement within a specific clinical experience. Methods The authors conducted semi-structured interviews in December 2011 and January 2012 with a purposive sample of medical student and faculty volunteers at student-run clinics ( SRCs). They were asked to discuss and compare student roles in SRCs with those in the core curriculum. An inductive approach and iterative process were used to analyse the interview transcripts. Themes identified from initial open coding were organised using the sensitising concepts of workplace learning and communities of practice and subsequently applied to code all transcripts. Results A total of 22 medical students and four faculty advisors were interviewed. Thematic analysis revealed pre-clerkship student roles in direct patient care (patient triage, history and physical examinations, patient education, laboratory and immunisation procedures) and in clinic management (patient follow-up, staff management, quality improvement). Students took ownership of patients and occupied central roles in the function of the clinic, with faculty staff serving as peripheral resources. Clinic-related features supporting this degree of legitimate participation included defined scopes of practice, limited presenting illnesses, focused student training, and clear protocols and operations manuals. Conclusions Pre-clerkship students are capable of legitimately participating in patient care experiences to an extent not usually available to them. The SRC represents one example of how early clinical experiences in the core curriculum might be transformed through the provision of patient care activities of narrow scope. [ABSTRACT FROM AUTHOR]

Background: The logistical necessity of students taking required clinical clerkship rotations in non-uniform sequences may have significant consequences on performance. Aims: To investigate (1) the impact of previous clinical clerkship experience and the national licensing examination (USMLE Step 1) rankings on end-of-clerkship overall skills assessments and (2) the effect of clinical clerkship order on end-of-year objective structured clinical examination (OSCE) performance. Method: The core clinical phase of UCLA consists at six clinical clerkships during a 48-week continuum. The clerkships are structured in two different tracks with different rotation order. Clinical performance scores were analyzed for 124 year-3 students in the two different tracks. Results: Performance, as reviewed on a standardized clinical clerkship evaluation form by faculty and residents, improved significantly across the clinical year, regardless of track suggesting an accumulated advantage of previous experiences. There were no significant differences between tracks on the OSCE. Conclusions: Overall clinical skills are more directly impacted by the time-of-year and not order whereas knowledge of specific specialties may be impacted by the order rotations that are taken. While this may not be obvious to students, perhaps we should share these results for their use in tracking their personal growth in clinical skills. [ABSTRACT FROM AUTHOR]

California has actively engaged in the Hartford Geriatric Social Work Initiative. Subsequently, the California Social Work Education Center Aging Initiative conducted a university survey of gerontology education in California graduate social work schools (N = 17). In 2005, students taking aging courses were 12% in comparison to a national report of 7% by the Council on Social Work Education and an earlier 1993 national survey of 3%. Still, the number of gerontology students remains less than needed numbers. However, California social work schools are well-prepared with infused curricula for all social workers and exceed previous standards for gerontology faculty and aging field placements. The implications for California are discussed as well as recommendations for updating the earlier gerontology curricula criteria. [ABSTRACT FROM AUTHOR]

Entering and exiting BSW students were compared on self-efficacy and on direct practice skill performance with a standardized client. Self-efficacy was tested as a predictor and as a mediator of skill performance. Ordinary least squares hierarchical regression found BSW education to be predictive of higher skill and higher self-efficacy. After controlling for BSW education, self-efficacy negatively predicted direct practice skill, and mediation was not supported as hypothesized. This study suggests caution in the use of self-efficacy as an outcome measure, advances the use of standardized clients for assessment, and affirms the need for the development of valid and reliable instruments for assessment of direct practice skill in social work education. [ABSTRACT FROM AUTHOR]

Interest in longitudinal integrated clerkships (LICs) as an alternative to traditional block rotations is growing worldwide. Leaders in medical education and those who seek physician workforce development believe that 'educational continuity' affords benefits to medical students and benefits for under-resourced settings. The model has been recognized as effective for advancing student learning of science and clinical practice, enhancing the development of students' professional role, and supporting workforce goals such as retaining students for primary care and rural and remote practice. Education leaders have created multiple models of LICs to address these and other educational and health system imperatives. This article compares three successful longitudinal integrated clinical education programs with attention to the case for change, the principles that underpin the educational design, the structure of the models, and outcome data from these educational redesign efforts. By translating principles of the learning sciences into educational redesign efforts, LICs address the call to improve medical student learning and potential and advance the systems in which they will work as doctors. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that a surgeon’s experience and training are the most important factors associated with graft selection, but no studies have qualified this association. Graft usage prevalence has not been described for large anterior cruciate ligament reconstruction (ACLR) populations in the United States.Purpose: To describe the prevalence of graft usage in a large community-based practice and evaluate the association of patient, surgeon, and site characteristics with choice of primary ACLR graft.Study Design: Cross-sectional study; Level of evidence, 3.Methods: Primary ACLRs performed between February 2005 and June 2010 were selected for the study. A community-based ligament registry was used to identify cases and variables used for analysis. Graft choice (any allograft, hamstring autograft, and bone–patellar tendon–bone [BPTB] autograft) was compared by patient characteristics and surgeon and site characteristics. Associations between independent variables and graft choice were evaluated using a polychotomous regression model.Results: Of the 9849 patients included in the study, 64% were male, and overall median age was 28 years. Of these, 2796 (28.4%) received BPTB autografts, 3013 (30.6%) received hamstring autografts, and 4040 (41.0%) received allografts. The prevalence of graft source by patients’ gender, race, age, body mass index (BMI), as well as surgeons’ fellowship training status, average volume, and site volume were significantly different (all P < .001). Adjusted models showed that patients’ gender (P < .001), race (P = .018), age (P < .001), BMI (P < .001), as well as surgeons’ fellowship training status (P < .001), average volume (P < .001), and site volume (P < .001) are associated with graft selection. Older and female patients with lower BMI were more likely to receive allografts and hamstring autografts than BPTB autografts. Cases performed by non–fellowship-trained surgeons, lower volume sites, and/or lower volume surgeons were also more likely to be performed with allografts or hamstring autografts than BPTB autografts.Conclusion: Gender, age, race, as well as facility and surgeon characteristics such as volume and location are associated with ACL graft choices. [ABSTRACT FROM PUBLISHER]

The article reports on the development and implementation of courses that are designed to instill a sense of compassion, service, and sensitivity in medical trainees. The Arnold P. Gold Foundation fosters humanism through grants and awards to medical students, residents, and faculties. According to health care professional Howard Spiro, the time to start dealing issues of humanism and ethics is during undergraduate work.

Calls from the psychological literature have highlighted a need for the integration of social justice training in APA-accredited internships in professional psychology. This article presents an example of how foundational principles of social justice can be integrated into predoctoral internships. The authors identified foundational principles of social justice from the literature and applied them to training, using the internship at the University of California San Diego's Psychological and Counseling Services as a case example. Ways in which these principles have shaped trainees, learning activities, and trainee perspectives are presented. Finally, recommendations for integration of these principles for teaching psychology trainees are underscored. [ABSTRACT FROM AUTHOR]

Objective To augment resident training in the delivery of culturally effective care in order to improve clinician capacity to effectively care for patients from diverse backgrounds. Methods Residents from the Naval Medical Center San Diego and the University of California San Diego participated in experiential learning and service activities. Programme evaluation assessed aspects of the delivery of culturally effective care in community settings. A community-based participatory approach to engaging residents in the delivery of culturally effective care and evaluation of the effectiveness of this approach are described. Results A significant pre−post rotation increase was noted in residents' self-perceived ability to identify culture-related issues that may impact on the patient's view of illness ( P < 0.001) and ability to address a culture-related issue ( P < 0.001). Community evaluations rated residents positively on behaviours that reflected communication skills and professionalism, but less positively on knowledge about communities. Conclusions The authors conclude that resident exposure to the block rotation curriculum contributes to improved knowledge of the skills necessary to provide culturally effective care in diverse community settings. [ABSTRACT FROM AUTHOR]

Objective: To determine how accurately preventive care reported in the medical record reflects actual physician practice or competence.Design: Scoring criteria based on national guidelines were developed for 7 separate items of preventive care. The preventive care provided by randomly selected physicians was measured prospectively for each of the 7 items. Three measurement methods were used for comparison: (1) the abstracted medical record from a standardized patient (SP) visit; (2) explicit reports of physician practice during those visits from the SPs, who were actors trained to present undetected as patients; and (3) physician responses to written case scenarios (vignettes) identical to the SP presentations.Setting: The general medicine primary care clinics of two university-afflliated VA medical centers.Participants: Twenty randomly selected physicians (10 at each site) from among eligible second- and third-year general internal medicine residents and attending physicians.Measurements and Main Results: Physicians saw 160 SPs (8 cases x 20 physicians). We calculated the percentage of visits in which each prevention item was recorded in the chart, determined the marginal percentage improvement of SP checklists and vignettes over chart abstraction alone, and compared the three methods using an analysis-of-variance model. We found that chart abstraction underestimated overall prevention compliance by 16% (P < .01) compared with SP checklists. Chart abstraction scores were lower than SP checklists for all seven items and lower than vignettes for four items. The marginal percentage improvement of SP checklists and vignettes to performance as measured by chart abstraction was significant for all seven prevention items and raised the overall prevention scores from 46% to 72% (P < .0001).Conclusions: These data indicate that physicians perform more preventive care than they report in the medical record. Thus, benchmarks of preventive care by individual physicians and institutions that rely solely on the medical record may be misleading, at best. [ABSTRACT FROM AUTHOR]

Summarizes the first year experiences of California State University-Chico and Fireman's Fund Insurance Co. with the electronic on-campus internship model. Combination of the positive characteristics of both the traditional internship and the off-campus co-op models; Key factors for considering such type of cooperative education model.

Focuses on Pomona-based California State Polytechnic University's redesigned internship program based on Piaget's theory of intellectual development. Importance of internship to the student; Addressing the problem of fitting internship into the cognitive development of the student; Internship program designer's problem.

Objective: To compare the initial diagnosis of cases presented at morning report with the final morning report diagnosis reached at discharge from the Medicine service and the diagnosis as evaluated 6 months after discharge.Design: Prospective cohort study of morning report cases.Setting: A university internal medicine residency program.Measurements: Proportion of morning report cases in which the initial morning report diagnosis differed from the final morning report diagnosis at discharge or, in cases where a firm diagnosis was not reached at discharge, the proportion for which a diagnosis was established by 6 months after discharge.Main Results: In 24% of cases, a firm morning report diagnosis was not available at discharge. For 61% of these, a diagnosis could be established by 6-month follow-up: for 36% the diagnosis differed from the final morning report diagnosis; and for 25% it was the same. Among cases where a firm final diagnosis was reached during morning report, the initial morning report diagnosis differed for 17%.Conclusions: Most patients discharged without a firm diagnosis have one established by 6 months later--often with surprising results. Postdischarge follow-up information could enhance the educational value of inpatient cases. [ABSTRACT FROM AUTHOR]

The article offers the author's insights regarding the 2010 Association of Educational Communication and Technology (AECT) International Convention Interns held at Anaheim, California. The author says that he met several Educational Communication and Technology (ECT) Foundation board members including Chris Miller, Robert Harrell, and Deborah Anthony, and that he received the AECT Intern medal. Furthermore, he says that his Intern group will create a portal/website for an open education project.

Background: Resident physicians are expected to demonstrate medical knowledge. However, little is known about the residents' reading habits and learning preferences. Aim: To assess residents’ reading habits and preferred educational resources. Methods: Residents at five internal medicine training programs were surveyed regarding their reading and learning habits and preferences. Results: The majority (77.7%) of residents reported reading less than 7 h a week. Most residents (81.4%) read in response to patient care encounters. The preferred educational format was electronic; 94.6% of residents cited UpToDate® as the most effective resource for knowledge acquisition, and 88.9% of residents reported that UpToDate® was their first choice for answering clinical questions. Conclusions: Residents spent little time reading and sought knowledge primarily from electronic resources. Most residents read in the context of patient care. Future research should focus on strategies for helping resident physicians learn in the electronic age. [ABSTRACT FROM AUTHOR]

Reports on the internship program of Kaiser Permanente in Los Angeles, California. Opportunity for registered nurses in developing new skills; Benefits of participation in hospital administration; Impact on nursing practices at the institution.

As a sixth-year medical student and the first exchange medical student from Fudan University, China, I had the opportunity to take a three-month elective at University of California at Davis (UC Davis) School of Medicine from October 2013 to January 2014. I worked and studied at the Division of Cardiothoracic Surgery, the General Medicine Consults Service, and the Department of Emergency Medicine in those days. This precious experience enhanced my medical knowledge, broadened my view, and at the same time, deepened my understanding of clerkship as part of medical education. [ABSTRACT FROM AUTHOR]

The article presents an obituary for Lawrence Borgsdorf, former ambulatory care pharmacist for the Kaiser Permanente Medical Program is presented.