Do Data Obtained From Admissions Interviews and Resident Evaluations Predict Later Personal and Practice Problems?
Department of Psychiatry, University at Buffalo, New York, USA. Academic Psychiatry
(Impact Factor: 0.81).
12/2005; 29(5):443-7. DOI: 10.1176/appi.ap.29.5.443
The authors assessed whether current methods of evaluating residency applicants and residents identify psychiatrists who later develop evidence of impairment.
Residency admissions and performance data for all physicians who were enrolled in a psychiatry residency between 1965 and 1994 and who were referred to an impaired physician program up to 35 years later were matched for age and gender with a nonreferred physician from the same class.
There were no significant differences between groups in admission interview assessments, performance ratings, or narrative observations by faculty during residency.
Standard approaches do not identify physicians at risk of later impairment.
Available from: informahealthcare.com
- "As teachers, we often wonder if it is possible to predict who will become a ''problem'' learner, hoping that we can avoid some of the anguish that is related to this educational experience. To date, however, studies have not been able to isolate factors that we can reliably use to either screen applicants to medical school/residency or predict future problems (Dubovsky et al. 2005; Brenner et al. 2010). ''Signs and symptoms'' A range of ''signs'' may suggest that a learner is in difficulty (Evans & Brown 2010; Evans et al. 2010). "
[Show abstract] [Hide abstract]
ABSTRACT: Clinical teachers often work with students or residents whom they perceive as a "problem". For some, it is a knowledge deficit that first alerts them to a problem; for others it is an attitudinal problem or distressing behaviour . And in some cases, it is difficult to know if the learner is, indeed, presenting with a problem. The goal of this Guide is to outline a framework for working with "problem" learners. This includes strategies for identifying and defining learners' problems, designing and implementing appropriate interventions, and assuring due process. The potential stress of medical school and residency training will also be addressed, as will a number of prevention strategies. Identifying learners' problems early - and providing guidance from the outset - can be an important investment in the training and development of future health professionals. It is hoped that this Guide will be of help to clinical teachers, program directors and faculty developers.
[Show abstract] [Hide abstract]
ABSTRACT: A hydrophobic segment present in the N-terminus of microsomal P450s is thought to serve as a membrane anchor. A variant of P450 2C3 was constructed, P450 2C3d, that lacked the putative membrane-spanning segment of the N-terminus, residues 3-20. This construct also incorporated substitutions of an alanine for 2Asp to facilitate expression in Escherichia coli and of serines for 24His and 25Gly to introduce a restriction site. P450 2C3d is expressed at relatively high levels in E. coli, 800-1200 nmol/liter of culture medium. In contrast to P450 2C3mod, which retains a membrane-spanning N-terminal sequence modified for expression in E. coli, the subcellular distribution of P450 2C3d in E. coli is dependent on the ionic strength of the buffer used for cell disruption. In low ionic strength buffers, 2C3d was mainly localized in the membrane fraction, whereas in buffers containing 1 M NaCl or 0.5 M KPi, P450 2C3d was predominantly found in the soluble fraction, indicating that deletion of the hydrophobic segment converted the intrinsic membrane protein to an extrinsic one. P450 2C3d was further modified by the incorporation of four histidine residues at the C-terminus (P450 2C3dH), and this enzyme could be purified in the absence of detergent using immobilized metal affinity chromatography following extraction from isolated membranes in high salt buffers. The catalytic properties of the purified, modified enzymes are similar to those of the native enzyme. Size-exclusion chromatography indicated that 2C3dH and 2C3d are predominantly dimers, whereas 2C3 is a larger oligomer (> 8-mer). Moreover, the detergents sodium cholate and Chaps each dissociate the dimers of 2C3dH to monomers at concentrations that do not alter the aggregation state of 2C3. These modifications are likely to facilitate attempts to crystallize the catalytic domains of microsomal P450s.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.