▼ 

The over $6 billion US wholesale mattress market is driven mostly by metal innerspring technology originally innovated by blacksmiths in the 1800s. New bedding market entrant Tempur-Pedic continues to enjoy phenomenal growth and the industry’s best profit margins founded on viscoelastic foam technology innovated by NASA. Visco mattress innovations are clearly disrupting the mattress industry as evidenced by several management, market, and financial metrics. However, visco mattress innovations cannot be classified as a disruptive innovation (DI) because the popularized term as commonly accepted and practiced requires that a DI cannot be used by mainstream users. Visco mattress innovations can be used by mainstream mattress users. Technology management researchers and practitioners may miss significant opportunities by rejecting potential innovations that would disrupt incumbent competitors and markets because they do not fit their current conceptual requirements for DIs such as that they cannot be used by mainstream users. Therefore, for this essay, a visco mattress innovation is characterized as a radical-disruptive innovation (RDI) with most characteristics of both radical and disruptive innovations in that it: (1) uniquely delivers new customer-demanded benefits useful even to mainstream users, (2) requires new organizational core competencies relative to the incumbent firms, and (3) disrupts the business models and markets of incumbent firms. This essay explores some of the management/organizational behaviors and market dynamics associated with the continuing disruption of the mattress industry by visco foam mattress RDIs. In addition, this essay briefly explores the managerial and financial constraints that LBO owners place on their firms that: help to allow a new firm with an RDI to enter the incumbent market and successfully compete, as well as mitigate the success of the new market entrant, both as the result of low organizational/financial slack. In conclusion, it is expected that Tempur-Pedic will continue to outperform innerspring incumbents by executing their current successful business model based on viscoelastic foam RDIs, albeit at slower rates. Also, it is expected that visco foam RDIs will become ubiquitous in the bedding and other industries, particularly in the high margin healthcare and sports industries, which is beneficial to all.

▼ Purpose

Communicating unexpected news of a patient death is rarely encountered in urology. We evaluated resident performance during an unexpected patient death scenario involving high fidelity simulation. We also studied simulation as a tool to teach and assess nontechnical skills in urology.

Materials and Methods

An unexpected patient death scenario was developed at a simulation center using high fidelity mannequins, urology residents, critical care fellows, nurses, hospital chaplains and actors. Scenario objectives addressed Accreditation Council for Graduate Medical Education core competencies. The 19 urology residents in training years 2 to 6 participated in the scenario. Performance was evaluated using 5-point Likert scale questionnaires and checklists completed by residents, faculty and actors.

Results

Overall resident performance was satisfactory in the simulation scenario. Verification of code status was identified as an area requiring improvement. Euphemisms for death were more commonly used in the initial delivery (16 residents or 84.2%) than the preferred words died or death (3 or 15.8%). After completing the scenario the perceived competency of residents increased from 73.7% before to 94.7% after the scenario. In addition, all residents agreed that the simulation experience was useful and overall realistic, and it should be part of the training curriculum.

Conclusions

Evaluation of urology resident performance was possible during an unexpected patient death scenario. Upon completion of the scenario perceived competency of the simulation task was increased. High fidelity simulation was found to be an effective method for teaching and assessing the acquisition of nontechnical skills. All residents agreed that the simulation was useful and should be included in urological training.

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The structure and infrastructure of the Indian research literature were determined. A representative database of technical articles was extracted from the Science Citation Index/Social Science Citation Index (SCI/SSCI) [SCI. Certain data included herein are derived from the Science Citation Index/Social Science Citation Index prepared by the THOMSON SCIENTIFIC®, Inc. (Thomson®), Philadelphia, Pennsylvania, USA: ©Copyright THOMSON SCIENTIFIC® 2006. All rights reserved. [1]] for 2005, with each article containing at least one author with an India address. Document clustering was used to identify the main technical themes (core competencies) of Indian research. Aggregate India bibliometrics were also performed, emphasizing the value of collaborative research to India. A unique mapping approach was used to identify networks of organizations that published together, networks of organizations with common technical interests, and especially those organizations with common technical interests that did not co-publish extensively. Finally, trend analyses were performed using other year data from the SCI/SSCI to place the 2005 results in their proper historical context.

▼ Objective

Report our implementation of a standardized handover process in a general surgery residency program.

Design

The standardized handover process, sign-out template, method of implementation, and continuous quality improvement process were designed by general surgery residents with support of faculty and senior hospital administration using standard work principles and business models of the Virginia Mason Production System and the Toyota Production System.

Setting

Nonprofit, tertiary referral teaching hospital.

Participants

General surgery residents, residency faculty, patient care providers, and hospital administration.

Results

After instruction in quality improvement initiatives, a team of general surgery residents designed a sign-out process using an electronic template and standard procedures. The initial implementation phase resulted in 73% compliance. Using resident-driven continuous quality improvement processes, real-time feedback enabled residents to modify and improve this process, eventually attaining 100% compliance and acceptance by residents.

Conclusions

The creation of a standardized template and protocol for patient handovers might eliminate communication failures. Encouraging residents to participate in this process can establish the groundwork for successful implementation of a standardized handover process. Integrating a continuous quality-improvement process into such an initiative can promote active participation of busy general surgery residents and lead to successful implementation of standard procedures.

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The structure and infrastructure of the Mexican technical literature was determined. A representative database of technical articles was extracted from the Science Citation Index for the year 2002, with each article containing at least one author with a Mexican address. Many different manual and statistical clustering methods were used to identify the structure of the technical literature (especially the science and technology core competencies). One of the pervasive technical topics identified from the clustering, thin films research, was analyzed further using bibliometrics, in order to identify the infrastructure of this technology.

▼ 

In the United States, access to qualified homebirth providers varies by state, city, and community, and consistent, evidence-based guidelines for intrapartum management at home are not available. This article examines the similarities and differences in midwifery management of the intrapartum, postpartum, and neonatal course between planned homebirths and planned hospital births. Characteristics of qualified attendants, essential medical supplies and equipment, methods for maternal and fetal surveillance, and common intrapartum indications for transfer are discussed. Unique features of management of the healthy woman and baby in the home are described, as well as the process of consultation and/or referral for collaborative or medical management. Current evidence for the management of fetal intolerance of labor, meconium stained amniotic fluid, prolonged labor, postpartum hemorrhage, and the unstable newborn is discussed in the context of homebirth practice. Aspects of homebirth care that require cultural competency and affect the informed consent process are included. Homebirth practice may provide opportunities to increase the congruence between espoused midwifery philosophy and actual practice.

▼ 

The technical structure of the Mexican science and technology literature was determined. A representative database of technical articles was extracted from the Science Citation Index for the year 2002, with each article containing at least one author with a Mexican address. Many different manual and statistical clustering methods were used to identify the structure of the technical literature (especially the science and technology core competencies), and to evaluate the strengths and weaknesses of each technique. Each method is summarized, and its results presented.

▼ Objectives

The Mortality and Morbidity (M&M) conference is a staple of surgical training programs. With reduced resident work hours, maximizing limited educational opportunities has become essential. We attempted to determine whether increasing the perceived educational value in M&M conference is associated with enhanced confidence levels in the future. We analyzed which features of M&M case reviews are associated with greater perceived educational value and enhanced confidence to deal with similar future clinical scenarios.

Design

Educational process variables were prospectively collected for 47 consecutive cases reviewed over a 16-week period at a single institution’s surgical M&M conference. General surgery residents completed self-reporting surveys rating the educational value of cases and impact on confidence in managing similar future clinical situations. Univariate regression analysis and multivariate regression analysis were calculated to study the relationship between various process variables and perceived educational and confidence values surveyed by residents.

Setting

Tertiary academic medical center.

Participants

General surgery residents PGY1 to PGY5.

Results

Increased perceived educational value was associated with increased confidence (p < 0.001). Perceived educational value was increased with more questioning of the audience, increasing explanations of cases, use of slides, increase in number of questions directed to attendings, use of radiologic images, the more junior the resident surveyed, and when teaching points were made specifically for the medical students in attendance. (p < 0.05) Level of confidence was increased with increased questioning to the audience, increased explanations, increased questioning of the attendings, and more junior the resident surveyed. Increased questioning of presenter did not increase perceived educational value or resident perceived confidence value.

Conclusions

These data demonstrate that audience interaction, not directed questioning of the presenter, may improve surgical resident perceived educational value and confidence in managing problems discussed at M&M. These data suggest that M&M moderators can play a central role in maximizing audience interaction and improve the educational value of this important conference.

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Science and technology (S&T) allows (1) automation to replace human labor, (2) enhanced human labor capabilities, (3) quicker and cheaper production of goods, and (4) more complex products and processes. In order to maintain competitive advantages, it is critical for any country to understand what other countries are producing in S&T, and what intrinsic S&T capabilities are being developed.

India and China are the two most populous countries in the world. These two dynamic economies are advancing rapidly in S&T, and it is prudent to assess the quantity and quality of their research output as well as to examine trends in their S&T capabilities.

This paper, the first of four in a Special Section on China's and India's S&T, introduces the remaining three papers. Specifically, this paper describes the motivation for the studies, the background for understanding national S&T assessments, an overview of text mining, a brief picture of the Indian and Chinese S&T establishments, and a summary of the analytical techniques used in the assessments.

▼ 

This paper identifies and analyzes the science and technology core competencies of China, based on a sampling of approximately half of the total Chinese publication output in the Science Citation Index/ Social Science Citation Index (SCI/SSCI) [SCI. Certain data included herein are derived from the Science Citation Index/Social Science Citation Index prepared by the Thomson Scientific®, Inc. (Thomson®), Philadelphia, Pennsylvania, USA: © Copyright Thomson Scientific® 2006. All rights reserved. [1]] for 2005. Aggregate China publication and citation bibliometrics were obtained and a hierarchical research taxonomy, based on document clustering, was generated. Additionally, bibliometrics and thematic trends were tracked over the past two decades.

The key findings were that China's output of research articles has significantly expanded in the last decade. In terms of sheer numbers of research articles, especially in cuting-edge technologies, such as nanotechnology and energetic materials, it is among the leaders. Compared to the USA, the bulk of China's articles focus on the physical and engineering sciences, while the USA articles (compared to China) focus on medical, social, and psychological sciences.

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Commercialization of new university technology within the new product development process is an important tool by which established firms can expand their innovative capabilities. The strategic importance of the university technology to the firm, however, can vary considerably. An exclusivity agreement is a useful tool to protect the firm’s investment and help ensure that value is appropriated through the commercialization process. An empirical study of 66 technology transfer projects in the information and communications technology industry reveals that licensing transactions are usually secured by some form of exclusivity agreements when the product innovation enabled by the new university technology is new-to-the-firm or new-to-the-market and the firm’s perception of the strategic value of the new technologies is high.

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Zusammenfassung

Die zunehmende Spezialisierung und wachsende Technisierung in der Medizin haben die Verlagerung von ursprünglich ärztlichen Aufgaben auf nichtärztliche Gehilfen nachhaltig gefördert. Der enorme Kostendruck infolge der knappen finanziellen Ressourcen im Gesundheitswesen macht die Übertragung früherer ärztlicher Leistungen auf billigeres nichtärztliches Hilfspersonal zweckdienlich, und auch der zum Teil schon sichtbare Ärztemangel gewinnt bei der Weggabe vieler Tätigkeiten aus ärztlicher Hand an Bedeutung. Im deutschen Gesundheitswesen gibt es keine Rechtsnorm, die das Tätigkeitsfeld des Arztes eindeutig und abschließend beschreibt. Wesentlich bei einer Neuordnung der Aufgabenbereiche zwischen Ärzten und nichtärztlichem Medizinpersonal ist die terminologische Unterscheidung zwischen der weisungsabhängigen, untergeordneten, unselbstständigen Assistenz und der Delegation ärztlicher Leistungen, die nichtärztlichem Personal zur selbstständigen, eigenverantwortlichen Erledigung unter Aufsicht und Kontrolle des Arztes übertragen werden. Die Gefahrengeneigtheit des ärztlichen Handelns, die Schutzbedürftigkeit des Patienten und die zur Durchführung der gebotenen Maßnahme erforderlichen intellektuellen Voraussetzungen ziehen der Delegation ärztlicher Leistungen auf nichtärztliche Mitarbeiter eine Grenze. Sie stecken bei sachverständiger Beurteilung das ausschließlich ärztliche Tätigkeitsfeld hinreichend genau und überzeugend ab.

▼ 

Zusammenfassung

Die zunehmende Spezialisierung und wachsende Technisierung in der Medizin haben die Verlagerung von ursprünglich ärztlichen Aufgaben auf nichtärztliche Gehilfen nachhaltig gefördert. Der enorme Kostendruck infolge der knappen finanziellen Ressourcen im Gesundheitswesen macht die Übertragung früherer ärztlicher Leistungen auf billigeres nichtärztliches Hilfspersonal zweckdienlich, und auch der zum Teil schon sichtbare Ärztemangel gewinnt bei der Weggabe vieler Tätigkeiten aus ärztlicher Hand an Bedeutung. Im deutschen Gesundheitswesen gibt es keine Rechtsnorm, die das Tätigkeitsfeld des Arztes eindeutig und abschließend beschreibt. Wesentlich bei einer Neuordnung der Aufgabenbereiche zwischen Ärzten und nichtärztlichem Medizinpersonal ist die terminologische Unterscheidung zwischen der weisungsabhängigen, untergeordneten, unselbstständigen Assistenz und der Delegation ärztlicher Leistungen, die nichtärztlichem Personal zur selbstständigen, eigenverantwortlichen Erledigung unter Aufsicht und Kontrolle des Arztes übertragen werden. Die Gefahrengeneigtheit des ärztlichen Handelns, die Schutzbedürftigkeit des Patienten und die zur Durchführung der gebotenen Maßnahme erforderlichen intellektuellen Voraussetzungen ziehen der Delegation ärztlicher Leistungen auf nichtärztliche Mitarbeiter eine Grenze. Sie stecken bei sachverständiger Beurteilung das ausschließlich ärztliche Tätigkeitsfeld hinreichend genau und überzeugend ab.

▼ Purpose

Resident-led teaching on surgical services is typically disorganized, and the primary responsibility is often unassigned. Creation of a specified role of “teaching resident” (TR) is hypothesized to encourage residents to teach more, develop leadership skills, and enhance medical student clerkship experiences.

Methods

All residents in general surgery training at the University of California, San Francisco, were surveyed to determine perceptions of teaching responsibility. Independently, second-year residents were solicited for voluntary participation in a TR program that gave them primary responsibility for teaching medical students assigned to their services during a 1-month rotation. After completion of the TR rotation, these residents evaluated the TR experience with their prior rotation at the same hospital (which had the same service structure but no TR duties). Medical student clerkship evaluations were reviewed to compare experiences between the 2 periods as well.

Results

Overall response rate for the general survey administered to all residents was 93% (67/72). All 6 second-year residents rotating through the designated services over a 6-month period volunteered to participate, but 2 did not have assigned medical students. Evaluations of the TR program were thus completed by 100% (4/4) residents. Time spent teaching medical students increased significantly, from 0.625 hours/week pre-TR to 2.75 hours/week during TR (p = 0.0026). All felt that teaching skills and motivation to teach increased, and 75% also reported improvement in leadership skills. Medical student scores on a 5-point scale revealed an increase in clinical instruction from 2.17 pre-TR to 3.25 (p = 0.0054). Satisfaction of clerkship objectives also increased from 3.17 pre-TR to 3.75 (p = 0.038).

Conclusions

Junior surgical residents have interest in teaching, and their time spent doing so is significantly increased by the specific assignment of responsibility in a mid-level leadership role. Both residents and students benefit from this clinical service structure. Further formal development and program evaluation are in progress.

▼ Objective

The Association of Program Directors in Surgery and the Division of Education of the American College of Surgeons developed and implemented a web-based system for end-of-rotation faculty assessment of ACGME core competencies of residents. This study assesses its reliability and validity across multiple programs.

Methods

Each assessment included ratings (1-5 scale) on 23 items reflecting the 6 core competencies. A total of 4241 end-of-rotation assessments were completed for 332 general surgery residents (≥5 evaluations each) at 5 sites during the 2004-2005 and 2005-2006 academic years. The mean rating for each resident on each item was computed for each academic year. The mean rating of items representing each competency was computed for each resident. Additional data included USMLE and ABSITE scores, PGY, and status in program (categorical, designated preliminary, and undesignated preliminary).

Results

Coefficient alpha was greater than 0.90 for each competency score. Mean ratings for each competency increased significantly (p < 0.01) as a function of PGY. Mean ratings for professionalism and interpersonal/communication skills (IPC) were significantly higher than all other competencies at all PGY levels. Competency ratings of PGY 1 residents correlated significantly with USMLE Step I, ranging from (r = 0.26, p < 0.01) for Professionalism to (r = 0.41, p < 0.001) for Systems-Based Practice. Ratings of Knowledge (r = 0.31, p < 0.01), Practice-Based Learning & Improvement (PBLI; r = 0.22, p < 0.05), and Systems-Based Practice (r = 0.20, p < 0.05) correlated significantly with 2005 ABSITE Total Percentile. Ratings of all competencies correlated significantly with the 2006 ABSITE Total Percentile Score (range: r = 0.20, p < 0.05 for professionalism to r = 0.35, p < 0.001 for knowledge). Categorical and designated preliminary residents received significantly higher ratings (p < 0.05) than nondesignated preliminaries for knowledge, patient care, PBLI, and systems-based practice only.

Conclusions

Faculty ratings of core competencies are internally consistent. The pattern of statistically significant correlations between competency ratings and USMLE and ABSITE scores supports the postdictive and concurrent validity, respectively, of faculty perceptions of resident knowledge. The pattern of increased ratings as a function of PGY supports the construct validity of faculty ratings of resident core competencies.

▼  <b>Purpose</b> - <i>The purpose of this paper is to warn managers of the common missteps that can trip up strategy making and suggest how such pitfalls can be avoided.</i> <b>Design/methodology/approach</b> - <i>Based on their experience and research, the authors identify seven key mistakes and describe the best practices that companies can follow.</i> <b>Findings</b> - <i>The article offers a sophisticated how-to process managers can use to seek a basis for advantage, say "no" to trying to do everything, focus on long-term-value creation, factor in competitor reactions, balance ambitious bets with caution, understand the organization's capabilities, and link vision to execution.</i> <b>Practical implications</b> - <i>By avoiding these seven basic missteps managers can stay on the path to strategic success.</i> <b>Originality/value</b> - <i>The authors highlight the best practices for making more effective strategic choices in an easy-to-remember and easy-to-teach format.</i>

▼ 

Zusammenfassung

Der vorliegende Artikel beschreibt aus der Sicht des Geschäftsführers einer BG-Klinik die Richtung der erforderlichen künftigen Entwicklung dieser Kliniken: Die BG-Klinik 2010 muss das Zentrum des BG-Netzwerks zur Versorgung von Unfallverletzten sein. Aufgrund ihrer Kernkompetenzen (Versorgung von Schwerstunfallverletzten, Traumazentrum zur interdisziplinären Versorgung von Unfallverletzten jeder Verletzungsschwere, Spezialeinrichtung für Komplikationsfälle, stationäre und ambulante Rehabilitation, Gutachteninstitut bzw. Beratungsstelle in allen Problemfällen) verfügen die BG-Kliniken über ein solides Fundament, auf dem sich die Zukunft gestalten lässt. Herausforderungen, denen sie sich stellen müssen, sind u. a. das DRG-Vergütungssystem, der Zwang zur Ausgabenbegrenzung im gesamten Gesundheitssystem und die Erwirtschaftung von Investitionen. Antwortmöglichkeiten auf diese Herausforderungen werden dargestellt und konkrete Beispiele für Maßnahmen anhand der derzeitigen Aktivitäten des ukb gegeben.

▼ 

Building on previous modeling of the separation between formal and real authority in organizations, the paper investigates some implications of growth for the scope of integration and the internal organization of firms. It stresses the role of headquarters' overload and the differential (and unmeasured) cost of internal and external units in terms of their use of a scarce corporate resource, namely headquarters attention.

The paper first shows how growth or other factors leads to restructuring, for example through spin offs, move of units to the periphery, and refocus on core competencies. It then looks at the internal allocation of tasks, and studies whether overload considerations may induce a firm to create profit centers and abandon a functional or unitary form (U-form) in favor of a multidivisional form (M-form).

▼ In this paper, we introduce the five partners model of the ''business network''. We argue that the cooperative, inter-industry and inter-firm relationships of the business network can ameliorate some of the costs found in markets and hierarchies. The business network is distinguished by a multinational enterprise's asymmetric strategic control over the network. We propose that it is this asymmetry which facilitates the establishment of credible commitments among the network partners. The business network, as a governance structure, embodies the findings of current research on inter-organizational learning and the embeddednes of economic action in social relations. As a case study we apply our business network theory to the Canadian telecommunications industry. The industry faces significant new challenges in terms of the pace of technological innovation and exposure to global competition. The organization of Canadian industry participants into the Stentor alliance is evaluated as a nascent business network

▼ 

FASAN J., ZAVARISE D., PALESE A. & MARCHESONI D. (2012) Midwifery students' perceived independence within the core competencies expected of the midwifery community upon graduation: an Italian study. International Nursing Review59, 208–214

Aim:  The general aim of this article is to describe the independence perceived by midwifery students who are due to qualify with regard to core competencies that are considered essential by the community of professional midwives working in Italian healthcare hospitals.

Methods:  A multi-method research project was undertaken. One hundred sixty-seven midwives working in 11 regional facilities were approached with the aim of selecting the core competencies expected by graduands. In the same region, all graduands (24) educated at two universities were involved in the study aiming to discover the level of the independence (from 0 none to 10 maximum) perceived in each core competence selected by the midwives.

Results:  The average score obtained by graduands in the questionnaire containing 102 core competencies was 717.4 (standard deviation 130.3, median 743). The minimum score was 363 and the highest was 916. Assuming the minimum cut-off at 612 points, five students (20.8%) had a perceived level of independence below sufficiency.

Conclusion:  Italian midwifery education has been reformed five times since 1940. The reduction in the length of the direct entry midwifery programme as introduced in the latest Italian national reform, and the higher standard of education requested also by European Directives, cause an increasing number of students to prefer to extend their course duration and postpone graduation until they feel independent. Any change in curriculum should consider the impact in the short, medium and long terms. For this reason, each new policy should consider carefully the point of view of experts in the disciplines, such as midwifery, with the objective of protecting and developing their competence in taking care of women, newborns and their families.

▼ 

Using firm-level panel data for Estonia, we analyse the impact of international competition on firm dynamics, considering both firm closedown and product switches. We contribute to the literature in two important ways: first, this is the first paper to study the determinants of exit and product switching in an emerging market; and second, we consider explicitly the role of export opportunities. Our results indicate that globalization does not affect firm exit significantly but it is an important factor explaining why firms choose a different core product. Previous studies on industrial countries have shown that product switching has been a defensive strategy against low-cost imports. In contrast, our results suggest that Estonian firms change their core products as an offensive strategy to take advantage of the export opportunities created by a globalized economy.

▼ Objectives

To review and assess educational strategies and formats regarding communication with families/survivors in the aftermath of unexpected and untimely patient death. To propose an integrated curriculum designed and intended to foster proficiency, competence, confidence, and composure in relaying catastrophic information in the context of the professional experience of a cohort of seasoned surgeons.

Background

Unexpected and untimely patient death is emotionally and psychologically wrenching for families, surgeons, and healthcare providers. We have previously proffered that 2 distinct, but interactive, phases of response are relevant when communicating with a family before and after the event: a proactive phase intended to establish a positive therapeutic relationship with the family; and a reactive phase intended to respond to the family in a compassionate and respectful manner and to ensure self-care for the physicians and health care providers.

Study Design

Survey of a cohort of senior surgeons (membership of the Southern Surgical Association) and Surgical Residency Program Directors (membership of the Association of Program Directors in Surgery).

Results

Sixty percent of the senior surgeons surveyed had experienced unexpected patient death. They advised strategies to cope with that clinical situation commensurate with the core competencies of the Accreditation Council for Graduate Medical Education: Medical Knowledge: maximize objective information/data and minimize subjective opinion; Patient Care: critique the events and conduct postmortem analyses; Interpersonal and Communication Skills: honesty, empathy, and patience; Professionalism: provide emotional and psychological support to family and personnel with privacy and in a nonaccusatory manner; Practice-Based Learning and Improvement: preoperative discussion and documentation in the context of informed consent and advanced directives vis-á-vis risk-benefit, effort-yield, and benefit-burden analyses; and Systems-Based Practice: involve chaplains and hospital personnel. Thirty-six percent of the graduate surgical educational programs surveyed allegedly provided educational venues to enable surgical residents to cope with unexpected patient death, although the formats were not specified.

Conclusions

Graduate, postgraduate, and continuing educational programs aspire to prepare physicians and surgeons for independent professional practice—scientifically, humanistically, and artistically. Incorporating educational strategies to enable graduates to cope with the emotional and psychological turmoil of unexpected patient death is relevant.

▼ Objectives

To review and assess educational strategies and formats regarding communication with families/survivors in the aftermath of unexpected and untimely patient death. To propose an integrated curriculum designed and intended to foster proficiency, competence, confidence, and composure in relaying catastrophic information in the context of the professional experience of a cohort of seasoned surgeons.

Background

Unexpected and untimely patient death is emotionally and psychologically wrenching for families, surgeons, and healthcare providers. We have previously proffered that 2 distinct, but interactive, phases of response are relevant when communicating with a family before and after the event: a proactive phase intended to establish a positive therapeutic relationship with the family; and a reactive phase intended to respond to the family in a compassionate and respectful manner and to ensure self-care for the physicians and health care providers.

Study Design

Survey of a cohort of senior surgeons (membership of the Southern Surgical Association) and Surgical Residency Program Directors (membership of the Association of Program Directors in Surgery).

Results

Sixty percent of the senior surgeons surveyed had experienced unexpected patient death. They advised strategies to cope with that clinical situation commensurate with the core competencies of the Accreditation Council for Graduate Medical Education: Medical Knowledge: maximize objective information/data and minimize subjective opinion; Patient Care: critique the events and conduct postmortem analyses; Interpersonal and Communication Skills: honesty, empathy, and patience; Professionalism: provide emotional and psychological support to family and personnel with privacy and in a nonaccusatory manner; Practice-Based Learning and Improvement: preoperative discussion and documentation in the context of informed consent and advanced directives vis-á-vis risk-benefit, effort-yield, and benefit-burden analyses; and Systems-Based Practice: involve chaplains and hospital personnel. Thirty-six percent of the graduate surgical educational programs surveyed allegedly provided educational venues to enable surgical residents to cope with unexpected patient death, although the formats were not specified.

Conclusions

Graduate, postgraduate, and continuing educational programs aspire to prepare physicians and surgeons for independent professional practice—scientifically, humanistically, and artistically. Incorporating educational strategies to enable graduates to cope with the emotional and psychological turmoil of unexpected patient death is relevant.

▼ Background

The Patient Assessment and Management Examination (PAME) is a standardized patient examination designed to assess management skills of senior residents. This study explored the relationship between faculty and resident self-evaluation by using PAME.

Methods

Nine postgraduate year (PGY) 4 and PGY5 residents were examined with a 5 case PAME. Faculty rated interactions between residents and standardized patients and residents rated themselves based on review of audio-video recordings of their interactions. We examined correlations between faculty and resident self-assessments.

Results

Faculty and resident ratings of physical examination skills was the only competency that correlated significantly. Correlations were not significant for the other 15 competencies (Pearson r, –.197 to .262). Correlation was no better when examined within each case.

Conclusions

Although PAME may be a useful tool, this study suggests that even senior residents do not assess their performance as clinicians similarly to faculty. Further research is needed to better understand the source of these disagreements.

▼ 

Using resource dependency theory (RDT), this research analyzes how organizations control their information technology resources to improve organizational performance. According to RDT, organizations must manage their dependency on external organizations and limit external dependencies when resources are considered critical. The current study proposes and tests a portion of a Strategic Control Model positing that managers seek to control important, strategic resources in order to create value for the firm and to avoid dependency on external entities. Utilizing a research design that captured extensive quantitative data on the control of IT functions and services, the research team gathered 5 years of data on 54 business units (BUs) in 27 global companies located in seven countries. Study examined the linkages of these 54 BUs to firm performance. Locating the Extent of Control within the firm in cases where the firm depends on IT as a strategic resource proves to be a good explanation for effective decisions leading to higher performance. Viewing IT as a strategic resource alone does not lead to positive business unit outcomes, but the moderating influence of Extent of Control is found to establish the complex statistical relationship with business unit performance. For these reasons, it is critical that a theoretically grounded firm-wide process for decisions on locating IT control is in place to capture business value.

▼ Objective

To describe the development of the EVATS rotation.

Design

Descriptive document.

Setting

University teaching hospital.

Participants

Faculty and residents of the University of Washington.

Methods

In July 2003 we identified the need for a new, independent, educational module within our residency training. Requirements for this rotation included dedicated time for technical skills training on simulators, independent competency learning modules, academic research project time, vacation time and coverage, and flexibility for unplanned leave (eg, interview travel, m/paternity leave).

Results

An EVATS rotation was created in July 2003 that is provided at each training level and lasts from 4 to 8 weeks depending on R-level. EVATS meets the following challenges: Emergency coverage (EVATS residents available for last-minute service coverage), vacation time/vacation coverage (2 weeks vacation + 1 week vacation coverage; this maintains vacations for all residents every 6 months), academic time (residents now must complete 1 academic project for graduation) and ACGME competency learning and assessment, and technical skills training (includes simulator work for open/lap skills). Initial implementation indices are high and include resident satisfaction, 80-hour work week compliance, academic productivity, and patient continuity of care.

Conclusions

The 21st century brought new challenges for surgical training. Increased societal demands for skills training in a laboratory setting using simulators and the 6 ACGME competencies all require classroom-type training periods. Paradoxically, the 80-hour work week restricted the time available for these educational activities and made it more difficult for programs to accommodate resident vacations and emergencies. These challenges provided an opportunity to enhance the educational experience for our residency program. The product was the EVATS rotation. Early data after implementation are favorable.

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Hou X.J., Zhu D. & Zheng M.H. (2010) Clinical Nursing Faculty Competence Inventory – development and psychometric testing. Journal of Advanced Nursing67(5), 1109–1117.

Aim.  This paper is a report of the development and psychometric testing of the Clinical Nursing Faculty Competence Inventory.

Background.  Clinical faculty plays a vital role in nursing education. Highly competent clinical faculty is a prerequisite for graduating competent future nurses. Many studies have examined the effectiveness of clinical nursing teaching. Yet, translating this body of knowledge into accurate and comprehensive assessment tools for measuring the competence of nursing faculty remains a challenge.

Method.  Thirty-one indicators of core competence of clinical nursing faculty were identified thorough literature review, expert consultation and a small sample pilot test. A total of 237 nursing faculty members, students and administrators from six advanced medical colleges in China were surveyed during 2007–2008. Using a five-point Likert-type scale, the respondents identified their level of agreement with statements addressing the components of clinical nursing faculty competence. Exploratory factor analysis was used to determine the factor structure of the inventory.

Results.  Students and faculty members valued aspects of clinical nursing faculty competence differently. Exploratory factor analysis using varimax rotation determined construct validity of the inventory and 26 items were retained. Five important categories of clinical nursing faculty competence were revealed: leadership ability, problem solving ability, educational intelligence, general teaching ability and clinical nursing skills. The Cronbach’s alpha level of the inventory was 0·91, with each domain ranging from 0·61 to 0·85.

Conclusion.  The inventory has good psychometric properties and can be used in training and evaluation of clinical nursing faculty.