The Safety Climate Assessment Tool (S-CAT): A rubric-based approach to measuring construction safety climate.

INTRODUCTION: This paper presents the development and validation of a new rubric-based Safety Climate Assessment Tool (S-CAT). The S-CAT gives companies the opportunity to use rubric descriptors, rather than traditional Likert scale responses, to self-assess their level of safety climate maturity and receive a composite score benchmarked against others in the S-CAT database. METHOD: The S-CAT is composed of 37 separate indicators of 8 safety climate factors identified by construction industry subject matter experts. The eight factors have between three and six indicators each with its own rubric-based response-scale. The scales comprise descriptors for five levels of safety climate maturity ranging from "inattentive" to "exemplary." Nine hundred and eighty-five respondents working in the construction industry completed the S-CAT via our online safety climate website. We used company recordable incident rates (RIR) to assess the S-CAT's criterion-related validity. RESULTS: Cronbach alphas for each factor ranged from 0.77 to 0.90 and a confirmatory factor analysis supported the hypothesized eight factor structure with a higher-order safety climate factor. Seven of the eight factor scores, as well as the overall S-CAT score, were significantly negatively correlated with RIR. Moreover, a relative weights analysis indicated that a weighted combination of the eight safety climate factors explained 27% of the variance in organizational RIR. CONCLUSIONS: These findings provide evidence that the S-CAT is a reliable tool allowing construction companies to self-assess their safety climate along eight different factors. Moreover, the S-CAT was significantly associated with organizational injury rates. Practical applications: We discuss how companies can use the rubric descriptors to strengthen their safety management systems and improve their safety climate maturity.

If you've seen one construction worksite stretch and flex program you've seen one construction worksite stretch and flex program.

BACKGROUND: Work-related Musculoskeletal Disorders (WMSD) account for approximately one-third of all injuries in the U.S. construction industry. Many companies have implemented stretch and flex (s/f) programs to reduce WMSD despite a lack of evidence showing effectiveness. METHODS: We conducted a mixed-methods study to understand (a) why employers continue devoting resources to s/f programs; (b) how programs vary; and (c) any actual or perceived benefits. RESULTS: Nineteen safety and health professionals were interviewed and 133 more (13.3% response rate) completed an on-line survey. Fifty-six percent had implemented an s/f program with the primary goal of reducing WMSDs; though most did not review data to determine goal achievement. Program structure varied in terms of duration, frequency, and type of stretches. There was strong agreement about mandating attendance but not participation, due primarily to liability issues. Cost was a factor when deciding to implement a program but not for sustaining one. The majority had not implemented other ergonomic prevention activities, but many had started conducting daily safety huddles for task and safety planning. Those reporting a reduction in WMSDs agreed that it was not due to the s/f program alone and that other benefits included increased worker camaraderie, communication, and collaboration. CONCLUSION: Although there is little to no scientific evidence showing that they work as intended, construction companies continue to implement s/f programs with the goal of reducing WMSDs. Bringing work crews together for s/f activities has prompted employers to also begin conducting daily safety huddles. Although employers may not be able to link reduced WMDS to an s/f program, the ancillary benefits may warrant the time and resources. PRACTICAL APPLICATIONS: S/f programs should be only one component of a more comprehensive ergonomics prevention program. Conducting daily safety huddles at the same time also may enhance worker communication, camaraderie, collaboration and improve safety outcomes.

Effectiveness of a geriatric medical student scholars program: a qualitative assessment.

In 2003, the University of Cincinnati College of Medicine initiated a 4-year Geriatric Medical Student Scholars (GMSS) program in which a selected group of 14 medical students participated in a variety of extracurricular geriatrics-related activities such as one-on-one mentoring and discussion groups. These students were also required to compose journal entries describing GMSS program-related activities using a semistructured on-line computer program designed specifically for this purpose. The reflective journals, in combination with the American Geriatrics Society (AGS) competencies, were used to evaluate the degree to which the GMSS program achieved its goal of enhancing students' understanding of the complex health and social challenges facing older adults. Using a confirmatory qualitative analysis strategy, the AGS competencies served as an a priori codebook to evaluate the student journal entries. Of the original 53 AGS competencies identified as being relevant for a first- or second-year medical student, 74% were used at least one time, and only 26% were never used. These findings strongly suggest that the GMSS program successfully moved this group of first- and second-year medical students closer to at least understanding the content of many of the AGS competencies by providing them with geriatrics-related experiences and a geriatrics-related framework they could draw on when participating in curricular and extracurricular activities. The findings also point to the potential value of using reflective journaling as a tool for conducting process evaluation of medical education interventions.

Geriatric medicine fellowship programs: a national study from the Association of Directors of Geriatric Academic Programs' Longitudinal Study of Training and Practice in Geriatric Medicine.

This report documents the development and growth of geriatric medicine fellowship training in the United States through 2002. A cross-sectional survey of geriatric medicine fellowship programs was conducted in the fall 2001. All allopathic (119) and osteopathic (7) accredited geriatric medicine fellowship-training programs in the United States were involved. Data were collected using self-administered mailed and Web-based survey instruments. Longitudinal data from the American Medical Association (AMA) and the Association of American Medical Colleges' (AAMC) National Graduate Medical Education (GME) Census, the Accreditation Council for Graduate Medical Education (ACGME), and the American Osteopathic Association (AOA) were also analyzed. The survey instrument was designed to gather data about faculty, fellows, program curricula, and program directors (PDs). In addition, annual AMA/AAMC data from 1991 to the present was compiled to examine trends in the number of fellowship programs and the number of fellows. The overall survey response rate was 76% (96 of 126 PDs). Most (54%) of the PDs had been in their current position 4 or more years (range: <1-20 years), and 59% of PDs reported that they had completed formal geriatric medicine fellowship training. The number of fellowship programs and the number of fellows entering programs has slowly increased over the past decade. During 2001-02, 338 fellows were training in allopathic programs and seven in osteopathic programs (all years of training). Forty-six percent (n = 44) of responding programs offered only 1-year fellowship-training experiences. PDs reported that application rates for fellowship positions were stable during the academic years (AYs) 1999-2002, with the median number of applications per first year position available in AY 2000-01 being 10 (range: 1-77). In 2001-02, data from the AMA/AAMC National GME Census indicated a fill rate for first-year geriatric medicine fellowship positions of 69% (259 first-year fellows for 373 positions). During 2001-02, more than half of programs (53%) reported having two or fewer first-year fellows, whereas 31% had three or four first-year fellows. Thirty-three programs (36%) reported having no U.S. medical school graduate first-year fellows, and another 25 (28%) reported having only one. Of the 51 programs offering second-year fellowship training, PDs reported 61 post-first-year fellows (median 1, range: 0-7). During the past 10 years, 27 new allopathic geriatric medicine fellowship programs opened; there are now 119 programs. There are also seven osteopathic programs. The recruitment of high-quality U.S. medical school graduates into these programs remains a challenge for the discipline. Furthermore, the retention of first-year fellows for additional years of academic training has been difficult. Incentives will be needed to attract the best graduates of U.S. family practice and internal medicine training programs into academic careers in geriatric medicine.

Geriatric psychiatry fellowship programs in the United States: findings from the Association of Directors of Geriatric Academic Programs' longitudinal study of training and practice.

OBJECTIVE: The authors document the development and growth of geriatric psychiatry fellowship training in the United States (U.S.) through 2002. METHODS: A cross-sectional survey of the 62 U.S. geriatric psychiatry fellowship programs was conducted in Fall 2001. They also analyzed longitudinal data from the American Medical Association (AMA) and the Association of American Medical Colleges' (AAMC) National Graduate Medical Education (GME) Census, along with data from the Accreditation Council for Graduate Medical Education (ACGME). RESULTS: Forty-six (74%) of 62 training directors (TDs) responded. The number of fellowship programs has slowly increased over the past 7 years. During 2001-2002, a total of 94 fellows were in training (all years of training). Seventy-eight percent (N=36) of responding programs offered only 1-year fellowship training experiences. TDs reported that application rates for fellowship positions were stable during the academic years 1999-2002, with a median number of eight applications per program for first-year positions in 2001-2002. The fill-rate for first-year geriatric psychiatry fellowship positions dropped from 84% in 1999-2000 to 61% in 2001-2002. During 2001-2002, 73% of programs reported having two or fewer first-year fellows, and 16% had no first-year fellows. Seventeen programs reported having no U.S. medical school graduates (USMGs) as first-year fellows. CONCLUSION: Recruiting high-quality USMGs into geriatric psychiatry fellowship programs remains a challenge. Furthermore, retaining first-year fellows for additional years of academic training has been difficult. Findings indicate that specific strategies need to be developed to stimulate undergraduate and graduate interest in careers in clinical and academic geriatric psychiatry.