Olson, Shawn M.; Odo, Nnaemeka U.; Duran, Alisa M.; Pereira, Anne G.; Mandel, Jeffrey H.
Background Regular physical activity plays an important role in the amelioration of several mental health disorders; however, its relationship with burnout has not yet been clarified. Objective To determine the association between achievement of national physical activity guidelines and burnout in internal medicine resident physicians. Methods A Web-based survey of internal medicine resident physicians at the University of Minnesota and Hennepin County Medical Center was conducted from September to October 2012. Survey measures included the Maslach Burnout Inventory-Human Services Survey and the International Physical Activity Questionnaire. Results Of 149 eligible residents, 76 (51.0%) completed surveys, which were used in the analysis. Burnout prevalence, determined by the Maslach Burnout Inventory, was 53.9% (41 of 76). Prevalence of failure to achieve US Department of Health and Human Services physical activity guidelines was 40.8% (31 of 76), and 78.9% (60 of 76) of residents reported that their level of physical activity has decreased since they began medical training. Residents who were able to meet physical activity guidelines were less likely to be burned out than their fellow residents (OR, 0.38, 95% CI 0.147–0.99). Conclusions Among internal medicine resident physicians, achievement of national physical activity guidelines appears to be inversely associated with burnout. Given the high national prevalence of burnout and inactivity, additional investigation of this relationship appears warranted. PMID:26140116
Doolittle, Benjamin R; Windish, Donna M; Seelig, Charles B
Burnout in physicians is common, and studies show a prevalence of 30% to 78%. Identifying constructive coping strategies and personal characteristics that protect residents against burnout may be helpful for reducing errors and improving physician satisfaction. We explored the complex relationships between burnout, behaviors, emotional coping, and spirituality among internal medicine and internal medicine-pediatrics residents. We anonymously surveyed 173 internal medicine and medicine-pediatrics residents to explore burnout, coping, and spiritual attitudes. We used 3 validated survey instruments: the Maslach Burnout Inventory, the Carver Coping Orientation to Problems Experienced (COPE) Inventory, and the Hatch Spiritual Involvement and Beliefs Scale (SIBS). A total of 108 (63%) residents participated, with 31 (28%) reporting burnout. Residents who employed strategies of acceptance, active coping, and positive reframing had lower emotional exhaustion and depersonalization (all, P < .03). Residents who reported denial or disengagement had higher emotional exhaustion and depersonalization scores. Personal accomplishment was positively correlated with the SIBS total score (r = +.28, P = .003), as well as the internal/fluid domain (r = +.32, P = .001), existential axes (r = +.32, P = .001), and humility/personal application domain (r = +.23, P = .02). The humility/personal application domain also was negatively correlated with emotional exhaustion (r = -.20, P = .04) and depersonalization (r = -.25, P = .009). No activity or demographic factor affected any burnout domain. Burnout is a heterogeneous syndrome that affects many residents. We identified a range of emotional and spiritual coping strategies that may have protective benefit.
King, Kelvin; Camfield, Peter; Breau, Lynn
The objective of the study was to survey recently hired physicians to Canadian Academic Departments of Pediatric and Internal Medicine to understand the factors that underlay successful recruitment. Recruits and Chairs agreed on the 10 most important values. Chairs overvalued the 10 least important Recruit values. Statistical analysis revealed five core themes - in order of importance they are: family lifestyle and opportunities, compensation methodology, children/community (housing, schools, recreational), professional working conditions (technology, staffing, facilities), and academic opportunities. Core themes varied by demographics and academic profile.
Potts, J T
Despite some initial success in the early 1970s, the important goal of increasing the numbers of underrepresented minorities in medical school and on medical faculties has stalled short of proportionate representation. To further the current efforts of the Association of Professors in Medicine (APM) and other national medical groups that are devoted to improving the numbers of minorities in medicine, ideas and program information must be shared among institutions. In this spirit, we review our experience at Massachusetts General Hospital. We found that the first step toward this goal must be an institutional commitment based on increased awareness and on special effort focused on housestaff recruitment. Once the numbers of minorities increase, the department chairperson, training program directors, and other involved faculty can work with younger minority physicians; the cooperative relationship thus created can guide the development of a strong minority recruitment program without requiring an undue time commitment from minority trainees and faculty. The APM has a combined goal: to achieve early practical results in individual departments, to play a catalytic role with the community and other national medical organizations, and to increase the number of minorities entering medical school and careers in medicine generally.
Duncan Alan K
Full Text Available Abstract Background We sought to assess self-rated importance of the medical interview to clinical practice and competence in physician-patient communication among new internal medicine faculty at an academic medical center. Methods Since 2001, new internal medicine faculty at the Mayo Clinic College of Medicine (Rochester, Minnesota have completed a survey on physician-patient communication. The survey asks the new faculty to rate their overall competence in medical interviewing, the importance of the medical interview to their practice, their confidence and adequacy of previous training in handling eight frequently encountered challenging communication scenarios, and whether they would benefit from additional communication training. Results Between 2001 and 2004, 75 general internists and internal medicine subspecialists were appointed to the faculty, and of these, 58 (77% completed the survey. The faculty rated (on a 10-point scale the importance of the medical interview higher than their competence in interviewing; this difference was significant (average ± SD, 9.4 ± 1.0 vs 7.7 ± 1.2, P Conclusion Although new internal medicine faculty rate high the importance of the medical interview, they rate their competence and adequacy of previous training in medical interviewing relatively low, and many indicate that they would benefit from additional communication training. These results should encourage academic medical centers to make curricula in physician-patient communication available to their faculty members because many of them not only care for patients, but also teach clinical skills, including communication skills, to trainees.
Full Text Available Abstract Background Two striking demographic shifts evident in today's workforce are also apparent in the medical profession. One is the entry of a new generation of physicians, Gen Xers, and the other is the influx of women. Both shifts are argued to have significant implications for recruitment and retention because of assumptions regarding the younger generation's and women's attitudes towards work and patient care. This paper explores two questions regarding the generations: (1 How do Baby Boomer and Generation X physicians perceive the generation shift in work attitudes and behaviours? and (2 Do Baby Boomer and Generation X physicians differ significantly in their work hours and work attitudes regarding patient care and life balance? Gen Xers include those born between 1965 and 1980; Baby Boomers are those born between 1945 and 1964. We also ask: Do female and male Generation X physicians differ significantly in their work hours and work attitudes regarding patient care and life balance? Methods We conducted exploratory interviews with 54 physicians and residents from the Department of Medicine (response rate 91% and asked about their perceptions regarding the generation and gender shifts in medicine. We limit the analyses to interview responses of 34 Baby Boomers and 18 Generation Xers. We also sent questionnaires to Department members (response rate 66%, and this analysis is limited to 87 Baby Boomers' and 65 Generation Xers' responses. Results The qualitative interview data suggest significant generation and gender shifts in physicians' attitudes. Baby Boomers generally view Gen Xer physicians as less committed to their medical careers. The quantitative questionnaire data suggest that there are few significant differences in the generations' and genders' reports of work-life balance, work hours and attitudes towards patient care. Conclusion A combined qualitative and quantitative approach to the generation shift and gender shift in
Dulohery, Megan M; Stoven, Samantha; Kurklinsky, Andrew K; Kurklinksy, Andrew; Halvorsen, Andrew; McDonald, Furman S; Bhagra, Anjali
With the advent of compact ultrasound (US) devices, it is easier for physicians to enhance their physical examinations through the use of US. However, although this new tool is widely available, few internal medicine physicians have US training. This study sought to understand physicians' baseline knowledge and skill, provide education in US principles, and demonstrate that proper use of compact US devices is a skill that can be quickly learned. Training was performed at the Mayo Clinic in June 2010 and June 2011. The participants consisted of internal medicine residents. The workshop included didactics and hands-on US experiences with human and cadaver models in a simulation center. Pretests and posttests of residents' knowledge, attitudes, and skills with US were completed. We reassessed the 2010 group in the spring of 2012 with a long-term retention survey for knowledge and confidence in viewing images. A total of 136 interns completed the workshop. Thirty-nine residents completed the long-term retention survey. Posttest assessments showed a statistically significant improvement in the knowledge of US imaging, confidence in identifying structures, image identification, and image acquisition (P internal medicine training and practice. © 2014 by the American Institute of Ultrasound in Medicine.
Juan E Corral
Full Text Available Guatemala is currently undergoing an epidemiologic transition. Preventive services are key to reducing the burden of non-communicable diseases, and smoking counseling and cessation are among the most cost-effective and wide-reaching strategies. Internal medicine physicians are fundamental to providing such services, and their knowledge is a cornerstone of non-communicable disease control.A national cross-sectional survey was conducted in 2011 to evaluate knowledge of clinical preventive services for non-communicable diseases. Interns, residents, and attending physicians of the internal medicine departments of all teaching hospitals in Guatemala completed a self-administered questionnaire. Participants' responses were contrasted with the Guatemalan Ministry of Health (MoH prevention guidelines and the US Preventive Services Task Force (USPSTF recommendations. Analysis compared knowledge of recommendations within and between hospitals.In response to simulated patient scenarios, all services were recommended by more than half of physicians regardless of MoH or USPSTF recommendations. Prioritization was adequate according to the MoH guidelines but not including other potentially effective services (e.g. colorectal cancer and lipid disorder screenings. With the exception of colorectal and prostate cancer screening, less frequently recommended by interns, there was no difference in recommendation rates by level.Guatemalan internal medicine physicians' knowledge on preventive services recommendations for non-communicable diseases is limited, and prioritization did not reflect cost-effectiveness. Based on these data we recommend that preventive medicine training be strengthened and development of evidence-based guidelines for low-middle income countries be a priority.
Venta, Kimberly; Baker, Erin; Fidopiastis, Cali; Stanney, Kay
The purpose of this study was to investigate the potential of developing an EHR-based model of physician competency, named the Skill Deficiency Evaluation Toolkit for Eliminating Competency-loss Trends (Skill-DETECT), which presents the opportunity to use EHR-based models to inform selection of Continued Medical Education (CME) opportunities specifically targeted at maintaining proficiency. The IBM Explorys platform provided outpatient Electronic Health Records (EHRs) representing 76 physicians with over 5000 patients combined. These data were used to develop the Skill-DETECT model, a predictive hybrid model composed of a rule-based model, logistic regression model, and a thresholding model, which predicts cognitive clinical skill deficiencies in internal medicine physicians. A three-phase approach was then used to statistically validate the model performance. Subject Matter Expert (SME) panel reviews resulted in a 100% overall approval rate of the rule based model. Area under the receiver-operating characteristic curves calculated for each logistic regression curve resulted in values between 0.76 and 0.92, which indicated exceptional performance. Normality, skewness, and kurtosis were determined and confirmed that the distribution of values output from the thresholding model were unimodal and peaked, which confirmed effectiveness and generalizability. The validation has confirmed that the Skill-DETECT model has a strong ability to evaluate EHR data and support the identification of internal medicine cognitive clinical skills that are deficient or are of higher likelihood of becoming deficient and thus require remediation, which will allow both physician and medical organizations to fine tune training efforts. Copyright © 2017 Elsevier B.V. All rights reserved.
Gotlib Conn Lesley
Full Text Available Abstract Background Studies in General Internal Medicine [GIM] settings have shown that optimizing interprofessional communication is important, yet complex and challenging. While the physician is integral to interprofessional work in GIM there are often communication barriers in place that impact perceptions and experiences with the quality and quantity of their communication with other team members. This study aims to understand how team members’ perceptions and experiences with the communication styles and strategies of either hospitalist or consultant physicians in their units influence the quality and effectiveness of interprofessional relations and work. Methods A multiple case study methodology was used. Thirty-one semi-structured interviews were conducted with physicians, nurses and other health care providers [e.g. physiotherapist, social worker, etc.] working across 5 interprofessional GIM programs. Questions explored participants’ experiences with communication with all other health care providers in their units, probing for barriers and enablers to effective interprofessional work, as well as the use of communication tools or strategies. Observations in GIM wards were also conducted. Results Three main themes emerged from the data:  availability for interprofessional communication,  relationship-building for effective communication, and  physician vs. team-based approaches. Findings suggest a significant contrast in participants’ experiences with the quantity and quality of interprofessional relationships and work when comparing the communication styles and strategies of hospitalist and consultant physicians. Hospitalist staffed GIM units were believed to have more frequent and higher caliber interprofessional communication and collaboration, resulting in more positive experiences among all health care providers in a given unit. Conclusions This study helps to improve our understanding of the collaborative environment
Monti, Matteo; Gachoud, David
The Swiss postgraduate training program in general internal medicine is now designed as a competency-based curriculum. In other words, by the end of their training, the residents should demonstrate a set of predefined competences. Many of those competences have to be learnt in outpatient settings. Thus, the primary care physicians have more than ever an important role to play in educating tomorrows doctors. A competency-based model of training requires a regular assessment of the residents. The mini-CEX (mini-Clinical Evaluation eXercise) is the assessment tool proposed by the Swiss institute for postgraduate and continuing education. The mini-CEX is based on the direct observation of the trainees performing a specific task, as well as on the ensuing feedback. This article aims at introducing our colleagues in charge of residents to the mini-CEX, which is a useful tool promoting the culture of feedback in medical education.
Blumenthal, Daniel M; Olenski, Andrew R; Tsugawa, Yusuke; Jena, Anupam B
Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking. To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non-locum tenens physicians. A random sample of Medicare fee-for-service beneficiaries hospitalized during 2009-2014 was used to compare quality and costs of hospital care delivered by locum tenens and non-locum tenens internal medicine physicians. Treatment by locum tenens general internal medicine physicians. The primary outcome was 30-day mortality. Secondary outcomes included inpatient Medicare Part B spending, length of stay, and 30-day readmissions. Differences between locum tenens and non-locum tenens physicians were estimated using multivariable logistic regression models adjusted for beneficiary clinical and demographic characteristics and hospital fixed effects, which enabled comparisons of clinical outcomes between physicians practicing within the same hospital. In prespecified subgroup analyses, outcomes were reevaluated among hospitals with different levels of intensity of locum tenens physician use. Of 1 818 873 Medicare admissions treated by general internists, 38 475 (2.1%) received care from a locum tenens physician; 9.3% (4123/44 520) of general internists were temporarily covered by a locum tenens physician at some point. Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non-locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non-locum tenens physicians (n = 44 520 physicians), was not associated with a significant difference in 30-day mortality (8.83% vs 8.70%; adjusted difference, 0.14%; 95% CI, -0.18% to 0.45%). Patients treated by locum tenens physicians had significantly higher Part B spending ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 to $154
Duarte, Jurandir Godoy; Azevedo, Raymundo Soares
To evaluate the satisfaction and expectations of patients and physicians before and after the implementation of an electronic health record (EHR) in the outpatient clinic of a university hospital. We conducted 389 interviews with patients and 151 with physicians before and after the implementation of a commercial EHR at the internal medicine clinic of Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HC-FMUSP), Brazil. The physicians were identified by their connection to the outpatient clinic and categorized by their years since graduation: residents and preceptors (with 10 years or less of graduation) or assistants (with more than 10 years of graduation). The answers to the questionnaire given by the physicians were classified as favorable or against the use of EHR, before and after the implementation of this system in this clinic, receiving 1 or 0 points, respectively. The sum of these points generated a multiple regression score to determine which factors contribute to the acceptance of EHR by physicians. We also did a third survey, after the EHR was routinely established in the outpatient clinic. The degree of patient satisfaction was the same before and after implementation, with more than 90% positive evaluations. They noted the use of the computer during the consultation and valued such use. Resident (younger) physicians had more positive expectations than assistants (older physicians) before EHR implementation. This optimism was reduced after implementation. In the third evaluation the use of EHR was higher among resident physicians. Resident physicians perceived and valued the EHR more and used it more. In 28 of the 57 questions on performance of clinical tasks, resident physicians found it easier to use EHR than assistant physicians with significant differences (pclinical setting should be preceded by careful planning to improve physician's adherence to the use of EHR. Patients do not seem to notice much difference to the
Wietholter, Jon P; Ponte, Charles D; Long, Dustin M
Few publications have addressed the perceptions of pharmacists and physicians regarding the value of clinical pharmacist services. A survey-based study was conducted to determine whether Internal Medicine (IM) and Family Medicine (FM) pharmacists and physicians differed in their attitudes regarding the benefits of collaboration in an acute care setting. The primary objective was to evaluate perceived differences regarding self-assessment of value between IM and FM pharmacists. The secondary objective was to evaluate perceived differences of clinical pharmacist benefit between IM and FM physicians. An eight-item questionnaire assessed the attitudes and beliefs of pharmacists and physicians regarding the value of clinical pharmacy services. Surveys were emailed and participants marked their responses using a 7-point Likert scale for each item. Demographic data and overall comments were collected from each participant. Overall, 167 surveys were completed. When comparing cumulative physician and pharmacist responses, none of the eight questions showed significant differences. Statistically significant differences were noted when comparing IM and FM clinical pharmacists on five of the eight survey items; for each of these items, FM pharmacists had more favourable perceptions than their IM counterparts. No statistically significant differences were noted when comparing responses of IM and FM physicians. This study found that FM pharmacists perceived a greater benefit regarding participation in inpatient acute care rounds when compared to their IM pharmacist counterparts. Future studies are necessary to determine if other medical specialties' perceptions of clinical pharmacy provision differ from our findings and to evaluate the rationale behind specific attitudes and behaviours. © 2016 Royal Pharmaceutical Society.
Jackson, Angela; Baron, Robert B; Jaeger, Jeffrey; Liebow, Mark; Plews-Ogan, Margaret; Schwartz, Mark D
The Graduate Medical Education (GME) system in the United States (US) has garnered worldwide respect, graduating over 25,000 new physicians from over 8,000 residency and fellowship programs annually. GME is the portal of entry to medical practice and licensure in the US, and the pathway through which resident physicians develop the competence to practice independently and further develop their career plans. The number and specialty distribution of available GME positions shapes the overall composition of our national workforce; however, GME is failing to provide appropriate programs that support the delivery of our society's system of healthcare. This paper, prepared by the Health Policy Education Subcommittee of the Society of General Internal Medicine (SGIM) and unanimously endorsed by SGIM's Council, outlines a set of recommendations on how to reform the GME system to best prepare a physician workforce that can provide high quality, high value, population-based, and patient-centered health care, aligned with the dynamic needs of our nation's healthcare delivery system. These recommendations include: accurate workforce needs assessment, broadened GME funding sources, increased transparency of the use of GME dollars, and implementation of incentives to increase the accountability of GME-funded programs for the preparation and specialty selection of their program graduates.
Internal Medicine can be defined as a medical specialty devoted to the comprehensive care of adult patients, focused in the diagnosis and non surgical treatment of diseases affecting internal organs and systems (excluding gyneco-obstetrical problems) and the prevention of those diseases. This position paper reviews the history of Internal Medicine, the birth of its subspecialties and the difficulties faced by young physicians when they decide whether to practice as internist or in a subspecialty. In Chile as in most occidental countries formal training in a subspecialty of internal medicine requires previous certification in internal medicine but the proportion of young physicians who remain in practice as general internists appears to be considerably lower than those who choose a subspecialty. The main reasons for this unbalance can be related to financial advantages (by the practice of specialized technologies) and the patients' tendency to request direct assistance by a professional thought to be better qualified to take care of their specific problems. Training programs in internal medicine should consider a greater emphasis in comprehensive outpatient care instead of the traditional emphasis for training in hospital wards.
von Babo, Michelle; Chmiel, Corinne; Müggler, Simon Andreas; Rakusa, Julia; Schuppli, Caroline; Meier, Philipp; Fischler, Manuel; Urner, Martin
Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.
Hallas, P; Folkestad, L; Brabrand, M
AIM: To establish the level of training doctors who participate in interhospital transfers in Denmark. METHODS: A questionnaire was sent to every hospital department in Denmark with acute internal medicine admissions. RESULTS: Eighty-nine internal medicine departments were contacted and 84...... responded (response rate 94.4%). Of the 84 hospitals, 75 (89.3%) indicated that they perform interhospital transfers. Most transfers were performed by interns (61.3%) or senior house officers (10.7%) with only a few months' experience in their current speciality. Training in interhospital transfer...
Knowledge, attitudes and barriers regarding vaccination against hepatitis A and B in patients with chronic hepatitis C virus infection: a survey of family medicine and internal medicine physicians in the United States.
Tenner, C T; Herzog, K; Chaudhari, S; Bini, E J; Weinshel, E H
Although vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for all patients with chronic hepatitis C virus (HCV) infection, physician vaccination practices are suboptimal. Since training for family medicine (FM) and internal medicine (IM) physicians differ, we hypothesised that there are differences in knowledge, attitudes and barriers regarding vaccination against HAV and HBV in patients with chronic HCV between these two groups. A two-page questionnaire was mailed to 3000 primary care (FM and IM) physicians randomly selected from the AMA Physician Masterfile in 2005. The survey included questions about physician demographics, knowledge and attitudes regarding vaccination. Among the 3000 physicians surveyed, 1209 (42.2%) returned completed surveys. There were no differences between respondents and non-respondents with regard to age, gender, geographic location or specialty. More FM than IM physicians stated that HCV+ patients should not be vaccinated against HAV (23.7% vs. 11.8%, p infection, physicians often do not test or vaccinate susceptible individuals. Interventions are needed to overcome the barriers identified and improve vaccination rates. © 2012 Blackwell Publishing Ltd.
1 Mayo Clinic Hospitals, Division of Hospital Internal Medicine, Rochester, Minn, USA ... Obstetric physicians have a specific role in managing pregnant and postpartum women with ... problems may also affect pregnancy outcomes, with increased risk of ... greatly benefited from good control of her diabetes and hypertension.
Michelle von Babo
Full Text Available Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland.In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed.560 physicians of 71 hospitals (64% responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women. 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients.This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.
Chee, Y C
This paper is divided into 4 parts. The first deals with the definition of specialties and traces its roots from the early 20th century in the United States of America with the formation and growth of Specialty Boards. The second is a reflection on the scene in Singapore from the 1960s to the present, describing the change from public healthcare institutions run by the civil service to the autonomous restructured public service hospitals towards the end of the 20th century. The third section deals with what the 4ps have expressed about changes necessary to the Singapore system in the 21st century. The 4ps are the politicians, the payers, the patients and the public. It is about value for money, better coordination and better communication. Finally, just what is Internal Medicine - its competencies and its practice. A review of the systems in Australia, New Zealand, and the USA is presented. The idea of the "hospitalist" is discussed. Concluding remarks deal with the viability of Internal Medicine because of low reimbursement, administrative burdens and brief patient visits.
[Work and Training Conditions of Young German Physicians in Internal Medicine - Results of a Second Nationwide Survey by Young Internists from the German Society of Internal Medicine and the German Professional Association of Internists.
Raspe, Matthias; Vogelgesang, Anja; Fendel, Johannes; Weiß, Cornelius; Schulte, Kevin; Rolling, Thierry
Medical specialty training is the basis for career development of young internists and it is vital for the delivery of high-quality medical care. In 2014 the young internists of two professional bodies in Germany conducted a survey among their young members and described major factors influencing training and working conditions. We present the results of a follow-up survey to describe changes of these factors over time. An additional focus is set on the difficulties of balancing medical career and family. In the end of 2016 we conducted an online-based survey of all members in training of the German Society of Internal Medicine (DGIM) and the Professional Association of German Internists (BDI). The questionnaire used in the 2014 survey was modified and items investigating the balance between career and family were added. A total of 1587 questionnaires were returned and analysed. Mayor findings did not change over time. Psychosocial strain remains very high among medical trainees in internal medicine. A structured training curriculum and meaningful feedback are associated with lower psychosocial strain and higher work satisfaction. Internists - and here especially women - with children experience the daily balance of medical career and family as extremely challenging. These results demonstrate that there is still a serious need for adjusting training and working conditions of young internists in Germany. Especially the role and increasing importance of female physicians has to be recognized by enabling a successful integration of medical career and family. © Georg Thieme Verlag KG Stuttgart · New York.
Langewitz, Wolf A; Loeb, Yael; Nübling, Matthias; Hunziker, Sabina
An increasing number of consultations are delivered in group practices, where a stable 1:1 relationship between patient and physician cannot be guaranteed. Therefore, correct documentation of the content of a consultation is crucial to hand over information from one health care professional to the next. We randomly selected 20 interviews from a series of 56 videotaped consultations with patients requesting a general check-up exam in the outpatient department of Internal Medicine at the University Hospital Basel. All patients actively denied having any symptoms or specific health concerns at the time they made their appointment. Videotapes were analysed with the Roter Interaction Analysis System (RIAS). Corresponding physician notes were analysed with a category check-list that contained the information related items from RIAS. Interviews contained a total of 9.002 utterances and lasted between 15 and 53min (mean duration: 37min). Patient-centred communication (Waiting, Echoing, Mirroring, Summarising) in the videos significantly correlated with the amount of information presented by patients: medical information (r=.57; p=.009), therapeutic information (r=.50; p=.03), psychosocial information (r=.41; p=.07), life style information (r=.52; p=.02), and with the sum of patient information (r=.64; p=.003). Even though there was a significant correlation between the amount of information from the video and information in physician's notes in some categories (patient gives medical information; Pearson's r=.45; p=.05, patient gives psychosocial information; Pearson's r=.49; p=.03), an inspection of the regression lines shows that a large extent of patient information is omitted from the charts. Physicians never discussed with patients whether information should be documented in the charts or omitted. The use of typical patient-centred techniques increases information gathered from patients. Physicians document only a small percentage of patient information in the charts
The purpose of this study was to define and describe the personal and professional profile of mountain medicine physicians including general physical training information and to include a detailed overview of the practice of mountain sports. A group of physicians participating in a specialized mountain medicine education program filled out a standardized questionnaire. The data obtained from this questionnaire were first analyzed in a descriptive way and then by statistical methods (chi2 test, t test, and analysis of variance). Detailed results have been provided for gender, age, marital status, general training frequency and methods, professional status, additional medical qualifications, memberships in professional societies and alpine clubs, mountain sports practice, and injuries sustained during the practice of mountain sports. This study has provided a detailed overview concerning the personal and professional profile of mountain medicine physicians. Course organizers as well as official commissions regulating the education in mountain medicine will be able to use this information to adapt and optimize the courses and the recommendations/requirements as detailed by the UIAA-ICAR-ISMM (Union Internationale des Associations Alpinistes, International Commission for Alpine Rescue, International Society for Mountain Medicine).
Paltved, Charlotte; Musaeus, Peter
Aim: This study aims to systematically review the qualitative research studying Emergency Medicine (EM) physicians in Emergency Departments (ED). Background: Qualitative research aims to study complex social phenomena. EM is a highly complex medical and social environment that can be investigated...... with qualitative research. Methods: Electronic databases of English peer-reviewed articles were searched from 1971 to 2012 using Medline through PubMed and PsychINFO. This search was supplemented with hand-searches of Academic Emergency Medicine and Emergency Medicine Journal from 1999 to 2012 and cross references...... and training, communication, professional roles, and organizational factors, and into 12 sub-themes. Conclusion: The strength of qualitative research is its ability to grasp and operationalize complex relations within EM. Although qualitative research methodologies have gained in rigour in recent years and few...
West, Colin P; Dupras, Denise M
Current medical training models in the United States are unlikely to produce sufficient numbers of general internists and primary care physicians. Differences in general internal medicine (GIM) career plans between internal medicine residency program types and across resident demographics are not well understood. To evaluate the general medicine career plans of internal medicine residents and how career plans evolve during training. A study of US internal medicine residents using an annual survey linked to the Internal Medicine In-Training Examination taken in October of 2009-2011 to evaluate career plans by training program, sex, and medical school location. Of 67,207 US eligible categorical and primary care internal medicine residents, 57,087 (84.9%) completed and returned the survey. Demographic data provided by the National Board of Medical Examiners were available for 52,035 (77.4%) of these residents, of whom 51,390 (76.5%) responded to all survey items and an additional 645 (1.0%) responded to at least 1 survey item. Data were analyzed from the 16,781 third-year residents (32.2%) in this sample. Self-reported ultimate career plans of internal medicine residents. A GIM career plan was reported by 3605 graduating residents (21.5%). A total of 562 primary care program (39.6%) and 3043 categorical (19.9%) residents reported GIM as their ultimate career plan (adjusted odds ratio [AOR], 2.76; 99% CI, 2.35-3.23; P international medical graduates (22.0% vs 21.1%, respectively; AOR, 1.76; 99% CI, 1.50-2.06; P international medical graduates (57.3% vs 27.3%, respectively; AOR, 3.48; 99% CI, 2.58-4.70; P internal medicine residents, including those in primary care training programs, and differed according to resident sex, medical school location, and program type.
Stache, Stephen; Howell, David; Meehan, William P
The primary purpose of this study was to examine concussion management practice patterns among sports medicine physicians in the United States. Cross-sectional study using a web-based survey. Members of the American Medical Society for Sports Medicine (AMSSM). We distributed a questionnaire to physician members of the AMSSM assessing the current practices for evaluating and managing concussions sustained during sports. Specifically, we asked respondents about their use of management guidelines, medications, balance assessments, neuropsychological tests, and return-to-play strategies. Of the 3591 members emailed, 425 (11.8%) respondents responded. Ninety-seven percent of respondents reported basing current management of sport-related concussion on a published set of criteria, with a majority (91.9%) following the guidelines provided by the Fourth International Conference on Concussion in Sport. Seventy-six percent of respondents reported using medication beyond 48 hours postinjury. Acetaminophen was reported as the most commonly administered medication, although tricyclic antidepressants and amantadine were also commonly administered. Vitamins, minerals, and dietary supplements were also reported as commonly administered. Most respondents reported using a form of neuropsychological testing (87.1%). A majority of respondents (88.6%) reported allowing athletes to return to competition after concussion only once the athlete becomes symptom free and completes a return-to-play protocol. Most sports medicine physicians seem to use recently developed guidelines for concussion management, regularly use medications and neuropsychological testing in management strategies, and follow established return-to-play guidelines. Sports medicine physicians seem to have clinical expertise in the management of sport-related concussion.
Litchy, Andrew P
The use of Complimentary and Alternative Medicine (CAM) is increasing in the United States; there is a need for physician level practitioners who possess extensive training in both CAM and conventional medicine. Naturopathic physicians possess training that allows integration of modern scientific knowledge and the age-old wisdom of natural healing techniques. Naturopathic philosophy provides a framework to implement CAM in concert with conventional therapies. The naturopathic physician's expertise in both conventional medicine and CAM allows a practice style that provides excellent care through employing conventional and CAM modalities while utilizing modern research and evidence-based medicine.
López-Jiménez, Francisco; Brito, Máximo; Aude, Y. Wady; Scheinberg, Phillip; Kaplan, Mariana; Dixon, Denise A.; Schneiderman, Neil; Trejo, Jorge F.; López-Salazar, Luis Humberto; Ramírez-Barba, Ector Jaime; Kalil, Roberto; Ortiz, Carmen; Goyos, José; Buenaño, Alvaro; Kottiech, Samer; Lamas, Gervasio A.
More than 500,000 new medical articles are published every year and available time to keep updated is scarcer every day. Nowadays, the task of selecting useful, consistent, and relevant information for clinicians is a priority in many major medical journals. This review has the aim of gathering the results of the most important findings in clinical medicine in the last few years. It is focused on results from randomized clinical trials and well-designed observational research. Findings were included preferentially if they showed solid results, and we avoided as much as possible including only preliminary data, or results that included only non-clinical outcomes. Some of the most relevant findings reported here include the significant benefit of statins in patients with coronary artery disease even with mean cholesterol level. It also provides a substantial review of the most significant trials assessing the effectiveness of IIb/IIIa receptor blockers. In gastroenterology many advances have been made in the H. pylori eradication, and the finding that the cure of H. pylori infection may be followed by gastroesophageal reflux disease. Some new antivirals have shown encouraging results in patients with chronic hepatitis. In the infectious disease arena, the late breaking trials in anti-retroviral disease are discussed, as well as the new trends regarding antibiotic resistance. This review approaches also the role of leukotriene modifiers in the treatment of asthma and discusses the benefit of using methylprednisolone in patients with adult respiratory distress syndrome, among many other advances in internal medicine. PMID:11068074
Borges, Nicole J.; Navarro, Anita M.; Grover, Amelia C.
Purpose Despite recent efforts to understand the complex process of physician career development, the medical education community has a poor understanding of why, how, and when women physicians embark on a career in academic medicine. Method In 2010, the authors phone-interviewed women physicians in academic medicine regarding why, how, and when they chose an academic medicine career. Project investigators first individually and then collectively analyzed transcripts to identify themes in the data. Results Through analyzing the transcripts of the 53 interviews, the investigators identified five themes related to why women choose careers in academic medicine: fit, aspects of the academic health center environment, people, exposure, and clincial medicine. They identified five themes related to how women make the decision to enter academic medicine: change in specialty, dissatisfaction with former career, emotionality, parental influence, and decision-making styles. The authors also identified four themes regarding when women decide to enter academic medicine: as a practicing phyisican, fellow, resident, or medical student. Conclusions Choosing a career in academic medicine is greatly influenced by the environment in which one trains and by people—be they faculty, mentors, role models, or family. An interest in teaching is a primary reason women choose a career in academic medicine. Many women physicians entering acadmic medicine chose this after or during fellowship, which is when they became more aware of academic medicine as a possible career. For many women, choosing academic medicine was not necessarily an active, planned decision; rather it was serendipitous or circumstantial. PMID:22104052
Matlow, Anne; Chan, Ming-Ka; Bohnen, Jordan David; Blumenthal, Daniel Mark; Sánchez-Mendiola, Melchor; de Camps Meschino, Diane; Samson, Lindy Michelle; Busari, Jamiu
Purpose Physicians are often ill-equipped for the leadership activities their work demands. In part, this is due to a gap in traditional medical education. An emergent international network is developing a globally relevant leadership curriculum for postgraduate medical education. The purpose of this article is to share key learnings from this process to date. Design/methodology/approach The Toronto International Summit on Leadership Education for Physicians (TISLEP) was hosted by the Royal College of Physicians and Surgeons of Canada, and the University of Toronto's Faculty of Medicine and Institute of Health Policy, Management and Evaluation. Of 64 attendees from eight countries, 34 joined working groups to develop leadership competencies. The CanMEDS Competency Framework, stage of learner development and venue of learning formed the scaffold for the work. Emotional intelligence was selected as the topic to test the feasibility of fruitful international collaboration; results were presented at TISLEP 2015. Findings Dedicated international stakeholders engaged actively and constructively through defined working groups to develop a globally relevant, competency-based curriculum for physician leadership education. Eleven principles are recommended for consideration in physician leadership curriculum development. Defining common language and taxonomy is essential for a harmonized product. The importance of establishing an international network to support implementation, evaluation, sustainability and dissemination of the work was underscored. Originality/value International stakeholders are collaborating successfully on a graduated, competency-based leadership curriculum for postgraduate medical learners. The final product will be available for adaptation to local needs. An international physician leadership education network is being developed to support and expand the work underway.
Macdonald, C; Cawood, T
Numerous factors influence career decisions for internal medicine trainees and Fellows. There is a perception that a greater emphasis is placed on work-family balance by younger physicians. To determine the characteristics of the modern internal medicine workforce and ascertain whether job flexibility is important to career decision-making. We hypothesised that factors which reflect flexibility would be highly influential in decision-making, especially for women and those with young children. A questionnaire was mailed to 250 New Zealand internal medicine trainees and Fellows. It focused on factors, including job flexibility, interest and collegial support, and included demographic details which were primarily aimed at ascertaining family responsibilities. Response rate was 54%. The majority of female physicians are the main person responsible for their children (62%), and the majority of their partners work full-time (80%). This contrasts with male physicians, of whom only 4% are the main person responsible for their children. Flexibility was found to be more influential in women, those with young children, trainees and those working in outpatient-based subspecialties. However, contrary to our original hypothesis, flexibility was not reported to be highly influential in any group, with career choice being most influenced by interest and enjoyment, intellectual challenge and variety within the job. It is hoped that results will inform employers and those involved with training to enable them to better cater for the needs of the workforce and also encourage trainees to consider future family commitments when making career decisions. © 2012 The Authors. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.
Adheed Khalid Sharrad
Full Text Available BackgroundThe use of cheaper generic medicines is a strategy promotedin many countries to reduce rising health care costs. The aimof this study was to explore factors affecting generic medicineprescribing by physicians in Basrah, Iraq.MethodologyA purposive sample of ten physicians practicing in Basrahwas interviewed using a semi-structured interview guide.ResultsAnalysis of the interviews identified seven major themes:medicine prescribing practice, knowledge of therapeuticequivalency of generic medicine, patients’ acceptance ofgeneric medicine, counterfeit medicine, drug informationsource and effect of drug advertising on medicines choice,brand substitution practice by community pharmacists, and,finally strategies to improve generic medicine usefulness.Participants identified helpful strategies to increase genericprescribing including; physician and patient education ongeneric medicine; persuading physicians about the safety andefficacy of generic medicines; and finally educating seniormedical students on generic prescribing.ConclusionThe data suggest that participants were enthusiasticabout prescribing generic medicines. However physiciansinsist that pharmacists should not be allowed tosubstitute generic drugs without prior approval ofdoctors.
Golnik, Allison E.; Ireland, Marjorie
Previous studies suggest over half of children with autism are using complementary alternative medicine (CAM). In this study, physicians responded (n = 539, 19% response rate) to a survey regarding CAM use in children with autism. Physicians encouraged multi-vitamins (49%), essential fatty acids (25%), melatonin (25%) and probiotics (19%) and…
Fisher, Carla L; Ledford, Christy J W; Moss, David A; Crawford, Paul
Integrating complementary therapies (acupuncture) into conventional medicine has garnered recent support. Given the health benefits, low cost, and minimal risks, the military has advocated for acupuncture and begun training family medicine physicians. Little is known about the role of physician communication in patients' acupuncture engagement (uptake and adherence) in conventional medicine settings. We interviewed physicians (N = 15) and patients (N = 17) to capture physician communication they perceived affected treatment engagement. Data for each group were thematically analyzed. Physicians and patients prioritized different communication approaches and associated strategies. Physicians identified four approaches that enhance treatment engagement: (1) using shared decision-making (e.g., treatment options); (2) not being pushy (e.g., in tone); (3) carefully choosing language (e.g., Eastern versus Western terms); and (4) explaining treatment outcomes (e.g., efficacy). Patients also prioritized explaining treatment outcomes but differently (e.g., timing clarity), with two additional approaches: (5) talking with the same physician (e.g., continuity) and (6) being responsive to patient (e.g., flexibility). Findings highlight how physicians and patients prioritize patient-centered communication differently and how it is embedded within a unique, complex therapy. Data showcase authentic narratives that could be translated into physician communication skills training to promote treatment engagement in integrative care.
Lockyer, Jocelyn M; Violato, Claudio; Fidler, Herta; Alakija, Pauline
There is increasing interest in ensuring that physicians demonstrate the full range of Accreditation Council for Graduate Medical Education competencies. To determine whether it is possible to develop a feasible and reliable multisource feedback instrument for pathologists and laboratory medicine physicians. Surveys with 39, 30, and 22 items were developed to assess individual physicians by 8 peers, 8 referring physicians, and 8 coworkers (eg, technologists, secretaries), respectively, using 5-point scales and an unable-to-assess category. Physicians completed a self-assessment survey. Items addressed key competencies related to clinical competence, collaboration, professionalism, and communication. Data from 101 pathologists and laboratory medicine physicians were analyzed. The mean number of respondents per physician was 7.6, 7.4, and 7.6 for peers, referring physicians, and coworkers, respectively. The reliability of the internal consistency, measured by Cronbach alpha, was > or = .95 for the full scale of all instruments. Analysis indicated that the medical peer, referring physician, and coworker instruments achieved a generalizability coefficient of .78, .81, and .81, respectively. Factor analysis showed 4 factors on the peer questionnaire accounted for 68.8% of the total variance: reports and clinical competency, collaboration, educational leadership, and professional behavior. For the referring physician survey, 3 factors accounted for 66.9% of the variance: professionalism, reports, and clinical competency. Two factors on the coworker questionnaire accounted for 59.9% of the total variance: communication and professionalism. It is feasible to assess this group of physicians using multisource feedback with instruments that are reliable.
Koike, Soichi; Matsumoto, Masatoshi; Ide, Hiroo; Kawaguchi, Hideaki; Shimpo, Masahisa; Yasunaga, Hideo
Establishing and managing a board certification system is a common concern for many countries. In Japan, the board certification system is under revision. The purpose of this study was to describe present status of internal medicine specialist board certification, to identify factors associated with maintenance of board certification and to investigate changes in area of practice when physicians move from hospital to clinic practice. We analyzed 2010 and 2012 data from the Survey of Physicians, Dentists and Pharmacists. We conducted logistic regression analysis to identify factors associated with the maintenance of board certification between 2010 and 2012. We also analyzed data on career transition from hospitals to clinics for hospital physicians with board certification. It was common for physicians seeking board certification to do so in their early career. The odds of maintaining board certification were lower in women and those working in locations other than academic hospitals, and higher in physicians with subspecialty practice areas. Among hospital physicians with board certification who moved to clinics between 2010 and 2012, 95.8% remained in internal medicine or its subspecialty areas and 87.7% maintained board certification but changed their practice from a subspecialty area to more general internal medicine. Revisions of the internal medicine board certification system must consider different physician career pathways including mid-career moves while maintaining certification quality. This will help to secure an adequate number and distribution of specialists. To meet the increasing demand for generalist physicians, it is important to design programs to train specialists in general practice.
Edwards, Asher; Nam, Samuel
As the baby boomer generation ages, the need for palliative care services will be paramount and yet training for palliative care physicians is currently inadequate to meet the current palliative care needs. Nonspecialty-trained physicians will need to supplement the gap between supply and demand. Yet, no uniform guidelines exist for the training of internal medicine residents in palliative care. To our knowledge, no systematic study has been performed to evaluate how internal medicine residencies currently integrate palliative care into their training. In this study, we surveyed 338 Accreditation Council for Graduate Medical Education-accredited internal medicine program directors. We queried how palliative care was integrated into their training programs. The vast majority of respondents felt that palliative care training was "very important" (87.5%) and 75.9% of respondents offered some kind of palliative care rotation, often with a multidisciplinary approach. Moving forward, we are hopeful that the data provided from our survey will act as a launching point for more formal investigations into palliative care education for internal medicine residents. Concurrently, policy makers should aid in palliative care instruction by formalizing required palliative care training for internal medicine residents.
Doshi, Tina L; Bicket, Mark C
Despite a growing awareness about the importance of gender equity and the rising number of women in medicine, women remain persistently underrepresented in pain medicine and anesthesiology. Pain medicine ranks among the bottom quartile of medical specialties in terms of female applicants, female trainees, and proportion of female practitioners. Female pain medicine physicians are also notably disadvantaged compared with their male colleagues in most objective metrics of gender equity, which include financial compensation, career advancement, public recognition, and leadership positions. Increased gender diversity among pain medicine physicians is vital to fostering excellence in pain research, education, and clinical care, as well as creating a high-quality work environment. Pain medicine stands at a crossroads as a specialty, and must examine reasons for its current gender gap and consider a call to action to address this important issue.
This research investigates e-learning readiness level of family medicine physicians (FM) in Turkey. The study measures the level of e-learning readiness of Turkish FM physicians by an online e-learning readiness survey. According to results five areas are ready at Turkish FM physicians but need a few improvements:…
Soltanifar, Atefeh; Pishbin, Elham; Attaran Mashhadi, Negin; Najaf Najafi, Mona; Siahtir, Maryam
The challenging and stressful nature of emergency medicine place the practitioners of this young branch of medicine at risk of burnout. In Iran, the number of women choosing the specialty of emergency medicine has been increasing in recent years. No studies have focused on burnout among female emergency medicine physicians. We conducted this study to evaluate the level of burnout in female emergency medicine physicians in Iran. In this cross-sectional study, all Iranian female emergency medicine physicians with more than 2 years of work experience as specialists, received a questionnaire containing 22-item Maslach Burnout Inventory scales and 7-item Cassidy social support scale, as well as questions about workload and career satisfaction. In total, 77 questionnaires were analysed (response rate: 75%; median age: 36 years, median for work experience = 3 years). A total of 34% of participants were academic faculties. The level of burnout in three subscales of emotional exhaustion, depersonalisation and perceived low personal accomplishment was moderate to high in 84.5, 48.1 and 80.5% of participants respectively. A total of 94.8% of female emergency medicine physicians perceived their workload to be moderate to high and only 1.3% of them had high job satisfaction. Alarming high rate of burnout and job dissatisfaction among female emergency medicine physicians in our study requires careful attention. Further investigations are suggested to identify the contributory factors to burnout and the probability of some gender disparities in this field. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Puchalski, Krzysztof; Korzeniowska, Elzbieta; Pyzalski, Jacek; Wojtaszczyk, Patrycja
According to the current Polish legislation on occupational health services, occupational medicine physicians should perform workplace health promotion (WHP) activities as a part of their professional work. The concept of workplace health promotion or health promotion programs, however, has not been defined in this legislation in any way. Therefore, two essential questions arise. First, what is the physicians' attitude towards workplace health issues and second, what is actually carried out under the label of health promotion? The main objective of the research described in this paper was to answer these questions. The survey was carried out by the National Center for Workplace Health Promotion in 2002. A questionnaire prepared by the Center for the purpose of this survey was sent to a random sample of occupational medicine physicians. The results of the survey showed that 53% of occupational medicine physicians consider WHP just as a new name for prophylactics. On the other hand almost all of the respondents (94%) agree that occupational medicine physicians should perform WHP activities and find them useful in improving patients' health (78%). The main obstacle for the development of this activity in the perception of physicians is the lack of interest in workplace health promotion among employers (86%). In the modern understanding of workplace health promotion concept this type of intervention includes not only safety measures and health education, but also a profound organizational change that allows employers, employees and social partners to improve wellbeing of people at work. Each of such projects should facilitate changes necessary to create a health promoting workplace. It also needs a skilled leader--well trained and aware of a multidisciplinary dimension of WHP interventions. Occupational medicine specialists should become natural partners of employers and employees. The majority of the occupational medicine physicians, however, are not sufficiently
Salive, M E
A shortage of preventive medicine (PM) physicians exists in the United States. Researchers know little about these physicians' earnings and practice characteristics. The American College of Preventive Medicine (ACPM) mailed a survey to all self-identified PM physicians on the American Medical Association (AMA) Physician Masterfile. A total of 3,771 (54%) responded; respondents' sex and region of residence were typical for PM physicians in general, with a slight excess of older physicians and those reporting board certification. A total of 2,664 (71%) were working full time, with median earnings of $85,000 (mean $90,000). Among full-time physicians, relatively higher earnings were associated with the following characteristics: male sex; age 45 to 64 years; major source of income from clinical, business, or industrial sources, rather than governmental or academic; and PM board certification. Full-time PM physicians earned much less than office-based private practitioners in several primary care specialties in 1989. The gap in earnings between PM specialists in government positions and those in the private sector is also substantial. Both disparities may require creative solutions.
Al-Tubaikh, Jarrah Ali; Sabah Hospital, Kuwait
This book explains how radiology can be a powerful tool for establishing the diagnosis of many internal medicine diseases that are usually diagnosed on the basis of their laboratory or clinical presentation. It is organized in the classic fashion for internal medicine books, with eleven chapters covering the different internal medicine specialties. Within these chapters, more than 450 diseases are considered, some of which are rarely encountered but are nonetheless significant. For each disease, radiological and clinical features are displayed in images and high-quality digital medical illustrations, and those differential diagnoses are identified that can be ruled out by imaging alone. In addition, the pathophysiology underlying the radiological features is described, enabling the reader to understand why a particular sign is seen on MR images, CT scans, or plain radiographs. The book will serve as an excellent radiological atlas for internal medicine practitioners and family physicians, showing disease presentations that may be hard to find in standard medical textbooks and explaining which imaging modalities are likely to be most informative in particular patients. (orig.)
Koller, Dionne L
The recognition of sports medicine and promulgation of practice guidelines for team physicians will push general medical malpractice standards to evolve into a more specialized standard of care for those who practice in this area. To the extent that practicing medicine in the sports context involves calculations that do not arise in typical medical practice, the sports medicine community can help elucidate those issues and create appropriate guidelines that can serve to inform athlete-patients and educate courts. Doing so will help best set the terms by which those who practice sports medicine are judged. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available BACKGROUND The neurosurgical patient is often a real challenge for the physicians, because of a frequent multimorbidity and a higher risk for severe complications. Cooperation between internal medicine specialist and neurosurgeon is essential to prevent the fatal effects of cranial and spinal injuries. The topic issues of medical interest in neurosurgery are the disorders of sodium balance, the glycemic control, the thromboembolic risk, the intracerebral bleeding management and the infective problems. The neurosurgeons could be worried by treating these complications that are mostly of internal medicine interest and that could unfortunately rise the risk of death or irreversible insults. AIM OF THE REVIEW This review summarizes the modality of diagnosis and therapy of the foremost concerns in neurosurgical field.
The number of women in medicine has increased dramatically in the last few decades, and women now represent half of all incoming medical students. Yet residency training still resembles the historical model when there were few women in medicine. This article reviews the issues facing women in residency today. Data suggest that the experience of female residents is more negative than that of males. Unique challenges facing female residents include the existence of gender bias and sexual harassment, a scarcity of female mentors in leadership positions, and work/family conflicts. Further research is needed to understand the experience of female residents and to identify barriers that hinder their optimal professional and personal development. Structural and cultural changes to residency programs are needed to better accommodate the needs of female trainees.
Nguyen, Chau T
Burnout is increasingly recognized as an issue of major importance affecting physicians of all ages and disciplines and thereby patients, systems, and health care in general. At the 2017 American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting, the scope of burnout in medicine was addressed, along with systematic issues that remain. While changing the culture of medicine and health systems to address this is needed, what strategies can health care providers use in their everyday lives to lessen the impact of burnout? Integrative medicine with its focus on wholeness of patient care, including the emotional, mental, social, and spiritual domains of health, is uniquely positioned in arming physicians with sets of tools to help them navigate patients to better health and healing. These very same methods are invaluable for personal self-care, as we are all potential patients. Integrative medicine is a pathway to improving one's own self-care and, thereby, improving patient care.
Full Text Available Objective: To explore the extent of aggression (verbal abuse and violence (physical abuse directed toward General Medicine physicians by their patients, to identify causes and consequences of such behaviour on physicians' professional work and to establish prevention measures. Method: All general medicine physicians who attended an educational seminar from 28 to 29 February 2015 in Belgrade were given the questionnaire and asked to complete it. Results: 411 general medicine physicians have completed the questionnaire. Both genders were included: 86.37% of them were women. Majority of the participants were in the age group of 51-60 years (45.25%, mean age was 49.27±9.32. Mean number of years in practice was 21.10±9.87. Most of them specialized in General Medicine (62.30%. 85.40% of physicians have encountered some kind of abuse during their work and there was no significant difference regarding physicians' gender or qualifications. In the preceding year 62.3% of participants have encountered aggression or violence in their workplace. Aggression was reported by 82.97% and violence by 8.83% of participants. There were no statistically significant differences in terms of physicians' gender (p=0.859, type of workplace (p=0.097, number of years in practice (p=0.640 and specialty (p=0.537. In 83.2% of cases acts of aggression or violence have been committed by patients and in 40.2% by members of their families. In 44.2% of these cases nobody tried to assist the physicians and even less so if they were male doctors (p=0.05. The most common causes were: patients' dissatisfaction (60.4%, long waiting time for examination (37.0% and patient's alcohol or drug intoxication (35.0%. The most common consequence of this on physicians was decreased satisfaction with their job (53.6%. Prevention measures for this issue would be: decreasing of the number of consultations per day (56.0%, introduction of a new 'in line of duty' status for healthcare workers (55
The textbook and reference work covers the entire field of internal medicine arranged in 15 chapters, each covering a particular branch of internal medicine. This subject arrangement corresponds to the subject clusters of the regime of post-graduate education. Every branch, i. e. every chapter, has its own responsible editor. This selection of editors and authors,- all in all 180 experts in general and clinical practice -, guarantees a maximum of competence and compliance with the frontiers of research and clinical experience. (orig./CB) [de
Day, Susan C.; And Others
In response to the perceived need for primary care physicians, two major changes in internal medicine training have occurred: (1) a third year of general training was required for internal medicine board certification and (2) many hospitals developed primary care internal medicine residencies with an increased emphasis on ambulatory training.…
As it is practiced in France, internal medicine meets the Anglo-Saxon definition of the specialty, ie doctors "equipped to handle the broad and comprehensive spectrum of illnesses that affect adults, and are recognized as experts in diagnosis, in treatment of chronic illness, and in health promotion and disease prevention - they are not limited to one type of medical problem or organ system". This 2017 "What's new in internal medicine" will consist of 2 parts, a first part on significant publications in the field of systemic and autoimmune diseases and a second part on more diverse publications (HIV, cancer, pregnancy, well-being...) important for medicine in general and its different specialties. © 2017 Elsevier Masson SAS. Tous droits réservés.
Full Text Available Background: Organizing the health system around family medicine (FM has been a productive approach for developed countries. The aim of this study, which was concurrent with the Iran Health Transform Plan (HTP and the establishment of the family physician in Iran, was to discuss the sufficiency of a family physician training program for their roles and increase their competency.Methods: This descriptive study was conducted in the Psychosomatic Research Center affiliated to Isfahan University of Medical Science, Iran, with the assistance of the Iranian Institute of Higher Health (2015. An expert panel consisting of 6 individuals including specialists, trainers, and researchers in FM and psychosomatic medicine was held for this purpose. Using the World Organization of Family Doctors (WONCA website for the definition of a family physician, the curriculum developed by the Ministry of Health and Medical Education was studied. Data were summarized in one table.Results: The current FM curriculum, with this content and method, does not seem to be capable of enabling physicians to perform their multidisciplinary roles. it still has a reductionist approach and disease orientation instead of a clinical reasoning method and systematic viewpoint. The psychosomatic approach is applicable at all prevention levels and in all diseases, since it is basically designed for this longitudinal (between all preventive levels and horizontal (bio-physical–social-spiritual intervention integration.Conclusion: Psychosomatic medicine, not as a biomedical specialty, but rather as a systems thinking model in health, had a rapid rise during previous decades. Now, its services have been integrated into all medical fields. This means that it should be adopted in the core of health care services (i.e., the family physician position before other sections. This would help the implementation of this approach in the health system, and the reduction of patients' pain and
Eniola, Kehinde; Evarts, Lori
Cases of child maltreatment (CM) in the United States remain high, and primary care providers lack the confidence and training to diagnose these cases. This study provides recommendations to improve family medicine physicians' confidence in diagnosing CM. We e-mailed an electronic survey to family medicine residents and physicians practicing in the United States. Responses were collected during August and September 2015. Respondents were asked about their familiarity and competence level regarding the diagnosis of CM. They also were asked about the frequency of their correctly diagnosing CM, timeliness of diagnosis, barriers to a diagnosis or early diagnosis of CM, and receipt of adequate CM training. Of the 420 surveys emailed, 258 (61%) were completed. The majority of respondents stated their self-reported level of competence in diagnosing CM as average or below average, with few (8%) indicating a competence level of above average. A timely diagnosis of child maltreatment was reported by 46% of respondents, whereas 54% were either late (19.2%) in diagnosing or could not recall (34.6%). The barriers to diagnosis cited by responders were inexperience (58%), lack of confidence and certainty (50%), lack of diagnosis protocol (43.3%), lack of confidence in communicating with parents (38.3%), and inadequate training (34.9%). The introduction of CM training into the family medicine residency training curriculum, coupled with the development of a standardized CM diagnosis protocol, may improve self-reported family medicine physicians' confidence and competence levels in diagnosing CM.
Economics is en route to its further expansion in medicine, but many in the medical community remain unconvinced that its impact will be positive. Thus, a philosophical enquiry into the compatibility of economics and medicine is necessary to resolve the disagreements. The fundamental mission of medicine obliges physicians to practise science and compassion to serve the patient's best interests. Conventional (neoclassical) economics assumes that individuals are self-interested and that competitive markets will emerge optimal states. Economics is seemingly incompatible with the emphasis of putting patients' interests first. This idea is refuted by Professor Kenneth Arrow's health economics seminal paper. Arrow emphasizes that medical practice involves agency, knowledge, trust and professionalism, and physician-patient relation critically affects care quality. The term Arrow Physician is used to mean a humanistic carer who has a concern for the patient and acts on the best available evidence with health equity in mind. To make this practice sustainable, implementing appropriate motivations, constitutions and institutions to enable altruistic agency is critical. There is substantial evidence that polycentric governance can encourage building trust and reciprocity, so as to avoid depletion of communal resources. This paper proposes building trusting institutions through granting altruistic physicians adequate autonomy to direct resources based on patients' technical needs. It also summarizes the philosophy bases of medicine and economics. It, therefore, contributes to developing a shared language to facilitate intellectual dialogues, and will encourage trans-disciplinary research into medical practice. This should lead to medicine being reoriented to care for whole persons again. © 2015 John Wiley & Sons, Ltd.
Ahmed, Awad A; Hwang, Wei-Ting; Thomas, Charles R; Deville, Curtiland
Data show that international medical graduates (IMGs), both US and foreign born, are more likely to enter primary care specialties and practice in underserved areas. Comprehensive assessments of representation trends for IMGs in the US physician workforce are limited. We reported current and historical representation trends for IMGs in the graduate medical education (GME) training pool and US practicing physician workforce. We compared representation for the total GME and active practicing physician pools with the 20 largest residency specialties. A 2-sided test was used for comparison, with P < .001 considered significant. To assess significant increases in IMG GME trainee representation for the total pool and each of the specialties from 1990-2015, the slope was estimated using simple linear regression. IMGs showed significantly greater representation among active practicing physicians in 4 specialties: internal medicine (39%), neurology (31%), psychiatry (30%), and pediatrics (25%). IMGs in GME showed significantly greater representation in 5 specialties: pathology (39%), internal medicine (39%), neurology (36%), family medicine (32%), and psychiatry (31%; all P < .001). Over the past quarter century, IMG representation in GME has increased by 0.2% per year in the total GME pool, and 1.1% per year for family medicine, 0.5% for obstetrics and gynecology and general surgery, and 0.3% for internal medicine. IMGs make up nearly a quarter of the total GME pool and practicing physician workforce, with a disproportionate share, and larger increases over our study period in certain specialties.
To establish physician compensation internally, finance leaders should: Educate decision makers on basic regulatory guidance and valuation theory. Determine fair market value. Consider using a compensation calculator.
Movahed, Assad; Gnanasegaran, Gopinath; Buscombe, John R.; Hall, Margaret
Nuclear cardiology is no longer a medical discipline residing solely in nuclear medicine. This is the first book to recognize this fact by integrating in-depth information from both the clinical cardiology and nuclear cardiology literature, and acknowledging cardiovascular medicine as the fundamental knowledge base needed for the practice of nuclear cardiology. The book is designed to increase the practitioner's knowledge of cardiovascular medicine, thereby enhancing the quality of interpretations through improved accuracy and clinical relevance.The text is divided into four sections covering all major topics in cardiology and nuclear cardiology: -Basic Sciences and Cardiovascular Diseases; -Conventional Diagnostic Modalities; -Nuclear Cardiology; -Management of Cardiovascular Diseases. (orig.)
Soares, William; Shenvi, Christina; Waller, Nikki; Johnson, Reuben; Hodgson, Carol S
Use of social media (SM) by physicians has exposed issues of privacy and professionalism. While guidelines have been created for SM use, details regarding specific SM behaviors that could lead to disciplinary action presently do not exist. To compare State Medical Board (SMB) directors' perceptions of investigation for specific SM behaviors with those of emergency medicine (EM) physicians. A multicenter anonymous survey was administered to physicians at 3 academic EM residency programs. Surveys consisted of case vignettes, asking, "If the SMB were informed of the content, how likely would they be to initiate an investigation, possibly leading to disciplinary action?" (1, very unlikely, to 4, very likely). Results were compared to published probabilities using exact binomial testing. Of 205 eligible physicians, 119 (58%) completed the survey. Compared to SMB directors, EM physicians indicated similar probabilities of investigation for themes involving identifying patient images, inappropriate communication, and discriminatory speech. Participants indicated lower probabilities of investigation for themes including derogatory speech (32%, 95% confidence interval [CI] 24-41 versus 46%, P social identity, compared to SMB directors, particularly for images of alcohol and derogatory speech.
Cranston, Mark; Slee-Valentijn, Monique; Davidson, Christopher; Lindgren, Stefan; Semple, Colin; Palsson, Runolfur
Limited information exists on the framework and content of postgraduate education in internal medicine in Europe. This report describes the results of a survey of postgraduate training in internal medicine in the European countries. Two online questionnaire-based surveys were carried out by the European Board of Internal Medicine, one on the practice of internists and the other on postgraduate training in internal medicine. The national internal medicine societies of all 30 member countries of the European Federation of Internal Medicine were invited to participate. The responses were reviewed by internal medicine residents from the respective countries and summaries of the data were sent to the national societies for approval. Descriptive analysis of the data on postgraduate training in internal medicine was performed. Twenty-seven countries (90%) completed the questionnaire and approved their datasets. The length of training ranged from four to six years and was commonly five years. The majority of countries offered training in internal medicine and a subspecialty. A common trunk of internal medicine was frequently a component of subspecialty training programmes. Hospital inpatient service was the predominant setting used for training. A final certifying examination was in place in 14 countries. Although some similarities exists, there appear to be significant differences in the organisation, content and governance of postgraduate training in internal medicine between the European countries. Our findings will prove invaluable for harmonisation of training and qualification in internal medicine in Europe. © 2013.
Soós, Sándor Árpád; Eőry, Ajándék; Eőry, Ajándok; Harsányi, László; Kalabay, László
The patients initiate the use of complementary and alternative medicine and this often remains hidden from their primary care physician. To explore general practitioners' knowledge and attitude towards complementary and alternative medicine, and study the need and appropriate forms of education, as well as ask their opinion on integration of alternative medicine into mainstream medicine. A voluntary anonymous questionnaire was used on two conferences for general practitioners organized by the Family Medicine Department of Semmelweis University. Complementary and alternative medicine was defined by the definition of the Hungarian Academy of Sciences and certified modalities were all listed. 194 general practitioners answered the questionnaire (39.8% response rate). 14% of the responders had licence in at least one of the complementary and alternative therapies, 45% used complementary and alternative therapy in their family in case of illness. It was the opinion of the majority (91.8%) that it was necessary to be familiar with every method used by their patients, however, 82.5% claimed not to have enough knowledge in complementary medicine. Graduate and postgraduate education in the field was thought to be necessary by 86% of the responders; increased odds for commitment in personal education was found among female general practitioners, less than 20 years professional experience and personal experience of alternative medicine. These data suggest that general practitioners would like to know more about complementary and alternative medicine modalities used by their patients. They consider education of medical professionals necessary and a special group is willing to undergo further education in the field.
Full Text Available Capillaroscopy is an actual inexpensive imaging technique, used to examine, non-invasively and safely, the morphology of nailfold dermal papillary capillaries. Many studies agree in the statement that the capillaroscopy is one of the gold standard methods for non-invasive examination of the microcirculation and it plays an important role in screening in Raynaud’s phenomenon and in monitoring of systemic sclerosis and other rheumatologic diseases. There are also many reports on the possible use of nailfold capillaroscopy in the diagnosis and monitoring of many other diseases in internal medicine.
Cherry, Mark J
Adequate response to physician-assisted suicide and euthanasia depends on fundamental philosophical and theological issues, including the character of an appropriate philosophically and theologically anchored anthropology, where the central element of traditional Christian anthropology is that humans are created to worship God. As I will argue, Christian morality and moral epistemology must be nested within and understood through this background Christian anthropology. As a result, I will argue that physician-assisted suicide and euthanasia can only be one-sidedly and inadequately appreciated through rational appeal to central values, such as "human dignity" and "self determination", or through "sola scriptura" biblical interpretation, or individual judgments of conscience. Adequately addressing physician-assisted suicide and euthanasia will depend on a more fundamental spiritual-therapeutic approach. This cluster of moral, epistemological, anthropological, and bioethical claims will be explored by drawing on the texts of St. Basil the Great, St. Maximos the Confessor, and St. Isaac the Syrian. Their reflections on medicine, the human good, and its relationship to worship, spiritual therapy, and God will be used as a basis to indicate a broader philosophical perspective, which will be needed to avoid a one-sided, incomplete approach to the challenges of physician-assisted suicide and euthanasia. Medical morality, I argue, is best understood within categories that transcend the right, the good, the just, and the virtuous; namely, the holy.
This chapter explores the place of Scottish medicine in the autobiographical writing of the Philadelphia physician and signer of the American Declaration of Independence, Benjamin Rush, who studied at the University of Edinburgh from 1766 to 1768. It focuses on Rush's 'Scottish journal' (his account of his period of study in Edinburgh), his protracted feud from 1797 over his treatment of yellow fever with the English journalist, politician and agriculturalist William Cobbett, and his account in 'Travels through Life' of that feud and of the influence of Cullen on his medical theory and practice. The different rhetorical strategies used by Rush to defend his character and practice and his role in the rise of physician autobiography are examined.
Flaherty, Gerard T; Walden, Lucas M; Townend, Michael
Few studies have examined emergency self treatment (EST) antimalarial prescribing patterns. 110 physician-members of the Travel Medicine Society of Ireland and British Global and Travel Health Association participated in this study. There was a trend towards the prescription of EST for travel to remote low-risk malaria areas; for long-term residents living in low-risk areas; and for frequent travellers to low-risk areas. This study provides insights into the use of EST in travellers' malaria. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: email@example.com.
Williams, Brent C; Warshaw, Gregg; Fabiny, Anne Rebecca; Lundebjerg Mpa, Nancy; Medina-Walpole, Annette; Sauvigne, Karen; Schwartzberg, Joanne G; Leipzig, Rosanne M
Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation. Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project. The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies. Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory
Isoardi, Jonathon; Spencer, Lyndall; Sinnott, Michael; Nicholls, Kim; O'Connor, Angela; Jones, Fleur
The primary objective of the present study was to learn the factors that influence the documentation practices of ED interns. A second objective was to identify the expectations of emergency physicians (EPs) towards the medical record documentation of ED interns. A qualitative design was adopted using semi-structured interviews in convenience samples drawn from both groups. Eighteen interviews were conducted with intern volunteers and 10 with EP volunteers. One (5%) intern and two (20%) EPs had received medical documentation training. Factors that encouraged interns' documentation included: patient acuity (the more critical the condition, the more comprehensive the documentation) and the support of senior colleagues. Inhibiting factors included uncertainty about how much to write, and the shift being worked (interns indicated they wrote less at night). Factors of consequence to senior personnel included the apparent reluctance of interns to document management plans. They noted that interns frequently confine their notes to assessment, investigations and treatments, whereas EPs preferred records that demonstrated intern thought processes and included such matters as future actions to follow immediate treatment. A positive theme that emerged included the high level of support interns received from their senior colleagues. Another theme, the influence of patient acuity, held both positive and negative implications for intern writing practices. The lack of formal training is an impediment to the production of useful medical records by ED interns. One solution proposed by both interns and senior personnel was the introduction of the subject into intern education programmes. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Murden, R A; Lamb, J F
We performed two surveys to uncover the status of philanthropic endowments in general internal medicine divisions. The initial survey of U.S. medical school departments of medicine found that only 14.1% of general internal medicine divisions hold endowments versus 21.9% of all other divisions, and that endowment sources for general medicine are atypical. The second survey of successfully endowed divisions found that sympathetic administrators and active pursuit of endowments were associated with endowment success. Aggressive pursuit of endowments, publicizing successes of general medicine, and consideration of endowment sources noted in this study are recommended to improve philanthropic contributions to general internal medicine.
Scheffer, Mario Cesar; Cassenote, Alex Jones Flores; Guilloux, Aline Gil Alves; Dal Poz, Mario Roberto
The internal migration of physicians from one place to another in the same country can unbalance the supply and distribution of these professionals in national health systems. In addition to economic, social and demographic issues, there are individual and professional factors associated with a physician's decision to migrate. In Brazil, there is an ongoing debate as to whether opening medicine programmes in the interior of the country can induce physicians to stay in these locations. This article examines the migration of physicians in Brazil based on the location of the medical schools from which they graduated. A cross-sectional design based on secondary data of 275,801 physicians registered in the Regional Councils of Medicine (Conselhos Regionais de Medicina-CRMs) who graduated between 1980 and 2014. The evaluated outcome was migration, which was defined as moving away from the state where they completed the medicine programme to another state where they currently work or live. 57.3% of the physicians in the study migrated. The probability of migration ratio was greater in small grouped municipalities and lower in state capitals. 93.4% of the physicians who trained in schools located in cities with less than 100,000 inhabitants migrated. Fewer women (54.2%) migrated than men (60.0%). More than half of the physicians who graduated between 1980 and 2014 are in federative units different from the unit in which they graduated. Individual factors, such as age, gender, time of graduation and specialty, vary between the physicians who did or did not migrate. The probability of migration ratio was greater in small municipalities of the Southeast region and strong in the states of Tocantins, Acre and Santa Catarina. New studies are recommended to deepen understanding of the factors related to the internal migration and non-migration of physicians to improve human resource for health policies.
Porter, Blake; Iriye, Brian; Ghamsary, Mark
Principles of practice management provide a foundation for clinical success and performance improvement. Scant data exist regarding maternal-fetal medicine (MFM) physicians' knowledge of these topics. We hypothesize that physicians enter practice with inadequate education in practice management. Surveys were emailed to members of the Society for Maternal-Fetal Medicine rating their knowledge and capabilities in practice management topics, and respondents assessed their current institution's business in the medical curriculum. A total of 325 (14.4%) physicians responded: 63 fellows in training and 262 MFM physician subspecialists. Practicing physicians reported learning most of their knowledge "in practice after fellowship" (85%) or "never at all" (10%). Only 3% of respondents had adequate business education during fellowship, and only 5% felt prepared to teach business principles. However, 85% of those surveyed agreed that this material should be taught during the fellowship. Among MFM subspecialists and fellows in training at institutions with fellowships, 60% reported no current curriculum for practice management, and those with current curricula reported it had "limited" or "no value" (76%). There is a significant desire for practice management curricula during MFM fellowship, and current training is insufficient. With many MFM physicians ill-prepared to teach these principles, professional education from other financial fields, and standardized education in practice management from current expert sources is needed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Full Text Available Background: In the pre-Hellenistic period, the concept of medicine was not well-defined. Usually, a disease was considered as a divine punishment and its treatment was devolved to the priests who asked for healing from the divinities. The only job that could be compared to medical practice was a kind of itinerant medicine, derived from the Egyptian therapeutic tradition based only on practical experience and performed by people that knew a number of remedies, mostly vegetable, but without any theoretical bases about the possible mechanisms of action. Opinions about the human nature (naturalistic thinking and the origin of the illness and heal were the basis of Greek medicine practiced by ancient priests of Asclepius. However, with the evolution of the thought for the continuous research of “κόσμος” (world knowledge, philosophy woulld become an integral part of medicine and its evolution. This close relationship between philosophy and medicine is confirmed by the Greek physician Galen in the era of the Roman Empire. Methods: Philosophical thought looked for world knowledge starting from mathematics, physics, astronomy, chemistry, medicine, psychology, metaphysics, sociology, and ethics. We must keep in mind that, according to the ancient people, the physicians could not heal the patients without the aid of a “divine God” until medicine, thanks to the Hippocratic practice, became more independent from the supernatural, and contemporary, ethical, and professional. Many physicians were philosophers, as confirmed by their views of life, such as Hippocrates of Cos, Aristotle (hailed as the father of comparative anatomy and physiology, Pythagoras of Samos, Alcmaeon of Croton, Empedocles, Praxagoras, Erasistratus, Galen, and others, including Asclepiades of Bithynia (atomists affinity. Asclepiades, a Greek physician born in Prusa, studied in Athens and Alexandria. His thought was influenced by Democritus’ theories, refusing extensively
Santacroce, Luigi; Bottalico, Lucrezia; Charitos, Ioannis Alexandros
Background: In the pre-Hellenistic period, the concept of medicine was not well-defined. Usually, a disease was considered as a divine punishment and its treatment was devolved to the priests who asked for healing from the divinities. The only job that could be compared to medical practice was a kind of itinerant medicine, derived from the Egyptian therapeutic tradition based only on practical experience and performed by people that knew a number of remedies, mostly vegetable, but without any theoretical bases about the possible mechanisms of action. Opinions about the human nature (naturalistic thinking) and the origin of the illness and heal were the basis of Greek medicine practiced by ancient priests of Asclepius. However, with the evolution of the thought for the continuous research of “κόσμος” (world) knowledge, philosophy woulld become an integral part of medicine and its evolution. This close relationship between philosophy and medicine is confirmed by the Greek physician Galen in the era of the Roman Empire. Methods: Philosophical thought looked for world knowledge starting from mathematics, physics, astronomy, chemistry, medicine, psychology, metaphysics, sociology, and ethics. We must keep in mind that, according to the ancient people, the physicians could not heal the patients without the aid of a “divine God” until medicine, thanks to the Hippocratic practice, became more independent from the supernatural, and contemporary, ethical, and professional. Many physicians were philosophers, as confirmed by their views of life, such as Hippocrates of Cos, Aristotle (hailed as the father of comparative anatomy and physiology), Pythagoras of Samos, Alcmaeon of Croton, Empedocles, Praxagoras, Erasistratus, Galen, and others, including Asclepiades of Bithynia (atomists affinity). Asclepiades, a Greek physician born in Prusa, studied in Athens and Alexandria. His thought was influenced by Democritus’ theories, refusing extensively the Hippocratic
Santacroce, Luigi; Bottalico, Lucrezia; Charitos, Ioannis Alexandros
Background: In the pre-Hellenistic period, the concept of medicine was not well-defined. Usually, a disease was considered as a divine punishment and its treatment was devolved to the priests who asked for healing from the divinities. The only job that could be compared to medical practice was a kind of itinerant medicine, derived from the Egyptian therapeutic tradition based only on practical experience and performed by people that knew a number of remedies, mostly vegetable, but without any theoretical bases about the possible mechanisms of action. Opinions about the human nature (naturalistic thinking) and the origin of the illness and heal were the basis of Greek medicine practiced by ancient priests of Asclepius. However, with the evolution of the thought for the continuous research of "κόσμος" (world) knowledge, philosophy woulld become an integral part of medicine and its evolution. This close relationship between philosophy and medicine is confirmed by the Greek physician Galen in the era of the Roman Empire. Methods: Philosophical thought looked for world knowledge starting from mathematics, physics, astronomy, chemistry, medicine, psychology, metaphysics, sociology, and ethics. We must keep in mind that, according to the ancient people, the physicians could not heal the patients without the aid of a "divine God" until medicine, thanks to the Hippocratic practice, became more independent from the supernatural, and contemporary, ethical, and professional. Many physicians were philosophers, as confirmed by their views of life, such as Hippocrates of Cos, Aristotle (hailed as the father of comparative anatomy and physiology), Pythagoras of Samos, Alcmaeon of Croton, Empedocles, Praxagoras, Erasistratus, Galen, and others, including Asclepiades of Bithynia (atomists affinity). Asclepiades, a Greek physician born in Prusa, studied in Athens and Alexandria. His thought was influenced by Democritus' theories, refusing extensively the Hippocratic ideas that
Full Text Available Alexander B Blum1, Sandra Shea2, Charles A Czeisler3,4, Christopher P Landrigan3-5, Lucian Leape61Department of Health and Evidence Policy, Mount Sinai School of Medicine, New York, NY, USA; 2Committee of Interns and Residents, SEIU Healthcare Division, Service Employees International Union, New York, NY, USA; 3Harvard Work Hours, Health and Safety Group, Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; 4Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; 5Division of General Pediatrics, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA; 6Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USAAbstract: Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of medicine.
International Journal of Medicine and Health Development ... This is the official publication of College of Medicine, University of Nigeria under the ... Health related quality of life and sociodemographic characteristics among Iranian students ...
Gourevitch, Marc N; Jay, Melanie R; Goldfrank, Lewis R; Mendelsohn, Alan L; Dreyer, Benard P; Foltin, George L; Lipkin, Mack; Schwartz, Mark D
We have described and evaluated the impact of a unique fellowship program designed to train postdoctoral, physician fellows in research at the interface of medicine and public health. We developed a rigorous curriculum in public health content and research methods and fostered linkages with research mentors and local public health agencies. Didactic training provided the foundation for fellows' mentored research initiatives, which addressed real-world challenges in advancing the health status of vulnerable urban populations. Two multidisciplinary cohorts (6 per cohort) completed this 2-year degree-granting program and engaged in diverse public health research initiatives on topics such as improving pediatric care outcomes through health literacy interventions, reducing hospital readmission rates among urban poor with multiple comorbidities, increasing cancer screening uptake, and broadening the reach of addiction screening and intervention. The majority of fellows (10/12) published their fellowship work and currently have a career focused in public health-related research or practice (9/12). A fellowship training program can prepare physician investigators for research careers that bridge the divide between medicine and public health.
Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian
A minimum of 10 hours off duty should be scheduled between shiftsResident physician input into work redesign should be actively solicitedSchedules should be designed that adhere to principles of sleep and circadian science; this includes careful consideration of the effects of multiple consecutive night shifts, and provision of adequate time off after night work, as specified in the IOM reportResident physicians should not be scheduled up to the maximum permissible limits; emergencies frequently occur that require resident physicians to stay longer than their scheduled shifts, and this should be anticipated in scheduling resident physicians' work shiftsHospitals should anticipate the need for iterative improvement as new schedules are initiated; be prepared to learn from the initial phase-in, and change the plan as neededAs resident physician work hours are redesigned, attending physicians should also be considered; a potential consequence of resident physician work hour reduction and increased supervisory requirements may be an increase in work for attending physicians; this should be carefully monitored, and adjustments to attending physician work schedules made as needed to prevent unsafe work hours or working conditions for this group"Home call" should be brought under the overall limits of working hours; work load and hours should be monitored in each residency program to ensure that resident physicians and fellows on home call are getting sufficient sleepMedicare funding for graduate medical education in each hospital should be linked with adherence to the Institute of Medicine limits on resident physician work hours. MOONLIGHTING BY RESIDENT PHYSICIANS: The Institute of Medicine report recommended including external as well as internal moonlighting in working hour limits. The recommendation is: All moonlighting work hours should be included in the ACGME working hour limits and actively monitored. (ABSTRACT TRUNCATED)
Balhara, Kamna S; Peterson, Susan M; Elabd, Mohamed Moheb; Regan, Linda; Anton, Xavier; Al-Natour, Basil Ali; Hsieh, Yu-Hsiang; Scheulen, James; Stewart de Ramirez, Sarah A
Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9-13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.
Chan, Ming-Ka; de Camps Meschino, Diane; Dath, Deepak; Busari, Jamiu; Bohnen, Jordan David; Samson, Lindy Michelle; Matlow, Anne; Sánchez-Mendiola, Melchor
Purpose This paper aims to highlight the importance of leadership development for all physicians within a competency-based medical education (CBME) framework. It describes the importance of timely international collaboration as a key strategy in promoting physician leadership development. Design/methodology/approach The paper explores published and Grey literature around physician leadership development and proposes that international collaboration will meet the expanding call for development of leadership competencies in postgraduate medical learners. Two grounding frameworks were used: complexity science supports adding physician leadership training to the current momentum of CBME adoption, and relational cultural theory supports the engagement of diverse stakeholders in multiple jurisdictions around the world to ensure inclusivity in leadership education development. Findings An international collaborative identified key insights regarding the need to frame physician leadership education within a competency-based model. Practical implications International collaboration can be a vehicle for developing a globally relevant, generalizable physician leadership curriculum. This model can be expanded to encourage innovation, scholarship and program evaluation. Originality/value A competency-based leadership development curriculum is being designed by an international collaborative. The curriculum is based on established leadership and education frameworks. The international collaboration model provides opportunities for ongoing sharing, networking and diversification.
Oshman, Lauren D; Combs, Gene N
Motivational interviewing is a useful skill to address the common problem of patient ambivalence regarding behavior change by uncovering and strengthening a person's own motivation and commitment to change. The Family Medicine Milestones underline the need for clear teaching and monitoring of skills in communication and behavior change in Family Medicine postgraduate training settings. This article reports the integration of a motivational interviewing curriculum into an existing longitudinal narrative therapy-based curriculum on patient-centered communication. Observed structured clinical examination for six participants indicate that intern physicians are able to demonstrate moderate motivational interviewing skill after a brief 2-h workshop. Participant self-evaluations for 16 participants suggest a brief 2-h curriculum was helpful at increasing importance of learning motivational interviewing by participants, and that participants desire further training opportunities. A brief motivational interviewing curriculum can be integrated into existing communication training in a Family Medicine residency training program. © The Author(s) 2016.
Reviews the rationale for including prevention in the clinical medicine clerkship. Summarizes current guidelines, presents examples of curricula in several medical schools, and proposes a future direction that stresses integrating teaching preventive medicine into internal medicine clerkships and across the entire four-year medical curriculum. (DB)
Bagshaw, Philip; Barnett, Pauline
Physician advocacy occurs when doctors speak up for the health and healthcare of patients and communities. Historically, this was strong in some Western countries with doctors finding that it enhanced their authority, prestige and power. But it weakened in the 20th century when the biomedical model of heath triumphed and medicine became a dominant profession. In the second part of the 20th century, this dominance was threatened by political, technological and socioeconomic forces. These weakened medicine's state support, brought it under managerial control and undermined the social contract on which trust between doctors and the community was based. Defence of the profession was assumed by medical colleges, societies and associations. They had some success in retaining professional autonomy but did not undertake open advocacy, particularly on social justice issues, and did not therefore enhance their standing in the community. Opinion is divided on the level of advocacy that it is ethically proper for the medical profession to employ. Some contend doctors should only advise authorities when expert opinion is requested. Others contend doctors should speak out proactively on all health issues, and that collective action of this type is a hallmark of professionalism. This lack of consensus needs to be debated. Recent developments such as clinical leadership have not revitalised physician advocacy. However, continued deterioration of the UK National Health Service has led some English medical colleges to take up open advocacy in its defence. It is to be seen whether medical colleges elsewhere follow suit, as and when their healthcare systems are similarly threatened.
Champion, Karine; Mouly, Stéphane; Lloret-Linares, Celia; Lopes, Amanda; Vicaut, Eric; Bergmann, Jean-François
We aimed to evaluate the impact of physicians' educational programs in the reduction of inappropriate intravenous lines in internal medicine. Fifty-six French internal medicine units were enrolled in a nationwide, prospective, blinded, randomized controlled trial. Forms describing the patients with an intravenous line and internal medicine department characteristics were filled out on 2 separate days in January and April 2007. Following the first visit, all units were randomly assigned to either a specific education program on the appropriate indications of an intravenous line, during February and March 2007, or no training (control group). The Investigators' Committee then blindly evaluated the clinical relevance of the intravenous line according to pre-established criteria. The primary outcome was the percentage of inappropriate intravenous lines. During January 2007, intravenous lines were used in 475 (24.9%) of the 1910 hospitalized patients. Of these, 80 (16.8%) were considered inappropriate. In April 2007, 416 (22.8%) of the 1823 hospitalized patients received an intravenous line, which was considered in 10.2% (21/205) of patients managed by trained physicians, versus 16.6% (35/211) of patients in the control group (relative difference 39%; 95% confidence interval, -0.6-13.3; P = .05). Reduced intravenous administration of fluids, antibiotics, and analgesics accounted for the observed decrease. The use of a simple education program reduced the rate of inappropriate intravenous lines by almost 40% in an internal medicine setting (NCT01633307). Copyright © 2013 Elsevier Inc. All rights reserved.
Spychalla, Megan T; Heathman, Joanne H; Pearson, Katherine A; Herber, Andrew J; Newman, James S
Hospital medicine is a growing field with an increasing demand for additional healthcare providers, especially in the face of an aging population. Reductions in resident duty hours, coupled with a continued deficit of medical school graduates to appropriately meet the demand, require an additional workforce to counter the shortage. A major dilemma of incorporating nonphysician providers such as nurse practitioners and physician assistants (NPPAs) into a hospital medicine practice is their varying academic backgrounds and inpatient care experiences. Medical institutions seeking to add NPPAs to their hospital medicine practice need a structured orientation program and ongoing NPPA educational support. This article outlines an NPPA orientation and training program within the Division of Hospital Internal Medicine (HIM) at the Mayo Clinic in Rochester, MN. In addition to a practical orientation program that other institutions can model and implement, the division of HIM also developed supplemental learning modalities to maintain ongoing NPPA competencies and fill learning gaps, including a formal NPPA hospital medicine continuing medical education (CME) course, an NPPA simulation-based boot camp, and the first hospital-based NPPA grand rounds offering CME credit. Since the NPPA orientation and training program was implemented, NPPAs within the division of HIM have gained a reputation for possessing a strong clinical skill set coupled with a depth of knowledge in hospital medicine. The NPPA-physician model serves as an alternative care practice, and we believe that with the institution of modalities, including a structured orientation program, didactic support, hands-on learning, and professional growth opportunities, NPPAs are capable of fulfilling the gap created by provider shortages and resident duty hour restrictions. Additionally, the use of NPPAs in hospital medicine allows for patient care continuity that is otherwise missing with resident practice models.
Ratelle, John T; Dupras, Denise M; Alguire, Patrick; Masters, Philip; Weissman, Arlene; West, Colin P
Hospital medicine is a rapidly growing field of internal medicine. However, little is known about internal medicine residents' decisions to pursue careers in hospital medicine (HM). To identify which internal medicine residents choose a career in HM, and describe changes in this career choice over the course of their residency education. Observational cohort using data collected from the annual Internal Medicine In-Training Examination (IM-ITE) survey. 16,781 postgraduate year 3 (PGY-3) North American internal medicine residents who completed the annual IM-ITE survey in 2009-2011, 9,501 of whom completed the survey in all 3 years of residency. Self-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2) and PGY-3. Of the 16,781 graduating PGY-3 residents, 1,552 (9.3 %) reported HM as their ultimate career choice. Of the 951 PGY-3 residents planning a HM career among the 9,501 residents responding in all 3 years, 128 (13.5 %) originally made this decision in PGY-1, 192 (20.2 %) in PGY-2, and 631 (66.4 %) in PGY-3. Only 87 (9.1 %) of these 951 residents maintained a career decision of HM during all three years of residency education. Hospital medicine is a reported career choice for an important proportion of graduating internal medicine residents. However, the majority of residents do not finalize this decision until their final year.
Describes the fundamental difference between complementary and alternative medicine (CAM) and holistic medicine, highlighting holistic medicine's emphasis on the promotion of healthy lifestyles for practitioners and patients alike. Asserts that offering physicians-to-be more course work in holistic medicine could lay the groundwork for future…
Gellert, G A
International Physicians for the Prevention of Nuclear War has had an impressive public impact in the 1980s, helping to shatter the myths of surviving and medically responding to a nuclear attack. The 1990s present a new challenge for the medical community in a different social and international context characterized by increasing global interdependence. Another view of physician activism is presented to complement advocacy for nuclear disarmament in the promotion of peace. A framework for analysis is provided by "fateful visions"--accepted policy views of prospective superpower relations--drawn from practitioners of foreign policy, international relations, and security affairs. A perceptual gap may exist between physicians who wish to address underlying ethical and public health concerns on security issues and policy practitioners who are accustomed to discussion within existing policy frames of reference that can be pragmatically used. A strategy is proposed for physicians to use their specialized training and skills to evaluate trends in global health interdependence. The international physicians' movement may contribute substantively to the formulation of policy by expanding and interpreting an increasingly complex database on interdependence, and by creating a dialogue with policy formulators based on mutual recognition of the value and legitimacy of each professions' expertise and complementary contributions to international security policy.
International Physicians for the Prevention of Nuclear War has had an impressive public impact in the 1980s, helping to shatter the myths of surviving and medically responding to a nuclear attack. The 1990s present a new challenge for the medical community in a different social and international context characterized by increasing global interdependence. Another view of physician activism is presented to complement advocacy for nuclear disarmament in the promotion of peace. A framework for analysis is provided by fateful visions--accepted policy views of prospective superpower relations--drawn from practitioners of foreign policy, international relations, and security affairs. A perceptual gap may exist between physicians who wish to address underlying ethical and public health concerns on security issues and policy practitioners who are accustomed to discussion within existing policy frames of reference that can be pragmatically used. A strategy is proposed for physicians to use their specialized training and skills to evaluate trends in global health interdependence. The international physicians' movement may contribute substantively to the formulation of policy by expanding and interpreting an increasingly complex database on interdependence, and by creating a dialogue with policy formulators based on mutual recognition of the value and legitimacy of each professions' expertise and complementary contributions to international security policy
Johnson, Benjamin K; Tierney, David M; Rosborough, Terry K; Harris, Kevin M; Newell, Marc C
Although focused cardiac ultrasonographic (FoCUS) examination has been evaluated in emergency departments and intensive care units with good correlation to formal echocardiography, accuracy for the assessment of left ventricular systolic function (LVSF) when performed by internal medicine physicians still needs independent evaluation. This prospective observational study in a 640-bed, academic, quaternary care center, included 178 inpatients examined by 10 internal medicine physicians who had completed our internal medicine bedside ultrasound training program. The ability to estimate LVSF with FoCUS as "normal," "mild to moderately decreased," or "severely decreased" was compared with left ventricular ejection fraction (>50%, 31-49%, and internal medicine physician-performed FoCUS and formal echocardiography for any LVSF impairment was "good/substantial" with κ = 0.77 (p Internal medicine physicians using FoCUS identify normal versus decreased LVSF with high sensitivity, specificity, and "good/substantial" interrater agreement when compared with formal echocardiography. These results support the role of cardiac FoCUS by properly trained internal medicine physicians for discriminating normal from reduced LVSF. © 2015 Wiley Periodicals, Inc.
Schaafsma, Frederieke; Hulshof, Carel; van Dijk, Frank; Verbeek, Jos
This study assessed the extent and nature of information demands among occupational health physicians and their attitude towards the application of evidence-based medicine in occupational health. A questionnaire survey was carried out among a random sample of 159 physicians practicing occupational medicine in The Netherlands. The questionnaire investigated the type and number of questions encountered in daily practice, the actions taken in response, the physicians' experience in using scientific databases on the Internet, and their attitude towards evidence-based medicine. The occupational health physicians' questions concerned medical, legal, and rehabilitation topics in particular. In pursuing answers to their questions, they generally chose to contact colleagues. Scientific databases were not consulted very often, although, in general, the attitude towards evidence-based medicine was positive. In addition to known barriers for practicing evidence-based medicine, occupational health physicians perceive a lack of scientific evidence in their field. The extensiveness of the field of knowledge in occupational health care was not regarded as an obstacle to their application of evidence-based medicine. Occupational health physicians have a demand for information on a broad range of topics, and, in most cases, their attitude towards evidence-based medicine is fairly positive. Besides education and training in evidence-based medicine, access to the Internet and the presence of a good knowledge infrastructure would help occupational health physicians use evidence-based medicine.
Ahmed S BaHammam
Full Text Available The professional content of sleep medicine has grown significantly over the past few decades, warranting the recognition of sleep medicine as an independent specialty. Because the practice of sleep medicine has expanded in Saudi Arabia over the past few years, a national regulation system to license and ascertain the competence of sleep medicine physicians and technologists has become essential. Recently, the Saudi Commission for Health Specialties formed the National Committee for the Accreditation of Sleep Medicine Practice and developed national accreditation criteria. This paper presents the newly approved Saudi accreditation criteria for sleep medicine physicians and technologists.
Chang, Leanne; Lim, Jing Ci Jill
In Singapore, the institutional preference for biomedicine and the cultural importance of traditional Chinese medicine (TCM) have created tensions between the two medical systems and erected barriers to a more collaborative health-care system. This study foregrounds TCM physicians' voice to reveal ideological struggles and power imbalances that underlie the interprofessional tensions and accompanying marginalization of TCM. Through in-depth interviews with 22 TCM physicians in Singapore, this study reveals the incongruences in ideological underpinnings between biomedicine and TCM, reflected in their different worldviews and epistemological approaches to knowledge formation and evaluation. Power differentials between the two medical systems are manifest in TCM physicians' inferior position in relation to their biomedical peers, the patients' internalization of biomedical standards to question the TCM profession and their own interest in seeking TCM treatments, and the state's limited support for TCM research, subsidies, and service provision in hospital settings. The results suggest that more open dialogue about the dichotomous framings of biomedicine and TCM is key to disrupting the mutual reinforcement of ideology and power, as well as to creating increased mutual understanding between the two medical systems.
Gibson, Denise D.; Borges, Nicole J.
This study examined physicians' level of satisfaction with their job and the match between expectations and actual practice of specialty. Quantitative results suggested that physicians (N = 211) had a moderately high level of overall job satisfaction with no significant differences found between men and women physicians. Among those in primary…
The International Journal of Medicine and Biomedical Research (IJMBR) is a peer-reviewed ... useful to researchers in all aspects of Clinical and Basic Medical Sciences including Anatomical Sciences, Biochemistry, Dentistry, Genetics, ...
Nazir, Arif; Smalbrugge, Martin; Moser, Andrea; Karuza, Jurgis; Crecelius, Charles; Hertogh, Cees; Feldman, Sid; Katz, Paul R
Physician burnout is a critical factor influencing the quality of care delivered in various healthcare settings. Although the prevalence and consequences of burnout have been well documented for physicians in various jurisdictions, no studies to date have reported on burnout in the postacute and long-term care setting. In this exploratory study, we sought to quantify the prevalence of burnout among 3 cohorts of physicians, each practicing in nursing homes in the United States (US), Canada, or The Netherlands. International comparisons were solicited to highlight cultural and health system factors potentially impacting burnout levels. Using standard survey techniques, a total of 721 physicians were solicited to participate (Canada 393; US 110; The Netherlands 218). Physicians agreeing to participate were asked to complete the "Maslach Burnout Inventory" using the Survey Monkey platform. A total of 118 surveys were completed from The Netherlands, 59 from Canada, and 65 from the US for response rates of 54%, 15%, and 59%, respectively. While US physicians demonstrated more negative scores in the emotional exhaustion subscale compared with their counterparts in Canada and The Netherlands, there were no meaningful differences on the depersonalization and personal accomplishments subscales. Factors explaining these differences are explored as well as approaches to future research on physician burnout in postacute and long-term care. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
O. M. Drapkina
Full Text Available Vertigo is observed in 30% of people above 65 y.o. and in 50% of peoples above 80 y.o. This disorder significantly affects patient quality of life and can be a reason of incidences, trauma and even disability. Vertigo is classified as systemic or non-systemic. It can be consequence of different disturbances. Physician of any clinical specialty can face with this problem. Identification of the vertigo cause is a quite difficult problem, but success of treatment depends on it. First of all treatment strategy should be directed to elimination of the vertigo cause.
Isaac, Carol; Byars-Winston, Angela; McSorley, Rebecca; Schultz, Alexandra; Kaatz, Anna; Carnes, Mary L.
The high attrition rate of female physicians pursuing an academic medicine research career has not been examined in the context of career development theory. We explored how internal medicine residents and faculty experience their work within the context of their broader life domain in order to identify strategies for facilitating career…
This documentation was distributed to the participants in the Course of Internal Dosimetry in Nuclear Medicine organised by the Nuclear Regulatory Authority (ARN) of Argentina and held in Buenos Aires, Argentina, August 9-13, 2004. The course was intended for people from IAEA Member States in the Latin American and Caribbean region, and for professionals and workers in medicine, related with the radiation protection. Spanish and English were the languages of the course. The following subjects were covered: radioprotection of the patient in nuclear medicine; injuries by ionizing radiations; MIRD methodology; radiation dose assessment in nuclear medicine; small scale and microdosimetry; bone and marrow dose modelling; medical internal dose calculations; SPECT and image reconstruction; principles of the gamma camera; scattering and attenuation correction in SPECT; tomography in nuclear medicine
Von Düring, Stephan; Mavrakanas, Thomas; Muller, Halima; Primmaz, Steve; Grosgurin, Olivier; Louis Simonet, Martine; Marti, Christophe; Nendaz, Mathieu; Serratrice, Jacques; Stirnemann, Jérome; Carballo, Sebastian; Darbellay Farhoumand, Pauline
In medicine, there are progresses which radically transform practices, change recommendations and win unanimous support in the medical community. There are some which divide, questioning principles that seemed established. There are also small advances, which can answer the questions that internists ask themselves in the daily care of their patients. Here are several articles published in 2017, read and commented for you by hospitalists, selected according to their impact on the medical world.
Fätkenheuer, G; Jung, N; Kern, W V; Fölsch, U R; Salzberger, B
Infectious diseases have recently gained wide public interest. Emerging infections and rising rates of antibiotic resistance are determining this trend. Both challenges will need to be addressed in international and local collaborations between different specialties in medicine and basic science. Infectious diseases as a clinical specialty in this scenario is directly responsible for the care of patients with infectious diseases. Its involvement in the care of patients with complicated infections has proved to be highly effective. Antibiotic stewardship programmes are effective measures in slowing the development of antibiotic resistance and have been widely implemented. But antibiotic stewardship specialists should not be confused with or taken as an alternative to infectious disease experts. Infectious diseases requires appropriate and specific training. It mainly uses the instrumentarium of internal medicine. With the current challenges in modern medicine, infectious diseases in Germany should thus be upgraded from a subspecialty to a clinical specialty, ideally within Internal Medicine.
This book examines medical diagnostic techniques. Topics considered include biological considerations in the approach to clinical medicines; infectious diseases; disorders of the heart; disorders of the vascular system; disorders of the respiratory system; diseases of the kidneys and urinary tract; disorders of the alimentary tract; disorders of the hepatobiliary system and pancreas; disorders of the hematopoietic system; disorders of bone and bone mineralization; disorders of the joints, connective tissues, and striated muscles; disorders of the nervous system; miscellaneous disorders; and procedures in diagnostic imaging
Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it ...
Kelly, Kimberly M.; Love, Margaret M.; Pearce, Kevin A.; Porter, Kyle; Barron, Mary A.; Andrykowski, Michael
Context: Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region. Purpose: To examine primary care physicians' identification of hereditary cancers. Methods: A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United…
Cranston, Mark; Semple, Colin; Duckitt, Roger; Vardi, Moshe; Lindgren, Stefan; Davidson, Christopher; Palsson, Runolfur
Current information on the role of internists in the European countries is scarce. This report describes the results of a survey of the practice of internists in Europe. Two online questionnaire-based surveys were carried out by the European Board of Internal Medicine, one on the practice of internists and the other on postgraduate training in internal medicine. The national internal medicine societies of all 30 member countries of the European Federation of Internal Medicine were invited to participate. The responses were reviewed by internal medicine trainees from the respective countries and summaries of the data were sent to the national societies for approval. Descriptive analysis of the data on the practice of internists was carried out. Twenty-seven countries (90%) completed the questionnaire and approved their datasets. In 8 European countries, most internists practised internal medicine alone and in 7 countries at least half of physicians practised internal medicine together with a subspecialty. Internal medicine was considered a hospital-based specialty in most countries. The majority of selected presenting problems and diagnoses were rated as commonly encountered in all countries. More variability between countries was observed in the performance of diagnostic and therapeutic procedures. Many similarities exist in the practice of internal medicine between the European countries, while some differences are present that likely reflect the variable impact of subspecialisation. The results of the survey should prove valuable for the definition of specific competencies and development of a common curriculum for internal medicine at the European level. © 2013.
Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian
work hours to 12–16 hour maximum shiftsA minimum of 10 hours off duty should be scheduled between shiftsResident physician input into work redesign should be actively solicitedSchedules should be designed that adhere to principles of sleep and circadian science; this includes careful consideration of the effects of multiple consecutive night shifts, and provision of adequate time off after night work, as specified in the IOM reportResident physicians should not be scheduled up to the maximum permissible limits; emergencies frequently occur that require resident physicians to stay longer than their scheduled shifts, and this should be anticipated in scheduling resident physicians’ work shiftsHospitals should anticipate the need for iterative improvement as new schedules are initiated; be prepared to learn from the initial phase-in, and change the plan as neededAs resident physician work hours are redesigned, attending physicians should also be considered; a potential consequence of resident physician work hour reduction and increased supervisory requirements may be an increase in work for attending physicians; this should be carefully monitored, and adjustments to attending physician work schedules made as needed to prevent unsafe work hours or working conditions for this group“Home call” should be brought under the overall limits of working hours; work load and hours should be monitored in each residency program to ensure that resident physicians and fellows on home call are getting sufficient sleepMedicare funding for graduate medical education in each hospital should be linked with adherence to the Institute of Medicine limits on resident physician work hours Moonlighting by resident physicians The Institute of Medicine report recommended including external as well as internal moonlighting in working hour limits. The recommendation is: All moonlighting work hours should be included in the ACGME working hour limits and actively monitored. Hospitals should
Schaafsma, Frederieke; Hulshof, Carel; van Dijk, Frank; Verbeek, Jos
Objectives This study assessed the extent and nature of information demands among occupational health physicians and their attitude towards the application of evidence-based medicine in occupational health. Methods A questionnaire survey was carried out among a random sample of 159 physicians
For more than two decades of activity, the European Medicines Agency has been operating as part of a network with the national medicines agencies in Europe, bringing together - in its various scienti c committees and working groups - European experts on a wide range of topics related to quality assurance, safety and ef cacy of medicines. The work carried out within the European Medicines Agency activities and the conclusions reached at European level affect millions of citizens. The European Medicines Agency considers that it is of great importance to maintain, in a sustainable and consistent manner, the active participation of general practitioners, as well as other medical specialists, in the process of medicines' evaluation and supervision. This article summarizes how the participation of doctors and health professionals in general is promoted in the European Medicines Agency activities.
Taylor, Jaime L; Aalsma, Matthew C; Gilbert, Amy L; Hensel, Devon J; Rickert, Vaughn I
The study objective was to identify commonalities amongst family medicine physicians who endorse annual adolescent visits. A nationally weighted representative on-line survey was used to explore pediatrician (N = 204) and family medicine physicians (N = 221) beliefs and behaviors surrounding adolescent wellness. Our primary outcome was endorsement that adolescents should receive annual preventive care visits. Pediatricians were significantly more likely (p family medicine physicians, bivariate comparisons were conducted between those who endorsed an annual visit (N = 164) compared to those who did not (N = 57) with significant predictors combined into two multivariate logistic regression models. Model 1 controlled for: patient race, proportion of 13-17 year olds in provider's practice, discussion beliefs scale and discussion behaviors with parents scale. Model 2 controlled for the same first three variables as well as discussion behaviors with adolescents scale. Model 1 showed for each discussion beliefs scale topic selected, family medicine physicians had 1.14 increased odds of endorsing annual visits (p family medicine physicians had 1.15 increased odds of also endorsing the importance of annual visits (p Family medicine physicians that endorse annual visits are significantly more likely to affirm they hold strong beliefs about topics that should be discussed during the annual exam. They also act on these beliefs by talking to parents of teens about these topics. This group appears to focus on quality of care in thought and deed.
Aguirre-Raya, Karen A; Castilla-Peón, María F; Barajas-Nava, Leticia A; Torres-Rodríguez, Violeta; Muñoz-Hernández, Onofre; Garduño-Espinosa, Juan
The influence, legitimacy and application of Evidence Based Medicine (EBM) in the world is growing as a tool that integrates, the best available evidence to decision making in patient care. Our goal was to identify the relationship between self-perception about the relevance of Evidence Based Medicine (EBM) and the degree of basic knowledge of this discipline in a group of physicians. A survey was carried out in a third level public hospital in Mexico City. Self-perception was measured by means of a structured scale, and the degree of knowledge through parameter or "rubrics" methodology. A total of 320 questionnaires were given to 55 medical students (17 %); 45 pre-graduate medical interns (14 %); 118 medical residents (37 %) and 102 appointed physicians of different specialties (32 %). Self-perception of EBM: The majority of those surveyed (n = 274, 86 %) declared that they were very or moderately familiar with EBM. The great majority (n = 270, 84 %) believe that EBM is very important in clinical practice and 197 physicians (61 %) said that they implement it always or usually. The global index of self-perception was 75 %. Knowledge of EBM: Definition of EBM; Seven of those surveyed (2 %) included 3 of the 4 characteristics of the definition, 82 (26 %) mentioned only two characteristics of the definition, 152 (48 %) mentioned only one characteristic and 79 (25 %) did not include any characteristic of EBM. Phases of the EBM process: The majority of those surveyed (n = 218, 68 %) did not include the steps that characterize the practice of EBM, of which 79 participants (25 %) mentioned elements not related to it. The global index of knowledge was 19 %. The majority of the surveyed physicians have a high self-perception of the relevance of EBM. In spite of this, the majority of them did not know the characteristics that define the EBM and phases of the process for its practice. A major discrepancy was found between self-perception and the
Parish, Sharon J; Rubio-Aurioles, Eusebio
Sexual problems in men and women are common; and physicians endorse many barriers to addressing these issues, including lack of knowledge about the diagnosis and management of sexual problems and inadequate training in sexual health communication and counseling. To update the recommendations published in 2004, from the International Consultation on Sexual Medicine (ICSM) relevant to the educational aspects of sexual health in undergraduate, graduate, and postgraducate medical education. A third international consultation in collaboration with the major sexual health organizations assembled over 186 multidisciplinary experts from 33 countries into 25 committees. Three experts from three countries contributed to this committee's review of Education in Sexual Medicine. Expert opinion was based on a comprehensive review of the medical literature, committee discussion, public presentation, and debate. A comprehensive review about the current state of undergraduate, graduate, and postgraduate sexual health education worldwide is provided. Recommendations about ideal sexual health curricula across training levels are provided. Best methods for achieving optimal training approaches to sexual health communication and interviewing, clinical skills and management, and counseling are described. Current sexual health education for undergraduate and practicing physicians is inadequate to meet the advancing science and technology and increasing patient demand for high-quality sexual health care. There is a need for enhanced training in medical institutions responsible for physician sexual health training worldwide. Future training programs at all levels of medical education should incorporate standardized measures of sexual health clinical skills acquisition and assessments of the impact on patient outcomes into the design of educational initiatives. © 2010 International Society for Sexual Medicine.
Paul, David P; Skiba, Michaeline
Concierge medicine is a medical management structure that has been in existence since the 1990s. Essentially, a typical concierge medical practice limits its number of patients and provides highly personalized attention that includes comprehensive annual physicals, same-day appointments, preventive and wellness care, and fast, 24/7 response time. Concierge medicine has become popular among both physicians and patients/consumers who are frustrated by the limitations imposed by managed care organizations. From many physicians' perspectives, concierge medicine offers greater autonomy, the opportunity to return to a more manageable patient load, and the chance to improve their incomes that have declined because of increasingly lowered reimbursements for their services. From many patients'/consumers' perspectives, concierge medicine provides more immediate, convenient, and caring access to their primary care physicians and, regardless of their physician's annual retainer fee, the elimination of third-party insurance coverage costs and hassles. The major criticisms of the concierge medicine model come from some health care policy makers and experts, who believe that concierge medicine is elitist and its widespread implementation will increase the shortage of primary care physicians, which is already projected to become worse because of the Affordable Care Act's individual mandate, which requires everyone to have health insurance.Utilizing these topics as its framework, this article explains why concierge medicine's form of medical management is gaining ground, cites its advantages and disadvantages for stakeholders, and examines some of the issues that will affect its growth.
Card, Sharon Elizabeth; Ward, Heather A; Chipperfield, Dylan; Sheppard, M Suzanne
Knowing one's own role is a key collaboration competency for postgraduate trainees in the Canadian competency framework (CanMEDS®). To explore methods to teach collaborative competency to internal medicine postgraduate trainees, baseline role knowledge of the trainees was explored. The perceptions of roles (self and others) at patient discharge from an acute care internal medicine teaching unit amongst 69 participants, 34 physicians (25 internal medicine postgraduate trainees and 9 faculty physicians) and 35 health care professionals from different professions were assessed using an adapted previously validated survey (Jenkins et al., 2001). Internal medicine postgraduate trainees agreed on 8/13 (62%) discharge roles, but for 5/13 (38%), there was a substantial disagreement. Other professions had similar lack of clarity about the postgraduate internal medicine residents' roles at discharge. The lack of interprofessional and intraprofessional clarity about roles needs to be explored to develop methods to enhance collaborative competence in internal medicine postgraduate trainees.
The book on physicians in the anti-nuclear peace movement of the 19080ies covers the following issues: (I) Frame of the subject: methodology, research fields and actors; (II) The social dimension of the physician's movement; (III) IPPNW (International physicians for the prevention of nuclear war) - a political idea is medicalized and organized, 1980 - 1984; (IV) Borderlines of the international peace idea during the Cold War - IPPNW 1980 - 1986.
Hamit Sirri Keten
Material and Method: A total of 170 family physicians working in Kahramanmaras were included in the study. After obtaining informed consent a questionnaire comprising questions regarding socio-demographic properties, conveying contracted family physicians as family medicine specialists and organization of the training program was applied to participants. Results: Among physicians participating in the study 130 (76.5% were male and 40 (23.5% were female, with a mean age of 40.7±7.1 (min = 26 years, max = 64 years. The mean duration of professional experience of physicians was 15.3±7.0 (min = 2 years, max = 40 years years. Of all, 91 (53.5% participants had already read the decree on family medicine specialist training program for contracted family physicians. A hundred and fifteen (67.6% family physicians supported that Family Medicine Specialty program should be taken part-time without interrupting routine medical tasks. Only 51 (30.0% participants stated the requirement of an entrance examination (TUS for family medicine specialty training. Conclusion: Family medicine specialty training program towards family physicians should be considered in the light of scientific criteria. In family medicine, an area exhibited a holistic approach to the patient; specialty training should be through residency training instead of an education program. For this purpose, family medicine departments in medical faculties should play an active role in this process. Additionally further rotations in needed branches should be implemented with a revision of area should be performed. In medicine practical training is of high importance and distant or part-time education is not appropriate, and specialist training shall be planned in accordance with the medical specialty training regulations. [Cukurova Med J 2014; 39(2.000: 298-304
Full Text Available Kourtney J Davis,1 Sarah H Landis,2 Yeon-Mok Oh,3 David M Mannino,4 MeiLan K Han,5 Thys van der Molen,6 Zaurbek Aisanov,7 Ana M Menezes,8 Masakazu Ichinose,9 Hana Muellerova11Worldwide Epidemiology, GlaxoSmithKline, Wavre, Belgium; 2Worldwide Epidemiology, GlaxoSmithKline, Uxbridge, UK; 3University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; 4University of Kentucky College of Public Health, Lexington, KY, USA; 5Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA; 6University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 7Pulmonology Research Institute, Moscow, Russia; 8Federal University of Pelotas, Pelotas, Brazil; 9Tohoku University Graduate School of Medicine, Sendai, JapanAim: Utilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease International Physician Survey, this study aimed to describe physicians’ knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs and respiratory specialists.Materials and methods: Physicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face to face. Physicians were questioned about COPD risk factors, prognosis, diagnosis, and treatment, including knowledge and application of the GOLD global strategy using patient scenarios.Results: Physicians reported using spirometry routinely (PCPs 82%, respiratory specialists 100%; P<0.001 to diagnose COPD and frequently included validated patient-reported outcome measures (PCPs 67%, respiratory specialists 81%; P<0.001. Respiratory
Full Text Available Background: Intussusception is the common acute abdomen in children with difficult clinical diagnosis. The routine ultrasound has recently been proposed as the initial diagnostic modality with high accuracy, but is not available for 24 h by gastroenterologists. We aimed to evaluate the validation of bedside ultrasound for intussusceptions performed by pediatric emergency physicians with ultrasound training during the night or holiday. Methods: A retrospective study was conducted in children with suspected intussusceptions when routine ultrasounds by gastroenterologists were not available over the period from July 2004 to July 2008. Patients were divided into two groups: those diagnosed by emergency physicians with ultrasound training and without training. The clinical characteristics and course for all patients were reviewed and compared for seeking the difference. Results: A total of 186 children were included. One hundred and thirteen (61% children were diagnosed by pediatric emergency physician with ultrasound training. The clinical symptoms were not statistically different between the two groups. The diagnostic sensitivity of the ultrasound training group was significantly higher (90% vs. 79%, p = 0.034. Children of the training group also had significantly shorter hospital stay duration at emergency departments before reduction (2.41 ± 2.01 vs. 4.58 ± 4.80 h, p = 0.002. Conclusion: Bedside ultrasound performed by pediatric emergency physicians with ultrasound training is a sensitive test for detecting intussusceptions. Knowledge and use of bedside ultrasound can aid the emergency physician in the diagnosis of pediatric intussusceptions with less delay in treatment.
Full Text : In Morocco, medicinal and aromatic plants occupy an important place in the traditional care system of a large number of local people. They are also economically strong potential, but unfortunately they are not valued enough. Indeed, Morocco by its privileged geographical position in the Mediterranean basin and its floristic diversity (with a total of over 4,200 species and subspecies of which over 500 are recognized as medicinal and aromatic plants), is a leading provider of traditional global market. In this context and given the back label of the natural global, group research and studies on Aromatic and Medicinal Plants (GREPAM), the Faculty of Semlalia and University Cadi Ayyad, organize: the International Congress on Medicinal and Aromatic Plants CIPAM 2009. The organization of this conference is part of scientific research developed by the GREPAM. [fr
The conference proceedings contain 92 abstracts of submitted papers dealing with various applications of radioisotopes in diagnosis and therapy. The papers were devoted to scintiscanning, radioimmunoassay, tomography, the applications of nuclear magnetic resonance and electron microscopy in different branches - oncology, cardiology, neurology, histology, gynecology, internal medicine, etc. (M.D.)
Religion, spirituality, health and medicine have common roots in the conceptual framework of relationship amongst human beings, nature and God. Of late, there has been a surge in interest in understanding the interplay of religion, spirituality, health and medicine, both in popular and scientific
Grant, Kathryn; Burg, Mary Ann; Fraser, Kathryn; Gui, Serena; Kosch, Shae Graham; Nierenberg, Barry; Oyama, Oliver; Pomm, Heidi; Sibille, Kimberly; Spruill, Timothy; Swartz, Virginia
This study explores the beliefs and practices of family medicine physicians regarding the use of nonconventional modalities for menopausal symptom management. Anonymous self-administered questionnaires were distributed to faculty and residents from eight participating family medicine residency programs around Florida, with an overall response rate of 66% (212 respondents). The survey explored what physicians report about patterns of patient inquiries and their responses to patients' inquiries about nonconventional modalities for specific menopausal symptoms and what physicians' report on their advice to patients about using specific herbs and supplements for menopausal symptom relief. Behavioral approaches were encouraged more than herbal therapies, acupuncture, and body therapies for the treatment of most of the menopausal symptoms. However, the most frequent response category was No advice. Resident physicians were significantly more likely than faculty to encourage acupuncture. Faculty physicians were more likely than residents to recommend particular herbal remedies. The majority of the respondents believed there was not sufficient evidence for recommending any of the herbs and supplements listed. These data reveal some important trends about how family medicine physicians respond to nontraditional approaches for menopausal symptom management. Because family medicine physicians typically receive some training in behavioral and psychotherapeutic approaches and there is some evidence for the effectiveness of behavioral strategies in menopausal symptom management, it is not surprising that they are more likely to endorse these approaches. Most family medicine physicians, however, have little or no training in the other nonconventional modalities, and our data show that these modalities received lower levels of endorsement, suggesting that physicians are not clear on their advantages or disadvantages.
It is plausible that what possible courses of action patients may legitimately expect their physicians to take is ultimately determined by what medicine as a profession is supposed to do and, consequently, that we can determine the moral acceptability of voluntary euthanasia and physician-assisted suicide on the basis of identifying the proper goals of medicine. This article examines the main ways of defining the proper goals of medicine found in the recent bioethics literature and argues that they cannot provide a clear answer to the question of whether or not voluntary euthanasia and physician-assisted suicide are morally acceptable. It is suggested that to find a plausible answer to this question and to complete the task of defining the proper goals of medicine, we must determine what is the best philosophical theory about the nature of prudential value.
Xu, Tim; Park, Angela; Bai, Ge; Joo, Sarah; Hutfless, Susan M; Mehta, Ambar; Anderson, Gerard F; Makary, Martin A
Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers. To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians. Retrospective analysis was conducted of professional fee payment claims made by the Centers for Medicare & Medicaid Services for all services provided to Medicare Part B fee-for-service beneficiaries in calendar year 2013. Data analysis was conducted from January 1 to July 31, 2016. Markup ratios for ED and internal medicine professional services, defined as the charges submitted by the hospital divided by the Medicare allowable amount. Our analysis included 12 337 emergency medicine physicians from 2707 hospitals and 57 607 internal medicine physicians from 3669 hospitals in all 50 states. Services provided by emergency medicine physicians had an overall markup ratio of 4.4 (340% excess charges), which was greater than the markup ratio of 2.1 (110% excess charges) for all services performed by internal medicine physicians. Markup ratios for all ED services ranged by hospital from 1.0 to 12.6 (median, 4.2; interquartile range [IQR], 3.3-5.8); markup ratios for all internal medicine services ranged by hospital from 1.0 to 14.1 (median, 2.0; IQR, 1.7-2.5). The median markup ratio by hospital for ED evaluation and management procedure codes varied between 4.0 and 5.0. Among the most common ED services, laceration repair had the highest median markup ratio (7.0); emergency medicine physician review of a head computed tomographic scan had the greatest interhospital variation (range, 1.6-27.7). Across hospitals, markups in the ED were often substantially higher than those in the internal medicine department for the same services. Higher ED markup ratios were associated with hospital for-profit ownership (median, 5.7; IQR, 4.0-7.1), a greater percentage of uninsured patients seen
Card, Sharon E; Clark, Heather D; Elizov, Michelle; Kassam, Narmin
General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition. However, interest amongst trainees in GIM was declining, and the GIM workforce in Canada, like that in many other countries, was in danger of serious shortfalls. After much deliberation and consultation, in 2010, the RCPSC recognized GIM as a distinct subspecialty of internal medicine. Since this time, despite the challenges in the educational implementation of GIM as a distinct discipline, there has been a resurgence of interest in this field of medicine. This paper outlines the journey of the Canadian GIM to educational implementation as a distinct discipline, the impact on the discipline, and the implications for the international GIM community.
Afsin Emre Kayipmaz
Full Text Available Medicine is a profession that carries certain risks. One risky area of practice is the emergency department. Emergency physicians diagnose and treat a high volume of patients, and are also responsible for preparing reports for forensic cases. In this study, we aim to investigate emergency physicians' legal-administrative problems and reveal their level of understanding on forensic cases.An electronic questionnaire form was prepared after the approval of an ethical committee. This form was sent to the residents, specialists and academicians of emergency medicine by e-mail. The physicians were asked to fill out the form online. All the gathered data was analyzed. Descriptive statistics were presented as frequency percentages with mean and standard deviation. Chi-square tests were used to compare the groups. Correlation between number of complaint cases and age, sex, career, institution, and duration of service in emergency department were investigated. p<0.05 was considered statistically significant.294 physicians participated in the questionnaire. According to the questionnaire, 170 of the physicians were reported to the patient communication units due to medical malpractice. Mean number of compliant reports was 3.20±3.5. 29 of the physicians received administrative penalties. 42 of the physicians were judged in the court for medical malpractice. 1 physician was fined 5000 Turkish Liras as a result of these judgments.We found that the number of complaint reports is negatively correlated with duration of service in emergency medicine and age. There was a significant difference between number of complaint reports and career (p<0.05. The physicians' level of awareness on forensic cases was found to be insufficient. Lack of legislation knowledge may be an important cause of complaint reports concerning emergency physicians, who have a high load of patients. Thus, we think that increasing the frequency of post-graduate education sessions and
Indulski, J A; Boczkowski, A; Mikulski, M
In order to determine key competences required of occupational medicine specialists, common throughout Europe, a questionnaire has been developed and distributed among several European countries. The questionnaire contained 115 subjects related to 8 fields of activities carried out by occupational medicine physicians (occupational hazards to health, assessment of disability and fitness for work, communications, research methods, management, environmental medicine, occupational health law and ethics, and health promotion). In each of these fields, competences were classified into three following categories: knowledge, experience and skills. Respondents were asked to allocate a score from 0 to 5 for each subject, where 0 = not necessary; 1 = of minimum importance, and 5 = most important or essential. In Poland the questionnaire was distributed among two groups of specialists: group I--experienced specialists in occupational medicine (leading representatives of occupational health care management), and group II--relatively younger and less experienced occupational medicine physicians, participating in the specialist training, organised by The Nofer Institute of Occupational Medicine. A comprehensive analysis of the completed questionnaires was carried out in two dimensions: substantive (the importance of individual competences as perceived by Polish specialists in occupational medicine), and comparative (evaluation and interpretation of similarities and differences between two groups of respondents). A hierarchy of requirements, occupational medicine training in Poland is to satisfy, was reconstructed with two sets of competences, one recognised by respondents as needless and the other recognised as useful with different grades of importance. Some characteristic differences in opinions between two groups studies were highlighted.
Ashley C. Wietsma
Full Text Available Despite the fact that women now comprise half of the medical student and resident populations, women remain underrepresented in prominent leadership positions in academia. Women are challenging themselves to live up to the expectations of their professional peers, society, and their patients in order to ‘have it all.’ These pressures are leading to professional and personal dissatisfaction. Is this a problem that will resolve itself as the younger generations of female physicians graduate into faculty positions, or does it require more attention from both male and female medical professionals?
Wietsma, Ashley C
Despite the fact that women now comprise half of the medical student and resident populations, women remain underrepresented in prominent leadership positions in academia. Women are challenging themselves to live up to the expectations of their professional peers, society, and their patients in order to 'have it all.' These pressures are leading to professional and personal dissatisfaction. Is this a problem that will resolve itself as the younger generations of female physicians graduate into faculty positions, or does it require more attention from both male and female medical professionals?
Page, Cameron; Stumbar, Sarah; Gold, Marji
Mifepristone offers internal medicine doctors the opportunity to greatly expand access to abortion for their patients. Almost 70% of pregnancy terminations, however, still occur in specialized clinics. No studies have examined the preferences of Internal Medicine patients specifically. Determine whether patient preference is a reason for the limited uptake of medication abortion among internal medicine physicians. Women aged 18-45 recruited from the waiting room in an urban academic internal medicine clinic. A semi-structured questionnaire was used to determine risk of unintended pregnancy and attitudes toward abortion. Support for provision of medication abortion in the internal medicine clinic was assessed with a yes/no question, followed by the open-ended question, "Why do you think this clinic should or should not offer medication abortion?" Subjects were asked whether it was very important, somewhat important, or not important for the internal medicine clinic to provide medication abortion. Of 102 women who met inclusion criteria, 90 completed the survey, yielding a response rate of 88%. Twenty-two percent were at risk of unintended pregnancy. 46.7% had had at least one lifetime abortion. Among those who would consider having an abortion, 67.7% responded yes to the question, "Do you think this clinic should offer medication abortions?" and 83.9% stated that it was "very important" or "somewhat important" to offer this service. Of women open to having an abortion, 87.1% stated that they would be interested in receiving a medication abortion from their primary care doctor. A clinically significant proportion of women in this urban internal medicine clinic were at risk of unintended pregnancy. Among those open to having an abortion, a wide majority would consider receiving it from their internal medicine doctor. The provision of medication abortion by internal medicine physicians has the potential to greatly expand abortion access for women.
Uhlmann, Marc; Burnard, Jérôme; Cosma Rochat, Monica; Gabus, Vincent; Micheloud, Valérie Geiser; Gobin, Niels; Laurent, Jean-Christophe; Marino, Laura; Méan, Marie; Merz, Laurent; Regamey, Julien; Stadelmann, Raphaël
Applying knowledge acquired from recent medical studies to patient care poses a daily challenge to physicians. Chief residents from the Department of Internal Medicine at the University Hospital of Lausanne carried out a review of some of the issues they considered important. The conclusions of these various publications may have a significant impact on the daily practice of hospital-based internal medicine. Modern medicine based on scientific studies is a reminder that in spite of the essential importance of clinical experience, it is crucial to confront it with the results of relevant publications from the medical literature.
Fong, Allan; Ratwani, Raj M
Interruptions can adversely impact human performance, particularly in fast-paced and high-risk environments such as the emergency department (ED). Understanding physician behaviors before, during, and after interruptions is important to the design and promotion of safe and effective workflow solutions. However, traditional human factors based interruption models do not accurately reflect the complexities of real-world environments like the ED and may not capture multiple interruptions and multitasking. We present a more comprehensive framework for understanding interruptions that is composed of three phases, each with multiple levels: Interruption Start Transition, Interruption Engagement, and Interruption End Transition. This three-phase framework is not constrained to discrete task transitions, providing a robust method to categorize multitasking behaviors around interruptions. We apply this framework in categorizing 457 interruption episodes. 457 interruption episodes were captured during 36 hours of observation. The interrupted task was immediately suspended 348 (76.1%) times. Participants engaged in new self-initiated tasks during the interrupting task 164 (35.9%) times and did not directly resume the interrupted task in 284 (62.1%) interruption episodes. Using this framework provides a more detailed description of the types of physician behaviors in complex environments. Understanding the different types of interruption and resumption patterns, which may have a different impact on performance, can support the design of interruption mitigation strategies. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Papenfuß, Tim; Roch, Carmen
74% of all hospitals had vacant positions in 2011, also departments of anaesthesiology and intensive care medicine. More than 50% of these departments work with locums. There are couple of reasons for the shortage of physicians. The consequences in anaesthesiology and intensive care medicine can result in qualitative and financial loss. To solve the shortage of physicians one has to solve the reasons. Main reasons are increasing feminization of medical profession and part-time-work, work-life-balance and a poor specialised education. © Georg Thieme Verlag Stuttgart · New York.
Chiba, Tsuyoshi; Sato, Yoko; Suzuki, Sachina; Umegaki, Keizo
We previously reported that some patients used dietary supplements with their medication without consulting with physicians. Dietary supplements and medicines may interact with each other when used concomitantly, resulting in health problems. An Internet survey was conducted on 2109 people who concomitantly took dietary supplements and medicines in order to address dietary supplement usage in people who regularly take medicines in Japan. A total of 1508 patients (two admitted patients and 1506 ambulatory patients) and 601 non-patients, who were not consulting with physicians, participated in this study. Purpose for dietary supplement use was different among ages. Dietary supplements were used to treat diseases in 4.0% of non-patients and 11.9% of patients, while 10.8% of patients used dietary supplements to treat the same diseases as their medication. However, 70.3% of patients did not declare dietary supplement use to their physicians or pharmacists because they considered the concomitant use of dietary supplements and medicines to be safe. A total of 8.4% of all subjects realized the potential for adverse effects associated with dietary supplements. The incidence of adverse events was higher in patients who used dietary supplements to treat their disease. Communication between patients and physicians is important for avoiding the adverse effects associated with the concomitant use of dietary supplements and medicines. PMID:25894658
Smock, W S
To address the forensic needs of living patients, the Department of Emergency Medicine at the University of Louisville School of Medicine in Louisville, Kentucky, USA initiated the first clinical forensic medicine training programme in the USA. In July 1991, formal training in clinical forensic medicine was incorporated into the core curriculum of the USA's second oldest academic emergency medicine training programme. The University of Louisville, in cooperation with the Kentucky Medical Examiner's Office, developed the curriculum to provide the emergency physician with the knowledge base and technical skills to perform forensic evaluations of living patients. Forensic lectures are given monthly by local and regional forensic experts including: forensic pathologists, prosecuting attorneys, firearm and ballistics examiners, law enforcement officers, forensic chemists and forensic odontologists. Topics which are presented include: forensic pathology, forensic photography, ballistics and firearms analysis, paediatric physical and sexual assault, crime scene investigation, forensic odontology, courtroom and expert testimony and the forensic evaluation of penetrating trauma. As a result of the introduction of clinical forensic medicine into the core curriculum of an emergency medicine training programme the residents are now actively addressing the forensic issues encountered in the Emergency department. Key, often short-lived forensic evidence, which was frequently overlooked or discarded while delivering patient care is now recognized, documented and preserved. The development and introduction of a clinical forensic medicine curriculum into emergency medicine training has greatly enhanced the emergency physician's ability to recognize, document and address the forensic needs of their patients who are victims of violent and non-fatal trauma.
Eisenberg, John M.
The organization and curricula of internal medicine residencies programs that emphasize primary care are described and compared with traditional residencies in internal medicine. It is noted that primary care residents spend more time in ambulatory care and are allowed more electives in specialties outside of internal medicine. Out-of-hospital…
Heine, R P
In the ambulatory care industry, increased competition and promotional costs are pressuring managers to design more creative and effective marketing strategies. One largely overlooked strategy is careful monitoring of the daily communication between physicians and ambulatory care staff providing physician services. Satisfying physician communication needs is the key to increasing physician commitment and referrals. This article outlines the steps necessary to first monitor, then improve the quality of all communication provided to physicians by ambulatory care personnel.
Klee, David; Covey, Carlton; Zhong, Laura
Incorporation of social media (SM) use in medicine is gaining support. The Internet is now a popular medium for people to solicit medical information. Usage of social networks, such as Facebook and Twitter, is growing daily and provides physicians with nearly instantaneous access to large populations for both marketing and patient education. The benefits are myriad, but so are the inherent risks. We investigated the role providers' age and medical experience played in their beliefs and use of SM in medicine. Using multiple state-wide and national databases, we assessed social media use by family medicine residents, faculty, and practicing family physicians with a 24-question online survey. Descriptive data is compared by age and level of medical experience. A total of 61 family medicine residents and 192 practicing family physicians responded. There is a trend toward higher SM utilization in the younger cohort, with 90% of resident respondents reporting using SM, half of them daily. A total of 64% of family physician respondents over the age of 45 have a SM account. An equal percentage of senior physicians use SM daily or not at all. Practicing physicians, more than residents, agree that SM can be beneficial in patient care. The vast majority of residents and physicians polled believe that SM should be taught early in medical education. The high utilization of SM by younger providers, high prevalence of patient use of the Internet, and the countless beneficial opportunities SM offers should be catalysts to drive curriculum development and early implementation in medical education. This curriculum should focus around four pillars: professional standards for SM use, SM clinical practice integration, professional networking, and research.
de Bruijn MC
Full Text Available Matthijs C de Bruijn,1 Boudewijn J Kollen,2 Frank Baarveld21Center for Sports Medicine, 2Department of General Practice, University Medical Center Groningen, University of Groningen, The NetherlandsBackground: In The Netherlands, sports medicine physicians are involved in the care of about 8% of all sports injuries that occur each year. Some patients consult a sports physician directly, without being referred by a general practitioner. This study aims to determine how many patients consult a sports physician directly, and to explore differences in the profiles of these patients compared with those who are referred.Methods: This was an exploratory cross-sectional study in which all new patients presenting with an injury to a regional sports medical center during September 2010 were identified. The characteristics of patients who self-referred and those who were referred by other medical professionals were compared.Results: A total of 234 patients were included (mean age 33.7 years, 59.1% male. Most of the injuries occurred during soccer and running, particularly injuries of the knee and ankle. In this cohort, 39.3% of patients consulted a sports physician directly. These patients were significantly more often involved in individual sports, consulted a sports physician relatively rapidly after the onset of injury, and had received significantly less care before this new event from medical professionals compared with patients who were referred.Conclusion: In this study, 39.3% of patients with sports injuries consulted a sports physician directly without being referred by another medical professional. The profile of this group of patients differed from that of patients who were referred. The specific roles of general practitioners and sports physicians in medical sports care in The Netherlands needs to be defined further.Keywords: sports injuries, sports medicine physician, primary care, secondary care
Hustedde, Carol; Paladine, Heather; Wendling, Andrea; Prasad, Rupa; Sola, Orlando; Bjorkman, Sarah; Phillips, Julie
The USA needs more rural physicians. Although women represent half of all US trained medical students, the rural physician workforce has remained predominantly male. Insight is needed into what makes rural practice attractive for women and which practice characteristics allow women physicians to practice successfully in rural areas. This study's purpose was to examine aspects of the practice environment that impact women physicians' professional satisfaction and commitment to rural medicine. Twenty-five women family physicians practicing in rural areas of the USA were interviewed by phone using a semi-structured format. Transcribed interviews were analyzed using an immersion and crystallization approach. Emergent themes were identified, coded, and discussed until team consensus was attained. Interviews continued until saturation of themes was reached. Three themes emerged from the data, in relationship to practice and employment attributes that contribute to US women physicians' professional satisfaction and willingness to remain in a rural setting: professional relationships, practice characteristics, and support during times of transition. Participants placed high importance on professional relationships, both within and outside of their rural practice. Rural women physicians enjoyed practicing an expanded scope of care, valued loan repayment opportunities, and appreciated supportive practice partners. Importantly, women physicians who found themselves struggling to maintain rural careers often had experienced difficulty during times of practice transition, including maternity leaves. Understanding practice attributes valued by successful rural women family physicians in the USA will help rural health systems, practices, and physicians-in-training to develop and evaluate opportunities that will best contribute to successful rural practice. Supporting women physicians during periods of practice transition may improve retention.
Full Text Available Ana M Menezes,1 Sarah H Landis,2 MeiLan K Han,3 Hana Muellerova,2 Zaurbek Aisanov,4 Thys van der Molen,5 Yeon-Mok Oh,6 Masakazu Ichinose,7 David M Mannino,8 Kourtney J Davis9 1Federal University of Pelotas, Pelotas, Brazil; 2Worldwide Epidemiology, GlaxoSmithKline, Uxbridge, UK; 3Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA; 4Pulmonology Research Institute, Moscow, Russia; 5University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 6University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; 7Tohoku University Graduate School of Medicine, Sendai, Japan; 8University of Kentucky College of Public Health, Lexington, KY, USA; 9Worldwide Epidemiology, GlaxoSmithKline, Wavre, Belgium Purpose: Using data from the Continuing to Confront COPD International Physician and Patient Surveys, this paper describes physicians’ attitudes and beliefs regarding chronic obstructive pulmonary disease (COPD prognosis, and compares physician and patient perceptions with respect to COPD. Methods: In 12 countries worldwide, 4,343 patients with COPD were identified through systematic screening of population samples, and 1,307 physicians who regularly saw patients with COPD were sampled from in-country professional databases. Both patients and physicians completed surveys about their COPD knowledge, beliefs, and perceptions; physicians answered further questions about diagnostic methods and treatment choices for COPD. Results: Most physicians (79% responded that the long-term health outlook for patients with COPD has improved over the past decade, largely attributed to the introduction of better medications. However, patient access to medication remains an issue in many countries, and some physicians (39% and patients (46% agreed/strongly agreed with the statement “there are no truly effective treatments for COPD”. There was strong concordance between physicians and patients
Hugenholtz, Nathalie I. R.; Schaafsma, Frederieke G.; Schreinemakers, Jos F.; van Dijk, Frank J. H.; Nieuwenhuijsen, Karen
OBJECTIVES: This study evaluated how physicians in a nonclinical setting perceive the value of an intervention with multifaceted evidence-based medicine with regard to enhancing their professional performance. METHODS: A qualitative study was conducted using focus groups and face-to-face interviews
Full Text Available Sejal J Patel,1 Kathi J Kemper,2 Joseph P Kitzmiller3 1College of Public Health, The Ohio State University, 2Center for Integrative Health and Wellness, The Ohio State Wexner University Medical Center, 3Department of Biological Chemistry and Pharmacology, College of Medicine, The Ohio State University, Columbus, OH, USA Abstract: Over recent decades, the demand for complementary and alternative medicine (CAM has continued to rise in the US. Like the practice of traditional Western medicine, CAM is associated with not only significant health benefits but also significant risks. Unlike traditional Western medicine, however, much of CAM use is less regulated and often occurs unbeknownst to a patient’s medical doctor. The use of herbals, dietary supplements, and over-the-counter (OTC medications can result in adverse effects, and many significant interactions can occur when their use is combined with allopathic medications. Even the more peripheral CAM practices (eg, acupuncture, massage, yoga, and Reiki have associated risk (eg, adverse effects or worsening of physical injury and conditions. There is, however, impetus for change: both patients and physicians favor increasing physician knowledge of CAM and the synergistic implementation of CAM into routine clinical practice. Although improvement has been achieved from contemporary physician educational efforts, recently published results from patient and physician surveys strongly indicate that additional effort to increase physician knowledge of CAM is needed. Utilizing a 37-item survey and convenience-sampling methodology, we collected detailed information from 114 physicians, fellows, and residents from the Ohio State University Medical Center regarding impediments to increasing physician knowledge of CAM and its implementation in routine clinical practice. The aggregate results of our survey data showed that most physicians 1 desired to increase their knowledge of CAM, 2 believed that less
Doarn, Charles R; Mohler, Stanley R
The training of U.S. physicians in aviation medicine closely followed the development of reliable airplanes. This training has matured as aviation and space travel have become more routine over the past several decades. In the U.S., this training began in support of military pilots who were flying increasingly complex aircraft in the early part of the 20th century. As individuals reached into the stratosphere, low Earth orbit, and eventually to the Moon, physicians were trained not only through military efforts but in academic settings as well. This paper provides an historical summary of how physician training in aerospace medicine developed in the U.S., citing both the development of the military activities and, more importantly, the perspectives of the academic programs. This history is important as we move forward in the development of commercial space travel and the needs that such a business model will be required to meet.
Hergon, Eric; Py, Jean-Yves; Jullien, Stéphanie; Quaranta, Jean-François; Folléa, Gilles; Andreu, Georges; Cabaud, Jean-Jacques; Staccini, Pascal; Rouger, Philippe
The evaluation of the professional practices (EPP) is obligatory for all the physicians since July 1, 2005 for a first five-year period. It represents one of the components of the continuous medical training (CMT). The French Society of Blood Transfusion and National Institute of Blood Transfusion are the promoters of the EPP in transfusion technology and medicine. Initially, the programs of EPP will be conceived and controlled by experts and will relate to their basic activities. During a five years cycle, the physician taking part in a program must validate a specific action and take part in a rolling programme. At the end of the programme, the physician will receive a certificate issued by National Institute of Blood Transfusion and will have to submit it to a committee placed under the responsibility of the regional physicians' committee.
Lupu, Dale; Quigley, Leo; Mehfoud, Nicholas; Salsberg, Edward S
The need for hospice and palliative care is growing rapidly as the population increases and ages and as both hospice and palliative care become more accepted. Hospice and palliative medicine (HPM) is a relatively new physician specialty, currently training 325 new fellows annually. Given the time needed to increase the supply of specialty-trained physicians, it is important to assess future needs to guide planning for future training capacity. We modeled the need for and supply of specialist HPM physicians through the year 2040 to determine whether training capacity should continue growing. To create a benchmark for need, we used a population-based approach to look at the current geographic distribution of the HPM physician supply. To model future supply, we calculated the annual change in current supply by adding newly trained physicians and subtracting physicians leaving the labor force. The current U.S. supply of HPM specialists is 13.35 per 100,000 adults 65 and older. This ratio varies greatly across the country. Using alternate assumptions for future supply and demand, we project that need in 2040 will range from 10,640 to almost 24,000 HPM specialist physicians. Supply will range from 8100 to 19,000. Current training capacity is insufficient to keep up with population growth and demand for services. HPM fellowships would need to grow from the current 325 graduates annually to between 500 and 600 per year by 2030 to assure sufficient physician workforce for hospice and palliative care services given current service provision patterns. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Bishop, Lisa; Young, Stephanie; Twells, Laurie; Dillon, Carla; Hawboldt, John
A pharmacist managed anticoagulation service was initiated in a multi-physician family medicine clinic in December 2006. In order to determine the patient and physician satisfaction with the service, a study was designed to describe the patients' satisfaction with the warfarin education and management they received from the pharmacist, and to describe the physicians' satisfaction with the level of care provided by the pharmacist for patients taking warfarin. A self-administered survey was completed by both eligible patients receiving warfarin and physicians prescribing warfarin between December 2006 and May 2008. The patient survey collected information on patient demographics, satisfaction with warfarin education and daily warfarin management. The physician survey collected data about the satisfaction with patient education and daily anticoagulation management by the pharmacist. Seventy-six of 94 (81%) patients completed the survey. Fifty-nine percent were male with a mean age of 65 years (range 24-90). Ninety-six percent agreed/strongly agreed the pharmacist did a good job teaching the importance of warfarin adherence, the necessity of INR testing and the risks of bleeding. Eighty-five percent agreed/strongly agreed the risk of blood clots was well explained, 79% felt the pharmacist did a good job teaching about dietary considerations and 77% agreed/strongly agreed the pharmacist explained when to see a doctor. All patients felt the pharmacist gave clear instructions on warfarin dosing and INR testing. Four of nine physicians (44%) completed the survey. All agreed/strongly agreed the pharmacist was competent in the care provided, were confident in the care their patients received, would like the pharmacist to continue the service, and would recommend this program to other clinics. Patients and family physicians were satisfied with the pharmacist managed anticoagulation program and recommended continuation of the program. These results support the role of the
Harish, Nir J; Miller, Harold D; Pines, Jesse M; Zane, Richard D; Wiler, Jennifer L
While there has been considerable effort devoted to developing alternative payment models (APMs) for primary care physicians and for episodes of care beginning with inpatient admissions, there has been relatively little attention by payers to developing APMs for specialty ambulatory care, and no efforts to develop APMs that explicitly focus on emergency care. In order to ensure that emergency care is appropriately integrated and valued in future payment models, emergency physicians (EPs) must engage with the stakeholders within the broader health care system. In this article, we describe a framework for the development of APMs for emergency medicine and present four examples of APMs that may be applicable in emergency medicine. A better understanding of how APMs can work in emergency medicine will help EPs develop new APMs that improve the cost and quality of care, and leverage the value that emergency care brings to the system. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available Abstract Background In the U.S., complementary and alternative medicine (CAM use is most prevalent among reproductive age, educated women. We sought to determine general attitudes and approaches to CAM among obstetric and gynecology patients and physicians. Methods Obstetrician-gynecologist members of the American Medical Association in the state of Michigan and obstetric-gynecology patients at the University of Michigan were surveyed. Physician and patient attitudes and practices regarding CAM were characterized. Results Surveys were obtained from 401 physicians and 483 patients. Physicians appeared to have a more positive attitude towards CAM as compared to patients, and most reported routinely endorsing, providing or referring patients for at least one CAM modality. The most commonly used CAM interventions by patients were divergent from those rated highest among physicians, and most patients did not consult with a health care provider prior to starting CAM. Conclusion Although obstetrics/gynecology physicians and patients have a positive attitude towards CAM, physician and patients' view of the most effective CAM therapies were incongruent. Obstetrician/gynecologists should routinely ask their patients about their use of CAM with the goal of providing responsible, evidence-based advice to optimize patient care.
Toulkidis, V; Donnelly, N J; Ward, J E
To assess Australian adult physicians' views about evidence-based medicine (EBM) and quality improvement (QI). Cross-sectional postal survey of two hundred and forty-four randomly selected Australian physicians (78.5% response rate). Physicians' views about the promotion of EBM and QI and their impact on patient care, strategies to support better clinical practice and self-reported understanding of EBM terms. Sixty-eight per cent (95% confidence interval (CI): 62-74%) of physicians had a positive view of the current promotion of EBM in Australia. Significantly fewer (45%; 95% CI: 38-51%) were so positive about QI (P evidence, significantly fewer (21%; 95% CI: 17-27%) agreed they had sufficient time to do so (P Australian physicians have positive views of EBM, QI appears less well regarded. Initiatives to improve quality and safety that incorporate principles and language of EBM will likely be received better by physicians than isolated QI. Further enhancement of EBM requires concomitant attention to physician training, workplace infrastructure and supportive professional development.
Komarraju, Aparna; Bartel, Twyla B; Dickinson, Lisa A; Grant, Frederick D; Yarbrough, Tracy L
Increasingly, emerging technologies are expanding instructional possibilities, with new methods being adopted to improve knowledge acquisition and retention. Within medical education, many new techniques have been employed in the undergraduate setting, with less utilization thus far in the continuing medical education (CME) sphere. This paper discusses the use of a new method for CME-the "flipped classroom," widely used in undergraduate medical education. This method engages learners by providing content before the live ("in class") session that aids in preparation and fosters in-class engagement. A flipped classroom method was employed using an online image-rich case-based module and quiz prior to a live CME session at a national nuclear medicine meeting. The preparatory material provided a springboard for in-depth discussion at the live session-a case-based activity utilizing audience response technology. Study participants completed a survey regarding their initial experience with this new instructional method. In addition, focus group interviews were conducted with session attendees who had or had not completed the presession material; transcripts were qualitatively analyzed. Quantitative survey data (completed by two-thirds of the session attendees) suggested that the flipped method was highly valuable and met attendee educational objectives. Analysis of focus group data yielded six themes broadly related to two categories-benefits of the flipped method for CME and programmatic considerations for successfully implementing the flipped method in CME. Data from this study have proven encouraging and support further investigations around the incorporation of this innovative teaching method into CME for nuclear imaging specialists.
Full Text Available Aim: This study aimed to define the manner and behaviour of first line treatment physicians%u2019 and general practitionars that work in the second line treatment hospitals regarding rational medicine use (RMU in the centre of Burdur and its surrounding districts. Material and Method:This descriptive study includes first line treatment physicians%u2019 prescribing medication and general practitionars that work in the second line treatment hospitals (total N=102 in the centre of Burdur, Turkey and its surrounding districts. There was no sampling for the study. All the physicians who agreed to participate were reached through a survey taker with a face-to-face interview between April 1, 2015 and July 7, 2015. 98 physicians participated in the study. The data from the study were analysed using the SPSS 17.0 for Windows program. Measurable values were described as arithmetic mean and standard deviation, and countable values were calculated as numbers and percentage. Results: In the study including 98 physicians, 78 (79.6% of them were males, 75 (76.5% were married, and their average age was 40.77±8.77. The leading factors affecting physicians%u2019 prescriptions were post-graduate studies as cited by 82 (83.7% and pharmacology lessons for 75 (76.5%. Drug company presentations were the least important factor, cited by 22 physicians (22.4%. The most important criteria for physicians in prescribing were the effectiveness of the drug as cited by 97 (99% and reliability of the drug for 96 (98%. Also, 98 of the physicians (100% stated that patients asked them to prescribe certain drugs. However, only eight physicians (8.2% indicated that they always prescribed the drug demanded by the patient while 88 physicians (89.8% indicated that they sometimes did this. Discussion: Physicians are frequently asked by patients to prescribe painkillers and antibiotics. However, the physicians cannot always meet these demands from the RMU point of view. Our study
Angus, Steven; Vu, T Robert; Halvorsen, Andrew J; Aiyer, Meenakshy; McKown, Kevin; Chmielewski, Amy F; McDonald, Furman S
The transition from medical student to intern may cause stress and burnout in new interns and the delivery of suboptimal patient care. Despite a formal set of subinternship curriculum guidelines, program directors have expressed concern regarding the skill set of new interns and the lack of standardization in that skill set among interns from different medical schools. To address these issues, the Accreditation Council for Graduate Medical Education's Next Accreditation System focuses on the development of a competency-based education continuum spanning undergraduate, graduate, and continuing medical education. In 2010, the Clerkship Directors in Internal Medicine subinternship task force, in collaboration with the Association of Program Directors in Internal Medicine survey committee, surveyed internal medicine residency program directors to determine which competencies or skills they expected from new medical school graduates. The authors summarized the results using categories of interest. In both an item rank list and free-text responses, program directors were nearly uniform in ranking the skills they deemed most important for new interns-organization and time management and prioritization skills; effective communication skills; basic clinical skills; and knowing when to ask for assistance. Stakeholders should use the results of this survey as they develop a milestone-based curriculum for the fourth year of medical school and for the internal medicine subinternship. By doing so, they should develop a standardized set of skills that meet program directors' expectations, reduce the stress of transitions across the educational continuum, and improve the quality of patient care.
Physicians who prescribe medicaments to patients are the preferred target group of sales promotion by pharmaceutical industry. As studies show, pharmaceutical advertising actually exerts some influence on a physician's knowledge and habit of prescribing medicine, to the point of even inducing him to give preference to a special drug. Information on pharmaceuticals given by advertisements may contain some potential of bias, instead of offering the physician a chance of objectives additional training. Free gifts from the pharmaceutical industry may easily plunge a physician into a conflict of interest while giving therapy with drugs. The gift relationship established between him and pharmaceutical enterprises is apt to mutate to some sort of commitment he owes to the givers. Favouring a drug which has come about through he influence of advertising, can thus violate the principles of "good prescribing". For a treatment which contains potential for bias and a conflict of interest cannot possibly match the profession's principles of responsibility, fostering informed choice (autonomy), protecting the patient from harm (nonmaleficence), acting in a patient's best interest (beneficence), and promoting equity in health care (justice). Each physician should therefore be aware of possibly belonging to a preferred target group pharmaceutical sales promotion is aiming at. He should take an independent attitude while acquiring knowledge, and critically view the adequateness of free gifts he is offered. Even students of medicine should be encouraged to critically reflect on the necessary and essential relationship to pharmaceutical industries so that it may be moulded according to the benefit of the patients.
Kayipmaz, Afsin Emre; Kavalci, Cemil; Gulalp, Betul; Kocalar, Ummu Gulsum; Giray, Tufan Akin; Yesilagac, Hasan; Ozel, Betul Akbuga; Celikel, Elif; Karagun, Ozlem
Medicine is a profession that carries certain risks. One risky area of practice is the emergency department. Emergency physicians diagnose and treat a high volume of patients, and are also responsible for preparing reports for forensic cases. In this study, we aim to investigate emergency physicians' legal-administrative problems and reveal their level of understanding on forensic cases. An electronic questionnaire form was prepared after the approval of an ethical committee. This form was sent to the residents, specialists and academicians of emergency medicine by e-mail. The physicians were asked to fill out the form online. All the gathered data was analyzed. Descriptive statistics were presented as frequency percentages with mean and standard deviation. Chi-square tests were used to compare the groups. Correlation between number of complaint cases and age, sex, career, institution, and duration of service in emergency department were investigated. pmedicine and age. There was a significant difference between number of complaint reports and career (p<0.05). The physicians' level of awareness on forensic cases was found to be insufficient. Lack of legislation knowledge may be an important cause of complaint reports concerning emergency physicians, who have a high load of patients. Thus, we think that increasing the frequency of post-graduate education sessions and periodical reviews might be beneficial.
Neri, P M; Redden, L; Poole, S; Pozner, C N; Horsky, J; Raja, A S; Poon, E; Schiff, G; Landman, A
To understand emergency department (ED) physicians' use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules. We invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes. Eight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources. We confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving
Full Text Available Background: In response to transforming healthcare and pursuit of the Triple Aim, many health systems have added team members to expand the capabilities and effectiveness of the team to facilitate these aims. The objective of this study was to explore knowledge and perceptions of pharmacist-physician collaboration among family medicine residents (FMR, family medicine faculty (FMF, and pharmacist faculty and residents in a practice where clinical pharmacy services were relatively new. Understanding the nuances of pharmacist-physician interactions will provide insight into how to improve FMR education to prepare learners for patient-centered, team-based practice. Methods: An exploratory descriptive qualitative study design was used to articulate perceptions of professional roles and team-based care in an interprofessional family medicine community-based clinical practice. Five, 60-minute focus groups were conducted in a clinical training setting that focuses on preparing family medicine physicians for collaborative rural primary care practice. Results: Twenty-one FMRs, eight FMF, and six clinical pharmacists participated. Three themes emerged from the focus groups and were consistent across the groups: 1 roles of pharmacists recognized by physicians in different settings, 2 benefits to collaboration, and 3 keys to successful pharmacist-physician collaboration which include a developing the relationship, b optimizing communication, c creating beneficial clinical workflow, d clarifying roles and responsibilities, and e increasing opportunities for meaningful interactions. Conclusion: This study demonstrated that by co-locating physicians and pharmacists in the same environment, and providing a basic structure for collaboration, a collaborative working relationship can be initiated. Practices looking to have more effective collaborative working relationships should strive to increase the frequency of interactions of the professions, help the
Full Text Available Abstract Background During the last decades research has disclosed gender differences and gender bias in different fields of academic and clinical medicine. Consequently, a gender perspective has been asked for in medical curricula and medical education. However, in reports about implementation attempts, difficulties and reluctance have been described. Since teachers are key persons when introducing new issues we surveyed physician teachers' attitudes towards the importance of gender in professional relations. We also analyzed if gender of the physician is related to these attitudes. Method Questionnaires were sent to all 468 senior physicians (29 % women, at the clinical departments and in family medicine, engaged in educating medical students at a Swedish university. They were asked to rate, on five visual analogue scales, the importance of physician and patient gender in consultation, of physician and student gender in clinical tutoring, and of physician gender in other professional encounters. Differences between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. Results The response rate was 65 %. The physicians rated gender more important in consultation than in clinical tutoring. There were significant differences between women and men in all investigated areas also when adjusting for speciality, age, academic degree and years in the profession. A higher proportion of women than men assessed gender as important in professional relationships. Those who assessed very low were all men while both men and women were represented among those with high ratings. Conclusions To implement a gender perspective in medical education it is necessary that both male and female teachers participate and embrace gender aspects as important. To facilitate implementation and to convince those who are indifferent, this study indicates that special efforts are needed to motivate men. We suggest that men with an interest in
Full Text Available Abstract Background The objectives of this study were: a to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM in primary care; b to investigate the influence of patient preferences on clinical decision-making; and c to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.
Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross E G
The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice. Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.
Wieland, Mark L; Szostek, Jason H; Wingo, Majken T; Post, Jason A; Mauck, Karen F
Clinicians are challenged to identify new practice-changing articles in the medical literature. To identify the practice-changing articles published in 2017 most relevant to outpatient general internal medicine, 5 internists reviewed the following sources: 1) titles and abstracts from internal medicine journals with the 7 highest impact factors, including New England Journal of Medicine, Lancet, Journal of the American Medical Association, British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine; 2) synopses and syntheses of individual studies, including collections in the American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine; 3) databases of synthesis, including Evidence Updates and the Cochrane Library. Inclusion criteria were perceived clinical relevance to outpatient general medicine, potential for practice change, and strength of evidence. This process yielded 140 articles. Clusters of important articles around one topic were considered as a single-candidate series. A modified Delphi method was utilized by the 5 authors to reach consensus on 7 topics to highlight and appraise from the 2017 literature. Copyright © 2018 Elsevier Inc. All rights reserved.
Santhosh, Lekshmi; Babik, Jennifer; Looney, Mark R; Hollander, Harry
Twenty years ago, the term "hospitalist" was coined at the University of California-San Francisco (San Francisco, CA), heralding a new specialty focused on the care of inpatients. There are now more than 50,000 hospitalists practicing in the United States. At many academic medical centers, hospitalists are largely replacing subspecialists as attendings on the inpatient medicine wards. At University of California-San Francisco, this has been accompanied by declining percentages of residency graduates who enter subspecialty training in internal medicine. The decline in subspecialty medicine interest can be attributed to many factors, including differences in compensation, decreased subspecialist exposure, and a changing research funding landscape. Although there has not been systematic documentation of this trend in pulmonary and critical care medicine, we have noted previously pulmonary and critical care-bound trainees switching to hospital medicine instead. With our broad, multiorgan system perspective, pulmonary and critical care faculty should embrace teaching general medicine. Residency programs have instituted creative solutions to encourage more internal medicine residents to pursue careers in subspecialty medicine. Some solutions include creating rotations that promote more contact with subspecialists and physician-scientists, creating clinician-educator tracks within fellowship programs, and appointing subspecialists to internal medicine residency leadership positions. We need more rigorous research to track the trends and implications of the generalist-specialist balance of inpatient ward teams on resident career choices, and learn what interventions affect those choices.
Levine, Max A; Shao, Wei; Klein, Douglas
To determine whether community-based, nurse-led monitoring of the international normalized ratio (INR) in patients requiring long-term warfarin therapy was comparable to traditional physician monitoring. A retrospective cohort analysis of patients taking long-term warfarin therapy. The study used data gathered from 3 family medicine clinics in a primary care network in Edmonton, Alta. Medical records of patients currently taking warfarin were examined. Implementation of nurse-led monitoring in a primary care network in place of standard family physician INR monitoring. The degree of INR control before and after the implementation of nurse-run INR monitoring was assessed. The average proportion of time spent outside of therapeutic INR ranges, as well as the average number of days between successive INR readings, was calculated and compared. The degree of control placed patients into either a good-control group (out of range ≤ 25% of the time) or a moderate-control group (out of range > 25% of the time) and these groups were compared. Before nurse monitoring, INR values were out of range 20.4% of the time; after nurse monitoring they were out of range 19.2% of the time (P = .115); the time between sequential INR readings also did not differ before and after implementation of nurse monitoring (23.9 vs 21.6 days, P = .789). Nurse-led monitoring of INR is as effective as traditional physician monitoring. Advantages of nurse-led monitoring might include freeing family physicians to see more patients or to spend less time at work. It might also represent potential cost savings.
Nikendei, C; Schilling, T; Nawroth, P; Hensel, M; Ho, A D; Schwenger, V; Zeier, M; Herzog, W; Schellberg, D; Katus, H A; Dengler, T; Stremmel, W; Müller, M; Jünger, J
An amendment to the German medical curriculum in April 2002 will place basic practical skills at the centre of medical training. We report here on the implementation and evaluation of an obligatory, tutor-guided, and integrated skills laboratory concept in the field of internal medicine. To test the effectiveness of a skills laboratory training on OSCE performance a pilot study was carried out. The experimental group, of 77 students, participated in seven sessions of communication training, skills laboratory training, and bedside teaching, each lasting one and a half hours. The control group of 66 students had as many sessions but was only offered bedside-teaching. The evaluation of acceptance of skills' training as well as the related increase in individual competence is on-going (summer term 2004: n = 176 students). The integrated skills laboratory concept was rated at 3.5 (SD = 1.2) on a 5-point scale and was acknowledged as practice-oriented (M = 4.2; SD = 1.0) and relevant for doctors' everyday lives (M = 3.6; SD = 1.1). Increased levels of competence according to individual self-evaluations proved to be highly significant (p<.001), and results of the pilot study showed that the experimental group had a significantly better OSCE performance than the control group (p<.001). This pilot study shows that curriculum changes promoting basic clinical skills are effective and lead to an improved practical education of tomorrow's physicians. The integrated skills laboratory concept is well accepted and leads to a relevant increase in competence in the practice of internal medical. The presented skills laboratory concept in internal medicine is proving to be a viable and efficient learning tool.
This article explores the causes of the crisis in the role of internists. As in the United States, the progressive specialization of internists lead to a dehumanized, expensive and technical practice of medicine. Aiming to better incomes and prestige, more than 60% of internists practice as specialists. Primary care physicians, with a very low rate of problem solving, cover 75% of consultations. Specialists, with increasing costs, cover the rest of consultations. Patients, medical schools and health organizations are claiming the return of the general internal medicine specialist. To increase the interest for general internal medicine, several strategies are applicable. Medical students interested in general internal medicine could receive a focused training, provided by these specialists. A greater emphasis should be put on primary care. More independent, secondary care diagnostic and treatment centers, should be created. Continuous medical education should be done with periodical re certification of physicians. The public health system should increase its wages and the generalist view should be maintained by physicians when practicing at their private offices.
Khoja, T A; Al-Ansary, L A
A questionnaire survey was made of primary health care physicians in Asir region, Saudi Arabia in 1999 to explore their awareness of and attitude towards evidence-based medicine. The 272 respondents welcomed the principles of evidence-based medicine. Awareness and use of extracting journals, review publications and databases was low. Pharmaceutical company sponsored journals were the most commonly read. Bibliographic databases could only be accessed by 13% of respondents and the Internet by only 6%. There was only partial understanding of technical terms used in evidence-based medicine. Absence of a local library and increased patient workload were seen by most respondents as the main obstacles to practising evidence-based medicine.
Miller, Eliza; Balmer, Dorene; Hermann, Nellie; Graham, Gillian; Charon, Rita
To learn what medical students derive from training in humanities, social sciences, and the arts in a narrative medicine curriculum and to explore narrative medicine's framework as it relates to students' professional development. On completion of required intensive, half-semester narrative medicine seminars in 2010, 130 second-year medical students at Columbia University College of Physicians and Surgeons participated in focus group discussions of their experiences. Focus group transcriptions were submitted to close iterative reading by a team who performed a grounded-theory-guided content analysis, generating a list of codes into which statements were sorted to develop overarching themes. Provisional interpretations emerged from the close and repeated readings, suggesting a fresh conceptual understanding of how and through what avenues such education achieves its goals in clinical training. Students' comments articulated the known features of narrative medicine--attention, representation, and affiliation--and endorsed all three as being valuable to professional identity development. They spoke of the salience of their work in narrative medicine to medicine and medical education and its dividends of critical thinking, reflection, and pleasure. Critiques constituted a small percentage of the statements in each category. Students report that narrative medicine seminars support complex interior, interpersonal, perceptual, and expressive capacities. Students' lived experiences confirm some expectations of narrative medicine curricular planners while exposing fresh effects of such work to view.
Huddle, Thomas S; Centor, Robert; Heudebert, Gustavo R
American internal medicine suffers a confusion of identity as we enter the 21st century. The subspecialties prosper, although unevenly, and retain varying degrees of connection to their internal medicine roots. General internal medicine, identified with primary care since the 1970s, retains an affinity for its traditional consultant-generalist ideal even as primary care further displaces that ideal. We discuss the origins and importance of the consultant-generalist ideal of internal medicine as exemplified by Osler, and its continued appeal in spite of the predominant role played by clinical science and accompanying subspecialism in determining the academic leadership of American internal medicine since the 1920s. Organizing departmental clinical work along subspecialty lines diminished the importance of the consultant-generalist ideal in academic departments of medicine after 1950. General internists, when they joined the divisions of general internal medicine that appeared in departments of medicine in the 1970s, could sometimes emulate Osler in practicing a general medicine of complexity, but often found themselves in a more limited role doing primary care. As we enter the 21st century, managed care threatens what remains of the Oslerian ideal, both in departments of medicine and in clinical practice. Twenty-first century American internists will have to adjust their conditions of work should they continue to aspire to practice Oslerian internal medicine. PMID:12950486
Harding, Richard K
America is in the midst of experiencing the sesquicentennial of the Civil War. We do so with some ambivalence knowing that the war forged a great union and ended slavery but also caused the deaths of more than 600,000 fellow citizens. Samuel A. Mudd, MD, University of Maryland School of Medicine class of 1856, was a man of this time. As a physician-farmer in Southern Maryland, he was a highly respected physician, a slave owner, and a devout citizen. The Civil War (1861-1865) would alter his life in ways few could have imagined. This article looks at his background, his education, his work as a physician-farmer, and his dramatic rise to national attention and infamy. Convicted by a military tribunal and imprisoned for his "crimes," he was able to partially redeem himself using his medical skills and professionalism. Mudd was a man of his time. And what a time it was.
Full Text Available Abstract Background Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun. As part of future activities of the Queen's University Family Medicine Development Program in the Balkans Region, technical assistance may be provided to Bosnia and Herzegovina to develop of national tobacco control strategies. This assistance may focus on training doctors and nurses on smoking cessation strategies with a view to helping their patients to stop smoking. Given this important role that health professionals have, data is needed on smoking rates as well as on smoking behaviour among doctors and nurses in Bosnia and Herzegovina. This study therefore seeks to determine the smoking rates and behaviour of family medicine physicians and nurses in Bosnia and Herzegovina and to determine how well prepared they feel with respect to counselling their patients on smoking cessation strategies. Methods The WHO Global Health Professional Survey, a self-administered questionnaire, was distributed to physicians and nurses in 19 Family Medicine Teaching Centres in Bosnia and Herzegovina in June 2002. Smoking rates and behaviour, as well as information on knowledge and attitudes regarding smoking were determined for both physicians and nurses. Results Of the 273 physicians and nurses currently working in Family Medicine Teaching Centres, 209 (77% completed the questionnaire. Approximately 45% of those surveyed currently smoke, where 51% of nurses smoked, compared to 40% of physicians. With respect to knowledge and attitudes, all respondents agreed that smoking is harmful to one's health. However, "ever" smokers, compared to "never" smokers, were less likely to agree that health professionals who smoke were less likely to advise patients to quit smoking than non-smoking health professionals. Less than half of physicians and nurses had received formal training in smoking
Hodgetts, Geoffrey; Broers, Teresa; Godwin, Marshall
Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun. As part of future activities of the Queen's University Family Medicine Development Program in the Balkans Region, technical assistance may be provided to Bosnia and Herzegovina to develop of national tobacco control strategies. This assistance may focus on training doctors and nurses on smoking cessation strategies with a view to helping their patients to stop smoking. Given this important role that health professionals have, data is needed on smoking rates as well as on smoking behaviour among doctors and nurses in Bosnia and Herzegovina. This study therefore seeks to determine the smoking rates and behaviour of family medicine physicians and nurses in Bosnia and Herzegovina and to determine how well prepared they feel with respect to counselling their patients on smoking cessation strategies. The WHO Global Health Professional Survey, a self-administered questionnaire, was distributed to physicians and nurses in 19 Family Medicine Teaching Centres in Bosnia and Herzegovina in June 2002. Smoking rates and behaviour, as well as information on knowledge and attitudes regarding smoking were determined for both physicians and nurses. Of the 273 physicians and nurses currently working in Family Medicine Teaching Centres, 209 (77%) completed the questionnaire. Approximately 45% of those surveyed currently smoke, where 51% of nurses smoked, compared to 40% of physicians. With respect to knowledge and attitudes, all respondents agreed that smoking is harmful to one's health. However, "ever" smokers, compared to "never" smokers, were less likely to agree that health professionals who smoke were less likely to advise patients to quit smoking than non-smoking health professionals. Less than half of physicians and nurses had received formal training in smoking cessations strategies, but about two thirds of health
Balkin, Emily M; Thompson, Daria; Colson, K Ellicott; Lam, Catherine G; Matthay, Katherine K
Studies have shown that children with cancer globally lack access to palliative care. Little is known regarding physicians' perceptions of palliative care, treatment access, and self-reported competence in providing palliative care. Members of the Global Neuroblastoma Network (online tumor board) were surveyed. Eighty-three respondents met inclusion criteria; 53 (64%) completed the survey. Most respondents trained in high-income countries (HIC) but practice in low- and middle-income countries (LMIC), and care for more than five patients with neuroblastoma annually. WHO Essential Medicines in palliative care varied in availability, with incomplete access across LMIC centers. Nonpharmacologic therapies were inconsistently available. Contrary to international definitions, 17% of respondents inappropriately considered palliative care as that initiated only after curative therapy is stopped. Mean physician competence composite score (Likert scale 1-5, 5 = very competent) in providing symptomatic relief and palliative care across phases of care was 2.93 (95% CI 2.71-3.22). Physicians reported significantly greater competence in symptom management during cure-directed therapy than during end-of-life (P = 0.02) or when patients are actively dying (P = 0.007). Practicing in HIC, prior palliative care training, having access to radiotherapy, and not having to turn patients away due to bed shortages were significantly predictive of perceived competence in providing palliative care at end of life. An international sample identified gaps in treatment and palliative care service availability, in understanding the definition of palliative care, and in self-reported competence in providing palliative care. Increased perceived competence was associated with training, which supports the need for increased palliative care education and advocacy, especially in LMIC. © 2016 Wiley Periodicals, Inc.
Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian
Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of...
Hamasaki, Tomoko; Hagihara, Akihito
The aim of this study was to review the typical factors related to physician's liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain. This study involved analyzing 366 medical litigation case reports from 1990 through 2008 where the duty to explain was disputed. We examined relationships between patients, physicians, variables related to physician's explanations, and physician's breach of the duty to explain by comparing mean values and percentages in obstetrics and gynecology, internal medicine, and surgical departments with the t-test and χ(2) test. When we compared the reasons for decisions in cases where the patient won, we found that the percentage of cases in which the patient's claim was recognized was the highest for both physician negligence, including errors of judgment and procedural mistakes, and breach of the duty to explain, in obstetrics and gynecology departments; breach of the duty to explain alone in internal medicine departments; and mistakes in medical procedures alone in surgical departments (p = 0.008). When comparing patients, the rate of death was significantly higher than that of other outcomes in precedents where a breach of the duty to explain was acknowledged (p = 0.046). The proportion of cases involving obstetrics and gynecology departments, in which care was claimed to be substandard at the time of treatment, and that were not argued as breach of a duty to explain, was significantly higher than those of other evaluated departments (p duty to explain had been breached when seeking patient approval (or not) was significantly higher than in other departments (p = 0.002). It is important for physicians working in obstetrics and gynecology departments to carefully explain the risk of death associated with any planned procedure, and to obtain genuinely informed patient consent.
Menezes, Ana M.; Landis, Sarah H.; Han, MeiLan K.; Muellerova, Hana; Aisanov, Zaurbek; van der Molen, Thys; Oh, Yeon-Mok; Ichinose, Masakazu; Mannino, David M.; Davis, Kourtney J.
Purpose: Using data from the Continuing to Confront COPD International Physician and Patient Surveys, this paper describes physicians' attitudes and beliefs regarding chronic obstructive pulmonary disease (COPD) prognosis, and compares physician and patient perceptions with respect to COPD. Methods:
Caskey, Rachel N; Abutahoun, Angelos; Polick, Anne; Barnes, Michelle; Srivastava, Pavan; Boyd, Andrew D
The US health care system uses diagnostic codes for billing and reimbursement as well as quality assessment and measuring clinical outcomes. The US transitioned to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) on October, 2015. Little is known about the impact of ICD-10-CM on internal medicine and medicine subspecialists. We used a state-wide data set from Illinois Medicaid specified for Internal Medicine providers and subspecialists. A total of 3191 ICD-9-CM codes were used for 51,078 patient encounters, for a total cost of US $26,022,022 for all internal medicine. We categorized all of the ICD-9-CM codes based on the complexity of mapping to ICD-10-CM as codes with complex mapping could result in billing or administrative errors during the transition. Codes found to have complex mapping and frequently used codes (n = 295) were analyzed for clinical accuracy of mapping to ICD-10-CM. Each subspecialty was analyzed for complexity of codes used and proportion of reimbursement associated with complex codes. Twenty-five percent of internal medicine codes have convoluted mapping to ICD-10-CM, which represent 22% of Illinois Medicaid patients, and 30% of reimbursements. Rheumatology and Endocrinology had the greatest proportion of visits and reimbursement associated with complex codes. We found 14.5% of ICD-9-CM codes used by internists, when mapped to ICD-10-CM, resulted in potential clinical inaccuracies. We identified that 43% of diagnostic codes evaluated and used by internists and that account for 14% of internal medicine reimbursements are associated with codes which could result in administrative errors.
Szostek, Jason H; Wieland, Mark L; Post, Jason A; Sundsted, Karna K; Mauck, Karen F
Identifying new practice-changing articles is challenging. To determine the 2015 practice-changing articles most relevant to outpatient general internal medicine, 3 internists independently reviewed the titles and abstracts of original articles, synopses of single studies and syntheses, and databases of syntheses. For original articles, internal medicine journals with the 7 highest impact factors were reviewed: New England Journal of Medicine, Lancet, Journal of the American Medical Association (JAMA), British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine. For synopses of single studies and syntheses, collections in American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine were reviewed. For databases of synthesis, Evidence Updates and the Cochrane Library were reviewed. More than 100 articles were identified. Criteria for inclusion were as follows: clinical relevance, potential for practice change, and strength of evidence. Clusters of important articles around one topic were considered as a single-candidate series. The 5 authors used a modified Delphi method to reach consensus on inclusion of 7 topics for in-depth appraisal. Copyright © 2016 Elsevier Inc. All rights reserved.
Loder, Elizabeth; Weizenbaum, Emma; Frishberg, Benjamin; Silberstein, Stephen
In an effort to draw attention to tests and procedures associated with low-value care in headache medicine, the American Headache Society (AHS) joined the Choosing Wisely initiative of the American Board of Internal Medicine Foundation. The AHS president appointed an ad hoc "Choosing Wisely" task force of the AHS. The committee surveyed AHS members to develop a candidate list of items for the AHS "Top 5" list of low-value care in headache medicine. Through a process of literature review and consensus, the final list of five items was chosen. Draft recommendations went through several rounds of revision and a process of outside review. The AHS Board of Directors approved the final list of "Five Things." The five recommendations approved by the AHS Board of Directors are: (1) don't perform neuroimaging studies in patients with stable headaches that meet criteria for migraine; (2) don't perform computed tomography imaging for headache when magnetic resonance imaging is available, except in emergency settings; (3) don't recommend surgical deactivation of migraine trigger points outside of a clinical trial; (4) don't prescribe opioid- or butalbital-containing medications as a first-line treatment for recurrent headache disorders; and (5) don't recommend prolonged or frequent use of over-the-counter pain medications for headache. We recommend that headache medicine specialists and other physicians who evaluate and treat headache disorders should use this list when discussing care with patients. © 2013 American Headache Society.
Ala Aeddine, Nada; Khayat, Mohamed; Alawieh, Hanaa; Adibilly, Siham; Adib, Salim
This survey aimed at assessing the perceptions of physicians regarding the appropriateness of prescribing herbal medicines (HM), their prescribing patterns and their knowledge regarding the interaction between HM and conventional drugs. No data are currently available in Lebanon concerning the frequency of HM prescription and indications. HM poorly prescribed can affect the overall quality of health among patients taking conventional drugs. This descriptive survey study was conducted in the Greater Beirut area in Lebanon during May-June 2009. All Primary Health Care (PHC) physicians in private community-based solo practice were identified from the Lebanese Order of Physicians listing, contacted and invited to participate. Those who agreed had to complete a pre-piloted face-to-face questionnaire. Of two hundred twelve participating physicians, 45% routinely prescribed HM to their patients. Between 64 to 67% prescribers believed that HM have more benefits, faster results and fewer side effects than conventional drugs. In addition, 58% thought that HM were less expensive, and 76% that they were easier to take than conventional drugs. More importantly, in a series of eight questions concerning the physicians' knowledge about the possible mechanism of drug-herb interactions, the general tendency was towards poor knowledge. A good percentage of PHC physicians who routinely prescribe HM do not know their mechanism of action or their possible interactions with the conventional drugs. Knowledge about mechanism of drug-herb interactions should be an integral part of the medical curriculum. The knowledge about HM should be an integral part of the medical curriculum as they are frequently prescribed by PHC physicians.
de Bruijn, Matthijs C; Kollen, Boudewijn J; Baarveld, Frank
Background In The Netherlands, sports medicine physicians are involved in the care of about 8% of all sports injuries that occur each year. Some patients consult a sports physician directly, without being referred by a general practitioner. This study aims to determine how many patients consult a sports physician directly, and to explore differences in the profiles of these patients compared with those who are referred. Methods This was an exploratory cross-sectional study in which all new patients presenting with an injury to a regional sports medical center during September 2010 were identified. The characteristics of patients who self-referred and those who were referred by other medical professionals were compared. Results A total of 234 patients were included (mean age 33.7 years, 59.1% male). Most of the injuries occurred during soccer and running, particularly injuries of the knee and ankle. In this cohort, 39.3% of patients consulted a sports physician directly. These patients were significantly more often involved in individual sports, consulted a sports physician relatively rapidly after the onset of injury, and had received significantly less care before this new event from medical professionals compared with patients who were referred. Conclusion In this study, 39.3% of patients with sports injuries consulted a sports physician directly without being referred by another medical professional. The profile of this group of patients differed from that of patients who were referred. The specific roles of general practitioners and sports physicians in medical sports care in The Netherlands needs to be defined further. PMID:24379706
Tasaki, Katsuya; Maskarinec, Gertraud; Shumay, Dianne M; Tatsumura, Yvonne; Kakai, Hisako
The aim of this paper is to identify barriers to communication between physicians and cancer patients regarding complementary and alternative medicine (CAM) by exploring the perspectives of patients. In face of the recent popularity of CAM use among cancer patients, the lack of communication is a serious problem. A number of CAM therapies may interfere with conventional treatments and thus impact patients' well-being and chances of survival. In addition, lack of communication is problematic in the health care context because the development of openness and trust between health care providers and clients is contingent upon effective interpersonal communication. We conducted semi-structured interviews with 143 cancer patients to explore their experiences with CAM use. Using a qualitative research method, we examined interview data from 93 CAM users who provided sufficient information about communication issues. As a result, three themes emerged describing barriers to unsuccessful communication as perceived from the patient's point of view: physicians' indifference or opposition toward CAM use, physicians' emphasis on scientific evidence, and patients' anticipation of a negative response from their physician. Increasing education about CAM and regular assessment of CAM use may help physicians to be more aware of their patients' CAM use. As a result, physicians may provide patients with information on risks and benefits of CAM use and refer patients to other services that may address unmet needs. Given a difference in epistemiologic beliefs about cancer and its treatment, the challenge is to find a common ground for an open discussion in which physicians consider that scientific evidence is not all that counts in the life of an individual facing a serious disease. Copyright 2002 John Wiley & Sons, Ltd.
Gilson Soares Feitosa-Filho
Full Text Available Summary Introduction: Emergency medicine is an area in which correct decisions often need to be made fast, thus requiring a well-prepared medical team. There is little information regarding the profile of physicians working at emergency departments in Brazil. Objective: To describe general characteristics of training and motivation of physicians working in the emergency departments of medium and large hospitals in Salvador, Brazil. Method: A cross-sectional study with standardized interviews applied to physicians who work in emergency units in 25 medium and large hospitals in Salvador. At least 75% of the professionals at each hospital were interviewed. One hospital refused to participate in the study. Results: A total of 659 physicians were interviewed, with a median age of 34 years (interquartile interval: 29-44 years, 329 (49.9% were female and 96 (14.6% were medical residents working at off hours. The percentage of physicians who had been trained with Basic Life Support, Advanced Cardiovascular Life Support and Advanced Trauma Life Support courses was 5.2, 18.4 and 11.0%, respectively, with a greater frequency of Advanced Cardiovascular Life Support training among younger individuals (23.6% versus 13.9%; p<0.001. Thirteen percent said they were completely satisfied with the activity, while 81.3% expressed a desire to stop working in emergency units in the next 15 years, mentioning stress levels as the main reason. Conclusion: The physicians interviewed had taken few emergency immersion courses. A low motivational level was registered in physicians who work in the emergency departments of medium and large hospitals in Salvador.
Oristrell, J; Casanovas, A; Jordana, R; Comet, R; Gil, M; Oliva, J C
There are no simple and validated instruments for evaluating the training of specialists. To analyze the reliability and validity of a computerized self-assessment method to quantify the acquisition of medical competences during the Internal Medicine residency program. All residents of our department participated in the study during a period of 28 months. Twenty-two questionnaires specific for each rotation (the Computer-Book of the Internal Medicine Resident) were constructed with items (questions) corresponding to three competence domains: clinical skills competence, communication skills and teamwork. Reliability was analyzed by measuring the internal consistency of items in each competence domain using Cronbach's alpha index. Validation was performed by comparing mean scores in each competence domain between senior and junior residents. Cut-off levels of competence scores were established in order to identify the strengths and weaknesses of our training program. Finally, self-assessment values were correlated with the evaluations of the medical staff. There was a high internal consistency of the items of clinical skills competences, communication skills and teamwork. Higher scores of clinical skills competence and communication skills, but not in those of teamwork were observed in senior residents than in junior residents. The Computer-Book of the Internal Medicine Resident identified the strengths and weaknesses of our training program. We did not observe any correlation between the results of the self- evaluations and the evaluations made by staff physicians. The items of Computer-Book of the Internal Medicine Resident showed high internal consistency and made it possible to measure the acquisition of medical competences in a team of Internal Medicine residents. This self-assessment method should be complemented with other evaluation methods in order to assess the acquisition of medical competences by an individual resident. Copyright © 2012 Elsevier Espa
Background Unhealthy substance use is the spectrum from use that risks harm, to use associated with problems, to the diagnosable conditions of substance abuse and dependence, often referred to as substance abuse disorders. Despite the prevalence and impact of unhealthy substance use, medical education in this area remains lacking, not providing physicians with the necessary expertise to effectively address one of the most common and costly health conditions. Medical educators have begun to address the need for physician training in unhealthy substance use, and formal curricula have been developed and evaluated, though broad integration into busy residency curricula remains a challenge. Discussion We review the development of unhealthy substance use related competencies, and describe a curriculum in unhealthy substance use that integrates these competencies into internal medicine resident physician training. We outline strategies to facilitate adoption of such curricula by the residency programs. This paper provides an outline for the actual implementation of the curriculum within the structure of a training program, with examples using common teaching venues. We describe and link the content to the core competencies mandated by the Accreditation Council for Graduate Medical Education, the formal accrediting body for residency training programs in the United States. Specific topics are recommended, with suggestions on how to integrate such teaching into existing internal medicine residency training program curricula. Summary Given the burden of disease and effective interventions available that can be delivered by internal medicine physicians, teaching about unhealthy substance use must be incorporated into internal medicine residency training, and can be done within existing teaching venues. PMID:20230607
Fara, Gaetano M; Nardi, Giuseppe; Signorelli, Carlo; Fanti, Mila
This survey was carried out under the sponsorship of the Italian Society of Hygiene (SItI), to evaluate the current professional position of physicians who completed their post-graduate professional training in Hygiene and Preventive Medicine in the years 2000 through 2003. An ad-hoc questionnaire was administered to 689 such specialists across Italy with a response rate of 40%. The results show that specialists in Hygiene and Preventive Medicine are generally satisfied with their professional choice though most specialists were found to have only temporary employment. Post-specialty training courses of major interest to specialists in Hygiene and Preventive medicine are those regarding occupational health, statistical analysis and epidemiology, and quality of health care.
Orth, Matthias; Averina, Maria; Chatzipanagiotou, Stylianos; Faure, Gilbert; Haushofer, Alexander; Kusec, Vesna; Machado, Augusto; Misbah, Siraj A; Oosterhuis, Wytze; Pulkki, Kari; Twomey, Patrick J; Wieland, Eberhard
The role of clinical pathologists or laboratory-based physicians is being challenged on several fronts-exponential advances in technology, increasing patient autonomy exercised in the right to directly request tests and the use of non-medical specialists as substitutes. In response, clinical pathologists have focused their energies on the pre-analytical and postanalytical phases of Laboratory Medicine thus emphasising their essential role in individualised medical interpretation of complex laboratory results. Across the European Union, the role of medical doctors is enshrined in the Medical Act. This paper highlights the relevance of this act to patient welfare and the need to strengthen training programmes to prevent an erosion in the quality of Laboratory Medicine provided to patients and their physicians. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Herain, C.; Machacek, C.; Menechal, P.; Aubert, B.; Celier, D.; Rehel, J.L.; Vidal, J.P.; Lahaye, T.; Gauron, C.; Barret, C.; Biau, A.; Donnarieix, D.; Gambini, D.; Gondran, C.; Pierrat, N.; Guerin, C.; Marande, J.L.; Mercier, J.; Paycha, F.
After having evoked the authorization for possessing and using radionuclides which is required to perform therapeutic nuclear medicine, this document indicates the various personnel involved in this activity, the radionuclide implementation process, the different associated hazards and risks (for sealed and non-sealed sources), how risk is assessed and exposure levels are determined (elements of risk assessment, delimitation of controlled and surveyed areas, personnel classification, selection of dosimetric control type between external passive, operational or internal dosimetry). It proposes a detailed risk management strategy which comprises different components: risk reduction, technical measures regarding the installation, protection measures, information and training, prevention measures, treatment of incident and dysfunction. It describes the medical control to be performed or measures to be taken for the different type of personnel and for pregnant women, indicates the content and management of the medical file and how personnel follow-up must me performed, how anomalies and incidents must be handled. It comments how risk management is to be assessed, and briefly evokes other risks. An example of workstation study is given in appendix
Palamara, Kerri; Kauffman, Carol; Stone, Valerie E; Bazari, Hasan; Donelan, Karen
Residency is an intense period. Challenges, including burnout, arise as new physicians develop their professional identities. Residency programs provide remediation, but emotional support for interns is often limited. Professional development coaching of interns, regardless of their performance, has not been reported. Design, implement, and evaluate a program to support intern professional development through positive psychology coaching. We implemented a professional development coaching program in a large residency program. The program included curriculum development, coach-intern interactions, and evaluative metrics. A total of 72 internal medicine interns and 26 internal medicine faculty participated in the first year. Interns and coaches were expected to meet quarterly; expected time commitments per year were 9 hours (per individual coached) for coaches, 5 1/2 hours for each individual coachee, and 70 hours for the director of the coaching program. Coaches and interns were asked to complete 2 surveys in the first year and to participate in qualitative interviews. Eighty-two percent of interns met with their coaches 3 or more times. Coaches and their interns assessed the program in multiple dimensions (participation, program and professional activities, burnout, coping, and coach-intern communication). Most of the interns (94%) rated the coaching program as good or excellent, and 96% would recommend this program to other residency programs. The experience of burnout was lower in this cohort compared with a prior cohort. There is early evidence that a coaching program of interactions with faculty trained in positive psychology may advance intern development and partially address burnout.
Miller, Eliza; Balmer, Dorene; Hermann, Nellie; Graham, Gillian; Charon, Rita
Purpose To learn what medical students derive from training in humanities, social sciences, and the arts in a narrative medicine curriculum and to explore narrative medicine’s framework as it relates to students’ professional development. Method On completion of required intensive, half-semester narrative medicine seminars in 2010, 130 second-year medical students at Columbia University College of Physicians and Surgeons participated in focus group discussions of their experiences. Focus group transcriptions were submitted to close iterative reading by a team who performed a grounded-theory-guided content analysis, generating a list of codes into which statements were sorted to develop overarching themes. Provisional interpretations emerged from the close and repeated readings, suggesting a fresh conceptual understanding of how and through what avenues such education achieves its goals in clinical training. Results Students’ comments articulated the known features of narrative medicine—attention, representation, and affiliation—and endorsed all three as being valuable to professional identity development. They spoke of the salience of their work in narrative medicine to medicine and medical education and its dividends of critical thinking, reflection, and pleasure. Critiques constituted a small percentage of the statements in each category. Conclusions Students report that narrative medicine seminars support complex interior, interpersonal, perceptual, and expressive capacities. Students’ lived experiences confirm some expectations of narrative medicine curricular planners while exposing fresh effects of such work to view. PMID:24362390
BACKGROUND:The career intention of undergraduate medical students may be influenced by the clerkship experience in the various specialties. AIM:This study was undertaken to assess the medical student's perception of the internal medicine clerkship and determine its influence in the choice of internal medicine as a ...
Robert L Robinson Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA Background: The last decade has brought significant changes to internal medicine clerkships through resident work-hour restrictions and the widespread adoption of hospitalists as medical educators. These key medical educators face competing demands for quality teaching and clinical service intensity. Objective: The study reported here was conducted to explore the rel...
Halm, Brunhild M; Leone, Tina A; Chaudoin, Lindsey T; McKinley, Kenneth W; Ruzal-Shapiro, Carrie; Franke, Adrian A; Tsze, Daniel S
The identification of hydrocephalus in infants by pediatric emergency medicine (PEM) physicians using cranial point-of-care ultrasound (POCUS) has not been evaluated. We aimed to conduct a pilot/proof-of-concept study to evaluate whether PEM physicians can identify hydrocephalus (anterior horn width >5 mm) in 15 infants (mean 69 ± 42 days old) from the neonatal intensive care unit using POCUS. Our exploratory aims were to determine the test characteristics of cranial POCUS performed by PEM physicians for diagnosing hydrocephalus and the interrater reliability between measurements made by the PEM physicians and the radiologist. Depending on the availability, 1 or 2 PEM physicians performed a cranial POCUS through the open anterior fontanel for each infant after a 30-minute didactic lecture to determine the size of the left and right ventricles by measuring the anterior horn width at the foramen of Monroe in coronal view. Within 1 week, an ultrasound (US) technologist performed a cranial US and a radiologist determined the ventricle sizes from the US images; these measurements were the criterion standard. A radiologist determined 12 of the 30 ventricles as hydrocephalic. The sensitivity and specificity of the PEM physicians performed cranial POCUS was 66.7% (95% confidence interval [CI], 34.9%-90.1%) and 94.4% (95% CI, 72.7%-99.9%), whereas the positive and negative predictive values were 88.9% (95% CI, 53.3%-98.2%) and 81.0% (95% CI, 65.5%-90.5%), respectively. The interrater reliability between the PEM physician's and radiologist's measurements was r = 0.91. The entire POCUS examinations performed by the PEM physicians took an average of 1.5 minutes. The time between the cranial POCUS and the radiology US was, on average, 4 days. While the PEM physicians in our study were able to determine the absence of hydrocephalus in infants with high specificity using cranial POCUS, there was insufficient evidence to support the use of this modality for identifying
Pham, Huy P; Raju, Dheeraj; Jiang, Ning; Williams, Lance A
Many practitioners believe in the phenomenon of either being labeled a "black cloud" or "white cloud" while on-call. A "white-cloud" physician is one who usually gets fewer cases. A "black-cloud" is one who often has more cases. It is unclear if the designation is only superstitious or if there is some merit. Our aim is to objectively assess this phenomenon in apheresis medicine at our center. A one-year prospective study from 12/2014 to 11/2015 was designed to evaluate the number of times apheresis physicians and nurses were involved with emergent apheresis procedures between the hours from 10 PM and 7 AM. Other parameters collected include the names of the physician, apheresis nurse, type of emergent apheresis procedure, day of the week, and season of the year. During the study period, 32 emergent procedures (or "black-cloud" events) occurred. The median time between two consecutive events was 8 days (range: 1-34 days). We found no statistically significant association between the "black-cloud" events and attending physicians, nurses, day of the week, or season of the year by Chi-square and Fisher's analyses. However, exploratory analysis using association rule demonstrated that "black-cloud" events were more likely to happen on Thursday (2.19 times), with attending physician 2 (1.18 times), and during winter (1.15 times). The results of this pilot study may support the common perception that some physicians or nurses are either "black cloud" or "white cloud". A larger, multi-center study population is needed to validate the results of this pilot study. © 2016 Wiley Periodicals, Inc.
Full Text Available The modern physician is often multiparadigmatic as he serves many different types of people in many different existential circumstances. The physician basically often has three, very different sets of technologies or “toolboxes” at his disposal, derived from three different medical paradigms: classical, manual medicine; biomedicine; and holistic or consciousness-oriented medicine. For lack of a better term, we have called the extended medical science — integrating these three different paradigms and their three strands of tools and methods — the “new medicine”. The excellent physician, mastering the “new medicine”, uses the most efficient way to help every patient, giving him or her exactly what is needed under the circumstances. The excellent physician will choose the right paradigm(s for the person, the illness, or the situation, and will use the case record to keep track of all the subjective and objective factors and events involved in the process of healing through time. The case or medical record has the following purposes: A. Reflection: To keep track of facts, to provide an overview, to encourage causal analysis, to support research and learning, and to reveal mistakes easily. B. Communication: To communicate with the patient with a printout of the case record to create trust and help the patient to remember all assignments and exercises. C. Evidence and safety: To provide evidence and safety for the patient or to be used in case of legal questions. D. Self-discipline: To encourage discipline, as a good case record is basically honest, sober, brief, and sticks to the point. It forces the physician to make an effort to be more diligent and careful than a busy day usually allows.The intention of the case or medical record is ethical: to be sure that you, as a physician, give the best possible treatment to your patient. It helps you to reflect deeply, communicate efficiently, provide evidence and safety, and back your self
Aksoy, Duygu Yazgan; Durusu Tanriover, Mine; Unal, Sule; Dizdar, Omer; Kalyoncu, Umut; Karakaya, Jale; Unal, Serhat; Kale, Gulsev
The purpose of this paper is to demonstrate burnout syndrome among internal medicine and pediatrics residents in a country that does not have the working time directive (WTD) and also to determine the risk factors and consequent impact on efficient functioning in clinical areas. A 57-item questionnaire was given to internal medicine and pediatrics residents. Responses from 22 pediatrics and 33 internal medicine residents were evaluated. Demographic findings, burnout scores, having hobbies, social activities and reading books unrelated to medicine were similar between the two groups. Six pediatrics residents (27.3 per cent) and 11 (33.3 per cent) internal medicine residents met the criteria for clinically significant burnout. Personal accomplishment scores and reading books unrelated to medicine were found to be related to burnout. Burnout is a syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal accomplishment. It is important to document burnout in countries where WTDs are not implemented. Further studies might demonstrate burnout's effect on patient safety, service quality and physician's performance.
Sonja E. Raaum
Full Text Available Purpose: Smartphone technology offers a multitude of applications (apps that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100% were calculated to assess the frequency of their use of general features (email, text and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%. The average score for using general features, 14.4/20 (72.2% was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001. The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1% than year 1–2 residents, 14.1/20 (70.5%, P=0.035, and for internal medicine residents, 14.9/20 (74.6% in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001. The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5% than for year 1–2 residents, 13.7/44 (31.1%; P=0.044. Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones.
Full Text Available Virtual patients represent a useful tool in teaching students clinical reasoning skills. Virtual Cases (www.e-kazuistiky.cz represent a newly developed interactive problem-based learning system, drawing information from virtual clinics, covering different fields of internal medicine, generating sets of unique virtual patients according to user-predefined program settings (spectrum of diagnoses, number of patients and criteria for passing the course. Basic clinical information including personal data, medical history, symptoms, laboratory values, etc. is generated for each virtual patient. The main task for the student is to determine the optimal diagnostic algorithm (choose adequate diagnostic steps in the correct order, and to determine the correct diagnosis in each virtual patient. Results of diagnostics tests and clinical findings are presented utilising a multimedia presentation (images, video-sequences, audio-recordings. Evaluation of students includes not only assessment of correctly determined diagnosis, but also the diagnostic pathway, which led the user to the specific diagnosis. Thus, the system enables assessment of appropriateness of each test as well as reasonable sequencing of tests and also financial costs of all examinations. The program is now routinely used in the undergraduate curriculum at the Medical Faculty in Hradec Králové. User hands-on experience was evaluated through anonymous questionnaires. The most appreciated attribute of the system is the game-like involvement and multimedia-supporting environment (for students as well as the possibility of a detailed analysis of each student’s performance and clear identification of their weakest areas (for tutors. The system is a useful tool for undergraduate medical education with positive feedback from both students and teachers. The main advantages are flexibility, potential for further growth and no restrictions regarding particular disease, clinical discipline
The Portuguese Ministry of Health performed five international recruitment rounds of Latin American physicians due to the need for physicians in certain geographic areas of the country and in some specialties, as a temporary solution to shortages. Among these recruitments is that of Colombian physicians in 2011 that was the largest of the five groups. This paper presents an evaluation of the international recruitment procedure of Colombian physicians based on the criteria of procedural outcomes and health system outcomes. The methodology used is qualitative, based on semi-structured interviews with key informants and Colombian physicians recruited in Portugal and also on documentary analysis of secondary sources. International recruitment of Colombian physicians coincided with a period of political change and severe economic crisis in Portugal that caused some problems in the course of this recruitment, mainly family reunification in the later group of Colombian physicians and non-compliance of the salary originally agreed upon. Furthermore, due to the continuous resignations of Colombian physicians throughout the 3-year contract, procedural outcomes and health system outcomes of this international recruitment were not fulfilled and therefore the expected results to meet the temporary needs for medical personnel in some areas of the country were not accomplished. Copyright © 2017 Elsevier B.V. All rights reserved.
Fishleder, Andrew J; Henson, Lindsey C; Hull, Alan L
Cleveland Clinic Lerner College of Medicine (CCLCM) is an innovative, five-year medical education track within Case Western Reserve University School of Medicine (Case) with a focused mission to attract and educate a limited number of highly qualified persons who seek to become physician investigators. CCLCM curriculum governance, faculty appointments and promotions, and admissions committees are integrated with respective Case committees. The CCLCM curriculum is based on faculty-defined professional attributes that graduates are expected to develop. These attributes were used to create curricular and assessment principles that guided the development of an integrated basic science, clinical science, and research curriculum, conducted in an active learning environment. An organ-system approach is used to solidify an understanding of basic science discipline threads in the context of relevant clinical problems presented in PBL and case-based discussion formats. Clinical skills are introduced in the first year as part of the two-year longitudinal experience with a family practice or internal medicine physician. The research program provides all students with opportunities to learn and experience basic and translational research and clinical research before selecting a research topic for their 12- to 15-month master-level thesis project. All Case students participate in required and elective clinical curriculum after the second year, but CCLCM students return to the Cleveland Clinic on selected Friday afternoons for program-specific research and professionalism-learning activities. A unique portfolio-based assessment system is used to assess student achievements in nine competency areas, seven of which reflect the Accreditation Council for Graduate Medical Education competencies.
Tan, Eng Keong; Loh, Kah Poh; Goff, Sarah L
Osteoporosis is a major public health concern affecting an estimated 10 million people in the United States. To the best of our knowledge, no qualitative study has explored barriers perceived by medicine hospitalists to secondary prevention of osteoporotic hip fractures. We aimed to describe these perceived barriers and recommendations regarding how to optimize secondary prevention of osteoporotic hip fracture. In-depth, semistructured interviews were performed with 15 internal medicine hospitalists in a tertiary-care referral medical center. The interviews were analyzed with directed content analysis. Internal medicine hospitalists consider secondary osteoporotic hip fracture prevention as the responsibility of outpatient physicians. Identified barriers were stratified based on themes including physicians' perception, patients' characteristics, risks and benefits of osteoporosis treatment, healthcare delivery system, and patient care transition from the inpatient to the outpatient setting. Some of the recommendations include building an integrated system that involves a multidisciplinary team such as the fracture liaison service, initiating a change to the hospital policy to facilitate inpatient care and management of osteoporosis, and creating a smooth patient care transition to the outpatient setting. Our study highlighted how internal medicine hospitalists perceive their role in the secondary prevention of osteoporotic hip fractures and what they perceive as barriers to initiating preventive measures in the hospital. Inconsistency in patient care transition and the fragmented nature of the existing healthcare system were identified as major barriers. A fracture liaison service could remove some of these barriers.
Shin, Sangheon; Lee, Soo Hoon; Kim, Dong Hoon; Kim, Seong Chun; Kim, Tae Yun; Kang, Changwoo; Jeong, Jin Hee; Lim, Daesung; Park, Yong Joo; Lee, Sang Bong
Although consultations are essential for delivering safe, high-quality care to patients in emergency departments, they contribute to emergency department patient flow problems and overcrowding which is associated with several adverse outcomes, such as increases in patient mortality and poor quality care. This study aimed to investigate how time flow metrics including emergency department length of stay is influenced by changes to the internal medicine consultation policy. This study is a pre- and post-controlled interventional study. We attempted to improve the internal medicine consultation process to be more concise. After the intervention, only attending emergency physicians consult internal medicine chief residents, clinical fellows, or junior staff of each internal medicine subspecialty who were on duty when patients required special care or an admission to internal medicine. Emergency department length of stay of patients admitted to the department of internal medicine prior to and after the intervention decreased from 996.94min to 706.62min. The times from consultation order to admission order and admission order to emergency department departure prior to and after the intervention were decreased from 359.59min to 180.38min and from 481.89min to 362.37min, respectively. The inpatient mortality rates and Inpatient bed occupancy rates prior to and after the intervention were similar. The improvements in the internal medicine consultation process affected the flow time metrics. Therefore, more comprehensive and cooperative strategies need to be developed to reduce the time cycle metrics and overcrowding of all patients in the emergency department. Copyright © 2017 Elsevier Inc. All rights reserved.
Fernando, Antonio T; Consedine, Nathan S
Compassion is an expectation of patients, regulatory bodies, and physicians themselves. Most research has, however, studied compassion fatigue rather than compassion itself and has concentrated on the role of the physician. The Transactional Model of Physician Compassion suggests that physician, patient, external environment, and clinical factors are all relevant. Because these factors vary both across different specialities and among physicians with differing degrees of experience, barriers to compassion are also likely to vary. We describe barriers to physician compassion as a function of specialization (psychiatry, general practice, surgery, internal medicine, and pediatrics) and physician experience. We used a cross-sectional study using demographic data, specialization, practice parameters, and the Barriers to Physician Compassion Questionnaire. Nonrandom convenience sampling was used to recruit 580 doctors, of whom 444 belonged to the targeted speciality groups. The sample was characterized before conducting a factorial Multivariate Analysis of Covariance and further post hoc analyses. A 5 (speciality grouping) × 2 (more vs. less physician experience) Multivariate Analysis of Covariance showed that the barriers varied as a function of both speciality and experience. In general, psychiatrists reported lower barriers, whereas general practitioners and internal medicine specialists generally reported greater barriers. Barriers were generally greater among less experienced doctors. Documenting and investigating barriers to compassion in different speciality groups have the potential to broaden current foci beyond the physician and inform interventions aimed at enhancing medical compassion. In addition, certain aspects of the training or practice of psychiatry that enhance compassion may mitigate barriers to compassion in other specialities. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Feb 3, 2011 ... ... India's efforts to develop medicinal plant gathering, processing, and marketing into a ... while protecting indigenous knowledge, some based on age-old texts. ... To date, his department has helped about a million people in ...
Carrera Magarino, F.; Salgado Garcia, C.; Ruiz Manzano, P.; Rivas Ballarin, M. A.; Jimenez Hefernan, A.; Sanchez Segovia, J.
The Department of Radio Physics and Radiation Protection, University Hospital Lozano Blesa Zaragoza presented a calculus textbook to estimate patient doses in diagnostic nuclear medicine. In this paper present an updated referred Book of calculation.
It also publishes valuable studies in areas of Biological Sciences related to health ... Medicine, Nursing, Physiotherapy, and Medical Ethics and Medical Education. ... The Journal charges US $ 250 (for overseas authors) and N 25,000 (for ...
Sep 5, 2014 ... Ethiopia faces a critical gap in emergency medical care. ... Dr Biruk Germa, Senior Emergency Medicine Resident at Addis Ababa University, also ... The issue Inaccessibility to veterinary services in Ethiopia's livestock sector.
Nüchtern, E; Bahemann, A; Egdmann, W; van Essen, J; Gostomzyk, J; Hemmrich, K; Manegold, B; Müller, B; Robra, B P; Röder, M; Schmidt, L; Zobel, A; von Mittelstaedt, G
In January, 2014, the division "Social Medicine in Practice and Rehabilitation" of the German Society for Social Medicine and Prevention established a working group on the self-image of the physicians active in the field of social medicine (medical expertise and counseling). The result of this work is the contribution presented here after consensus was achieved by specialists of social medicine from different fields and institutions (social security etc.) and in good cooperation with Prof. Dr. Gostomzyk and Prof. Dr. Robra. Based on the importance of an up to date social medicine for claimants and recipients of benefits on the one hand and the social security system on the other, and also on a description of the subjects, objectives and methods the following aspects are presented: · The perspective of social medicine. · Qualification in social medicine, concerning specialist training and continuing medical education. · The fields of duty of experts in social medicine. · The proceedings in social medicine. The working group identified challenges for the specialists in social medicine by a narrowed perception of social medicine by physicians in hospitals and practice, accompanied by an enlarged importance of expertise in social medicine, by the demand for more "patient orientation" and gain of transparency, and concerning the scientific foundation of social medicine. The working group postulates: · The perspective of social medicine should be spread more widely.. · Confidence in experts of social medicine and their independency should be strengthened.. · The not case-related consulting of the staff and executives should be expanded.. · Social medicine in practice needs support by politics and society, and especially by research and teaching.. · Good cooperation and transfer of experiences of the different branches of social security are essential for the impact of social medicine.. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Four physicians working in private family medicine offices in Dalmatian Hinterland described their first hand experience of teaching sixthyear medical students. They supervised students during the 2010/2011 academic year, in an area that is economically undeveloped, rural, and where a number of people live in extended families. Although hesitant at first, the patients came to like the interaction with students, and later even yearned to provide students with as much information as possible. They also liked the letters that students had to write to them about their illness, because they could take them home and look for information without needing to see the doctor. The students showed diverse attitudes to different types of work in family medicine offices, mostly depending on their plans for future career. In general, they either complained or hesitated to perform duties that they did not fully master during earlier education, especially working with children. They needed several days to adapt to direct contact with the patients, and were more relaxed and cooperative when working in pairs than alone. The physicians themselves felt that they profited both from the novelty in the everyday routine and from the exchange of their experiences with the students. They liked their young colleagues and admitted they could not objectively review their own work, knowledge and skills.
Kumar, Rohit; Hassali, Mohamed Azmi; Saleem, Fahad; Alrasheedy, Alian A; Kaur, Navneet; Wong, Zhi Yen; Kader, Muhamad Ali Sk Abdul
Generic medicine prescribing has become a common practice in public hospitals. However, the trend in private medical centres seems to be different. The objective of this study was to investigate knowledge, perceptions and behavior of physicians from private medical centres in Malaysia regarding generic medicines. This study was a cross-sectional nationwide survey targeting physicians from private medical centres in Malaysia. The survey was conducted using questionnaire having (i) background and demographic data of the physicians, volume of prescription in a day, stock of generic medicines in their hospital pharmacy etc. (ii) their knowledge about bioequivalence (iii) prescribing behavior (iv) physicians' knowledge of quality, safety and efficacy of generic medicines, and their cost (v) perceptions of physicians towards issues pertaining to generic medicines utilization. A total of 263 questionnaires out of 735 were received, giving a response rate of 35.8%. Of the respondents, 214 (81.4%) were male and 49 (18.6%) were females. The majority of the participants were in the age range of 41-50 years and comprised 49.0% of the respondents. Only 2.3% of physicians were aware of the regulatory limits of bioequivalence standards in Malaysia. Of the respondents, 23.2% agreed that they 'always' write their prescriptions using originator product name whereas 50.2% do it 'usually'. A number of significant associations were found between their knowledge, perceptions about generic medicines and their demographic characteristics. The majority of the physicians from private medical centres in Malaysia had negative perceptions about safety, quality and the efficacy of generic medicines. These negative perceptions could be the cause of the limited use of generic medicines in the private medical centres. Therefore, in order to facilitate their use, it is recommended that the physicians need to be reassured and educated about the drug regulatory authority approval system of generic
Papadakis, Maxine A; Arnold, Gerald K; Blank, Linda L; Holmboe, Eric S; Lipner, Rebecca S
Physicians who are disciplined by state licensing boards are more likely to have demonstrated unprofessional behavior in medical school. Information is limited on whether similar performance measures taken during residency can predict performance as practicing physicians. To determine whether performance measures during residency predict the likelihood of future disciplinary actions against practicing internists. Retrospective cohort study. State licensing board disciplinary actions against physicians from 1990 to 2006. 66,171 physicians who entered internal medicine residency training in the United States from 1990 to 2000 and became diplomates. Predictor variables included components of the Residents' Annual Evaluation Summary ratings and American Board of Internal Medicine (ABIM) certification examination scores. 2 performance measures independently predicted disciplinary action. A low professionalism rating on the Residents' Annual Evaluation Summary predicted increased risk for disciplinary action (hazard ratio, 1.7 [95% CI, 1.3 to 2.2]), and high performance on the ABIM certification examination predicted decreased risk for disciplinary action (hazard ratio, 0.7 [CI, 0.60 to 0.70] for American or Canadian medical school graduates and 0.9 [CI, 0.80 to 1.0] for international medical school graduates). Progressively better professionalism ratings and ABIM certification examination scores were associated with less risk for subsequent disciplinary actions; the risk ranged from 4.0% for the lowest professionalism rating to 0.5% for the highest and from 2.5% for the lowest examination scores to 0.0% for the highest. The study was retrospective. Some diplomates may have practiced outside of the United States. Nondiplomates were excluded. Poor performance on behavioral and cognitive measures during residency are associated with greater risk for state licensing board actions against practicing physicians at every point on a performance continuum. These findings support
Román-Franco, Angel A
Medicine's cardinal diagnostic and therapeutic resource is the clinical encounter. Over the last two centuries and particularly over the last five decades the function of the clinical encounter has been eroded to the point of near irrelevance because of the atomized and atomizing influence of technology and microspecialization. Meanwhile, over the past five decades the exceptionalist view of Homo sapiens inherent in the social and religious traditions of the West has similarly undergone radical changes. H. sapiens is now best understood as a microecosystem integrated into a much broader ecosystem: the biosphere. That human microecosystem is composed of constituents derived from the archaeal, bacterial, and eukaryan domains via endosymbiotic, commensalistic and mutualistic interactions. This amalgamation of 100 trillion cells and viral elements is regulated by a composite genome aggregated over the 3.8 billion years of evolutionary history of organic life. No component of H. sapiens or its genome can be identified as irreducibly and exclusively human. H. sapiens' humanity is an emergent property of the microecosystem. Ironically as H. sapiens is viewed by evolutionary science in a highly integrated manner medicine approaches it as a balkanized, deaggregated entity through the eye of 150 different specialties. To effectively address the needs of H sapiens in its role as patient by the same species in its role as physician the disparate views must be harmonized. Here I review some conceptual elements that would assist a physician in addressing the needs of the patient in integrum, as a microecosystem, by the former address the latter as a historical gestalt being. The optimal way to recover the harmony between patient and physician is through a revitalization of the clinical encounter via an ecological and Darwinian epistemology.
Mok, Emily A
Access to essential medicines is a critical problem that plagues many developing countries. With a daunting number of domestic constraints - technologically, economically, and otherwise - developing countries are faced with a steep uphill battle to meet the human rights obligation of providing essential medicines immediately. To meet these challenges, the international human rights obligations of international assistance and cooperation can play a key role to help developing countries fulfill the need for access to essential medicines. This article seeks to highlight and expand upon the current understanding of international assistance and cooperation for access to essential medicines through a review of obligations identified in international human rights law and a synthesis of official guidance provided on the matter.
...) 2002, the Internal Medicine (IM) clinic at Evans Army Community Hospital, Fort Carson, Colorado, failed to meet access to care standards for routine appointments, and was only marginally successful in meeting standards for urgent appointments...
Ge Jin; Fishman, Jessica; Vapiwala, Neha; Li, Susan Q.; Desai, Krupali; Xie, Sharon X.; Mao, Jun J.
Purpose: Despite the extensive use of complementary and alternative medicine (CAM) among cancer patients, patient-physician communication regarding CAM therapies remains limited. This study quantified the extent of patient-physician communication about CAM and identified factors associated with its discussion in radiation therapy (RT) settings. Methods and Materials: We conducted a cross-sectional survey of 305 RT patients at an urban academic cancer center. Patients with different cancer types were recruited in their last week of RT. Participants self-reported their demographic characteristics, health status, CAM use, patient-physician communication regarding CAM, and rationale for/against discussing CAM therapies with physicians. Multivariate logistic regression was used to identify relationships between demographic/clinical variables and patients’ discussion of CAM with radiation oncologists. Results: Among the 305 participants, 133 (43.6%) reported using CAM, and only 37 (12.1%) reported discussing CAM therapies with their radiation oncologists. In multivariate analyses, female patients (adjusted odds ratio [AOR] 0.45, 95% confidence interval [CI] 0.21-0.98) and patients with full-time employment (AOR 0.32, 95% CI 0.12-0.81) were less likely to discuss CAM with their radiation oncologists. CAM users (AOR 4.28, 95% CI 1.93-9.53) were more likely to discuss CAM with their radiation oncologists than were non-CAM users. Conclusions: Despite the common use of CAM among oncology patients, discussions regarding these treatments occur rarely in the RT setting, particularly among female and full-time employed patients. Clinicians and patients should incorporate discussions of CAM to guide its appropriate use and to maximize possible benefit while minimizing potential harm.
The conference proceedings contain abstracts of 100 presented papers, mainly dealing with radioimmunoassays, radiopharmaceuticals, scintiscanning, computer tomography, radionuclide lymphography, ventriculography, angiography, nuclear cardiology, liquid scintillator techniques, radioisotope generators, radiospirometry and various uses of labelled compounds and tracer techniques in nuclear medicine. (M.D.)
Aerospace Medicine technical reports are available in full-text from the Civil Aerospace Medical Institute’s publications Web site: www.faa.gov/library...System in Space and Other Extreme Conditions. England – USA: Harwood Academic Publishers, 1991. Konstantinova IV, Petrov RV. Sistema Immuniteta v
Maldonado, Jesús Adrián; Peinado, José María
The aim of this study was to analyze Internal Medicine as a subject and its requirement in each of the Universities curriculum in Mexico that offers a degree in General Medicine. By the end of the first quarter of 2014, the research was closed and 81 campuses were studied. This research was quantitative, using an analytical technique, written discourse, exploratory and purposive sampling not random and homogeneous type. The Likert questionnaire was used in this study to analyse the following variables: the record of Internal Medicine as a subject, the burden of credit, and the location of the program. The procedure consisted of three phases. First obtaining an official list of all the Universities in the Mexican Association of Colleges and Schools of Medicine. Second, obtaining an analysis of each of the Universities' curriculums, and lastly gathering each variable of the study. The results of the Universities were 63% were public and 37% private. Internal Medicine as a subject in the curriculum was 37.1%, and 20% of the universities include it for six months and 9% offer it the whole year. However, the undergraduate internship in Internal Medicine offers it 100%. In conclusion, Internal Medicine as a subject could disappear from the curriculum in General Medicine before coming to the undergraduate internship, even though the latter is declared required in hospital shifts.
Chang, Anna; Fernandez, Helen; Cayea, Danelle; Chheda, Shobhina; Paniagua, Miguel; Eckstrom, Elizabeth; Day, Hollis
Internal medicine residents today face significant challenges in caring for an increasingly complex patient population within ever-changing education and health care environments. As a result, medical educators, health care system leaders, payers, and patients are demanding change and accountability in graduate medical education (GME). A 2012 Society of General Internal Medicine (SGIM) retreat identified medical education as an area for collaboration between internal medicine and geriatric medicine. The authors first determined a short-term research agenda for resident education by mapping selected internal medicine reporting milestones to geriatrics competencies, and listing available sample learner assessment tools. Next, the authors proposed a strategy for long-term collaboration in three priority areas in clinical medicine that are challenging for residents today: (1) team-based care, (2) transitions and readmissions, and (3) multi-morbidity. The short-term agenda focuses on learner assessment, while the long-term agenda allows for program evaluation and improvement. This model of collaboration in medical education combines the resources and expertise of internal medicine and geriatric medicine educators with the goal of increasing innovation and improving outcomes in GME targeting the needs of our residents and their patients.
Full Text Available In recent decades, in the medical field, criteria and methods of decision-making have radically changed, going from an environment dominated by opinions and knowledge transmitted from experts to a context of evidence-based medicine, that finds its practical realization in the drafting of guidelines (GL. However, GL have a poor implementation in the real world for several factors. In the field of chronic obstructive pulmonary disease (COPD, there are already many GL, international, national, regional and by specific scientific societies. This multiplicity, while it responds to the legitimate needs to respect the diversity of interpretation of the available scientific data, on the other hand, however, can be an element of confusion for physicians. In this varied scenery we have tried to create some new tools, easy and quick to use, in order to improve the local application of existing GL on COPD, by planning a limited number of pathways in the management of acute exacerbation of COPD, which focus on the fundamental diagnostic and therapeutic aspects, as a tool to improve appropriateness in Internal Medicine Departments. These pathways, reported on individual sheets, which can be distributed to medical personnel of wards/units involved in the care of patients with COPD (First Aid, Internal Medicine, Geriatrics, Pulmonology, Intensive Respiratory Care Unit, Resuscitation, are useful to support the physician in the decision-making process and help you to resolve any disputes.
... these... Read More More Than 850 Hours of Online Education Log In Now > Physicians Podcasts and Apps Reimbursement Quality Issues MOC Resource Center International Residents & Students Contracts & ... Medicine Foundation Online Buyers' Guide Emergency Care For You emCareers.org ...
Kim, Kyeong Min; Byun, Byun Hyun; Cheon, Gi Jeong; Lim, Sang Moo
Radionuclide therapy has been an important field in nuclear medicine. In radionuclide therapy, relevant evaluation of internally absorbed dose is essential for the achievement of efficient and sufficient treatment of incurable disease, and can be accomplished by means of accurate measurement of radioactivity in body and its changes with time. Recently, the advances of nuclear medicine imaging and multi modality imaging processing techniques can provide chance of more accurate and easier measurement of the measures commented above, in cooperation of conventional imaging based approaches. In this review, basic concept for internal dosimetry using nuclear medicine imaging is summarized with several check points which should be considered in real practice
Shaheen, Amy; Papp, Klara K; Torre, Dario
Education in the ambulatory setting should be an integral part of undergraduate medical education. However, previous studies have shown education in this setting has been lacking in medical school. Ambulatory education occurs on some internal medicine clerkships. The extent of this education is unclear. The purpose of this survey was to assess the structure, curriculum, assessment methods, and barriers to implementation of ambulatory education on the internal medicine clerkship. An annual survey of institutional members of the Clerkship Directors in Internal Medicine (CDIM) was done in April 2010. The data were anonymous and descriptive statistics were used to summarize responses. Free text results were analyzed using qualitative techniques. The response rate was 75%. The majority of respondents had a required ambulatory component to the clerkship. Ambulatory experiences distinct from the inpatient internal medicine experience were common (46%). Integration with either the inpatient experiences or other departmental clerkships also occurred. The majority of ambulatory educational experiences were with generalists (74%) and/or subspecialists (45%). The most common assessment tool was the National Board of Medical Examiners (NBME) ambulatory shelf exam. Thematic analysis of the question about how practice based learning was taught elicited four major themes: Not taught; taught in the context of learning evidence based medicine; taught while learning chronic disease management with quality improvement; taught while learning about health care finance. Barriers to implementation included lack of faculty and financial resources. There have been significant increases in the amount of time dedicated to ambulatory internal medicine. The numbers of medical schools with ambulatory internal medicine education has increased. Integration of the ambulatory experiences with other clerkships such as family medicine occurs. Curriculum was varied but difficulties with dissemination
Prazak, Kristine A
The purpose of this project was to infuse palliative medicine and end-of-life care creatively into physician assistant (PA) education. Nine second-year PA students volunteered to participate in this quasi-experimental, pretest-posttest pilot study. Students initially completed an anonymous survey evaluating seven domains of knowledge in palliative medicine coupled with a self-assessment in competence. Virtual patient software was then used to simulate clinical encounters that addressed major palliative care domains. Upon completion of these cases, the same survey, with the addition of three questions about their own personal feelings, was administered. Overall response was positive in regard to improved knowledge and the virtual patient experience. After completion of the cases, students rated their self-assessed skills higher in all domains than prior to completing the cases. Factual knowledge scores showed a slight but not significant improvement, with an average pre-survey score of 4.56 and post-survey score of 4.67. Using virtual patient software can be a way of infusing palliative medicine and end-of-life care into PA education. These encounters can then be modified to include interprofessional encounters within the health professions.
Corruption, an undeniable reality in the health sector, is arguably the most serious ethical crisis in medicine today. However, it remains poorly addressed in scholarly journals and by professional associations of physicians and bioethicists. This article provides an overview of the forms and dynamics of corruption in healthcare as well as its implications in health and medicine. Corruption traps millions of people in poverty, perpetuates the existing inequalities in income and health, drains the available resources undermines people's access to healthcare, increases the costs of patient care and, by setting up a vicious cycle, contributes to ill health and suffering. No public health programme can succeed in a setting in which scarce resources are siphoned off, depriving the disadvantaged and poor of essential healthcare. Quality care cannot be provided by a healthcare delivery system in which kickbacks and bribery are a part of life. The medical profession, historically considered a noble one, and the bioethics community cannot evade their moral responsibility in the face of this sordid reality. There is a need to engage in public discussions and take a stand - against unethical and corrupt practices in healthcare and medicine - for the sake of the individual's well-being as well as for social good.
University, 1974. Gerathewohl ST. Principles of Bioastronautics. Englewood Cliffs, NJ, USA: Prentice-Hall, 1963. Gibson DC. Commercial Space Tourism ...College of Sports Medicine, 1996. Jenkins M. Human-Rating Requirements. Houston, TX, USA: Lyndon B. Johnson Space Center, 1998. Johnson B, May GL...USA: U.S. Government Printing Office, 2000. Spencer J, Rugg KL. Space Tourism : Do You Want to Go? Burlington, Canada: Apogee Books, 2004. Stahle J
Havyer, Rachel D A; Wingo, Majken T; Comfere, Nneka I; Nelson, Darlene R; Halvorsen, Andrew J; McDonald, Furman S; Reed, Darcy A
Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties. We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies. Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams. Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated. Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes. Review is limited to quantitative assessments of teamwork in internal
E. C. Moschik
Full Text Available Kampo medicine has been the primary medical model in Japan until the mid 1800s, regained a prominent role in today's Japanese medical system. Today, 148 herbal Kampo formulas can be prescribed under the national health insurance system, allowing physicians to integrate Kampo in their daily practice. This article aims to provide information about the extent to which Kampo is now used in clinics throughout Japan and about physician's current attitudes toward Kampo. We used the results of a 2008 survey that was administered to physicians throughout Japan (n = 684. The data showed that 83.5% of physicians currently use Kampo in the clinic, although the distribution of physicians who use Kampo differ widely depending on the specialty and provided a breakdown of Kampo usage by specialty. It will be interesting to see how each specialty incorporates Kampo into its respective field as Kampo continues to play a pertinent role in Japanese medical system.
Peltier, J W; Boyt, T; Westfall, J E
Physician turnover is costly for health care organizations, especially for rural organizations. One approach management can take to reduce turnover is to promote physician loyalty by treating them as an important customer segment. The authors develop an information--oriented framework for generating physician loyalty and illustrate how this framework has helped to eliminate physician turnover at a rural health care clinic. Rural health care organizations must develop a more internal marketing orientation in their approach to establishing strong relationship bonds with physicians.
Zaccone, Vincenzo; Tosoni, Alberto; Passaro, Giovanna; Vallone, Carla Vincenza; Impagnatiello, Michele; Li Puma, Domenica Donatella; De Cosmo, Salvatore; Landolfi, Raffaele; Mirijello, Antonio
Sepsis represents a global health problem in terms of morbidity, mortality, social and economic costs. Although usually managed in Intensive Care Units, sepsis showed an increased prevalence among Internal Medicine wards in the last decade. This is substantially due to the ageing of population and to multi-morbidity. These characteristics represent both a risk factor for sepsis and a relative contra-indication for the admission to Intensive Care Units. Although there is a lack of literature on the management of sepsis in Internal Medicine, the outcome of these patients seems to be gradually improving. This is due to Internists' increased adherence to guidelines and "bundles". The routine use of SOFA score helps physicians in the definition of septic patients, even if the optimal score has still to come. Point-of-care ultrasonography, lactates, procalcitonin and beta-d-glucan are of help for treatment optimization. The purpose of this narrative review is to focus on the management of sepsis in Internal Medicine departments, particularly on crucial concepts regarding diagnosis, risk assessment and treatment. Key Messages Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The prevalence of sepsis is constantly increasing, affecting more hospital patients than any other disease. At least half of patients affected by sepsis are admitted to Internal Medicine wards. Adherence to guidelines, routine use of clinical and lab scores and point-of-care ultrasonography are of help for early recognition of septic patients and treatment optimization.
Clark, Natalie A; Will, Matthew A; Moravek, Molly B; Xu, Xiao; Fisseha, Senait
To determine use of and attitudes toward complementary and alternative medicine (CAM) among infertility patients and subspecialty physicians. Infertility patients were asked to complete anonymous written surveys at an academic infertility practice; members of the Society for Reproductive Endocrinology and Infertility were electronically surveyed. Both groups were assessed regarding their use of and attitudes toward CAM. The response rate was 32.1% (115/358) among patients and 22.6% (225/995) among physicians (Pinfertility patients requires greater physician attention and justifies further study on the risks and benefits of integrating CAM into the biomedical treatment of infertility. Published by Elsevier Ireland Ltd.
Full Text Available Thomas S MacKinnon,1 Norbert F Banhidy,1 Daniel R Tuite21School of Medicine, Imperial College London, London, 2Faculty of Medicine, Brighton and Sussex Medical School, Brighton, UKWe read with great interest the article by Patel et al1 discussing the changing perspectives towards complementary and alternative medicine (CAM, and an impetus for additional physician knowledge of the strengths and drawbacks of CAM. These findings are indeed relevant in the UK, with an estimated 41.1% one-year prevalence of CAM use, responsible for an annual out-of-pocket expenditure of £1.6 billion.2 We agree that improved training and education in medical school and residencies – which can be thought of as a “bottom-up” approach – are fundamental in preparing the health care system for improved integration of CAM. However, we also suggest that “top-down” changes are required to optimize patient care.Authors' reply Sejal J Patel,1 Kathi J Kemper,2 Joseph P Kitzmiller31College of Public Health, The Ohio State University, 2Center for Integrative Health and Wellness, The Ohio State Wexner University Medical Center, 3Department of Biological Chemistry and Pharmacology, College of Medicine, The Ohio State University, Columbus, OH, USAWe agree the letter is worthy of publication but have a little to add: a top-down approach (as suggested and described by the authors of the letter certainly complements the bottom-up approach (described in our article.1View the original paper by Patel et al.
Marmor, Theodore Richard
This article is a condensed and edited version of a speech delivered to the business of medicine: A Course for Physician Leaders symposium presented by Yale-New Haven Hospital and the Medical Directors Leadership Council at Yale University in November 2012 and drawn from Politics, Health, and Health Care: Selected Essays by Theodore R. Marmor and Rudolf Klein . It faithfully reflects the major argument delivered, but it does not include the typical range of citations in a journal article. The material presented here reflects more than 40 years of teaching a course variously described as Political Analysis and Management, Policy and Political Analysis, and The Politics of Policy. The aim of all of these efforts is to inform audiences about the necessity of understanding political conflict in any arena, not least of which is the complex and costly world of medical care.
Grossman Michael D
Full Text Available Abstract The role of Emergency Medicine Physicians (EMP in the care of trauma patients in North America has evolved since the advent of the specialty in the late 1980's. The evolution of this role in the context of the overall demands of the specialty and accreditation requirements of North American trauma centers will be discussed. Limited available data published in the literature examining the role of EMP's in trauma care will be reviewed with respect to its implications for an expanded role for EMPs in trauma care. Two training models currently in the early stages of development have been proposed to address needs for increased manpower in trauma and the critical care of trauma patients. The available information regarding these models will be reviewed along with the implications for improving the care of trauma patients in both Europe and North America.
Tondeur Dejonckheere, Marianne; Glinoer, Daniel; Verelst, Jean; Sand, Alain; Ham, Hamphrey
Full text: While radioiodine (RI) is a well established treatment for hyperthyroidism, there is no consensus regarding the administration of fixed or calculated doses. Guidelines from scientific societies do not specify the preferable approach, nor the parameters to be used in order to calculate the latter. Therefore, the doses might, for the same patient, be different with regard to the chosen procedure. This study was undertaken to assess the variability of RI amounts administered in Belgium in various cases of hyperthyroidism. 21 Belgian nuclear medicine physicians issued from different departments and universities participated into the study. They received a file with clinical and biological data, iodine turnover rate, scintigraphic images and calculated thyroid surfaces from 10 patients (8 females, 2 males), 30-77 yrs suffering from hyperthyroidism of various etiologies: 7 patients had clinically overt hyperthyroidism and 3 subclinical hyperthyroidism; 7 patients had toxic goiters of various size (Graves' disease), 2 multi nodular goiter and 1 toxic nodule. None suffered from cardiac anomalies or ophthalmopathy. Participants were asked to define the amount of RI they would give in each case. Answers were received during a 8-week period. Analysing data from case 1 to case 10, the ranges of the proposed doses varied between 8 and 22 milli Curies (mCi) (sd : 2.4 - 6.07). Considering all the patients, the proposed doses varied between 2 mCi and 25 mCi. Analysing answers among the 21 participants, mean proposed doses varied between 4.5 and 17.3 mCi (sd: 0.69 - 7.99). Conclusion: These results demonstrate a wide variability among nuclear medicine physicians in the proposed RI doses and confirm that in Belgium there is no uniformity in the procedure used to determine the amount of RI to administer for various causes of hyperthyroidism. This emphasizes the notion that the determination of the amount of RI to be administered remains a matter of debate. (author)
Strong, Erin A; De Castro, Rochelle; Sambuco, Dana; Stewart, Abigail; Ubel, Peter A; Griffith, Kent A; Jagsi, Reshma
Leaders in academic medicine are often selected from the ranks of physician-researchers, whose demanding careers involve multiple professional commitments that must also be balanced with demands at home. To gain a more nuanced understanding of work-life balance issues from the perspective of a large and diverse group of faculty clinician-researchers and their mentors. A qualitative study with semi-structured, in-depth interviews conducted from 2010 to 2011, using inductive analysis and purposive sampling. One hundred former recipients of U.S. National Institutes of Health (NIH) K08 or K23 career development awards and 28 of their mentors. Three researchers with graduate training in qualitative methods conducted the interviews and thematically coded verbatim transcripts. Five themes emerged related to work-life balance: (1) the challenge and importance of work-life balance for contemporary physician-researchers, (2) how gender roles and spousal dynamics make these issues more challenging for women, (3) the role of mentoring in this area, (4) the impact of institutional policies and practices intended to improve work-life balance, and (5) perceptions of stereotype and stigma associated with utilization of these programs. In academic medicine, in contrast to other fields in which a lack of affordable childcare may be the principal challenge, barriers to work-life balance appear to be deeply rooted within professional culture. A combination of mentorship, interventions that target institutional and professional culture, and efforts to destigmatize reliance on flexibility (with regard to timing and location of work) are most likely to promote the satisfaction and success of the new generation of clinician-researchers who desire work-life balance.
Tesch, B J; Wood, H M; Helwig, A L; Nattinger, A B
To assess possible explanations for the finding that the percentage of women medical school faculty members holding associate or full professor rank remains well below the percentage of men. Cross-sectional survey of physician faculty of US medical schools using the Association of American Medical Colleges (AAMC) database. Surveyed were 153 women and 263 men first appointed between 1979 and 1981, matched for institutions of original faculty appointment. Academic rank achieved, career preparation, academic resources at first appointment, familial responsibilities, and academic productivity. After a mean of 11 years on a medical school faculty, 59% of women compared with 83% of men had achieved associate or full professor rank, and 5% of women compared with 23% of men had achieved full professor rank. Women and men reported similar preparation for an academic career, but women began their careers with fewer academic resources. The number of children was not associated with rank achieved. Women worked about 10% fewer hours per week and had authored fewer publications. After adjustment for productivity factors, women remained less likely to be associate or full professors (adjusted odds ratio [OR] = 0.37; 95% confidence interval [CI], 0.21 to 0.66) or to achieve full professor rank (adjusted OR = 0.27; 95% CI, 0.12 to 0.63). Based on the AAMC database, 50% of both women and men originally appointed as faculty members between 1979 and 1981 had left academic medicine by 1991. Women physician medical school faculty are promoted more slowly than men. Gender differences in rank achieved are not explained by productivity or by differential attrition from academic medicine.
Plunkett-Rondeau, Jevon; Hyland, Katherine; Dasgupta, Shoumita
Advances in genomic technologies are transforming medical practice, necessitating the expertise of genomically-literate physicians. This study examined 2013-2014 trends in genetics curricula in US and Canadian medical schools to ascertain whether and how curricula are keeping pace with this rapid evolution. Medical genetics course directors received a 60-item electronic questionnaire covering curriculum design, assessment, remediation of failing grades, and inclusion of specific topics. The response rate was 74%. Most schools teach the majority of genetics during the first 2 years, with an increase in the number of integrated curricula. Only 26% reported formal genetics teaching during years 3 and 4, and most respondents felt the amount of time spent on genetics was insufficient preparation for clinical practice. Most participants are using the Association of Professors of Human and Medical Genetics Core Curriculum(1) as a guide. Topics recently added include personalized medicine (21%) and direct-to-consumer testing (18%), whereas eugenics (17%), linkage analysis (16%), and evolutionary genetics (15%) have been recently eliminated. Remediation strategies were heterogeneous across institutions. These findings provide an important update on how genetics and genomics is taught at US and Canadian medical schools. Continuous improvement of educational initiatives will aid in producing genomically-literate physicians.
Apellaniz-Ruiz, Maria; Gallego, Cristina; Ruiz-Pinto, Sara; Carracedo, Angel; Rodríguez-Antona, Cristina
In this article, we present the progress driven by the recent technological advances and new revolutionary massive sequencing technologies in the field of human genetics. We discuss this knowledge in relation with drug response prediction, from the germline genetic variation compiled in the 1000 Genomes Project or in the Genotype-Tissue Expression project, to the phenome-genome archives, the international cancer projects, such as The Cancer Genome Atlas or the International Cancer Genome Consortium, and the epigenetic variation and its influence in gene expression, including the regulation of drug metabolism. This review is based on the lectures presented by the speakers of the Symposium "Human Genetics: International Projects & New Technologies" from the VII Conference of the Spanish Pharmacogenetics and Pharmacogenomics Society, held on the 20th and 21st of April 2015.
The close connections between colonialism and tropical medicine have been widely discussed by historians over the last fifty years. However, few authors consider the relationship between tropical medicine and European and North American imperialism in the immediate post-World War II period. This article examines the Fourth International Congresses on Tropical Medicine and Malaria, held jointly in Washington in 1948. Using the research presented during the conference, it questions to what degree the specialisation had changed in the postwar period. It argues that although some changes are discernable, imperial traditions and relationships remained firmly embedded within the tropical medicine of the congress.
Cramer, Holger; Lauche, Romy; Langhorst, Jost; Paul, Anna; Michalsen, Andreas; Dobos, Gustav
Yoga seems to be an effective means to cope with a variety of internal medicine conditions. While characteristics of yoga users have been investigated in the general population, little is known about predictors of yoga use and barriers to yoga use in internal medicine patients. The aim of this cross-sectional analysis was to identify sociodemographic, clinical, and psychological predictors of yoga use among internal medicine patients. A cross-sectional analysis was conducted among all patients being referred to a Department of Internal and Integrative Medicine during a 3-year period. It was assessed whether patients had ever used yoga for their primary medical complaint, the perceived benefit, and the perceived harm of yoga practice. Potential predictors of yoga use including sociodemographic characteristics, health behavior, internal medicine diagnosis, general health status, mental health, satisfaction with health, and health locus of control were assessed; and associations with yoga use were tested using multiple logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for significant predictors. Of 2486 participants, 303 (12.19%) reported having used yoga for their primary medical complaint. Of those, 184 (60.73%) reported benefits and 12 (3.96%) reported harms due to yoga practice. Compared to yoga non-users, yoga users were more likely to be 50-64 years old (OR = 1.45; 95%CI = 1.05-2.01; P = 0.025); female (OR = 2.45; 95%CI = 1.45-4.02; P internal health locus of control (OR = 1.92; 95%CI = 1.38-2.67; P internal integrative medicine patient population and was commonly perceived as beneficial. Yoga use was not associated with the patients' specific diagnosis but with sociodemographic factors, mental health, and health locus of control. To improve adherence to yoga practice, it should be considered that male, younger, and anxious patients and those with low internal health locus of control might be less intrinsically
Background Many practicing physicians lack skills in physical examination. It is not known whether physical examination skills already show deficiencies after an early phase of clinical training. At the end of the internal medicine clerkship students are expected to be able to perform a general physical examination in every new patient encounter. In a previous study, the basic physical examination items that should standardly be performed were set by consensus. The aim of the current observational study was to assess whether medical students were able to correctly perform a general physical examination regarding completeness as well as technique at the end of the clerkship internal medicine. Methods One hundred students who had just finished their clerkship internal medicine were asked to perform a general physical examination on a standardized patient as they had learned during the clerkship. They were recorded on camera. Frequency of performance of each component of the physical examination was counted. Adequacy of performance was determined as either correct or incorrect or not assessable using a checklist of short descriptions of each physical examination component. A reliability analysis was performed by calculation of the intra class correlation coefficient for total scores of five physical examinations rated by three trained physicians and for their agreement on performance of all items. Results Approximately 40% of the agreed standard physical examination items were not performed by the students. Students put the most emphasis on examination of general parameters, heart, lungs and abdomen. Many components of the physical examination were not performed as was taught during precourses. Intra-class correlation was high for total scores of the physical examinations 0.91 (p internal medicine clerkship. Possible causes and suggestions for improvement are discussed. PMID:24712683
Hussey, Peter S
To analyze the dynamics of physician international migration patterns and identify the countries deviating most from expected migration rates. A negative binomial log-linear model of physician migration to the United States from every other country was constructed using a panel of country-level data for years 1994-2000. The model was used to identify factors associated with physician migration and to identify countries with higher or lower rates of physician migration than expected. Physician migration varied with a country's GDP per capita in an inverse-U pattern, with highest migration rates from middle-income countries. The absence of medical schools, immigrant networks in the United States, medical instruction in English, proximity to the United States, and the lack of political and civil liberties were also associated with higher migration rates. Countries with higher-than-predicted migration rates included Iceland, Albania, Armenia, Dominica, Lebanon, Syria, the United Arab Emirates, and Bulgaria. Countries with lower-than-predicted migration rates included Mexico, Japan, Brazil, Zimbabwe, Mauritania, Portugal, Senegal, and France. This analysis shows that many of the most powerful factors associated with physician migration are difficult or impossible for countries to change through public policy. GDP per capita and proximity to the U.S. are two of the most powerful predictors of physician migration. Networks of immigrants in the U.S. and fewer political and civil liberties also put countries at higher risk for physician emigration. Several other factors that were associated with physician migration might be more easily amenable to policy intervention. These factors include the absence of a medical school and medical instruction in English. Policies addressing these factors would involve making several difficult tradeoffs, however. Other examples of policies that are effective in minimizing physician migration might be found by examining countries with lower
Huhn, D; Lauter, J; Roesch Ely, D; Koch, E; Möltner, A; Herzog, W; Resch, F; Herpertz, S C; Nikendei, C
Particularly at the beginning of their studies, international medical students face a number of language-related, social and intercultural challenges. Thus, they perform poorer than their local counterparts in written and oral examinations as well as in Objective Structured Clinical Examinations (OSCEs) in the fields of internal medicine and surgery. It is still unknown how international students perform in an OSCE in the field of psychosocial medicine compared to their local fellow students. All students (N = 1033) taking the OSCE in the field of psychosocial medicine and an accompanying written examination in their eighth or ninth semester between 2012 and 2015 were included in the analysis. The OSCE consisted of four different stations, in which students had to perform and manage a patient encounter with simulated patients suffering from 1) post-traumatic stress disorder, 2) schizophrenia, 3) borderline personality disorder and 4) either suicidal tendency or dementia. Students were evaluated by trained lecturers using global checklists assessing specific professional domains, namely building a relationship with the patient, conversational skills, anamnesis, as well as psychopathological findings and decision-making. International medical students scored significantly poorer than their local peers (p International students showed poorer results in clinical-practical exams in the field of psychosocial medicine, with conversational skills yielding the poorest scores. However, regarding factual and practical knowledge examined via a multiple-choice test, no differences emerged between international and local students. These findings have decisive implications for relationship building in the doctor-patient relationship.
Armstrong, Katrina; Keating, Nancy L; Landry, Michael; Crotty, Bradley H; Phillips, Russell S; Selker, Harry P
After five decades of growth that has included advances in medical education and health care delivery, value cohesion, and integration of diversity, we propose an overarching mission for academic general internal medicine to lead excellence, change, and innovation in clinical care, education, and research. General internal medicine aims to achieve health care delivery that is comprehensive, technologically advanced and individualized; instills trust within a culture of respect; is efficient in the use of time, people, and resources; is organized and financed to achieve optimal health outcomes; maximizes equity; and continually learns and adapts. This mission of health care transformation has implications for the clinical, educational, and research activities of divisions of general internal medicine over the next several decades.
Shumer, Gregory; Warber, Sara; Motohara, Satoko; Yajima, Ayaka; Plegue, Melissa; Bialko, Matthew; Iida, Tomoko; Sano, Kiyoshi; Amenomori, Masaki; Tsuda, Tsukasa; Fetters, Michael D
There is growing interest in the use of complementary and alternative medicine (CAM) throughout the world, however previous research done in Japan has focused primarily on CAM use in major cities. The purpose of this study was to develop and distribute a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) to assess the use of CAM among people who visit rural Japanese family medicine clinics. Using a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q), a cross-sectional survey was conducted in three rural family medicine clinics. All patients and those accompanying patients who met inclusion criteria were eligible to participate. Data were entered into SPSS Statistics and analyzed for use by age, gender, and location. Of the 519 respondents who participated in the project, 415 participants reported CAM use in the past 12 months (80.0%). When prayer is excluded, the prevalence of CAM use drops to 77.3% in the past year, or 403 respondents. The most common forms of CAM used by respondents were pain relief pads (n = 170, 32.8%), herbal medicines/supplements (n = 167, 32.2%), and massage by self or family (n = 166, 32.0%). Female respondents, individuals with higher levels of education, and those with poorer overall health status were more likely to use CAM than respondents without these characteristics. Only 22.8% of CAM therapies used were reported to physicians by survey participants. These data indicate that CAM use in rural Japan is common. The results are consistent with previous studies that show that Japanese individuals are more interested in forms of CAM such as pain relief pads and massage, than in mind-body forms of CAM like relaxation and meditation. Due to the high utilization of certain CAM practices, and given that most CAM users do not disclose their CAM use to their doctors, we conclude that physicians in rural Japan would benefit by asking about CAM use
Casal, E R; Vázquez, E N; Husni, C
In our country general internists are the providers of adult medical care in urban areas. In the past twenty years, with the increasing subspecialization within internal medicine and the development of advances in technology, the role of the general internist seems to be endangered. Recently much attention has been focused on this area and Divisions and Programs of General Internal Medicine have been established in most medical schools in the USA. The University of Buenos Aires instituted a Program of General Internal Medicine in its major teaching hospital in 1987. One of its purposes was to offer an educational experience to residents in the field of internal medicine primary care. This paper summarizes how this program was carried out and the subjects proposed in the area of Diagnosis and Treatment. The Program of General Internal Medicine is performed in the Outpatient Division and it is staffed by 3 faculty members and 4 fellows. Residents in Internal Medicine have a three month, full-time block rotation in the Program. A young, city dwelling, lower middle class population participates in the Program, with almost 10000 visits a year. The Program offers an experience that includes supervised patient care, an average of 100 office visits a month, and seminars and/or workshops covering topics of "Diagnosis and Treatment", "Case Presentations", "Clinical Epidemiology", "Prevention", and "Doctor-Patient Interview". In the area of Diagnosis and Treatment, the criteria used were: 1-frequency of diagnosis as determined by previous investigations, 2-relevant clinical conditions absent from the frequency list as determined by a consensus process by faculty members.(ABSTRACT TRUNCATED AT 250 WORDS)
Wang, Jennifer Y; Lin, Hillary; Lewis, Patricia Y; Fetterman, David M; Gesundheit, Neil
Undergraduate (i.e., baccalaureate) premedical students have limited exposure to clinical practice before applying to medical school-a shortcoming, given the personal and financial resources required to complete medical training. The Stanford Immersion in Medicine Series (SIMS) is a program that streamlines the completion of regulatory requirements for premedical students and allows them to develop one-on-one mentor-mentee relationships with practicing physicians. The program, offered quarterly since 2007, is an elective available for Stanford University sophomores, juniors, and seniors. Participants apply to the program and, if accepted, receive patient rights and professionalism training. Students shadow the physician they are paired with at least four times and submit a reflective essay about their experience.SIMS program coordinators administered surveys before and after shadowing to assess changes in students' perceptions and understanding of medical careers. The authors observed, in the 61 Stanford premedical students who participated in SIMS between March and June 2010 and completed both pre- and postprogram questionnaires, significant increases in familiarity with physician responsibilities and in understanding physician-patient interactions. The authors detected no significant changes in student commitment to pursuing medicine. Student perceptions of the value of shadowing-high both pre- and post shadowing-did not change. Physician shadowing by premedical baccalaureate students appears to promote an understanding of physician roles and workplace challenges. Future studies should identify the ideal timing, format, and duration of shadowing to optimize the experience and allow students to make informed decisions about whether to pursue a medical career.
Tondeur, M.; Ham, H.; Sand, A.
Radiation protection is of major importance in pregnant and breast feeding women. This work was undertaken to assess the practices of Belgian nuclear medicine physicians towards performing diagnostic tests during pregnancy and in breast feeding women. A questionnaire was sent to 201 Belgian nuclear medicine physicians; 82 answers (41 %) were received. 51 % of the responding physicians agree to perform lung perfusion scan during pregnancy provided a reduced dose is administered, 33% refuse to perform it during first three months and 24% refuse to perform it for pregnancies older than three months. For the Tc-99m ventilation scan 79% and 66% refuse to perform it before and after first three months. Better agreement was observed for other Tc-99m scintigraphies or tests using other radionuclides. In breast feeding women 89% agree to perform Tc-99m tests provided a breast feeding break; however, the duration of this break appears variable. The need for obtaining a written informed consent appears controversial. Given the variability of the attitudes of nuclear medicine physicians, official guidelines for nuclear medicine diagnostic tests during pregnancy is needed. (authors)
Pana, A L; McShane, J
To examine the gender differences in practice patterns, experiences, and career opportunities for family physicians who practice sports medicine. Descriptive, self-administered questionnaire. Family physicians with Certificate of Added Qualification (CAQ) in sports medicine were surveyed. The survey was sent to all women with a CAQ in Sports Medicine and a random sample of 20% of the men with CAQs in sports medicine. Survey consisted of multiple choice, Likert scale, and opened-ended questions. The data was analyzed with contingency tables, with gender as the dependent variable. Response rate to the survey was 75%, which included 42 females and 102 males. Demographics of our population demonstrated some gender differences. Males were of higher average age (41.1 vs. 38.1), and more likely to be married and have children. Practice types, location, and time spent in sports medicine did not differ with the exception of training room and event coverage. Males were more likely to cover all levels of training room except at the Division I level, where the percent of males and females covering training rooms were equal. Males were also more likely to cover all types of sporting events. Job satisfaction and reasons for choosing current jobs did not show significant gender differences. However, factors affecting career opportunities did vary. Professional relationships with athletic trainers and coaches were perceived to be different by males and females surveyed. Our survey of sports medicine physicians showed some gender differences in practice patterns relative to training room and sporting event coverage. Surprisingly, there were not many differences in the factors that affected job choice and factors affecting job opportunities with the exception of gender itself. However, our study does not conclude how or when gender begins to affect the female sports medicine physician's career opportunities.
Full Text Available Modern medicine began in the last half of the nineteenth century when doctors started practising the scientific method at the bedside. However, in his presidential address to the Association of American Physicians in 1979 James Wyngaarden postulated that the clinical scientist was an endangered species. Several reasons for this have been suggested, including “the seductive incomes that now derive from procedure-based specialty medicine”. Others have suggested that it is simply because the things left to be discovered at bedside have become exhausted, and that all the big medical advances will now be made by high-powered institutions.
The tasks of preclinical emergency medicine systems (PEMS) are to stabilize and maintain the vital functions and to guarantee qualified transport to the hospital. Worldwide, different structures exist as a result of historical developments. Legal regulations for PEMS have been introduced in most of the industrialized countries since 1960. More and more aspects have been subject to detailed regulations. PEMS are provided either by state-owned or by state-controlled (private) organisations. In most of the "underdeveloped" countries legal regulations do not exist and PEMS is often provided by social workers, by the army or by volunteers. In most countries, PEMS are financed by the state with a charge on the patient. In a few states PEMS are totally financed by the public health structure. Modern PEMS are controlled from dispatch centres which receive emergency calls (mostly by telephone) and send the appropriate rescue unit. In most states the staff of dispatch centres are paramedics; in some countries and in some urban areas physicians control the dispatch centre. In PEMS without physicians on the scene, an information exchange between the scene and the hospital can be observed frequently, in contrast to systems with physicians on the scene. Worldwide, ground-based PEMS are preferred, but in most countries an additional air rescue system has been established. The quality and quantity of the technical equipment of the ground-based PEMS differ widely: nationwide regulations exist, however, in the USA and Germany. Generally, there are two main concepts concerning the personnel structure: PEMS are either physician based or not. Requirements for emergency physicians differ greatly: in some countries no formal requirements exist, in others extensive practical and theoretical training is required.(ABSTRACT TRUNCATED AT 250 WORDS)
Robinson, Robert L
The last decade has brought significant changes to internal medicine clerkships through resident work-hour restrictions and the widespread adoption of hospitalists as medical educators. These key medical educators face competing demands for quality teaching and clinical service intensity. The study reported here was conducted to explore the relationship between clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students. A retrospective correlation analysis of clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students during the 2009 to 2013 academic years at Southern Illinois University School of Medicine was conducted. Internal medicine hospitalists who supervise the third-year inpatient experience for medical students during the 2009 to 2013 academic years participated in the study. Clinical service intensity data in terms of work relative value units (RVUs), patient encounters, and days of inpatient duty were collected for all members of the hospitalist service. Medical students rated hospitalists in the areas of patient rapport, enthusiasm about the profession, clinical skills, sharing knowledge and skills, encouraging the students, probing student knowledge, stimulating independent learning, providing timely feedback, providing constructive criticism, and observing patient encounters with students. Significant negative correlations between higher work RVU production, total patient encounters, duty days, and learner evaluation scores for enthusiasm about the profession, clinical skills, probing the student for knowledge and judgment, and observing a patient encounter with the student were identified. Higher duty days had a significant negative correlation with sharing knowledge/skills and encouraging student initiative. Higher work RVUs and total patient encounters were negatively correlated with timely feedback and constructive criticism. The results suggest that
A G Lim
Full Text Available Background. Emergency medicine (EM is a relatively new, but growing medical specialty in sub-Saharan Africa. African EM training programmes have used small-group learning (SGL modalities in their curricula. However, there is little knowledge of whether SGL modalities are perceived to be effective in these African EM training programmes. Objectives. To investigate the acceptability of SGL for physicians’ training in an academic Tanzanian emergency department using a novel EM curriculum. Methods. Using responses to a written questionnaire, we explored the perceived effectiveness of SGL compared with traditional didactic lectures among 38 emergency department physician learners in Dar es Salaam, Tanzania. Perceptions of SGL were identified from qualitative responses, and regression analyses were used to determine strength of association between quantitative outcomes. Results. Reported benefits of SGL included team building, simulation training, enhancement of procedural skills, and the opportunity to discuss opinions on clinical management. SGL scored more favourably with regard to improving clinical practice, enjoyment of learning, and building peer-to-peer relations. Lectures scored more favourably at improving medical knowledge. Preference towards SGL over lectures for overall training increased with years of clinical experience (95% confidence interval (CI 0.16 - 0.62, p=0.002, Spearman’s rho 0.51, and the perception that SGL reinforces learner-teacher relationships correlated with seniority within residency training (95% CI 0.14 - 0.86, p=0.007, Spearman’s rho 0.47. Conclusion. Techniques of SGL were perceived as effective at improving clinical practice in the emergency department setting. These modalities may be more favourably accepted by more experienced physician learners – therefore, new EM teaching programmes in Africa should consider these factors when targeting educational strategies for their respective regions and learner
West, Colin P; Shanafelt, Tait D; Kolars, Joseph C
Physician distress is common and has been associated with negative effects on patient care. However, factors associated with resident distress and well-being have not been well described at a national level. To measure well-being in a national sample of internal medicine residents and to evaluate relationships with demographics, educational debt, and medical knowledge. Study of internal medicine residents using data collected on 2008 and 2009 Internal Medicine In-Training Examination (IM-ITE) scores and the 2008 IM-ITE survey. Participants were 16,394 residents, representing 74.1% of all eligible US internal medicine residents in the 2008-2009 academic year. This total included 7743 US medical graduates and 8571 international medical graduates. Quality of life (QOL) and symptoms of burnout were assessed, as were year of training, sex, medical school location, educational debt, and IM-ITE score reported as percentage of correct responses. Quality of life was rated "as bad as it can be" or "somewhat bad" by 2402 of 16,187 responding residents (14.8%). Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8343 of 16,192 (51.5%), 7394 of 16,154 (45.8%), and 4541 of 15,737 (28.9%) responding residents, respectively. In multivariable models, burnout was less common among international medical graduates than among US medical graduates (45.1% vs 58.7%; odds ratio, 0.70 [99% CI, 0.63-0.77]; P $200,000 relative to no debt). Residents reporting QOL "as bad as it can be" and emotional exhaustion symptoms daily had mean IM-ITE scores 2.7 points (99% CI, 1.2-4.3; P ITE scores 5.0 points (99% CI, 4.4-5.6; P ITE scores.
Orbai, Ana-Maria; de Wit, Maarten; Mease, Philip
OBJECTIVE: To identify a core set of domains (outcomes) to be measured in psoriatic arthritis (PsA) clinical trials that represent both patients' and physicians' priorities. METHODS: We conducted (1) a systematic literature review (SLR) of domains assessed in PsA; (2) international focus groups t...
Mazur, Nicole; Zarzeka, Aleksander; Dąbrowski, Filip; Panczyk, Mariusz; Gałązkowski, Robert; Gotlib, Joanna
Due to the amendment of the Nurse and Midwife professions Act, since 1st of January 2016 Polish nurses and midwives with certain qualifications are able to prescribe medicines and referral for diagnostic tests. To analyse attitudes of physicians on new professional competencies of nurses and midwives regarding: prescribing medicines and referring patients for certain diagnostic tests. In the study took part 436 physicians (245 women, 193 man). The average age was 36,6 years old (min.: 21; max.: 76; SD: 11,65; median: 31). 274 people lived in a city with over 500 thousand citizens, 70 people - city below 100 thousand citizens, 54 people - city between 100-500 thousands citizens and 14 people lived in a country. Most of people lived in masovian district. Authors prepared and validated own questionnaire, which contained statements assessed in Likert scale (1-strongly disagree, 5-stronlgy agree). It contained 22 questions about opinions of new abilities of nurses and midwives. The questionnaire was sent three times to Regional Medical Chamber in Warsaw via an online questionnaire: https://docs.google.com/forms/d/1cxiaJFPxDVphByhBTk4gDIBsm6bQsxGLVXDK-RtpGnk/ The reliability of the questionnaire used was tested in a pilot study by the coefficient α-Cronbach, which amounted to 0.937. Due to the fact that the study was performed in a group of doctors they did not require the consent of the Bioethics Committee, of Medical University of Warsaw to carry them out. The results are presented using descriptive statistics, which were obtained through statistical analysis using Microsoft Excel and StatSoft Statistica 12.0 (license Medical University of Warsaw). 53% of doctors claim that the new powers do not improve patient care. 35% of respondents disagreed with the opinion that the new powers will raise the prestige of professional nurses and midwives. At the same time 49% believe that prescriptions for nurses and midwives reduce the responsibilities of doctors. Only 9% agreed
Korf, Bruce R; Berry, Anna B; Limson, Melvin; Marian, Ali J; Murray, Michael F; O'Rourke, P Pearl; Passamani, Eugene R; Relling, Mary V; Tooker, John; Tsongalis, Gregory J; Rodriguez, Laura L
Completion of the Human Genome Project, in conjunction with dramatic reductions in the cost of DNA sequencing and advances in translational research, is gradually ushering genomic discoveries and technologies into the practice of medicine. The rapid pace of these advances is opening up a gap between the knowledge available about the clinical relevance of genomic information and the ability of clinicians to include such information in their medical practices. This educational gap threatens to be rate limiting to the clinical adoption of genomics in medicine. Solutions will require not only a better understanding of the clinical implications of genetic discoveries but also training in genomics at all levels of professional development, including for individuals in formal training and others who long ago completed such training. The National Human Genome Research Institute has convened the Inter-Society Coordinating Committee for Physician Education in Genomics (ISCC) to develop and share best practices in the use of genomics in medicine. The ISCC has developed a framework for development of genomics practice competencies that may serve as a starting point for formulation of competencies for physicians in various medical disciplines.
Taylor, David R; Park, Yoon Soo; Smith, Christopher A; Karpinski, Jolanta; Coke, William; Tekian, Ara
Competency-based medical education has not advanced residency training as much as many observers expected. Some medical educators now advocate reorienting competency-based approaches to focus on a resident's ability to do authentic clinical work. To develop descriptions of clinical work for which internal medicine residents must gain proficiency to deliver meaningful patient care (for example, "Admit and manage a medical inpatient with a new acute problem"). A modified Delphi process involving clinical experts followed by a conference of educational experts. The Royal College of Physicians and Surgeons of Canada. In phase 1 of the project, members of the Specialty Committee for Internal Medicine participated in a modified Delphi process to identify activities in internal medicine that represent the scope of the specialty. In phase 2 of the project, 5 experts who were scholars and leaders in competency-based medical education reviewed the results. Phase 1 identified important activities, revised descriptions to improve accuracy and avoid overlap, and assigned activities to stages of training. Phase 2 compared proposed activity descriptions with published guidelines for their development and application in medical education. The project identified 29 activities that qualify as entrustable professional activities. The project also produced a detailed description of each activity and guidelines for using them to assess residents. These activities reflect the practice patterns of the developers and may not fully represent internal medicine practice in Canada. Identification of these activities is expected to facilitate modification of training and assessment programs for medical residents so that programs focus less on isolated skills and more on integrated tasks. Southeastern Ontario Academic Medical Organization Endowed Scholarship and Education Fund and Queen's University Department of Medicine Innovation Fund.
Full Text Available Robert L Robinson Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA Background: The last decade has brought significant changes to internal medicine clerkships through resident work-hour restrictions and the widespread adoption of hospitalists as medical educators. These key medical educators face competing demands for quality teaching and clinical service intensity. Objective: The study reported here was conducted to explore the relationship between clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students. Design: A retrospective correlation analysis of clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students during the 2009 to 2013 academic years at Southern Illinois University School of Medicine was conducted. Participants: Internal medicine hospitalists who supervise the third-year inpatient experience for medical students during the 2009 to 2013 academic years participated in the study. Measures: Clinical service intensity data in terms of work relative value units (RVUs, patient encounters, and days of inpatient duty were collected for all members of the hospitalist service. Medical students rated hospitalists in the areas of patient rapport, enthusiasm about the profession, clinical skills, sharing knowledge and skills, encouraging the students, probing student knowledge, stimulating independent learning, providing timely feedback, providing constructive criticism, and observing patient encounters with students. Results: Significant negative correlations between higher work RVU production, total patient encounters, duty days, and learner evaluation scores for enthusiasm about the profession, clinical skills, probing the student for knowledge and judgment, and observing a patient encounter with the student were identified. Higher duty days had a significant negative correlation
The first International Telemedicine/Disaster Medicine Conference was held in Dec. 1991. The overall purpose was to convene an international, multidisciplinary gathering of experts to discuss the emerging field of telemedicine and assess its future directions; principally the application of space technology to disaster response and management, but also to clinical medicine, remote health care, public health, and other needs. This collection is intended to acquaint the reader with recent landmark efforts in telemedicine as applied to disaster management and remote health care, the technical requirements of telemedicine systems, the application of telemedicine and telehealth in the U.S. space program, and the social and humanitarian dimensions of this area of medicine.
Kraaijenbrink, B V C; Lambers, W M; Mathus-Vliegen, E M H; Siegert, C E H
Refeeding syndrome is a potentially fatal shift of fluids and electrolytes that may occur after reintroducing nutrition in a malnourished patient. Its incidence in internal medicine patients is not known. We aimed at determining the incidence in a heterogeneous group of patients acutely admitted to a department of internal medicine. All patients acutely admitted to the department of internal medicine of a teaching community hospital in Amsterdam, the Netherlands, between 22 February 2011 and 29 April 2011, were included. We applied the National Institute for Health and Care Excellence (NICE) criteria for determining people at risk of refeeding syndrome and took hypophosphataemia as the main indicator for the presence of this syndrome. Of 178 patients included in the study, 97 (54%) were considered to be at risk of developing refeeding syndrome and 14 patients actually developed the syndrome (14% of patients at risk and 8% of study population). Patients with a malignancy or previous malignancy were at increased risk of developing refeeding syndrome (p refeeding syndrome. The Short Nutritional Assessment Questionnaire score had a positive and negative predictive value of 13% and 95% respectively. The incidence of refeeding syndrome was relatively high in patients acutely admitted to the department of internal medicine. Oncology patients are at increased risk of developing refeeding syndrome. When taking the occurrence of hypophosphataemia as a hallmark, no other single clinical or composite parameter could be identified that accurately predicts the development of refeeding syndrome.
Kraaijenbrink, B. V. C.; Lambers, W. M.; Mathus-Vliegen, E. M. H.; Siegert, C. E. H.
Refeeding syndrome is a potentially fatal shift of fluids and electrolytes that may occur after reintroducing nutrition in a malnourished patient. Its incidence in internal medicine patients is not known. We aimed at determining the incidence in a heterogeneous group of patients acutely admitted to
Flannery, Michael T
This perspective attempts to bring graduate medical offices, residency programs and medical students interested in categorical internal medicine (CIM) a brief update on the American Board of Internal Medicine (ABIM), Accreditation Council for Graduate Medical Education (ACGME) and the National Registry for Medical Programs (NRMP) changes for the past 3-5 years in the United States (US). The US model for certification and recertification may serve as a homogenous example for other countries. This model will be described so that there is an understanding of the importance of such changes in the American system and its effect on resident education. This is critical knowledge for both teachers and learners in internal medicine in preparation for a lifetime career and requirements for certification/credentialing for both programs and their residents/fellows. Data from the review indicate a small increase in the number of applicants but a concordant decrease in ABIM initial certification exams. Programs should well be aware of the new focus on outcomes via the Next Accreditation System (NAS) being put forth by the ACGME. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Jones, Roger; Panda, Mukta; Desbiens, Norman
Background: Medical knowledge is essential for appropriate patient care; however, the accuracy of internal medicine (IM) residents' assessment of their medical knowledge is unknown. Methods: IM residents predicted their overall percentile performance 1 week (on average) before and after taking the in-training exam (ITE), an objective and well…
Anderson, Alexander S.; Botticelli, Max G.
The implementation of a clinical clerkship in internal medicine that was flexible in time required that a new evaluation program be developed to assess the progress of students. The progress of the classes of 1979 and 1980 toward achievement of predetermined levels of mastery is presented. (Author/MLW)
Ma, Irene W Y; Arishenkoff, Shane; Wiseman, Jeffrey; Desy, Janeve; Ailon, Jonathan; Martin, Leslie; Otremba, Mirek; Halman, Samantha; Willemot, Patrick; Blouw, Marcus
Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1-3) and expanded (general internal medicine PGY 4-5) training programs. We recommend four POCUS applications for the core PGY 1-3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4-5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.
Blackstone, Jacquelyn; Will, Vanessa K; Rayburn, William F
To examine trends of female physicians either pursuing fellowships or in active practice in maternal-fetal medicine (MFM). This observational study examined complete sets of MFM fellows and active members of the Society for Maternal-Fetal Medicine (SMFM) between 1985 and 2016. Databases from SMFM, American College of Obstetricians and Gynecologists (ACOG), and Accreditation Council for Graduate Medical Education were used. Analysis of covariance testing was used to assess interactions over time between groups. The proportion of female MFM fellows increased steadily from 17.1% in 1985 to 72.5% in 2016. The proportion of females grew more rapidly among the MFM fellows than obstetrics and gynecology (ob-gyn) residents (2.1 vs. 1.4% per year; p = 0.001) and among those who were active SMFM members than ACOG Fellows (1.4 vs. 1.2% per year; p = 0.013). Slightly more than half (52.4%) of all SMFM members are now female and will approach two-thirds (64.4%) by 2025 (compared with 53.4% in 2016 and 65.3% in 2025 of ACOG fellows). The rising proportion of female MFM fellows is directly related to the high number of female ob-gyn residents. Females comprise slightly more than half of all active SMFM members now and projected to approach two-thirds by 2025. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Irving, Greg; Neves, Ana Luisa; Dambha-Miller, Hajira; Oishi, Ai; Tagashira, Hiroko; Verho, Anistasiya; Holden, John
To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. This is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes. One hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction. There are international variations in consultation length, and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Park, Elyse R; Betancourt, Joseph R; Miller, Elizabeth; Nathan, Michael; MacDonald, Ellie; Ananeh-Firempong, Owusu; Stone, Valerie E
BACKGROUND Physicians increasingly face the challenge of managing clinical encounters with patients from a range of cultural backgrounds. Despite widespread interest in cross-cultural care, little is known about resident physicians' perceptions of what will best enable them to provide quality care to diverse patient populations. OBJECTIVES To assess medicine residents' (1) perceptions of cross-cultural care, (2) barriers to care, and (3) training experiences and recommendations. DESIGN, SETTING, AND PATIENTS Qualitative individual interviews were conducted with 26 third-year medicine residents at Massachusetts General Hospital in Boston (response rate = 87%). Interviews were recorded, transcribed, and analyzed. RESULTS Despite significant interest in cross-cultural care, almost all of the residents reported very little training during residency. Most had gained cross-cultural skills through informal learning. A few were skeptical about formal training, and some expressed concern that it is impossible to understand every culture. Challenges to the delivery of cross-cultural care included managing patients with limited English proficiency, who involve family in critical decision making, and who have beliefs about disease that vary from the biomedical model. Residents cited many implications to these barriers, ranging from negatively impacting the patient-physician relationship to compromised care. Training recommendations included making changes to the educational climate and informal and formal training mechanisms. CONCLUSIONS If cross-cultural education is to be successful, it must take into account residents' perspectives and be focused on overcoming residents' cited barriers. It is important to convey that cross-cultural education is a set of skills that can be taught and applied, in a time-efficient manner, rather than requiring an insurmountable knowledge base. PMID:16704391
Folkl, Alex; Chan, Teresa; Blau, Elaine
Free, open access medical education (FOAM) has the potential to revolutionize continuing medical education, particularly for rural physicians who practice emergency medicine (EM) as part of a generalist practice. However, there has been little study of rural physicians' educational needs since the advent of FOAM. We asked how rural physicians in Southwestern Ontario obtained their continuing EM education. We asked them to assess their perceived level of comfort in different areas of EM. To understand how FOAM resources might serve the rural EM community, we compared their responses with urban emergency physicians. Responses were collected via survey and interview. There was no significant difference between groups in reported use of FOAM resources. However, there was a significant difference between rural and urban physicians' perceived level of EM knowledge, with urban physicians reporting a higher degree of confidence for most knowledge categories, particularly those related to critical care and rare procedures. This study provides the first description of EM knowledge and FOAM resource utilization among rural physicians in Southwestern Ontario. It also highlights an area of educational need -- that is, critical care and rare procedures. Future work should address whether rural physicians are using FOAM specifically to improve their critical care and procedural knowledge. As well, because of the generalist nature of rural practice, future work should clarify whether there is an opportunity cost to rural physicians' knowledge of other clinical domains if they chose to focus more time on continuing education in critical care EM.
Greene, Jeremy A; Podolsky, Scott H
Recent critiques of the role of pharmaceutical promotion in medical practice invoke a nostalgic version of 1950s and 1960s medicine as representing an uncomplicated relationship between an innovative pharmaceutical industry and an idealistic and sovereign medical profession-a relationship that was later corrupted by regulatory or business practice changes in the 1980s or 1990s. However, the escalation of innovation and promotion in the pharmaceutical industry at mid-century had already provoked a broader crisis of overflow in medical education in which physicians came to use both commercial and professional sources in an attempt to "keep modern" by incorporating emerging therapeutics into their practices. This phenomenon was simultaneously a crisis for the medical profession- playing a key role in attempts to inculcate a "rational therapeutics"-and a marketing opportunity for the pharmaceutical industry, and produced the structural foundations for contemporary debates regarding the role of pharmaceutical promotion in medical practice. Tracing the issue from the advent of the wonder drugs through today's concerns regarding formal CME, we document how and why the pharmaceutical industry was allowed (and even encouraged) to develop and maintain the central role it now plays within postgraduate medical education and prescribing practice.
Makowiec-Dabrowska, Teresa; Sprusińska, Elzbieta; Hanke, Wojciech; Radwan-Włodarczyk, Zyta; Koszada-Włodarczyk, Wiesława
The aim of the study was to define associations between intensity of perimenstrual complaints, the type of job performed and working conditions, taking also account of non-occupational factors. The study preceding the development of a preventive program was carried out in a group of women employed in work settings different in the character and burden of adverse agents. The group was composed of 142 women, aged 21-45 years, employed in a cosmetics manufacture plant (27%) and a bank (27%), as well as of hospital and ambulatory nurses and auxiliary personnel (50%). A questionnaire on premenstrual and menstrual complaints, working conditions, characteristics of the women and their household duties load was the main tool of the study. The study revealed that about 80% of women experienced premenstrual and about 75% menstrual symptoms, which were strongly intensified in 40% of women. After applying logistic regression, it was found that physical workload and occupational stress were the major occupational risk factors, whereas chronic diseases, age, household duties load and alcohol consumption were the major non-occupational risk factors. The evidenced relationship between complaints and adverse agents typical of the job performed should prompt occupational medicine physicians to more comprehensive analysis of individual jobs in view of reducing occupational load.
van Schothorst, Jannine; van den Brand, Crispijn L; Gaakeer, Menno I; Wallenburg, Iris
Emergency medicine is a fast-growing medical profession. Nevertheless, the clinical activities emergency physicians (EPs) carry out and the responsibilities they have differ considerably between hospitals. This article addresses the question how the role of EPs is shaped and institutionalized in the everyday context of acute care in hospitals. A cross-case ethnographic study was conducted, comprising observations, document analysis, and in-depth interviews in three emergency departments in the Netherlands. Drawing on the theoretical concept of institutional work, we show that managers, already established medical specialties, and EPs all conduct institutional work to enhance private interests, which both restricts and enlarges EPs' work domain. These actions are strategic and intentional, as well as unintentional and part of EPs' everyday work in acute care delivery. It is in this very process that tasks and responsibilities are redistributed and the role of the EP is shaped. In contemporary literature it is often argued that the role and status of EPs should be enhanced by strengthening regulation and improving training programs. This article shows that attention should also be paid to the more subtle everyday processes of role development.
Giebel, Stephen; Kothari, Rashmi; Koestner, Amy; Mohney, Gretchen; Baker, Robert
Numerous guidelines to grade and manage sports-related concussions have been published. However, little is known about how frequently they are implemented in the emergency department. This study evaluates the current practices of emergency physicians (EPs) in managing sports-related concussions. To evaluate the current practice of EP evaluation and management of sports-related concussions. All EPs and emergency medicine residents in Kalamazoo County were surveyed regarding their management of sports-related concussions. The surveys obtained demographic data, participants' use of guidelines, and the importance of clinical and non-clinical factors in deciding when to allow a player to return to play. Of the 73 EP respondents, only 23% used a nationally recognized guideline, with no significant difference between attending and resident EPs. The symptomatic complaints of loss of consciousness, amnesia of the event, and difficulty concentrating were ranked most important by EPs in assessing patients with sports-related concussions. Among non-clinical factors, residents were significantly more likely than attendings to report that medical-legal, parental, and players' concerns were more likely to influence their decision in allowing a patient to return to play. EPs take into consideration important clinical factors in assessing patients with sports-related concussion. However, almost 75% do not use any nationally recognized guideline in their evaluation. Residents are more likely than attendings to be influenced by non-clinical factors. Copyright © 2011 Elsevier Inc. All rights reserved.
Huynh, Christine; Bowles, Darci; Yen, Miao-Shan; Phillips, Allison; Waller, Rachel; Hall, Lindsey; Tu, Shin-Ping
Adaptive Reserve (AR) is positively associated with implementing change in ambulatory settings. Deficits in AR may lead to change fatigue or burnout. We studied the association of self-reported AR and burnout among providers to hospitalized medicine patients in an academic medical center. An electronic survey containing a 23-item Adaptive Reserve scale, burnout inventory, and demographic questions was sent to a convenience sample of nurses, house staff team members, and hospitalists. A total of 119 self-administered, online surveys collected from June 2014 to March 2015 were analyzed. Ordinal regression analyses were used to examine the association between AR and burnout. Eighty percent of participants reported either level 1 or 2 burnout. Additionally, 10.9% of participants responded level 0% and 7.6% of participants reported level 3. Participants reporting higher burnout were about three times more likely to report lower AR levels. AR is strongly associated with self-reported burnout by physicians and nurses providing inpatient care at this academic medical center. Growing evidence supports the positive association of AR to successful change implementation in ambulatory settings. Similar studies are needed to determine whether certain levels of AR can predict successful change in hospital settings.
Hao, Shujie; Zhang, Ning; Fish, Anne Folta; Yuan, Xiaodan; Liu, Lin; Li, Fan; Fang, Zhaohui; Lou, Qingqing
To evaluate the prevalence of hyperglycemia among inpatients in internal medicine, and specifically, to assess the glycemic management of inpatients in non-endocrinology departments in three large urban hospitals in China. A multicenter observational study was conducted using electronic health records, and a survey of 1939 patients who were admitted to internal medicine units and followed until discharge. Those with previously diagnosed diabetes, newly diagnosed diabetes, or impaired fasting glucose were included. Aspects of glycemic management examined were (a) hyperglycemia, (b) endocrinology consultation for hyperglycemia and (c) hypoglycemia. The prevalence of hyperglycemia in internal medicine was 45.7% (886 out of 1939). A total of 741 (83.6%) patients were treated by non-endocrinology departments; of those, 230 (31.1%) were in poor glycemic control and needed an endocrinology consultation. Yet only 57 (24.8%) received one. In 4 cases, the physician did not follow the consultants' advice. Among the remaining 53 consulted patients, 35 (66.1%) were still in poor glycemic control, yet only about half received a second consultation. Finally, among patients treated in non-endocrinology departments, 58 (7.8%) had hypoglycemia; less than half retested their blood glucose after treatment. The majority of patients with hyperglycemia were in non-endocrinology departments. Their glycemic management was poor; the endocrinology consultation rate was low and the result was suboptimal. Also, the management of hypoglycemia was not ideal. Therefore, improving glycemic management is urgently needed in Chinese hospitals.
Barsoumian, Alice E; Hartzell, Joshua D; Bonura, Erin M; Ressner, Roseanne A; Whitman, Timothy J; Yun, Heather C
Nationally, the number of internal medicine physicians practicing in primary care has decreased amidst increasing interest in hospitalist medicine. Current priorities in the Military Health System include access to primary care and retention of trained personnel. Recently, we have conducted a study of military internal medicine residents' decision to enter infectious disease. As part of our larger effort, we saw an opportunity to characterize factors impacting decision making of internal medicine residents' desire to apply for subspecialty training and to extend active duty service obligations. Questions were developed after discussion with various military graduate medical education and internal medicine leaders, underwent external review, and were added to a larger question set. The survey link was distributed electronically to all U.S. military affiliated residencies' graduating internal medicine residents in December 2016-January 2017. Data were analyzed by decision to apply to fellowship and decision to extend military obligation using Fisher's exact test or Pearon's chi-square test. Sixty-eight residents from 10 of 11 military residency programs responded, for a response rate of 51%. The majority (62%) applied to fellowship to start after residency completion. Reasons cited for applying to fellowship included wanting to become a specialist as soon as possible (74%), wishing to avoid being a general internist (57%), and because they are unable to practice as a hospitalist in the military (52%). Fellowship applicants were more likely to plan to extend their military obligation than non-applicants, as did those with longer duration of military commitments. No other factors, including Uniformed Services University attendance or participation in undergraduate military experiences, were found to impact plan to extend active duty service commitment. The majority of graduating internal medicine residents apply for fellowship and report a desire to avoid being a
Full Text Available LR Stoneking,1 AL Waterbrook,1 J Garst Orozco,2 D Johnston,1 A Bellafiore,1 C Davies,3 T Nuño,1 J Fatás-Cabeza,4 O Beita,5 V Ng,1 KH Grall,6 W Adamas-Rappaport7 1Department of Emergency Medicine, University of Arizona, Tucson, AZ, 2Department of Emergency Medicine, Sinai Health System, Chicago, IL, 3Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, 4Department of Spanish and Portuguese, University of Arizona, Tucson, AZ, 5Department of Family and Community Medicine, University of Arizona, Tucson, AZ, 6Department of Emergency Medicine, Regions Hospital, St Paul, MN, 7Department of Surgery, University of Arizona, Tucson, AZ, USA Background: After emergency department (ED discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.Objectives: To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.Methods: Our ED has two Emergency Medicine Residency Programs, University Campus (UC and South Campus (SC. SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions.Results: Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study
West, Colin P; Halvorsen, Andrew J; Swenson, Sara L; McDonald, Furman S
Physician burnout and distress has been described in national studies of practicing physicians, internal medicine (IM) residents, IM clerkship directors, and medical school deans. However, no comparable national data exist for IM residency program directors. To assess burnout and distress among IM residency program directors, and to evaluate relationships of distress with personal and program characteristics and perceptions regarding implementation and consequences of Accreditation Council for Graduate Medical Education (ACGME) regulations. The 2010 Association of Program Directors in Internal Medicine (APDIM) Annual Survey, developed by the APDIM Survey Committee, was sent in August 2010 to the 377 program directors with APDIM membership, representing 99.0 % of the 381 United States categorical IM residency programs. The 2010 APDIM Annual Survey included validated items on well-being and distress, including questions addressing quality of life, satisfaction with work-life balance, and burnout. Questions addressing personal and program characteristics and perceptions regarding implementation and consequences of ACGME regulations were also included. Of 377 eligible program directors, 282 (74.8 %) completed surveys. Among respondents, 12.4 % and 28.8 % rated their quality of life and satisfaction with work-life balance negatively, respectively. Also, 27.0 % reported emotional exhaustion, 10.4 % reported depersonalization, and 28.7 % reported overall burnout. These rates were lower than those reported previously in national studies of medical students, IM residents, practicing physicians, IM clerkship directors, and medical school deans. Aspects of distress were more common among younger program directors, women, and those reporting greater weekly work hours. Work-home conflicts were common and associated with all domains of distress, especially if not resolved in a manner effectively balancing work and home responsibilities. Associations with program characteristics
Full Text Available Faculty of Medicine of the Masaryk University (MU, and especially its departments focusing on acute medicine, make an active effort to find and to support extra motivated students by organising courses and congresses with simulation-based learning sessions for them. 4th Emergency Medicine Course (EMC and 6th AKUTNĚ.CZ Congress were organised during 2014. EMC was held during a weekend in mid-April for 80 medical students. The congress was held on 22nd November 2014. A group of more than 700 enthusiastic professionals including physicians, nursing staff and medical students interested in acute medicine met again in Brno at the University Campus Bohunice. We also report the evaluation of effectiveness of different types of sessions, as well as its influence on practical skills and the fixation of memory footprint. The website AKUTNĚ.CZ (www.akutne.cz is freely accessible, and anyone can find and watch all the videos and presentations there.
Chahed, N.; Mtimet, S.; Hammami, H.; Mhiri, A.
Therapeutic applications in nuclear medicine use high activities of 131 I in sodium iodine liquid from which is volatile at ambient temperature. Besides external exposure there is, for the nuclear medicine personnel, an internal exposure risk induced by 131 iodine inhalation. So we tried to assess this risk among the personnel in a nuclear medicine department. We used direct method for measuring 131 radioactivity in vivo by external counting. Gamma ray detector with a Nal ( TI ) probe positioned near the thyroid gland allows investigation of 131 radioactivity. We realised 34 measurements among the personnel, two times at an interval of one month. The results indicate that an 131 iodine internal contamination is found. Estimated thyroid activities were ranging from 35 to 132 Bq. The highest activities has been found in the thyroid of the technicians involved in the administration of 131 iodine therapy. Therefore this values are lower than norms. This study must lead to the implementation control of the 131 iodine internal contamination in order to optimise the personnel protection in nuclear medicine departments (author)
Grasland, A; Mortier, E
Internal medicine is an in-hospital speciality. Along with its expertise in rare diseases, it shares with general medicine the global care of patients but its place in the ambulatory shift has yet to be defined. The objective of our work was to evaluate the benefits of an internal medicine day-hospital devoted to general medicine. Named "Centre Vi'TAL" to underline the link between the city and the hospital, this novel activity was implemented in order to respond quickly to general practitioners having difficulties to synthesize their complex patients or facing diagnostic or therapeutic problems. Using preferentially email for communication, the general practitioners can contact an internist who is committed to respond on the same day and take over the patient within 7 days if day-hospital is appropriate for his condition. The other patients are directed either to the emergency department, consultation or full hospitalization. In 14 months, the center has received 213 (144 women, 69 men) patients, mean age 53.6, addressed by 88 general practitioners for 282 day-hospital sessions. Requests included problem diagnoses (n=105), synthesis reviews for complex patients (n=65), and treatment (n=43). In the ambulatory shift advocated by the authorities, this experience shows that internal medicine should engage in the recognition of day-hospital as a place for diagnosis and synthesis reviews connected with the city while leaving the general practitioners coordinator of their patient care. This activity of synthesis in day-hospital is useful for the patients and efficient for our healthcare system. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.
Kohlwes, R Jeffrey; Cornett, Patricia; Dandu, Madhavi; Julian, Katherine; Vidyarthi, Arpana; Minichiello, Tracy; Shunk, Rebecca; Jain, Sharad; Harleman, Elizabeth; Ranji, Sumant; Sharpe, Brad; O'Sullivan, Patricia; Hollander, Harry
Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices. To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data. METHODS AND PROGRAM EVALUATION: We evaluated features of our AoD program, including program enrollment, resident satisfaction, recruitment surveys, quantity of scholarly products, and the results of our resident's certifying examination scores. Finally, we described the costs of implementing and maintaining the AoDs. AoD enrollment increased from 81% to 98% during the past 5 years. Both quantitative and qualitative data demonstrated a positive effect on recruitment and improved resident satisfaction with the program, and the number and breadth of scholarly presentations have increased without an adverse effect on our board certification pass rate. The AoD system led to favorable outcomes in the domains of resident recruitment, satisfaction, scholarship, and board performance. Our intervention showed that residents can successfully obtain clinical training while engaging in specialized education beyond the bounds of core medicine training. Nurturing these interests 5 empower residents to better shape their careers by providing earlier insight into internist roles that transcend classic internal medicine training.
Kolade, Victor O; Sethi, Anuradha
Quality improvement (QI) has become an essential component of medical care in the United States. In residency programs, QI is a focus area of the Clinical Learning Environment Review visits conducted by the Accreditation Council for Graduate Medical Education. The readiness of applicants to internal medicine residency to engage in QI on day one is unknown. To document the reporting of QI training or experience in residency applications. Electronic Residency Application Service applications to a single internal medicine program were reviewed individually looking for reported QI involvement or actual projects in the curriculum vitae (CVs), personal statements (PSs), and letters of recommendation (LORs). CVs were also reviewed for evidence of education in QI such as completion of Institute for Healthcare Improvement (IHI) modules. Of 204 candidates shortlisted for interview, seven had QI items on their CVs, including one basic IHI certificate. Three discussed their QI work in their PSs, and four had recommendation letters describing their involvement in QI. One applicant had both CV and LOR evidence, so that 13 (6%) documented QI engagement. Practice of or instruction in QI is rarely mentioned in application documents of prospective internal medicine interns.
Background Several residency program characteristics have been suggested as measures of program quality, but associations between these measures are unknown. We set out to determine associations between these potential measures of program quality. Methods Survey of internal medicine residency programs that shared an online ambulatory curriculum on hospital type, faculty size, number of trainees, proportion of international medical graduate (IMG) trainees, Internal Medicine In-Training Examination (IM-ITE) scores, three-year American Board of Internal Medicine Certifying Examination (ABIM-CE) first-try pass rates, Residency Review Committee-Internal Medicine (RRC-IM) certification length, program director clinical duties, and use of pharmaceutical funding to support education. Associations assessed using Chi-square, Spearman rank correlation, univariate and multivariable linear regression. Results Fifty one of 67 programs responded (response rate 76.1%), including 29 (56.9%) community teaching and 17 (33.3%) university hospitals, with a mean of 68 trainees and 101 faculty. Forty four percent of trainees were IMGs. The average post-graduate year (PGY)-2 IM-ITE raw score was 63.1, which was 66.8 for PGY3s. Average 3-year ABIM-CE pass rate was 95.8%; average RRC-IM certification was 4.3 years. ABIM-CE results, IM-ITE results, and length of RRC-IM certification were strongly associated with each other (p ITE scores were higher in programs with more IMGs and in programs that accepted pharmaceutical support (p < 0.05). RRC-IM certification was shorter in programs with higher numbers of IMGs. In multivariable analysis, a higher proportion of IMGs was associated with 1.17 years shorter RRC accreditation. Conclusions Associations between quality indicators are complex, but suggest that the presence of IMGs is associated with better performance on standardized tests but decreased duration of RRC-IM certification. PMID:21651768
McCabe, James M.; Johnson, Colleen J; Marcus, Gregory M
Atrial fibrillation (AF) is often managed by general internal medicine physicians. Available data suggest that guidelines regarding AF management are often not followed, but the reasons for this remain unknown. We sought to assess the knowledge and beliefs of internists regarding strategies to treat AF. We conducted a national electronic survey of internal medicine physicians regarding their perceptions of optimal AF management, with an emphasis on the rationale for choosing a rhythm or rate control strategy. One hundred and forty-eight physicians from 36 different states responded (representing at least 19% of unique e-mails opened). Half of the respondents reported managing their AF patients independently without referral to a cardiologist. Seventy-three percent of participants believe a rhythm control strategy conveys a decreased stroke risk, 64% believe there is a mortality benefit to rhythm control, and 55% think that it would help avoid long term anticoagulation. Comparing those who prefer a rhythm control strategy to everyone else, those who favor rhythm control statistically significantly more often believe that rhythm control reduces the risk for stroke (96% versus 67%, p=0.009) and that rhythm control allows for the discontinuation of anticoagulation therapy (76% versus 49%, p=0.045). In conclusion, contrary to available data in clinical trials and recent guidelines regarding the rationale for choosing a rhythm control strategy in treating AF, the majority of study participants believe that rhythm control decreases stroke risk, decreases mortality, and allows for discontinuation of anticoagulation therapy. These prevalent misconceptions may substantially contribute to guideline non-adherence. PMID:19195516
Hutchinson, Nora; Baird, Grayson L; Garg, Megha
The National Institutes of Health (NIH) recommend that health materials be written at a grade 6-7 reading level, which has generally not been achieved in online reading materials. Up to the present time, there have not been any assessments focused on the reading level of online educational materials across the most popular consumer Web sites for common internal medicine diagnoses. In this study, we examined the readability of open-access online health information for 9 common internal medicine diagnoses. Nine of the most frequently encountered inpatient and ambulatory internal medicine diagnoses were selected for analysis. In November and December 2014, these diagnoses were used as search terms in Google, and the top 5 Web sites across all diagnoses and a diagnosis-specific site were analyzed across 5 validated reading indices. On average, the lowest reading grade-level content was provided by the NIH (10.7), followed by WebMD (10.9), Mayo Clinic (11.3), and diagnosis-specific Web sites (11.5). Conversely, Wikipedia provided content that required the highest grade-level readability (14.6). The diagnoses with the lowest reading grade levels were chronic obstructive pulmonary disease (10.8), followed by diabetes (10.9), congestive heart failure (11.7), osteoporosis (11.7) and hypertension (11.7). Depression had the highest grade-level readability (13.8). Despite recommendations for patient health information to be written at a grade 6-7 reading level, our examination of online educational materials pertaining to 9 common internal medicine diagnoses revealed reading levels significantly above the NIH recommendation. This was seen across both diagnosis-specific and general Web sites. There is a need to improve the readability of online educational materials made available to patients. These improvements have the potential to greatly enhance patient awareness, engagement, and physician-patient communication. Published by Elsevier Inc.
Single photon emission computed tomography (SPECT) is currently being used universally in clinical practice, while positron emission tomography (PET), originally developed as a technique for research, has also gradually moved from the research laboratory to the clinical environment. However, there are significant differences in nuclear medicine capabilities, especially in tomography, between developed and developing countries. The present status and future prospects of nuclear medicine tomography were the main topics of discussion at this latest international symposium, organized by the IAEA in co-operation with the World Health Organization and held in Vienna from 21 to 25 August 1995. The purpose of the meeting was to share experience and information on new developments and clinical applications of two promising tomographic techniques: SPECT and PET. Eight invited papers and 34 regular papers from 23 countries were presented. In addition, there was a panel discussion on the future and direction of tomography in nuclear medicine for developing countries. Refs, figs, tabs
No clinical laboratory would admit they do not practice team medicine, at least conceptually. However, true team medicine is more than an aspiration--it is an intentional care structure built, led, and delivered by a diverse, multidisciplinary team of physicians, medical technologists, nurses, pharmacists, and dozens of other professionals. We clinical laboratory physicians are able to fulfill an important role as competent members of the team medicine. Because we can look at the results of clinical examinations of patients earlier than anyone else, we can interpret the patient's condition by analyzing that results, and provide useful information to facilitate team medicine. I have conducted a questionnaire survey on team medicine targeting clinical laboratory physicians to clarify the tasks we are performing. In this paper, I describe what clinical laboratory physicians are currently doing, and how should we develop in the future.
Kor, Elham Movahed; Rashidian, Arash; Hosseini, Mostafa; Azar, Farbod Ebadi Fard; Arab, Mohammad
It is essential to organize private physicians in urban areas by developing urban family medicine in Iran. Acceptance of this project is currently low among physicians. The present research determined the factors affecting acceptability of the Urban Family Medicine Project among physicians working in the private sector of Mazandaran and Fars provinces in Iran. This descriptive-analytical and cross-sectional study was conducted in Mazandaran and Fars provinces. The target population was all physicians working in private offices in these regions. The sample size was calculated to be 860. The instrument contained 70 items that were modified in accordance with feedback from eight healthcare managers and a pilot sample of 50 physicians. Data was analyzed using the LISREL 8.80. The response rate was 82.21% and acceptability was almost 50% for all domains. The fit indices of the structural model were the chi-square to degree-of-freedom (2.79), normalized fit index (0.98), non-normalized fit index (0.99), comparative fit index (0.99), and root mean square error of approximation (0.05). Training facilities had no significant direct effect on acceptability; however, workload had a direct negative effect on acceptability. Other factors had direct positive effects on acceptability. Specification of the factors relating to acceptance of the project among private physicians is required to develop the project in urban areas. It is essential to upgrade the payment system, remedy cultural barriers, decrease the workload, improve the scope of practice and working conditions, and improve collaboration between healthcare professionals.
Full Text Available Background and purpose: Proper communication between a physician and a patient is the key to diagnosis and management of diseases.Communication skills are essential for gathering information from patients, enhancing patients trust on physicians, relaxing them and managing them .The main purpose of this study was to determine the states of communication skills of medical interns to communicate with patients.Method: In this cross sectional study, communication skills of 72 medical interns of Kerman Medical University was assessed based on a checklist completed with direct observation and a questionnaire completed through interview with patients.The checklist included two parts: the first part for individual characteristics and the second part for 24 specifications related to initiation of an interview, conducting an interview and completion of aninterview.Another questionnaire with a similar structure was developed to gather patients’ comments about communication of medical interns with them.Results: Communication skills of medical interns were weak in 29.3%, moderate in 85.4% and good in 15.9% of interns. An agreement between observed communication skills and patients’ survey results about greeting, asking patients’ names and calling them by their names, acceptable physicians’ appearance, listening to patients’ words, friendly doctor- patient encounter, empathizing with patients (0.37, 0.26, 0.22.0.41and 0.44 respectively was seen. Results of individual variables show that relationship between age of patient and his or her opinion about communication was significant.Based on patient’s survey, the communication score given to the student increases with age of the patient.Conclusion: The study shows deficits in doctor-patient communication of medical interns in history taking. Given the importance of communication skills, the necessity to teach them in clinical skill centers before real contact with patients is obvious
Marco, Catherine A; Wahl, Robert P; Counselman, Francis L; Heller, Barry N; Harvey, Anne L; Joldersma, Kevin B; Kowalenko, Terry; Coombs, Andrea B; Reisdorff, Earl J
As part of the American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) program, ABEM-certified physicians are required to pass the Continuous Certification (ConCert) examination at least every 10 years. With the 2015 ConCert examination, ABEM sought to better understand emergency physicians' perceptions of the benefits of preparing for and taking the examination and the career benefits of staying ABEM-certified. This was a prospective survey study. A voluntary postexamination survey was administered at the end of the 2015 ABEM ConCert examination (September 21-26, 2015). Physicians were asked about the benefits of preparing for the examination and maintaining ABEM certification. Examination performance was compared to perceptions of learning and career benefits. Of the 2,601 on-time test takers, 2,511 respondents participated (96.5% participation rate). The majority of participants (92.0%) identified a benefit to preparing for the ConCert examination, which included reinforced medical knowledge (73.9%), increased knowledge (66.8%), and making them a better clinician (39.4%). The majority of respondents (90.8%) identified a career benefit of maintaining ABEM certification, which included more employment options (73.8%), more positively viewed by other physicians (56.8%), and better financial outcomes (29.8%). There was a statistically significant association between the perception of knowledge reinforcement and examination performance (p Medicine.
Diehl, Andrew K; Kumar, Vineeta; Gateley, Ann; Appleby, Jane L; O'Keefe, Mary E
BACKGROUND Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents' specialty choices have received little attention. OBJECTIVE To identify factors that predict the clinical practice of residents following their training. DESIGN Prospective cohort study. PARTICIPANTS Two hundred and four categorical residents from 2 university-based residency programs. MEASUREMENTS Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later. RESULTS International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%, Pinternal medicine was observed among those who perceived General Internists to have lower potential incomes (69.0% vs 53.3%, P = .08). There was a trend for generalists to have lower scores on scales measuring authoritarianism, negative orientation to psychological problems, and Machiavellianism (0.05medicine, with trends apparent for higher debt (P = .05) and greater comfort caring for patients with psychological problems (P = .07). CONCLUSION Recruitment of IMGs may not increase the supply of General Internists. Prospects of lower income, even in the face of large debt, may not discourage residents from becoming generalists. If increasing generalist manpower is a goal, residencies should consider weighing applicants' personal attributes during the selection process. PMID:16836624
Cornett, Patricia A; Williams, Chris; Alweis, Richard L; McConville, John; Frank, Michael; Dalal, Bhavin; Kopelman, Richard I; Luther, Vera P; O'connor, Alec B; Muchmore, Elaine A
Some internal medicine residency program directors have expressed concerns that their third-year residents may have been subjected to inappropriate communication during the 2016 fellowship recruitment season. The authors sought to study applicants' interpersonal communication experiences with fellowship programs. Many respondents indicated that they had been asked questions that would constitute violations of the National Residency Matching Program (NRMP) Communications Code of Conduct agreement, including how they plan to rank specific programs. Moreover, female respondents were more likely to have been asked questions during interview experiences about other programs to which they applied, and about their family plans. Post-interview communication policies were not made clear to most applicants. These results suggest ongoing challenges for the internal medicine community to improve communication with applicants and uniform compliance with the NRMP communications code of conduct during the fellowship recruitment process.
Tudiver, F.; Permaul-Woods, J. A.
OBJECTIVE: To discover whether family physicians who go through residency training and The College of Family Physicians of Canada's (CFPC) certification process are more responsive than other physicians to woman abuse, whether they perceive and approach such abuse more appropriately, and whether they seek out more education on the subject. DESIGN: A national survey using a pretested 43-item mailed questionnaire to examine perceptions of and approaches to detection and management of woman abus...
Cornett, PA; Williams, C; Alweis, RL; McConville, J; Frank, M; Dalal, B; Kopelman, RI; Luther, VP; O'connor, AB; Muchmore, EA
ABSTRACT Some internal medicine residency program directors have expressed concerns that their third-year residents may have been subjected to inappropriate communication during the 2016 fellowship recruitment season. The authors sought to study applicants’ interpersonal communication experiences with fellowship programs. Many respondents indicated that they had been asked questions that would constitute violations of the National Residency Matching Program (NRMP) Communications Code of Condu...
Full Text Available The third International Electronic Conference on Medicinal Chemistry, organized and sponsored by MDPI AG, publisher, and the journal Pharmaceuticals, took place in November 2017 on the SciForum website (www.sciforum.net/conference/ecmc-3. Around 300 authors from 34 different countries participated at the event, which hosted more than 70 presentations, keynotes, videos, and posters. A short description of some works presented during that scientific meeting is disclosed in this report.
Gopal, R. K.; Carreira, F.; Baker, W. A.; Glasheen, J. J.; Crane, L. A.; Miyoshi, T. J.; Prochazka, A. V.
Background Increasing complexity of medical care, coupled with limits on resident work hours, has prompted consideration of extending Internal Medicine training. It is unclear whether further hour reductions and extension of training beyond the current duration of 3?years would be accepted by trainees. Objective We aimed to determine if further work-hour reductions and extension of training would be accepted by trainees and whether resident burnout affects their opinions. Design A postal surv...
Weinberger, Steven E; Pereira, Anne G; Iobst, William F; Mechaber, Alex J; Bronze, Michael S
Recent efforts to improve medical education include adopting a new framework based on 6 broad competencies defined by the Accreditation Council for Graduate Medical Education. In this article, the Alliance for Academic Internal Medicine Education Redesign Task Force II examines the advantages and challenges of a competency-based educational framework for medical residents. Efforts to refine specific competencies by developing detailed milestones are described, and examples of training program initiatives using a competency-based approach are presented. Meeting the challenges of a competency-based framework and supporting these educational innovations require a robust faculty development program. Challenges to competency-based education include teaching and evaluating the competencies related to practice-based learning and improvement and systems-based practice, as well as implementing a flexible time frame to achieve competencies. However, the Alliance for Academic Internal Medicine Education Redesign Task Force II does not favor reducing internal medicine training to less than 36 months as part of competency-based education. Rather, the 36-month time frame should allow for remediation to address deficiencies in achieving competencies and for diverse enrichment experiences in such areas as quality of care and practice improvement for residents who have demonstrated skills in all required competencies.
Holmboe, Eric; Beasley, Brent W.
Background There are no nationwide data on the methods residency programs are using to assess trainee competence. The Accreditation Council for Graduate Medical Education (ACGME) has recommended tools that programs can use to evaluate their trainees. It is unknown if programs are adhering to these recommendations. Objective To describe evaluation methods used by our nation’s internal medicine residency programs and assess adherence to ACGME methodological recommendations for evaluation. Design Nationwide survey. Participants All internal medicine programs registered with the Association of Program Directors of Internal Medicine (APDIM). Measurements Descriptive statistics of programs and tools used to evaluate competence; compliance with ACGME recommended evaluative methods. Results The response rate was 70%. Programs were using an average of 4.2–6.0 tools to evaluate their trainees with heavy reliance on rating forms. Direct observation and practice and data-based tools were used much less frequently. Most programs were using at least 1 of the Accreditation Council for Graduate Medical Education (ACGME)’s “most desirable” methods of evaluation for all 6 measures of trainee competence. These programs had higher support staff to resident ratios than programs using less desirable evaluative methods. Conclusions Residency programs are using a large number and variety of tools for evaluating the competence of their trainees. Most are complying with ACGME recommended methods of evaluation especially if the support staff to resident ratio is high. PMID:18612734
Smith, Ann-Loren M; Ruiz, Inés A; Jirón, Marcela A
Patients admitted to internal medicine services receive multiple drugs and thus are at risk of medication errors. To determine the frequency of medication errors (ME) among patients admitted to an internal medicine service of a high complexity hospital. A prospective observational study conducted in 225 patients admitted to an internal medicine service. Each stage of drug utilization system (prescription, transcription, dispensing, preparation and administration) was directly observed by trained pharmacists not related to hospital staff during three months. ME were described and categorized according to the National Coordinating Council for Medication Error Reporting and Prevention. In each stage of medication use, the frequency of ME and their characteristics were determined. A total of 454 drugs were prescribed to the studied patients. In 138 (30,4%) indications, at least one ME occurred, involving 67 (29,8%) patients. Twenty four percent of detected ME occurred during administration, mainly due to wrong time schedules. Anticoagulants were the therapeutic group with the highest occurrence of ME. At least one ME occurred in approximately one third of patients studied, especially during the administration stage. These errors could affect the medication safety and avoid achieving therapeutic goals. Strategies to improve the quality and safe use of medications can be implemented using this information.
W. Frank Peacock
Full Text Available Nonvalvular atrial fibrillation- (NVAF- related stroke and venous thromboembolism (VTE are cardiovascular diseases associated with significant morbidity and economic burden. The historical standard treatment of VTE has been the administration of parenteral heparinoid until oral warfarin therapy attains a therapeutic international normalized ratio. Warfarin has been the most common medication for stroke prevention in NVAF. Warfarin use is complicated by a narrow therapeutic window, unpredictable dose response, numerous food and drug interactions, and requirements for frequent monitoring. To overcome these disadvantages, direct-acting oral anticoagulants (DOACs—dabigatran, rivaroxaban, apixaban, and edoxaban—have been developed for the prevention of stroke or systemic embolic events (SEE in patients with NVAF and for the treatment of VTE. Advantages of DOACs include predictable pharmacokinetics, few drug-drug interactions, and low monitoring requirements. In clinical studies, DOACs are noninferior to warfarin for the prevention of NVAF-related stroke and the treatment and prevention of VTE as well as postoperative knee and hip surgery VTE prophylaxis, with decreased bleeding risks. This review addresses the practical considerations for the emergency physician in DOAC use, including dosing recommendations, laboratory monitoring, anticoagulation reversal, and cost-effectiveness. The challenges of DOACs, such as the lack of specific laboratory measurements and antidotes, are also discussed.
Coyle, Natalie; Strumpf, Erin; Fiset-Laniel, Julie; Tousignant, Pierre; Roy, Yves
New models of delivering primary care are being implemented in various countries. In Quebec, Family Medicine Groups (FMGs) are a team-based approach to enhance access to, and coordination of, care. We examined whether physicians' and patients' characteristics predicted their participation in this new model of primary care. Using provincial administrative data, we created a population cohort of Quebec's vulnerable patients. We collected data before the advent of FMGs on patients' demographic characteristics, chronic illnesses and health service use, and their physicians' demographics, and practice characteristics. Multivariate regression was used to identify key predictors of joining a FMG among both patients and physicians. Patients who eventually enrolled in a FMG were more likely to be female, reside outside of an urban region, have a lower SES status, have diabetes and congestive heart failure, visit the emergency department for ambulatory sensitive conditions and be hospitalized for any cause. They were also less likely to have hypertension, visit an ambulatory clinic and have a usual provider of care. Physicians who joined a FMG were less likely to be located in urban locations, had fewer years in medical practice, saw more patients in hospital, and had patients with lower morbidity. Physicians' practice characteristics and patients' health status and health care service use were important predictors of joining a FMG. To avoid basing policy decisions on tenuous evidence, policymakers and researchers should account for differential selection into team-based primary health care models. Copyright © 2014. Published by Elsevier Ireland Ltd.
Full Text Available Asaee R1, Nasari H2,Hoseini S3 1. Assistant professor, Department of Physiology, Faculty of Medicine, Lorestanl University of Medical Sciences, Khorramabad, Iran 1. Assistant professor, Department of Psychiatry, Faculty of Medicine, Lorestanl University of Medical Sciences, Khorramabad, Iran 2. G.P, Khorramabad, Iran Abstract Background: Delirium is common in elderly persons and in hospitalized patients especially after surgical procedures. But many of them are undetected and don’t receive treatment so they involve with increased mortality and morbidity, adverse outcomes, length of hospital stay and mental disability sequels. Unfortunetly , despite the importance of this syndrom , physicians and staff are able to diagnose only one thirth of the patients. Material and methods: In this cross sectional study, 240 inpatiants (120 from surgery ward and 120 from miernal medicine ward from Shohadaye Ashayer hospital of Khorramabad were selected randomly. The diagnostic criteria for delirium were Mini-Mental state examination (MMSE questionnaire, and patients daily examination for 4 days by MMSE. Results: Delirium was observed in 37 (30.8% of the patients of internal medicine ward and 25 (20.8% of the patients of surgery ward. 27 (22.5% of the patients of internal medicine ward and 37 (30.8% of the patients of surgery ward were suspicious for delirium. In age group of 58-77 years in surgery ward and patients over 77 years in internal medicine ward had the most frequency of delirium. There was significant relationship (p=0.01 between two sex in surgery ward. But there was not significant difference (p=0.92 between two sex in internal medicine ward for delirium. Conclusion: Reading the results of this study and frequency of delirum in surgery and internal medicine wards, presence of a psychiatrist in mentioned wards is necessary of early diagnosis and control of delirium.
Brickman, J P
The late 1930s challenged laissez-faire medicine. Recognition of serious inadequacies in the distribution of medical services stirred activists who questioned fee-for-service delivery and posited a national health program, including health insurance. The AMA and its components--state and county medical societies--counterattacked, mobilizing money and their powerful political arsenal to fight government intrusion in private medicine. The Physicians Forum, initially under the leadership of Ernst P. Boas, emerged as a formidable element within the New York County Medical Society (the largest component of the AMA). The Forum provoked discussion of medical indigence and economics, upsetting the Society leadership with independent candidate slates and telling the public that doctors spoke with more than one voice. For 25 years, the Physicians Forum altered the dynamics of the Medical Society of the County of New York. While the Forum effort to institutionalize minority opinion in the councils of medicine failed, the interchange between County regulars and Forum insurgents broadened the medical reform agenda and moved the County Society in directions that historically it had avoided. Although medical economics formed an unbridgeable chasm between County regulars and rebels, Forum members demonstrated that medicine was not monolithic, that "majority opinion [was not] ... unanimous opinion," and that doctors must speak to issues of medical and social policy.
Asawarattanapakdee, J.; Sritongkul, N.; Chaudakshetrin, P.; Kanchanaphiboon, P.; Tuntawiroon, M.
Every type of work performed in a nuclear medicine department will make a contribution to both external and internal exposure of the worker. The purpose of this study is to evaluate the potential risks of internal contamination to staff members during nuclear medicine practices and to conclude about the requirement of a routine internal monitoring. Following the method describes in the ICRP Publication 78 and the IAEA Safety Standard Series No. RS- G-1.2, in vivo thyroid bioassays using NaI(Tl) thyroid probe were performed to determine the intake estimates on 7 groups of nuclear medicine personnel working with I-131 and Tc-99m, based on working conditions and amount of radionuclides being handled. Frequency of measurements was between 7 and 14 days. These include (1) physicians and physicists, (2) radiochemists (3) technologists, (4) nurses and assistant nurses, (5) imaging room assistants, (6) hot lab workers and (7) hospital ward housekeepers/cleaners. Among all workers, the intake estimates of I-131 in the thyroid ranged from 0 to 76.7 kBq and of the technetium-99m from 0 to 35.4 MBq. The mean committed effective dose equivalent (CEDE) from both I-131 and Tc-99m were 0.63, 1.44 0.53, 0.57, 0.73, 0.98, and 1.36, mSv, for group 1 through group 7 respectively. However, the highest mean CEDE of 1.44 (max. 1.75) and 1.36 (max. 2.11) mSv observed in groups of radiochemists and hospital ward housekeepers were within the permissible level. Our results showed that CEDE for internal exposure in this study were less than investigate level of 5 mSv according to the ICRP Publication 78 and the IAEA Basic Safety Standards. However, the mean CEDE for radiochemists and hospital ward housekeepers were considered in exceed of the limits of recording level (1 mSv).The increasing use of I-131 and Tc-99m in nuclear medicine poses significant risks of internal exposure to the staff. This study suggests that a routine monitoring program for internal exposures should be implemented for
Hawthorne, Mary R; Dinh, An
There is a growing need for primary care physicians, but only a small percentage of graduating medical students enter careers in primary care. To assess whether a Primary Care Intraclerkship within the Medicine clerkship can significantly improve students' attitudes by analyzing scores on pre- and post-tests. Students on the Medicine clerkship at the University of Massachusetts Medical School participated in full-day 'intraclerkships',to demonstrate the importance of primary care and the management of chronic illness in various primary care settings. Pre-and post-tests containing students' self-reported, five-point Likert agreement scale evaluations to 26 items (measuring perceptions about the roles of primary care physicians in patient care and treatment) were collected before and after each session. Eleven intraclerkships with 383 students were held between June 2010 and June 2013. Responses were analyzed using the GLM Model Estimate. Results from the survey analysis showed significantly more positive attitudes toward primary care in the post-tests compared to the pre-tests. Students who were satisfied with their primary care physicians were significantly more likely to show an improvement in post-test attitudes toward primary care in the areas of physicians improving the quality of patient care, making a difference in overall patient health, finding primary care as an intellectually challenging field, and in needing to collaborate with specialists. Older students were more likely than younger students to show more favorable answers on questions concerning the relative value of primary care vs. specialty care. A curriculum in Primary Care Internal Medicine can provide a framework to positively influence students' attitudes toward the importance of primary care, and potentially to influence career decisions to enter careers in Primary Care Internal Medicine. Ensuring that medical students receive excellent primary care for themselves can also positively influence
Background Little is known about whether and how medical knowledge relates to interest in subspecialty fellowship training. The purpose of this study was to examine the relationships between residents' interest in subspecialty fellowship training and their knowledge of internal medicine (IM). Methods A questionnaire was emailed to 48 categorical postgraduate-year (PGY) two and three residents at a New York university-affiliated IM residency program in 2007 using the Survey Monkey online survey instrument. Overall and content area-specific percentile scores from the IM in-training examination (IM-ITE) for the same year was used to determine objective knowledge. Results Forty-five of 48 residents (response rate was 93.8%) completed the survey. Twenty-two (49%) were PG2 residents and 23(51%) were PGY3 residents. Sixty percent of respondents were male. Six (13%) residents were graduates of U.S. medical schools. Eight (18%) reported formal clinical training prior to starting internal medicine residency in the U.S. Of this latter group, 6 (75%) had training in IM and 6 (75) % reported a training length of 3 years or less. Thirty-seven of 45 (82%) residents had a subspecialty fellowship interest. Residents with a fellowship interest had a greater mean overall objective knowledge percentile score (56.44 vs. 31.67; p = 0.04) as well as greater mean percentile scores in all content areas of IM. The adjusted mean difference was statistically significant (p internal medicine residents. PMID:21281500
Evans, Randolph W; Ghosh, Kamalika
Two prior studies have shown an increased prevalence of migraine among physicians who are headache medicine specialists (HMS). There have been no studies of the prevalence of other headache disorders among HMS. A prior survey showed that neurologists like to treat some headaches more than others but there has not been a similar survey of HMS. The aim of the survey was to learn more about the prevalence of headaches among HMS and which headache disorders they like to treat. An email survey was sent to 749 physician members of the American Headache Society who were asked to respond to the following statement using a 5-point Likert scale (from 1, strongly disagree to 5, strongly agree): "I like to treat patients with the following types of headaches or syndromes." They were asked, "Have you personally suffered from any of the following at any time during your life: episodic migraine (EM), chronic migraine (CM), refractory migraine (RM), episodic cluster (EC), chronic cluster (CC), new daily persistent headache (NDPH), and postconcussion syndrome (PCS)." The response rate was 15.8% (n = 118) with a mean age of 51.4 years, 64.4% males, and 85.6% neurologists. HMS reported likeability for treating disorders in rank order as follows: EM (mean = 4.69, SD = 0.61); CM (mean = 4.20, SD = 0.94); RM (mean = 3.62, SD = 1.17); EC (mean = 4.37, SD = 0.80); CC (mean = 3.68, SD = 1.10); NDPH (mean = 3.52, SD = 1.21); and PCS (mean = 3.66, SD = 1.18). The lifetime prevalence of disorders was as follows: EM, 69.5% (85.7% in females and 60.5% in males); CM, 13.6% (19% in females and 10.5% in males); RM, .9% (2.4% females and 0% males); EC, 1.7% (0% females and 2.6% males); CC, 0%; NDPH, 0%, and PCS, 4.2% (7.1% females and 2.6% males). HMS with a personal history of EM (mean = 4.73, SD = 0.51) showed a significant preference (t130 = 7.30, P headaches (mean = 3.90, SD = 0.77). HMS preferred to treat some
Perez, Jose A., Jr.; Greer, Sharon
The Internal Medicine In-Training Examination (ITE) is administered during residency training in the United States as a self-assessment and program assessment tool. Performance on this exam correlates with outcome on the American Board of Internal Medicine Certifying examination. Internal Medicine Program Directors use the United States Medical…
Eliason, B C; Schubot, D B
Personal social values have been identified as important determinants of generalists' specialty choice. However, the personal values or "guiding principles" of generalist physicians have not been identified scientifically. To establish a benchmark, we measured the personal values of exemplary family physicians because they serve as role models for current and future physicians. We also explored the relationship between personal values and practice satisfaction. We obtained a list of 330 family physicians nominated for the American Academy of Family Physicians' (AAFP) Family Doctor of the Year award for the years 1988 through 1993. We asked them to complete the Schwartz Values Questionnaire, a 56-item instrument for measuring personal values. They also answered three questions concerning practice satisfaction. The return rate was 83%. The physicians' mean age was 63 years. They had been in practice an average of 34 years, 93% were male, and 52% practiced in rural areas. Honesty was rated as the most important of the 56 values, and social power as the least important. Of the 10 value types (groups of common values), the responding physicians rated "Benevolence" as most important and "Power" as least important. Practice satisfaction correlated positively with the Benevolence value type (r = .21, P = .001) and negatively with the Power value type (r = -.15, P = .023). Of the 10 value types, Benevolence was rated the most important and Power the least important by exemplary family physicians, and both value types also correlated, positively and negatively, respectively, with their practice satisfaction. These results have implications for the selection, training, and career satisfaction of generalist physicians.
Sara W. Nelson
Full Text Available Introduction Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM interns as a way to teach empathy and conscientious patient care. Methods We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED by ambulance and half were family members. Interns then took part in focus groups that discussed the experience. Data collected during these focus groups were coded by two investigators using a grounded theory approach and constant comparative methodology. Results We identified 10 major themes and 28 subthemes in the resulting qualitative data. Themes were in three broad categories: the experience as a patient or family member in the ED; application to current clinical practice; and evaluation of the exercise itself. Interns experienced firsthand the physical discomfort, emotional stress and confusion patients and families endure during the ED care process. They reflected on lessons learned, including the importance of good communication skills, frequent updates on care and timing, and being responsive to the needs and concerns of patients and families. All interns felt this was a valuable orientation experience. Conclusion Conducting a patient experience simulation may be a practical and effective way to develop empathy in EM resident physicians. Additional research evaluating the effect of participation in the simulation over a longer time period and assessing the effects on residents’ actual clinical care is warranted.
Skedros John G; Hunt Kenneth J; Pitts Todd C
Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs) and physical medicine and rehabilitation (PMRs) physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anest...
Conclusion: These findings indicate that the diagnostic accuracy of emergency medicine specialists is significantly higher than those of general physicians. The diagnostic accuracy of both physician groups was higher than the values in similar studies that signifies the role of relevant training given in the emergency departments of the Hospital.
Rochoy, M; Gautier, S; Bordet, R; Caron, J; Launay, D; Hachulla, E; Hatron, P-Y; Lambert, M
Patients hospitalized in internal medicine often have unexplained clinical symptoms for which a drug origin can be considered. The prevalence of patients hospitalized for iatrogenic is estimated between 4-22%. We wanted to evaluate the diagnostic value of the regional center of pharmacovigilance to identify or confirm an iatrogenic disease in the department of internal medicine of Lille and characterize factors associated with drug-related side effect. This is a single-center prospective diagnostic study. We included all subsequent requests from the department of internal medicine with the Nord-Pas-de-Calais regional pharmacovigilance center between 2010 and 2012. The opinion of the regional pharmacovigilance centre was held on the record of the adverse drug reaction in the national pharmacovigilance database and analyzed according to the conclusion of iatrogenic used by clinicians in internal medicine (reference diagnosis) with a follow-up to June 2013. The variables relating to the patient, medication and adverse events were analyzed by binary logistic regression. We analyzed 160 contacts: 118 concordant cases, 38 false-positives (drug-related side effect retained by the regional pharmacovigilance center only), 4 false negatives. Registration in the national pharmacovigilance database had a sensitivity of 96% (95% CI [0.92 to 0.99]), a specificity of 46% (95% CI [0.38 to 0.53]), a value positive predictive of 69% (95% CI [0.62 to 0.76]), a negative predictive value of 89% (95% CI [0.84 to 0.94]) and a negative likelihood ratio of 0.1. False-positive had chronological and semiological accountabilities questionable (adjusted RR=2.1, 95% CI [1.2 to 2.8]). In our study, the regional pharmacovigilance center confirms the clinician's suspicion of drug-related side effects and helps to exclude drug-induced with a high negative predictive value. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.
Horn, Leora; Tzanetos, Katina; Thorpe, Kevin; Straus, Sharon E
Currently, there are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. To address the concern about physician imbalances in internal medicine subspecialties, we need to examine the factors that motivate residents when making career decisions. In this two-phase study, Canadian internal medicine residents participating in the post graduate year 4 (PGY4) subspecialty match were invited to participate in a web-based survey and focus group discussions. The focus group discussions were based on issues identified from the survey results. Analysis of focus group transcripts grew on grounded theory. 110 PGY3 residents participating in the PGY4 subspecialty match from 10 participating Canadian universities participated in the web-based survey (54% response rate). 22 residents from 3 different training programs participated in 4 focus groups held across Canada. Our study found that residents are choosing careers that provide intellectual stimulation, are consistent with their personality, and that provide a challenge in diagnosis. From our focus group discussions it appears that lifestyle, role models, mentorship and the experience of the resident with the specialty appear to be equally important in career decisions. Males are more likely to choose procedure based specialties and are more concerned with the reputation of the specialty as well as the anticipated salary. In contrast, residents choosing non-procedure based specialties are more concerned with issues related to lifestyle, including work-related stress, work hours and time for leisure as well as the patient populations they are treating. This study suggests that internal
Full Text Available Abstract Background Currently, there are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. To address the concern about physician imbalances in internal medicine subspecialties, we need to examine the factors that motivate residents when making career decisions. Methods In this two-phase study, Canadian internal medicine residents participating in the post graduate year 4 (PGY4 subspecialty match were invited to participate in a web-based survey and focus group discussions. The focus group discussions were based on issues identified from the survey results. Analysis of focus group transcripts grew on grounded theory. Results 110 PGY3 residents participating in the PGY4 subspecialty match from 10 participating Canadian universities participated in the web-based survey (54% response rate. 22 residents from 3 different training programs participated in 4 focus groups held across Canada. Our study found that residents are choosing careers that provide intellectual stimulation, are consistent with their personality, and that provide a challenge in diagnosis. From our focus group discussions it appears that lifestyle, role models, mentorship and the experience of the resident with the specialty appear to be equally important in career decisions. Males are more likely to choose procedure based specialties and are more concerned with the reputation of the specialty as well as the anticipated salary. In contrast, residents choosing non-procedure based specialties are more concerned with issues related to lifestyle, including work-related stress, work hours and time for leisure as well as the patient populations
Favrat, B; Pécoud, A; Jaussi, A
Background The general proficiency in physical diagnostic skills seems to be declining in relation to the development of new technologies. The few studies that have examined this question have invariably used recordings of cardiac events obtained from patients. However, this type of evaluation may not correlate particularly well with bedside skills. Our objectives were 1) To compare the cardiac auscultatory skills of physicians in training with those of experienced cardiologists by using real patients to test bedside diagnostic skills. 2) To evaluate the impact of a five-month bedside cardiac auscultation training program. Methods 1) In an academic primary care center, 20 physicians (trainees in internal medicine and family practice) and two skilled academic cardiologists listened to 33 cardiac events in 13 patients directly at bedside and identified the cardiac events by completing an open questionnaire. Heart sounds, murmurs and diagnosis were determined beforehand by an independent skilled cardiologist and were validated by echocardiography. Thirteen primary cardiologic diagnoses were possible. 2) Ten of the physicians agreed to participate in a course of 45-minute sessions once a week for 5 months. After the course they listened again to the same patients (pre/post-interventional study). Results 1) The experts were the most skillful, achieving 69% recognition of heart sounds and murmurs and correct diagnoses in 62% of cases. They also heard all of the diastolic murmurs. The residents heard only 40% of the extra heart sounds and made a correct diagnosis in 24% of cases. 2) After the weekly training sessions, their mean percentage for correct diagnosis was 35% [an increase of 66% (p < 0.05)]. Conclusions The level of bedside diagnostic skills in this relatively small group of physicians in training is indeed low, but can be improved by a course focusing on realistic bedside teaching. PMID:15056393
Baskerville, Jerry Ray; Herrick, John
This study focuses on clinically assigned prospective estimated pretest probability and pretest perception of legal risk as independent variables in the ordering of multidetector computed tomographic (MDCT) head scans. Our primary aim is to measure the association between pretest probability of a significant finding and pretest perception of legal risk. Secondarily, we measure the percentage of MDCT scans that physicians would not order if there was no legal risk. This study is a prospective, cross-sectional, descriptive analysis of patients 18 years and older for whom emergency medicine physicians ordered a head MDCT. We collected a sample of 138 patients subjected to head MDCT scans. The prevalence of a significant finding in our population was 6%, yet the pretest probability expectation of a significant finding was 33%. The legal risk presumed was even more dramatic at 54%. These data support the hypothesis that physicians presume the legal risk to be significantly higher than the risk of a significant finding. A total of 21% or 15% patients (95% confidence interval, ±5.9%) would not have been subjected to MDCT if there was no legal risk. Physicians overestimated the probability that the computed tomographic scan would yield a significant result and indicated an even greater perceived medicolegal risk if the scan was not obtained. Physician test-ordering behavior is complex, and our study queries pertinent aspects of MDCT testing. The magnification of legal risk vs the pretest probability of a significant finding is demonstrated. Physicians significantly overestimated pretest probability of a significant finding on head MDCT scans and presumed legal risk. Copyright © 2012 Elsevier Inc. All rights reserved.
Zandbelt, Linda C.; Smets, Ellen M. A.; Oort, Frans J.; Godfried, Mieke H.; de Haes, Hanneke C. J. M.
OBJECTIVE: To compare patients' and physicians' visit-specific satisfaction in an internal medicine outpatient setting, and to explain their respective views. DESIGN: Patients' and physicians' background characteristics were assessed prior to outpatient encounters. Immediately after the encounter,
Edwardson, Nicholas; Bolin, Jane N; McClellan, David A; Nash, Philip P; Helduser, Janet W
Demand for a wide array of colorectal cancer screening strategies continues to outpace supply. One strategy to reduce this deficit is to dramatically increase the number of primary care physicians who are trained and supportive of performing office-based colonoscopies or flexible sigmoidoscopies. This study evaluates the clinical and economic implications of training primary care physicians via family medicine residency programs to offer colorectal cancer screening services as an in-office procedure. Using previously established clinical and economic assumptions from existing literature and budget data from a local grant (2013), incremental cost-effectiveness ratios are calculated that incorporate the costs of a proposed national training program and subsequent improvements in patient compliance. Sensitivity analyses are also conducted. Baseline assumptions suggest that the intervention would produce 2394 newly trained residents who could perform 71,820 additional colonoscopies or 119,700 additional flexible sigmoidoscopies after ten years. Despite high costs associated with the national training program, incremental cost-effectiveness ratios remain well below standard willingness-to-pay thresholds under base case assumptions. Interestingly, the status quo hierarchy of preferred screening strategies is disrupted by the proposed intervention. A national overhaul of family medicine residency programs offering training for colorectal cancer screening yields satisfactory incremental cost-effectiveness ratios. However, the model places high expectations on primary care physicians to improve current compliance levels in the US. Copyright © 2016 Elsevier Inc. All rights reserved.
Zeger, Scott L.; Kolars, Joseph C.
BACKGROUND Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge acquisition. OBJECTIVE To examine associations of learning habits on medical knowledge acquisition. DESIGN, PARTICIPANTS Cohort study of all 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times over 4 years while enrolled in the Internal Medicine Residency, Mayo Clinic, Rochester, MN. MEASUREMENTS Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects model. RESULTS When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score increase of 5.1% per year (95%CI 4.1%, 6.2%; p international medical school graduation, −3.4% (95%CI −6.5%, −0.36%; p = .03). CONCLUSIONS Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training. PMID:17468889
Steel, Amie; Cramer, Holger; Leung, Brenda; Lauche, Romy; Adams, Jon; Langhorst, Jost; Dobos, Gustav
Homeopathy use continues to grow in many European countries, and some studies have examined the characteristics of patients using homeopathy within the general population. The aim of this study was to identify predictors for homeopathy use among internal medicine patients. A cross-sectional analysis was conducted among all patients being referred to the Department of Internal and Integrative Medicine at Essen, Germany, over a 3-year period. The analysis examined whether patients had used homeopathy for their primary medical complaint before, the perceived benefit, and the perceived harm of homeopathy use. Odds ratios with 95% confidence intervals were calculated using multiple logistic regression analysis. Of 2,045 respondents, 715 (35.0%) reported having used homeopathy for their primary medical complaint (diagnosis according to the International Statistical Classification of Diseases and Related Health Problems), with 359 (50.2%) reporting perceived benefits and 15 (2.1%) reporting harm. Homeopathy use was positively associated with female gender, high school level education, suffering from fibromyalgia or subthreshold depression, and being fast food abstinent, while patients with osteoarthritis, spinal or other pain, smokers, and patients with a high external-social health locus of control were less likely to use homeopathy. Personal characteristics and health status may impact on the use and the perceived helpfulness of homeopathy. © 2016 S. Karger GmbH, Freiburg.
Engelmann, L; Schneider, D
Issuing from the accomplishments of Köhler for the development of the intensive medicine in internal medicine-in 1964 he performed the first long-term respiration at the then Medical Clinic of the Karl Marx University, in 1969 he institutionalized the young subdiscipline at the clinic, in 1978 he founded the department for intensive medicine and is at work by his decisions concerning the development of young scientists, by the handbook "Intensive Medicine. Internal Medicine and Adjacent Subjects" as well as a member of the presidium of the GDR Society for Internal Medicine for the development of the internal intensive medicine-a description of the development of the department, its achievements and problems is given. The promotion of the intensive medicine by Köhler results, as we think, also from the comprehension that it has the duty to perform a function integrating the subdisciplines, which the modern internal medicine oriented to organs and systems threatens to lose, which, however, makes its self-apprehension, which the patient wishes and the teaching is demanding. From this and from the charge for a highly specialized care of patients who life-threateningly fell ill with internal diseases as well as from the duty to create a scientific forerunning results the stringent necessity of the development of the non-operative, in reality internal intensive medicine in the clinics for internal medicine of the county hospitals and university institutions as well as the greater identification of the internist with the subdiscipline in the district hospitals dealing with multidisciplinary intensive medicine.
Ken N. Kuo
Conclusion: The physician-scientist has a unique ability to bridge the gap between bench/laboratory and bedside. In a changing socioeconomic climate as well as cultural evolution in medical practice, external pressures are unavoidable. The support of research from institutions or government is very important, as are financial resources, space and equipment. For those physicians who are going into research, a special training of strict methodology in research will obviously become necessary.
Testa, Americo; Francesconi, Andrea; Giannuzzi, Rosangela; Berardi, Silvia; Sbraccia, Paolo
The economic crisis, the growing healthcare demand, and Defensive Medicine wastefulness, strongly recommend the restructuring of the entire medical network. New health technology, such as bedside ultrasonography, might successfully integrate the clinical approach optimizing the use of limited resources, especially in a person-oriented vision of medicine. Bedside ultrasonography is a safe and reliable technique, with worldwide expanding employment in various clinical settings, being considered as "the stethoscope of the 21st century". However, at present, bedside ultrasonography lacks economic analysis. We performed a Cost-Benefit Analysis "ex ante", with a break-even point computing, of bedside ultrasonography implementation in an Internal Medicine department in the mid-term. Number and kind estimation of bedside ultrasonographic studies were obtained by a retrospective study, whose data results were applied to the next 3-year period (foresight study). All 1980 foreseen bedside examinations, with prevailing multiorgan ultrasonographic studies, were considered to calculate direct and indirect costs, while specific and generic revenues were considered only after the first semester. Physician professional training, equipment purchase and working time represented the main fixed and variable cost items. DRG increase/appropriateness, hospitalization stay shortening and reduction of traditional ultrasonography examination requests mainly impacted on calculated revenues. The break-even point, i.e. the volume of activity at which revenues exactly equal total incurred costs, was calculated to be 734 US examinations, corresponding to € 81,998 and the time considered necessary to reach it resulting 406 days. Our economic analysis clearly shows that bedside ultrasonography implementation in clinical daily management of an Internal Medicine department can produce consistent savings, or economic profit according to managerial choices (i.e., considering public or private targets
Loignon, Christine; Gottin, Thomas; Valois, Carol; Couturier, François; Williams, Robert; Roy, Pierre-Michel
To explore the perceived effect of an elective international health rotation on family medicine resident learning. Qualitative, collaborative study based on semistructured interviews. Quebec. A sample of 12 family medicine residents and 9 rotation supervisors (N = 21). Semistructured interviews of residents and rotation supervisors. Residents and supervisors alike reported that their technical skills and relationship skills had benefited. All increased their knowledge of tropical pathologies and learned to expand their clinical examinations. They benefited from having very rich interactions in other care settings, working with vulnerable populations. The rotations had their greatest effect on relationship skills (communication, empathy, etc) and the ability to work with vulnerable patients. All of the participants were exposed to local therapies and local interpretations of disease symptoms and pathogenesis. The findings of this study will have a considerable effect on pedagogy. The residents' experiences of their international health rotations and what they learned in terms of medical skills and pedagogic approaches in working with patients are described. Using a collaborative approach with the rotation supervisors, the data were triangulated and the benefits of an international rotation on academic training were more accurately defined. The findings can now be used to enrich academic programs in social and preventive medicine and more adequately prepare future family physicians for work in various social and cultural settings. Copyright© the College of Family Physicians of Canada.
Fazio, Sara B; Torre, Dario M; DeFer, Thomas M
Clerkship evaluation and grading practices vary widely between U.S. medical schools. Grade inflation continues to exist, and grade distribution is likely to be different among U.S. medical schools. Increasing the number of available grades curtails "grade inflation." A national survey of all Clerkship Directors in Internal Medicine members was administered in 2011. The authors assessed key aspects of grading. Response rate was 76%. Among clerkship directors (CDs), 61% of respondents agreed that grade inflation existed in the internal medicine clerkship at their school, and 43% believed that it helped students obtain better residency positions. With respect to grading practices, 79% of CDs define specific behaviors needed to achieve each grade, and 36% specify an ideal grade distribution. In addition, 44% have a trained core faculty responsible for evaluating students, 35% describe formal grading meetings, and 39% use the Reporter-Interpreter-Manager-Educator (RIME) scheme. Grading scales were described as follows: 4% utilize a pass/fail system, 13% a 3-tier (e.g., Honors/Pass/Fail), 45% 4-tier, 35% 5-tier, and 4% 6+-tier system. There was a trend to higher grades with more tiers available. Grade inflation continues in the internal medicine clerkship. Almost half of CDs feel that this practice assists students to obtain better residency positions. A minority of programs have a trained core faculty who are responsible for evaluation. About one third have formal grading meetings and use the RIME system; both have been associated with more robust and balanced grading practices. In particular, there is a wide variation between schools in the percentage of students who are awarded the highest grade, which has implications for residency applications. Downstream users of clinical clerkship grades must be fully aware of these variations in grading in order to appropriately judge medical student performance.
Buscemi, Dolores; Kumar, Ashwani; Nugent, Rebecca; Nugent, Kenneth
Study Objectives: Epidemiological studies have demonstrated an association between short sleep times and obesity as defined by body mass index (BMI). We wanted to determine whether this association occurs in patients with chronic medical diagnoses since the number of confounding factors is likely higher in patients than the general population. Methods: Two hundred patients attending internal medicine clinics completed a survey regarding sleep habits, lifestyle characteristics, and medical diagnoses. An independent surveyor collected the information on the questionnaires and reviewed the medical records. Height and weight were measured by clinic personnel. Data were analyzed with multivariate logistic regression. Results: Subjects with short sleep times (< 7 hours) had an increased likelihood of obesity as defined by a BMI ≥ 30 kg/m2 when compared to the reference group of (8, 9] hours (odds ratio 2.93; 95% confidence interval, 1.06–8.09). There was a U-shaped relationship between obesity and sleep time in women but not in men. Young age (18 to 49 years), not smoking, drinking alcohol, hypertension, diabetes, and sleep apnea were also associated with obesity in the overall model. Conclusions: This study demonstrates an association between short sleep times and obesity in undifferentiated patients attending an internal medicine clinic using models adjusting for age, lifestyle characteristics, and some medical diagnoses. The U-shaped relationship in women suggests that sleep patterns may have gender specific associations. These observations provide the background for therapeutic trials in weight loss in patients with established medical problems. Citation: Buscemi D; Kumar A; Nugent R; Nugent K. Short sleep times predict obesity in internal medicine clinic patients. J Clin Sleep Med 2007;3(7):681–688. PMID:18198800
The proceedings of the German Society of Internal Medicine from its 94th congress held at Wiesbaden (April 10-14, 1988) provide coverage of the following issues: Gastrointestinal tumours - diagnosis and therapy at an early stage; diagnostic methods used in the pancreas; endoscopy during surgery; medical imaging in gastroenterology; therapy of chronic inflammatory changes of the intestine; proctology on an out-patient basis and geriatric patients showing cerebrovasucular insufficiency. Three papers have been separately for the database. (GDG) With 290 figs., 248 tabs [de
Régny, P; Cathébras, P
To describe the clinical characteristics of a series of patients presenting conversion disorder in a general internal medicine ward and outpatient clinic, the arguments retained by the physicians in favour of the diagnosis, the somatic and psychiatric co-morbidities, the management and the outcome of the disorder. We report the study of 37 patients diagnosed with conversion disorder in an internal medicine department of a French university hospital over a period of 14 years. We retrospectively reviewed the charts of the patients and contacted their primary care physicians to obtain follow-up data. No structured instrument was used for the diagnosis of conversion disorder or for the assessment of psychiatric comorbidities. As expected, patients were mostly young females, although a great variety of age, gender, and socio-cultural background was observed. Motor symptoms predominated (62%). A relevant psychogenic factor was explicitly mentioned in only 43% of the cases. In many cases, organic disease was also present, and an organic cause for the symptom initially considered as conversion was suspected in 3 cases. Depressive and anxious disorders were present respectively in 38% and 35% of cases. A pain complaint was associated in half of the cases. Among patients for whom follow-up data is available, conversion symptoms persisted or recurred in 70% of cases and were associated with a poor quality of life. This case series confirms that the DSM-IV-TR criterion of "psychogenicity" (later abandoned in DSM-5) is highly problematic in clinical practice. It suggests a close relationship between conversion disorder and unexplained chronic pain. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.
Levine, Rachel B; Lin, Fenny; Kern, David E; Wright, Scott M; Carrese, Joseph
The number of women in academic medicine has steadily increased, although gender parity still does not exist and women leave academics at somewhat higher rates than men. The authors investigated the reasons why women leave careers in academic medicine. Semistructured, one-on-one interviews were conducted in 2007-2008 with 20 women physicians who had left a single academic institution to explore their reasons for opting out of academic careers. Data analysis was iterative, and an editing analysis style was used to derive themes. A lack of role models for combining career and family responsibilities, frustrations with research (funding difficulties, poor mentorship, competition), work-life balance, and the institutional environment (described as noncollaborative and biased in favor of male faculty) emerged as key factors associated with a decision to leave academic medicine for respondents. Faced with these challenges, respondents reevaluated their priorities and concluded that a discrepancy existed between their own and institutional priorities. Many respondents expressed divergent views with the institutional norms on how to measure success and, as a consequence, felt that they were undervalued at work. Participants report a disconnection between their own priorities and those of the dominant culture in academic medicine. Efforts to retain women faculty in academic medicine may include exploring the aspects of an academic career that they value most and providing support and recognition accordingly.
Pizzo, Giuseppe; Guiglia, Rosario; Lo Russo, Lucio; Campisi, Giuseppina
During past decades the relationship between dentistry and internal medicine and especially the concept of the so-called focal infection theory have long been a matter of debate. The pathogenesis of focal diseases has been classically attributed to dental pulp pathologies and periapical infections. Nonetheless, in recent years, their role is being dismissed while increasing interest is being devoted to the possible associations between periodontal infection and systemic diseases. In fact, periodontal pathogens and their products, as well as inflammatory mediators produced in periodontal tissues, might enter the bloodstream, causing systemic effects and/or contributing to systemic diseases. On the basis of this mechanism, chronic periodontitis has been suggested as a risk factor for cardiovascular diseases associated with atherosclerosis, bacterial endocarditis, diabetes mellitus, respiratory disease, preterm delivery, rheumatoid arthritis, and, recently, osteoporosis, pancreatic cancer, metabolic syndrome, renal diseases and neurodegenerative diseases such as Alzheimer's disease. Various hypotheses, including common susceptibility, systemic inflammation, direct bacterial infection and cross-reactivity, or molecular mimicry, between bacterial antigens and self-antigens, have been postulated to explain these relationships. In this scenario, the association of periodontal disease with systemic diseases has set the stage for introducing the concept of periodontal medicine. This narrative review summarizes the evolution of focal infection theory up to the current pathophysiology of periodontal disease, and presents an update on the relationships between chronic periodontitis and systemic diseases. Copyright © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Haring, Catharina M; van der Meer, Jos W M; Postma, Cornelis T
Performance of a focused physical examination will induce a high cognitive load for medical students in the early phase of the clinical clerkships. To come to a workable and clinically applicable standard physical examination for medical students to be used in every new patient in the daily clinical practice of internal medicine. A questionnaire held among physicians that supervise students during the clerkship of internal medicine in one Dutch training region. Of the complete list of physical examination 55 items were considered to be an integral part of the standard general physical examination for medical students. Most emphasized were elements of the physical examination aimed at general parameters, thorax and abdomen, vascular status, lymph nodes, spinal column, skin and some parts of the neurological examination. The standard physical examinations performed by supervisors themselves contain fewer items than they expected from the students. The expectations a supervisor has towards the student correlates with the frequency with which they apply the various components in their own physical examination. This study provides us with a 'core' physical examination for medical students that can be applied in the early phase of the clinical clerkships.
Narang, Akhil; Arora, Vineet M
Background Residency programs face many challenges in educating learners. The millennial generation’s learning preferences also force us to reconsider how to reach physicians in training. Social media is emerging as a viable tool for advancing curricula in graduate medical education. Objective The authors sought to understand how social media enhances a residency program’s educational mission. Methods While chief residents in the 2013-2014 academic year, two of the authors (PB, AN) maintained a Twitter feed for their academic internal medicine residency program. Participants included the chief residents and categorical internal medicine house staff. Results At the year’s end, the authors surveyed residents about uses and attitudes toward this initiative. Residents generally found the chief residents’ tweets informative, and most residents (42/61, 69%) agreed that Twitter enhanced their overall education in residency. Conclusions Data from this single-site intervention corroborate that Twitter can strengthen a residency program’s educational mission. The program’s robust following on Twitter outside of the home program also suggests a need for wider adoption of social media in graduate medical education. Improved use of data analytics and dissemination of these practices to other programs would lend additional insight into social media’s role in improving residents’ educational experiences. PMID:27731845
Ramaswamy, Ravishankar; Williams, Alicia; Clark, Elizabeth M; Kelley, Amy S
Effective communication is an important aspect of caring for the elderly, who are more likely to have multimorbidity, limited health literacy, and psychosocial barriers to care. About half of Internal Medicine (IM) trainees in the United States are foreign medical graduates, and may not have been exposed to prior communication skills education. This novel communication skills curriculum for IM interns aimed to increase trainees' confidence and use of specific communication tools with older adults, particularly in delivering bad news and conducting family meetings. The workshop consisted of two interactive sessions in a small group with two learners and one or two facilitators, during the 4-week geriatrics block in IM internship training year. Twenty-three IM interns at an urban Veterans Affairs Medical Center were surveyed at the beginning and at the end of the 4-week block and 3 months after completion of the workshop about their knowledge, confidence, and skill in communication and asked about challenges to effective communication with older adults. The primary outcome measure was change in self-reported confidence and behavior in communication at 4 weeks. On a 4-point Likert scale, there was average improvement of 0.70 in self-reported confidence in communication, which was sustained 3 months after completion of the workshop. Participants reported several patient, physician, and system barriers to effective communication. Communication skills education in a small-group setting and the opportunity for repeated practice and self-reflection resulted in a sustained increase in overall confidence in IM interns in communication with older adults and may help overcome certain patient- and physician-specific communication barriers. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Ramaswamy, Ravishankar; Williams, Alicia; Clark, Elizabeth M.; Kelley, Amy S.
Background Effective communication is an important aspect of caring for the elderly, who are more likely to have multimorbidity, limited health literacy and psychosocial barriers to care. About half of Internal Medicine (IM) trainees in the United States are foreign medical graduates, and may not have been exposed to prior communication skills education. This novel communication skills curriculum for IM interns aimed to increase trainees' confidence and use of specific communication tools with older adults, particularly in delivering bad news and conducting family meetings. Methods The workshop consisted of 2 interactive sessions, in a small group with 2 learners and 1-2 facilitators, during the Geriatrics block of the internship year. Twenty-three IM interns were surveyed at the beginning and at the end of the 4-week block and at 3 months after completion of the workshop about their knowledge, confidence and skill in communication, and asked about any challenges to effective communication with older patients. The primary outcome measure was change in self-reported confidence and behavior in communication at 4 weeks. Results On a 4-point Likert scale, there was an average improvement of 0.70 in self-reported confidence in communication, which sustained at 3 months after completion of the workshop. Participants reported several patient, physician and system barriers to effective communication. Conclusion Communication skills education in a small-group setting and the opportunity for repeated practice and self-reflection resulted in sustained increase in overall confidence among IM interns in communication with older adults, and may help overcome certain patient and physician-specific communication barriers. PMID:25354834
Narayanan, Roshni; Nugent, Rebecca; Nugent, Kenneth
Accreditation Council for Graduate Medical Education guidelines require internal medicine residents to develop skills in the interpretation of medical literature and to understand the principles of research. A necessary component is the ability to understand the statistical methods used and their results, material that is not an in-depth focus of most medical school curricula and residency programs. Given the breadth and depth of the current medical literature and an increasing emphasis on complex, sophisticated statistical analyses, the statistical foundation and education necessary for residents are uncertain. We reviewed the statistical methods and terms used in 49 articles discussed at the journal club in the Department of Internal Medicine residency program at Texas Tech University between January 1, 2013 and June 30, 2013. We collected information on the study type and on the statistical methods used for summarizing and comparing samples, determining the relations between independent variables and dependent variables, and estimating models. We then identified the typical statistics education level at which each term or method is learned. A total of 14 articles came from the Journal of the American Medical Association Internal Medicine, 11 from the New England Journal of Medicine, 6 from the Annals of Internal Medicine, 5 from the Journal of the American Medical Association, and 13 from other journals. Twenty reported randomized controlled trials. Summary statistics included mean values (39 articles), category counts (38), and medians (28). Group comparisons were based on t tests (14 articles), χ2 tests (21), and nonparametric ranking tests (10). The relations between dependent and independent variables were analyzed with simple regression (6 articles), multivariate regression (11), and logistic regression (8). Nine studies reported odds ratios with 95% confidence intervals, and seven analyzed test performance using sensitivity and specificity calculations
Full Text Available International health work during the 1930s was influenced by several inter-acting developments which caused general attention to turn away from pathogens and individual diseases to social conditions and their impact on the status of public health. Internationally, the League of Nations Health Organisation became the centre of initiatives in social medicine. After 1932, the search for the health implications of the depression invigorated ongoing social studies. Thus, nutrition, housing and rural hygiene became major issues, followed by discussions on sports. All these topics had important political connotations because they touched sensitive questions of welfare, status and the distribution of wealth and poverty within societies. In the process, they opened discussions on abstract issues like social and moral justice and on tangible questions of political systems.
Full Text Available Holistic medicine seems to be efficient in the treatment of chronic pain in internal organs, especially when the pain has no known cause. It is quite surprising that while chronic pain can be one of the toughest challenges in the biomedical clinic, it is often one of the simplest things to alleviate in the holistic clinic. These pains are regarded as being caused by repressed emotions and are explained as psychosomatic reactions. Using holistic medicine, the patients can often be cured of their suffering when they assume responsibility for the repressed feelings. The holistic process theory of healing states that the return to the natural (pain free state of being is possible whenever the person obtains the resources needed for existential healing. This shift is explained by the related quality of life and life mission theories. The resources needed are “holding” or genuine care in the dimensions of awareness, respect, care, acknowledgment, and acceptance with support and processing in the dimensions of feeling, understanding, and letting go of negative attitudes and beliefs. The preconditions for the holistic healing to take place are “love” and trust. Obtaining the full trust of the patient, therefore, seems to be the biggest challenge of holistic medicine, especially when dealing with a patient in pain.
Wiler, Jennifer L; Granovsky, Michael; Cantrill, Stephen V; Newell, Richard; Venkatesh, Arjun K; Schuur, Jeremiah D
In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician's to focus on quality of care measures and report quality performance for the first time. Initially termed "The Physician Voluntary Reporting Program," various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the "traditional PQRS" reporting program and the newer "Value Modifier" program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.
Baker, Robert B; Washington, Harriet A; Olakanmi, Ololade; Savitt, Todd L; Jacobs, Elizabeth A; Hoover, Eddie; Wynia, Matthew K; Blanchard, Janice; Boulware, L Ebony; Braddock, Clarence; Corbie-Smith, Giselle; Crawley, LaVera; LaVeist, Thomas A; Maxey, Randall; Mills, Charles; Moseley, Kathryn L; Williams, David R
An independent panel of experts, convened by the American Medical Association (AMA) Institute for Ethics, analyzed the roots of the racial divide within American medical organizations. In this, the first of a 2-part report, we describe 2 watershed moments that helped institutionalize the racial divide. The first occurred in the 1870s, when 2 medical societies from Washington, DC, sent rival delegations to the AMA's national meetings: an all-white delegation from a medical society that the US courts and Congress had formally censured for discriminating against black physicians; and an integrated delegation from a medical society led by physicians from Howard University. Through parliamentary maneuvers and variable enforcement of credentialing standards, the integrated delegation was twice excluded from the AMA's meetings, while the all-white society's delegations were admitted. AMA leaders then voted to devolve the power to select delegates to state societies, thereby accepting segregation in constituent societies and forcing African American physicians to create their own, separate organizations. A second watershed involved AMA-promoted educational reforms, including the 1910 Flexner report. Straightforwardly applied, the report's population-based criterion for determining the need for phySicians would have recommended increased training of African American physicians to serve the approximately 9 million African Americans in the segregated south. Instead, the report recommended closing all but 2 African American medical schools, helping to cement in place an African American educational system that was separate, unequal, and destined to be insufficient to the needs of African Americans nationwide.
Full Text Available Abstract Background Little is known about whether and how medical knowledge relates to interest in subspecialty fellowship training. The purpose of this study was to examine the relationships between residents' interest in subspecialty fellowship training and their knowledge of internal medicine (IM. Methods A questionnaire was emailed to 48 categorical postgraduate-year (PGY two and three residents at a New York university-affiliated IM residency program in 2007 using the Survey Monkey online survey instrument. Overall and content area-specific percentile scores from the IM in-training examination (IM-ITE for the same year was used to determine objective knowledge. Results Forty-five of 48 residents (response rate was 93.8% completed the survey. Twenty-two (49% were PG2 residents and 23(51% were PGY3 residents. Sixty percent of respondents were male. Six (13% residents were graduates of U.S. medical schools. Eight (18% reported formal clinical training prior to starting internal medicine residency in the U.S. Of this latter group, 6 (75% had training in IM and 6 (75 % reported a training length of 3 years or less. Thirty-seven of 45 (82% residents had a subspecialty fellowship interest. Residents with a fellowship interest had a greater mean overall objective knowledge percentile score (56.44 vs. 31.67; p = 0.04 as well as greater mean percentile scores in all content areas of IM. The adjusted mean difference was statistically significant (p Conclusions More than half of surveyed residents indicated interest in pursuing a subspecialty fellowship. Fellowship interest appears positively associated with general medical knowledge in this study population. Further work is needed to explore motivation and study patterns among internal medicine residents.
Prisco, Domenico; Ageno, Walter; Becattini, Cecilia; D'Angelo, Armando; Davì, Giovanni; De Cristofaro, Raimondo; Dentali, Francesco; Di Minno, Giovanni; Falanga, Anna; Gussoni, Gualberto; Masotti, Luca; Palareti, Gualtiero; Pignatelli, Pasquale; Santi, Roberto M; Santilli, Francesca; Silingardi, Mauro; Tufano, Antonella; Violi, Francesco
The direct oral anticoagulants (DOACs) are drugs used in clinical practice since 2009 for the prevention of stroke or systemic embolism in non-valvular atrial fibrillation, and for the treatment and secondary prevention of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and one direct thrombin inhibitor (dabigatran) provide oral anticoagulation therapy alternatives to Vitamin K antagonists (VKAs). Despite their clear advantages, the DOACs require on the part of the internist a thorough knowledge of their pharmacokinetic and pharmacodynamic characteristics to ensure their correct use, laboratory monitoring and the appropriate management of adverse events. This document represents a consensus paper on the use of DOACs by representatives of three Italian scientific societies: the Italian Society of Internal Medicine (SIMI), the Federation of the Associations of Hospital Managers (FADOI), and the Society for the Study of Haemostasis and Thrombosis (SISET). This document formulates expert opinion guidance for pragmatic managing, monitoring and reversing the anticoagulant effect of DOACs in both chronic and emergency settings. This practical guidance may help the internist to create adequate protocols for patients hospitalized ion internal medicine wards, where patients are often elderly subjects affected by poly-morbidities and renal insufficiency, and, thus, require particular attention to drug-drug interactions and peri-procedural protocols.
Morrison, Ann; Roman, Brenda; Borges, Nicole
Objective: The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden…
Full Text Available Markus Krautter,1 Sven Andreesen,2 Nadja Köhl-Hackert,2 Katja Hoffmann,3 Wolfgang Herzog,2 Christoph Nikendei2 1Department of Nephrology, University of Heidelberg, 2Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, 3Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany Background: Peer-assisted learning (PAL has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective.Purpose: To provide insights into students' experiences regarding their on-ward training with and without accompanying PAL tutors.Methods: A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80. The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants. The discussions were analyzed using content analysis.Results: The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students' anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available.Conclusion: On-ward PAL programs represent a particularly valuable tool for students' support in training clinical competencies on ward. The tutor–student working alliance
Lert, France; Grimaldi-Bensouda, Lamiae; Rouillon, Frederic; Massol, Jacques; Guillemot, Didier; Avouac, Bernard; Duru, Gerard; Magnier, Anne-Marie; Rossignol, Michel; Abenhaim, Lucien; Begaud, Bernard
Homeopathic care has not been well documented in terms of its impact on patients' utilization of drugs or other complementary and alternative medicines (CAM). The objective of this study was to describe and compare patients who visit physicians in general practice (GPs) who prescribe only conventional medicines (GP-CM), regularly prescribe homeopathy within a mixed practice (GP-Mx), or are certified homeopathic GPs (GP-Ho). The EPI3-LASER study was a nationwide observational survey of a representative sample of GPs and their patients from across France. Physicians recorded their diagnoses and prescriptions on participating patients who completed a self-questionnaire on socio-demographics, lifestyle, quality of life Short Form 12 (SF-12) and the complementary and alternative medicine beliefs inventory (CAMBI). A total of 6379 patients (participation rate 73.1%) recruited from 804 GP practices participated in this survey. Patients attending a GP-Ho were slightly more often female with higher education than in the GP-CM group and had markedly healthier lifestyle. They did not differ greatly in their comorbidities or quality of life but exhibited large differences in their beliefs in holistic medicine and natural treatments, and in their attitude toward participating to their own care. Similar but less striking observations were made in patients of the GP-Mx group. Patients seeking care with a homeopathic GP did not differ greatly in their socio-demographic characteristics but more so by their healthier lifestyle and positive attitude toward CAM. Further research is needed to explore the directionality of those associations and to assess the potential economic benefits of homeopathic management in primary care. Copyright © 2013 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.
Ie, Kenya; Tahara, Masao; Murata, Akiko; Komiyama, Manabu; Onishi, Hirotaka
Despite recent developments in post-graduate family medicine training in Japan, the numbers of junior doctors entering family medicine residencies are still limited. The objective of this qualitative study was to investigate the possible factors associated to the career choice of family medicine, especially in the context of the newly established family medicine programs in Japan. From December 2010 to January 2011, we distributed a semi-structured questionnaire about career choice to 58 physician members of the Japan Primary Care Association, and 41 of them responded. Four researchers used the Modified Grounded Theory Approach (Kinoshita, 2003) for three-stage conceptualization. We extracted a conceptual model of the choice of newly established family medicine as a career in Japan, consisting of six categories and 77 subordinate concepts from 330 variations. The subcategories of personal background affecting the family-medicine career choice were characteristics ("self-reliance," "pioneering spirit"), career direction ("community/rural-orientedness," "multifaceted orientation") and experience (e.g., "discomfort with fragmented care"). We divided the influencing factors that were identified for career choice into supporters (e.g., "role model"), conflict of career choice (e.g., "anxiety about diverse/broad practice"), and the dawn of a new era in family medicine in Japan (e.g., "lack of social recognition," "concern about livelihood," and "too few role models"). Although the dawn of a new era seemed a rather negative influencer, it was unique to our study that the dawn itself could attract those with a "pioneering spirit" and an "attitude of self-training." Unlike previous studies, the positive factors such as lifestyle and the short residency program were not shown to be part of family medicine's attractiveness. In contrast, "concern about livelihood" was specific among our respondents and was related to career choice in the dawn period. "Community
Cramer, Holger; Chung, Vincent C H; Lauche, Romy; Zhang, Yan; Zhang, Anthony; Langhorst, Jost; Dobos, Gustav
To identify socio-demographic and health-related factors associated with (a) acupuncture use and (b) the rated helpfulness of acupuncture among internal medicine patients. Data from a larger cross-sectional trial were reanalyzed. Patients who had used acupuncture for managing their primary medical complaint were compared to patients who had not. Predictors for (a) acupuncture use and (b) rated helpfulness were determined using logistic regression analyses. Of 2486 included patients, 51.49% reported acupuncture use and 39.22% reported no prior use. The use of acupuncture was associated with higher age, i.e. those aged 50-64 were more likely to have used acupuncture, while those younger than 30 were less likely. Patients with spinal pain, fibromyalgia, or headache were more likely to be acupuncture users; while IBS patients were less likely. Patients with good to excellent health status, high external-social health locus of control and current smokers were less likely to have used acupuncture. Among those who had used acupuncture, 42.34% perceived the treatment as helpful, while 35.94% did not. Rated helpfulness was associated with female gender, full-time employment, high health satisfaction, and high internal health locus of control. Those with a diagnosis of osteoarthritis or inflammatory bowel disease were more likely to find acupuncture helpful; those with headache or other types of chronic pain were less likely to find acupuncture helpful. Acupuncture was used by more than half of internal medicine patients. Prevalence and rated helpfulness of acupuncture use was associated with the patients' medical condition, sociodemography, and health locus of control. Copyright © 2015 Elsevier Ltd. All rights reserved.
Krautter, Markus; Andreesen, Sven; Köhl-Hackert, Nadja; Hoffmann, Katja; Herzog, Wolfgang; Nikendei, Christoph
Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective. To provide insights into students' experiences regarding their on-ward training with and without accompanying PAL tutors. A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80). The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants). The discussions were analyzed using content analysis. The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students' anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available. On-ward PAL programs represent a particularly valuable tool for students' support in training clinical competencies on ward. The tutor-student working alliance acts through its flat hierarchy. Nevertheless, tutors cannot represent an adequate substitute for experienced physicians.
Heuser, Cara C; Gibbins, Karen J; Herrera, Christina A; Theilen, Lauren H; Holmgren, Calla M
Physician satisfaction is linked to positive patient outcomes. Mothers form an increasing fraction of the obstetrics and gynecology (ob/gyn) workforce. Define factors that affect physician satisfaction among ob/gyn physicians who are also mothers. We constructed and validated a Redcap survey and invited members of online ob/gyn-mom groups to participate. Characteristics of participants' professional and personal lives were evaluated for possible association with the satisfaction outcomes. Comparison testing was performed using Chi-squared test or Fisher's exact test for categorical variables, Student's t-test for parametric variables, and Wilcoxon Rank-Sum test for non-parametric variables. Responses were received from 232 participants. A majority reported being unsatisfied with their time to spend with children (66%), partner (70%), and on personal hobbies/activites (75%). Eighty-percent rate professional morale as very/somewhat positive. Women who rated their morale as very/somewhat positive worked fewer hours per week than women with neutral/negative responses (43.6 vs 49.7, p = 0.01). Women with positive morale were also less likely to work over 50 h/week (39.5% vs 56.8%, p = 0.04). Ob/gyn physician-mothers have high professional morale but are dissatisfied with time for extra-professional activities. Longer clinical hours correlate with dissatisfaction based on several measurements.
Wiler, Jennifer L.; Granovsky, Michael; Cantrill, Stephen V.; Newell, Richard; Venkatesh, Arjun K.; Schuur, Jeremiah D.
In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians. PMID:26973757
Jennifer L. Wiler, MD, MBA
Full Text Available In 2007, the Centers for Medicaid and Medicare Services (CMS created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS. As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM. For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.
Many studies have shown that men and women differ in communication styles. The question is whether these differences also play a role during medical consultation. Potential differences between male and female physicians that have been investigated, are differences in doctor-patient communication,
Francisco Javier Valverde Bolívar
Conclusion: Physicians excel in terms of creating a friendly environment, possessing good listening skills, and providing the patient with information. However the ability to empathise, exploring the psychosocial sphere, carrying out shared decision-making, and asking open questions must be improved. Being a tutor, devoting more time to consultations, and being younger, results in a significant improvement in communication with the patient.
to physicians.7 Using the actual casemix and attitudes toward extenders prevailing at each demonstra- tion base and applying this least constraining...Fairchild, 17 percent; Nellis, 16 percent. The Chanute estimate is lower because its large student population presents a simple casemix , and its patients
McDonald, Furman S; Duhigg, Lauren M; Arnold, Gerald K; Hafer, Ruth M; Lipner, Rebecca S
Some have questioned whether successful performance in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program is meaningful. The association of the ABIM Internal Medicine (IM) MOC examination with state medical board disciplinary actions is unknown. To assess risk of disciplinary actions among general internists who did and did not pass the MOC examination within 10 years of initial certification. Historical population cohort study. The population of internists certified in internal medicine, but not a subspecialty, from 1990 through 2003 (n = 47,971). ABIM IM MOC examination. General internal medicine in the USA. The primary outcome measure was time to disciplinary action assessed in association with whether the physician passed the ABIM IM MOC examination within 10 years of initial certification, adjusted for training, certification, demographic, and regulatory variables including state medical board Continuing Medical Education (CME) requirements. The risk for discipline among physicians who did not pass the IM MOC examination within the 10 year requirement window was more than double than that of those who did pass the examination (adjusted HR 2.09; 95% CI, 1.83 to 2.39). Disciplinary actions did not vary by state CME requirements (adjusted HR 1.02; 95% CI, 0.94 to 1.16), but declined with increasing MOC examination scores (Kendall's tau-b coefficient = - 0.98 for trend, p actions were less severe among those passing the IM MOC examination within the 10-year requirement window than among those who did not pass the examination. Passing a periodic assessment of medical knowledge is associated with decreased state medical board disciplinary actions, an important quality outcome of relevance to patients and the profession.
Washington, Harriet A; Baker, Robert B; Olakanmi, Ololade; Savitt, Todd L; Jacobs, Elizabeth A; Hoover, Eddie; Wynia, Matthew K; Blanchard, Janice; Boulware, L Ebony; Braddock, Clarence; Corbie-Smith, Giselle; Crawley, LaVera; LaVeist, Thomas A; Maxey, Randall; Mills, Charles; Moseley, Kathryn L; Williams, David R
Between 1910 and 1968, the National Medical Association (NMA) repeatedly clashed with the American Medical Association (AMA) over the latter organization's racial bars to membership and other health policy issues. The NMA, founded in 1895 as a nonexclusionary medical society to provide a voice for disenfranchised black physicians and patients, struggled in its early years, during which AMA leadership took scant notice of it. But skirmishes ensued over such actions as stigmatizing racial labels in the AMA's American Medical Directory, which, beginning in 1906, listed all U.S. physicians but designated African Americans with the notation col. The NMA also repeatedly asked the AMA to take action against overt racial bars on blacks' membership in its constituent state and county societies. During the civil rights era, African American physicians received no AMA support in seeking legal remedies to hospital segregation. And the NMA and AMA found themselves opposed on other policy issues, including Medicaid and Medicare. These differences eventually catalyzed a series of direct confrontations. The 1965 AMA meeting in New York City, for example, was protested by about 200 NMA-led picketers. The NMA's quest for racial equality in medicine was supported by some other medical organizations, such as the Medical Committee for Human Rights. In 1966, the AMA House voted to amend the AMA Constitution and Bylaws, giving its Judicial Council (now the Council on Ethical and Judicial Affairs) the authority to investigate allegations of discrimination. This paved the way for a subsequent era of increasing cooperation and understanding.
Wang, Hong-Bo; Zhang, Qing-Zhao; Zhang, Zhen; Hou, Chang-Song; Li, Wen-Liang; Yang, Hui; Sun, Quan-Fu
This work intends to quantify the risk of internal contaminations in the nuclear medicine staff of one hospital in Henan province, China. For this purpose, the criteria proposed by the International Atomic Energy Agency (IAEA) to determine whether it is necessary to conduct internal individual monitoring was applied to all of the 18 nuclear medicine staff members who handled radionuclides. The activity of different radionuclides used during a whole calendar year and the protection measures adopted were collected for each staff member, and the decision as to whether nuclear medicine staff in the hospital should be subjected to internal monitoring was made on the basis of the criteria proposed by IAEA. It is concluded that for all 18 members of the nuclear medicine staff in the hospital, internal monitoring is required. Internal exposure received by nuclear medicine staff should not be ignored, and it is necessary to implement internal monitoring for nuclear medicine staff routinely.
Tam, Penny; Nijjar, Aman P; Fok, Mark; Little, Chris; Shingina, Alexandra; Bittman, Jesse; Raghavan, Rashmi; Khan, Nadia A
The effect of a multi-faceted handoff strategy in a high volume internal medicine inpatient setting on process and patient outcomes has not been clearly established. We set out to determine if a multi-faceted handoff intervention consisting of education, standardized handoff procedures, including fixed time and location for face-to-face handoff would result in improved rates of handoff compared with usual practice. We also evaluated resident satisfaction, health resource utilization and clinical outcomes. This was a cluster randomized controlled trial in a large academic tertiary care center with 18 inpatient internal medicine ward teams from January-April 2013. We randomized nine inpatient teams to an intervention where they received an education session standardizing who and how to handoff patients, with practice and feedback from facilitators. The control group of 9 teams continued usual non-standardized handoffs. The primary process outcome was the rate of patients handed over per 1000 patient nights. Other process outcomes included perceptions of inadequate handoff by overnight physicians, resource utilization overnight and hospital length of stay. Clinical outcomes included medical errors, frequency of patients requiring higher level of care overnight, and in-hospital mortality. The intervention group demonstrated a significant increase in the rate of patients handed over to the overnight physician (62.90/1000 person-nights vs. 46.86/1000 person-nights, p = 0.002). There was no significant difference in other process outcomes except resource utilization was increased in the intervention group (26.35/1000 person-days vs. 17.57/1000 person-days, p-value = 0.01). There was no significant difference between groups in medical errors (4.8% vs. 4.1%), need for higher level of care or in hospital mortality. Limitations include a dependence of accurate record keeping by the overnight physician, the possibility of cross-contamination in the handoff process, analysis at
Tøttenborg, Sandra Søgaard; Topp, Marie; Ingebrigtsen, Truls Sylvan
Non-adherence to medicine is common in patients with chronic diseases, contributing to significant worsening of disease, increased mortality and health expenditure. Methods of measuring adherence include self report, prescription refill rates, biomarkers, electronic monitoring and therapeutic...
Elder, Nancy C.; Jacobson, C. Jeffrey; Bolon, Shannon K.; Fixler, Joseph; Pallerla, Harini; Busick, Christina; Gerrety, Erica; Kinney, Dee; Regan, Saundra; Pugnale, Michael
PURPOSE The clinician-colleague relationship is a cornerstone of relationship-centered care (RCC); in small family medicine offices, the clinician–medical assistant (MA) relationship is especially important. We sought to better understand the relationship between MA roles and the clinician-MA relationship within the RCC framework. METHODS We conducted an ethnographic study of 5 small family medicine offices (having informed by clinicians’ roles in hiring and managing MAs and the social familiarity of MAs and clinicians. Within the RCC framework, these findings can be seen as previously undefined constraints and freedoms in what is known as the Complex Responsive Process of Relating between clinicians and MAs. CONCLUSIONS Improved understanding of clinician-MA relationships will allow a better appreciation of how clinicians and MAs function in family medicine teams. Our findings may assist small offices undergoing practice transformation and guide future research to improve the education, training, and use of MAs in the family medicine setting. PMID:24615311
Morrison, Ann; Roman, Brenda; Borges, Nicole
The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden curriculum" in medical education, in which values are communicated from teacher to student outside of the formal instruction. A group of 79 students on Psychiatry and 66 on Emergency Medicine clerkships were surveyed at the beginning and end of their rotation regarding their attitudes toward homeless persons by use of the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI). The HPATHI was also administered to 31 Psychiatry residents and faculty and 41 Emergency Medicine residents and faculty one time during the course of this study. For Psychiatry clerks, t-tests showed significant differences pre- and post-clerkship experiences on 2 of the 23 items on the HPATHI. No statistically significant differences were noted for the Emergency Medicine students. An analysis of variance revealed statistically significant differences on 7 out of the 23 survey questions for residents and faculty in Psychiatry, as compared with those in Emergency Medicine. Results suggest that medical students showed small differences in their attitudes toward homeless people following clerkships in Psychiatry but not in Emergency Medicine. Regarding resident and faculty results, significant differences between specialties were noted, with Psychiatry residents and faculty exhibiting more favorable attitudes toward homeless persons than residents and faculty in Emergency Medicine. Given that medical student competencies should be addressing the broader social issues of homelessness, medical schools need to first understand the attitudes of medical students to such issues, and then develop curricula to overcome inaccurate or stigmatizing beliefs.
Full Text Available BACKGROUND Metabolic Syndrome (MetS, currently defined as slight differences in the criteria of diagnosis – depending on which authority is quoted [i.e.: NCEP-ATP III (National Cholesterol Education Program/Adult Treatment Panel III; WHO (World Health Organization; IDF (International Diabetes Federation; AACE (American Association of Clinical Endocrinologists], designates a cluster of metabolic risk factors that come together in a single individual, leading to cardiovascular disease. MetS is quite common, approximately 20-30% of the population in industrialized countries being affected. However, most of epidemiological data regarding MetS are derived from populations consisting mostly of middle-aged and younger subjects. AIM OF THE STUDY To assess the prevalence of the MetS in Internal Medicine wards and to determine its related comorbidities, including other clinical forms of atherosclerotic disease such as CHD risk equivalents. METHODS Our study was performed in patients admitted in Internal Medicine wards and selected as a randomization list in 12 Emilia Romagna-Marche FADOI centers. 1.316 patients were registered. According to explicit inclusion/exclusion criteria, we studied overall 902 participants (50.6% men, mean of age: 71-73 years. RESULTS According to NCEP-ATP III and IDF criteria the prevalence of MetS was 45.3% (IC 95%: 41.6-49.1 and 38.6% (IC 95%: 34.9-42.3, respectively. Patients with MetS presented a higher significant rate of ALT increase, syncope, atrial fibrillation, COPD, unstable angina, chronic kidney disease, cancer, valvular heart disease, peripheral arterial disease and carotid plaques. A strong association between IDF-MetS and congestive heart failure was observed, suggesting a role of central obesity as an independent risk factor in the elderly. DISCUSSION World-wide populations are becoming older. Aging and MetS are two conditions that represent an important part of health-care spending. Trunkal fatness increases in
Full Text Available Introduction: the method and way of learning and teaching are effective in acquiring clinical skills, and identifying the shortcomings of learning and teaching will lead to better planning. The purpose of this study was to explain the experiences of the learning clinical procedures of the internal medicine residents in gastroenterology department. Methods: qualitative study using content thematic analysis was done. Six fourth-year residents were selected and interviewed considering purposive sampling. The data of the interviews were transcribed and analyzed after rereading. Results: the collected data are divided into three categories: learning and experience with the following four categories (learning time and experiencing, leaning and experiencing times, learning and experiencing opportunities, training and the lack of the training of some procedures. These categories are explained by using some quotes derived from the data. Conclusion: the results of this study suggest that the administrative management of internal residency is poor and should get seriously in implementation and application of intended instructions existing in the prepared program of Medical Education and Specialized Council of internal residency period. The attending physicians and residents must be aware of the content of education program at the beginning of the residency periods and the trainers must try to supervise the residents’ education.
Zhang, Rui; Liu, Jialin; Huang, Yong; Wang, Miye; Shi, Qingke; Chen, Jun; Zeng, Zhi
It has been shown that the entities in everyday clinical text are often expressed in a way that varies from how they are expressed in the nomenclature. Owing to lots of synonyms, abbreviations, medical jargons or even misspellings in the daily used physician notes in clinical information system (CIS), the terminology without enough synonyms may not be adequately suitable for the task of Chinese clinical term recognition. This paper demonstrates a validated system to retrieve the Chinese term of clinical finding (CTCF) from CIS and map them to the corresponding concepts of international clinical nomenclature, such as SNOMED CT. The system focuses on the SNOMED CT with Chinese synonyms enrichment (SCCSE). The literal similarity and the diagnosis-related similarity metrics were used for concept mapping. Two CTCF recognition methods, the rule- and terminology-based approach (RTBA) and the conditional random field machine learner (CRF), were adopted to identify the concepts in physician notes. The system was validated against the history of present illness annotated by clinical experts. The RTBA and CRF could be combined to predict new CTCFs besides SCCSE persistently. Around 59,000 CTCF candidates were accepted as valid and 39,000 of them occurred at least once in the history of present illness. 3,729 of them were accordant with the description in referenced Chinese clinical nomenclature, which could cross map to other international nomenclature such as SNOMED CT. With the hybrid similarity metrics, another 7,454 valid CTCFs (synonyms) were succeeded in concept mapping. For CTCF recognition in physician notes, a series of experiments were performed to find out the best CRF feature set, which gained an F-score of 0.887. The RTBA achieved a better F-score of 0.919 by the CTCF dictionary created in this research. This research demonstrated that it is feasible to help the SNOMED CT with Chinese synonyms enrichment based on physician notes in CIS. With continuous
Paul Konitzer was one of the outstanding and well-known physicians in the years after the World War II in East-Germany. THe paper describes his professional way as hygienist, social medical, municipal physician and last but not least as health politician in the times of four different political regimes: the imperial era in Germany till 1918, the time of "Weimarer Republic" till 1933, the Nazi dictatorship till 1945 and the early years in the Soviet occupation zone of Germany. The life of Konitzer is a typical example of the fate of a German doctor in the first half of the 20th century. Konitzer was arrested in February 1947 by the Soviet Military Government in Berlin in connection with some political troubles and reproach with a typhus epidemic in a German camp for Russian Prisoners of War in the Nazi era. On April 22nd 1947 he died in prison of Dresden by suicide without condemnation.
Roberts J Mark
Full Text Available Abstract Background To manage the voluminous formal curriculum content in a limited amount of structured teaching time, we describe the development and evaluation of a curriculum map for academic half days (AHD in a core internal medicine residency program. Methods We created a 3-year cyclical curriculum map (an educational tool combining the content, methodology and timetabling of structured teaching, comprising a matrix of topics under various specialties/themes and corresponding AHD hours. All topics were cross-matched against the ACP-ASIM in-training examination, and all hours were colour coded based on the categories of core competencies. Residents regularly updated the map on a real time basis. Results There were 208 topics covered in 283 AHD hours. All topics represented core competencies with minimal duplication (78% covered once in 3 years. Only 42 hours (15% involved non-didactic teaching, which increased after implementation of the map (18–19 hours/year versus baseline 5 hours/year. Most AHD hours (78% focused on medical expert competencies. Resident satisfaction (90% response was high throughout (range 3.64 ± 0.21, 3.84 ± 0.14 out of 4, which improved after 1 year but returned to baseline after 2 years. Conclusion We developed and implemented an internal medicine curriculum map based on real time resident input, with minimal topic duplication and high resident satisfaction. The map provided an opportunity to balance didactic versus non-didactic teaching, and teaching on medical versus non medical expert topics.
Stein, Melissa R.; Arnsten, Julia H.; Parish, Sharon J.; Kunins, Hillary V.
Teaching about diagnosis, treatment, and sequelae of substance use disorders (SUDs) is insufficient in most Internal Medicine residency programs. To address this, the authors developed, implemented, and evaluated a novel and comprehensive SUD curriculum for first year residents (interns) in Internal Medicine, which anchors the ensuing 3-year…
Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L
To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.
Although Internal Medicine (IM) has played for many years a crucial role in the medical education and in the diagnostic framing of the most common diseases, starting from the beginning of the 70's the knowledge explosion, the recognition of the multidisciplinary nature of IM and the consequent impossibility for the Internist to master an ever growing array of notions have resulted in the development of specialized disciplines restricted to pathologies of single organs or apparatus. The parcelling out of medical knowledge has thus induced the onset of a number of specializations stemmed from IM and, as a direct consequence, an identity crisis of the same IM. Social transformations and variations in the epidemiology of several diseases have contributed to such crisis, including aging, frailty and disability, polypathology and chronicity. In the last few years, however, IM has regained a central role in medicine, in that the Internist is an expert of "medicine of complexity" and the only specialist able to envisage an holistic approach to the patient. The development of biotechnologies, characterized on one side by nanotechnologies and on the other by the instruments of diagnostic imaging, has provided an important contribution to make clinical medicine more and more precise and reliable. The genomic analysis of novel pharmacological targets has opened new therapeutic horizons, especially in the oncology field. A striking aspect of modern medicine, again based on unreasonable expectations of improvement and recovery, is the progressive increment of malpractice claims leading to an indemnity payment. Defensive medicine has been the answer to face this growing problem: physicians are in fact induced to prescribe a much higher number of often unnecessary examinations and laboratory tests, that result in a wasting rise of health costs. In view of the rapidly changing reality, it seems fair to ask the question as to whether in our country the medical education is abreast
Full text: Calculation of individual internal dosimetry in nuclear medicine is a complex, multi-stage process. Most often, calculations are biased on the MIRD methodology, which assumes uniform distribution of cumulated activity inside a set of mathematically described internal organs. The MIRD 'reference man' geometry is highly simplified and the dosimetry estimates generated by this method were originally only intended to predict the average dose expected in an exposed population. We have developed a software package for the Macintosh computer ('Mister Voxel') that uses a fast Fourier transform to calculate the 3D distribution of absorbed dose by convolving a 3D dose kernel with a 3D distribution of cumulated activity. This makes it possible to generate dose volume histograms and isodose contours for organs or tumours treated with radiopharmaceuticals, a task not possible using the MIRD technique. In addition to providing 3D convolution, Mister Voxel performs basic image processing functions (image math, filters, cut and paste) and provides a collection of painting tools and simple morphological operators to facilitate the delineation of regions of interest (ROIs) along anatomical boundaries. The package also includes an image registration module with tools for automated or manual registration of 3D data sets. The structure of the package allows ROIs drawn on CT or MRI data to be easily transferred to registered SPECT data. Dose kernels are implemented by plug-in code modules, allowing the user to extend the system's capabilities if required. File import and export capabilities are also extensible
Evidence based medicine (EBM) is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The practice of EBM is an expectation of professional healthcare and requisite component in many medical school curricula. Yet, despite
Garcia, M.T.; Alfaro, L.M.M.; Angeles, C.A.
Internal dosimetry plays an important role in nuclear medicine dosimetry control of personnel occupationally exposed, and that in recent years there has been a large increase in the use of radionuclides both in medical diagnosis as radiotherapy. But currently, in Mexico and in many parts of the world, this internal dosimetry control is not performed. The Instituto Nacional de lnvestigaciones Nucleares de Mexico (ININ) together with the Centro Oncologico de Toluca (ISEMMYM) have developed a simple and feasible methodology for monitoring of personnel working in these facilities. It was aimed to carry out the dosimetry of the personnel, due to the incorporation of I-131, using the spectrometric devices that the hospital has, a gamma camera. The first step in this methodology was to make a thyroid phantom to meet the specifications of the ninth ANSI. This phantom is compared under controlled conditions with RMC- II phantom used for system calibration of the ININ internal dosimetry (ACCUSCAN - Ll), and with another phantom developed in Brazil with ANSI specifications, in order to determine the variations in measurements due to the density of the material of each of the phantoms and adjust to the system ACCUSCAN, already certificate. Furthermore, necessary counts were performed with the gamma camera of the phantom developed at ININ, with a standard source of 133 Ba which simulates the energy of 131 I. With these data, were determined the counting efficiencies for a distance of 15 to 20 cm between the surface of the phantom and the the plate of the detectors. Another important aspect was to determine the lower limit of detection (LLD). In this paper we present the results obtained from the detectors calibration of the gamma camera of the hospital.
Leigh, J Paul; Tancredi, Daniel; Jerant, Anthony; Kravitz, Richard L
Disparities in remuneration between primary care and other physician specialties may impede health care reform by undermining the sustainability of a primary care workforce. Previous studies have compared annual incomes across specialties unadjusted for work hours. Wage (earnings-per-hour) comparisons could better inform the physician payment debate. In a cross-sectional analysis of data from 6381 physicians providing patient care in the 2004-2005 Community Tracking Study (adjusted response rate, 53%), we compared wages across broad and narrow categories of physician specialties. Tobit and linear regressions were run. Four broad specialty categories (primary care, surgery, internal medicine and pediatric subspecialties, and other) and 41 specific specialties were analyzed together with demographic, geographic, and market variables. In adjusted analyses on broad categories, wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. In adjusted analyses for 41 specific specialties, wages were significantly lower for the following than for the reference group of general surgery (wage near median, $85.98): internal medicine and pediatrics combined (-$24.36), internal medicine (-$24.27), family medicine (-$23.70), and other pediatric subspecialties (-$23.44). Wage rankings were largely impervious to adjustment for control variables, including age, race, sex, and region. Wages varied substantially across physician specialties and were lowest for primary care specialties. The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists, and pathologists. In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians.
Esch, Lindsay M.; Bird, Amber-Nicole; Oyler, Julie L.; Lee, Wei Wei; Shah, Sachin D.; Pincavage, Amber T.
Introduction Internal medicine (IM) interns start continuity clinic with variable ambulatory training. Multiple other specialties have utilized a boot camp style curriculum to improve surgical and procedural skills, but boot camps have not been used to improve interns’ ambulatory knowledge and confidence. The authors implemented and assessed the impact of an intern ambulatory boot camp pilot on primary care knowledge, confidence, and curricular satisfaction. Methods During July 2014, IM interns attended ambulatory boot camp. It included clinically focused case-based didactic sessions on common ambulatory topics as well as orientation to the clinic and electronic medical records. Interns anonymously completed a 15-question pre-test on topics covered in the boot camp as well as an identical post-test after the boot camp. The interns were surveyed regarding their confidence and satisfaction. Results Thirty-eight interns participated in the boot camp. Prior to the boot camp, few interns reported confidence managing common outpatient conditions. The average pre-test knowledge score was 46.3%. The average post-test knowledge score significantly improved to 76.1% (pinterns reported that the boot camp was good preparation for clinics and 97% felt that the boot camp boosted their confidence. Conclusions The ambulatory boot camp pilot improved primary care knowledge, and interns thought it was good preparation for clinic. The ambulatory boot camp was well received and may be an effective way to improve the preparation of interns for primary care clinic. Further assessment of clinical performance and expansion to other programs and specialties should be considered. PMID:26609962
Kunde, A; Harendza, S
Due to the ageing population, internal medicine has become increasingly important for dental education. Although several studies have reported dentists' dissatisfaction with their internal medicine training, no guidelines exist for internal medicine learning objectives in dental education. The aim of this study was to identify topics of internal medicine considered to be relevant for dental education by dentists and internists. Eight dentists from private dental practices in Hamburg and eight experienced internal medicine consultants from Hamburg University Hospital were recruited for semi-structured interviews about internal medicine topics relevant for dentists. Internal diseases were clustered into representative subspecialties. Dentists and internists were also asked to rate medical diseases or emergencies compiled from the literature by their relevance to dental education. Coagulopathy and endocarditis were rated highest by dentists, whilst anaphylaxis was rated highest by internists. Dentists rated hepatitis, HIV, organ transplantation and head/neck neoplasm significantly higher than internists. The largest number of different internal diseases mentioned by dentists or internists could be clustered under cardiovascular diseases. The number of specific diseases dentists considered to be relevant for dental education was higher in the subspecialties cardiovascular diseases, haematology/oncology and infectiology. We identified the internal medicine topics most relevant for dental education by surveying practising dentists and internists. The relevance of these topics should be confirmed by larger quantitative studies to develop guidelines how to design specific learning objectives for internal medicine in the dental curriculum. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
The Emergency Department is a risk-laden environment for clinicians caring for children. A number of factors can increase the risk of medical errors and adverse events, including lack of standardized medication dosing because of size variation in the pediatric age range, unique physical and developmental characteristics of children that affect treatment strategies, and the inability of young or non-verbal children to provide a medical history or to clearly communicate pain and other symptoms. The Emergency Department (ED) setting is often hectic and chaotic, with lots of interruptions. Many EDs lack the pediatric-specific supplies deemed essential for managing pediatric emergencies, and long hours or overnight shifts, while necessary for maintaining 24-hour emergency services, can cause provider fatigue that can lead to increased medical errors. It is in this environment that ED physicians make decisions about the use of CT scans in children, often without evidence-based guidelines to help them weigh risks and benefits. Although recent efforts have raised the awareness of the risk of exposure to radiation, many pediatric providers and families lack adequate information to guide decisions about the use of CT. Pediatricians and emergency physicians need to collaborate with radiologists to maintain current knowledge of the risks and benefits of CT scans, to advocate for pediatric protocols and evidence-based guidelines, and to engage families in decisions regarding the evaluation and treatment of pediatric patients in the Emergency Department. (orig.)
Frush, Karen [Duke University School of Medicine, DUMC, Department of Pediatrics, Box 3701, Durham, NC (United States)
The Emergency Department is a risk-laden environment for clinicians caring for children. A number of factors can increase the risk of medical errors and adverse events, including lack of standardized medication dosing because of size variation in the pediatric age range, unique physical and developmental characteristics of children that affect treatment strategies, and the inability of young or non-verbal children to provide a medical history or to clearly communicate pain and other symptoms. The Emergency Department (ED) setting is often hectic and chaotic, with lots of interruptions. Many EDs lack the pediatric-specific supplies deemed essential for managing pediatric emergencies, and long hours or overnight shifts, while necessary for maintaining 24-hour emergency services, can cause provider fatigue that can lead to increased medical errors. It is in this environment that ED physicians make decisions about the use of CT scans in children, often without evidence-based guidelines to help them weigh risks and benefits. Although recent efforts have raised the awareness of the risk of exposure to radiation, many pediatric providers and families lack adequate information to guide decisions about the use of CT. Pediatricians and emergency physicians need to collaborate with radiologists to maintain current knowledge of the risks and benefits of CT scans, to advocate for pediatric protocols and evidence-based guidelines, and to engage families in decisions regarding the evaluation and treatment of pediatric patients in the Emergency Department. (orig.)
Guicciardi, Stefano; Riforgiato, Chiara; Leopardi, Eleonora
In the past three years there has been increasing debate regarding the educational system of physicians in Italy, mainly due to the implementation of radical changes in the selection and admission criteria to medical courses. From the students' point of view, it is possible to identify different educational challenges to be faced in order to develop a more adequate learning system.First of all, it is necessary to elaborate an accurate planning of the physicians based on the needs of the Italian Healthcare System with a proportionate regulation of access to medical and specialty courses. Secondly, there is the strong need to update the traditional curricula based on a biological reductionist perspective with innovative and integrated courses that could teach new essential topics in a radically changed and globalized world, such as global health or medical ethics. Thirdly, it is crucial to introduce innovative teaching methods that could help students improve and evaluate their practical skills and participate actively in their own education, developing the attitudes and competences needed in their future profession.
Hök, Johanna; Lewith, George; Weidenhammer, Wolfgang; Santos-Rey, Koldo; Fønnebø, Vinjar; Wiesener, Solveig; Falkenberg, Torkel
The aim of this study was to analyse global research and development (R&D) strategies for traditional medicine (TM) and complementary and alternative medicine (CAM) across the world to learn from previous and on-going activities. 52 representatives within CAMbrella nominated 43 key international stakeholders (individuals and organisations) and 15 of these were prioritised. Information from policy documents including mission statements, R&D strategies and R&D activities were collected in combination with personal interviews. Data were analysed using the principles of content analysis. Key stakeholders vary greatly in terms of capacity, mission and funding source (private/public). They ranged from only providing research funding to having a comprehensive R&D and communication agenda. A common shift in R&D strategy was noted; whereas 10 years ago research focused mainly on exploring efficacy and mechanisms, today the majority of stakeholders emphasise the importance of a broad spectrum of research, including methodologies exploring context, safety and comparative effectiveness. The scarce public investment in this field in Europe stands in stark contrast to the large investments found in Australia, Asia and North America. There is an emerging global trend supporting a broad research repertoire, including qualitative and comparative effectiveness research. This trend should be considered by the EU given the experience and the substantial research funding committed by the included stakeholders. To facilitate international collaborative efforts and minimise the risk of investment failure, we recommend the formation of a centralised EU CAM research centre fostering a broad CAM R&D agenda with the responsibility for implementing the relevant findings of CAMbrella.
Desnoyer, Aude; Blanc, Anne-Laure; Pourcher, Valérie; Besson, Marie; Fonzo-Christe, Caroline; Desmeules, Jules; Perrier, Arnaud; Bonnabry, Pascal; Samer, Caroline; Guignard, Bertrand
Potentially inappropriate medication (PIM) occurs frequently and is a well-known risk factor for adverse drug events, but its incidence is underestimated in internal medicine. The objective of this study was to develop an electronic prescription-screening checklist to assist residents and young healthcare professionals in PIM detection. Five-step study involving selection of medical domains, literature review and 17 semistructured interviews, a two-round Delphi survey, a forward/back-translation process and an electronic tool development. 22 University and general hospitals from Canada, Belgium, France and Switzerland. 40 physicians and 25 clinical pharmacists were involved in the study.Agreement with the checklist statements and their usefulness for healthcare professional training were evaluated using two 6-point Likert scales (ranging from 0 to 5). Agreement and usefulness ratings were defined as: >65% of the experts giving the statement a rating of 4 or 5, during the first Delphi-round and >75% during the second. 166 statements were generated during the first two steps. Mean agreement and usefulness ratings were 4.32/5 (95% CI 4.28 to 4.36) and 4.11/5 (4.07 to 4.15), respectively, during the first Delphi-round and 4.53/5 (4.51 to 4.56) and 4.36/5 (4.33 to 4.39) during the second (pinternal medicine. It is intended to help young healthcare professionals in their clinical practice to detect PIM, to reduce medication errors and to improve patient safety. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Files, Julia A; Mayer, Anita P; Ko, Marcia G; Friedrich, Patricia; Jenkins, Marjorie; Bryan, Michael J; Vegunta, Suneela; Wittich, Christopher M; Lyle, Melissa A; Melikian, Ryan; Duston, Trevor; Chang, Yu-Hui H; Hayes, Sharonne N
Gender bias has been identified as one of the drivers of gender disparity in academic medicine. Bias may be reinforced by gender subordinating language or differential use of formality in forms of address. Professional titles may influence the perceived expertise and authority of the referenced individual. The objective of this study is to examine how professional titles were used in the same and mixed-gender speaker introductions at Internal Medicine Grand Rounds (IMGR). A retrospective observational study of video-archived speaker introductions at consecutive IMGR was conducted at two different locations (Arizona, Minnesota) of an academic medical center. Introducers and speakers at IMGR were physician and scientist peers holding MD, PhD, or MD/PhD degrees. The primary outcome was whether or not a speaker's professional title was used during the first form of address during speaker introductions at IMGR. As secondary outcomes, we evaluated whether or not the speakers professional title was used in any form of address during the introduction. Three hundred twenty-one forms of address were analyzed. Female introducers were more likely to use professional titles when introducing any speaker during the first form of address compared with male introducers (96.2% [102/106] vs. 65.6% [141/215]; p form of address 97.8% (45/46) compared with male dyads who utilized a formal title 72.4% (110/152) of the time (p = 0.007). In mixed-gender dyads, where the introducer was female and speaker male, formal titles were used 95.0% (57/60) of the time. Male introducers of female speakers utilized professional titles 49.2% (31/63) of the time (p addressed by professional title than were men introduced by men. Differential formality in speaker introductions may amplify isolation, marginalization, and professional discomfiture expressed by women faculty in academic medicine.
Goertz, Christine M; Salsbury, Stacie A; Vining, Robert D
commonly doctors of chiropractic. However, a collaborative model of treatment coordination between these two provider groups has yet to be tested. The primary aim of the Collaborative Care for Older Adults Clinical Trial is to develop and evaluate the clinical effectiveness and feasibility of a patient......-centered, collaborative care model with family medicine physicians and doctors of chiropractic for the treatment of low back pain in older adults. METHODS/DESIGN: This pragmatic, pilot randomized controlled trial will enroll 120 participants, age 65 years or older with subacute or chronic low back pain lasting at least...... one month, from a community-based sample in the Quad-Cities, Iowa/Illinois, USA. Eligible participants are allocated in a 1:1:1 ratio to receive 12 weeks of medical care, concurrent medical and chiropractic care, or collaborative medical and chiropractic care. Primary outcomes are self-rated back pain...
Hanhart, W-A; Gusmini, W; Kehtari, R
The emergency ward constitutes the main extra/intra-hospital interface most in demand by general physicians (GP). In order to evaluate the needs and the expectations of GP and, thus, to improve the cooperation between different partners, we underwent a study over 150 GP in Neuchâtel, Switzerland. The rate of participation within the time limit was 61.3%. The results showed that only 49% of GP find an interest in emergency medicine and less than a half (43%) feel not at ease when facing to vital emergencies. However 67% of GP confirmed being highly interested to attend special training in emergency field. The cooperation with medical emergency team (SMUR) and paramedics came out to be satisfactory. Facilities to access to the medico-technical platform of the emergency ward is also highly requested.
Geiger, H Jack
The academic discipline of social medicine has always had a political and policy advocacy component, in addition to its core functions of research and teaching. Its origins lie in the 18th and 19th centuries, in the work of Johann Peter Frank and Rudolph Virchow, among others. Virchow's dictum that "politics is nothing else but medicine on a large scale" highlights that most social determinants of health are politically determined and shape population health. Yet despite intense epidemiological and sociological research on the social determinants of health, less attention has been paid to this political and policy dimension.During the 1960s, the author and many other clinicians were directly involved in attempts to use health care institutions to foster structural change. However, the author argues that efforts to assist individual patients and more effectively manage their interactions with the health care system, as described in the articles in this issue's special collection on "structural competency," while worthy and useful, do not confront root causes. Going forward, efforts to effect structural change must take place outside the arena of the clinical encounter and involve interprofessional teams and collaborations with nongovernmental organizations. They should intervene directly on the structures that contribute to illness such as poor housing, income and wealth inequality, inferior education, racism and residential segregation, and toxic concentrations of extreme poverty in urban areas. Collectively, these efforts-within and outside the spheres of medicine-represent the real operative form of structural competency.
The Society of Nuclear Medicine, Bangladesh organized its 10th Annual Conference at Dhaka on 10-11 February 2005. The theme of this year's convention was 'Interventional Nuclear Medicine'. Besides the faculty from Bangladesh including consultants from various clinical specialties, four international experts also participated in the two day meeting. The pre-congress CME was held in the premises of Bangladesh Atomic Energy Commission on 10 February. Several lectures on the management of Thyroid Disorders using radionuclide techniques were delivered by a distinguished national and international faculty. The lectures were attended by a large audience with a packed auditorium, mostly nuclear medicine specialists, general physicians, surgeons and endocrinologists from Dhaka and other places of Bangladesh. There was good interaction and participants took active part in the discussions. The actual Annual Convention of Society of Nuclear Medicine Bangladesh (SNMB) was held in Dhaka on 11 February 2005. The convention was attended by more than 250 registered participants, including nuclear medicine physicians, clinicians, residents, and technologists, representative of the Atomic Energy Commission and pioneers of nuclear medicine in Bangladesh
Jansky, Maximiliane; Jaspers, Birgit; Radbruch, Lukas; Nauck, Friedemann
The need to regulate physician-assisted suicide (PAS) and organizations offering assisted suicide has been controversially debated in Germany. Before the German parliament voted on various drafts in November 2015, the German Association for Palliative Medicine surveyed its members on their attitudes and experiences regarding PAS. Items for the survey were derived from the literature and consented in a focus group. 2005-2015 - PubMed: PAS [Title/Abstract] UND survey (all countries), grey literature. We invited 5152 members of the DGP to participate in the online/paper survey. Descriptive quantitative and content analytic qualitative analysis of data using SPSS and MaxQDA. We obtained 1811 valid data sets (response rate 36.9%). 33.7% of the participants were male, 43.6% were female, and 0.4% identifed as other. Physicians accounted for 48.5% of the respondents, 17.8% nurses, other professions 14.3%, and about 20% of the data was missing socio-demographic information. More than 90% agreed that "wishes for PAS may be ambivalent" and "are rather a wish to end an unbearable situation". Of the 833 participating physicians, 56% refused participating in PAS and 74.2% had been asked to perform PAS. PAS was actually performed by 3%. Of all participating members, 56% approved of a legal ban of organizations offering assisted suicide. More than 60% of all professions agreed that PAS is not a part of palliative care. The respondents show a broad spectrum of attitudes, only partly supporting statements of relevant bodies, such as DGP. Because many are confronted with the issue, PAS is relevant to professionals in palliative care.
Steven J Durning
Full Text Available Burnout is prevalent in residency training and practice and is linked to medical error and suboptimal patient care. However, little is known about how burnout affects clinical reasoning, which is essential to safe and effective care. The aim of this study was to examine how burnout modulates brain activity during clinical reasoning in physicians. Using functional Magnetic Resonance Imaging (fMRI, brain activity was assessed in internal medicine residents (n=10 and board-certified internists (faculty, n=17 from the Uniformed Services University (USU while they answered and reflected upon United States Medical Licensing Examination and American Board of Internal Medicine multiple-choice questions. Participants also completed a validated two-item burnout scale, which includes an item assessing emotional exhaustion and an item assessing depersonalization. Whole brain covariate analysis was used to examine blood-oxygen-level-dependent (BOLD signal during answering and reflecting upon clinical problems with respect to burnout scores. Higher depersonalization scores were associated with less BOLD signal in the right dorsolateral prefrontal cortex and middle frontal gyrus during reflecting on clinical problems and less BOLD signal in the bilateral precuneus while answering clinical problems in residents. Higher emotional exhaustion scores were associated with more right posterior cingulate cortex and middle frontal gyrus BOLD signal in residents. Examination of faculty revealed no significant influence of burnout on brain activity. Residents appear to be more susceptible to burnout effects on clinical reasoning, which may indicate that residents may need both cognitive and emotional support to improve quality of life and to optimize performance and learning. These results inform our understanding of mental stress, cognitive control as well as cognitive load theory.
Rhodes, Ramona L.; Tindall, Kate; Xuan, Lei; Paulk, M. Elizabeth; Halm, Ethan A.
Background Despite increasing awareness about the importance of discussing end-of-life (EOL) care options with terminally ill patients and families, many physicians remain uncomfortable with these discussions. Objective The objective of the study was to examine perceptions of and comfort with EOL care discussions among a group of internal medicine residents and the extent to which comfort with these discussions has improved over time. Methods In 2013, internal medicine residents at a large academic medical center were asked to participate in an on-line survey that assessed their attitudes and experiences with discussing EOL care with terminally-ill patients. These results were compared to data from a similar survey residents in the same program completed in 2006. Results Eighty-three (50%) residents completed the 2013 survey. About half (52%) felt strongly that they were able to have open, honest discussions with patients and families, while 71% felt conflicted about whether CPR was in the patient’s best interest. About half (53%) felt strongly that it was okay for them to tell a patient/family member whether or not CPR was a good idea for them. Compared to 2006 respondents, the 2013 cohort felt they had more lectures about EOL communication, and had watched an attending have an EOL discussion more often. Conclusions Modest improvements were made over time in trainees’ exposure to EOL discussions; however, many residents remain uncomfortable and conflicted with having EOL care discussions with their patients. More effective training approaches in EOL communication are needed to train the next generation of internists. PMID:24418692
Rhodes, Ramona L; Tindall, Kate; Xuan, Lei; Paulk, M Elizabeth; Halm, Ethan A
Despite increasing awareness about the importance of discussing end-of-life (EOL) care options with terminally ill patients and families, many physicians remain uncomfortable with these discussions. The objective of the study was to examine perceptions of and comfort with EOL care discussions among a group of internal medicine residents and the extent to which comfort with these discussions has improved over time. In 2013, internal medicine residents at a large academic medical center were asked to participate in an on-line survey that assessed their attitudes and experiences with discussing EOL care with terminally-ill patients. These results were compared to data from a similar survey residents in the same program completed in 2006. Eighty-three (50%) residents completed the 2013 survey. About half (52%) felt strongly that they were able to have open, honest discussions with patients and families, while 71% felt conflicted about whether CPR was in the patient's best interest. About half (53%) felt strongly that it was okay for them to tell a patient/family member whether or not CPR was a good idea for them. Compared to 2006 respondents, the 2013 cohort felt they had more lectures about EOL communication, and had watched an attending have an EOL discussion more often. Modest improvements were made over time in trainees' exposure to EOL discussions; however, many residents remain uncomfortable and conflicted with having EOL care discussions with their patients. More effective training approaches in EOL communication are needed to train the next generation of internists. © The Author(s) 2014.
Ryskina, Kira L; Korenstein, Deborah; Weissman, Arlene; Masters, Philip; Alguire, Patrick; Smith, Cynthia D
Although high-value care (HVC) that balances benefits of tests or treatments against potential harms and costs has been a recently emphasized competency for internal medicine (IM) residents, few tools to assess residents' knowledge of HVC are available. To describe the development and initial results of an HVC subscore of the Internal Medicine In-Training Examination (IM-ITE). The HVC concepts were introduced to IM-ITE authors during question development. Three physicians independently reviewed each examination question for selection in the HVC subscore according to 6 HVC principles. The final subscore was determined by consensus. Data from the IM-ITE administered in October 2012 were analyzed at the program level. U.S. IM residency programs. 362 U.S. IM residency programs with IM-ITE data for at least 10 residents. Program-level performance on the HVC subscore was compared with performance on the overall IM-ITE, the Dartmouth Atlas hospital care intensity (HCI) index of the program's primary training hospital, and residents' attitudes about HVC assessed with a voluntary survey. The HVC subscore comprised 38 questions, including 21 (55%) on managing conservatively when appropriate and 14 (37%) on identifying low-value care. Of the 362 U.S. IM programs in the sample, 41% were in a different quartile when ranked based on the HVC subscore compared with overall IM-ITE performance. Rankings by HVC subscore and HCI index were modestly inversely associated, with 30% of programs ranked in the same quartile based on both measures. Knowledge of HVC assessed from examination vignettes may not reflect practice of HVC. Although the HVC subscore has face validity and can contribute to evaluation of residents' HVC knowledge, additional tools are needed to accurately measure residents' proficiency in HVC. None.
Emura Sei SE
Full Text Available Abstract Background Evidence based medicine plays a crucial role as a tool that helps integrate research evidence into clinical practice. However, few reports have yet to examine its application in daily practice among resident physicians in Japan. The aim of this study was to assess the attitudes towards and knowledge of EBM among resident physicians in Japanese and determine perceived barriers to its use. Findings A cross-sectional, self-administered anonymous questionnaire was distributed to 60 resident staffs at Saga University Hospital in Japan. Forty residents completed and returned the questionnaire. Fifty four percent of respondents understood the basic terminology of EBM, 3% could explain this to others, and 41% indicated they would like to understand the terminology more. Thirteen percent admitted having a good understanding of EBM basic skills. Fifty respondents indicated having read EBM sources, but only 3% indicated that they use these sources in clinical decision making. The most prominent barriers of EBM application revealed in this study were insufficient time to access the sources, a lack of native language references, and insufficient basic EBM skills, but not scepticism about the EBM concept. Conclusions In general, respondents positively welcomed EBM, and moderately understood and knew basic EBM skill; however, barriers in its application were shown to exist.
Moral pluralism is the norm in contemporary society. Even the best philosophical arguments rarely persuade moral opponents who differ at a foundational level. This has been vividly illustrated in contemporary debates in bioethics surrounding contentious issues such as abortion and euthanasia. It is readily apparent that bioethics discourse lacks an empirical explanation for the broad differences about various topics in bioethics and health policy. In recent years, social and cognitive psychology has generated novel approaches for defining basic differences in moral intuitions generally. We propose that if empirical research using social intuitionist theory explains why people disagree with one another over moral issues, then the results of such research might help people debate their moral differences in a more constructive and civil manner. We illustrate the utility of social intuitionism with data from a national physician survey. PMID:25366256
Helble, Matthias; Aizawa, Toshiaki
Empirical studies on pharmaceutical pricing across countries have found evidence that prices vary according to per capita income. These studies are typically based on survey data from a subset of countries and cover only one year. In this paper, we study the international trade and price of insulin by using detailed trade data for 186 importing countries from 1995 to 2013. With almost 12,000 observations, our study constitutes the largest comparative study on pharmaceutical pricing conducted so far. The large dataset allows us to uncover new determinants of price differentials. Our analysis shows that the international trade of insulin increased substantially over this time period, clearly outpacing the increasing prevalence of diabetes. Using the unit values of imports, we also study the determinants of price differentials between countries. Running various panel regressions, we find that the differences in prices across countries can be explained by the following factors: First, corroborating earlier studies, we find that per capita GDP is positively correlated with the unit price of insulin. Second, the price of insulin drugs originating from Organisation for Economic Co-operation and Development countries tends to be substantially higher than for those imported from developing countries. Third, more intense competition among suppliers leads to lower insulin prices. Fourth, higher out-of-pocket payments for health care are associated with higher prices. Finally, higher volumes and tariffs seem to result in lower unit prices. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
International motor sport teams travel extensively. Over the years, the design and build of racing cars has improved so that morbidity and mortality in motor sport has been lessened. Those team members supporting the competitors need to be physically and mentally fit to perform complicated tasks, despite having traveled. This group of travelers has not been studied to any extent previously. An anonymous questionnaire asking some basic travel medicine related questions was distributed to the support team members of a Rally team, and Formula One Grand Prix team. Both teams were based in the UK, and competed in all the rounds of their respective world championships. Ten Rally team members and 18 Formula One team members responded to the questionnaire. The results showed moderate coverage of commonly used vaccinations; appropriate use of antimalarials and insect repellents, but by no means by all team members; little or no problems with traveler's diarrhea; some tendencies to problems related to jet lag, but no real attempt to prevent the problem; and finally some attempt at skin protection against solar damage. Support teams are reasonably well prepared for the combination of, the rigors of frequent travel, and a demanding job. There is a deficit in vaccine coverage, especially of both hepatitis A and B, some education is needed in preventing skin problems later in life due to sun exposure, and further study of jet lag and its implications might be appropriate.
Madsen, Tracy E; Linden, Judith A; Rounds, Kirsten; Hsieh, Yu-Hsiang; Lopez, Bernard L; Boatright, Dowin; Garg, Nidhi; Heron, Sheryl L; Jameson, Amy; Kass, Dara; Lall, Michelle D; Melendez, Ashley M; Scheulen, James J; Sethuraman, Kinjal N; Westafer, Lauren M; Safdar, Basmah
A 2010 survey identified disparities in salaries by gender and underrepresented minorities (URM). With an increase in the emergency medicine (EM) workforce since, we aimed to 1) describe the current status of academic EM workforce by gender, race, and rank and 2) evaluate if disparities still exist in salary or rank by gender. Information on demographics, rank, clinical commitment, and base and total annual salary for full-time faculty members in U.S. academic emergency departments were collected in 2015 via the Academy of Administrators in Academic Emergency Medicine (AAAEM) Salary Survey. Multiple linear regression was used to compare salary by gender while controlling for confounders. Response rate was 47% (47/101), yielding data on 1,371 full-time faculty: 33% women, 78% white, 4% black, 5% Asian, 3% Asian Indian, 4% other, and 7% unknown race. Comparing white race to nonwhite, 62% versus 69% were instructor/assistant, 23% versus 20% were associate, and 15% versus 10% were full professors. Comparing women to men, 74% versus 59% were instructor/assistant, 19% versus 24% were associate, and 7% versus 17% were full professors. Of 113 chair/vice-chair positions, only 15% were women, and 18% were nonwhite. Women were more often fellowship trained (37% vs. 31%), less often core faculty (59% vs. 64%), with fewer administrative roles (47% vs. 57%; all p disparities in salary and rank persist among full-time U.S. academic EM faculty. There were gender and URM disparities in rank and leadership positions. Women earned less than men regardless of rank, clinical hours, or training. Future efforts should focus on evaluating salary data by race and developing systemwide practices to eliminate disparities. © 2017 by the Society for Academic Emergency Medicine.
Specialists in social medicine and the organization of health services, in particular those in leading functions, are the most important persons who master the argumentation and justification of optimal relations of proposed innovations from the aspect of improving the health status of the population and from the aspect of national economy, ensuring expedient investment into the system of health services and early return of these investments. These leading workers must have exceptional abilities as regards management and organization and moreover be able to stimulate collaborators to creative work, ensure their effective cooperation, team work and consequential integration at the level of different health and economic facilities entrusted to them.
Pipe, Andrew; Sorensen, Michelle; Reid, Robert
The smoking status of physicians can impact interactions with patients about smoking. The 'Smoking: The Opinions of Physicians' (STOP) survey examined whether an association existed between physician smoking status and beliefs about smoking and cessation and a physician's clinical interactions with patients relevant to smoking cessation, and perceptions of barriers to assisting with quitting. General and family practitioners across 16 countries were surveyed via telephone or face-to-face interviews using a convenience-sample methodology. Physician smoking status was self-reported. Of 4473 physicians invited, 2836 (63%) participated in the survey, 1200 (42%) of whom were smokers. Significantly fewer smoking than non-smoking physicians volunteered that smoking was a harmful activity (64% vs 77%; Pnon-smoking physicians identified willpower (37% vs 32%; P<0.001) and lack of interest (28% vs 22%; P<0.001) as barriers to quitting, more smoking physicians saw stress as a barrier (16% vs 10%; P<0.001). Smoking physicians are less likely to initiate cessation interventions. There is a need for specific strategies to encourage smoking physicians to quit, and to motivate all practitioners to adopt systematic approaches to assisting with smoking cessation.
The chair of internal medicine in Republic of Macedonia was created in 1947. The Department of Internal Medicine (CIM) is the most numerous at Skopje's medical faculty (currently 56 members). According to the archive material from the first session of the Scientific Teaching Council of the Faculty of Medicine (17.03.1947), Mr Mario Krmpotic (Professor of Internal Medicine) was proposed as the first Director of the Internal Clinic (1947). For reasons unknown, Mr Krmpotic never came to Skopje to accept the post. As a consequence of this fact, the real founder of the CIM was the Russian Professor Alexandar Ignjatovski (1875-1955). Mr Ignjatovski was elected as the first Director of the Clinic for Internal Medicine in 1948 for a period of 4 years (1948-1952). At the same time, he was the first Chief of the CIM in Skopje (Macedonia). Dr D. Arsov was elected as the first Assistant Professor of Medicine in 1947, and second (and last) Director of the Clinic for Internal Medicine (1952-1974). For the same period (22 years) he was Head of the CIM. Dr D. Arsov sequentially and successively became first associated and then ordinary professor of medicine in the years 1951 and 1958. The regular activities of the CIM are as follows: 1) Undergraduate education for students (Clinical Investigation, Internal Medicine, Clinical Pharmacy) in general medicine, dentistry, geriatrics, urgent and family medicine (ECKTS); Undergraduate educationfor nurses, speech therapists, physiotherapists, radiologists (high /three year/ nurses School, ECKTS); 2) Postgraduate education (candidates for specialisation in internal medicine, infectology, anaesthesiology, neurology and surgery; 3) Continual medical education (a traditional morning scientific meeting on Thursdays, 08 h; weekly meetings of all internal medicine subspecialists); Scientific meetings, symposiums, congresses of former internal medicine associations (cardiology, pulmoallergology, gastroenterology, nephrology, haematology
Full Text Available BACKGROUND: Effective teamwork is necessary for optimal patient care. There is insufficient understanding of interactions between physicians and nurses on internal medicine wards. OBJECTIVE: To describe resident physicians' and nurses' actual behaviours contributing to teamwork quality in the setting of a simulated internal medicine ward. METHODS: A volunteer sample of 14 pairs of residents and nurses in internal medicine was asked to manage one non-urgent and one urgent clinical case in a simulated ward, using a high-fidelity manikin. After the simulation, participants attended a stimulated-recall session during which they viewed the videotape of the simulation and explained their actions and perceptions. All simulations were transcribed, coded, and analyzed, using a qualitative method (template analysis. Quality of teamwork was assessed, based on patient management efficiency and presence of shared management goals and of team spirit. RESULTS: Most resident-nurse pairs tended to interact in a traditional way, with residents taking the leadership and nurses executing medical prescriptions and assuming their own specific role. They also demonstrated different types of interactions involving shared responsibilities and decision making, constructive suggestions, active communication and listening, and manifestations of positive team building. The presence of a leader in the pair or a truly shared leadership between resident and nurse contributed to teamwork quality only if both members of the pair demonstrated sufficient autonomy. In case of a lack of autonomy of one member, the other member could compensate for it, if his/her own autonomy was sufficiently strong and if there were demonstrations of mutual listening, information sharing, and positive team building. CONCLUSIONS: Although they often relied on traditional types of interaction, residents and nurses also demonstrated readiness for increased sharing of responsibilities. Interprofessional
Guerrero-Lillo, Lisette; Medrano-Díaz, Jorge; Pérez, Carmen; Chacón, Rodrigo; Silva-Urra, Juan; Rodriguez-Morales, Alfonso J
Because information about travel medicine in Chile is lacking, a knowledge, attitudes, and practices evaluation in international travelers and medical students was done. The travelers and medical students did not know the travel medicine and sanitary conditions of their destinations, although they perceived travel-associated health risks, but <10% had any vaccination and 5% got sick during international trips.
Rutherford, Bret R.; Hellerstein, David J.
Objective: To determine the degree to which the medical humanities have been integrated into the fields of internal medicine and psychiatry, the authors assessed the presence of medical humanities articles in selected psychiatry and internal medicine journals from 1950 to 2000. Methods: The journals searched were the three highest-ranking…
Blank, Linda L.; And Others
The evaluation processes of 75 internal medicine residencies visited by the American Board of Internal Medicine (ABIM) in 1978-82 are reviewed. The methods of evaluation used by the residencies are described and compared with the findings from an earlier cycle of visits in 1972-75. (Author/MLW)
Rhodes Erinn T
Full Text Available Abstract Background Information about the availability and effectiveness of childhood obesity training during residency is limited. Methods We surveyed residency program directors from pediatric, internal medicine-pediatrics (IM-Peds, and family medicine residency programs between September 2007 and January 2008 about childhood obesity training offered in their programs. Results The response rate was 42.2% (299/709 and ranged by specialty from 40.1% to 45.4%. Overall, 52.5% of respondents felt that childhood obesity training in residency was extremely important, and the majority of programs offered training in aspects of childhood obesity management including prevention (N = 240, 80.3%, diagnosis (N = 282, 94.3%, diagnosis of complications (N = 249, 83.3%, and treatment (N = 242, 80.9%. However, only 18.1% (N = 54 of programs had a formal childhood obesity curriculum with variability across specialties. Specifically, 35.5% of IM-Peds programs had a formal curriculum compared to only 22.6% of pediatric and 13.9% of family medicine programs (p Conclusions While most residents receive training in aspects of childhood obesity management, deficits may exist in training quality with a minority of programs offering a formal childhood obesity curriculum. Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children.
Daniel J. Minter
Full Text Available Background. The United States (US is experiencing a growing shortage of critical care medicine (CCM trained physicians. Little is known about the exposures to CCM experienced by internal medicine (IM residents or factors that may influence their decision to pursue a career in pulmonary/critical care medicine (PCCM. Methods. We conducted a survey of US IM residency program directors (PDs and then used multivariable logistic regression to identify factors that were predictive of residency programs with a higher percentage of graduates pursuing careers in PCCM. Results. Of the 249 PDs contacted, 107 (43% completed our survey. University-sponsored programs more commonly had large ICUs (62.3% versus 42.2%, p=0.05, primary medical ICUs (63.9% versus 41.3%, p=0.03, and closed staffing models (88.5% versus 41.3%, p20 beds, residents serving as code leaders, and greater proportion of graduates pursuing specialization. Conclusions. While numerous differences exist between the ICU rotations at community- and university-sponsored IM residencies, the percentage of graduates specializing in PCCM was similar. Exposure to larger ICUs, serving as code leaders, and higher rates of specialization were predictive of a career choice in PCCM.
Wolff, Margaret S; Rhodes, Erinn T; Ludwig, David S
Information about the availability and effectiveness of childhood obesity training during residency is limited. We surveyed residency program directors from pediatric, internal medicine-pediatrics (IM-Peds), and family medicine residency programs between September 2007 and January 2008 about childhood obesity training offered in their programs. The response rate was 42.2% (299/709) and ranged by specialty from 40.1% to 45.4%. Overall, 52.5% of respondents felt that childhood obesity training in residency was extremely important, and the majority of programs offered training in aspects of childhood obesity management including prevention (N = 240, 80.3%), diagnosis (N = 282, 94.3%), diagnosis of complications (N = 249, 83.3%), and treatment (N = 242, 80.9%). However, only 18.1% (N = 54) of programs had a formal childhood obesity curriculum with variability across specialties. Specifically, 35.5% of IM-Peds programs had a formal curriculum compared to only 22.6% of pediatric and 13.9% of family medicine programs (p obesity training was competing curricular demands (58.5%). While most residents receive training in aspects of childhood obesity management, deficits may exist in training quality with a minority of programs offering a formal childhood obesity curriculum. Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children.
Linzer, Mark; Poplau, Sara; Babbott, Stewart; Collins, Tracie; Guzman-Corrales, Laura; Menk, Jeremiah; Murphy, Mary Lou; Ovington, Kay
General internal medicine (GIM) careers are increasingly viewed as challenging and unsustainable. We aimed to assess academic GIM worklife and determine remediable predictors of stress and burnout. We conducted an email survey. Physicians, nurse practitioners, and physician assistants in 15 GIM divisions participated. A ten-item survey queried stress, burnout, and work conditions such as electronic medical record (EMR) challenges. An open-ended question assessed stressors and solutions. Results were categorized into burnout, high stress, high control, chaos, good teamwork, high values alignment, documentation time pressure, and excessive home EMR use. Frequencies were determined for national data, Veterans Affairs (VA) versus civilian populations, and hospitalist versus ambulatory roles. A General Linear Mixed Model (GLMM) evaluated associations with burnout. A formal content analysis was performed for open-ended question responses. Of 1235 clinicians sampled, 579 responded (47 %). High stress was present in 67 %, with 38 % burned out (burnout range 10-56 % by division). Half of respondents had low work control, 60 % reported high documentation time pressure, half described too much home EMR time, and most reported very busy or chaotic workplaces. Two-thirds felt aligned with departmental leaders' values, and three-quarters were satisfied with teamwork. Burnout was associated with high stress, low work control, and low values alignment with leaders (all p less burnout than civilian counterparts (17 % vs. 40 %, p stress and burnout, division rates vary widely. Sustainability efforts within GIM could focus on visit length, staff support, schedule control, clinic chaos, and EMR stress.
To determine knowledge and skills competencies in internal medicine for the undergraduate curriculum in Saudi Arabia, competencies were identified based on group work utilizing common textbooks. The Delphi Technique was used as a consensus method to determine and prioritize competencies in internal medicine. A group of 20 clinicians rated the identified competencies from 0-3 (0: no need to know, 1: interesting to know, 2: should know and 3: must know). After formulating the results, a second Delphi round was conducted with 5 experts in internal medicine. A total of 1513 knowledge competencies and 189 skills competencies were determined and prioritized. The competencies corresponded to the 12 systems in internal medicine. All competencies rated 2.2-3.0 were produced separately and considered core competencies for the undergraduate internal medicine curriculum. Determining and prioritizing competencies should influence the curriculum reform process.
Bhogal, Ashvinder K; Brunger, Fern
To help family physicians practise effective genetic counseling and offer practical strategies for cross-cultural communication in the context of prenatal genetic counseling. PubMed and the Cochrane Database of Systematic Reviews were searched. Most evidence was level II and some was level III. The values and beliefs of practitioners, no less than those of patients, are shaped by culture. In promoting a patient's best interest, the assumptions of both the patient and the provider must be held up for examination and discussed in the attempt to arrive at a consensus. Through the explicit discussion and formation of trust, the health professionals, patients, and family members who are involved can develop a shared understanding of appropriate therapeutic goals and methods. Reflecting on the cultural nature of biomedicine's ideas about risk, disability, and normality helps us to realize that there are many valid interpretations of what is in a patient's best interest. Self-reflection helps to ensure that respectful communication with the specific family and patient is the basis for health care decisions. Overall, this helps to improve the quality of care.
Castillo, J-M; Agard, C; Artifoni, M; Brisseau, J-M; Connault, J; Durant, C; Espitia, O; Masseau, A; Neel, A; Perrin, F; Pistorius, M-A; Planchon, B; Ponge, T; Hamidou, M; Pottier, P
Clinical reasoning and treatment challenges within the scope of general practice led to the development of an internal medicine assistance line provided by Nantes University Hospital. The primary outcome of this study was to describe callers' profile, their requests and answers provided. A prospective, cross-sectional, observational, descriptive study was undertaken. For each call were identified the calling physician, her/his specialty and work setting, the call's object and adequacy, the answer provided, the time needed to connect with the assistance line, the time devoted by the internal medicine physician to provide an answer to the request, and whether the assistance line prevented a visit to the emergency room. Each calling physician was then called back to obtain demographic and professional characteristics, and data relating to the call and to the assistance line. Sixty-three days were analyzed and 276 calls identified. The 237 identified calling physicians were mainly females (54%, n=93), with a mean age of 46 years, graduated from Nantes University (65%, n=86), practicing ambulatory general medicine (69%, n=164) in Loire-Atlantique department area (82%, n=176) for a mean duration of 15 years. Calls were mostly associated with diagnostic challenges (61%, n=166) concerning clinical issues (57%, n=155). A sole telephone advice was the main type of answer provided (56%, n=147) and a visit to the emergency room was prevented for 17% of calls. The assistance line activity is adequate with its missions and seems to facilitate patients' healthcare delivery advocating for the development of similar structures in other units. Improvements relating to the information, availability and physicians' training should be considered. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.
Full Text Available Abstract Background There is a paucity of information describing patients with musculoskeletal disorders (MSDs using complementary and alternative medicines (CAMs and almost none distinguishing homeopathy from other CAMs. The objective of this study was to describe and compare patients with MSDs who consulted primary care physicians, either certified homeopaths (Ho or regular prescribers of CAMs in a mixed practice (Mx, to those consulting physicians who strictly practice conventional medicine (CM, with regard to the severity of their MSD expressed as chronicity, co-morbidity and quality of life (QOL. Methods The EPI3-LASER study was a nationwide observational survey of a representative sample of general practitioners and their patients in France. The sampling strategy ensured a sufficient number of GPs in each of the three groups to allow comparison of their patients. Patients completed a questionnaire on socio-demographics, lifestyle and QOL using the Short Form 12 (SF-12 questionnaire. Chronicity of MSDs was defined as more than twelve weeks duration of the current episode. Diagnoses and co-morbidities were recorded by the physician. Results A total of 825 GPs included 1,692 MSD patients (predominantly back pain and osteoarthritis were included, 21.6% in the CM group, 32.4% Ho and 45.9% Mx. Patients in the Ho group had more often a chronic MSD (62.1% than the CM (48.6% or Mx (50.3% groups, a result that was statistically significant after controlling for patients' characteristics (Odds ratio = 1.43; 95% confidence interval (CI: 1.07 - 1.89. Patients seen by homeopaths or mixed practice physicians who were not the regular treating physician, had more often a chronic MSD than those seen in conventional medicine (Odds ratios were1.75; 95% CI: 1.22 - 2.50 and 1.48; 95% CI: 1.06 - 2.12, respectively. Otherwise patients in the three groups did not differ for co-morbidities and QOL. Conclusion MSD patients consulting primary care physicians who
Sundsted, Karna K; Wieland, Mark L; Szostek, Jason H; Post, Jason A; Mauck, Karen F
The practice of outpatient general internal medicine requires a diverse and evolving knowledge base. General internists must identify practice-changing shifts in the literature and reflect on their impact. Accordingly, we conducted a review of practice-changing articles published in outpatient general internal medicine in 2014. To identify high-quality, clinically relevant publications, we reviewed all titles and abstracts published in the following primary data sources in 2014: New England Journal of Medicine, Journal of the American Medical Association (JAMA), Annals of Internal Medicine, JAMA Internal Medicine, and the Cochrane Database of Systematic Reviews. All 2014 primary data summaries from Journal Watch-General Internal Medicine and ACP JournalWise also were reviewed. The authors used a modified Delphi method to reach consensus on inclusion of 8 articles using the following criteria: clinical relevance to outpatient internal medicine, potential for practice change, and strength of evidence. Clusters of important articles around one clinical question were considered as a single-candidate series. The article merits were debated until consensus was reached on the final 8, spanning a variety of topics commonly encountered in outpatient general internal medicine. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available Polypharmacy and inappropriate medication prescriptions are associated with increased morbidity and mortality. Most interventions proposed to improve appropriate prescribing are time and resource intensive and therefore hardly applicable in daily clinical practice.To test the efficacy of an easy-to-use checklist aimed at supporting the therapeutic reasoning of physicians in order to reduce inappropriate prescribing and polypharmacy.We assessed the efficacy and safety of a 5-point checklist to be used by all physicians on the internal medicine wards of a Swiss hospital by comparing outcomes in 450 consecutive patients aged ≥65 years hospitalized after the introduction of the checklist, and in 450 consecutive patients ≥65 years hospitalized before the introduction of the checklist. The main measures were the proportion of patients with prescription of potentially inappropriate medications (PIMs at discharge, according to STOPP criteria, and the number of prescribed medications at discharge, before and after the introduction of the checklist. Secondary outcomes were the prevalence of polypharmacy (≥ 5 drugs and hyperpolypharmacy (≥ 10 drugs, and the prevalence of potentially inappropriate prescribing omissions (PPOs according to START criteria.At admission 59% of the 900 patients were taking > 5 drugs, 13% ≥ 10 drugs, 37% had ≥ 1 PIM and 25% ≥ 1 PPO. The introduction of the checklist was associated with a significant reduction by 22% of the risk of being prescribed ≥ 1 PIM at discharge (adjusted risk ratios [RR] 0.78; 95% CI: 0.68-0.94, but not with a reduction of at least 20% of the number of drugs prescribed at discharge, nor with a reduction of the risk of PPOs at discharge.The introduction of an easy-to-use 5-point checklist aimed at supporting therapeutic reasoning of physicians on internal medicine wards significantly reduced the risk of prescriptions of inappropriate medications at discharge.
Guignard, Bertrand; Bonnabry, Pascal; Perrier, Arnaud; Dayer, Pierre; Desmeules, Jules; Samer, Caroline Flora
Patients admitted to general internal medicine wards might receive a large number of drugs and be at risk for drug-related problems (DRPs) associated with increased morbidity and mortality. This study aimed to detect suboptimal drug use in internal medicine by a pharmacotherapy evaluation, to suggest treatment optimizations and to assess the acceptance and satisfaction of the prescribers. This was a 6-month prospective study conducted in two internal medicine wards. Physician rounds were attended by a pharmacist and a pharmacologist. An assessment grid was used to detect the DRPs in electronic prescriptions 24h in advance. One of the following interventions was selected, depending on the relevance and complexity of the DRPs: no intervention, verbal advice of treatment optimization, or written consultation. The acceptance rate and satisfaction of prescribers were measured. In total, 145 patients were included, and 383 DRPs were identified (mean: 2.6 DRPs per patient). The most frequent DRPs were drug interactions (21%), untreated indications (18%), overdosages (16%) and drugs used without a valid indication (10%). The drugs or drug classes most frequently involved were tramadol, antidepressants, acenocoumarol, calcium-vitamin D, statins, aspirin, proton pump inhibitors and paracetamol. The following interventions were selected: no intervention (51%), verbal advice of treatment optimization (42%), and written consultation (7%). The acceptance rate of prescribers was 84% and their satisfaction was high. Pharmacotherapy expertise during medical rounds was useful and well accepted by prescribers. Because of the modest allocation of pharmacists and pharmacologists in Swiss hospitals, complementary strategies would be required. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Steele, John C; Clark, Hadleigh J; Hong, Catherine H L; Jurge, Sabine; Muthukrishnan, Arvind; Kerr, A Ross; Wray, David; Prescott-Clements, Linda; Felix, David H; Sollecito, Thomas P
To explore international consensus for the validation of clinical competencies for advanced training in Oral Medicine. An electronic survey of clinical competencies was designed. The survey was sent to and completed by identified international stakeholders during a 10-week period. To be validated, an individual competency had to achieve 90% or greater consensus to keep it in its current format. Stakeholders from 31 countries responded. High consensus agreement was achieved with 93 of 101 (92%) competencies exceeding the benchmark for agreement. Only 8 warranted further attention and were reviewed by a focus group. No additional competencies were suggested. This is the first international validated study of clinical competencies for advanced training in Oral Medicine. These validated clinical competencies could provide a model for countries developing an advanced training curriculum for Oral Medicine and also inform review of existing curricula. Copyright © 2015 Elsevier Inc. All rights reserved.
Phang, Sen Han; Ravani, Pietro; Schaefer, Jeffrey; Wright, Bruce; McLaughlin, Kevin
Training in Bayesian reasoning may have limited impact on accuracy of probability estimates. In this study, our goal was to explore whether residents previously exposed to Bayesian reasoning use heuristics rather than Bayesian reasoning to estimate disease probabilities. We predicted that if residents use heuristics then post-test probability estimates would be increased by non-discriminating clinical features or a high anchor for a target condition. We randomized 55 Internal Medicine residents to different versions of four clinical vignettes and asked them to estimate probabilities of target conditions. We manipulated the clinical data for each vignette to be consistent with either 1) using a representative heuristic, by adding non-discriminating prototypical clinical features of the target condition, or 2) using anchoring with adjustment heuristic, by providing a high or low anchor for the target condition. When presented with additional non-discriminating data the odds of diagnosing the target condition were increased (odds ratio (OR) 2.83, 95% confidence interval [1.30, 6.15], p = 0.009). Similarly, the odds of diagnosing the target condition were increased when a high anchor preceded the vignette (OR 2.04, [1.09, 3.81], p = 0.025). Our findings suggest that despite previous exposure to the use of Bayesian reasoning, residents use heuristics, such as the representative heuristic and anchoring with adjustment, to estimate probabilities. Potential reasons for attribute substitution include the relative cognitive ease of heuristics vs. Bayesian reasoning or perhaps residents in their clinical practice use gist traces rather than precise probability estimates when diagnosing.
Garcia, Rina L; Windish, Donna M; Rosenbaum, Julie R
Few residency programs have centralized resources for career planning. As a consequence, little is known about residents' informational needs regarding career planning. To examine career preparation stressors, practical needs, and information that residents wished they were privy to when applying. In 2007 and 2008, we surveyed 163 recent graduates or graduating residents from 10 Yale-based and Yale-affiliated hospitals' internal medicine programs regarding their experiences with applying for positions after residency. We included questions about demographics, mentorship, stress of finding a job or fellowship, and open-ended questions to assess barriers and frustrations. Qualitative data were coded independently and a classification scheme was negotiated by consensus. A total of 89 residents or recent graduates responded, and 75% of them found career planning during residency training at least somewhat stressful. Themes regarding the application process included (1) knowledge about the process, (2) knowledge about career paths and opportunities, (3) time factors, (4) importance of adequate personal guidance and mentorship, and (5) self-knowledge regarding priorities and the desired outcome. Residents identified the following advice as most important: (1) start the process as early as possible and with a clear knowledge of the process timeline, (2) be clear about personal goals and priorities, and (3) be well-informed about a prospective employer and what that employer is looking for. Most residents felt career planning should be structured into the curriculum and should occur in the first year or throughout residency. This study highlights residents' desire for structured dissemination of information and counseling with regard to career planning during residency. Our data suggest that exposure to such resources may be beneficial as early as the first year of training.
Laube, Justin G R; Shapiro, Martin F
Health history questionnaires (HHQs) are a set of self-administered questions completed by patients prior to a clinical encounter. Despite widespread use, minimal research has evaluated the content of HHQs used in general internal medicine and family medicine (GIM/FM), integrative medicine, and complementary and alternative medicine (CAM; chiropractic, naturopathic, and Traditional Chinese Medicine [TCM]) clinics. Integrative medicine and CAM claim greater emphasis on well-being than does GIM/FM. This study investigated whether integrative medicine and CAM clinics' HHQs include more well-being content and otherwise differ from GIM/FM HHQs. HHQs were obtained from GIM/FM (n = 9), integrative medicine (n = 11), naturopathic medicine (n = 5), chiropractic (n = 4), and TCM (n = 7) clinics in California. HHQs were coded for presence of medical history (chief complaint, past medical history, social history, family history, surgeries, hospitalizations, medications, allergies, review of systems), health maintenance procedures (immunization, screenings), and well-being components (nutrition, exercise, stress, sleep, spirituality). In HHQs of GIM/FM clinics, the average number of well-being components was 1.4 (standard deviation [SD], 1.4) compared with 4.0 (SD, 1.1) for integrative medicine (p medicine (p = 0.04), 2.0 (SD, 1.4) for chiropractic (p = 0.54), and 2.0 (SD, 1.5) for TCM (p = 0.47). In HHQs of GIM/FM clinics, the average number of medical history components was 6.4 (SD, 1.9) compared with 8.3 (SD, 1.2) for integrative medicine (p = 0.01), 9.0 (SD, 0) for naturopathic medicine (p = 0.01), 7.1 (SD, 2.8) for chiropractic (p = 0.58), and 7.1 (SD, 1.7) for TCM (p = 0.41). Integrative and naturopathic medicine HHQs included significantly more well-being and medical history components than did GIM/FM HHQs. Further investigation is warranted to determine the optimal HHQ content to support the clinical and preventive
Jin, Qun; Jiang, Xiaohong; Park, James; ITME 2013
IT changes everyday’s life, especially in education and medicine. The goal of ITME 2013 is to further explore the theoretical and practical issues of IT in education and medicine. It also aims to foster new ideas and collaboration between researchers and practitioners.
Stites, Steven; Steffen, Patrick; Turner, Scott; Pingleton, Susan
A new metric was developed and implemented at the University of Kansas School of Medicine Department of Internal Medicine, the financial value unit (FVU). This metric analyzes faculty clinical compensation compared with clinical work productivity as a transparent means to decrease the physician compensation variability and compensate faculty equitably for clinical work.The FVU is the ratio of individual faculty clinical compensation compared with their total work relative value units (wRVUs) generated divided by Medical Group Management Association (MGMA) salary to wRVUs of a similar MGMA physician.The closer the FVU ratio is to 1.0, the closer clinical compensation is to that of an MGMA physician with similar clinical productivity. Using FVU metrics to calculate a faculty salary gap compared with MGMA median salary and wRVU productivity, a divisional production payment was established annually.From FY 2006 to FY 2011, both total faculty numbers and overall clinical activity increased. With the implementation of the FVU, both clinical productivity and compensation increased while, at the same time, physician retention rates remained high. Variability in physician compensation decreased. Dramatic clinical growth was associated with the alignment of clinical work and clinical compensation in a transparent and equable process.
Brandt-Rauf, Sherry I; Brandt-Rauf, Elka; Gershon, Robyn; Brandt-Rauf, Paul W
Genetic testing in the workplace holds the promise of improving worker health but also raises ethical, legal, and social issues. In considering such testing, it is critical to understand the perspectives of workers, who are most directly affected by it, and occupational health professionals, who are often directly involved in its implementation. Therefore, a series of focus groups of unionized workers (n=25) and occupational medicine physicians (n=23) was conducted. The results demonstrated strikingly different perspectives of workers and physicians in several key areas, including the goals and appropriateness of genetic testing, and methods to minimize its risks. In general, workers were guided by a profound mistrust of the employer, physician, and government, while physicians were guided primarily by scientific and medical concerns, and, in many cases, by the business concerns distrusted by the workers.
Sobocan, Monika; Turk, Neja; Dinevski, Dejan; Hojs, Radovan; Pecovnik Balon, Breda
Teaching using paper problem-based learning (p-PBL) sessions has left some students fatigued with the learning process. Therefore, attempts have been made to replace p-PBL with digitally enhanced, decision-making PBL in the form of virtual patients (VP). Student enthusiasm for substituting p-PBL with VP has not been quantitatively evaluated on the intended educational effects. To determine the educational effects of substituting p-PBL sessions with VP on undergraduate medical students in their internal medicine course. We conducted a randomised controlled study on 34 third-year undergraduate medical students in the academic year 2015-2016. Student performance after an intervention substituting p-PBL sessions with VP was analysed. The educational outcomes were measured with knowledge exams and the Diagnostic Thinking Inventory. There was no difference in exam performance between groups (P > 0.833) immediately after the intervention, or in long term. Nor was there a significant difference in improvement of diagnostic thinking between groups (P > 0.935 and P > 0.320). Our study showed no significant improvement in diagnostic thinking abilities or knowledge exam results with the use of VP. Educators can add VP to sessions to motivate students, but a significant improvement to educational outcome should not be expected. © 2016 Royal Australasian College of Physicians.
Full Text Available Objective: There are limited data regarding anger and its management with respect to physicians and many other professionals. Our objective was to evaluate anger expression and control in physicians. Material and Methods: The physicians of the Düzce School of Medicine were the participants in the study. Physicians were assigned to either an internal medicine or a surgery study group. Each group contained physicians from several specialties. The Spielberger State-Trait Anger Expression Inventory, and the Beck Anxiety and Depression Inventories were administered to all participants. The physicians (n=158 were evaluated and compared with controls (n=105 in terms of anger control and sociodemographic variables. Results: Anger-control scores were higher in physicians (p<0.01 and in those who willingly chose the medical profession (p<0.05. Age, number of years as a physician, and the specialty were negatively correlated with anger management in physicians working in the surgical disciplines (p<0.01. Only Beck anxiety and depression scores were positively correlated with anger-trait scores and anger-in scores for physicians working in the internal medicine disciplines (p<0.01.Conclusion: Physicians were relatively successful in coping with anger. A willingness to choose the medical profession was a factor influencing anger control. Age was the major factor affecting anger management in physicians.
Panda, Mukta; Desbiens, Norman A
Lifelong learning is an integral component of practice-based learning and improvement. Physicians need to be lifelong learners to provide timely, efficient, and state-of-the-art patient care in an environment where knowledge, technology, and social requirements are rapidly changing. To assess graduates' self-reported perception of the usefulness of a residency program requirement to submit a narrative report describing their planned educational modalities for their future continued medical learning ("Education for Life" requirement), and to compare the modalities residents intended to use with their reported educational activities. Data was compiled from the Education for Life reports submitted by internal medicine residents at the University of Tennessee College of Medicine Chattanooga from 1998 to 2000, and from a survey sent to the same 27 graduates 2 to 4 years later from 2000 to 2004. Twenty-four surveys (89%) were returned. Of the responding graduates, 58% (14/24) found the Education for Life requirement useful for their future continued medical learning. Graduates intended to keep up with a mean of 3.4 educational modalities, and they reported keeping up with 4.2. In a multivariable analysis, the number of modalities graduates used was significantly associated with the number they had planned to use before graduation (P = .04) but not with their career choice of subspecialization. The majority of residents found the Education for Life requirement useful for their future continued medical learning. Graduates, regardless of specialty, reported using more modalities for continuing their medical education than they thought they would as residents. Considering lifelong learning early in training and then requiring residents to identify ways to practice lifelong learning as a requirement for graduation may be dispositive.
Dantas, Bernardo M.; Dantas, Ana Leticia A.; Juliao, Ligia Q.C.; Lourenco, Maria Cristina; Melo, Dunstana R.
This work presents the simulation of the internal monitoring criteria application for the most used radionuclides by the area of nuclear medicine, taking into consideration the usual conditions of usual source handling and the activity bands authorized by the CNEN. It is concluded that the handling of Iodine 131 for therapeutical purposes is the practice which presents the most risk of internal exposure for the works, requiring the adoption of a program for internal monitoring by the nuclear medicine services
Vacca, Caludia; Acosta, Angela; Rodriguez, Ivan
To suggest a scheme of decision making on pricing for medicines that are part of Free Regulated Regime, a regulation way of the pharmaceutical pricing policy in Colombia. It includes two regulation tools: international reference prices and a cost minimization analysis methodology. Following the current pricing policy, international reference prices were built with data from five countries for selected medicines, which are under Free Regulated Regime. The cost minimization analysis methodology includes selection of those medicines under Free Regulated Regime with possible comparable medicines, selection of comparable medicines, and treatment costs evaluation. As a result of the estimate of International Reference Prices, four medicines showed in the domestic pharmaceutical market a bigger price than the Reference Price. A scheme of decision-making was design containing two possible regulation tools for medicines that are part of Free Regulated Regime: estimate of international reference prices and cost minimization analysis methodology. This diagram would be useful to assist the pricing regulation of Free Regulated Regime in Colombia. As present results shows, international reference prices make clear when domestic prices are higher than those of reference countries. In the current regulation of pharmaceutical prices in Colombia, the international reference price has been applied for four medicines. Would be suitable to extend this methodology to other medicines of high impact on the pharmaceutical expenditure, in particular those covered by public funding. The availability of primary sources about treatment costs in Colombia needs to be improved as a requirement to develop pharmaco-economic evidence. SISMED is an official database that represents an important primary source of medicines prices in Colombia. Nevertheless, having into account that SISMED represents an important advantage of transparency in medicines prices, it needs to be improved in quality and data
Kravitz Richard L
Full Text Available Abstract Background Specialty-specific data on career satisfaction may be useful for understanding physician workforce trends and for counseling medical students about career options. Methods We analyzed cross-sectional data from 6,590 physicians (response rate, 53% in Round 4 (2004-2005 of the Community Tracking Study Physician Survey. The dependent variable ranged from +1 to -1 and measured satisfaction and dissatisfaction with career. Forty-two specialties were analyzed with survey-adjusted linear regressions Results After adjusting for physician, practice, and community characteristics, the following specialties had significantly higher satisfaction levels than family medicine: pediatric emergency medicine (regression coefficient = 0.349; geriatric medicine (0.323; other pediatric subspecialties (0.270; neonatal/prenatal medicine (0.266; internal medicine and pediatrics (combined practice (0.250; pediatrics (0.250; dermatology (0.249;and child and adolescent psychiatry (0.203. The following specialties had significantly lower satisfaction levels than family medicine: neurological surgery (-0.707; pulmonary critical care medicine (-0.273; nephrology (-0.206; and obstetrics and gynecology (-0.188. We also found satisfaction was significantly and positively related to income and employment in a medical school but negatively associated with more than 50 work-hours per-week, being a full-owner of the practice, greater reliance on managed care revenue, and uncontrollable lifestyle. We observed no statistically significant gender differences and no differences between African-Americans and whites. Conclusion Career satisfaction varied across specialties. A number of stakeholders will likely be interested in these findings including physicians in specialties that rank high and low and students contemplating specialty. Our findings regarding "less satisfied" specialties should elicit concern from residency directors and policy makers since they
de Azevedo Marques, João Mazzoncini; Zuardi, Antonio W
To evaluate the validity and applicability of the Mini International Neuropsychiatric Interview (MINI) used by family medicine residents in primary health care (PHC) in Brazil. Training for administrating the MINI was given as part of a broad psychiatry education program. Interviews were held with 120 PHC patients who were at least 15 years old. MINI was administered by 25 resident physicians, while the Structured Clinical Interview for Diagnosis (SCID) was administered by a psychiatrist blind to patients' results on the MINI, and the diagnoses on both interviews were compared. The resident physicians answered questions on the applicability of the MINI. Concordance levels for any mental disorder, the broader current diagnostic categories and the most common specific diagnoses were analyzed. Kappa coefficients ranged between 0.65 and 0.85; sensitivity, between 0.75 and 0.92; specificity, between 0.90 and 0.99; positive predictive values (PPV), between 0.60 and 0.86; negative predictive values (NPV), between 0.92 and 0.99; and accuracy, between 0.88 and 0.98. The resident physicians considered MINI comprehensibility and clinical relevance satisfactory. These good psychometric results in a real-world setting may be related to a special training program, which is more frequent, intensive and diversified. In these conditions, the MINI is a useful tool for general practitioners.
Falcone, John L; Gonzalo, Jed D
To determine Internal Medicine residency program compliance with the Accreditation Council for Graduate Medical Education 80% pass-rate standard and the correlation between residency program size and performance on the American Board of Internal Medicine Certifying Examination. Using a cross-sectional study design from 2010-2012 American Board of Internal Medicine Certifying Examination data of all Internal Medicine residency pro-grams, comparisons were made between program pass rates to the Accreditation Council for Graduate Medical Education pass-rate standard. To assess the correlation between program size and performance, a Spearman's rho was calculated. To evaluate program size and its relationship to the pass-rate standard, receiver operative characteristic curves were calculated. Of 372 Internal Medicine residency programs, 276 programs (74%) achieved a pass rate of =80%, surpassing the Accreditation Council for Graduate Medical Education minimum standard. A weak correlation was found between residency program size and pass rate for the three-year period (p=0.19, pInternal Medicine residency programs complied with Accreditation Council for Graduate Medical Education pass-rate standards, a quarter of the programs failed to meet this requirement. Program size is positively but weakly associated with American Board of Internal Medicine Certifying Examination performance, suggesting other unidentified variables significantly contribute to program performance.
azadeh Khonsari; kourosh Gorji; arman Mousavi; foad Abdollahpur
Herbal medicine, a complementary and alternative medical system has been used to treat various diseases over thousands of years in many countries and the use of herbal medicine is growing in all of the world. Exploring the most frequently used herbs and herbal products in alternative and complementary medicine worldwide is a challenging issue because herbal medicine has been increased popularity among physicians and patients. The aim of this study was to systematically review literature repor...
Wardrop, Richard M; Berkowitz, Lee R
The promotion of change and growth within medical education is oftentimes the result of a complex mix of societal, cultural and economic forces. Graduate medical education in internal medicine is not immune to these forces. Several entities and organizations can be identified as having a major influence on internal medicine training and graduate medical education as a whole. We have reviewed how this is effectively accomplished through these entities and organizations. The result is a constantly changing and dynamic landscape for internal medicine training. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
Mraihi, Hamza; Chevaux, Fabienne; Castoni, Julien; Aebischer, Oriane; Christou, Foetini; Jaccard, Evrim; Benmachiche, Malik; Tasheva, Plamena; Giroud, Sabine; Kraege, Vanessa; Lamy, Olivier
The year 2016 was rich in significant advances in all areas of internal medicine. Many of them have an impact on our daily practice in general internal medicine. From the treatment of NSTEMI in population older than 80, to new sepsis and septic shock criteria to antidotes of new oral anticoagulants, this selection offers to the readers a brief overview of the major advances. The chief residents in the Service of internal medicine of the Lausanne University hospital are pleased to share their readings.
Pereg, David; Gronich, Naomi; Lishner, Michael
Recently, the popularity of internal medicine residency has been decreasing. We studied the effect of an improved working environment and a decrease in residents' workload on the selection of internal medicine residency. An organizational diagnosis team joined our department and identified several causes for residents' heavy workload. These findings were subsequently discussed in a workshop and led to a modification of the daily routine and a parallel decrease in workload and rise in residents' satisfaction. Following these changes, the demand for residency in our department rose. We conclude that an improvement in the working environment and workload during residency increases the residents' satisfaction and the demand for residency in internal medicine.
Cañigueral-Vila, Nuria; Chen, Jennifer C; Frenkel-Rorden, Lindsey; Laing, Richard
Some humanitarian and development organizations respond to major natural disasters and emergencies by donating medicines. Many provide medicines on a routine basis to support health systems, particularly those run by Faith-Based Organizations. Although such donations can provide essential medicines to populations in great need, inappropriate donations also take place, with burdensome consequences. The World Health Organization (WHO) has developed the interagency Guidelines for Medicine Donations for use by donors and recipients in the context of emergency aid and international development assistance. Although comprehensive in nature and transferable to various emergency situations, adjustments to both content and formatting would improve this resource. Recommendations for the next version of these guidelines include: specific wording and consistent formatting; definition of who is a recipient, clear distinction between acute and long-term emergencies, and proper donation procedures pertaining to each; inclusion of visual aides such as flowcharts, checklists, and photos; and improving the citations system.
Stoller, James K; Rose, Mark; Lee, Rita; Dolgan, Colleen; Hoogwerf, Byron J
The purpose of this report is to describe and evaluate the impact of a 1-day retreat focused on developing leadership skills and teambuilding among postgraduate year 1 residents in an internal medicine residency. A group of organizers, including members of the staff, the chief medical residents, administrative individuals in the residency office, and an internal organizational development consultant convened to organize an off-site retreat with activities that would provide experiential learning regarding teamwork and leadership, including a "reef survival exercise" and table discussions regarding the characteristics of ideal leaders. In addition, several energizing activities and recreational free time was provided to enhance the interaction and teamwork dimensions of the retreat. To evaluate the impact of the retreat, attendees completed baseline and follow-up questionnaires regarding their experience of the retreat. Attendees universally regarded the retreat as having value for them. Comparison of baseline to postretreat responses indicated that attendees felt that the retreat enhanced their abilities to be better physicians, resident supervisors, and leaders. Follow-up responses indicated significant increases in attendees' agreement that good leaders challenge the process, make decisions based on shared visions, allow others to act, recognize individual contributions, and serve as good role models. Results on the survival exercise indicated a high frequency with which team-based decisions surpassed individual members' decisions, highlighting the importance and value of teamwork to attendees. Our main findings were that: participants universally found this 1-day retreat beneficial in helping to develop teamwork and leadership skills and the experiential learning aspects of the retreat were more especially highly rated and highlighted the advantages of teamwork. In the context that this 1-day retreat was deemed useful by faculty and residents alike, further
Stoller, James K; Rose, Mark; Lee, Rita; Dolgan, Colleen; Hoogwerf, Byron J
OBJECTIVE The purpose of this report is to describe and evaluate the impact of a 1-day retreat focused on developing leadership skills and teambuilding among postgraduate year 1 residents in an internal medicine residency. METHOD A group of organizers, including members of the staff, the chief medical residents, administrative individuals in the residency office, and an internal organizational development consultant convened to organize an off-site retreat with activities that would provide experiential learning regarding teamwork and leadership, including a “reef survival exercise” and table discussions regarding the characteristics of ideal leaders. In addition, several energizing activities and recreational free time was provided to enhance the interaction and teamwork dimensions of the retreat. To evaluate the impact of the retreat, attendees completed baseline and follow-up questionnaires regarding their experience of the retreat. RESULTS Attendees universally regarded the retreat as having value for them. Comparison of baseline to postretreat responses indicated that attendees felt that the retreat enhanced their abilities to be better physicians, resident supervisors, and leaders. Follow-up responses indicated significant increases in attendees’ agreement that good leaders challenge the process, make decisions based on shared visions, allow others to act, recognize individual contributions, and serve as good role models. Results on the survival exercise indicated a high frequency with which team-based decisions surpassed individual members’ decisions, highlighting the importance and value of teamwork to attendees. CONCLUSIONS Our main findings were that: participants universally found this 1-day retreat beneficial in helping to develop teamwork and leadership skills and the experiential learning aspects of the retreat were more especially highly rated and highlighted the advantages of teamwork. In the context that this 1-day retreat was deemed useful
Royse, Colin F; Canty, David J; Faris, John; Haji, Darsim L; Veltman, Michael; Royse, Alistair
The use of ultrasound in the acute care specialties of anesthesiology, intensive care, emergency medicine, and surgery has evolved from discrete, office-based echocardiographic examinations to the real-time or point-of-care clinical assessment and interventions. "Goal-focused" transthoracic echocardiography is a limited scope (as compared with comprehensive examination) echocardiographic examination, performed by the treating clinician in acute care medical practice, and is aimed at addressing specific clinical concerns. In the future, the practice of surface ultrasound will be integrated into the everyday clinical practice as ultrasound-assisted examination and ultrasound-guided procedures. This evolution should start at the medical student level and be reinforced throughout specialist training. The key to making ultrasound available to every physician is through education programs designed to facilitate uptake, rather than to prevent access to this technology and education by specialist craft groups. There is evidence that diagnosis is improved with ultrasound examination, yet data showing change in management and improvement in patient outcome are few and an important area for future research.
Kuntz, Susan; Ali, Syed Haris; Hahn, Emily
An assessment of educational needs is essential for curricular reform in medical education. Using the conceptual framework of needs assessment, this study aimed to determine which content should be emphasized in teaching evidence-based medicine (EBM) skills to physician assistant (PA) students. Key content areas were identified from the published literature and objectives for previous courses. A questionnaire-type needs assessment instrument was created and given to a graduating class of PA students (n = 21) at the University of North Dakota. The response format had two 5-option scales, one to assess current skill levels and the other to assess ideal skill levels. Means for each category were calculated, and a mean difference analysis was performed. An average mean difference of 0.5 was noted in 3 domains (information retrieval skills, writing skills, and overall gains), and a mean difference of 0.7 was noted in one domain (statistical skills). Items with a mean difference of ≥ 0.7 were identified for prioritization for curricular reform. Open-ended input from respondents substantiated the need for greater emphasis on these content areas. Several content areas related to EBM skills can be identified and prioritized through a systematically conducted educational needs assessment. This method can be used to identify discrepancies between the existing and ideal states of affairs in PA education.
Shah, Siddharth P; Patel, Kinner M; Subedi, Rogin; Gambhir, Harvir Singh
Oseltamivir is a very commonly prescribed anti-viral medication by the Emergency Medicine (EM) physicians for the prophylactic and therapeutic treatment of Influenza infection. While the drug interaction of Warfarin with various antibiotics is known, the drug interaction between Oseltamivir and Warfarin is not common. We present a case where an 83-year female patient, on Warfarin for Pulmonary Embolism, had worsening of coagulopathy after she was started on Oseltamivir. The INR was monitored daily in our patient and Warfarin was stopped when the INR became supra-therapeutic. Our patient did not have any minor or major bleeding complication. This is the first reported case of Oseltamivir related worsening coagulopathy in patient on Warfarin to the best of our knowledge. Keeping in mind the possible interaction between the two as it was evident in our case and few other published reports, we recommend monitoring the INR closely in patients using Warfarin after they are started on Oseltamivir therapy. Copyright © 2017 Elsevier Inc. All rights reserved.
Tengilimoglu, Dilaver; Kisa, Adnan; Ekiyor, Aykut
In many developed countries, the physician/pharmaceutical sales representative relationship has increasingly become the focus of ethical questions. Given this context, the purpose of the present study was to determine the ethical dilemmas faced by pharmaceutical sales representatives in Turkey in their relations with physicians, and to identify possible solutions. Through an investigator-designed questionnaire, the ethical problems perceived by 215 pharmaceutical sales representatives were quantitatively analyzed. Nearly all of the participants (96.7%) reported that they had faced ethical dilemmas in marketing drugs to physicians. The most commonly reported problems included paramedical requests (for free lab test kits, etc.) and the necessity of bargaining with physicians over the use of their firm's drugs by offering gifts and sponsorships. The participants in the study felt that physicians were the primary source of ethical problems in the marketing of drugs, and the participants' most highly ranked potential solution to these ethical problems was a better understanding, on the part of physicians, of the role of pharmaceutical sales representatives. At the end of this study, suggestions are given with a view to helping health policy makers understand and address the current controversies involving drug company representatives and physicians.
Turner, Barbara J; Centor, Robert M; Rosenthal, Gary E
SGIM endoreses seven principles related to current thinking about internal medicine training: 1) internal medicine requires a full three years of residency training before subspecialization; 2) internal medicine residency programs must dramatically increase support for training in the ambulatory setting and offer equivalent opportunities for training in both inpatient and outpatient medicine; 3) in settings where adequate support and time are devoted to ambulatory training, the third year of residency could offer an opportunity to develop further expertise or mastery in a specific type or setting of care; 4) further certification in specific specialties within internal medicine requires the completion of an approved fellowship program; 5) areas of mastery in internal medicine can be demonstrated through modified board certification and recertification examinations; 6) certification processes throughout internal medicine should focus increasingly on demonstration of clinical competence through adherence to validated standards of care within and across practice settings; and 7) regardless of the setting in which General Internists practice, we should unite to promote the critical role that this specialty serves in patient care. PMID:16637826
Higgins Angela Y
Full Text Available Abstract Background The benefit of screening for decreasing the risk of death from colorectal cancer (CRC has been shown, yet many patients in primary care are still not undergoing screening according to guidelines. There are known variations in delivery of preventive health care services among primary care physicians. This study compared self-reported CRC screening rates and patient awareness of the need for CRC screening of patients receiving care from family medicine (FPs vs. internal medicine (internists physicians. Methods Nationally representative sample of non-institutionalized beneficiaries who received medical care from FPs or internists in 2006 (using Medicare Current Beneficiary Survey. The main outcome was the percentage of patients screened in 2007. We also examined the percentage of patients offered screening. Results Patients of FPs, compared to those of internists, were less likely to have received an FOBT kit or undergone home FOBT, even after accounting for patients' characteristics. Compared to internists, FPs' patients were more likely to have heard of colonoscopy, but were less likely to receive a screening colonoscopy recommendation (18% vs. 27%, or undergo a colonoscopy (43% vs. 46%, adjusted odds ratios [AOR], 95% confidence interval [CI]-- 0.65, 0.51-0.81 or any CRC screening (52% vs. 60%, AOR, CI--0.80, 0.68-0.94. Among subgroups examined, higher income beneficiaries receiving care from internists had the highest screening rate (68%, while disabled beneficiaries receiving care from FPs had the lowest screening rate (34%. Conclusion Patients cared for by FPs had a lower rate of screening compared to those cared for by internists, despite equal or higher levels of awareness; a difference that remained statistically significant after accounting for socioeconomic status and access to healthcare. Both groups of patients remained below the national goal of 70 percent.
Huang, Angela; Seshadri, Kapila; Matthews, Tara Anne; Ostfeld, Barbara M
Complementary and alternative medicine (CAM) use appears to be increasing in children with developmental disorders. However, it is not clear whether parents perceive their healthcare providers as resources who are knowledgeable about CAM therapies and are interested in further developing their knowledge. (1) To establish and compare use of, and perceived satisfaction with, traditional medicine and CAM in children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) and (2) to assess parental perceptions of physician knowledge of CAM and physician interest in continuing education about CAM for the two groups of parents. Families of children with a diagnosis of ADHD or ASD were surveyed regarding the frequency of use of traditional treatment and CAM, parental perceptions of the helpfulness of each therapy, parental perceptions regarding physicians' knowledge level about CAM, and physician interest in continuing education. Thirty-six percent (n=135) of 378 surveys were returned: 41 contained a diagnosis of ADHD and 22 of ASD. Traditional therapies were used by 98% of children with ADHD and 100% of those with ASD. Perceived helpfulne