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Balbach ML, Neely G, Yorke A, Figueroa-Medina E, Paly J, Shulman RM, Dempsey C, Shulman A, Biancia CD, Cutrer WB, Li BC. Developing an educational "hub": impact of a distance-learning curriculum in a multinational cohort. BMC Med Educ 2024; 24:406. [PMID: 38610008 PMCID: PMC11010438 DOI: 10.1186/s12909-024-05193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/17/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE To address a gap in radiation oncology education in low- and middle-income countries (LMICs), we sought to evaluate the effectiveness and generalizability of a refined curriculum on intensity modulated radiotherapy (IMRT) offered to existing radiation therapy (RT) clinics across Africa and Latin America (LATAM) at no cost. METHODS A curriculum was created based on prior needs assessments and adapted for participating medical physicists, radiation oncologists, radiation therapists, and trainees in LMICs. English-speaking and Spanish-speaking teams of volunteer educators delivered 27 hour-long sessions 1-2 times weekly for 4 months using video conferencing to African and LATAM cohorts, respectively. Pre- and post-course multiple-choice examinations were administered to LATAM participants, and pre- and post-course self-confidence (1-5 Likert-scale) and open-ended feedback were collected from all participants. RESULTS Twenty-five centers across Africa (13) and LATAM (12) participated, yielding a total of 332 enrolled participants (128 African, 204 LATAM). Sessions were delivered with a mean of 44 (22.5) and 85 (25.4) participants in the African and LATAM programs, respectively. Paired pre and post-course data demonstrated significant (p < 0.001) improvement in knowledge from 47.9 to 89.6% and self-confidence across four domains including foundations (+ 1.1), commissioning (+ 1.3), contouring (+ 1.7), and treatment planning (+ 1.0). Attendance was a significant predictor of change in self-confidence in "high attendance" participants only, suggesting a threshold effect. Qualitative data demonstrates that participants look forward to applying their knowledge in the clinical setting. CONCLUSION A specialized radiation oncology curriculum adapted for LMIC audiences was effective for both African and LATAM participants. Participant feedback suggests that the refined IMRT course empowered clinics with knowledge and confidence to help train others. This feasible "Hub and Spokes" approach in which a distance-learning course establishes a hub to be leveraged by spokes (learners) may be generalizable to others aiming to reduce global health care disparities through training efforts.
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Affiliation(s)
| | | | - Afua Yorke
- Department of Radiation Oncology, University of Washington Seattle, Seattle, WA, USA
| | | | - Jonathan Paly
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Adam Shulman
- University of Colorado, Boulder, Colorado, USA
- Rayos Contra Cancer, Nashville, TN, USA
| | | | | | - Benjamin C Li
- Rayos Contra Cancer, Nashville, TN, USA
- UCSF Department of Radiation Oncology, San Francisco, CA, USA
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Augustyniak M, Lou E, Jacobs G, Fleming M, Marshall J, Coutinho A, Yoshino T. Learning Outcomes of "GetSMART," Education for Diagnostics and Targeted Treatment for HER2+ Metastatic Gastric and Colorectal Cancers. J Cancer Educ 2024; 39:118-125. [PMID: 38135836 PMCID: PMC10995009 DOI: 10.1007/s13187-023-02384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 12/24/2023]
Abstract
The treatment landscape for patients affected by gastric and colorectal cancer (G&CRC) has significantly broadened over the past decade. Molecular diagnostic methods have improved with a precision oncology-driven approach to the development of treatment options tailored to specific molecular targets, including the human epidermal growth factor 2 (HER2). While scientific evidence on the role of HER2 in G&CRC has improved, there has been a lag in general understanding and applications of testing for HER2+ G&CRC and resulting targeting treatment in the wider oncology community. To better understand and address the root causes of this gap, a needs assessment deployed among 85 oncology care providers was conducted and informed the development of an accredited online educational program entitled "GetSMART." The program consisted of four modules developed and narrated by experts in gastrointestinal oncology. The educational content and assessment metrics were guided by a confidence-based assessment (CBA) model and the Moore, Green, and Gallis outcomes framework. Assessment methods consisted of quantitative pre- and post-activity tests, an evaluation embedded within the education (n = 163), and semi-structured interviews (n = 5) post-activity completion. Findings indicated that "GetSMART" enhanced participants' knowledge, confidence, and intent to change practice in relation to their (1) identification of HER2 aberrations, (2) selection of appropriate treatments for HER2+ G&CRC, and (3) ability to engage patients in shared decision-making and management of adverse events. "GetSMART" can therefore be a valuable educational resource for oncology HCPs caring for patients affected by HER2+ metastatic G&CRC, offering strategies to ensure an optimal team and patient-centered approach to the care being delivered.
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Affiliation(s)
| | - Emil Lou
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ginny Jacobs
- AXDEV Global, Inc, Virginia Beach, Virginia, USA
| | | | - John Marshall
- District of Columbia, Georgetown University, Washington, USA
| | - Anelisa Coutinho
- Multidisciplinary Oncology Institution, Clinica AMO, Salvador, Bahia, Brazil
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Aubignat M, Skierkowski H, Tir M. Descriptive study of general practitioner's practices and knowledge about Parkinson's disease in the north of France. Rev Neurol (Paris) 2024:S0035-3787(24)00477-6. [PMID: 38556412 DOI: 10.1016/j.neurol.2024.02.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 01/04/2024] [Accepted: 02/03/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Parkinson's disease (PD), the second most frequent neurodegenerative disease, constitutes a major public health challenge. A guide published by the French National Authority for Health in 2012 and revised in 2016 put forward recommendations for general practitioners (GP) planning care pathways for parkinsonian patients. It is well known that PD can be difficult to diagnose, and that when patients consult their GP, symptoms are often still limited and embedded in clinical uncertainty. This means the pathway to confirmed diagnosis of PD can be lengthy and uncertain. Consequently, it is important to identify the difficulties GPs encounter when caring for PD patients in order to help them better close the gaps in care strategies. METHODS We conducted a descriptive cross-sectional survey in northern France to evaluate GP practices and knowledge about PD and their accordance with care pathway recommendations. The survey was conducted using a 30-item questionnaire sent to a sample of GPs. RESULTS There were 164 GPs who responded to the study questionnaire. The responding GPs generally followed current care pathway recommendations. In presence of a parkinsonian syndrome, 93.3% of the GPs reported systematically looking for an iatrogenic cause; 57.4% did not announce the diagnosis without the advice of a neurologist; 97.6% referred patients to a neurologist when they suspected PD; and 80.5% asked the neurologist to modify treatments. Our findings also revealed some difficult aspects of GP practices: only 2.5% had had additional training in neurology; only 53.6% felt comfortable with the diagnosis of PD; 63.6% prescribed additional exams for the diagnosis; most of the GPs were unaware of second-line treatments and their indications, and finally existence of PD expert centers was unknown for 85.2%. CONCLUSIONS These findings could be useful to guide implementation of new measures supporting more holistic care for PD patients; PD expert centers in France could provide complementary information and training for GPs.
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Affiliation(s)
- M Aubignat
- Neurology Department and Parkinson's Disease Expert Center, University Hospital of Amiens, Amiens, France.
| | - H Skierkowski
- Department of General Medicine, University of Picardy Jules-Verne (UPJV), Amiens, France
| | - M Tir
- Neurology Department and Parkinson's Disease Expert Center, University Hospital of Amiens, Amiens, France
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Davis CS, Carr DH, Stein BD. Drug-related physician continuing medical education requirements, 2010-2020. J Subst Use Addict Treat 2024; 161:209356. [PMID: 38548061 DOI: 10.1016/j.josat.2024.209356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/25/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION The crisis of drug-related harm in the United States continues to worsen. While prescription-related overdoses have fallen dramatically, they are still far above pre-2010 levels. Physicians can reduce the risk of overdose and other drug-related harms by improving opioid prescribing practices and ensuring that patients are able to easily access medications for substance use disorder treatment. Most physicians received little or no training in those subjects in medical school. It is possible that continuing medical education can improve physician knowledge of appropriate prescribing and substance use disorder treatment and patient outcomes. METHODS Descriptive legal review. Laws in all 50 states and the District of Columbia were searched for provisions that require all or most physicians to receive either one-time or continuing medical education regarding controlled substance prescribing, pain management, or substance use disorder treatment. RESULTS There has been a rapid increase in the number of states with relevant requirements, from three states at the end of 2010 to 42 at the end of 2020. The frequency and duration of required education varied substantially across states. In all states, the number of hours required in relevant topics is a small fraction of overall required continuing education, an average of 1 h per year. Despite recent shifts in the substances driving overdose, most requirements remain focused on opioids. CONCLUSION While most states have now adopted continuing education requirements regarding controlled substance prescribing, pain management, or substance use disorder treatment, these requirements comprise a small component of the required post-training education requirements. Research is needed to determine whether this training translates into reductions in drug-related harm.
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Affiliation(s)
- Corey S Davis
- Harm Reduction Legal Project, Network for Public Health Law, 3701 Wilshire Blvd. #750, Los Angeles, CA 90010, United States of America.
| | - Derek H Carr
- Network for Public Health Law, United States of America
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Rodríguez de Castro F, Carrillo Díaz T, Gual I Sala A, Palés Argullós J. [Human resources in the National Health System. Medical education. SESPAS Report 2024]. Gac Sanit 2024:S0213-9111(24)00027-X. [PMID: 38643057 DOI: 10.1016/j.gaceta.2024.102380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 04/22/2024]
Abstract
The problems posed by medical education in Spain are diverse. This paper analyzes the system currently used to select candidates who will be admitted to a public faculty of medicine in Spain and some issues arising from the unprecedented increase in both public and private medical schools in our country. The importance of generic competencies in today's medicine and the need to return to a core design in specialist training are other aspects that are discussed. The degree of development of advanced accreditation diplomas and areas of specific competence is also subject to analysis. Finally, the authors emphasize the importance of continuous professional development and the idea of professional recertification as a system that guarantees patients the quality of the care they receive.
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Affiliation(s)
- Felipe Rodríguez de Castro
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España; Fundación de Educación Médica, Barcelona, España.
| | - Teresa Carrillo Díaz
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
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Yang S, Zhao H, Zhang H, Wang J, Jin H, Stirling K, Ge X, Ma L, Pu Z, Niu X, Yu D. Current status and continuing medical education need for general practitioners in Tibet, China: a cross-sectional study. BMC Med Educ 2024; 24:265. [PMID: 38459539 PMCID: PMC10924353 DOI: 10.1186/s12909-024-05143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/07/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND The Tibetan area is one of China's minority regions with a shortage of general practice personnel, which requires further training and staffing. This research helps to understand the current condition and demand for general practitioner (GP) training in Tibetan areas and to provide a reference for promoting GP education and training. METHODS We conducted a cross-sectional survey using stratified sampling targeting 854 GPs in seven cities within the Tibetan Autonomous Region, utilizing an online questionnaire. Achieving a high response rate of 95.1%, 812 GPs provided invaluable insights. Our meticulously developed self-designed questionnaire, available in both Chinese and Tibetan versions, aimed to capture a wide array of data encompassing basic demographics, clinical skills, and specific training needs of GPs in the Tibetan areas. Prior to deployment, the questionnaire underwent rigorous development and refinement processes, including expert consultation and pilot testing, to ensure its content validity and reliability. In our analysis, we employed descriptive statistics to present the characteristics and current training needs of GPs in the Tibetan areas. Additionally, chi-square tests were utilized to examine discrepancies in training needs across various demographic groups, such as age, job positions, and educational backgrounds of the participating GPs. RESULTS The study was completed by 812 (812/854, 95.1%) GPs, of whom 62.4% (507/812) were female. The top three training needs were hypertension (81.4%, 661/812), pregnancy management (80.7%, 655/812), and treatment of related patient conditions and events (80.5%, 654/812). Further research shows that the training required by GPs of different ages in "puncturing, catheterization, and indwelling gastric tube use" (64.6% vs. 54.8%, p = 9.5 × 10- 6) varies statistically. GPs in various positions have different training needs in "community-based chronic disease prevention and management" (76.6% vs. 63.9%, p = 0.009). The training needs of GPs with different educational backgrounds in "debridement, suturing, and fracture fixation" (65.6% vs. 73.2%, p = 0.027) were also statistically significant. CONCLUSIONS This study suggests the need for targeted continuing medical education activities and for updating training topics and content. Course developers must consider the needs of GPs, as well as the age, job positions, and educational backgrounds of GPs practicing in the Tibetan Plateau region. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Sen Yang
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China
- Department of General Practice, Lazi County Health Service Center, Xigatse, Tibet, 858100, PR China
| | - Huaxin Zhao
- Department of Oncology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Hanzhi Zhang
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China
| | - Junpeng Wang
- Medical Administration Affiliationision, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, PR China
| | - Hua Jin
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, PR China
| | - Kyle Stirling
- Crisis Technologies Innovation Lab, Luddy School of Informatics, Computing and Engineering, Indiana University, Bloomington, IN, 47408, USA
| | - Xuhua Ge
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China
| | - Le Ma
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China
| | - Zhen Pu
- Department of General Practice, Lazi County Health Service Center, Xigatse, Tibet, 858100, PR China
| | - Xiaomin Niu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 Huaihai West Road, Shanghai, 200030, PR China.
| | - Dehua Yu
- Department of General Practice, Research Center for General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu District, Shanghai, 200090, PR China.
- Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, PR China.
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Protz K, Dissemond J, Augustin M, Janke TM. [Acquisition, status and transfer of knowledge in compression therapy : Cross-sectional study in healthcare professions using phlebological compression therapy]. Dermatologie (Heidelb) 2024:10.1007/s00105-024-05314-x. [PMID: 38413502 DOI: 10.1007/s00105-024-05314-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Due to scientific progress, healthcare professionals should regularly undergo appropriate continuing education. For this, knowledge transfer is essential. Therefore, the aim of this cross-sectional study was to investigate the acquisition, status and transfer of knowledge of professional groups applying phlebological compression therapy in Germany. MATERIALS AND METHODS Healthcare professionals (physicians, nurses and medical assistants) received a questionnaire developed for this study, which queried different aspects of acquisition, status and transfer of knowledge. RESULTS Responses from 522 participants were analysed. The topic of compression therapy was not taught in the nursing or medical education of 43.3%. Specialist journals that address compression therapy were read regularly (at least 6 times/year) by 16.1% of the participants; 63.0% had no specialist books on this subject. Only 6.7% were aware of AWMF ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften") guidelines on the topic and 16.3% of the corresponding DNQP ("Deutsches Netzwerk für Qualitätsentwicklung in der Pflege") expert standard. In all, 41.2% participated in at least one internal training on compression therapy per year, 72.0% in external training and 19.2% in online training. A total of 30.7% stated that they did not use any information sources to acquire knowledge. CONCLUSIONS Possible sources of knowledge about compression therapy in Germany are insufficiently known within the investigated healthcare professional groups studied or are not regularly used. The result is a considerable knowledge deficit with a discrepancy between the current state of science and practice.
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Affiliation(s)
- Kerstin Protz
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Deutschland
| | - Matthias Augustin
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Toni Maria Janke
- CWC - Comprehensive Wound Center, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
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Fazekas C, Zieser M, Hanfstingl B, Saretzki J, Kunschitz E, Zieser-Stelzhammer L, Linder D, Matzer F. Physician resilience and perceived quality of care among medical doctors with training in psychosomatic medicine during the COVID-19 pandemic: a quantitative and qualitative analysis. BMC Health Serv Res 2024; 24:249. [PMID: 38413956 PMCID: PMC10900785 DOI: 10.1186/s12913-024-10681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/03/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND At an individual level, physician resilience protects against burnout and against its known negative effects on individual physicians, patient safety, and quality of care. However, it remains uncertain whether physician resilience also correlates with maintaining a high level of healthcare quality during crises such as a pandemic. This study aimed to investigate whether higher resilience among physicians, who had received training in resilience-related competences in the past, would be associated with higher quality of care delivered during the COVID-19 pandemic. METHODS This study enrolled physicians working in family medicine, psychiatry, internal medicine, and other medical specialties, who had obtained at least one of three consecutive diplomas in psychosomatic medicine in the past. Participants completed a quantitative and qualitative anonymous online survey. Resilience was measured using the Connor-Davidson Resilience Scale, and healthcare quality was assessed through single-item quality indicators, including perceived quality of care, professional autonomy, adequate time for patient care, and job satisfaction. RESULTS The study included 229 physicians (70 males/159 females) with additional training in psychosomatic medicine, working in family medicine (42.5%), psychiatry (28.1%), internal medicine (7.0%), or other medical specialties (22.4%). Participants represented four intensity levels of training background (level 1 to level 4: 9.2%, 32.3%, 46.3%, and 12.2% of participants). Training background in psychosomatic medicine was positively associated with resilience (B = 0.08, SE = 0.04, p <.05). Resilience and training background independently predicted perceived quality of care, even after controlling for variables such as own health concerns, involvement in the treatment of COVID-19 patients, financial strain, percentage of working hours spent on patient care, age, and gender (resilience: B = 0.33, SE = 0.12, p <.01; training background: B = 0.17, SE = 0.07, p <.05). Both resilience and training background predicted job satisfaction (resilience: B = 0.42, SE = 0.12, p <.001; training background: B = 0.18, SE = 0.07, p <.05), while resilience alone predicted professional autonomy (B = 0.27, SE = 0.12, p <.05). In response to an open question about their resources, resilient physicians more frequently reported applying conscious resilient skills/emotion regulation (p <.05) and personal coping strategies (p <.01) compared to less resilient medical doctors. CONCLUSION Physician resilience appears to play a significant role in the perceived quality of patient care, professional autonomy, and job satisfaction during healthcare crises.
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Affiliation(s)
- Christian Fazekas
- Department of Psychiatry, Psychosomatics and Psychotherapy, Division of Medical Psychology, Psychosomatics and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria.
| | | | | | | | - Evelyn Kunschitz
- II. Medical Department for Cardiology, Hanusch Hospital, Vienna, Austria
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Hanusch Hospital, Vienna, Austria
| | - Luise Zieser-Stelzhammer
- Department of Psychosocial, Psychosomatic and Psychotherapeutic Medicine, Austrian Medical Association, Vienna, Austria
| | - Dennis Linder
- Department of Psychiatry, Psychosomatics and Psychotherapy, Division of Medical Psychology, Psychosomatics and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Franziska Matzer
- Department of Psychiatry, Psychosomatics and Psychotherapy, Division of Medical Psychology, Psychosomatics and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria
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Bendayan M, Bonneau C, Delespierre MT, Sais E, Picard F, Alter L, Boitrelle F, Cazabat L. Evaluating the satisfaction and utility of social networks in medical practice and continuing medical education. BMC Med Educ 2024; 24:186. [PMID: 38395875 PMCID: PMC10893748 DOI: 10.1186/s12909-024-05149-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Digital health has surged during the Covid health crisis, and the use of social media, already prevalent in medicine, has significantly increased. There are Social Networks groups dedicated to physicians with an educational purpose. These groups also facilitate peer discussions on medical questions and the sharing of training materials. OBJECTIVES The aim of our study was to assess the value of these new tools and their contribution to medical education. METHODS An anonymous questionnaire was conducted among members of a Social Networks community group for physicians. The survey received responses from 1451 participants. RESULTS The majority of participants believed they had enriched their medical knowledge and accessed documents they would not have accessed without the group. Subgroup analysis showed that the contribution of this tool is more pronounced for general practitioners and doctors practicing in limited healthcare access. CONCLUSION It is essential to develop digital tools that enhance physician training, and social networks represent a valuable educational tool.
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Affiliation(s)
- Marion Bendayan
- Service de Biologie de la Reproduction- Andrologie- CECOS, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, 10 rue du Champ Gaillard, 78300, Poissy, France.
- INRAE, ENVA, BREED, UVSQ, Université Paris Saclay Jouy-en-Josas, Gif-sur-Yvette, France.
| | - Claire Bonneau
- Département de chirurgie, Institut Curie- Saint-Cloud, 35 rue Dailly, 92210, Saint Cloud, France
- Inserm U900, Institut Curie, Université Versailles Saint Quentin en Yvelines, Université Paris Saclay, Saint-Cloud, France
| | - Mai Thi Delespierre
- Département de Médecine Générale, Faculté de médecine de Montpellier-Nîmes, Nîmes, France
| | - Emine Sais
- Service de Biologie de la Reproduction- Andrologie- CECOS, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, 10 rue du Champ Gaillard, 78300, Poissy, France
- INRAE, ENVA, BREED, UVSQ, Université Paris Saclay Jouy-en-Josas, Gif-sur-Yvette, France
| | - Fanie Picard
- Service de Biologie de la Reproduction- Andrologie- CECOS, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, 10 rue du Champ Gaillard, 78300, Poissy, France
| | - Laura Alter
- Service de Biologie de la Reproduction- Andrologie- CECOS, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, 10 rue du Champ Gaillard, 78300, Poissy, France
| | - Florence Boitrelle
- Service de Biologie de la Reproduction- Andrologie- CECOS, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, 10 rue du Champ Gaillard, 78300, Poissy, France
- INRAE, ENVA, BREED, UVSQ, Université Paris Saclay Jouy-en-Josas, Gif-sur-Yvette, France
| | - Laure Cazabat
- UMR 1198 BREED, équipe RHuMA, UFR Simone Veil Santé, Université Versailles Saint Quentin en Yvelines, Université Paris Saclay, Paris, France
- Service de Neurochirurgie, Hôpital Foch, Suresnes, France
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Jindal SK, Lee T, Agrawal A, Demers L, Schwartz AW. A National Survey on Point of Care Ultrasonography Use Among Veterans Affairs Clinicians in Home Care and Skilled Nursing Facilities. J Am Med Dir Assoc 2024:104930. [PMID: 38336356 DOI: 10.1016/j.jamda.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Older adults who are homebound and those in skilled nursing facilities (SNFs) often have limited access to point of care imaging to inform clinical decision making. Point-of-care ultrasonography (POCUS) can help span this gap by augmenting the physical examination to aid in diagnosis and triaging. Although training in POCUS for medical trainees is becoming more common and may focus on settings such as the emergency department, intensive care unit, and inpatient care, little is known about POCUS training among practicing clinicians who work outside of these settings. We conducted a national needs assessment survey around experience with POCUS focused on practicing clinicians in the sub-acute, long-term, and home-based care settings in the Veterans Affairs (VA) health system. METHODS An electronic survey was developed and sent out to clinicians via Listservs for the VA long-term and sub-acute care facilities [Community Living Centers (CLCs)], Home Based Primary Care outpatient teams, and Hospital in Home teams to assess current attitudes, previous training, and skills related to POCUS. RESULTS Eighty-eight participants responded to the survey, for an overall response rate of 29% based on the number of emails on each Listserv, representing CLC, home-based primary care, and hospital in home. Sixty percent of clinicians reported no experience with POCUS, and 76% reported that POCUS and POCUS training would be useful to their practice. More than 50% cited lack of training and lack of equipment as 2 significant barriers to POCUS use. DISCUSSION This national needs assessment survey of VA clinicians reveals important opportunities for training in POCUS for clinicians working with older adults who are receiving home care homebound or living in SNFs.
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Affiliation(s)
- Shivani K Jindal
- Cincinnati VA Medical Center, Medical Service, Cincinnati, OH, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA.
| | | | - Arushi Agrawal
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lindsay Demers
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
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11
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Simon NT, Niblock FC, Rabaza CA, Hoss ML, Sheeder JK, Hurt KJ. Family medicine physician identification of obstetric lacerations: a US national survey. Int Urogynecol J 2024; 35:391-399. [PMID: 38078914 DOI: 10.1007/s00192-023-05689-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS We evaluated family medicine obstetric providers' identification and categorization of vaginal delivery lacerations in the USA. We hypothesized that there would be inaccuracy in family medicine physicians' identification of vaginal delivery injuries, similar to our previous studies of midwives and obstetricians (OBs). METHODS We included clinically active physicians who attended deliveries within 2 years and evaluated their identification and categorization of delivery lacerations using descriptive text and visual images. We asked about their education on this topic and how they document lacerations in the labor and delivery record. RESULTS We analyzed 250 completed responses (70% of opened surveys). Fifty-five percent of respondents characterized their obstetric laceration training as "good" or "excellent" and half previously had education on obstetric lacerations. The median accuracy overall for the classification and identification of perineal lacerations was 78% (IQR 56-91%). Respondents frequently mischaracterized nonperineal lacerations. Few respondents (36%) reported using the third-degree injury subclassification system. In adjusted analysis, the highest scoring respondents were board certified in family medicine, with fewer years in practice, and a higher obstetric volume. CONCLUSIONS Obstetric laceration diagnoses may be inaccurate, which could influence perinatal quality and patient outcomes. We found gaps in knowledge similar to previous reports on midwives and obstetricians in the USA. These data suggest a need for increased education and training on obstetric injuries, perhaps especially for physicians with less obstetric activity. Improved categorization and identification of vaginal delivery trauma can impact management and improve women's postpartum care and long-term pelvic floor outcomes.
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Affiliation(s)
- Natalie T Simon
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Franklin C Niblock
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Cristina A Rabaza
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Molly L Hoss
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Jeanelle K Sheeder
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - K Joseph Hurt
- Divisions of Maternal Fetal Medicine and Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.
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Okpalauwaekwe U, Holinaty C, Smith-Windsor T, Barton JW, MacLean C. From field of dreams to back to the future? Exploring barriers to participating in continuing professional development (CPD) programs. BMC Med Educ 2024; 24:106. [PMID: 38302979 PMCID: PMC10835933 DOI: 10.1186/s12909-024-05038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND In 2009, Yvonne Steinert et al., at McGill University, published a study exploring barriers to faculty development (FD) participation among urban faculty. Over a decade later, we set out to replicate and expand on that study to learn what has changed in continued professional development (CPD) and what the current barriers are to participation in CPD for specialists and family physicians in rural and urban locations. METHODS Informed by a collaborative inquiry research framework, we invited faculty across rural and urban Saskatchewan to focus groups and interview sessions. The results were analyzed for themes. RESULTS Thirty-four faculty members from both rural and urban areas participated in this study. Of these, 50% were female, 74% practiced in urban areas, and 56% had over 20 years of experience. Frequently cited reasons for nonparticipation included time constraints, organizational and logistical challenges, poor resonance with material and presenters, and lack of recognition for teaching provided. Racism contributed to feelings of disconnectedness among physician faculty members. CONCLUSION Even after more than a decade, our research uncovered consistent reasons for nonparticipation in locally organized CPD events. New findings highlighted feelings of disconnectedness, notably stemming from racism and workplace discrimination. However, with recent societal developments brought about by the COVID-19 pandemic, can we ride these major waves of change to a new future of engagement? The pandemic led to a shift to virtual and hybrid professional development programs, presenting both benefits and challenges. Additionally, the peri-COVID anti-racism movement may positively address previously unidentified reasons for nonattendance. Harnessing these major changes could lead to a new future of engagement for continued professional development.
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Affiliation(s)
- Udoka Okpalauwaekwe
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7M 3Y5, Canada.
| | - Carla Holinaty
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7M 3Y5, Canada
| | - Tom Smith-Windsor
- College of Medicine, Victoria Hospital, Prince Albert, SK, S6V 5T4, Canada
| | - James W Barton
- College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
| | - Cathy MacLean
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, S7M 3Y5, Canada.
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13
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Páez DC, Flórez J, Gómez MT, García D, Arango-Paternina CM, Duperly J. Curricular and pedagogical approaches for physical activity prescription training: a mixed-methods study of the "Exercise is Medicine" workshops in Colombia. BMC Med Educ 2024; 24:79. [PMID: 38254169 PMCID: PMC10804704 DOI: 10.1186/s12909-023-04999-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The physical activity (PA) prescription workshop for physicians, through the global health initiative "Exercise is Medicine" (EIM), has trained more than 4000 health care professionals (HCPs) in Latin America. It has shown to be effective in increasing PA prescription knowledge and awareness among HCPs. The purpose of this paper is to evaluate the curricular and pedagogical approach used by EIM Colombia at the PA prescription workshops implemented between 2014 and 2015. METHODS A mixed methods study, with a sequential explanatory design was implemented among a convenience sample of HCPs attending twenty-six PA prescription workshops. HCPs health status, PA personal habits, and medical practices were collected using a questionnaire at baseline among 795 participants (pre-test measurement), and subsequently quantitatively analyzed. A workshop satisfaction survey was administered after the completion of the workshop among 602 HCPs. The curricular and pedagogical approach of the workshop, the designers' and students' contextual factors, and perceptions about the workshop were measured using qualitative methods (analysis of the procedures manual, two workshop observations, three semi-structured interviews, and one focus group including 8 HCPs). RESULTS The workshop is student-centered and guided by an expert with an academic and clinical background. Learning was achieved with theoretical and practical components using authentic performance and collaborative learning. An active teaching and learning approach was used with strategies such as interactive lectures, hands-on elements, and role-playing (patient-counselor). The workshop emphasized an individual approach when prescribing PA integrating in clinical practice not only health benefits but also patient´s beliefs, motivations, needs, and barriers. CONCLUSIONS Evidence-based practices and authentic performance were the most salient pedagogical elements used by EIM Colombia at the PA prescription workshop. A knowledge assessment that includes the practical aspect is suggested for future workshops. The curricular and pedagogical approach of the PA prescription workshop implemented in Colombia is well received by the medical community and a useful continuing medical education intervention with a potential contribution to current, and future health promotion needs.
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Affiliation(s)
- Diana C Páez
- School of Medicine, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia.
| | - Johanna Flórez
- School of Medicine, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia
| | - María Teresa Gómez
- School of Medicine, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia
- Centro de Investigación y Formación en Educación, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia
| | - Daniel García
- Centro de Investigación y Formación en Educación, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia
| | - Carlos M Arango-Paternina
- Instituto Universitario de Educación Física y Deporte, Universidad de Antioquia, Calle 74 # 70 - 59, Medellín, Colombia
| | - John Duperly
- School of Medicine, Universidad de los Andes, Carrera 1, #18a-12, Bogotá, Colombia
- Institute of Exercise Medicine and Rehabilitation, Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia
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Wang YF, Lee YH, Lee CW, Shih YZ, Lee YK. Differences in patient-physician communication between the emergency department and other departments in a hospital setting in Taiwan. BMC Health Serv Res 2023; 23:1279. [PMID: 37986078 PMCID: PMC10662510 DOI: 10.1186/s12913-023-10311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Communication fosters trust and understanding between patients and physicians, and specific communication steps help to build relationships. Communication in the emergency department may be different from that in other departments due to differences in medical purposes and treatments. However, the characteristics of communication in the clinical settings of various departments have not been explored nor compared. OBJECTIVES This study aimed to construct the steps in patient-physician communication based on the Roter Communication Model and compare communication performance between the emergency department and three other clinical settings-internal medicine, surgery, and family medicine departments. METHODS Both qualitative and quantitative approaches were adopted. First, in-depth interviews were used to analyze clinical communication steps and meanings. Then, a quantitative questionnaire was designed based on the interview results to investigate differences in communication between the emergency department and the other three departments. Qualitative and quantitative data were analyzed from 20 interviews and 98 valid questionnaires. RESULTS Patient-physician communication consists of four steps and ten factors. The four steps-greeting and data gathering, patient education and counseling, facilitation and patient activation, and building a relationship-had significant progressive effects. Patient education and counseling had an additional significant effect on building a relationship. The emergency department performed less well in the facilitation and patient activation, building a relationship step and the evaluation method, enhancement method, and attitude factors than the other departments. CONCLUSIONS To improve the quality of patient-physician communication in the emergency department, physicians should strengthen the steps of facilitation and patient activation to encourage patients' active engagement in their health care.
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Affiliation(s)
- Yi-Fen Wang
- Department of Senior Citizen Services, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Ya-Hui Lee
- Department of Adult & Continuing Education, National Chung Cheng University, Chiayi, Taiwan
| | - Chen-Wei Lee
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County, 622, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Ze Shih
- Department of Adult & Continuing Education, National Chung Cheng University, Chiayi, Taiwan
| | - Yi-Kung Lee
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County, 622, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
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McKay J, Needham E, Walsh W. Including Patient Voices in Continuing Medical Education: One Provider's Experience. J CME 2023; 12:2275504. [PMID: 37942272 PMCID: PMC10629417 DOI: 10.1080/28338073.2023.2275504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
In 2021, UpToDate began offering continuing medical education (CME) planned and delivered by patients. The patient-authored medical topic reviews focus on lessons learned from interactions with the healthcare system and emphasise quality of life for those living with specific conditions. Having access to the patient voice at the point of care provides clinicians with a perspective that can improve patient-provider communication and promote shared decision-making. Participants who viewed the patient-authored topics were emailed a survey about the content; several responses indicated that the new topics were useful in clinical practice. While positive responses demonstrate that clinicians value the patient perspective, we also received replies from participants and from the patient authors themselves indicating there is more work to be done in developing patient-led CME. As more patients are invited to join the conversation, their expertise will be increasingly recognised as integral to CME.
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Affiliation(s)
- Jennifer McKay
- Editorial Operations, Content Management Analyst – CME/CPD, Wolters Kluwer, Waltham, MA, USA
| | - Emma Needham
- Editorial Operations, Content Editing Coordinator – Pediatrics, CME, Wolters Kluwer, Waltham, MA, USA
| | - Wendy Walsh
- Editorial Operations, Editorial Consultant, Wolters Kluwer, Waltham, MA, USA
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16
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Yan H, Han Z, Nie H, Yang W, Nicholas S, Maitland E, Zhao W, Yang Y, Shi X. Continuing medical education in China: evidence from primary health workers' preferences for continuing traditional Chinese medicine education. BMC Health Serv Res 2023; 23:1200. [PMID: 37924090 PMCID: PMC10623727 DOI: 10.1186/s12913-023-10153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Continuing Medical Education (CME) is an important part of the training process for health workers worldwide. In China, training in Traditional Chinese Medicine (TCM) not only improves the expertise of medical workers, but also supports the Chinese Government's policy of promoting TCM as an equal treatment to western medicine. CME, including learning Traditional Chinese Medicine Technologies (TCMTs), perform poorly and research into the motivation of health workers to engage in CME is urgently required. Using a discrete choice experiment, this study assessed the CME learning preferences of primary health workers, using TCMT as a case study of CME programs. METHODS We conducted a discrete choice experiment among health workers in Shandong Province, Guizhou Province, and Henan provinces from July 1, 2021 to October 1, 2022 on the TCMT learning preferences of primary health workers. The mixed logit model and latent class analysis model were used to analyze primary health workers' TCMT learning preferences. RESULTS A total of 1,063 respondents participated in this study, of which 1,001 (94.2%) passed the consistency test and formed the final sample. Our key finding was that there were three distinct classes of TCMT learners. Overall, the relative importance of the seven attributes impacting the learning of TCMTs were: learning expenses, expected TCMT efficacy, TCMT learning difficulty, TCMT mode of learning, TCMT type, time required to learn, and expected frequency of TCMT use. However, these attributes differed significantly across the three distinct classes of TCMT learners. Infrequent users (class 1) were concerned with learning expenses and learning difficulty; workaholics (class 2) focused on the mode of learning; and pragmatists (class 3) paid more attention to the expected TCMT efficacy and the expected frequency of TCMT use. We recommend targeted strategies to motivate TCMT learning suited to the requirements of each class of TCMT learners. CONCLUSION Rather than a single TCMT medical education program for primary health workers, CME programs should be targeted at different classes of TCMT learners.
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Affiliation(s)
- Hao Yan
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Zhaoran Han
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Hanlin Nie
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Wanjin Yang
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China
- Newcastle Business School, University of Newcastle, Callaghan, NSW, Australia
| | - Elizabeth Maitland
- University of Liverpool Management School, University of Liverpool, Liverpool, UK
| | - Weihan Zhao
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Yong Yang
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China.
- National Institute of Traditional Chinese Medicine Strategy and Development, Beijing University of Chinese Medicine, Beijing, China.
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Álvarez-Montero S, Crespí P, Gómez-Salgado J, Ramírez-Durán MV, Rodríguez-Gabriel MDP, Coronado-Vázquez V. Assessment of a medical student mentoring programme to improve attitudes related to grief and coping with death. Heliyon 2023; 9:e20959. [PMID: 37916093 PMCID: PMC10616318 DOI: 10.1016/j.heliyon.2023.e20959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/28/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023] Open
Abstract
Objectives To evaluate the impact of a mentoring programme for medical students doing a palliative care rotation, aimed at improving coping with death and attitudes towards the suffering produced by illness. Methods A quasi-experimental study without a control group was carried out on second-year medical students. Five 1-h group sessions were conducted. Attitudes towards grief and coping with death were assessed before the mentoring programme began and afterwards, using the Brief Humanizar Scale and the Bugen's Coping with Death Scale, respectively. Results In terms of the sense of grieving as measured by the Brief Humanizar Scale, the mean score for the 'Burden' factor was 7 points and for the 'Change' factor it was 28.6, indicating that suffering makes more sense as a lever for positive change than as a burden. Regarding Bugen's Coping with Death Scale, the mean score was 127.8 points before the mentoring programme and 139.2 afterwards. Hence, the score after the mentoring programme increased by 11.4 points, improving strategies to cope with death. Conclusion Medical professionals must cope with death and end-of-life patients. In addition to scientific knowledge, students need to acquire competencies for better coping with the death of patients, with mentoring programmes helping to enhance this process of learning.
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Affiliation(s)
| | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health. Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Program. Universidad Espíritu Santo, Guayaquil, Ecuador
| | | | | | - Valle Coronado-Vázquez
- Universidad Francisco de Vitoria, Madrid, Spain
- B21-20R Group, Instituto Aragonés de Investigaciones Sanitarias, University of Zaragoza, Zaragoza, Spain
- Las Cortes Health Centre, Madrid Health Service, Madrid, Spain
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Senulytė A, Vasiliauskaitė G, Rudzikaitė-Fergizė G, Grigaitienė J. Psychodermatology in Lithuania. A survey on knowledge, awareness, and practice patterns in Lithuanian dermatovenereologists. Arch Dermatol Res 2023; 315:2351-2357. [PMID: 37162577 DOI: 10.1007/s00403-023-02631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
The aim of this study was to evaluate the knowledge, awareness, and practice patterns of Lithuanian dermatovenereologists regarding psychocutaneous medicine. An online survey questionnaire was distributed to the members of the Lithuanian Association of Dermatovenereologists and to dermatovenereologists through public and private healthcare institutions in Lithuania. The questionnaire consisted of questions related to dermatovenereologists' awareness, knowledge, experience, and training needs regarding psychocutaneous disorders. 50% of respondents reported having a good or excellent understanding and knowledge of psychodermatology, and 42% feel prepared to consult psychodermatology patients. 54% of doctors rated their preparedness to prescribe psychopharmacological treatment as poor. The most frequent diagnoses referred to mental health professionals were dermatitis artefacta, acne excoriée, other self-inflicted dermatoses, trichotillomania, and pruritus. The most common course of action with patients at high risk of suicide or other acute psychiatric condition was trying to provide psychological support during dermatovenereology consultation. The most frequent management tactic for patients with chronic psychological problems was a referral to a psychiatrist. 85% of all respondents would participate in educational events about psychodermatology. 70% expressed interest in events about psychopharmacological treatment in dermatology. Lithuanian dermatovenereologists have a good understanding and knowledge of psychodermatology and are willing to further their education in this field. However, some gaps remain. Many doctors reported feeling poorly prepared to administer psychopharmacological treatment to their patients and there seems to be a lack of formal training in psychodermatology in Lithuania.
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Affiliation(s)
- Augustė Senulytė
- Clinic of Infectious Diseases and Dermatovenerology, Vilnius University Faculty of Medicine, Vilnius, Lithuania.
| | - Gabrielė Vasiliauskaitė
- Clinic of Infectious Diseases and Dermatovenerology, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | | | - Jūratė Grigaitienė
- Vilnius University Hospital Santaros Klinikos Centre of Dermatovenereology, Vilnius, Lithuania
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Bao G, Yang P, Yi J, Peng S, Liang J, Li Y, Guo D, Li H, Ma K, Yang Z. Full-sized realistic 3D printed models of liver and tumour anatomy: a useful tool for the clinical medicine education of beginning trainees. BMC Med Educ 2023; 23:574. [PMID: 37582729 PMCID: PMC10428657 DOI: 10.1186/s12909-023-04535-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/24/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Simulation-based medical education (SBME) and three-dimensional printed (3DP) models are increasingly used in continuing medical education and clinical training. However, our understanding of their role and value in improving trainees' understanding of the anatomical and surgical procedures associated with liver surgery remains limited. Furthermore, gender bias is also a potential factor in the evaluation of medical education. Therefore, the aim of this study was to evaluate the educational benefits trainees receive from the use of novel 3DP liver models while considering trainees' experience and gender. METHODS Full-sized 3DP liver models were developed and printed using transparent material based on anonymous CT scans. We used printed 3D models and conventional 2D CT scans of the liver to investigate thirty trainees with various levels of experience and different genders in the context of both small group teaching and formative assessment. We adopted a mixed methods approach involving both questionnaires and focus groups to collect the views of different trainees and monitors to assess trainees' educational benefits and perceptions after progressing through different training programs. We used Objective Structured Clinical Examination (OSCE) and Likert scales to support thematic analysis of the responses to the questionnaires by trainees and monitors, respectively. Descriptive analyses were conducted using SPSS statistical software version 21.0. RESULTS Overall, a 3DP model of the liver is of great significance for improving trainees' understanding of surgical procedures and cooperation during operation. After viewing the personalized full-sized 3DP liver model, all trainees at the various levels exhibited significant improvements in their understanding of the key points of surgery (p < 0.05), especially regarding the planned surgical procedure and key details of the surgical procedures. More importantly, the trainees exhibited higher levels of satisfaction and self-confidence during the operation regardless of gender. However, with regard to gender, the results showed that the improvement of male trainees after training with the 3DP liver model was more significant than that of female trainees in understanding and cooperation during the surgical procedure, while no such trend was found with regard to their understanding of the base knowledge. CONCLUSION Trainees and monitors agreed that the use of 3DP liver models was acceptable. The improvement of the learning effect for practical skills and theoretical understanding after training with the 3DP liver models was significant. This study also indicated that training with personalized 3DP liver models can improve all trainees' presurgical understanding of liver tumours and surgery and males show more advantage in understanding and cooperation during the surgical procedure as compared to females. Full-sized realistic 3DP models of the liver are an effective auxiliary teaching tool for SBME teaching in Chinese continuing medical education.
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Affiliation(s)
- Guoqiang Bao
- Department of General Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, 710038, China
| | - Ping Yang
- Department of General Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, 710038, China
| | - Jiangpu Yi
- 3D Printing Research Center of Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Shujia Peng
- Department of General Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, 710038, China
| | - Jiahe Liang
- 3D Printing Research Center of Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yajie Li
- Xi 'an Ma Ke Medical Technology Ltd, Room 21516, Block C, Chaoyang International Plaza, Xi'an, Shaanxi, China
| | - Dian Guo
- Xi 'an Ma Ke Medical Technology Ltd, Room 21516, Block C, Chaoyang International Plaza, Xi'an, Shaanxi, China
| | - Haoran Li
- Department of General Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, 710038, China
| | - Kejun Ma
- Xi 'an Ma Ke Medical Technology Ltd, Room 21516, Block C, Chaoyang International Plaza, Xi'an, Shaanxi, China
| | - Zhenyu Yang
- Department of General Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, Shaanxi, 710038, China.
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Noya FC, Carr SE, Thompson SC. Expert consensus on the attributes and competencies required for rural and remote junior physicians to work effectively in isolated indonesian communities. Adv Health Sci Educ Theory Pract 2023:10.1007/s10459-023-10275-2. [PMID: 37556029 DOI: 10.1007/s10459-023-10275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 08/06/2023] [Indexed: 08/10/2023]
Abstract
Indonesian physicians working in rural and remote areas must be equipped not only with generic competencies but also with the attributes and skills necessary to provide health care services without compromising quality. This study sought to reach a consensus on the attributes and competencies that are viewed as essential and important for working effectively as an early career doctor in rural and remote practice in Indonesia. A two-round Delphi study was conducted by reference to 27 consenting physicians working in rural and remote Indonesia. Forty-three items covering 9 attributes and 34 competencies were sent to these physicians to be rated on a Likert scale ranging from 1 to 5 in terms of their importance for effective rural and remote practice. Nine attributes and 29 competencies progressed to Round 2. All nine attributes and 29 competencies were identified as essential or important for junior physicians' ability to be effective in their practice. The essential attributes included professional quality related to prioritising the rural community. The essential competencies included medical skills, professional behaviour, interprofessional skills, health promotion and connection to the rural community. The consensus thus reached on these essential and important attributes and competencies can inform curriculum development for the undergraduate and postgraduate training of junior rural and remote physicians.
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Affiliation(s)
- Farah C Noya
- Division of Health Professions Education, School of Allied Health, The University of Western Australia, Perth, Australia.
- Medical Education Unit, Faculty of Medicine, Universitas Pattimura, Ambon, Indonesia.
| | - Sandra E Carr
- Division of Health Professions Education, School of Allied Health, The University of Western Australia, Perth, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Australia
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21
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Daubert JP, Tedrow U. Heart Rhythm Society Education Council Update. Heart Rhythm 2023; 20:1216-1218. [PMID: 37517863 DOI: 10.1016/j.hrthm.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 08/01/2023]
Affiliation(s)
- James P Daubert
- Cardiology Division, Department of Medicine, Duke University, Durham, North Carolina.
| | - Usha Tedrow
- Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Yee MS, Tarshis J. Anesthesia quality indicators to measure and improve your practice: a modified delphi study. BMC Anesthesiol 2023; 23:256. [PMID: 37525089 PMCID: PMC10388503 DOI: 10.1186/s12871-023-02195-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 07/02/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Implementation of the new competency-based post-graduate medical education curriculum has renewed the push by medical regulatory bodies in Canada to strongly advocate and/or mandate continuous quality improvement (cQI) for all physicians. Electronic anesthesia information management systems contain vast amounts of information yet it is unclear how this information could be used to promote cQI for practicing anesthesiologists. The aim of this study was to create a refined list of meaningful anesthesia quality indicators to assist anesthesiologists in the process of continuous self-assessment and feedback of their practice. METHODS An initial list of quality indicators was created though a literature search. A modified-Delphi (mDelphi) method was used to rank these indicators and achieve consensus on those indicators considered to be most relevant. Fourteen anesthesiologists representing different regions across Canada participated in the panel. RESULTS The initial list contained 132 items and through 3 rounds of mDelphi the panelists selected 56 items from the list that they believed to be top priority. In the fourth round, a subset of 20 of these indicators were ranked as highest priority. The list included items related to process, structure and outcome. CONCLUSION This ranked list of anesthesia quality indicators from this modified Delphi study could aid clinicians in their individual practice assessments for continuous quality improvement mandated by Canadian medical regulatory bodies. Feasibility and usability of these quality indicators, and the significance of process versus outcome measures in assessment, are areas of future research.
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Affiliation(s)
- May-Sann Yee
- Southlake Regional Health Centre, Newmarket, ON, L3Y 2P9, Canada.
| | - Jordan Tarshis
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Rottman BM, Caddick ZA, Nokes-Malach TJ, Fraundorf SH. Cognitive perspectives on maintaining physicians' medical expertise: I. Reimagining Maintenance of Certification to promote lifelong learning. Cogn Res Princ Implic 2023; 8:46. [PMID: 37486508 PMCID: PMC10366070 DOI: 10.1186/s41235-023-00496-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Until recently, physicians in the USA who were board-certified in a specialty needed to take a summative test every 6-10 years. However, the 24 Member Boards of the American Board of Medical Specialties are in the process of switching toward much more frequent assessments, which we refer to as longitudinal assessment. The goal of longitudinal assessments is to provide formative feedback to physicians to help them learn content they do not know as well as serve an evaluation for board certification. We present five articles collectively covering the science behind this change, the likely outcomes, and some open questions. This initial article introduces the context behind this change. This article also discusses various forms of lifelong learning opportunities that can help physicians stay current, including longitudinal assessment, and the pros and cons of each.
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Affiliation(s)
- Benjamin M Rottman
- Learning Research and Development Center, University of Pittsburgh, 3420 Forbes Ave., Pittsburgh, PA, 15260, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Zachary A Caddick
- Learning Research and Development Center, University of Pittsburgh, 3420 Forbes Ave., Pittsburgh, PA, 15260, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Timothy J Nokes-Malach
- Learning Research and Development Center, University of Pittsburgh, 3420 Forbes Ave., Pittsburgh, PA, 15260, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Scott H Fraundorf
- Learning Research and Development Center, University of Pittsburgh, 3420 Forbes Ave., Pittsburgh, PA, 15260, USA.
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA.
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Jankie S, Sewdass K, Smith W, Naraynsingh C, Johnson J, Farnon N, Mahadeo K, Motilal S. A cross-sectional survey of prospective healthcare professionals' knowledge, attitudes and perceptions of medical Cannabis. Explor Res Clin Soc Pharm 2023; 10:100275. [PMID: 37168830 PMCID: PMC10165452 DOI: 10.1016/j.rcsop.2023.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
Background Compounds isolated from Cannabis possess many beneficial effects creating a renewed worldwide interest in its therapeutic potential. With increased legalization for medicinal use globally, healthcare professionals must be familiar with the drug's uses and potential adverse effects. Objective To determine prospective healthcare providers' knowledge, attitude and perception to medical Cannabis. Method A self-administered online questionnaire comprising 21 questions to assess the knowledge, attitude and perception of medical Cannabis was distributed via google forms among students at the Faculty of Medical Sciences, the University of the West Indies, St Augustine Campus. Chi-square analysis was used to detect significant associations between demographics and measured variables. A p-value <0.05 was considered significant. Results Popular perceived therapeutic benefits of Cannabis were chronic pain (91.2%), anxiety (84.2%) and seizures (71.1%), and identification of the risks associated with the use of Cannabis was low. Users of Cannabis were able to identify indications and symptoms that can be treated with Cannabis but were less aware of the adverse effects of the drug than non-users (p < 0.001). More than three-quarters (87.3%) believed they could identify therapeutic uses and adverse effects but only 14.2% were ready to answer queries from patients. The main source of Cannabis information was the internet and information was lacking in the medical school curriculum. Conclusion The majority of students could not identify the drug's indications and adverse effects. There is a need to improve training for all prospective medical personnel to cater for the change in legislation status.
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Affiliation(s)
- Satish Jankie
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
- Corresponding author at: School of Pharmacy, Faculty of Medical Sciences, Building 39, Ground Floor, Eric Williams Medical Sciences Complex, Champ Fleurs, Mt Hope, Trinidad and Tobago.
| | - Keshav Sewdass
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - William Smith
- School of Dentistry, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Candy Naraynsingh
- School of Dentistry, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Jenelle Johnson
- School of Veterinary Medicine, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Niall Farnon
- Optometry Unit, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Kavita Mahadeo
- School of Advanced Nursing, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Department of ParaClinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
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Oh N, Choi GS, Lee WY. ChatGPT goes to the operating room: evaluating GPT-4 performance and its potential in surgical education and training in the era of large language models. Ann Surg Treat Res 2023; 104:269-273. [PMID: 37179699 PMCID: PMC10172028 DOI: 10.4174/astr.2023.104.5.269] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 05/15/2023] Open
Abstract
Purpose This study aimed to assess the performance of ChatGPT, specifically the GPT-3.5 and GPT-4 models, in understanding complex surgical clinical information and its potential implications for surgical education and training. Methods The dataset comprised 280 questions from the Korean general surgery board exams conducted between 2020 and 2022. Both GPT-3.5 and GPT-4 models were evaluated, and their performances were compared using McNemar test. Results GPT-3.5 achieved an overall accuracy of 46.8%, while GPT-4 demonstrated a significant improvement with an overall accuracy of 76.4%, indicating a notable difference in performance between the models (P < 0.001). GPT-4 also exhibited consistent performance across all subspecialties, with accuracy rates ranging from 63.6% to 83.3%. Conclusion ChatGPT, particularly GPT-4, demonstrates a remarkable ability to understand complex surgical clinical information, achieving an accuracy rate of 76.4% on the Korean general surgery board exam. However, it is important to recognize the limitations of large language models and ensure that they are used in conjunction with human expertise and judgment.
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Affiliation(s)
- Namkee Oh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Jiménez-Alés R, Páez-González R, de la Torre-Quiralte ML, Poch-Olivé ML, Boukichou-Abdelkader N, Andrés Esteban EM. Creation and validation of an instrument to quantify attitudes, knowledge and difficulties in the approach to social problems. An Pediatr (Barc) 2023:S2341-2879(23)00093-5. [PMID: 37121812 DOI: 10.1016/j.anpede.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/17/2022] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVES The aim of the study was to develop and validate a questionnaire to assess attitudes, knowledge and difficulties in the management of social problems by paediatric care providers. METHODS The development of the tool started with a conceptualization phase, followed by the design, pilot testing and psychometric evaluation of the questionnaire based on the responses obtained from 407 professionals. We performed exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess the construct validity of the questionnaire. We used the normed fit index (NFI), the root mean square error of approximation (RMSEA), the χ2 test and the comparative fit index (CFI) to test the goodness of fit. We assessed reliability through the Cronbach's α coefficient of internal consistency. All quantitative analyses were performed with the Stata/SE software, version16.1. RESULTS The EFA identified twelve factors. All factors exhibited a good internal consistency (Cronbach's α, 0.8434). The CFA showed the model was a good fit (RMSEA=0.037). The NAI and CAI values were 0.742 and 0.797, respectively. CONCLUSIONS This questionnaire comprising 138 items distributed in twelve factors is a reliable and valid instrument to analyse the attitudes, knowledge and difficulties in the approach to social problems in children by paediatricians, which will allow the design of interventions according to the needs and deficiencies identified through it.
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Affiliation(s)
| | | | | | | | - Nisa Boukichou-Abdelkader
- Unidad de Ciencia del Dato, Innovación Sanitaria de La Rioja. Fundación Rioja Salud, CIBIR, Logroño, Spain
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Titus SJ, Badar P, Coston Z, Khan F, Ogola GO, Ahmed KW. COVID-19's impact on family medicine resident training and wellness. Proc AMIA Symp 2023; 36:490-495. [PMID: 37334074 PMCID: PMC10269402 DOI: 10.1080/08998280.2023.2204795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background The COVID-19 global pandemic has raised many challenges in training family medicine residents. Family medicine is at the frontline for treating and managing patients with COVID-19. Attention is needed on the critical issue of the effect of the pandemic on resident training, the safety of those performing needed medical services, and the psychological well-being of trainees. Methods We performed a cross-sectional, 25-question survey-based study to evaluate the perceived effect of the COVID-19 pandemic on family medicine residents' training and residents' well-being in the state of Texas. Results A total of 250 Texas-based family medicine residents were surveyed with a response rate of 12.8% (n = 32). After the pandemic began, all residents worried about exposing their loved ones to COVID-19, and 65% felt like the COVID-19 pandemic negatively impacted their training overall. Respondents indicated that changes occurred in their respective residency curricula that altered training such as canceling of scheduled lectures (84.3%) and more telemedicine visits (56.25%). There was a significant difference for postgraduate year level and the effect on rotation assignments, with more disruption to the first- and third-year residents (P = 0.03). Conclusions The COVID-19 pandemic has had a notable impact on the perception of quality of training and mental health within family medicine. Our findings may guide programs in how to proactively target pandemic-related training challenges.
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Affiliation(s)
- Stephen J. Titus
- Department of Family Medicine, Baylor University Medical Center, Dallas, Texas
| | - Parivash Badar
- Department of Family Medicine, Baylor University Medical Center, Dallas, Texas
| | - Zachary Coston
- Department of Family Medicine, Baylor University Medical Center, Dallas, Texas
| | - Fatima Khan
- Department of Family Medicine, Baylor University Medical Center, Dallas, Texas
| | - Gerald O. Ogola
- Biostatistics Core, Baylor Scott & White Research Institute, Dallas, Texas
| | - Kashif Waqiee Ahmed
- Department of Graduate Medical Education, Baylor University Medical Center, Dallas, Texas
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Jang A, Kim MR, Lee SMK, Ha IH, Shin JY, McClain R, Lee J. Evaluating the effectiveness of online Continuing medical education during the COVID-19 pandemic. Med Teach 2023:1-7. [PMID: 37013818 DOI: 10.1080/0142159x.2023.2183787] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
OBJECTIVES The study determined the effects of online continuing medical education (CME) on the clinical competency, performance, and patient outcomes of physicians and other healthcare professionals during the COVID-19 pandemic regarding the topics of COVID-19 and back pain. METHODS Survey studies on six online CME activities were conducted from April 2020 to February 2021 at a South Korean hospital. Surveys were conducted immediately after and three months after the CME activity to measure the effectiveness of the CME activity regarding professional competence and performance, as well as patient outcomes. RESULTS A total of 624 individuals participated in the six CME activities. Of the 2007 post-activity responses, a total of 1135 out of 1332 (85.21%) participants indicated that they were satisfied with the online education activities, and a total of 1752 out of 2007 (87.29%) participants responded that the content would influence their clinical practice. Upon a three-month follow-up, 477 out of 611 (78.07%) respondents indicated that they had made actual changes to their clinical practice. CONCLUSIONS The online delivery method is effective for delivering CME. The results suggest that online CME ultimately influences physicians' clinical competency and performance, which leads to enforcing change in clinical practice.
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Affiliation(s)
- Andrew Jang
- Jaseng Medical Academy, Seoul, Republic of Korea
| | - Me-Riong Kim
- Jaseng Medical Academy, Seoul, Republic of Korea
| | | | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Ji-Yun Shin
- Jaseng Medical Academy, Seoul, Republic of Korea
| | - Rance McClain
- Arkansas College of Osteopathic Medicine, Arkansas Colleges of Health Education, Fort Smith, USA
| | - Jinho Lee
- Jaseng Hospital of Korean Medicine, Seoul, South Korea
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Pariser AC, Brita J, Harrigan M, Capozza S, Khairallah A, Sanft TB. Delivery of Cancer Survivorship Education to Community Healthcare Professionals. J Cancer Educ 2023; 38:625-631. [PMID: 35394562 PMCID: PMC8991658 DOI: 10.1007/s13187-022-02164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 05/20/2023]
Abstract
Our pilot study aimed to evaluate the needs of community oncology providers with regard to cancer survivorship education, develop a survivorship curriculum based on the needs assessment, and evaluate the acceptability of the Project ECHO® (Extension for Community Healthcare Outcomes) model for delivery of the survivorship curriculum. A needs assessment was delivered to participants in suburban community cancer practices, and a curriculum was developed based on the results. Participants were enrolled in an ECHO curriculum consisting of 6 sessions from October to December 2019. Participants included registered nurses (RN), registered dietitians (RD), clinical social workers (LCSW), advanced practice providers (APP), radiation oncologists, and medical oncologists (MD). Participants were invited to participate in exit interviews designed to better evaluate the participant experience. Ninety percent of needs assessment participants (n = 37) expressed an interest in cancer survivorship education. Eight participants from 3 community practices in suburban Connecticut enrolled in the ECHO curriculum. Four participants (50%) agreed to participate in exit interviews. Five themes emerged from the exit interviews: interest in survivorship, time, positive experience, empowerment, and community. Our Survivorship ECHO pilot demonstrated the acceptability of the Project ECHO® model for delivering cancer survivorship education to oncology providers. Further research confirming the feasibility of this model in additional oncology provider settings is needed.
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Affiliation(s)
- Ashley C Pariser
- Division of Medical Oncology, Wexner Medical Center, The Ohio State University, 1800 Cannon Drive, Lincoln Tower Suite 1300L, Columbus, OH, 43210, USA.
| | - Javin Brita
- Yale New Haven Hospital, PO Box 208028, New Haven, CT, 06520-8028, USA
| | - Maura Harrigan
- Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA
| | - Scott Capozza
- Yale New Haven Hospital, 20 York St, EP 10-635, New Haven, CT, 06510, USA
| | - Angela Khairallah
- Yale New Haven Hospital, 20 York St, EP 10-635, New Haven, CT, 06510, USA
| | - Tara B Sanft
- Section of Medical Oncology, Yale School of Medicine, PO Box 208028, New Haven, CT, 06520-8028, USA
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Morren JA, Rheaume C, Pioro EP. Self-reported factors contributing to delay in ALS diagnosis among primary care providers in a large Ohio-based US healthcare network. J Neurol Sci 2023; 445:120532. [PMID: 36628902 DOI: 10.1016/j.jns.2022.120532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/08/2022] [Accepted: 12/20/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study's primary objective is to identify self-reported factors that contribute to diagnostic delay in ALS among Primary Care Providers (PCPs). METHODS A de novo email-based survey was deployed to Ohio-based PCPs in the Cleveland Clinic Health System. RESULTS Of the 77 PCP participants [including 30 Advance Practice Providers (APPs)] only: (a) 18% of physicians, and 3% of APPs were very confident or confident with recognizing signs and symptoms of ALS, (b) 13% of physicians, and 21% of APP s felt very confident or confident with distinguishing between a neurologic cause of dysfunction from other possible causes, and (c) 23% of physicians, and 11% of APPs felt very confident or confident with distinguishing between upper and lower motor neuron signs. If presented with a weak patient without a specific diagnosis, PCPs most frequently ordered electrodiagnostic testing, brain MRI, cervical or thoracic spine MRI, and serum creatine kinase. PCPs identified top reasons for delayed ALS diagnosis as: (a) patient's delay in seeking medical help, (b) diagnostic uncertainty (c) waiting time for neurology/neuromuscular medicine (NM) consultation. The most desired strategies to shorten diagnostic delay involved: (a) educating PCPs and other non-neurologist "gatekeeper" providers, (b) improving access to specialist neurology care, and (c) developing a reliable diagnostic test for ALS. DISCUSSION Self-reported factors that increase ALS diagnostic delay among PCPs primarily comprise gaps in clinical knowledge and skills required to detect key symptoms and signs, and suboptimal referral access to a neurology/NM provider. These areas represent important opportunities for targeted improvement efforts.
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Thepwongsa I, Muthukumar R, Sripa P, Piterman L. Uptake and effectiveness of online diabetes continuing education: The perspectives of Thai general practitioner trainees. Heliyon 2023; 9:e13355. [PMID: 36755621 PMCID: PMC9900372 DOI: 10.1016/j.heliyon.2023.e13355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Background Despite continuing medical education (CME) programmes on evidence-based diabetes care, evidence-based best practice and actual GP practice remain scant. Online CME offers numerous benefits to general practitioners (GPs), particularly during the coronavirus disease 2019 (COVID-19) pandemic. In Thailand, CME is a voluntary process and is yet to be established as a mandatory requirement. This study examined GP uptake of online diabetes CME and the changes in GPs' attitudes to and knowledge of Type 2 diabetes management. Methods A cross-sectional study and a before-and-after study were employed with 279 GP trainees who voluntarily undertook a newly-developed online diabetes programme. A follow-up survey was conducted six months after the GP trainees completed their training. Results One hundred and twelve out of 279 GP trainees (40.1%) participated in the study, of whom 37 (13.3%) enrolled in the online diabetes programme, and 20 (7.2%) completed the programme. Before enrolling in the programme, the participants' mean diabetes knowledge score was 61.5%. The participants' confidence in effective insulin treatment increased significantly after the programme (95% Confidence interval [CI], -0.51-0.00; P = 0.05), but their knowledge scores before and after the programme were not statistically different (95% CI, -3.93-0.59; P = 0.14). Conclusion Uptake of the online diabetes CME was poor, although appropriate recruitment strategies were employed, and the online educational option was attractive and accessible during the COVID-19 pandemic. This study emphasises the gap between evidence-based practice and actual GP practice and the need for mandatory CME.
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Affiliation(s)
- Isaraporn Thepwongsa
- Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand,Corresponding author. Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen province, 40002, Thailand.
| | | | - Poompong Sripa
- Medicine for the Elderly Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Leon Piterman
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Australia
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Magwenya RH, Ross A. Developing a CPD model for Eswatini-a participatory action research study. BMC Med Educ 2023; 23:45. [PMID: 36670420 PMCID: PMC9854159 DOI: 10.1186/s12909-023-04016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Continuing professional development (CPD) is a key aspect to fulfil a commitment to lifelong learning for professionals registered with the Medical and Dental Council, the intention being to promote the health of patients and develop clinical expertise. The absence of formal CPD requirements for practitioners in Eswatini has resulted in a move to introduce an accredited system. METHODS The qualitative study followed a participatory action research (PAR) methodology using a cooperative inquiry group of 10 medical practitioners in Eswatini to investigate how the current CPD program could be improved and formalised. PAR entailed four stages; observation, reflection, planning and action, using a semi-structured format to explore the areas of concern. RESULTS Reflecting on the current situation resulted in three ways to improve CPD being identified: (1) adopt a formal, compulsory CPD model; (2) recognise achievements by practitioners who endeavour to improve their skills/knowledge through Entrustable Professional Activities, and (3) ensure that CPD is relevant to the workplace by using Quality-Improvement CPD (QI-CPD) and reflective diaries. These would be done by involving local practitioners, using adult learning principles and ensuring continuous evaluation and improvement of the CPD model. CONCLUSIONS There was general agreement on the need for a formalised CPD system to improve skill levels and provide an open platform to enhance patient care in a resource constrained setting. The findings provided information that can be used to plan and action its implementation through engagement with the country's doctors in various forums and through ongoing research.
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Affiliation(s)
| | - Andrew Ross
- Department Family Medicine, University of KwaZulu Natal, Private Bag 7 Congella 4013, Durban, South Africa
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Khan YS, Khoodoruth MAS, Ghaffar A, Al Khal A, Alabdullah M. The Impact of Multisource Feedback on Continuing Medical Education, Clinical Performance and Patient Experience: Innovation in a Child and Adolescent Mental Health Service. J CME 2023; 12:2202834. [PMID: 37123200 PMCID: PMC10142306 DOI: 10.1080/28338073.2023.2202834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This paper reiterates the importance of the role of multisource feedback (MSF) in continuing medical education/continuing professional development (CME/CPD) and its impact on doctors' performance and patient experience globally. It summarises a unique initiative of robust utilisation of internationally recognised multisource feedback tools in an outpatient child and adolescent mental health service (CAMHS) in Qatar. The process involved the effective adoption and administering of the General Medical Council's (GMC) self-assessment questionnaire (SQ), patient questionnaire (PQ), and colleague questionnaire (CQ) followed by the successful incorporation of these tools in CME/CPD. The original version of the PQ questionnaire and the instructions to the patient document were translated into Arabic through the blind back-translation technique. This initiative of introducing gold-standard MSF tools and processes into clinical practice, among other quality-improvement projects, has contributed to the improvement of service standards and doctors' clinical practice. Patient satisfaction was measured through the annual patient experience analysis using the Experience of Service Questionnaire (ESQ) whereas changes in doctors' performance were evaluated by comparing annual appraisal scores before and after implementation of this initiative. We have demonstrated that when MSF is obtained impartially and transparently using recognised and valid tools, it can improve patient experience and enhance doctors' performance.
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Affiliation(s)
- Yasser Saeed Khan
- Mental Health Service, Hamad Medical Corporation, Doha, Qatar
- CONTACT Yasser Saeed Khan Mental Health Service,Hamad Medical Corporation, Doha, Qatar P.O Box 3050
| | - Mohamed Adil Shah Khoodoruth
- Mental Health Service, Hamad Medical Corporation, Doha, Qatar
- Division of Genomics and Precision Medicine, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Adeel Ghaffar
- Graduat
e Medical Education, Hamad Medical Corporation, Doha, Qatar
| | | | - Majid Alabdullah
- Mental Health Service, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
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Kulo V, Cestone C. A continuing professional development imperative? Examining trends and characteristics of health professions education doctoral programs. BMC Med Educ 2022; 22:853. [PMID: 36482331 PMCID: PMC9733163 DOI: 10.1186/s12909-022-03937-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Despite the long-standing faculty development initiatives for improving teaching skills in the health professions, there is still a growing need for educators who are formally trained in educational theory and practice as health professions schools experience dramatic demand and growth. Graduate programs in health professions education (HPE) provide an avenue for health professions' faculty continuing professional development to enhance their knowledge and skills for teaching and curriculum leadership roles. There has been a proliferation of certificate, master's, and doctoral programs in HPE over the last two decades to respond to the growing need for well-prepared faculty educators and program leadership. The purpose of this study was to identify and describe current HPE doctoral programs in United States (U.S.) and Canada. METHODS The study first examined doctoral programs in HPE identified in earlier studies. Next, we searched the literature and the web to identify new doctoral programs in the U.S. and Canada that had been established between 2014, when the prior study was conducted, and 2022. We then collated and described the characteristics of these programs, highlighting their similarities and differences. RESULTS We identified a total of 20 doctoral programs, 17 in the U.S. and 3 in Canada. Of these, 12 programs in the U.S. and 1 program in Canada were established in the last 8 years. There are many similarities and some notable differences across programs with respect to degree title, admission requirements, duration, delivery format, curriculum, and graduation requirements. Most programs are delivered in a hybrid format and the average time for completion is 4 years. CONCLUSIONS The workforce shortage facing health professional schools presents an opportunity, or perhaps imperative, for continuing professional development in HPE through certificate, master's, or doctoral programs. With the current exponential growth of new doctoral programs, there is a need to standardize the title, degree requirements, and further develop core competencies that guide the knowledge and skills HPE graduates are expected to have upon graduation.
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Affiliation(s)
- Violet Kulo
- Health Professions Education, Graduate School, University of Maryland Baltimore, MD, Baltimore, USA.
| | - Christina Cestone
- Health Professions Education, Graduate School, University of Maryland Baltimore, MD, Baltimore, USA
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Harkemanne E, Duyver C, Leconte S, Sawadogo K, Baeck M, Tromme I. Short- and Long-Term Evaluation of General Practitioners' Competences After a Training in Melanoma Diagnosis: Refresher Training Sessions May Be Needed. J Cancer Educ 2022; 37:1928-1941. [PMID: 34704171 PMCID: PMC8547729 DOI: 10.1007/s13187-021-02063-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
General practitioners (GPs) are first-line clinicians in melanoma diagnosis. It is, therefore, important to ensure that they maintain their melanoma diagnostic accuracy over time. The objective of this study was to assess the short- and long-term competences of GPs after a training session in naked-eye melanoma diagnosis. An interventional prospective study was conducted whereby, over a 6-month period, GPs attended a 1-h melanoma diagnostic training session. To assess their acquired competences, GPs were asked to fill in a questionnaire on basic melanoma knowledge and to evaluate 10 clinical images of pigmented skin lesions prior to training, immediately after and 1 year later. In total, 89 GPs completed the questionnaire prior and immediately after training. As expected, the number of GPs who appropriately managed [Formula: see text] 50% of the melanoma cases increased after training (P < 0.001). One year after training, only 27 (30%) of the 89 GPs completed the questionnaire. This number of participants was too low to obtain significant figures but the GPs' mean overall score of appropriately managed clinical cases was much lower than in the immediate post-test. In conclusion, although this short training improved the GPs' diagnostic accuracy and management of melanoma in the short-term, participating GPs do not seem to have maintained these competences in the long-term. Further studies are needed to assess whether refresher training sessions are able to sustain acquired diagnostic and management skills.
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Affiliation(s)
- Evelyne Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - Corentin Duyver
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - Sophie Leconte
- Centre Académique de Médecine Générale (CAMG), UCLouvain, Brussels, Belgium
| | - Kiswendsida Sawadogo
- Statistical Support Unit, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marie Baeck
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium
| | - Isabelle Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Herrmann LE, Jones YO, Kinnear B, Rule A, Piper L, Shah SS, Klein M. Development and evaluation of a pediatric hospital medicine board review course. BMC Med Educ 2022; 22:804. [PMID: 36402975 PMCID: PMC9675241 DOI: 10.1186/s12909-022-03862-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/03/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND The American Board of Medical Specialties recognized Pediatric Hospital Medicine (PHM) for subspecialty certification in 2016, with the first certification exam in 2019. To address the need for exam preparatory materials, we designed and evaluated a novel PHM board review course that was offered both in-person and online. METHODS Course content was based on the American Board of Pediatrics (ABP) PHM certifying exam outline. Course objectives were developed from published PHM core competencies and the 2012 ABP general pediatrics content objectives. National experts served as faculty, presenting didactic sessions, and contributing to a question bank for high-yield review. For program evaluation, we applied the Kirkpatrick Model, evaluating estimated exam pass rates (Level 4), participant learning (Level 2) via post-presentation practice questions, and participants' ratings of presenters (via five-point Likert scale) and satisfaction (Level 1). RESULTS There were 112 in-person and 144 online participants with estimated pass rates of 89 and 93%, respectively. The mean correct response for the post-presentation knowledge questions was 84%. Faculty effectiveness ratings ranged from 3.81 to 4.96 (median score 4.60). Strengths included the pace of the course, question bank, and printed syllabus. Suggestions for improvement included question bank expansion, focus on "testable" points rather than general information, and challenges with long days of didactic presentations. CONCLUSIONS This novel PHM board review course demonstrated effectiveness. Hospitalists preferred focused "testable" information, an active learning environment, and a robust question bank. Future preparatory courses should consider including more opportunities for practice questions, focused content review, and learner engagement.
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Affiliation(s)
- Lisa E Herrmann
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Yemisi O Jones
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Benjamin Kinnear
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amy Rule
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Laura Piper
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Samir S Shah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Melissa Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Lazure P, Parikh AR, Ready NE, Davies MJ, Péloquin S, Caterino JM, Lewandowski R, Lazar AJ, Murray S. Challenges associated with the integration of immuno-oncology agents in clinical practice. BMC Med Educ 2022; 22:781. [PMID: 36371179 PMCID: PMC9652913 DOI: 10.1186/s12909-022-03847-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The availability of new immuno-oncology therapeutics markedly impacts oncology clinicians' treatment decision-making. To effectively support healthcare professionals (HCPs) in their practice, it is important to better understand the challenges and barriers that can accompany the introduction of these agents. This study aimed to establish the types and causes of clinical challenges posed by the introduction of new immuno-oncology agents. METHODS The mixed-methods design included qualitative in-depth interviews and group discussions with HCPs, in which participants discussed clinical challenges and potential underlying reasons for these challenges. Qualitative findings informed a quantitative survey. This survey investigated the extent and distribution of challenges using HCPs' self-rating of knowledge, skill, confidence, and exposure to system-level effects. These two phases were conducted sequentially with distinctly stratified samples of oncologists, nurse practitioners (NPs), physician assistants (PAs), pathologists, clinical pharmacists, interventional radiologists, rheumatologists, pulmonologists, and emergency department physicians. Participants were from the United States and had various levels of clinical experience and represented both academic and community-based settings. RESULTS The final sample included 107 HCPs in the qualitative phase and 554 in the quantitative phase. Analyses revealed clinical challenges related to the use of pharmacodiagnostics. For example, 47% of pathologists and 42% of oncologists reported skill gaps in identifying the appropriate marker and 46% of oncologists, 61% of PAs, 66% of NPs, 74% of pulmonologists and 81% of clinical pharmacists reported skill gaps in selecting treatment based on test results. Challenges also emerged regarding the integration of immuno-oncology agents, as oncologists, rheumatologists, pulmonologists, clinical pharmacists, PAs, and NPs reported knowledge gaps (74-81%) of the safety profiles of recently approved agents. In addition, 90% of clinical pharmacists reported skill gaps weighing the risks and benefits of treating patients with immuno-oncology agents while affected by lupus. Finally, patient communication challenges were identified: HCPs reported difficulties discussing essential aspects of immunotherapy to patients as well as how they might compare to other types of therapies. CONCLUSION The challenges highlighted in this study reveal substantial educational gaps related to the integration of immuno-oncology agents into practice for various groups of HCPs. These findings provide a strong base of evidence for future educational initiatives.
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Affiliation(s)
- Patrice Lazure
- AXDEV Group Inc, 210-8, Place du Commerce, QC, J4W 3H2, Brossard, Canada.
| | - Aparna R Parikh
- Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Neal E Ready
- Duke University School of Medicine, Durham, NC, USA
| | - Marianne J Davies
- Smilow Cancer Center, Yale University School of Nursing, New Haven, CT, USA
| | - Sophie Péloquin
- AXDEV Group Inc, 210-8, Place du Commerce, QC, J4W 3H2, Brossard, Canada
| | | | | | - Alexander J Lazar
- Departments of Pathology and Genomic Medicine, The University of Texas MD Anderson Cancer Center, TX, Houston, USA
| | - Suzanne Murray
- AXDEV Group Inc, 210-8, Place du Commerce, QC, J4W 3H2, Brossard, Canada
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Wang H, Li Z, Fan R, Tian S, Yang X. Can scope-of-practice transfer psychiatrists be up for their job? A cross-sectional study of clinical competence status and related factors. BMC Med Educ 2022; 22:777. [PMID: 36357917 PMCID: PMC9650843 DOI: 10.1186/s12909-022-03860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The great economic and social changes have resulted in the prevalence of mental disorder increasing year by year in China. Mental health medical service resources of China are significantly insufficient. The program of Transfer Training for psychiatrist was launched in China in October 2015. Thousands of physicians completed the transfer training and obtained certificates. To date, there is little evidence to identify the status and related factors of clinical competence among scope-of-practice transfer psychiatrists in China. PURPOSE This study aimed to investigate the status and related factors of clinical competence among scope-of-practice transfer psychiatrists of Sichuan Province, China. PATIENTS AND METHODS The sample was composed of 291 physicians who certificated the transfer training. Data were collected between September and November 2021, using self-made questionnaire with a total of 22 items to record demographic characteristics, practice status and workplace of participants. Descriptive statistics analysis, independent sample T-test, one-way ANOVA, Spearman rank correlation, and multiple regression analysis were used to analyze the data. RESULTS The clinical competence of participants score was (8.02 ± 1.48). Significant differences were found in clinical competence scores among: the subgroups of practice category, reasons for attending in the transfer training for psychiatrists, whether transfer to/ add mental health practice registration, whether engage in mental / psychological work after training, whether the level of transfer training meeting participants' job needs, whether the level of transfer training meeting their theoretical learning needs, whether the level of transfer training meeting their clinical practice needs, salary change compared with pre-training, whether join in continuing education after training, whether wanted to join in continuing education after training, whether the workplace before training has mental / psychological department, whether the workplace after training has mental / psychological department, institutional nature, institutional level and institutional affiliation. Multiple regression analysis identified that level of transfer training meeting participants' job needs, level of transfer training meeting their clinical practice needs, Whether the workplace before training has mental / psychological department, whether wanted to join in continuing education after training, institutional nature were the contributors of clinical competence. CONCLUSION The study demonstrated that clinical competence of scope-of-practice transfer psychiatrists needed to be improved. Whether workplace has mental/psychological departments was an important factor of clinical competence. Besides, interest of physicians is another crucial factor for their clinical competence. The continuing education of those psychiatrists may be one effective measure considering their factual working conditions.
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Affiliation(s)
- Huan Wang
- Nursing Department, the Third Hospital of Mianyang ▪ Sichuan Mental Health Centre, Mianyang, Sichuan Province, 621000, People's Republic of China
| | - Zuowei Li
- Nursing Department, the Third Hospital of Mianyang ▪ Sichuan Mental Health Centre, Mianyang, Sichuan Province, 621000, People's Republic of China
| | - Ruoxin Fan
- Department for prevention and control of mental illness, the Third Hospital of Mianyang ▪ Sichuan Mental Health Centre, Mianyang, Sichuan Province, 621000, People's Republic of China
| | - Shaoli Tian
- Department for prevention and control of mental illness, the Third Hospital of Mianyang ▪ Sichuan Mental Health Centre, Mianyang, Sichuan Province, 621000, People's Republic of China
| | - Xianmei Yang
- Department for prevention and control of mental illness, the Third Hospital of Mianyang ▪ Sichuan Mental Health Centre, Mianyang, Sichuan Province, 621000, People's Republic of China.
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Löffler C, Altiner A, Blumenthal S, Bruno P, De Sutter A, De Vos BJ, Dinant GJ, Duerden M, Dunais B, Egidi G, Gibis B, Melbye H, Rouquier F, Rosemann T, Touboul-Lundgren P, Feldmeier G. Challenges and opportunities for general practice specific CME in Europe - a narrative review of seven countries. BMC Med Educ 2022; 22:761. [PMID: 36344994 PMCID: PMC9641932 DOI: 10.1186/s12909-022-03832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Several changes have led to general practitioners (GPs) working in a more differentiated setting today and being supported by other health professions. As practice changes, primary care specific continuing medical education (CME) may also need to adapt. By comparing different primary care specific CME approaches for GPs across Europe, we aim at identifying challenges and opportunities for future development. METHODS Narrative review assessing, analysing and comparing CME programs for general practitioners across different north-western European countries (UK, Norway, the Netherlands, Belgium (Flanders), Germany, Switzerland, and France). Templates containing detailed items across seven dimensions of country-specific CME were developed and used. These dimensions are role of primary care within the health system, legal regulations regarding CME, published aims of CME, actual content of CME, operationalisation, funding and sponsorship, and evaluation. RESULTS General practice specific CME in the countries under consideration are presented and comparatively analysed based on the dimensions defined in advance. This shows that each of the countries examined has different strengths and weaknesses. A clear pioneer cannot be identified. Nevertheless, numerous impulses for optimising future GP training systems can be derived from the examples presented. CONCLUSIONS Independent of country specific CME programs several fields of potential action were identified: the development of curriculum objectives for GPs, the promotion of innovative teaching and learning formats, the use of synergies in specialist GP training and CME, the creation of accessible yet comprehensive learning platforms, the establishment of clear rules for sponsorship, the development of new financing models, the promotion of fair competition between CME providers, and scientifically based evaluation.
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Affiliation(s)
- Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
| | - Attila Altiner
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
| | - Sandra Blumenthal
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Speaker section advanced training German Society for General Practice and Family Medicine (DEGAM), Berlin, Germany
| | - Pascale Bruno
- Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Université Côte d’Azur, Nice, France
| | - An De Sutter
- Department of Public Health and Primary Care, Centre for Family Medicine, Ghent University, Ghent, Belgium
| | - Bart J. De Vos
- National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Geert-Jan Dinant
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Martin Duerden
- Centre for Medical Education, Cardiff University, Cardiff, UK
| | - Brigitte Dunais
- Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Université Côte d’Azur, Nice, France
| | - Günther Egidi
- General Practice Bremen Germany, Deputy Speaker section advanced training German Society for General Practice and family medicine (DEGAM), Bremen, Germany
| | - Bernhard Gibis
- National Association of Statutory Health Insurance Physicians (KBV), Berlin, Germany
| | - Hasse Melbye
- General Practice Research Unit, UIT the Arctic University of Norway, Tromsø, Norway
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Pia Touboul-Lundgren
- Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Université Côte d’Azur, Nice, France
| | - Gregor Feldmeier
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057 Rostock, Germany
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Jensen RL, Dunson B, Richards B, Park YS, Hirshfield LE. A Longitudinal, Qualitative Examination of Participant Intent-To-Change Statements that do not Match the Stated Learning Objectives of American Association of Neurological Surgeons-Sponsored Continuing Medical Education Activities. World Neurosurg 2022; 167:e1325-e1334. [PMID: 36108913 DOI: 10.1016/j.wneu.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Continuing medical education (CME) programs are planned to provide medical professionals with the opportunity to stay abreast of new developments in their field. After each program, CME attendees are given the chance to evaluate the success of the activity in meeting its defined learning objectives. Over one-third of intent-to-change statements from CME evaluations do not match the stated learning objectives. We examined unmatched objectives and intent-to-change statements to determine their usefulness for future meeting planning. METHODS This retrospective mixed-method content analysis used quantitative, deductive content analysis to compare intent-to-change statements and learning objectives from American Association of Neurological Surgeons-sponsored CME activities to explore unintended learning themes. RESULTS We examined 85 CME activities with 424 meeting objectives and 1950 intent-to-change statements. Approximately 37% of intent-to-change statements were unrelated to any meeting objective, and 15% of learning objectives had no associated intent-to-change statements. Among unmatched objectives, those regarding more general subject matter often failed to be met with intent-to-change statements for multiple years, whereas those related to clinical practice were more likely to be unmatched for only 1 year. Some CME learning objectives are repeated for the same meeting for multiple years without change, although 22.6% of unmatched intent-to-change statements led to new learning objectives in subsequent years. CONCLUSIONS An analysis of intent-to-change statements that are unmatched to meeting learning objectives is a potential avenue for understanding outcomes of CME activities. Our observations about general versus specific learning objective language may prove useful for CME planners' future educational event formulation.
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Affiliation(s)
- Randy L Jensen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
| | - Blake Dunson
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Boyd Richards
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois, Chicago, Illinois, USA
| | - Laura E Hirshfield
- Department of Medical Education, University of Illinois, Chicago, Illinois, USA
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Löffler C, Buuck T, Iwen J, Schulz M, Zapf A, Kropp P, Wollny A, Krause L, Müller B, Ozga AK, Goldschmidt E, Altiner A. Promoting rational antibiotic therapy among high antibiotic prescribers in German primary care-study protocol of the ElektRA 4-arm cluster-randomized controlled trial. Implement Sci 2022; 17:69. [PMID: 36195897 PMCID: PMC9530431 DOI: 10.1186/s13012-022-01241-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background The rational use of antibiotics is of great importance in health care. In primary care, acute respiratory infections are the most common cause of inappropriate antibiotic prescribing. Since existing studies aiming to optimize antibiotic use are usually based on the voluntary participation of physicians, general practitioners (GPs) with inappropriate prescribing behavior are underrepresented. For the first time in Germany, the ElektRA study will assess and compare the effects of three interventions on antibiotic prescribing rates for respiratory and urinary tract infections among high prescribers in primary care. Method ElektRA is a 4-arm cluster-randomized controlled trial among German GPs in nine regional Associations of Statutory Health Insurance Physicians. On their behalf, the Central Research Institute of Ambulatory Health Care in Germany (Zi) analyses all outpatient claims and prescription data. Based on this database, high antibiotic prescribing GPs are identified and randomized into four groups: a control group (N=2000) and three intervention arms. We test social norm feedback on antibiotic prescribing (N=2000), social norm feedback plus online training on rational prescribing practice and communication strategies (N=2000), and social norm feedback plus online peer-moderated training on rational antibiotic prescribing, communication strategies, and sustainable behavior change (N=1250). The primary outcome is the overall rate of antibiotic prescriptions. Outcomes are measured before intervention (T0, October 2020–September 2022) and over a period of 15 months (T1, October 2022 to December 2023) after randomization. Discussion The aim of the study is to implement individualized, low-threshold interventions to reduce antibiotic prescribing among high prescribers in primary care. If successful, a change in behavior among otherwise difficult-to-reach high prescribers will directly improve patient care. The increase in quality of care will ideally be achieved both in terms of the quantity of antibiotics used as well as the kind of substances prescribed. Also, if effective strategies for high prescribers are identified through this study, they can be applied not only to the antibiotics addressed in this study, but also to other areas of prescription management. Trial registration Current Controlled Trials ISRCTN95468513. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01241-4.
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Affiliation(s)
- Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Postbox 100888, 18055, Rostock, Germany.
| | - Theresa Buuck
- Institute of General Practice, Rostock University Medical Center, Postbox 100888, 18055, Rostock, Germany
| | - Julia Iwen
- Association of Substitute Health Funds (Vdek) e.V, Berlin, Germany
| | - Maike Schulz
- Central Research Institute of Ambulatory Health Care in Germany (Zi), Berlin, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, Rostock University Medical Center, Rostock, Germany
| | - Anja Wollny
- Institute of General Practice, Rostock University Medical Center, Postbox 100888, 18055, Rostock, Germany
| | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Britta Müller
- Institute of Medical Psychology and Medical Sociology, Rostock University Medical Center, Rostock, Germany
| | - Ann-Katrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Attila Altiner
- Institute of General Practice, Rostock University Medical Center, Postbox 100888, 18055, Rostock, Germany
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Rosenberg DM, Braunstein SE, Fields EC, Gillespie EF, Gunther JR, Jimenez RB, Yechieli RL, Golden DW. Radiation Oncology Education Collaborative Study Group Annual Spring Symposium: Initial Impact and Feedback. J Cancer Educ 2022; 37:1504-1509. [PMID: 33728871 DOI: 10.1007/s13187-021-01990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
The Radiation Oncology Education Collaborative Study Group (ROECSG) is an international collaborative network of radiation oncology (RO) professionals with the goal of improving RO education. This report summarizes the first two ROECSG annual symposia including an overview of presentations and analysis of participant feedback. One-day symposia were held in June 2018 and May 2019. Programs included oral and poster presentations, RO education leadership perspectives, and keynote addresses. Post-symposia surveys were collected. Research presentations were recorded and made available online. The 2018 symposium was had 36 attendees from 25 institutions in three countries. The 2019 symposium had 76 individuals from 41 institutions in five countries. Attendees represented diverse backgrounds including attending physicians (46%), residents (13%), medical students (14%), physicists (2%), nurses (1%), and program coordinators (1%). Fifty-five oral presentations were given with 53 released online. Ninety percent of attendees rated the symposium as improving their knowledge of RO educational scholarship, 98% felt the symposium provided the opportunity to receive feedback on RO education scholarship, and 99% felt that the symposium fostered the development of collaborative RO education projects. ROECSG was rated higher than professional organizations in fostering educational scholarship (p<0.001). All attendees felt that the symposium produced new RO education scholarship ideas and provided unique networking opportunities. The first two ROECSG symposia drew a diverse population of attendees and provided unique opportunities for presentation of RO education scholarship. Future ROECSG symposia will be designed to enhance opportunities to present RO education scholarship and to facilitate networking.
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Affiliation(s)
- David M Rosenberg
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Emma C Fields
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jillian R Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Raphael L Yechieli
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, The University of Chicago, 5758 South Maryland Avenue MC 9006, Chicago, IL, 60637, USA.
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Rivest J, Chammas M, Desbeaumes Jodoin V, Blouin S, Gupta M, Leclair S. Learning about psychiatric aspects of medical assistance in dying: a pilot survey of self-perceived educational needs among assessors in a Canadian academic hospital. Ann Palliat Med 2022; 11:3123-3134. [PMID: 36127297 DOI: 10.21037/apm-22-422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/17/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Medical assistance in dying (MAiD) was legalized in Canada in 2016, although it has been accessible as an end-of-life option in the province of Quebec since 2015. Before its implementation in clinical settings, few physicians had received formal training on requests assessments. New data indicate MAiD requesters have high rates of psychiatric comorbidities. Hence, assessment and management of psychiatric and psychosocial issues among MAiD requesters are important competencies to develop for assessors, although few training programs address them. The aim of our study was to explore physicians' self-perceived educational needs on psychiatric aspects related to MAiD in the province of Quebec. METHODS We conducted a cross-sectional online survey and used a non-probability sampling design in one academic tertiary care center. A descriptive analysis was performed, and responders were compared on different variables. RESULTS From twenty-five physician assessors, nineteen responded anonymously to an online survey (n=19). The findings of our pilot study revealed that participants felt highly competent in most psychiatric aspects at end-of-life and related to MAiD practice, except for psychotherapy and psychopharmacology as well as depression identification. Most indicated strong interest in further training. No statistical differences were found among responders regarding previous experience or training in palliative care. CONCLUSIONS Based on our study, MAiD assessors reported high level of competency in managing psychiatric issues among requesters, but that they also expressed a strong desire for additional education.
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Affiliation(s)
- Jacynthe Rivest
- Department of Psychiatry, University of Montreal Hospital Center (CHUM) and Research Center of University of Montreal Hospital Center (CRCHUM), Montréal, Canada
| | - Marc Chammas
- Department of Psychiatry, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Véronique Desbeaumes Jodoin
- Department of Psychiatry, University of Montreal Hospital Center (CHUM) and Research Center of University of Montreal Hospital Center (CRCHUM), Montréal, Canada
| | - Samuel Blouin
- Department of Sociology, University de Montreal, Montreal, Canada
| | - Mona Gupta
- Department of Psychiatry, University of Montreal Hospital Center (CHUM) and Research Center of University of Montreal Hospital Center (CRCHUM), Montréal, Canada
| | - Suzanne Leclair
- Department of Psychiatry, University of Montreal Hospital Center (CHUM), Montreal, Canada
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Abstract
ISSUE Health systems have been increasingly called upon to address population health concerns and continuing medical education (CME) is an important means through which clinical practices can be improved. This manuscript elaborates on existing conceptual frameworks in order to support CME practitioners, funders, and policy makers to develop, implement, and evaluate CME vis-a-vis population health concerns. EVIDENCE Existing CME conceptual models and conceptions of CME effectiveness require elaboration in order to meet goals of population health improvement. Frameworks for the design, implementation and evaluation of CME consistently reference population health, but do not adequately conceptualize it beyond the aggregation of individual patient health. As a pertinent example, opioid prescribing CME programs use the opioid epidemic to justify their programs, but evaluation approaches are inadequate for demonstrating population health impacts. CME programs that are built to have population health outcomes using frameworks intended primarily for physician performance and patient health outcomes are thus not able to recognize either non-linear associations or negative unintended consequences. IMPLICATIONS This proposed conceptual framework draws on the fields of clinical population medicine, the social determinants of health, health equity, and philosophies of population health to build conceptual bridges between the CME outcome levels of physician performance and patient health to population health. The authors use their experience developing, delivering, and evaluating opioid prescribing- and poverty-focused CME programs to argue that population health-focused CME must be re-oriented in at least five ways. These include: 1) scaling effective CME programs while evaluating at population health levels; 2) (re)interpreting evidence for program content from a population perspective; 3) incorporating social determinants of health into clinically-oriented CME activities; 4) explicitly building fluency in population health concepts and practices among health care providers and CME planners; and 5) attending to social inequity in every aspect of CME programs.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kate Hodgson
- Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Bloch
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ross Upshur
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Fang JT, Chen SY, Yang LY, Liao KC, Lin CH, Fujimori M, Tang WR. Improving transitional care through online communication skills training. Aging Clin Exp Res 2022; 34:3063-3071. [PMID: 36129617 PMCID: PMC9489478 DOI: 10.1007/s40520-022-02251-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/04/2022] [Indexed: 11/26/2022]
Abstract
Background As the aging population is increasing significantly, the communication skills training (CST) on transitional care (TC) is insufficient. Aims This study aimed to test the effectiveness of an intervention (the online TC CST [OTCCST] and TC) through the perspectives of healthcare providers (HCPs), older patients, and family members. Methods A total of 38 HCPs caring for older patients were randomized to the experimental (n = 18) or control groups (n = 20), and 84 pairs of patients and family members were enrolled (experimental: n = 42 vs. control: n = 42). The primary outcome was HCP communication confidence; while secondary outcomes included patient quality of life (QoL), activities of daily living (ADL), rehospitalization counts, and family caregiving burden. Data were collected from HCPs using a scale measuring confidence in communicating with patients. Patient outcomes were assessed using the McGill QoL Questionnaire-Revised and Barthel Index. Family members were assessed with the Caregiver Burden Inventory. Rehospitalization counts were tracked for 3 months post-discharge. Data were analyzed using multiple regression analysis. Results Experimental group HCPs showed a significant improvement in communication confidence over the control group (p = 0.0006). Furthermore, experimental group patients had significantly fewer rehospitalization counts within 3-month post-discharge (p < 0.05). However, no significant group differences were found in patient QoL and ADL nor in family caregiver burden. Conclusion The OTCCST can effectively improve HCP communication confidence, and the combination of OTCCST and TC can reduce rehospitalization counts for older patients. The OTCCST allows HCPs to learn asynchronously at their convenience, ideal for continuing education, especially during the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02251-4.
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Affiliation(s)
- Ji-Tseng Fang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital Taoyuan, Taoyuan City, Taiwan
| | - Shih-Ying Chen
- School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Gueishan Dist., Taoyuan City, 333, Taiwan
| | - Lan-Yen Yang
- Division of Medical Education, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chen Liao
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Hao Lin
- Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Maiko Fujimori
- Section of Psychological Science, Division of Health Care Research/Section of Behavior Research, Division of Behavioral Science, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Kashiwa, Chiba, Japan
| | - Woung-Ru Tang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital Taoyuan, Taoyuan City, Taiwan. .,School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Gueishan Dist., Taoyuan City, 333, Taiwan.
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Atreya S, Datta SS, Salins N. Views of general practitioners on end-of-life care learning preferences: a systematic review. BMC Palliat Care 2022; 21:162. [PMID: 36127706 PMCID: PMC9490975 DOI: 10.1186/s12904-022-01053-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background General practitioners (GPs) play a pivotal role in providing end-of-life care in the community. Although they value end-of-life care, they have apprehensions about providing care in view of the limitations in knowledge and skills in end-of-life care. This review aimed to explore, synthesise, and analyse the views of general practitioners on end-of-life care learning preferences. Methods MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science, and Cochrane were searched for literature on the views of general practitioners on end-of-life care learning preferences from 01/01/1990 to 31/05/2021. Methodological quality was reported. Results Of the 10,037 articles identified, 23 were included for the review. Five themes developed from the review. The desire to provide palliative care, as well as self-actualisation needs, relevance to practice, a sense of responsibility, and a therapeutic bond, motivates general practitioners to learn end-of-life care. Some of the learning needs expressed were pain and symptom management, communication skills, and addressing caregiver needs. Experiential learning and pragmatist learning styles were preferred learning styles. They perceived the need for an amicable learning environment in which they could freely express their deficiencies. The review also identified barriers to learning, challenges at personal and professional level, feelings of disempowerment, and conflicts in care. Conclusion GPs’ preference for learning about end-of-life care was influenced by the value attributed to learning, context and content, as well as preference for learning styles and the availability of resources. Thus, future trainings must be in alignment with the GPs’ learning preferences. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01053-9.
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Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, 700160, India
| | - Soumitra S Datta
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, 700160, India.,Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
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Baatarpurev B, Tsogbadrakh B, Bandi S, Samdankhuu GE, Nyamjav S, Badamdorj O. Online continuing medical education in Mongolia: needs assessment. Korean J Med Educ 2022; 34:191-200. [PMID: 36070989 PMCID: PMC9452369 DOI: 10.3946/kjme.2022.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/17/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Due to the shortage in the healthcare workforce, insufficient qualifications, a lack of infrastructure and limited resources in Mongolia, it is not always possible for healthcare workers in rural areas who wish to attend continuous training and retraining courses to do so. However, in order to provide high-quality care, the demand for distance learning and the upgrading of knowledge and practice of many medical topics (especially related to morbidity and mortality) are necessary for the rural population. This study aimed to assess the needs of e-learning medical education, of graduates in Mongolia. METHODS A cross-sectional research design was implemented. We collected data from 1,221 healthcare professionals (nursing professionals, physicians, midwives, and feldshers) who were randomly selected from 69 government hospitals in Mongolia. Data were collected using self-assessment questionnaires which captured the needs assessment in a survey for online continuous medical education in Mongolia. Data were analyzed using descriptive statistics and Kruskal-Wallis statistical test. RESULTS Ninety percent of the respondents reported that they plan on attending online continuous medical education with the most preferred specialty area being emergency medicine. Results using the Kruskal-Wallis statistical technique suggested the preferred specialty area, educational content, appropriate time schedule, available devices, and tools were statistically significant and were different between the nursing professionals, physicians, midwives, and feldshers (p<0.05). CONCLUSION Findings provide important evidence for the implementation of measures and strategies which can assist healthcare professionals in low and middle-income areas/countries to constructively address their need for enhanced knowledge and practice through distance learning.
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Affiliation(s)
- Baljinnyam Baatarpurev
- Division for Faculty Development and E-Learning, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
| | - Basbish Tsogbadrakh
- School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
| | - Solongo Bandi
- School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
| | - Gal-Erdene Samdankhuu
- Division for Faculty Development and E-Learning, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
| | - Sumberzul Nyamjav
- Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
| | - Oyungoo Badamdorj
- School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
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Harkemanne E, Goublomme N, Sawadogo K, Tromme I. Early Melanoma Detection in Primary Care: Clinical Recognition of Melanoma is Not Enough, One Must Also Learn the Basics. J Cancer Educ 2022; 37:898-904. [PMID: 33073347 DOI: 10.1007/s13187-020-01897-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
To improve early melanoma detection, educational programs have been developed for general practitioners (GPs). This study aimed to determine whether the adjunct of teaching basic knowledge of pigmented skin lesions (PSL) to the training in melanoma diagnosis improves the GPs' diagnostic accuracy of melanoma. An interventional prospective study was conducted over a 3-month period where GPs attended a 2-h training course. The 1st session taught clinical melanoma recognition and the 2nd session instructed basic knowledge of PSL. Prior to training, after the 1st, and after the 2nd session, GPs were asked to select the malignant or benign nature of 15 clinical images associated to their clinical history. In total, 56 GPs participated in this study. The number of GPs identifying correctly ≥ 50% of the melanomas increased the most after the 1st session from 15 (26.8%; CI = (15.2; 38.4)) to 44 (78.6%; CI = (67.8; 89.3)) GPs (P < 0.001). The number of GPs correctly identifying ≥ 50% of the benign PSL only increased after completing the entire training, going from 10 (17.9%; CI = [(7.8; 27.9)) GPs to 50 (89.3%; CI = (81.2; 97.4)) GPs (P < 0.001). In this study, GPs identified benign PSL most accurately after the 2nd session. This suggested that teaching GPs the basics of PSL would especially improve their diagnostic accuracy for benign PSL, which could reduce unnecessary referrals to dermatologists. Teaching basic knowledge of PSL in addition to melanoma recognition seemed to enable GPs to triage skin lesions more effectively than when they were only trained to recognize melanoma.
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Affiliation(s)
- Evelyne Harkemanne
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium.
- Institute of Experimental and Clinical Research (IREC), UCLouvain, Brussels, Belgium.
| | - Noémie Goublomme
- General Practice in Centre Médical Chrysalide, Pironchamps, Belgium
| | - Kiswendsida Sawadogo
- Statistical Support Unit, King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Isabelle Tromme
- Dermatology Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, B-1200, Brussels, Belgium
- King Albert II Cancer and Hematology Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Stabel LS, McGrath C, Björck E, Elmberger A, Laksov KB. Navigating Affordances for Learning in Clinical Workplaces: A Qualitative Study of General Practitioners' Continued Professional Development. Vocat Learn 2022; 15:427-448. [PMID: 35818439 PMCID: PMC9261199 DOI: 10.1007/s12186-022-09295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
Medical specialists' lifelong learning is essential for improving patients' health. This study identifies affordances for learning general practitioners (GPs) engage in, and explores what influences engagement in those affordances. Eleven GPs were interviewed and the interview transcripts were analysed thematically. Stephen Billett's theoretical framework of workplace participatory practices was used as an analytical lens to explore the topic. Challenging patient cases were identified as the main trigger for engagement in learning. Local, national and international colleagues from the same and other specialties, were found to be an important affordance for learning, as was written material such as websites, journals and recommendations. Other inputs for learning were conferences and courses. Workplace aspects that were essential for GPs to engage in learning related to: place and time to talk, relevance to work, opportunity for different roles, organisation of work and workload, and working climate. Importantly, the study identifies a need for a holistic approach to lifelong learning, including spontaneous and structured opportunities for interaction over time with colleagues, establishment of incentives and arenas for exchange linked to peer learning, and acknowledgement of the workplace as an important place for learning and sufficient time with patients. This study contributes with a deepened understanding of how GPs navigate existing affordances for learning both within and outside their workplaces.
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Affiliation(s)
- Linda Sturesson Stabel
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Cormac McGrath
- Department of Education, Stockholm University, Stockholm, Sweden
| | - Erik Björck
- Department of Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Agnes Elmberger
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Klara Bolander Laksov
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Education, Stockholm University, Stockholm, Sweden
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Lupariello F, Capello F, Grossi V, Bonci C, Di Vella G. Child abuse and neglect: Are future medical doctors prepared? Leg Med (Tokyo) 2022; 58:102100. [PMID: 35749869 DOI: 10.1016/j.legalmed.2022.102100] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 03/05/2022] [Accepted: 06/18/2022] [Indexed: 11/27/2022]
Abstract
Diagnosis of child abuse and neglect is a challenging matter: in case of misdiagnosis, the child cannot benefit from an early treatment; erroneous interpretation may generate legal issues. Some studies reported physicians' lack of knowledge in child abuse and neglect. However, it is not clear if the reasons of this lack relay on an insufficient preparation of students during medical school and/or a deficiency in continuing medical education during/after fellowships. For these reasons, the authors of the present manuscript administered a questionnaire to last year medical students to: evaluate the degree of knowledge on this thematic in a medical student sample; understand if the abovementioned lack may be due to insufficient preparation of students during medical school. Study population included 179 students. The 77.7% demonstrated a low knowledge of this thematic, but they showed a high insight of their lack. The authors pointed out that medical school education can represent a weak point in future medical doctor knowledge on child abuse and neglect. It also allowed to identify as study sample's medical students had high awareness of their lacks in this field. In addition, comparison of medical schools from different geographical areas suggested common issues independent of which accreditation system is implemented. Thus - independent of which corrective strategy will be planned - the study highlighted necessity for each medical school to define: its current ability to properly train students in child abuse and neglect; students' awareness of their level of expertise. This can help schools to identify the most suitable correctives.
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Affiliation(s)
- Francesco Lupariello
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino", USA.
| | - Francesca Capello
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino", USA
| | - Valeria Grossi
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino", USA
| | - Camilla Bonci
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino", USA
| | - Giancarlo Di Vella
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino Dipartimento di Scienze della Sanità Pubblica e Pediatriche - Sezione di Medicina Legale - "Università degli Studi di Torino", USA
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