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Paton M, Zakeri B, Rowland P, Tavares W, Williams BW, Schneeweiss S, Wiljer D. Decision making in continuing professional development organisations during a crisis. Med Educ 2024; 58:722-729. [PMID: 38105389 DOI: 10.1111/medu.15265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/26/2023] [Accepted: 10/22/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Early in COVID-19, continuing professional development (CPD) providers quickly made decisions about program content, design, funding and technology. Although experiences during an earlier pandemic cautioned providers to make disaster plans, CPD was not entirely prepared for this event. We sought to better understand how CPD organisations make decisions about CPD strategy and operations during a crisis. METHODS This is a descriptive qualitative research study of decision making in two organisations: CPD at the University of Toronto (UofT) and the US-based Society for Academic Continuing Medical Education (SACME). In March 2021, using purposive and snowball sampling, we invited faculty and staff who held leadership positions to participate in semi-structured interviews. The interview focused on the individual's role and organisation, their decision-making process and reflections on how their units had changed because of COVID-19. Transcripts were reviewed, coded and analysed using thematic analysis. We used Mazmanian et al.'s Ecological Framework as a further conceptual tool. RESULTS We conducted eight interviews from UofT and five from SACME. We identified that decision making during the pandemic occurred over four phases of reactions and impact from COVID-19, including shutdown, pivot, transition and the 'new reality'. The decision-making ability of CPD organisations changed throughout the pandemic, ranging from having little or no independent decision-making ability early on to having considerable control over choosing appropriate pathways forward. Decision making was strongly influenced by the creativity, adaptability and flexibility of the CPD community and the need for social connection. CONCLUSIONS This adds to literature on the changes CPD organisations faced due to COVID-19, emphasising CPD organisations' adaptability in making decisions. Applying the Ecological Framework further demonstrates the importance of time to decision-making processes and the relational aspect of CPD. To face future crises, CPD will need to embrace creative, flexible and socially connected solutions. Future scholarship could explore an organisation's ability to rapidly adapt to better prepare for future crises.
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Affiliation(s)
- Morag Paton
- Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Bita Zakeri
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Paula Rowland
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, Toronto, Canada
| | - Walter Tavares
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, Toronto, Canada
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Canada
| | - Betsy White Williams
- Department of Psychiatry, School of Medicine, University of Kansas, Clinical Program, Kansas City, Kansas, USA
- Professional Renewal Center, Lawrence, Kansas, USA
| | - Suzan Schneeweiss
- Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - David Wiljer
- Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- University Health Network, Toronto, Canada
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Fortbildung am See. Inn Med (Heidelb) 2024; 65:480-2. [PMID: 38683220 DOI: 10.1007/s00108-024-01704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
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Pfäfflin F, Stegemann MS, Heim KM, Achterberg S, Pfitzner U, Götze L, Oesterhelweg L, Suttorp N, Herzog C, Stadtmann B, Uhrig A. Preparing for patients with high-consequence infectious diseases: Example of a high-level isolation unit. PLoS One 2022; 17:e0264644. [PMID: 35239726 PMCID: PMC8893674 DOI: 10.1371/journal.pone.0264644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Patients with high-consequence infectious diseases (HCID) are rare in Western Europe. However, high-level isolation units (HLIU) must always be prepared for patient admission. Case fatality rates of HCID can be reduced by providing optimal intensive care management. We here describe a single centre’s preparation, its embedding in the national context and the challenges we faced during the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic.
Methods
Ten team leaders organize monthly whole day trainings for a team of doctors and nurses from the HLIU focusing on intensive care medicine. Impact and relevance of training are assessed by a questionnaire and a perception survey, respectively. Furthermore, yearly exercises with several partner institutions are performed to cover different real-life scenarios. Exercises are evaluated by internal and external observers. Both training sessions and exercises are accompanied by intense feedback.
Results
From May 2017 monthly training sessions were held with a two-month and a seven-month break due to the first and second wave of the SARS-CoV-2 pandemic, respectively. Agreement with the statements of the questionnaire was higher after training compared to before training indicating a positive effect of training sessions on competence. Participants rated joint trainings for nurses and doctors at regular intervals as important. Numerous issues with potential for improvement were identified during post processing of exercises. Action plans for their improvement were drafted and as of now mostly implemented. The network of the permanent working group of competence and treatment centres for HCID (Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger (STAKOB)) at the Robert Koch-Institute (RKI) was strengthened throughout the SARS-CoV-2 pandemic.
Discussion
Adequate preparation for the admission of patients with HCID is challenging. We show that joint regular trainings of doctors and nurses are appreciated and that training sessions may improve perceived skills. We also show that real-life scenario exercises may reveal additional deficits, which cannot be easily disclosed in training sessions. Although the SARS-CoV-2 pandemic interfered with our activities the enhanced cooperation among German HLIU during the pandemic ensured constant readiness for the admission of HCID patients to our or to collaborating HLIU. This is a single centre’s experience, which may not be generalized to other centres. However, we believe that our work may address aspects that should be considered when preparing a unit for the admission of patients with HCID. These may then be adapted to the local situations.
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Affiliation(s)
- Frieder Pfäfflin
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- * E-mail:
| | - Miriam Songa Stegemann
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katrin Moira Heim
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Stephan Achterberg
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ursula Pfitzner
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Louise Götze
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Lars Oesterhelweg
- Institute of Legal Medicine and Forensic Sciences, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Norbert Suttorp
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Christian Herzog
- Centre for Biological Threats, Strategy and Incident Response, Robert Koch-Institute, Berlin, Germany
| | - Benjamin Stadtmann
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Alexander Uhrig
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Trout LJ, Weisman A, Miller JS, Kramer C, Keshavjee S, Kleinman AM, Kulkarni S, Baldwin T, Tobey ML, Buffey T, Harris NS. Siamit: A Novel Academic-Tribal Health Partnership in Northwest Alaska. Acad Med 2021; 96:1560-1563. [PMID: 34261866 DOI: 10.1097/acm.0000000000004239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PROBLEM American Indians and Alaska Natives hold a state-conferred right to health, yet significant health and health care disparities persist. Academic medical centers are resource-rich institutions committed to public service, yet few are engaged in responsive, equitable, and lasting tribal health partnerships to address these challenges. APPROACH Maniilaq Association, a rural and remote tribal health organization in Northwest Alaska, partnered with Massachusetts General Hospital and Harvard Medical School to address health care needs through physician staffing, training, and quality improvement initiatives. This partnership, called Siamit, falls under tribal governance, focuses on supporting community health leaders, addresses challenges shaped by extreme geographic remoteness, and advances the mission of academic medicine in the context of tribal health priorities. OUTCOMES Throughout the 2019-2020 academic year, Siamit augmented local physician staffing, mentored health professions trainees, provided continuing medical education courses, implemented quality improvement initiatives, and provided clinical care and operational support during the COVID-19 pandemic. Siamit began with a small budget and limited human resources, demonstrating that relatively small investments in academic-tribal health partnerships can support meaningful and positive outcomes. NEXT STEPS During the 2020-2021 academic year, the authors plan to expand Siamit's efforts with a broader social medicine curriculum, additional attending staff, more frequent trainee rotations, an increasingly robust mentorship network for Indigenous health professions trainees, and further study of the impact of these efforts. Such partnerships may be replicable in other settings and represent a significant opportunity to advance community health priorities, strengthen tribal health systems, support the next generation of Indigenous health leaders, and carry out the academic medicine mission of teaching, research, and service.
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Affiliation(s)
- Lucas J Trout
- L.J. Trout is managing partner, Siamit, Sayaqagvik director, Maniilaq Social Medicine, and lecturer on global health and social medicine, Harvard Medical School, Kotzebue, Alaska; ORCID: https://orcid.org/0000-0002-5074-6092
| | - Ashley Weisman
- A. Weisman is emergency medicine faculty, Siamit, and assistant professor of emergency medicine, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
| | - James S Miller
- J.S. Miller is internal medicine faculty, Siamit, and a fellow in global medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corina Kramer
- C. Kramer is social medicine faculty and community director, Della Keats Fellowship in Indigenous Health Equity, Siamit, and lead Qargi facilitator, Maniilaq Social Medicine, Kotzebue, Alaska
| | - Salmaan Keshavjee
- S. Keshavjee is faculty advisor, Siamit, director, Harvard Medical School Center for Global Health Delivery, and professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts
| | - Arthur M Kleinman
- A.M. Kleinman is faculty advisor, Siamit, Esther and Sidney Rabb Professor of Anthropology, Harvard University, professor of medical anthropology in global health and social medicine, and professor of psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Suchitra Kulkarni
- S. Kulkarni is senior program coordinator, Siamit and Harvard Medical School Center for Global Health Delivery, Boston, Massachusetts
| | - Teressa Baldwin
- T. Baldwin is Sayaqagvik youth counselor, Maniilaq Social Medicine, and a Della Keats Fellow in Indigenous Health Equity, Siamit, Kotzebue, Alaska
| | - Matthew L Tobey
- M.L. Tobey is rural medicine faculty, Siamit, and rural health leadership fellowship director, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Timothy Buffey
- T. Buffey is medical director, Department of Medicine, Maniilaq Health Services, Kotzebue, Alaska
| | - N Stuart Harris
- N.S. Harris is emergency medicine faculty, Siamit, associate professor of emergency medicine, Harvard Medical School, and chief, Division of Wilderness Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Martin S, Khatib M, Reissis D, Srinivasan JR. Bridging the gap for aesthetic training amidst the Covid-19 pandemic. J Plast Reconstr Aesthet Surg 2021; 75:439-488. [PMID: 34774445 PMCID: PMC8801923 DOI: 10.1016/j.bjps.2021.09.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 04/26/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Serena Martin
- ST7 Plastic Surgery, Regional Plastic Surgery Unit, Ulster Hospital, Upper Newtownards Road, BT16 1RH, United Kingdom.
| | - Manaf Khatib
- ST7 Plastic Surgery, Regional Plastic Surgery Unit, Ulster Hospital, Upper Newtownards Road, BT16 1RH, United Kingdom
| | - Dimitris Reissis
- ST7 Plastic Surgery, Regional Plastic Surgery Unit, Ulster Hospital, Upper Newtownards Road, BT16 1RH, United Kingdom
| | - Jeyaram R Srinivasan
- ST7 Plastic Surgery, Regional Plastic Surgery Unit, Ulster Hospital, Upper Newtownards Road, BT16 1RH, United Kingdom
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Abstract
The world's health care providers have realized that being agile in their thinking and growth in times of rapid change is paramount and that continuing education can be a key facet of the future of health care. As the world recovers from the COVID-19 pandemic, educators at academic health centers are faced with a crucial question: How can continuing professional development (CPD) within teams and health systems be improved so that health care providers will be ready for the next disruption? How can new information about the next disruption be collected and disseminated so that interprofessional teams will be able to effectively and efficiently manage a new disease, new information, or new procedures and keep themselves safe? Unlike undergraduate and graduate/postgraduate education, CPD does not always have an identified educational home and has had uneven and limited innovation during the pandemic. In this commentary, the authors explore the barriers to change in this sector and propose 4 principles that may serve to guide a way forward: identifying a home for interprofessional continuing education at academic health centers, improving workplace-based learning, enhancing assessment for individuals within health care teams, and creating a culture of continuous learning that promotes population health.
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Affiliation(s)
- David Sklar
- D. Sklar is professor of emergency medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, professor, Arizona State University, College of Health Solutions, Phoenix, Arizona, and professor, University of Arizona College of Medicine, Tucson, Arizona; ORCID: http://orcid.org/0000-0003-4705-7904
| | - Yusuf Yilmaz
- Y. Yilmaz is a postdoctoral fellow, McMaster Education Research, Innovation, and Theory (MERIT) and Continuing Professional Development Office, McMaster University, Hamilton, Ontario, Canada, and a researcher-lecturer, Department of Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey; ORCID: http://orcid.org/0000-0003-4378-4418
| | - Teresa M. Chan
- T.M. Chan is associate dean, Continuing Professional Development, Faculty of Health Sciences, McMaster University, associate professor, Divisions of Education & Innovation and Emergency Medicine, Department of Medicine, McMaster University, program director, Clinician Educator Area of Focused Competence Diploma Program, Royal College of Physicians and Surgeons of Canada, and clinician scientist, McMaster Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6104-462X
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Abstract
The value of structured development processes has been recognized and implemented in formal physician training programs such as residencies and fellowships. Physicians are seemingly viewed as a "finished product" upon completing formal training. In recent years, a number of academic medical centers have implemented formalized early-career development programs for physicians, largely those who have a major research focus. However, beyond the early stage of physicians' careers, formalized and intentional physician career development programs are rare. The lack of a philosophy of intentional, career-long individual development at academic medical centers reflects a narrow understanding of the implicit contract between employers and employees. The resulting gap leads the vast majority of physicians to fall short of their potential, further leading to long-term loss for the academic medical centers, their physicians, and society as a whole. Based on the framework of analyze-design-develop-implement-evaluate, the authors propose a robust, iterative model for physician career development that goes beyond skills and knowledge maintenance toward leveraging a broad range of individual capabilities, needs, and contexts along the career lifespan. The model provides a means for harnessing physicians' strengths and passions in concert with the needs of their organization to create greater physician fulfillment and success, which in turn would benefit the patients they care for and the academic medical centers in which they work.
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Affiliation(s)
- R Thomas Collins
- R.T. Collins II is clinical associate professor, Departments of Pediatrics and Internal Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: http://orcid.org/0000-0002-3387-6629
| | - Rania Sanford
- R. Sanford is director, Faculty Professional Development, Stanford University School of Medicine, Palo Alto, California
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Wang Y, Yang J, Ma H, Dong X, Xie G, Ye S, Du J. Application of telemedicine in the COVID-19 epidemic: An analysis of Gansu Province in China. PLoS One 2021; 16:e0249872. [PMID: 34347779 PMCID: PMC8336882 DOI: 10.1371/journal.pone.0249872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/27/2021] [Indexed: 12/16/2022] Open
Abstract
This paper analyzes the application of various telemedicine services in Gansu Province, China during the COVID-19 epidemic, and summarizes the experiences with these services. In addition, the satisfaction levels of patients and doctors with the application of telemedicine in COVID-19 were investigated, the deficiencies of telemedicine in Gansu were determined, and recommendations for modification were proposed. Coronavirus Disease 2019 (COVID-19) has broken out in China, and Gansu Province in Northwest of China has not been spared. To date, there are 91 local COVID-19 cases and 42 imported cases. 109 hospitals were selected as designated hospitals during the COVID-19 outbreak, and most of them were secondary hospitals. However, it was unsatisfactory that the ability of medical services is relatively low in most of secondary hospitals and primary hospitals. Therefore, we helped the secondary hospitals cope with COVID-19 by means of remote consultation, long-distance education, telemedicine question and answer (Q&A). Our practical experience shows that telemedicine can be widely used during the COVID-19 epidemic, especially in developing countries and areas with lagging medical standards.
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MESH Headings
- COVID-19/epidemiology
- COVID-19/therapy
- China/epidemiology
- Disease Outbreaks
- Education, Distance/organization & administration
- Education, Distance/statistics & numerical data
- Education, Medical, Continuing/methods
- Education, Medical, Continuing/organization & administration
- Education, Medical, Continuing/statistics & numerical data
- Education, Nursing, Continuing/methods
- Education, Nursing, Continuing/organization & administration
- Education, Nursing, Continuing/statistics & numerical data
- Epidemics
- Geography
- Health Services Accessibility/organization & administration
- Health Services Accessibility/statistics & numerical data
- Humans
- Physician-Patient Relations
- Remote Consultation/instrumentation
- Remote Consultation/methods
- Remote Consultation/organization & administration
- Remote Consultation/statistics & numerical data
- SARS-CoV-2/physiology
- Software
- Telemedicine/instrumentation
- Telemedicine/methods
- Telemedicine/organization & administration
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Affiliation(s)
- Yan Wang
- Department of Telemedicine Consultation Center, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jie Yang
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu China
| | - Huijuan Ma
- Department of Telemedicine Consultation Center, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Xinchun Dong
- Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Guangmei Xie
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu China
- * E-mail:
| | - Songning Ye
- Department of Telemedicine Consultation Center, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Juan Du
- Department of Human Resources, Gansu Provincial Hospital, Lanzhou, Gansu, China
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Weber C, Ntasumbumuyange D, Ngoga E, Bazzett-Matabele L, Francis J, Paley P, Graef K, Ghebre R. Continuing medical education during COVID-19: virtual training for gynecologic oncology management in Rwanda. Int J Gynecol Cancer 2021; 31:1184-1185. [PMID: 34016700 PMCID: PMC8141375 DOI: 10.1136/ijgc-2021-002476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Callie Weber
- BIO Ventures for Global Health (BVGH), Seattle, Washington, USA
| | | | - Eugene Ngoga
- Department of Obstetrics and Gynecology, Rwanda Military Hospital, Kigali, Rwanda
| | | | - Julie Francis
- R.S McLaughlin Cancer Center, Lakeridge Health, Oshawa, Ontario, Canada
| | - Pam Paley
- Overlake Cancer Center, Overlake Hospital Medical Center, Bellevue, Washington, USA
| | - Katy Graef
- BIO Ventures for Global Health, Seattle, Washington, USA
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota, USA
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Abstract
The COVID-19 crisis has forced physicians to make daily decisions that require knowledge and skills they did not acquire as part of their biomedical training. Physicians are being called upon to be both managers-able to set processes and structures-and leaders-capable of creating vision and inspiring action. Although these skills may have been previously considered as just nice to have, they are now as central to being a physician as physiology and biochemistry. While traditionally only selected physicians have received management training, either through executive or joint degree programs, the authors argue that the pandemic has highlighted the importance of all physicians learning management and leadership skills. Training should emphasize skills related to interpersonal management, systems management, and communication and planning; be seamlessly integrated into the medical curriculum alongside existing content; and be delivered by existing faculty with leadership experience. While leadership programs, such as the Pediatric Leadership for the Underserved program at the University of California, San Francisco, and the Clinical Process Improvement Leadership Program at Mass General Brigham, may include project work, instruction by clinical leaders, and content delivered over time, examples of leadership training that seamlessly blend biomedical and management training are lacking. The authors present the Leader and Leadership Education and Development curriculum used at the Uniformed Services University of the Health Sciences, which is woven through 4 years of medical school, as an example of leadership training that approximates many of the principles espoused here. The COVID-19 pandemic has stretched the logistical capabilities of health care systems and the entire United States, revealing that management and leadership skills-often viewed as soft skills-are a matter of life and death. Training all physicians in these skills will improve patient care, the well-being of the health care workforce, and health across the United States.
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Affiliation(s)
- Lisa S Rotenstein
- L.S. Rotenstein is assistant medical director, Population Health and Faculty Development and Wellbeing, Brigham and Women's Hospital, and instructor of medicine, Harvard Medical School, Boston, Massachusetts
| | - Robert S Huckman
- R.S. Huckman is professor of business administration, Harvard Business School, unit head, Technology and Operations Management, and faculty chair, Harvard Business School Health Care Initiative, Boston, Massachusetts
| | - Christine K Cassel
- C.K. Cassel is senior advisor on strategy and policy, Department of Medicine, University of California, San Francisco, San Francisco, California. The author was planning dean, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Tuca AC, Münch J, Schwappach DLB, Borenich A, Banfi C, Mautner S, Hoffmann M, Schwarz C, Kamolz LP, Brunner G, Sendlhofer G. Implementation status of morbidity and mortality conferences in Austrian hospitals-A cross-sectional national survey study. PLoS One 2021; 16:e0248692. [PMID: 33730067 PMCID: PMC7968694 DOI: 10.1371/journal.pone.0248692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/04/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Morbidity and mortality conferences (M&MCs) are an instrument for learning from past complications, unexpected follow-ups and deaths in hospitals and are important for improving patient safety. However, there are currently no quantitative data on the implementation of M&MCs in Austria. The aim of the study was to determine the status quo of the M&MCs in Austria. MATERIALS AND METHODS A national cross-sectional study was conducted by means of a survey of 982 chief physicians of surgical disciplines, internal medicine, anesthesiology, intensive care, gynecology/obstetrics and pediatrics. The questionnaire focused on overall goals, structure and procedures of hospital M&MCs. RESULTS Of the 982 contacted chief physicians, 314 (32.0%) completed the survey. Almost two thirds of the respondents, i.e. 203 (64.7%), had already implemented M&MCs. Of the 111 chief physicians who had not yet introduced M&MCs, 62 (55.9%) were interested in introducing such conferences in the future. Of the 203 respondents that had implemented M&MCs, 100 stated that their M&MC could be improved. They reported issues with "shame and blame" culture, hierarchical structures, too little knowledge about the capability of M&MC and, in particular, time constraints. Overall, the participating chief physicians showed that they are striving to improve their existing M&MCs. DISCUSSION/CONCLUSION While we found a relatively high number of already implemented M&MCs we also identified a large heterogeneity in the format of the M&MCs. A highly structured M&MC including guidelines, checklists or templates does not only considerably improve its outcome but can also alleviate the main limiting factor which is the lack of time.
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Affiliation(s)
- Alexandru-Cristian Tuca
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Johanna Münch
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - David L. B. Schwappach
- Swiss Patient Safety Foundation Zurich, Zürich, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andrea Borenich
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Chiara Banfi
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Selma Mautner
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Magdalena Hoffmann
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Christine Schwarz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lars-Peter Kamolz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
- Austrian Society for Quality and Safety in Healthcare (ASQS), Graz, Austria
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Turner SR, Mador B, Lai H, White J, Kim M. Toward competency based continuing professional development for practicing surgeons. Am J Surg 2021; 222:1139-1145. [PMID: 33579538 DOI: 10.1016/j.amjsurg.2021.01.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/14/2020] [Revised: 01/08/2021] [Accepted: 01/31/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND There has been a recent call for formal competency assessments of practicing physicians and surgeons to form a framework of competency based continuing professional development (CBCPD). METHODS An email questionnaire was conducted regarding CBCPD. Responses were further used to inform development of semi-structured interviews. RESULTS There were 58 questionnaire respondents (42%). There was moderate support for assessment of surgeons' technical skills (50.9%) or decision making (56.6%). Support was highest for a mechanism to flag surgeons in need of a focused competence assessment (83.0%). Eight surgeons participated in interviews. Interviews identified a range of benefits of CBCPD but also several challenges to implementation, including the need for fair, data-driven assessments, taking into account patient outcomes. CONCLUSIONS Through listening to surgeon concerns and recommendations for implementation strategies, this study's findings may support development of an effective CBCPD strategy with the potential to be embraced by surgeons and foster an environment of improved safety and performance.
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Affiliation(s)
- Simon R Turner
- Division of Thoracic Surgery, University of Alberta, 8440 112 St, Edmonton, AB, T6G 2R7, Canada.
| | - Brett Mador
- Division of General Surgery, University of Alberta, 8440 112 St, Edmonton, AB, T6G 2R7, Canada
| | - Hollis Lai
- Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St, Edmonton, AB, T6G 2R7, Canada
| | - Jonathan White
- Division of General Surgery, University of Alberta, 8440 112 St, Edmonton, AB, T6G 2R7, Canada
| | - Michael Kim
- Division of General Surgery, University of Alberta, 8440 112 St, Edmonton, AB, T6G 2R7, Canada
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Smith CEP, Prasad V. Targeted Cancer Therapies. Am Fam Physician 2021; 103:155-163. [PMID: 33507053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Targeted cancer therapies involve chemotherapeutic agents that attack, directly or indirectly, a specific genetic biomarker found in a given cancer. Targeted oncology includes monoclonal antibodies, small molecule inhibitors, antibody-drug conjugates, and immunotherapy. For example, the monoclonal antibodies trastuzumab and pertuzumab target human epidermal growth factor receptor 2 (HER2) and are used when treating HER2-positive breast cancer. Although targeted oncology has improved survival by years for some incurable cancers such as metastatic breast and lung cancer, as few as 8% of patients with advanced cancer qualify for targeted oncology medications, and even fewer benefit. Other limitations include serious adverse events, illustrated by a 20% to 30% rate of heart attack, stroke, or peripheral vascular events among patients taking ponatinib, which is used in treating chronic myelogenous leukemia. Immune checkpoint inhibitor therapy-related adverse effects such as hypothyroidism are common, and more severe adverse events such as colitis and pneumonitis can be fatal and require immediate intervention. Drug interactions with widely prescribed medications such as antacids and warfarin are common. Additionally, financial toxicities are a problem for patients with cancer who are using costly targeted therapies. Future directions for targeted oncology include tumor-agnostic drugs, which target a given mutation and could be used in treating cancers from multiple organ types. An overview of indications, mechanism of action, and toxicities of targeted cancer therapies is offered here.
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O'Brien Pott M, Blanshan AS, Huneke KM, Baasch Thomas BL, Cook DA. What Influences Choice of Continuing Medical Education Modalities and Providers? A National Survey of U.S. Physicians, Nurse Practitioners, and Physician Assistants. Acad Med 2021; 96:93-100. [PMID: 32969838 DOI: 10.1097/acm.0000000000003758] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To explore what influences clinicians in selecting continuing medical education (CME) activities in the United States. METHOD In August 2018, the authors conducted an Internet-based national survey, sampling 100 respondents from each of 5 groups: family medicine physicians, internal medicine and hospitalist physicians, medicine specialist physicians, nurse practitioners, and physician assistants. In total, 1,895 clinicians were invited and 500 (26%) responded. Questions addressed the selection and anticipated use of CME delivery modalities and perceived characteristics of specific CME providers. Response formats used best-worst scaling or 5-point ordinal response options. RESULTS The factors identified as most important in selecting CME activities were topic (best-worst scaling net positivity 0.54), quality of content (0.51), availability of CME credit (0.43), and clinical practice focus (0.41), while referral frequency (-0.57) ranked lowest. The activities that the respondents anticipated using most in the future were live (mean 3.8 [1 = not likely, 5 = very likely]), online (mean 3.5), point-of-care (mean 3.5), and print-based (mean 3.5) activities. For online CME, the features of greatest appeal were that learning could be done when clinicians had time (mean 4.4), at their own pace (mean 4.2), and at lower cost (mean 4.2). For live CME, the features of greatest appeal were that the subject was best taught using this modality (mean 4.0), or the activity was located in a destination spot (mean 4.0) or a regional location (mean 3.9). When rating specific CME providers, most academic institutions received relatively high ratings for research focus and clinical practice focus, whereas commercial providers had slightly higher ratings for ease of access. Responses were generally similar across clinician types and age groups. CONCLUSIONS Physicians, nurse practitioners, and physician assistants are interested in using a variety of CME delivery modalities. Appealing features of online and live CME were different.
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Affiliation(s)
- Maureen O'Brien Pott
- M. O'Brien Pott is senior analyst, Planning Services, Mayo Clinic, Rochester, Minnesota
| | - Anissa S Blanshan
- A.S. Blanshan is senior marketing manager, Mayo Clinic, Rochester, Minnesota
| | - Kelly M Huneke
- K.M. Huneke is instructor, health care administration, and administrator, Center for Military Medicine and Mayo Clinic School of Continuous Professional Development, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Barbara L Baasch Thomas
- B.L. Baasch Thomas is senior director of education and professional development, Mayo Clinic School of Continuous Professional Development, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - David A Cook
- D.A. Cook is professor of medicine and medical education and director, Section of Research and Data Analytics, Mayo Clinic School of Continuous Professional Development; director of education science, Office of Applied Scholarship and Education Science; and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633
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Brownson RC, Jacob RR, Carothers BJ, Chambers DA, Colditz GA, Emmons KM, Haire-Joshu D, Kerner JF, Padek M, Pfund C, Sales A. Building the Next Generation of Researchers: Mentored Training in Dissemination and Implementation Science. Acad Med 2021; 96:86-92. [PMID: 32941251 PMCID: PMC7769184 DOI: 10.1097/acm.0000000000003750] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PROBLEM Dissemination and implementation (D&I) science provides the tools needed to close the gap between known intervention strategies and their effective application. The authors report on the Mentored Training for Dissemination and Implementation Research in Cancer (MT-DIRC) program-a D&I training program for postdoctoral or early-career cancer prevention and control scholars. APPROACH MT-DIRC was a 2-year training institute in which fellows attended 2 annual Summer Institutes and other conferences and received didactic, group, and individual instruction; individualized mentoring; and other supports (e.g., pilot funding). A quasi-experimental design compared changes in 3 areas: mentoring, skills, and network composition. To evaluate mentoring and D&I skills, data from fellows on their mentors' mentoring competencies, their perspectives on the importance of and satisfaction with mentoring priority areas, and their self-rated skills in D&I competency domains were collected. Network composition data were collected from faculty and fellows for 3 core social network domains: contact, mentoring, and collaboration. Paired t tests (mentoring), linear mixed models (skills), and descriptive analyses (network composition) were performed. OUTCOMES Mentors were rated as highly competent across all mentoring competencies, and each mentoring priority area showed reductions in gaps between satisfaction and importance between the 6 and 18 months post-first Summer Institute. Fellows' self-rated skills in D&I competencies improved significantly in all domains over time (range: 42.5%-52.9% increase from baseline to 18 months post-first Summer Institute). Mentorship and collaboration networks grew over time, with the highest number of collaboration network ties for scholarly manuscripts (n = 199) in 2018 and for research projects (n = 160) in 2019. NEXT STEPS Building on study findings and existing literature, mentored training of scholars is an important approach for building D&I skills and networks, and thus to better applying the vast amount of available intervention evidence to benefit cancer control.
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Affiliation(s)
- Ross C. Brownson
- R.C. Brownson is Steven H. and Susan U. Lipstein Distinguished Professor of Public Health, Prevention Research Center, Brown School at Washington University in St. Louis, and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Rebekah R. Jacob
- R.R. Jacob is research manager, Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Bobbi J. Carothers
- B.J. Carothers is senior data analyst, Center for Public Health Systems Science, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - David A. Chambers
- D.A. Chambers is deputy director for implementation science, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Graham A. Colditz
- G.A. Colditz is Niess-Gain Professor of Surgery, Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Karen M. Emmons
- K.M. Emmons is professor of social and behavioral sciences, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Debra Haire-Joshu
- D. Haire-Joshu is Joyce Wood Professor, Center for Diabetes Translation Research and Center for Obesity Prevention and Policy Research, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Jon F. Kerner
- J.F. Kerner was senior scientific advisor, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Margaret Padek
- M. Padek is research manager, Implementation Science Center for Cancer Control, Brown School at Washington University in St. Louis, and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Christine Pfund
- C. Pfund is senior scientist, Center for the Improvement of Mentored Experiences in Research, and Wisconsin Center for Education Research and Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
| | - Anne Sales
- A. Sales is professor, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Lim SC, Mustapha FI, Aagaard-Hansen J, Calopietro M, Aris T, Bjerre-Christensen U. Impact of continuing medical education for primary healthcare providers in Malaysia on diabetes knowledge, attitudes, skills and clinical practices. Med Educ Online 2020; 25:1710330. [PMID: 31891330 PMCID: PMC6968562 DOI: 10.1080/10872981.2019.1710330] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Background: Continuing Medical Education (CME) is a cornerstone of improving competencies and ensuring high-quality patient care by nurses and physicians. The Ministry of Health (MOH) Malaysia collaborated with Steno Diabetes Centre to improve diabetes-related competencies of general physicians and nurses working in primary care through a six-month training programme called the Steno REACH Certificate Course in Clinical Diabetes Care (SRCC).Objective: This impact evaluation aimed to assess the effect of participation of general physicians and nurses in the SRCC in selected public primary healthcare clinics in Kuala Lumpur and Selangor, Malaysia.Design: The quasi-experimental, embedded, mixed-methods study used concurrent data collection and the Solomon four-group design. Participants in an intervention group (Arm 1) and control group (Arm 3) were assessed by pre-and post-test, and participants in separate intervention (Arm 2) and control (Arm 4) groups were assessed by post-test only. Quantitative and qualitative methods were used to assess the effect of the programme.Results: Thirty-four of the 39 participants in the intervention groups (Arms 1 and 2) completed the SRCC and were included in the analysis. All 35 participants in the control groups (Arms 3 and 4) remained at the end of the study period. Significant improvements in diabetes-related knowledge, skills and clinical practise were found among general physicians and nurses in the intervention group after the six-month SRCC, after controlling the pretest effects. No clear changes could be traced regarding attitudes.Conclusion: SRCC participants had significant improvements in knowledge, skills and clinical practice that meet the current needs of general physicians and nurses working in primary care in Malaysia. Thus, SRCC is an effective CME approach to improving clinical diabetes care that can be scaled up to the rest of the country and, with some modification, beyond Malaysia.
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MESH Headings
- Adult
- Clinical Competence/standards
- Diabetes Mellitus/epidemiology
- Diabetes Mellitus/physiopathology
- Education, Medical, Continuing/organization & administration
- Education, Medical, Continuing/standards
- Education, Nursing, Continuing/organization & administration
- Education, Nursing, Continuing/standards
- Female
- General Practitioners/education
- Health Knowledge, Attitudes, Practice
- Humans
- Malaysia
- Male
- Middle Aged
- Primary Health Care/organization & administration
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Affiliation(s)
- Shiang Cheng Lim
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- United Nations University – International Institute for Global Health, Kuala Lumpur, Malaysia
- CONTACT Shiang Cheng Lim United Nations University – International Institute for Global Health (UNU-IIGH) Building, UKM Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur56000, Malaysia
| | - Feisul Idzwan Mustapha
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Jens Aagaard-Hansen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- MRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Tahir Aris
- Institute for Public Health, Ministry of Health Malaysia, Putrajaya, Malaysia
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De Angelis M. [There is no progress without school. Postgraduate specialization school completes the paradigm shift in palliative care.]. Recenti Prog Med 2020; 111:647-651. [PMID: 33205762 DOI: 10.1701/3474.34565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With the conversion of law decree no. 34 of 19 May 2020, bearing urgent measures concerning health, support to work and the economy, as well as social policies related to CoViD-19 epidemiological emergency, thanks to the approval of an amendment to legislative decree "Rilancio" signed by Giorgio Trizzino, the Specialization school in medicine and palliative care will be established starting from a.y. 2021-2022. Additionally, a course in pediatric palliative care will be introduced in pediatrics specialization schools. The news has been welcomed with enthusiasm by the scientific community and the main stakeholders, some of which have made a strong contribution to this result: the Italian Society for Palliative Care, the Italian Federation for Palliative Care, the Maruzza Levebvre d'Ovidio Foundation, as well as the many professionals, institutions, and NPOs that have been supporting for the past forty years the progress of palliative care in Italy. An assessment of the impact of such a measure and its effects entails due process and contextualization in different areas: first of all, that of demand and current supply, followed by the historical-cultural, the social, and the normative.
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Affiliation(s)
- Marta De Angelis
- Medico palliativista, responsabile clinico AGLAIA, Associazione per l'assistenza palliativa onlus, Spoleto (PG)
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Brunner M, Vogelman B, Smith J. Rapid development of an outpatient-to-inpatient crash curriculum for COVID-19 providers. Med Educ 2020; 54:953-954. [PMID: 32418244 PMCID: PMC7276814 DOI: 10.1111/medu.14244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 06/01/2023]
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Affiliation(s)
- F Trimarchi
- Accademia Peloritana dei Pericolanti, University of Messina, Messina, Italy.
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Balakumar C, Montauban P, Rait J, Iqbal S, Burr T, Taleb K, Featherstone B, Zarsadias P, Fernandes R, Basnyat P, Shah A. Surgeons' response to COVID-19 - Preparing from the sideline. Br J Surg 2020; 107:e192. [PMID: 32364257 PMCID: PMC7267587 DOI: 10.1002/bjs.11647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 11/20/2022]
Affiliation(s)
- C Balakumar
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - P Montauban
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - J Rait
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - S Iqbal
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - T Burr
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - K Taleb
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - B Featherstone
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - P Zarsadias
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - R Fernandes
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - P Basnyat
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - A Shah
- William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
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Continuing Education Activities: May/June 2020. Neonatal Netw 2020; 39:170-4. [PMID: 32457192 DOI: 10.1891/0730-0832.39.3.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Quanbeck A, Almirall D, Jacobson N, Brown RT, Landeck JK, Madden L, Cohen A, Deyo BMF, Robinson J, Johnson RA, Schumacher N. The Balanced Opioid Initiative: protocol for a clustered, sequential, multiple-assignment randomized trial to construct an adaptive implementation strategy to improve guideline-concordant opioid prescribing in primary care. Implement Sci 2020; 15:26. [PMID: 32334632 PMCID: PMC7183389 DOI: 10.1186/s13012-020-00990-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rates of opioid prescribing tripled in the USA between 1999 and 2015 and were associated with significant increases in opioid misuse and overdose death. Roughly half of all opioids are prescribed in primary care. Although clinical guidelines describe recommended opioid prescribing practices, implementing these guidelines in a way that balances safety and effectiveness vs. risk remains a challenge. The literature offers little help about which implementation strategies work best in different clinical settings or how strategies could be tailored to optimize their effectiveness in different contexts. Systems consultation consists of (1) educational/engagement meetings with audit and feedback reports, (2) practice facilitation, and (3) prescriber peer consulting. The study is designed to discover the most cost-effective sequence and combination of strategies for improving opioid prescribing practices in diverse primary care clinics. METHODS/DESIGN The study is a hybrid type 3 clustered, sequential, multiple-assignment randomized trial (SMART) that randomizes clinics from two health systems at two points, months 3 and 9, of a 21-month intervention. Clinics are provided one of four sequences of implementation strategies: a condition consisting of educational/engagement meetings and audit and feedback alone (EM/AF), EM/AF plus practice facilitation (PF), EM/AF + prescriber peer consulting (PPC), and EM/AF + PF + PPC. The study's primary outcome is morphine-milligram equivalent (MME) dose by prescribing clinicians within clinics. The study's primary aim is the comparison of EM/AF + PF + PPC versus EM/AF alone on change in MME from month 3 to month 21. The secondary aim is to derive cost estimates for each of the four sequences and compare them. The exploratory aim is to examine four tailoring variables that can be used to construct an adaptive implementation strategy to meet the needs of different primary care clinics. DISCUSSION Systems consultation is a practical blend of implementation strategies used in this case to improve opioid prescribing practices in primary care. The blend offers a range of strategies in sequences from minimally to substantially intensive. The results of this study promise to help us understand how to cost effectively improve the implementation of evidence-based practices. TRIAL REGISTRATION NCT04044521 (ClinicalTrials.gov). Registered 05 August 2019.
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Affiliation(s)
- Andrew Quanbeck
- Department of Family Medicine and Community Health, University of Wisconsin–Madison, 800 University Bay Drive, Suite 210, Madison, WI 53705-2278 USA
| | - Daniel Almirall
- Department of Statistics and Institute for Social Research, University of Michigan, 2448 Institute for Social Research, 426 Thompson St., Ann Arbor, MI 48104-2321 USA
| | - Nora Jacobson
- Institute for Clinical and Translational Research and School of Nursing, University of Wisconsin, Madison, 5130 Signe Skott Cooper Hall, 701 Highland Ave, Madison, WI 53705-2202 USA
| | - Randall T. Brown
- Department of Family Medicine and Community Health, University of Wisconsin–Madison, 1100 Delaplaine Ct, Madison, WI 53705-1840 USA
| | - Jillian K. Landeck
- Department of Family Medicine and Community Health, University of Wisconsin–Madison, 1100 Delaplaine Ct, Madison, WI 53705-1840 USA
| | - Lynn Madden
- APT Foundation, 1 Long Wharf Drive, Suite 321, New Haven, CT 06511-5991 USA
| | - Andrew Cohen
- Bellin Health Systems, Inc., 744 S. Webster Ave, Green Bay, WI 54305 USA
| | - Brienna M. F. Deyo
- Department of Family Medicine and Community Health, University of Wisconsin–Madison, 1100 Delaplaine Ct, Madison, WI 53705-1840 USA
| | - James Robinson
- Forward Data Analytic Services, LLC, 6700 Cross Country Road, Verona, WI 53593 USA
| | - Roberta A. Johnson
- Department of Family Medicine and Community Health, University of Wisconsin–Madison, 800 University Bay Drive, Suite 210, Madison, WI 53705-2278 USA
| | - Nicholas Schumacher
- Department of Family Medicine and Community Health, University of Wisconsin–Madison, 800 University Bay Drive, Suite 210, Madison, WI 53705-2278 USA
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DeRusso PA, Greeley WJ, St Geme JW. Leading from the Middle: Benefits of a Physician Leadership Program. J Pediatr 2020; 219:4-6.e1. [PMID: 32204805 DOI: 10.1016/j.jpeds.2019.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Patricia A DeRusso
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - William J Greeley
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Joseph W St Geme
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
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Friett K. Corona, conferences and continuing development points. Br J Community Nurs 2020; 25:S38. [PMID: 32271104 DOI: 10.12968/bjcn.2020.25.sup4.s38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Tolppa T, Vangu AM, Balu HC, Matondo P, Tissingh E. Impact of the primary trauma care course in the Kongo Central province of the Democratic Republic of Congo over two years. Injury 2020; 51:235-242. [PMID: 31864671 DOI: 10.1016/j.injury.2019.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/15/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The two-day Primary Trauma Care (PTC) course covers the management of injured patients and takes into account resource constraints experienced in low and middle-income countries. Currently, there are no studies on the long-term impact of the course on knowledge or attitudes. The PTC course was introduced in Kongo Central Central province in the Democratic Republic of Congo (DRC) as part of a series of interventions to improve trauma care. The aim of this study was to evaluate the impact of PTC on the trauma knowledge, confidence and attitudes regarding trauma care of healthcare workers (HCWs) in the DRC over two years. METHOD A retrospective cohort study was conducted comparing multiple-choice questionnaire (MCQ) and confidence matrix results of PTC attendees prior to the course, immediately after, and at the time of follow up at either 12, 16 or 24 months. A semi-structured questionnaire was additionally administered at follow up to explore the effect of PTC on key areas of trauma learning: skills, attitudes and relationships. RESULTS A total of 59/80 HCWs who attended the PTC course completed follow-up questionnaires. Participants were predominantly male (42/59) with a mean age of 41.6 years. There was an increase of 4.8 in MCQ scores and 9.6 in confidence scores (p < 0.01) post-PTC. MCQ scores were maintained 24 months after the course, whereas confidence scores declined (p = 0.03). At follow-up, 36/59 participants reported that equipment was not available for procedures and 52/59 felt more could be done to better manage injured patients locally. All participants believed trauma services were important and felt that the course contributed to improving the management of trauma patients. CONCLUSIONS This study found that knowledge gained from the PTC course was maintained over two years, although individuals felt less clinically confident. A refresher course may be appropriate within two years to improve relatively low overall knowledge scores and participants' confidence. Whilst resource constraints within the DRC may hinder trauma care development, the PTC course has equipped attendees with the knowledge, skills, confidence and attitudes to improve trauma service development in their region.
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Affiliation(s)
- T Tolppa
- King's Kongo Central Partnership, United Kingdom; King's Centre for Global Health, United Kingdom; King's College, London, United Kingdom; King's Health Partner, United Kingdom.
| | - A M Vangu
- King's Kongo Central Partnership, United Kingdom; King's Centre for Global Health, United Kingdom; King's College, London, United Kingdom; King's Health Partner, United Kingdom
| | - H C Balu
- Université Joseph Kasa Vubu, Boma, Kongo Central, United Kingdom
| | - P Matondo
- Hôpital Provincial de Reference de Kinkanda, Matadi, Kongo Central, United Kingdom
| | - E Tissingh
- King's Kongo Central Partnership, United Kingdom; King's Centre for Global Health, United Kingdom; King's College, London, United Kingdom; King's Health Partner, United Kingdom
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Price DW, Campbell CM. Rapid Retooling, Acquiring New Skills, and Competencies in the Pandemic Era: Implications and Expectations for Physician Continuing Professional Development. J Contin Educ Health Prof 2020; 40:74-75. [PMID: 32433321 DOI: 10.1097/ceh.0000000000000297] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The SARS-CoV-2 (COVID 19) pandemic has necessitated changes in health care delivery, including increases in delivery of care through asynchronous or virtual means, and deployment of clinicians in different teams and settings. Physical distancing and redeployment of clinicians has also necessitated changes in health care continuing professional development (CPD). Health care delivery and CPD is unlikely to fully return (in the near term, if at all) to pre-pandemic status. The authors raise questions and opportunities for development and provision of CPD during and after the pandemic.
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Affiliation(s)
- David W Price
- Dr. Price: Professor, Department of Family Medicine, University of Colorado Anschutz School of Medicine, Denver, CO, and Senior Advisor to the President, American Board of Family Medicine, Lexington, KY. Dr. Campbell: Associate Professor of Medicine, Facuty of Medicine, and Director, Curriulum UGME Program, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Stratman EJ. Dermatology continuing certification changes for the better. Cutis 2020; 105:14-15. [PMID: 32074148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Abstract
More than 67% of people diagnosed with cancer in the United States are alive five years after receiving the diagnosis; but even if they are cancer free, the effects of the disease and its treatment will remain with them for the rest of their lives. Distress, which can be of a psychological, social, physical, or spiritual nature, is common among cancer survivors. Spiritual distress is a broad concept that is not necessarily associated with any specific religious beliefs, practices, or affiliations. Both religious and nonreligious people may have a strong sense of spirituality and may experience spiritual distress at various points throughout cancer survivorship. But clinicians often neglect to explore the spiritual components of distress, and despite the well-established association between spiritual well-being and quality of life, few of the instruments designed to assess the care needs of cancer survivors address spiritual needs. Through a composite clinical case, this article illustrates how nurses can incorporate into practice evidence-based recommendations for assessing and managing spiritual distress in cancer survivors.
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Affiliation(s)
- Timiya S Nolan
- Timiya S. Nolan is an assistant professor in the College of Nursing at Ohio State University (OSU), Columbus, and a nurse scientist at the OSU Wexner Medical Center. Kristine Browning is an associate professor of clinical nursing and assistant dean for graduate clinical programs in the OSU College of Nursing and an NP at the OSU Wexner Medical Center-James Cancer Hospital. At the time this article was written, Jacqueline B. Vo was a PhD candidate at the University of Alabama, Birmingham (UAB); she is now a graduate of that program. Rachel J. Meadows is a predoctoral fellow in the OSU College of Public Health. Raheem J. Paxton is an associate professor in the UAB College of Community Health Sciences. This article grew out of the lead author's doctoral dissertation, the writing of which was funded by the American Cancer Society and the Susan G. Komen Graduate Traineeship in Disparities Research. Contact author: Timiya S. Nolan, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the authors is available at www.ajnonline.com
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Cullen MW, Geske JB, Anavekar NS, McAdams JA, Beliveau ME, Ommen SR, Nishimura RA. Reinvigorating Continuing Medical Education: Meeting the Challenges of the Digital Age. Mayo Clin Proc 2019; 94:2501-2509. [PMID: 31806103 DOI: 10.1016/j.mayocp.2019.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/17/2019] [Accepted: 07/05/2019] [Indexed: 12/18/2022]
Abstract
Clinicians in today's health care environment face an overwhelming quantity of knowledge that requires continued education and lifelong learning. However, traditional continuing medical education (CME) courses cannot meet these educational needs, particularly given the proliferation of knowledge and increasing demands on clinicians' time and resources. CME courses that previously offered only in-person, face-to-face education must evolve in a learner-centric manner founded on principles of adult learning theory to remain relevant in the current era. In this article, we describe the transition of the Mayo Clinic Cardiovascular Review for Cardiology Boards and Recertification (CVBR) from a traditional course with only live content to a course integrating live, online, and enduring materials. This evolution has required leveraging technology to maximize learner engagement, offering faculty development to ensure content alignment with learner needs, and strong leadership dedicated to providing learners an unparalleled educational experience. Despite stagnation in growth of the traditional live course, these changes have increased the overall reach of the Mayo Clinic CVBR. Learners engaging with digital content have demonstrated larger increases in knowledge with less educational time commitment. Courses seeking to implement similar changes must develop formal learning objectives focused on learner needs, build an online presence that includes an assessment of learner knowledge, enlist a cohort of dedicated faculty who teach based on principles of adult learning theory, and perpetually refresh educational content based on learner feedback and performance. Following these principles will allow traditional CME courses to thrive despite learners' resource constraints and alternative means to access information.
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Affiliation(s)
- Michael W Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Julie A McAdams
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Asghari S, Heeley T, Walsh A, Rourke J, Bethune C, Graham W. Rural360: incubating socially accountable research in the Canadian North. Int J Circumpolar Health 2019; 78:1633191. [PMID: 31232213 PMCID: PMC6598539 DOI: 10.1080/22423982.2019.1633191] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/04/2019] [Accepted: 06/11/2019] [Indexed: 11/04/2022] Open
Abstract
People in Northern Newfoundland and Coastal Labrador (NNCL), Canada, face major challenges obtaining accessible and contextually-relevant healthcare. Rural360 is a socially accountable research incubator that provides funding for NNCL physicians to research solutions to these issues. NNCL graduates of the adjoined 6for6 research training program for rural physicians are invited to submit the research project they have conceptualised as part of that initiative as a letter of intent, and subsequently as a research proposal, to Rural360. These submissions are reviewed by relevant subject matter experts as part of the Rural360 adjudication process. This process is iterative and strives to guide and assist participants in refining their submission. The overarching objective of Rural360 is to collaborate with rural physicians to conduct, disseminate or otherwise catalyze unsupported community-based research in NNCL. In so doing, it is highly socially accountable, empowering participants to become change-makers who investigate contextually important health issues that emerge from NNCL communities.
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Affiliation(s)
- Shabnam Asghari
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Canada
| | - Thomas Heeley
- Centre for Rural Health Studies, Memorial University of Newfoundland, St. John’s, Canada
| | - Anna Walsh
- Clinical Epidemiology, Memorial University of Newfoundland, St. John’s, Canada
| | - James Rourke
- Center for Rural Health Studies, Memorial University of Newfoundland, St. John’s, Canada
| | - Cheri Bethune
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Canada
| | - Wendy Graham
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Canada
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Easton G, Parry D. Bringing anatomy to life for general practitioners. Med Educ 2019; 53:1152-1153. [PMID: 31650610 DOI: 10.1111/medu.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Ananthakrishnan N, Sethuraman KR, Ravishankar M, Karthikeyan P, Jaganmohan P. Competency-based learning and training for medical postgraduates within regulatory guidelines in India: The SBV Competency-Based Learning and Training Model©. Natl Med J India 2019; 32:365-368. [PMID: 33380635 DOI: 10.4103/0970-258x.303629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Postgraduate medical education in India is beset with many problems including lack of a uniform national syllabus, nonexistence of an accepted list of competencies across disciplines, lack of uniformity in teaching/learning methods between different institutions, a poor evaluation system which focuses on a day's performance rather than the whole course and lack of attention to attitude and professionalism both in the training and evaluation processes. Since there is no national-level quality control of the outgoing postgraduates, there is no uniformity either in knowledge or skill level among them. Regulatory control over the whole process inhibits institutions from making any changes. Furthermore, the summative examination process is entirely under regulatory guidelines, with little or no option to universities and institutions to change the same. In this scenario, Sri Balaji Vidyapeeth, Puducherry, introduced and implemented a competency-based training programme for medical postgraduates, which is now in the 4th year. This model is suitable for the Indian milieu as it can be implemented within the regulatory guidelines. The model has been described with details of the processes involved in preparation, implementation, monitoring and overcoming possible hurdles and pitfalls in the Indian context.
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Affiliation(s)
- N Ananthakrishnan
- Sri Balaji Vidyapeeth (Deemed University), NH 45A, Puducherry 607402, India
| | - K R Sethuraman
- Sri Balaji Vidyapeeth (Deemed University), NH 45A, Puducherry 607402, India
| | - M Ravishankar
- Sri Balaji Vidyapeeth (Deemed University), NH 45A, Puducherry 607402, India
| | - P Karthikeyan
- Sri Balaji Vidyapeeth (Deemed University), NH 45A, Puducherry 607402, India
| | - P Jaganmohan
- Sri Balaji Vidyapeeth (Deemed University), NH 45A, Puducherry 607402, India
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Movsisyan NK, Petrosyan V, Abelyan G, Sochor O, Baghdasaryan S, Etter JF. Learning to assist smokers through encounters with standardized patients: An innovative training for physicians in an Eastern European country. PLoS One 2019; 14:e0222813. [PMID: 31557211 PMCID: PMC6762076 DOI: 10.1371/journal.pone.0222813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/06/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives A lack of physician training is a major obstacle for effective tobacco dependence treatment. This study assessed the feasibility of an active learning training program and its effects on smoking cessation counselling skills of medical residents in Armenia, an Eastern European country with high smoking prevalence. Study design The study used a pre-post assessment of smoking cessation counselling activities and a course evaluation survey to assess the feasibility of the intervention in a different environment. Methods We adapted an active learning training model developed in Switzerland. Residents were trained in Yerevan, Armenia, using video-taped counselling sessions, role plays, standardized patients (actors), group discussions and immediate feedback. The training evaluation was done using a semi-structured anonymous questionnaire. The study assessed the physicians’ self-reported smoking cessation counselling activities before and 6 months after the training. A non-parametric Mann-Whitney test was used to assess pre-post differences in physicians’ counselling skills measured on ordinal scale. Results Of the 37 residents trained, 75% were female, 89% aged 20–29 years and 83% were never-smokers. Twenty-eight trainees (76%) returned the course evaluation survey and 32 (86%) answered a questionnaire on skills self-assessment at 6 months follow-up. The majority agreed the course was successful in achieving its learning objectives (64%-96%) and increased their confidence in assisting their patients to quit (74%). After 6 months, the physicians were more likely than at baseline to adhere to evidence-based counselling strategies, including assessing the smoking status and dependence and matching the advice to the patient motivation. The training did not, however, improve the prescription of tobacco dependence medications. Conclusions Six months after the training, several self-reported smoking cessation counselling activities had significantly improved compared to baseline. This training model is acceptable for medical residents in Yerevan, Armenia and offers a promising approach in addressing the lack of physician counselling skills in similar settings and populations.
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Affiliation(s)
- Narine K. Movsisyan
- American University of Armenia, Gerald and Patricia Turpanjian School of Public Health, Yerevan, Armenia
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- * E-mail:
| | - Varduhi Petrosyan
- American University of Armenia, Gerald and Patricia Turpanjian School of Public Health, Yerevan, Armenia
| | - Gohar Abelyan
- American University of Armenia, Gerald and Patricia Turpanjian School of Public Health, Yerevan, Armenia
| | - Ondrej Sochor
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Satenik Baghdasaryan
- Yerevan State Medical University, Department of Postgraduate and Continuing Medical Education, Yerevan, Armenia
| | - Jean-François Etter
- Institute of Global Health, Faculty of Medicine, University of Geneva, Campus Biotech, Geneva, Switzerland
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Wei MH, Chen XZ, Zhan XX, Zhang ZX, Yu SJ, Yan WR. The effect of a web-based training for improving primary health care providers' knowledge about diabetes mellitus management in rural China: A pre-post intervention study. PLoS One 2019; 14:e0222930. [PMID: 31550282 PMCID: PMC6759173 DOI: 10.1371/journal.pone.0222930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022] Open
Abstract
Background The performance of primary health care providers regarding DM management is poor in rural China, and effective training methods for providers are urgently needed. This study aimed to evaluate the effect of web-based training for improving knowledge about DM management among primary health care providers in rural China and to further compare the effects of the training effect between primary health care providers with different backgrounds. Methods A pre-post intervention study was conducted from April to August 2014. In this study, a total of 901 primary health care workers were recruited from six counties in Hubei province. To evaluate the effect of the web-based training, the knowledge achievement of participants was measured with multiple choice questions (MCQ) at baseline, at the end of two weeks of training and at three months after training. A mixed linear model (MLM) was used to measure group differences in the mean scores at baseline and follow-up. Results After the web-based training, the knowledge scores of the village doctors increased from 73.58 at baseline to 89.98 at posttest and to 84.57 three months after the training. For township health workers, we observed an upward trend in scores from 78.87 at the pre-test to 91.72 at the second test, and at the three months after the training, the scores increased to 94.91. For village doctors, greater knowledge achievement was observed between the scores at baseline and after two weeks of training(adjusted difference: 3.55, P = 0.03) compared to that observed for the township health workers, while decreased their knowledge achievement between baseline and the third-test compared with that of township health workers (adjusted difference: 5.05, P = 0.01). Conclusions This study suggested that web-based training was an effective method for improving the knowledge of primary health care providers about management of DM in remote areas. Compared with the effect of the training on village doctors, the training had a poor short-term effect on township health workers but a better long-term effect.
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Affiliation(s)
- Mu-Hong Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Xian-Zhen Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Xing-Xin Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
- School of Nursing and Rehabilitation, Xinyu University, Xinyu, China
| | - Zhi-Xia Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
- Wuchang University of Technology, Wuhan, China
| | - Shao-Jing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Wei-Rong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
- * E-mail:
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Amgalan N, Shin JS, Lee SH, Badamdorj O, Yoon HB. Applying a mixed methods design for needs assessment of an international fellowship training program for Mongolian health professions. Korean J Med Educ 2019; 31:227-237. [PMID: 31455052 PMCID: PMC6715895 DOI: 10.3946/kjme.2019.133] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/24/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Continuing professional development is essential for improving health care services, especially in developing countries. Most of the training programs in Mongolia were not based on a targeted needs assessment. Therefore, we aimed to apply a mixed methods design to assess the training needs of Mongolian health professions. METHODS We conducted a needs assessment using a convergent parallel mixed methods design in two steps. The survey and interview questions were developed to identify priority areas, targeted trainees, and effective training methods. A survey on 60 respondents, 15 individual interviews, and a focus group interview with 14 participants were conducted in the first step. In the second step, 12 representatives of key stakeholders were invited to a second focus group interview. RESULTS Current health policy areas, areas related to future national plans, and areas not currently receiving governmental or international support were suggested as the main priorities. The stakeholder suggested that trainees should be selected based on their professional experience and language level, as well as each hospital's needs. Building teams including various professions, such as nurses, technicians, and biomedical engineers, was recommended as a way to exchange ideas with each other and to build teamwork for future collaboration. CONCLUSION Medical training needs are dynamic and complex; therefore, a deep understanding of the context and setting is necessary. In this study, we assessed the targeted training needs of Mongolian health professions through a mixed methods design, which could be an effective way to conduct needs assessments for training programs.
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Affiliation(s)
- Nomin Amgalan
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Jwa-Seop Shin
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Hee Lee
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Oyungoo Badamdorj
- Division of Educational Policy and Management, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Hyun-Bae Yoon
- Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea
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Hjelmqvist H. [Not Available]. Lakartidningen 2019; 116:FPWI. [PMID: 31454060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Hans Hjelmqvist
- Karolinska Universitetssjukhuset - ANOPIVA-kliniken Stockholm, Sweden Karolinska Universitetssjukhuset - ANOPIVA-kliniken Stockholm, Sweden
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Hjelmqvist H, Rydgren Stale S, Ledin T. [Not Available]. Lakartidningen 2019; 116:FR4R. [PMID: 31454057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Hans Hjelmqvist
- Karolinska Universitetssjukhuset - ANOPIVA-kliniken Stockholm, Sweden Karolinska Universitetssjukhuset - ANOPIVA-kliniken Stockholm, Sweden
| | - Sofia Rydgren Stale
- Sveriges läkarförbund - Stockholm, Sweden Sveriges läkarförbund - Stockholm, Sweden
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Patel M, James K, Moss-Morris R, Husain M, Ashworth M, Frank P, Ferreira N, Mosweu I, McCrone P, Hotopf M, David A, Landau S, Chalder T. Persistent physical symptoms reduction intervention: a system change and evaluation (PRINCE)-integrated GP care for persistent physical symptoms: protocol for a feasibility and cluster randomised waiting list, controlled trial. BMJ Open 2019; 9:e025513. [PMID: 31340956 PMCID: PMC6661663 DOI: 10.1136/bmjopen-2018-025513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Persistent physical symptoms (PPS), also known as medically unexplained symptoms are associated with profound physical disability, psychological distress and high healthcare costs. England's annual National Health Service costs of attempting to diagnose and treat PPS amounts to approximately £3 billion. Current treatment relies on a positive diagnosis, life-style advice and drug therapy. However, many patients continue to suffer from ongoing symptoms and general practitioners (GPs) are challenged to find effective treatments. Training GPs in basic cognitive behavioural skills and providing self-help materials to patients could be useful, but availability in primary care settings is limited. METHODS AND ANALYSIS A cluster randomised waiting list, controlled trial will be conducted to assess the feasibility of an integrated approach to care in general practice. Approximately 240 patients with PPS will be recruited from 8 to 12 GP practices in London. GP practices will be randomised to 'integrated GP care plus treatment as usual' or waiting list control. Integrated GP care plus treatment as usual will include GP training in cognitive behavioural skills, GP supervision and written and audio visual materials for both GPs and participants. The primary objectives will be assessment of trial and intervention feasibility. Secondary objectives will include estimating the intracluster correlation coefficient for potential outcome measures for cluster effects in a sample size calculation. Feasibility parameters and identification of suitable primary and secondary outcomes for future trial evaluations will be assessed prerandomisation and at 12 and 24 weeks' postrandomisation, using a mixed-methods approach. ETHICS AND DISSEMINATION Ethical approval was granted by the Camberwell St Giles Ethics Committee. Results will be disseminated via peer-reviewed publications and conference presentations. This trial will inform researchers, clinicians, patients and healthcare providers about the feasibility and potential cost-effectiveness of an integrated approach to managing PPS in primary care. TRIAL REGISTRATION NUMBER NCT02444520; Pre-results.
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Affiliation(s)
- Meenal Patel
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kirsty James
- Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mujtaba Husain
- Persistent Physical Symptoms Research and Treatment Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Philipp Frank
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nicola Ferreira
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Iris Mosweu
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paul McCrone
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Matthew Hotopf
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anthony David
- Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sabine Landau
- Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Trudie Chalder
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Latif A, Hopkins L, Robinson D, Brown C, Abdelrahman T, Egan R, Iorwerth A, Pollitt J, Lewis WG. Influence of Trainer Role, Subspecialty and Hospital Status on Consultant Workplace-based Assessment Completion. J Surg Educ 2019; 76:1068-1075. [PMID: 30745232 DOI: 10.1016/j.jsurg.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 10/08/2018] [Revised: 12/17/2018] [Accepted: 01/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Performance assessment is challenging to administer and validate, yet remains central to patient safety and quality of care. The aim of this study was to evaluate Consultant Surgeon trainer performance with respect to Workplace Based Assessment (WBA) completion. DESIGN All WBAs for 60 Core Surgical Trainees (n = 2932) recorded in one academic year were analyzed using the Intercollegiate Surgical Curriculum Progamme. Primary outcome measures were numbers of WBAs performed related to trainer role (Assigned Educational Supervisor vs. Clinical Supervisor vs. No Training Role), gender, surgical subspecialty, hospital status (teaching vs. district general), and trainer RCSEng. TrACE course accreditation. SETTING A core surgical training program serving a single UK (Wales) deanery. PARTICIPANTS Sixty consecutively appointed core surgical trainees. RESULTS Median WBA number performed irrespective of trainer role was 6 (range 0-51), consisting of CBD 2 (0-18), mini-CEX 2 (0-22), DOPS 2 (0-32), and PBA 0 (0-10). Assigned Educational Supervisor trainers were more likely to complete the full range of WBAs compared with Clinical Supervisor and No Training Role assessors; WBA 17 vs. 6 vs. 3; CBD 5 vs. 2 vs. 1; mini-CEX 5 vs. 2 vs. 1; DOPS 4 vs. 2 vs. 1; and PBA 0 vs. 0 vs. 0 (p < 0.001). WBAs completed varied by subspecialty; first quartile performance: ENT, Plastic Surgery, (median 12, interquartile range 13), compared with fourth quartile: OMFS, Urology, T&O, and Cardiothoracic Surgery (median 5, interquartile range 11, p = 0.016). Hospital status, gender, and TrACE accreditation were not associated with WBA performance. CONCLUSIONS Important variations in trainer WBA completion were apparent; training programme directors and trainees alike should be aware of this when agreeing educational contracts.
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Affiliation(s)
- Ahmed Latif
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - Luke Hopkins
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - David Robinson
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - Christopher Brown
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - Tarig Abdelrahman
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - Richard Egan
- Department of Surgery, Morriston Hospital, Swansea, Wales, United Kingdom
| | - Awen Iorwerth
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - John Pollitt
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom
| | - Wyn G Lewis
- Wales Deanery PGMDE School of Surgery, Health Education and Improvement Wales, Nantgarw, Cardiff, United Kingdom.
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Kotecha D, Bax JJ, Carrera C, Casadei B, Merkely B, Anker SD, Vardas PE, Kearney PP, Roffi M, Ros M, Vahanian A, Weidinger F, Beeri R, Budaj A, Calabrò P, Czerwińska-Jelonkiewicz K, D'Ascenzi F, De Potter T, Fox KF, Hartikainen J, McAdam B, Milicic D, Pasquet AA, Sionis A, Sohaib SMA, Tsioufis C, Verhorst PMJ, Kirchhof P. Roadmap for cardiovascular education across the European Society of Cardiology: inspiring better knowledge and skills, now and for the future. Eur Heart J 2019; 40:1728-1738. [PMID: 30226525 DOI: 10.1093/eurheartj/ehy058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/14/2017] [Accepted: 01/24/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS The provision of high-quality education allows the European Society of Cardiology (ESC) to achieve its mission of better cardiovascular practice and provides an essential component of translating new evidence to improve outcomes. METHODS AND RESULTS The 4th ESC Education Conference, held in Sophia Antipolis (December 2016), brought together ESC education leaders, National Directors of Training of 43 ESC countries, and representatives of the ESC Young Community. Integrating national descriptions of education and cardiology training, we discussed innovative pathways to further improve knowledge and skills across different training programmes and health care systems. We developed an ESC roadmap supporting better cardiology training and continued medical education (CME), noting: (i) The ESC provides an excellent framework for unbiased and up-to-date cardiovascular education in close cooperation with its National Societies. (ii) The ESC should support the harmonization of cardiology training, curriculum development, and professional dialogue and mentorship. (iii) ESC congresses are an essential forum to learn and discuss the latest developments in cardiovascular medicine. (iv) The ESC should create a unified, interactive educational platform for cardiology training and continued cardiovascular education combining Webinars, eLearning Courses, Clinical Cases, and other educational programmes, along with ESC Congress content, Practice Guidelines and the next ESC Textbook of Cardiovascular Medicine. (v) ESC-delivered online education should be integrated into National and regional cardiology training and CME programmes. CONCLUSION These recommendations support the ESC to deliver excellent and comprehensive cardiovascular education for the next generation of specialists. Teamwork between international, national and local partners is essential to achieve this objective.
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Earn Your EPI® Intensive Certificate In 2019. Am J Infect Control 2019; 47:601. [PMID: 31146829 DOI: 10.1016/j.ajic.2019.04.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Das MK, Chaudhary C, Kaushal SK, Khanna R, Chatterji S. Impact of Neonatal Resuscitation Capacity Building of Birth Attendants on Stillbirth Rate at Public Health Facilities in Uttar Pradesh, India. Indian Pediatr 2019; 56:369-373. [PMID: 31102378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To document the impact of neonatal resuscitation capacity building of birth attendants at district and sub-district level on fresh stillbirth within the public health system in India. DESIGN An implementation research using pre-post study design. SETTING 3 high-infant and neonatal mortality districts (Gonda, Aligarh and Raebareli) of Uttar Pradesh, India. PARTICIPANTS Pregnant women who delivered at the health facilities and their newborns. INTERVENTIONS An intervention package with (i) training on essential newborn care resuscitation; (ii) skill laboratories establishment for peer-interactive learning; (iii) better documentation; and (iv) supportive supervision was implemented at all health facilities in the districts. MAIN OUTCOME MEASURES Impact on fresh stillbirth rates and resuscitation practices were documented at 42 health facilities (Gonda-17, Aligarh-8 and Raebareli-17) over 12-18 months. RESULTS Out of the 3.3% (4431/133627) newborns requiring resuscitation, 58.5% (n=2599) were completely revived, 19% (n=842) had some features of hypoxic insult after birth and 1.4% (n=62) were stillbirths. There was 15.6% reduction in still birth rate in the three districts with the intervention package. CONCLUSIONS The reduction in still birth rate and improvement in newborn resuscitation efforts in the three districts indicated feasibility of implementation and scalability of the intervention package. However sustenance of the impact over longer period needs documentation.
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MESH Headings
- Capacity Building
- Education, Medical, Continuing/methods
- Education, Medical, Continuing/organization & administration
- Education, Nursing, Continuing/methods
- Education, Nursing, Continuing/organization & administration
- Feasibility Studies
- Female
- Hospitals, District
- Humans
- India/epidemiology
- Infant
- Infant Mortality
- Infant, Newborn
- Midwifery/education
- Outcome and Process Assessment, Health Care
- Pregnancy
- Resuscitation/education
- Stillbirth/epidemiology
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Affiliation(s)
- Manoja Kumar Das
- INCLEN Trust International, New Delhi, India. Correspondence to: Dr Manoja Kumar Das, Director Projects, The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi 110 020, India.
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García-Rojo E, Medina-Polo J, Sopeña-Sutil R, Guerrero-Ramos F, García-Gómez B, Aguilar-Gisbert L, García-Álvarez G, Azcutia-Gómez MR, Gómez-Martín F, Molero-García JM, Pereda-Arregui E, Vargas-Machuca Cabañero MC, Villacampa-Aubá F, Tejido Sánchez Á. Analysis of referrals after a synergic work between Primary Care and Urology. Impact of joint protocol implementation and a continuing education program in our healthcare area. Actas Urol Esp 2019; 43:176-181. [PMID: 30824338 DOI: 10.1016/j.acuro.2018.10.001] [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: 08/09/2018] [Accepted: 10/07/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyse the evolution and adequacy of referrals from Primary Care to Urology, after the implementation of referral protocols on the most frequent urological diseases and the establishment of a continuing education program. MATERIAL AND METHODS A Primary Care-Urology work group was created in 2011. Initially, performance and clinical practice protocols in prostatic pathology (BPH and PSA) were established. These were supported by training sessions for primary care physicians. After analysing the effect of the mentioned joint work, 3more (scrotal pathology, urinary tract infections and urinary incontinence) were included. We analysed and compared the referrals and their adequacy before and after the establishment of the protocols. RESULTS The most common referral causes were symptoms of the lower urinary tract due to BPH, which initially represented 22.8% of the total, and decreased to 16.9%. After the introduction of the new algorithms, we observed a decrease in referrals for scrotal pathology (13-14% to 7.8%), an increase in urinary incontinence referrals (3% al 10.3%) and those related to urinary tract infections remained stable. The adequacy to the protocols improved progressively: LUTS from 46% to 65.3%; PSA from 55% to 84.4% and urinary incontinence from 66.2% to 73.1%. Adequacy in scrotal pathology decreased (de 67.1% a 63.3%), while in UTI it stayed much the same (around 76%). CONCLUSIONS The joint work between Urology and Primary Care achieves an improvement in referrals adequacy regarding the most frequent urological pathologies.
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Affiliation(s)
- E García-Rojo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J Medina-Polo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - R Sopeña-Sutil
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Guerrero-Ramos
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - B García-Gómez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - L Aguilar-Gisbert
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - G García-Álvarez
- Dirección Continuidad Asistencial Centro, Hospital Universitario 12 de Octubre, Madrid, España
| | - M R Azcutia-Gómez
- Dirección Continuidad Asistencial Centro, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Gómez-Martín
- Centro de Salud Joaquín Rodrigo, Dirección Asistencial Centro, Madrid, España
| | - J M Molero-García
- Centro de Salud San Andrés, Dirección Asistencial Centro, Madrid, España
| | - E Pereda-Arregui
- Centro de Salud Almendrales, Dirección Asistencial Centro, Madrid, España
| | | | - F Villacampa-Aubá
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Á Tejido Sánchez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España
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Thomas Thattil AM, Sunny S, Arasu SS, Joseph B. Letter from Ganiyari. Natl Med J India 2019; 32:186-187. [PMID: 32129318 DOI: 10.4103/0970-258x.278681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Sobin Sunny
- Department of Community Health, St John's Medical College, Bengaluru, Karnataka, India
| | - S Sakthi Arasu
- Department of Community Health, St John's Medical College, Bengaluru, Karnataka, India
| | - Bobby Joseph
- Department of Community Health, St John's Medical College, Bengaluru, Karnataka, India
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Abstract
OBJECTIVES To examine what activities constitute the work of Foundation doctors and understand the factors that determine how that work is constructed. DESIGN Cross-sectional mixed methods study. Questionnaire survey of the frequency with which activities specified in curricular documents are performed. Semistructured interviews and focus groups. SETTING Postgraduate medical training in the UK. PARTICIPANTS Doctors in their first 2 years of postgraduate practice (Foundation Programme). Staff who work with Foundation doctors-supervisors, nurses and employers (clinical; non-clinical). RESULTS Survey data from 3697 Foundation doctors identified curricular activities (41/103, 42%) that are carried out routinely (performed at least once or twice per week by >75% of respondents). However, another 30 activities (29%) were carried out rarely (at least once or twice per week by <25% respondents), largely because they are routinely part of nurses', and not doctors', work. Junior doctors indicated their work constituted three roles: 'support' of ward and team, 'independent practitioner' and 'learner'. The support function dominated work, but conflicted with stereotyped expectations of what 'being a doctor' would be. It was, however, valued by the other staff groups. The learner role was felt to be incidental to practice, but was couched in a limited definition of learning that related to new skills, rather than consolidation and practice. Activities and perceived role were shaped by the organisational context, medical hierarchies and through relationships with nurses, which could change unpredictably and cause tension. Training progression did not affect what activities were done, but supported greater autonomy in how they were carried out. CONCLUSIONS New doctors must be fit for multiple roles. Strategies for transition should manage graduates' expectations of real-world work, and encourage teams and organisations to better accommodate graduates. These strategies may help ensure that new doctors can adapt to the variable demands of the evolving multiprofessional workforce.
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Affiliation(s)
- Gillian Vance
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Sharmila Jandial
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Jon Scott
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
- Northern Foundation School, Health Education England working across North East and North Cumbria, Newcastle Upon Tyne, UK
| | - Bryan Burford
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
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Bundy DG, Singh H, Stein RE, Brady TM, Lehmann CU, Heo M, O'Donnell HC, Rice-Conboy E, Rinke ML. The design and conduct of Project RedDE: A cluster-randomized trial to reduce diagnostic errors in pediatric primary care. Clin Trials 2019; 16:154-164. [PMID: 30720339 DOI: 10.1177/1740774518820522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diagnostic errors contribute to the large burden of healthcare-associated harm experienced by children. Primary care settings involve high diagnostic uncertainty and limited time and information, creating ideal conditions for diagnostic errors. We report on the design and conduct of Project RedDE, a stepped-wedge, cluster-randomized controlled trial of a virtual quality improvement collaborative aimed at reducing diagnostic errors in pediatric primary care. METHODS Project RedDE cluster-randomized pediatric primary care practices into one of three groups. Each group participated in a quality improvement collaborative targeting the same three diagnostic errors (missed diagnoses of elevated blood pressure and adolescent depression and delayed diagnoses of abnormal laboratory studies), but in a different sequence. During the quality improvement collaborative, practices worked both independently and collaboratively, leveraging general quality improvement strategies (e.g. process mapping) in addition to error-specific content (e.g. pocket guides for blood pressure norms) delivered during the intervention phase for each error. The quality improvement collaborative intervention included interactive learning sessions and webinars, quality improvement coaching at the team level, and repeated evaluation of failures via root cause analyses. Pragmatic data were collected monthly, submitted to a centralized data aggregator, and returned to the practices in the form of run charts comparing each practice's progress over time to that of the group. The primary analysis used patients as the unit of analysis and compared diagnostic error proportions between the intervention and baseline periods, while secondary analyses evaluated the sustainability of observed reductions in diagnostic errors after the intervention period ended. RESULTS A total of 43 practices were recruited and randomized into Project RedDE. Eleven practices withdrew before submitting any data, and one practice merged with another participating practice, leaving 31 practices that began work on Project RedDE. All but one of the diverse, national pediatric primary care practices that participated ultimately submitted complete data. Quality improvement collaborative participation was robust, with an average of 63% of practices present on quality improvement collaborative webinars and 85% of practices present for quality improvement collaborative learning sessions. Complete data included 30 months of outcome data for the first diagnostic error worked on, 24 months of outcome data for the second, and 16 months of data for the third. LESSONS LEARNED AND LIMITATIONS Contamination across study groups was a recurring concern; concerted efforts were made to mitigate this risk. Electronic health records played a large role in teams' success. CONCLUSION Project RedDE, a virtual quality improvement collaborative aimed at reducing diagnostic errors in pediatric primary care, successfully recruited and retained a diverse, national group of pediatric primary care practices. The stepped-wedge, cluster-randomized controlled trial design allowed for enhanced scientific efficiency.
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Affiliation(s)
- David G Bundy
- 1 Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Hardeep Singh
- 2 Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Ruth Ek Stein
- 3 Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY, USA
| | - Tammy M Brady
- 4 Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christoph U Lehmann
- 5 Departments of Biomedical Informatics and Pediatrics, Vanderbilt University, Nashville, TN, USA
| | - Moonseong Heo
- 6 Departments of Public Health Sciences and Mathematical Sciences, Clemson University, Clemson, SC, USA
| | - Heather C O'Donnell
- 3 Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY, USA
| | | | - Michael L Rinke
- 3 Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY, USA
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Mehanni S, Wong L, Acharya B, Agrawal P, Aryal A, Basnet M, Citrin D, Dangal B, Deukmedjian G, Dhungana SK, Gauchan B, Gupta TK, Halliday S, Kalaunee SP, Kshatriya U, Kumar A, Maru D, Maru S, Nguyen V, Paudel JS, Rimal P, Saleh M, Schwarz R, Swar SB, Thapa A, Tiwari A, White R, Wu WJ, Schwarz D. Transition to active learning in rural Nepal: an adaptable and scalable curriculum development model. BMC Med Educ 2019; 19:61. [PMID: 30786884 PMCID: PMC6383231 DOI: 10.1186/s12909-019-1492-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/27/2018] [Accepted: 02/12/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Traditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curriculum in a rural Nepali district hospital, for which a core objective was an organizational shift towards active learning. METHODS The intervention occurred in a district hospital in remote Nepal, staffed primarily by mid-level providers. Before the intervention, education sessions included traditional didactics. We conducted a mixed-methods needs assessment to determine the content and educational strategies for a revised curriculum. Our goal was to develop an effective, relevant, and acceptable curriculum, which could facilitate active learning. As part of the intervention, physicians acted as both learners and teachers by creating and delivering lectures. Presenters used lecture templates to prioritize clarity, relevance, and audience engagement, including discussion questions and clinical cases. Two 6-month curricular cycles were completed during the study period. Daily lecture evaluations assessed ease of understanding, relevance, clinical practice change, and participation. Periodic lecture audits recorded learner talk-time, the proportion of lecture time during which learners were talking, as a surrogate for active learning. Feedback from evaluation and audit results was provided to presenters, and pre- and post-curriculum knowledge assessment exams were conducted. RESULTS Lecture audits showed a significant increase in learner talk-time, from 14% at baseline to 30% between months 3-6, maintained at 31% through months 6-12. Lecture evaluations demonstrated satisfaction with the curriculum. Pre- and post-curriculum knowledge assessment scores improved from 50 to 64% (difference 13.3% ± 4.5%, p = 0.006). As an outcome for the measure of organizational change, the curriculum was replicated at an additional clinical site. CONCLUSION We demonstrate that active learning can be facilitated by implementing a new educational strategy. Lecture audits proved useful for internal program improvement. The components of the intervention which are transferable to other rural settings include the use of learners as teachers, lecture templates, and provision of immediate feedback. This curricular model could be adapted to similar settings in Nepal, and globally.
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Affiliation(s)
- Stephen Mehanni
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Gallup Indian Medical Center, Gallup, NM USA
| | - Lena Wong
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Tuba City Regional Health Care, Tuba City, AZ USA
| | - Bibhav Acharya
- Possible, Kathmandu, Nepal
- Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
| | | | | | - Madhur Basnet
- Possible, Kathmandu, Nepal
- Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - David Citrin
- Possible, Kathmandu, Nepal
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Anthropology, University of Washington, Seattle, WA USA
| | | | - Grace Deukmedjian
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Department of Pediatrics, Natividad Medical Center, Salinas, CA USA
| | | | - Bikash Gauchan
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | | | - Scott Halliday
- Possible, Kathmandu, Nepal
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | - S. P. Kalaunee
- Possible, Kathmandu, Nepal
- College of Business and Leadership, Eastern University, St. Davids, PA USA
| | | | - Anirudh Kumar
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Duncan Maru
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Sheela Maru
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Viet Nguyen
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Jhalak Sharma Paudel
- National Health Training Center, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Pragya Rimal
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Marwa Saleh
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Ryan Schwarz
- Possible, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Sikhar Bahadur Swar
- Possible, Kathmandu, Nepal
- Department of Psychiatry, Kathmandu Medical College, Kathmandu, Nepal
| | | | | | - Rebecca White
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Wan-Ju Wu
- Possible, Kathmandu, Nepal
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA USA
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA
| | - Dan Schwarz
- Possible, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
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Muddiman E, Bullock AD, Hampton JM, Allery L, MacDonald J, Webb KL, Pugsley L. Disciplinary boundaries and integrating care: using Q-methodology to understand trainee views on being a good doctor. BMC Med Educ 2019; 19:59. [PMID: 30770777 PMCID: PMC6377780 DOI: 10.1186/s12909-019-1493-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/23/2017] [Accepted: 02/12/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND Rising numbers of patients with multiple-conditions and complex care needs mean that it is increasingly important for doctors from different specialty areas to work together, alongside other members of the multi-disciplinary team, to provide patient centred care. However, intra-professional boundaries and silos within the medical profession may challenge holistic approaches to patient care. METHODS We used Q methodology to examine how postgraduate trainees (n = 38) on a range of different specialty programmes in England and Wales could be grouped based on their rankings of 40 statements about 'being a good doctor'. Themes covered in the Q-set include: generalism (breadth) and specialism (depth), interdisciplinarity and multidisciplinary team working, patient-centredness, and managing complex care needs. RESULTS A by-person factor analysis enabled us to map distinct perspectives within our participant group (P-set). Despite high levels of overall commonality, three groups of trainees emerged, each with a clear perspective on being a good doctor. We describe the first group as 'generalists': team-players with a collegial and patient-centred approach to their role. The second group of 'general specialists' aspired to be specialists but with a generalist and patient-centred approach to care within their specialty area. Both these two groups can be contrasted to those in the third 'specialist' group, who had a more singular focus on how their specialty can help the patient. CONCLUSIONS Whilst distinct, the priorities and values of trainees in this study share some important aspects. The results of our Q-sort analysis suggest that it may be helpful to understand the relationship between generalism and specialism as less of a dichotomy and more of a continuum that transcends primary and secondary care settings. A nuanced understanding of trainee views on being a good doctor, across different specialties, may help us to bridge gaps and foster interdisciplinary working.
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Affiliation(s)
- E Muddiman
- Cardiff University School of Social Sciences, Cardiff, UK.
| | - A D Bullock
- Cardiff University School of Social Sciences, Cardiff, UK
| | - J M Hampton
- Cardiff University School of Social Sciences, Cardiff, UK
| | - L Allery
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
| | - J MacDonald
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
| | - K L Webb
- Cardiff University School of Social Sciences, Cardiff, UK
| | - L Pugsley
- Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
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Wijk H, Ponzer S, Heikkilä K, Kihlström L, Nordquist J. Factors influencing effectiveness in postgraduate medical education - a qualitative study of experiences of the responsible clinical consultants. BMC Med Educ 2019; 19:3. [PMID: 30606174 PMCID: PMC6318888 DOI: 10.1186/s12909-018-1433-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/10/2017] [Accepted: 12/14/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND Medical education leaders are important for educational quality in postgraduate medical education. Their work tasks are complex and contain different components. However, factors that are influencing leaders´ effectiveness in completing these tasks are unexplored. Understanding and developing these factors is most likely essential to strengthen postgraduate medical education and to consequently improve the quality in health care delivery. This study explores the experiences of factors that influence effectiveness of clinical consultants responsible for postgraduate medical education at clinical departments. Effectiveness was defined as fulfillment of work tasks. METHODS A qualitative study was performed with data gathered through semi-structured face-to-face interviews with 17 consultants responsible for postgraduate medical education. Data was analyzed by qualitative content analysis. RESULTS Findings clustered into four themes of factors influencing effectiveness: individual (being an expert, social competence), relational (support and cooperation, communication), attitudinal (shared vision, organizational values, colleagues' attitudes) and structural (organizational characteristics, regulations and guidelines, conditions for the role). The factors were experienced to influence effectiveness in a positive or a negative direction. CONCLUSIONS This study shed light on the complex and interrelated factors experienced to have impact on the role of consultant responsible for postgraduate medical education. Viewing the result through the concept of power, the role mainly relies on personal power sources like expert and referent power whereas power connected to the position often are lacking. To increase effectiveness of the role, a differentiated strategy which involves activities at both individual, group and organizational levels is needed.
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Affiliation(s)
- Hanna Wijk
- Medical Case Centre, Department of Medicine (Huddinge), Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Kristiina Heikkilä
- Department of Health and Care Sciences, Linnaeus University, Kalmar, Sweden
| | - Lars Kihlström
- Department of Research and Education, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Nordquist
- Medical Case Centre, Department of Medicine (Huddinge), Karolinska Institutet, 141 86 Stockholm, Sweden
- Department of Research and Education, Karolinska University Hospital, Stockholm, Sweden
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Kuruvilla A, Jacob KS. Reimagining Psychiatric Education for Physicians. Natl Med J India 2019; 32:1-4. [PMID: 31823929 DOI: 10.4103/0970-258x.272083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Anju Kuruvilla
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - K S Jacob
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
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