Preferences, Career Aspects, and Factors Influencing the Choice of Specialty by Medical Students and Interns in Saudi Arabia: A Cross-Sectional Study

Background and objective Choosing a medical specialty is one of the most critical career decisions medical students and interns make. However, little is known about the factors these graduates consider when choosing their specialty. Our study assessed factors that medical students and interns consider when determining their specialty. Methods This is a cross-sectional survey-based study, conducted from November to December 2022. We utilized a previously published questionnaire for 1074 participants, including 837 medical students and 237 interns from Saudi Arabian universities. Results The majority of female participants (80.4%), compared with only 19.6% of male participants, considered interest in specific procedures and techniques typical of the specialty an important factor in choosing a specialty (p = 0.036). Dissertation research experience was an important factor for 83.5% of female participants and 16.5% of male participants (p = 0.024). Additionally, good quality teaching within the study program framework was important for 81.2% of female participants and 18.8% of male participants (p = 0.033), suggesting that male and female participants viewed the importance of good quality teaching differently. Female participants accounted for 80% of those who considered the overseas experience a factor in their specialty choice. Also, 74.4% of female and 25.6% of male participants considered friends, relatives, or other connections in the healthcare field a factor that affects their choice. Furthermore, 79.6% of female and 20.4% of male participants reported having good experiences with physician role models as an impactful factor in their specialty choice. Conclusion Female participants were most interested in obstetrics and gynecology (12.1%,), internal medicine (11.8%), and family medicine (10.8%). Male participants, on the other hand, showed more interest in family medicine (12.7%,), internal medicine (11.0%), and emergency medicine (10.1%). Medical schools and healthcare institutions must provide students and interns with enough information and resources to help them explore different specialties and make well-informed decisions about their careers.

Overview on and Contextual Determinants of Medical Residencies in North Brazil

The aim of this study was to analyze the scenario of medical residency programs (MRPs) in the north region of Brazil as well as the contextual determinants (socioeconomic, structural, and epidemiological) influencing the number of MRPs in this region. An ecological study was conducted using MRPs data from 2022. This study used multiple data sources. MRP indicators were described based on the Brazilian state and specialty. The dependent variable was the number of MRPs. The independent variables included sociodemographic, structural, and epidemiological factors. Poisson regression was performed to analyze the association between contextual variables and the number of MRPs. The results showed that only 3.6% of the municipalities had authorized MRPs. The idleness rate in the region was 46.0%, with family and community medicine as the specialties with the greatest idleness. The total density of authorized vacancies in the MRPs was 14.0 vacancies per 100,000 inhabitants. The models showed that with each increase of one unit of the vulnerability index (Socioeconomic Index in the Geographic Context for Health Studies-GeoSES), the number of MRPs increased, ranging from 8122 (p value < 0.001) to 11,138 (p value < 0.001). With each increase in undergraduate degrees in medicine, the number of MRPs increased by 0.945 (p value < 0.001). With each increase of 1 physician per 1000 population, the number of MRPs increased from 0.537 (p value < 0.001) to 0.845 (p value < 0.001). With each increase of one unit in general hospitals, specialized hospitals, teaching hospitals, and primary healthcare units, the number of MRPs increased by 0.176 (p value < 0.001), 0.168 (p value < 0.001), 0.022 (p value < 0.001) and 0.032 (p value < 0.001), respectively. Finally, with each increase of one death per 100,000 inhabitants, the overall mortality rate increased, ranging from 0.006 (p value < 0.001) to 0.022 (p value < 0.001). The study showed a low supply of MRPs in the northern region, a high rate of idleness, and important socioeconomic, structural, and epidemiological determinants of the number of MRPs.

Impact of educational interventions on pharmacovigilance and adverse drug reaction reporting by resident doctors and faculty members: A prospective comparative study

Purpose/Aim

Adverse drug reactions (ADRs) are significantly under-reported worldwide. The aim of this study was to assess the impact of educational interventions (EIs) on knowledge, attitude, and practice (KAP) of hospital resident doctors and faculty members and compare ADR reporting in EI (medical specialties) vs. non-EI (surgical specialties) in these two cadres of doctors.

Materials and Methods

This study was a prospective comparative study conducted in two groups (EI and non-EI) in resident doctors and faculty members working at a tertiary care hospital. EI group (medical specialties) were provided with EI to increase awareness about ADR reporting, whereas in non-EI group (surgical specialties), no EI was provided and they served as control. Respondents were asked to fill a pretest questionnaire followed by interactive EI in EI group and posttest questionnaire in both groups. The impact of EI among respondents was evaluated by their response to questionnaire and number of ADRs reported after intervention.

Results

Total (n = 202) respondents were enrolled in the study. The number of resident doctors and faculty members in each group were (n = 101 [50%]). Overall, (n = 100 [49.5%]) were from the medical and (n = 102 [50.5%]) from surgical specialty. Post-EI period, there was statistically significant improvement in KAP domains.

Conclusion

Our study serves as credible evidence that through EI; statistically significant improvement in KAP of resident doctors and faculty members in both medical and surgical specialties toward ADR reporting and existing pharmacovigilance system can be achieved.

Specialty Gender Composition and Prevalence of Physician Harassment

Background: Women physicians remain a minority in most medical specialties and are at higher risk of workplace harassment than men. This research examines the relationship between a medical specialty's gender composition and physicians' workplace harassment experience. Materials and Methods: We used the Association of American Medical Colleges' National Sample Survey of Physicians 2019 (n = 6000). Participants self-reported harassment experiences in the 12 months preceding the survey, including threats of physical harm, physical harm, offensive and sexist remarks, and unwanted sexual advances from patients and coworkers. We used data from the American Medical Association to determine medical specialties' gender composition. We used multiple logistic regression to assess the relationship between harassment experiences and specialty gender composition. Results: Women and men physicians reported threats and harm at similar rates. However, women reported offensive, sexist remarks and unwanted sexual advances more frequently. We found greater representation of women within a specialty is associated with a lower prevalence of harassment experienced by men and women physicians (e.g., threats of physical harm, odds ratio [OR] = 0.973 [women] and 0.984 [men], and unwanted sexual advances, OR = 0.976 [women] and 0.981 [men]). Also, as women's representation in a specialty increases, the gender gap in experiences of most types of harassment decreases. Conclusions: Greater representation of women within a medical specialty is associated with a safer environment for both men and women physicians and narrower gender gaps in harassment experience. Our findings support efforts to increase gender diversity across the specialties and illuminate the dire need for antiharassment solutions in specialties with low women's representation.

[Applications of cone beam computed tomography of the craneofacial structure in medical specialties. A review]

Cone-beam computed tomography (CBCT) of the craniofacial structure has demonstrated its usefulness in the dental area during the last decades, thus it has become a fundamental tool in the diagnosis, planning, and evaluation of treatment, and although it was not developed for the exclusive use in dentistry, as it is commonly considered, it is used in other areas such as medicine. It is specifically used in the head and neck area where different medical specialties interact, and at the same time these interact with dental specialties, so knowing the advantages of CBCT over different imaging technologies in the medical area is necessary. The purpose of this review was to describe the applications of observation, diagnosis, planning, and evolution of treatments using maxillofacial HSCT in different medical specialties. This work highlights the use of TCHC in different medical applications and highlights where it is most useful compared to other technologies.

Identification and Assessment of Strategies to Address Gender Inequity in the Specialty of Critical Care Medicine: A Scoping Review, Modified Consensus Process, and Stakeholder Meeting

We sought to identify and prioritize improvement strategies that Critical Care Medicine (CCM) programs could use to inform and advance gender equity among physicians in CCM.

DESIGN

This study involved three sequential phases: 1) scoping review that identified strategies to improve gender equity in all medical specialties; 2) modified consensus process with 48 CCM stakeholders to rate and rank identified strategies; and 3) in-person stakeholder meeting to refine strategies and discuss facilitators and barriers to their implementation.

SETTING

CCM.

SUBJECTS

CCM stakeholders (physicians, researchers, and decision-makers; mutually inclusive).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We identified 190 unique strategies from 416 articles. Strategies were grouped thematically into 20 categories across four overarching pillars of equity: access, participation, reimbursement, and culture. Participants prioritized 22 improvement strategies for implementation in CCM. The top-rated strategy from each pillar included: 1) nominate gender diverse candidates for faculty positions and prestigious opportunities (equitable access); 2) mandate training in unconscious bias and equitable treatment for committee (e.g., hiring, promotion) members (equitable participation); 3) ensure equitable starting salaries regardless of sex or gender (equitable reimbursement); and, 4) conduct 360° evaluations of leaders (including their direct work circle of supervisors, peers, and subordinates) through a diversity lens (equitable culture). Interprofessional collaboration, leadership, and local champions were identified as key enablers for implementation.

CONCLUSIONS

We identified stakeholder-prioritized strategies that can be used to inform and enhance gender equity among physicians in CCM under four overarching equity pillars: access, participation, reimbursement, and culture. Implementation approaches should include education, policy creation, and measurement, and reporting.

COVID-19 pandemic in São Paulo: a quantitative study on clinical practice and mental health among medical residency specialties

BACKGROUND

2020 was a challenging year for all healthcare professionals worldwide. In São Paulo, Brazil, the virus SARS-CoV-2 took 47,222 lives up to December 29, 2020. The front line of medical professionals in São Paulo was composed of many residents, who were transferred from their rotations to cover the needs of the pandemic.

OBJECTIVE

To identify medical residents' mental health and clinical issues, regarding symptoms of burnout, depression and anxiety during the pandemic, and to compare them among specialties.

DESIGN AND SETTING

Quantitative study using a convenience sample of medical resident volunteers who responded to an anonymous online survey that was available during April 2020.

METHODS

This investigation collected sociodemographic information and used the Oldenburg Burnout Inventory (OLBI) to measure burnout, the Patient Health Questionnaire (PHQ-9) to measure depression and the General Anxiety Disorder (GAD-7) scale to measure anxiety symptoms. This study also developed a COVID-19 Impact Questionnaire (CIQ-19) to assess the residents' beliefs and clinical practices relating to COVID-19 patients.

RESULTS

The sample comprised 1,392 medical residents in São Paulo, Brazil. Clinical specialty physicians showed the highest rates of anxiety symptoms (52.6%) and burnout (51.2%), among the specialties.

CONCLUSION

Clinical specialty residents are at higher risk of anxiety, depression and burnout. The symptoms of anxiety and depression have worsened during the COVID-19 pandemic. There is a general need for mental health support interventions for medical resident physicians, which requires reinforcement during this worldwide crisis.

Vascular surgery in the most populous state in the Amazon: socio-professional profile and aspirations of the specialty

Background

There is a dearth of studies conducted to understand the socio-professional profile of the vascular surgery specialty and the population demands of specific regions, which are needed to support creation of care policies and direct infrastructure improvements in healthcare.

Objectives

The purpose of this study was to describe the socio-professional profile of vascular surgeons in the state of Pará, Brazil, to guide creation of tools for professional improvement.

Methods

A cross-sectional, self-report survey was conducted in Pará using a questionnaire comprising 30 questions covering six main topics.

Results

All vascular surgeons actively practicing in the state participated in this study. The total number of specialists was 59, with 71.2% working in the greater Belém area and 16.9% exclusively practicing in the interior of the state. The mean age of these professionals was 48 ± 11.1 years, 86.4% of respondents were men, 64.4% of surgeons had completed medical residency, and 96.6% (n=57) of the surgeons would like to improve their skills in venous surgery, echo-guided vascular access, and endovascular surgery. The method of professional improvement of greatest interest was simulation courses (hands-on), endorsed by 93% of the participants.

Conclusions

Pará has 59 vascular surgeons. These professionals mainly work in the greater Belém (71.2%), in hospitals (100%) or in private clinics or offices (94.9%), performing a wide range of procedures, including venous and arterial surgery, amputations, and provision of hemodialysis access. More than 90% of these surgeons were satisfied professionally and reported that they would choose the specialty again. However, 22% had a pessimistic view of the specialty's future. The vast majority of professionals (96.6%) consider that training or a continuing education program are necessary.

A Narrative Review of Factors Historically Influencing Telehealth Use across Six Medical Specialties in the United States

Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future.

Who repeats more laboratory tests inappropriately? Surgeons versus physicians

BACKGROUND

Inappropriate repeat testing is an objectively measurable type of health service overutilization which may harm patients.

OBJECTIVE

To evaluate both the frequency and cost of inappropriate repeat testing in a tertiary hospital in terms of specialties.

METHODS

This cross-sectional study was conducted in a tertiary hospital. Laboratory results of 26 tests ordered between 1 July 2014 and 30 June 2017 were evaluated retrospectively. Test that were repeated earlier than the minimum re-test interval were accepted as inappropriate repeat testing. After analyzing the descriptive statistics, the cluster analysis method was used to determine whether groups were formed within specialties.

RESULTS

Specialties form two clusters were found: the first cluster included specialties mostly from surgical science and the second cluster included specialties mostly from medical science. It was found that the cluster that includes mostly surgical specialties repeats laboratory tests at a higher rate but causes a waste of less resources, whereas the cluster that includes mostly medical specialties repeats laboratory tests at a lower rate but causes a waste of more resources due to a higher volume of test orders.

CONCLUSION

Due to the high rates of inappropriate repeat testing, surgical specialties seem to be the first target of intervention strategies, but medical specialties, which account for a higher volume of inappropriate repeat testing and higher unnecessary cost, should be the primary target of intervention strategies.

Relating Medical Errors to Medical Specialties: A Mixed Analysis Based on Litigation Documents and Qualitative Data

Background

We know a great deal about types, causes, and prevention of medical errors, as well as the risks of each medical specialties. Although we know something about medical errors, much remains to be done in this area particularly around effective prevention. However, little is known about whether medical errors are related to medical specialties. Our objective was to categorize and map the distribution of medical errors and analyze their relationships with medical specialties.

Methods

First, public cases of medical disputes were searched on “China Judgment Online” according to the key words including medical errors. Second, we set up a database with 5237 medical litigations. After removing unrelated judgment documents, we used systematic random sampling to extract half of these. Then, we hired two frontline physicians with M.D. to review the litigation documents and independently determine the medical errors and the departments in which they took place. A third physician further reviewed the divergent results. After the descriptive statistical analysis and mind map analysis, semi-structured interviews were further conducted with 63 doctors to reveal the relationships mentioned above.

Results

More than 97.8% of medical errors occurred in clinical departments. The insufficient implementation of informed consent obligations is the top medical error in all medical departments [internal medical departments (12.86%, N=36), surgical departments (14.57%, N=106), specialist departments (13.16%, N=86)]. The types of medical errors in diverse medical departments might be associated with therapeutic means used by physicians. Errors related to surgical operations were common in surgical departments, errors related to diagnoses were common in internal medicine departments, and errors related to therapy were common in specialist departments. A lack of clinical experience and undesirable work system design have contributed to the occurrence of medical errors. Inadequate human resources and unreasonable shift systems have increased the workload of staff members and this has in turn increased the incidence rate of medical errors.

Conclusion

Medical departments are facing medical errors both in humanity and technology. Medical institutions should be alert to the harm caused by medical humanity (mainly including insufficient communication between physicians and patients, insufficient implementation of infringement of informed consent, infringement of patient’s privacy and overtreatment). Improving the clinical skill and vigilance of medical staff is a top priority. Medical institutions should also improve undesirable system designs.

Authorship growth in contemporary medical literature

OBJECTIVES

The aims of this study were to investigate authorship trends among publications in high-impact, peer-reviewed specialty journals published within the last decade and to assess how publication practices differ among medical specialties.

METHODS

The National Institutes of Health's Portfolio Analysis platform, iCite, was queried for PubMed-indexed case reports, review articles, and original research articles published between 2005 and 2017 in 69 high-impact, clinical journals encompassing 23 medical specialties. Overall, 121,397 peer-reviewed publications were evaluated-of which, 45.1% were original research, 28.7% were review articles, and 26.3% were case reports. Multivariable regression was used to evaluate the magnitude of association of publication year on the number of authors per article by specialty and article type.

RESULTS

Original research articles have the greatest increase in authorship (0.23 more authors per article per year), as compared with review articles (0.18 authors per article per year) and case reports (0.01 authors per article per year). Twenty-two of the 23 specialties evaluated had increase in authorship in high-impact specialty journals. Specialty growth rates ranged from 0.42 authors/year (Neurology), Psychiatry (0.35 authors/year), General Surgery (0.29 authors/year), Urology (0.27 authors/year), and Pathology (0.27 authors/year). Specialties with a greater percentage of graduates entering academics had more authors per article; surgical specialties and length of residency were not found to be predictive factors.

CONCLUSION

There has been substantial growth in the authorship bylines of contemporary medical literature, much of which cannot be explained by increased complexity or collaboration alone.

Person- and job-specific factors of intuitive decision-making in clinical practice: results of a sample survey among Hungarian physicians and nurses

Objective: To assess the prevalence of intuitive decision-making (IDM) among health care practitioners (HCPs) and explore its person- and job-specific factors. Design and Outcome Measures: We used on-line survey data from a cross-sectional sample of Hungarian physicians and nurses (N = 460) to assess their reliance on IDM. In a second survey we asked physicians (N = 104) to rate medical specialties on dimensions of 'emergency' (necessity of making instantaneous decisions in unforeseeable situations) and 'complexity' (necessity of considering multiple perceptual and diagnostic aspects of patients' health condition along with diverse treatment options). Results: Altogether 40% of participants reported ever relying on IDM. Using logistic regression analysis, we found the estimated probability of IDM was 0.24 greater for physicians than for nurses, 0.10 greater for females than for males, and 0.11 greater for advanced level HCPs than for novices. Reaching expert level further increased (by 0.31) the probability of IDM for physicians, but not for nurses. Concerning physicians, practicing in a medical specialty of 'high likelihood of emergency' or 'high complexity' increased the probability of IDM by 0.25 and 0.23; the same effects for nurses were 0.20 and 0.07. We found some (inconclusive) evidence for education positively influencing HCPs' propensity for IDM. Additionally, we performed content analysis of participants' free-text answers to explore the psychological background of IDM instances. HCPs educated in the subject of IDM were found more disposed to perform or request further medical investigation, less prone to deviate from medical protocols, apter to reflect on their mental processes, and more inclined to rely on a large scope of information for their decisions. Conclusions: The associations between job- and person-specific factors and HCPs' propensity for IDM may have implications for their training and allocation in the health care system. Education has great potential for enhancing the quality of IDM in clinical practice.

Strengthening medical specialisation policy in low-income and middle-income countries

The availability of medical specialists has accelerated in low-income and middle-income countries (LMICs), driven by factors including epidemiological and demographic shifts, doctors' preferences for postgraduate training, income growth and medical tourism. Yet, despite some policy efforts to increase access to specialists in rural health facilities and improve referral systems, many policy questions are still underaddressed or unaddressed in LMIC health sectors, including in the context of universal health coverage. Engaging with issues of specialisation may appear to be of secondary importance, compared with arguably more pressing concerns regarding primary care and the social determinants of health. However, we believe this to be a false choice. Policy at the intersection of essential health services and medical specialties is central to issues of access and equity, and failure to formulate policy in this regard may have adverse ramifications for the entire system. In this article, we describe three critical policy questions on medical specialties and health systems with the aim of provoking further analysis, discussion and policy formulation: (1) What types, and how many specialists to train? (2) How to link specialists' production and deployment to health systems strengthening and population health? (3) How to develop and strengthen institutions to steer specialisation policy? We posit that further analysis, discussion and policy formulation addressing these questions presents an important opportunity to explicitly determine and strengthen the linkages between specialists, health systems and health equity.

Retrospective analysis of South Australian pediatric oral and maxillofacial pathology over a 16-year period

AIM

The epidemiological features and distribution of pediatric oral and maxillofacial pathology in South Australia, Australia, is unknown. The medical and dental specialties involved in the management of oral and maxillofacial pathology is also unknown. The aim of the present study was to audit oral and maxillofacial pathology specimens submitted for diagnosis in a pediatric tertiary-referral hospital setting.

METHODS

Histopathology records were retrieved from the Women's and Children's Hospital, Adelaide over a 16-year period. Age, sex, histopathological diagnosis, location of the lesion, and department involved were recorded. Lesions were classified into 12 categories.

RESULTS

A total of 676 lesions involving the oral and maxillofacial region were collected from patients aged 0-18 years. The mean age was 8.71 years. Diagnosis was not significantly associated with sex (P = 0.123). A total of 97.37% of cases were benign, with connective tissue and salivary gland lesions most frequently biopsied and more frequently biopsied by medical departments. Mucoceles (19.23%) were most commonly diagnosed, followed by dentigerous cysts (5.62%). The Department of Paediatric Dentistry submitted most specimens, followed by the Department of Otolaryngology, the Australian Craniofacial Unit, and the Departments of Paediatric Surgery and Plastics.

CONCLUSION

The present study provides valuable understanding into the epidemiological features of, and the specialties involved in, oral and maxillofacial histopathology in an Australian pediatric population.

Associations among medication regimen complexity, medical specialty, and medication possession ratio in newly diagnosed hypertensive patients: A population-based study

The aim of this study was to explore the associations among the medication regimen complexity index (MRCI), medical specialty, and medication possession ratio (MPR) in newly diagnosed hypertensive patients.Data from 19,859 newly diagnosed hypertensive patients were collected from 2,000,000 random samples of the National Health Insurance Research Database in Taiwan. All study participants were followed for 1 year after the first diagnosis of hypertension. MPR was defined as total days of antihypertensive drugs supplied/365 days. MRCI was calculated on the basis of the type of dosage forms, dosing frequency, and additional directions for use of antihypertensive drugs. Patients were further restricted to those who visited the same medical specialty to examine specialty-specific variations in the MRCI and MPR.The mean MPR was 54.83%, and the sample sizes for the low-, medium-, and high-MPR groups were 9806 (49.38%), 4619 (23.26%), and 5434 (27.36%), respectively. More than 50% of the patients visited the same medical specialty during the 1-year follow-up. The mean MRCI was 3.64; the cardiology specialty had the highest MRCI, and the family medicine specialty had the lowest. Multiple linear regression analyses showed that MRCI was negatively associated with MPR (β = -7.75, P ≤ .01) whether or not the patients visited the same medical specialty. For the patients who visited the same medical specialty, those treated by endocrinology and metabolism specialists had a significantly higher MPR (β = 9.87, P ≤ .01) than that of those treated by family medicine specialists.MRCI and medical specialty were both significantly associated with the MPR of newly diagnosed hypertensive patients.

Inappropriate Prescribing in Older Hospitalized Adults: A Comparison of Medical Specialties

OBJECTIVES

To evaluate the prevalence and number of potentially inappropriate medications (PIMs) in hospitalized older adults, comparing prescription patterns of medical specialties.

DESIGN

Retrospective cohort study.

SETTING

Tertiary general hospital.

PARTICIPANTS

All older adults hospitalized from January through May 2015 (N = 1,900).

MEASUREMENTS

Information on medications prescribed during the first and last days of hospitalization was collected and evaluated regarding PIMs using Beers and Screening Tool of Older People's Prescriptions (STOPP) criteria. Medical specialties (internal medicine, cardiology, gastroenterology, infectious disease, nephrology, neurology, pneumology) were compared regarding the prevalence of PIMs and the increase in the number of PIMs during hospitalization.

RESULTS

The number of individuals with PIMs increased significantly according to both criteria (62.3% to 66.6% according to Beers criteria, 43.4% to 50.0% according to STOPP criteria). The most common PIMs were sliding-scale insulin (26.9%), clonazepam (9.5%), and periciazine (6.4%) using Beers criteria and spironolactone (10.3%), acetylsalicylic acid (9.8%), and periciazine (8.7%) using STOPP criteria. Neurology, infectious disease, and pneumology had the highest numbers of PIMs, and neurology, pneumology, and cardiology had a greater increase in PIMs during hospitalization than the other specialties.

CONCLUSION

This study demonstrates the high and growing prevalence of PIMs in the hospital environment, according to Beers and STOPP criteria. Educational measures and specific pharmaceutical interventions for each specialty are needed to change this situation.

Integrating Frailty Research into the Medical Specialties-Report from a U13 Conference

Although the field of frailty research has expanded rapidly, it is still a nascent concept within the clinical specialties. Frailty, conceptualized as greater vulnerability to stressors because of significant depletion of physiological reserves, predicts poorer outcomes in several medical specialties, including cardiology, human immunodeficiency virus care, and nephrology, and in the behavioral and social sciences. Lack of a consensus definition, proliferation of measurement tools, inadequate understanding of the biology of frailty, and lack of validated clinical algorithms for frail individuals hinders incorporation of frailty assessment and frailty research into the specialties. In 2015, the American Geriatrics Society, the National Institute on Aging (NIA), and the Alliance for Academic Internal Medicine held a conference for awardees of the NIA-sponsored Grants for Early Medical/Surgical Specialists Transition into Aging Research program to review the current state of knowledge regarding frailty in the subspecialties and to highlight examples of integrating frailty research into the medical specialties. Research questions to advance frailty research into specialty medicine are proposed.

Evaluation of feedback given to trainees in medical specialties

The aim of this study was to evaluate the quality of feedback provided to specialty trainees (ST3 or higher) in medical specialties during their workplace-based assessments (WBAs). The feedback given in WBAs was examined in detail in a group of 50 ST3 or higher trainees randomly selected from those taking part in a pilot study of changes to the WBA system conducted by the Joint Royal Colleges of Physicians Training Board. They were based in Health Education Northeast (Northern Deanery) and Health Education East of England (Eastern Deanery). Thematic analysis was used to identify commonly occurring themes. Feedback was mainly positive but there were differences in quality between specialties. Problems with feedback included insufficient detail, such that it was not possible to map the progression of the trainee, insufficient action plans made and the timing of feedback not being contemporaneous (feedback not being given at the time of assessment). Recommendations included feedback should be more specific; there need to be more options in the feedback forms for the supervisor to compare the trainee's performance to what is expected and action plans need to be made.

The virgin land of quality management: a first measure of patient safety climate at the National Hospital of the Faroe Islands

PURPOSE

The Faroe Islands are formally part of the Kingdom of Denmark, but the islands enjoy extensive autonomy as home ruled. In Denmark, extensive quality management initiatives have been implemented throughout hospitals, this was not the case in the Faroese Islands in 2013. The purpose of this study is to investigate the patient safety culture in the National Hospital of the Faroe Islands prior to implementation of quality management initiatives.

METHODS

The Danish version of the Safety Attitudes Questionnaire (SAQ-DK) was distributed electronically to 557 staff members from five medical centers of the hospital, and one administrative unit. SAQ-DK has six cultural dimensions. The proportion of respondents with positive attitudes and mean scale scores were described, and comparison between medical specialties, and between clinical leaders and frontline staff was made using analysis of variance and chi-square test, respectively.

RESULTS

The response rate was 65.8% (N=367). Job satisfaction was rated most favorable, and the perceived culture of the top management least favorable. Safety climate was the dimension with the greatest variability across the 28 units. The diagnostic center had the most favorable culture of all centers. More leaders than frontline staff had positive attitudes toward teamwork and safety climate, and working conditions, respectively. Also, the leaders perceived these dimensions more positive than the frontline staff, P<0.05. Among three management levels, the unit management was perceived most favorable and the top management least favorable.

CONCLUSION

The management group is recommended to raise awareness of their role in supporting a safe and caring environment for patients and staff, moreover the leaders should ensure that every day work achieves its objectives; keeping the patients safe. Furthermore, following the development in patient safety culture over time is recommended.

Emergency medicine as a primary specialty-French emergency medicine residents' attitudes

Emergency medicine (EM) has been a fellowship program (supra-specialty) in France since 2004. Even though the program can be accessed after completion of one of several primary specialties, the vast majority (97%) of its residents enter the program after having completed training in family medicine. A change to develop a primary EM specialty is being discussed. Our objective was to assess French residents and young EM physicians' attitudes toward EM as a primary specialty. We conducted a brief cross-sectional online survey among young EM physicians and trainees in November and December 2012. There were 288 respondents to the survey. Forty-nine percent (n=142) of respondents would have chosen EM if it was a primary specialty, but 73% (n=209) prefer maintaining the status quo, offering EM training as a supra-specialty fellowship program. Work-related quality of life was the main reason for those not choosing EM as a primary specialty.

[Experiences of bullying in medical residents]

BACKGROUND

Harassment and abuse are forms of persistent intimidating behavior against a person and in medical practice those are accepted and justified at all levels of education and are considered specific to the hospital culture.

OBJECTIVE

To identify the frequency of harassment and some factors related to its existence on residents of medical specialties in Mexico City.

METHOD

A linear study was carried out in which a total of 260 interns pertaining to the following medical specialties: surgery, internal medicine, gynecology and obstetrics, and pediatrics participated. The study took place in three general hospitals in Mexico City. Two evaluations with Leymann Inventory of Psychological-Terrorization (LIPT-60) with 6 months between assessments were performed.

RESULTS

Comparison between the first and second evaluations did not show differences in any of the harassment measurements obtained. Of all residents, 265 (98.5%) claimed to have experienced some type of harassing behavior against them at least once during the previous 6 months, with a 1.4 (±0.5) average intensity, showing no difference between men and women. Women received a higher grade than men on the communication block scale. Harassing behaviors that obtained the highest average values were evident intimidation and occupational discredit. Among all harassment measurements, the specialty of gynecology and obstetrics showed the highest grade. The hospital influenced the reported harassment.

CONCLUSIONS

The most common harassing behaviors were occupational discredit, verbal threats, shouting, and mockery. The high frequency of harassment that medical residents experience during their hospital training deserves our attention.

Israeli medical students' perceptions of six key medical specialties

BACKGROUND

Choosing a medical specialty requires medical students to match their interests and social-cultural situations with their perceptions of the various specialties.

OBJECTIVES

Examine Israeli 6th-year medical students' perceptions of six key specialties: pediatrics, orthopedic surgery, anesthesiology, obstetrics/gynecology, general surgery and family medicine.

METHODS

Questionnaires distributed to 355 6th-year students from three successive classes (2008-2010) of 6th-year students at the Hebrew University - Hadassah School of Medicine, Jerusalem, Israel and the 2010 class of the Ben Gurion University School of Medicine, Be'er Sheva, Israel.

RESULTS

Responses were obtained from 234 students, for a response rate of 66%. Pediatrics and obstetrics/gynecology were the specialties most often under positive career consideration by individual students. Anesthesiology and general surgery were least often under positive career consideration and were viewed as being in a workforce crisis. Pediatrics and family medicine, found to be especially popular among women, were perceived by 58% and 78% of respondents, respectively, as providing reasonable ratios of lifestyle to income. None of the students thought the same about general surgery and only 28% thought so about anesthesiology. Pediatrics and obstetrics/gynecology were reported to afford a controllable lifestyle by 63% and 8%, respectively, With respect to positive career considerations and lifestyle perceptions, there were no differences between the opinions of men and women students. Differences between genders arose in responses to queries of whether a specialty was interesting and challenging. Women were more likely than men to perceive pediatrics and family medicine as interesting and challenging while men were more likely to think that general and orthopedic surgery are interesting and challenging.

CONCLUSIONS

Knowing the medical students' perceptions of the various specialties should help in understanding the maldistribution of physicians among the various specialties. Such data can also be an important input into the efforts of the healthcare leadership to promote a specialty distribution that matches the population's evolving needs.

Dropping the baton: specialty referrals in the United States

CONTEXT

In the United States, more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Despite the frequency of referrals and the importance of the specialty-referral process, the process itself has been a long-standing source of frustration among both primary care physicians (PCPs) and specialists. These frustrations, along with a desire to lower costs, have led to numerous strategies to improve the specialty-referral process, such as using gatekeepers and referral guidelines.

METHODS

This article reviews the literature on the specialty-referral process in order to better understand what is known about current problems with the referral process and what solutions have been proposed. The article first provides a conceptual framework and then reviews prior literature on the referral decision, care coordination including information transfer, and access to specialty care.

FINDINGS

PCPs vary in their threshold for referring a patient, which results in both the underuse and the overuse of specialists. Many referrals do not include a transfer of information, either to or from the specialist; and when they do, it often contains insufficient data for medical decision making. Care across the primary-specialty interface is poorly integrated; PCPs often do not know whether a patient actually went to the specialist, or what the specialist recommended. PCPs and specialists also frequently disagree on the specialist's role during the referral episode (e.g., single consultation or continuing co-management).

CONCLUSIONS

There are breakdowns and inefficiencies in all components of the specialty-referral process. Despite many promising mechanisms to improve the referral process, rigorous evaluations of these improvements are needed.

Factors affecting the choice of health specialty by medical graduates

A specialty is the transition from the undifferentiated medical graduate phase to the final, fully-differentiated specialist who is almost restricted to one specialized area of medical work. The medical specialty chosen by the medical practitioner is important for both the practitioner and the society. It is an important determinant of the future supply of doctors in different specialties and the planning of the workforce for the health-care services.Many factors influence specialty choices of the medical student and medical practitioner. These range from individual characteristics to the features of the specialty itself, including specialty-related lifestyle.This article explores factors influencing specialty choices of medical students and young practitioners. The article also suggests some general and practical principles that junior doctors should follow in selecting a specialty to suit their personality bearing in mind the health needs of the society.

The evolution of the hospitalist movement in the USA

The hospitalist movement represents a novel paradigm of health care delivery in the USA, its evolution hastened by a variety of financial, clinical, and time pressures. Hospitalists are site-defined specialists who spend the majority of their professional time practising in the hospital, and in this respect are similar to emergency medicine or critical care specialists. Community hospitals were the sites of early growth in hospitalist systems, and academic medical centres quickly followed suit. The field has grown rapidly, and now has its own textbook, professional society, training programme, and research and educational agenda. Published research to date has upheld the promise of the hospitalist model: improving efficiency of care by reducing length of stay and hospital costs without compromising quality or patient satisfaction. Future hospitalist research will aim to elucidate the role of hospitalists in the care of critically ill and surgical patients, identify the competencies that will ultimately define this specialty, and expand our understanding of key inpatient issues, such as prevention of nosocomial infections, end-of-life care, and hospital quality measurement.

The European Union: open to the practising physician?

The European Union (EU) has powers and responsibilities in the area of public health, while the organisation of healthcare facilities remains the concern of member states. However, a series of directives has, since the late 1970s, sought to ensure the right of individual practitioners to travel freely throughout the EU, both to obtain specialist training and to practise in all member states on the same basis as doctors working in the member states where they were first registered. More recently, there has been mutual recognition of completion of specialist training across the EU. A new directive concerning the mobility of medical practitioners across the EU is under discussion.