Academic literature on the topic 'Physicians (General practice) Training of Victoria'

ObjectivesClinical practice guidelines recommend that people with chronic obstructive pulmonary disease (COPD) should be encouraged to increase their physical activity levels. However, it is not clear how these guidelines are applied in clinical practice. This study aimed to understand the perspectives of respiratory healthcare professionals on the provision of physical activity advice to people with COPD. These perspectives may shed light on the translation of physical activity recommendations into clinical practice.DesignA qualitative study using thematic analysis.SettingHealthcare professionals who provided care for people with COPD at two major tertiary referral hospitals in Victoria, Australia.Participants30 respiratory healthcare professionals including 12 physicians, 10 physical therapists, 4 nurses and 4 exercise physiologists.InterventionsSemistructured voice-recorded interviews were conducted, transcribed verbatim and analysed by two independent researchers using an inductive thematic analysis approach.ResultsHealthcare professionals acknowledged the importance of physical activity for people with COPD. They were conscious of low physical activity levels among such patients; however, few specifically addressed this in consultations. Physicians described limitations including time constraints, treatment prioritisation and perceived lack of expertise; they often preferred that physical therapists provide more comprehensive assessment and advice regarding physical activity. Healthcare professionals perceived that there were few evidence-based strategies to enhance physical activity. Physical activity was poorly differentiated from the prescription of structured exercise training. Although healthcare professionals were aware of physical activity guidelines, few were able to recall specific recommendations for people with COPD.ConclusionPractical strategies to enhance physical activity prescription may be required to encourage physical activity promotion in COPD care.

Introduction. Advocacy is a perceived social and professional obligation of physicians, yet many feel their training and practice environment don’t support increased engagement in advocacy. The aim of this qualitative project was to delineate the role advocacy plays in physicians’ careers and the factors driving physician engagement in advocacy. Methods. We identified physicians engaged in health advocacy in Kansas through personal contacts and referrals through snowball sampling. They received an email invitation to participate in a short in-person or phone interview which was recorded using Apple Voice Memos and Google Dictation. Two team members independently identified themes from interview transcripts, while a third member served as a moderator if themes identified were dyssynchronous. Results. Of the 19 physicians invited to participate, 13 were interviewed. The most common reasons for engaging in advocacy included the desire to change policy, obligation to go beyond regular clinic duties, giving patients a voice, and avoiding burnout. Physicians reported passion for patients and past experiences with disparities as the most common inspiration. Most physicians did not have formal advocacy training in school or residency, but identify professional societies and peers as informal guides. Common support for advocacy were professional organizations, community partners, and employers. Time was the most common barrier to conducting advocacy work. Conclusions. Physicians have a broad number of reasons for the importance of doing advocacy work, but identify key professional barriers to further engagement. Providing accessible opportunities through professional organizations and community partnerships may increase advocacy participation.

Although, recently, the biopsychosocial approach has been emphasized in the practice of family medicine, how psychologists and physicians interact in collaborative family health care practice is still emerging in Portugal. This article describes a qualitative study that focused on the understanding of psychologists and family physicians' perceptions of their role and the collaborative approach in health care.A questionnaire gathered information regarding collaboration, referral, training and the practice of biopsychosocial medicine. A content analysis on respondents' discourse was performed. Results show that both physicians and psychologists agree on the importance of the biopsychosocial model and interdisciplinary collaboration. However, they also mentioned several difficulties that have to do with the lack of psychologists working full time in health care centers, lack of communication and different expectancies regarding each other roles in health care delivery.Both physicians and psychologists acknowledge the lack of academic training and consider the need for multidisciplinary teams in their training and practice to improve collaboration and integrative care. Implications for future research and for the practice of biopsychosocial medicine are addressed.

Objective. This study sought to examine variations in the frequency of procedures performed and patterns of care of sick infants and older children by general pediatricians in different sized communities. The results of the study will be considered in developing relevant educational experiences for postgraduate trainees. Methodology. Questionnaires were sent to 1412 Texas pediatricians requesting frequency information for 29 procedures and whether they provided various levels of care to sick infants and older children. Responses were tabulated by the size of the community in which each pediatrician practiced. Results. Fifty-four percent of the questionnaires were returned. The proportion of pediatricians performing each procedure was significantly different for all but 8 of the 29 procedures between communities of less than 100 000 and more than 100 000 population. For all procedures with significant differences, the proportion of physicians performing the procedures was significantly greater for pediatricians practicing in communities of less than 100 000 population. No significant difference was found between the proportion of pediatricians providing newborn level II and III care; however, more than 65% of both groups provided level II care. Physicians in communities of less than 100 000 population were more likely to provide intermediate and intensive care beyond the newborn period. Conclusion. The general practice rotation in the community setting will not provide adequate training experiences for many of the procedures currently being performed by general pediatricians.

Background and Objectives: To achieve the goal of 300,000 general practitioners by 2020—an increase of 215,200 in a decade—China is utilizing multiple training pathways. To comprehensively illustrate general practitioner training strategies in China, this article introduces and describes these pathways. Methods: We used descriptive policy analysis. This involved taking an inventory of existing literature and source documents and developing a model to illustrate pathways for training general practice physicians. Results: The rural doctor pathway represents rural clinicians who had only basic training and practiced multiple years prior to training reforms. The 3+2 pathway to assistant general practitioners requires 3 years of junior college and 2 years of clinical training. The transfer pathway for current physicians requires 1-2 years of training. The 5+3 pathway comprises 5 years of bachelor of science degree training in clinical medicine and 3 years of standardized residency training. Despite the development of advanced degree programs, their use remains limited. Conclusions: These pathways illustrate significant heterogeneity in training of general practitioners. Training ranges from a 2-year technical degree to a doctorate with research. Emphasis on the 5+3 track shows promise for China’s goals of improved quality and new goal of 500,000 additional general practitioners by 2030.

ABSTRACT To investigate the practice characteristics of newly licensed physicians for the purpose of identifying the knowledge and skills expected of those holding the general, unrestricted license to practice medicine, a questionnaire was mailed in May 2012 to 8,001 U.S. physicians who had been granted an unrestricted license to practice medicine between 2007 and 2011. The questionnaire requested information on stage of training, moonlighting, and practice setting; it also listed 58 clinical procedures and asked respondents to indicate whether they had ordered, performed, or interpreted the results of each procedure since obtaining their unrestricted license. A strategy was implemented to identify the relevance of each clinical activity for undifferentiated medical practice. The response rate was 37%. More than two-thirds of newly licensed physicians still practiced within a training environment; nearly one-half of those in training reported moonlighting, mostly in inpatient settings or emergency departments. Physicians who had completed training and entered independent practice spent most of their time in outpatient settings. Residents/fellows engaged in a broader range of clinical activities than physicians in independent practice. Several clinical procedures were identified that were specialty-specific and did not appear to be skills expected for general medical practice. The results may help residency programs and licensing authorities identify the knowledge and skills required of newly licensed physicians as they transition from supervised to unsupervised practice. The results are relevant to the topic of moonlighting by identifying the skills and procedures required of physicians who engage in this activity. While the study identified procedures that have limited utility for licensure decisions because they are not consistent with general medical practice, the inclusion of such procedures in residency may add value by promoting beneficial variation in training experiences.

ABSTRACT Background Variation in physicians' practice patterns contributes to unnecessary health care spending, yet the influences of modifiable determinants on practice patterns are not known. Identifying these mutable factors could reduce unnecessary testing and decrease variation in clinical practice. Objective To assess the importance of the residency program relative to physician personality traits in explaining variations in practice intensity (PI), the likelihood of ordering tests and treatments, and in the certainty of their intention to order. Methods We surveyed 690 interns and residents from 7 internal medicine residency programs, ranging from small community-based programs to large university residency programs. The surveys consisted of clinical vignettes designed to gauge respondents' preferences for aggressive clinical care, and questions assessing respondents' personality traits. The primary outcome was the participant-level mean response to 23 vignettes as a measure of PI. The secondary outcome was a certainty score (CS) constructed as the proportion of vignettes for which a respondent selected “definitely” versus “probably.” Results A total of 325 interns and residents responded to the survey (47% response rate). Measures of personality traits, subjective norms, demographics, and residency program indicators collectively explained 27.3% of PI variation. Residency program identity was the largest contributor. No personality traits were significantly independently associated with higher PI. The same collection of factors explained 17.1% of CS variation. Here, personality traits were responsible for 63.6% of the explained variation. Conclusions Residency program affiliations explained more of the variation in PI than demographic characteristics, personality traits, or subjective norms.

Bibliography: leaves 554-636. Examines aspects of teaching medical students communication skills at a time when they are entering their clinical years. Integrates reports of 12 data-gathering exercises centred on medical student communication skills with the international literature, and with the author's reflections as an experienced educator and G.P. Recommends that communication skills training in a general practice setting should be a crucial factor in all future training of medical students.

To train to be a general practitioner in the U.K. a doctor must spend two years in hospital training posts and one year in general practice as a general practice registrar (GPR). Concern has been expressed in the literature about both the duration and adequacy of general practice training. A literature review identified that there was limited knowledge of and understanding about the learning experiences of GPRs. The aim of the study was to describe and interpret the learning experiences of GPRs in the South East of Scotland during their year in general practice. The methodology was derived from Denzin's concept of Interpretivism and involved in depth interviews over time with GPRs and thick description to capture and interpret the GPRs learning experiences. Two cohorts of 24 GPRs were recruited, cohort one ran from September 2002 to July 2003 and cohort two from September 2003 to August 2004. The GPRs were interviewed on three occasions during their year. In addition to the interviews six GPR focus groups and six GP trainer focus groups were held over the period December 2002 to September 2003. 21 GPRs in cohort one completed all three interviews and 20 GPRs in cohort two. All the participating GPRs completed at least two interviews. The results were interpreted within the educational concept of the curriculum. Four main curricula were identified during the GPR year: these were the formal, assessment, individual and hidden. Each independently contributed to the GPRs learning and also interacted synergistically at various times during the year. In the last quarter of the year there was a tension between the requirements of the assessment and individual curricula. The individual curriculum which was composed of the GPRs clinical experiences and in particular epiphanies was the main driver of GPR learning. Epiphanies were identified by GPRs as having the most significant impact on their learning. Central to this learning was the contribution of their general practice trainer who supported their learning both through the development of the practice learning environment and the promotion of reflection and self directed learning. GPR learning during the year was an iterative process, which involved a reflective and supported interaction between the GPR, their clinical experiences, epiphanies and their trainer. Through this process the GPRs became self directed and reflective learners and developed individual learning networks which led to changes in the way they practiced medicine. This process also led to the socialisation of their learning and promoted their integration into the culture of working general practice, through which they were exposed to the working realities of life as a general practitioner and these experiences had a critical effect on their future career choice. A number of important policy implications were identified which have implications for the present and future direction of training for general practice. The process of thick description and the longitudinal nature of the study allowed for a new interpretation of the learning experiences of GPRs and added to the knowledge and understanding of how GPRs learn during their training.

Thesis (MFamMed)--Stellenbosch University, 2014.
BACKGROUND:Family physicians are trained to enable them to staff community health centres and primary care hospitals. Part of this training is teaching them procedural skills for anaesthetics and surgery. Knysna hospital is a training facility for family medicine registrars and this article aims to evaluate if sufficient learning opportunities exist in Knysna hospital’s theatre to teach family medicine registrars procedural skills. METHODS:A descriptive study was undertaken of the number and type of procedures performed in Knysna hospital theatre for a one year period, and compared with the required skills,as stipulated in the national training outcomes, for the discipline. RESULTS:Three thousand seven hundred and forty one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by caesarean section. There were adequate opportunities for teaching most core skills. CONCLUSIONS: There were sufficient opportunities for a registrar to be taught all the core skills that are exclusive to theatre. Further research is needed to evaluate Knysna hospital as a training facility for all procedural skills.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.

Thesis (PhD)--University of Stellenbosch, 2004.
ENGLISH ABSTRACT: District hospitals play a pivotal role in the district health system of the Western Cape and other provinces of South Africa. It is a dual role, supporting both primary health care services and serving as a gateway to higher levels of care. Most district hospitals are in rural areas, staffed by generalist medical practitioners who provide health services often supplied by specialists in urban areas. There is a paucity of research and published material on the scope of practice of district hospital practitioners in South Africa, as well as the factors influencing the performance of their duties. There were two main objectives for this study. Firstly, to identify the professional knowledge and skills of medical practitioners delivering district hospital services in the Western Cape and to compare these with service platform needs. Secondly, to use the information gathered to make recommendations regarding human resource development and appropriate education and training and continuing professional development of these doctors. The study was conducted in three phases to ensure coherent evolution of investigation, co-ordination and response. Phase One was a comprehensive survey, utilising district hospital data, medical officer questionnaires and in-depth interviews to determine the professional knowledge and skills of medical practitioners working in district hospitals in the Western Cape. This information gathering endeavour resulted in a skills and knowledge compendium being formulated. It established that the spectrum of functions required of these doctors was extremely wide - ranging from the management of undifferentiated problems to performing complex surgical procedures, as well as providing a vital public health function. Two main factors influenced their performance, namely their working conditions and the education and training which they received.In common with rural practice in other countries, it was apparent that the working environment had a major impact on attitudes and functioning. These findings were developed into a conceptual framework depicting the negative influences that can build up and result in these doctors opting out of rural practice. In addition, other influences were established having a profound effect on doctors’ satisfaction, mainly in the realm of education and training. This gave rise to a second more comprehensive framework being evolved, encapsulating the positive and negative factors enhancing or retarding efficiency and satisfaction in the workplace. Phase Two of the study consisted of the validation of the findings of the basic research data. In keeping with the second aim of the study, the education and training perspectives of rural and district hospital practice were explored. The deficiencies exposed have implications for undergraduate and postgraduate education and training, as well as for continuing professional development programmes. Phase Three concentrated on the exploration of ways and means of defining and maintaining ongoing professional competence for district hospital practice. This was approached by using the data captured in Phase One and refined in Phase Two to pose a series of educational problems to a group of experts. Using the Delphi Technique, a series of electronic exchanges achieved consensus on a range of topics varying from educational content to learning modalities and modern adult teaching techniques applicable to district hospital practice. This research presents information defining the circumstances, experiences and needs of medical practitioners working in district hospitals in the Western Cape province of South Africa. It reveals clear challenges to the capacity, attitudes, costs, isolation, political will, monitoring and organisation which will be crucial in the development of future human resource strategies.It, furthermore, defines the educational objectives, content and methods required to establish and maintain the ongoing professional competence of medical practitioners delivering district hospital services in the Western Cape.
AFRIKAANSE OPSOMMING: Distrikshospitale speel ‘n sentrale rol in die distriksgesondheidstelsel van die Wes- Kaap en ander provinsies in Suid-Afrika. Dit is ‘n dubbele rol wat beide primêre gesondheidsorgdienste ondersteun en optree as ‘n deurgang vir verwysing na hoër vlakke van sorg. Die meeste distrikshospitale is te vinde in plattelandse gebiede. Dit is hier waar die algemene geneeskundige praktisyn dienste lewer wat gewoonlik deur spesialiste in stedelike gebiede verrig word. Daar is ‘n gebrek aan bestaande navorsing en publikasies oor die omvang van praktyk van geneeshere in distrikshospitale in Suid- Afrika, sowel as onvoldoende inligting in verband met faktore wat die funksionering van hierdie praktisyns beïnvloed. Hierdie studie het twee hoofdoelwitte vervat. Die eerste doelwit was die bepaling van die professionele kennis en vaardighede van geneeshere werksaam in distrikshospitale in die Wes-Kaap, en die vergelyking daarvan met die behoetes van die diensplatform. Die tweede doelwit was om hierdie inligting te gebruik om aanbevelings te doen aangaande menslike hulpbronontwikkeling en toepaslike onderrig, opleiding en voortgesette professionele ontwikkeling vir hierdie geneeshere. Die studie is in drie fases uitgevoer om samehangende ontwikkeling van ondersoek, koördinasie en respons te verseker. Fase Een het bestaan uit ‘n omvattende opname van die professionele kennis en vaardighede van geneeshere werksaam in distrikshospitale in die Wes-Kaap deur die gebruik van distrikshospitaaldata, vraelyste vir geneeshere, en in-diepte onderhoude. Die resultate is gebruik om ‘n omvattende stel kennis en vaardigheidsareas te identifiseer. Fase Een het bewyse gelewer dat die rol en funksie van dokters in distrikshospitale uitsonderlik wyd is en wissel tussen die hantering van ongedifferensieërde probleme en die uitvoer van komplekse chirurgiese prosedures, sowel as ‘n belangrike rol in openbare gesondheid. Werksomstandighede en onderrigen opleiding is geïdentifiseer as die twee belangrikste invloede wat die uitvoer van hierdie praktisyns se pligte beïnvloed. Soortgelyk aan plattelandse praktyke in ander lande, het dit duidelik geword dat werksomstandighede ‘n groot invloed op houdings en funksionering het. Hierdie bevindings is saamgevoeg in ‘n konseptuele raamwerk om die negatiewe invloede toe te lig wat veroorsaak dat hierdie geneeshere die plattelandse diens verlaat. Ander faktore wat ‘n beduidende uitwerking op praktisyns se werksbevrediging gehad het, veral wat onderrig en opleiding betref, is saamgevat in ‘n tweede en omvattende raamwerk wat die positiewe en negatiewe invloede op effektiwiteit van dienslewering en werksverrigting uitspel. Fase Twee van die studie het bestaan uit die bevestiging van die bevindings van die basiese navorsingsinligting. Perspektiewe in die onderrig en opleiding vir plattelandse praktyk is ondersoek in oorleg met die tweede doelwit van die studie. Verskeie implikasies vir voorgraadse en nagraadse onderrig en opleiding en voortgesette professionele ontwikkelingsprogramme is uit ontblote tekortkomings geïdentifiseer. Die omskrywing en die behoud van professionele bevoegdheid is in Fase Drie ondersoek. Data verkry in Fase Een, en verfyn in Fase Twee, is gebruik in die ontwikkeling van ‘n reeks opvoedkundige vraagstukke. ‘n Groep deskundiges is daarna die taak gestel om konsensus te bereik oor ‘n spektrum van onderwerpe, insluitend toepaslike inhoud, metodes van leer en moderne volwasse onderrigtegnieke vir distrikshospitaal praktykvoering. Die Delphi tegniek met herhalende elektroniese rondtes is hiervoor gebruik. Hierdie navorsing lewer inligting wat die omstandighede, ondervindings en behoeftes van geneeshere werksaam in distrikshospitale in die Wes-Kaap provinsie van Suid- Afrika beskryf.Die navorsing onthul duidelike uitdagings vir die kapasiteit, houdings, koste, isolasie, politieke wilskrag, monitering en organisasie van strategieë vir die ontwikkeling van menslike hulpbronne. Dié navorsing definieër hierbenewens die opvoedkundige doelwitte, inhoude en metodes wat nodig is vir die vestiging en instandhouding van die professionele bevoegdheid van distrikshospitaalpraktisyns in die Wes-Kaap.

Bibliography: leaves 554-636.
637 leaves
Examines aspects of teaching medical students communication skills at a time when they are entering their clinical years. Integrates reports of 12 data-gathering exercises centred on medical student communication skills with the international literature, and with the author's reflections as an experienced educator and G.P. Recommends that communication skills training in a general practice setting should be a crucial factor in all future training of medical students.
Thesis (M.D.) -- University of Adelaide, Dept. of Psychiatry, 2000

Opioid dependence is a chronic relapsing condition resulting in significant individual and community harms, for which the most effective treatment is long term opioid pharmacotherapy (OP). In contrast to other Australian states and territories, in Victoria, 80-85 % of OP prescribing is undertaken by GPs, and while demand for this treatment is difficult to estimate, all evidence indicates that the current and future GP workforce is inadequate to meet projected need.
GPs have shown a reluctance to become actively involved in the treatment of patients with drug dependence, especially where illicit drugs are involved. In order to prescribe OP, Australian medical practitioners are required to complete a specific training program. Little is known of the reasons why GPs decline to undertake this training, and why the majority who complete training, subsequently prescribe to very few or no patients.
Using in-depth interviews and an analysis of existing data from the Victorian Department of Human Services, this thesis not only explores why GPs are unwilling to complete OP training, and why many subsequently fail to prescribe, but also identifies both barriers and facilitators which influence GPs in their decisions regarding these issues. The results have not only provided new information on the reasons GPs decline the offer of training but also supported existing research.

Training in primary care has received limited attention in medical schools despite state and federal funding to increase its emphasis. Departments of internal medicine, which have been responsible for most training in primary care, have shifted their interests to the medical subspecialties. Departments of family practice, which have been established by most medical schools in response to government pressure, have had a limited role in the undergraduate curriculum. Residency programs in family practice have become widespread and popular with medical students. Primary care has been defined as that type of medicine practiced by the first physician whom the patient contacts. Most primary care has involved well-patient care, the treatment of a wide variety of functional, acute, self-limited, chronic, and emotional disorders in ambulatory patients, and routine hospital care. Primary care physicians have provided continuing care and coordinated the treatment of their patients by specialists. The major specialties providing primary care have been family practice, general internal medicine, and pediatrics. General and family physicians in particular have been major providers of ambulatory care. This was shown in a study of diaries kept in 1977–1978 by office-based physicians in a number of specialties. General and family physicians treated 33 percent or more of the patients in every age group from childhood to old age. They delivered at least 50 percent of the care for 6 of the 15 most common diagnostic clusters and over 20 percent of the care for the remainder. The 15 clusters, which accounted for 50 percent of all outpatient visits to office-based physicians, included activities related to many specialties, including pre- and postnatal care, ischemic heart disease, depression/anxiety, dermatitis/eczema, and fractures and dislocations. According to the study, ambulatory primary care was also provided by many specialists who have not been considered providers of primary care. A substantial part of the total ambulatory workload of general surgeons involved general medical examinations, upper respiratory ailments, and hypertension. Obstetricians/ gynecologists performed many general medical examinations. The work activities of these and other specialists have demonstrated that training in primary care has been essential for every physician who provides patient care, not just those who plan to become family physicians, general internists, or pediatricians.

Graduate medical education has become as important as attendance at medical school in the training of physicians. Up to 1970, most graduates of medical schools first took an internship in general medicine and then a residency in a specialty. After 1970, practically all medical school graduates entered residency training in a specialty immediately after graduation. Residency programs have been located in hospitals affiliated with medical schools and have been accredited by specialty boards, which have been controlled by medical school faculty members. This situation has led to insufficient breadth of training and lax regulation of the programs. The internship, which followed graduation from medical school until its elimination after 1970, consisted of one or two years of hospital training, usually unconnected with any medical specialty. It was designed to provide gradually increasing responsibility for patient care, supplemented by formal teaching in rounds and seminars. In practice, as George Miller observed in 1963, it was “virtually impossible to find an internship [program with] a graded and sequential course of study leading to relatively well-defined goals.” This was also the finding of several surveys of interns and physicians. A 1959 survey of 2,616 interns found that the two most frequently cited deficiencies of internships were lack of “sufficient review and criticism of your work with patients,” cited by 47 percent, and “adequate instruction in the application of scientific knowledge to patient care,” cited by 34 percent. A 1952 survey of 6,662 graduates of the medical school classes of 1937 and 1947 and a later survey of over 3,000 interns and residents produced similar findings. Formal instruction during the internship was usually casual and unsystematic. Stephen Miller's study of one university hospital found that interns spent only a few hours per week in formal lectures and conferences and on rounds. In teaching on rounds, “the visiting physician does not prepare a lecture or other teaching material. He simply walks onto the ward and responds to patients and their problems with opinions and examples from his own clinical experience.” The educational value of rounds therefore depended on the illnesses of the patients and the relevant skills of the physicians.

Undergraduate medical education has changed markedly in the decades after mid-century. The basic medical sciences have been de-emphasized; clinical training in the specialties has replaced that in general medicine; and both types of training have been compressed to permit much of the fourth year to be used for electives. The patients used for teaching in the major teaching hospitals have become less typical of those found in community practice. Innovations in medical education have been successful only when they have been compatible with other interests of the faculty. As medicine and medical schools have changed, major differences of opinion have developed over the goals of undergraduate medical education. Practicing physicians have continued to believe that the fundamentals of clinical medicine should be emphasized. A survey in the 1970s of 903 physicians found that over 97 percent of them believed that each of the following was “a proper goal of medical school training:” “knowing enough medical facts;” “being skillful in medical diagnosis;” “making good treatment plans;” “understanding the doctor-patient relationship;” “understanding the extent to which emotional factors can affect physical illness;” “being able to keep up with new developments in medicine;” and being able to use and evaluate sources of medical information. Only 52 percent felt that “being able to carry out research” was a proper goal of medical school training. Medical students have also believed that undergraduate medical education should emphasize clinical training. Bloom asked students at one medical school in the early 1960s whether they would prefer to “work at some interesting research problem that does not involve any contact with patients,” or to “work directly with patients, even though tasks are relatively routine.” About 25 percent of the students in all four classes chose research, while 58 percent of the freshmen and 70 percent of the juniors and seniors chose patient care. The same study also asked students their criteria for ranking classmates “as medical students.” Clinical skills were the predominant criteria used by students, with “ability to carry out research” ranking far down on the list. Faculty members, on the other hand, have emphasized the basic and preliminary nature of undergraduate medical education.

Regulation of the medical profession is to ensure medicine is only practised by qualified individuals. Regulatory systems set and maintain standards of education and training, control entry into practice, and ensure competence of practising physicians. Medical regulators also identify and take action against incompetent, unethical, or immoral practices by physicians. In the UK, these regulatory roles are carried out by the General Medical Council (GMC). The Medical Act 1983 provides the statutory basis for the GMC’s overall functions. Its role in education has evolved significantly of late as it now holds responsibility for postgraduate medical education and training in the UK and is tasked with developing combined standards for undergraduate and postgraduate education. The GMC also governs medical revalidation, the purpose of which is to improve the safety, quality, and effective delivery of care for patients by bringing all doctors into a governed system that prioritizes professional development and accountability.

Professionalism guides how intensivists provide care, and communicating effectively is a core principle of professionalism. Communicating with families is common in intensive care units because patients may be in extremis or unable to understand their critical illness. Interpersonal and communication skills are core competency areas at all levels of medical training and practice. The Accreditation Council for Graduate Medical Education included interpersonal and communication skills as a general competence, and the American Board of Medical Specialties endorsed the same competencies for practicing physicians. Nonetheless, a physician must rely on experience to recommend certain options to patients’ families, guide them toward understanding, and proceed with the best professional choice.

The years around 1830, as just described, were a turning point in the movement to create a more systematic and uniform approach to the training of doctors. For the next quarter-century, a battle royal raged in the transatlantic countries between those seeking to create a common standard of medical training for all practitioners and those who defended the many-tiered systems of preparing healers that prevailed in most of them. At stake were such important issues as the care of the rural populations, largely unserved by university-trained physicians, the ever larger role claimed for science and academic study in educating doctors, the place of organized medical groups in decision making about professional training, and the role to be played by government in setting standards of medical education. In Great Britain, the conflict over change centered on the efforts of reformers, mainly liberal Whigs, apothecary-surgeons, and Scottish teachers and practitioners, to gain a larger measure of recognition for the rights of general practitioners to ply their trade freely throughout the nation. Ranged against them were the royal colleges, the traditional universities, and other defenders of the status quo. Particularly sensitive in Britain was the entrenched power of the royal colleges of medicine and surgery— “the most conservative bodies in the medical world,” S. W. F. Holloway called them—which continued to defend the importance of a liberal, gentlemanly education for medicine, as well as their right to approve the qualifications for practice of all other practitioners except apothecaries. Members of the Royal College of Physicians of London, the most elite of all the British medical bodies, were divided by class into a small number of fellows, almost all graduates of Oxford and Cambridge, and a larger number of licentiates, who, though permitted to practice, took no part in serious policy discussions and could not even use such college facilities as the library or the museum. “The Fellows,” claimed a petition signed by forty-nine London physicians in 1833, “have usurped all the corporate power, offices, privileges, and emoluments attached to the College.”

The study is devoted to the analysis of the formation of physical culture of students in a medical university. The specificity of the medical profession contains a number of important characteristics (emotional and volitional stability, endurance, physical and mental endurance, dexterity in carrying out medical procedures, motor coordination, etc.) that require appropriate physical training. Physical culture in this regard for physicians is not only a part of general culture, but also a professional culture. However, as shown by a sociological survey of medical students, they do not sufficiently assess the degree of importance of the discipline “Physical culture”. This requires the development of new approaches to organizing and conducting physical education classes in a medical University including such as the proposed practice-oriented (D.A. will allow raising the status of the discipline in question in a medical university and linking it with the professional training of medical students.

The assessment and diagnosis phase of autism spectrum disorder (ASD) is a very difficult time for the parent. You will likely feel completely bewildered. You will be filled with many mixed emotions such as love for your child and fear for your child’s future. You may feel like your heart is breaking. But I can tell you, you are going to make it through this—just like I have. You will likely have to overcome significant denial to even discuss the unusual signs or symptoms that you have noticed in your young child. You may be afraid to hear the term “autism” come from your pediatrician’s mouth. However, you are about to start a very important journey with your child. You have to be strong in order to obtain for your child vital treatments and therapies that can dramatically improve your child’s life and future. Theoretically, ASD is not difficult to recognize and diagnose. However, in practice, it can be challenging. The full spectrum of symptoms included in ASD is quite wide. One child may appear quite typical with only minor eccentricities while another has significant intellectual disability, social impairment, self-injurious behavior, and aggression. No two individuals with ASD are exactly alike. In fact, individuals with autism are often more different than similar. We cannot easily pigeonhole or stereotype our children. Further complicating diagnosis, professionals often have little training in ASD, even in fields that have autism within their scope of practice. Furthermore, children with more subtle ASD symptoms or those who are “high-functioning” (more verbal and with more capabilities in general) do not always have symptoms that are evident at a very young age. At times, autism symptoms may not be identifiable until social problems become more significant as the child grows older. Primary care physicians are not typically able to spend long enough with your child during visits to pick up on the sometimes subtle signs needed to alert them to a possible ASD diagnosis.

Medical marijuana (MMJ) is legal in the state of Florida for the treatment of specific qualifying medical conditions.1,2 As of July 2020, over 2,450 physicians are authorized to order MMJ, and 360,000 patients are registered in Florida’s MMJ program.3 With this rapid uptake come concerns regarding physicians’ knowledge about MMJ,4–7 and the lack of preparing physicians-in-training to manage MMJ.4,7,8 We conducted a state-wide survey of certified MMJ providers in Florida. The survey was developed by the Consortium for Medical Marijuana Clinical Outcomes research team. The aim of the survey was to inform physicians of the mission of the consortium, which is to support and disseminate research. The survey items were developed accordingly, and the survey was pilot tested with a small group of physicians. We identified all physicians licensed to certify patients for MMJ who care currently practicing in the State of Florida (n=1609), to investigate their information sources and training needs regarding MMJ. The survey was disseminated via mail and email, including a $40 incentive for survey completion. Preliminary responses from 51 (5%) providers (mean age 56, 74% male) are summarized here. The sample included providers from 22 Florida counties and represented a broad range of medical specialties. The majority (92%) practiced in both medical marijuana and traditional medical practice. To learn about MMJ, 98% used research articles, 90% used online sources, 86% learned from dispensary staff, 84% learned from discussions with other providers, 72% used books, 65% used conferences, 61% used magazines, and 35% had a personal experience with marijuana. The sources most cited as “very useful” were conferences (51%), research articles (50%), discussions with other providers (47%), and online sources (47%). Topics rated as a high priority for training included drug-MMJ interactions (80%), strategies to help patients reduce their use of opioids or other drugs (80%), information about the selection of doses and CBD: THC ratios (80%), evidence for managing specific medical conditions or symptoms (78%), information about the effect of different phytocannabinoids and terpenes (75%), advantages and disadvantages of specific modes of delivery (71%), general updates on research findings (71%), educational information about the endocannabinoid system (67%), the safety of medical marijuana use (55%), identification and management of cannabis use disorder (51%), and comparison of products available in different dispensaries (49%). The majority of providers either strongly agreed or agreed (77%) that they could provide better care if they knew which products their patients receive at dispensaries. Physicians use a blend of primary research, online sources, and exchanges with colleagues to learn about MMJ. Perceived needs for more pharmacological information and indication-specific detail for treatment regimen were high. Most physicians believe that details on dispensed MMJ would improve patient care.