Journal articles on the topic 'Physicians (General practice) Training of Victoria'
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Lahham, Aroub, Angela T. Burge, Christine F. McDonald, and Anne E. Holland. "How do healthcare professionals perceive physical activity prescription for community-dwelling people with COPD in Australia? A qualitative study." BMJ Open 10, no. 8 (August 2020): e035524. http://dx.doi.org/10.1136/bmjopen-2019-035524.
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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.
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Israilova, Darygul Kubanychbekovna, Guldeste Askarbekovna Askarbekova, Abdilatip Abdyrakhmanovich Shamshiev, and Yrysbek Abdyzhaparovich Aldashukurov. "TRAINING OF SPECIALISTS FOR GENERAL (FAMILY) PRACTICE PHYSICIANS." Bulletin of Osh State University, no. 3 (2022): 38–43. http://dx.doi.org/10.52754/16947452_2022_3_38.
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Piterman, Leon, and Chris Silagy. "Hospital interns' and residents' perceptions of rural training and practice in Victoria." Medical Journal of Australia 155, no. 9 (November 1991): 630–33. http://dx.doi.org/10.5694/j.1326-5377.1991.tb93934.x.
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Warwick, Sophia, Laura Kantor, Erin Ahart, Katie Twist, Terrance Mabry, and Ky Stoltzfus. "Physician Advocacy: Identifying Motivations for Work Beyond Clinical Practice." Kansas Journal of Medicine 15, no. 3 (December 19, 2022): 433–36. http://dx.doi.org/10.17161/kjm.vol15.18255.
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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.
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Pereira, M. Graça, Alfonso Alonso Fachado, and Thomas Edward Smith. "Practice of Biopsychosocial Medicine in Portugal: Perspectives of Professionals Involved." Spanish journal of psychology 12, no. 1 (May 2009): 217–25. http://dx.doi.org/10.1017/s1138741600001621.
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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.
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Feigin, Ralph D., Jan E. Drutz, E. O'Brian Smith, and Carol Ritter Collins. "Practice Variations by Population: Training Significance." Pediatrics 98, no. 2 (August 1, 1996): 186–90. http://dx.doi.org/10.1542/peds.98.2.186.
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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.
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Lian, Siqing, Qi Chen, Mi Yao, Chunhua Chi, and Michael D. Fetters. "Training Pathways to Working as a General Practitioner in China." Family Medicine 51, no. 3 (March 1, 2019): 262–70. http://dx.doi.org/10.22454/fammed.2019.329090.
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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.
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Raymond, Mark R., Janet Mee, Steven A. Haist, Aaron Young, Gerard F. Dillon, Peter J. Katsufrakis, Suzanne M. McEllhenney, and David Johnson. "Expectations for Physician Licensure: A National Survey of Practice." Journal of Medical Regulation 100, no. 1 (March 1, 2014): 15–23. http://dx.doi.org/10.30770/2572-1852-100.1.15.
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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.
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Dine, C. Jessica, Lisa M. Bellini, Gretchen Diemer, Allison Ferris, Ashish Rana, Gina Simoncini, William Surkis, et al. "Assessing Correlations of Physicians' Practice Intensity and Certainty During Residency Training." Journal of Graduate Medical Education 7, no. 4 (December 1, 2015): 603–9. http://dx.doi.org/10.4300/jgme-d-15-00092.1.
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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.
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Twilling, Lisa L., Mark E. Sockell, and Lucia S. Sommers. "Collaborative practice in primary care: Integrated training for psychologists and physicians." Professional Psychology: Research and Practice 31, no. 6 (2000): 685–91. http://dx.doi.org/10.1037/0735-7028.31.6.685.
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Nawka, Marie Teresa, Jens Fiehler, Johanna Spallek, Jan-Hendrik Buhk, and Andreas Maximilian Frölich. "Current status of training environments in neuro-interventional practice: are animal models still contemporary?" Journal of NeuroInterventional Surgery 11, no. 3 (July 26, 2018): 283–89. http://dx.doi.org/10.1136/neurintsurg-2018-014036.
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PurposeSeveral different training environments for practicing neurointerventional procedures have been realized in silico, in vitro, and in vivo. We seek to replace animal-based training with suitable alternatives. In an effort to determine present training model distribution and preferences, we interviewed interventional neuroradiologists from 25 different countries about their experience in distinct training environments.MethodsA voluntary online survey comprising 24 questions concerning the different training facilities was designed and electronically conducted with the members of the European Society for Minimally Invasive Neurological Therapy.ResultsSeventy-one physicians with an average experience of 11.8 (±8.7) years completed the survey. The majority of participants had experience with animal-based training (eg, stroke intervention: 36; 50.7%). Overall, animal-based training was rated as the most suitable environment to practice coil embolization (20 (±6)), flow diverter placement (13 (±7)), and stroke intervention (13.5 (±9)). In-vitro training before using a new device in patients was supported by most participants (35; 49.3%). Additionally, preference for certain training models was related to the years of experience.ConclusionThis survey discloses the preferred training modalities in European neurointerventional centers with the majority of physicians supporting the general concept of in-vitro training, concomitantly lacking a standardized curriculum for educating neurointerventional physicians. Most suitable training modalities appeared to be dependent on procedure and experience. As animal-based training is still common, alternate artificial environments meeting these demands must be further developed.
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Islam, Mohammad Rafiqul, Sarmistha Biswas, Mohammad Robed Amin, and Md Ridwanur Rahman. "Knowledge Attitude and Practice of Dengue Syndrome Management on the Basis of National Guideline by the Physicians of Dhaka City." Journal of Medicine 22, no. 1 (January 14, 2021): 18–21. http://dx.doi.org/10.3329/jom.v22i1.51386.
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Objectives: Dengue is the fastest emerging arboviral infection. It was expected that the National Control Program will promote the use of the revised and updated version of the guideline for uniform clinical management of Dengue/DHF in the country with a view to reduce case fatality due to dengue. We tried to assess the knowledge attitude and practice of different tier of physicians on the basis of this guideline.
Method: Total 317 physicians from academic hospital, 57 physicians from non-academic hospital and 21 private practitioners took part in the survey.
Results: knowledge and attitude regarding management protocol of Dengue syndrome were significantly (p<0.05) associated with different academic tier but practice was not significantly (p<0.05) associated with different academics. The mean of accurate knowledge regarding management protocol of Dengue syndrome was significantly (p<0.05) associated with training status but attitude and practice were not significantly (p<0.05) associated with training status.
Conclusion: This study reveals that physicians possibly didn’t went through the dengue guideline properly as their knowledge, attitude and practice were poor in each tier of professional practice. But dengue training improved knowledge regarding management of patients.
J MEDICINE JAN 2021; 22 (1) : 18-21
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Wood, Amy M., M. Douglas Jones, James H. Wood, Zhaoxing Pan, and Thomas A. Parker. "Neonatal Resuscitation Skills Among Pediatricians and Family Physicians: Is Residency Training Preparing for Postresidency Practice?" Journal of Graduate Medical Education 3, no. 4 (December 1, 2011): 475–80. http://dx.doi.org/10.4300/jgme-d-10-00234.1.
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Abstract Background Pediatricians and family physicians are responsible for providing newborn resuscitation, yet Accreditation Council for Graduate Medical Education requirements for training in this area during residency differ markedly for the two specialties. Our objectives were to determine (1) the extent to which neonatal resuscitation training differs for pediatric and family medicine residents; (2) the extent to which general pediatricians and family physicians engage in newborn resuscitation in their practice; and (3) whether use of resuscitation skills differs between urban/suburban and rural providers. Methods We surveyed a national cohort of pediatricians and family physicians who obtained board certification between 2001 and 2005. Data were analyzed based on type of physician and setting of current practice. Results Survey response rate was 22% (382 of 1736). Compared with family medicine physicians, pediatricians received more neonatal resuscitation training during residency. Most members of both groups had attended no deliveries in the year prior to the survey (75% [111 of 148] versus 74% [114 of 154]). In their current practice, the groups were equally likely to have provided a newborn bag and mask ventilation, chest compressions, and resuscitation medications. Pediatricians were more likely than family physicians to have attempted to either intubate a newborn (20% [28 of 148] versus 10% [16 of 153]; P = .0495) or insert umbilical catheters (15% [22 of 148] versus 5% [8 of 153]; P = .005). Regardless of specialty, rural physicians were much more likely to report that they attended deliveries (61% [41 of 67] versus 15% [36 of 234]; P < .001). Among rural pediatricians attending deliveries, 44% (7 of 16) reported feeling inadequately prepared for at least one delivery in the past year. Conclusions Few primary care pediatricians and family physicians provide newborn resuscitation after residency. For those who do attend deliveries, current training may provide insufficient preparation. Flexible, individualized residency curricula could target intensive resuscitation training to individuals who plan to practice in rural areas and/or attend deliveries after graduation.
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Turki, M., T. Babbah, R. Ouali, S. Ellouze, W. Abid, R. Charfi, N. Halouani, and J. Alouou. "Psychiatric referrals in general practice." European Psychiatry 64, S1 (April 2021): S402—S403. http://dx.doi.org/10.1192/j.eurpsy.2021.1079.
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IntroductionOver half of patients with mental disorders are seen by primary care physicians. However, as for patients with somatic problems, referral to psychiatrists seems to be sometimes necessary.ObjectivesThe present study aimed to identify reasons and difficulties perceived by general practitioners (GP) in mental health referrals.MethodsA cross-sectional web-based survey was conducted between August 22 and September 23, 2020, so that 47 responses of GP were included.ResultsThe mean age of respondents was 37.3 years. Their seniority as doctors was 8 years on average. Among them, only 17% attended a post-university psychiatric training. The participants reported that they refer on average 32.5% of patients with mental disorders to psychiatrist: 85.1% to psychiatric hospital, 40.4% to liberal psychiatrists and 21.3% to clinical psychologists. Regarding the reasons for referral to mental healthcare structures, 70.2% of doctors justified their doing so by their insufficient training in mental healthcare; 66% by a need for hospitalization, 57.4% by the presence of delusions, while in 27.7 % of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by GP were patient refusal to consult a psychiatrist (70.2%) and difficulties related to the management delay (44.7%).ConclusionsPatient and health system factors, as well as physicians experience seem to have important influences on mental health referral. Open communication and ease of consultation with psychiatrists can make the care of patients with mental health problems even more rewarding to the primary care physician.
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Green-McKenzie, Judith, and Edward A. Emmett. "Characteristics and Outcomes of an Innovative Train-in-Place Residency Program." Journal of Graduate Medical Education 9, no. 5 (October 1, 2017): 634–39. http://dx.doi.org/10.4300/jgme-d-16-00689.1.
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ABSTRACT Background Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable outcomes, created to train midcareer physicians who desire formal training in occupational medicine. Objective We evaluated educational outcomes from a novel residency program for midcareer physicians seeking formal training and board certification in occupational medicine. Methods Physicians train in place at selected clinical training sites where they practice, and participate in 18 visits to the primary training site over a 2-year period. Program components include competency-based training structured around rotations, mentored projects, and periodic auditing visits to train-in-site locations by program faculty. Main outcome measures are achievement of Accreditation Council for Graduate Medical Education Occupational Medicine Milestones, American College of Occupational and Environmental Medicine competencies, performance on the American College of Preventive Medicine examinations, diversity in selection, placement of graduates, and the number of graduates who remain in the field. Results Since inception of this program in 1997, there have been 109 graduates who comprise 7.2% of new American Board of Preventive Medicine diplomates over the past decade. Graduates scored competitively on the certifying examination, achieved all milestones, expressed satisfaction with training, and are geographically dispersed, representing every US region. Most practice outside the 25 largest standard metropolitan statistical areas. More than 95% have remained in the field. Conclusions Training in place is an effective approach to provide midcareer physicians seeking comprehensive skills and board certification in occupational medicine formal training, and may be adaptable to other specialties.
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Jasani, MD, Gregory, James MacNeal, DO, MPH, and Jon Mark Hirshon, MD, PhD. "Emergency department active shooter training: A survey of current practices in 2020." American Journal of Disaster Medicine 16, no. 4 (December 1, 2021): 263–69. http://dx.doi.org/10.5055/ajdm.2021.0410.
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Background: Shooting events in hospitals are increasing in frequency, with the emergency department (ED) being the most common site of such events. EDs must be prepared for shooting events, but current practices surrounding active shooter preparation are unknown.Objective: To determine what active shooter training emergency medicine physicians are receiving.Methods: A survey was developed to assess current practices around active shooter preparation in EDs. The survey was distributed to members of the American College of Emergency Physicians’ Emergency Medicine Practice Research Network. All members of the Emergency Medicine Practice Research Network are currently practicing emergency medicine physicians.Results: There were 194 respondents. The most common form of training received was online (76/194), followed by lecture (50/194). Only 39 respondents had participated in an active shooter drill. Sixty-five respondents (33 percent) reported having never received any formal active shooter training.Conclusion: There is a wide array of active shooter training that emergency medicine physicians are receiving, with nearly one-third receiving no training at all.
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Lefevre, Frank V., Teresa M. Waters, and Peter P. Budetti. "A Survey of Physician Training Programs in Risk Management and Communication Skills for Malpractice Prevention." Journal of Law, Medicine & Ethics 28, no. 3 (2000): 258–66. http://dx.doi.org/10.1111/j.1748-720x.2000.tb00669.x.
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Malpractice lawsuits serve as a great source of pain, consternation and loss for physicians and patients alike, usually leaving all parties involved in the process with a sense of betrayal. A significant number of physicians will be sued at least once in their career, especially if they practice in some of the more vulnerable specialties. In addition, there is some evidence that the threat of malpractice lawsuits changes the practice style of many physicians, leading to the practice of “defensive medicine” and raises the total cost of health care. Clearly, the prevention of medical malpractice is an issue that deserves considerable attention from physicians and from those who train them.Empirical evidence suggests that medical negligence may play a relatively minor role in malpractice lawsuits. As demonstrated by Localio, et al., one in thirty-five cases of negligence or incompetence actually results in a lawsuit.
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Patterson, Davis G., C. Holly A. Andrilla, and Lisa A. Garberson. "Preparing Physicians for Rural Practice: Availability of Rural Training in Rural-Centric Residency Programs." Journal of Graduate Medical Education 11, no. 5 (October 1, 2019): 550–57. http://dx.doi.org/10.4300/jgme-d-18-01079.1.
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ABSTRACT Background Exposing residents to rural training encourages future rural practice, but unified accreditation of allopathic and osteopathic graduate medical education under one system by 2020 has uncertain implications for rural residency programs. Objective We describe training locations and rural-specific content of rural-centric residency programs (requiring at least 8 weeks of rurally located training) before this transition. Methods In 2015, we surveyed residency programs that were rurally located or had rural tracks in 7 specialties and classified training locations as rural or urban using Rural-Urban Commuting Area (RUCA) codes. Results Of 1849 residencies in anesthesiology, emergency medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry, 119 (6%) were rurally located or offered a rural track. Ninety-seven programs (82%) responded to the survey. Thirty-six programs required at least 8 weeks of rural training for some or all residents, and 69% of these rural-centric residencies were urban-based and 53% were osteopathic. Locations were rural for 26% of hospital rotations and 28% of continuity clinics. Many rural-centric programs (35%) reported only urban ZIP codes for required rural block rotations; 54% reported only urban ZIP codes for required rural clinic sessions, and 31% listed only urban ZIP codes in reporting rural full-time training locations. Programs varied widely in coverage of rural-specific training in 6 core competencies. Conclusions In multiple specialties important for rural health care systems, little rurally located residency training and rural-specific content was available. Substantial proportions of training locations reported to be rural were actually urban according to a common rural definition.
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Wong, Mitchell D., Lourdes Guerrero, Tamer Sallam, Joy S. Frank, Alan M. Fogelman, and Linda L. Demer. "Outcomes of a Novel Training Program for Physician-Scientists: Integrating Graduate Degree Training With Specialty Fellowship." Journal of Graduate Medical Education 8, no. 1 (February 1, 2016): 85–90. http://dx.doi.org/10.4300/jgme-d-15-00135.1.
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ABSTRACT Background Although physician-scientists generally contribute to the scientific enterprise by providing a breadth of knowledge complementary to that of other scientists, it is a challenge to recruit, train, and retain physicians in a research career pathway. Objective To assess the outcomes of a novel program that combines graduate coursework and research training with subspecialty fellowship. Methods A retrospective analysis was conducted of career outcomes for 123 physicians who graduated from the program during its first 20 years (1993–2013). Using curricula vitae, direct contact, and online confirmation, data were compiled on physicians' subsequent activities and careers as of 2013. Study outcomes included employment in academic and nonacademic research, academic clinical or private practice positions, and research grant funding. Results More than 80% of graduates were actively conducting research in academic, institutional, or industrial careers. The majority of graduates (71%) had academic appointments; a few (20%) were in private practice. Fifty percent had received career development awards, and 19% had received investigator-initiated National Institutes of Health (NIH) R01 or equivalent grants. Individuals who obtained a PhD during subspecialty training were significantly more likely to have major grant funding (NIH R series or equivalent) than those who obtained a Master of Science in Clinical Research. Trainees who obtained a PhD in a health services or health policy field were significantly more likely to have research appointments than those in basic science. Conclusions Incorporation of graduate degree research, at the level of specialty or subspecialty clinical training, is a promising approach to training and retaining physician-scientists.
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Yasien, Esraa, and Qais kadhem. "Knowledge, attitude and practice of family physicians toward osteoporosis in Babylon governorate." Iraqi National journal of Medicine 4, no. 2 (July 1, 2022): 195–203. http://dx.doi.org/10.37319/iqnjm.4.2.4.
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Introduction: Osteoporosis is a metabolic bone illness that occurs in males and females and is widely disturbed around the world. Research shows that females are more affected after menopause than males due to decreased estrogen secretion. The aim of this research is to evaluate the knowledge, attitude, and practice of family physicians concerning osteoporosis. Method: A cross-sectional study started from May to July 2020 in Babylon region. Almost all family physicians work in rural and urban areas in Babylon governorate have been included in the current study. A self-administered questionnaire was collected after taking verbal consent from all participants, with no exclusion criteria. The first part focused on demographic and specialized practice information data, while the second part contained a Knowledge, Attitude, and Practices (KAP) survey. Results: Out of 97 family physicians, 59% scored moderate, 34% poor, and 6% good in awareness response. Regarding attitude response, 76% were good, 22% moderate, and 2% poor. In practice response, 53% were moderate, 33% good, and 13% poor. There was a significant association between place of work and attitude, source of experience and practice, practice and osteoporosis-training course, practice and use of guidelines, and the years of work and practice. Conclusion: Most family physicians in Babylon province had moderate awareness, good attitude, and moderate practice towards osteoporosis. Family doctors working in hospitals had poor attitude towards osteoporosis. Therefore, all family doctors can benefit from training courses, especially family doctors who work in a hospital. Further, the current osteoporosis guidelines must be revised for any mistakes. Keywords: Knowledge, Attitude, Practice, Family Physicians, Osteoporosis, Babylon City.
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Lin, Tso-Chou, Luo-Ping Ger, Joseph V. Pergolizzi, Robert B. Raffa, Ju-O. Wang, and Shung-Tai Ho. "Knowledge, Attitude and Practice Survey of Prescribing Opioids for Chronic Noncancer Pain in Taiwan—Comparison of Pain and Non-Pain Physicians." Pain Medicine 20, no. 12 (August 13, 2016): 2397–410. http://dx.doi.org/10.1093/pm/pnw189.
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Abstract Background Prescribing opioids for chronic noncancer pain (CNCP) has been strictly regulated in Taiwan. This study was undertaken to survey pain and non-pain related physicians’ knowledge, attitudes, and practices regarding prescribing opioids for CNCP. Methods A questionnaire survey was conducted in this comparison study. All 66 physicians who were treating officially registered CNCP outpatients were visited and completed anonymous questionnaires. The other physicians (anesthesiologists, oncologists, and non-pain physicians) were surveyed by a mailed questionnaire. Results A total of 266 (75%) questionnaires were received from 355 board-certified physicians. More CNCP physicians (81.8%) and anesthesiologists (69.7%) had received prior CNCP-related training courses than had oncologists (21.2%) and non-pain physicians (10.3%). Varied proportions of physicians by type were unfamiliar with the Taiwan opioid regulations (16.7–86.8%) and would accordingly skip or reduce dosage of opioid prescriptions (27.3–73.5%). In addition, non-pain physicians had a significantly lower knowledge level, more negative attitudes, and greater hesitation about prescribing opioids compared to the pain-related physicians (P < 0.001). CNCP physicians who had received CNCP-related training courses had a higher knowledge score than did those not receiving training (P = 0.002). Overall, the leading barriers for prescribing opioids were inadequate knowledge of pain management (76%), physician reluctance (73%), and family reluctance (78%). Conclusion There are substantial knowledge gaps, negative attitudes, and hesitation toward prescribing long-term opioids for CNCP patients by physicians in Taiwan, suggesting that efforts are needed to improve postgraduate education regarding adequate opioid management for CNCP.
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Umar, Badar Uddin, Nazmun Nahar Alam, Tanbira Alam, Mahmudul Mannan, and S. M. Niazur Rahman. "Impact of Training Modules on Physicians’ Perspective of COVID-19: An Online Survey." Journal of Medicine 22, no. 2 (December 1, 2021): 107–13. http://dx.doi.org/10.3329/jom.v22i2.56699.
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Background: The outbreak of COVID-19 has remained a massive challenge for healthcare workers specially physicians. Effective professional training has a crucial role in preparing doctors for responding to pandemics. Objective: To assess the effectiveness of existing training modules on enhancing knowledge, ensuring safe practice, and improving behavior on COVID-19 among physicians. Methods: This is a descriptive, cross-sectional, online survey; where a virtual questionnaire was used to collect data through online professional platforms. A pre-tested survey tool was employed to assess the impact of professional training on infection prevention and control. Results: Total 161 physicians participated in this survey from 15 different countries. Most of the respondents (72%) received training from various sources like the workplace (60%) and international agencies (21%), through the in-person or online format. Knowledge assessment revealed advanced (43%) and competent (40%) understanding by the participants. Improving knowledge progression was displayed by the cohort who received professional training (p<0.00). Physicians’ positive behavior and good practices were observed with the training modules. Conclusion: It became evident from this study, that professional training is effective in enhancing knowledge, improving behavior, and ensuring safe practices. Hence, designing such training modules for the physicians is warranted to tackle ongoing and future pandemics. J MEDICINE 2021; 22: 107-113
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Kopanczyk, Rafal, Micah T. Long, Sree V. Satyapriya, Amar M. Bhatt, and Michael Lyaker. "Developing Cardiothoracic Surgical Critical Care Intensivists: A Case for Distinct Training." Medicina 58, no. 12 (December 17, 2022): 1865. http://dx.doi.org/10.3390/medicina58121865.
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Cardiothoracic surgical critical care medicine is practiced by a diverse group of physicians including surgeons, anesthesiologists, pulmonologists, and cardiologists. With a wide array of specialties involved, the training of cardiothoracic surgical intensivists lacks standardization, creating significant variation in practice. Additionally, it results in siloed physicians who are less likely to collaborate and advocate for the cardiothoracic surgical critical care subspeciality. Moreover, the current model creates credentialing dilemmas, as experienced by some cardiothoracic surgeons. Through the lens of critical care anesthesiologists, this article addresses the shortcomings of the contemporary cardiothoracic surgical intensivist training standards. First, we describe the present state of practice, summarize past initiatives concerning specific training, outline why standardized education is needed, provide goals of such training standardization, and offer a list of desirable competencies that a trainee should develop to become a successful cardiothoracic surgical intensivist.
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Widyahening, Indah S., Rodri Tanoto, Fedri Rinawan, Elsa P. Setiawati, and Zorayda E. Leopando. "Does the establishment of universal health coverage drive the foundation of postgraduate education for primary care physicians?" Medical Journal of Indonesia 26, no. 2 (August 18, 2017): 141–51. http://dx.doi.org/10.13181/mji.v26i2.1857.
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Background: Studying the formation of postgraduate training in primary care within countries which has attained Universal Health Coverage (UHC) is important to support the development of similar training in low-and middle-income countries aiming to achieve UHC by 2030. This review aims to describe the state of postgraduate training for primary care physicians in UHC-attaining countries.Methods: A literature review of published literature and official documents from the websites of regional and global health/primary care organizations or societies such as World Health Organization (WHO), World Organization of Family Doctors (WONCA), European Forum for Primary Care, European Union of General Practitioners (GP)/Family Physicians (FP), European Academy of Teachers in GP/Family Medicine (FM), as well as the websites of GP/FP organizations in each of the respective countries. The list of UHC attained countries were identified through WHO and International Labor Organization databases.Results: A total number of 72 UHC-attained countries were identified. Postgraduate education for primary care physicians exists in 62 countries (86%). Explicit statements that establish primary care postgraduate training were corresponded with the policy on UHC is found in 11 countries (18%). The naming of the program varies, general practice and family medicine were the commonest. In 33 countries (53%), physicians are required to undertake training to practice in primary level. The program duration ranged from 2–6 years with 3 years for the majority.Conclusion: Although UHC is not the principal driving force for the establishment of postgraduate training for primary care physicians in many countries, most UHC-attaining countries make substantial endeavor to ensure its formation as a part of their health care reform to improve national health.
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Umoren, Rachel, Veronica Chinyere Ezeaka, Ireti B. Fajolu, Beatrice N. Ezenwa, Patricia Akintan, Emeka Chukwu, and Chuck Spiekerman. "Perspectives on simulation-based training from paediatric healthcare providers in Nigeria: a national survey." BMJ Open 10, no. 2 (February 2020): e034029. http://dx.doi.org/10.1136/bmjopen-2019-034029.
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ObjectivesThe objective of this study was to explore the access to, and perceived utility of, various simulation modalities by in-service healthcare providers in a resource-scarce setting.SettingPaediatric training workshops at a national paediatric conference in Nigeria.ParticipantsAll 200 healthcare workers who attended the workshop sessions were eligible to participate. A total of 161 surveys were completed (response rate 81%).Primary and secondary outcome measuresA paper-based 25-item cross-sectional survey on simulation-based training (SBT) was administered to a convenience sample of healthcare workers from secondary and tertiary healthcare facilities.ResultsRespondents were mostly 31–40 years of age (79, 49%) and women (127, 79%). Consultant physicians (26, 16%) and nurses (56, 35%) were in both general (98, 61%) and subspecialty (56, 35%) practice. Most had 5–10 years of experience (62, 37%) in a tertiary care setting (72, 43%). Exposure to SBT varied by profession with physicians more likely to be exposed to manikin-based (29, 30% physicians vs 12, 19% nurses, p<0.001) or online training (7, 7% physician vs 3, 5% nurses, p<0.05). Despite perceived barriers to SBT, respondents thought that SBT should be expanded for continuing education (84, 88% physician vs 39, 63% nurses, p<0.001), teaching (73, 76% physicians vs 16, 26% nurses, p<0.001) and research (65, 68% physicians vs 14, 23% nurses, p<0.001). If facilities were available, nearly all respondents (92, 98% physicians; 52, 96% nurses) would recommend the use of online simulation for their centre.ConclusionsThe access of healthcare workers to SBT is limited in resource-scarce settings. While acknowledging the challenges, respondents identified many areas in which SBT may be useful, including skills acquisition, skills practice and communication training. Healthcare workers were open to the use of online SBT and expressed the need to expand SBT beyond the current scope for health professional training in Nigeria.
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GeneI, Myron, and Adrian Dobs. "Article Commentary: Translating Clinical Research into Practice: Practice-Based Research Networks—A Promising Solution." Journal of Investigative Medicine 51, no. 2 (March 2003): 64–71. http://dx.doi.org/10.1177/108155890305100207.
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Greater effort is needed to translate research discoveries into clinical practice and to ensure that proven treatments are routinely implemented by physicians. Practice-based research networks are an undervalued resource in the endeavor to bring research results to bear in patient care. These networks are groups of practicing health care providers who have organized to address research questions of primary importance to their patients. Existing practice-based research networks have addressed a wide range of issues, including improvement of preventive service delivery, reliability of diagnostic measures, practice variation, disease prevention, and systems of care coordination. Several deficiencies in the current system prevent practice-based research networks from reaching their full potential as mechanisms of translating clinical research into practice. For practice-based research networks to flourish, they need increased funding for practice-based research networks; information systems to facilitate research by practicing physicians; training programs for health care providers; and communication networks between providers, clinical researchers, professional societies, and academic health centers.
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Grimm, JW, and NR Chumbler. "Surgical referrals as evidence of a de facto podiatric medical specialization." Journal of the American Podiatric Medical Association 85, no. 9 (September 1, 1995): 481–87. http://dx.doi.org/10.7547/87507315-85-9-481.
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The authors present evidence on the patterns and correlates of surgical referrals to podiatric physicians that suggests a surgical specialty now exists in podiatric medicine. The primary factors on which surgical specialization appears to be based are residency training, hospital medical staff membership, and increased hospital podiatric practice activity. Surgically specialized podiatric physicians tend to be younger, but such specialization is not related to either the gender or race of podiatric physicians.
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Andrade, Joana Verdelho, Ana Manuela Rocha, Maria Inês Santos, Joana Campos, Elisabete Santos, and Alzira Ferrão. "Autoavaliação de médicos sobre sua formação em Medicina do Adolescente." Scientia Medica 28, no. 3 (July 19, 2018): 29642. http://dx.doi.org/10.15448/1980-6108.2018.3.29642.
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AIMS: To characterize the way in which general and family physicians and pediatricians consider approaching adolescents, identify their qualifications in Adolescent Medicine, ascertain which topics of this specialty these physicians would like to see addressed in future training, and to compare the perceptions of physicians of both specialties with respect to their experience in adolescent health practice.METHODS: Cross-sectional study based on a survey sent by e-mail to 241 physicians in the area of influence of a level II hospital, including specific training interns or experts in Pediatrics and General and Family Medicine from health centers of the municipality of Viseu, Portugal. Chi-square tests or Fisher's exact test were used to test associations between variables, assuming statistical significance when p <0.05.RESULTS: A total of 113 physicians completed the survey, of them 74% female, with a median of 12 years of practice (interquartile range 5-30, minimum 2 years, maximum 38 years). The pediatrics group had more training in Adolescent Medicine (57%) than the general and family medicine group (25%) (p=0.007). More physicians with specific training in Adolescent Medicine considered themselves prepared for the adolescent interview (51%, vs. 28% of those who did not have specific training, p=0.03). Family and general practitioners guided adolescents more about substance use, contraception, and sexually transmitted diseases, while pediatrics doctors identified more adolescents with depression. Most physicians rated themselves as having insufficient knowledge in Adolescent Medicine, with insufficient training being the most frequently referred barrier. Fifty-seven percent of pediatrics doctors, 78% of general practitioners and 84% of those with no specific training in Adolescent Medicine, considering the two specialties, would like to deepen their knowledge in this area.CONCLUSIONS: This study allowed identifying which areas of knowledge on Adolescent Medicine are deficient in the training of pediatricians and general practitioners. Most physicians, especially those with no training in Adolescent Medicine, showed interest in filling this gap.
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Xu, Rixiang, Tingyu Mu, Wang Jian, Caiming Xu, and Jing Shi. "Knowledge, Attitude, and Prescription Practice on Antimicrobials Use Among Physicians: A Cross-Sectional Study in Eastern China." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 58 (January 2021): 004695802110599. http://dx.doi.org/10.1177/00469580211059984.
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Over-prescription of antimicrobials for patients is a major driver of bacterial resistance. The aim of the present study was to assess the knowledge, attitude, and prescription practices regarding antimicrobials among physicians in the Zhejiang province in China, and identify the determining factors. A total of 600 physicians in public county hospitals and township health institutions were surveyed cross-sectionally using a structured electronic questionnaire. The questionnaire was completed by 580 physicians and the response rate was 96.67%. The mean score of 11 terms related to antimicrobial knowledge was 6.81, and an average of 32.1% of patients with upper respiratory tract infections (URTIs) were prescribed antimicrobials. Multivariate analysis indicated that young general practitioners with less training are more likely to contribute to more frequent antimicrobial prescriptions ( P < .05). In contrast, older physicians with more training are more willing to provide patients with the correct knowledge regarding antimicrobials and less likely to prescribe antimicrobials for URTIs. Correlation analysis showed that the level of physician's knowledge, attitude, and prescription practice is related ( P < .05). In conclusion, proper prescription of antimicrobials depends on adequate knowledge and regular training programs for physicians.
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Beagan, Brenda, Erin Fredericks, and Mary Bryson. "Family physician perceptions of working with LGBTQ patients: physician training needs." Canadian Medical Education Journal 6, no. 1 (April 20, 2015): e14-e22. http://dx.doi.org/10.36834/cmej.36647.
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Background: Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ). Understanding physician perceptions of this area of practice may aid in developing improved education.Method: In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software.Results: Three major themes emerged: 1) Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2) Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3) Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Conclusions: Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women.
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Fischer, Lisa M., Michael Y. Woo, A. Curtis Lee, Ray Wiss, Steve Socransky, and Jason R. Frank. "Emergency medicine point-of-care ultrasonography: a national needs assessment of competencies for general and expert practice." CJEM 17, no. 1 (January 2015): 74–88. http://dx.doi.org/10.2310/8000.2013.131205.
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AbstractIntroductionEmergency medicine point-of-care ultrasonography (EM-PoCUS) is a core competency for residents in the Royal College of Physicians and Surgeons of Canada and College of Family Physicians of Canada emergency medicine (EM) training programs. Although EM-PoCUS fellowships are currently offered in Canada, there is little consensus regarding what training should be included in a Canadian EM-PoCUS fellowship curriculum or how this contrasts with the training received in an EM residency.ObjectivesTo conduct a systematic needs assessment of major stakeholders to define the essential elements necessary for a Canadian EM-PoCUS fellowship training curriculum.MethodsWe carried out a national survey of experts in EM-PoCUS, EM residency program directors, and EM residents. Respondents were asked to identify competencies deemed either nonessential to EM practice, essential for general EM practice, essential for advanced EM practice, or essential for EM-PoCUS fellowship trained (‘‘expert’’) practice.ResultsThe response rate was 81% (351 of 435). PoCUS was deemed essential to general EM practice for basic cardiac, aortic, trauma, and procedural imaging. PoCUS was deemed essential to advanced EM practice in undifferentiated symptomatology, advanced chest pathologies, and advanced procedural applications. Expert-level PoCUS competencies were identified for administrative, pediatric, and advanced gynecologic applications. Eighty-seven percent of respondents indicated that there was a need for EM-PoCUS fellowships, with an ideal length of 6 months.ConclusionThis is the first needs assessment of major stakeholders in Canada to identify competencies for expert training in EM-PoCUS. The competencies should form the basis for EM-PoCUS fellowship programs in Canada.
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Gillespie, Suzanne M., Loralei L. Thornburg, Thomas V. Caprio, and Annette Medina-Walpole. "Love Letters: An Anthology of Constructive Relationship Advice Shared Between Junior Mentees and Their Mentors." Journal of Graduate Medical Education 4, no. 3 (September 1, 2012): 287–89. http://dx.doi.org/10.4300/jgme-d-11-00304.1.
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Abstract Mentorship is critical to the professional success of physicians, physicians-in-training, and junior faculty in academic practice. There are challenges to being a thoughtful and effective mentor and to being an engaged mentee. Many physicians and physicians-in-training cite difficulty finding professional time to dedicate to building their mentoring relationships, particularly given demanding clinical workloads and competing time commitments. Therefore, making the most out of the time in mentoring relationships is key to success. We present a collection of frustrations and good advice that have been passed between mentees and mentors on improving the mentor-mentee relationship. The information was compiled from actual interactions between mentors and mentees, and these “love letters” draw on complex associations, which like any “committed” relationship require constant reevaluation and discussion to bring them to their full potential.
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Fielding, Alison, Dominica Moad, Amanda Tapley, Andrew Davey, Elizabeth Holliday, Jean Ball, Michael Bentley, et al. "Prevalence and associations of rural practice location in early-career general practitioners in Australia: a cross-sectional analysis." BMJ Open 12, no. 4 (April 2022): e058892. http://dx.doi.org/10.1136/bmjopen-2021-058892.
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ObjectivesTo: (1) establish the prevalence of urban, regional, rural and remote practice location of early-career general practitioners (GPs); and (2) examine demographic and training-related characteristics associated with working in regional, rural or remote areas post attainment of vocational general practice qualifications.DesignCross-sectional, questionnaire-based study, combined with contemporaneously collected data from participants’ prior vocational training.SettingAustralian general practice.ParticipantsNewly vocationally qualified GPs (ie, within 6 months–2 years post fellowship) who had completed vocational training with regional training organisations in New South Wales, Australian Capital Territory, eastern Victoria, and Tasmania between January 2016 and July 2018.Primary outcome measureRurality of post-fellowship practice location, as defined by Modified Monash Model (MMM) geographical classifications, based on current practice postcode. Prevalence of regional/rural/remote (‘rural’) practice was described using frequencies, and associations of rural practice were established using multivariable logistic regression, considering a range of demographic factors and training characteristics as independent variables.ResultsA total of 354 participants completed the questionnaire (response rate 28%) with 319 providing information for their current practice location. Of these, 100 (31.4%) reported currently practising in a rural area (MMM2-7). Factors most strongly associated with practising in a rural area included having undertaken vocational GP training in a rural location OR 16.0 (95% CI 6.79 to 37.9); p<0.001; and undertaking schooling in rural area prior to university OR 4.21 (1.98, 8.94); p<0.001.ConclusionsThe findings suggest that vocational training experience may have a role in rural general practice location post fellowship, attenuating the previously demonstrated ‘leakage’ from the rural practice pipeline.
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Epstein, Arnold M., William C. Taylor, and George R. Seage. "Effects of patients' socioeconomic status and physicians' training and practice on patient-doctor communication." American Journal of Medicine 78, no. 1 (January 1985): 101–6. http://dx.doi.org/10.1016/0002-9343(85)90469-3.
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Monseau, Aaron J., Brenden J. Balcik, Matthew Negaard, Christa Lilly, Christopher P. Hogrefe, Sara Gould, Mitchell J. Odom, et al. "Training and Practice Settings of Physicians Dual-Certified in Emergency and Sports Medicine." Current Sports Medicine Reports 22, no. 1 (January 2023): 29–35. http://dx.doi.org/10.1249/jsr.0000000000001029.
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Yamoul, M., I. Hanine, F. Laboudi, and A. Ouanass. "COVID-19 DIAGNOSIS ANNOUNCEMENT." International Journal of Advanced Research 9, no. 5 (May 31, 2021): 424–31. http://dx.doi.org/10.21474/ijar01/12855.
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Introduction: Physicians find it difficult to announce the diagnosis of Covid-19 and often resort to the advice of a psychiatrist. This is due to the fear of the patients reaction and the negative psychological impact that the announcement would cause, the poorly known evolution of this pathology and to the lack of training regarding Covid-19 diagnosis announcement practices. The purpose of our study is trying to better understand the current practice and the difficulties encountered during the Covid-19 diagnosis announcement as well as evaluating the patients general reactions. Material and Methods: Quantitative, descriptive and analytical, cross-sectional study based on an online questionnaire. Results: 114 physicians filled in our questionnaire. More than half of them had not received any training regarding Covid-19 dignosis announcement. 94.7% of the physicians believe that it is necessary to announce the diagnosis of Covid-19, most of them considering it as an asset in their disease management. The reluctance to announce a disease with a severe prognosis, along with the fear of negative social and therapeutic repercussions, would slow down clinicians in their practice. Although most clinicians provide a variety of information (clinical, therapeutic, prognostic, target symptoms, and treatment side effects), the majority of participants were satisfied with the information they provide to Covid+ patients. Conclusion: A framework for the diagnostic process, training dedicated to the announcement and the use of material aids should be considered in order to limit these difficulties and to support physicians in their practice. In this respect, primary care physicians are almost unanimous in their desire for specific training.
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Hegarty, Kelsey, Rhian Parker, Danielle Newton, Laura Forrest, Janelle Seymour, and Lena Sanci. "Feasibility and acceptability of nurse-led youth clinics in Australian general practice." Australian Journal of Primary Health 19, no. 2 (2013): 159. http://dx.doi.org/10.1071/py12025.
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Internationally, youth access to primary health care is problematic due to documented barriers such as cost, concerns about confidentiality, and knowledge about when to attend and available services. The treatment of health problems earlier in life together with engagement in prevention and health education can optimise youth health and maximise the potential of future wellbeing. This study investigated the feasibility, acceptability and cost of establishing nurse-led youth clinics in Victoria, Australia. Three general practices in rural and regional areas of Victoria implemented the nurse-led youth health clinics. The clinics were poorly attended by young people. Practice nurses identified several barriers to the clinic attendance including the short timeframe of the study, set times of the clinics and a lack of support for the clinics by some GPs and external youth health clinics, resulting in few referrals. The clinics cost from $5912 to $8557 to establish, which included training the practice nurses. Benefits of the clinics included increased staff knowledge about youth health issues and improved relationships within the general practice staff teams. The implementation of youth health clinics is not feasible in a short timeframe and to maximise use of the clinics, all members of the general practice team need to find the clinics acceptable.
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Han, Misop, Sean O. Hogan, Eric Holmboe, Yuezhou Jing, Kenji Yamazaki, and Bruce J. Trock. "Trends in Industry Payments to Physicians in the First 6 Years After Graduate Medical Training." JAMA Network Open 5, no. 10 (October 19, 2022): e2237574. http://dx.doi.org/10.1001/jamanetworkopen.2022.37574.
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ImportanceFinancial incentives and conflicts of interest may influence physician decision-making. It is important to understand financial interactions between the pharmaceutical and medical device industries and newly independent physicians who have recently completed their graduate medical education using a national transparency program.ObjectiveTo identify trends in industry payments to recent graduates of Accreditation Council for Graduate Medical Education–accredited residency or fellowship programs in orthopedic surgery, neurosurgery, and internal medicine.Design, Setting, and ParticipantsThis retrospective cohort study analyzed Open Payments reports of industry payments made between July 1, 2015, and June 30, 2021, to newly independent physicians from residency or fellowship programs in neurosurgery, orthopedic surgery, and internal medicine who graduated between January 1, 2015, and December 31, 2019.ExposuresSpecialties (neurosurgery and orthopedic surgery, with internal medicine as a comparison group).Main Outcomes and MeasuresIndustry payments to newly independent physicians, including any general payments (noninvestment or nonresearch) and at least $5000 of general payments in aggregate value per year, which are considered significant financial conflicts of interest. The percentage of newly independent physicians accepting general payments during the first 6 years after graduation was analyzed by specialty and sex using cumulative incidence curves and hazard ratios (HRs) in univariable and multivariable analyses.ResultsThere were 45 745 recent graduates (28 137 men [62%]; median age at graduation, 33.0 [IQR, 31.0-35.0 years]) in neurosurgery (n = 595), orthopedic surgery (n = 3481), and internal medicine (n = 41 669). In the first 2 years of independent practice, 95% (n = 3297), 92% (n = 546), and 59% (n = 24 522) of newly independent physicians in orthopedic surgery, neurosurgery, and internal medicine, respectively, accepted any general payments. A higher percentage of the newly independent physicians in orthopedic surgery and neurosurgery accepted any general payments (orthopedic surgery vs internal medicine: HR, 5.36 [95% CI, 4.42-6.51] for women and 7.01 [95% CI, 6.35-7.73] for men; neurosurgery vs internal medicine: HR, 3.25 [95% CI, 2.24-4.72] for women and 4.08 [95% CI, 3.37-4.94] for men; P = .03). A higher percentage of male physicians compared with female physicians accepted any general payments (orthopedic surgery, 2884 of 3026 [95%] vs 413 of 455 [91%]; P &lt; .001; neurosurgery, 466 of 502 [93%] vs 80 of 93 [86%]; P = .01; and internal medicine, 15 462 of 24 609 [63%] vs 9043 of 17 034 [53%]; P &lt; .001) and at least $5000 of general payments (orthopedic surgery, 763 of 3026 [25%] vs 71 of 455 [16%]; P &lt; .001; neurosurgery, 87 of 502 [17%] vs 5 of 93 [5%%]; P &lt; .001; and internal medicine, 882 of 24 609 [4%] vs 210 of 17 034 [1%]; P &lt; .001).Conclusions and RelevanceIn this cohort study of newly independent physicians in orthopedic surgery, neurosurgery, and internal medicine, the financial relationship with potential conflicts of interest between newly independent physicians and industry began to develop soon after training programs and continued to expand in the early years of newly independent physician practice. Newly independent physicians in surgical specialties and male physicians accepted significantly higher industry payments. Further studies are needed to evaluate whether modifiable factors are associated with the future outcome of newly independent physicians accepting general payments.
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Hilmi, Marc, Anna Pellat, Olivier Benoit, Aude-Marie Foucaut, Jean-Christophe Mino, Agnes Kauffmann, Fanny Rochet, et al. "Nutrition and physical activity professional education in gastrointestinal oncology: a national multidisciplinary survey." BMJ Supportive & Palliative Care 10, no. 3 (July 14, 2020): 324–30. http://dx.doi.org/10.1136/bmjspcare-2020-002342.
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ObjectivesSarcopenia, present in more than 50% of digestive oncology patients, has a negative impact on clinical outcomes. Nutrition and adapted physical activity are two major interventions for the management of sarcopenia. However, young hepato-gastroenterologists, oncologists and surgeons in France have limited awareness on these topics. We aimed to evaluate the need for training programmes of physicians (residents and senior doctors) involved in digestive oncology on nutrition and adapted physical activity.MethodsA 42-question survey was developed, by a working group of clinicians, dieticians and adapted physical activity teachers, to assess five areas related to demographics of respondents, nutrition practices, nutrition training, adapted physical activity practices and adapted physical activity training. The national survey was undertaken between April and July of 2019.Results230 physicians participated in the survey; 34% were hepato-gastroenterologists, 31% were oncologists, 23% were surgeons and 40% were residents. Sixty-one per cent of participants had received training in nutrition and only 21% in adapted physical activity. Ninety per cent of the physicians expressed their desire for more effective training on these two topics. Disparities in clinical practices were observed between hepato-gastroenterologists, oncologists and surgeons.ConclusionsMore initial and continuing training on nutrition and adapted physical activity is needed for French physicians in the current digestive oncology clinical practice.
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Hoffman, Leslie A., Frederick J. Tasota, Carmella Scharfenberg, Thomas G. Zullo, and Michael P. Donahoe. "Management of Patients in the Intensive Care Unit: Comparison Via Work Sampling Analysis of an Acute Care Nurse Practitioner and Physicians in Training." American Journal of Critical Care 12, no. 5 (September 1, 2003): 436–43. http://dx.doi.org/10.4037/ajcc2003.12.5.436.
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• Background Little is known about aspects of practice that differ between acute care nurse practitioners and physicians that might affect patients’ outcomes.• Objective To determine if time spent in work activities differs between an acute care nurse practitioner and physicians in training (pulmonary/critical care fellows) managing patients’ care in a step-down medical intensive care unit.• Methods Work sampling techniques were used to collect data when the nurse practitioner had 6 months’ or less experience in the role (T1), after the nurse practitioner had 12 months’ experience in the role (T2), and when physicians in training provided care on a rotational schedule (nurse practitioner not present, T3). These data were used to estimate the time spent in direct management of patients, coordination of care, and nonunit activities.• Results Results for T1 and T2 were similar. When T2 and T3 were compared, the nurse practitioner and the physicians in training spent approximately half their time in activities directly related to management of patients (40% vs 44%, not significantly different). The nurse practitioner spent more time in activities related to coordination of care (45% vs 18%; P < .001) and less time in nonunit activities (15% vs 37%; P < .001).• Conclusion The nurse practitioner and the physicians in training spent a similar proportion of time performing required tasks. Because of training requirements, physicians spent more time than the nurse practitioner in nonunit activities. Conversely, the nurse practitioner spent more time interacting with patients and patients’ families and collaborating with health team members.
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McLean, Lianne, and Resa E. Lewiss. "Point-of-Care Ultrasound for Physicians in Practice – A Training Model for Specialty Specific and Clinically Relevant Skill Development." POCUS Journal 7, no. 1 (April 21, 2022): 118–19. http://dx.doi.org/10.24908/pocus.v7i1.15433.
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Point-of-care Ultrasound (POCUS) skills are required competencies for emergency medicine and paediatric emergency medicine training [1,2,3,4]. Over time, more specialties will require these skills of their graduates. Experienced physicians who completed their training before POCUS requirements may ask: How can I gain POCUS skills training and competency? In this perspective piece we describe in-person and asynchronous training programs available to these clinicians in practice. We highlight these programs due to their person-centred design: they maximise the needs of the learner, provide personalised education, and expose them to respected and established POCUS faculty and training centers.
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Pak, Daniel J., Jesse Gruber, Timothy Deer, David Provenzano, Amitabh Gulati, Yifan Xu, Virginia Tangel, and Neel Mehta. "Spinal cord stimulator education during pain fellowship: unmet training needs and factors that impact future practice." Regional Anesthesia & Pain Medicine 44, no. 3 (January 22, 2019): 407–14. http://dx.doi.org/10.1136/rapm-2018-100065.
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Background and objectivesWith a growing need for non-opioid chronic pain treatments, pain physicians should understand the proper utilization of neuromodulation therapies to provide the most comprehensive care. We aimed to identify the unmet training needs that deter physicians from using spinal cord stimulation (SCS) devices.MethodsInternet-based surveys were fielded to fellows enrolled in pain fellowships during the 2016–2017 academic year accredited by the Accreditation Council for Graduate Medical Education and past pain fellows identified through pain medicine societies and SCS manufacturers.ResultsCurrent fellows were more likely to have received SCS training during fellowship compared with past fellows (100.0% vs 84.0%), yet there was variability in fellows’ SCS experiences with a wide range of trials and implants performed. Forty-six percent of current fellows felt there was an unmet training need regarding SCS. Deficiency in SCS case volume was the most common barrier that was noted (38.5%), followed by lack of SCS curriculum (30.8%) and lack of faculty with SCS expertise (23.1%). Lack of training was a predominant reason for past fellows choosing not to use SCS devices postfellowship. The majority of current and past fellows (79.5% and 55.4%, respectively) strongly supported direct training of fellows by SCS manufacturers.ConclusionsWhile SCS training during pain fellowship has become more universal, the experiences that fellows receive are highly variable, and most rely on industry-sponsored programs to supplement training deficiencies. Standardization of SCS procedures may also enable less experienced providers to navigate the SCS treatment algorithm.
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HIRSCHKORN, KRISTINE A., ROBERT ANDERSEN, and IVY L. BOURGEAULT. "Canadian Family Physicians and Complementary/Alternative Medicine: The Role of Practice Setting, Medical Training, and Province of Practice." Canadian Review of Sociology/Revue canadienne de sociologie 46, no. 2 (May 2009): 143–59. http://dx.doi.org/10.1111/j.1755-618x.2009.01208.x.
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Russell, Deborah J., Elizabeth Wilkinson, Stephen Petterson, Candice Chen, and Andrew Bazemore. "Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice." Journal of Graduate Medical Education 14, no. 4 (August 1, 2022): 441–50. http://dx.doi.org/10.4300/jgme-d-21-01143.1.
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ABSTRACT Background Rural US populations face a chronic shortage of physicians and an increasing gap in life expectancy compared to urban US populations, creating a need to understand how to increase residency graduates' desire to practice in such areas. Objective This study quantifies associations between the amount of rural training during family medicine (FM) residencies and subsequent rural work. Methods American Medical Association (AMA) Masterfile, AMA graduate medical education (GME) supplement, American Board of Family Medicine certification, Accreditation Council for Graduate Medical Education (ACGME), and Centers for Medicare and Medicaid Services hospital costs data were merged and analyzed. Multiple logistic regression measured associations between rural training and rural or urban practice in 2018 by all 12 162 clinically active physicians who completed a US FM residency accredited by the ACGME between 2008 and 2012. Analyses adjusted for key potential confounders (age, sex, program size, region, and medical school location and type) and clustering by resident program. Results Most (91%, 11 011 of 12 162) residents had no rural training. A minority (14%, 1721 of 12 162) practiced in a rural location in 2018. Residents with no rural training comprised 80% (1373 of 1721) of those in rural practice in 2018. Spending more than half of residency training months in rural areas was associated with substantially increased odds of rural practice (OR 5.3-6.3). Only 4% (424 of 12 162) of residents spent more than half their training in rural locations, and only 5% (26 of 436) of FM training programs had residents training mostly in rural settings or community-based clinics. Conclusions There is a linear gradient between increasing levels of rural exposure in FM GME and subsequent rural work.
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Sinard, John H., Suzanne Z. Powell, and Donald S. Karcher. "Pathology Training in Informatics: Evolving to Meet a Growing Need." Archives of Pathology & Laboratory Medicine 138, no. 4 (April 1, 2014): 505–11. http://dx.doi.org/10.5858/arpa.2013-0328-ra.
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Context.—The mechanics of the practice of medicine in general and of pathology in particular is evolving rapidly with the rise in the use of electronic information systems for managing the care of individual patients, including the ordering and reporting of laboratory tests, maintaining the health of served populations, and documenting the full range of health care activities. Pathologists currently in practice and those in training need to acquire additional skills in informatics to be prepared to maintain a central role in patient care. Objective.—To summarize the evolving landscape of pathology informatics, with particular attention to the preparation of pathologists for this discipline and to the possible influence of the new subspecialty certification in clinical informatics. Data Sources.—Most of the information discussed is drawn from the authors' direct experience with informatics, resident and fellow education, and the organizations supporting these activities in pathology. Conclusions.—The increasing reliance of medical practice on electronic health records and other clinical information systems is creating a greater need for physicians skilled in the use and management of these tools. The establishment of clinical informatics as a formal subspecialty in medicine will likely help secure a role for physicians within information management structures at health care institutions. Pathologists must actively engage in informatics to assure that our specialty is appropriately recognized and represented in this growing discipline.
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Goldmann, Donald A., David G. Nathan, Frederick H. Lovejoy, Sally M. Andrews, and Sarah Pasternack. "A Service Chief Model for General Pediatric Inpatient Care and Residency Training." Pediatrics 89, no. 4 (April 1, 1992): 601–7. http://dx.doi.org/10.1542/peds.89.4.601.
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Pediatric training programs are faced with rapid, fundamental changes in hospital practice and an increasingly rigorous regulatory and fiscal environment. Traditional models for providing care and teaching students and house officers may not be sufficiently responsive to these challenges. In 1986, the Department of Medicine at Children's Hospital, Boston, reorganized the general inpatient program and implemented a “service chief”system adapted from British hospital “firms.” Three age-based inpatient services (Thomas Morgan Rotch infant/toddler service, Kenneth Daniel Blackfan school-age service, and Charles Alderson Janeway adolescent/young adult service) were created, each headed by an experienced clinician and teacher (service chief). The service chiefs developed age-appropriate curricula, recruited a balanced faculty of generalists and specialists to serve as attending physicians and provide teaching in their areas of expertise, and established strong collaborative relationships with nurse managers on their respective wards. Implementation of the service chief system has been associated with development of faculty esprit de corps,standardized tracking of faculty performance, enhanced supervision and counseling of housestaff, and improved continuity of patient care. Relationships with referring physicians have improved dramatically, as measured by formal satisfaction surveys. Accountability and documentation have been emphasized, and departmental billings have increased sharply. Ongoing quality indicators have been developed, and collaborative patient care,teaching, and quality-improvement projects have been initiated with the nursing staff. Naming the services for distinguished past physicians-in-chief has provided a focus for fund-raising. Although an additional objective of the service chief system was to provide a framework for general pediatric clinical research by housestaff and service faculty, this goal remains largely unrealized. It is concluded that the service chief system is an efficient,effective strategy for providing quality patient care and teaching while meeting the fiscal and administrative burdens of contemporary hospital practice.
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Shirzadi, M. R., R. Majdzadeh, ,F Pourmalek, and K. Naraghi. "Adherence of the private sector to national tuberculosis guidelines in the Islamic Republic of Iran, 2001-02." Eastern Mediterranean Health Journal 9, no. 4 (September 4, 2003): 796–804. http://dx.doi.org/10.26719/2003.9.4.796.
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We determined the knowledge and practice of private sector physicians in three cites regarding management of pulmonary tuberculosis [TB] and their determinants. A random sample questionnaire survey was conducted of 732 private physicians. Stratified analysis and logistic regression were used to identify the adjusted determinants of the two outcomes. A high proportion of the doctors had correct knowledge about the major diagnostic criteria but there was a low level of knowledge and practice of TB management. Significant risk factors for poor knowledge were age > / = 36 years, being a GP rather than a specialist and no attendance in TB training courses or attendance in courses held by institutions other than the public health system. Age > / = 36 years was the only significant risk factor for poor practice
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Emorinken, Airenakho, Mercy Ofunami Dic-Ijiewere, Oluwaseun Remi Agbadaola, Tijani Idris Ahmad Oseni, Patrick Ojojarumiu Echekwube, Asuwemhe Johnson Ugheoke, and Onosegbe Moses Aikhuomogbe. "Assessment of physicians’ knowledge and awareness of fibromyalgia: a cross-sectional study." International Journal of Advances in Medicine 9, no. 3 (February 23, 2022): 306. http://dx.doi.org/10.18203/2349-3933.ijam20220435.
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Background: Fibromyalgia is not an uncommon cause of chronic musculoskeletal pain, and despite its rising prevalence, it remains a diagnostic challenge for physicians. This study aimed to assess the knowledge and awareness of fibromyalgia among Nigerian physicians.Methods: This was a cross-sectional, self-reported online survey. A total of 502 physicians participated in the study. The data was collected using a semi-structured questionnaire. The questionnaire comprised of sociodemographic data and questions related to fibromyalgia. A scoring system was developed to stratify knowledge of fibromyalgia into very low, low, average, high, and very high. The level of significance was set at p<0.05.Results: Responses were obtained from 502 physicians with a mean age of 36±7.02 years. Most of the respondents (41.3%) had low fibromyalgia knowledge levels. Only 15.2% of the respondents obtained their knowledge of fibromyalgia during their undergraduate training, and 33.5% were familiar with at least one diagnostic criteria. Physical exercise (79.2%), opioids (65.6%), and non-steroidal anti-inflammatory drugs (63.8%) were the most selected treatment options. The years in clinical practice, type of health facility, respondents’ cadre, and specialty were significantly associated with fibromyalgia knowledge levels (p<0.001). The number of years in clinical practice was found to be a predictor of fibromyalgia knowledge (p=0.001).Conclusions: This study found low levels of fibromyalgia knowledge among Nigerian physicians. The survey emphasizes the importance of improving Nigerian physicians' training modules for the diagnosis and treatment of fibromyalgia.
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Barry, Jonathan. "Educating physicians in seventeenth-century England." Science in Context 32, no. 2 (June 2019): 137–54. http://dx.doi.org/10.1017/s0269889719000188.
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ArgumentThe tension between theoretical and practical knowledge was particularly problematic for trainee physicians. Unlike civic apprenticeships in surgery and pharmacy, in early modern England there was no standard procedure for obtaining education in the practical aspects of the physician’s role, a very uncertain process of certification, and little regulation to ensure a suitable reward for their educational investment. For all the emphasis on academic learning and international travel, the majority of provincial physicians returned to practice in their home area, because establishing a practice owed more to networks of kinship, patronage and credit than to formal qualifications. Only when (and where) practitioners had to rely solely on their professional qualification to establish their status as young practitioners that the community could trust would proposals to reform medical education, such as those put forward to address a crisis of medicine in Restoration London, which are examined here, be converted into national regulation of medical education in the early nineteenth century, although these proposals prefigured many informal developments in medical training in the eighteenth century.
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Provenzano, David Anthony, Samuel Ambrose Florentino, Jason S. Kilgore, Jose De Andres, B. Todd Sitzman, Scott Brancolini, Tim J. Lamer, et al. "Radiation safety and knowledge: an international survey of 708 interventional pain physicians." Regional Anesthesia & Pain Medicine 46, no. 6 (March 9, 2021): 469–76. http://dx.doi.org/10.1136/rapm-2020-102002.
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IntroductionInterventional pain procedures have increased in complexity, often requiring longer radiation exposure times and subsequently higher doses. The practicing physician requires an in-depth knowledge and evidence-based knowledge of radiation safety to limit the health risks to themselves, patients and healthcare staff. The objective of this study was to examine current radiation safety practices and knowledge among interventional pain physicians and compare them to evidence-based recommendations.Materials and methodsA 49-question survey was developed based on an extensive review of national and international guidelines on radiation safety. The survey was web-based and distributed through the following professional organizations: Association of Pain Program Directors, American Academy of Pain Medicine, American Society of Regional Anesthesia and Pain Medicine, European Society of Regional Anesthesia and Pain Therapy, International Neuromodulation Society, and North American Neuromodulation Society. Responses to radiation safety practices and knowledge questions were evaluated and compared with evidence-based recommendations. An exploratory data analysis examined associations with radiation safety training/education, geographical location, practice type, self-perceived understanding, and fellowship experience.ResultsOf 708 responding physicians, 93% reported concern over the health effects of radiation, while only 63% had ever received radiation safety training/education. Overall, ≥80% physician compliance with evidence-based radiation safety practice recommendations was demonstrated for only 2/15 survey questions. Physician knowledge of radiation safety principles was low, with 0/10 survey questions having correct response rates ≥80%.ConclusionWe have identified deficiencies in the implementation of evidence-based practices and knowledge gaps in radiation safety. Further education and training are warranted for both fellowship training and postgraduate medical practice. The substantial gaps identified should be addressed to better protect physicians, staff and patients from unnecessary exposure to ionizing radiation during interventional pain procedures.