Fitness to practise sanctions in UK doctors are predicted by poor performance at MRCGP and MRCP(UK) assessments: data linkage study.

BACKGROUND: The predictive validity of postgraduate examinations, such as MRCGP and MRCP(UK) in the UK, is hard to assess, particularly for clinically relevant outcomes. The sanctions imposed on doctors by the UK's General Medical Council (GMC), including erasure from the Medical Register, are indicators of serious problems with fitness to practise (FtP) that threaten patient safety or wellbeing. This data linkage study combined data on GMC sanctions with data on postgraduate examination performance. METHODS: Examination results were obtained for UK registered doctors taking the MRCGP Applied Knowledge Test (AKT; n = 27,561) or Clinical Skills Assessment (CSA; n = 17,365) at first attempt between 2010 and 2016 or taking MRCP(UK) Part 1 (MCQ; n = 37,358), Part 2 (MCQ; n = 28,285) or Practical Assessment of Clinical Examination Skills (PACES; n = 27,040) at first attempt between 2001 and 2016. Exam data were linked with GMC actions on a doctor's registration from September 2008 to January 2017, sanctions including Erasure, Suspension, Conditions on Practice, Undertakings or Warnings (ESCUW). Examination results were only considered at first attempts. Multiple logistic regression assessed the odds ratio for ESCUW in relation to examination results. Multiple imputation was used for structurally missing values. RESULTS: Doctors sanctioned by the GMC performed substantially less well on MRCGP and MRCP(UK), with a mean Cohen's d across the five exams of - 0.68. Doctors on the 2.5th percentile of exam performance were about 12 times more likely to have FtP problems than those on the 97.5th percentile. Knowledge assessments and clinical assessments were independent predictors of future sanctions, with clinical assessments predicting ESCUW significantly better. The log odds of an FtP sanction were linearly related to examination marks over the entire range of performance, additional performance increments lowering the risk of FtP sanctions at all performance levels. CONCLUSIONS: MRCGP and MRCP(UK) performance are valid predictors of professionally important outcomes that transcend simple knowledge or skills and the GMC puts under the headings of conduct and trust. Postgraduate examinations may predict FtP sanctions because the psychological processes involved in successfully studying, understanding and practising medicine at a high level share similar mechanisms to those underlying conduct and trust.

Osteopathic Versus Allopathic Radiologist Workforce Characteristics: A Medicare Administrative and Claims Data Analysis.

PURPOSE: Radiologist medical school pathways have received little attention in recent workforce investigations. With osteopathic enrollment increasing, we assessed the osteopathic versus allopathic composition of the radiologist workforce. METHODS: Linking separate Medicare Doctors and Clinicians Initiative databases and Physician and Other Supplier Files from 2014 through 2019, we assessed (descriptively and using multivariate panel logistic regression modeling) individual and practice characteristics of radiologists who self-reported medical degrees. RESULTS: Between 2014 and 2019, as the number of osteopathic radiologists increased 46.0% (4.7% to 6.0% of total radiologist workforce), the number of allopathic radiologists increased 12.1% (representing a relative workforce decrease from 95.3% to 94.0%). For each year since completing training, practicing radiologists were 3.7% less likely to have osteopathic (versus allopathic) degrees (odds ratio [OR] = 0.96 per year, P < .01). Osteopathic radiologists were less likely to work in urban (versus rural) areas (OR = 0.95), and compared with the Midwest, less likely to work in the Northeast (OR = 0.96), South (OR = 0.95), and West (OR = 0.94) (all P < .01). Except for cardiothoracic imaging (OR = 0.78, P = .24), osteopathic radiologists were more likely than allopathic radiologists to practice as general (rather than subspecialty) radiologists (range OR = 0.37 for nuclear medicine to OR = 0.65 for neuroradiology, all P < .01). CONCLUSIONS: Osteopathic physicians represent a fast-growing earlier-career component of the radiologist workforce. Compared with allopathic radiologists, they more frequently practice as generalist radiologists, in rural areas, and in the Midwest. Given recent calls for greater general and rural radiology coverage, increasing osteopathic representation in the national radiologist workforce could improve patient access.

Characteristics of Home-Visit Nursing Agencies That Closed after the 2012 Fee Revision for Home-Visit Nursing Services: A Nationwide Panel Data Analysis in Japan.

Despite the 2012 fee revision raising fees for home-visit nursing services to increase their supply in Japan, 300 to 500 home-visit nursing agencies (VNA) are still being closed annually. This study aims to identify the regional and organizational characteristics of the VNAs that closed after the 2012 fee revision. A longitudinal observational study was conducted using nationwide panel data of VNAs from 2014 to 2017 (N = 6496). Multiple logistic regression models stratified by years of operation were used for the analysis. We identified 821 closed agencies (12.6%). In this study, many important factors related to VNA closures were found. In the less than three years group, there were regional factors (lower aging rate and larger number of clinics) and an organizational factor (higher proportion of users under 40 years of age). In the 3-14 years group, there was a regional factor (larger number of clinics) and organizational factors (smaller number of FTE nurses, smaller number of users per FTE nurse, and smaller number of medical care types that can be provided). In the over 15 years group, there was an organizational factor (smaller number of FTE nurses). The findings provide valuable insights for policymakers in avoiding VNA closures.

Comparing Regional Distribution Equity among Doctors in China before and after the 2009 Medical Reform Policy: A Data Analysis from 2002 to 2017.

BACKGROUND: Although China began implementing medical reforms in 2009 aimed at fair allocation of the regional distribution of doctors, little is known of their impact. This study analyzed the geographic distribution of doctors from 2002 to 2017. METHODS: This study calculated the Gini coefficient and Theil index among doctors in the eastern, central, and western regions (Category 1) of China, and in urban and rural areas (Category 2). The statistical significance of fairness changes was analyzed using the Mann-Whitney U test. RESULTS: The annual growth rates of the number of doctors for the periods from 2002 to 2009 and 2010 to 2017 were 2.38% and 4.44%. The Gini coefficients among Category 1 were lower than those in Category 2, and statistically decreased after the medical reforms (P < 0.01) but continued to increase in Category 2 (P = 0.463). In 2017, the Theil decomposition result of Category 1 was 74.33% for the between-group, and in Category 2, it was 95.22% for the within-group. CONCLUSIONS: The fairness among the regional distribution of doctors in Category 1 is now at a high level and is better than that before the reforms. While the fairness in Category 2 is worse than that before the reforms, it causes moderate inequality and is continually decreasing. Overall unfairness was found to be derived from the between-group.

Otolaryngology Match Trends: Considerations for Proper Data Interpretation.

There is an extensive amount of data available from the leading organizations involved in the residency selection process. Tracking trends in otolaryngology residency applications and match outcomes is vital to understand the pipeline of individuals joining our profession. As we make changes to the application or match process, proper interpretation of available data is vital to prevent erroneous analyses and inappropriate conclusions. In the commentary, we explore the nuances of data from the Electronic Residency Application Service and National Residency Matching Program to help our specialty direct research endeavors and policy changes that will ultimately affect the makeup of our future workforce.

Blockchain en salud: transformando la seguridad y la gestión de datos clínicos / Blockchain in health: Transforming security and clinical data management

Introducción Los avances tecnológicos continúan transformando la sociedad, incluyendo el sector de la salud. La naturaleza descentralizada y verificable de la tecnología blockchain presenta un gran potencial para abordar desafíos actuales en la gestión de datos sanitarios. Discusión Este artículo indaga sobre cómo la adopción generalizada de blockchain se enfrenta a importantes desafíos y barreras que deben abordarse, como la falta de regulación, la complejidad técnica, la salvaguarda de la privacidad y los costos tanto económicos como tecnológicos. La colaboración entre profesionales médicos, tecnólogos y legisladores es esencial para establecer un marco normativo sólido y una capacitación adecuada. Conclusión La tecnología blockchain tiene potencial de revolucionar la gestión de datos en el sector de la salud, mejorando la calidad de la atención médica, empoderando a los usuarios y fomentando la compartición segura de datos. Es necesario un cambio cultural y regulatorio, junto a más evidencia, para concluir sus ventajas frente a las alternativas tecnológicas existentes. (AU)

Introduction Technological advances continue to transform society, including the health sector. The decentralized and verifiable nature of blockchain technology presents great potential for addressing current challenges in healthcare data management. Discussion This article reports on how the generalized adoption of blockchain faces important challenges and barriers that must be addressed, such as the lack of regulation, technical complexity, safeguarding privacy, and economic and technological costs. Collaboration between medical professionals, technologists and legislators is essential to establish a solid regulatory framework and adequate training. Conclusion Blockchain technology has the potential to revolutionize data management in the healthcare sector, improving the quality of medical care, empowering users, and promoting the secure sharing of data, but an important cultural change is needed, along with more evidence, to reveal its advantages in front of the existing technological alternative. (AU)

Anistiados da Vale e identificação organizacional / Amnestied of Vale and organizational identification

Este artigo tem por objetivo compreender o processo de identificação das pessoas irregularmente demitidas da Companhia Vale do Rio Doce (CVRD) durante o governo Collor e reintegradas ao serviço público a partir de 2011, em relação à Universidade Federal de Itajubá (Unifei). Esses trabalhadores são chamados de "anistiados" pela Lei n. 8.878/94. Entende-se que o processo de identificação com a organização na qual o anistiado foi reintegrado assume um papel fundamental na construção de sua identidade. Num estudo qualitativo-descritivo, foram realizadas 21 entrevistas semiestruturadas, representação gráfica e levantamento da avaliação de desempenho, sendo que a análise dos dados foi por análise de conteúdo. Como resultados destacam-se sentimentos de gratidão em relação à Universidade, alto grau de identificação com a Universidade e com a Vale e atuação pouco efetiva na Universidade. As expectativas acerca do desempenho dos anistiados são baixas e não existe nenhum processo de gestão de seu desempenho.

This paper aims to understand the process of identifying the people irregularly dismissed from Vale do Rio Doce Company (CVRD) during the Collor government and reintegrated into the public service as of 2011, in relation to the Federal University of Itajubá (Unifei). These workers are called "amnestied" by Law 8.878/94. It is understood that the identification process with the organization in which the amnestied was reinstated assumes a fundamental role in the construction of their identity. In a qualitative-descriptive study, 21 semi-structured interviews, graphical representation and performance evaluation were conducted, and data analysis was by content analysis. As a result, stand out feelings of gratitude in relation to the University, a high degree of identification with the University and with Vale and ineffective performance at the University. Expectations about the performance of the amnestied are low and there is no process of managing their performance.

Modelo pedagógico predominante en un grupo de profesores de una escuela de enfermería: estudio exploratorio / Pedagogical predominant model in a group of teachers in a school of Nursing: exploratory study

Introducción. En los últimos años se ha propuesto un modelo enseñanza-aprendizaje centrado en el estudiante. Objetivo. Elaborar un diagnóstico del modelo pedagógico predominante en los profesores y las metodologías educativas más relevantes en términos de aprendizaje desde la perspectiva de los estudiantes. Sujetos y métodos. Se recogió información de características demográficas y académicas y formación pedagógica de los profesores y se les aplicó el instrumento Approaches to Teaching Inventory (ATI). Los estudiantes respondieron una encuesta para identificar las metodologías más relevantes en términos de su aprendizaje y la frecuencia con que los profesores las utilizaban. Resultados. La muestra estuvo constituida por 35 profesores (68,6%), que en promedio tienen 13,6 ± 10,5 años de experiencia en docencia universitaria y han realizado 3,86 ± 3,19 actividades de formación pedagógica. De acuerdo al ATI, la mayoría enfoca su enseñanza en los estudiantes, lo que se refuerza en la intención y estrategias que refieren. Con respecto a los estudiantes, la muestra quedó constituida por 444 alumnos de pregrado (82,6%), los cuales identifican claramente las metodologías más favorables para su aprendizaje y la frecuencia con que los docentes las utilizan. Conclusiones. La mayoría de los profesores refiere que se centra en el estudiante y su aprendizaje, y se enfoca en la adquisición de conceptos. Los alumnos reconocen claramente algunas metodologías como muy favorables para su aprendizaje y la frecuencia con que se practican

Introduction. In the last years there has been proposed a model teaching focused on the student and his learning. Aim. To develop a diagnostic about the predominant teaching model in teachers and relevant educational methodologies in terms of learning from the perspective of students. Subjects and methods. Demographic, academic information and pedagogical training of teachers were collected and were applied the Approaches to Teaching Inventory (ATI) instrument. Students answered a survey to identify the most relevant methodologies in terms of their learning and how often teachers used them. Results. The sample consisted of 35 teachers (68.6%) on average have 13.6 ± 10.5 years in university teaching experience and have made 3.86 ± 3.19 teacher training activities. According to the ATI the majority report that your teaching focusing on student learning. Regarding students, the sample was composed of 444 undergraduate students (82.6%), which clearly identifies the most favorable methodologies for your learning and teachers often use them. Conclusions. Most of the teachers focuses on the student and learning and in the acquisition of concepts. Students clearly recognize some methodologies as very favorable for learning and the frequency with which these are used

Associação entre fatores sociodemográficos e eventos reprodutivos de mulheres cadastradas no Programa Saúde da Família / Association between sociodemographic factors and reproductive events of women registered in the Family Health Program

A saúde reprodutiva é influenciada por uma interação de fatores, entre eles os de ordem social e econômica aos quais se somam os problemas oriundos da atenção oferecida à saúde das mulheres que não tem atendido adequadamente às demandas, comprometendo assim sua qualidade de vida. O Programa Saúde da Família (PSF) por apresenta-se como possibilidade de se obter respostas mais efetivas, desenvolveu-se um estudo que teve como objetivos descrever as características das mulheres cadastradas em uma unidade de PSF com ênfase em eventos reprodutivos e verificar associações entre os fatores sociodemográficos e eventos reprodutivos. Trata-se de pesquisa de corte transversal, exploratória, realizada em uma área circunscrita a uma Unidade de Saúde da Família, no Subúrbio Ferroviário de Salvador-Ba. Os dados foram obtidos no período de maio a julho de 2009 por meio de questionário estruturado, aplicado face a face em domicílio a 376 mulheres na faixa etária de 15 a 49 anos cadastradas no PSF. O estudo teve como variáveis: os fatores sociodemográficos, fatores relacionados às experiências reprodutivas. Foram selecionadas como variáveis indicadoras à idade da iniciação sexual, idade da primeira gravidez e relato de aborto provocado. Utilizou-se para verificar diferenças entre as proporções os testes estatísticos c2 de Pearson e Exato de Fischer ao nível de 5% de significância (a 0,05) e a Odds Ratio (OR) e respectivos intervalos de confiança a 95% para estimar a magnitude das associações. A base de dados, foi constituída utilizando o Microsoft Access versão 2002, para análise dos dados utilizouse o Software STATA versão 8.0. Verificou-se uma associação positiva entre a idade da iniciação sexual e as variáveis escolaridade e situação ocupacional. A associação foi positiva entre primeira gravidez antes dos 20 anos e religião, escolaridade e situação ocupacional. Não houve associação entre os fatores sociodemográficos e o aborto provocado, entretanto, a maior prevalência foi entre as mulheres com melhores níveis de renda e escolaridade. O estudo revelou que mulheres com iniciação sexual antes dos 20 anos têm 4,4 vezes mais chance em realizar aborto provocado, quando comparadas com aquelas que não tiveram a iniciação sexual antes dos 20 anos. Não houve associação entre o relato de aborto provocado e as mulheres com primeira gravidez antes ou após os 20 anos. Diante dos resultados cabe ao poder público promover ações intersetoriais principalmente entre saúde e educação objetivando desenvolver ações que promovam desde a adolescência orientações que diminuam os riscos de gravidez não planejada e de IST/HIV garantindo-se os direitos sexuais e reprodutivos.(AU)

Guía técnica para la identificación de competencias y diseño de estándares e instrumentos de evaluación de competencias específicas con el enfoque funcional / Technical Guide for identifying competencies and design standards and assessment tools specific competences with the functional approach

La guía técnica contiene la metodología para identificar competencias y diseñar estándares e instrumentos de evaluación de competencias específicas con el enfoque funcional; elaborada de manera simple y con un lenguaje sencillo, que permitirá su entendimiento y aplicación por los gestores de recursos humanos. Este documento normativo permitirá a los gestores de recursos humanos en salud definir las competencias requeridas en los perfiles de puestos, para desarrollar con eficiencia los procesos de planificación, de reclutamiento, de selección, de inducción, de evaluación del desempeño, de capacitación y de desarrollo; así, se concretiza el alineamiento de los procesos de gestión de recursos humanos al marco estratégico de las entidades de salud, para contribuir a garantizar la efectividad, la oportunidad y la seguridad en las prestaciones, concordante con las expectativas de los usuarios y con recursos humanos que posean las competencias necesarias para asumir con éxito los retos que supone una nueva forma de organización y de gestión de los servicios de salud, definida por el actual proceso de reforma del Sector Salud

Guía técnica para la identificación de competencias y diseño de estándares e instrumentos de evaluación de competencias específicas con el enfoque funcional / Technical Guide for identifying competencies and design standards and assessment tools specific competences with the functional approach

La presente guía técnica contiene la metodología para identificar competencias y diseñar estándares e instrumentos de evaluación de competencias específicas con el enfoque funcional; elaborada de manera simple y con un lenguaje sencillo, que permitirá su entendimiento y aplicación por los gestores de recursos humanos. Este documento normativo permitirá a los gestores de recursos humanos en salud definir las competencias requeridas en los perfiles de puestos, para desarrollar con eficiencia los procesos de planificación, de reclutamiento, de selección, de inducción, de evaluación del desempeño, de capacitación y de desarrollo; así, se concretiza el alineamiento de los procesos de gestión de recursos humanos al marco estratégico de las entidades de salud, para contribuir a garantizar la efectividad, la oportunidad y la seguridad en las prestaciones, concordante con las expectativas de los usuarios y con recursos humanos que posean las competencias necesarias para asumir con éxito los retos que supone una nueva forma de organización y de gestión de los servicios de salud, definida por el actual proceso de reforma del Sector Salud(AU)

Guía técnica para la metodología de cálculo de las brechas de recursos humanos en salud para los servicios asistenciales del primer nivel de atención / Technical Guide to the methodology for calculating the human resource breaches in health care services from first level of care

La presente publicación describe la metodología de cálculo de las brechas de recursos humanos en salud asistenciales en el primer nivel de atención a fin de plantear estrategias de dotación que posibilite, el derecho al acceso de la población a una atención de salud con equidad, oportunidad y calidad, así como para promover la implementación de estrategias de dotación de recursos humanos en salud para servicios asistenciales del primer nivel de atención en el marco de la universalización de la protección social en salud y la descentralización(AU)

Segunda medición de las metas regionales de recursos humanos para la salud Perú 2007 - 2015 / Second measurement of regional objectives of human resources for health Peru 2007 - 2015

La publicación diseña una metodología centrada en el trabajo coordinado con las instituciones prestadoras de salud, universidades y colegios profesionales, la cual obtiene información precisa, procesada, analizada y consensuada permitiendo optimizar la medición de los indicadores de cada una de las 20 metas regionales

Segunda medición de las metas regionales de recursos humanos para la salud Perú 2007 - 2015 / Second measurement of regional objectives of human resources for health Peru 2007 - 2015

La presente publicación diseña una metodología centrada en el trabajo coordinado con las instituciones prestadoras de salud, universidades y colegios profesionales, la cual obtiene información precisa, procesada, analizada y consensuada permitiendo optimizar la medición de los indicadores de cada una de las 20 metas regionales(AU)

Competencias laborales para la mejora del desempeño de los recursos humanos en salud / Occupational competencies to improve the performance of human resources for health

La presente publicación incorpora tres documentos: El primero de ellos, sistematiza el proceso y resultados en la definición de competencias laborales genéricas para el personal de salud. El segundo, presenta una guía técnica para la formulación de competencias laborales específicas en salud empleando el enfoque funcional. El tercero, muestra el resultado de la aplicación de la metodología ya explicada, para la identificación de competencias laborales específicas en el primer nivel de atención(AU)