Protocol for a prospective, randomized, controlled trial of Mental Contrasting with Implementation Intentions (MCII) to enhance the effectiveness of VA's MOVE! weight management program: WOOP (Wish, Outcome, Obstacle, Plan) VA.

INTRODUCTION: Intensive weight management programs are effective but often have low enrollment and high attrition. Lack of motivation is a key psychological barrier to enrollment, engagement, and weight loss. Mental Contrasting with Implementation Intentions (MCII) is a unique imagery technique that increases motivation for behavior change. We describe our study protocol to assess the efficacy and implementation of MCII to enhance the effectiveness of VA's MOVE! or TeleMOVE! weight management programs using a procedure called "WOOP" (Wish, Outcome, Obstacle, Plan) for Veterans. We hypothesize that WOOP+MOVE! or TeleMOVE! (intervention) will lead to greater MOVE!/TeleMOVE! program engagment and consequently weight loss than MOVE!/TeleMOVE! alone (control). METHOD: Veterans are randomized to either the intervention or control. Both arms receive the either MOVE! or TeleMOVE! weight management programs. The intervention group receives an hour long WOOP training while the control group receives patient education. Both groups receive telephone follow up calls at 3 days, 4 weeks, and 2 months post-baseline. Eligible participants are Veterans (ages 18-70 years) with either obesity (BMI ≥ 30 kg/m2) or overweight (BMI ≥ 25 kg/m2) and an obesity-associated co-morbidity. At baseline, 6 and 12 months, we assess weight, diet, physical activity in both groups. The primary outcome is mean percent weight change at 6 months. Secondary outcomes include changes in waist circumference, diet, physical activity, and dieting self-efficacy and engagement in regular physical activity. We assess implementation using the RE-AIM framework. CONCLUSION: If WOOP VA is found to be efficacious, it will be an important tool to facilitate weight management and improve weight outcomes. CLINICAL TRIAL REGISTRATION: NCT05014984.

Peering Into the Future: A First Look at the CBME Transition to Practice Stage in Diagnostic Radiology.

RATIONALE AND OBJECTIVES: Queen's University (Kingston, ON, Canada) adopted a competency-based medical education (CBME) curriculum for Diagnostic Radiology residency training in an accelerated manner in 2017, with the curriculum comprised of four stages of training. This article focuses on the final stage (Transition to Practice), during which assessment methods of the new national curriculum (implemented in July 2022) were piloted. This study aims to highlight the challenges and opportunities associated with the implementation of CBME in Diagnostic Radiology training and specific considerations for programs undergoing this curricular transition. MATERIALS AND METHODS: Ethics approval was provided by the affiliated hospital Research Ethics Board. All relevant electronic assessments pertaining to all trainees who had completed the Transition to Practice stage (n = 3) were collated, deidentified, analyzed, and presented in tabulated format. RESULTS: A total of 39 evaluations completed by 13 assessors were assessed, with an average time of 3 minutes and 6 seconds to complete an assessment form. Also, 95% of evaluations were rated as entrustments. However, no residents met the minimum number of required entrustments for all five stage-specific Entrustable Professional Activities. These 39 evaluations included 219 milestone rating scores, with 86% rated as "achieved." Following review by the residency program Competence Committee, all three residents were promoted from the Transition to Practice stage. CONCLUSION: Challenges in CBME implementation include the number and quality of resident assessments. Strategies for success may include providing clear guidelines and training for both faculty and residents, early identification and intervention, and adopting a holistic evaluation strategy. CBME has the potential to enhance medical education quality by emphasizing learner progress toward competency and providing personalized feedback and support.

Migração dos médicos: uma análise dos movimentos migratórios dos profissionais da saúde no Brasil segundo Unidades de Federação (2000-2010) / Migration of physicians: an analysis of the migratory movements of health professionals in Brazil according to Federation Units (2000-2010)

O objetivo do trabalho é identificar os principais padrões migratórios dos profissionais médicos segundo as Unidades de Federação (UFs) do Brasil, a partir dos Censos Demográficos dos anos 2000 e 2010. Construíram-se matrizes de migração para cada um dos pontos do tempo e se estimam taxas liquidas de migração para cada UF. Os resultados mostram que, apesar da identificação de um aumento no número de médicos que migram para outras UFs durante o período de estudo, continuam existindo diferenças significativas entre as regionais e UFs, em relação à alocação de médicos. A região Sudeste, especificamente, São Paulo, Minas Gerais e Rio de Janeiro são as principais UFs, fornecedoras de médicos para outros Estados e também são as principais receptoras. Realidade oposta é a de Amapá, a UF que recebe a menor quantidade de médicos imigrantes. Acreditamos que os resultados desta natureza permitem que o conhecimento sobre os deslocamentos dos médicos contribua a melhorar desenhos de planos estratégicos para estabelecer a quantidade mínima de médicos que cada Unidade de Federação do Brasil possa ter e monitorar estas correntes migratórias de mão de obra tão qualificada e específica como são os médicos.

The aim of this study is to identify the main migration patterns of medical professionals according to the Brazilian Federative Units (UFs), based on Demographic Census data of the years 2000 and 2010. Migration matrices for each of point in time are produced, and net migration rates for each UF are estimated. The results show that despite the increase in the number of physicians out flowing to other UFs during the study period, there are still significant differences between Regions and UFs related to the allocation of physicians. The Southeast Region, particularly, São Paulo, Minas Gerais and Rio de Janeiro are the main UFs providing these professionals to other states and are also the main attractors. Amapá shows opposite reality: it is the UF that receives the lowest inflow of physicians. Results suggest that the sort of knowledge presented about spatial movements of physicians may contribute to the design of strategic plans that allow each Federation Units of Brazil count on a minimum quantity of physicians. It is also am important tool for monitoring in-outflows of highly qualified and specific labor force as the physicians are.