Improving Treatment of Elderly Patients by Interprofessional Education in a Quality Network of Geriatric Medicine: Protocol for Evaluating an Educational Initiative.

BACKGROUND: All statistics on the development of demand for care for multimorbid elderly patients highlight the acute pressure to act to adequately respond to the expected increase in geriatric patient population in the next 15 years. Against this background, great importance must be attached to the improvement of cross-occupational group and cross-sector treatment of these patients. In addition, many professionals in the health care sector often have little knowledge about the special treatment and care needs of the elderly. OBJECTIVE: The Quality Network of Geriatric Medicine in north-west Germany is the body responsible for the project; with its member organizations, it provides care for over 400,000 inpatients and is thus one of the largest associations for geriatrics in Germany. The Quality Network conducts binding evaluated qualification measures for staff involved in the treatment and care of multimorbid elderly patients. The training offers are especially intended for staff who have not yet been trained in working with elderly patients. This approach is intended to improve the expertise of various occupational groups on different hierarchy levels, to include patients and their family members in the evaluation process, and to initiate changes within the organizations. METHODS: Various instruments are used in the evaluation of qualification measures: besides written surveys and questionnaires, structured work groups (consensus groups) and interviews are conducted. The evaluation starts before the qualification measures to determine the starting point and then continues during the measure and after its completion. This allows major findings to be integrated directly into the ongoing qualification program. At least 100 trainings on geriatric topics, 80 consensus groups, and 120 patients (and family members) are going to be included in the study. RESULTS: The evaluation of the educational initiative is funded by the State of Northrhine-Westfalia (Germany; LZG TG 71 001 / 2015 and LZG TG 71 002 / 2015). The results of the study will be published after review and approval by the state authorities - presumably by the end of 2019. The before and after comparison of the treatment-related outcomes at the beginning and near the completion of the educational initiative gives insights into how transfer-oriented education can improve the treatment of elderly patients across sector lines for inpatients as well as outpatients. The evaluation of the implementation of educational content in day-to-day work and occupational groups is to facilitate recommendations about economically sensible use of educational resources and about further adjustments to the training content. CONCLUSIONS: The evaluation develops the foundation for targeted and needs-oriented qualification measures as well as transfer in cross-sector, multiprofessional networks. Instruments and results will be published and provided to other health care networks and institutions. The Quality Network will implement the results of the evaluation process in its member institutions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/11067.

Improving female physician's careers in academic medicine: Chances and challenges.

University hospitals are involved in the care of critically ill patients, pregraduate and postgraduate education, and medical research with an increasing demand on physicians due to a higher burden of disease. The number of female physicians is increasing; however, young female physicians are less willing to work at university hospitals under the given conditions. They often do not find appropriate working conditions in mostly hierarchically structured university hospitals. Institutional structures involuntarily erect barriers against the recruitment, retention, and career progression of women. Gendered working conditions remain firmly fixed, and this is even more challenging - overt discrimination has been replaced by less visible mostly implicit stereotypes and prejudices against women. Having children is an additional "career stopper" for female physicians: those with children are less likely to be promoted and have a lower income. Regulatory measures should act in several directions: cultural gender equality policies, family support policies, and active work policies.

Medicine Goes Female: Protocol for Improving Career Options of Females and Working Conditions for Researching Physicians in Clinical Medical Research by Organizational Transformation and Participatory Design.

BACKGROUND: All European countries need to increase the number of health professionals in the near future. Most efforts have not brought the expected results so far. The current notion is that this is mainly related to the fact that female physicians will clearly outnumber their male colleagues within a few years in nearly all European countries. Still, women are underrepresented in leadership and research positions throughout Europe. OBJECTIVES: The MedGoFem project addresses multiple perspectives with the participation of multiple stakeholders. The goal is to facilitate the implementation of Gender Equality Plans (GEP) in university hospitals; thereby, transforming the working conditions for women working as researchers and highly qualified physicians simultaneously. Our proposed innovation, a crosscutting topic in all research and clinical activities, must become an essential part of university hospital strategic concepts. METHODS: We capture the current status with gender-sensitive demographic data concerning medical staff and conduct Web-based surveys to identify cultural, country-specific, and interdisciplinary factors conducive to women's academic success. Individual expectations of employees regarding job satisfaction and working conditions will be visualized based on "personal construct theory" through repertory grids. An expert board working out scenarios and a gender topic agenda will identify culture-, nation-, and discipline-specific aspects of gender equality. University hospitals in 7 countries will establish consensus groups, which work on related topics. Hospital management supports the consensus groups, valuates group results, and shares discussion results and suggested measures across groups. Central findings of the consensus groups will be prepared as exemplary case studies for academic teaching on research and work organization, leadership, and management. RESULTS: A discussion group on gender equality in academic medicine will be established on an internationally renowned open-research platform. Project results will be published in peer-reviewed journals with high-impact factors. In addition, workshops on gender dimension in research using the principles of Gendered Innovation will be held. Support and consulting services for hospitals will be introduced in order to develop a European consulting service. CONCLUSIONS: The main impact of the project will be the implementation of innovative GEP tailored to the needs of university hospitals, which will lead to measurable institutional change in gender equality. This will impact the research at university hospitals in general, and will improve career prospects of female researchers in particular. Simultaneously, the gender dimension in medical research as an innovation factor and mandatory topic will be strengthened and integrated in each individual university hospital research activity. Research funding organizations can use the built knowledge to include mandatory topics for funding applications to enforce the use and implementation of GEP in university hospitals.

Securing the Continuity of Medical Competence in Times of Demographic Change: A Proposal.

BACKGROUND: University hospitals make up the backbone of medical and economic services of hospitals in Germany: they qualify specialist physicians, ensure medical research, and provide highly specialized maximum medical care, which other hospitals cannot undertake. In addition to this assignment, medical research and academic teaching must be managed despite a growing shortage of specialist physicians. By the year 2020, the need for the replacement of retired physicians and increased demand will total 30,000 positions. The situation will become more difficult because, on the whole, patients are becoming older and sicker and because specialist physicians are able to find more attractive working conditions in smaller hospitals, abroad, or outside of curative medicine. OBJECTIVE: In order to retain sufficient qualified employees, major improvements in quality are required in terms of working and training conditions. For this purpose, a sustainable innovation process is necessary, which incorporates solutions from outside of the health care sector in order to be able to learn from experiences and mistakes from other industries. The FacharztPlus project aims to find suitable measures in order to retain specialist physicians for more years after the completion of 5 years of professional training. This should determine the suitability of additional qualifications alongside the professional career and an expertise-related work organization oriented to different stages of life. METHODS: Structured interviews, surveys, and repertory grids are used as preparation for cross-industry expert panels to create future work scenarios for university hospitals. Industries involved are harbor logistics (container terminal), airports, and digitized industrial production ("industry 4.0") because these industries are also facing a shortage of qualified staff and have to respond to rapidly changing demands. Based on the experts' scenarios, consensus groups will be established in each university hospital trying to reach consensus about the implementation of relevant factors in order to improve employee retention. RESULTS: We expect these consensus groups to develop and introduce measures for more structured training procedures, individual and team incentives, organizational guidelines for better recruiting and retention in hospitals, models of flexible and attractive working conditions including shift work and vacation planning, and use of new learning tools (eg, tablet PCs and mobile phones). CONCLUSIONS: All measures are implemented in the Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine at the University Hospital Muenster (UKM) with approximately 150 physicians and in the further 44 departments of the UKM and 22 teaching hospitals, which all together employ more than 5000 physicians. The measures will also be implemented at the university hospitals in Aachen, Rostock, and Greifswald. All decisions and measures will be discussed with representatives from hospital management and professional associations. Results will be presented at conferences and published in journals.