RESUMEN
BACKGROUND: There are multiple classes of pharmacologic agents approved for treatment of osteoporosis, but their costs vary widely, and systematic data on their efficacy compared with the traditional standard, bisphosphonates, for reducing fractures in postmenopausal women are lacking. The objective was to perform a systematic review and meta-analysis assessing the efficacy of denosumab compared with bisphosphonates. METHODS: Researchers selected randomized controlled trials (RCTs) comparing denosumab to bisphosphonates that included information on clinical and/or osteoporotic fracture events over the follow-up period. Each clinical outcome was meta-analyzed using a fixed-effects analysis, with clinical and osteoporotic fractures as the outcomes of interest. A meta-regression was performed using change in bone mineral density (BMD) as the moderator variable. RESULTS: Seven RCTs were included. Denosumab was not associated with a reduction in clinical or osteoporotic fractures compared with bisphosphonates. There was no association between the change in BMD with denosumab and bisphosphonates and denosumab's effect on both osteoporotic and clinical fractures. DISCUSSION: Existing data do not support the use of the more expensive denosumab as a first-line agent over bisphosphonates for reduction of fractures in postmenopausal women with osteoporosis. One limitation in this study was each RCT was not individually powered for fracture incidences.
Asunto(s)
Conservadores de la Densidad Ósea , Osteoporosis Posmenopáusica , Osteoporosis , Fracturas Osteoporóticas , Femenino , Humanos , Difosfonatos/uso terapéutico , Difosfonatos/farmacología , Fracturas Osteoporóticas/etiología , Fracturas Osteoporóticas/prevención & control , Fracturas Osteoporóticas/tratamiento farmacológico , Conservadores de la Densidad Ósea/uso terapéutico , Conservadores de la Densidad Ósea/farmacología , Posmenopausia , Osteoporosis Posmenopáusica/complicaciones , Osteoporosis Posmenopáusica/tratamiento farmacológico , Osteoporosis/complicaciones , Osteoporosis/tratamiento farmacológico , Densidad ÓseaRESUMEN
Medical students must learn how to practice high-value, cost-conscious care. By modifying the traditional SOAP (Subjective-Objective-Assessment-Plan) presentation to include a discussion of value (SOAP-V), we developed a cognitive forcing function designed to promote discussion of high-value, cost-conscious care during patient delivery. The SOAP-V model prompts the student to consider (1) the evidence that supports a test or treatment, (2) the patient's preferences and values, and (3) the financial cost of a test or treatment compared to alternatives. Students report their findings to their teams during patient care rounds. This tool has been successfully used at 3 medical schools. Preliminary results find that students who have been trained in SOAP-V feel more empowered to address the economic healthcare crisis, are more comfortable in initiating discussions about value, and are more likely to consider potential costs to the healthcare system.
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Control de Costos/métodos , Atención a la Salud/economía , Innovación Organizacional , Estudiantes de Medicina , Competencia Clínica , Educación de Pregrado en Medicina , Humanos , Ciudad de Nueva YorkRESUMEN
INTRODUCTION: Research suggests that students become less patient-centered and empathetic in response to both internal and external factors, including the organizational culture, or hidden curriculum, of medical school. Students often feel compelled to make compromises when they experience tension between competing values in clinical teaching environments. To address this, we implemented a modular, longitudinal professionalism curriculum for third-year medical students, based on a conceptual model that highlights a student's ideal, as well as the internal and environmental forces that can either sustain or change their ideal over time. METHODS: As students progressed through the third year, they participated in various modules linked to different clerkships, each focusing on a different aspect of the conceptual model. Each module includes a reflective writing exercise followed by a faculty-facilitated discussion. RESULTS: In general, students rated the group discussions and faculty facilitation as the most useful parts of each session and the writing exercises as the least useful. Written comments were mostly favorable and suggested that the session facilitated self-reflection and provided a safe environment for students to discuss stressors of third-year clerkships. DISCUSSION: This curriculum represents a unique approach to fostering professional role formation through its broad potential applicability to multiple types and levels of learners, its adaptability to fit various course lengths and learning environments, and its incorporation of a conceptual model that allows individual learners to address different facets of the sustaining and acculturating forces that impact their personal professional identity formation for future encounters.
RESUMEN
OBJECTIVE: Eating disorders (EDs) result in the highest mortality rate of all psychiatric disorders, and in the United States, approximately one in twenty females suffers from an eating disorder. However, training provided within residency programs to address the needs of these patients is sparse. The objective of this study was to conduct a national survey that assesses the amount of EDs training for trainees across five ACGME accredited specialties: internal medicine, pediatrics, family medicine, psychiatry, and child and adolescent psychiatry. The results of the survey will be used to develop strategies to improve eating disorder education among residents. METHOD: Eight hundred eighty training coordinators were contacted using information available on the ACGME website and asked to complete the survey. RESULTS: Of the 637 responding programs, 514 did not offer any scheduled or elective rotations for EDs. Of the 123 programs offering rotations, only 42 offered a formal, scheduled rotation. Child and adolescent psychiatry offered the most clinical experiences, and pediatric programs offered the greatest number of didactic hours on EDs. DISCUSSION: Training in EDs is limited. Simulated patient encounters, massive open online courses, web-based curricula, dedicated rotations and clinical experiences, didactic curricula, and brief-training programs may help to improve eating disorder diagnostic and treatment skills among trainees.
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Trastornos de Alimentación y de la Ingestión de Alimentos , Internado y Residencia/estadística & datos numéricos , Psiquiatría/educación , Adolescente , Niño , Curriculum/estadística & datos numéricos , Salud de la Familia/educación , Humanos , Medicina Interna/educación , Pediatría/educación , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Risky health behaviors and social factors are linked to half of all causes of morbidity and mortality in the United States. Physicians report lack of training as one of the barriers to providing behavior change counseling. Formal behavior change curricula are infrequent in medical schools, and where they are available, they are often isolated from clinical experiences or presented through a limited approach. The authors developed the Health Beliefs and Behavior (HBB) course at University of Medicine and Dentistry-New Jersey Medical School (UMDNJ-NJMS) to teach the impact of unhealthy behaviors on health and wellness, to broaden students' understanding of the many factors that affect behavior, and to give medical students tools to facilitate health behavior change in patients. To the authors' knowledge, this is the only comprehensive, clinically integrated course on health behavior change in a U.S. medical school.The authors intercalated the 60-hour HBB course in the four-week, third-year internal medicine clerkship ambulatory block. Thus, students practice learned techniques in both the ambulatory and classroom settings, and they gain insight into health behavior by applying learned health models to patients and engaging in experiential exercises. Course components stress the biopsychosocial and patient-centered approach. The authors measure the impact of the course through student surveys. Third-year medical students at UMDNJ-NJMS who have completed the HBB course report enhanced understanding of the principles of behavior change and improved ability to perform behavior change counseling.
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Prácticas Clínicas/organización & administración , Competencia Clínica/normas , Curriculum/normas , Docentes Médicos , Conductas Relacionadas con la Salud , Rol del Médico/psicología , Relaciones Médico-Paciente , Actitud del Personal de Salud , Terapia Conductista/educación , Prácticas Clínicas/normas , Continuidad de la Atención al Paciente/organización & administración , Cultura , Humanos , Medicina Interna/educación , Modelos Educacionales , Educación del Paciente como Asunto , Atención Dirigida al Paciente/normasRESUMEN
BACKGROUND: The importance of teaching residents how to instruct medical students is recognized, but time and logistics challenge the implementation of teaching skills programs. No study has described a dissemination model with chief residents as trainers and managers of a teaching skills program. DESCRIPTION: All chief residents in three departments (n = 16), participated in an 8-hr train-the-trainer teaching skills program and then trained 178 residents through seven 1-hr sessions. Outcome was measured through student surveys using a validated instrument with seven teaching domains and overall assessment of teaching effectiveness. EVALUATION: Survey results revealed a significant improvement in the vast majority of teaching domains 9 months after implementation of the program in all three departments. Student perceptions of overall teaching effectiveness improved in two departments and trended upwards in the third. CONCLUSION: A resident teaching skills program utilizing chief residents as trainers resulted in improved 3rd-year medical student ratings of resident teaching.