College complaints against resident physicians in Canada: a retrospective analysis of Canadian Medical Protective Association data from 2013 to 2017.

BACKGROUND: An understanding of regulatory complaints against resident physicians is important for practice improvement. We describe regulatory college complaints against resident physicians using data from the Canadian Medical Protective Association (CMPA). METHODS: We conducted a retrospective analysis of college complaint cases involving resident doctors closed by the CMPA, a mutual medicolegal defence organization for more than 100 000 physicians, representing an estimated 95% of Canadian physicians. Eligible cases were those closed between 2008 and 2017 (for time trends) or between 2013 and 2017 (for descriptive analyses). To explore the characteristics of college cases, we extracted the reason for complaint, the case outcome, whether the complaint involved a procedure, and whether the complaint stemmed from a single episode or multiple episodes of care. We also conducted a 10-year trend analysis of cases closed from 2008 to 2017, comparing cases involving resident doctors with cases involving only nonresident physicians. RESULTS: Our analysis included 142 cases that involved 145 patients. Over the 10-year period, college complaints involving residents increased significantly (p = 0.003) from 5.4 per 1000 residents in 2008 to 7.9 per 1000 in 2017. While college complaints increased for both resident and nonresident physicians over the study period, the increase in complaints involving residents was significantly lower than the increase across all nonresident CMPA members (p < 0.001). For cases from the descriptive analysis (2013-2017), the top complaint was deficient patient assessment (69/142, 48.6%). Some patients (22/145, 15.2%) experienced severe outcomes. Most cases (135/142, 97.9%) did not result in severe physician sanctions. Our classification of complaints found 106 of 163 (65.0%) involved clinical problems, 95 of 163 (58.3%) relationship problems (e.g., communication) and 67 of 163 (41.1%) professionalism problems. In college decisions, 36 of 163 (22.1%) had a classification of clinical problem, 66 of 163 (40.5%) a patient-physician relationship problem and 63 of 163 (38.7%) a professionalism problem. In 63 of 163 (38.7%) college decisions, the college had no criticism. INTERPRETATION: Problems with communication and professionalism feature prominently in resident college complaints, and we note the potential for mismatch between patient and health care provider perceptions of care. These results may direct medical education to areas of potential practice improvement.

Congresos y publicaciones depredadoras, un nuevo factor a tener en cuenta / Congresses and predatory publications, a new factor to consider

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Medical negligence laws and virtual reality in healthcare.

BACKGROUND: As technological innovation increases the availability of novel therapeutic options in general practice, healthcare professionals will need to equip themselves with a sound understanding of their professional legal duties in light of emerging medical technologies, including virtual reality (VR). OBJECTIVE: Using a case study of VR to augment analgesia in burn treatment, this article examines how medical negligence laws apply to the use of new technology in healthcare settings. DISCUSSION: While there is currently no positive duty on healthcare professionals to use VR when treating patients, healthcare professionals may be held liable for harm arising from negligent advice or treatment using VR technology. The case study illustrates the flexible nature of negligence principles in adapting to harms arising from new risks such as simulation sickness. Specific warnings and standards of best practice will need to be developed if VR becomes a feature of general practice.

Scholarly Black Market.

Fake and unethical publishers' activities are known by most of the readers of Science and Engineering Ethics. This letter tries to draw the readers' attention to the hidden side of some of these publishers' business. Here the black market of scholarly articles, which negatively affects the validity and reliability of research in higher education, as well as science and engineering, will be introduced.

Case Studies for Recognizing Appropriate and Inappropriate Behaviors in the Clinical Learning Environment.

Introduction: The Association of American Medical Colleges surveys graduating medical students regarding the persistent prevalence of learning environment concerns. This training module is designed to increase awareness of appropriate and inappropriate behaviors in the clinical learning environment among medical professionals and trainees. Methods: An introductory PowerPoint presents the types of inappropriate behaviors that may be observed in the clinical learning environment along with institution-specific mechanisms for reporting such behaviors. We have also created six vignettes depicting various scenarios that trainees may encounter. The vignettes are presented in both text and video format and may be used in any combination. The entire module consisting of the PowerPoint presentation and the case studies can be delivered in 90 minutes to a large group of learners. Learners are divided into smaller groups of six to eight for discussions. The presentation and discussion can be done by a single or multiple facilitators. The target audience is primarily medical professionals and trainees at various levels of clinical exposure. Results: Since implementation of this training module at our institution, awareness of what constitutes mistreatment and how to report it has increased to nearly 100%. Representative institutional responses are provided for each vignette. Discussion: This training module can be presented to medical students, residents, and faculty at different stages of their professional development. We have enhanced learner awareness of what constitutes mistreatment and how to report these events. We offer these educational materials for other institutions to adapt and use in their specific institutional contexts.

Declaración de los posibles conflictos de interés de las revistas biomédicas españolas: un largo camino por recorrer / Disclosure of sources of possible conflicts of interest in Spanish biomedical journals: a long way to go

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Réplica a los autores de la carta: Declaración de los posibles conflictos de interés de las revistas biomédicas españolas: un largo camino por recorrer / Replicates the authors of the letter: Disclosure of sources of possible conflicts of interest in Spanish biomedical journals: a long way to go

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Mala praxis en Psicología Clínica y Forense a la luz de los tribunales de justicia españoles: un análisis exploratorio / Malpractice in Clinical and Forensic Psychology in Spanish courts: an exploratory analysis

En este artículo se analizan los problemas más significativos en la práctica de la Psicología Clínica y Forense que han llegado a los tribunales de justicia españoles en los últimos años. Entre estos problemas de mala praxis se incluyen: a) ausencia de consentimiento informado en relación con el diagnóstico y el tratamiento psicológico, b) errores en el diagnóstico debidos a una negligencia profesional, c) transgresión del secreto profesional y revelación de información confidencial del paciente en determinadas circunstancias, d) negligencia para prevenir el daño para el propio paciente u otras personas (suicidio u homicidio), e) conflictos relacionados con la protección o conservación de la historia clínica, f) problemas relacionados con la hospitalización psiquiátrica involuntaria y con el manejo del riesgo en pacientes suicidas o violentos y g) peritajes contradictorios en los tribunales. Se comentan asimismo algunas sugerencias para las investigaciones futuras en este campo

This paper reviews the most relevant ethical and malpractice issues in Clinical and Forensic Psychology arising in Spanish courts of justice. The main issues related to malpractice include: a) lack of informed consent regarding diagnosis and psychological treatment, b) mistakes in diagnosis because of professional negligence, c) violation of the professional secrecy and disclosure of confidential information without the consent of the individual in various circumstances, d) clinical negligence in preventing harm to patients or other people (suicide or homicide), e) negligence in protecting clinical records regarding the ownership of psychological records and data, f) involuntary psychiatric hospitalization and risk management with suicidal or violent patients and g) contradictory expert reports in courts. Suggestions for good practice in this field are considered

The 'I believe' and the 'I invest' of work-family balance: the indirect influences of personal values and work engagement via perceived organizational climate and workplace burnout / El 'creo' y el 'invierto' del conflicto trabajo-familia: influencias indirectas de los valores personales y la implicación en el trabajo a través de la percepción del clima organizacional y del agotamiento emocional en el trabajo

Based on Schwartz's (1992, 1994) Human Values Theory and the Conservation of Resources Theory (Hobfoll, 1988, 1998, 2001), the present research sought to advance the understanding of Work-Family Balance antecedents by examining personal values and work engagement as predictors of Work-Family Conflict via their associations with perceived organizational climate and work burnout. The results of two studies supported the hypotheses, and indicated that perceived organizational climate mediated the relations between values of hedonism, self-direction, power, and achievement and Work-Family Conflict, and that work burnout mediated the relations between work engagement and Work-Family Conflict. Theoretical and practical implications regarding individual differences and experiences of Work-Family Balance are discussed (AU)

Siguiendo la Teoría de los Valores Humanos (Schwartz, 1992, 1994) y la de la Conservación de Recursos (Hobfoll, 1988, 1998, 2001), este trabajo pretende avanzar en el conocimiento de los antecedentes del equilibrio trabajo-familia mediante el análisis de los valores personales y la implicación en el trabajo como predictores del conflicto trabajo-familia a través de su asociación con la percepción del clima organizacional y el agotamiento emocional en el trabajo. Los resultados de dos estudios respaldan las hipótesis, indicando que la percepción del clima organizacional mediatiza la relación entre valores de hedonismo, autodirección, poder y logro y conflicto trabajo-familia y que el agotamiento emocional en el trabajo mediatiza la relación entre implicación laboral y conflicto trabajo-familia. Se comentan las implicaciones teóricas y prácticas relativas a las diferencias individuales y experiencias del equilibrio trabajo-familia (AU)

Unprofessional Behaviors Among Tomorrow's Physicians: Review of the Literature With a Focus on Risk Factors, Temporal Trends, and Future Directions.

PURPOSE: Recent reports have identified concerning patterns of unprofessional and dishonest behavior by physician trainees. Despite this publicity, the prevalence and impact of these behaviors is not well described; thus, the authors aimed to review and analyze the various studies on unprofessional behavior among U.S. medical trainees. METHOD: The authors performed a literature review. They sought all reports on unprofessional and dishonest behavior among U.S. medical school students or resident physicians published in English and indexed in PubMed between January 1980 and May 2014. RESULTS: A total of 51 publications met criteria for inclusion in the study. The data in these reports suggest that plagiarism, cheating on examinations, and listing fraudulent publications on residency/fellowship applications were reported in 5% to 15% of the student and resident populations that were studied. Other behaviors, such as inaccurately reporting that a medical examination was performed on a patient or falsifying duty hours, appear to be even more common (reportedly occurring among 40% to 50% of students and residents). CONCLUSIONS: "Unprofessional behavior" lacks a unified definition. The data on the prevalence of unprofessional behavior in medical students and residents are limited. Unprofessional behaviors are common and appear to be occurring in various demographic groups within the medical trainee population. The relationship between unprofessional behaviors in training and future disciplinary action is poorly understood. Going forward, defining "unprofessional behavior"; developing validated instruments to evaluate such behaviors scientifically; and studying their incidence, motivations, and consequences are critical.

Spanning a Decade of Physician Boundary Violations: Are We Improving?

Sexual boundary violations can negatively impact the culture of safety within a medical practice or healthcare institution and severely compromise the covenant of care and physician objectivity. Lack of education and training is one factor associated with physician misconduct that leads to high financial and personal cost. This paper presents a follow-up study of physicians referred to a professional development course in 2001 and presents demographic data from 2001 to present. The paper focuses on the education and remediation progress regarding sexual misconduct by physicians.

The Reputational Consequences of Failed Replications and Wrongness Admission among Scientists.

Scientists are dedicating more attention to replication efforts. While the scientific utility of replications is unquestionable, the impact of failed replication efforts and the discussions surrounding them deserve more attention. Specifically, the debates about failed replications on social media have led to worry, in some scientists, regarding reputation. In order to gain data-informed insights into these issues, we collected data from 281 published scientists. We assessed whether scientists overestimate the negative reputational effects of a failed replication in a scenario-based study. Second, we assessed the reputational consequences of admitting wrongness (versus not) as an original scientist of an effect that has failed to replicate. Our data suggests that scientists overestimate the negative reputational impact of a hypothetical failed replication effort. We also show that admitting wrongness about a non-replicated finding is less harmful to one's reputation than not admitting. Finally, we discovered a hint of evidence that feelings about the replication movement can be affected by whether replication efforts are aimed one's own work versus the work of another. Given these findings, we then present potential ways forward in these discussions.

Fraude y plagio en la carrera y en la profesión / Fraud and plagiarisim in school and career

Entre el 0 y el 94% de los estudiantes reconocen haber cometido fraude durante su carrera. Sus formas son diversas: engaños en los exámenes, suplantación en exámenes y trabajos, plagios, citas falsas o inventadas, presentación de resultados ficticios en experimentos, historias clínicas o exploraciones físicas, conducta desleal hacia los compañeros y muchos otros. Entre las consecuencias del fraude en los estudios se encuentran el aprendizaje de la corrupción, los esfuerzos baldíos de alumnos y profesores, la evaluación incorrecta y la selección injusta para puestos de trabajo. Dado que las trampas en la universidad pueden ser el preludio de la corrupción de los futuros médicos o investigadores, revisamos la prevalencia, factores de riesgo, motivaciones, formas clínicas, detección y prevención de la enfermedad del fraude académico (AU)

Between 0% and 94% of university students acknowledge having committed academic fraud. Its forms are varied: cheating on examinations, submitting someone else's work, plagiarism, false citations, false reporting on experiments, tests or findings in the medical history and physical examination, unfair behavior toward fellow students, and many others. The consequences of academic fraud include learning corruption, useless efforts by students and faculty, incorrect performance evaluations and unfair selection for jobs. Since this can be a prelude to future fraud as doctors or researches, the prevalence, risk factors, motivations, clinical appearances, detection and prevention of the disease of academic fraud are here reviewed (AU)

Conducta del médico de atención primaria ante el mal control de la hipertensión arterial. Estudio PRESCAP 2010 / Medical conduct in Primary Care as regards blood pressure control. PRESCAP 2010 Study

Introducción. Es necesario tener mayor información sobre la inercia terapéutica en la hipertensión arterial (HTA). El objetivo de este estudio fue conocer la conducta del médico de atención primaria (AP) en pacientes hipertensos que presentan mal control de presión arterial (PA) y determinar los factores asociados. Pacientes y métodos. Estudio transversal y multicéntrico realizado en hipertensos asistidos en el ámbito de la AP española. Se registraron datos de los pacientes (sociodemográficos, clínicos y tratamiento) y médicos (asistenciales, formativos y conducta ante el mal control de PA). Se consideró mal control cuando el promedio de PA era >= 140/90mmHg. Resultados. Se incluyeron 12.961 hipertensos (52,0% mujeres), con una edad media de 66,3 (11,4) años y antigüedad media de la HTA de 9,1 (6,7) años. El 62,4% recibía terapia combinada (44,2%, 2 fármacos, y 18,2%, 3 o más). El 38,9% (IC 95%: 38,1-39,7) presentó mal control de PA. El médico modificó el tratamiento en el 41,8% (IC 95%: 40,4-43,2) de los 5.036 pacientes mal controlados. La conducta terapéutica más frecuente fue la asociación farmacológica (55,6%). La percepción por parte del médico de buen control de PA en el hipertenso mal controlado y la presencia de terapia combinada fueron las variables que mostraron mayor probabilidad de no modificar el tratamiento farmacológico. Conclusiones. El médico de AP modifica el tratamiento antihipertensivo en tan solo 4 de cada 10 hipertensos mal controlados. La percepción por parte del médico de buen control de PA es la variable que más incrementa la probabilidad de no modificar el tratamiento farmacológico (AU)

Introduction. There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients. Patients and methods. Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where >=140/90mmHg. Results. A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia. Conclusions. The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia (AU)

La responsabilidad profesional en cardiología / Professional liability in cardiology

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Seguridad clínica en atención primaria. los errores médicos (II) / Clinical safety in primary care: medical errors (II)

El primer artículo de esta serie sobre seguridad clínica lo dedicamos a la epidemiología y a las políticas preventivas de tipo sistémico. En la presente revisión nos centraremos en los errores médicos con especial énfasis en los errores de tipo diagnóstico. Estos errores derivan de las características a veces elusivas de la propia enfermedad, las circunstancias en que el paciente presenta sus síntomas, y las características del propio profesional. Si consideráramos al clínico como una «máquina de diagnóstico» -paradigma del «médico-robot»-, nos sería más fácil admitir unas limitaciones cognitivas, y poner en marcha estrategias institucionales que humanizarían el trato que en ocasiones recibe. De manera más concreta examinaremos 3 estrategias de mejora del razonamiento clínico: reconocimiento de situaciones peligrosas, metacognición y supervisor interno(AU)

The first article of this series on Clinical Safety was dedicated to the epidemiology and systemic preventive policies. In the present review we focus on medical errors with special emphasis on diagnostic type errors. These errors sometimes arise from the elusive characteristics of the disease itself, the way in which the patients present their symptoms, and the characteristics of the professionals themselves. If we consider a general practitioner as a diagnostic machine, -paradigm of "physician as a robot"- it would be easier for us to accept some cognitive limitations and introduce institutional strategies that would humanise the treatment occasionally received. More specifically we will examine three strategies for improving clinical reasoning: recognising dangerous situations, metacognition, and an internal supervisor(AU)