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2.
Presse Med ; 48(12): e382-e388, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31757737

RESUMEN

BACKGROUND: Rare diseases are defined by a prevalence of less than one out of 2000 persons. In clinical practice, their management is difficult, due to their diversity, their complexity and a lack of adapted physician training. OBJECTIVE: The aims of this study were to identify rare skin diseases in a reference center, to describe the difficulties encountered by general practitioners (GPs) in management of these uncommon cases, and to pinpoint the characteristics of the GPs having the most problems. METHODS: A survey conducted from March to June 2017 involving GPs at least one of whose rare skin disease patients was being monitored in a reference center. RESULTS: All in all, 96/195 (49.2%) of the GPs contacted completed the questionnaire, and virtually all of them (95%) reported five main categories of difficulties: giving a diagnosis, monitoring treatment, coordinating care, providing support, and ensuring management of intercurrent pathologies. The most widely reported difficulties were related to diagnosis (88.5%) and care coordination (76%). The GPs most in need of assistance were those practicing in rural areas (11 times more likely to experience difficulties), those with over 10 years of experience (up to 9.8 times more risk) and those not considering their role in the management of patients with rare diseases as instrumental (2.28 times more risk). CONCLUSIONS: This study brought to light the difficulties encountered by GPs in management of patients with rare skin diseases. We identified those the most in need of assistance, who are to be targeted for actions aimed at improving the care and treatment of patients suffering from rare skin diseases.


Asunto(s)
Competencia Clínica , Médicos Generales , Pautas de la Práctica en Medicina , Enfermedades Raras/terapia , Enfermedades de la Piel/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Actitud del Personal de Salud , Niño , Preescolar , Competencia Clínica/normas , Competencia Clínica/estadística & datos numéricos , Femenino , Francia/epidemiología , Medicina General/educación , Médicos Generales/normas , Médicos Generales/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Enfermedades Raras/epidemiología , Enfermedades de la Piel/epidemiología , Encuestas y Cuestionarios , Adulto Joven
4.
Z Evid Fortbild Qual Gesundhwes ; 147-148: 20-27, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31623979

RESUMEN

INTRODUCTION: The aim of this pilot study was to evaluate the effectiveness of a complex educational intervention to improve the diagnostic competencies of general practitioners (GPs) regarding the detection of depression, anxiety and somatization. METHODS: Cluster-randomized controlled pilot study with six practices each in the intervention group and in the control group. Psychological morbidity was determined by patient self-report using the Patient Health Questionnaire (PHQ-D). GPs rated the extent of psychological morbidity on a numerical rating scale from 0 (no co-morbidity) to 10 (maximum) of the individual patient after the consultation, independent of the reason for encounter. RESULTS: 364 patients participated. There were moderate correlations between GP rating and the PHQ scales (Spearman correlation between 0.27 and 0.42). There was no significant difference between intervention and control group. Diagnostic accuracy of the GPs, as determined with areas under the curves (AUCs), ranged between 0.52 (95%KI 0.30-0.73) and 0.84 (95%KI 0.67-1.00). The AUCs showed significant heterogeneity (Cochran Q=25.0; p<0.01). The regression analysis with 'presence of psychological disorder' (in PHQ) as the dependent variable showed that longer duration of doctor-patient-relationship was negatively associated with psychological morbidity (OR 0.96; 95%KI 0.92-0.99; p=0.01). There was a significant interaction between the factors 'time of doctor-patient relationship' and 'GP rating' (ß=0.02; OR 1.02, 95%KI 1.01-1.03; p<0.001), pointing towards increasing diagnostic accuracy when patients are known for a longer time. DISCUSSION: We found no significant effect regarding the educational intervention. The GPs' estimation regarding psychological morbidity correlated significantly with the self-rating of the patients on PHQ scales. However, there was a considerable inter-individual variation between the GPs' diagnostic accuracy. The diagnostic estimation improved with increasing duration of doctor-physician relationship. CONCLUSION: A one-time educational intervention seems not to be sufficient to improve diagnostic competencies in the detection of psychological morbidity. The considerable variation of the diagnostic accuracy might explain why 'one-size-fits-all' educational interventions will not help improve diagnostic competencies.


Asunto(s)
Competencia Clínica , Medicina General , Médicos Generales/educación , Trastornos Mentales/diagnóstico , Relaciones Médico-Paciente , Educación Médica Continua , Medicina Familiar y Comunitaria , Medicina General/educación , Medicina General/normas , Alemania , Humanos , Proyectos Piloto , Derivación y Consulta
5.
J Med Vasc ; 44(5): 331-335, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31474343

RESUMEN

OBJECTIVES: Cardiovascular diseases represent the leading cause of death worldwide. In a previous survey, we have shown that the management of patients with atherosclerosis by general practitioners depends on the locations of the disease. The aim of this survey was to assess general practice residents' (GPR) knowledge on three clinical presentations which are ischemic stroke, coronary artery disease (CAD), and peripheral artery disease (PAD). MATERIALS AND METHODS: Between May 2017 and September 2017, a national self-administered survey that we previously used to assess the GPs' knowledge was emailed to GPRs from French medicine faculties. The questionnaire was composed of three clinical cases dealing with transient ischemic attack (TIA), stable angina (SA) and intermittent claudication (IC). Each clinical case was explored by seven similar questions. The primary endpoint was the number of GPRs who correctly answered 5 of the 7 questions for each clinical case. RESULTS: Five hundred and fifty-three GPRs (10%) answered the questionnaire entirely. There is a significant difference between TIA knowledge (19.9% of correct answers) which is greater than SA knowledge (0.9%) and IC knowledge (0.4%). The diagnosis was correctly done by 525 (94.9%) GPRs for TIA, 513 (92.8%) for SA, and 532 (96.2%) for IC. The main difficulties encountered by the GPRs concerned complementary investigations and treatment. CONCLUSION: As for general practitioners, this study reveals a difference in GPRs' knowledge depending on the location of the atherosclerosis. Considering the results, the improvement of initial training and continuing medical education (CME) in general medicine would be desirable.


Asunto(s)
Aterosclerosis/diagnóstico , Aterosclerosis/terapia , Educación de Postgrado en Medicina , Medicina General/educación , Conocimientos, Actitudes y Práctica en Salud , Internado y Residencia , Atención Primaria de Salud , Angina Estable/diagnóstico , Angina Estable/terapia , Actitud del Personal de Salud , Competencia Clínica , Curriculum , Encuestas de Atención de la Salud , Humanos , Claudicación Intermitente/diagnóstico , Claudicación Intermitente/terapia , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/terapia
6.
Lakartidningen ; 1162019 Aug 27.
Artículo en Sueco | MEDLINE | ID: mdl-31454059

RESUMEN

The Swedish Association of General Practice has published a set of guidelines for general practitioner's (GPs') learning in general practice/family medicine. This article is a summary of principles, guidelines and applications regarding Swedish GPs' continuing professional development (CPD). We argue that reflection on own practice, reflection with colleagues in small groups and use of written learning plans and portfolios for courses and lectures are important parts of CPD and should be increasingly used and supported by employers. Collection of CME credits for certification purposes does not ensure that educational measures have been effective. Statements of recurring CPD should be incorporated in contracts between health care authorities and health care units.


Asunto(s)
Educación Médica Continua/métodos , Medicina General/educación , Guías como Asunto , Humanos , Aprendizaje , Sociedades Médicas , Suecia
7.
Presse Med ; 48(7-8 Pt 1): 767-779, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31303371

RESUMEN

OBJECTIVES: In France, too few general practitioners (GP) follow the training about suicide prevention and risk. This study aimed at reviewing international publications regarding GP's training on suicide risk, in order to inform us about the training practices in the world and potentially discover new methodologies. METHODS: We performed bibliographic databases searches on GPs training about suicide prevention and risk, for practicing GPs, excluding studies about particular population groups, following the PRISMA statement guidelines. Training duration, educational program, content, time of assessment, tools, and information about train the trainers or kirkpatrick's level were identified for each selected study. RESULTS: This review revealed that there is no consensus on the training program or on the assessment tools in GP's training about suicide prevention and risk. Nevertheless, it reveals a similar framework including a theoretical part, with a fundamental knowledge content, and an interactive part. CONCLUSION: If reaching standardized training practices seems difficult to achieve, standardizing assessment tools might be a relevant purpose. Indeed, using the same tools would allow proper training comparison. Practically speaking, this review inspired us in the implementation of in situ training and convincing us to undertake a French translation of an assessment scale.


Asunto(s)
Medicina General/educación , Médicos Generales/educación , Suicidio/prevención & control , Estudios de Casos y Controles , Educación Médica Continua/métodos , Educación Médica Continua/normas , Educación Médica Continua/estadística & datos numéricos , Evaluación Educacional , Francia/epidemiología , Medicina General/métodos , Medicina General/normas , Medicina General/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Aprendizaje Basado en Problemas/métodos , Aprendizaje Basado en Problemas/normas , Suicidio/estadística & datos numéricos , Intento de Suicidio/prevención & control , Intento de Suicidio/estadística & datos numéricos
11.
GMS J Med Educ ; 36(3): Doc26, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31211221

RESUMEN

Introduction: The aim of the Objective Structured Clinical Examination (OSCE) is a standardized and fair assessment of clinical skills. Observing second clinical year medical students during a summative OSCE assessing a General Practice clerkship, we noticed that information exchange with peers led to a progressively faster and overly focused management of simulations. Therefore, we established a Multiple Scenario-OSCE (MS-OSCE) where all students had to manage the same chief complaint at a station but it's underlying scenarios being randomly changed during students' rotation through their parcours. We wanted to ensure they fully explore differential diagnosis instead of managing their task influenced by shared information. We wanted to assess if a MS-OSCE violates the assumption of objectivity and fairness given that students are not tested with the same scenarios. Methods: We developed and piloted five OSCE stations (chest pain, abdominal pain, back pain, fatigue and acute cough) with two or three different underlying scenarios each. At each station these scenarios randomly changed from student to student. Performance was assessed with a checklist and global rating. The effect of scenarios and raters on students' grades was assessed calculating the intraclass correlation coefficient with a fixed effect two level linear model. Results: A total of 169 students and 23 raters participated in the MS-OSCE. The internal consistency over all stations was 0.65 by Cronbach's alpha. The difference of the mean grades between the scenarios of a given chief complaint ranged from 0.03 to 0.4 on a 1 to 5 grading scale. The effect of scenarios on the variance of the final grades at each station ranged from 4% to 9% and of raters from 20% to 50% when adjusted for students' skills. Conclusions: The effect of different scenarios on the grades was relevant but small compared to the effect of raters on grades. Improving rater training is more important to ensure objectivity and fairness of MS-OSCE than providing the same scenario to all students.


Asunto(s)
Competencia Clínica/normas , Evaluación Educacional/normas , Medicina General/educación , Adulto , Competencia Clínica/estadística & datos numéricos , Evaluación Educacional/estadística & datos numéricos , Femenino , Medicina General/normas , Medicina General/estadística & datos numéricos , Humanos , Masculino , Proyectos Piloto , Estándares de Referencia , Estudiantes de Medicina/psicología , Estudiantes de Medicina/estadística & datos numéricos
12.
BMC Health Serv Res ; 19(1): 338, 2019 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-31138189

RESUMEN

BACKGROUND: Australians living in rural and remote areas have access to considerably fewer doctors compared with populations in major cities. Despite plentiful, descriptive data about what attracts and retains doctors to rural practice, more evidence is needed which informs actions to address these issues, particularly in remote areas. This study aimed to explore the factors influencing General Practitioners (GPs), primary care doctors, and those training to become GPs (registrars) to work and train in remote underserved towns to inform the building of primary care training capacity in areas needing more primary care services (and GP training opportunities) to support their population's health needs. METHODS: A qualitative approach was adopted involving a series of 39 semi-structured interviews of a purposeful sample of 14 registrars, 12 supervisors, and 13 practice managers. Fifteen Australian Medical Graduates (AMG) and eleven International Medical Graduates (IMG), who did their basic medical training in another country, were among the interviewees. Data underwent thematic analysis. RESULTS: Four main themes were identified including 1) supervised learning in underserved communities, 2) impact of working in small, remote contexts, 3) work-life balance, and 4) fostering sustainable remote practice. Overall, the findings suggested that remote GP training provides extensive and safe registrar learning opportunities and supervision is generally of high quality. Supervisors also expressed a desire for more upskilling and professional development to support their retention in the community as they reach mid-career. Registrars enjoyed the challenge of remote medical practice with opportunities to work at the top of their scope of practice with excellent clinical role models, and in a setting where they can make a difference. Remote underserved communities contribute to attracting and retaining their GP workforce by integrating registrars and supervisors into the local community and ensuring sustainable work-life practice models for their doctors. CONCLUSIONS: This study provides important new evidence to support development of high-quality GP training and supervision in remote contexts where there is a need for more GPs to provide primary care services for the population.


Asunto(s)
Educación de Postgrado en Medicina/organización & administración , Medicina General/educación , Adulto , Creación de Capacidad , Femenino , Médicos Generales/educación , Humanos , Capacitación en Servicio , Masculino , Área sin Atención Médica , Persona de Mediana Edad , Atención Primaria de Salud/estadística & datos numéricos , Queensland , Salud Rural/estadística & datos numéricos , Servicios de Salud Rural/provisión & distribución , Recursos Humanos/estadística & datos numéricos , Adulto Joven
13.
Med J Aust ; 210(8): 354-359, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30977150

RESUMEN

OBJECTIVE: To assess whether entrustment levels for junior trainees with respect to entrustable professional activities (EPAs) increase over time; whether entrustment levels for senior trainees are higher than for junior trainees; and whether self-assessment of entrustment levels by senior trainees more closely matches supervisor assessment than self-assessment by junior trainees. DESIGN, SETTING, PARTICIPANTS: Observational study of 130 junior and 153 senior community-based general practice trainees in South Australia, 2017. MAIN OUTCOME MEASURES: Differences in entrustment levels between junior and senior trainees; change in entrustment levels for junior trainees over 9 months; concordance of supervisor and trainee assessment of entrustment level over 9 months. RESULTS: Senior trainees were 2.1 (95% CI, 1.66-2.58) to 3.7 times (95% CI, 2.60-5.28) as likely as junior trainees to be entrusted with performing clinical EPAs without supervision. The proportion of EPAs with which junior trainees were entrusted to perform unsupervised increased from 26% at 3 months to 35% at 6 months (rate ratio [RR], 1.37; 95% CI; 1.15-1.63), to 50% at 9 months (RR, 1.92; 95% CI, 1.64-2.26), and 69% at 12 months (RR, 2.68; 95% CI; 2.32-3.12). At 3 months, the mean differences in entrustment ratings between supervisors and trainees was 5.5 points (SD, 6.6 points) for junior trainees and 2.93 points (SD, 2.8 points) for senior trainees (P < 0.001). CONCLUSIONS: EPAs are valid assessment tools in a workplace-based training environment.


Asunto(s)
Medicina General/educación , Autonomía Profesional , Rendimiento Laboral , Lugar de Trabajo/organización & administración , Educación Basada en Competencias/métodos , Humanos , Australia del Sur
16.
Fam Med ; 51(3): 262-270, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30861081

RESUMEN

BACKGROUND AND OBJECTIVES: To achieve the goal of 300,000 general practitioners by 2020-an increase of 215,200 in a decade-China is utilizing multiple training pathways. To comprehensively illustrate general practitioner training strategies in China, this article introduces and describes these pathways. METHODS: We used descriptive policy analysis. This involved taking an inventory of existing literature and source documents and developing a model to illustrate pathways for training general practice physicians. RESULTS: The rural doctor pathway represents rural clinicians who had only basic training and practiced multiple years prior to training reforms. The 3+2 pathway to assistant general practitioners requires 3 years of junior college and 2 years of clinical training. The transfer pathway for current physicians requires 1-2 years of training. The 5+3 pathway comprises 5 years of bachelor of science degree training in clinical medicine and 3 years of standardized residency training. Despite the development of advanced degree programs, their use remains limited. CONCLUSIONS: These pathways illustrate significant heterogeneity in training of general practitioners. Training ranges from a 2-year technical degree to a doctorate with research. Emphasis on the 5+3 track shows promise for China's goals of improved quality and new goal of 500,000 additional general practitioners by 2030.


Asunto(s)
Educación de Postgrado en Medicina/métodos , Educación de Pregrado en Medicina/métodos , Medicina General/educación , Médicos Generales/provisión & distribución , Internado y Residencia , Mejoramiento de la Calidad , Servicios de Salud Rural , Humanos , Población Rural
17.
Med J Aust ; 210(6): 263-268, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30802313

RESUMEN

OBJECTIVE: To examine whether the Ways of Thinking and Ways of Doing (WoTWoD) cultural respect framework improves clinically appropriate anticipatory care in general practice and the cultural respect levels of medical practice staff. DESIGN: Mixed methods, cluster randomised controlled trial with a participatory action research approach. SETTING, PARTICIPANTS: Fifty-six general practices in Sydney and Melbourne, 2014-2017. INTERVENTION: WoTWoD encompasses a toolkit (ten scenarios illustrating cross-cultural behaviour in clinical practice), one half-day workshop, cultural mentor support for practices, and a local care partnership between participating Medicare locals/primary health networks and local Aboriginal Community Controlled Health Services for guiding the program and facilitating community engagement. The intervention lasted 12 months at each practice. MAJOR OUTCOMES: Rates of claims for MBS item 715 (health assessment for Aboriginal and Torres Strait Islander People) and recording of chronic disease risk factors; changes in cultural quotient (CQ) scores of practice staff. RESULTS: Complete results were available for 28 intervention (135 GPs, 807 Indigenous patients) and 25 control practices (210 GPs, 1554 Indigenous patients). 12-Month rates of MBS item 715 claims and recording of risk factors for the two groups were not statistically significantly different, nor were mean changes in CQ scores, regardless of staff category and practice attributes. CONCLUSION: The WoTWoD program did not increase the rate of Indigenous health checks or improve cultural respect scores in general practice. Conceptual, methodologic, and contextual factors that influence cultural mentorship, culturally respectful clinical practice, and Indigenous health care require further investigation. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry ACTRN12614000797673.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Competencia Cultural/educación , Medicina General/educación , Mentores , Australia , Análisis por Conglomerados , Medicina General/métodos , Servicios de Salud del Indígena/organización & administración , Humanos , Grupo de Ascendencia Oceánica
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