Imbalanced specialty representation of USMLE and NBME test writers.

PURPOSE: The United States Medical Licensing Examination (USMLE) is an examination series required for allopathic physician licensure in the United States (US). USMLE content is created and maintained by the National Board of Medical Examinations (NBME). The specialty composition of the USMLE and NBME taskforce members involved in the creation of examination content is currently unknown. METHODS: Using the 2021 USMLE and 2021 NBME Committees and Task Forces documents, we determined each member's board-certified primary specialty and involvement in test material development committees who we dubbed "test writers". Total active physicians by primary specialty were recorded from the 2020 Physician Specialty Data Report published by the Association of American Medical Colleges (AAMC). Descriptive statistics and chi-square analysis were used to analyze the cohorts. RESULTS: The USMLE and NBME test writer primary specialty composition was found to be significantly different compared to the US active physician population (USMLE χ2[32] = 172, p < .001 and NBME χ2[32] = 200, p < .001). Only nineteen specialties were represented within USMLE test writers, with three specialties being proportionally represented. Two specialties were represented within NBME test writers. Obstetrics and Gynecology physicians were proportionally represented in USMLE but not within NBME test writers. Internal Medicine (IM) accounts for the largest percentage of all USMLE test writers (60/197, 30%) with an excess representation of 31 individuals. CONCLUSIONS: There is an imbalance in the specialty representation of USMLE and NBME test writers compared to the US active physician population. These findings may have implications for the unbiased and accurate portrayal of topics in such national examinations; thus, future investigation is warranted.

Until when will we grant specialist titles to doctors without medical residency?

This is a letter to the editor praising the editorial published in the Revista do Colégio Brasileiro de Cirurgiões which details the process of granting specialist titles in the field of surgery. At the same time, however, the issuance of these titles to doctors who have not completed medical residency is questioned.

[Looking back on 100 years of board certification for urology in Germany : Formation of a medical subject in the context of specialization and professionalization]. / 100 Jahre Facharzt für Urologie : Zur Ausbildung eines medizinischen Faches im Kontext von Spezialisierung und Professionalisierung.

This article examines the development of urology as an independent medical discipline in Germany, with a particular focus on professionalization and specialization in the 19th and 20th centuries. Based on historical sources, the text illuminates the importance of the German medical profession's further training regulations as an instrument of medical self-administration and the classification of urology as a medical specialty in the Bremen guidelines of 1924, which established board certification in diseases of the urinary organs (urology).

What medical specialists want to stay in remote areas of Indonesia: Discrete choice experiments.

INTRODUCTION: The equitable distribution of medical specialists in Indonesia's remote areas remains a challenge. This study investigated the preferences of medical specialists regarding retention programs aimed at addressing this issue. METHODS: A Discrete Choice Experiment (DCE) was utilized to collect stated preferences from 341 medical specialist working in district general hospitals across 10 Indonesian provinces. The DCE retention questionnaire focused on eight key characteristics: location, medical facilities, net income, continuing professional development program, security, length of commitment, source of incentives, and caseload. RESULTS: The study found that the most influential factors for retention in remote areas were security guarantees from the local government (OR = 6.11), fully funded continuing professional development programs (OR = 2.84), and access to advanced medical facilities (OR = 2.35). CONCLUSION: The findings indicate that a comprehensive intervention package, with a particular emphasis on security provisions, is necessary to retain medical specialists in remote areas. Financial incentives are also recommended to improve retention. However, it is crucial to acknowledge that no single intervention will suffice, as the factors influencing specialist retention in remote areas of Indonesia are complex and multifaceted.

Veterinary students' attitudes toward anesthesiology as a specialty.

OBJECTIVE: To identify the perceptions of veterinary students interested in specialization regarding veterinary anesthesiology. STUDY DESIGN: Cross-sectional, multi-institutional, voluntary, anonymous, nonrandomized survey. POPULATION: Veterinary students (303 of 557 total respondents) from 10 veterinary schools. METHODS: Quantitative data were obtained via 5-point Likert scale questions about anesthesia-related topics. Open-ended questions were used to obtain qualitative data. A multivariate logistic regression model assessed the likelihood of choosing a career as an anesthesiologist. Spearman's rank correlation coefficient was used to assess the relationship between 'anesthesia is interesting' and other variables. RESULTS: Of the respondents, 14 (6%) indicated veterinary anesthesia as their chosen specialty. There was a significant positive relationship between 'anesthesia is interesting' and the following variables: age, enjoyment in anesthesia class, belief in the importance of anesthesia for their career, belief in the importance of analgesia for their career, belief that anesthesia and analgesia have a large impact on patient care, interest in pharmacology, interest in physiology, interest in learning technical skills, belief that anesthesiologists are respected by their colleagues and belief that anesthesiologists are an important part of the health care team. More weeks on the anesthesia clinical rotation was positively and significantly associated with increased rotation enjoyment. Enjoyment in the anesthesia class [p = 0.001, Exp(ß) = 2.1, 95% confidence interval (CI): 1.3-3.4] and belief that anesthesia is interesting [p = 0.013, Exp(ß) = 2.6, 95% CI: 1.2-5.4] were predictors that respondents would be more likely to consider a career as a veterinary anesthesiologist. CONCLUSIONS: Those veterinary students with an interest in pharmacology and who enjoyed their anesthesia course were more likely to consider a career as a veterinary anesthesiologist. If students indicated no interest in specializing in veterinary anesthesia, they appreciated the value the specialty brings to animal care and believed that veterinary anesthesiologists are respected by their peers.

Patients report high information coordination between rostered primary care physicians and specialists: A cross-sectional study.

Our study aimed to describe patient experience of information coordination between their primary care physician and specialists and to examine the associations between their experience and their personal and primary care characteristics. We conducted a cross-sectional study of Ontario residents rostered to a primary care physician and visited a specialist physician in the previous 12 months by linking population-based health administrative data to the Health Care Experience Survey collected between 2013 and 2020. We described respondents' sociodemographic and health care utilization characteristics and their experience of information coordination between their primary care physician and specialists. We measured the adjusted association between patient-reported measures of information coordination before and after respondents received care from a specialist physician and their type of primary care model. 1,460 out 20,422 (weighted 7.5%) of the respondents reported that their specialist physician did not have basic medical information about their visit from their primary care physician in the previous 12 months. 2,298 out of 16,442 (weighted 14.9%) of the respondents reported that their primary care physician seemed uninformed about the care they received from the specialist. Females, younger individuals, those with a college or undergraduate level of education, and users of walk-in clinics had a higher likelihood of reporting a lack of information coordination between the primary care and specialist physicians. Only respondents rostered to an enhanced fee-for-service model had a higher odds of reporting that the specialist physician did not have basic medical information about their visit compared to those rostered to a Family Health Team (OR 1.22, 95% Cl 1.12-1.40). We found no significant association between respondent's type of primary care model and that their primary care physician was uninformed about the care received from the specialist physician. In this population-based health study, respondents reported high information coordination between their primary care physician and specialists. Except for respondents rostered to an enhanced fee-for-service model of care, we did not find any difference in information coordination across other primary care models.

[What about extending Specialised Health Training to architecture and engineering?] / ¿Y si ampliamos la Formación Sanitaria Especializada para la arquitectura e ingeniería?

Projects and construction management in healthcare facilities are usually assigned to architectural firms and engineering companies with previous experience. However, there is no evaluation system to ensure their level of competence in the healthcare sector. In the past, this was also the case for clinicians when they were self-appointed specialists without any supervision. Currently, the Specialised Health Training (SHT) programme in Spain is the only official specialisation pathway and consists of a period that combines training and paid healthcare practice. Similarly, but from Argentina, hospital residencies in architecture have been carried out for specialised postgraduate training. The aim of this article was to show the experience in Argentina and to propose the extension of the SHT in Spain. Our proposal consists of a programme of residencies in architecture and engineering to be developed in healthcare centres. We believe that this initiative has great potential to address health from its multiple disciplines and to reinforce the maturity of a National Health System in constant change.

Los proyectos y la dirección de obras en los centros sanitarios se suelen asignar a estudios de arquitectura y empresas de ingeniería con experiencia previa. Sin embargo, no hay un sistema de evaluación que asegure su nivel de competencia en el sector sanitario. Antiguamente, esta situación también se daba en los profesionales clínicos, cuando se autotitulaban especialistas sin ningún tipo de supervisión. En la actualidad, el programa de Formación Sanitaria Especializada (FSE) en España es la única vía de especialización oficial y consiste en un periodo que aúna formación y práctica asistencial remunerada. De manera similar, pero desde Argentina, se llevan realizando unas residencias hospitalarias de arquitectura para la formación especializada de posgrado. El objetivo de este artículo fue mostrar la experiencia en Argentina y proponer la ampliación de la FSE en España. Nuestra propuesta consiste en un programa de residencias en arquitectura e ingeniería a desarrollar en centros sanitarios. Consideramos que esta iniciativa tiene un gran potencial para abordar la salud desde sus múltiples disciplinas y reforzar la madurez de un Sistema Nacional de Salud en constante cambio.

Roles and Responsibilities of the Global Specialist Digital Health Workforce: Analysis of Global Census Data.

Background: The Global Specialist Digital Health Workforce Census is the largest workforce survey of the specialist roles that support the development, use, management, and governance of health data, health information, health knowledge, and health technology. Objective: This paper aims to present an analysis of the roles and functions reported by respondents in the 2023 census. Methods: The 2023 census was deployed using Qualtrics and was open from July 1 to August 13, 2023. A broad definition was provided to guide respondents about who is in the specialist digital health workforce. Anyone who self-identifies as being part of this workforce could undertake the survey. The data was analyzed using descriptive statistical analysis and thematic analysis of the functions respondents reported in their roles. Results: A total of 1103 respondents completed the census, with data reported about their demographic information and their roles. The majority of respondents lived in Australia (n=870, 78.9%) or New Zealand (n=130, 11.8%), with most (n=620, 56.3%) aged 35-54 years and identifying as female (n=720, 65.3%). The top four occupational specialties were health informatics (n=179, 20.2%), health information management (n=175, 19.8%), health information technology (n=128, 14.4%), and health librarianship (n=104, 11.7%). Nearly all (n=797, 90%) participants identified as a manager or professional. Less than half (430/1019, 42.2%) had a formal qualification in a specialist digital health area, and only one-quarter (244/938, 26%) held a credential in a digital health area. While two-thirds (502/763, 65.7%) reported undertaking professional development in the last year, most were self-directed activities, such as seeking information or consuming online content. Work undertaken by specialist digital health workers could be classified as either leadership, functional, occupational, or technological. Conclusions: Future specialist digital health workforce capability frameworks should include the aspects of leadership, function, occupation, and technology. This largely unqualified workforce is undertaking little formal professional development to upskill them to continue to support the safe delivery and management of health and care through the use of digital data and technology.

Patient regional index: a new way to rank clinical specialties based on outpatient clinics big data.

BACKGROUND: Many existing healthcare ranking systems are notably intricate. The standards for peer review and evaluation often differ across specialties, leading to contradictory results among various ranking systems. There is a significant need for a comprehensible and consistent mode of specialty assessment. METHODS: This quantitative study aimed to assess the influence of clinical specialties on the regional distribution of patient origins based on 10,097,795 outpatient records of a large comprehensive hospital in South China. We proposed the patient regional index (PRI), a novel metric to quantify the regional influence of hospital specialties, using the principle of representative points of a statistical distribution. Additionally, a two-dimensional measure was constructed to gauge the significance of hospital specialties by integrating the PRI and outpatient volume. RESULTS: We calculated the PRI for each of the 16 specialties of interest over eight consecutive years. The longitudinal changes in the PRI accurately captured the impact of the 2017 Chinese healthcare reforms and the 2020 COVID-19 pandemic on hospital specialties. At last, the two-dimensional assessment model we devised effectively illustrates the distinct characteristics across hospital specialties. CONCLUSION: We propose a novel, straightforward, and interpretable index for quantifying the influence of hospital specialties. This index, built on outpatient data, requires only the patients' origin, thereby facilitating its widespread adoption and comparison across specialties of varying backgrounds. This data-driven method offers a patient-centric view of specialty influence, diverging from the traditional reliance on expert opinions. As such, it serves as a valuable augmentation to existing ranking systems.

Mixed practice was my plan then cattle health specialisation caught my attention.

Gaining experience in mixed practice was the starting point for Nicola Gladden, then locuming and travel gave her the space to decide which career route to follow next, choosing a residency pathway.

Pediatric subspecialty outreach clinics: reach and impact on access to care.

BACKGROUND: Recent research highlighting a shortage of pediatric subspecialists in the United States has shown wide variations in the distance from children to the nearest subspecialists but has not accounted for subspecialty outreach clinics, in which specialists may improve access in rural areas by periodically staffing clinics there. This study aimed to determine the impact of pediatric subspecialty outreach clinics on the driving times to the nearest pediatric subspecialists for children in Maine. METHODS: This cross-sectional study utilized administrative data on the schedule and location of pediatric subspecialty clinics in Maine in 2022 to estimate the driving time from each ZIP-code tabulation area to the nearest subspecialist, with and without the inclusion of outreach clinics. Using 2020 census data, we calculated the median and interquartile ranges of driving times for the state's overall child population, as well as for children living in urban and rural areas. RESULTS: Of 207,409 individuals under 20 years old in Maine, 68% were located closer to an outreach location than to a clinical hub. Across the seven subspecialties offering outreach clinics, outreach clinics decreased median driving times to the nearest pediatric subspecialist by 5 to 26 minutes among all children, and by 16 to 46 minutes among rural children. CONCLUSIONS: Pediatric subspecialty outreach clinics can substantially reduce the driving time to the nearest pediatric subspecialist , especially for children living in rural areas. The use of outreach clinics should be accounted for in research describing the geographic access or barriers to care. Expanding the number of outreach clinics should be considered by policymakers hoping to improve access.

Early sports specialization in Japanese young soccer players and related factors.

Although understanding the status of sports participation is essential for preventing injuries in young athletes, the level of specialization and relevant information in Japan is unknown. This study aimed to clarify the status of sports specialization and examine the relationships between specialization and training status in Japanese young soccer players. Four hundred Japanese young male soccer players were included. The players' parents completed a web questionnaire that consisted of three-point questions regarding specialization and training status (year, days of playing soccer, age when starting soccer). The level of specialization and accompanying information were calculated, and data were compared by specialization status. Of the participants, 53.8% demonstrated a high level of specialization. In addition, 74.5% considered soccer more important than other sports, 89.0% trained in soccer for more than 8 months of the year, and 74.0% had quit other sports to focus on soccer or played only soccer. The proportion of participants who played only soccer was significantly higher in the high-specialization group (37.6%) than in the moderate-specialization (22.5%; P < .01) and low-specialization (7.1%; P < .01) groups. By specialization status at grades 4 to 6 (9-12 years), 40.3% of participants demonstrated a high level of specialization. Young Japanese soccer players tend toward early specialization. Factors contributing to the high specialization level are being active throughout the year and rarely playing other sports. Training volume should be controlled, and an environment allowing young soccer players to participate in other sports simultaneously is needed, with early specialization being avoided.

Team-based care in specialist practice: a path to improved physician experience in British Columbia.

BACKGROUND: Specialist physicians in the province of British Columbia commonly work on teams in acute care settings such as operating rooms or inpatient hospital units. However, while the implementation of team-based care (TBC) has been supported in primary care clinics, no formal mechanisms have supported specialist physicians in adopting TBC in their private outpatient offices. Adopting TBC models is associated with improving physician experience, efficiency, and patient experience. METHODS: The Institute for Healthcare Improvement Breakthrough Series guided a program to support 11 specialist physicians, representing nine different specialties, to develop and implement TBC in outpatient offices. Participants were supported through resources including funding, mentorship, and learning opportunities. To determine whether the program improved physician experience, quantitative data were collected using the validated Mini Z survey and qualitative data were collected through monthly reports, semi-structured interviews, and focus groups. Patient experience data were collected through surveys and follow-up calls. RESULTS: The fifteen-month program was successful, with 10 of the 11 specialists implementing TBC in their offices. The Mini Z results demonstrated that physician experience improved over the course of the program, with scores on job satisfaction, work pace, and time spent on the electronic medical record improving the most. Interviews with specialists and focus groups with specialists' team members support these findings, with participants stating that TBC modulates workloads, begins to affect burnout, improves work-life balance, and increases the efficiency of care. Patients reported positive experiences while receiving TBC. Patients were less likely to visit the emergency department after consultations with specialist teams, and providers agreed that their patients would be less likely to seek acute care because of the new practice models. CONCLUSION: TBC is a viable model for specialist physicians and their health care teams practicing in British Columbia to foster well-being, job satisfaction, and efficiency, and to improve patient experience. These findings may be of interest to specialists, health care providers, policymakers, and administrators looking to better support and retain specialist practices that are integral to patient care.