A questionnaire for quality control in postgraduate medical education in Switzerland.

BACKGROUND: To ensure high qualification standards in medical institutions, a questionnaire has been developed to evaluate the postgraduate medical education in Switzerland. AIM: This article describes the development and longitudinal analysis of a questionnaire using eight scales to assess the quality of postgraduate medical education. METHOD: The questionnaire has been administered to all residents every year since 2003. In 2020, 8,745 residents returned the questionnaire, resulting in a response rate of 70%. In addition, a survey is conducted annually among the directors of medical institutions. RESULTS: We present results of the directors' survey and the resident evaluation from 2020, as well as longitudinal data over 16 years. The mean values of the eight scales remained stable or increased slightly over the years. The decision-making culture scale is generally rated best by the residents, while the evidence-based medicine scale is rated as the least good. The most important drivers of residents' satisfaction with a training site are the work environment and leadership culture scales. The directors perceive the evaluation to be fair and useful. CONCLUSIONS: The questionnaire represents a reliable and useful tool for the quality control in postgraduate medical training. It provides yearly feedback to the directors regarding how the residents perceive their training giving insights for improvments.

[Polypharmacy and Neuroleptics in Swiss Nursing Homes in the Years 2019 and 2020]. / Polymedikation und Neuroleptika in Schweizer Pflegeheimen in den Jahren 2019 und 2020.

Polypharmacy and Neuroleptics in Swiss Nursing Homes in the Years 2019 and 2020 Abstract. We present data from 92404 clinical assessments from 619 Swiss nursing homes . The data were collected in 2019 and 2020 from over 65-year-old residents. Two-thirds of those studied had severe cognitive limitations, one quarter had significant behavioral disorders and just over half of the assessed patients showed signs of emotional instability or depression. 46% were treated with nine or more different drugs, 37% received a neuroleptic in 85% for more than 90 days. There is a positive correlation between the number of drugs taken, age, cognitive impairment and susceptibility to falls. Since neuroleptics are administered in 30% under uncertain indication and the susceptibility to falls is increased by 40% under neuroleptics, their use should be reduced in the course of structured interprofessional processes.

Care workers' view on factors leading to unplanned hospitalizations of nursing home residents: A cross-sectional multicenter study.

Nursing home residents have a high risk of adverse events during hospitalizations. Since up to two-thirds of hospitalizations of nursing home residents are rated as potentially preventable, this study aimed to describe factors related to unplanned hospitalizations and to describe rates of unplanned hospitalizations, comparing differences between high- and low-hospitalization nursing homes. This cross-sectional multicenter study was conducted in 19 Swiss nursing homes and used questionnaire surveys of ward supervisors (n = 33) and nursing staff (n = 146) and retrospectively assessed hospitalization data. The study revealed several issues regarding unplanned hospitalizations, mostly concerning limitations regarding physicians' availability, lack of acquaintance of on-call physicians with the residents, and health professionals' lack of knowledge about the residents' wishes concerning therapeutic decisions. Our findings suggest that standardizing advance care planning processes and better physician availability might further reduce hospitalizations and improve quality of care in nursing homes.

[Iron substitution in outpatients in Switzerland: Increase of costs associated with intravenous administration]. / Ambulante Eisensubstitution in der Schweiz - Kostensteigerung infolge venöser Applikation.

Iron anaemia and iron-deficient erythropoiesis are treated with oral iron supplements. For chronic haemodialysis or in the case of therapy failure or intolerance to oral iron therapy, intravenous supplements are administered. The costs of iron supplements borne by statutory health care insurance had strongly increased during the observation period from 2006 to 2010. Based on the invoice data of a large health insurance company with a market share of around 18 %, prescription data of iron preparations and laboratory tests were analysed and extrapolated to the Swiss population. During the 5-year observation period, costs of intravenous iron substitution increased by 16.5 m EUR (340.3 %) and the number of individuals treated by 243.5 %. A sharp rise was observed in women of menstruating age, which was mainly due to prescriptions issued by primary care physicians. More than 8 % of intravenous iron substitutions were administered without prior laboratory analysis,and must therefore be regarded as off-label use. A cost-benefit analysis is needed to demonstrate the additional value of intravenous over oral iron supplementation, and intravenous iron supplementation should be administered only to patients with proven iron deficiency.

Attitudes toward shared decision-making and risk communication practices in residents and their teachers.

BACKGROUND: Health professionals' attitudes toward shared decision-making (SDM) are an important facilitator of SDM, but information on these attitudes is limited. AIMS: The purpose of this study is to examine attitudes, education and practices around SDM and risk communication in residents and their teachers. METHOD: A questionnaire was mailed to residents in Swiss hospitals in postgraduate medical training programs assessing risk communication education and SDM. In an Internet survey, teachers of the medical training programs answered questions on SDM and risk communication practices. Data were analyzed with ANOVAs and paired samples t-tests. RESULTS: Significant differences in residents' and teachers' opinions regarding SDM were found between specialties and number of residents in a residency (1-3, 4-10, ≥11 residents). Teachers showed a high use of verbal risk communication. Neither residents nor teachers expressed a strong feeling that they lacked the time for decision-making. Residents were significantly more negative about the ability of patients to participate in decision-making compared to their teachers. CONCLUSIONS: As residents are more negative about SDM compared to teachers and teachers do not always use the preferred and best methods for risk communication, more education for teachers and residents is needed to improve communication practices in the future.

Residents' reasons for specialty choice: influence of gender, time, patient and career.

OBJECTIVE This study examined reasons for specialty choice among Swiss residents (post graduate doctors training in specialties). METHODS In 2006, a questionnaire was sent to 8626 Swiss residents registered in postgraduate medical training programmes to obtain specialist qualifications. The response rate was 65% (n = 5631). As residents are allowed to decide on the specialty they want to acquire later in the training process, only residents who had already chosen a specific specialty were included (n = 5038). In responding, residents rated the importance of 19 factors in making their choice of specialty. Categorical principal component analysis was conducted to obtain underlying dimensions within the reasons for choice. A two-way analysis of variance was performed for each dimension to compare the mean object scores for the 10 specialties chosen by the most residents and to examine possible interactions by gender and year of graduation. Contrasts between the specialties were analysed with Scheffe post hoc tests. RESULTS Categorical principal component analyses yielded three factors underlying residents' choice of specialty, which explained 40.8% of the variance in responses: work and time-related aspects; career-related aspects, and patient orientation. Women considered work and time-related aspects and patient orientation to be more important factors in their choice, and career-related aspects to be less important, than did men. Career-related aspects became less important with advancing training status. CONCLUSIONS This study showed that reasons for specialty choice differ according to gender, year of graduation and specialty. With progressing training status, gender differences in reasons for choice and specialty choice may become more pronounced, especially regarding career aspects, which may lead to a change in preferred specialty. Therefore, a modular constructed postgraduate training programme might give residents the flexibility to change from one specialty to another.

A Swiss survey on teaching evidence-based medicine.

QUESTIONS UNDER STUDY: To explore the degree to which evidence-based medicine (EBM) is taught in postgraduate training in different clinical fields. METHODS: A questionnaire was mailed to all residents in Swiss hospitals in postgraduate medical training programs to obtain specialist titles. Response rate was 65%. In an Internet survey, directors of the medical training programs answered questions on teaching EBM. Response rate was 75%. RESULTS: Four items used to measure the teaching of EBM formed a reliable scale. Teaching EBM is more important in internal medicine than in the other clinical fields examined. The lowest values were obtained for general surgery. Higher values were observed in the teacher sample compared with the resident sample. CONCLUSIONS: In most clinical fields, EBM seems not to be an important part of the curriculum. Residents evaluate the training differently from teachers. Feedback mechanisms are essential so that teachers can know how their training programs are evaluated.

Adverse drug events caused by medication errors in medical inpatients.

PRINCIPLES: In view of growing concern in recent years regarding medication errors as causes of adverse drug events (ADEs), we explore the frequency and characteristics of error-associated ADEs in medical inpatients. METHODS: All patients with ADEs or ADErelated hospital admission in a cohort of medical inpatients identified by "event monitoring" (SAS/CHDM database, Br J Clin Pharmacol 2000:49:158-67) were evaluated independently by two experienced physicians. ADEs were first divided into ADEs occurring during cohort stay (incident ADE) and ADE present prior to/at admission. ADEs were then grouped as error-associated ADEs (eADEs: indication error, missed contraindication, wrong dosage regimen or inadequate surveillance) and adverse drug reactions (ADRs: indication established, no contraindications, appropriate dosage regimen and adequate surveillance). RESULTS: Among the 6383 patients analysed (100%), 481 (7.5%) experienced at least one incident ADE. Incident ADRs occurred in 457 (7.2%). Incident eADEs were recorded in 28 patients, corresponding to an eADE incidence of 0.4% (95% CI: 0.2, 0.7). Error types were missing/inappropriate indication (4 cases), missed contraindications (9), relative overdoses (8), absolute overdoses (3) and inadequate clinical surveillance (4). The responsible drugs included antithrombotics (6), cardiovascular drugs (5), antibiotics (5), hypnotics (4) and non-steroidal anti-inflammatory drugs (3). ADE-related hospital admissions were observed in 262 patients (4.1%); 183 (2.9%) were classified as ADRs and 79 (1.2%) as eADEs. CONCLUSIONS: Incident eADEs were observed in 1 out of 250 patients and accounted for approximately 6% of ADEs. In contrast, eADEs accounted for 30% of ADE-related hospital admissions. Hence, in medical inpatients, eADEs represented a small fraction of total incident ADEs, whereas they contributed significantly to hospital admissions.