Commercial Interests in Continuing Medical Education: Where Do Electronic Health Record Vendors Fit?

The Accreditation Council for Continuing Medical Education (ACCME) will not accredit an organization that it defines as a commercial interest, that is an entity that produces, markets, resells, or distributes health care goods or services consumed by, or used on, patients. Thus, commercial interests are not eligible to be accredited organizations offering continuing medical education (CME) credit to physicians. This decision is based on the concern that commercial interests may use CME events to market their products or services to physicians, who then might inappropriately prescribe or administer those products or services to patients. Studies have shown that CME events supported by pharmaceutical companies, for example, have influenced physicians' prescribing behaviors.Currently, however, the ACCME does not recognize electronic health record (EHR) vendors, which are part of a multi-billion-dollar business, as commercial interests, and it accredits them to provide or directly influence CME events. Like pharmaceutical company-sponsored CME events, EHR vendor activities, which inherently only focus on use of the sponsoring vendor's EHR system despite its potential intrinsic limitations, can lead to physician reciprocity. Such events also may inappropriately influence EHR system purchases, upgrades, and implementation decisions. These actions can negatively influence patient safety and care. Thus, the authors of this Perspective call on the ACCME to recognize EHR vendors as commercial interests and remove them from the list of accredited CME providers.

Ethics and Industry Interactions: Impact on Specialty Training, Clinical Practice, and Research.

Physicians in training and their mentors must be cognizant of ethical concerns related to industry interactions. Mentors perceived to have conflicts of interest or to be engaging in misconduct can unconsciously and profoundly affect the learning and academic environment by implying certain values and expectations. Despite increased awareness of ethical concerns related to industry interactions in clinical practice and research, there remains a need for interventions to prevent ethical transgressions. Ethics education is essential and a move in the right direction, but it alone is likely inadequate in preventing unethical behavior. Education should be supplemented with ethical environments at institutions.

The socio-political scene and Henrys crisis influence on the curricula of physical education undergraduate courses in Brazil / O cenário sociopolítico e a influência da crise de Henry nos currículos de graduações em educação física no Brasil

ABSTRACT From 1980s to 1990s, the Brazilian Physical Education (BPE) was strongly influenced by the discussion concerning its identity as an academic discipline; the final period of the Brazilian military dictatorship; the regulation of the BPE as a profession. Hence, this study analyzed the influence of that epistemological and political setting on the curricula of three BPE undergraduate courses. The Political Pedagogic Project and the Curriculum Matrix of the three undergraduate courses, from public universities, were analyzed using two qualitative research techniques: body of knowledge analysis, and content analysis. The results showed that the curricula analyzed did not cover a definition of professional intervention procedures based on ethical conduct specific to the area. Furthermore, the knowledge basis of the curricula is mainly constituted by discipline knowledge, which contributes to distancing the student's training from their field of professional practice . These findings may be associated with the insufficient epistemological discussion early initiated by Henry's works and unclear definition if the BPE is an academic or professional area. This investigation suggests that political disputes related to professionalization of BPE overlapped the academic discussions, which might have contributed to the problems identified on the preparation through bachelor courses of physical education professionals.

RESUMO De 1980 a 1990, a Educação Física Brasileira (EFB) foi fortemente influenciada pela discussão sobre sua identidade como disciplina acadêmica; pelo período final da ditadura militar; e pela regulamentação da EFB como profissão. Assim, este estudo analisou a influência dessa configuração epistemológica e política sobre o currículo de três cursos de graduação em Educação Física (EF) no Brasil. O Projeto Político Pedagógico e a Matriz Curricular dos três cursos, de universidades públicas, foram analisados utilizando duas técnicas de pesquisa qualitativa: análise do corpo de conhecimento e análise de conteúdo. Os resultados mostraram que todos os currículos analisados não apresentaram uma definição clara dos procedimentos de intervenção profissional baseados em condutas éticas específicas da área. Além disso, a base de conhecimento dos currículos é principalmente constituída pelo conhecimento acadêmico, contribuindo para o distanciamento da formação do graduando com o campo de atuação profissional. Essas descobertas podem estar associadas à insuficiente discussão epistemológica que foi iniciada pelos trabalhos de Henry e a não definição se a EFB é uma área acadêmica ou profissional. Esta investigação sugere que as disputas políticas relacionadas à profissionalização da EFB se sobrepuseram às discussões acadêmicas, o que pode ter contribuído para os problemas identificados na formação do tipo bacharelado dos profissionais de EF.

An Ethiopian Training Program in Neurosurgery with Norwegian Support.

After a 4-year planning period, a joint Ethiopian/Norwegian training program in neurosurgery was started in June 2006. The collaborating partners were Addis Ababa University; Department of Surgery, Tikur Anbessa Specialized Hospital; University of Bergen; Haukeland University Hospital; and Myungsung Christian Medical Center, a Korean missionary hospital in Addis Ababa, Ethiopia. A memorandum of understanding was signed at dean/chief executive officer levels. Although other initiatives have been involved in supporting neurosurgery in Addis Ababa during the same period, this institutionally founded program has been the main external contributor to neurosurgical capacity building through the education of 21 Ethiopian neurosurgeons, and in supporting a sustainable environment for neurosurgical training within a network of 5 centers in Addis Ababa. This article gives an account of the strategies underlying the program planning, the history of the program, and on the experience gained by it. Finally, ethical problems and challenges encountered in the program are discussed.

Consultation's sleight of hand seeks to sugar unpalatable bursaries pill.

The Department of Health's consultation on student bursaries has begun and people are being encouraged to take part in it. However, this consultation is not a consultation - it is predictable spin where sleight of hand seeks to sugar an unpalatable pill.

¿Nos formamos los pediatras para publicar artículos médicos? Encuesta piloto / How are pediatricians trained to write biomedical articles? A pilot study

Introducción: Redactar y publicar requiere una metodología, una organización y una sistemática que los pediatras deben conocer. Objetivo: Evaluar la formación en publicaciones biomédicas entre los pediatras y especialistas médicos que trabajan en nuestra área de pediatría, así como su experiencia personal respecto a la publicación de artículos. Material y métodos: Se realizó una encuesta de oportunidad con 13 preguntas cerradas y una mixta sobre formación, experiencia y motivación para publicar. La muestra estuvo constituida por los asistentes a una sesión sobre «Cómo publicar artículos » de un curso dirigido a pediatras, médicos de familia, residentes de pediatría (MIR-pediatría) y residentes de medicina familiar. La estadística descriptiva se llevó a cabo con el programa SPSS versión 15. Resultados: La población diana estuvo formada por 53 médicos; cumplimentaron el cuestionario 34 (64,1%). Sólo 13 de los 34 respondedores (38%) refirieron haber asistido a cursos o seminarios sobre cómo realizar una publicación: 9 de 21 pediatras (42,8%), 2 de 6 MIR-pediatría (33,3%) y 2 de 7 MIR-medicina de familia (28,6%). Respecto a la experiencia, 18 pediatras (85,7%) publicaron al menos 1 artículo en los últimos 5 años; publicaron más de 5 artículos 5 pediatras (23,8%), 2 MIR-pediatría (ambos menos de 6 artículos) y 5 MIR-medicina de familia. Respecto a la motivación, publicar les resultó «demasiado difícil» a 5 (un 20% de los que publicaron). El motivo principal para publicar fue el currículum personal (un 94,1% de 34). Discusión: Este estudio piloto nos sirvió para conocer la realidad y la necesidad formativa para escribir artículos biomédicos en nuestra muestra local. Es una propuesta para extender este tipo de estudios a otros distritos o áreas sanitarias. Un porcentaje importante señaló que no le resultó emocionalmente positivo publicar, antes al contrario, que tuvo «demasiadas dificultades». Conclusiones: En nuestra muestra se observa una falta de formación percibida en escritura científica. Para conocer, promover y orientar las necesidades de formación en docencia sobre escritura biomédica, creemos recomendable potenciar herramientas como este tipo de encuestas (AU)

Title: How are pediatricians trained to write biomedical articles? A pilot study Introduction: Writing and publishing require a methodology, organization, and systematics that all pediatricians should know. Objective: To evaluate the level of training on biomedical publications among pediatricians and other medical specialists who work in pediatrics in our area, as well as their personal experience in publishing. Material and methods: An opportunity survey with 13 closed questions and another mixed question on training, experience, and motivation to publish. Sample: physicians attending to a lecture about «How to publish articles» from a course aimed to pediatricians, family physicians, pediatrics residents (MIR-pediatrics), and residents in family medicine (MIR-family physicians). Descriptive statistics: SPSS version 15. Results: The target population was 53 physicians. Thirty four (64.1%) fulfilled the questionnaire. Only 13 (38.2%) from the people who answered were trained in publication techniques (through courses and seminars): pediatricians 9 out of 21 (42.8%), MIR-pediatrics 2 out of 6 (33.3%), MIR-family physicians 2 out of 7 (28.6%). Experience: a) published at least one article in the last 5 years: pediatricians 18 (85.7%); b) more than 5 articles: pediatricians 5 (23.8%), MIR-pediatrics 2 (33%, both <6 articles), MIR-family physicians 5. Motivation: publishing was experienced as «too difficult» for 5 (20% of those who had published). The main reason for publishing was personal curriculum (94.1% of 34). Discussion: This pilot study offers a glance at reality and let us know the necessity to train on how to write biomedical article. This work is a proposal to extend this kind of studies to other districts or sanitary areas. A considerable percentage of people didn't remark publishing as emotionally positive, instead, they found it «too difficult». Conclusions: In our sample, a lack of training in scientific writing has been proven. We recommend enhancing tools such as these surveys, in order to discover, promote, and guide through training skills to teach biomedical writing (AU)

Conflicts of interest in medical school: missing policies and high need for student information at most German universities.

OBJECTIVES: Medical students interact with pharmaceutical representatives already during medical school. The goal of this study was to find out: Do policies exist at German medical faculties that govern the interactions between medical students and pharmaceutical representatives, do schools offer courses on the subject and do students attend these courses? And What are the attitudes of medical students concerning the role of pharmaceutical companies in medical teaching? METHODS: All 36 German medical faculty deans and 1151 medical students at eight German universities were asked to complete a questionnaire of 4 and 7 questions, respectively, regarding the above mentioned topics. RESULTS: 30 (83.3%) deans and 1038 (90.3%) medical students filled in the questionnaire, respectively. According to the deans' answers, only one school had a policy concerning conflicts of interest and one had a policy governing the interactions between medical students and industry. 8 (26.7%) deans showed an interest in constructing a policy or educational an activity on this subject. 149 (14.4%) students had participated in an activity that focussed the subject of conflicts of interest and 779 (77.8%) wanted more education on the subject. 701 (73.4%) were opposed to an improvement of medical studies through financial support by pharmaceutical companies, whereas 216 (21.9%) were of the opinion that students should not meet with pharmaceutical representatives. CONCLUSIONS: Unlike in other countries, like the US, most German medical faculties do not have policies that govern the interactions between medical students and pharmaceutical companies. Since most students want to be taught more about these interactions, the implementation of respective policies and lectures would be desirable.

The two (institutional) cultures: a consideration of structural barriers to interdisciplinarity.

C. P. Snow's famous Two Cultures essay has become a foil for decades of discussions over the relation between science and the humanities. The problem of the "two cultures" is often framed in terms of how the particular epistemological claims or general intellectual orientations of particular individuals on either side of this purported divide obstruct interdisciplinary dialogue or cooperation. This formulation, however, fails to consider the institutional frameworks within which such debates occur. This article examines the broader structural constraints that provide incentives, erect barriers, or otherwise shape the potential for interdisciplinary research and practice, with particular attention to work involving the life sciences. It argues that in order to understand the nature and scope of the problems facing interdisciplinary work, we must focus on the institutional constraints that shape how individuals frame questions, pursue investigations, develop careers, and collaborate.

The relationship between industry and surgery.

This article examines industry's involvement in medicine, particularly with respect to surgeons and clinical research, as well as continuing medical education. We describe some historical events involving industry and how these events have led to guidelines by various organizations to handle conflicts of interest. We also review the advantages and disadvantages of collaborating with industry and provide practical guides for interactions with industry in terms of clinical research, continuing medical education, and clinical practice. With careful consideration to protect all parties involved, collaboration with industry can be advantageous to surgeons, industry, and patients.

El compromiso social de las facultades de educación: reflexiones pedagógicas en torno a la educación y la crisis de la modernidad / The social commitment of the colleges of education: pedagogical reflections around education and the modernity crisis

Este escrito parte del siguiente supuesto teórico: las facultades de educación en su fundamentación pedagógica requieren reconstruir y reflexionar acerca de sus compromisos sociales. Sin embargo, y como consecuencia de las cada vez más sugestivas y colonizadoras dinámicas del pensamiento consumista, este tema ha pasado en los últimos tiempos a ser un asunto periférico. Por lo anterior, en este texto se reivindica el tema del compromiso social como asunto fundante y central para la configuración pedagógica de las Facultades de educación

This text starts from the following theoretical assumption: the colleges of education, in their pedagogical foundation, require to reconstruct and to reflect about their social commitments. Nevertheless and as a consequence of the more and more thought-provoking and colonizing dynamics of the consumeristic thought, this issue has been recently become a peripheral matter. Due to the above, in this text, the issue of social commitment, as a founding matter, is demanded, and it is key to the pedagogical configuration of the colleges of education

Posibilidades y límites de la universidad latinoamericana desde una perspectiva histórica / Possibilities and limits of the latin american university from a historical perspective

La Universidad Latinoamericana se configuró a través de la historia bajo el influjo de diversas fuerzas que le dieron una forma particular dados los contextos específicos donde surgió, en relación con las potencias coloniales, la iglesia, el Estado y el impacto de los diferentes modelos que se establecieron acerca de los propósitos a los que debía atender, definidos por los ingleses, franceses, alemanes y americanos. Pese a los intereses que se ciernen sobre La Universidad Latinoamericana, surgen desde múltiples miradas (las experiencias de México, Perú, Guatemala, Argentina, Chile y Colombia), posibilidades de considerar la idea de estructurar un pensamiento propio, que diera cuenta de una identidad distinta que la separa del discurso eurocentrista y la ubica en una perspectiva de análisis concerniente a las realidades a las que debe hacer frente. En la conformación de la Universidad Latinoamericana se ubican entonces, el pensamiento de Andrés Bello, las ideas de José Vasconcelos y las implicaciones del movimiento de Córdoba, en relación con otros movimientos sociales y estudiantiles con características similares, que convergen en la reflexión acerca de la necesidad de hacer un giro decolonial, no sólo a modo de resistencia, sino de autoconciencia acerca de quiénes somos y cómo cimentar un futuro común, fundamentalmente en esta época cuando la Universidad Latinoamericana enfrenta los embates de la globalización y la aplicación de políticas macroeconómicas que desdibujan su ser social y académico deslegitimándola

The Latin American University, throughout history, was shaped under the influence of diverse forces which outlined it in a particular manner, given the specific contexts where it appeared, in relation with colonial powers, the church, the State, and the impact of the different models which were established based on the purposes it had to fulfill, which were defined by the English, the French, the German, and the American people. Despite the interests which hang over the Latin American university, from diverse glances (the experiences of Mexico, Peru, Guatemala, Argentina, Chile, and Colombia) appear possibilities of considering the idea of restructuring an individual thinking which could recount a different identity that separates it from the Euro-centered discourse and places it in a perspective of analysis concerning the realities it has to deal with. In the configuration of the Latin American University, the following can stand out: Andrés Bello’s thought, José Vasconcellos’ ideas, and the implications of the Movement of Cordoba, as for the social and student movements with similar characteristics, which are directed toward the reflection about the need of making a decolonized change, not just as a matter of resistance, but of self-awareness of who we are and how to strengthen a common future. This is especially done in this epoch when the Latin American University is facing the attacks of globalization and the application of macro-economic policies that blur its social and academic being, undermining it