US Medical Licensing Exam Performance and American Board of Surgery Qualifying and Certifying Examinations.

BACKGROUND: Program directors use US Medical Licensing Exam (USMLE) scores as criteria for ranking applicants. First-time pass rates of the American Board of Surgery (ABS) Qualifying (QE) and Certifying (CE) Examinations have become important measures of residency program quality. USMLE Step 1 will become pass/fail in 2022. STUDY DESIGN: American Board of Surgery QE and CE success rates were assessed considering multiple characteristics of highly ranked (top 20) applicants to 22 general surgery programs in 2011. Chi-square, t-test, Wilcoxon Rank sum, linear and logistic regression were used, as appropriate. RESULTS: The QE and CE first attempt pass rates were 96% (235/244) and 86% (190/221), respectively. QE/CE success was not significantly associated with sex, race, research experience, or publications. Alpha Omega Alpha (AΩA) status was associated with success on the index CE (98% vs 83%; p = 0.008). Step 1 and Step 2 Clinical Knowledge (CK) scores of surgeons who passed QE on their first attempt were higher than scores of those who failed (Step 1: 233 vs 218; p = 0.016); (Step 2CK: 244 vs 228, p = 0.009). For every 10-point increase in Step 1 and 2CK scores, the odds of passing CE on the first attempt increased 1.5 times (95% CI 1.12, 2.0; p = 0.006) and 1.5 times (95% CI 1.11, 2.02, p = 0.008), respectively. For every 10-point increase in Steps 1 and 2CK scores, the odds of passing the QE on the first attempt increased 1.85 times (95% CI 1.11, 3.09; p = 0.018) and 1.86 times (95% CI 1.14, 3.06, p = 0.013), respectively. CONCLUSIONS: USMLE Step 1 and Step 2 CK examination scores correlate with American Board of Surgery QE and CE performance and success. The USMLE decision to transition Step 1 to a pass/fail examination will require program directors to identify other factors that predict ABS performance for ranking applicants.

Emergency Medicine Journal Editorial Boards: Analysis of Gender, H-Index, Publications, Academic Rank, and Leadership Roles.

INTRODUCTION: Our goal in this study was to determine female representation on editorial boards of high-ranking emergency medicine (EM) journals. In addition, we examined factors associated with gender disparity, including board members' academic rank, departmental leadership position, h-index, total publications, total citations, and total publishing years. METHODS: In this retrospective study, we examined EM editorial boards with an impact factor of 1 or greater according to the Clarivate Journal Citations Report for a total of 16 journals. All board members with a doctor of medicine or doctor of osteopathic medicine degree, or international equivalent were included, resulting in 781 included board members. We analyzed board members' gender, academic rank, departmental leadership position, h-index, total publications, total citations, and total publishing years. RESULTS: Gender disparity was clearly notable, with men holding 87.3% (682/781) of physician editorial board positions and women holding 12.7% (99/781) of positions. Only 6.6% (1/15) of included editorial board chiefs were women. Male editorial board members possessed higher h-indices, total citations, and more publishing years than their female counterparts. Male board members held a greater number of departmental leadership positions, as well as higher academic ranks. CONCLUSION: Significant gender disparity exists on EM editorial boards. Substantial inequalities between men and women board members exist in both the academic and departmental realms. Addressing these inequalities will likely be an integral part of achieving gender parity on editorial boards.

Gender Representation at Conferences, Executive Boards, and Program Committees in Otolaryngology.

OBJECTIVE: Women represent approximately 28.0% of academic otolaryngologists. Previous studies have shown that women in academic medicine, including surgical subspecialties, have disparate career advancement opportunities and grant funding compared to male counterparts. Representation at major academic meetings is an important career advancement opportunity. In this study, we assess the representation of women at otolaryngology conferences. STUDY DESIGN: Cross-sectional analysis of otolaryngology conference programs. METHODS: All publicly available scientific programs from The American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting (AAO-HNSF), the Triological Society Annual Combined Sections Meeting (TS), and the Triological Society Annual Meeting at Combined Otolaryngology Spring Meetings (TS-COSM) were obtained and analyzed. Name and gender were collected, along with the type of role: speaker, panelist, oral session moderator, and other leadership positions. Yearly trends were analyzed and compared between the conferences and in aggregate. RESULTS: AAO-HNSF had available scientific programs from 2012-2017, while TS and TS-COSM had programs available from 2003-2018. Across all conferences and years, 16.9% of recorded opportunities were occupied by women, with an upward trend from 2005 to 2018. Program committees had the highest proportion of women (21.4%) and presidential citation and guest of honor recipients had the lowest (9.1%). Of all panels, 87.5% did not have any women panelists in 2003, but by 2018 only 24.0% panels were male-only. There was marked repetition among women occupying roles, with only 423 unique women occupying a total of 1,733 filled spots. CONCLUSION: Measured representation of women in academic otolaryngology conferences has improved from 2003-2018. Despite this improvement, gender disparity still exists. LEVEL OF EVIDENCE: 5 Laryngoscope, 131:E373-E379, 2021.

Association Between Sex Composition and Publication Productivity of Journal Editorial and Professional Society Board Members in Ophthalmology.

Importance: Because women remain underrepresented in leadership positions in medicine, including ophthalmology, knowledge of sex composition of ophthalmic journal editorial and professional society boards seems warranted. Objectives: To investigate the sex composition of ophthalmic journal editorial and professional society boards and compare the publication productivity and number of citations of male vs female board members. Design, Setting, and Participants: In this cross-sectional study, the SCImago Journal Rank indicator was used to identify the 20 highest-ranked ophthalmology journals. Faculty members from each ophthalmic subspecialty were surveyed within a US academic ophthalmology department to identify 15 influential ophthalmology societies. The 2018 board members of each journal and society were identified from the journals' and societies' official websites, and the sex of each individual was recorded. Information regarding journals and societies was collected from October 1 to December 31, 2018. The Scopus database was accessed in January 2019 and then used to find each member's h-index and m-quotient. Main Outcomes and Measures: The h-index, defined as the highest number of an author's publications that received at least h number of citations, was calculated for each board member. The m-quotient, which accounts for varying lengths of academic careers, was calculated by dividing the h-index by the number of years since first publication. Results: Of the 1077 members of ophthalmic journal editorial and society leadership boards, 797 (74.0%) were men and 280 (26.0%) were women. Among the 24 editors in chief of the 20 journals investigated, 23 (95.8%) were male. Thirteen of the 15 professional society presidents (86.7%) were men. Male board members had significantly higher median h-indexes (male vs female journals: 34 [interquartile range {IQR}, 23-47] vs 28 [IQR, 19-40], P < .001; male vs female societies: 27 [IQR, 15-41] vs 17 [IQR, 8-32], P = .006), median publication numbers (male vs female journal board members: 157 [IQR, 88-254] vs 109 [IQR, 66-188], P < .001; male vs female society board members: 109 [IQR, 57-190] vs 58 [IQR, 28-139, P = .001), and median citations (male vs female journal board members: 4027 [IQR, 1897-8005] vs 2871 [IQR, 1344-5852], P < .001; male vs female society board members: 2228 [IQR, 1005-5069] vs 1090 [IQR, 410-2527], P = .003). However, the median m-quotients for male and female board members were comparable (male vs female journal board members: 1.2 [IQR, 0.8-1.6] vs 1.1 [IQR, 0.8-1.5], P = .54; male vs female society board members: 1.0 [IQR, 0.7-1.4] vs 0.9 [IQR, 0.6-1.3], P = .32). Conclusions and Relevance: The findings suggest that the sex composition on journal editorial and professional society boards in ophthalmology is consistent with the sex composition of ophthalmologists in the US, as reported by the Association of American Colleges, but that editor in chief and society president positions are male dominated despite the apparent equality in academic productivity.

El rol directivo en la Universidad de Ciencias Médicas de Matanzas en cada una de sus etapas / The managing role in the University of the Medical Sciences of Matanzas in each organizational stage

RESUMEN Introducción: en la organización de las universidades, el saber y el poder se han administrado a través de cadenas lineales ascendentes, desde las cátedras y jefes de departamentos hasta el consejo Universitario y el rector. La actual universidad de Ciencias Médicas de Matanzas ha pasado por diferentes etapas o períodos y durante este proceso sus directivos han recibido diferentes nomenclaturas en función de la estructura asumida. A pesar del importante rol que tienen los gerentes o directivos del sistema, no se ha encontrado ningún documento en el que se recojan nombres y funciones desempeñadas, lo cual se considera importante para la historia de la Universidad. Objetivo: proponer dejar asentado los principales directivos del proceso docente educativo en la universidad de Ciencias Médicas de Matanzas en cada una de sus etapas. Materiales y métodos: se han utilizado métodos cualitativos del nivel teórico y del empírico, de este último las entrevistas y la revisión de documentos. Resultados: la investigación muestra definidos seis períodos o etapas en el desarrollo de la docencia médica en la provincia, su estructura organizativa y sus directivos especificando especialidad y períodos en que ejercieron su labor de dirección. Conclusiones: en todo el tiempo transcurrido desde los inicios de la docencia médica hasta la actualidad, se ha contado con equipos de dirección que han variado según los momentos históricos, pero que entre todos han logrado el objetivo de hacer perdurar la docencia médica en el territorio y que la misma haya alcanzado altos niveles de calidad.

ABSTRACT Introduction: in the organization of the universities, knowledge and management have been administered through lineally ascendant chains, from the chairs and professorships to the University Council and headmaster. The current University of Medical Sciences of Matanzas has gone through different stages and periods, and during this process its managing staff has received different denominations in dependence on the structure assumed by educational center. In spite of the important role played by the managing staff and headmasters, no document has been found recording their full names and performed functions, what is very important for the history of the University. Objective: to propose recording names and data of the main managers of the teaching-educative process in the University of Medical Sciences of Matanzas. Material and methods: Qualitative methods of the theoretical and empiric levels have been used, interviews and documental reviews among the last ones. Results: the research showed six well defined periods or stages in the development of medical teaching in the province of Matanzas, its organizational structure and members of the managing staff specifying medical specialty and periods of time they occupied that function. Conclusions: in the period of time passed from the beginning of the medical teaching and nowadays, the managing staff has varied according to the historical times, but the common effort has allowed the continuation of medical teaching in the province and the high quality levels it has reached.

El rol directivo en la Universidad de Ciencias Médicas de Matanzas en cada una de sus etapas / The managing role in the University of the Medical Sciences of Matanzas in each organizational stage

RESUMEN Introducción: en la organización de las universidades, el saber y el poder se han administrado a través de cadenas lineales ascendentes, desde las cátedras y jefes de departamentos hasta el consejo Universitario y el rector. La actual universidad de Ciencias Médicas de Matanzas ha pasado por diferentes etapas o períodos y durante este proceso sus directivos han recibido diferentes nomenclaturas en función de la estructura asumida. A pesar del importante rol que tienen los gerentes o directivos del sistema, no se ha encontrado ningún documento en el que se recojan nombres y funciones desempeñadas, lo cual se considera importante para la historia de la Universidad. Objetivo: proponer dejar asentado los principales directivos del proceso docente educativo en la universidad de Ciencias Médicas de Matanzas en cada una de sus etapas. Materiales y métodos: se han utilizado métodos cualitativos del nivel teórico y del empírico, de este último las entrevistas y la revisión de documentos. Resultados: la investigación muestra definidos seis períodos o etapas en el desarrollo de la docencia médica en la provincia, su estructura organizativa y sus directivos especificando especialidad y períodos en que ejercieron su labor de dirección. Conclusiones: en todo el tiempo transcurrido desde los inicios de la docencia médica hasta la actualidad, se ha contado con equipos de dirección que han variado según los momentos históricos, pero que entre todos han logrado el objetivo de hacer perdurar la docencia médica en el territorio y que la misma haya alcanzado altos niveles de calidad (AU).

ABSTRACT Introduction: in the organization of the universities, knowledge and management have been administered through lineally ascendant chains, from the chairs and professorships to the University Council and headmaster. The current University of Medical Sciences of Matanzas has gone through different stages and periods, and during this process its managing staff has received different denominations in dependence on the structure assumed by educational center. In spite of the important role played by the managing staff and headmasters, no document has been found recording their full names and performed functions, what is very important for the history of the University. Objective: to propose recording names and data of the main managers of the teaching-educative process in the University of Medical Sciences of Matanzas. Material and methods: Qualitative methods of the theoretical and empiric levels have been used, interviews and documental reviews among the last ones. Results: the research showed six well defined periods or stages in the development of medical teaching in the province of Matanzas, its organizational structure and members of the managing staff specifying medical specialty and periods of time they occupied that function. Conclusions: in the period of time passed from the beginning of the medical teaching and nowadays, the managing staff has varied according to the historical times, but the common effort has allowed the continuation of medical teaching in the province and the high quality levels it has reached (AU).

Regulating drivers with epilepsy in Maryland: Results of the application of a United States consensus guideline.

OBJECTIVE: Driving regulations for people with seizures vary widely throughout the United States and the world. Maryland updated their guidelines in 2003 to reflect those of a U.S. consensus guideline requiring a minimum 3-month seizure-free period as well as an individual risk assessment by a Medical Advisory Board (MAB). This retrospective study provides the first analysis of outcomes after the implementation of the consensus guidelines and an assessment of their predictive validity through longitudinal outcome data. METHODS: MAB reviews and licensing records for Maryland driver applicants with seizures between 2004 and 2005 were reviewed, during which 254 first-time applicants were processed. The initial licensing decisions were assessed and the subsequent seizure recurrence and crash rates over the following 7 years were evaluated. RESULTS: The MAB approved driving for 74.8% of initial applicants; most had been seizure-free for over 6 months. Approved drivers had a longer median seizure-free period (563 days) compared to those who were denied (104.5 days, p < 0.01), and 22.7% of approved drivers had seizures recur during monitoring over the next year, although none resulted in crashes or deaths. Of applicants initially denied (n = 50), 89.3% were eventually licensed. Treating physicians recommended driving for 84.4% of applicants rejected by the MAB. SIGNIFICANCE: Maryland's individualized system for assessing driving applicants with seizures resulted in a dynamic process of approvals and denials based on favorable and unfavorable risk factors and lengths of seizure freedom. Seizure recurrences were comparable to internationally accepted rates. Over the course of monitoring, most applicants were eventually licensed. Treating physicians recommended that nearly all their patient applicants be permitted to drive, which raises safety concerns for the 10 states that rely solely on physician recommendations. Further assessment is needed of the risk factors deemed favorable and unfavorable by the U.S. consensus guidelines.

Tumor Boards from the Perspective of Ambulant Oncological Care.

BACKGROUND: Cancer therapy requires the cooperation of physicians from different disciplines. At the core of the collaboration are 'tumor boards' (also known as 'multidisciplinary team meetings' and 'tumor conferences'). However, there is limited health care research that addresses the multiple facets of such meetings. MATERIAL AND METHODS: Data were analyzed from 3 routinely conducted surveys comprising information from (i) office-based hematologists and oncologists, (ii) their patients, and (iii) quality indicators. RESULTS: Most office-based oncologists stated that they participate in tumor boards taking place in hospitals. Although tumor boards are viewed as time intensive and lack financial compensation, they are considered as beneficial for patient care. Less than half of patients knew that their cases were discussed at a tumor board; those who knew rated the collaboration between their treating doctors as more positive, but also experienced slightly higher distress levels. The quality indicators showed that tumor board meetings were documented in three-quarters of the patient charts, but only half included the tumor board's recommendation. CONCLUSIONS: Participation in tumor boards is perceived as beneficial by oncologists and not just considered as a fulfillment of societies' recommendations or guidelines. The higher distress levels in patients who knew that their case was discussed at a tumor board may have occurred because more difficult cases are discussed at tumor boards and since the oncologists spend more time explaining the therapy process in complex cases, including the tumor board results.

Presencia de las mujeres en los órganos de dirección de los colegios profesionales del ámbito de la salud en 2015 / Presence of women in management bodies of the profesional associations of the field of health in 2015

Fundamentos: La progresiva incorporación de las mujeres en las profesiones sanitarias no se corresponde con su presencia en puestos de responsabilidad. Dado que los colegios profesionales tienen un papel esencial en la representación y regulación profesional, se plantea como objetivo describir la frecuencia de la presencia de las mujeres en las estructuras directivas de los colegios profesionales del ámbito de la salud en España y comprobar el grado de cumplimiento de los criterios de paridad. Métodos: Se identificó el género de la persona que ocupaba la presidencia, los cargos ejecutivos y la junta directiva visitando las webs del Consejo General de los colegios profesionales de Psicología, Consejo General de Colegios Oficiales de Médicos, Consejo General de Colegios Oficiales de Enfermería de España, Consejo General de Colegios de Fisioterapeutas, Consejo General de Dentistas, Organización Farmacéutica colegial y Consejo General de Colegios oficiales de Podólogos. Se describió el porcentaje de mujeres de forma global y según profesión y se comparó con las cifras de colegiados y colegiadas según el INE para 2014. Resultados: De 251 colegios profesionales en julio de 2015, 41 (21,91%) la presidencia estaba ocupada por mujeres. También ocupaban el 34,69% de los puestos ejecutivos y el 42,80% del total de las juntas directivas. Los colegios médicos y de enfermería tenían una mujer en la presidencia en el 11,32% y 43,48% respectivamente. Los de psicología fueron los que presentaron mayor presencia femenina en la presidencia, el 45,83%. Conclusión: No existe paridad entre hombres y mujeresen el conjunto de los colegios estudiados. La presencia femenina es mayor en colegios de psicología y enfermería y mucho menor en los de odontología, fisioterapia, podología y medicina con el nivel de responsabilidad disminuye la presencia de las mujeres (AU)

Background: The gradual increase of women in the health professions does not correspond with her presence in positions of power. Given that professional colleges have an essential role in the representation and professional regulation, arises as an aim to describe the presence of women in the managerial structures of the professional colleges of health in Spain now to verify the degree of compliance with the criteria of parity. Methods: The Spanish official professionals´ colleges were compiled by visiting the websites of the General Council of the Psychology of Spain, General Council of Medical Associations of Spain, General Council of Colleges of Nursing of Spain, General Council of Physiotherapists Schools of Spain, General Dental Council , Organization collegiate Pharmaceutical General and Council of Associations of Podiatrists. All their webs were visited. The sex of the presidency, the executive and the entire board was identified. Data were analyzed according to the overall percentage of women and profession. We compared this to the INE-2014 collegiate professionals. Results: Out of 251 professionals´ colleges in July-2015, 21, 91% had a female president. Women hold 34,69% of the executive positions and 42,80% of total boards. 11, 32% of Medical colleges had a female president and 43,48% of Nursing ones. The Psychology are those with more women in the presidency, 45, 83%. Conclusion: There is no parity, being higher in Psychology and Nursing and, much lower in Dentistry, Physiotherapy, Podiatry and Medicine. It decreases with the responsibility level. Health Inequality (AU)

Do patients have a voice? The social stratification of health center governing boards.

CONTEXT: To ensure community responsiveness, federally qualified health centres (FQHCs) in the United States are required to be governed by a patient majority. However, to the extent that these patient trustees resemble the typical low-income patients served by FQHCs, status generalization theory suggests that they will be passed over for leadership positions within the board in favour of more prestigious individuals. METHODS: Using 4 years of data on health centre governing boards obtained from the Health Resources and Services Administration via a Freedom of Information Act Request, the likelihood of holding executive committee office is modelled as a function of trustee characteristics using Chamberlain's conditional logistic regressions. RESULTS: The results indicate that representative patient trustees are significantly less likely than other trustees to hold a position on the executive committee or serve as board chair. CONCLUSIONS: Given the power of the board leadership to set the agenda, the reduced likelihood of representative patient trustees serving in leadership positions may ultimately limit the representative voice given to patients, making FQHCs potentially less responsive to their communities. These findings also have important implications for other settings where engaging and empowering patients is sought.

[Which medical errors do general practitioners make? Data from the Expert Arbitration and Advisory Board of the Baden-Württemberg State Medical Association]. / Welche Fehler machen Hausärzte? Daten der Gutachter-Kommission der Landesärztekammer Baden-Württemberg.

BACKGROUND: In Germany, medical error reporting systems are well established. They collect information reported principally by physicians. Systematic data collection concerning medical errors is also performed by expert arbitration and advisory boards of the German State Medical Associations. METHODS: Data base MERS (Medical Error Reporting System); cases from the Expert Arbitration and Advisory Board of the State Baden-Württemberg from the years 2004-2011 (8,042 cases) were evaluated as follows: extraction of the cases from general practitioners (n=307, 4%); categorisation of the type of error and degree of severity; classification according to ICD-10 (International Classification of Diseases); overview of confirmed cases including commentaries of the above board; logistic regression analysis of factors potentially associated with confirmed cases. RESULTS: In 26% (n=80) the board confirmed medical errors. 55% of the errors were assigned to the category "diagnosis" (n=44), 21% to "general therapy" (n=17), 8% to "operative therapy" ("minor surgical operations") (n=6) and 10% to "injections" (n=8). 29% of cases (n=23) were associated with permanent damage or death. The majority of cases could be assigned to ICD-10 categories "I" (cardiovascular system, n=20) and "S-T" or "V-Y" (consequences of external causes or external causes of morbidity and mortality, n=34). No significant associations were found by logistic regression analysis. CONCLUSION: The rate of confirmed cases corresponds with the rate of all medical disciplines. The presented overview is illustrative and may be of help to avoid errors by using it for continuing medical education.

A survey of board chairs of English hospitals shows greater attention to quality of care than among their US counterparts.

There is growing international interest in the role that hospital boards of directors play in improving the quality of health care. In England the National Health Service created a program to help boards become more effective at ensuring quality. We sought to evaluate how boards at English hospitals are engaged in quality, and we conducted the first national survey of the governance practices of the chairpersons of English hospitals. The survey was completed by 132 of 171 board chairs. We compared the results to those of a survey of the chairs of US hospital boards that we published in 2010. We found that English board chairs had more expertise in quality-of-care issues and spent a greater proportion of their time on quality of care than their US counterparts. At the same time, the association in England between hospital performance on quality metrics and board engagement in quality was generally not as substantial as was evident in our earlier US survey. English board chairs tend to greatly overestimate the quality performance of their hospitals, much as their US counterparts do. Our analysis suggests that there is room for improvement in both countries to bolster board expertise and focus on key quality metrics, and to hold managers accountable for the delivery of safe, effective health care.

Composition and duties of local boards of health: findings from a 2011 national survey.

OBJECTIVE: To describe the composition and duties of local boards of health (LBOHs). DESIGN: An online and written survey was utilized for data collection. The survey included demographics, roles and responsibilities, orientation and training, and concerns and needs of LBOHs. SETTING: This article seeks to expand what limited information we have on the composition and duties of LBOHs as an important foundational step in analyzing the role of LBOHs in leveraging improved public health outcomes. PARTICIPANTS: In 2011, the mixed methods survey was sent to a random sample of 2420 LBOHs in the 41 states, which meet the definition of having LBOHs. MAIN OUTCOME MEASURE: The data represent responses from 353 LBOHs in 35 states. RESULTS: Elected officials appoint members of 68% of LBOHs. The average board consists of a 7-member, county-based LBOH made up primarily of males (60%) and whites (96%). Hispanics make up 9% of boards. The majority of LBOH chairs have a graduate degree but no formal education or experience in public health. Local boards of health report reviewing public health regulations as their most common power but list recommending the approval of the budget for the local health department as boards' most frequent activity in the past 3 years. CONCLUSIONS: LBOH members and chairs are more similar in demographics to the top executives at local health departments than the general population or the public health workforce. Most LBOH chairs, however, lack experience in public health, and a quarter or more of LBOHs do not use their powers to set or recommend health priorities as a mechanism to leverage better community health outcomes.

Variation in the adoption of patient safety practices among New Zealand district health boards.

OBJECTIVE: To investigate the adoption and impact of quality improvement measures in New Zealand hospitals. METHOD: Structured interviews with quality and safety managers of District Health Boards (DHBs). Correlation of use of measures with adjusted 30-day mortality data. RESULTS: Eighteen of New Zealand's 21 DHBs participated in the survey. Structural or policy measures to improve patient safety, such as credentialing and event reporting procedures, had been introduced into all DHBs, whereas changes to general clinical processes such as medicine reconciliation, falls prevention interventions and disease-specific management guidelines were less consistently used. There was no meaningful correlation between risk-adjusted mortality rates for three common medical conditions and related quality measures. CONCLUSION: Widespread variation exists among New Zealand DHBs in their adoption of quality and safety practices, especially in relation to clinical processes of care.

The ideal of biopsychosocial chronic care: how to make it real? A qualitative study among Dutch stakeholders.

BACKGROUND: Chronically ill patients often experience psychosocial problems in everyday life. A biopsychosocial approach is considered to be essential in chronic care. In Dutch primary health care the current biomedically oriented clinical practice may conflict with the biopsychosocial approach. This study is aimed to explore the views of Dutch stakeholders on achieving a biopsychosocial approach to the care of patients with chronic diseases. METHODS: In a qualitative explorative study design, we held semi-structured interviews with stakeholders, face-to-face or by telephone. Data were analysed using content analysis. Thirty representatives of Dutch patients with chronic illnesses, primary care professionals, policy makers, health inspectorate, health insurers, educational institutes and researchers were interviewed. RESULTS: Stakeholders were aware that a systematic biopsychosocial care approach is lacking in current practice. Opportunities for effective change are multidimensional. Achieving a biopsychosocial approach to care relates to active patient participation, the training of professionals, high-quality guidelines, protocols and tools, integrated primary care, research and financial issues. CONCLUSIONS: Although the principles and importance of the biopsychosocial model have been recognized, the provision of care that starts from the medical, emotional or social needs of individual patients does not fit in easily with the current Dutch health care system. All parties involved need to make a commitment to realize the ideal of biopsychosocial chronic care. Together they need to equip health professionals with skills to understand patients' multifaceted needs and to reward integrated biopsychosocial care. Patients need to be empowered to be active partners in their own care.

Medical licensing board characteristics and physician discipline: an empirical analysis.

This article investigates the relationship between the characteristics of medical licensing boards and the frequency with which boards discipline physicians. Specifically, we take advantage of variation in the structure of medical licensing boards between 1993 and 2003 to determine the effect of organizational and budgetary independence, public oversight, and resource constraints on rates of physician discipline. We find that larger licensing boards, boards with more staff, and boards that are organizationally independent from state government discipline doctors more frequently. Public oversight and political control over board budgets do not appear to influence the extent to which medical licensing boards discipline doctors. These findings are broadly consistent with theories of regulatory behavior that emphasize the importance of bureaucratic autonomy for effective regulatory enforcement.

The internal processes and behavioral dynamics of hospital boards: an exploration of differences between high- and low-performing hospitals.

BACKGROUND: Nonprofit hospital boards are under increasing pressure to improve financial, clinical, and charitable and community benefit performance. Most research on board effectiveness focuses on variables measuring board structure and attributes associated with competing ideal models of board roles. However, the results do not provide clear evidence that one role is superior to another and suggest that in practice boards pursue hybrid roles. Board dynamics and processes have received less attention from researchers, but emerging theoretical frameworks highlight them as key to effective corporate governance. PURPOSE: We explored differences in board processes and behavioral dynamics between financially high- and low-performing hospitals, with the goal of developing a better understanding of the best board practices in nonprofit hospitals. METHODOLOGY/APPROACH: A comparative case study approach allowed for in-depth, qualitative assessments of how the internal workings of boards differ between low- and high-performing facilities. FINDINGS: Boards of hospitals with strong financial performance exhibited behavioral dynamics and internal processes that differed in important ways from those of hospitals with poor financial performance. PRACTICE IMPLICATIONS: Boards need to actively attend to key processes and foster positive group dynamics in decision making to be more effective in governing hospitals.