[Specialist examination: Is the current format still up-to-date?] / Die mündliche Facharztprüfung: Ist das aktuelle Format noch zeitgemäß?

The non-standardized oral specialist examination is the final step of the specialist medical training in Germany. The debate on its current format has long been at the centre of discussions on further training policies. The purpose of this article is to draw attention to relevant structural deficits of the German specialist examination - also in comparison to German-speaking neighboring countries and pan-European developments - and to provide possible approaches to a more structured oral examination.

Pathology Residency Curriculum: Time for a Change?

The current Anatomical and Clinical Pathology residency curriculum, as outlined by the American Board of Pathology (ABP), emphasizes resident exposure to a wide variety of subjects without in-depth training. This has led to a large number of residents pursuing fellowship training. With the demand for further sub-specialization, there is a necessity for the establishment of an updated curriculum that not only encompasses the basic knowledge of pathology but is also focused on training residents in their desired subspecialty.We herein propose a new comprehensive AP/CP residency syllabus. The new curriculum will be divided into two major categories: preliminary and subspecialty training. The curriculum will require residents to undergo basic pathology training within the first two preliminary years, followed by two subspecialty years. In their subspecialty years, each resident will be required to either pick two subjects as majors, each having a duration of one year, or one subject as a major and two subjects as minors, in which case the major will have a one-year duration and the minors will each be six months in length. The proposed curriculum meets the current guidelines of the ABP, reduces the burden of residents to complete multiple fellowships, and allows residents earlier entrance into the workforce.

Metabolic Shifts as the Hallmark of Most Common Diseases: The Quest for the Underlying Unity.

A hyper-specialization characterizes modern medicine with the consequence of classifying the various diseases of the body into unrelated categories. Such a broad diversification of medicine goes in the opposite direction of physics, which eagerly looks for unification. We argue that unification should also apply to medicine. In accordance with the second principle of thermodynamics, the cell must release its entropy either in the form of heat (catabolism) or biomass (anabolism). There is a decreased flow of entropy outside the body due to an age-related reduction in mitochondrial entropy yield resulting in increased release of entropy in the form of biomass. This shift toward anabolism has been known in oncology as Warburg-effect. The shift toward anabolism has been reported in most diseases. This quest for a single framework is reinforced by the fact that inflammation (also called the immune response) is involved in nearly every disease. This strongly suggests that despite their apparent disparity, there is an underlying unity in the diseases. This also offers guidelines for the repurposing of old drugs.

Rational use of shoulder MRI in the private setting: specialist-ordered MRIs influence clinical management significantly more often than primary care physicians.

PURPOSE: The aim of this study was to determine the difference in proportion of shoulder MRIs that influence the management plan of shoulder patients based on whether MRI was ordered by a shoulder specialist, orthopaedic surgeon or primary care provider prior to referral to a specialist. METHODS: This observational analytical study was conducted in a private practice setting. Data were obtained from 153 MRIs performed on 151 patients. Seventy-seven MRIs were ordered by a specialist shoulder surgeon and 76 by a primary care provider (general practitioner, non-operative sports medicine physician or physiotherapist). RESULTS: Specialist-ordered MRIs influenced patient management significantly more often than primary care-ordered MRIs (82% vs. 22%, p < 0.001). Fifty-four percent of referral letters from primary care providers to the specialist did not have documentation of a physical examination, yet an MRI had been ordered. The most common diagnoses for primary care-ordered MRIs which did not have influence on patient management were subacromial bursitis and adhesive capsulitis. CONCLUSION: With less than 25% of primary care-ordered shoulder MRIs influencing clinical management, questions must be raised about the indications for MRI. Greater than 50% of referrals contained no documented physical examination, suggesting that MRI is being relied upon for assessment. If access to private MRI was to be rationalized, perhaps shoulder specialist-ordered CT and X-ray could be covered by insurance providers. Currently, they are not covered in our system, yet are more likely to influence clinical management than primary care-ordered MRIs, which are currently covered by insurance without restriction on indications.

Investing in Skilled Specialists to Grow Hospital Infrastructure for Quality Improvement.

OBJECTIVES: Hospitals can reduce labor costs by hiring lowest skill possible for the job, stretching clinical hours, and reducing staff not at bedside. However, these labor constraints designed to reduce costs may paradoxically increase costs. Specialty staff, such as board-certified clinicians, can redesign health systems to evaluate the needs of complex patients and prevent complications. The aim of the study was to evaluate whether investing in skilled specialists for supporting hospital quality infrastructure improves value and performance. METHODS: We evaluated pressure injury rates as an indicator of performance in a retrospective observational cohort of 55 U.S. academic hospitals from the Vizient clinical database between 2007 and 2012. Pressure injuries were defined by U.S. Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator 3 (PSI-03) for stage 3, 4, and unstageable pressure injuries not present on admission in hospitalized adults. We compared ratios of board-certified wound care nurses per 1000 hospital beds to hospital-acquired pressure injury rates in these hospitals using mixed-effects regression of hospital quarters. RESULTS: High-performing hospitals invested in prevention infrastructure with skilled specialists and observed performance improvements. Regression indicated that by adding one board-certified wound care nurse per 1000 hospital beds, hospitals had associated decreases in pressure injury rates by -17.7% relative to previous quarters, controlling for other interruptions. Highest performers supplied fewer skilled specialists and achieve improved outcomes. CONCLUSIONS: Skilled specialists bring important value to health systems as a representation of investment in infrastructure, and the proportion of these specialists could be scaled relative to the hospital's patient capacity. Policy should support hospitals to make investments in infrastructure to drive down patient costs and improve quality.

Do Adult Patients With Type 1 or 2 Diabetes Who Present to the Emergency Department With Hyperglycemia Have Improved Outcomes if They Have Access to Specialized Diabetes Care?

OBJECTIVES: Few studies have examined the effect of specialized care on patients with diabetes who present to the emergency department (ED) visits for acute hyperglycemia. The objective of this study was to characterize ED patients presenting with hyperglycemia and compare the 30-day outcomes of those followed by specialized diabetes clinics with those not followed. We hypothesized that patients followed by specialized clinics would have improved clinical outcomes compared with those who had no specialized follow up. METHODS: We conducted this single-centre retrospective cohort study of adults (≥18 years) with an ED visit for hyperglycemia over 1 year (January to December 2014). Data from ED visits were linked to specialized diabetes clinic records, which contained diabetes-specific clinical data not available in ED visit records. Descriptive statistics were summarized and comparisons between groups were performed, when appropriate. RESULTS: There were 456 patients (55.0% men; mean age, 47.7 years; 46.3% with type 1 diabetes) with 250 followed by the specialized diabetes clinics. The 206 patients who were not followed by the diabetes clinics (45%) were more likely to have a recurrent hyperglycemia ED visit (32.5% vs 9.6%, p<0.001) and to require hospitalization for hyperglycemia (14.1% vs 5.2%, p=0.001) within 30 days of initial presentation. CONCLUSIONS: Patients followed by specialized diabetes clinics had fewer recurrent ED visits and hospital admissions for hyperglycemia at 30 days compared with those not followed, suggesting that greater continuity of care between endocrinology and emergency medicine may help reduce these adverse outcomes for patients with diabetes.

Is Specialisation Needed in Laparoscopic Cholecystectomy? A Retrospective Cohort Study of 5122 Patients.

Background: Gallstone disease is a common problem and laparoscopic cholecystectomy (LC) is a common elective procedure. This operation was performed by a general surgeon, colorectal surgeons, breast and vascular surgeons according to the largest UK's audit (CholeS study). Objectives: To compare the outcomes of laparoscopic cholecystectomy performed by a specialist upper gastrointestinal (UGI) surgeon to that of CholeS and large international studies. Our hypothesis is: UGI specialist is producing better outcomes for LC patients. Methods: All patient who underwent LC between 1999 and 2019 at one hospital by an UGI consultant and 2014-2019 at another hospital by another UGI consultant surgeon were included. The inclusion criteria were LC performed by UGI surgeon. Lost to follow up, procedures done by trainees and gallbladder cancer patients were excluded. The outcome measures of bile leak, bile duct injuries, bleeding, infectious complications, bowel injuries, vascular injuries and pseudoaneurysms, neuralgia, port site hernia, mesenteric haematoma, 30-day mortality and conversion to open were reported. Statistical tests were used to assess the significant differences, the confidence interval was 95% and the p-value was taken as 0.05. Results: Two UGI specialists performed 5122 LC, 4396 (86%) were female and 715 (14%) male. The age was 13-93 year (median of 48 years). 3681 (72 %) was done as a day surgery case. 1431(28%) as an inpatient and 287 (5.6%) emergency LC. There was no death in the 30 days periods of surgery, 8 (0.15%) biliary leak from the duct of Luschka, 4 (0.19%) common bile duct (CBD) injuries, 9(0.02%) conversions and 17(0.33%) procedures were abandoned. There were significant differences in the above complications between our study and the CholeS report. Conclusions: Laparoscopic cholecystectomy is associated with acceptable outcomes, low risk of bile duct injury and no mortality when performed by a specialist upper GI surgeon.

La evaluación final en la especialidad Medicina Interna: propuesta de adecuaciones / Final evaluation in Internal Medicine specialty: proposal of adjustments

Introducción: La evaluación de graduación constituye el examen de culminación de los estudios de la especialización, correspondiente a la enseñanza de posgrado. Objetivo: Proponer y fundamentar la realización de modificaciones en la evaluación de graduación de la especialidad Medicina Interna, en nuestro contexto. Método: Investigación sustentada en el análisis de documentos metodológicos y en una reflexión crítica de la praxis, para la construcción teórica de la propuesta de modificaciones. Resultados: A partir de la identificación de puntos de mejoría y guiados por una serie de principios, se proponen los siguientes cambios: 1) readecuación en la secuencia de los ejercicios teóricos y prácticos que conforman el examen estatal, 2) mayor peso de las actividades prácticas en la evaluación, tanto por aumento del número de actividades como por el tiempo destinado a las ejecuciones, 3) representación más amplia de la diversidad de habilidades y competencias objetivo de aprendizaje en la residencia, y 4) una mirada más exigente y valorizada de las competencias investigativas en general, y del trabajo de terminación de la especialidad en particular. Conclusiones: Mediante los cambios que se proponen se logra una certificación más real y objetiva de las competencias profesionales de los educandos para el cumplimiento del encargo social, y contribuye al mejoramiento de la calidad del profesional egresado, al estimular un proceso formativo dirigido a garantizar la aplicación de los conocimientos(AU)

Introduction: The graduation evaluation constitute the final assessment of the specializing studies, corresponding to postgraduate education. Objective: To propose and to substantiate the conduction of modifications in the graduation evaluation of Internal Medicine specialty, in our context. Method: A research based on the analysis of methodological documents and on praxis critical reflection was carried out for the theoretical construction of the proposed modifications. Results: From the identification of çimprovement points and guided by a series of principles, the following changes are proposed: 1) Readjusting the sequence of theoretical and practical exercises that make up the state exams, 2) Providing greater importance of practical activities in the assessment, both due to the increase in the number of activities and the time allocated to performing, 3) Bringing broader representation of the diversity of skills and competencies which are learning objective in the residence, and 4) Demanding and measuring more the research competences in general, and of the completion paper of the specialty in particular. Conclusions: These proposed changes result in more real and objective certification of the professional competences of the students for achieving the fulfillment of the social mandate. These changes improve the quality of the professional, by stimulating a training process aimed at guaranteeing the application of knowledge(AU)

The role of an expert discussion panel on shaping the views of the undergraduate in health sciences on the use of stem cells and pre-implantation embryos / La influencia de un panel de discusión de expertos en la formación de opinión sobre el uso de células madre y embriones preimplantacionales en los estudiantes de ciencias de la salud de pregrado

INTRODUCTION: There are four objectives to this paper: (1) To determine whether undergraduates enrolled in Health-Sciences studies agree with the use of human stem cells for medical research, treatment and genetic uses. (2) Whether they would consider the use of pre-implantation-embryos for medical research. (3) Whether attitudes toward the previous two issues are linked to gender, field of study, transcendental/spiritual convictions and political biases. (4) A panel of discussion will modify their opinion. RESULTS: The present study shows that, before attending a discussion panel session, media was the main source of information that the students had on the surveyed topics. A discussion panel was useful for clarifying respondents' opinions on the explored items. Significantly, the discussion panel had an influence on those respondents who did not have a formed opinion on the explored items. CONCLUSIONS: A discussion panel is a convenient, but limited tool, in the shaping of undergraduate opinions on ethically controversial scientific matters

INTRODUCCIÓN: Los objetivos de este artículo son conocer si: 1) los estudiantes de pregrado matriculados en titulaciones de grado de ciencias de la salud están de acuerdo con la utilización de las células madre humanas para la investigación médica de los embriones preimplantatorios, la cura de enfermedades y los usos génicos; 2) consideran el uso de los embriones preimplantatorios humanos para la investigación; 3) las actitudes hacia los 2 temas anteriores están relacionadas con el género, el grado universitario en curso, la afiliación política y las convicciones trascendentales o espirituales, y 4) conocer si un panel de discusión, con expertos, modifica esas opiniones. RESULTADOS: Los resultados del presente estudio mostraron que antes del panel de discusión, los medios de comunicación eran la principal fuente de información de los encuestados sobre los temas estudiados. El panel de discusión fue útil para aclarar las opiniones de los encuestados, aprobar o desaprobar los ítems explorados. Significativamente, el panel de discusión influyó en los encuestados que dijeron que no tenían una opinión formada sobre los ítems explorados antes del panel de discusión. CONCLUSIONES: El panel de discusión es una herramienta conveniente pero limitada en la formación de las opiniones de los estudiantes de pregrado en titulaciones de ciencias de la salud sobre cuestiones científicas éticamente controvertidas

Patients with shoulder pain referred to specialist care; treatment, predictors of pain and disability, emotional distress, main symptoms and sick-leave: a cohort study with a six-months follow-up.

Objectives Recommendations for referral of patients with shoulder pain from primary to specialist care are mainly clinical. Several patients are referred without meeting these criteria for referral, whereas some are referred for a second opinion although surgery is not recommended. The aims of this study were to describe a shoulder pain cohort in specialist healthcare according to demographic data, clinical, and psychological factors; evaluate changes in pain and disability, distress and main symptoms from baseline to six-month follow-up; and to assess predictors of pain and disability, changes in the main symptoms and sick-leave at six-months. Results were compared to previous randomised trials conducted at the same clinic in patients with subacromial shoulder pain. Methods This prospective study included 167 patients from an outpatient clinic in specialist healthcare with shoulder pain for more than 6 weeks. Clinical (pain duration, intensity, pain sites), sociodemographic (age, gender, educational level, work status) and psychological variables (emotional distress (HSCL-10), fear of pain, screening of "yellow flags", health-related quality of life) were collected. Shoulder pain and disability (SPADI-score) were assessed and the patients were asked about their outcome expectation and to predict their status of their shoulder problem the next month. They underwent a clinical interview, a clinical assessment of shoulder function and orthopaedic tests for diagnostic purposes. After six months they received a questionnaire with main variables. Results Of the 167 patients (55% women), 50% had symptoms for more than 12 months and 37 (22%) were on sick-leave. Characteristics were in general comparable to patients previously included in clinical trials at the same department. The SPADI-score was 46 (23) points. Mean emotional distress was within the normal range (1.7 (SD 0.6)). More than 80% had received treatment before, mainly physiotherapy in addition to the GPs treatment. One hundred and thirty-seven patients (82%) were re-referred to physiotherapy, 74 (44%) in the outpatient clinic specialist healthcare, and 63 (38%) in primary care. One hundred and eighteen (71%) answered the follow-up questionnaire. Mean change in SPADI-score was 10.5 points (95% CI (6.5-14.5)), and 29% of the patients improved more than the smallest detectable difference (SDD). The percentage sick-listed was 19.5%, and mean change in main symptoms (-9 to +9) was 3.4 (SD 3.9). The subgroup of patients receiving physiotherapy in outpatient specialist care did not show any significant change in the main variables. The prediction models suggested that a lower level of education, more fear of pain and a high baseline SPADI-score, predicted a higher SPADI-score at follow-up. A high baseline HSCL-10 score was the only significant predictor for a high HSCL-10 score. At follow-up, less pain at rest predicted more change in main symptoms and more yellow flags (a higher score on the Örebro screening test) predicted sick-leave. Conclusions Within the limitations of a cohort study, patients with persistent shoulder pain referred to an outpatient specialist clinic had similar baseline characteristics but shorter treatment duration, inferior clinical results and predictors somewhat different compared with previous clinical trials conducted at the same clinic. The study raises some questions about the effectiveness of the routines in daily clinical practice, the selection of patients, the treatment duration and content.

Competencies for Diabetes Care and Education Specialists.

PURPOSE: Diabetes care and education specialists provide collaborative, comprehensive, and person-centered care and education to people with diabetes and cardiometabolic conditions. The implementation of the vision for the specialty has prompted the need to reexamine the knowledge, skills, and abilities necessary for diabetes care and education specialists in today's dynamic health care environment. The purpose of this article is to introduce an updated set of competencies reflective of the profession in this dynamic health care environment. Diabetes care and education specialists are health care professionals who have achieved a core body of knowledge and skills in the biological and social sciences, communication, counseling, and education and who have experience in the care of people with diabetes and related conditions. Members of this specialty encompass a diverse set of health disciplines, including nurses, dietitians, pharmacists, physicians, mental health professionals, podiatrists, optometrists, exercise physiologists, physicians, and others. The competencies are intended to guide practice regardless of discipline and encourage mastery through continuing education, individual study, and mentorship. CONCLUSION: This document articulates the competencies required for diabetes care and education specialists in today's dynamic health care environment as they pursue excellence in the specialty.

Developing the 2020 Diabetes Care & Education Specialist Competencies: A Modified Delphi Study.

PURPOSE: The purpose of the study was to develop diabetes care and education specialty competencies that align with the Association of Diabetes Care & Education Specialists (ADCES). METHOD: A Delphi method of consensus development was used, comprising 5 survey rounds. Interprofessional diabetes specialty experts were asked to identify and rate trends and issues important to diabetes specialists on a global scale. Use of a 5-round Delphi process allowed diabetes care and education specialty experts to refine their views considering the progress of the group's work from round to round. RESULTS: A total of 457 diabetes care and education specialists across the United States in various professions participated in the Delphi rounds to identify a final set of 130 competencies across 6 domains. CONCLUSION: Use of the Delphi method as a consensus guideline helped to identify core competencies for diabetes care and education specialists, reflecting the knowledge and skills necessary to provide evidence-based, high-quality care.

What helps and hinders doctors in engaging in continuous professional development? An explanatory sequential design.

BACKGROUND: Licensure and registration are the traditional approaches to ensure minimally acceptable standards of care for practice. However, due to advances in medical technology and changes in clinical practice, the knowledge and skills obtained from basic education and training may rapidly become out of date. There is no mandated, structured and ongoing mechanism to assess all doctors' competence in Hong Kong. This paper assessed doctors' perceived needs for continuous professional development, and to identify facilitators and barriers that are likely to influence the implementation of compulsory continuous professional development for maintaining professional competence and ensuring patient safety. METHODS: An explanatory sequential mixed method design with two distinct interactive phases was adopted comprising a postal self-administered questionnaire survey among a random sample of 2,459 of doctors (Phase 1), followed by individual interviews of a stratified sample of 30 questionnaire respondents for the subsequent qualitative analysis (Phase 2). RESULTS: The majority of doctors (over 90%) agreed the importance of continuous professional development to update knowledge and skills. However, just 30.7% of non-specialists compared with 65.4% of specialists agreed it would be desirable for continuous professional development to be a requirement for renewal of licenses. A relatively higher percentage of non-specialists compared with specialists reported barriers to participation such as accessibility, availability and relevance of the content of the programmes. Facilitators for uptake included more convenient schedule and location, relevant content, and incentives for participation such as making this a pre-condition for enrolling in government-funded services. CONCLUSIONS: To address the needs of individual doctors, the spheres of practice, personal preferences and learning styles should be considered in deciding the content and processes of continuous professional development. Flexibility is also an important principle. A learning model, incentives for participation and a compliance strategy (instead of deterrence) could be effective strategy for continuous professional development.

Conflict of Interest: Are Iranian Breast Cancer Specialists Prone to it?

INTRODUCTION: Giving gifts is a common way to promote and encourage the use of products of trading companies and increase the patient referrals to diagnostic centers. The present study aimed to assess the practice of physicians of different (sub) specialties/educational levels engaged in breast cancer management in some conflict of interest (COI) situations in their relation with pharmaceutical companies and paraclinical centers. METHODS: A self-administered online questionnaire including questions on demographic and professional information as well as the attitude of physicians toward COI by answering the questions in three different practical scenarios was developed. Respondents were asked to answer each question by selecting one of the five options: strongly agree, agree, undecided/neutral, disagree, and strongly disagree in their own practices as well as the same questions asking the same subject for what they think of the other physicians. Descriptive statistical analysis was used to report qualitative and quantitative variables. RESULT: The response rate was 66.24%. In general, physicians considered their performance better than that of other physicians in the situations asked. More than 90% stated that they would participate in the sponsorship congress for introducing new drugs. One fifth of the physicians stated that they would accept the 30% financial proposition for the referral of every single patient to other clinics. More than half of the physicians stated that they had considered the risks resulted from the COI for referring patients to private radiobiological centers. CONCLUSION: This study indicated that physicians in the field of breast cancer were at the risk of COI. Even within the medical field, there is not sufficient trust in the proper functioning of doctors in dealing with COI situations.
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Producción intelectual de los egresados de posgrados clínico-quirúrgicos de la Universidad Surcolombiana desde 1999 hasta 2016 / Intellectual production of physicians graduated from clinical-surgical specialisations of the Universidad Surcolombiana from 1999 to 2016

INTRODUCCIÓN: El proceso de la investigación en un pilar fundamental dentro de la formación de posgrado en el área de la medicina, ya que conlleva a que el médico residente desarrolle competencias que le permitan aplicar la medicina basada en la evidencia, incrementar la investigación en ciencias básicas y clínicas y generar nuevo conocimiento. MATERIALES Y MÉTODOS: Se presenta un estudio de tipo descriptivo con corte transversal en el que se evaluó la producción científica de los egresados de los posgrados clínico-quirúrgicos de la Universidad Surcolombiana. Se realizó análisis descriptivo de tipo univariado además de un análisis bivariado mediante cálculo de la razón de prevalencias y usando chi cuadrado y prueba exacta de Fisher. RESULTADOS: El total de publicaciones fue de 161, Cirugía general es la especialidad con el mayor número de publicaciones (n=79), el artículo en revista es el tipo de publicación con mayor frecuencia (86%). La media de publicación por egresado es de 0,76 y se observó una asociación entre la vinculación docente y las publicaciones (p = 0,0024). CONCLUSIONES: La producción científica de los egresados de los posgrados clínico-quirúrgicos de la Facultad de Salud de la Universidad Surcolombiana tiene un comportamiento diverso entre los diferentes programas. Con base en los resultados se evidencia la necesidad del fortalecimiento, fomento de la investigación y el apoyo para la publicación en los posgrados clínico-quirúrgicos

BACKGROUND: Research is fundamental in the post-graduate areas of medicine, since it helps the resident doctors to develop aptitudes that will allow them to use evidence based medicine, as well as to increase research in basic and clinics sciences, and to generate new knowledge. METHODS: A descriptive, cross-sectional study was carried out to assess the scientific production of graduated physicians from clinical-surgical specialisations of the Universidad Surcolombiana. A univariate descriptive analysis and bivariate analysis was performed, as well as the calculation of the prevalence ratio, using Chi-squared and the Fisher exact test. RESULTS: The total number of publications was 161, with general surgery being the specialisation with the highest number of publications (n = 79), with an article being the most frequent type of publication (86%). The mean of publication by graduated physicians was 0.76, and a relationship was observed between teaching links and publication (p = .0024). CONCLUSIONS: Scientific production by graduate physicians from clinical-surgical specialisations of the health faculty of the Universidad Surcolombiana varies between different courses. Based on the results obtained, there is evidence for the need of strengthening and promoting research, as well as support to publish in the clinical-surgical specialisations

Implementing a stepwise educational approach for bridging the gap between specialty and primary care for childhood cancer survivors.

PURPOSE: To create a community of learning involving primary care providers and subspecialist to enhance providers' knowledge regarding care of adult childhood cancer survivors (CCS). METHODS: A stepwise approach was used to develop educational opportunities for providers. This process started with a local/regional in-person conference, which informed a webinar series, and resulted in the development of enduring material using a dynamic learning management system. RESULTS: Participants in all three learning platforms had an increase in knowledge from baseline regarding care for adult CCS. Majority of participants at the in-person conference and webinar series were oncology or other specialty providers. The enduring dynamic learning management system successfully reached a variety of providers and other allied health providers across the country. There was a slightly higher rate of participation on this platform by primary care providers of 12.5%. CONCLUSIONS: Care providers' knowledge of survivorship needs of adult CCS can be increased by multiple forms of instruction. However, the dynamic learning management system was most successful at reaching a broad audience. Advertisement through local and national organizations was not as successful as anticipated. Additional strategies are needed to successfully engage providers, specifically primary care providers (PCPs). IMPLICATIONS FOR CANCER SURVIVORS: The professional development needs of primary care providers regarding care of adult CCS is well recognized. A dynamic learning management system may represent the most convenient and accessible way to provide education, but new strategies for increasing providers' awareness and engagement are required. The goal of improving care of adult CCS requires increased providers knowledge.

Youtube as a Source of Patients' and Specialists' Information on Hemorrhoids and Hemorrhoid Surgery.

BACKGROUND: In the past, most people sought medical information by consulting health care professionals. Nowadays, many people started to use online resources to access medical information. OBJECTIVE: The study aims to investigate whether YouTube videos on hemorrhoids and hemorrhoid surgery can be a useful e-learning source for the general population, surgical trainees and specialists. METHODS: A YouTube search was performed in October 2019 using the keywords "hemorrhoids" and "hemorrhoid surgery", and the videos were divided into 2 groups according to the keywords. Three independent researchers assessed the metadata and classified them according to the level of accuracy (hemorrhoid group) and the level of usefulness (hemorrhoid surgery group). Cohen's test and Kappa (K) value were used to evaluate the inter-investigators agreement. RESULTS: A total of 200 videos were analyzed, 100 for each keyword. Regarding the hemorrhoid group, 43 videos (48.3%) were misleading, 9 were accurate (10.1%), 18 were approximate (20.2%), and 19 were considered a personal experience (21.4%). Regarding the hemorrhoid surgery group, around 60% of the videos were lacking a clear explanation, while about 16% were inaccurate. Only the remaining 24% were considered useful for teaching. CONCLUSION: Around half of the YouTube videos regarding hemorrhoids topic were found to be misleading or inaccurate and present a risk of harmful consequences. Credible videos with accurate information need to be uploaded by medical professionals and medical institutions and some sort of filtering, using categories by the staff of YouTube, appears to be necessary. Care must be taken to produce clear, high-quality operative clips with proper scientific commentary.

Simulation-Based Examination of Arterial Line Insertion Method Reveals Interdisciplinary Practice Differences.

INTRODUCTION: Arterial cannulation is frequently performed on intensive care unit (ICU) and operating room patients; a 1% complication rate has been reported. Investigators applied simulation to study clinical providers' arterial catheter (AC) insertion performance and to assess for interdisciplinary and intradisciplinary variation that may contribute to complications. METHODS: Anesthesia, medical critical care, and surgical critical care providers with AC insertion experience were enrolled at 2 academic hospitals. Each subject completed a simulated AC insertion on an in situ task trainer. Using a Delphi-derived checklist that incorporated published recommendations, expert opinion, and institutional requirements, 2 investigators completed offline video reviews to compare subjects' technical performance. RESULTS: Ten anesthesia, 11 medical ICU (MICU, 1 excluded), and 10 surgical ICU (SICU) subjects with significant between-group differences in training level and AC insertion experience were enrolled for 2 years. Differences in procedural planning, equipment preparation, and patient preparation steps did not attain significance across groups except for anesthesia participants using only ad hoc AC kits, and MICU and SICU subjects preferentially using commercial kits (P < 0.001). Time-outs were completed by 1 anesthesia subject, 5 MICU subjects, and 4 SICU subjects (P = 0.29, NS). For proceduralist preparation steps, fewer anesthesiology subjects donned gowns (P < 0.001). Only MICU subjects used ultrasound guidance (P = 0.0053), and only MICU (100%) and SICU (100%) subjects sutured ACs in place. Overall observance of sterile technique was similar across groups at 70% to 100% (P = 0.32). CONCLUSIONS: Simulated AC insertions revealed procedural performance variability that may derive from individual provider differences, discipline-based practice parameters, and setting-specific cultural factors.