Training and career opportunities for residencies in Hygiene and Preventive Medicine: results of a survey on 39 Italian schools.

INTRODUCTION: The Italian National Health Service (SSN) is currently grappling. with a complex situation, characterized by a persistent shortage of medical personnel and the divergent aspirations of young medical graduates. Additionally, recent regulatory developments concerning specialist training further contribute to the intricacies of the landscape, calling for a comprehensive analysis of the challenges and opportunities within the sector. This study aims to provide an updated overview of the current placement of medical graduates, residents and specialists in the specific hygiene and preventive medicine (Public Health) field. METHODS: Data on admissions, withdrawals and resignations were obtained from the Ministries of Universities and Health and from the archives of the "Associazione Liberi Specializzandi" (ALS). Information regarding the professional prospects for specialists and residents in the field of Public Health was gathered through a tailored survey conducted by the "Consulta dei Medici in Formazione Specialistica" (Council of Medical Residents) of the Italian Society of Hygiene (SItI). RESULTS: In 2022, a total of 483 specialization contracts were granted, indicating a decrease of 37% compared to the previous year. Notably, 85 positions (17.6%) remained unallocated or resulted in dropouts. Six months after completing their residency, 1.5% of hygiene residents were still actively seeking employment. On a positive note, 75.4% of fourth-year residents secured contracts under the "Decreto Calabria". Career opportunities within the Italian SSN have witnessed growth, with a significant proportion of placements in territorial services and hospital medical directorates. DISCUSSION AND CONCLUSIONS: The updating of training programs provided by residency schools and the exploration of innovative approaches are of paramount importance to address the urgent need for high-quality training and to cater to the requirements of the national health system.

Influence of Preventive Medicine Residency Programs and Combined Master of Public Health Programs on Specialty Selection.

INTRODUCTION: To determine medical school characteristics that may result in graduates entering the specialty of public health and general preventive medicine (PH&GPM), the authors conducted an analysis comparing the presence of affiliated preventive medicine residency programs and combined Master of Public Health degree programs with the likelihood of graduates entering the specialty of PH&GPM. METHODS: Using data from the American Board of Preventive Medicine and publicly available information on medical schools and residencies, in spring 2022, the authors compared medical schools that produced PH&GPM physicians with the presence of a PH&GPM residency program, the presence of any preventive medicine residency (public health and general preventive medicine or occupational medicine or aerospace medicine), and the presence of a combined Doctor of Medicine‒Master of Public Health or Doctor of Osteopathic Medicine‒Master of Public Health program. RESULTS: Between 2017 and 2021, there were 385 physicians newly board certified in PH&GPM, 210 medical schools, and 75 preventive medicine residencies. The 385 physicians graduated from 110 of the 210 medical schools. Analyses showed statistically significant associations between medical schools that graduated PH&GPM physicians and the presence of PH&GPM residencies (OR=3.74; 95% CI=1.61, 8.69), all preventive medicine residencies (OR=2.75; 95% CI=1.37, 5.51), and combined degree programs (OR=4.37; 95% CI=2.45, 7.79). CONCLUSIONS: Because PH&GPM residency programs affiliated with medical schools are a significant factor associated with PH&GPM physicians obtaining board certification, such analyses may provide critical guidance in the utilization of resources intended to produce more physicians certified in this specialty.

Professor Arouca

Na década de 70, Arouca dava aulas e não usava barba.

Preventing Breast Cancer Through Identification and Pharmacologic Management of High-Risk Patients.

Breast cancer remains the most common cancer in women in the United States. For certain women at high risk for breast cancer, endocrine therapy (ET) can greatly decrease the risk. Tools such as the Breast Cancer Risk Assessment Tool (or Gail Model) and the International Breast Cancer Intervention Study risk calculator are available to help identify women at increased risk for breast cancer. Physician awareness of family history, reproductive and lifestyle factors, dense breast tissue, and history of benign proliferative breast disease are important when identifying high-risk women. The updated US Preventive Services Task Force and American Society of Clinical Oncology guidelines encourage primary care providers to identify at-risk women and offer risk-reducing medications. Among the various ETs, which include tamoxifen, raloxifene, anastrozole, and exemestane, tamoxifen is the only one available for premenopausal women aged 35 years and older. A shared decision-making process should be used to increase the usage of ET and must be individualized. This individualized approach must account for each woman's medical history and weigh the benefits and risks of ET in combination with the personal values of the patient.

Population Health Rounds: A Novel Vehicle for Training in Population Medicine and Clinical Preventive Medicine.

CONTEXT: Preventive medicine residents must train in population medicine (including analytics and population health) and clinical preventive medicine (including screening, behavioral counseling, and chemoprophylaxis). Yet, opportunities to perform both functions concurrently for the same population are scarce. Residents must also master the art of preventive medicine, but they often lack an established community of practice that provides a continuous forum to do so. This project explored Population Health Rounds as a novel vehicle to optimize preventive medicine residency training. PROGRAM DESCRIPTION: Modeled after traditional medical rounds, Population Health Rounds consist of a 1-hour weekly meeting engaging preventive medicine residents and supervising attendings at Stony Brook Medicine in both population medicine and clinical preventive medicine concurrently, including patient case discussions and targeted population health analytics. EVALUATION AND RESULTS: Because of the pandemic, the rounds have predominantly focused on COVID-19 and its effects on the hospital employee population. In addition to providing direct patient care to COVID-19-positive and exposed employees, residents have analyzed data on this population and made recommendations to hospital leadership based on COVID-19's institutional epidemiology, including incidence, prevalence, and predictive factors. A formative qualitative survey of resident perceptions offers insights on the value and learning outcomes of this new model. DISCUSSION AND CONCLUSION: Factors that may impact the implementation, sustainability, and feasibility of this model are discussed. The preventive medicine residency program is commissioned to address gaps in clinical preventive services for the patient-centered medical home tied to the sponsoring institution's family medicine practice. Additional plans are underway to expand the rounds to other clinical contexts, such as lifestyle medicine in the occupational setting, and for targeted populations, such as the underserved. Replication of the Population Health Rounds model is recommended to determine its effectiveness.

The SARS-CoV-2 Pandemic: Real-Time Training and Service for Preventive Medicine Residents.

The 2020 SARS-CoV-2 pandemic created a unique opportunity for Public Health/General Preventive Medicine (PH/GPM) and Occupational and Environmental Medicine (OM) residents to contribute to pandemic public health response activities. We surveyed all 18 Health Resources and Services Administration (HRSA)-funded PH/GPM and OM residency program directors to evaluate program and resident involvement in pandemic response activities from January 1 through June 30, 2020. Of 116 residents, 110 (95%) participated at some level in the response activities including screening/testing, contact tracing, surveillance, data analysis, incident command, provider support, reopening, direct patient care, education, and risk communication. Residents' response activities were in multiple settings, such as state, local, and federal health agencies; hospital systems; long-term care facilities; academic centers; local businesses and labor unions; Federally Qualified Health Centers; homeless shelters; and clinics. Residents' participation was facilitated by their training in public health, epidemiology, the care of patients and populations, and emergency preparedness. Programs should continue to promote these experiences and key roles that PH/GPM and OM residents can play, as this leadership is a necessity for the successful navigation of future major public health events. As the pandemic continues, evaluation of residents' experiences will help guide longer-term changes to program curriculum and partnerships. Many trainees' contributions and expertise met both educational and service goals and therefore should be integrated into ongoing pandemic response work in PH/GPM and OM programs.

Optimizing preventive medicine to bridge the gap between clinical medicine and public health for disease control in China: A lesson from COVID-19.

The pandemic of Coronavirus Disease 2019 (COVID-19) highlights the importance of early detection of disease outbreaks, taking swift and decisive public health actions, and strengthening public health systems. Preventive medicine, as a specialty of medicine, trains students on both clinical medicine and public health and is of a particular need in battling against this pandemic. In China, preventive medicine plays a unique role in the disease control system where preventive medicine graduates represent a large share of the workforce. However, there is a shortage of qualified staff in the Chinese disease control system. The reasons for such a shortage are multifaceted. From the human resource perspective, the undergraduate preventive medicine curricula and exclusive public health training for preventive medicine postgraduates limit their clinical capacities. A series of disease control and public health education reforms may further incapacitate preventive medicine graduates' clinical skills, unintentionally widening the gap between public health and clinical medicine and thus posing threats to effective disease detection and control. The authors call for reforming and optimizing preventive medicine to bridge the gap between clinical medicine and public health by strengthening curricula on clinical medicine, diversifying curricula on public health, enhancing preventive medicine residency programs, and rectifying regulations that restrict preventive medicine graduates from practicing curative medicine.

SARS-CoV-2 infection: advocacy for training and social distancing in healthcare settings.

This article reports the observed rate of infection with severe acute respiratory syndrome coronavirus-2 in healthcare workers (HCWs) who worked on wards dedicated to care of patients with coronavirus disease 2019 (COVID-19) compared with HCWs who worked on non-COVID-19 wards. The infection rate was significantly higher among HCWs who worked on non-COVID-19 wards (odds ratio 2.3, P=0.005), illustrating the need to strengthen social distancing measures and training.

[Preventive medicine curriculum system in training program of clinical medicine in the era of Healthy China].

Objective: To understand the provision of preventive medicine curriculum system in the training programs of clinical medicine in the era of Healthy China. Methods: A total of 36 training programs of clinical medicine were selected from different areas of China for a statistical analysis on their basic information, involvement of concept of preventive medicine in program objectives, and provision of preventive medicine curriculum system. Results: Of all the 36 training programs of clinical medicine, 22(61%) have no mentions of prevention medicine in their program objectives; only one university's training program states preventive medicine together with basic medicine and clinical medicine as one of the three main disciplines. The total class hours for the core courses of preventive medicine (hygiene, medical statistics, epidemiology, evidence-based medicine, and social medicine) range from 80 to 252, with an average of (156.7±43.2) hours. The average percentage of class hours for preventive medicine courses among the total class hours is 4.3%±1.1% (range: 2.5%-7.5%), and obvious differences exist among universities. Conclusions: In current training programs of clinical medicine, the proportion of prevention medicine curriculum is insufficient, the percentage of hours for preventive medicine course is very low, and the differences among various universities are obvious. It is urgently needed to strengthen preventive medicine curriculum in training programs for clinical medical students in new era. It is suggested to further promote the concept of putting prevention first, improve the curriculum system of clinical medicine, intensify the integrated development preventive medicine and clinical medicine and pay attention to clinical research ability enhancement for the further improvement of training program of clinical medicine.

Continuing medical education during a pandemic: an academic institution's experience.

The COVID-19 pandemic has affected healthcare systems worldwide. The disruption to hospital routines has affected continuing medical education (CME) for specialty trainees (STs). We share our academic institution's experience in mitigating the disruption on the CME programme amidst the pandemic. Most specialty training programmes had switched to videoconferencing to maintain teaching. Some programmes also utilized small group teachings with precautions and e-learning modules. Surgical residencies were disproportionately affected due to reductions in elective procedures but some ways to provide continued surgical exposure include going through archived surgical videos with technical pointers from experienced faculty and usage of surgical simulators . We should adapt CME sessions to keep trainees up to date with core clinical competencies as they will continue to manage both COVID-19 and non-COVID-19 cases and this pandemic may last until year's end.

[Thoughts on the reform of preventive medicine education in the context of new medicine].

Talent training is the core and foundation of public health system construction. Shortage of talents in the field of disease prevention and public health exposed by COVID-19 pandemic highlights the importance of developing preventive medical education. This article analyzes the challenges of medical education in the dilemma of "separation of medical treatment and prevention", and the new requirements for preventive medical education in the construction of New Medicine under the Healthy China strategy. Four aspects including stepping up the resource allocation and investment, educating responsible public health professionals, the education of all medical students who implement the core competence of public health, and the establishment of a continuing education system for preventive medicine have been considered. A series of specific suggestions are put forward including the establishment of a full-chain closed-loop research system to support the cultivation of top-notch innovative public health talents, strengthening the assessment of core public health capabilities for clinical medical professional admission, formulating a "medical and preventive integration" training program for primary health personnel, and implementing "combination of peace and war" public health personnel reserve system, with the purpose of providing reference for the reform and development of preventive medical education in China.

Preventive medicine's equivalence problem.

The structure of preventive medicine residency training in the U.S. warrants serious examination. U.S. public health and general preventive medicine residencies have suffered a 17% decline in the number of residency programs since 2000, and current residency programs are, on average, half-empty. The required clinical year is not unique to preventive medicine, a basic, undifferentiated MPH for preventive medicine doesn't distinguish the preventive medicine specialist, and practicum year requirements are overly broad and not necessarily specific to the specialty, leaving the specialty vulnerable to equivalence by most other specialties. Strategies including creation of an additional preventive medicine-specific clinical year, developing a new public health degree for the specialty, and more specific practicum rotations, as well as potentially changing the specialty's name and altering the annual structure of training, are proposed along with an equivalence test.

Early experiences with combined fellowship training in clinical informatics.

Given the ubiquitous nature of information systems in modern health care, interest in the pursuit of formal training in clinical informatics is increasing. This interest is not restricted to generalists-informatics training is increasingly being sought by future subspecialists. The traditional structure of Accreditation Council on Graduate Medical Education subspecialty training requires completion of both clinical and clinical informatics fellowship programs, and understandably lacks appeal due to the time commitment required. One approach to encourage clinical informatics training is to integrate it with clinical fellowships in order to confer dual-board eligibility. In this perspective, we describe 3 successful petitions for combined training in clinical informatics in order to support other programs and the American Board of Preventive Medicine in establishing pathways for training subspecialists in clinical informatics.

Effects of protocol on prevention of delirium in hospitalized hip fracture patients: A quality improvement project.

BACKGROUND: Delirium is a sudden change of consciousness experienced by hospitalized patients that results in negative outcomes. The incidence of delirium is under-reported and can be prevented in many patients. The purpose of this evidence-based study was to determine if the incidence of delirium decreased with the use of prevention interventions for hip fracture patients. METHODS: The project was a prospective quality improvement project. An audit of medical records using the CHART-DEL instrument was conducted pre- and post-implementation of an evidence-based protocol. Medical records were reviewed until discharge for the use of prevention interventions and the diagnosis of delirium. RESULTS: The sample included 90 hip fracture patients, 45 patients in both the pre- and post-implementation groups. The hip fracture protocol was used by admitting physicians in 31% of admissions and prevention interventions were documented by nurses in 75.6% of medical records. The incidence of delirium was similar in both groups; 11.1% in the pre-implementation group and 15.6% in the post-implementation group and was not statistically significant. DISCUSSION: Healthcare workers should take measures to reduce the incidence of delirium. There is a need for further studies on the use of protocols in the identification, prevention, and treatment of delirium in hospitalized patients.

Teaching Health Advocacy: A Systematic Review of Educational Interventions for Postgraduate Medical Trainees.

PURPOSE: A systematic review was undertaken to characterize the training approaches that are currently being implemented in postgraduate medical education to teach residents advocacy skills. METHOD: An initial search was conducted in MEDLINE, PubMed, Embase, ERIC, and PsycINFO in November 2016 (updated in December 2017) for articles discussing postgraduate medical education interventions covering advocacy. Articles published between 1995 and 2017 were included. Two authors independently reviewed titles and abstracts (and, if needed, the full text) for inclusion; disagreements were resolved by consensus. Data were extracted from studies to characterize the content and pedagogy of the interventions by mapping them to the CanMEDS health advocate core competencies and key concepts. RESULTS: A total of 3,027 unique abstracts were retrieved; 2,864 were excluded upon title and abstract review, and another 85 were excluded upon full-text review. Seventy-eight total articles were included. More studies involved residents from pediatrics, psychiatry, primary care or preventative medicine, or internal medicine than from emergency medicine, surgery, obstetrics and gynecology, or neurology. Published interventions varied widely by pedagogical approach and assessment method. CONCLUSIONS: Using the CanMEDS framework, this review maps the breadth and nature of postgraduate medical education interventions in health advocacy, with applicability to community organizations, program directors, educators, and administrators working to develop advocacy training interventions. Areas of focus included adapting practice to respond to the needs of or advocacy in partnership with patients, communities, or populations served; determinants of health; health promotion; mobilizing resources as needed; and social accountability.