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1.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31690710

RESUMO

BACKGROUND AND OBJECTIVES: The American Board of Pediatrics (ABP) certifies that general and subspecialty pediatricians meet standards of excellence established by their peers, immediately after training and over the course of their careers (ie, Maintenance of Certification [MOC]). In 2015-2016, the ABP developed the Maintenance of Certification Assessment for Pediatrics (MOCA-Peds) as an alternative assessment to the current proctored, closed-book general pediatrics (GP) MOC examination. This article is 1 of a 2-part series examining results from the MOCA-Peds pilot in 2017. METHODS: We conducted quantitative and qualitative analyses with 5081 eligible pediatricians who registered to participate in the 2017 pilot; 81.4% (n = 4016) completed a quarter 4 survey and/or end-of-year survey (January 2018) and comprise the analytic sample. RESULTS: The majority of pediatricians considered the MOCA-Peds to be feasible and acceptable as an alternative to the proctored MOC GP examination. More than 90% of respondents indicated they would participate in the proposed MOCA-Peds model instead of the examination. Participants also offered recommendations to improve the MOCA-Peds (eg, enhanced focus of questions on outpatient GP, references provided before taking questions); the ABP is carefully considering these as the MOCA-Peds is further refined. CONCLUSIONS: Pilot participant feedback in 2017 suggested that the MOCA-Peds could be implemented for GP starting in January 2019, with all 15 subspecialties launched by 2022. Current and future evaluations will continue to explore feasibility, acceptability, and learning and practice change as well as sustainability of participation.


Assuntos
Atitude do Pessoal de Saúde , Certificação/normas , Competência Clínica/normas , Pediatras/psicologia , Pediatras/normas , Inquéritos e Questionários , Adulto , Idoso , Certificação/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
2.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31690712

RESUMO

BACKGROUND AND OBJECTIVES: This article is the second of a 2-part series examining results regarding self-reported learning and practice change from the American Board of Pediatrics 2017 pilot of an alternative to the proctored, continuing certification examination, termed the Maintenance of Certification Assessment for Pediatrics (MOCA-Peds). Because of its design, MOCA-Peds has several learning advantages compared with the proctored examination. METHODS: Quantitative and qualitative analyses with 5081 eligible pediatricians who registered to participate in the 2017 pilot; 81.4% (n = 4016) completed a quarter 4 survey and/or the end-of-year survey (January 2018) and compose the analytic sample. RESULTS: Nearly all (97.6%) participating pediatricians said they had learned, refreshed, or enhanced their medical knowledge, and of those, 62.0% had made a practice change related to pilot participation. Differences were noted on the basis of subspecialty status, with 68.9% of general pediatricians having made a practice change compared with 41.4% of subspecialists. Within the 1456 open-ended responses about participants' most significant practice change, responses ranged widely, including both medical care content (eg, "care for corneal abrasions altered," "better inform patients about. . .flu vaccine") and nonspecific content (eg, providing better patient education, using evidence-based medicine, increased use of resources in regular practice). CONCLUSIONS: As a proctored examination alternative, MOCA-Peds positively influenced self-reported learning and practice change. In future evaluation of MOCA-Peds and other medical longitudinal assessments, researchers should study ways to further encourage learning and practice change and sustainability.


Assuntos
Atitude do Pessoal de Saúde , Certificação/normas , Competência Clínica/normas , Educação Médica Continuada/normas , Aprendizagem , Pediatras/normas , Adulto , Certificação/métodos , Educação Médica Continuada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pediatras/psicologia , Projetos Piloto , Padrões de Prática Médica/normas , Inquéritos e Questionários
3.
J Am Podiatr Med Assoc ; 109(S1): 1-4, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31760757

RESUMO

The Board of Directors of the American Board of Podiatric Medicine approved the following position statement regarding hospital and surgical privileges for doctors of podiatric medicine on February 27, 2019. This statement is based on federal law, Centers for Medicare and Medicaid Services Conditions of Participation and Standards of the Joint Commission, and takes into account the current education, training, and experience of podiatrists to recommend best practices for hospital credentialing and privileging.


Assuntos
Certificação/normas , Privilégios do Corpo Clínico/normas , Podiatria/normas , Certificação/legislação & jurisprudência , Política Organizacional , Podiatria/educação , Conselhos de Especialidade Profissional , Estados Unidos
4.
Rev Esp Salud Publica ; 932019 Oct 04.
Artigo em Espanhol | MEDLINE | ID: mdl-31582718

RESUMO

EDAC stands for Evidence-based Design Accreditation and Certification and identifies individuals able to apply the evidence-based design process for healthcare buildings. This process consists of basing design decisions on credible research to achieve the best possible outcomes. What differentiates this design process from others is its emphasis on using research both to inform a priori and to evaluate a posteriori design decision. The evidence-based design term appeared printed for the first time in 2000 but its origins date back to three key factors that happened years before: i) the evidence-based medicine movement, ii) the patientcentred care movement and, iii) a published paper that related a design strategy (the windows of the hospitalisation patient bedroom) with the recovery process of the patients. This scientific link between design and clinical outcomes not only evidenced the potential of architectural design on influencing patients' recovery but also the financial impact for the healthcare institutions. While in other countries evaluation mechanisms are already in place to improve the efficiency and performance of healthcare buildings, in Spain only one person has obtained the EDAC program. To what extent can this knowledge be incorporated into the Spanish design process for healthcare buildings and will this influence architects to confront their social responsibility with the healthcare system?


Assuntos
Acreditação/normas , Certificação/normas , Projeto Arquitetônico Baseado em Evidências , Pesquisa sobre Serviços de Saúde , Humanos , Administração em Saúde Pública , Responsabilidade Social , Espanha
5.
Semin Vasc Surg ; 32(1-2): 48-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540657

RESUMO

The evolving demands of surgical training have led to the successful implementation of skills examinations in the areas of laparoscopic and endoscopic surgery. Currently, there is no similar formal skills assessment in vascular surgery, despite endovascular intervention replacing open surgery in treatment of many vascular conditions. The adoption of less invasive techniques to treat aneurysm and occlusive disease has resulted in new training paradigms and technical challenges for trainees. The duty hour restriction for trainees and declining numbers of complex open vascular interventions have added to the challenges of vascular surgery training. Simulation is a promising avenue for both skills training and assessment. The ability to evaluate the fundamental skills of trainees would be an important step to ensure a degree of uniformity in trainees' technical abilities. The role of simulation-based training in acquiring, testing, and refining these skills is still in its infancy in the vascular surgery training paradigm. This article aims to impart a deeper understanding of the conditions for developing and implementing the fundamentals of vascular and endovascular surgery, and to provide guidance regarding the role of simulation-based training in a rapidly evolving specialty. There are various forms of simulation available, including benchtop models, high-fidelity simulators, and virtual-reality simulators, and each requires a different method of proficiency assessment. Both open surgery and endovascular skills can be assessed and the application of successful implementation in academic vascular surgery training program is presented.


Assuntos
Certificação , Instrução por Computador/métodos , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência , Treinamento por Simulação/métodos , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Certificação/normas , Competência Clínica , Instrução por Computador/normas , Currículo , Educação de Pós-Graduação em Medicina/normas , Humanos , Curva de Aprendizado , Treinamento por Simulação/normas , Cirurgiões/normas , Procedimentos Cirúrgicos Vasculares/normas
7.
Salud Publica Mex ; 61(4): 524-531, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31322845

RESUMO

OBJECTIVE: To analyze the possible effect of certification models and healthcare organizations' (HOs) participation incentives in the General Health Council certification process in the 1999-2017 period. MATERIALS AND METHODS: Official printed and online documents about HOs' certification were collected. Information from instances related to the process was requested through transparency mechanisms. Health organizations' participation in political-administrative periods between 1997-2017 was analyzed. RESULTS: The annual average participation in the certification process during the 1999-2000 period was 259.5 HOs; during the 2013-2016 period, the average was 72.5. Public units' participation in this process has been decreasing. In 2017, certified HO were <1%. CONCLUSIONS: No positive effects of adjustments to the certification model or the incentives applied were identified. Conversely, there is decreasing participation in the different political-administrative periods. The National HO Certification System and its possible effect on clinical quality must be thoroughly evaluated.


Assuntos
Acreditação/normas , Certificação/normas , Instalações de Saúde/normas , Instalações de Saúde/estatística & dados numéricos , México , Setor Privado/normas , Setor Privado/estatística & dados numéricos , Logradouros Públicos/normas , Logradouros Públicos/estatística & dados numéricos
11.
Comput Inform Nurs ; 37(8): 396-404, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31149911

RESUMO

This study yielded a map of the alignment of American Association of Colleges of Nursing Graduate-Level Nursing Informatics Competencies with American Medical Informatics Association Health Informatics Core Competencies in an effort to understand graduate-level accreditation and certification opportunities in nursing informatics. Nursing Informatics Program Directors from the American Medical Informatics Association and a health informatics expert independently mapped the American Association of Colleges of Nursing competencies to the American Medical Informatics Association Health Informatics knowledge, skills, and attitudes. The Nursing Informatics Program Directors' map connected an average of 4.0 American Medical Informatics Association Core Competencies per American Association of Colleges of Nursing competency, whereas the health informatics expert's map connected an average of 5.0 American Medical Informatics Association Core Competencies per American Association of Colleges of Nursing competency. Agreement across the two maps ranged from 14% to 60% per American Association of Colleges of Nursing competency, revealing alignment between the two groups' competencies according to knowledge, skills, and attitudes. These findings suggest that graduates of master's degree programs in nursing, especially those specializing in nursing informatics, will likely be prepared to sit for the proposed Advanced Health Informatics Certification in addition to the American Nurses Credentialing Center bachelor's-level Informatics Nursing Certification. This preliminary map sets the stage for further in-depth mapping of nursing informatics curricula with American Medical Informatics Association Core Competencies and will enable interprofessional conversations around nursing informatics specialty program accreditation, nursing workforce preparation, and nursing informatics advanced certification. Nursing informaticists should examine their need for credentials as key contributors who will address critical health informatics needs.


Assuntos
Certificação/normas , Informática Médica/normas , Informática em Enfermagem/normas , Competência Profissional , American Nurses' Association , Currículo , Educação de Pós-Graduação em Enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estados Unidos
13.
Intern Med J ; 49(5): 669-671, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31083806

RESUMO

Over careers spanning 35 years each, we have witnessed great advances in medicine especially in genetics, imaging, immunotherapies and targeted cancer therapies. Our respective specialties of endocrinology and medical oncology have come to overlap significantly necessitating better communication and skills across both specialties. We will highlight common scenarios that straddle endocrinology and medical oncology. The same broad issues apply to other closely related specialties, albeit with different clinical challenges. At present, we see expensive and inefficient cross-referrals to other subspecialists or sometimes no referral at all, leading to significant clinical omissions. Opportunities for dual advanced training, or for more comprehensive single advanced training could more efficiently lead to enhanced patient care and communication.


Assuntos
Certificação , Endocrinologia/educação , Oncologia/educação , Encaminhamento e Consulta , Escolha da Profissão , Certificação/normas , Certificação/tendências , Endocrinologia/normas , Endocrinologia/tendências , Humanos , Oncologia/normas , Oncologia/tendências , Medicina/normas , Medicina/tendências , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/tendências
15.
BMC Public Health ; 19(1): 481, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046741

RESUMO

BACKGROUND: Many developing countries are experiencing the epidemiological transition, with the majority of deaths attributed to cardiovascular disease, cancer, Type 2 diabetes (T2DM) and others. In some countries, large proportional mortality attributed to diabetes is evident in official mortality statistics, with Mauritius and Fiji rated as the highest in the world. METHODS: This study investigates trends in recorded diabetes and cardiovascular disease mortality in Mauritius and Fiji under coding from the International Classification of Diseases (ICD) versions 9 and 10, using mortality data reported from these countries to the World Health Organization (WHO). RESULTS: In Mauritius over 1981-2004, T2DM proportional mortality varied between 4% and 7% in males (M) and 5% and 9% in females (F). In 2005 there was a sudden increase to M 20% and F 25%, which continued to M 25% and F 30% by 2012. Over 1981-2004 the proportion of circulatory disease mortality rose from 44% to 49% in males, and from 46% to 57% in females. In 2005, circulatory disease mortality proportions fell precipitously to 34% in males and 37% in females, and declined to 31% and 34% by 2013. ICD-10 coding was introduced in 2005. In Fiji, sharp rises in proportional T2DM mortality from 3% in both sexes in 2001 to M 15% and F 20% in 2002 were followed by more gradual trend increases to M 20% and F 26% by 2012-13. Circulatory disease proportions fell steeply from M 57% and F 53% in 2001 to M 44% and M 38% by 2004, with subsequent less steep declines to M 39% and F 30% by 2012. ICD-10 coding was introduced in 2001. CONCLUSIONS: Large, abrupt changes in diabetes and circulatory disease proportional mortality in Fiji and Mauritius coincided with the local introduction of ICD-10 coding in different years. There is also evidence for diabetes-related misclassification of underlying cause of death in Australia and the USA. These artefacts can undermine accurate monitoring of cause of death for evaluation of effectiveness of prevention and control, especially of circulatory disease mortality which is demonstrably reversible in populations.


Assuntos
Doenças Cardiovasculares/mortalidade , Certificação/normas , Atestado de Óbito , Diabetes Mellitus Tipo 2/mortalidade , Controle de Formulários e Registros/normas , Idoso , Austrália , Causas de Morte , Feminino , Fiji , Humanos , Classificação Internacional de Doenças/normas , Masculino , Maurício , Pessoa de Meia-Idade , Sistema de Registros , Organização Mundial da Saúde
16.
Aerosp Med Hum Perform ; 90(5): 484-487, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31023410

RESUMO

INTRODUCTION: This study explores the safety risk due to delayed detection of hazardous health conditions that would result from increasing the duration of U.S. first-class aeromedical certificates from 6 mo to 12 mo for pilots ages 40 yr old through 60 yr old.METHODS: All pilots who submitted a U.S. first-class application in 2014 with no electrocardiogram and with the previous exams 4.5 to 7.5 mo prior were selected from the FAA pilot medical database. Proportions of Federal Aviation Administration (FAA) denial pathology codes and Aviation Medical Examiner (AME) deferrals were compared for these exams within and between age groups from 40 yr old through 75 yr old. The absolute incidence rates for delayed detection were calculated and relative incidence of these proportions was compared graphically.RESULTS: The relative risk between age groups for delayed identification of disqualifying medical conditions showed that the 56-60-yr-old group would be at about twice the risk as the 40-45-yr-old group. The absolute incidence for the 56-60-yr-old group was 0.46% for denial conditions and 0.60% for AME deferrals over 6 mo.DISCUSSION: Increasing FAA first-class medical certificate duration from 6 mo to 12 mo would put 56-60-yr-old pilots at double the currently accepted risk for delayed detection of significant medical conditions. The absolute risk for this 6-mo delayed identification for the 56-60-yr-old group would average 0.53%.Mills WD, DeJohn CA. Safety implications of 6-month vs. 1-year first-class aeromedical certificates. Aerosp Med Hum Perform. 2019; 90(5):484-487.


Assuntos
Medicina Aeroespacial/organização & administração , Certificação/organização & administração , Pilotos/legislação & jurisprudência , Segurança/normas , Avaliação da Capacidade de Trabalho , Acidentes Aeronáuticos/prevenção & controle , Adulto , Medicina Aeroespacial/normas , Fatores Etários , Idoso , Aviação/legislação & jurisprudência , Aviação/estatística & dados numéricos , Certificação/normas , Diagnóstico Tardio/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico/normas , Exame Físico/estatística & dados numéricos , Pilotos/estatística & dados numéricos , Medição de Risco , Fatores de Tempo , Estados Unidos
18.
Artigo em Chinês | MEDLINE | ID: mdl-30884597

RESUMO

Objective: To investigate the qualifications current situations of the medical and health institutions and certified doctors for providing occupational disease diagnosis in Jiangsu Province to provide reference for occupational disease prevention and control. Methods: Quantitative and qualitative analysis was carried out on 28 institutionsfor occupational disease diagnosis and 1 278 certified doctors for occupational disease diagnosis in Jiangsu Province between 2012 and 2017, announcement from Jiangsu provincial commission of health and family planning commission, SPSS16.0 was used for statistical analysis. Results: By the end of 2017, there had been 28 medical and health institutions which were qualified for providing occupational disease diagnosis in Jiangsu Province, including 16 centers for disease control and prevention, accounting for 57.14%, 6 general hospitals, accounting for 21.42%, and 6 institutes or centers for occupational disease prevention and control, accounting for 21.42%; a total of 313 occupational disease diagnosis were employed in these 28 diagnostic institutions, with 9.4 certified doctors on average in each institution; In addition, 17.86% of the institutions get all the qualifications for diagnosing 10 occupational diseases, and 10.71% of the institutions get the qualification for diagnosing one tothree occupational diseases. A total of 1278 physicians obtain the qualification of certified doctors for occupational disease diagnosis, the largest number was 221 in Wuxi city, at least 16 in Zhenjiang city, including 599 centers for disease control and prevention, accounting for 46.87%, 118 institutes or centers for occupational disease prevention and control, accounting for 9.23%, 304 general hospitals, accounting for 23.79%, 257 enterprise-owned hospitals, accounting for 20.11%; The highest number of occupational poisoning diagnoses was obtained, accounting for 796 (62.28%) . Conclusion: A provincial occupational disease diagnosis network has been established in Jiangsu, but it is far from covering all districts and counties, and the imbalance in regional distribution and specialty programs still exists among the qualified medical and health institutions and certified doctors. It is essential to further strengthen the training of qualified doctors and the development of qualified medical and health institutions.


Assuntos
Certificação/normas , Doenças Profissionais/diagnóstico , Médicos/normas , China , Humanos
19.
Anesth Analg ; 129(1): 226-234, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30925556

RESUMO

BACKGROUND: With the integration of Objective Structured Clinical Examinations into the Anesthesiology primary board certification process, residency programs may choose to implement Objective Structured Clinical Examinations for resident skill assessment. The aim of this study was to evaluate Objective Structured Clinical Examination-based milestone assessment and compare with Clinical Competency Committee milestone assessment that is based purely on clinical evaluations. METHODS: An annual Objective Structured Clinical Examination event was used to obtain milestone assessment of clinical anesthesia year 0-clinical anesthesia year 3 residents for selected milestones in patient care, professionalism, and interpersonal/communication skills. The Objective Structured Clinical Examination scenarios were different for each training level. The Clinical Competency Committee evaluated each resident semiannually based on clinical evaluations of resident performance. The Clinical Competency Committee milestone assessments from 2014 to 2016 that were recorded closest to the Objective Structured Clinical Examination event (±3 months) were compared to the Objective Structured Clinical Examination milestone assessments. A total of 35 residents were included in this analysis in 3 different training cohorts: A (graduates 2016, n = 12); B (graduates 2017, n = 10); and C (graduates 2018, n = 13). All residents participated in Objective Structured Clinical Examinations because their clinical anesthesia year 0 year and Clinical Competency Committee milestone data had been reported since December 2014. RESULTS: Both assessment techniques indicated a competency growth proportional to the length in training. Despite limited cumulative statistics in this study, average trends in the Objective Structured Clinical Examination-Clinical Competency Committee relationship indicated: (1) a good proportionality in reflecting competency growth; (2) a grade enhancement associated with Clinical Competency Committee assessment, dominated by evaluations of junior residents (clinical anesthesia year 0-clinical anesthesia year 1); and (3) an expectation bias in Clinical Competency Committee assessment, dominated by evaluation of senior residents (clinical anesthesia year 2-clinical anesthesia year 3). CONCLUSIONS: Our analysis confirms the compatibility of the 2 evaluation methods in reflecting longitudinal growth. The deviation of Objective Structured Clinical Examination assessments versus Clinical Competency Committee assessments suggests that Objective Structured Clinical Examinations may be providing additional or different information on resident performance. Educators might consider using both assessment methods to provide the most reliable and valid competency assessments during residency.


Assuntos
Anestesiologistas/educação , Anestesiologia/educação , Certificação/normas , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/normas , Internato e Residência/normas , Avaliação Educacional , Escolaridade , Humanos , Curva de Aprendizado , Estudos Retrospectivos
20.
Dermatol Surg ; 45(4): 581-587, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30829773

RESUMO

BACKGROUND: The regulation of medical spas (med-spas) in the United States varies considerably from state to state with important ramifications for patient safety. OBJECTIVE: To describe the current state of med-spas in the United States and degree of medical oversight in these facilities. MATERIALS AND METHODS: Descriptive study based on web search and standardized phone interviews of med-spas in the most heavily populated cities in each state of the United States. Information obtained included the following: whether medical directors were listed; if so, whether they were advertised as being on site; medical directors' training and board certification; and services offered. RESULTS: Of 247 medical spas reviewed, 72% advertised a medical director on their website, and 6.5% claimed that the director was on site. Of listed medical directors, 41% were trained in dermatology and/or plastic surgery. In phone interviews, 79% of med-spas endorsed the medical director to be board certified, and 52% stated that the medical director was on site less than 50% of the time. CONCLUSION: There is significant variation in medical directorship and oversight among medical spas in the United States. Appropriate regulation of medical directors' training and the degree of oversight provided are warranted to optimize patient safety.


Assuntos
Técnicas Cosméticas/normas , Dermatologia/normas , Instalações de Saúde/legislação & jurisprudência , Instalações de Saúde/normas , Diretores Médicos/legislação & jurisprudência , Diretores Médicos/normas , Certificação/legislação & jurisprudência , Certificação/normas , Técnicas Cosméticas/estatística & dados numéricos , Dermatologia/estatística & dados numéricos , Regulamentação Governamental , Instalações de Saúde/estatística & dados numéricos , Humanos , Segurança do Paciente/legislação & jurisprudência , Segurança do Paciente/normas , Estados Unidos/epidemiologia
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