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1.
J Grad Med Educ ; 11(4): 402-409, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31440333

RESUMO

Background: Little is known about the level of burnout among program administrators (PAs) working in graduate medical education. Objective: We created a national database with baseline burnout data for PAs from residency and fellowship programs, including intention to leave their current positions. Methods: A cross-sectional study was conducted in July 2017 to assess levels of burnout in a national cohort of PAs, who were largely members of online specialty forums. The Copenhagen Burnout Inventory (CBI) was used to measure burnout. Univariate analysis produced descriptive statistics for CBI. We performed a 2-sample t test to measure differences in average burnout scores for those who had thoughts of resigning from their positions and those who had not. Results: Of the approximately 10 205 national PAs, we sampled 1126 (11%). Of the 1126 individuals who received the study information, 931 (83%) completed the baseline survey. Total mean scores for all subscales were elevated (personal: 53.7, SD 21.4; work-related: 52.0, SD 22; and client-related: 30.6, SD 20.8; each scale ranged from 0, low, to 100, high). Burnout scores differed between those contemplating leaving their jobs and those who were not, across all subscales of CBI, including personal (64.2 versus 42.4, -24.18 to -19.44 confidence interval [CI]), work-related (63.5 versus 39.7, -26.12 to -21.35 CI), and client-related (36.6 versus 24.2, -14.95 to -9.84 CI; P < .0001 for all). Conclusions: In this national survey of PAs, burnout scores measured by the CBI were higher among those who had considered leaving their positions.


Assuntos
Esgotamento Profissional/psicologia , Bolsas de Estudo , Internato e Residência , Diretores Médicos , Carga de Trabalho/psicologia , Adulto , Estudos Transversais , Bases de Dados Factuais/estatística & dados numéricos , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reorganização de Recursos Humanos , Diretores Médicos/psicologia , Diretores Médicos/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
2.
BMC Health Serv Res ; 19(1): 388, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200709

RESUMO

BACKGROUND: There is an increasing number of pediatric urgent care centers that are largely staffed by pediatric residency graduates. It is unclear if pediatric residency adequately prepares a physician to fully and successfully provide care in an urgent care setting. The goal of this study is to conduct an assessment of urgent care directors' perceptions of recent pediatric residency graduates' preparedness to successfully provide pediatric urgent care after graduation. METHODS: This is a 2018 cross-sectional survey of all pediatric emergency medicine division chiefs in the United States and all pediatric urgent care directors who are members of the Society for Pediatric Urgent Care. An electronic survey was distributed consisting of eight multiple choice questions regarding perceived preparedness and knowledge gaps of recent pediatric residency graduates for independent practice in urgent care. Descriptive statistics were used to analyze results and qualitative data were analyzed via an inductive thematic approach. RESULTS: Forty-two percent (65/154) of surveys were completed. No respondents believed that a recent pediatric residency graduate would be adequately prepared to independently practice in a pediatric urgent care and 81% of respondents recommended some additional training. Most respondents described this training as important (46%) or very important (35%). Most respondents recommended between 6 months and 1 year as the appropriate amount of time to achieve competency. CONCLUSIONS: Despite the growing number pediatric residency graduates staffing pediatric urgent care centers, the majority of surveyed pediatric emergency medicine division chiefs and pediatric urgent care directors do not think that pediatric residency adequately prepares graduates to successfully provide urgent care to pediatric patients. We recommend further exploration of gaps in knowledge of recent pediatric residency graduates as a next step towards developing systems for further training for pediatric residency graduates to gain competency in urgent care management.


Assuntos
Medicina de Emergência/educação , Internato e Residência/normas , Pediatria/educação , Assistência Ambulatorial/normas , Atitude do Pessoal de Saúde , Criança , Competência Clínica/normas , Estudos Transversais , Assistência à Saúde/normas , Medicina de Família e Comunidade , Bolsas de Estudo , Humanos , Internato e Residência/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Diretores Médicos/psicologia , Médicos , Inquéritos e Questionários , Estados Unidos
3.
J Surg Res ; 242: 332-335, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31129242

RESUMO

BACKGROUND: Chair of the Department of Surgery, sometimes known as the Chief, holds a title that has significant historical connotations. Our goal was to assess a group of objectively measurable characteristics that unify these individuals as a group. METHODS: Utilizing publicly available data for all US teaching hospitals, demographic information was accumulated for the named chiefs/chairs of surgery. Information collected included location of their program, their medical/surgical training history, their surgical specialty, previous chair/chief titles held, and academic productivity. RESULTS: Of the 259 programs listed, data were available on 244 individuals who were trained in 19 different specialties. The top three specialties of these practitioners are General Surgery (40, 16.3%), Surgical Oncology (38, 15.5%), and Vascular Surgery (33, 13.5%). There were only 14 female chairs (5.7%) and only one chair with a doctor of osteopathic medicine degree. The majority (62.3%) had been a previous chief of a surgical subdivision with only 26% having been a previous chair/chief of the surgical department. The average chair had 72 peer-reviewed manuscripts with 28 published book chapters. Chair's at academic institutions with university affiliation had a significantly higher number of peer-reviewed manuscripts (P < 0.0001) as well as were more likely to be trained at academic institutions (P = 0.013). CONCLUSIONS: There are no set characteristics that define the Chair of a Department of Surgery. By understanding a group of baseline characteristics that unify these surgical leaders, young faculty and trainees with leadership aspirations may begin to understand what is necessary to fill these roles in the future.


Assuntos
Docentes de Medicina/psicologia , Hospitais de Ensino/organização & administração , Liderança , Diretores Médicos/psicologia , Centro Cirúrgico Hospitalar/organização & administração , Docentes de Medicina/estatística & dados numéricos , Feminino , Humanos , Masculino , Diretores Médicos/estatística & dados numéricos , Editoração/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
4.
J Health Organ Manag ; 33(2): 204-220, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30950308

RESUMO

PURPOSE: The purpose of this paper is to gain a better understanding of the difficulties encountered in the hybrid roles of physician-managers (P-Ms), examine the impact of organizational constraints on the role conflicts experienced by P-Ms and explore the different ways their two roles are integrated. DESIGN/METHODOLOGY/APPROACH: A qualitative approach was adopted, using six focus groups made up of clinical co-managers, medical directors and P-Ms. In all, 43 different people were interviewed to obtain their perceptions of the day-to-day realities of the role of the P-M. The data collected were subsequently validated. FINDINGS: Although the expectations of the different groups involved regarding the role of P-Ms are well understood and shared, there are significant organizational constraints affecting what P-Ms are able to do in their day-to-day activities, and these constraints can result in role conflicts for the people involved. Such constraints also affect the ways P-Ms integrate the two roles. The authors identify three role hybridization profiles. PRACTICAL IMPLICATIONS: The results afford a better understanding of how organizational constraints might be used as levers of organizational change to achieve a better hybridization of the dual roles of P-Ms. ORIGINALITY/VALUE: This paper seeks to reach beyond a simple identification of constraints affecting the dual roles of P-Ms by analyzing how such constraints impact on these professionals' day-to-day activities. Results also enable us to further refine Katz and Kahn's (1966) role model, in addition to identifying hybridization profiles.


Assuntos
Hospitais Universitários/organização & administração , Diretores Médicos/psicologia , Médicos/psicologia , Papel Profissional/psicologia , Canadá , Feminino , Grupos Focais , Humanos , Masculino , Inovação Organizacional , Diretores Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Pesquisa Qualitativa
5.
Work ; 62(2): 353-359, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829645

RESUMO

BACKGROUND: Management by Objectives (MbO) has been shown to establish efficient team work in both industry and medicine. Its most important prerequisite for success is target agreements between managers and medical professionals on equal footing. In medicine, lump-sum financing urges the delivery of a health care service with minimal effort. Consequently, daily clinical life changed, with economic goals seeming to become priority over medical principles. OBJECTIVE: To determine how well MbO can still be practiced in hospitals with lumped treatment prices. METHODS: We used an anonymized questionnaire for already retired physician executives who completed their active leadership positions between 2010 and 2015 in Saxony (Germany). We asked various type of target agreements that had been used in order to achieve medical or economic targets. RESULTS AND CONCLUSIONS: Out of 111 former executives, the questionnaires of 25 respondents could be analysed. Eight respondents confirmed target agreements that were mostly set by managing directors. If used, most targets had not been adapted to the infrastructure and personnel strength, nor were they coordinated with neighbouring departments. Four respondents received financial incentives. Most medical executives were unsatisfied and preferred to abandon further goal setting. Due to the low number of cases, the representativeness of the study is limited. Nevertheless, it might be questioned if a flat-rate remuneration system facilitates the change into an authoritarian leadership concept.


Assuntos
Administração Hospitalar/normas , Liderança , Diretores Médicos/psicologia , Alemanha , Administração Hospitalar/métodos , Administração Hospitalar/tendências , Hospitais/normas , Hospitais/tendências , Humanos , Diretores Médicos/normas , Inquéritos e Questionários
6.
Curr Opin Anaesthesiol ; 32(2): 195-199, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30817395

RESUMO

PURPOSE OF REVIEW: Against the background of increasing healthcare costs and diminishing budgets, this review aims to present clinicians with ethically viable options to overcome budgetary restraints when seeking to introduce novel products. RECENT FINDINGS: Healthcare administrators and primary healthcare providers are not unlikely to have different opinions when discussing the introduction of novel products. However, rather than taking a 'no' for an answer, doctors may be able to argue for a change - even if this may seem to come at a higher cost. The recent introduction of the reversal agent sugammadex may provide a timely example for the possibility of success 'against all financial odds'. SUMMARY: Health professionals have the responsibility to deliver high-quality care while acknowledging the financial budget constraints. However, evidence (vs. perception) for outcome benefits of novel drugs or devices should stimulate a robust desire for their timely introduction. Demonstrating actual benefits understandable to administrators, seeking alliances with other medical specialties or patient groups, as well as negotiations with the healthcare industry may all represent viable options. Simply waiting for patents to expire should remain a measure of last resort.


Assuntos
Orçamentos/organização & administração , Custos de Cuidados de Saúde , Diretores Médicos/psicologia , Médicos de Atenção Primária/psicologia , Austrália , Comportamento de Escolha , Redução de Custos , Análise Custo-Benefício , Medicina Baseada em Evidências/economia , Humanos , Percepção
7.
Ann Otol Rhinol Laryngol ; 128(1): 28-35, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30371115

RESUMO

OBJECTIVE:: To determine attitudes of residents and program directors towards research during residency training. STUDY DESIGN:: Survey of current otolaryngology residents and program directors. SETTING:: Otolaryngology residency programs. METHODS:: An anonymous web-based survey ( www.surveymonkey.com ) was sent to 106 program directors (PDs) and 115 program coordinators. The program coordinators subsequently sent it to residents. Fisher exact tests and correlations were used to determine statistically significant differences. RESULTS:: Overall, 178 residents and 31 PDs responded to our surveys. All residents surveyed reported some research experience prior to residency. Residents who reported a previous first-author manuscript publication prior to residency were more likely than residents who had no previous first-author publication to report a first-author publication during residency (58.44% vs 27.27%, P < .0001); 33% of the residents reported academics as a desired future career setting after residency. The most significant barrier to research perceived by the residents was time constraint due to residency duties and personal commitments (93% and 74%, respectively). The second and third most common barriers to research were lack of statistical knowledge at 52% and lack of interest in research at 43.6%. CONCLUSIONS:: Research is a required component of otolaryngology residency training. The most significant barrier in our survey was the lack of protected research time, followed by lack of biostatistical knowledge and interest. Program directors may need to implement structured research rotations tailored to individual residents' research interests and integrate training in research methodology and biostatistics.


Assuntos
Atitude do Pessoal de Saúde , Pesquisa Biomédica/educação , Internato e Residência , Otolaringologia/educação , Diretores Médicos/psicologia , Autoria , Humanos , Inquéritos e Questionários
8.
J Manag Care Spec Pharm ; 24(11): 1173-1183, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30362919

RESUMO

BACKGROUND: Behavioral economics is a field of economics that draws on insights from psychology to understand and identify patterns of decision making. Cognitive biases are psychological tendencies to process information in predictable patterns that result in deviations from rational decision making. Previous research has not evaluated the influence of cognitive biases on decision making in a managed care setting. OBJECTIVE: To assess the presence of cognitive biases in formulary decision making. METHODS: An online survey was conducted with a panel of U.S. pharmacy and medical directors who worked at managed care organizations and served on pharmacy and therapeutics committees. Survey questions assessed 4 cognitive biases: relative versus absolute framing effect, risk aversion, zero-risk bias, and delay discounting. Simulated data were presented in various scenarios related to adverse event profiles, drug safety and efficacy, and drug pricing for new hypothetical oncology products. Survey questions prompted participants to select a preferred drug based on the information provided. Survey answers were analyzed to identify decision patterns that could be explained by the cognitive biases. Likelihood of bias was analyzed via chi-square tests for framing effect, risk aversion, and zero-risk bias. The delay discounting section used a published algorithm to characterize discounting patterns. RESULTS: A total of 35 pharmacy directors and 19 medical directors completed the survey. In the framing effect section, 80% of participants selected the suboptimal choice in the relative risk frame, compared with 38.9% in the absolute risk frame (P < 0.0001). When assessing risk aversion, 42.6% and 61.1% of participants displayed risk aversion in the cost- and efficacy-based scenarios, respectively, but these were not statistically significant (P = 0.27 and P = 0.10, respectively). In the zero-risk bias section, results from each scenario diverged. In the first zero-risk bias scenario, 90.7% of participants selected the drug with zero risk (P < 0.001), but in the second scenario, only 32.1% chose the zero-risk option (P < 0.01). In the section assessing delay discounting, 54% of survey participants favored a larger delayed rebate over a smaller immediate discount. A shallow delay discounting curve was produced, which indicated participants discounted delayed rewards to a minimal degree. CONCLUSIONS: Pharmacy and medical directors, like other decision makers, appear to be susceptible to some cognitive biases. Directors demonstrated a tendency to underestimate risks when they were presented in relative risk terms but made more accurate appraisals when information was presented in absolute risk terms. Delay discounting also may be applicable to directors when choosing immediate discounts over delayed rebates. However, directors neither displayed a statistically significant bias for risk aversion when assessing scenarios related to drug pricing or clinical efficacy nor were there significant conclusions for zero-risk biases. Further research with larger samples using real-world health care decisions is necessary to validate these findings. DISCLOSURES: This research was funded by Xcenda. Mezzio, Nguyen, and O'Day are employees of Xcenda. Kiselica was employed by Xcenda at the time the study was conducted. The authors have nothing to disclose. A portion of the preliminary data was presented as posters at the 2017 AMCP Managed Care & Specialty Pharmacy Annual Meeting; March 27-30, 2017; in Denver, CO, and the 2017 International Society for Pharmacoeconomics and Outcomes Research 22nd Annual International Meeting; May 20-24, 2017; in Boston, MA.


Assuntos
Tomada de Decisões , Programas de Assistência Gerenciada/organização & administração , Farmácia/organização & administração , Diretores Médicos/psicologia , Preconceito/psicologia , Cognição , Farmacoeconomia , Humanos , Funções Verossimilhança , Programas de Assistência Gerenciada/economia , Medição de Risco , Inquéritos e Questionários
10.
Leadersh Health Serv (Bradf Engl) ; 31(2): 238-253, 2018 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-29771222

RESUMO

Purpose This study aims to explore the structural aspects (roles, responsibilities and reporting) of dyad leadership in one health-care organization (HCO). Design/methodology/approach The perceptions of 32 leaders (17 physician leaders and 15 dyad co-leaders) in formal leadership positions (six first-level with formal authority limited to teams or divisions, 23 middle-level with wider departmental or program responsibility and three senior-level with institution-wide authority) were obtained through focus groups and surveys. In addition, five senior leaders were interviewed. Descriptive statistics was used for quantitative data, and qualitative data were analyzed for themes by coding and categorization. Findings There are a large number of shared responsibilities in the hybrid model, as most activities in HCOs bridge administrative and professional spheres. These span the leadership (e.g. global performance and quality improvement) and management (e.g. human resources, budgets and education delivery) domains. The individual responsibilities, except for staff and physician engagement are in the management domain (e.g. operations and patient care). Both partners are responsible for joint decision-making, projecting a united front and joint reporting through a quadrat format. The mutual relationship and joint accountability are key characteristics and are critical to addressing potential conflicts and contradictions and achieving coherence. Practical implications Clarity of role will assist development of standardized job descriptions and required competencies, recruitment and leadership development. Originality/value This is an original empirical study presenting an integrated view of dyad leaders and senior leadership, meaningful expansion of shared responsibilities including academic functions and developing mutual relationship and emphasizing the central role of stability generating management functions.


Assuntos
Atitude do Pessoal de Saúde , Liderança , Diretores Médicos/psicologia , Papel do Médico , Humanos , Descrição de Cargo , Competência Profissional , Saskatchewan
11.
J Am Board Fam Med ; 31(2): 286-291, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29535247

RESUMO

BACKGROUND AND OBJECTIVE: To determine whether family medicine program directors (PDs) experienced moral distress due to obstacles to Hepatitis C virus (HCV) treatment, and to explore whether they found those obstacles to be unethical. DESIGN: An omnibus survey by the Council of Academic Family Medicine's Educational Research Alliance was administered to 452 and completed by 273 US-based PDs. The survey gauged attitudes and opinions regarding ethical dilemmas in patient access to HCV treatment. RESULTS: Most of the respondents were male. Sixty-four percent of respondents believed that treatment should be an option for all patients regardless of cost. Forty-one percent believed that it was unethical to deny treatment based on past or current substance use, and 38% believed treatment should be offered to patients who were substance abusers. Moral distress was reported by 61% (score >3) of participants when they were unable to offer treatment to patients due to the patient's failure to meet eligibility criteria. In addition, PDs reporting moderate-to-high levels of moral distress were also likely to report the following opinions: 1) treatment should be offered regardless of cost, 2) it is unethical to deny treatment based on past behavior, 3) substance abusers should be offered treatment, 4) it is unethical for medicine to be prohibitively expensive, and 5) Medicaid policy that limits treatment will worsen racial and ethnic disparities. CONCLUSIONS: Currently, important ethical dilemmas exist in the access and delivery of HCV therapy. Although a diversity of opinions is noted, a significant proportion of PDs are concerned about patients' inability to avail equitable care and experience distress. In some cases, this moral distress is in response to, and in conflict with, current guidelines.


Assuntos
Medicina de Família e Comunidade/ética , Acesso aos Serviços de Saúde/economia , Hepatite C/tratamento farmacológico , Princípios Morais , Diretores Médicos/psicologia , Antivirais/economia , Antivirais/uso terapêutico , Custos de Medicamentos/ética , Medicina de Família e Comunidade/organização & administração , Medicina de Família e Comunidade/normas , Feminino , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/normas , Hepatite C/economia , Hepatite C/etiologia , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/ética , Cobertura do Seguro/normas , Masculino , Medicaid/economia , Medicaid/normas , Estresse Ocupacional/psicologia , Diretores Médicos/ética , Diretores Médicos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Transtornos Relacionados ao Uso de Substâncias/complicações , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
12.
Epidemiol Prev ; 42(1): 34-39, 2018.
Artigo em Italiano | MEDLINE | ID: mdl-29506359

RESUMO

OBJECTIVES: to explore clinicians vision on hospital discharge records in order to identify useful elements to foster a more accurate compiling. DESIGN: qualitative research with phenomenological approach. SETTING AND PARTICIPANTS: participants were selected through purposive sampling among clinicians of two hospitals located in Sardinia; the sample included 76 people (32 medical directors and 44 doctors in training). MAIN OUTCOME MEASURES: identified codes for themes under investigation: vision of accurate compiling, difficulties, and proposals. RESULTS: collected data highlighted two prevailing visions, respectively focused on the importance of an accurate compiling and on the burden of such activity. The accurate compiling is hindered by the lack of motivation and training, by the limits of the registration system and the information technology, by the distortions induced by the prominent role of the hospital discharge records in the evaluation processes. Training, timely updating of the information system accompanied by a proper cross-cultural validation process, improvement of the computer system, and activation of support services could promote more accurate compiling. CONCLUSIONS: the implementation of services, unconnected with evaluation and control processes, dedicated to training and support in the compiling of the hospital discharge records and in the conduction of related epidemiological studies would facilitate the compliance to the compilation. Such services will make tangible the benefits obtainable from this registration system, increasing skills, motivation, ownership, and facilitating greater accuracy in compiling.


Assuntos
Coleta de Dados/métodos , Registros Hospitalares , Corpo Clínico Hospitalar/psicologia , Alta do Paciente , Diretores Médicos/psicologia , Confiabilidade dos Dados , Registros Eletrônicos de Saúde , Registros Hospitalares/estatística & dados numéricos , Humanos , Itália , Administradores de Registros Médicos/educação , Motivação , Alta do Paciente/estatística & dados numéricos , Pesquisa Qualitativa
13.
Fam Med ; 50(2): 106-112, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29432625

RESUMO

BACKGROUND AND OBJECTIVES: Nearly one-half (46%) of physicians report at least one symptom of burnout. Family medicine residency program directors may have similar and potentially unique levels of burnout as well as resiliency. The primary aims of this study were to examine burnout and resiliency among family medicine residency directors and characterize associated factors. METHODS: The questions used were part of a larger omnibus survey conducted by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) in 2016. Program and director-specific characteristics were obtained. Symptoms of burnout were assessed using two single-item measures adapted from the full Maslach Burnout Inventory, and level of resiliency was assessed using the Brief Resilience Scale. RESULTS: The overall response rate for the survey was 53.7% (245/465). Symptoms of high emotional exhaustion or high depersonalization were reported in 27.3% and 15.8% of program directors, respectively. More than two-thirds of program directors indicated that they associated themselves with characteristics of resiliency. Emotional exhaustion and depersonalization were significantly correlated with never having personal time, an unhealthy work-life balance, and the inability to stop thinking about work. The presence of financial stress was significantly correlated with higher levels of emotional exhaustion and depersonalization. In contrast, the level of resiliency reported was directly correlated with having a moderate to great amount of personal time, healthy work-life balance, and ability to stop thinking about work, and negatively correlated with the presence of financial stress. CONCLUSIONS: Levels of emotional exhaustion, depersonalization, and resiliency are significantly related to personal characteristics of program directors rather than characteristics of their program.


Assuntos
Esgotamento Profissional/psicologia , Medicina de Família e Comunidade/educação , Internato e Residência/estatística & dados numéricos , Diretores Médicos/psicologia , Resiliência Psicológica , Carga de Trabalho/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Diretores Médicos/estatística & dados numéricos , Inquéritos e Questionários
14.
Disaster Med Public Health Prep ; 12(5): 644-648, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29362006

RESUMO

PurposeTo assess perceptions and attitudes toward disasters and disaster planning among outpatient primary care leaders. METHODS: Written surveys and semi-structured interviews of non-physician clinical managers and physician medical directors were conducted using the 2009 H1N1 pandemic as a case-based scenario at 5 university-affiliated family medicine clinics. Domains assessed included perceived pandemic threat; value, existence, and barriers to creating personal disaster plans; staff absenteeism estimates; barriers to work attendance. Quantitative and qualitative data were analyzed using descriptive statistics and content analysis with identification and coding of common themes, respectively. RESULTS: All 12 invited leaders participated and believed a personal disaster plan was important but only 2 had plans. None had ever discussed with their staff the importance of having a personal disaster plan. Two common barriers in creating a plan were low threat perception level and never considering the possibility of pandemic influenza. Only half of respondents could list common barriers preventing staff from working. Staff were confident employees would come to work during a disaster. CONCLUSION: Outpatient primary care leaders may hold misconceptions regarding future disasters, underestimate their potential impact on clinics, and lack personal preparedness. Further investigation and interventions are needed to ensure clinics can be prepared so they can function and help hospital and emergency services when disasters strike. (Disaster Med Public Health Preparedness. 2018;12:644-648).


Assuntos
Defesa Civil/métodos , Percepção , Diretores Médicos/psicologia , Atenção Primária à Saúde/métodos , Adulto , Defesa Civil/organização & administração , Defesa Civil/tendências , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Influenza Humana/diagnóstico , Influenza Humana/mortalidade , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/tendências , Pesquisa Qualitativa , Inquéritos e Questionários
15.
Acad Psychiatry ; 42(1): 68-72, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28939953

RESUMO

OBJECTIVE: The primary purpose of this study was to determine the prevalence of burnout among Psychiatry clerkship directors. METHODS: Psychiatry clerkship directors were solicited via email to complete an electronic version of the Maslach Burnout Inventory-General Survey and the Respondent Information Form. RESULTS: Fifty-four out of 110 surveys (49%) were completed. Fourteen percent of respondents scored in the "high exhaustion" category, 21.6% scored in the "low professional efficacy" category, 20.4% scored in the "high cynicism" category, and 15.1% of respondents met threshold for at least two of the three categories. Those who scored in the "low professional efficacy" category reported higher levels of salary support for research, while those who scored in the "high cynicism" category reported lower levels of salary support at a trend level. Those who scored in the "high cynicism" category were younger. CONCLUSIONS: Approximately 14-22 percent of psychiatry clerkship directors reported some level of burnout depending on the subscale used. Future studies should aim to better identify those clerkship directors who are at greatest risk for becoming burned out by their educational role and to clarify the link between salary support for research, age, and burnout.


Assuntos
Esgotamento Profissional/psicologia , Estágio Clínico , Diretores Médicos/psicologia , Médicos/psicologia , Psiquiatria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
16.
Acad Med ; 93(5): 693-698, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28834843

RESUMO

Recently, a student-initiated movement to end the United States Medical Licensing Examination Step 2 Clinical Skills and the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation has gained momentum. These are the only national licensing examinations designed to assess clinical skills competence in the stepwise process through which physicians gain licensure and certification. Therefore, the movement to end these examinations and the ensuing debate merit careful consideration. The authors, elected representatives of the Directors of Clinical Skills Courses, an organization comprising clinical skills educators in the United States and beyond, believe abolishing the national clinical skills examinations would have a major negative impact on the clinical skills training of medical students, and that forfeiting a national clinical skills competency standard has the potential to diminish the quality of care provided to patients. In this Perspective, the authors offer important additional background information, outline key concerns regarding the consequences of ending these national clinical skills examinations, and provide recommendations for moving forward: reducing the costs for students, exploring alternatives, increasing the value and transparency of the current examinations, recognizing and enhancing the strengths of the current examinations, and engaging in a national dialogue about the issue.


Assuntos
Competência Clínica/normas , Avaliação Educacional/normas , Licenciamento em Medicina/normas , Diretores Médicos/psicologia , Avaliação Educacional/métodos , Humanos , Estados Unidos
19.
J Grad Med Educ ; 9(2): 173-177, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28439349

RESUMO

BACKGROUND: Since 2013, the National Resident Matching Program (NRMP) has asked all programs to declare themselves to be "all in" or "all out" for the NRMP. Before this rule was enacted, program directors who were surveyed expressed concerns about what they anticipated with the change, including resources for increased applications and potential delays with residency start times. OBJECTIVE: This study investigated the positive and negative effects of the rule change on recruiting seen from the perspective of internal medicine (IM) program directors. METHODS: In this mixed model cross-sectional survey, Accreditation Council for Graduate Medical Education-accredited IM program directors were surveyed regarding their impressions of the impact of the policy change. Data were aggregated using constant comparative analysis. RESULTS: A total of 127 of 396 (32%) IM program directors responded, and 122 of 127 (96%) identified their program as "all in." A total of 110 respondents expressed impressions of the rule change, with 48% (53 of 111) reporting positive responses, 28% (31 of 111) neutral responses, and 24% (27 of 111) negative responses. Programs with higher percentages of visa-holding residents had lower positive responses (37% [22 of 60] versus 61% [31 of 51]). Resident quality was felt to be unchanged or improved by most program directors (93%, 103 of 111), yet 24% (27 of 112) reported increases in delayed start times for visa-holding residents. Qualitative analysis identified increased fairness, at the expense of an increase in program resources as a result of the change. CONCLUSIONS: A slight majority of residency programs reported a neutral or negative impression of the rule change. Since the rule change, program directors noted increased application volume and delayed residency starts for visa-holding residents.


Assuntos
Educação de Pós-Graduação em Medicina/normas , Medicina Interna/educação , Internato e Residência/organização & administração , Diretores Médicos/psicologia , Estudos Transversais , Humanos , Liderança , Inquéritos e Questionários , Estados Unidos
20.
J Adv Nurs ; 73(9): 2156-2166, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28251675

RESUMO

AIM: The aim of this study was to describe the process of how nurse and physician managers in formalized dyads work together to address clinical management issues in the surgical division of one hospital setting. BACKGROUND: Nurse and physician managers are uniquely positioned to co-lead and transform healthcare delivery. However, little is known about how this management dyad functions in the healthcare setting. DESIGN: A constructivist grounded theory approach was used to investigate the process of how nurse and physician managers work together in formalized dyads in an urban Canadian university affiliated teaching hospital. METHODS: Data collection occurred from September 2013-August 2014. Data included participant observation (n = 142 hours) and intensive interviews (n = 36) with nurse-physician manager dyads (12 nurses, 9 physicians) collected in a surgical department. Theoretical sampling was used to elaborate on properties of emerging concepts and categories. RESULTS/FINDINGS: A substantive theory on 'intentional partnering' was generated. Nurses' and physicians' professional agendas, which included their interests and purposes for working with each other served as the starting point of 'intentional partnering'. The theory explains how nurse and physician managers align their professional agendas through the processes of 'accepting mutual necessity', 'daring to risk (together)' and 'constructing a shared responsibility'. Being credible, earning trust and safeguarding respect were fundamental to communicating effectively. CONCLUSION: Intentional partnering elucidates the relational components of working together and the strategizing that occurs as each partner deliberates on what he or she is willing to accept, risk and put into place to reap the benefits of collaborating.


Assuntos
Assistência à Saúde/organização & administração , Relações Interprofissionais , Recursos Humanos de Enfermagem/psicologia , Diretores Médicos/psicologia , Centros Cirúrgicos/organização & administração , Adulto , Canadá , Feminino , Teoria Fundamentada , Humanos , Masculino , Pessoa de Meia-Idade
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