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1.
Methodist Debakey Cardiovasc J ; 16(3): 212-219, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133357

RESUMO

The learning health system is a conceptual model for continuous learning and knowledge generation rooted in the daily practice of medicine. While companies such as Google and Amazon use dynamic learning systems that learn iteratively through every customer interaction, this efficiency has not materialized on a comparable scale in health systems. An ideal learning health system would learn from every patient interaction to benefit the care for the next patient. Notable advances include the greater use of data generated in the course of clinical care, Common Data Models, and advanced analytics. However, many remaining barriers limit the most effective use of large and growing health care data assets. In this review, we explore the accomplishments, opportunities, and barriers to realizing the learning health system.


Assuntos
Big Data , Cardiologistas/educação , Cardiologia/educação , Prestação Integrada de Cuidados de Saúde , Educação Médica Continuada , Educação de Pós-Graduação em Medicina , Sistema de Aprendizagem em Saúde , Acesso à Informação , Confidencialidade , Humanos , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde
2.
West J Emerg Med ; 21(5): 1089-1094, 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32970559

RESUMO

INTRODUCTION: The correct use of personal protective equipment (PPE) limits transmission of serious communicable diseases to healthcare workers, which is critically important in the era of coronavirus disease 2019 (COVID-19). However, prior studies illustrated that healthcare workers frequently err during application and removal of PPE. The goal of this study was to determine whether a simulation-based, mastery learning intervention with deliberate practice improves correct use of PPE by physicians during a simulated clinical encounter with a COVID-19 patient. METHODS: This was a pretest-posttest study performed in the emergency department at a large, academic tertiary care hospital between March 31-April 8, 2020. A total of 117 subjects participated, including 56 faculty members and 61 resident physicians. Prior to the intervention, all participants received institution-mandated education on PPE use via an online video and supplemental materials. Participants completed a pretest skills assessment using a 21-item checklist of steps to correctly don and doff PPE. Participants were expected to meet a minimum passing score (MPS) of 100%, determined by an expert panel using the Mastery Angoff and Patient Safety standard-setting techniques. Participants that met the MPS on pretest were exempt from the educational intervention. Testing occurred before and after an in-person demonstration of proper donning and doffing techniques and 20 minutes of deliberate practice. The primary outcome was a change in assessment scores of correct PPE use following our educational intervention. Secondary outcomes included differences in performance scores between faculty members and resident physicians, and differences in performance during donning vs doffing sequences. RESULTS: All participants had a mean pretest score of 73.1% (95% confidence interval [CI], 70.9-75.3%). Faculty member and resident pretest scores were similar (75.1% vs 71.3%, p = 0.082). Mean pretest doffing scores were lower than donning scores across all participants (65.8% vs 82.8%, p<0.001). Participant scores increased 26.9% (95% CI of the difference 24.7-29.1%, p<0.001) following our educational intervention resulting in all participants meeting the MPS of 100%. CONCLUSION: A mastery learning intervention with deliberate practice ensured the correct use of PPE by physician subjects in a simulated clinical encounter of a COVID-19 patient. Further study of translational outcomes is needed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Educação Médica Continuada/métodos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Treinamento por Simulação/métodos , California , Lista de Checagem , Competência Clínica/estatística & dados numéricos , Infecções por Coronavirus/transmissão , Serviço Hospitalar de Emergência , Humanos , Controle de Infecções/instrumentação , Pneumonia Viral/transmissão
3.
Tex Med ; 116(7): 42-45, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32872701

RESUMO

The need for improved training on hemorrhage control in emergencies has been building for decades. Physicians say it's just as important to reach out to the community to promote hemorrhage control in the same way CPR and other life-saving methods are promoted.


Assuntos
Educação Médica Continuada , Serviços Médicos de Emergência/métodos , Medicina de Emergência/educação , Hemorragia/terapia , Médicos , Torniquetes , Hemorragia/prevenção & controle , Humanos
4.
BMC Fam Pract ; 21(1): 203, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32988371

RESUMO

BACKGROUND: Continuing medical education (CME) is essential to developing and maintaining high quality primary care. Traditionally, CME is delivered face-to-face, but due to geographical distances, and pressure of work in Bangladesh, general practitioners (GPs) are unable to relocate for several days to attend training. Using chronic obstructive pulmonary disease (COPD) as an exemplar, we aimed to assess the feasibility of blended learning (combination of face-to-face and online) for GPs, and explore trainees' and trainers' perspectives towards the blended learning approach. METHODS: We used a mixed-methods design. We trained 49 GPs in two groups via blended (n = 25) and traditional face-to-face approach (n = 24) and assessed their post-course knowledge and skills. The COPD Physician Practice Assessment Questionnaire (COPD-PPAQ) was administered before and one-month post-course. Verbatim transcriptions of focus group discussions with 18 course attendees and interviews with three course trainers were translated into English and analysed thematically. RESULTS: Forty GPs completed the course (Blended: 19; Traditional: 21). The knowledge and skills post course, and the improvement in self-reported adherence to COPD guidelines was similar in both groups. Most participants preferred blended learning as it was more convenient than taking time out of their busy work life, and for many the online learning optimised the benefits of the subsequent face-to-face sessions. Suggested improvements included online interactivity with tutors, improved user friendliness of the e-learning platform, and timing face-to-face classes over weekends to avoid time-out of practice. CONCLUSIONS: Quality improvement requires a multifaceted approach, but adequate knowledge and skills are core components. Blended learning is feasible and, with a few caveats, is an acceptable option to GPs in Bangladesh. This is timely, given that online learning with limited face-to-face contact is likely to become the norm in the on-going COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Educação a Distância/métodos , Educação Médica Continuada , Clínicos Gerais/educação , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Ensino , Atitude do Pessoal de Saúde , Bangladesh/epidemiologia , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Instrução por Computador , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Educação Médica Continuada/organização & administração , Educação Médica Continuada/tendências , Estudos de Viabilidade , Humanos , Modelos Educacionais , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Melhoria de Qualidade , Ensino/normas , Ensino/tendências
5.
J Cancer Res Ther ; 16(4): 703-707, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32930106

RESUMO

Pathologists have been using their tool of trade, "the microscope," since the early 17th century, but now diagnostic pathology or tissue-based diagnosis is characterized by its high specificity and sensitivity. Technological telecommunication advances have revolutionized the face of medicine, and in pursuit of better health-care delivery, telepathology has emerged. Telepathology is the practice of diagnostic pathology performed at a distance, with images viewed on a video monitor rather than directly through the (light) microscope. This article aims to provide an overview of the field, including specific applications, practice, benefits, limitations, regulatory issues, latest advances, and a perspective on the current status of telepathology in Indian scenario based on literature review.


Assuntos
Sistemas Computacionais/normas , Educação Médica Continuada/métodos , Microscopia de Vídeo/métodos , Consulta Remota/métodos , Telepatologia/métodos , Humanos , Índia , Telepatologia/normas , Telepatologia/tendências
7.
PLoS One ; 15(8): e0235826, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760142

RESUMO

BACKGROUND: Thrombophilia-screen tests are specialised haemostasis tests that are affected by numerous unique patient variables including the presence of acute thrombosis, the concomitant use of medication and patient demographics. Complete information on the request form is therefore crucial for the haematological pathologist to make patient-specific interpretation of patients' results. OBJECTIVES: To assess the completeness of thrombophilia-screen test request forms and determine the impact of provision of incomplete information, on the interpretive comments generated by reporting haematological pathologists. To assess the impact of an educational session given to clinicians on the importance of providing all the relevant information on the request forms. METHOD: Two retrospective audits, each covering 3 months, were performed to evaluate the completeness of demographic and clinical information on thrombophilia-screen request forms and its impact on the quality of the interpretive comments before and after an educational intervention. RESULTS: One hundred and seventy-one request forms were included in the first audit and 146 in the second audit. The first audit revealed that all 171 thrombophilia-screen request forms had complete patient demographic information but none had clinical information. Haematological pathologists only made generic comments which could not be applied to a specific patient. The second audit, conducted after a physician educational session, did not reveal any improvement in the clinical information provision by the test-ordering physicians. This was reportedly due to the lack of space on the request form. The interpretive comments therefore remained generic and not patient-specific. CONCLUSION: Physicians' failure to provide relevant clinical information made it impossible for pathologists to make patient-specific interpretation of the results. A single physician education session did not change the practice, reportedly due to the inappropriate design of the test request form. Further studies are required to investigate the impact of an improved request form and the planned electronic test requesting.


Assuntos
Educação Médica Continuada , Programas de Rastreamento/normas , Registros Médicos/normas , Médicos/normas , Trombofilia/diagnóstico , Controle de Formulários e Registros/estatística & dados numéricos , Humanos , Programas de Rastreamento/estatística & dados numéricos , Auditoria Médica/estatística & dados numéricos , Registros Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , África do Sul
8.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 28(Special Issue): 851-856, 2020 Aug.
Artigo em Russo | MEDLINE | ID: mdl-32856837

RESUMO

The article discusses the changes made to the existing procedure for continuing medical education and the accreditation of medical workers due to a pandemic that began with the outbreak of coronavirus infection COVID-19 in early 2020. Under current circumstances, medical organizations encountered difficulties in organizing quarantine, purchasing disinfecting drugs, personal protective equipment and additional medical equipment, the need to introduce an emergency mode of work for employees, so there was a need to review and develop new rules for the work of medical workers during a coronavirus pandemic. Medicine is one of the progressive fields of scientific and entrepreneurial activity, making high demands on medical workers. Therefore, continuous training of doctors and medical personnel is caused by vital necessity, especially in the context of the coronavirus pandemic. Currently, the legislative level provides for the re-profiling of doctors of other specialties and the involvement of teachers and general medical organizations in the fight against coronavirus infection. In the face of the threat of the spread of coronavirus infection, on the recommendation of the Ministry of Science and Higher Education of the Russian Federation, it was decided to transfer educational institutions to distance learning using educational technologies, which also requires great efforts on the part of doctors, as medical specialists need not only a large amount of theoretical knowledge , but also a sufficient number of practical skills. The article presents statistical and analytical data, the results of surveys of Russian doctors, expert estimates that allow us to draw conclusions regarding the effectiveness of educational programs and courses for the professional retraining of doctors in the context of a coronavirus pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Educação Médica Continuada/organização & administração , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Pandemias , Federação Russa
9.
PLoS One ; 15(8): e0237632, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817679

RESUMO

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.


Assuntos
Educação Médica Continuada/normas , Conhecimentos, Atitudes e Prática em Saúde , Determinação de Necessidades de Cuidados de Saúde/normas , Médicos/normas , Competência Profissional/normas , Especialização/normas , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários , Adulto Jovem
10.
Medicine (Baltimore) ; 99(31): e20912, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756081

RESUMO

INTRODUCTION: Adverse events (AE) in care are recognized as a leading cause of mortality and injury in patients. Improving patients' safety is difficult to achieve. Therefore, innovative research strategies are needed to identify errors in subgroups of patients and related severity of outcomes as well as reliably measured efficiency of reproducible strategies to improve safety. This trial aims to evaluate the impact of a combined multiprofessional education program on the rate of AE in neonatal intensive care units (NICUs). METHODS AND ANALYSIS: This is a stepped-wedge cluster randomised controlled trial with 3 clusters each containing 4 units. The study time period will be 20 months. The education program will be implemented within each cluster following a random sequence with a control period, a 4-month transition period and a post-educational intervention period. Eligibility criteria: for clusters: 6 NICUs from Ile-de-France and 6 NICUs from different regions in France; for patients: in-hospital during the study period (November 23, 2015 and November 2, 2017 [inclusion start dates varying by unit]) in one of the 12 NICUs; corrected gestational age ≤42 weeks upon admission; hospitalization period >2 days; and parents informed and not opposed to the use of their newborn's data. A routine occurrence reporting of medical errors and their consequence will take place during the entire study period. The intervention will combine an education to implement a standardized root cause analysis method, creation of bundles (insertion, daily goals, maintenance bundles) to prevent catheter-associated blood-stream infection and a poster to prevent extravasation injuries. OUTCOME: We hypothesize a reduction from 60 (control) to 50 (intervention) AE/1000 patient-days. The primary outcome will be the rate of AE/1000 patient-days in the NICU. TRIAL REGISTRATION NUMBER: NCT02598609, trial registered November 6, 2015. https://clinicaltrials.gov/ct2/show/NCT02598609. ETHICS AND DISSEMINATION: Study approved by the regional ethic committee CPP Ile-de-France III (no 2014-A01751-46). The results will be published in peer-reviewed journals.


Assuntos
Unidades de Terapia Intensiva Neonatal , Erros Médicos/prevenção & controle , Neonatologia/educação , Infecções Relacionadas a Cateter/prevenção & controle , Educação Médica Continuada/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controle , Humanos , Recém-Nascido , Segurança do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
J Dtsch Dermatol Ges ; 18(7): 699-723, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32713146

RESUMO

The increasingly frequent use of immunomodulatory agents in dermatology requires the observance of specific recommendations for immunization. These recommendations are developed and regularly updated by the German Standing Committee on Vaccination (STIKO), an independent advisory group at the Robert Koch Institute. Dermatological patients on immunosuppressive treatment should ideally receive all vaccinations included in the standard immunization schedule. Additionally, it is recommended that they also undergo vaccination against the seasonal flu, pneumococci, and herpes zoster (inactivated herpes zoster subunit vaccine for patients ≥ 50 years). Additional immunizations against Haemophilus influenzae type B, hepatitis B and meningococci may be indicated depending on individual comorbidities and exposure risk. Limitations of use, specific contraindications and intervals to be observed between vaccination and immunosuppression depend on the immunosuppressive agent used and its dosing. Only under certain conditions may live-attenuated vaccines be administered in patients on immunosuppressive therapy. Given its strong suppressive effect on the humoral immune response, no vaccines - except for flu shots - should be given within six months after rituximab therapy. This CME article presents current recommendations on immunization in immunocompromised individuals, with a special focus on dermatological patients. Its goal is to enable readers to provide competent counseling and to initiate necessary immunizations in this vulnerable patient group.


Assuntos
Hospedeiro Imunocomprometido , Síndromes de Imunodeficiência , Vacinação , Dermatologia/educação , Educação Médica Continuada , Alemanha , Humanos , Vacinação/normas
14.
Radiography (Lond) ; 26 Suppl 2: S49-S53, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32698948

RESUMO

INTRODUCTION: Radiologists' image reading skills vary, such variations in image interpretations can influence the effectiveness of the early treatment of disease and may have important clinical and economic implications. In screening mammography, clinical audits are used to assess radiologists' performance annually, however, the nature of these audits prevent robust data analysis due to the low prevalence of breast cancer and the long waiting periods for the audit results. Research-based evidence revealed a need for changes in the methods utilised to optimise the assessment of the efficacy of radiologists' interpretations. METHODS: A cloud-based platform was developed to assess and enhance radiologists' performance help reduce variability in medical image interpretations in a research environment; however, to address a number of limitations, the platform was commercialised to make it available worldwide. RESULTS: DetectED-X's team have been able to make their cloud-based platform available worldwide, tailored to the needs of radiologists and accredited for continuing medical/professional education; thus, changing the continuous professional development practice globally. CONCLUSION: DetectED-X's Rivelato, was developed to address a need for effective, available and affordable educational solutions for clinicians and health care workers wherever they are located. A true fusion of industry, academia, clinics and consumer to adapt to the growing needs of clinicians' around the world, the latest being COVID-19 global pandemic. DetectED-X repurposed its platform to educate physicians around the world on the appearances of COVID-19 on Lung Computed Tomography scans, introducing CovED to clinicians worldwide free of charge as a multi-national consortium of collaboration to help fight COVID-19, showing how research-based evidence can create effective and scalable change globally.


Assuntos
Competência Clínica , Educação Médica Continuada/métodos , Interpretação de Imagem Radiográfica Assistida por Computador , Radiologia/educação , Betacoronavirus , Neoplasias da Mama/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Mamografia , Pandemias , Pneumonia Viral/diagnóstico por imagem
16.
Ann Biol Clin (Paris) ; 78(4): 446-448, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32627731

RESUMO

Training and education are essential for medical students. During the COVID-19 outbreak, numerous schools and universities have had to close. Ensuring pedagogical continuity requires alternatives to the traditional classroom, especially in medical education. Usual distance learning tools such as videos and downloadable handouts are not sufficient to promote efficient teaching. Distance learning requires self-motivation and does not give you direct access to your instructor. Some students fear the loss of human contact with an instructor - like asking questions during and after class - which promotes learning, understanding and communication. Moreover, classical distance learning methods do not offer immediate feedback that can help students in their understanding of the lecture. In this context, interactive pedagogic tools (IPT) could be useful for medical education continuity and for maintaining human contact necessary in pedagogy. We briefly evaluated interactive pedagogic tool compared to traditionnal distancial tools on medical students. This study showed the importance to have direct contact with a teacher and feedback during a lecture and to not exclusively perform distance learning without direct interaction and feedback. Hence, in the present context, we encourage teacher to use this type of tools to maintain direct interaction with students - which is essential in pedagogy - and ensure a qualitative pedagogical continuity.


Assuntos
Instrução por Computador/métodos , Infecções por Coronavirus/epidemiologia , Educação a Distância/métodos , Educação Médica Continuada/métodos , Pneumonia Viral/epidemiologia , Treinamento por Simulação , Software , Betacoronavirus , Serviços de Laboratório Clínico/organização & administração , Instrução por Computador/normas , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Educação a Distância/organização & administração , Educação a Distância/normas , Educação Médica Continuada/organização & administração , Humanos , Internet/organização & administração , Internet/normas , Aprendizagem , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Aprendizagem Baseada em Problemas/métodos , Aprendizagem Baseada em Problemas/organização & administração , Aprendizagem Baseada em Problemas/normas , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Treinamento por Simulação/normas , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Gravação em Vídeo/métodos , Gravação em Vídeo/normas
17.
Artigo em Inglês | MEDLINE | ID: mdl-32640652

RESUMO

The COVID-19 pandemic forced physicians to quickly adapt and find ways to provide their usual offline services by using online tools. We aimed to understand how physicians adapted to the sudden need for telehealth and if their perception of telehealth changed due to their experience during the COVID-19 pandemic. We conducted an exploratory sequential mixed-methods study. We interviewed five Lebanese physicians and thematically analyzed the interviews. We developed a questionnaire based on the analysis results and administered it online to physicians in Lebanon. In total, 140 responses were collected. We found that, during the COVID-19 pandemic, physicians engaged in more telehealth activities in the realms of telemedicine, public awareness, continuing medical education, research, administration, and teaching. They also expanded their repertoire of information-technology tools. Our results also show that there was a significant shift in the physicians' perceptions, indicating greater openness and willingness to adopt telehealth services. However, a significant amount of skepticism and uncertainty regarding telemedicine remains, especially concerning its efficiency, safety, and the adequacy of existing regulations. Based on our findings, we offer recommendations for health IT policy makers, developers, and researchers, to sustain the continuity of telehealth activities beyond the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Pandemias , Médicos/psicologia , Pneumonia Viral , Telemedicina/estatística & dados numéricos , Atitude do Pessoal de Saúde , Betacoronavirus , Educação Médica Continuada , Humanos , Líbano , Inquéritos e Questionários , Telemedicina/métodos
20.
Public Health Rep ; 135(4): 428-434, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579862

RESUMO

Although writing is a valued public health competency, authors face a multitude of barriers (eg, lack of time, lack of mentorship, lack of appropriate instruction) to publication. Few writing courses for applied public health professionals have been documented. In 2017 and 2018, the Council of State and Territorial Epidemiologists and the Centers for Disease Control and Prevention partnered to implement a Morbidity and Mortality Weekly Report Intensive Writing Training course to improve the quality of submissions from applied epidemiologists working at health departments. The course included 3 webinars, expert mentorship from experienced authors, and a 2-day in-person session. As of April 2020, 39 epidemiologists had participated in the course. Twenty-four (62%) of the 39 epidemiologists had submitted manuscripts, 17 (71%) of which were published. The program's evaluation demonstrates the value of mentorship and peer feedback during the publishing process, the importance of case study exercises, and the need to address structural challenges (eg, competing work responsibilities or supervisor support) in the work environment.


Assuntos
Currículo , Educação Médica Continuada/organização & administração , Epidemiologistas/educação , Epidemiologia/educação , Editoração/normas , Redação/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
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