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1.
Medicine (Baltimore) ; 100(6): e24690, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578603

RESUMO

ABSTRACT: Pediatric procedural sedation (PPS) is often performed outside of the operating room, and by various sub-specialty providers. There is no consistency in how pediatric emergency medicine (PEM) fellows are trained in PPS. The objective of this study was to survey PEM program directors (PDs) and PEM fellows about their current sedation teaching practices via a direct survey. While many fellowship programs train PEM fellows in PPS, we hypothesize that there is no consistent method of developing and measuring this skill.A 12-question survey was sent to PEM PDs directly via email. A separate 17-question survey was sent to current PEM fellows via their program coordinators by email. Each survey had multiple choice, yes-no and select-all program questions. Responses were collected in an online (REDCap) database and summarized as frequencies and percentages.Based on identifiable email, 67 programs were contacted, with a PD response rate of 46 (59%). Sixty-two program coordinators were contacted based on identifiable email with 78 fellow responses. We noted that 11/46 PD respondents offer a formal PPS rotation. Thirty programs report using propofol in the emergency department and 93% of PD respondents (28/30) actively train fellows in the use of propofol. Approximately 62% of PEM fellow respondents (48/78) report sedating without any attending oversight. Twenty-eight percent of PEM fellow respondents report using simulation as a component of their sedation training.PPS is a critical skill. However, there is a lack of consistency in both education and evaluation of competency in this area. An organized PPS rotation would improve PPS case exposure and PPS skills.


Assuntos
Anestesiologia/educação , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Medicina de Emergência Pediátrica/educação , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/uso terapêutico , Competência Clínica/estatística & dados numéricos , Gerenciamento de Dados , Educação de Pós-Graduação em Medicina/métodos , Escolaridade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Internato e Residência/normas , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Propofol/administração & dosagem , Propofol/uso terapêutico , Treinamento por Simulação/estatística & dados numéricos , Inquéritos e Questionários
2.
Acad Med ; 96(1): 108-112, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394662

RESUMO

PURPOSE: Combined baccalaureate-MD programs exist to fulfill a variety of educational missions, including to promote the development of physician-scientists, increase workforce diversity, promote primary care careers, and meet the needs of underserved patients. The authors sought to determine the demographics of combined program graduates, as well as their intention to practice in primary care (IPPC) and intention to work with the medically underserved (IWMU), as compared with graduates of traditional MD programs. METHOD: Data from the 2010-2017 Association of American Medical Colleges Graduation Questionnaire, a national survey of graduating medical students, were recategorized (e.g., as combined program or traditional program) before analysis. Logistic regression models on the 2 primary outcomes (IPPC and IWMU) were conducted to estimate odds ratios for the effects of covariates and predictors (e.g., gender, underrepresented in medicine [URM] group member, type of medical degree program). RESULTS: Data from a total of 109,028 respondents were included (3,182 from combined and 105,846 from traditional programs). Compared with students in traditional programs, those in combined programs were more likely to be younger (age at graduation ≤ 29: 3,143, 98.8% vs 89,688, 84.7%) and female (1,813, 57.0% vs 52,013, 49.1%) but less likely to identify as a URM group member (276, 8.7% vs 14,757, 13.9%). In an adjusted logistic regression model, graduating from a combined program, identifying as female, and IWMU predicted significantly greater odds of IPPC, while identifying as a URM, identifying as female, and having debt predicted significantly greater odds of IWMU. Graduating medical students who indicated family medicine as a career specialty were more likely to indicate an IWMU. CONCLUSIONS: Medical students graduating from combined programs were more likely to indicate an IPPC but were no more likely to indicate an IWMU than traditional program graduates.


Assuntos
Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/tendências , Educação de Graduação em Medicina/estatística & dados numéricos , Educação de Graduação em Medicina/tendências , Avaliação Educacional/estatística & dados numéricos , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Adulto , Escolha da Profissão , Feminino , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
3.
Int J Radiat Oncol Biol Phys ; 108(2): 416-420, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32890524

RESUMO

PURPOSE: Telemedicine was rapidly and ubiquitously adopted during the COVID-19 pandemic. However, there are growing discussions as to its role postpandemic. METHODS AND MATERIALS: We surveyed patients, radiation oncology (RO) attendings, and RO residents to assess their experience with telemedicine. Surveys addressed quality of patient care and utility of telemedicine for teaching and learning core competencies. Satisfaction was rated on a 6-point Likert-type scale. The quality of teaching and learning was graded on a 5-point Likert-type scale, with overall scores calculated by the average rating of each core competency required by the Accreditation Council for Graduate Medical Education (range, 1-5). RESULTS: Responses were collected from 56 patients, 12 RO attendings, and 13 RO residents. Patient feedback was collected at 17 new-patient, 22 on-treatment, and 17 follow-up video visits. Overall, 88% of patients were satisfied with virtual visits. A lower proportion of on-treatment patients rated their virtual visit as "very satisfactory" (68.2% vs 76.5% for new patients and 82.4% for follow-ups). Only 5.9% of the new patients and none of the follow-up patients were dissatisfied, and 27% of on-treatment patients were dissatisfied. The large majority of patients (88%) indicated that they would continue to use virtual visits as long as a physical examination was not needed. Overall scores for medical training were 4.1 out of 5 (range, 2.8-5.0) by RO residents and 3.2 (range, 2.0-4.0) by RO attendings. All residents and 92% of attendings indicated they would use telemedicine again; however, most indicated that telemedicine is best for follow-up visits. CONCLUSIONS: Telemedicine is a convenient means of delivering care to patients, with some limitations demonstrated for on-treatment patients. The majority of both patients and providers are interested in using telemedicine again, and it will likely continue to supplement patient care.


Assuntos
Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Radioterapia (Especialidade) , Telemedicina , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia
6.
Am J Ophthalmol ; 218: 261-267, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32574772

RESUMO

PURPOSE: To describe applicant characteristics and outcomes associated with the ophthalmology fellowship match. DESIGN: Retrospective case-control study. METHODS: This study took place in San Francisco and matched data for ophthalmology fellowship applicants in the USA. The study population was registrants for the 2010-2017 ophthalmology fellowship match cycles. The match rate took place during the 8-year study period. Applicant characteristics were stratified by match status and factors associated with matching to ophthalmology fellowship positions. RESULTS: Between 2010 and 2017, most applicants (2,558/3,471; 73.7%) were matched into ophthalmology fellowship programs. No difference over time in the proportion of applicants that matched for fellowship was identified (P = .41). On average, ophthalmology residents who were matched into fellowships had higher step 1 (difference: 9; 99% confidence interval [CI]: 6.8-10.9; P < .001), step 2 (difference: 9.5; 99% CI: 7-12; P < .001), and step 3 (difference: 7.4; 99% CI: 5-9.7; P <.001) scores than those who did not match. Applicants who matched also had a greater number of application distributions (difference: 9.6; 99% CI: 7.9-11.2; P < .001), and ranked programs on the match list (difference: 6.2; 99% CI: 5.8-6.7; P < .001). Among applicants who matched, 15% matched at the same institute, 29% matched in the same state, and 45% matched in the same region. On multivariable analysis, factors associated with an increased likelihood of matching into an ophthalmology fellowship program included graduates from the US versus graduates from non-US residency programs (odds ratio [OR]: 2.09; 99% CI: 1.27-3.44; P <.001), increasing percentage of applications ranked (number of ranked programs and/or number of applications distributed) (OR: 1.02; 99% CI: 1.02-1.03; P < .001) as well as having ranked more programs (OR: 1.24; 99% CI: 1.17-1.31; P < .001). Medical graduate status outside of the US (OR: 0.58; 99% CI: 0.36-0.93; P < .001) was associated with decreased odds of matching for fellowship. CONCLUSIONS: From 2010 to 2017, approximately three-quarters of residents applying for an ophthalmology fellowship position matched. Factors associated with increased likelihood of matching included the applicant's graduating from a U.S. residency, graduating from a U.S. medical school, ranking more programs, and having a higher percentage of applications ranked (number of programs ranked by applicant and/or number of applications distributed). The information gained from this study may help applicants as they consider applying to fellowship programs.


Assuntos
Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Oftalmologia/educação , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Masculino , Estudos Retrospectivos , São Francisco , Critérios de Admissão Escolar
9.
J Grad Med Educ ; 12(2): 217-220, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32322357

RESUMO

Background: International medical graduates (IMGs) form a significant portion of the physician workforce in the United States and are vital in filling training slots due to a shortage of American medical graduates. Most often, IMGs require visa sponsorship, which must be solidified before applying for a residency or fellowship. Objective: We examined the association of H-1B visa sponsorship on retention of physician trainees within the state of Ohio. Methods: This was a single institutional study that examined all visa-sponsored residency and fellowship graduates who entered fully licensed clinical practice between 2006 and 2015. Practice location was ascertained immediately upon completion of training and at follow-up to determine which visa group (H-1B or J-1) were more likely to initially practice in Ohio after graduation and remain within the state. Results: Of 103 visa-sponsored residency and fellowship graduates, 42 were H-1B sponsored and 61 were J-1-sponsored. Fifty-two percent (22) of H-1B visa-sponsored trainees and 31% (19) of J-1 visa-sponsored trainees were retained in Ohio after graduation. At follow-up, 40% (17) of H-1B and 26% (16) of J-1 visa holders remained in the state. Conclusions: H-1B visa-sponsored trainees were more likely than those with J-1 visas to practice in the state of Ohio after graduation. Regardless of visa status, graduates tended not to change their geographical location over time.


Assuntos
Bolsas de Estudo/estatística & dados numéricos , Médicos Graduados Estrangeiros/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Emigração e Imigração/legislação & jurisprudência , Humanos , Ohio , Médicos/provisão & distribução
10.
Public Health ; 182: 143-150, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32305513

RESUMO

OBJECTIVES: The problem of uneven distribution of medical services and inequitable distribution of physicians is drawing much attention worldwide. Revealing how changes in the specialty training system in Japan have affected the distribution of doctors could help us understand this problem. In 2018, a new and standardized specialty training system was implemented by the Japanese Medical Specialty Board, which is recognized by the Ministry of Health, Labor and Welfare. The purpose of this study was to investigate how this new system has affected the geographical distribution of doctors commencing specialty training (trainees) and choice of specialty in Japan. STUDY DESIGN: Retrospective observational study. METHODS: The change in the number of trainees between the control period (2012-2014) and 2018 was investigated, taking into account the prefecture and specialty selected. Population, the proportion of residents aged 65 years or older (aging rate), and the total number of overall doctors in each prefecture were considered as the background characteristics of each prefecture. We created a Lorenz curve and calculated the Gini coefficient for the distribution of trainees. RESULTS: In 2018, the number of trainees per 100,000 population increased to 6.6 nationwide compared with 5.5 during the control period. The number of trainees per 100,000 population in 2018 increased in prefectures with a large population of ≧ 2,000,000, a low aging rate (<27%), and a high doctor density (≧ 250 doctors per 100,000 population). The Gini coefficient showed an increase to 0.226 in 2018 compared with only 0.160 during the control period. CONCLUSIONS: After the implementation of the new training system, there was an increase in the number of doctors enrolling in specialty programs, and the specialties other than internal medicine and surgery have attracted more trainees. Inequality in the distribution of doctors between urban and rural prefectures worsened. This indicates the need to explore new ways of balancing distribution while maintaining optimal opportunities for specialist training.


Assuntos
Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Médicos/provisão & distribução , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Densidade Demográfica , Estudos Retrospectivos , População Rural , Especialização , População Urbana
11.
J Grad Med Educ ; 12(1): 80-85, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32089797

RESUMO

Background: In 2014, the Accreditation Council for Graduate Medical Education (ACGME) formally mandated trainee (resident and fellow) participation in health care quality improvement (QI) projects as one of the Clinical Learning Environment Review (CLER) Pathways to Excellence. Subsequent national reviews showed large variations in how QI education is conducted, as well as a significant mismatch between educational and organizational goals. Objective: We developed a web-based platform to engage trainees in QI that better aligned with best practice methodology and matched identified institutional priorities. Methods: A needs assessment survey was distributed to trainees to understand the obstacles to compliance with ACGME QI requirements. Based on the results, a web-based clearinghouse, called the QI Platform, was developed and launched in July 2016, and utilization was analyzed in February 2019. Results: A total of 196 of 440 needs assessment surveys (45%) were completed. Themes extracted from surveys to identify barriers in QI participation included difficulties designing projects, lack of mentorship or expert support, and difficulty engaging an interprofessional team. Over 2.5 years, 151 projects were registered on the platform. Of these, 17 (11%) were collaborative entries. At the time of analysis, 166 of 437 trainees (38%) were listed as participants in active QI projects. A total of 22 projects were archived as complete, and 68 incomplete projects were reassigned to the "Ideas" section as works in progress after lead trainee graduation. Conclusions: An institutional QI Platform clearinghouse for GME QI projects was feasible to develop and maintain, and it appeared acceptable to most GME programs and trainees for recording and tracking QI projects, and linking these to hospital QI priorities.


Assuntos
Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Acreditação , Educação de Pós-Graduação em Medicina/métodos , Humanos , Internet , Informática Médica , Determinação de Necessidades de Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Sociedades Médicas , Inquéritos e Questionários
12.
Br J Anaesth ; 124(3): e70-e76, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31982114

RESUMO

BACKGROUND: Women face gender-based challenges in their medical education and career. Inequitable access to procedural training, a confidence gap, and professional identity deficit have been shown. We made a gender comparison of procedural case volume, confidence for independent practice, perceived gender and ethnic bias, and professional identity in Australasian anaesthesia trainees. METHODS: An online, voluntary, anonymous survey using SurveyMonkey® was delivered to Australasian anaesthesia trainees. Information collected included demographics, experience and confidence in 12 anaesthetic procedures, assessments relating to confidence and professional identity, and perceived gender and ethnic bias. Gender differences were evaluated. RESULTS: Three hundred and fifty-six trainees (22.2%) of the Australian and New Zealand College of Anaesthetists (ANZCA) responded. Male trainees reported a higher number (standard deviation) of procedures performed greater than 10 times (men 4.45 [2.55], women 3.78 [1.95]; P<0.001 adjusted for training level). Men were more likely to rate themselves at a training competency above their actual training level (men 18.6%, women 7.8%; P=0.004) and exaggerate procedural experience to supervisors (men 30.8%, women 11.8%; P<0.001). Final-year male trainees felt significantly more prepared for independent practice (P=0.021, trend across ordered responses). Women reported significantly higher levels of gender bias exhibited by patients (men 1.1%, women 84.5%; P<0.001) and in training overall (men 10.3%, women 55.3%; P<0.001), which was compounded in women with an ethnic minority background. CONCLUSIONS: A discrepancy exists between the number of procedures performed by male and female anaesthesia trainees in Australia and New Zealand. Relative male overconfidence may be a major contributing factor to the gender confidence gap.


Assuntos
Anestesiologia/educação , Educação de Pós-Graduação em Medicina/organização & administração , Médicas/psicologia , Sexismo , Adulto , Atitude do Pessoal de Saúde , Austrália , Competência Clínica/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Feminino , Humanos , Masculino , Nova Zelândia , Relações Médico-Paciente , Autoimagem , Fatores Sexuais , Estudantes de Medicina/psicologia
13.
Int Rev Psychiatry ; 32(2): 178-185, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31476944

RESUMO

Mental health disorders cause a large burden on global public health, with many patients living years with the disability. However, many doctors are ill-equipped to treat mental health disorders given inadequate training during their undergraduate years. In some countries, psychiatry is even considered an elective course rather than a core module. There is, therefore, a pressing need to improve the training of medical students in managing mental health disorders. Measures need to be implemented to attract students to choose psychiatry as their career. Given the developments in the fields and the challenges currently faced by trainees and early career psychiatrists, changes may also be made to the training programme in the postgraduate stage to unify the variations across the world in terms of the training duration and format. This paper will describe the ways that undergraduate and postgraduate psychiatry training may be ameliorated to improve the delivery of mental healthcare around the world and to equip doctors to face challenges in the future.


Assuntos
Educação Baseada em Competências , Educação de Pós-Graduação em Medicina , Educação de Graduação em Medicina , Serviços de Saúde Mental , Psiquiatria/educação , Educação Baseada em Competências/organização & administração , Educação Baseada em Competências/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Educação de Graduação em Medicina/organização & administração , Educação de Graduação em Medicina/estatística & dados numéricos , Humanos , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/estatística & dados numéricos , Psiquiatria/tendências
14.
Laryngoscope ; 130(7): 1651-1656, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31532842

RESUMO

OBJECTIVES: Gender disparity exists in medicine, such as differences in pay and promotion opportunities. We hypothesize that there is also a gender difference in graduate medical education as manifested by operative case volume. This study compares surgical case volume by gender for graduating US otolaryngology residents. STUDY DESIGN: Cohort study. METHODS: With data use approval from the Accreditation Council for Graduate Medical Education, we evaluated the key indicator case log summaries of graduating otolaryngology residents from 2009-2017. Mean and standard deviation were used for all cases, and t-tests were used to compare cases by resident gender. The Bonferroni method was used to adjust for multiple comparisons across years. RESULTS: Data from 1740 male and 804 female residents were evaluated. Across all years, the average number of key indicator cases reported was 778.8 and 813.6 by female and male residents, respectively, with an average difference of 34.8 cases per graduating year (95% confidence interval [CI] 19.4, 50.2; P < .001). When a resident self-reported the role of resident surgeon/supervisor, the average number of key indicator cases reported was 602.6 and 643.9 by female and male residents, respectively, with an average difference of 41.3 cases per graduating year (95% CI, 28.0, 54.6; P < .001). CONCLUSION: Gender-based discrepancies in surgical case volume exist among graduating otolaryngology residents. This disparity is partially attributed to the self-reported role in the surgery. This study has identified those discrepancies so that training programs can implement strategies to ensure improved gender parity. LEVEL OF EVIDENCE: 2b Laryngoscope, 130:1651-1656, 2020.


Assuntos
Competência Clínica/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Sexismo/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Otolaringologia , Estudos Retrospectivos , Fatores Sexuais , Estados Unidos
15.
Int Rev Psychiatry ; 32(2): 145-150, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31418604

RESUMO

The analysis of the training of mental health professionals in WPA Zone 10 was performed based on a comparison of data of a specifically designed questionnaire comprising 29 questions on undergraduate education, 34 questions on postgraduate training, and six questions on training of general practitioners to work in the field of mental health. The project involved National Associations of psychiatrists of Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, Uzbekistan, and Ukraine. This comparison provides an opportunity to identify ways to improve psychiatric training in Eastern Europe.


Assuntos
Currículo , Educação de Pós-Graduação em Medicina , Educação de Graduação em Medicina , Psiquiatria/educação , Ásia Central , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Educação de Graduação em Medicina/organização & administração , Educação de Graduação em Medicina/estatística & dados numéricos , Europa Oriental , Humanos , Psiquiatria/estatística & dados numéricos , Inquéritos e Questionários , Transcaucásia
16.
Surgery ; 167(2): 302-307, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31296432

RESUMO

BACKGROUND: The inception of work hour restrictions for resident physicians in 2003 created controversial changes within surgery training programs. On a recent Accreditation Council for Graduate Medical Education survey at our institution, we noted a discrepancy between low recorded violations of the duty hour restrictions and the surgery resident's perception of poor duty hour compliance. We sought to identify factors that lead to duty hour violations and to encourage accurate reporting among surgery trainees. METHODS: The A3/Lean methodology, an industry-derived, systematic, problem-solving approach, was used to investigate barriers to accurate reporting of duty hours by residents within the Department of Surgery at our academic institution. In partnership with our office of Graduate Medical Education, we encouraged a 6-month period where residents were asked to record duty hour accurately and to provide honest, descriptive explanations of violations without punitive effects on residents or the program. We performed a 6-month before-and-after analysis of duty hours violations after the A3/Lean implementation. Quantitative analysis was used to elucidate trends in violations by post graduate year and rotation. Qualitative evaluation by key thematic areas revealed resident attitudes and opinions about duty hour violations. RESULTS: Residents reported concern for personal and programmatic, punitive measures, desire to retain control of their education, and frustration with the administrative burden after violations as deterrents to honest duty hour reporting. The intervention was successful in changing logging behavior with 10 total violations prior to A3 meeting and 179 violations afterward (P = .003). This change was driven largely from an increase in short break violations (4 vs 134, P = .021). Analysis of violations revealed trends by post-graduate year, rotation, and weekend cross-coverage. Key findings including less than anticipated violations of the 80-hour work week despite high rates of short break violations. The ability to participate in procedures voluntarily and a sense of professional responsibility emerged as the prevailing themes among surgery residents describing violations. CONCLUSION: Systematic evaluation of duty hour reporting within a surgery training program can identify structural and cultural barriers to accurate reporting of duty hours. Accurate reporting can identify program-specific trends in duty hour violations that can be addressed though programmatic intervention.


Assuntos
Educação de Pós-Graduação em Medicina/normas , Cirurgia Geral/educação , Fidelidade a Diretrizes/estatística & dados numéricos , Carga de Trabalho , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Cirurgia Geral/normas , Humanos , Relações Médico-Paciente
17.
Ann R Coll Surg Engl ; 102(1): 49-53, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31755741

RESUMO

INTRODUCTION: Testicular torsion treatment rests on the horns of a dilemma, with widespread national variation in whether the responsible surgical specialty is general surgery or urology, even in hospitals with both general surgery and urology emergency service assets. This study aimed to quantify higher surgical trainee operative experience and confidence in managing suspected testicular torsion in a single UK deanery (Wales). MATERIALS AND METHODS: Anonymised logbook data were obtained via the Intercollegiate Surgical Curriculum Programme version 10 using the head of school report function for all general surgery (n=53) and urology (n=15) higher surgical trainees, which were combined with the distribution of an electronic self-administered questionnaire. RESULTS: Median operative scrotal explorations recorded for all general surgery higher surgical trainees and senior general surgery higher surgical trainees (ST7+) was 7 (range 1-22) and 10 (range 1-22), compared with 21 (range 9-64, p=0.00104) and 24 (19-64, p<0.001) for urology higher surgical trainees. The questionnaire response rate was 64.6% (general surgery 31/50, urology 11/15). Confidence levels in assessing adult and paediatric patients were lower in general surgery when compared with urology higher surgical trainees: median adult confidence rate 7/10 compared with 9/10, and paediatric confidence rate 7/10 compared with 8/10 (p<0.001 and p=0.053, respectively). All higher surgical trainees preferred urology as the accountable hospital specialty when both assets were available. DISCUSSION AND CONCLUSION: General surgery higher surgical trainees receive less than 50% of the operative exposure of urology higher surgical trainees in emergency scrotal surgery, which has important implications for curriculum competence development and patient safety.


Assuntos
Cirurgia Geral/educação , Torção do Cordão Espermático/cirurgia , Urologia/educação , Adulto , Atitude do Pessoal de Saúde , Criança , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Pediatria/educação , Pediatria/estatística & dados numéricos , Inquéritos e Questionários , Urologistas/educação , Urologistas/normas , Urologia/estatística & dados numéricos , País de Gales
18.
Clin Nucl Med ; 45(9): 679-680, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31876820

RESUMO

Some of the causes for resident burnout and other impairments of wellness are the same as for other physicians, but some are quite different. For example, residents have much less autonomy and control, are under more pressure to learn a huge amount of information quickly, are more frequently evaluated, have stress from taking more examinations, and have more financial pressure than a typical physician who has graduated from formal training. Residency education also involves oversight from the Accreditation Council of Graduate Medical Education, which seeks to decrease some of the pressures of residency, but an unintended consequence of their limitation of work hours has been, in some programs, the phenomenon of "work compression."


Assuntos
Esgotamento Profissional/epidemiologia , Internato e Residência/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Segurança , Acreditação , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Humanos
19.
J Grad Med Educ ; 11(6): 663-667, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31871566

RESUMO

Background: Resident attrition negatively affects residents and programs. The incidence of attrition in emergency medicine (EM) and program-specific factors associated with attrition remain unclear. Objective: We quantified the percentage of EM residencies affected by attrition between 2007 and 2016 and identified program-specific factors associated with attrition. Methods: We performed a retrospective analysis of data derived from the American Medical Association National Graduate Medical Education Census. We defined attrition as any postgraduate who left their residency training program prior to completion. We calculated the percentage of residency programs that experienced attrition and the overall incidence of attrition. We used Fisher's exact tests, Wilcoxon rank sum tests, and t tests, as well as multivariable logistic regression, to identify program-specific factors associated with attrition. Results: Between 2007 and 2016, 139 EM residency programs (82%) experienced attrition of at least 1 resident. An average of 23% of EM training programs experienced attrition annually. The incidence of EM resident attrition averaged 0.85% per year. Program-specific factors associated with attrition include 4-year residencies (P = .031), programs with medium class size (P = .0003), more female residents (P = .002), and more female faculty (P = .003). After analysis, only medium class size (compared to small) was associated with attrition (odds ratio = 4.96, 95% confidence interval 1.65-14.91). Conclusions: Between 2007 and 2016, while the incidence of resident attrition in EM was low (< 1%), the majority of programs experienced resident attrition. Medium class size (7 to 12 residents) was the only program-specific factor associated with increased attrition.


Assuntos
Escolha da Profissão , Medicina de Emergência/educação , Internato e Residência/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estados Unidos
20.
S Afr Med J ; 109(12): 914-918, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31865952

RESUMO

In 2011, the Faculty of Health Sciences at the University of Cape Town, South Africa (SA), established the Clinician-Scientist Training Programme (UCTCSTP), consisting of intercalated BMedSci Hons/MB ChB and integrated MB ChB/MSc/PhD tracks. We report and reflect on the programme's performance and challenges. The UCTCSTP has so far enrolled 71 students: 51 have received BMedSci Hons degrees and 4 have received Master's degrees, while there are 14 BMedSci Hons, 4 MSc and 4 PhD candidates. Graduates have produced significant research outputs, and many remain actively engaged in research. The UCTCSTP has been successful in encouraging a cohort of future clinician-scientists, but should aim to broaden and improve its appeal to address the need to transform and grow the SA clinical academic workforce. As graduates progress with their postgraduate clinical training, they require institutional support and guidance, which may necessitate policy reform.


Assuntos
Pesquisa Biomédica/educação , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Educação de Graduação em Medicina/estatística & dados numéricos , Universidades/estatística & dados numéricos , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , África do Sul
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