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2.
GMS J Med Educ ; 36(6): Doc78, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31844650

RESUMO

Introduction: Specialist medical assessments fulfil the task of ensuring that physicians have the clinical competence to independently represent their field and provide the best possible care to patients, taking into account the current state of knowledge. To date, there are no comprehensive reports on the status of specialist assessments in the German-speaking countries (DACH). For that reason, the assessment methods used in the DACH region are compiled and critically evaluated in this article, and recommendations for further development are described. Methods: The websites of the following institutions were searched for information regarding testing methods used and the organisation of specialist examinations: Homepage of the Swiss Institute for Medical Continuing Education (SIWF), Homepage of the Academy of Physicians (Austria) and Homepage of the German Federal Medical Association (BAEK). Further links were considered and the results were presented in tabular form. The assessment methods used in the specialist assessments are critically examined with regard to established quality criteria and recommendations for the further development of the specialist assessments are derived from these. Results: The following assessment methods are already used in Switzerland and Austria: written examinations with multiple choice and short answer questions, structured oral examinations, the Script Concordance Test (SCT) and the Objective Structured Clinical Examination (OSCE). In some cases, these assessment methods are combined (triangulation). In Germany, on the other hand, the oral examination has so far been conducted in an unstructured manner in the form of a 'collegial content discussion'. In order to test knowledge, practical and communicative competences equally, it is recommended to implement a triangulation of methods and follow the further recommendations described in this article. Conclusion: While there are already accepted approaches for quality-assured and competence-based specialist assessments in Switzerland and Austria at present, there is still a long way to go in Germany. Following the recommendations presented in this article, a contribution could be made to improving the specialist assessments in the DACH region according to the specialist assessments objectives.


Assuntos
Competência Clínica/normas , Educação Médica/métodos , Avaliação Educacional/normas , Medicina/normas , Áustria , Alemanha , Humanos , Medicina/classificação , Especialização/normas , Suíça
3.
S Afr Med J ; 109(4): 254-258, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-31084691

RESUMO

BACKGROUND: The 2011 Health Professions Council of South Africa mandate requires a research component in the form of an MMed degree to permit specialist registration. Registrars consider that the time required to complete an MMed interferes with clinical training, service delivery obligations, and study and exam time. Net research time to completion is difficult to establish because MMed research activity is often intermittent, starting and finishing anywhere within the 4-year clinical training period. Conversely, gross dissertation completion time (DCT) is easily calculated by subtracting the ethics approval date from the dissertation submission date. OBJECTIVES: To use gross DCT as a proxy to assess the time needed by registrars to finish the required research project. Additionally, the effect of four variables, namely dissertation format, clinical discipline, university research resources and the introduction of the 2011 ruling on gross DCT, was determined. METHODS: The sample was 213 MMed dissertations, downloaded from the public domain. The dissertation submission date was subtracted from the ethics approval date to give the gross DCT in months. Descriptive analysis and χ2 testing were used to determine the effects of the four variables on gross DCT, with significance set at p<0.05. A 12-month proposal preparation time was added to the gross DCT to fully reflect the MMed research timeline. RESULTS: Sampled dissertations were from 2005 to 2017 and all eight MMed training universities were represented, as were 23 clinical disciplines. The mean (standard deviation) gross DCT was 31.0 (19.6) months, with a wide completion range of 0.2 - 109 months. When 12 months' proposal preparation time was added, gross mean research completion time rose to 43 months (31 + 12 = 43). A mere 41% of dissertations were sufficiently concluded to free up the final year for exam preparation. Gross DCT was not significantly affected by the 2011 requirement, university resources or clinical discipline. Dissertation format (publication ready v. monograph) significantly decreased gross DCT (p=0.01). CONCLUSIONS: Large standard deviations and a wide range of finishing times detract from the positive findings that most dissertations were completed within the 4-year clinical training time period. Publication-ready dissertations significantly shortened MMed completion time. Unique study and work commitments and lack of research experience challenge speedy MMed completion. Existing research and supervisory supportive structures should be remodelled to better suit the research needs of the andragogic specialist registrar.


Assuntos
Dissertações Acadêmicas como Assunto , Pesquisa Biomédica/educação , Educação de Pós-Graduação em Medicina , Pesquisa Biomédica/normas , Pesquisa Biomédica/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/métodos , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Humanos , África do Sul , Especialização/normas , Fatores de Tempo
4.
Reg Anesth Pain Med ; 44(5): 540-548, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30902912

RESUMO

This article in our point-of-care ultrasound (PoCUS) series is dedicated to the role the focused assessment with sonography in trauma (FAST) exam plays for the regional anesthesiologist and pain specialists in the perioperative setting. The FAST exam is a well-established and extensively studied PoCUS exam in both surgical and emergency medicine literature with over 20 years demonstrating its benefit in identifying the presence of free fluid in the abdomen following trauma. However, only recently has the FAST exam been shown to be beneficial to the anesthesiologist in the perioperative setting as a means to identify the extravasation of free fluid into the abdomen from the hip joint following hip arthroscopy. In this article, we will describe how to obtain the basic FAST views (subcostal four-chamber view, perihepatic right upper quadrant view, perisplenic left upper quadrant view, and pelvic view in the longitudinal and short axis) as well as cover the relevant sonoanatomy. We will describe pathological findings seen with the FAST exam, primarily free fluid in the peritoneal space as well as in the pericardial sac. As is the case with any PoCUS skill, the application evolves with understanding and utilization by new clinical specialties. Although this article will provide clinical examples of where the FAST exam is beneficial to the regional anesthesiologist and pain specialist, it also serves as an introduction to this powerful PoCUS skill in order to encourage clinical practitioners to expand the application of the FAST exam within the scope of regional anesthesia and pain management practice.


Assuntos
Anestesia por Condução/normas , Anestesiologistas/normas , Manejo da Dor/normas , Dor/diagnóstico por imagem , Ferimentos e Lesões/diagnóstico por imagem , Anestesia por Condução/métodos , Humanos , Manejo da Dor/métodos , Sistemas Automatizados de Assistência Junto ao Leito/normas , Especialização/normas , Ferimentos e Lesões/terapia
5.
Clin Obes ; 9(3): e12301, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30761766

RESUMO

We aimed to develop an expert consensus on standardizing data collections in specialist obesity management clinics in Australia. A panel of 16 experts participated in a structured consensus-driven Delphi process to reach agreement on a minimum set of baseline patient data collections for consideration in specialist obesity services. The panel included surgeons, clinicians, allied health professionals (dietician, exercise physiologist, psychologist), a bariatric nurse and obesity researchers. We produced a recommended list of core and useful data items that should comprise the baseline patient data set. Consensus was achieved for recommended measures of demographic, anthropometric, biochemical, weight-loss history, medication, medical history and comorbidity data items using a 70% agreement threshold. In this iterative process, there was also consideration of specific data items for patients referred for bariatric surgery. We present the first expert panel consensus on recommendations for a minimum and standard set of baseline patient data collections in obesity management services in Australia. These may be relevant to other countries with similar obesity management service models. Implementation of these recommendations should facilitate data pooling for clinical audits and research collaborations across clinics seeking to improve the quality of specialist obesity care.


Assuntos
Coleta de Dados/normas , Manejo da Obesidade/normas , Obesidade/terapia , Adulto , Antropometria/métodos , Austrália , Consenso , Coleta de Dados/métodos , Técnica Delfos , Feminino , Humanos , Masculino , Manejo da Obesidade/métodos , Especialização/normas
7.
Int J Surg ; 62: 67-73, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30673595

RESUMO

BACKGROUND: General surgeons have become increasingly subspecialised in their elective practice. Emergency laparotomies, however, are performed by a range of subspecialists who may or may not have an interest in the affected area of gastrointestinal tract. This retrospective cohort study evaluates the impact of surgical subspecialisation on patient outcomes following emergency laparotomy. METHODS: Data was collected for patients who underwent an emergency abdominal procedure on the gastrointestinal tract in the North of England from 2001 to 2016. This included demographics, co-morbidities, diagnoses and procedures undertaken. Patients were grouped according to consultants' subspecialist interest. The primary outcome of interest was 30-day postoperative mortality. RESULTS: 24,291 emergency laparotomies were performed with an associated 30-day postoperative mortality of 11.7%. Laparotomies undertaken by upper gastrointestinal (UGI) or colorectal surgeons have significantly lower mortality (10.1%) when compared with other subspecialities (13.5%). More specifically, mortality was decreased for UGI (7.9% vs. 12.9%) and colorectal procedures (10.9% vs. 14.2%) when performed by surgeons with a specialist interest in the relevant area of the gastrointestinal tract (both p < 0.001). The utilisation of laparoscopic surgery is higher, in both UGI (21.8% vs. 9.0%) and colorectal procedures (7.2% vs. 3.5%), when the causative pathology is relevant to the surgeon's subspeciality (both p < 0.001). CONCLUSION: Mortality following emergency laparotomy is improved when performed under the care of gastrointestinal surgeons. Both UGI and colorectal emergency procedures have improved outcomes, with lower mortality and higher rates of laparoscopy, when under the care of a surgeon with a subspecialist interest in the affected area of the gastrointestinal tract.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/normas , Especialização/normas , Adulto , Idoso , Competência Clínica , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Emergências , Inglaterra/epidemiologia , Feminino , Humanos , Laparoscopia/métodos , Laparotomia/métodos , Laparotomia/mortalidade , Laparotomia/normas , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Especialização/estatística & dados numéricos , Especialidades Cirúrgicas/normas , Especialidades Cirúrgicas/estatística & dados numéricos , Cirurgiões/normas , Resultado do Tratamento
10.
Mil Med ; 184(1-2): e65-e70, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29947800

RESUMO

Introduction: The education of health professionals and the assessment of their long-term goals are essential. Additionally, in the military health system (MHS), such programs also have the goals of improving readiness, providing high-quality care and meeting the needs and challenges of the MHS. The Uniformed Services University F. Edward Hebert School of Medicine (USUHS) has existed for over 40 years and the assessment of the longer term outcomes of its medical school graduates is an important endeavor. The purpose of this study is to describe the relationship of USUHS on the care in the MHS by reporting specialty choices, practice characteristics and locations of two consecutive cohorts of USUHS graduates and to compare these cohort findings with national data. Two cohorts were chosen as the first cohort has reached retirement and we sought to describe the impact of our graduates following their military service commitment. Materials and Methods: We performed a retrospective analysis of our graduates (1980-2009) using data obtained from the American Medical Association Physician Masterfile in two 15-year cohorts. USU graduate data are described and compared with national allopathic medical school data in order to explore USUHS graduates' practice characteristics and how these contrast with national data. Results: Family medicine was the most commonly identified primary care specialty across both USUHS cohorts. Other primary care specialties such as Internal Medicine and Pediatrics became more popular among USUHS graduates over time. There were a lower percentage of inactive USUHS graduates from the 1980-1994 cohorts than the U.S. national sample (3.23% vs. 3.98%). The proportion of USUHS graduates working in an office-based practice increased from 34.8% (1980-1994) to 43.6% (1995-2009) yet still was lower than U.S. national data (1980-1994: 73.5%; 1995-2009: 73.8%). The type of practice in which the majority of USUHS and national graduates were involved was direct patient care (over 70% of the population). Practice locations for medical school graduates included all 50 states. Furthermore, though several states such as Mississippi, Nevada, South Carolina, and Utah were among the top 20 practice locations among USUHS graduates, they did not appear among the top 20 practicing states for U.S. graduates. Conclusions: USUHS can play a major role by training health care professionals needed to meet the large health care strategic goals of a transforming military health system. A high percentage of USUHS graduates had significant changes in practice characteristics over time, are staying in practice for longer time compared with U.S. graduates, and practice in all 50 states including those that are underserved.


Assuntos
Escolha da Profissão , Médicos/psicologia , Especialização/normas , Comportamento de Escolha , Estudos de Coortes , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Humanos , Médicos/organização & administração , Médicos/estatística & dados numéricos , Estudos Retrospectivos , Faculdades de Medicina/estatística & dados numéricos , Especialização/estatística & dados numéricos , Estados Unidos
11.
BMC Health Serv Res ; 18(1): 983, 2018 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-30567542

RESUMO

OBJECTIVE: Limited epidemiological data are available at tertiary care teaching hospitals in Japan. We reviewed infectious disease (ID) consultations in a tertiary acute care teaching hospital in Japan. METHODS: This is a retrospective review of the ID consultations from October 2016 to December 2017. The demographic data, such as requesting department, consultation wards, and final diagnosis, were analyzed. RESULTS: There were 508 ID consultations during the 15-month study period. Among the 508 consultations, 201 cases (39.6%) were requested from the internal medicine department and 307 cases (60.4%) were requested from departments other than internal medicine. The most frequent requesting departments were Surgery (n = 102, 20.1%), Pulmonary Medicine (n = 41, 8.1%), and Plastic Surgery (n = 35, 6.7%). The most common diagnoses were intra-abdominal (n = 81, 16.0%), respiratory (n = 62, 12.2%), and skin and soft tissue infections (n = 59, 11.6%). ID consultations for disease diagnosis and management were more frequent in the internal medicine group than in the non-internal medicine group (37 cases, 20.8% vs. 40 cases, 13.7%, p = 0.046), and the number of requests for consultations for noninfectious diseases at the time of final diagnosis was higher in the internal medicine group than in the non-internal medicine group (21 cases, 11.8% vs. 16 cases, 5.5%, p = 0.0153). CONCLUSION: Some physicians prefer ID specialists to identify and solve various medical problems. Internists had a greater tendency to request consultations for diagnostic problems, and noninfectious disease specialists have more requests for consultation at the point of final diagnosis. The role of ID specialists is expanding, from individual patient management to antibiotic stewardship, antibiotic prophylaxis, and development of and adherence to antibiotic protocol implementation based on the hospital's microbial susceptibility and infection control. Although the number of specialists is limited in Japan, ID services now play an important role for achieving a good outcome in patient management.


Assuntos
Doenças Transmissíveis/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Competência Clínica/normas , Doenças Transmissíveis/tratamento farmacológico , Utilização de Instalações e Serviços , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Medicina Interna/estatística & dados numéricos , Japão , Masculino , Corpo Clínico Hospitalar/normas , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Papel do Médico , Encaminhamento e Consulta , Estudos Retrospectivos , Especialização/normas , Especialização/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Atenção Terciária à Saúde/estatística & dados numéricos , Adulto Jovem
15.
J Am Assoc Nurse Pract ; 30(10): 551-559, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30320708

RESUMO

The role of the Emergency Nurse Practitioner (ENP) has evolved as a specialty and is appreciated within the context of the 2008 Consensus Model document (APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee, 2008). The first in a series of five articles, this article describes the appraisal of the ENP role as well as the specialty and the distinctive role of the ENP. The second article, Emergency Nurse Practitioner Practice Analysis: Report and Implications of the Findings, presents research to support the scientific basis of emergency specialty practice and content validity for a national certification program. Article 3, Beyond Competencies; Practice Standards for Emergency Nurse Practitioners: A Model for Clinicians, Educators, and Employers, introduces a new conceptual model that defines the specialty of emergency care's knowledge, skills, and abilities identified by the ENP practice analysis as practice standards not traditional competencies. In Article 4, Proposed Standardized Educational Preparation for the Emergency Nurse Practitioner, essential content for ENP preparation within graduate, postgraduate, and doctoral programs. The fifth article, Envisioning the Future for ENPs: Implications for Clinical Practice, Education, Research, and Health Policy, describes how ENPs are envisioning and impacting the future of emergency care and how their evolution can serve as a model for development of other advanced practice nursing specialties.


Assuntos
Medicina de Emergência/normas , Profissionais de Enfermagem/tendências , Papel do Profissional de Enfermagem , Especialização/normas , Medicina de Emergência/métodos , História do Século XX , História do Século XXI , Humanos , Profissionais de Enfermagem/história
16.
J Am Assoc Nurse Pract ; 30(10): 560-569, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30320709

RESUMO

BACKGROUND AND PURPOSE: A practice analysis of nurse practitioners (NPs) working in emergency care was undertaken to define their job tasks and develop a specialty certification by examination. METHOD: In phase I, clinical experts created a qualitative description of domains of practice, tasks performed, knowledge required, and procedures performed by NPs in emergency care. Phase II involved validating the qualitative description through a national survey (N = 474) of emergency nurse practitioners (ENPs). Evidence from the validation survey was used to create a test content outline for the ENP examination. FINDINGS AND CONCLUSIONS: The delineation of ENP practice validated by the survey (Cronbach alpha = 0.86-0.94 across rating scales) included 5 ENP practice domains: medical screening, medical decision-making/differential diagnoses, patient management, patient disposition and professional, legal and ethical practices. There were 22 job tasks across domains, 10 types of patient conditions/emergency types, 42 knowledge areas, and 68 procedures performed by ENPs. These resulted in a test blueprint providing the foundation for the ENP certification examination content validity. IMPLICATIONS FOR PRACTICE: Beyond certification, the practice analysis has the potential to further inform the scientific basis of emergency specialty practice. Additional uses include refining professional scope and standards of practice, job descriptions, performance appraisals, research, and policy development.


Assuntos
Medicina de Emergência/normas , Profissionais de Enfermagem/normas , Papel do Profissional de Enfermagem , Padrões de Prática em Enfermagem/normas , Especialização/normas , Humanos
17.
J Am Assoc Nurse Pract ; 30(10): 570-578, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30320710

RESUMO

BACKGROUND/PURPOSE: The growth of advanced practice nursing specialties requires additional expertise for practice that goes beyond entry-level competencies, knowledge, skills, and abilities. A practice standards model for specialty nurse practitioners (PSMSNPs) is introduced that differentiates entry-to-practice population foci competencies from advanced specialty practice standards. OBJECTIVES: (a) Differentiate competencies and practice standards in context to specialty NPs using the emergency specialty as the exemplar, (b) articulate the process to develop the PSMSNP that evolved from an evidence-based practice analysis of NPs working in emergency care, (c) apply the PSMSNP for adaptation to other specialties, and (d) provide implications for the utilization of the PSMSNP by educators, clinicians, and employers. DATA SOURCES: American Academy of Nurse Practitioners Certification Board's Practice Analysis of Emergency Nurse Practitioners, Consensus Model for APRN Regulation, Future of Nursing report, Peer Nursing Report, Strong Model of Advanced Practice, Entrustable Professional Activities, Emergency Medicine Milestones Project, and the Advancing Healthcare Transformation: A New Era for Academic Nursing report. CONCLUSIONS: The PSMSNP has been defined and adapted to other specialties and threaded through other models of practice for educators, clinicians, and employers. The adaptability of this model differentiates the core population foci and unique practice variables of specialty NPs. National boards of nursing, hospital credentialing committees, colleges, and universities can use this model to establish standards for specialty evaluation and guide clinical practice. IMPLICATIONS FOR PRACTICE: The implementation of the PSMSNP will support the delineation of the specialty. This model will fulfill the American Nurses Association and Consensus Model specialty constructs.


Assuntos
Medicina de Emergência/normas , Modelos de Enfermagem , Profissionais de Enfermagem/normas , Especialização/tendências , Competência Clínica/normas , Medicina de Emergência/métodos , Humanos , Padrões de Prática em Enfermagem/normas , Especialização/normas
20.
Catheter Cardiovasc Interv ; 92(7): 1356-1364, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30260064

RESUMO

The present-day cardiac catheterization laboratory (CCL) is home to varied practitioners who perform both diagnostic, interventional, and complex invasive procedures. Invasive, non-interventional cardiologists are performing a significant proportion of the work as the CCL environment has evolved. This not only includes those who perform diagnostic-only cardiac catheterization but also heart failure specialists who may be involved in hemodynamic assessment and in mechanical circulatory support and pulmonary hypertension specialists and transplant cardiologists. As such, the training background of those who work in the CCL is varied. While most quality metrics in the CCL are directed towards evaluation of patients who undergo traditional interventional procedures, there has not been a focus upon providing these invasive, noninterventional cardiologists, hospital/CCL administrators, and CCL directors a platform for quality metrics. This document focuses on benchmarking quality for the invasive, noninterventional practice, providing this physician community with guidance towards a patient-centered approach to care, and offering tools to the invasive, noninterventionalists to help their professional growth. This consensus statement aims to establish a foundation upon which the invasive, noninterventional cardiologists can thrive in the CCL environment and work collaboratively with their interventional colleagues while ensuring that the highest quality of care is being delivered to all patients.


Assuntos
Benchmarking/normas , Cateterismo Cardíaco/normas , Cardiologistas/normas , Prestação Integrada de Cuidados de Saúde/normas , Padrões de Prática Médica/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Cateterismo Cardíaco/efeitos adversos , Cardiologistas/educação , Certificação/normas , Competência Clínica/normas , Consenso , Educação de Pós-Graduação em Medicina/normas , Humanos , Especialização/normas
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