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1.
Int J Mol Sci ; 22(8)2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33921428

RESUMO

A hyper-specialization characterizes modern medicine with the consequence of classifying the various diseases of the body into unrelated categories. Such a broad diversification of medicine goes in the opposite direction of physics, which eagerly looks for unification. We argue that unification should also apply to medicine. In accordance with the second principle of thermodynamics, the cell must release its entropy either in the form of heat (catabolism) or biomass (anabolism). There is a decreased flow of entropy outside the body due to an age-related reduction in mitochondrial entropy yield resulting in increased release of entropy in the form of biomass. This shift toward anabolism has been known in oncology as Warburg-effect. The shift toward anabolism has been reported in most diseases. This quest for a single framework is reinforced by the fact that inflammation (also called the immune response) is involved in nearly every disease. This strongly suggests that despite their apparent disparity, there is an underlying unity in the diseases. This also offers guidelines for the repurposing of old drugs.


Assuntos
Imunidade/fisiologia , Medicina/classificação , Metabolismo/fisiologia , Especialização/normas , Reposicionamento de Medicamentos , Entropia , Guias como Assunto , Humanos
2.
Chirurgia (Bucur) ; 115(6): 756-766, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378634

RESUMO

Background: Gallstone disease is a common problem and laparoscopic cholecystectomy (LC) is a common elective procedure. This operation was performed by a general surgeon, colorectal surgeons, breast and vascular surgeons according to the largest UK's audit (CholeS study). Objectives: To compare the outcomes of laparoscopic cholecystectomy performed by a specialist upper gastrointestinal (UGI) surgeon to that of CholeS and large international studies. Our hypothesis is: UGI specialist is producing better outcomes for LC patients. Methods: All patient who underwent LC between 1999 and 2019 at one hospital by an UGI consultant and 2014-2019 at another hospital by another UGI consultant surgeon were included. The inclusion criteria were LC performed by UGI surgeon. Lost to follow up, procedures done by trainees and gallbladder cancer patients were excluded. The outcome measures of bile leak, bile duct injuries, bleeding, infectious complications, bowel injuries, vascular injuries and pseudoaneurysms, neuralgia, port site hernia, mesenteric haematoma, 30-day mortality and conversion to open were reported. Statistical tests were used to assess the significant differences, the confidence interval was 95% and the p-value was taken as 0.05. Results: Two UGI specialists performed 5122 LC, 4396 (86%) were female and 715 (14%) male. The age was 13-93 year (median of 48 years). 3681 (72 %) was done as a day surgery case. 1431(28%) as an inpatient and 287 (5.6%) emergency LC. There was no death in the 30 days periods of surgery, 8 (0.15%) biliary leak from the duct of Luschka, 4 (0.19%) common bile duct (CBD) injuries, 9(0.02%) conversions and 17(0.33%) procedures were abandoned. There were significant differences in the above complications between our study and the CholeS report. Conclusions: Laparoscopic cholecystectomy is associated with acceptable outcomes, low risk of bile duct injury and no mortality when performed by a specialist upper GI surgeon.


Assuntos
Colecistectomia Laparoscópica , Colelitíase , Especialização/normas , Especialidades Cirúrgicas/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/mortalidade , Colecistectomia Laparoscópica/normas , Colecistectomia Laparoscópica/estatística & dados numéricos , Colelitíase/cirurgia , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Especialização/estatística & dados numéricos , Especialidades Cirúrgicas/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
3.
Rev. cuba. med ; 59(4): e1398, oct.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144503

RESUMO

Introducción: La evaluación de graduación constituye el examen de culminación de los estudios de la especialización, correspondiente a la enseñanza de posgrado. Objetivo: Proponer y fundamentar la realización de modificaciones en la evaluación de graduación de la especialidad Medicina Interna, en nuestro contexto. Método: Investigación sustentada en el análisis de documentos metodológicos y en una reflexión crítica de la praxis, para la construcción teórica de la propuesta de modificaciones. Resultados: A partir de la identificación de puntos de mejoría y guiados por una serie de principios, se proponen los siguientes cambios: 1) readecuación en la secuencia de los ejercicios teóricos y prácticos que conforman el examen estatal, 2) mayor peso de las actividades prácticas en la evaluación, tanto por aumento del número de actividades como por el tiempo destinado a las ejecuciones, 3) representación más amplia de la diversidad de habilidades y competencias objetivo de aprendizaje en la residencia, y 4) una mirada más exigente y valorizada de las competencias investigativas en general, y del trabajo de terminación de la especialidad en particular. Conclusiones: Mediante los cambios que se proponen se logra una certificación más real y objetiva de las competencias profesionales de los educandos para el cumplimiento del encargo social, y contribuye al mejoramiento de la calidad del profesional egresado, al estimular un proceso formativo dirigido a garantizar la aplicación de los conocimientos(AU)


Introduction: The graduation evaluation constitute the final assessment of the specializing studies, corresponding to postgraduate education. Objective: To propose and to substantiate the conduction of modifications in the graduation evaluation of Internal Medicine specialty, in our context. Method: A research based on the analysis of methodological documents and on praxis critical reflection was carried out for the theoretical construction of the proposed modifications. Results: From the identification of çimprovement points and guided by a series of principles, the following changes are proposed: 1) Readjusting the sequence of theoretical and practical exercises that make up the state exams, 2) Providing greater importance of practical activities in the assessment, both due to the increase in the number of activities and the time allocated to performing, 3) Bringing broader representation of the diversity of skills and competencies which are learning objective in the residence, and 4) Demanding and measuring more the research competences in general, and of the completion paper of the specialty in particular. Conclusions: These proposed changes result in more real and objective certification of the professional competences of the students for achieving the fulfillment of the social mandate. These changes improve the quality of the professional, by stimulating a training process aimed at guaranteeing the application of knowledge(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Especialização/normas , Medicina Interna/educação , Competência Profissional , Avaliação Educacional/métodos
4.
Educ. med. (Ed. impr.) ; 21(5): 313-323, sept.-oct. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-196875

RESUMO

INTRODUCTION: There are four objectives to this paper: (1) To determine whether undergraduates enrolled in Health-Sciences studies agree with the use of human stem cells for medical research, treatment and genetic uses. (2) Whether they would consider the use of pre-implantation-embryos for medical research. (3) Whether attitudes toward the previous two issues are linked to gender, field of study, transcendental/spiritual convictions and political biases. (4) A panel of discussion will modify their opinion. RESULTS: The present study shows that, before attending a discussion panel session, media was the main source of information that the students had on the surveyed topics. A discussion panel was useful for clarifying respondents' opinions on the explored items. Significantly, the discussion panel had an influence on those respondents who did not have a formed opinion on the explored items. CONCLUSIONS: A discussion panel is a convenient, but limited tool, in the shaping of undergraduate opinions on ethically controversial scientific matters


INTRODUCCIÓN: Los objetivos de este artículo son conocer si: 1) los estudiantes de pregrado matriculados en titulaciones de grado de ciencias de la salud están de acuerdo con la utilización de las células madre humanas para la investigación médica de los embriones preimplantatorios, la cura de enfermedades y los usos génicos; 2) consideran el uso de los embriones preimplantatorios humanos para la investigación; 3) las actitudes hacia los 2 temas anteriores están relacionadas con el género, el grado universitario en curso, la afiliación política y las convicciones trascendentales o espirituales, y 4) conocer si un panel de discusión, con expertos, modifica esas opiniones. RESULTADOS: Los resultados del presente estudio mostraron que antes del panel de discusión, los medios de comunicación eran la principal fuente de información de los encuestados sobre los temas estudiados. El panel de discusión fue útil para aclarar las opiniones de los encuestados, aprobar o desaprobar los ítems explorados. Significativamente, el panel de discusión influyó en los encuestados que dijeron que no tenían una opinión formada sobre los ítems explorados antes del panel de discusión. CONCLUSIONES: El panel de discusión es una herramienta conveniente pero limitada en la formación de las opiniones de los estudiantes de pregrado en titulaciones de ciencias de la salud sobre cuestiones científicas éticamente controvertidas


Assuntos
Humanos , Especialização/normas , Implantação do Embrião , Biologia do Desenvolvimento/educação , Estudantes de Ciências da Saúde/estatística & dados numéricos , Ocupações em Saúde/educação , Pesquisas com Embriões/ética , Opinião Pública , Transplante de Células-Tronco/ética , Estudos Transversais , Inquéritos e Questionários
5.
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
7.
Educ. med. (Ed. impr.) ; 21(3): 168-176, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-195104

RESUMO

INTRODUCCIÓN: El proceso de la investigación en un pilar fundamental dentro de la formación de posgrado en el área de la medicina, ya que conlleva a que el médico residente desarrolle competencias que le permitan aplicar la medicina basada en la evidencia, incrementar la investigación en ciencias básicas y clínicas y generar nuevo conocimiento. MATERIALES Y MÉTODOS: Se presenta un estudio de tipo descriptivo con corte transversal en el que se evaluó la producción científica de los egresados de los posgrados clínico-quirúrgicos de la Universidad Surcolombiana. Se realizó análisis descriptivo de tipo univariado además de un análisis bivariado mediante cálculo de la razón de prevalencias y usando chi cuadrado y prueba exacta de Fisher. RESULTADOS: El total de publicaciones fue de 161, Cirugía general es la especialidad con el mayor número de publicaciones (n=79), el artículo en revista es el tipo de publicación con mayor frecuencia (86%). La media de publicación por egresado es de 0,76 y se observó una asociación entre la vinculación docente y las publicaciones (p = 0,0024). CONCLUSIONES: La producción científica de los egresados de los posgrados clínico-quirúrgicos de la Facultad de Salud de la Universidad Surcolombiana tiene un comportamiento diverso entre los diferentes programas. Con base en los resultados se evidencia la necesidad del fortalecimiento, fomento de la investigación y el apoyo para la publicación en los posgrados clínico-quirúrgicos


BACKGROUND: Research is fundamental in the post-graduate areas of medicine, since it helps the resident doctors to develop aptitudes that will allow them to use evidence based medicine, as well as to increase research in basic and clinics sciences, and to generate new knowledge. METHODS: A descriptive, cross-sectional study was carried out to assess the scientific production of graduated physicians from clinical-surgical specialisations of the Universidad Surcolombiana. A univariate descriptive analysis and bivariate analysis was performed, as well as the calculation of the prevalence ratio, using Chi-squared and the Fisher exact test. RESULTS: The total number of publications was 161, with general surgery being the specialisation with the highest number of publications (n = 79), with an article being the most frequent type of publication (86%). The mean of publication by graduated physicians was 0.76, and a relationship was observed between teaching links and publication (p = .0024). CONCLUSIONS: Scientific production by graduate physicians from clinical-surgical specialisations of the health faculty of the Universidad Surcolombiana varies between different courses. Based on the results obtained, there is evidence for the need of strengthening and promoting research, as well as support to publish in the clinical-surgical specialisations


Assuntos
Humanos , Educação de Pós-Graduação em Medicina/normas , Avaliação Educacional/normas , Competência Clínica , Medicina Baseada em Evidências , Pesquisa Científica e Desenvolvimento Tecnológico , Medicina , Especialização/normas , Estudos Transversais , Pesquisa Biomédica/educação , Pesquisa Biomédica/estatística & dados numéricos , Colômbia
11.
J Asthma ; 57(2): 188-195, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30663904

RESUMO

Objective: To learn factors associated with desire for asthma specialist care among parents of children seeking emergency department (ED) care for asthma, and if referral was indicated based on national asthma guidelines. Methods: We surveyed parents of children ages 0-18 years seeking pediatric ED asthma care, then comparisons were made according to parental level of interest in asthma specialist care, with regard to socio-demographics, asthma morbidity and care, by chi-squared and logistic regression. Results: Of 149 children, 20% reported specialist care, but 75% met guideline criteria for referral. About 80% of parents not seeing an asthma specialist expressed a desire to see one. Higher rates of prior urgent care visits (48% vs. 22%, p = 0.03), ED visits (82% vs. 35%, p < 0.001) and oral steroid use (53% vs. 22%, p = 0.009) were reported by parents who desired an asthma specialist compared with parents who did not. 87% of parents not seeing a specialist attributed this to a perceived lack of necessity by their primary care provider. An ED visit within the prior 12 months was the most significant predictor in parental desire for specialist care (odds ratio 9.75; 95% CI 3.42-27.76) in adjusted logistic regression models. Conclusion: High rates of parental preference for asthma specialist care suggest that directly querying parents may be an efficient method to identify children appropriate for specialist care in the ED.


Assuntos
Asma/epidemiologia , Asma/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pais/psicologia , Encaminhamento e Consulta/estatística & dados numéricos , Especialização/estatística & dados numéricos , Absenteísmo , Adolescente , Asma/fisiopatologia , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Preferência do Paciente , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Índice de Gravidade de Doença , Fatores Socioeconômicos , Especialização/normas
12.
J Telemed Telecare ; 26(4): 239-247, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30717627

RESUMO

INTRODUCTION: Poor communication between health professionals can compromise patient safety, yet specialists rarely receive feedback on their written communication. Although worldwide implementation of electronic consultation (eConsult) services is rising rapidly, little is known about the features of effective communication when specialists provide online advice to primary care providers (PCP). To inform efforts to ensure and maintain high-quality communication via eConsult, we aim to identify features of high-quality eConsult advice to incorporate into an assessment tool that can provide specialists with feedback on their correspondence. METHODS: Initial items for the tool were generated by PCPs and specialists using the nominal group technique (NGT). Invited PCPs were above-median eConsult users between July 2016 and June 2017. Specialists were purposively recruited to represent the range of available specialties. Participants individually wrote down items they felt should be included in the tool. A moderator with consensus group expertise then led a round-robin discussion for each item. Items were ranked anonymously and included if highly-ranked by over 70% of participants. RESULTS: Eight PCPs (six family physicians, two nurse practitioners) and three specialists (dermatology, hematology, pediatric orthopedics) produced 49 items that were refined to 14 after group discussion and two rounds of ranking. Highly-ranked items encompassed specific, up-to-date, patient-individualized, and practical advice that the PCP could implement. DISCUSSION: Features of high-quality eConsult correspondence derived from consensus methods highlight similarities and differences between face-to-face consultation letters and eConsult. Our findings could be used to inform feedback and education for eConsult specialists on their advice to PCPs.


Assuntos
Atenção Primária à Saúde/normas , Relações Profissional-Paciente , Melhoria de Qualidade/normas , Consulta Remota/normas , Comunicação , Feminino , Acesso aos Serviços de Saúde/organização & administração , Humanos , Profissionais de Enfermagem/normas , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta/normas , Consulta Remota/métodos , Especialização/normas
13.
ASAIO J ; 66(3): 314-318, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30973401

RESUMO

Extracorporeal membrane oxygenation (ECMO) is a low-volume, high-risk modality of care. Clinical specialists (CS) who manage ECMO circuit emergencies vary in background and approach to circuit emergencies based on institutional training standards, leading to variation that may impact the quality of care. Validated checklists to assess CS performance are crucial to eliminate disparities and improve efficiency. This study focused on the development and validation of checklists to evaluate the clinical performance of ECMO CS in three ECMO circuit emergencies. A research team with diverse clinical background from our institution developed the first iteration of three ECMO emergency checklists: (1) venous air, (2) arterial air, and (3) oxygenator failure. A modified Delphi technique with a panel of 11 national content experts in ECMO was used to develop content validity evidence. Rating scales from 1 to 7 were used to evaluate each checklist item. The response rate for three rounds of Delphi was 100%. Items with mean score >4 were kept, and new item recommendations were added based on comments from the panel. The venous air, arterial air, and oxygenator failure checklists were revised from 10, 13, and 9 items to 12, 12, and 10 items, respectively. A Cronbach's α of 0.74 during the second round of responses indicated an acceptable degree of agreement. This study demonstrated content validation of three ECMO emergency checklists to assess performance of ECMO CS using a consensus-based Delphi technique. Future validity evidence should be acquired by implementing these checklists in the simulation environments.


Assuntos
Lista de Checagem , Técnica Delfos , Emergências , Oxigenação por Membrana Extracorpórea/educação , Especialização , Adolescente , Lista de Checagem/normas , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Especialização/normas , Desempenho Profissional
14.
Acad Med ; 95(3): 336-339, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31688033

RESUMO

Today, medical schools graduate doctors, not physicians. Thousands of doctors who are U.S. citizens and graduates of U.S. and international medical schools will never become physicians because they do not obtain a residency position. Doctors need at least one year of residency to become a licensed physician. However, 4,099 applicants in 2018 and 4,170 in 2019 failed to get a position through the National Resident Matching Program Main Match; about 1,000 students get positions after the Main Match each year. The personal and societal cost is enormous: each year, approximately 3,000 nonphysician doctors cannot use 12,000 education years and three-quarters of a billion dollars they invested in medical education and cannot mitigate the shortfall of 112,000 physicians expected in 2030.To ameliorate this problem, medical schools could guarantee one year of residency. This is affordable: despite federally funded slots being capped, residency positions have increased for 17 consecutive years (20,602 in 2002 to 32,194 in 2019) because residents are cost-effective additions to the workforce. Alternatively, a 3-year curriculum plus required fourth-year primary care residency is another option. The salary during the residency year could equal other first-year residents', or there could be a token amount for this "internship." Both models decrease the cost of medical education; the second financially unburdens the hospital.Since the Flexner Report (when there was no formal postgraduate training), the end point of medical education has moved from readiness for independent medical practice (physician) to readiness for postgraduate training (doctor). To benefit individuals and society, medical education must take steps to ensure that all graduates are physicians, not just doctors.


Assuntos
Currículo , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/tendências , Internato e Residência/normas , Médicos/provisão & distribuição , Médicos/estatística & dados numéricos , Especialização/normas , Adulto , Feminino , Previsões , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Especialização/estatística & dados numéricos , Estados Unidos , Adulto Jovem
15.
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
16.
GMS J Med Educ ; 36(5): Doc58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31815168

RESUMO

Background: The 2002 Medical Licensure Act gave German universities certain freedoms for reforming their medical degree courses. The Medical Faculty of the University of Cologne took advantage of this opportunity and introduced a model study course in the winter semester 2003/04 through §41 of the Medical Licensure Act. One of the main reasons for this was that back then there was an increasing shortage of doctors in clinical curative medicine and GP primary care. This study investigates whether the introduction of the Cologne Model Study Course (MSG) can show stronger interest in curative medical work (especially General Practice) compared to students of the standard degree course (RSG). Methodology: The proof of added value was examined through graduate surveys conducted at the University of Cologne and through the proportion of students who completed the PY elective rotation "General Practice". The students of the standard degree course (start of studies prior to winter semester 2003/2004) were compared with students of the model study course (start of studies from winter semester 2003/04 onwards). Measurements were carried out using descriptive frequency tables and correlation analyzes according to Spearman. Results: The students' interest in curative medicine was already high (91%) even before the model study course was introduced and increased only slightly (to 91.9%). There is also only a slight increase in specialization in General Practice (RSG=5.9% vs. MSG=9.2%). However, selection of rotations in General Practice was significantly increased (RSG=1.9% vs. MSG=3.4%, r=0.046 **, p<0.005). Conclusion: The Cologne Model Study Course in Human Medicine has increased awareness of the subject of General Practice among students through a large number of curricular changes. The fact that only marginal effects can be demonstrated shows once more the strong dependence of choosing General Medicine as a career path on other factors (such as gender or the presence of positive role models) and emphasizes the necessity of promoting General Practice student education not only through increased curricular mapping but by additional innovative concepts to maximize the status of General Practice from the perspective of students.


Assuntos
Escolha da Profissão , Educação de Graduação em Medicina/normas , Medicina Geral/educação , Especialização/normas , Educação de Graduação em Medicina/legislação & jurisprudência , Educação de Graduação em Medicina/métodos , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/educação , Clínicos Gerais/provisão & distribuição , Humanos , Melhoria de Qualidade , Especialização/estatística & dados numéricos , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
17.
J Med Imaging Radiat Sci ; 50(4): 543-550, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31668680

RESUMO

INTRODUCTION: A clinical specialist radiation therapist (CSRT) position in palliative radiation therapy (RT) was created at our institution. Herein, we report the details of the CSRT's orientation, training, and support program. METHODS: We performed an audit and needs assessment of palliative RT services at our centre. This identified opportunities for improvement that could be facilitated by the CSRT. We defined the CSRT job description including priority responsibilities: (1) optimizing palliative RT services for outpatients and developing a rapid access palliative RT program, (2) optimizing palliative RT services for inpatients at our institution, (3) improving links to community physicians and hospitals caring for patients with advanced cancers. We formed a core resource team to provide ongoing support and to design and implement the orientation and training program. The program involved training in clerical and administrative systems as well as treatment planning and physics training relevant to palliative RT. Clinical placements at several hospitals were arranged in both inpatient and outpatient settings. The CSRT worked with radiation and medical oncologists, palliative care specialists, nurse practitioners, hospitalists, and social workers. RESULTS: Through clinical placements and self-directed learning, the CSRT gained knowledge and competencies in patient care coordination, history taking and physical examination, clinical oncology practice including the evidence-based use of palliative RT and symptom control measures, treatment planning, communication, patient advocacy, and advance care planning. We provided practice resources including office space and a planning station, educational opportunities including workshops in palliative and psychosocial care, and research opportunities including methodologic and research ethics training. DISCUSSION: To our knowledge, this is the first detailed report of its kind for an advanced practice radiation therapy role. We hope our report will inform the design and implementation of programs elsewhere to help prepare individuals for similar roles in palliative RT. CONCLUSION: The CSRT in palliative RT at our institution underwent a comprehensive orientation and training program. Institutions with similar CSRT positions are encouraged to report the details of their own programs.


Assuntos
Competência Clínica , Pessoal de Saúde/educação , Aprendizagem , Cuidados Paliativos , Radiologia/educação , Especialização/normas , Humanos
20.
Radiography (Lond) ; 25(3): 241-249, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31301782

RESUMO

INTRODUCTION: This study assesses the feasibility of a new role for radiation therapists in Ontario, Canada, called the Advanced Practice Radiation Therapist (APRT), which would address health service pressures and improve patients' access to care. METHODS: A literature search and expert consensus were used to define advanced practice. A standardized template was used to record each APRTs activities/competencies, along with the requisite knowledge, skills and judgment required to perform these competencies. A thematic analysis of the lists was undertaken to develop a single competency profile. Seven APRTs were deployed at four cancer centres to gather contextual information on the development and integration of the new role. RESULTS: The definition of AP consists of seven key traits and includes a framework identifying stages of practice from entry-level practitioner through expert to advanced practitioner. The competency profile consists of clinical, technical and professional domains which further define the scope of practice and shepherd the role through stages of implementation. Role testing showed support for the role and demonstrated that APRTs can deliver specialized services, perform delegated tasks and their work can lead to program efficiencies and new services. The new role may also lead to improved radiation therapist recruitment rates and work satisfaction. CONCLUSIONS: This feasibility assessment served as the foundation for the future long-term implementation of the Clinical Specialist Radiation Therapist (CSRT) Project. As of 2018, there were 24 CSRTs in Ontario. The APRT role is a natural progression for a readying profession which can play a transformative role in addressing health human resource shortages.


Assuntos
Competência Clínica/normas , Pessoal de Saúde/normas , Prática Profissional/normas , Radio-Oncologistas/normas , Institutos de Câncer/organização & administração , Estudos de Viabilidade , Pessoal de Saúde/organização & administração , Humanos , Satisfação no Emprego , Neoplasias/radioterapia , Ontário , Papel do Médico , Radio-Oncologistas/organização & administração , Especialização/normas
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