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4.
J Forensic Leg Med ; 72: 101965, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32452455

RESUMO

Within the regime of professional liability of doctors in training, the limits and the medico-legal aspects of their professional duties are not well-defined. The Italian Court of Cassation established in its sentence no. 26311/2019 that resident doctors do not work at hospitals just to receive their professional training. They are, indeed, licensed physicians and therefore bear full responsibility for the acts performed within the compass of their professional activity. The purpose of this article is to briefly define the possible consequences of this judgment.


Assuntos
Internato e Residência/legislação & jurisprudência , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Humanos , Itália , Relações Médico-Paciente , Médicos/legislação & jurisprudência
7.
J Patient Saf ; 15(4): e94-e97, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764533

RESUMO

BACKGROUND: Restrictions to residents' working hours have been shown to increase the workload of other medical resources; few studies have measured the effects on medical emergency teams (METs). OBJECTIVES: This study evaluated how limiting residents' working hours affected the workload of MET in a pulmonology unit. METHODS: This retrospective observational study analyzed MET activity during periods before and after we limited the working hours of residents in our pulmonary unit to 88 h/wk: Period 1, March 2014 to February 2015; and Period 2, March 2015 to February 2016. Medical emergency team activities, dose (activations/1000 admissions), intensive care unit transfers, and mortality were compared between the two periods for weekdays and for weekends and holidays. RESULTS: There were no significant differences between the two periods in MET dose (85.0 in Period 1 versus 91.3 in Period 2, P = 0.675), intensive care unit transfers (P = 0.828), 30-day mortality (P = 0.701), and 60-day mortality (P = 0.531). However, some activities increased significantly or near significantly in Period 2, including portable echocardiography (P < 0.001), arterial line insertion (P = 0.034), mechanical ventilation (P = 0.063), and fluid therapy (P = 0.220). These increases were greater for weekends and holidays than for weekdays. CONCLUSIONS: Since December 2017, a specific law for improving the training environment and status of residents has been implemented and applied at all hospitals in Korea. This legal restriction to working hours raises concerns regarding other medical personnel and system improvements to ensure patient safety and care continuity.


Assuntos
Medicina de Emergência , Serviço Hospitalar de Emergência , Internato e Residência , Assistência ao Paciente , Segurança do Paciente , Tolerância ao Trabalho Programado , Carga de Trabalho , Idoso , Continuidade da Assistência ao Paciente , Medicina de Emergência/métodos , Medicina de Emergência/normas , Departamentos Hospitalares , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Internato e Residência/legislação & jurisprudência , Masculino , Assistência ao Paciente/métodos , Assistência ao Paciente/normas , Transferência da Responsabilidade pelo Paciente , Admissão e Escalonamento de Pessoal , Políticas , Pneumologia , República da Coreia , Estudos Retrospectivos , Carga de Trabalho/legislação & jurisprudência
9.
Perspect Med Educ ; 8(6): 353-359, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31642049

RESUMO

BACKGROUND: Despite the use of 'patient ownership' as an embodiment of professionalism and increasing concerns over its loss among trainees, how its development in residents has been affected by duty hour regulations has not been well described. In this qualitative study, we aim to outline the key features of patient ownership in internal medicine, factors enabling its development, and how these have been affected by the adoption of a night float system to comply with duty hour regulations. METHODS: In this qualitative descriptive study, we interviewed 18 residents and 12 faculty internists at one university centre and conducted a thematic analysis of the data focused on the concept of patient ownership. RESULTS: We identified three key features of patient ownership: personal concern for patients, professional capacity for autonomous decision-making, and knowledge of patients' issues. Within the context of a night float system, factors that facilitate development of patient ownership include improved fitness for duty and more consistent interactions with patients/families resulting from working the same shift over consecutive days (or nights). Conversely, the increase in patient handovers, if done poorly, is a potential threat to patient ownership development. Trainees often struggle to develop ownership when autonomy is not supported with supervision and when role-modelling by faculty is lacking. DISCUSSION: These features of patient ownership can be used to frame discussions when coaching trainees. Residency programs should be mindful of the downstream effects of shift-based scheduling. We propose strategies to optimize factors that enable trainee development of patient ownership.


Assuntos
Docentes de Medicina/psicologia , Internato e Residência/legislação & jurisprudência , Transferência da Responsabilidade pelo Paciente , Jornada de Trabalho em Turnos/psicologia , Estudantes de Medicina/psicologia , Adulto , Feminino , Humanos , Medicina Interna/educação , Internato e Residência/métodos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Jornada de Trabalho em Turnos/legislação & jurisprudência , Estudantes de Medicina/legislação & jurisprudência
11.
J Gen Intern Med ; 34(7): 1337-1341, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31069706

RESUMO

The current and projected deficit in the physician workforce in the US is a challenge for primary care and specialty medical settings. Foreign medical graduates (FMGs) represent an important component of the US graduate medical education (GME) training pathway and can help to address the US physician workforce deficit. Availability of FMGs is particularly important to the internal medicine community, as recent data demonstrate that internal medicine is the specialty with the highest number of FMGs. System-based and logistical inefficiencies in the current US visa system represent significant obstacles to FMG trainees and have important psychological, emotional, and logistical consequences to FMG engagement and participation in US GME training and in the post-training workforce. In this article, we review the contemporary structure, process, and challenges of obtaining a visa for GME training. The H1B and J1 visa programs are compared and contrasted, with an emphasis on logistical specifics for FMG GME trainees and training programs. The process of and options for J1 visa waivers are reviewed. These considerations are specifically reviewed in the context of recent policy decisions by the Trump administration, with emphasis on the effects of these decisions on FMGs in medical training and practice.


Assuntos
Educação de Pós-Graduação em Medicina/legislação & jurisprudência , Emigrantes e Imigrantes/legislação & jurisprudência , Médicos Graduados Estrangeiros/legislação & jurisprudência , Internato e Residência/legislação & jurisprudência , Escolha da Profissão , Educação de Pós-Graduação em Medicina/tendências , Médicos Graduados Estrangeiros/tendências , Humanos , Internato e Residência/tendências , Médicos/legislação & jurisprudência , Médicos/tendências , Estados Unidos/epidemiologia , Recursos Humanos/legislação & jurisprudência , Recursos Humanos/tendências
12.
J Surg Res ; 241: 302-307, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31048221

RESUMO

BACKGROUND: In 1993, the Family and Medical Leave Act (FMLA) mandated 12 weeks of unpaid, job-protected leave. The current impact of taking 12 weeks of leave during residency has not been evaluated. METHODS: We examined the 2018 Accreditation Council for Graduate Medical Education (n = 24) specialty leave policies to determine the impact of 6- and 12-week leave on residency training, board eligibility, and fellowship training. We compared our findings with a 2006 study. RESULTS: In 2018, five (21%) specialties had policy language regarding parental leave during residency, and four (16%) had language regarding medical leave. Median leave allowed was 4 weeks (IQR 4-6). Six specialties (25%) decreased the number of weeks allowed for leave from 2006 to 2018. In 2006, a 6-week leave would cause a 1-year delay in board eligibility in six specialties; in 2018, it would not cause delayed board eligibility in any specialty. In 2018, a 12-week (FMLA) leave would extend training by a median of 6 weeks (mean 4.1, range 0-8), would delay board eligibility by 6-12 months in three programs (mean 2.25, range 0-12), and would delay fellowship training by at least 1 year in 17 specialties (71%). The impact of a 12-week leave was similar between medical and surgical specialties. CONCLUSIONS: While leave policies have improved since 2006, most specialties allow for 6 weeks of leave, less than half of what is mandated by the FMLA. Moreover, a 12-week, FMLA-mandated leave would cause significant delays in board certification and entry into fellowship for most residency programs.


Assuntos
Internato e Residência/estatística & dados numéricos , Medicina/estatística & dados numéricos , Licença Parental/estatística & dados numéricos , Equilíbrio Trabalho-Vida/estatística & dados numéricos , Acreditação/legislação & jurisprudência , Estudos Transversais , Feminino , Humanos , Internato e Residência/legislação & jurisprudência , Legislação Médica , Masculino , Licença Parental/legislação & jurisprudência , Políticas , Conselhos de Especialidade Profissional/legislação & jurisprudência , Fatores de Tempo , Estados Unidos , Equilíbrio Trabalho-Vida/legislação & jurisprudência
13.
J Leg Med ; 39(4): 417-426, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31940249

RESUMO

Duty-hours policies continue to be debated. Most know the pro and con arguments, but many may not be aware of background information preceding and intertwining the development and implementation of these policies. Interestingly, several aspects of law were involved or potentially correlated with policies enacted. This review updates new generations of physicians and scholars on the historical trajectory of duty-hour policies and highlights policy implications and the current state of evidence. In reviewing the historical and legal trajectory of duty-hours, many updates seemed to be a reaction to potential federal entanglement. Additionally, the review of the postimplementation literature revealed minimal empirical evidence. Instead, the majority of the positive findings were perception based. These summaries demonstrate a need for further outcomes evidence to validate policies.


Assuntos
Educação de Pós-Graduação em Medicina/organização & administração , Internato e Residência/história , Internato e Residência/legislação & jurisprudência , Internato e Residência/tendências , Políticas , Jornada de Trabalho em Turnos/legislação & jurisprudência , Tolerância ao Trabalho Programado , Esgotamento Profissional/prevenção & controle , Continuidade da Assistência ao Paciente/normas , História do Século XX , História do Século XXI , Humanos , Erros Médicos/prevenção & controle , Segurança do Paciente/normas , Privação do Sono/prevenção & controle , Carga de Trabalho
19.
Plast Reconstr Surg ; 141(5): 768e-774e, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29697635

RESUMO

BACKGROUND: The purposes of this study were to (1) determine the proportion of plastic surgery residents pursuing subspecialty training relative to other surgical specialties, and (2) analyze trends in Accreditation Council for Graduate Medical Education accreditation of plastic surgery subspecialty fellowship programs. METHODS: The American Medical Association provided data on career intentions of surgical chief residents graduating from 2014 to 2016. The percentage of residents pursuing fellowship training was compared by specialty. Trends in the proportion of accredited fellowship programs in craniofacial surgery, hand surgery, and microsurgery were analyzed. The percentage of accredited programs was compared between subspecialties with added-certification options (hand surgery) and subspecialties without added-certification options (craniofacial surgery and microsurgery). RESULTS: Most integrated and independent plastic surgery residents pursued fellowship training (61.8 percent versus 49.6 percent; p = 0.014). Differences existed by specialty from a high in orthopedic surgery (90.8 percent) to a low in colon and rectal surgery (3.2 percent). From 2005 to 2015, the percentage of accredited craniofacial fellowship programs increased, but was not significant (from 27.8 percent to 33.3 percent; p = 0.386). For hand surgery, the proportion of accredited programs that were plastic surgery (p = 0.755) and orthopedic surgery (p = 0.253) was stable, whereas general surgery decreased (p = 0.010). Subspecialty areas with added-certification options had more accredited fellowships than those without (100 percent versus 19.2 percent; p < 0.001). CONCLUSION: There has been slow adoption of accreditation among plastic surgery subspecialty fellowships, but added-certification options appear to be highly correlated.


Assuntos
Acreditação/tendências , Certificação/tendências , Bolsas de Estudo/legislação & jurisprudência , Internato e Residência/legislação & jurisprudência , Cirurgia Plástica/educação , Acreditação/estatística & dados numéricos , Certificação/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Estados Unidos
20.
Aesthet Surg J ; 38(10): 1145-1152, 2018 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-29474525

RESUMO

Background: Ethical guidelines for appropriate use of social media are beginning to be delineated. As social media becomes ingrained in plastic surgery culture, education of residents on appropriate use of social media is increasingly important. Recently, plastic surgery residency programs have begun to utilize social media. Objectives: This study characterized the trends and content of plastic surgery residency-associated Instagram accounts. Methods: Active individual residency program Instagram accounts were identified for integrated plastic surgery programs. Metrics for each account were retrieved on September 16, 2017, including date of first post, number of posts, and followers. Individual posts were analyzed for content of post. Results: Fourteen of 67 (21%) integrated plastic surgery programs were found to have active Instagram accounts. There has been an exponential growth of programs adopting Instagram since August 2015. A total of 806 posts were created. Thirty-two (3.97%) posts had intraoperative photos and only one (0.12%) showed a patient image. There were 4466 followers of plastic surgery residency programs. A linear correlation was found between number of posts and number of followers, while there was no correlation of number of followers and time since account start. Conclusions: Instagram use by plastic surgery integrated programs continues to grow exponentially, and programs are appropriately using the platform. Active use of the resident social media results in increased influence. Resident use of social media has many benefits. We propose social media guidelines for plastic surgery trainees and advocate for continued appropriate use and autoregulation by plastic surgery trainees.


Assuntos
Códigos de Ética , Internato e Residência/ética , Mídias Sociais/ética , Cirurgia Plástica/educação , Humanos , Internato e Residência/legislação & jurisprudência , Marketing de Serviços de Saúde/ética , Marketing de Serviços de Saúde/legislação & jurisprudência , Mídias Sociais/legislação & jurisprudência , Cirurgia Plástica/ética , Cirurgia Plástica/legislação & jurisprudência
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