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1.
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
6.
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
7.
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
8.
Acad Med ; 93(3S Competency-Based, Time-Variable Education in the Health Professions): S27-S31, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29485484

RESUMO

As competency-based medical education is adopted across the training continuum, discussions regarding time-variable medical education have gained momentum, raising important issues that challenge the current regulatory environment and infrastructure of both undergraduate and graduate medical education in the United States. Implementing time-variable medical training will require recognizing, revising, and potentially reworking the multiple existing structures and regulations both internal and external to medical education that are not currently aligned with this type of system. In this article, the authors explore the impact of university financial structures, hospital infrastructures, national accrediting body standards and regulations, licensure and certification requirements, government funding, and clinical workforce models in the United States that are all intimately tied to discussions about flexible training times in undergraduate and graduate medical education. They also explore the implications of time-variable training to learners' transitions between medical school and residency, residency and fellowship, and ultimately graduate training and independent practice. Recommendations to realign existing structures to support and enhance competency-based, time-variable training across the continuum and suggestions for additional experimentation/demonstration projects to explore new training models are provided.


Assuntos
Educação Baseada em Competências/legislação & jurisprudência , Educação Baseada em Competências/normas , Educação Médica/métodos , Faculdades de Medicina/legislação & jurisprudência , Faculdades de Medicina/normas , Acreditação/legislação & jurisprudência , Certificação/legislação & jurisprudência , Educação Médica/legislação & jurisprudência , Educação Médica/normas , Avaliação Educacional/normas , Humanos , Internato e Residência/legislação & jurisprudência , Internato e Residência/normas , Licenciamento/legislação & jurisprudência , Estados Unidos
9.
Arch. esp. urol. (Ed. impr.) ; 71(1): 34-39, ene.-feb. 2018. graf
Artigo em Espanhol | IBECS | ID: ibc-171825

RESUMO

Objetivo: La Ley 44/2003 de Ordenación de profesiones sanitarias creó el Consejo Nacional de Especialidades en Ciencias de la Salud y las Comisiones Nacionales de las Especialidades en Ciencias de la Salud. Métodos: Revisión de las principales normas legales implicadas en la Formación Especializada y papel de la Comisión Nacional de Especialidad. Discusión: La Ley 44/2003 regula la formación de los profesionales sanitarios y establece el procedimiento para la creación por la Comisión Nacional de Especialidad y su posterior aprobación y publicación en el BOE de los programas formativos de las especialidades. El acceso a la formación especializada se realizará con la convocatoria anual y de carácter nacional de examen MIR. El Ministerio de Sanidad fija los criterios de acreditación de los centros y unidades docentes, y la Comisión Nacional de Especialidad, como órgano asesor, emite un informe favorable o desfavorable sobre las nuevas peticiones de acreditación. El RD 183/2008 desarrolla la figura del tutor, la evaluación formativa junto con el Libro del Residente y cómo serán las rotaciones externas. Conclusiones: Para poder entender el sistema de formación en la especialidad de Urología debemos conocer las normas que lo regulan, siendo la más importante la 44/2003. La Comisión Nacional de Especialidad es un órgano consultivo del Ministerio, cuya función principal es la de elaborar el programa formativo de Urología y establecer los criterios de evaluación de los especialistas en formación (AU)


Objectives: 44/2003 Law involved the creation of the National Council of Specialties in Health Sciences and the National Commissions of the Specialties in Health Sciences. Methods: Analysis of the main laws implicated in Specialized Training and the role of the National Specialty Commission.Discussion: 44/2003 Law regulates the training of health professionals and establishes the procedure for the training programs creation by the National Specialty Commission and its later approval and publication in the BOE. Access to specialized training will be carried out with the annual and national MIR exam. The Health Ministry establishes the criteria for educational centers accreditation, and the National Specialty Commission issues a favorable or unfavorable report as advisor about new accreditation requests. 183/2008 RD develops the tutor figure, the formative evaluation through the Resident’s Book and how will be like the external rotations. Conclusions: to understand the Urology's specialty training system we must know the laws that regulate it, being the most important the 44/2003 Law. The National Specialty Commission is an advisory party of the Ministry, whose main function is to elaborate the Urology training program and to establish the evaluation criteria of the specialists in formation (AU)


Assuntos
Internato e Residência/legislação & jurisprudência , Acreditação de Programas , Urologia/educação , Programas de Estudo , Educação/legislação & jurisprudência , Espanha
10.
Acad Med ; 93(3): 357-359, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28953565

RESUMO

Through a series of six recent conferences, the Josiah Macy Jr. Foundation wanted to try to change the discussion about graduate medical education (GME) reform to one that is about the innovations needed to better prepare residents for the changing world of practice they will be entering and for meeting the needs of the patient population they will serve. These conferences featured some of the encouraging innovations in GME that are occurring at local and regional levels. An ongoing theme from many of these reforms is the empowerment of residents. The author examines what it would mean for health care systems, residency programs, and residents themselves to pursue empowerment for this significant portion of the health care workforce. Residents should be seen as a valuable component of the health care workforce with the ability to contribute to institutional and societal goals. The author highlights examples of existing programs that use residents in this way, but to accomplish this more broadly will require culture change and greater flexibility on the part of GME and institutional leadership.


Assuntos
Assistência à Saúde/normas , Educação de Pós-Graduação em Medicina/tendências , Internato e Residência/tendências , Educação de Pós-Graduação em Medicina/legislação & jurisprudência , Reforma dos Serviços de Saúde , Mão de Obra em Saúde/tendências , Humanos , Internato e Residência/legislação & jurisprudência , Medicina/estatística & dados numéricos , Especialização/tendências
11.
Artigo em Alemão | MEDLINE | ID: mdl-29260267

RESUMO

BACKGROUND: Undergraduate medical education in Germany takes place in the medical faculties of universities, whereas postgraduate medical education takes place in nearly all hospitals under the aegis of medical associations. Both phases of the medical qualification process live on their own; the communication between the two responsible bodies is negligible. Previous reforms have always tackled undergraduate education only, whereas postgraduate education takes place without public attention. OBJECTIVE: This position paper discusses the origins and consequences of the complete separation between undergraduate and postgraduate medical education in Germany with regard to responsible bodies, learning objectives, and didactical concepts. On the basis of this critical analysis, proposals are presented to narrow the gap between the two phases. MATERIALS AND METHODS: This paper is based on several sources: data from historical documents, information retrieved from the internet on educational concepts in other OECD countries as well as intensive discussions among the authors. RESULTS AND DISCUSSION: The dissociation between under- and postgraduate education has historical reasons. Over a longer period of time the German Federal States reduced their responsibility for postgraduate education in favor of medical associations. The authors propose steps towards a better integration of both sequences, towards seeing the educational process as a continuum. In such a concept, medical associations would have a greater influence on undergraduate education and - vice versa - medical faculties on the postgraduate phase.


Assuntos
Competência Clínica/normas , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Graduação em Medicina/organização & administração , Competência Clínica/legislação & jurisprudência , Currículo/normas , Currículo/tendências , Educação de Pós-Graduação em Medicina/legislação & jurisprudência , Educação de Pós-Graduação em Medicina/tendências , Educação de Graduação em Medicina/legislação & jurisprudência , Educação de Graduação em Medicina/tendências , Alemanha , Humanos , Comunicação Interdisciplinar , Internato e Residência/legislação & jurisprudência , Internato e Residência/organização & administração , Internato e Residência/tendências , Colaboração Intersetorial , Corpo Clínico Hospitalar/legislação & jurisprudência , Corpo Clínico Hospitalar/organização & administração , Corpo Clínico Hospitalar/tendências , Modelos Educacionais , Faculdades de Medicina/legislação & jurisprudência , Faculdades de Medicina/organização & administração , Faculdades de Medicina/tendências
12.
Am J Kidney Dis ; 72(1): 113-117, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29221624

RESUMO

International medical graduates (IMGs) have become an increasingly essential part of many residency and fellowship programs in the United States. IMGs, who may be of either US or non-US citizenship, contribute significantly to the physician workforce across this country, particularly in underserved areas, as well as in their home countries on their return after training. Approximately 65% of nephrology fellows are IMGs, with most of these being non-US citizens. Non-US IMG applications for nephrology fellowship have been declining, exacerbating an ongoing shortage of nephrology trainees. IMGs face visa status restrictions and immigration policy concerns, limitations on federally funded research support, and difficulty finding desirable jobs in both private practices and academia after fellowship. We review training, examination, and licensure requirements, as well as visa status rules for IMGs. We also discuss the potential negative impact of recent immigration policies limiting the entry of non-US IMGs on the medical community in general and in nephrology in particular.


Assuntos
Internacionalidade , Internato e Residência/legislação & jurisprudência , Licenciamento em Medicina/legislação & jurisprudência , Nefrologia/legislação & jurisprudência , Médicos/legislação & jurisprudência , Humanos , Internato e Residência/normas , Internato e Residência/tendências , Licenciamento em Medicina/normas , Licenciamento em Medicina/tendências , Nefrologia/normas , Nefrologia/tendências , Médicos/normas , Médicos/tendências , Fatores de Risco
13.
J Am Board Fam Med ; 30(6): 838-842, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29180562

RESUMO

BACKGROUND: Due to the Accreditation Council for Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) single-accreditation model, the specialty of family medicine may see as many as 150 programs and 500 trainees in AOA-accredited programs seek ACGME accreditation. This analysis serves to better understand the composition of physicians completing family medicine residency training and their subsequent certification by the American Board of Family Medicine. METHODS: We identified residents who completed an ACGME-accredited or dual-accredited family medicine residency program between 2006 and 2016 and cross-tabulated the data by graduation year and by educational background (US Medical Graduate-MD [USMG-MD], USMG-DO, or International Medical Graduate-MD [IMG-MD]) to examine the cohort composition trend over time. RESULTS: The number and proportion of osteopaths completing family medicine residency training continues to rise concurrent with a decline in the number and proportion of IMGs. Take Rates for USMG-MDs and USMG-IMGs seem stable; however, the Take Rate for the USMG-DOs has generally been rising since 2011. CONCLUSIONS: There is a clear change in the composition of graduating trainees entering the family medicine workforce. As the transition to a single accreditation system for graduate medical education progresses, further shifts in the composition of this workforce should be expected.


Assuntos
Acreditação/legislação & jurisprudência , Educação de Pós-Graduação em Medicina/legislação & jurisprudência , Medicina de Família e Comunidade/educação , Medicina Osteopática/educação , Médicos de Família/educação , Acreditação/tendências , Educação de Pós-Graduação em Medicina/métodos , Educação de Pós-Graduação em Medicina/tendências , Humanos , Internato e Residência/legislação & jurisprudência , Internato e Residência/tendências , Medicina Osteopática/legislação & jurisprudência , Medicina Osteopática/tendências , Médicos de Família/legislação & jurisprudência , Médicos de Família/tendências , Sociedades Médicas/legislação & jurisprudência , Estados Unidos
15.
J Am Board Fam Med ; 30(5): 570-571, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28923808

RESUMO

In response to growing concern about the declining performance on the American Board of Family Medicine Certification Examination, several strategies were employed to assist program directors with preparing their residents to take the examination. The effect of these efforts seems to have resulted in significant improvement in performance.


Assuntos
Competência Clínica , Avaliação Educacional , Medicina de Família e Comunidade/educação , Licenciamento , Médicos de Família/educação , Desempenho Acadêmico/estatística & dados numéricos , Acreditação/legislação & jurisprudência , Humanos , Internato e Residência/legislação & jurisprudência , Internato e Residência/estatística & dados numéricos , Conselhos de Especialidade Profissional/legislação & jurisprudência , Estados Unidos
18.
Acad Radiol ; 24(6): 717-720, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28526512

RESUMO

RATIONALE AND OBJECTIVES: Academic radiologists commonly hold multiple simultaneous roles within the landscape of physician training. This paper analyzes theoretical scenarios describing relationships between medical students, residents, and physician educators in radiology. MATERIALS AND METHODS: The scenarios presented involve medical student supervision, radiology resident recruitment, and resident termination with respect to relevant ethical, regulatory, and legal considerations. Legal precedents and the medical social contract are addressed. RESULTS: The Family Educational Rights and Privacy Act defines a framework for the privacy practices of medical schools, but it does not confer individual rights. Resident physicians rarely win wrongful termination lawsuits. Physician educators are ethically bound to act in the best interest of society. CONCLUSIONS: Courts have ruled that medicine is intended to be a self-regulatory profession. Such a power requires that physicians remain accountable to the public while providing a fair learning environment for medical trainees.


Assuntos
Emprego/legislação & jurisprudência , Internato e Residência/legislação & jurisprudência , Privacidade/legislação & jurisprudência , Radiologia/educação , Estudantes de Medicina/legislação & jurisprudência , Competência Clínica , Disciplina no Trabalho/legislação & jurisprudência , Humanos , Estados Unidos
20.
Am Surg ; 83(2): 119-126, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28228197

RESUMO

Residents have the rights and responsibilities of both students and employees. Dismissal of a resident from a training program is traumatic and has lasting repercussions for the program director, the faculty, the dismissed resident, and the residency. A review of English language literature was performed using PUBMED and OVID databases, using the search terms, resident dismissal, resident termination, student dismissal, student and resident evaluation, legal aspects of education, and remediation. The references of each publication were also reviewed to identify additional appropriate citations. If the Just Cause threshold has been met, educators have the absolute discretion to evaluate academic and clinical performance. Legal opinion has stated that it is not necessary to wait until a patient is harmed to dismiss a resident. Evaluations should be standard and robust. Negative evaluations are not defamatory as the resident gave consent to be evaluated. Provided departmental and institutional polices have been followed, a resident can be dismissed without a formal hearing. Residencies are entitled to modify academic requirements and dismissal is not considered a breach of contract. Although there is anxiety regarding resident dismissal, the courts have uniformly supported faculty having this role. When indicated, failure to dismiss a resident also places the program director and the faculty at risk for educational malpractice.


Assuntos
Competência Clínica , Disciplina no Trabalho/legislação & jurisprudência , Avaliação de Desempenho Profissional/legislação & jurisprudência , Emprego/legislação & jurisprudência , Internato e Residência/legislação & jurisprudência , Pessoal Administrativo , Direitos Civis/legislação & jurisprudência , Avaliação Educacional/métodos , Avaliação Educacional/normas , Emprego/normas , Pesar , Humanos , Internato e Residência/normas , Imperícia/legislação & jurisprudência , Profissionalismo , Estados Unidos
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