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3.
J Grad Med Educ ; 11(3): 307-312, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31210862

RESUMO

Background: State medical licensing boards ask program directors (PDs) to complete verification of training (VOT) forms for licensure. While residency programs use Accreditation Council for Graduate Medical Education core competencies, there is no uniform process or set of metrics that licensing boards use to ascertain if academic competency was achieved. Objective: We determined the performance metrics PDs are required to disclose on state licensing VOT forms. Methods: VOT forms for allopathic medical licensing boards for all 50 states, Washington, DC, and 5 US territories were obtained via online search and reviewed. Questions were categorized by disciplinary action (investigated, disciplined, placed on probation, expelled, terminated); documents placed on file; resident actions (leave of absence, request for transfer, unexcused absences); and non-disciplinary actions (remediation, partial or no credit, non-renewal, non-promotion, extra training required). Three individuals reviewed all forms independently, compared results, and jointly resolved discrepancies. A fourth independent reviewer confirmed all results. Results: Most states and territories (45 of 56) accept the Federation Credentials Verification Service (FCVS), but 33 states have their own VOT forms. Ten states require FCVS use. Most states ask questions regarding probation (43), disciplinary action (41), and investigation (37). Thirty-four states and territories ask about documents placed on file, 36 ask about resident actions, and 7 ask about non-disciplinary actions. Eight states' VOT forms ask no questions regarding resident performance. Conclusions: Among the states and territories, there is great variability in VOT forms required for allopathic physicians. These forms focus on disciplinary actions and do not ask questions PDs use to assess resident performance.


Assuntos
Revelação , Internato e Residência/normas , Licenciamento em Medicina/legislação & jurisprudência , Disciplina no Trabalho , Humanos , Competência Profissional , Má Conduta Profissional , Estados Unidos
7.
Am J Bioeth ; 19(1): 16-34, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30676904

RESUMO

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.


Assuntos
Análise Ética , Ética Médica , Prescrição Inadequada/estatística & dados numéricos , Licenciamento em Medicina/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Médicos/legislação & jurisprudência , Má Conduta Profissional/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Disciplina no Trabalho , Humanos , Prescrição Inadequada/ética , Prescrição Inadequada/legislação & jurisprudência , Licenciamento em Medicina/ética , Licenciamento em Medicina/estatística & dados numéricos , Imperícia/legislação & jurisprudência , Médicos/ética , Má Conduta Profissional/ética , Má Conduta Profissional/legislação & jurisprudência , Delitos Sexuais/ética , Delitos Sexuais/legislação & jurisprudência , Estados Unidos
8.
J Am Acad Psychiatry Law ; 46(4): 458-471, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30593476

RESUMO

Substantial numbers of medical students and physicians live with some form of mental illness. Over the years, many medical licensure boards have asked physician medical licensure applicants with Doctor of Medicine (MD) degrees intrusive questions about whether they have any psychiatric history. This has discouraged many who need psychiatric treatment from seeking it because of fear of the questions. Gradually, court decisions and the United States Department of Justice have established that such questions violate the Americans with Disabilities Act (ADA). The 2014 Louisiana Supreme Court Settlement Agreement set definite limits on law licensure mental health questions, followed by a least one licensing body revising its physician licensure questions to be consistent with ADA standards. In this article we examine the current medical licensure questions from each state and the District of Columbia about the mental health of applicants and discuss their validity under ADA standards. Our original investigation of these questions found that the majority still ask questions that are unlikely to meet ADA standards. The judicial and Department of Justice developments, however, may compel them to abandon these questions. If not, legal action will enforce ADA compliance. This change will significantly benefit applicants who need psychiatric treatment.


Assuntos
Pessoas com Deficiência/legislação & jurisprudência , Licenciamento em Medicina/legislação & jurisprudência , Pessoas Mentalmente Doentes/legislação & jurisprudência , Médicos/legislação & jurisprudência , Humanos , Inabilitação do Médico/legislação & jurisprudência , Estigma Social , Estados Unidos
11.
Med Law Rev ; 26(2): 202-224, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29669017

RESUMO

This article critically considers the question of whether an increase in legal recognition of patient autonomy culminating in the decision of the Supreme Court in Montgomery v Lanarkshire Health Board in 2015 has led to the death of deference to doctors, not only within the courts and healthcare regulatory arenas in England and Wales but also in the consulting room and the health care system more broadly. We argue that deference has not been eradicated, but that the types of deference paid to doctors and to the medical profession have changed. In addition, whilst traditionally deference was extended towards the medical profession, increasing instances of deference being shown to other parties in the healthcare setting can be identified, allowing wider debate or recognition of the complexity of understandings, interests and aims of all those involved. Finally, we note instances in which deference to the medical profession has become more hidden.


Assuntos
Consentimento Livre e Esclarecido/legislação & jurisprudência , Responsabilidade Legal , Autonomia Pessoal , Relações Médico-Paciente , Humanos , Licenciamento em Medicina/legislação & jurisprudência , Formulação de Políticas , Reino Unido
12.
Z Orthop Unfall ; 156(4): 393-398, 2018 08.
Artigo em Alemão | MEDLINE | ID: mdl-29523015

RESUMO

BACKGROUND: The national competence-based catalogue of learning-goals in surgery (NKLC) defines competence levels for each of its 230 goals, including "competence level in 1: factual knowledge" up to "competence level 3: independent action". Aside from the cumulative examinations influencing the learning behaviour of students, those teaching targets do not affect the second state examination. This study analyses the extent to which the questions of the German second medical licensing examination compiled by the IMPP (central German institute for medical and pharmaceutical examinations) are congruent with the trauma-surgical and orthopaedic learning goals in the NKLC, in which this thematic focus is emphasised. MATERIAL AND METHODS: Exam questions from autumn 2009 to autumn 2014 (n = 11) were retrospectively analysed. Orthopaedic and trauma-surgical teaching targets defined in NKLC were identified by five senior orthopaedic physicians and trauma surgery experts. All questions addressing one of these learning goals were identified and analysed (re: the number of learning goals, the number of questions addressing a trauma-surgical, or orthopaedic goal, as well as different competency levels). RESULTS: We found 113 learning goals of NKLC (49.1% of the overall NKLC learning goals) identified as orthopaedic or trauma surgery subjects. During the study period, 543 questions included teaching targets referring to orthopaedic or trauma surgery subjects (15.6% of the total of 3480 questions). Per exam, a mean of 49.36 ± 14.1 questions (minimum 30; maximum 80) was identified that addressed a learning goal referring to these issues. For each exam, 13.45 ± 6.39 (minimum 6; maximum 24) questions referred to learning goals of competence level 3a and b, 21.45 ± 9.94 (minimum 9; maximum 39) questions referred to learning goals of competence level 2, and 14.45 ± 6.36 (minimum 6; maximum 25) questions referred to learning goals of competence level 1. Most questions addressed the topic: "disorders of the rheumatic spectrum" (n = 16 questions in autumn 2009). CONCLUSION: Questions focusing on orthopaedic and trauma surgery appeared sufficiently often during the second state examination. There is a thematic imbalance, and important clinical learning goals tagged with high competence levels were not addressed in a satisfactory manner. This indicates that a clear adjustment between the state examination and NKLC is necessary.


Assuntos
Competência Clínica/legislação & jurisprudência , Educação Médica Continuada/legislação & jurisprudência , Avaliação Educacional/normas , Licenciamento em Medicina/legislação & jurisprudência , Procedimentos Ortopédicos/educação , Ortopedia/educação , Traumatologia/educação , Currículo/normas , Alemanha , Humanos , Objetivos Organizacionais , Estudos Retrospectivos
13.
Prehosp Emerg Care ; 22(5): 650-654, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29485328

RESUMO

OBJECTIVE: Previous research conducted in November 2013 found there were a limited number of states and territories in the United States (US) that authorize emergency medical technicians (EMTs) and emergency medical responders (EMRs) to administer opioid antagonists. Given the continued increase in the number of opioid-related overdoses and deaths, many states have changed their policies to authorize EMTs and EMRs to administer opioid antagonists. The goal of this study is to provide an updated description of policy on EMS licensure levels' authority to administer opioid antagonists for all 50 US states, the District of Columbia (DC), and the Commonwealth of Puerto Rico (PR). METHODS: State law and scopes of practice were systematically reviewed using a multi-tiered approach to determine each state's legally-defined EMS licensure levels and their authority to administer an opioid antagonist. State law, state EMS websites, and state EMS scope of practice documents were identified and searched using Google Advanced Search with Boolean Search Strings. Initial results of the review were sent to each state office of EMS for review and comment. RESULTS: As of September 1, 2017, 49 states and DC authorize EMTs to administer an opioid antagonist. Among the 40 US jurisdictions (39 states and DC) that define the EMR or a comparable first responder licensure level in state law, 37 states and DC authorize their EMRs to administer an opioid antagonist. Paramedics are authorized to administer opioid antagonists in all 50 states, DC, and PR. All 49 of the US jurisdictions (48 states and DC) that define the advanced emergency medical technician (AEMT) or a comparable intermediate EMS licensure level in state law authorize their AEMTs to administer an opioid antagonist. CONCLUSIONS: 49 out of 52 US jurisdictions (50 states, DC, and PR) authorize all existing levels of EMS licensure levels to administer an opioid antagonist. Expanding access to this medication can save lives, especially in communities that have limited advanced life support coverage.


Assuntos
Serviços Médicos de Emergência/legislação & jurisprudência , Auxiliares de Emergência/legislação & jurisprudência , Licenciamento em Medicina/legislação & jurisprudência , Antagonistas de Entorpecentes/administração & dosagem , Overdose de Drogas/tratamento farmacológico , Política de Saúde , Humanos , Estados Unidos
16.
Artigo em Alemão | MEDLINE | ID: mdl-29256182

RESUMO

Medical science is constantly evolving. Teaching and training must keep pace with these innovations and react in a flexible fashion to new requirements. Model medical education programs, which are governed by the provisions of Sect. 41 of the Regulations for the Licensing of Medical Practitioners (ÄAppO), permit the piloting of innovative teaching programs, which support the continuous development of medical training through incorporation into the standard curricula. This paper reports on the model study programs at the University Medical Centre Hamburg-Eppendorf (iMED) and Charité - University Medicine Berlin (MSM). It describes the reform objectives, the curricula and selected projects accompanying both models and concludes by exploring the significance of various training concepts for the development of medical education.


Assuntos
Educação Médica/organização & administração , Modelos Educacionais , Berlim , Pesquisa Biomédica/legislação & jurisprudência , Pesquisa Biomédica/tendências , Currículo/tendências , Educação Médica/legislação & jurisprudência , Educação Médica/tendências , Educação Médica Continuada/legislação & jurisprudência , Educação Médica Continuada/organização & administração , Educação Médica Continuada/tendências , Educação de Pós-Graduação em Medicina/legislação & jurisprudência , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Pós-Graduação em Medicina/tendências , Previsões , Alemanha , Licenciamento em Medicina/legislação & jurisprudência , Licenciamento em Medicina/tendências
17.
Artigo em Alemão | MEDLINE | ID: mdl-29209759

RESUMO

Through the years, a range of privately funded medical training opportunities has been established in Germany. Only a few of them operate along the German Medical Licensure Act and thus underlie quality assurance regulations in Germany. Most of the courses are a result of German hospitals cooperating with universities from other EU countries. The content of the courses and the examinations underlie the regulations of the university's home country. This article aims to give an overview of the private medical training opportunities offered in Germany and to show differences compared to state funded German medical schools. The authors discuss the opportunities of private medical training as well as its challenges and risks. Basic principles concerning finances and quality assurance of national and international private medical training are provided. Regardless of their mode of financing, the superior goal of the training, according to the German Medical Licensure Act, should always be to enable young doctors to pursue further professional training, so that they can maintain the best possible quality in patient care, research, and medical education.


Assuntos
Competência Clínica/legislação & jurisprudência , Educação Médica/legislação & jurisprudência , Licenciamento em Medicina/legislação & jurisprudência , Setor Privado/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Competência Clínica/normas , Currículo/normas , Educação Médica/normas , Educação Médica Continuada/legislação & jurisprudência , Educação Médica Continuada/normas , Educação de Pós-Graduação em Medicina/legislação & jurisprudência , Educação de Pós-Graduação em Medicina/normas , Alemanha , Humanos , Licenciamento em Medicina/normas , Setor Privado/normas , Setor Público/legislação & jurisprudência , Setor Público/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Faculdades de Medicina/legislação & jurisprudência , Faculdades de Medicina/normas
18.
Artigo em Alemão | MEDLINE | ID: mdl-29230515

RESUMO

In Germany, future physicians have to pass a national licensing examination at the end of their medical studies. Passing this examination is the requirement for the license to practice medicine. The Masterplan Medizinstudium 2020 with its 41 measures aims to shift the paradigm in medical education and medical licensing examinations.The main goals of the Masterplan include the development towards competency-based and practical medical education and examination as well as the strengthening of general medicine. The healthcare policy takes into account social developments, which are very important for the medical education and licensing examination.Seven measures of the Masterplan relate to the realignment of the licensing examinations. Their function to drive learning should better support students in achieving the study goal defined in the German Medical Licensure Act: to educate a medical doctor scientifically and practically who is qualified for autonomous and independent professional practice, postgraduate education and continuous training.


Assuntos
Competência Clínica/legislação & jurisprudência , Educação Baseada em Competências/legislação & jurisprudência , Educação Médica/legislação & jurisprudência , Licenciamento em Medicina/legislação & jurisprudência , Competência Clínica/normas , Educação Baseada em Competências/normas , Educação Baseada em Competências/tendências , Currículo/normas , Currículo/tendências , Educação Médica/normas , Educação Médica/tendências , Educação Médica Continuada/legislação & jurisprudência , Educação Médica Continuada/normas , Educação Médica Continuada/tendências , Educação de Pós-Graduação em Medicina/legislação & jurisprudência , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/tendências , Previsões , Alemanha , Objetivos , Humanos , Licenciamento em Medicina/tendências
19.
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
20.
Zentralbl Chir ; 142(6): 614-621, 2017 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-29237221

RESUMO

Background The working party of the German Society for Surgery (DGCH) on undergraduate surgical education has developed a national expertise-based catalogue of learning goals in surgery (NKLC). This study analyses the extent to which the questions of the German second medical licensing examination compiled by the IMPP are congruent with the NKLC and which thematic focus is emphasised. Materials and Methods Firstly, a guideline and evaluation sheet were developed in order to achieve documentation of the individual examination questions of the second licensing examination with respect to the learning goals of the NKLC. In a retrospective analysis from autumn 2009 to autumn 2014, eleven licensing examinations in human medicine were screened independently by three different reviewers. In accordance with the guideline, the surgical questions were identified and subsequently matched to the learning goals of the NKLC. The analysis included the number of surgical learning goals as well as the number of surgical questions for each examination, learning goal, and different levels of expertise (LE). Results Thirteen reviewers from six surgical disciplines participated in the analysis. On average, reviewers agreed on the differentiation between surgical and non-surgical questions in 79.1% of all 3480 questions from 11 licensing examinations. For each examination (n = 320 questions), 98.8 ± 22.6 questions (min.: 69, max.: 150) were rated as surgical. For each surgical learning goal addressed, 2.2 ± 0.3 questions (min.: 1, max.: 16) were asked. For each examination, 23.5 ± 6.3 questions (min.: 11; max.: 31) referred to learning goals of LE 3, 52.5 ± 16.7 questions (min.: 34; max.: 94) addressed learning goals of LE 2 and 22.8 ± 7.7 questions (min.: 9; max.: 34) were related to learning goals of LE 1. 64 learning goals (27.8% of all learning goals of the NKLC) were not reflected in the examinations. With a total of 70 questions, the most frequently examined surgical topic was "disorders of the rheumatic spectrum". Conclusion The number of surgical examination questions in the German second medical licensing examination seems to be sufficient. However, the questions seem to be unevenly distributed between different surgical areas of undergraduate education. In order to achieve a more homogenous representation of relevant surgical topics, improved alignment is needed between the state examination with existing catalogues of learning goals by the IMPP.


Assuntos
Competência Clínica/legislação & jurisprudência , Educação Médica/legislação & jurisprudência , Cirurgia Geral/educação , Objetivos , Licenciamento em Medicina/legislação & jurisprudência , Currículo , Cirurgia Geral/legislação & jurisprudência , Alemanha , Humanos
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