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1.
Rev Med Chil ; 149(4): 598-601, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-34479348

RESUMO

Alejandro Goic, M.D., son of Croatian immigrants, graduated as M.D. in 1955, studying at the Catholic University of Chile Medical School. After a residency in internal medicine, he followed post graduate studies in psychosomatic medicine at the University of Oklahoma and in gastroenterology at Harvard University. Upon his return to Chile he had a brilliant career as clinician and medical educator, becoming a leader and advisor in medical education, clinical ethics and public health. Elected Dean of the University of Chile School of Medicine (1986-1994), he promoted important changes in undergraduate studies as well as in Magister and PhD programs in Biomedical Sciences. During the difficult years of the military government intervention in Chilean universities, he was one of the leaders of critical opposition. In parallel he was chief editor of Revista Médica de Chile (1976-1996), improving the editorial process according to the recommendations of ICMJE and WAME. In 1989 he was elected member of the Chilean Academy of Medicine and became its President (2000-2010). He was awarded honors and membership in prominent national and foreign institutions. In 2006 he received the National Prize in Medicine, the highest medical distinction in Chile. His wise thinking and enthusiasm gave origin to several books that have become classics in Medicine and Medical Education, permeating our institutions.


Assuntos
Distinções e Prêmios , Educação Médica , Chile , História do Século XX , Humanos , Medicina Interna , Faculdades de Medicina , Universidades
2.
BMC Med Educ ; 21(1): 485, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34503500

RESUMO

BACKGROUND: The transfer of training to the workplace is the aim of training interventions. Three primary factors influence transfer: trainee characteristics, training design and work environment influences. Within medical education, the work environment factors influencing transfer of training remain underexplored. Burke and Hutchins' review of training transfer outlined five work environment influences: opportunity to perform, supervisor/peer support, strategic link, transfer climate and accountability. This study aimed to explore the ways in which work environment factors influence the transfer of training for medical trainees. METHODS: Internal Medicine Training in Scotland includes a three-day boot camp involving simulation-based mastery learning of procedural skills, immersive simulation scenarios and communication workshops. Following ethical approval, trainees were invited to take part in interviews at least three months after following their boot camp. Interviews were semi-structured, anonymised, transcribed verbatim and analysed using template analysis. Member checking interviews were performed to verify findings. RESULTS: A total of 26 trainees took part in interviews between January 2020 and January 2021. Trainees reported a lack of opportunities to perform procedures in the workplace and challenges relating to the transfer climate, including a lack of appropriate equipment and resistance to change in the workplace. Trainees described a strong sense of personal responsibility to transfer and they felt empowered to change practice in response to the challenges faced. CONCLUSIONS: This study highlights barriers to transfer of training within the clinical workplace including procedural opportunities, a transfer climate with challenging equipment availability and, at times, an unsupportive workplace culture. Trainees are driven by their own sense of personal responsibility; medical educators and healthcare leaders must harness this enthusiasm and take heed of the barriers to assist in the development of strategies to overcome them.


Assuntos
Medicina Interna , Transferência de Experiência , Competência Clínica , Educação de Pós-Graduação em Medicina , Humanos , Local de Trabalho
3.
Ann Palliat Med ; 10(7): 8203-8214, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34353104

RESUMO

BACKGROUND: Procalcitonin (PCT) plays an important role in the identification of bacterial infection and therapy guidance. The relevant literature is mainly classified under critical care medicine or infectious disease. The research status of PCT in general internal medicine (GIM) is currently unclear. This research aimed to analyze PCT-related literature in the GIM field and provide references for future research. METHODS: A subject search strategy was used for the term PCT, with the search scope limited to Medicine, General & Internal. We conducted a search of relevant literature in the Science Citation Index Expanded (SCIE) database in the Web of Science Core Collection (WOSCC), with no publication date limit (1900 to May 16, 2021, the date of the final search for this study). The search results were analyzed using CiteSpace software to assess the status of PCT research in the GIM field based on annual paper publication numbers, the number of citations, country distribution, institution distribution, author distribution, journal distribution, and keyword usage. RESULTS: A total of 905 document records were retrieved. Articles were mainly from Europe, the United States, and China, and the number of citations totaled 15,917. There were 5 research institutions that published more than 10 related papers and 3 authors who published more than 10 papers. There was little cooperation between authors from different countries and institutions. This field should focus on leading journals in critical care medicine and quality comprehensive journals. Keyword analysis showed that the current research focus is the standardized application of PCT. CONCLUSIONS: There are few targeted studies on the application of PCT in GIM, and the relevant important literature mainly comes from other journals. GIM-specific research should be increased in the future.


Assuntos
Bibliometria , Pró-Calcitonina , China , Cuidados Críticos , Humanos , Medicina Interna , Estados Unidos
7.
MedEdPORTAL ; 17: 11178, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34423125

RESUMO

Introduction: Preoperative assessment is a core competency for internal medicine residents, but one with limited educational resources available presently. Ideally, residencies would provide an introduction to this topic prior to their residents performing preoperative assessments in clinic or during internal medicine consultation rotations. Methods: We developed a 120-minute case-based teaching session on preoperative assessment for PGY 2 residents where they reviewed a series of cases, applied preoperative risk calculators, and made recommendations on medication management using the same online tools they employ while working clinically. Interspersed lecture sections reviewed guiding principles, detailed key trials, and explored nuances of the topic. We performed pre- and posttests of knowledge and also obtained learner feedback. Results: Thirty-three out of 40 participants completed the pre- and posttests. The session was rated highly (M = 4.0 out of 5) and was viewed as preferable to a lecture-based approach (M = 4.4 out of 5); mean participant knowledge improved from 11.7 to 17.5 (p < .001) out of 22 points possible. The most consistently offered feedback was to give more time for the session than the 120 minutes allotted. Discussion: A teaching session mixing lecture with review of composite cases and application of preoperative assessment tools with immediate feedback improved knowledge and was viewed as enjoyable and preferable to lecture alone by participants. We recommend providing more time for the teaching by increasing the session length from 120 minutes to 140 minutes.


Assuntos
Medicina Interna , Internato e Residência , Retroalimentação , Humanos , Medicina Interna/educação
8.
Ther Umsch ; 78(7): 395-401, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34427106

RESUMO

"Smarter Medicine" in ambulatory general internal medicine, at present and in future Abstract. Overuse and inappropriate care resulting in potential harm and unwarranted waste of healthcare resources were leading to the international "Choosing Wisely" campaign (CWC) almost a decade ago. In Switzerland, the movement started 2014 / 15 under the label "Smarter Medicine", with a top-5 list of interventions better to avoid in ambulatory general internal medicine (GIM). Yet from the beginning of the international CWC campaign, its effectiveness has been questioned, and we don't know if the "Smarter Medicine" top-5 list for ambulatory GIM efficiently is reducing overuse and inappropriate care, as there is almost no evaluation data available. The prerequisites for an efficient reduction of overuse and inappropriate care are a. the scientific evidence for the recommendations, b. the recommendations coming from a trusted source, c. reliable data for the evaluation, d. the active role of patients, the public, professional healthcare societies and politicians. Another key factor for a successful implementation is the involvement of the final users at an early stage of recommendation development. Keeping this in mind, we recently developed new suggestions for interventions better to avoid, in collaboration with 538 general practitioners. These suggestions lead to a next top-5 list for the ambulatory GIM.


Assuntos
Medicina Geral , Clínicos Gerais , Atenção à Saúde , Humanos , Medicina Interna , Suíça
10.
Harefuah ; 160(8): 486-487, 2021 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-34396720

RESUMO

BACKGROUND: We welcome the readers of Harefuah to the following issue that deals with the research and clinical practice that was carried out in this challenging year of the COVID-19 pandemic. Despite the high hospitalization rates throughout the country in these times, our clinicians found the spirit to continue and conduct their research activities. The following issue presents the essence of the good clinical practice along with interesting research outcomes.


Assuntos
COVID-19 , Pandemias , Hospitalização , Humanos , Medicina Interna , SARS-CoV-2
11.
Harefuah ; 160(8): 493-496, 2021 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-34396722

RESUMO

INTRODUCTION: The clerkship of internal medicine is pursued in the 2nd semester of the 4th year at the Technion Medical School. Following the COVID-19 outbreak, frontal and bedside teaching was interrupted. Therefore, we decided to provide distant teaching until having the opportunity to resume clinical bedside teaching. A team of tutors composed a course of weekly units, each week assigned to a different subject in internal medicine. A total of 120 students were divided into 15 groups of 8 students, each group guided by a personal tutor. The format of each unit included online pretest, clinical virtual cases and two separate 2 hour ZOOM sessions with the tutor. The pretest was based on 1-3 chapters from Harrison's Internal Medicine textbook, 20th edition, and consisted of both clinical reasoning and knowledge questions. During ZOOM sessions with the tutor, the students practiced clinical problem solving. In addition, all the students were granted free access to the commercial "Aquifer" case-based virtual course for more practice. The students' feedback at the end of the learning period revealed that, although frustrated in being away from the clinics, the overall level of satisfaction from the course was good (rated 5 or 4/5 by 65% of responders) and the time was used efficiently. In conclusion, the students received a positive proactive learning experience of both theoretical aspects and clinical reasoning skills in internal medicine. There is no doubt that bedside teaching in medicine is invaluable and can't be replaced by any other means, however, given the circumstances, our format provided a reasonable temporary alternative.


Assuntos
COVID-19 , Educação de Graduação em Medicina , Estudantes de Medicina , Surtos de Doenças , Docentes de Medicina , Humanos , Medicina Interna , SARS-CoV-2 , Ensino
12.
Harefuah ; 160(8): 541-544, 2021 08.
Artigo em Hebraico | MEDLINE | ID: mdl-34396732

RESUMO

INTRODUCTION: In recent years, the status of Internal Medicine has been constantly wearing down. There has been a dramatic decrease in the number of internal medicine students and residents planning to pursue careers in internal medicine. This is mainly due to a higher workload, as well as physical and professional exhaustion leading to work dissatisfaction and provision of suboptimal patient care. Therefore, an increased tendency towards selecting a career in internal medicine sub-specialties has been noted. In this paper, we will present an open and sincere talk with three young internal medicine specialists, who willingly decided to keep working in internal medicine departments despite the challenging work environment. We will discuss the burnout associated with poor work-life/home balance and disruptive work environment and suggest measurements that may enhance the educational and professional experience and career satisfaction and increase the well-being of internal medicine specialists in the future. We aim to promote awareness to the importance of maintaining high-quality senior physicians working in Internal Medicine departments.


Assuntos
Esgotamento Profissional , Médicos , Humanos , Medicina Interna , Satisfação no Emprego , Inquéritos e Questionários , Carga de Trabalho
13.
J Grad Med Educ ; 13(4): 548-552, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34434515

RESUMO

Background: The cost and stress of applying to residency programs are increasing. Planning for interviews with limited lead time can cause additional burden to residency applicants. Objective: We sought to determine if the specialty of orthopaedics was affording the same lead time between interview invitation and interview dates as its surgical and medical counterparts. Methods: Dates for the first interview invitation and last possible interview were gathered for each program in orthopaedic surgery, general surgery, otolaryngology, vascular surgery, plastic surgery, neurological surgery, internal medicine, psychiatry, pediatrics, and family medicine. Interview lead time was calculated for each specialty. Mann-Whitney U and independent sample Kruskal-Wallis tests were used for nonparametric data with P < .05 considered as significant. Results: Orthopaedic surgery lead time is significantly different when compared individually and pairwise to other specialties (P < .05 for all comparisons), with a median lead time of 57 days. The next lowest lead time specialty is otolaryngology with a 70-day lead time. The specialty with the longest is pediatrics (median 106 days). Conclusions: Residency programs (orthopaedic surgery in particular) vary widely in the amount of lead time given to schedule and attend interviews. The authors propose that interview invitations be extended into mid-October.


Assuntos
Internato e Residência , Ortopedia , Otolaringologia , Criança , Humanos , Medicina Interna , Ortopedia/educação , Otolaringologia/educação , Fatores de Tempo
14.
Jt Comm J Qual Patient Saf ; 47(8): 481-488, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34330410

RESUMO

BACKGROUND: Professional organizations emphasize the need to train health care professionals in quality improvement (QI). Many reports of QI education programs involve small numbers of participants. Little is known about QI education programs on a larger scale and whether participants subsequently engage in QI activities. METHODS: The Northwestern Medicine Academy for Quality and Safety Improvement (NM AQSI) was developed to prepare individuals across the Northwestern health system to lead QI. The 7-month program consists of classwork and team-based project work. Participant knowledge was assessed using a multiple-choice test and adapted Quality Improvement Knowledge Application Tool (QIKAT). The study team surveyed participants 18 months after AQSI completion to assess their activity in QI. Project status was assessed at AQSI completion and at 18 months. RESULTS: Over 8 years, 80 teams consisting of 441 individuals participated, representing a range of specialties, settings, and professions. Participants had higher multiple-choice test (70.7 ± 14.0 vs. 78.1 ± 13.0; p < 0.001) and adapted QIKAT scores (56.1 ± 15.9 vs. 60.8 ± 15.8; p < 0.001) after AQSI. The majority of participants at 18 months (180/243; 74.1%) had engaged in subsequent QI efforts; many (105/243; 43.2%) had led other QI projects, and (103/243; 42.4%) provided QI mentorship to others. The majority of teams (53/80; 66.3%) improved project measure performance. CONCLUSION: NM AQSI is a team-based QI training program that shows measurable improvements in care and a high degree of participants' subsequent involvement in QI. Other health systems may use a similar approach to successfully train health care professionals to lead QI.


Assuntos
Internato e Residência , Melhoria de Qualidade , Competência Clínica , Currículo , Humanos , Medicina Interna/educação
15.
Adv Clin Exp Med ; 30(8): 805-811, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34286517

RESUMO

BACKGROUND: The initial approval of the Pfizer/BioNTech and Moderna vaccines by the European Medicines Agency (EMA) and Food and Drug Administration (FDA) marked a milestone in the fight against the COVID-19 pandemic. The increased public debate about the vaccine development process and vaccine side effects has activated the anti-vaccine community, which has begun to spread conspiracy theories about vaccine safety. OBJECTIVES: Our study is the first to investigate the awareness of Polish patients suffering from various chronic diseases, mainly cancer, about vaccination against SARS-CoV-2. MATERIAL AND METHODS: An anonymous survey was made available from November 2020 to February 2021 to representatives of patient organizations through social media (Facebook) and to patients in the Chemotherapy Department of the Clinical Hospital in Poznan. The survey was completed by 836 patients. The majority of the survey respondents had cancer (77%, n = 644), and almost 1/5 of the respondents indicated hypertension (15.7%, n = 131) as well as depression and/or anxiety disorders (11.1%, n = 93). RESULTS: Less than half of the respondents (43.5%, n = 364) believed that SARS-CoV-2 vaccines were safe (40.4%, n = 260, among cancer patients; 53.9%, n = 104, among patients with other medical conditions). More than half of the respondents (60.5%, n = 506) intended to be vaccinated against SARS-CoV-2 (58.8%, n = 378, among cancer patients; 66.3%, n = 128, among patients with other medical conditions). Fear of vaccine complications and lack of belief in vaccine effectiveness were prevalent among both cancer patients and patients with other medical conditions. CONCLUSIONS: The vast majority of cancer and medical patients wanted to be vaccinated against COVID-19. More than half of the respondents did not believe that the COVID-19 vaccine would be safe for them. Education of cancer and medical patients on the safety and effectiveness of the vaccine, as well as the use of additional protective measures against infection, is an extremely important element of prevention during the COVID-19 pandemic.


Assuntos
COVID-19 , Neoplasias , Vacinas contra COVID-19 , Humanos , Medicina Interna , Pandemias , Polônia , SARS-CoV-2 , Vacinação
17.
BMJ Open ; 11(6): e053506, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193507

RESUMO

OBJECTIVES: This study aimed to explore how the COVID-19 pandemic has impacted the workplace core needs of internal medicine (IM) trainees in Scotland. DESIGN: This qualitative study used an observational approach of interprofessional workshops combined with subsequent individual interviews with IM trainees. Workshops and interviews were audiorecorded, transcribed verbatim and analysed utilising NVivo software. Template analysis was used with the Autonomy/control, Belonging and Competence (ABC) of doctors' core needs outlined in the 2019 General Medical Council report Caring for doctors, caring for patients as a conceptual lens for the study. SETTING: The national IM boot camp in Scotland includes a 2-hour interprofessional workshop which is trainee led and explores current challenges in the workplace, including the impact of the pandemic on such relationships. PARTICIPANTS: Twelve workshops, involving 72 trainees, were included with ten trainees taking part in the subsequent interview process. Trainees representing all four regions in Scotland were involved. RESULTS: Trainees described all core needs having been impacted by the pandemic. They described a loss of autonomy with emergency rotas but also through a pervasive sense of uncertainty. The data revealed that work conditions improved initially with additional resources which have since been removed in some areas, affecting trainees' sense of value. Analysis found that belonging was affected positively in terms of increased camaraderie but also challenged through inability to socialise. There were concerns regarding developing competence due to a lack of teaching opportunities. CONCLUSIONS: Using the ABC of doctor's core needs as a conceptual framework for this study highlighted the impact of the COVID-19 pandemic on all domains for IM trainees in Scotland. It has highlighted an opportunity to foster the renewed sense of camaraderie among healthcare teams, while rebuilding work conditions to support autonomy and competence.


Assuntos
COVID-19 , Pandemias , Competência Clínica , Educação de Pós-Graduação em Medicina , Humanos , Medicina Interna , SARS-CoV-2 , Escócia/epidemiologia , Local de Trabalho
20.
BMC Med Educ ; 21(1): 411, 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34330260

RESUMO

BACKGROUND: If the education of intensive care unit (ICU) residents focuses on individual learning behavior, the faculty's style of teaching and level of supervision need to be adapted accordingly. The aim of this study was to delineate the associations between residents' perceived learning behavior, experience, and demographics and their expectations with regard to teaching style and supervision levels. METHODS: This multicenter survey obtained data on ICU residents' base specialty, duration of ICU training, individual postgraduate year, gender, and number of repetitions of ICU skills. Using 4-point Likert scales, residents assessed perceived learning behavior, expected teaching style, and supervision level for respective skills. Multivariate regression analysis was used to evaluate associations between assessed variables. RESULTS: Among 109 residents of four interdisciplinary ICUs, 63 (58%) participated in the survey and 95% (60/63) questionnaires were completed. The residents' perceived learning behavior was associated with number of skill repetitions (p < 0.0001), internal medicine as base specialty (p = 0.02), and skill type (p < 0.0001). Their expected teaching style was associated with learning behavior (p < 0.0001) and skill type (p < 0.0001). Their expected supervision level was associated with skill repetitions (p < 0.0001) and skill type (p < 0.0001). CONCLUSION: For effective learner-centered education, it appears useful to recognize how the residents' learning behavior is affected by the number of skill repetitions and the skill type. Hence, faculty may wish to take into account the residents' learning behavior, driven mainly by skill complexity and the number of skill repetitions, to deliver the appropriate teaching style and supervision level.


Assuntos
Internato e Residência , Motivação , Competência Clínica , Humanos , Unidades de Terapia Intensiva , Medicina Interna , Ensino
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