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1.
J Grad Med Educ ; 13(5): 691-698, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34721799

RESUMO

Background: Team-based learning (TBL) is an alternative to traditional lectures in graduate medical education, but evidence is scarce regarding its impact on knowledge acquisition and standardized testing performance. Objective: We examined the association between resident performance on the Internal Medicine In-Training Examination (IM-ITE) and these 2 educational methods. Methods: In 2013, the internal medicine residency program at Albany Medical College transitioned from a lecture-based curriculum to TBL. Residents enrolled in academic years 2011-2012 and 2012-2013 comprised the lecture cohort, and those enrolled in 2015-2016 and 2016-2017 the TBL cohort. Covariates included the type of medical school attended, gender, and United States Medical Licensing Examination Step 2 Clinical Knowledge scores. We performed univariate analysis and multivariable regression to determine the association between covariates and ITE scores. Results: Of 120 residents, 60 were in the lecture cohort and 60 in the TBL cohort. The IM-ITE percent correct scores were higher with TBL than lecture (PGY-1 61.0% vs 55.0%, P < .001; PGY-2 69.0% vs 59.7%, P < .001; PGY-3 73.2% vs 61.7%, P < .001). In a multivariable regression analysis of 3 PGYs combined, the transition from lecture to TBL resulted in an increase in IM-ITE Z-score of 0.415 (P < .001), equivalent to 0.415 SD, when including the effects of all covariates. Conclusions: Compared to a lecture-based curriculum, TBL was associated with improved resident medical knowledge acquisition as evidenced by higher IM-ITE scores.


Assuntos
Internato e Residência , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina , Avaliação Educacional , Humanos , Medicina Interna/educação , Estados Unidos
2.
JAAPA ; 34(12): 49-53, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34813534

RESUMO

BACKGROUND: Hospitalist physicians are performing fewer procedures because of multiple reasons, including expanded responsibilities beyond their patient panel. A procedure service that offloads hospitalists could expedite these necessary services. An opportunity exists for physician assistants (PAs) and NPs to fill this gap. OBJECTIVE: To describe the implementation of a PA- and NP-run procedure service at a large academic hospital. METHODS: This is a retrospective cohort study of procedures by the procedure service at one institution from 2015 to 2019. RESULTS: Over 5 years, 7,002 procedures were performed, with requests increasing over time. The most frequent procedures were venous access, lumbar puncture, paracentesis, and placement of nasogastric or nasojejunal tubes. Requesting services included hospitalists and residents from internal medicine, surgery, and neurology. CONCLUSIONS: A PA- and NP-run procedure service is well accepted at a large academic hospital despite the lack of involvement by attending physicians. Future directions are focused on augmenting coverage and procedures offered.


Assuntos
Médicos Hospitalares , Assistentes Médicos , Humanos , Medicina Interna , Corpo Clínico Hospitalar , Estudos Retrospectivos
3.
Intern Med J ; 51(11): 1940-1945, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34796627

RESUMO

The COVID-19 pandemic has increased anxiety in society and particularly in healthcare workers, as shown with a questionnaire in our centre at the beginning of the pandemic. In this collaborative study, we aimed to evaluate the effects of the pandemic on anxiety 1 year later by applying the same questionnaire to the physicians working in the same department. A total of 77 participants consented to the study. The median age was 28 (interquartile range = 4) years and 55.8% were male. As in the first survey, female gender, having family members over 65 years of age, and having family members with chronic diseases were significantly associated with high anxiety scores and levels. There were no statistically significant differences between the first and second survey participants in any of the anxiety scales, which means anxiety persists.


Assuntos
COVID-19 , Médicos , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Pré-Escolar , Estudos Transversais , Depressão , Feminino , Humanos , Medicina Interna , Masculino , Pandemias , SARS-CoV-2
5.
Rev Med Suisse ; 17(760): 2022-2026, 2021 Nov 24.
Artigo em Francês | MEDLINE | ID: mdl-34817939

RESUMO

Albumin has multiple physiological functions such as maintenance of oncotic pressure, binding of plasmatic molecule, immunomodulation and endothelial stabilization. Considering potential negative effects of hypoalbuminemia, the question of albumin substitution arises. For cirrhotic patients, indications for substitution are well established with a scientific consensus for spontaneous bacterial peritonitis, paracentesis-induced circulatory dysfunction and hepatorenal syndrome. However, in the case of hepatic encephalopathy or of hypoalbuminemia in non-cirrhotic patients, the scientific consensus is absent, and the results of clinical studies differ. In this article, we present the different indications of albumin substitution by examining the most recent studies.


Assuntos
Síndrome Hepatorrenal , Peritonite , Albuminas , Ascite , Humanos , Medicina Interna , Cirrose Hepática , Paracentese
6.
Rev Med Suisse ; 17(760): 2038-2041, 2021 Nov 24.
Artigo em Francês | MEDLINE | ID: mdl-34817942

RESUMO

Medical informatics played a decisive role in the management of the health crisis linked to COVID-19, in particular for the support of hospital clinical, governance and communication activities. In this article, we present the experience of CHUV's Internal Medicine Service in these three areas, and analyse some critical points of our information system revealed by the crisis. The development, implementation, and maintenance of new IT tools during the crisis is a challenge. The involvement of medical informatics in the decision-making processes of hospitals and the training of healthcare professionals in this field are essential to strengthen the efficiency of information technologies and the innovation of our healthcare systems.


Assuntos
COVID-19 , Informática Médica , Atenção à Saúde , Humanos , Medicina Interna , SARS-CoV-2
7.
Rev Med Suisse ; 17(760): 2042-2048, 2021 Nov 24.
Artigo em Francês | MEDLINE | ID: mdl-34817943

RESUMO

Efficient management of hospitalized patients requires carefully planning each stay by taking into account patients' pathologies and hospital constraints. Therefore, the ability to accurately estimate length of stays allows for better interprofessional tasks coordination, improved patient flow management, and anticipated discharge preparation. This article presents how we built and evaluated a predictive model of length of stay based on clinical data available upon admission to a division of internal medicine. We show that Machine Learning-based approaches can predict lengths of stay with a similar level of accuracy as field experts.


Assuntos
Inteligência Artificial , Hospitalização , Humanos , Medicina Interna , Tempo de Internação , Alta do Paciente
8.
Rev Med Suisse ; 17(760): 2049-2054, 2021 Nov 24.
Artigo em Francês | MEDLINE | ID: mdl-34817944

RESUMO

Nosocomial COVID-19 infections are a challenge for hospitals. In order to assess possible demographic, personal, environmental or medical care related risk factors, data of nosocomial cases occurring in the Service of internal medicine at CHUV between February and March 2021 were retrospectively analyzed. Neither personal nor medical care related factors were identified as risk factor for a nosocomial infection. However, a significant number of patients with hospital-acquired COVID infection stayed in a 5-bed ward (versus 1-2 beds) and shared toilets in these rooms. Patient distancing measures and weekly screening led to a subsequent significant reduction of nosocomial SARS-CoV-2 infections.


Assuntos
COVID-19 , Infecção Hospitalar , Infecção Hospitalar/epidemiologia , Humanos , Medicina Interna , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
10.
Rev Med Suisse ; 17(756): 1814-1818, 2021 Oct 27.
Artigo em Francês | MEDLINE | ID: mdl-34704676

RESUMO

POCUS is a valuable tool for the internist. Its field of application in internal medicine is multisystemic and requires rigorous training. This training includes an initiation phase, followed by a practical training phase for the acquisition of images from patients or simulators. Supervision by experts is vital for mastering the necessary skills for the safe use of POCUS. Although, supervisors are available in French speaking Switzerland, there are too few to meet training needs. Several associations provide training courses to obtain POCUS certification, the content of which has been established since 2018 in Switzerland. In order to maintain a high level of proficiency and to identify tomorrow's supervisors, it is essential to provide the necessary means to allow more internists to obtain POCUS certification.


Assuntos
Internato e Residência , Sistemas Automatizados de Assistência Junto ao Leito , Currículo , Humanos , Medicina Interna/educação , Ultrassonografia
11.
Rev Med Suisse ; 17(756): 1819-1823, 2021 Oct 27.
Artigo em Francês | MEDLINE | ID: mdl-34704677

RESUMO

Point-of-Care Ultrasonography (POCUS) is an emerging important diagnostic tool in internal medicine wards. The concept is to focus on specific or binary questions to rule in disease and has a proven additional benefit for procedural guidance in terms of patients' safety. Its advantages lie in its rapid and non-invasive use at the patient's bedside. It does not replace the traditional diagnostic procedures or specialists' investigations. Since medical decisions can be guided by ultrasounds results, it's important to remember that the diagnostic performance is largely operator dependent. Implementation of POCUS in internal medicine wards is still challenging regarding the small number of ultrasound experts to provide education programs and the lack of well-established learning objectives and training programs.


Assuntos
Medicina Interna , Sistemas Automatizados de Assistência Junto ao Leito , Humanos , Ultrassonografia
12.
Rev Med Suisse ; 17(756): 1826-1829, 2021 Oct 27.
Artigo em Francês | MEDLINE | ID: mdl-34704678

RESUMO

This article has been brought to you by clinicians in general internal medicine passionate about ultrasound, using it for many years daily and having long been committed to training in abdominal ultrasound. The term POCUS, Point-Of-Care Ultrasound or targeted ultrasonography, has appeared in recent years, quickly establishing itself as an essential tool in certain specialties, such as emergency medicine. Since 2018, the Swiss Institute for Medical postgraduate and continues Education (ISFM) delegates training and accreditation of POCUS in various specialties to the Swiss Society of Ultrasound in Medicine (SSUM). However, we did not wait for the term POCUS to use it, our daily medical life leading us to regularly use this tool in a very targeted manner, depending on the requirements of our patients.


Assuntos
Medicina de Emergência , Clínicos Gerais , Humanos , Medicina Interna , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia
16.
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
17.
J Cardiovasc Med (Hagerstown) ; 22(11): 840-847, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34482327

RESUMO

BACKGROUND AND AIMS: The spreading speed of the COVID-19 pandemic forced the medical community to produce efforts in updating and sharing the evidence about this new disease, trying to preserve the accuracy of the data but at the same time avoiding the potentially harmful delay from discovery to implementation. The aim of our analysis was to assess the impact of the COVID-19 pandemic on medical literature in terms of proportion of COVID-19-related published papers and temporal patterns of publications within a sample of general/internal medicine and cardiology journals. METHODS: We searched through PubMed scientific papers published from 1 January 2020 to 31 January 2021 about COVID-19 in ten major medical journals, of which five were in general/internal medicine and five in the cardiology field. We analyzed the proportion of COVID-19-related papers, and we examined temporal trends in the number of published papers. RESULTS: Overall, the proportion of COVID-19-related papers was 18.5% (1986/10 756). This proportion was higher among the five selected general/internal medicine journals, compared with cardiology journals (23.8% vs 9.5%). The vast majority of papers were not original articles; in particular, in cardiology journals, there were 28% 'original articles', 17% 'review articles' and 55.1% 'miscellaneous', compared with 20.2%, 5.1% and 74.7% in general/internal medicine journals, respectively. CONCLUSIONS: Our analysis highlights the big impact of the COVID-19 pandemic on international scientific literature. General and internal medicine journals were mainly involved, with cardiology journals only at a later time.


Assuntos
COVID-19 , Disseminação de Informação/métodos , Editoração , COVID-19/epidemiologia , COVID-19/prevenção & controle , Cardiologia/métodos , Humanos , Medicina Interna/métodos , Publicações Periódicas como Assunto , Editoração/organização & administração , Editoração/tendências , SARS-CoV-2
19.
Med Educ Online ; 26(1): 1981198, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34569433

RESUMO

The purpose of this scoping review is to update the recent progress of EPAs research in GME, focusing on the topical concern of EPAs effectiveness, and to provide a reference for medical researchers in countries/regions interested in introducing EPAs. Guided by Arksey and O'Malley's framework regarding scoping reviews, the researchers, in January 2021, conducted a search in five databases to ensure the comprehensiveness of the literature. After the predetermined process, 29 articles in total were included in this study. The most common areas for the implementation and evaluation of EPAs were Surgery (n = 7,24.1%), Pediatric (n = 5,17.2%) and Internal medicine (n = 4,13.8%), a result that shows a relatively large change in the research trend of EPAs in the last two years. Prior to 2018, EPAs research focused on internal medicine, psychiatry, family medicine, and primary care. The articles in the category of EPAs implementation and evaluation had four main themes: (1) validation of EPAs (n = 16,55.2%); (2) describing the experience of implementing EPAs (n = 11,37.9%); (3) examining the factors and barriers that influence the implementation and evaluation of EPAs (n = 6,20.6%); and (4) researching the experiences of faculty, interns, and other relevant personnel in using EPAs. Training programs were the most common EPAs implementation setting (n = 26,89.6%); direct observation and evaluation (n = 12,41.4%), and evaluation by scoring reports (n = 5,17.2%) were the two most common means of assessing physicians' EPA levels; 19 papers (65.5%) used faculty evaluation, and nine of these papers also used self-assessment (31.0%); the most frequently used tools in the evaluation of EPAs were mainly researcher-made instruments (n = 37.9%), assessment form (n = 7,24.1%), and mobile application (n = 6,20.7%). Although EPAs occupy an increasingly important place in international medical education, this study concludes that the implementation and diffusion of EPAs on a larger scale is still difficult.


Assuntos
Educação Baseada em Competências , Internato e Residência , Criança , Competência Clínica , Educação de Pós-Graduação em Medicina , Humanos , Medicina Interna/educação
20.
Pol Arch Intern Med ; 131(9): 848-853, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34590450

RESUMO

Meta-research has highlighted that up to half of all clinical studies may be redundant and do not add any value. We suggest that such unnecessary studies will continue to be prepared and published unless researchers systematically and transparently identify and consider the existing evidence. This approach of identifying and utilizing the existing knowledge base before and after conducting a new trial is called Evidence­Based Research (EBR), defined as the use of prior research in a systematic and transparent way to inform a new study so that it is answering questions that matter in a valid, efficient, and accessible manner. This paper describes the issues that have led to the development of the EBR approach, suggests what researchers should do to avoid wasteful and unnecessary research, and outlines the benefits of conducting evidence­based research. Finally, we present the international EBR Network established to support the efforts to minimize waste in research and increase the value of clinical studies.


Assuntos
Medicina Interna , Projetos de Pesquisa , Humanos
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