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BMC Health Serv Res ; 22(1): 1161, 2022 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-36104727


BACKGROUND: Achieving equity in the distribution of health services is one major goal in the health system. This study aimed to determine equality in distributing health human resources (physicians) in the Qazvin University of Medical Sciences before and after the Health Transformation Plan (HTP) based on the Hirschman-Herfindahl index (HHI). METHODS: In this descriptive-analytical study, the statistical population was general practitioners (GPs), specialists and subspecialists in the Qazvin University of Medical Sciences from 2011-to 2017. We extracted demographic statistics of the cities from the Statistical Center of Iran. Physicians' statistics were obtained from the Curative Affairs Deputy at the Qazvin University of Medical Sciences. We assessed inequality using the HHI. RESULTS: The highest number of GPs was in 2014, and specialists and subspecialists were in 2017. The lowest number of GPs, specialists, and subspecialists were in 2016, 2011 and 2015. The HHI for GPs in 2011-2017 was between 4300 and 5200. The lowest concentration for specialists before the HTP plan was the cardiologist with 3300, and after the HTP, the internal specialist with 3900. Also, the numerical value of this index for all subspecialty physicians after the HTP was 10,000, the highest level of concentration. CONCLUSION: The values obtained from the HHI index indicate the high concentration and disproportionate and inequitable distribution of human resources in the health sector in this province. The number of specialists in some cities is still much less than acceptable, and some cities even have shortcomings in the critical specialists.

Clínicos Gerais , Mão de Obra em Saúde , Programas Governamentais , Humanos , Especialização , Recursos Humanos
Urologie ; 61(9): 996-1010, 2022 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-35943546


Alongside Paris, Vienna was one of the early centers of specialization and professionalization in medicine and urology in the 19th century. Especially the 2nd Vienna Medical School (Erna Lesky) with its main representatives Carl Freiherr von Rokitansky (in Czech: Karel Rokytanský; 1804-1878) and Joseph Ritter von Skoda (1895-1881) was able to create the perfect scientific environment for young students to become acquainted with new fields of research often in an interdisciplinary setting, e.g., chemistry, microscopy or pathology in combination with clinical departments like surgery. We analyze the process of habilitation using the example of a urologist to outline this process within the history of science.

Medicina , Urologia , História do Século XIX , Humanos , Faculdades de Medicina/história , Especialização , Urologistas , Urologia/história
JAMA Health Forum ; 3(1): e214634, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-35977236


Importance: Public and private payers continue to expand use of alternative payment models, aiming to use value-based payment to affect the care delivery of their contracted health system partners. In parallel, health systems and their employment of physicians continue to grow. However, the degree to which health system physician compensation reflects an orientation toward value, rather than volume, is unknown. Objective: To characterize primary care physician (PCP) and specialist compensation arrangements among US health system-affiliated physician organizations (POs) and measure the portion of total physician compensation based on quality and cost performance. Design Setting and Participants: This study was a cross-sectional mixed-methods analysis of in-depth multimodal data (compensation document review, interviews with 40 PO leaders, and surveys conducted between November 2017 and July 2019) from 31 POs affiliated with 22 purposefully selected health systems in 4 states. Data were analyzed from June 2019 to September 2020. Main Outcomes and Measures: The frequency of PCP and specialist compensation types and the percentage of compensation when included, including base compensation incentives, quality and cost performance incentives, and other financial incentives. The top 3 actions physicians could take to increase their compensation. The association between POs' percentage of revenue from fee-for-service and their physicians' volume-based compensation percentage. Results: Volume-based compensation was the most common base compensation incentive component for PCPs (26 POs [83.9%]; mean, 68.2% of compensation; median, 81.4%; range, 5.0%-100.0% when included) and specialists (29 POs [93.3%]; mean, 73.7% of compensation; median, 90.5%; range, 2.5%-100.0% when included). While quality and cost performance incentives were common (included by 83.9%-56.7% of POs for PCPs and specialists, respectively), the percentage of compensation based on quality and cost performance was modest (mean, 9.0% [median, 8.3%; range, 1.0%-25.0%] for PCPs and 5.3% [median, 4.5%; range, 0.5%-16.0%] for specialists when included). Increasing the volume of services was the most commonly cited action for physicians to increase compensation, reported as the top action by 22 POs (70.0%) for PCPs and specialists. We observed a very weak, nonsignificant association between the percentage of revenue of POs from fee for service and the PCP and specialist volume-based compensation percentage (r = 0.08; P = .78 and r = -0.04; P = .89, respectively). Conclusions and Relevance: The results of this cross-sectional study suggest that PCPs and specialists despite receiving value-based reimbursement incentives from payers, the compensation of health system PCPs and specialists was dominated by volume-based incentives designed to maximize health systems revenue.

Motivação , Médicos , Estudos Transversais , Planos de Pagamento por Serviço Prestado , Humanos , Especialização
J Am Coll Surg ; 235(3): 550-558, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35972178


BACKGROUND: The Early Specialization Program (ESP) in vascular surgery (VS) began as a "pilot program" in 2003. There is only one published report on ESP outcomes. STUDY DESIGN: The general surgery (GS) and VS programs of all institutions using the ESP were contacted. Data gathered included demographics of ESP enrollees, participants' case logs (CLs), and CLs of participants' residency graduating classmates. National CLs, program and institutional data, and participants' certification status were publicly available. RESULTS: Nine institutions have enrolled 34 participants. Four withdrew, and four are in the GS component. Of 26 who have completed ESP, residency CLs were available for 20. Participants' percentile rankings among national contemporaries were lower than 13th for surgeon-junior cases (SJCs), higher than 73rd for surgeon-chief cases (SCCs), and 49th for total major cases (TMCs). They were lower than the 40th percentile in all domains except operative trauma (52; SD 23.8) and vascular (84.7; SD 22.1). As a percentage of the mean (% mean) for their own graduating classes, participants performed 91.8% (SD 16.5) as many SJCs, 143.7% (SD 45.1) as many SCCs, and 105% (SD 11.4) as many TMCs. Participants performed more than 79 % mean in every domain, including 213.4% (SD 82.4) as many vascular cases. As fellows, they ranked higher than the 50th percentile nationally in all but two categories. Twenty-four of 26 certified in GS. GS certification has lapsed for 5, 17 remain initially certified, and 2 have re-certified. All have current VS certification. CONCLUSION: Although infrequently employed, ESP remains an effective option for those who seek both GS and VS certification.

Cirurgia Geral , Internato e Residência , Especialidades Cirúrgicas , Certificação , Competência Clínica , Educação de Pós-Graduação em Medicina , Cirurgia Geral/educação , Humanos , Especialização , Especialidades Cirúrgicas/educação , Procedimentos Cirúrgicos Vasculares/educação
Am Nat ; 200(3): 303-315, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35977788


AbstractSpecies interaction networks are subject to natural and anthropogenic disturbances that lead to their disassembly, while natural regeneration or restoration efforts facilitate their reassembly. Previous models for assembling ecological networks did not include stochasticity at the level of population dynamics (e.g., demographic noise, environmental noise) and focused mainly on food webs. Here, we present a model for the assembly of mutualistic bipartite networks, such as plant-pollinator networks, and examine the influence of demographic noise on the trajectory of species and strategy diversity, that is, the range of present strategies from specialism to generalism. We find that assembled communities show at intermediate assembly stages a maximum of species diversity and of average generalization. Our model thus provides a mechanism for nonlinear, hump-shaped diversity trajectories at intermediate succession, consistent with the intermediate disturbance hypothesis. Long-term coexistence of specialists and generalists emerges only in the presence of demographic noise and is due to a persistent species turnover. These findings highlight the importance of stochasticity for maintaining long-term diversity.

Especialização , Simbiose , Ecossistema , Cadeia Alimentar , Plantas , Dinâmica Populacional
Br J Hosp Med (Lond) ; 83(6): 1-5, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35787176


Microbiologists are frequently consulted for guidance on the investigation and management of infection, including antimicrobial prescribing in hospital settings. There is a rising demand for timely microbiology advice in the context of increasing global travel and antibiotic resistance, which give rise to complex cases. However, junior doctors are seldom trained in making effective referrals. Improving confidence in this key skill saves time for both the referring clinician and the specialist, and results in more accurate advice being given. This benefits patients who are more likely to receive appropriate treatment. This article presents guidance, developed in consultation with specialists, to improve the quality of referrals to microbiologists. This includes the information required for a high-quality referral, and signposts referring clinicians to existing resources which are suitable for simpler cases not requiring specialist input.

Anti-Infecciosos , Encaminhamento e Consulta , Antibacterianos/uso terapêutico , Humanos , Corpo Clínico Hospitalar , Especialização
Artigo em Inglês | MEDLINE | ID: mdl-35897376


This paper analyzes the Romanian biomedical engineering educational path and certification process in European and international contexts and emphasizes the existence of a deficient operationalization of this qualification and profession, arguing that the domestic shortcomings are both a consequence of an unquestioned process of adopting European and even international classification schemes, and of insufficiently developed national administrative capabilities to properly implement the aforementioned classification frameworks. The core part of the article investigates the current academic track of the biomedical engineering specialization and scrutinizes the classification of occupations at different jurisdictional levels. The conclusions of the study indicate that one of the possible solutions for improving this unsatisfying status quo comes from a better communication between the national and European levels, and by their pro-active involvement in the international attempts of reviewing and refining the existing frameworks. The article ends with several recommendations and policy proposals meant to strengthen the role of various profession-certifying European documents, as well as to alleviate the regulatory deficiencies that this specialization has at Romanian level, in order to maximize its potential in the labor market.

Certificação , Especialização , Ocupações , Romênia
Health Policy ; 126(9): 906-914, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35858954


The growing demand for referrals is a main policy concern in health systems. One approach involves the development of demand management tools in the form of clinical prioritization to regulate patient referrals from primary care to specialist care. For clinical prioritization to be effective, it is critical that general practitioners (GPs) assess patient priority in the same way as specialists. The progressive development of IT tools in clinical practice, in the form of electronic referrals support systems (e-RSS), can facilitate clinical prioritization. In this study, we tested if higher use of e-RSS or higher use of high-priority categories was associated with the degree of agreement and therefore consensus on clinical priority between GPs and specialists. We found that higher use by GPs of the e-RSS tool was positively associated with greater degree of priority agreement with specialists, while higher use of the high-priority categories was associated with lower degree of priority agreement with specialists. Furthermore, female GPs, GPs in association with others, and GPs using a specific electronic medical record showed higher agreement with specialists. Our study therefore supports the use of electronic referrals systems to improve clinical prioritization and manage the demand of specialist visits and diagnostic tests. It also shows that there is scope for reducing excessive use by GPs of high-priority categories.

Clínicos Gerais , Encaminhamento e Consulta , Consenso , Feminino , Humanos , Especialização
Transl Behav Med ; 12(8): 834-840, 2022 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-35866841


We trace the evolution of digital health industry careers for behavioral medicine specialists. We discuss the current misalignment of career opportunities in the private sector with the predominant graduate education training model that emphasizes the pursuit of academic positions. We describe the potential risks to the profession and public health if the field does not adapt professional training models to be inclusive of private sector industry roles. Finally, we offer a series of recommendations aimed at trainees, faculty advisors, and training programs to better prepare trainees for meaningful careers in industry.

This commentary focuses on the career paths available for behavioral medicine scientists in the private sector digital health industry. Although this field has exciting and impactful career options, graduate training models have been slow to adapt to prepare graduates for these opportunities. We describe many actionable steps that trainees, advisors, and graduate programs can take to help training programs to evolve to prepare graduate for more diverse career paths.

Medicina do Comportamento , Médicos , Escolha da Profissão , Educação de Pós-Graduação , Humanos , Especialização
Psychiatr Q ; 93(3): 883-890, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35841451


Peer telemental health recently became Medicaid reimbursable during the COVID-19 crisis, increasing the need for standardized training on digital peer support (DPS) services. DPS has the potential to reduce barriers to services and expand the reach of peer support specialists. The 4-h Digital Peer Support Training program was developed to train peer support specialists for rapid uptake in providing digital peer support during the COVID-19 crisis. The purpose of this study was to examine the impact of the 4-h DPS course for peer support specialists. Surveys were administered to examine pre-post changes in DPS course for participants (N = 75) related to attitudes/ beliefs towards DPS, ability to use/ engage in DPS, and organizational readiness to implement DPS. Data were analyzed by conducting paired samples t-tests. Linear mixed models were used to explore significant results further. Statistically significant (< .05) changes were observed related to readiness to use DPS, attitudes/ beliefs towards DPS, and ability to use/ engage in DPS. The 4-h DPS course may be beneficial in providing diverse groups of peer support specialists with a standardized training framework. Widespread dissemination of the DPS short course may be beneficial in rapidly equipping peer support specialists with the skills and resources needed to expand the reach of peer support services during the COVID-19 crisis and beyond.

Grupo Associado , Grupos de Autoajuda , COVID-19 , Humanos , Projetos Piloto , Especialização , Inquéritos e Questionários
Nursing (Säo Paulo) ; 25(290): 8195-8206, julho.2022.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1379921


Na saúde mental nos deparamos com desafios ao longo dos anos, avançamos com políticas públicas direcionadas ao atendimento dos pressupostos da Reforma Psiquiátrica Brasileira. Com a ampliação de redes substitutivas a psiquiatria, novas práticas foram produzidas, influenciando o processo de formação de enfermeiros desde a graduação quanto na pós-graduação. Objetivo: analisar estratégias de enfermeiros para a integração ensino-assistência junto à residentes multiprofissionais em Saúde Mental. Métodos: Estudo qualitativo, descritivo, com dez enfermeiros de uma instituição psiquiátrica universitária. Os dados foram coletados de fevereiro/17 a maio/17, por entrevista semiestruturada e submetidos à análise de conteúdo, na modalidade temática. Resultados: Identificamos como estratégias: interação interprofissional; trabalho em equipe; estímulo ao cuidado psicossocial. Conclusão: Os enfermeiros atuam como facilitadores do processo de ensino-aprendizagem independentemente de serem preceptores ou não, porquanto permanentemente atuam na assistência. Sugerimos a formalidade no preparo de enfermeiros-preceptores utilizadores de metodologias de ensino apropriadas para o campo da saúde mental.(AU)

In mental health we have faced challenges over the years, we have advanced with public policies aimed at meeting the assumptions of the Brazilian Psychiatric Reform. With the expansion of substitutive networks for psychiatry, new practices were produced, influencing the process of training nurses from undergraduate and graduate levels. Objective: to analyze nurses' strategies for teaching-care integration with multiprofessional residents in Mental Health. Methods: Qualitative, descriptive study with ten nurses from a university psychiatric institution. Data were collected from February/17 to May/17, through semi-structured interviews and submitted to content analysis, in the thematic mode. Results: We identified as strategies: interprofessional interaction; team work; stimulus to psychosocial care. Conclusion: Nurses act as facilitators of the teaching-learning process regardless of whether they are preceptors or not, as they permanently work in care. We suggest formality in the preparation of nurse-preceptors who use appropriate teaching methodologies for the field of mental health.(AU)

En salud mental hemos enfrentado desafíos a lo largo de los años, hemos avanzado con políticas públicas dirigidas a cumplir con los presupuestos de la Reforma Psiquiátrica Brasileña. Con la expansión de las redes sustitutivas de la psiquiatría, se produjeron nuevas prácticas que influyeron en el proceso de formación de enfermeros de pregrado y posgrado. Objetivo: analizar las estrategias de los enfermeros para la integración enseñanza-cuidado con residentes multiprofesionales en Salud Mental. Métodos: Estudio cualitativo, descriptivo con diez enfermeras de una institución psiquiátrica universitaria. Los datos fueron recolectados del 17/02 al 17/05, por medio de entrevista semiestructurada y sometidos a análisis de contenido, en la modalidad temática. Resultados: Identificamos como estrategias: interacción interprofesional; trabajo en equipo; estímulo a la atención psicosocial. Conclusión: Los enfermeros actúan como facilitadores del proceso de enseñanza-aprendizaje independientemente de que sean preceptores o no, ya que actúan permanentemente en el cuidado. Sugerimos formalidad en la preparación de enfermeros-preceptores que utilicen metodologías de enseñanza adecuadas al campo de la salud mental.(AU)

Especialização , Saúde Mental , Enfermagem , Psiquiatria
Metas enferm ; 25(6): 24-31, Jul-Ago, 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-206879


La gestión del procedimiento de la solicitud para la acreditación desde cualquiera de las especialidades vigentes en Ciencias de la Salud por el sistema de residencia es un proceso complejo. Por una parte, se necesita de un riguroso estudio de la especialidad solicitante para dar respuestas a las exigencias del itinerario formativo, y por otra parte es preciso conocer la documentación necesaria para la tramitación que se realiza a través del Formulario General de Acreditación de la página del Ministerio de Sanidad, Consumo y Bienestar Social. En este contexto se presenta la “Guía del Itinerario Formativo de la especialidad de Enfermería Geriátrica del Hospital Central de la Cruz Roja San José y Santa Adela” (Madrid, España) junto con las competencias de cada rotación, recientemente acreditada. Es un documento esencial de referencia no solo para las enfermeras internas residentes (EIR) y tutores, también para todos los que participan en su formación y resto de profesionales de la institución. Al no existir ninguna publicación en esta línea, puede resultar orientativo para futuras solicitudes en la acreditación.(AU)

Managing the application procedure for accreditation from any of the current specialties in Health Sciences through the residency system represents a complex process: on one hand, a thorough study of the specialty applying is required in order to address the demands of the training itinerary, and on the other hand, awareness of the documentation required for the process, which is conducted through the General Form of Accreditation available in the Ministry of Health, Consumer Affairs and Social Welfare website. In this context, the “Guidelines for the Training Itinerary for the Geriatric Nursing specialty of the Hospital Central de la Cruz Roja San José y Santa Adela” (Madrid, Spain) is hereby presented, alongside the competencies of each rotation, recently accredited. This is an essential document of reference, not only for the internal resident nurses (IRNs) and tutors, but also for all those involved in their training, and the rest of professionals in the institution. There is no current publication along this line, and therefore it can be used as a guidance for future applications for accreditation.(AU)

Humanos , Masculino , Feminino , Geriatria , Recursos em Saúde , Educação em Enfermagem , Enfermeiras Especialistas , Enfermagem Geriátrica/educação , Especialização , Especialidades de Enfermagem , Enfermagem
Wiad Lek ; 75(6): 1578-1582, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35907238


OBJECTIVE: The aim: Is scientific substantiation of introduction of innovative technologies in the process of training future specialists in physical therapy and ergo therapy (occupational therapy). PATIENTS AND METHODS: Materials and methods: We used following set of theoretical research methods: analysis and synthesis of scientific and scientific-methodical literature, which made it possible to identify existing contradictions, to formulate the specifics of the introduction of innovative technologies in the process of training of future specialists in physical therapy and occupational therapy and to find possible ways of its improvement. We also used generalization and systematization of research data, which allowed to form the theoretical and methodological basis of the study. We performed a synthesis of scientific theories, approaches and concepts to identify favorable conditions for the formation of future specialists in physical therapy and occupational therapy. Among empirical methods we used observations and surveys. CONCLUSION: Conclusions: Our research shows that the use of such interconnected innovative pedagogical technologies as: technologies of personal and professional development, technology of full acquisition of knowledge, information and communication technologies, exploratory research technologies and technologies of contextual education contributes to the effective implementation of the educational process of training specialists in physical therapy and occupational therapy in a medical school.

Modalidades de Fisioterapia , Comunicação , Humanos , Medicina , Especialização , Tecnologia
Fam Med ; 54(7): 536-541, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35833934


BACKGROUND AND OBJECTIVES: Medical schools should understand how to matriculate students who are more likely to enter primary care specialties and put admissions processes into place that achieve this result. However, there are no existing reviews that have systematically evaluated medical school admission practices and primary care specialty choice. METHODS: We conducted a narrative synthesis utilizing a systematic literature search to evaluate the effectiveness of medical school admission strategies designed to increase the percentage of graduates entering primary care specialties. RESULTS: We included 34 articles in the narrative review. Multiple prematriculation programs that appear to produce students with a high likelihood of entering primary care have been described in the literature. However, all of these studies are from single institutions, were observational, and limited by selection bias. Applicants who self-identify an interest in primary care, grew up with a rural background, and are older at matriculation are more likely to enter primary care, with stated interest in primary care being most predictive. Gender and race have been associated with primary care specialty choice in some studies, but not all. Insufficient literature on admissions policies and procedures exists to draw conclusions about best practices. CONCLUSIONS: Medical schools that want to increase the percentage of graduates entering primary care should consider developing a prematriculation program that attracts and prepares motivated and talented students with primary care interest. Admissions committees should understand which demographic criteria are associated with increased likelihood of entering primary care. The most important identifiable trait is an applicant's stated interest in primary care.

Escolha da Profissão , Estudantes de Medicina , Medicina de Família e Comunidade/educação , Humanos , Atenção Primária à Saúde , Faculdades de Medicina , Especialização