Do the public think medical regulation keep them safe?

OBJECTIVE: To assess public knowledge and expectations of the ways to assess doctors' competence to ensure patient safety. DESIGN SETTING AND PARTICIPANTS: Telephone survey of a random sample of 1000 non-institutionalized Hong Kong residents. MEASURES AND RESULTS: Only 5% of public were correct that doctors are not required to periodically be assessed, and 9% were correct that the doctors are not required to update knowledge and skills for renewing their license. These results echo international studies showing a low public knowledge of medical regulation. The public overwhelmingly felt a periodic assessment (92%) and requirements for continuous medical education (91%) were important processes for assuring doctors' competence. A high proportion of the public felt that lay representation in the Medical Council was insufficient. CONCLUSION: There is a significant gap between public expectations and understanding of the existing medical regulation and the actual policies and practices. Despite a lack of public knowledge, the public thought it important to have an ongoing structured monitoring and assessment mechanism to assure doctors' competence. The public also expects a greater involvement in the regulatory processes as members of the Medical Council. There is a need to review and enhance the current regulatory system to meet public expectation and ensure accountability for the privilege and trust granted by the State in professional self-regulation. In the context of our complex health system, a thorough understanding on the dynamic interactions between different institutions and their complementary roles in a meta-regulatory framework is required in assuring patient safety.

[Model study programs in medicine : Innovations in medical education in Hamburg and Berlin]. / Modellstudiengänge in der Medizin : Lehrinnovationen am Beispiel der Studiengänge in Hamburg und Berlin.

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.

[Private medical education in Germany]. / Medizinische Studienangebote privater Träger in Deutschland.

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.

[Competence-based assessment in the national licensing examination in Germany]. / Kompetenzorientiert prüfen im Staatsexamen Medizin.

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.

[Current SHI physician legislation: succession rules for surgical seats : Surgical vacancies can be filled with orthopedic/trauma surgery specialists only within narrow limits]. / Aktuelles Vertragsarztrecht: Nachfolge bei Chirurgensitzen : Nachbesetzung einer chirurgischen Zulassung durch Fachärzte für Orthopädie/Unfallchirurgie nur in engen Grenzen.

It is a physician's certified continuing medical education category-rather than their actual medical activity, in this case in the field of trauma surgery-that is decisive in filling statutory health insurance (SHI) practice vacancies. This evaluation arising from §16 of the requirement planning guideline applies accordingly when filling physician vacancies. Thus physician vacancies or statutory health insurance (SHI) practice places can only be filled by a physician in the same physician group in line with requirement planning. Scope for argumentation initially remains in the context of filling surgical SHI physician vacancies where the ceding physician is certified as an accident insurance consultant.

[[New in the Development of Medical Education in Russia: Continuity and Specialists' Accreditation].]

The authors provide information about the factors affecting the quality of medical care, recent changes in the regulatory framework in medical education and its development in Russia compared with developed countries. For healthcare leaders are described the risks for the implementation of these changes in public health practice, are given recommendations for leveling the risks and further improve the quality of medical care in the Russian Federation.

[Approval procedures for clinical trials in the field of radiation oncology]. / Genehmigungsverfahren klinischer Studien im Bereich der Radioonkologie.

BACKGROUND AND PURPOSE: Application of ionizing radiation for the purpose of medical research in Germany needs to be approved by the national authority for radiation protection (Bundesamt für Strahlenschutz, BfS). For studies in the field of radiation oncology, differentiation between use of radiation for "medical care (Heilkunde)" versus "medical research" frequently leads to contradictions. The aim of this article is to provide principle investigators, individuals, and institutions involved in the process, as well as institutional review or ethics committees, with the necessary information for this assessment. Information on the legal frame and the approval procedures are also provided. METHODS: A workshop was co-organized by the German Society for Radiation Oncology (DEGRO), the Working Party for Radiation Oncology (ARO) of the German Cancer Society (DKG), the German Society for Medical Physics (DGMP), and the German Cancer Consortium (DKTK) in October 2013. This paper summarizes the results of the workshop and the follow-up discussions between the organizers and the BfS. RESULTS: Differentiating between "Heilkunde" which does not need to be approved by the BfS and "medical research" is whether the specific application of radiation (beam quality, dose, schedule, target volume, etc.) is a clinically established and recognized procedure. This must be answered by the qualified physician(s) ("fachkundiger Arzt" according to German radiation protection law) in charge of the study and the treatments of the patients within the study, taking into consideration of the best available evidence from clinical studies, guidelines and consensus papers. Among the important parameters for assessment are indication, total dose, and fractionation. Radiation treatments applied outside clinical trials do not require approval by the BfS, even if they are applied within a randomized or nonrandomized clinical trial. The decision-making by the "fachkundigem Arzt" may be supported on request by an opinion given by the DEGRO Expert Committee for clinical trials. CONCLUSION: An important aim for promoting clinical research and patient care in radiation oncology is to further professionalize planning and implementation of clinical trials in this field. Correct assessment, at an early stage, whether a trial needs to be approved by the BfS may reduce unnecessary costs and reduce the time needed for the approval procedure for those trials which need to be assessed by the BfS.

[The network model is an effective form of training preventive medicine physicians (in case of medical parasitologists)].

Professional medical education is most cost-based when training highly skilled personnel. This is associated with expensive material and technical resources and a high labor-to-output ratio of practicing programs. The network model makes it possible to blaze new trails to achieve the quality of training the staff and the governmental support of its educational programs strengthens the coordination between higher educational establishments, research organizations, and professional learning communities. By using the training of medical parasitologists as an example, the paper shows a network model how to implement the educational program.

[THE FUNCTIONAL CONSTITUENT OF A BIOLOGICAL COMPONENT IN PROGRAMS FOR TRAINING SPECIALISTS IN THE AREA OF PARASITOLOGY FOR ACCREDITATION].

The paper considers the functional aspects of a biological component in programs for training specialists in the area of Parasitology for accreditation within the current enactments, including those on modernization of public health and additional professional education. The working program of the module "Fundamental Disciplines" has been used as an example to outline approaches to molding a medical parasitologist's capacity and readiness to solve professional tasks on the basis of knowledge of fundamental disciplines: biology, immunology, and medical geography. Education fundamentalization is shown to suggest more unsupervised work of a learner in the teaching process. The fundamental constituent of a biological component of the 'programs for training learners in the specialty of Parasitology for accreditation is shown in the interaction of all sections of this area with special and allied subjects.

[Clinical diagnosis progress and continuing medical education].

The paper discusses current approaches to diagnosing in an internal medicine clinic and to improving diagnostic tactics. It gives prospects for training physicians in current diagnostic approaches in the framework of the continuing medical education system.

Melanoma, version 2.2013: featured updates to the NCCN guidelines.

The NCCN Guidelines for Melanoma provide multidisciplinary recommendations on the clinical management of patients with melanoma. This NCCN Guidelines Insights report highlights notable recent updates. Foremost of these is the exciting addition of the novel agents ipilimumab and vemurafenib for treatment of advanced melanoma. The NCCN panel also included imatinib as a treatment for KIT-mutated tumors and pegylated interferon alfa-2b as an option for adjuvant therapy. Also important are revisions to the initial stratification of early-stage lesions based on the risk of sentinel lymph node metastases, and revised recommendations on the use of sentinel lymph node biopsy for low-risk groups. Finally, the NCCN panel reached clinical consensus on clarifying the role of imaging in the workup of patients with melanoma.

Quality indicators in the management of bladder cancer.

Bladder cancer is predominantly seen in elderly patients. With the aging United States population, the incidence and prevalence of bladder cancer are on the rise, heightening the relevance of this disease as a public health issue. Despite having one of the greatest average cancer treatment costs per patient, improvements in disease-specific survival have been subtle. Clinical guidelines based predominantly on expert opinion and randomized controlled studies offer some guidance, but adherence to these guidelines is lacking. Building awareness of quality indicators to optimize patient care represents an opportunity to improve bladder cancer outcomes. Although quality indicators exist for other disease states, widely accepted quality indicators for the management of bladder cancer have not yet been established. This article proposes an initial set of quality indicators for both non-muscle-invasive and muscle-invasive bladder cancer based on established clinical guidelines and the available literature.

[Current medicolegal and ethical issues in pathology]. / Aktuelle medizinrechtliche und -ethische Herausforderungen der Pathologie.

The increase in density of information available in relation to patients and research participants, in particular in the context of genetic diagnostics and analysis, results in an increased potential for uncovering details which were unexpected but are of particular significance for the patient. Deciding how this information is dealt with and who is entitled to receive this information, is a medicolegal and ethical balancing act. Incidental findings and the challenges posed by the advent of personalised medicine are but two areas which increasingly impact medical disciplines that do not conventionally work directly with patients. Both areas raise questions of what is legally required and morally necessary. The authors briefly sketch these two areas and the medicolegal and ethical implications for diagnostics and research in pathology.

Final priority--National Institute on Disability and Rehabilitation Research--Rehabilitation Research and Training Centers. Final priority.

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority for a Rehabilitation Research and Training Center (RRTC) on Promoting Healthy Aging for Individuals with Long-Term Physical Disabilities. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2013 and later years. We take this action to focus research attention on areas of national need. We intend this priority to improve health and function outcomes for individuals aging with long-term physical disabilities.

Final priority; National Institute on Disability and Rehabilitation Research--Rehabilitation Research and Training Centers. Final priority.

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority for a Rehabilitation Research and Training Center (RRTC) on Community Living Policy. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2013 and later years. We take this action to focus research attention on areas of national need. We intend this priority to improve outcomes among individuals with disabilities.

[Optimization of educational activity of departments of educational creativity in the Extension Course Institute for Medical Practitioners MUNKTs n. a. P.V.Mandryka].

Educational creativity is the key component of educational activity. The article is devoted to logical structure of educational creativity, difficulties and problems of formation and development of educational creativity in lecturers participating in educative process with participants of the Extension Course Institute for Medical Practitioners MUNKTs n. a. P.V. Mandryka. Heuristic activity and methods that are a huge part of educational creativity are emphasized. Specific features of heuristic activity are shown; classification of heuristic methods is presented. For the first time authors gave characteristic of qualitative levels of educational creativity.