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Concept: Medical education

332

Surgical training has always been hard on residents. During my own residency more than 20 years ago, 100-hour workweeks and in-house call every other night were routine. A resident’s life outside the hospital was simply not a priority. Residency may be even harder on patients. A large body of research has linked sleep deprivation in resident physicians to poor performance in neurobehavioral testing and, more alarmingly, to higher rates of attention failure in patient care.(1),(2) Reacting to concerns about both resident well-being and patient safety, the Accreditation Council for Graduate Medical Education (ACGME) implemented duty-hour reforms in 2003 that . . .

Concepts: Medicine, Patient, Hospital, Sleep deprivation, Physician, Medical school, Hospital accreditation, Medical education

182

Physical activity (PA) is a key component of healthy lifestyle and disease prevention. In contrast, physical inactivity accounts for a significant proportion of premature deaths worldwide. Physicians are in a critical position to help patients develop healthy lifestyles by actively counseling on PA. Sports medicine physicians, with their focus on sports and exercise medicine are uniquely trained to provide such expertise to patients, learners and colleagues. To succeed, physicians need clinical tools and processes that support PA assessment and counseling. Linking patients to community resources, and specifically to health and fitness professionals is a key strategy. Efforts should be made to expand provider education during medical school, residency and fellowship training, and continuing medical education. Lastly, physically active physicians are more likely to counsel patients to be active. A key message for the sports medicine community is the importance of serving as a positive PA role model.

Concepts: Medicine, Obesity, Exercise, Physician, Weight loss, Pediatrics, Medical school, Medical education

43

Financial relationships between pharmaceutical manufacturers and health care professionals remain controversial. Some interactions, such as those involving research and exchange of expertise, promote the development and study of new drugs; by contrast, payments in the form of meals and continuing medical education (CME) programs have been criticized for being promotional and have been linked to non-evidence-based prescribing practices. The prevalence of these relationships has been estimated from national physician surveys, which found that, across seven specialties, about 83% of physicians received gifts from industry (excluding samples) in 2004. The prevalence has decreased slightly in recent years: a 2009 survey showed . . .

Concepts: Health care, Pharmacology, Medicine, Physician, Medical school, Residency, Medical education, Doctor of Medicine

35

Death certificates contain critical information for epidemiology, public health research, disease surveillance, and community health programs. In most teaching hospitals, resident physicians complete death certificates. The objective of this study was to examine the experiences and opinions of physician residents in New York City on the accuracy of the cause-of-death reporting system.

Concepts: Medicine, Public health, Epidemiology, Hospital, Demography, Physician, New York City, Medical education

28

BACKGROUND: Resident remediation is required for all residents who do not meet minimum standards in one or more of the Accreditation Council for Graduate Medical Education core competencies. The Council of Residency Directors in Emergency Medicine Remediation Taskforce identified the need for case-based examples of remediation efforts. OBJECTIVES: 1) To describe a complicated resident remediation case and employ consensus panel evaluation of the process. 2) To discuss the available assessment tools (including neuropsychologic/medical testing), due process, documentation, reassessment, and relevant barriers to implementation for this and other resident remediations. DISCUSSION: Details of a remediation case were altered to protect resident confidentiality, and then presented to a multidisciplinary group of program directors. The case details, action plan, and course were submitted and the remediation process, action plan, and course are assessed based on a standardized remediation approach. The resident entered remediation for poor organizational skills and an inability to make or follow through with patient care plans. Opportunities for improvement in the applied remediation process are identified and discussed. Legal concerns and utility of neuropsychological assessment of residents are reviewed. CONCLUSIONS: Remediation requires a complicated and detailed effort. This case demonstrates issues that program directors may face when working with residents and provides suggestions for use of specific remediation tools.

Concepts: Evaluation, Physician, Assessment, Educational psychology, Management, Medical school, Medical education, Resident

15

Abstract Twitter is a tool for physicians to increase engagement of learners and the public, share scientific information, crowdsource new ideas, conduct, discuss and challenge emerging research, pursue professional development and continuing medical education, expand networks around specialized topics and provide moral support to colleagues. However, new users or skeptics may well be wary of its potential pitfalls. The aims of this commentary are to discuss the potential advantages of the Twitter platform for dialogue among physicians, to explore the barriers to accurate and high-quality healthcare discourse and, finally, to recommend potential safeguards physicians may employ against these threats in order to participate productively.

Concepts: Scientific method, Medicine, Physician, Science, Profession, Medical school, Medical education, Twitter

8

Most economists seem to view graduate medical education (GME) - training graduates of medical schools to become independently practicing physicians - as a stand-alone effort, without considering its relationship to other activities of major teaching hospitals within academic medical centers (AMCs). Payments with a GME label are often examined in isolation, rather than as part of the complex economics of AMCs, whose missions include training physicians, conducting groundbreaking research, providing a full spectrum of clinical care, and improving community health. The literature offers a variety of models to explain the economic behavior of hospitals, particularly not-for-profits - to clarify, for . . .

Concepts: Health care, Medicine, Education, Physician, Medical school, Social sciences, School, Medical education

7

BACKGROUND: Transformation of medical students to become medical professionals is a core competency required for physicians in the 21st century. Role modeling was traditionally the key method of transmitting this skill. Medical schools are developing medial curricula which are explicit in ensuring students develop the professional competency and understand the values and attributes of this role.The purpose of this study was to determine student perception of Professionalism at the University of Ottawa and gain insights for improvement in promotion of professionalism in undergraduate medical education. METHODS: Survey on student perception of professionalism in general, the curriculum and learning environment at the University of Ottawa, and the perception of student behaviors, was developed by faculty and students and sent electronically to all University of Ottawa medical students. The survey included both quantitative items including an adapted Pritzker list and qualitative responses to eight open ended questions on professionalism at the University of Ottawa. All analyses were performed using SAS version 9.1 (SAS Institute Inc. Cary, NC, USA). Chi-square and Fischer’s exact test (for cell count less than 5) were used to derive p-values for categorical variables by level of student learning. RESULTS: Response rate was 45.6% (255 of 559 students) for all four years of the curriculum. 63% of the responses were from students in years 1 and 2 (pre-clerkship). Students identified role modeling as the single most important aspect of professionalism. The strongest curricular recommendations included faculty-led case scenario sessions, enhancing inter-professional interactions and the creation of special awards to staff and students to “celebrate” professionalism. Current evaluation systems were considered least effective. The importance of role modeling and information how to report lapses and breaches was highlighted in the answers to the open ended questions. CONCLUSIONS: Students identify the need for strong positive role models in their learning environment, and for effective evaluation of the professionalism of students and teachers. Medical school leaders must facilitate development of these components within the MD education and faculty development programs as well as in clinical milieus where student learning occurs.

Concepts: Psychology, Medicine, Education, Physician, University, Medical school, Medical education, Doctor of Medicine

6

Trainee mistreatment remains an important and serious medical education issue. Mistreatment toward trainees by the medical team has been described; mistreatment by patients and families has not. Motivated by discrimination towards a resident by a family in their emergency department, the authors sought to identify strategies for trainees and physicians to respond effectively to mistreatment by patients and families.

Concepts: Patient, Hospital, Physician, Illness, Doctor-patient relationship, Profession, Medical school, Medical education

5

New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME).

Concepts: Medicine, Physician, Medical school, Residency, Medical education, Continuing education, Media, Illinois