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Physician competence

Anders Klingberg, Lee Alan Wallis, Marie Hasselberg, Po-Yin Yen, Sara Caroline Fritzell
BACKGROUND: The referral process in acute care remains challenging in many areas including burn care. Mobile phone apps designed explicitly for medical referrals and consultations could streamline the referral process by using structured templates and integrating features specific to different specialties. However, as these apps are competing with commercial chat services, usability becomes a crucial factor for successful uptake. OBJECTIVE: The aim of this study was to assess the usability of a mobile phone app for remote consultations and referrals of burn injuries...
October 19, 2018: JMIR MHealth and UHealth
Hiroyuki Otsuka, Toshiki Sato, Keiji Sakurai, Hiromichi Aoki, Takeshi Yamagiwa, Shinichi Iizuka, Sadaki Inokuchi
Aim: Despite recent advancements in trauma management following introduction of interventional radiology (IVR) and damage-control strategies, challenges remain regarding optimal use of resources for severe trauma. Methods: In October 2014, we implemented a trauma management system comprising emergency physicians competent in severe trauma management, surgical techniques, and IVR. To evaluate this system, of 5,899 trauma patients admitted to our hospital from January 2011 to January 2018, we selected 107 patients with severe trauma (injury severity score ≥ 16) who presented with persistent hypotension (two or more systolic blood pressure measurements <90 mmHg), regardless of primary resuscitation...
October 2018: Acute Medicine & Surgery
Naoto Tamai, Hiroyuki Aihara, Masayuki Kato, Kimio Isshi, Kazuki Sumiyama
BACKGROUND: Objective assessment of endoscopist competency is important. Recently, the endoscopic part-task training box (Thompson Endoscopic Skills Trainer [TEST]) was developed to assess endoscopist competency. We aimed to evaluate the ability of the TEST to assess competency during endoscopic procedures, especially endoscopic submucosal dissection (ESD). METHODS: Twenty-three physicians were included in this study. Correlations between TEST scores and the following factors were evaluated: years of endoscopic experience, number of esophagogastroduodenoscopies (EGDs) performed, number of colonoscopies (CSs) performed, cecal intubation rate, number of gastric ESDs performed, gastric ESD procedure time/lesion size (min/mm2 ), and gastric ESD self-completion rate...
October 17, 2018: Surgical Endoscopy
Yuzhu Huang, Wei Wang, Haijian Zhao, Yuxuan Du, Jiali Liu, Falin He, Kun Zhong, Shuai Yuan, Zhiguo Wang
Background This study aimed to evaluate the ability of comment providers who were responsible for interpreting results in clinical laboratories in China and to improve the quality of interpretative comments. Methods Basic information and interpretative comments for five cases of 1912 routine chemistry External Quality Assessment (EQA) participant laboratories were collected by web-based EQA system in May 2018. EQA organizers assigned scores to each key phrase of comments based on predetermined marking scale and calculated total scores for each participant's answer...
October 17, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
Stig H Jensen, Jesper Weile, Rasmus Aagaard, Kåre M Hansen, Troels B Jensen, Morten C Petersen, Jacob J Jensen, Poul Petersen, Hans Kirkegaard
BACKGROUND: Supervision via tele-ultrasound presents a remedy for lacking on-site supervision in focused cardiac ultrasound, but knowledge of its impact is largely absent. We aimed to investigate tele-supervised physicians' cine-loop quality compared to that of non-supervised physicians and compared to that of experts. METHODS: We conducted a single-blinded cluster randomized controlled trial in an emergency department in western Denmark. Physicians with basic ultrasound competence scanned admitted patients twice...
October 17, 2018: Acta Anaesthesiologica Scandinavica
S Albisinni, F Legrand, Th Roumeguère
Beyond its scientific and ethical competencies, a good doctor is characterized by his communication skills. The ability to listen is fundamental. During an interview, the physician must keep in mind a bio-psycho-social approach while being able to hear the unspeakable and inaudible. Knowledge of patients and their relatives, which seems to be a specific knowledge for general practitioners, offers a lot of information. Among the main sensitive topics that the clinician must identify are: intrafamily violence, domestic violence, substance abuse and anxiety-depressive disorders...
2018: Revue Médicale de Bruxelles
Fernando A Angarita, Benjamin Price, Matthew Castelo, Mauricio Tawil, Juan Carlos Ayala, Lilian Torregrossa
PURPOSE: Clinical breast examination (CBE) is an important step in the assessment of patients with breast-related complaints. We developed a standardized simulation and multimedia-based (SSMBI) curriculum using current evidenced-based recommendations. This study aimed to determine if SSMBI training resulted in better performance (examination scores and detection of abnormal findings) than the traditional teaching method. METHODS: Novice fourth-year medical students were exposed to the SSMBI curriculum (n = 68) or traditional (n = 52) training...
October 12, 2018: Breast Cancer Research and Treatment
Louise C Druedahl, Johanne Mølby Hansen, Ellen Linnea Freese, Anna Birna Almarsdóttir, Janine M Traulsen
Medication use is a complex process involving different types of healthcare personnel. This study investigated and compared mandatory medication content in the curricula of six types of healthcare personnel with patient contact. Using content analysis, three independent raters analysed the mandatory medication content for physicians, pharmacists, pharmaconomists, nurses, healthcare assistants, and support workers in the Capital Region of Denmark. Three dimensions were analysed: communication with patients about medication, medication use or pharmacology, and medication formulation and production...
October 12, 2018: Basic & Clinical Pharmacology & Toxicology
Sarah B Thach, Bryan Hodge, Misty Cox, Anna Beth Parlier-Ahmad, Shelley L Galvin
BACKGROUND AND OBJECTIVES: Rural health disparities are growing, and medical schools and residency programs need new approaches to encourage learners to enter and stay in rural practice. Top correlates of rural practice are rural upbringing and rurally located training, yet preparation for rural practice plays a role. The authors sought to explore how selected programs develop learners' competencies associated with rural placement and retention: rural life, community engagement, and community leadership...
October 2018: Family Medicine
Jessica Taylor Goldstein, Scott G Hartman, Matthew R Meunier, Bethany Panchal, Christine Chang Pecci, Nancy M Zink, Sara G Shields
Maternity care access in the United States is in crisis. The American Congress of Obstetrics and Gynecology projects that by 2030 there will be a nationwide shortage of 9,000 obstetrician-gynecologists (OB/GYNs). Midwives and OB/GYNs have been called upon to address this crisis, yet in underserved areas, family physicians are often providing a majority of this care. Family medicine maternity care, a natural fit for the discipline, has been on sharp decline in recent years for many reasons including difficulties cultivating interdisciplinary relationships, navigating privileging, developing and maintaining adequate volume/competency, and preventing burnout...
October 2018: Family Medicine
Jonathan B Kruskal, Ronald L Eisenberg, Muneeb Ahmed, Bettina Siewert
The Joint Commission, our major accreditation organization, requires that all physicians who have been granted privileges at an organization must undergo evaluation of and collect data relating to their performance, to make the decisions of privileging more objective and continuous by that organization. For radiologists, this so-called ongoing professional practice evaluation (OPPE) can be assessed by using the six general core competencies. These competencies were initially developed for graduate medical education and defined by the Accreditation Council for Graduate Medical Education and have now been expanded to provide a general framework for defining categories of data to be collected in assessing the performance of practicing radiologists...
October 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Thomas R Porter
In a study, published in this issue of Echo Research and Practice, Ntoskas et al. retrospectively analyzed the safety of a cardiac physiologist performing, and interpreting, Dobutamine stress echocardiography (DSE) in of 300 patients undergoing DSE for the detection of inducible reversible ischemia, myocardial viability and valvular heart disease. While safety during the tests themselves did not appear to be compromised with this unsupervised approach, the interpretation of these DSEs causes concerns regarding broad patient safety relative to misread results...
September 1, 2018: Echo Research and Practice
Hossam Hamdy
The complexity of medical education and healthcare systems is a 'wicked problem'. Change will be a continuous iteration between evaluation and revaluation. Medicine is a social science. It is about people, societies and human interaction and communication. Medical College of the future should be developed in the light of social constructivism theories. Students from year one, day one, should be embedded in the work environment. Academic Healthcare Systems will be the norm not the exceptional. The training of students will be in all healthcare related facilities in the community...
October 9, 2018: Medical Teacher
Siqin Ye, Aaron L Leppin, Amy Y Chan, Nancy Chang, Nathalie Moise, Lusine Poghosyan, Victor M Montori, Ian Kronish
Background. Shared decision making (SDM) is recommended prior to initiation of statin therapy for primary prevention but is underutilized. We designed an informatics decision-support tool to facilitate use of the Mayo Clinic Statin Choice decision aid at the point-of-care and evaluated its impact. Methods. Using an iterative approach, we designed and implemented a single-click decision-support tool embedded within the electronic health records (EHRs) to automate the calculation of 10-year atherosclerotic cardiovascular disease (ASCVD) risk and populate the Statin Choice decision aid...
January 2018: MDM policy & practice
Pamela Turrillas, Maria Joao Teixeira, Matthew Maddocks
CONTEXT: Symptom management is a priority area within palliative care core competencies for generalist providers. While several educational initiatives exist, a comprehensive evidence synthesis on the effectiveness of symptom management training on trainees' learning and patient-reported outcomes is lacking. OBJECTIVES: To determine the effectiveness of training in symptom management in palliative care providers in non-palliative specialities. METHODS: A systematic review following Best Evidence Medical Education (BEME) methods from searches of MEDLINE, EMBASE, ERIC, CINAHL, PsycINFO, Cochrane database of systematic, Clinical Trials...
October 1, 2018: Journal of Pain and Symptom Management
Heather C Nixon, Jillian Stariha, Jason Farrer, Cynthia A Wong, Max Maisels, Paloma Toledo
BACKGROUND: Physician educators must balance the need for resident procedural education with clinical time pressures as well as patient safety and comfort. Alternative educational strategies, including e-learning tools, may be beneficial to orient novice learners to new procedures and speed proficiency. We created an e-learning tool (computer-enhanced visual learning [CEVL] neuraxial) to enhance trainee proficiency in combined spinal-epidural catheter placement in obstetric patients and performed a randomized controlled 2-center trial to test the hypothesis that use of the tool improved the initial procedure performed by the anesthesiology residents...
October 3, 2018: Anesthesia and Analgesia
Justin T Lui, Evan D Compton, Won Hyung A Ryu, Monica Y Hoy
BACKGROUND: Given mounting pressure of work hour restrictions, resource constraints, and variability of clinical exposure, Otolaryngology-Head & Neck Surgery (OHNS) residency training has shifted away from the apprenticeship model to embrace the Royal College of Physicians and Surgeons of Canada's "Competence by Design" initiative. As a result, appraising both current and potential educational adjuncts has become increasingly important. In this investigation, a national needs assessment survey was performed to identify strengths, weaknesses, and future opportunities of the current training landscape...
October 1, 2018: Journal of Otolaryngology—Head & Neck Surgery
Adam E M Eltorai, Ashley Szabo Eltorai, Carolina Fuentes, Wesley M Durand, Alan H Daniels, Shihab Ali
PURPOSE: To examine the approximated financial outcomes of physicians by specialty and to determine whether these correlate with mean USMLE Step 1 scores. METHODS: Specialty-specific data from the Association of American Medical Colleges Careers in Medicine website were analyzed for total length of training, mean USMLE Step 1 scores, average hours worked per week, and median clinical practice salary for physicians. Hourly wage and estimated net worth at retirement were calculated...
October 1, 2018: Rhode Island Medical Journal
Megan M Marron, Diane G Ives, Robert M Boudreau, Tamara B Harris, Anne B Newman
OBJECTIVES: To understand which causes of death are higher in black than white community-dwelling older adults and determine whether differences in baseline risk factors explain racial differences in mortality. DESIGN: Longitudinal cohort study (Health, Aging, and Body Composition Study). SETTING: Pittsburgh, Pennsylvania; and Memphis, Tennessee. PARTICIPANTS: Black and white men and women aged 70 to 79 during recruitment (N=3,075; 48% men, 42% black) followed for a median of 13 years...
October 2018: Journal of the American Geriatrics Society
Stephen Gauthier, Lindsay Melvin, Maria Mylopoulos, Nadine Abdullah
OBJECTIVES: Direct observation is the foundation of assessment and learning in competency-based medical education (CBME). Despite its importance, there is significant uncertainty about how to effectively implement frequent and high-quality direct observation. This is particularly true in specialties where observation of non-procedural skills is highly valued and presents unique challenges. It is therefore important to understand perceptions of direct observation to ensure successful acceptance and implementation...
October 1, 2018: Medical Education
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