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Autonomy and supervision

Amy O'Brien, Julie McCormack, Kimberley J Hoiles, Hunna J Watson, Rebecca A Anderson, Phillipa Hay, Sarah J Egan
OBJECTIVE: There are few evidence-based guidelines for inpatient pediatric eating disorders. The aim was to gain perspectives from those providing and receiving inpatient pediatric eating disorder care on the essential components treatment. METHOD: A modified Delphi technique was used to develop consensus-based opinions. Participants (N = 74) were recruited for three panels: clinicians (n = 24), carers (n = 31), and patients (n = 19), who endorsed three rounds of statements online...
March 14, 2018: International Journal of Eating Disorders
Roisin M Heaney, Michael Murray, Aine M Heaney, Eva M Doherty
BACKGROUND: Obtaining patient consent is a fundamental process in surgical practice and is integral in respecting and safeguarding patient autonomy. It has been reported that the task of consenting patients frequently lies with junior doctors, who have the least experience of the procedure. AIM: To examine the role of interns in the consent process in the Irish context as well as to identify their concerns. METHODS: A 12-point questionnaire, assessing interns' experience with surgical consent, was circulated to interns in three Irish university teaching hospitals based in different geographical locations...
March 9, 2018: Irish Journal of Medical Science
Gurjit Sandhu, Julie Thompson-Burdine, Vahagn C Nikolian, Danielle C Sutzko, Kaustubh A Prabhu, Niki Matusko, Rebecca M Minter
Importance: A critical balance is sought between faculty supervision, appropriate resident autonomy, and patient safety in the operating room. Variability in the release of supervision during surgery represents a potential safety hazard to patients. A better understanding of intraoperative faculty-resident interactions is needed to determine what factors influence entrustment. Objective: To assess faculty and resident intraoperative entrustment behaviors and to determine whether faculty behaviors drive resident entrustability in the operating room...
February 21, 2018: JAMA Surgery
Severine Z Cao, Steven T Chen
The appropriate balance between autonomy and supervision in graduate medical education remains an understudied question within dermatology. A recent survey of residents in a large academic dermatology residency program revealed concerns over inadequate autonomy in outpatient clinics. Residents in this program rotate through general and specialty clinics as well as two continuity clinics, but the degree of autonomy remains attending dependent, with most clinics following an "apprenticeship model" where residents function as assistants to their attending...
February 14, 2018: Journal of the European Academy of Dermatology and Venereology: JEADV
Benjamin T Jarman, Colette T O'Heron, Kara J Kallies, Thomas H Cogbill
OBJECTIVE: Providing opportunities for autonomy to enhance the development of independence and confidence during surgery residency remains among the greatest challenges of the current training paradigm. The objective of this study was to evaluate the implementation and outcomes of a chief resident service (CRS). DESIGN: A CRS was designed with operative, call and office responsibilities. Supervision and evaluation were consistent with institutional guidelines. CRS operative logs from 2011 to 2014 were compared with logs from the participants' first year in practice...
February 2, 2018: Journal of Surgical Education
Maria Fröberg, Charlotte Leanderson, Birgitta Fläckman, Erik Hedman-Lagerlöf, Karin Björklund, Gunnar H Nilsson, Terese Stenfors
OBJECTIVE: To explore how a student-run clinic (SRC) in primary health care (PHC) was perceived by students, patients and supervisors. DESIGN: A mixed methods study. Clinical learning environment, supervision and nurse teacher evaluation scale (CLES + T) assessed student satisfaction. Client satisfaction questionnaire-8 (CSQ-8) assessed patient satisfaction. Semi-structured interviews were conducted with supervisors. SETTING: Gustavsberg PHC Center, Stockholm County, Sweden...
January 25, 2018: Scandinavian Journal of Primary Health Care
Joan Costa-Font, Martin Ljunge
The association between occupational status and health has been taken to reveal the presence of occupational health inequalities. However, that interpretation assumes no influence of health status in climbing the occupational ladder. This paper documents evidence of non-negligible returns to occupation status on health (which we refer as 'healthy worker effect'). We use a unique empirical strategy that addresses the problem of reverse causality. That is, an instrumental variable strategy using the variation in average health in the migrant's country of origin, a health measure plausibly not determined by the migrant's occupational status...
January 9, 2018: Economics and Human Biology
Virginie Muller-Juge, Anne Catherine Pereira Miozzari, Arabelle Rieder, Jennifer Hasselgård-Rowe, Johanna Sommer, Marie-Claude Audétat
Purpose: The predicted shortage of primary care physicians emphasizes the need to increase the family medicine workforce. Therefore, Swiss universities develop clerkships in primary care physicians' private practices. The objective of this research was to explore the challenges, the stakes, and the difficulties of clinical teachers who supervised final year medical students in their primary care private practice during a 1-month pilot clerkship in Geneva. Methods: Data were collected via a focus group using a semistructured interview guide...
2018: Advances in Medical Education and Practice
Luisa Colucci, Ivana Molino, Francesco Amenta, Giuseppe Lucio Gaeta
OBJECTIVE: Families choice to institutionalize an Alzheimer's disease (AD)-affected relative is hard and possibly painful. Recent literature contributions have investigated the causes of the emergence of desire to institutionalize (DI) who is affected by AD. This paper contributes to the topic by providing an Italy-based empirical analysis of factors correlated with DI in primary informal caregivers of patients affected by AD. METHODS: Data were drawn from an original survey carried out over 2009...
December 30, 2017: Archives of Gerontology and Geriatrics
Jack P Cossman, Miaoyuan Wang, Alison A Fischer
No abstract text is available yet for this article.
December 19, 2017: Journal of the American Academy of Dermatology
Golnoosh Ahmadi, Mohsen Shahriari, Shahnaz Kohan, Mahmood Keyvanara
Fear is a normal emotion that can evoke an appropriate response when facing threat. However, sometimes the consequences of fear can lead to responses that are maladaptive. Fear can have negative effects on learning. Research has focused on the experience of fear and its consequences among midwifery students during their undergraduate program. A qualitative analysis was conducted of interviews with ten midwifery students in different years of an undergraduate program. The data was analyzed through a content analysis approach...
December 11, 2017: Nurse Education in Practice
Scott Feyereisen, Joseph P Broschak, Beth Goodrick
We further our understanding of jurisdictional disputes between established professional groups through a 10-year longitudinal analysis of the differential adoption by U.S. states of policies expanding Certified Registered Nurse Anesthetists' (CRNAs) autonomy. In the United States, CRNAs are trained to deliver anesthetics to patients in the same way as physician anesthesiologists but have more restrictions in practice. Following a 2001 federal decision regarding Medicare reimbursement, states were permitted but not required to allow CRNAs to practice without physician supervision, potentially reducing health care costs...
January 1, 2017: Medical Care Research and Review: MCRR
Nita Kohli, Nicholas Golda
BACKGROUND: There is a paucity of data on Mohs surgery workforce patterns. OBJECTIVE: To identify if gender differences exist in practice patterns of Mohs surgeons, factors that influence these differences, and factors influencing job satisfaction among Mohs surgeons. MATERIALS AND METHODS: An electronic survey was distributed to dermatology organizations targeting members of the American College of Mohs Surgery (ACMS), from October 2015 to April 2016...
November 14, 2017: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
David Oliver
No abstract text is available yet for this article.
November 14, 2017: BMJ: British Medical Journal
Jane Turner, Lisa Mackenzie, Brian Kelly, David Clarke, Patsy Yates, Sanchia Aranda
PURPOSE: This report describes the views of front-line health professionals who participated in a randomised controlled trial examining a model of care in which depressed cancer patients received a brief psychosocial intervention. Health professionals from four cancer centres received focused training, skill development and clinical supervision in order to deliver the intervention. METHODS: We interviewed 20 health professionals asking them about their perceptions of participation in the study and their views about more widespread implementation of this model of care...
October 23, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Stephen Parker, Shuichi Suetani, Balaji Motamarri
OBJECTIVE: The importance of clinical supervision is emphasised in psychiatric training programs. Despite this, the purpose and processes of supervision are often poorly defined. There is limited guidance available for trainees about their role in making supervision work. This paper considers the nature of supervision in psychiatric training and provides practical advice to help supervisees take active steps to make supervision work. CONCLUSIONS: In obtaining value from supervision, the active role of the supervisee in seeking feedback, finding value in criticism and building autonomy is emphasised...
December 2017: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
Joana Cunha-Cruz, Colleen E Huebner, Sharity Ludwig, Jeanne Dysert, Melissa Mitchell, Gary Allen, R Mike Shirtcliff, JoAnna M Scott, Peter Milgrom
INTRODUCTION: Twice-daily caregiver-supervised toothbrushing with fluoridated toothpaste is an effective and widely recommended strategy to prevent tooth decay in children. Qualitative research suggests that low-income caregivers know the recommendation but would benefit from toothbrushing supplies and advice about how to introduce this health behavior especially as the child becomes older and asserts autonomy to do it "myself." Our objective is to assess consumer satisfaction with the evidence-based theory-informed campaign and usefulness of materials that were home delivered...
2017: Frontiers in Public Health
Mantosh Dewan, John Norcini
The fourth year of medical school has been repeatedly found to be ineffective, and concerns exist about its purpose and academic quality, as well as grade inflation. Since Flexner, the purpose of undergraduate medical training has moved from readiness for independent practice to readiness for postgraduate training. However, training directors report that medical graduates are inadequately prepared to enter residency. The authors propose a fourth year with two components: first, a yearlong, longitudinal ambulatory experience of at least three days each week on an interprofessional team with consistent faculty supervision and mentoring, increasing independence, and a focus on education; and second, rigorous clinical-scales-based assessment of meaningful outcomes...
October 3, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
Kristopher M Day, Evon S Zoog, Chase T Kluemper, Jillian K Scott, Caleb M Steffen, James Woodfin Kennedy, David Marshall Jemison, Jason P Rehm, Mark A Brzezienski
OBJECTIVE: Resident clinics (RCs) are intended to catalyze the achievement of educational milestones through progressively autonomous patient care. However, few studies quantify their effect on competency-based surgical education, and no previous publications focus on hand surgery RCs (HRCs). We demonstrate the achievement of progressive surgical autonomy in an HRC model. DESIGN: A retrospective review of all patients seen in a weekly half-day HRC from October 2010 to October 2015 was conducted...
September 26, 2017: Journal of Surgical Education
Reed G Williams, Brian C George, Shari L Meyerson, Jordan D Bohnen, Gary L Dunnington, Mary C Schuller, Laura Torbeck, John T Mullen, Edward Auyang, Jeffrey G Chipman, Jennifer Choi, Michael Choti, Eric Endean, Eugene F Foley, Samuel Mandell, Andreas Meier, Douglas S Smink, Kyla P Terhune, Paul Wise, Debra DaRosa, Nathaniel Soper, Joseph B Zwischenberger, Keith D Lillemoe, Jonathan P Fryer
BACKGROUND: Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. METHODS: We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure...
September 23, 2017: Surgery
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