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Autonomy and supervision

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https://www.readbyqxmd.com/read/29148326/understanding-professional-jurisdiction-changes-in-the-field-of-anesthesiology
#1
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
https://www.readbyqxmd.com/read/29140863/practice-patterns-and-job-satisfaction-of-mohs-surgeons
#2
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.]
https://www.readbyqxmd.com/read/29138140/david-oliver-supervision-and-clinical-autonomy-for-junior-doctors-have-we-gone-too-far
#3
David Oliver
No abstract text is available yet for this article.
November 14, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29063389/building-psychosocial-capacity-through-training-of-front-line-health-professionals-to-provide-brief-therapy-lessons-learned-from-the-prompt-study
#4
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
https://www.readbyqxmd.com/read/29034694/on-being-supervised-getting-value-from-a-clinical-supervisor-and-making-the-relationship-work-when-it-is-not
#5
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...
October 1, 2017: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
https://www.readbyqxmd.com/read/29021979/everybody-brush-consumer-satisfaction-with-a-tooth-decay-prevention-program
#6
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
https://www.readbyqxmd.com/read/28991845/a-purpose-driven-fourth-year-of-medical-school
#7
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
https://www.readbyqxmd.com/read/28967577/progressive-surgical-autonomy-observed-in-a-hand-surgery-resident-clinic-model
#8
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
https://www.readbyqxmd.com/read/28950992/what-factors-influence-attending-surgeon-decisions-about-resident-autonomy-in-the-operating-room
#9
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
https://www.readbyqxmd.com/read/28948588/-impact-and-challenges-of-genetic-disorders-on-nursing
#10
Yao-Hua Wang
Genetic disorders greatly impact human life. Nursing staffs should provide counseling and health education before and after patients receive genetic testing. Current attitudes toward women who receive genetic tests emphasize respect patient autonomy and allowing the patient to make her own decisions regarding the tests she wants to take and her reproductive planning. For patients whose results include them in the high-risk group for dementia, providing mental support and counseling to assist them to understand the meaning of these results is important...
October 2017: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/28911332/-we-are-toothless-and-hanging-but-optimistic-sub-county-managers-experiences-of-rapid-devolution-in-coastal-kenya
#11
Mary M Nyikuri, Benjamin Tsofa, Philip Okoth, Edwine W Barasa, Sassy Molyneux
BACKGROUND: In March 2013, Kenya transitioned from a centralized to a devolved system of governance. Within the health sector, this entailed the transfer of service provision functions to 47 newly formed semi-autonomous counties, while policy and regulatory functions were retained at the national level. The devolution process was rapid rather than progressive. METHODS: We conducted qualitative research within one county to examine the early experiences of devolution in the health sector...
September 15, 2017: International Journal for Equity in Health
https://www.readbyqxmd.com/read/28882683/structured-operative-autonomy-an-institutional-approach-to-enhancing-surgical-resident-education-without-impacting-patient-outcomes
#12
Brandon M Wojcik, Zhi Ven Fong, Madhukar S Patel, David C Chang, Dustin R Long, Haytham M A Kaafarani, Emil Petrusa, John T Mullen, Keith D Lillemoe, Roy Phitayakorn
BACKGROUND: Although barriers to granting surgical residents autonomy in the operating room are well described, few have proposed practical strategies to overcome these barriers. Our department adopted a multidisciplinary approach to develop a rotation that aimed to grant chief residents structured operative autonomy. In this study, we assess the feasibility of implementation, impact on patient safety, and educational benefit to residents after the program's pilot year. STUDY DESIGN: During a 1-month rotation, chief residents began cases alone using their own operative block time...
September 5, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28783470/differences-in-fitness-level-between-women-aged-60-and-over-participating-in-three-different-supervised-exercise-programs-and-a-sedentary-group
#13
Maria Viladrosa, Ana Lavedán, Pilar Jürschik, Sebastià Mas-Alòs, Antoni Planas-Anzano, Olga Masot
The aim of this study was to compare fitness levels in women aged 60 and over participating in a supervised exercise program (involving tai chi, recreational gymnastics, and/or aquatic fitness) with those in a sedentary group. An observational, descriptive, cross-sectional study was performed on a total of 171 women aged from 60 to 92 who attended public community clubs for older adults. The instruments used included the Senior Fitness Test, the Tinetti Balance Assessment Tool, the Katz Index, and the Lawton & Brody Activities of Daily Living Scale...
August 7, 2017: Journal of Women & Aging
https://www.readbyqxmd.com/read/28760467/resident-autonomy-in-the-operating-room-expectations-versus-reality
#14
Shari L Meyerson, Joel M Sternbach, Joseph B Zwischenberger, Edward M Bender
BACKGROUND: There is concern about graduating thoracic trainees' independent operative skills due to limited autonomy in training. This study compared faculty and trainee expected levels of autonomy with intraoperative measurements of autonomy for common cardiothoracic operations. METHODS: Participants underwent frame-of-reference training on the 4-point Zwisch scale of operative autonomy (show and tell → active help → passive help → supervision only) and evaluated autonomy in actual cases using the Zwisch Me!! mobile application...
September 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28742711/readiness-of-us-general-surgery-residents-for-independent-practice
#15
MULTICENTER STUDY
Brian C George, Jordan D Bohnen, Reed G Williams, Shari L Meyerson, Mary C Schuller, Michael J Clark, Andreas H Meier, Laura Torbeck, Samuel P Mandell, John T Mullen, Douglas S Smink, Rebecca E Scully, Jeffrey G Chipman, Edward D Auyang, Kyla P Terhune, Paul E Wise, Jennifer N Choi, Eugene F Foley, Justin B Dimick, Michael A Choti, Nathaniel J Soper, Keith D Lillemoe, Joseph B Zwischenberger, Gary L Dunnington, Debra A DaRosa, Jonathan P Fryer
OBJECTIVE: This study evaluates the current state of the General Surgery (GS) residency training model by investigating resident operative performance and autonomy. BACKGROUND: The American Board of Surgery has designated 132 procedures as being "Core" to the practice of GS. GS residents are expected to be able to safely and independently perform those procedures by the time they graduate. There is growing concern that not all residents achieve that standard. Lack of operative autonomy may play a role...
October 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28669788/the-effect-of-gender-on-resident-autonomy-in-the-operating-room
#16
Shari L Meyerson, Joel M Sternbach, Joseph B Zwischenberger, Edward M Bender
OBJECTIVE: Discrimination against women training in medicine and surgery has been subjectively described for decades. This study objectively documents gender differences in the degree of autonomy given to thoracic surgery trainees in the operating room. DESIGN: Thoracic surgery residents and faculty underwent frame of reference training on the use of the 4-point Zwisch scale to measure operative autonomy. Residents and faculty then submitted evaluations of their perception of autonomy granted for individual operations as well as operative difficulty on a real-time basis using the "Zwisch Me!!" mobile application...
June 29, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28651531/supervision-and-autonomy-of-ophthalmology-residents-in-the-outpatient-clinic-in-the-united-states-a-survey-of-acgme-accredited-programs
#17
Eric L Singman, Divya Srikumaran, Laura Green, Jing Tian, Peter McDonnell
BACKGROUND: The development and demonstration of incremental trainee autonomy is required by the ACGME. However, there is scant published research concerning autonomy of ophthalmology residents in the outpatient clinic setting. This study explored the landscape of resident ophthalmology outpatient clinics in the United States. METHODS: A link to an online survey using the QualtricsTM platform was emailed to the program directors of all 115 ACGME-accredited ophthalmology programs in the United States...
June 26, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/28631199/practical-interventions-to-enhance-resident-ownership-of-patient-care
#18
Thomas Soeprono, Jesse Markman, Michael Grodesky, Deborah Cowley
OBJECTIVE: In the modern training environment, some question whether trainees have the opportunity to develop ownership of patient care, which includes concepts such as advocacy, autonomy, commitment, communication, follow-through, knowledge about the patient, responsibility, and teamwork. Despite descriptions of what ownership is, there is little discussion of how to foster ownership during residency. The objective of this study was to solicit psychiatry resident and faculty perspectives on ways to enhance resident ownership in training...
June 19, 2017: Academic Psychiatry
https://www.readbyqxmd.com/read/28607848/progressive-surgical-autonomy-in-a-plastic-surgery-resident-clinic
#19
Kristopher M Day, Jillian K Scott, Lani Gao, Tara M Lee, Jimmy L Waldrop, Larry A Sargent, J Woody Kennedy, Jason P Rehm, Mark A Brzezienski
BACKGROUND: Resident clinics are thought to catalyze educational milestone achievement through opportunities for progressively autonomous surgical care, but studies are lacking for general plastic surgery resident clinics (PSRCs). We demonstrate the achievement of increased surgical autonomy and continuity of care in a PSRC. METHODS: A retrospective review of all patients seen in a PSRC from October 1, 2010, to October 1, 2015, was conducted. Our PSRC is supervised by faculty plastic surgery attendings, though primarily run by chief residents in an accredited independent plastic surgery training program...
May 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28596445/development-of-a-new-care-model-for-hospitalized-children-with-medical-complexity
#20
Christine M White, Joanna E Thomson, Angela M Statile, Katherine A Auger, Ndidi Unaka, Matthew Carroll, Karen Tucker, Derek Fletcher, David E Hall, Jeffrey M Simmons, Patrick W Brady
Children with medical complexity are a rapidly growing inpatient population with frequent, lengthy, and costly hospitalizations. During hospitalization, these patients require care coordination among multiple subspecialties and their outpatient medical homes. At a large freestanding children's hospital, a new inpatient model of care was developed in an effort to consistently provide coordinated, family-centered, and efficient care. In addition to expanding the multidisciplinary team to include a pharmacist, dietician, and social worker, the team redesign included: (1) medication reconciliation rounds, (2) care coordination rounds, and (3) multidisciplinary weekly handoff with outpatient providers...
June 8, 2017: Hospital Pediatrics
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