Toward a more professional and practical medical education: a novel Central European approach.

PubMed

Drexel, Heinz; Vonbank, Alexander; Fraunberger, Peter; Riesen, Walter F; Saely, Christoph H

2015-01-01

We here present an innovative curriculum for a complete medical education that conforms to the current European Bologna system of academic training. The curriculum aims at raising doctors who are excellently prepared for clinical work over as short a time as 5 years; it provides a comprehensive, yet shorter than usual, education that strongly pronounces the importance of increasing the students' practical clinical competences and rigorously excludes superfluous contents. The curriculum encompasses 52 modules, 32 at the bachelor's and 20 at the master's level. Already at the level of the bachelor degree, full employability is given; the students finish the master's course as medical doctors optimally prepared to manage patients at the level of postgraduate medical education. The structure of the curriculum is modular; each modular component is essential for medical education and contains an average of five European Credit Transfer System credits, amounting to 150 hours of education. Depending on the subspecialty, the courses include lectures, seminars, practical laboratory training, and clinical training at varying quantities. In addition to attendance times, sufficient time slots are prepared for self-study in lectures, seminars, and practical work. With our curriculum, we provide an easily applicable backbone for a modern course of medicine that can be installed also at smaller academic institutions.

Payer Negotiations in the New Healthcare Environment: How to Prepare for and Succeed in a Value-Based World.

PubMed

Howrigon, Ron

2016-01-01

Because of their involvement with the Affordable Care exchanges, the national insurance companies have reported significant financial losses. As a result, there will soon be significant payer pressure to reduce medical expenses. To succeed in future negotiations with the payers, medical practices must understand the needs of the payers and then play to those needs. The author is a former managed care executive with more than 25 years of experience managing provider networks and implementing payer strategies for some of the largest payers in the United States. In this article, he outlines important things medical practices should be doing to prepare for the new world of value-based contracting. Medical practices that embrace this change and work hard to evolve with the future are the ones that are going to survive and succeed.

The impact of problem-based learning on students' perceptions of preparedness for advanced pharmacy practice experiences.

PubMed

Hogan, Shirley; Lundquist, Lisa M

2006-08-15

To evaluate graduating pharmacy students' perceptions of their preparedness for advanced pharmacy practice experiences and the effectiveness of problem-based learning in their preparation. A survey instrument was administered anonymously in May 2004 and May 2005 to graduating pharmacy students of the University of Mississippi School of Pharmacy. Students reported that the areas in which problem-based learning prepared them most effectively for advanced pharmacy practice experiences were retrieval of medical information (80%), discussion of disease states and drug therapies at the basic science level (56%), and evaluation of the appropriateness of a medication regimen based on patient specific information (50%). Areas in which students reported being inadequately prepared included identifying and utilizing drug assistance programs (42%) and processing prescriptions/hospital orders (40%). Data from 2 consecutive graduating classes supports that problem-based learning is an effective format for preparing pharmacy students for advanced pharmacy practice experiences in a variety of areas.

Physicians-in-training are not prepared to prescribe medical marijuana.

PubMed

Evanoff, Anastasia B; Quan, Tiffany; Dufault, Carolyn; Awad, Michael; Bierut, Laura Jean

2017-11-01

While medical marijuana use is legal in more than half of U.S. states, evidence is limited about the preparation of physicians-in-training to prescribe medical marijuana. We asked whether current medical school and graduate medical educational training prepare physicians to prescribe medical marijuana. We conducted a national survey of U.S. medical school curriculum deans, a similar survey of residents and fellows at Washington University in St. Louis, and a query of the Association of American Medical Colleges (AAMC) Curriculum Inventory database for keywords associated with medical marijuana. Surveys were obtained from 101 curriculum deans, and 258 residents and fellows. 145 schools were included in the curriculum search. The majority of deans (66.7%) reported that their graduates were not at all prepared to prescribe medical marijuana, and 25.0% reported that their graduates were not at all prepared to answer questions about medical marijuana. The vast majority of residents and fellows (89.5%) felt not at all prepared to prescribe medical marijuana, while 35.3% felt not at all prepared to answer questions, and 84.9% reported receiving no education in medical school or residency on medical marijuana. Finally, only 9% of medical school curriculums document in the AAMC Curriculum Inventory database content on medical marijuana. Our study highlights a fundamental mismatch between the state-level legalization of medical marijuana and the lack of preparation of physicians-in-training to prescribe it. With even more states on the cusp of legalizing medical marijuana, physician training should adapt to encompass this new reality of medical practice. Copyright © 2017 Elsevier B.V. All rights reserved.

The Preparation of Educational Leaders: What's Needed and What's Next?

ERIC Educational Resources Information Center

Hills, Jean

This essay formulates some recommendations for educational administrator preparation programs and predicts the course of their future development. While the case of medical practice as a paradigm for the practice of educational administration is found only generally useful, the clinical analogy yields the suggestion that educational leader…

Growing a medical practice with social media marketing.

PubMed

Laban, Jake

2012-01-01

Many medical practices are facing the lack of practice growth that their social media efforts are generating. This article provides concrete ideas that can be put in place by any medical practice to realize sustainable practice growth through social media marketing. In the article, the author demonstrates that social media marketing of the medical practice has become absolutely essential in today's evolving, competitive, and fast-paced environment. This demonstration is made through an exploration of the evolution of what "good" marketing has looked like for medical practices over time. In addition, attention is paid to the shift in the definition of good marketing that is required for the practice that is preparing a social media-marketing plan. Specifically, the article investigates the proven requirements for a balanced blend of unique and engaging promotional and nonpromotional community outreach, which is required on a daily basis to achieve the significant, lasting, and sustainable growth that the practice wishes to achieve.

Case Reports, Case Series - From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education.

PubMed

Sayre, Jerry W; Toklu, Hale Z; Ye, Fan; Mazza, Joseph; Yale, Steven

2017-08-07

Case reports and case series or case study research are descriptive studies that are prepared for illustrating novel, unusual, or atypical features identified in patients in medical practice, and they potentially generate new research questions. They are empirical inquiries or investigations of a patient or a group of patients in a natural, real-world clinical setting. Case study research is a method that focuses on the contextual analysis of a number of events or conditions and their relationships. There is disagreement among physicians on the value of case studies in the medical literature, particularly for educators focused on teaching evidence-based medicine (EBM) for student learners in graduate medical education. Despite their limitations, case study research is a beneficial tool and learning experience in graduate medical education and among novice researchers. The preparation and presentation of case studies can help students and graduate medical education programs evaluate and apply the six American College of Graduate Medical Education (ACGME) competencies in the areas of medical knowledge, patient care, practice-based learning, professionalism, systems-based practice, and communication. A goal in graduate medical education should be to assist residents to expand their critical thinking, problem-solving, and decision-making skills. These attributes are required in the teaching and practice of EBM. In this aspect, case studies provide a platform for developing clinical skills and problem-based learning methods. Hence, graduate medical education programs should encourage, assist, and support residents in the publication of clinical case studies; and clinical teachers should encourage graduate students to publish case reports during their graduate medical education.

What you do not know about disease management: a new ally in the pay-for-performance era.

PubMed

Peck, Charles A

2008-01-01

Disease management is relatively new, and many medical practices have misconceptions about how it works. Far from being a burden to busy medical practices, disease management programs can reduce hassles for physicians and office managers by coaching patients to be more compliant, better prepared, and less likely to make unnecessary phone calls. Disease management programs cost the medical practices nothing. They can even help practices make money by providing data needed for bonuses from the growing number of pay-for-performance programs.

Preparing Interprofessional Faculty to Be Humanistic Mentors for Medical Students: The GW-Gold Mentor Development Program.

PubMed

Blatt, Benjamin; Plack, Margaret M; Simmens, Samuel J

2018-01-01

The GW-Gold Humanistic Mentor Development Program addresses the challenge faced by medical schools to educate faculty to prepare students for humanistic practice. Grounded in Branch's Teaching Professional and Humanistic Values model, the program prepares interprofessional faculty mentoring teams in humanistic communities of practice. The teams consist of physician-psychosocial professional pairs, each mentoring a small student group in their professional development course. Through GW-Gold workshops, faculty mentors develop interprofessional humanistic communities of practice, preparing them to lead second such communities with their students. This article describes the program and its evaluation. To assess outcomes and better understand the mentor experience, we used a mixed-method validating triangulation design consisting of simultaneous collection of quantitative (mentor and student surveys) and qualitative (open-ended survey questions and focus group) data. Data were analyzed in parallel and merged at the point of interpretation, allowing for triangulation and validation of outcomes. Mentors rated the program highly, gained confidence in their humanistic skills, and received high scores from students. Three themes emerged that validated program design, confirmed outcomes, and expanded on the mentor experience: (1) Interprofessional faculty communities developed through observation, collaboration, reflection, and dialogue; (2) Humanistic mentors created safe environments for student engagement; and (3) Engaging in interprofessional humanistic communities of practice expanded mentors' personal and professional identities. Outcomes support the value of the GW-Gold program's distinctive features in preparing faculty to sustain humanism in medical education: an interprofessional approach and small communities of practice built on humanistic values.

Integration of Pharmacy Practice and Pharmaceutical Analysis: Quality Assessment of Laboratory Performance.

ERIC Educational Resources Information Center

McGill, Julian E.; Holly, Deborah R.

1996-01-01

Laboratory portions of courses in pharmacy practice and pharmaceutical analysis at the Medical University of South Carolina are integrated and coordinated to provide feedback on student performance in compounding medications. Students analyze the products they prepare, with early exposure to compendia requirements and other references. Student…

Medical Simulation Practices 2010 Survey Results

NASA Technical Reports Server (NTRS)

McCrindle, Jeffrey J.

2011-01-01

Medical Simulation Centers are an essential component of our learning infrastructure to prepare doctors and nurses for their careers. Unlike the military and aerospace simulation industry, very little has been published regarding the best practices currently in use within medical simulation centers. This survey attempts to provide insight into the current simulation practices at medical schools, hospitals, university nursing programs and community college nursing programs. Students within the MBA program at Saint Joseph's University conducted a survey of medical simulation practices during the summer 2010 semester. A total of 115 institutions responded to the survey. The survey resus discuss overall effectiveness of current simulation centers as well as the tools and techniques used to conduct the simulation activity

Tips for medical practice success in the upcoming accountable care era.

PubMed

Bobbitt, Julian D

2012-01-01

Due to the unsustainable cost of healthcare, the movement to accountable care will be inevitable. This author predicts that recent Medicare Accountable Care Organization (ACO) regulations will energize ACO development. There are specific practical strategies every medical practice leader should know in order to navigate this new healthcare environment successfully. There is a window of opportunity, which will not stay open long, to control a medical practice's destiny in molding a fair, sustainable, and successful ACO. Not being prepared and defaulting to the status quo through passivity is also a choice that promises more work for less compensation for medical practices. The choice is clear, and the blueprint for success is available.

Outcomes of an Advanced Ultrasound Elective: Preparing Medical Students for Residency and Practice.

PubMed

Prats, Michael I; Royall, Nelson A; Panchal, Ashish R; Way, David P; Bahner, David P

2016-05-01

Many medical specialties have adopted the use of ultrasound, creating demands for higher-quality ultrasound training at all levels of medical education. Little is known about the long-term benefit of integrating ultrasound training during undergraduate medical education. This study evaluated the effect of a longitudinal fourth-year undergraduate medical education elective in ultrasound and its impact on the future use of ultrasound in clinical practice. A cross-sectional survey of medical graduates from The Ohio State University College of Medicine (2006-2011) was done, comparing those who participated and those who did not participate in a rigorous ultrasound program for fourth-year medical students. A 38-item questionnaire queried graduates concerning ultrasound education in residency, their proficiency, and their current use of ultrasound in clinical practice. Surveys were completed by 116 respondents, for a return rate of 40.8% (116 of 284). The participants of the undergraduate medical education ultrasound elective (n = 61) reported more hours of ultrasound training after graduation (hands-on training, bedside scanning, and number of scans performed; P < .001), higher ultrasound proficiency (proficiency in using ultrasound for clinical decision making, use in emergency settings, and use of novel techniques; P< .001), and higher rates of ultrasound use in clinical practice (P < .001). The longitudinal undergraduate medical education ultrasound elective produced physicians who were more likely to seek additional training in residency, evaluate themselves as more proficient, and use ultrasound in their clinical practice. Early training in bedside ultrasound during undergraduate medical education yields physicians who are better prepared for integration of ultrasound into clinical practice. © 2016 by the American Institute of Ultrasound in Medicine.

Impact of Robotic Antineoplastic Preparation on Safety, Workflow, and Costs

PubMed Central

Seger, Andrew C.; Churchill, William W.; Keohane, Carol A.; Belisle, Caryn D.; Wong, Stephanie T.; Sylvester, Katelyn W.; Chesnick, Megan A.; Burdick, Elisabeth; Wien, Matt F.; Cotugno, Michael C.; Bates, David W.; Rothschild, Jeffrey M.

2012-01-01

Purpose: Antineoplastic preparation presents unique safety concerns and consumes significant pharmacy staff time and costs. Robotic antineoplastic and adjuvant medication compounding may provide incremental safety and efficiency advantages compared with standard pharmacy practices. Methods: We conducted a direct observation trial in an academic medical center pharmacy to compare the effects of usual/manual antineoplastic and adjuvant drug preparation (baseline period) with robotic preparation (intervention period). The primary outcomes were serious medication errors and staff safety events with the potential for harm of patients and staff, respectively. Secondary outcomes included medication accuracy determined by gravimetric techniques, medication preparation time, and the costs of both ancillary materials used during drug preparation and personnel time. Results: Among 1,421 and 972 observed medication preparations, we found nine (0.7%) and seven (0.7%) serious medication errors (P = .8) and 73 (5.1%) and 28 (2.9%) staff safety events (P = .007) in the baseline and intervention periods, respectively. Drugs failed accuracy measurements in 12.5% (23 of 184) and 0.9% (one of 110) of preparations in the baseline and intervention periods, respectively (P < .001). Mean drug preparation time increased by 47% when using the robot (P = .009). Labor costs were similar in both study periods, although the ancillary material costs decreased by 56% in the intervention period (P < .001). Conclusion: Although robotically prepared antineoplastic and adjuvant medications did not reduce serious medication errors, both staff safety and accuracy of medication preparation were improved significantly. Future studies are necessary to address the overall cost effectiveness of these robotic implementations. PMID:23598843

Assessing curriculum effectiveness: a survey of Uniformed Services University medical school graduates.

PubMed

Picho, Katherine; Gilliland, William R; Artino, Anthony R; DeZee, Kent J; Dong, Ting; McManigle, John E; Cruess, David F; Durning, Steven J

2015-04-01

This study assessed alumni perceptions of their preparedness for clinical practice using the Accreditation Council for Graduate Medical Education (ACGME) competencies. We hypothesized that our alumni's perception of preparedness would be highest for military-unique practice and professionalism and lowest for system-based practice and practice-based learning and improvement. 1,189 alumni who graduated from the Uniformed Services University (USU) between 1980 and 2001 completed a survey modeled to assess the ACGME competencies on a 5-point, Likert-type scale. Specifically, self-reports of competencies related to patient care, communication and interpersonal skills, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement, and military-unique practice were evaluated. Consistent with our expectations as the nation's military medical school, our graduates were most confident in their preparedness for military-unique practice, which included items assessing military leadership (M = 4.30, SD = 0.65). USU graduates also indicated being well prepared for the challenges of residency education in the domain of professionalism (M = 4.02, SD = 0.72). Self-reports were also high for competencies related to patient care (M = 3.86, SD = 0.68), communication and interpersonal skills (M = 3.88, SD = 0.66), and medical knowledge (M = 3.78, SD = 0.73). Consistent with expectations, systems-based practice (M = 3.50, SD = 0.70) and practice-based learning and improvement (M = 3.57, SD = 0.62) were the lowest rated competencies, although self-reported preparedness was still quite high. Our findings suggest that, from the perspective of our graduates, USU is providing both an effective military-unique curriculum and is preparing trainees for residency training. Further, these results support the notion that graduates are prepared to lead and to practice medicine in austere environments. Compared to other competencies that were assessed, self-ratings for systems-based practice and practice-based learning and improvement were the lowest, which suggests the need to continue to improve USU education in these areas. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Errors in preparation and administration of parenteral drugs in neonatology: evaluation and corrective actions.

PubMed

Hasni, Nesrine; Ben Hamida, Emira; Ben Jeddou, Khouloud; Ben Hamida, Sarra; Ayadi, Imene; Ouahchi, Zeineb; Marrakchi, Zahra

2016-12-01

The medication iatrogenic risk is quite unevaluated in neonatology Objective: Assessment of errors that occurred during the preparation and administration of injectable medicines in a neonatal unit in order to implement corrective actions to reduce the occurrence of these errors. A prospective, observational study was performed in a neonatal unit over a period of one month. The practice of preparing and administering injectable medications were identified through a standardized data collection form. These practices were compared with summaries of the characteristics of each product (RCP) and the bibliography. One hundred preparations were observed of 13 different drugs. 85 errors during preparations and administration steps were detected. These errors were divided into preparation errors in 59% of cases such as changing the dilution protocol (32%), the use of bad solvent (11%) and administration errors in 41% of cases as errors timing of administration (18%) or omission of administration (9%). This study showed a high rate of errors during stages of preparation and administration of injectable drugs. In order to optimize the care of newborns and reduce the risk of medication errors, corrective actions have been implemented through the establishment of a quality assurance system which consisted of the development of injectable drugs preparation procedures, the introduction of a labeling system and staff training.

Quality in Context: A Guide to Certification and Registration by the Medical Library Association.

ERIC Educational Resources Information Center

Fitzsimons, Eileen; Mayfield, M. Kent

This guide is designed to assist prospective examinees in preparing for the certification/registration examination of the Medical Library Association (MLA). The format of the examination and the types of questions to be found on the examination are discussed, and suggestions for test preparation are provided. Several practice "mini"…

The preparation of students of medical faculties and other public colleges for educative activities within the national programme of health support.

PubMed

Kukurova, E; Bernadic, M; Kralova, E; Bernadicova, H; Traubner, P

2005-01-01

The tradition of education of physicians at the Medical Faculty of Comenius University (MFCU) has been developing for more than 85 years. Currently, the education has been widened by non-medical fields of study (nursing, obstetrical assistance, rehabilitation, public health care and laboratory and examination methods). After joining EU, the accreditation study programmes have been subject to transformation in compliance with current world trends in education. In accord with the transformation of content and forms of medical physics training, the authors demonstrate the main objectives and goals of this process. The goal is to prepare the graduates on high theoretical and practical levels, to teach them to work in team, and to prepare them for whole-life education. Practical skills in pre-clinical and clinical disciplines are being strengthened. One of the important outputs of pre-graduate education is the readiness of graduates for educative activities in favour of the National Programme of Health Support. (Tab. 1, Fig. 1, Ref. 7.)

Contemporary issues: The pre-licensure nursing student and medication errors.

PubMed

Green, Cheryl

2018-06-01

In Modern health care, the creation of cultures of safety for patients is of the upmost importance. Impacting the institutional stabilization of health care facilities safety initiatives, is the preparation of pre-licensure nursing students to safely administer medications to patients. Therefore, preparation of the pre-licensure nursing student must be evidence-based practice focused and incorporate innovative ways to reduce the potential for medication errors. Copyright © 2018. Published by Elsevier Ltd.

Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

PubMed Central

Adams, Diane L.; Norman, Helen; Burroughs, Valentine J.

2002-01-01

Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction, disciplinary action and exclusion from participation in government programs. Part II of this article recommends an approach for assessing potential risk, preventing improper billing, and improving financial management of the medical practice. Images p432-a PMID:12078924

Pediatric Nurses' Perceptions of Medication Safety and Medication Error: A Mixed Methods Study.

PubMed

Alomari, Albara; Wilson, Val; Solman, Annette; Bajorek, Beata; Tinsley, Patricia

2018-06-01

This study aims to outline the current workplace culture of medication practice in a pediatric medical ward. The objective is to explore the perceptions of nurses in a pediatric clinical setting as to why medication administration errors occur. As nurses have a central role in the medication process, it is essential to explore nurses' perceptions of the factors influencing the medication process. Without this understanding, it is difficult to develop effective prevention strategies aimed at reducing medication administration errors. Previous studies were limited to exploring a single and specific aspect of medication safety. The methods used in these studies were limited to survey designs which may lead to incomplete or inadequate information being provided. This study is phase 1 on an action research project. Data collection included a direct observation of nurses during medication preparation and administration, audit based on the medication policy, and guidelines and focus groups with nursing staff. A thematic analysis was undertaken by each author independently to analyze the observation notes and focus group transcripts. Simple descriptive statistics were used to analyze the audit data. The study was conducted in a specialized pediatric medical ward. Four key themes were identified from the combined quantitative and qualitative data: (1) understanding medication errors, (2) the busy-ness of nurses, (3) the physical environment, and (4) compliance with medication policy and practice guidelines. Workload, frequent interruptions to process, poor physical environment design, lack of preparation space, and impractical medication policies are identified as barriers to safe medication practice. Overcoming these barriers requires organizations to review medication process policies and engage nurses more in medication safety research and in designing clinical guidelines for their own practice.

Using an expanded outcomes framework and continuing education evidence to improve facilitation of patient-centered medical home recognition and transformation.

PubMed

Van Hoof, Thomas J; Kelvey-Albert, Michele; Katz, Matthew; Lalime, Ken; Sacks, Ken; Meehan, Thomas P

2014-01-01

The patient-centered medical home is a model for delivering primary care in the United States. Primary care clinicians and their staffs require assistance in understanding the innovation and in applying it to practice. The purpose of this article is to describe and to critique a continuing education program that is relevant to, and will become more common in, primary care. A multifaceted educational strategy prepared 20 primary care private practices to achieve National Committee for Quality Assurance Level 3 recognition as Patient-Centered Medical Homes. Eighteen (90%) practices submitted an application to the National Committee for Quality Assurance. On the first submission attempt, 13 of 18 (72%) achieved Level 3 recognition and 5 (28%) achieved Level 1 recognition. An interactive multifaceted educational strategy can be successful in preparing primary care practices for Patient-Centered Medical Homes recognition, but the strategy may not ensure transformation. Future educational activities should consider an expanded outcomes framework and the evidence of effective continuing education to be more successful with recognition and transformation.

Does a summative portfolio foster the development of capabilities such as reflective practice and understanding ethics? An evaluation from two medical schools.

PubMed

O'Sullivan, Anthony J; Howe, Amanda C; Miles, Susan; Harris, Peter; Hughes, Chris S; Jones, Philip; Scicluna, Helen; Leinster, Sam J

2012-01-01

Portfolios need to be evaluated to determine whether they encourage students to develop in capabilities such as reflective practice and ethical judgment. The aims of this study were (i) to determine whether preparing a portfolio helps promote students' development in a range of capabilities including understanding ethical and legal principles, reflective practice and effective communication, and (ii) to determine to what extent the format of the portfolio affected the outcome by comparing the experiences of students at two different medical schools. A questionnaire was designed to evaluate undergraduate medical students' experiences of completing a portfolio at two medical schools. A total of 526 (45% response rate) students answered the on-line questionnaire. Students from both medical schools gave the highest ranking for the portfolio as a trigger for reflective practice. 63% of students agreed their portfolio helped them develop reflective practice skills (p < 0.001), whereas only 22% disagreed. 48% of students agreed portfolios helped them understand ethical and legal principles whereas 29% disagreed (p < 0.001). In contrast, only 34% of students thought the portfolio helped them to develop effective communication. Students perceive portfolio preparation as an effective learning tool for the development of capabilities such as understanding ethical and legal principles and reflective practice, whereas other capabilities such as effective communication require complementary techniques and other modes of assessment.

A New Paradigm Is Needed for Medical Education in the Mid-Twenty-First Century and Beyond: Are We Ready?

PubMed Central

Benor, Dan E.

2014-01-01

The twentieth century witnessed profound changes in medical education. All these changes, however, took place within the existing framework, suggested by Flexner a century ago. The present paper suggests that we are approaching a singularity point, where we shall have to change the paradigm and be prepared for an entirely new genre of medical education. This suggestion is based upon analysis of existing and envisaged trends: first, in technology, such as availability of information and sophisticated simulations; second, in medical practice, such as far-reaching interventions in life and death that create an array of new moral dilemmas, as well as a change in patient mix in hospitals and a growing need of team work; third, in the societal attitude toward higher education. The structure of the future medical school is delineated in a rough sketch, and so are the roles of the future medical teacher. It is concluded that we are presently not prepared for the approaching changes, neither from practical nor from attitudinal points of view, and that it is now high time for both awareness of and preparation for these changes. PMID:25120918

Problem-Based Learning of Social Sciences and Humanities by Fourth-Year Medical Students.

ERIC Educational Resources Information Center

Colby, Kathleen K.; And Others

1986-01-01

A required fourth-year course integrating the social sciences and humanities into the required clinical medical curriculum at Dartmouth Medical School is intended to prepare students to deal with the social and humanistic issues involved in medical practice, including law, ethics, economics, and social anthropology. (MSE)

New Pathways to Medical Education: Learning To Learn at Harvard Medical School.

ERIC Educational Resources Information Center

Tosteson, Daniel C., Ed.; And Others

This book details how Harvard Medical School (Massachusetts) overcame prevailing educational inertia and developed a curriculum and educational program consistent with preparing students to practice medicine in the 21st century. The New Pathway in General Medical Education program emphasizes both acquiring current knowledge and developing learning…

Medical Dictation and Transcription; Business Education: 7707.43.

ERIC Educational Resources Information Center

Hoffman, Carol S.

The course prepares the business education student for the duties and ethics of the medical secretary and involves intensive practice with a high degree of speed and accuracy in taking dictation and transcribing materials related to the medical profession. Included are skills in spelling, pronouncing, and defining the most-used medical terms and…

Evaluating the Relationship between Simulation and Clinical Decision-Making in Physical Therapy Students

ERIC Educational Resources Information Center

Macauley, Kelly

2017-01-01

Physical therapy students are frequently ill-prepared to practice in the dynamic healthcare environment immediately after graduation. Implementing other teaching modalities may help to better prepare physical therapy graduates. Medical student and nursing education have effectively used simulation to help prepare students effectively for clinical…

Effects of Information Access Cost and Accountability on Medical Residents' Information Retrieval Strategy and Performance During Prehandover Preparation: Evidence From Interview and Simulation Study.

PubMed

Yang, X Jessie; Wickens, Christopher D; Park, Taezoon; Fong, Liesel; Siah, Kewin T H

2015-12-01

We aimed to examine the effects of information access cost and accountability on medical residents' information retrieval strategy and performance during prehandover preparation. Prior studies observing doctors' prehandover practices witnessed the use of memory-intensive strategies when retrieving patient information. These strategies impose potential threats to patient safety as human memory is prone to errors. Of interest in this work are the underlying determinants of information retrieval strategy and the potential impacts on medical residents' information preparation performance. A two-step research approach was adopted, consisting of semistructured interviews with 21 medical residents and a simulation-based experiment with 32 medical residents. The semistructured interviews revealed that a substantial portion of medical residents (38%) relied largely on memory for preparing handover information. The simulation-based experiment showed that higher information access cost reduced information access attempts and access duration on patient documents and harmed information preparation performance. Higher accountability led to marginally longer access to patient documents. It is important to understand the underlying determinants of medical residents' information retrieval strategy and performance during prehandover preparation. We noted the criticality of easy access to patient documents in prehandover preparation. In addition, accountability marginally influenced medical residents' information retrieval strategy. Findings from this research suggested that the cost of accessing information sources should be minimized in developing handover preparation tools. © 2015, Human Factors and Ergonomics Society.

A survey of views and practice patterns of dialysis medical directors toward end-of-life decision making for patients with end-stage renal disease.

PubMed

Fung, Enrica; Slesnick, Nate; Kurella Tamura, Manjula; Schiller, Brigitte

2016-07-01

Patients with end-stage renal disease report infrequent end-of-life discussions, and nephrology trainees report feeling unprepared for end-of-life decision making, but the views of dialysis medical directors have not been studied. Our objective is to understand dialysis medical directors' views and practice patterns on end-of-life decision making for patients with ESRD. We administered questionnaires to dialysis medical directors during medical director meetings of three different dialysis organizations in 2013. Survey questions corresponded to recommendations from the Renal Physicians Association clinical practice guidelines on initiation and withdrawal of dialysis. There were 121 medical director respondents from 28 states. The majority of respondents felt "very prepared" (66%) or "somewhat prepared" (29%) to participate in end-of-life decisions and most (80%) endorsed a model of shared decision making. If asked to do so, 70% of the respondents provided prognostic information "often" or "nearly always." For patients with a poor prognosis, 36% of respondents would offer a time-limited trial of dialysis "often" or "nearly always", while 56% of respondents would suggest withdrawal from dialysis "often" or "nearly always" for those with a poor prognosis currently receiving dialysis therapy. Patient resistance and fear of taking away hope were the most commonly cited barriers to end-of-life discussions. Views and reported practice patterns of medical directors are consistent with clinical practice guidelines for end-of-life decision making for patients with end-stage renal disease but inconsistent with patient perceptions. © The Author(s) 2016.

Interprofessional education for the quality use of medicines: designing authentic multimedia learning resources.

PubMed

Levett-Jones, Tracy; Gilligan, Conor; Lapkin, Samuel; Hoffman, Kerry

2012-11-01

It is claimed that health care students who learn together will be better prepared for contemporary practice and more able to work collaboratively and communicate effectively. In Australia, although recognised as important for preparing nursing, pharmacy and medical students for their roles in the medication team, interprofessional education is seldom used for teaching medication safety. This is despite evidence indicating that inadequate communication between health care professionals is the primary issue in the majority of medication errors. It is suggested that the pragmatic constraints inherent in university timetables, curricula and contexts limit opportunities for health professional students to learn collaboratively. Thus, there is a need for innovative approaches that will allow nursing, medical and pharmacy students to learn about and from other disciplines even when they do not have the opportunity to learn with them. This paper describes the development of authentic multimedia resources that allow for participative, interactive and engaging learning experiences based upon sound pedagogical principles. These resources provide opportunities for students to critically examine clinical scenarios where medication safety is, or has the potential to be compromised and to develop skills in interprofessional communication that will prepare them to manage these types of situations in clinical practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

Liberating the Oppressed: Research Knowledge Differentials and Ethical Investigation in Special Operations Forces Clinical Science.

PubMed

Kemplin, Kate Rocklein; Bowling, F Young

Special Operations Forces (SOF) medics do not have preparation in research knowledge that enables them to independently initiate or generate their own studies. Thus, medics rely on evidence generated by others, who are removed from medics' practice environment. Here, salient literature on research self-efficacy and the genesis of institutional review boards (IRBs) are reviewed and interpreted for contextual applications to medics' practice and initiation of studies. More publications delving into research methods are warranted to promote medics' participation and initiation of selfdirected scientific investigation, in collaboration with research scientists. 2017.

Eliminating the use of intravenous glass bottles using a FOCUS-PDCA model and providing a practical stability reference guide.

PubMed

Maraiki, Fatma; Farooq, Faiyaz; Ahmed, Mohamed

2016-08-01

To identify the intravenous (IV) medications that are prepared in glass bottles at the institution and establish which of these medications can be prepared in flexible IV bags such as polyvinyl chloride (PVC) or non-PVC instead of glass bottles. The cost implication of switching from glass bottles to flexible IV bags was calculated. A study using FOCUS-PDCA model to identify IV medications prepared in glass bottles and establish which of these medications could be prepared in IV bags (PVC or non-PVC). The cost impact of switching from glass bottles to IV plastic bags (including PVC or non-PVC) was calculated. The stability data obtained were used as a reference for updating pharmacy internal IV preparation charts. A total of 17 IV medications were found to be prepared in IV glass bottles. Of these 17 medications, only 8 (47%) were prepared in IV glass bottles due to incompatibility with PVC bags. For 7 (41%) of the medications, of which 6 were monoclonal antibodies (MABs), the reason for preparation in glass bottles was unclear as these medications are compatible with either PVC or non-PVC or both. The potential cost savings associated with switching all of the identified medications to IV plastic bags (either non-PVC or PVC) exceeded $200 000. The elimination of glass bottles within the institution resulted in a significant cost saving. The use of FOCUS-PDCA model can help healthcare institution achieve significant improvements in process and realize significant cost savings. © 2016 Royal Pharmaceutical Society.

Applying Quality by Design Concepts to Pharmacy Compounding.

PubMed

Timko, Robert J

2015-01-01

Compounding of medications is an important part of the practice of the pharmacy profession. Because compounded medications do not have U.S. Food and Drug Administration approval, a pharmacist has the responsibility to ensure that compounded medications are of suitable quality, safety, and efficacy. The Federal Government and numerous states have updated their laws and regulations regarding pharmacy compounding as a result of recent quality issues. Compounding pharmacists are expected to follow good preparation prodecures in their compounding practices in much the same way pharmaceutical manufacturers are required to follow Current Good Manufacturing Procedures as detailed in the United States Code of Federal Regulations. Application of Quality by Design concepts to the preparation process for a compounded medication can help in understanding the potential pitfalls and the means to mitigate their impact. The goal is to build quality into the compounding process to ensure that the resultant compounded prescription meets the human or animal patients' requirements.

Practical Tips for Working as an Expedition Doctor on High-Altitude Expeditions.

PubMed

Brants, Anne; Metcalfe, Tracee

2017-09-01

Brants, Anne, and Tracee Metcalfe. Practical tips for working as an expedition doctor on high-altitude expeditions. High Alt Med Biol. 18:193-198, 2017.-With the explosion of adventure travel over the past decade, there has been a concurrent increase in mountaineering expeditions to extreme elevations, including many of the 8000-m peaks. This trend has created an increased demand for qualified expedition doctors to provide specialized medical advice and care to climbers and expedition staff. This review is intended to help physicians prepare for work on such expeditions. The authors rely heavily on their own experience and discuss the types of work available on high-altitude expeditions; how to identify a safe and reputable guiding company; personal and medical preparation; priorities in selecting or building an appropriate medical kit; and medical conditions commonly encountered on expeditions. The review concludes by considering ethical dilemmas and other difficult issues unique to this work.

Development of a health care systems curriculum.

PubMed

Pruitt, Zachary; Mhaskar, Rahul; Kane, Bryan G; Barraco, Robert D; DeWaay, Deborah J; Rosenau, Alex M; Bresnan, Kristin A; Greenberg, Marna Rayl

2017-01-01

There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution. This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created to assess student health system competence. Student evaluation of course curriculum design, delivery, and assessment was provided through web-based surveys. To meet competency standards for system-based practice, a health systems curriculum was developed and delivered across 4 years of medical school training. Each of the health system lectures and problem-based learning activities are described herein. The majority of first and second year medical students stated they gained working knowledge of health systems by engaging in these sessions. The majority of the 2016 graduating students (88.24%) felt that the course content, overall, prepared them for their career. A health systems curriculum in undergraduate medical education using a problem-based learning approach is feasible. The majority of students learning health systems curriculum through this format reported being prepared to improve individual patient care and optimize the health system's value (better care and health for lower cost).

A liberal arts education as preparation for medical school: how is it valued? How do graduates perform?

PubMed

Stratton, Terry D; Elam, Carol L; McGrath, Michael G

2003-10-01

This study examines the utility of a liberal arts education on medical students' preparation and performance. Data included a survey of admission committee members, a preadmission survey of two cohorts of students, and academic performance and extracurricular involvement during medical school. Some admission committee members perceived applicants with liberal arts backgrounds to have certain advantages. These students preferred "discussing issues," and showed an initial preference for the practice of psychiatry. Despite entering with lower total grade-point average and being less involved in extracurricular activities, they were more likely to receive formal commendation and be elected to Alpha Omega Alpha. Although similarities outweigh differences, students with liberal arts backgrounds may benefit from an educational breadth well-suited for practicing the "art of medicine."

A Multidisciplinary Approach to Sexual Dysfunction in Medical Education

ERIC Educational Resources Information Center

Foley, Sallie; Wittmann, Daniela; Balon, Richard

2010-01-01

Objective: Addressing sexual health concerns in medical practice has been an emerging concept for the past two decades. However, there have been very few educational opportunities in medical training that would prepare future physicians for such a responsibility. Since assessing and treating sexual problems requires knowledge that encompasses many…

Prepared for practice? Law teaching and assessment in UK medical schools.

PubMed

Preston-Shoot, Michael; McKimm, Judy

2010-11-01

A revised core curriculum for medical ethics and law in UK medical schools has been published. The General Medical Council requires medical graduates to understand law and ethics and behave in accordance with ethical and legal principles. A parallel policy agenda emphasises accountability, the development of professionalism and patient safety. Given the renewed focus on teaching and learning law alongside medical ethics and the development of professional identity, this survey aimed to identify how medical schools are responding to the preparation of medical students for practice in the future. Questions were asked about the location, content and methods of teaching and assessment of law in undergraduate medical education. Examples of course documentation were requested to illustrate the approaches being taken. A 76% response rate was achieved. Most responding schools integrate law teaching with medical ethics, emphasising both the acquisition of knowledge and its application in a clinical context. Teaching, learning and assessment of law in clinical attachments is much less formalised than that in non-clinical education. Coverage of recommended topic areas varies, raising questions about the degree to which students can embed their knowledge and skills in actual practice. More positively, teaching does not rely on single individuals and clear descriptions were offered for problem-based and small group case-based learning. Further research is required to explore whether there are optimum ways of ensuring that legal knowledge, and skills in its use, form part of the development of professionalism among doctors in training.

Clinical Experience in Advanced Practice Nursing: A Canadian Perspective.

ERIC Educational Resources Information Center

Donnelly, Glenn

2003-01-01

The role of advanced practice (AP) nurses must be clearly articulated and defined and not overshadowed by medical functions. Consensus on their educational preparation and explication of the nature of expertise in advanced practice are needed if AP nurses are to realize the full scope of their practice. (Contains 35 references.) (SK)

Students Learning from Patients: Let's Get Real in Medical Education

ERIC Educational Resources Information Center

Bleakley, Alan; Bligh, John

2008-01-01

Medical students must be prepared for working in inter-professional and multi-disciplinary clinical teams centred on a patient's care pathway. While there has been a good deal of rhetoric surrounding patient-centred medical education, there has been little attempt to conceptualise such a practice beyond the level of describing education of…

Updating medical school psychiatry curricula to meet projected mental health needs.

PubMed

Thomas, Susan; Pai, Nagesh; Dawes, Kerry; Wilson, Coralie; Williams, Virginia

2013-12-01

In view of the growing disease burden of mental disorders, we consider the pressing need to update medical school psychiatry education to better equip doctors to recognise and treat these conditions. Key challenges to the delivery of medical school mental health curricula, and possible directions for reform, are reviewed with the aims of stimulating collaboration and enhancing the efficiency across schools. In Australia, medical school expansion provides opportunities to prepare many training doctors to meet growing mental health care needs. Despite this, published reviews of practice and curriculum models are notably lacking. Australia, unlike other countries, has yet to agree on a core curriculum in medical school psychiatry, with practices varying widely between schools. Curricula should equip doctors to better recognise and treat common mental disorders during early stages, as well as preparing some for specialist psychiatry training. High-quality, multidisciplinary teaching in varied clinical settings may boost teaching resources. Additionally, medical education provides opportunities to better equip doctors to take care of their own mental health. Key challenges are to achieve a consensus on core curricula across Australian medical schools, and an appropriate proportion of medical school curriculum time for mental disorders, relative to their complexity and large disease burden.

Predictors of scoring at least 600 on COMLEX-USA Level 1: successful preparation strategies.

PubMed

Vora, Aditya; Maltezos, Nathan; Alfonzo, Lauren; Hernandez, Nilda; Calix, Erica; Fernandez, M Isabel

2013-02-01

Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 scores are an important criterion used by residency directors to make residency placement decisions. To explore the association between scoring at least 600 on COMLEX-USA Level 1 and grade point average (GPA), scores on the Medical College Admission Test (MCAT), and different test preparation strategies. Third-year osteopathic medical students at Nova Southeastern University were invited to complete a self-administered survey regarding their COMLEX-USA preparation strategies and to provide consent for the researchers to access their preclinical GPA and their MCAT and COMLEX-USA scores. Descriptive analyses were conducted to understand examination preparation procedures and resources used, and bivariate analyses were conducted to identify the statisically significant predictors of scoring 600 or higher. Two separate logistic regressions were also run. The first included all of the statisically significant factors that emerged from the bivariate analyses, and the second examined which candidate predictors remained statistically significant once the effects of GPA and MCAT scores were removed. One hundred twenty-two students completed the survey, and 113 (93%) provided informed consent to access their preclinical GPA and their MCAT and COMLEX-USA scores. In the first regression, scoring 600 or higher was associated with a higher GPA (P<.02), a higher MCAT score (P<.05), earlier preparation initiation (P<.05), and not ranking the Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) as the most helpful practice examination (P<.04). In the second regression, scoring 600 or higher was associated with earlier initiation of examination preparation (P<.01) and not ranking COMBANK (question bank for COMLEX-USA) as the most helpful question bank (P<.03). Among the different examination preparation methods, the specific resources ranked as most helpful were First Aid for the USMLE (United States Medical Licensing Examination) (review book), the COMSAE (practice examination); COMBANK (question bank); and Kaplan USMLE (lecture videos). Preclinical GPA and MCAT scores continue to be important predictors of scoring at least 600 on COMLEX-USA Level 1. However, the findings underscore the importance of maintaining a high GPA during the first 2 years of medical school and initiating COMLEX-USA preparation early.

Medical student preparedness for an era of personalized medicine: findings from one US medical school.

PubMed

Eden, Caroline; Johnson, Kipp W; Gottesman, Omri; Bottinger, Erwin P; Abul-Husn, Noura S

2016-03-01

The objective of this research was to assess medical student preparedness for the use of personalized medicine. A survey instrument measuring attitude toward personalized medicine, perceived knowledge of genomic testing concepts and perceived ability to apply genomics to clinical care was distributed to students in medical school (MS) years 1-4. Of 212 participants, 79% felt that it was important to learn about personalized medicine, but only 6% thought that their medical education had adequately prepared them to practice personalized medicine. Attitude did not vary across years; knowledge and ability increased after MS1, but not after MS2. While medical students support the use of personalized medicine, they do not feel prepared to apply genomics to clinical care.

The case for undergraduate medical education in healthcare business and management.

PubMed

Hsu, Benson S; Hosokawa, Michael C; Maria, Bernard

2007-01-01

Current undergraduate medical education does notprepare students to approach the intricacies of healthcare business. This absence within medical education creates significant challenges for physicians throughout their careers. The field of academic medicine has clearly documented the need for medical education to prepare students for practice management, yet there exist only a small number of attempts at exposing students to healthcare business and management. The authors argue that this curriculum must start at the level ofundergraduate medical education. Furthermore, this curriculum must possess the basic components of support, integration, practicality, application, and continuation. Fulfilling these requirements will allow for the successful adaptation of the healthcare business and management curriculum.

The School Leader Communication Model: An Emerging Method for Bridging School Leader Preparation and Practice

ERIC Educational Resources Information Center

Dotger, Benjamin H.

2011-01-01

School leaders make countless decisions but do not receive adequate preparation for communicating their decisions to parents, students, and teachers. Building on the need to prepare school leaders for a variety of complex professional situations, this article introduces the medical education pedagogy of standardized patients to the field of school…

Improving medical graduates’ training in palliative care: advancing education and practice

PubMed Central

Head, Barbara A; Schapmire, Tara J; Earnshaw, Lori; Chenault, John; Pfeifer, Mark; Sawning, Susan; Shaw, Monica A

2016-01-01

The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients. PMID:26955298

Nurses' experiences and perspectives on medication safety practices: an explorative qualitative study.

PubMed

Smeulers, Marian; Onderwater, Astrid T; van Zwieten, Myra C B; Vermeulen, Hester

2014-04-01

To explore nurses' experiences with and perspectives on preventing medication administration errors. Insight into nurses' experiences with and perspectives on preventing medication administration errors is important and can be utilised to tailor and implement safety practices. A qualitative interview study of 20 nurses in an academic medical centre was conducted between March and December of 2011. Three themes emerged from this study: (1) nurses' roles and responsibilities in medication safety: aside from safe preparation and administration, the clinical reasoning of nurses is essential for medication safety; (2) nurses' ability to work safely: knowledge of risks and nurses' work circumstances influence their ability to work safely; and (3) nurses' acceptance of safety practices: advantages, feasibility and appropriateness are important incentives for acceptance of a safety practice. Nurses' experiences coincide with the assumption that they are in a pre-eminent position to enable safe medication management; however, their ability to adequately perform this role depends on sufficient knowledge to assess the risks of medication administration and on the circumstances in which they work. Safe medication management requires a learning climate and professional practice environment that enables further development of professional nursing skills and knowledge. © 2014 John Wiley & Sons Ltd.

Development of a health care systems curriculum

PubMed Central

Pruitt, Zachary; Mhaskar, Rahul; Kane, Bryan G; Barraco, Robert D; DeWaay, Deborah J; Rosenau, Alex M; Bresnan, Kristin A; Greenberg, Marna Rayl

2017-01-01

Background There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution. Methods This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created to assess student health system competence. Student evaluation of course curriculum design, delivery, and assessment was provided through web-based surveys. Results To meet competency standards for system-based practice, a health systems curriculum was developed and delivered across 4 years of medical school training. Each of the health system lectures and problem-based learning activities are described herein. The majority of first and second year medical students stated they gained working knowledge of health systems by engaging in these sessions. The majority of the 2016 graduating students (88.24%) felt that the course content, overall, prepared them for their career. Conclusion A health systems curriculum in undergraduate medical education using a problem-based learning approach is feasible. The majority of students learning health systems curriculum through this format reported being prepared to improve individual patient care and optimize the health system’s value (better care and health for lower cost). PMID:29138614

A combined intervention to reduce interruptions during medication preparation and double-checking: a pilot-study evaluating the impact of staff training and safety vests.

PubMed

Huckels-Baumgart, Saskia; Niederberger, Milena; Manser, Tanja; Meier, Christoph R; Meyer-Massetti, Carla

2017-10-01

The aim was to evaluate the impact of staff training and wearing safety vests as a combined intervention on interruptions during medication preparation and double-checking. Interruptions and errors during the medication process are common and an important issue for patient safety in the hospital setting. We performed a pre- and post-intervention pilot-study using direct structured observation of 26 nurses preparing and double-checking 431 medication doses (225 pre-intervention and 206 post-intervention) for 36 patients (21 pre-intervention and 15 post-intervention). With staff training and the introduction of safety vests, the interruption rate during medication preparation was reduced from 36.8 to 28.3 interruptions per hour and during double-checking from 27.5 to 15 interruptions per hour. This pilot-study showed that the frequency of interruptions decreased during the critical tasks of medication preparation and double-checking after the introduction of staff training and wearing safety vests as part of a quality improvement process. Nursing management should acknowledge interruptions as an important factor potentially influencing medication safety. Unnecessary interruptions can be successfully reduced by considering human and system factors and increasing both staff and nursing managers' awareness of 'interruptive communication practices' and implementing physical barriers. This is the first pilot-study specifically evaluating the impact of staff training and wearing safety vests on the reduction of interruptions during medication preparation and double-checking. © 2017 John Wiley & Sons Ltd.

Primary care training and the evolving healthcare system.

PubMed

Peccoralo, Lauren A; Callahan, Kathryn; Stark, Rachel; DeCherrie, Linda V

2012-01-01

With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians. © 2012 Mount Sinai School of Medicine.

Improving the transition from medical school to internship - evaluation of a preparation for internship course.

PubMed

Scicluna, Helen A; Grimm, Michael C; Jones, Philip D; Pilotto, Louis S; McNeil, H Patrick

2014-02-03

This study evaluates the impact of a new 'Preparation for Internship' (PRINT) course, which was developed to facilitate the transition of University of New South Wales (UNSW) medical graduates from Medical School to Internship. During a period of major curricular reform, the 2007 (old program) and 2009 (new program) cohorts of UNSW final year students completed the Clinical Capability Questionnaire (CCQ) prior to and after undertaking the PRINT course. Clinical supervisors' ratings and self-ratings of UNSW 2009 medical graduates were obtained from the Hospital-based Prevocational Progress Review Form. Prior to PRINT, students from both cohorts perceived they had good clinical skills, with lower ratings for capability in procedural skills, operational management, and administrative tasks. After completing PRINT, students from both cohorts perceived significant improvement in their capability in procedural skills, operational management, and administrative tasks. Although PRINT also improved student-perceived capability in confidence, interpersonal skills and collaboration in both cohorts, curriculum reform to a new outcomes-based program was far more influential in improving self-perceptions in these facets of preparedness for hospital practice than PRINT. The PRINT course was most effective in improving students' perceptions of their capability in procedural skills, operational management and administrative tasks, indicating that student-to-intern transition courses should be clinically orientated, address relevant skills, use experiential learning, and focus on practical tasks. Other aspects that are important in preparation of medical students for hospital practice cannot be addressed in a PRINT course, but major improvements are achievable by program-wide curriculum reform.

Improving the transition from medical school to internship – evaluation of a preparation for internship course

PubMed Central

2014-01-01

Background This study evaluates the impact of a new 'Preparation for Internship’ (PRINT) course, which was developed to facilitate the transition of University of New South Wales (UNSW) medical graduates from Medical School to Internship. Methods During a period of major curricular reform, the 2007 (old program) and 2009 (new program) cohorts of UNSW final year students completed the Clinical Capability Questionnaire (CCQ) prior to and after undertaking the PRINT course. Clinical supervisors’ ratings and self-ratings of UNSW 2009 medical graduates were obtained from the Hospital-based Prevocational Progress Review Form. Results Prior to PRINT, students from both cohorts perceived they had good clinical skills, with lower ratings for capability in procedural skills, operational management, and administrative tasks. After completing PRINT, students from both cohorts perceived significant improvement in their capability in procedural skills, operational management, and administrative tasks. Although PRINT also improved student-perceived capability in confidence, interpersonal skills and collaboration in both cohorts, curriculum reform to a new outcomes-based program was far more influential in improving self-perceptions in these facets of preparedness for hospital practice than PRINT. Conclusions The PRINT course was most effective in improving students’ perceptions of their capability in procedural skills, operational management and administrative tasks, indicating that student-to-intern transition courses should be clinically orientated, address relevant skills, use experiential learning, and focus on practical tasks. Other aspects that are important in preparation of medical students for hospital practice cannot be addressed in a PRINT course, but major improvements are achievable by program-wide curriculum reform. PMID:24485072

Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

PubMed

Metz, Anneke M

2017-01-01

Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U.S. physician diversity and practice within underserved communities. MEDPREP recruits disadvantaged and underrepresented in medicine students to complete a 2-year academic enhancement program that includes science coursework, standardized test preparation, study/time management training, and emphasis on professional development. Five hundred twenty-five disadvantaged or underrepresented students over 15 years completed MEDPREP and were tracked through entry into medical practice. MEDPREP accepts up to 36 students per year, with two thirds coming from the Midwest region and another 20% from nearby states in the South. Students complete science, test preparation, academic enhancement, and professionalism coursework taught predominantly by MEDPREP faculty on the Southern Illinois University Carbondale campus. Students apply broadly to medical schools in the region and nation but are also offered direct entry into our School of Medicine upon meeting articulation program requirements. Seventy-nine percent of students completing MEDPREP became practicing physicians. Fifty-eight percent attended public medical schools, and 62% attended medical schools in the Midwest. Fifty-three percent of program alumni chose primary care specialties compared to 34% of U.S. physicians, and MEDPREP alumni were 2.7 times more likely to work in medically underserved areas than physicians nationally. MEDPREP increases the number of disadvantaged and underrepresented students entering and graduating from medical school, choosing primary care specialties, and working in medically underserved areas. MEDPREP may therefore serve as a model for increasing physician diversity and addressing the needs of medically underserved communities.

Medical Discrimination against Children with Disabilities. A Report of the U.S. Commission on Civil Rights.

ERIC Educational Resources Information Center

Commission on Civil Rights, Washington, DC.

This report, prepared pursuant to Public Law 98-183 (Child Abuse Amendments of 1984), examines the nature and extent of the practice of withholding medical treatment or nourishment from infants born with disabilities and makes recommendations to remedy deficiencies in existing law. Evidence suggests that decisions to withhold medically indicated…

Perception of Preparedness for Clinical Work Among New Residents: A Cross-sectional Study from Oman

PubMed Central

Al Sinawi, Hamed; Al Alawi, Mohammed; Al Qubtan, Ali; Al Lawati, Jaber; Al Habsi, Assad; Jose, Sachin

2017-01-01

Objectives To evaluate new residents’ perceptions of their own preparedness for clinical practice and examine the associated factors. Methods This is a cross-sectional study conducted on August 20−23, 2016. New residents accepted for postgraduate training by Oman Medical Specialty Board were asked to complete the Preparation for Hospital Practice Questionnaire (PHPQ). Data was analyzed using the Statistical Package for the Social Sciences version 22. Results A total of 160 residents were invited to participate in this study. Out of 160, 140 residents participated (87.5%), 70.7% were female and 59.3% were graduates from Sultan Qaboos University (SQU). Ninety-nine percent of the graduates were either ‘well prepared’ or ‘fairly well prepared’ for hospital practice. Male residents scored higher in the confidence scale, while residents who did a post-internship general practice placement scored higher in understanding science. Graduates from Oman Medical College felt more prepared compared to graduates from SQU. Conclusions Most of the new residents were well prepared to clinical work. Factors such as place of undergraduate study, training, and duration of internship significantly influenced the residents’ perception of preparedness. Addressing these factors will enhance residents’ preparedness for clinical work. PMID:28584600

A national survey to define a new core curriculum to prepare physicians for managed care practice.

PubMed

Meyer, G S; Potter, A; Gary, N

1997-08-01

All levels of medical education will require modification to address the challenges in health care practice brought about by managed care. Because preparation for practice in a managed care environment has received insufficient attention, and because the need for change is so great, in 1995 the authors sought information from a variety of sources to serve as a basis for identifying the core curricular components and the staging of these components in the medical education process. This research effort consisted of a survey of 125 U.S. medical school curriculum deans (or equivalent school representatives); four focus groups of managed care practitioners, administrators, educators, and residents; and a survey of a national sample of physicians and medical directors. Findings indicate that almost all the 91 responding school representatives recognized the importance of revising their curricula to meet the managed care challenge and that the majority either had or were developing programs to train students for practice in managed care environments. The focus groups identified a core set of competencies for managed care practice, although numbers differed on whether the classroom or a managed care setting was the best place to teach the components of a new curriculum. Although medical directors and staff physicians differed with respect to the relative levels of importance of these competencies, the findings suggest that before medical school, training should focus on communication and interpersonal skills, information systems, and customer relations; during medical school, on clinical epidemiology, quality assurance, risk management, and decision analysis; during residency, on utilization management, managed care essentials, and multidisciplinary team building; and after residency, on a review of customer relations, communication skills, and utilization management. The authors conclude that a core curriculum and its sequencing can be identified, that the majority of curricular components exist but in s some cases needed to be modified to more clearly relate to managed care practice, and that their findings may provide a useful starting point for making decisions about curricular reform.

Using simulation to prepare for clinical practice.

PubMed

Morgan, James; Green, Victoria; Blair, John

2018-02-01

A significant proportion of medical students feel underprepared for clinical practice, especially in skills such as decision making, prioritisation and prescribing. Changes to medical curricula, including assistantships and shadowing, provide supervised practise, but students remain unable to fully take responsibility for patient care. Simulation may assist in addressing this deficit. A simulation course entitled 'Simulated ward round and professional skills' (SWAPS) was developed to improve student preparation for clinical practice. Preliminary work surveyed 22 foundation doctors to identify perceived areas of weakness and to guide the learning outcomes of the course. Following the design and development of the course, 133 final-year medical students were observed completing a 60-minute simulation scenario aimed at providing experiential learning in a ward environment, reflecting professional practice. Students received structured feedback and completed pre- and post-course questionnaires to evaluate changes in confidence over the learning domains. Qualitative feedback was also collected. A significant proportion of medical students feel underprepared for clinical practice RESULTS: The p values were significant in all assessed domains, indicating a perceived improvement in confidence following the SWAPS course. Qualitative feedback highlighted the perceived utility of the course in exposing students to clinical ward-based scenarios infrequently encountered in their medical curriculum. Students praised the personal feedback received and realism of the simulation. This paper contributes to the growing body of literature supporting the use of simulation to replicate a ward round and the daily roles of a junior doctor. The SWAPS course seems to empower students to take responsibility for clinical decision making and experience some of the realities of foundation training in a simulated setting. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Medical student preparedness for an era of personalized medicine: findings from one US medical school

PubMed Central

Eden, Caroline; Johnson, Kipp W; Gottesman, Omri; Bottinger, Erwin P; Abul-Husn, Noura S

2016-01-01

Aim The objective of this research was to assess medical student preparedness for the use of personalized medicine. Materials & methods A survey instrument measuring attitude toward personalized medicine, perceived knowledge of genomic testing concepts and perceived ability to apply genomics to clinical care was distributed to students in medical school (MS) years 1–4. Results Of 212 participants, 79% felt that it was important to learn about personalized medicine, but only 6% thought that their medical education had adequately prepared them to practice personalized medicine. Attitude did not vary across years; knowledge and ability increased after MS1, but not after MS2. Conclusion While medical students support the use of personalized medicine, they do not feel prepared to apply genomics to clinical care. PMID:27528879

Code of Practice for Scientific Diving: Principles for the Safe Practice of Scientific Diving in Different Environments. Unesco Technical Papers in Marine Science 53.

ERIC Educational Resources Information Center

Flemming, N. C., Ed.; Max, M. D., Ed.

This publication has been prepared to provide scientific divers with guidance on safe practice under varying experimental and environmental conditions. The Code offers advice and recommendations on administrative practices, insurance, terms of employment, medical standards, training standards, dive planning, safety with different breathing gases…

The world as the new local clinic: a critical analysis of three discourses of global medical competency.

PubMed

Martimianakis, Maria Athina Tina; Hafferty, Frederic W

2013-06-01

The effects of globalization on health are the focus of administrators, educators, policy makers and researchers as they work to consider how best to train and regulate health professionals to practice in a globalized world. This study explores what happens to constructs such as medical competence when the context of medical practice is discursively expanded to include the whole world. An archive of texts was assembled (1970-2011) totaling 1100 items and analyzed using a governmentality approach. Texts were included that articulated rationales for pursuing global education activities, and/or that implicitly or explicitly took a position on medical competencies in relation to practicing medicine in international or culturally diverse contexts, or in dealing with health issues as global concerns. The analysis revealed three distinct visions, representative of a primarily western mentality, for preparing physicians to practice in a globalized world: the universal global physician, the culturally versed global physician and the global physician advocate. Each has its own epistemological relationship to globalization and is supported by an evidence base. All three discourses are active and productive, sometimes within the same context. However, the discourse of the universal global physician is currently the most established. The challenge to policy makers and educators in evolving regulatory frameworks and curricula that are current and relevant necessitates a better understanding of the socio-political effects of globalization on medical education, and the ethical, political, cultural and scientific issues underlying efforts to prepare students to practice competently in a globalized world. Copyright © 2013 Elsevier Ltd. All rights reserved.

Medical emergencies in the dental surgery. Part 1: Preparation of the office and basic management.

PubMed

Malamed, Stanley F

2015-12-01

Medical emergencies can and do happen in the dental surgery. In the 20- to 30-year practice lifetime of the typical dentist, he/she will encounter between five and seven emergency situations. Being prepared in advance of the emergency increases the likelihood of a successful outcome. PURPOSE OF THE PAPER: To prepare members of the dental office staff to be able to promptly recognize and efficiently manage those medical emergency situations that can occur in the dental office environment. Preparation of the dental office to promptly recognize and efficiently manage medical emergencies is predicated on successful implementation of the following four steps: basic life support for ALL members of the dental office staff; creation of a dental office emergency team; activation of emergency medial services (EMS) when indicated; and basic emergency drugs and equipment. The basic emergency algorithm (P->C->A->B->D) is designed for implementation in all emergency situations. Prompt implementation of the basic emergency management protocol can significantly increase the likelihood of a successful result when medical emergencies occur in the dental office environment.

The role of medical education in the development of the scientific practice of medicine.

PubMed

Cardinal, Lucien; Kaell, Alan

2017-01-01

The authors describe the important role of medical schools and graduate medical education programs (residencies) in relationship to the advances in Medicine witnessed during the twentieth century; diagnosis, prognosis and treatment were revolutionized. This historical essay details the evolution of the education system and the successful struggle to introduce a uniform, science-based curriculum and bedside education. The result was successive generations of soundly educated physicians prepared with a broad knowledge in science, an understanding of laboratory methods and the ability to practice medicine at the bedside. These changes in medical education created a foundation for the advancement of medicine.

Education for Rural Practice: A Saga of Pipelines and Plumbers. Commentary.

ERIC Educational Resources Information Center

Norris, Thomas E.

2000-01-01

Current efforts to address the severe and worsening shortage of rural physicians include attracting and preparing rural students for medical school, enhancing medical school curricula, and placing and retaining rural physicians. Recommendations include creating incentives for successful rural training programs, encouraging innovation in rural…

Looking at Graduate Medical Education Through a Different Lens: A Health Care System's Perspective.

PubMed

Roemer, Beth M; Azevedo, Theresa; Blumberg, Bruce

2015-09-01

In the era of the accountable care organization, U.S. models of physician practice are shifting from the solo, independent practitioner to the physician who is part of a multispecialty group practice or is employed by a health care institution, and from paper-based small offices to practice settings that emphasize technology-enabled, team-based systems of care. In this light, Kaiser Permanente's (KP's) long experience as an integrated, population-based health care delivery system makes it an increasingly relevant model in which to consider how graduate medical education (GME) can best prepare physicians for 21st-century health care. KP's multiple perspectives-as a GME setting, a health care delivery system, a health research enterprise, a community benefit organization, and the nation's largest private, multispecialty group practice of physicians-provide a multifaceted opportunity to consider GME in the context of health care transformation. The authors suggest that all participants in medical education have a role to play in preparing physicians for this future. They recommend that partnerships between universities and health care delivery systems serve as a highly effective model for education; that to better serve the needs of society, medical education institutions must adopt a broad community benefit mindset; and that, when medical groups and other institutions that employ physicians take the baton from GME, they need to commit to ongoing development and lifelong learning to enable their new physicians to reach their full potential.

Outbreak of Pantoea agglomerans Bloodstream Infections at an Oncology Clinic-Illinois, 2012-2013.

PubMed

Yablon, Brian R; Dantes, Raymund; Tsai, Victoria; Lim, Rachel; Moulton-Meissner, Heather; Arduino, Matthew; Jensen, Bette; Patel, Megan Toth; Vernon, Michael O; Grant-Greene, Yoran; Christiansen, Demian; Conover, Craig; Kallen, Alexander; Guh, Alice Y

2017-03-01

OBJECTIVE To determine the source of a healthcare-associated outbreak of Pantoea agglomerans bloodstream infections. DESIGN Epidemiologic investigation of the outbreak. SETTING Oncology clinic (clinic A). METHODS Cases were defined as Pantoea isolation from blood or catheter tip cultures of clinic A patients during July 2012-May 2013. Clinic A medical charts and laboratory records were reviewed; infection prevention practices and the facility's water system were evaluated. Environmental samples were collected for culture. Clinical and environmental P. agglomerans isolates were compared using pulsed-field gel electrophoresis. RESULTS Twelve cases were identified; median (range) age was 65 (41-78) years. All patients had malignant tumors and had received infusions at clinic A. Deficiencies in parenteral medication preparation and handling were identified (eg, placing infusates near sinks with potential for splash-back contamination). Facility inspection revealed substantial dead-end water piping and inadequate chlorine residual in tap water from multiple sinks, including the pharmacy clean room sink. P. agglomerans was isolated from composite surface swabs of 7 sinks and an ice machine; the pharmacy clean room sink isolate was indistinguishable by pulsed-field gel electrophoresis from 7 of 9 available patient isolates. CONCLUSIONS Exposure of locally prepared infusates to a contaminated pharmacy sink caused the outbreak. Improvements in parenteral medication preparation, including moving chemotherapy preparation offsite, along with terminal sink cleaning and water system remediation ended the outbreak. Greater awareness of recommended medication preparation and handling practices as well as further efforts to better define the contribution of contaminated sinks and plumbing deficiencies to healthcare-associated infections are needed. Infect Control Hosp Epidemiol 2017;38:314-319.

Nursing and Medication Education: Concept Analysis Research for Curriculum and Practice Development. Researching Professional Education Research Report Series.

ERIC Educational Resources Information Center

Latter, Sue; Yerrell, Paul; Rycroft-Malone, Jo; Shaw, David

The knowledge needed by nurses to educate patients and their caregivers on medication use was examined to provide policymakers, practitioners, and others with the information needed to plan nursing education programs in England. The study focused on the following topics: the contributions of nurses to medication education; their preparation for…

Networking in medical education: creating and connecting.

PubMed

Supe, Avinash N

2008-03-01

Social networking is being increasingly used as a tool of choice for communications and collaborations in business and higher education. Learning and practice become inseparable when professionals work in communities of practice that create interpersonal bonds and promote collective learning. Individual learning that arises from the critical reconstruction of practice, in the presence of peers and other health professionals, enhances a physician's capability of clinical judgment and evidence-based practice. As such, it would be wise for medical schools, whose responsibility it is to prepare students to make a transition to adult life with the skills they need to succeed in both arenas, to reckon with it.

Moving Beyond the Theoretical: Medical Students' Desire for Practical, Role-Specific Ethics Training.

PubMed

Stites, Shana D; Clapp, Justin; Gallagher, Stefanie; Fiester, Autumn

2018-05-04

Background It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this most U.S. medical schools include ethics curricula in their undergraduate programs. However, the content of these curricula vary substantially. Our pilot study aimed to discover, from the students' perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain. This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences. While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education. We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension to act on ethical concerns.

Core Pedagogy: Individual Uncertainty, Shared Practice, Formative Ethos

ERIC Educational Resources Information Center

Dotger, Benjamin H.

2015-01-01

Attention to the core practices of teaching necessitates core pedagogies in teacher preparation. This article outlines the diffusion of one such pedagogy from medical to teacher education. The concept of clinical simulations is outlined through the lens of "signature pedagogies" and their uncertain, engaging, formative qualities.…

The future of practical skills in undergraduate medical education – an explorative Delphi-Study

PubMed Central

Dannenberg, Katja Anne; Stroben, Fabian; Schröder, Therese; Thomas, Anke; Hautz, Wolf E.

2016-01-01

Background: 64% of young medical professionals in Germany do not feel adequately prepared for the practical requirements of the medical profession. The goal of “outcome-orientated training” is to structure medical curricula based on the skills needed when entering the workforce after completing undergraduate medical education, and thus to bridge the gap between the skills graduates have attained and those necessary for a career in the medical profession. Outcome frameworks (OFs) are used for this purpose. In preparation for developing the National Competence-Based Catalogue of Learning Objectives for Medicine (NKLM) – the German OF – the “Consensus Statement of Practical Skills in Undergraduate Medical Education” (which structures the teaching and acquisition of practical skills in Germany and which strongly influenced the “Clinical-Practical Skills” chapter of the NKLM) was published in 2011. It is not uncommon for at least a decade to elapse between the definition and implementation of an OF and the students’ graduation, which can further increase the gap between necessary and acquired skills. Thus, the purpose of this paper is to posit theses for future development in healthcare and to apply these theses to a current OF. Methodology: Partially structured interviews with experts were used to generate theses pertaining to general, future development in healthcare. These theses were assessed by physician experts based on the likelihood of implementation by the year 2025. The 288 learning goals of the consensus statement were assessed for their relevance for medical education in the interim. Results: 11 theses were generated for the development of medicine, and these theses were assessed and discussed by 738 experts. These theses include the increase in diseases associated with old age, the increasing significance of interprofessional cooperation, and the growing prevalence of telemedicine applications. Of the 288 learning goals of the consensus statement, 231 of the goals were assessed as relevant, and 57 were deemed irrelevant for the short-term future. Discussion: The theses on the future of healthcare, which were generated in this study and which were validated by numerous experts, provide indications of future developments of overall requirements for medical school graduates. For example, when applied to the content of the “Clinical-Practical Skills” NKLM chapter, they largely validate the future relevance of developing practical skills while also providing indications for their further development as applied to the consensus statement. PMID:27579362

The future of practical skills in undergraduate medical education - an explorative Delphi-Study.

PubMed

Dannenberg, Katja Anne; Stroben, Fabian; Schröder, Therese; Thomas, Anke; Hautz, Wolf E

2016-01-01

64% of young medical professionals in Germany do not feel adequately prepared for the practical requirements of the medical profession. The goal of "outcome-orientated training" is to structure medical curricula based on the skills needed when entering the workforce after completing undergraduate medical education, and thus to bridge the gap between the skills graduates have attained and those necessary for a career in the medical profession. Outcome frameworks (OFs) are used for this purpose. In preparation for developing the National Competence-Based Catalogue of Learning Objectives for Medicine (NKLM) - the German OF - the "Consensus Statement of Practical Skills in Undergraduate Medical Education" (which structures the teaching and acquisition of practical skills in Germany and which strongly influenced the "Clinical-Practical Skills" chapter of the NKLM) was published in 2011. It is not uncommon for at least a decade to elapse between the definition and implementation of an OF and the students' graduation, which can further increase the gap between necessary and acquired skills. Thus, the purpose of this paper is to posit theses for future development in healthcare and to apply these theses to a current OF. Partially structured interviews with experts were used to generate theses pertaining to general, future development in healthcare. These theses were assessed by physician experts based on the likelihood of implementation by the year 2025. The 288 learning goals of the consensus statement were assessed for their relevance for medical education in the interim. 11 theses were generated for the development of medicine, and these theses were assessed and discussed by 738 experts. These theses include the increase in diseases associated with old age, the increasing significance of interprofessional cooperation, and the growing prevalence of telemedicine applications. Of the 288 learning goals of the consensus statement, 231 of the goals were assessed as relevant, and 57 were deemed irrelevant for the short-term future. The theses on the future of healthcare, which were generated in this study and which were validated by numerous experts, provide indications of future developments of overall requirements for medical school graduates. For example, when applied to the content of the "Clinical-Practical Skills" NKLM chapter, they largely validate the future relevance of developing practical skills while also providing indications for their further development as applied to the consensus statement.

Medical Assisting. Secondary Level Curriculum.

ERIC Educational Resources Information Center

New York City Board of Education, Brooklyn, NY. Office of Occupational and Career Education.

This curriculum guide is intended to prepare students for entry-level employment in the health care industry. The two-year program, designed to be used in high schools in New York City, will prepare students to assist in various health career settings such as doctors' offices, hospital clinics, and group practice facilities. The curriculum guide,…

Medical education, global health and travel medicine: a modern student's experience.

PubMed

Tissingh, Elizabeth Khadija

2009-01-01

Today's medical student will practice medicine in a globalised world, where an understanding of travel medicine and global health will be vital. Students at UK medical schools are keen to learn more about these areas and yet receive little specific training. Tomorrow's doctors should be taught about global health and travel medicine if they are to be prepared to work in tomorrow's world.

Nursing Principles & Skills. Teacher Edition.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This curriculum guide contains 14 units for a course on nursing principles and skills needed by practical nurses. The 14 units of instruction cover the following: (1) using medical terminology; (2) practicing safety procedures; (3) using the nursing process for care planning; (4) using infection control techniques; (5) preparing a patient…

What is the impact of commercial test preparation courses on medical examination performance?

PubMed

McGaghie, William C; Downing, Steven M; Kubilius, Ramune

2004-01-01

Commercial test preparation courses are part of the fabric of U.S. medical education. They are also big business with 2,000 sales for 1 firm listed at nearly $250 million. This article systematically reviews and evaluates research published in peer-reviewed journals and in the "grey literature" that addresses the impact of commercial test preparation courses on standardized, undergraduate medical examinations. Thirteen computerized English language databases were searched using 29 search terms and search concepts from their onset to October 1, 2002. Also manually searched was medical education conference proceedings and publications after the end date; and medical education journal editors were contacted about articles accepted for publication, but not yet in print, that were deemed pertinent to this review. Studies that met three criteria were selected: (a) a commercial test preparation course or service was an educational intervention, (b) the outcome variable was one of several standardized medical examinations, and (c) results are published in a peer-reviewed journal or another outlet that insures scholarly scrutiny. The criteria were applied and data extracted by consensus of 2 reviewers. The search identified 11 empirical studies, of which 10 (8 journal articles, 2 unpublished reports) are included in this review. Qualitative data synthesis and tabular presentation of research methods and outcomes are used. The articles and unpublished reports reveal that current research lacks control and rigor; the incremental validity of the commercial courses on medical examination performance, if any, is extremely small; and evidence in support of the courses is weak or nonexistent; almost no details are given about the form and conduct of the commercial test preparation courses; studies are confined to courses in preparation for the Medical College Admission Test, the former National Board of Medical Examiners Part 1, and the United States Medical Licensing Examination Step 1, not tests of clinical science; and that cost-benefit analyses of the test preparation courses have not been done. It is concluded that the utility and value of commercial test preparation courses in medicine have not been demonstrated, and that evaluation apprehension in the medical profession and aggressive marketing practices are most likely responsible for commercial course prosperity.

Platelet-rich preparations to improve healing. Part I: workable options for every size practice.

PubMed

Davis, Vicki L; Abukabda, Alaeddin B; Radio, Nicholas M; Witt-Enderby, Paula A; Clafshenkel, William P; Cairone, J Vito; Rutkowski, James L

2014-08-01

Numerous studies have demonstrated that platelet-rich preparations applied to surgical sites, injuries, or wounds are a safe and effective way to promote soft tissue healing and bone growth. Various protocols have been developed for preparing platelet-rich preparations, with subtle but important differences between them. Unfortunately, only a minority of clinicians use platelet-rich preparations, such as platelet-rich plasma and platelet-rich fibrin, in their practice, possibly due to confusion about the different methods and their advantages and disadvantages. Therefore, the different types of preparations are described to help guide the selection of the best method for any size practice. Classic methods generally require large volumes of blood and can be expensive, complicated, and time-intensive. Simpler protocols have been developed recently, which require relatively inexpensive equipment and small blood volumes and, thus, may be more applicable for small clinical practices. Platelet-rich preparations accelerate healing at earlier time points to reduce discomfort and the potential for adverse outcomes, including infection, poor wound closure, and delays in forming strong bone for subsequent procedures (such as implants). However, platelet-rich preparations may also improve long-term outcomes in patients expected to have impaired healing, such as with lifestyle choices (eg, smoking), medications (eg, steroids), diseases (eg, diabetes, osteoporosis, atherosclerosis), and aging, by supplementing the deficient wound environment to restore proper healing. Therefore, both large and small clinical practices would benefit from utilizing platelet-rich preparations to enhance healing in their patients.

An Elective Pharmaceutical Care Course to Prepare Students for an Advanced Pharmacy Practice Experience in Kenya

PubMed Central

Miller, Monica L.; Ogallo, William; Pastakia, Sonak D.

2013-01-01

Objective. To develop a prerequisite elective course to prepare students for an advanced pharmacy practice experience (APPE) in Kenya. Design. The course addressed Kenyan culture, travel preparation, patient care, and disease-state management. Instructional formats used were small-group discussions and lectures, including some Web-based presentations by Kenyan pharmacists on disease states commonly treated in Kenya. Cultural activities include instruction in conversational and medical Kiswahili and reading of a novel related to global health programs. Assessment. Student performance was assessed using written care plans, quizzes, reflection papers, a formulary management exercise, and pre- and post-course assessments. Student feedback on course evaluations indicated that the course was well received and students felt prepared for the APPE. Conclusion. This course offered a unique opportunity for students to learn about pharmacy practice in global health and to apply previously acquired skills in a resource-constrained international setting. It prepares students to actively participate in clinical care activities during an international APPE. PMID:23610478

Transition to surgical residency: a multi-institutional study of perceived intern preparedness and the effect of a formal residency preparatory course in the fourth year of medical school.

PubMed

Minter, Rebecca M; Amos, Keith D; Bentz, Michael L; Blair, Patrice Gabler; Brandt, Christopher; D'Cunha, Jonathan; Davis, Elisabeth; Delman, Keith A; Deutsch, Ellen S; Divino, Celia; Kingsley, Darra; Klingensmith, Mary; Meterissian, Sarkis; Sachdeva, Ajit K; Terhune, Kyla; Termuhlen, Paula M; Mullan, Patricia B

2015-08-01

To evaluate interns' perceived preparedness for defined surgical residency responsibilities and to determine whether fourth-year medical school (M4) preparatory courses ("bootcamps") facilitate transition to internship. The authors conducted a multi-institutional, mixed-methods study (June 2009) evaluating interns from 11 U.S. and Canadian surgery residency programs. Interns completed structured surveys and answered open-ended reflective questions about their preparedness for their surgery internship. Analyses include t tests comparing ratings of interns who had and had not participated in formal internship preparation programs. The authors calculated Cohen d for effect size and used grounded theory to identify themes in the interns' reflections. Of 221 eligible interns, 158 (71.5%) participated. Interns self-reported only moderate preparation for most defined care responsibilities in the medical knowledge and patient care domains but, overall, felt well prepared in the professionalism, interpersonal communication, practice-based learning, and systems-based practice domains. Interns who participated in M4 preparatory curricula had higher self-assessed ratings of surgical technical skills, professionalism, interpersonal communication skills, and overall preparation, at statistically significant levels (P < .05) with medium effect sizes. Themes identified in interns' characterizations of their greatest internship challenges included anxiety or lack of preparation related to performance of technical skills or procedures, managing simultaneous demands, being first responders for critically ill patients, clinical management of predictable postoperative conditions, and difficult communications. Entering surgical residency, interns report not feeling prepared to fulfill common clinical and professional responsibilities. As M4 curricula may enhance preparation, programs facilitating transition to residency should be developed and evaluated.

Student-directed retrieval practice is a predictor of medical licensing examination performance.

PubMed

Deng, Francis; Gluckstein, Jeffrey A; Larsen, Douglas P

2015-12-01

A large body of evidence indicates that retrieval practice (test-enhanced learning) and spaced repetition increase long-term information retention. Implementation of these strategies in medical curricula is unfortunately limited. However, students may choose to apply them autonomously when preparing for high-stakes, cumulative assessments, such as the United States Medical Licensing Examination Step 1. We examined the prevalence of specific self-directed methods of testing, with or without spaced repetition, among preclinical students and assessed the relationship between these methods and licensing examination performance. Seventy-two medical students at one institution completed a survey concerning their use of user-generated (Anki) or commercially-available (Firecracker) flashcards intended for spaced repetition and of boards-style multiple-choice questions (MCQs). Other information collected included Step 1 score, past academic performance (Medical College Admission Test [MCAT] score, preclinical grades), and psychological factors that may have affected exam preparation or performance (feelings of depression, burnout, and test anxiety). All students reported using practice MCQs (mean 3870, SD 1472). Anki and Firecracker users comprised 31 and 49 % of respondents, respectively. In a multivariate regression model, significant independent predictors of Step 1 score included MCQs completed (unstandardized beta coefficient [B] = 2.2 × 10 - 3 , p < 0.001), unique Anki flashcards seen (B = 5.9 × 10 - 4 , p = 0.024), second-year honours (B = 1.198, p = 0.002), and MCAT score (B = 1.078, p = 0.003). Test anxiety was a significant negative predictor (B= - 1.986, p < 0.001). Unique Firecracker flashcards seen did not predict Step 1 score. Each additional 445 boards-style practice questions or 1700 unique Anki flashcards was associated with an additional point on Step 1 when controlling for other academic and psychological factors. Medical students engage extensively in self-initiated retrieval practice, often with spaced repetition. These practices are associated with superior performance on a medical licensing examination and should be considered for formal support by educators.

Transforming primary care training--patient-centered medical home entrustable professional activities for internal medicine residents.

PubMed

Chang, Anna; Bowen, Judith L; Buranosky, Raquel A; Frankel, Richard M; Ghosh, Nivedita; Rosenblum, Michael J; Thompson, Sara; Green, Michael L

2013-06-01

The U.S. faces a critical gap between residency training and clinical practice that affects the recruitment and preparation of internal medicine residents for primary care careers. The patient-centered medical home (PCMH) represents a new clinical microsystem that is being widely promoted and implemented to improve access, quality, and sustainability in primary care practice. We address two key questions regarding the training of internal medicine residents for practice in PCMHs. First, what are the educational implications of practice transformations to primary care home models? Second, what must we do differently to prepare internal medicine residents for their futures in PCMHs? The 2011 Society of General Internal Medicine (SGIM) PCMH Education Summit established seven work groups to address the following topics: resident workplace competencies, teamwork, continuity of care, assessment, faculty development, 'medical home builder' tools, and policy. The output from the competency work group was foundational for the work of other groups. The work group considered several educational frameworks, including developmental milestones, competencies, and entrustable professional activities (EPAs). The competency work group defined 25 internal medicine resident PCMH EPAs. The 2011 National Committee for Quality Assurance (NCQA) PCMH standards served as an organizing framework for EPAs. The list of PCMH EPAs has the potential to begin to transform the education of internal medicine residents for practice and leadership in the PCMH. It will guide curriculum development, learner assessment, and clinical practice redesign for academic health centers.

Nutrition in Medicine: Nutrition Education for Medical Students and Residents

PubMed Central

Adams, Kelly M.; Kohlmeier, Martin; Powell, Margo; Zeisel, Steven H.

2015-01-01

Proper nutrition plays a key role in disease prevention and treatment. Many patients understand this link and look to physicians for guidance diet and physical activity. Actual physician practice, however, is often inadequate in addressing the nutrition aspects of diseases such as cancer, obesity, and diabetes. Physicians do not feel comfortable, confident, or adequately prepared to provide nutrition counseling, which may be related to suboptimal knowledge of basic nutrition science facts and understanding of potential nutrition interventions. Historically, nutrition education has been underrepresented at many medical schools and residency programs. Our surveys over a decade show that most medical schools in the United States are still not ensuring adequate nutrition education, and they are not producing graduates with the nutrition competencies required in medical practice. Physicians, residents, and medical students clearly need more training in nutrition assessment and intervention. The Nutrition in Medicine (NIM) project, established to develop and distribute a core nutrition curriculum for medical students, offers a comprehensive online set of courses free of charge to medical schools. The NIM medical school curriculum is widely used in the United States and abroad. A new initiative, Nutrition Education for Practicing Physicians, offers an innovative online medical nutrition education program for residents and other physicians-in-training, but with targeted, practice-based educational units designed to be completed in 15 minutes or less. The NIM project is strengthening medical nutrition practice by providing a free, comprehensive, online nutrition curriculum with clinically relevant, evidence-based medical education for undergraduate and postgraduate learners. PMID:20962306

Neurological Basis and Potential Modification of Emotional Intelligence through Affective/Behavioral Training

DTIC Science & Technology

2014-12-01

December 2014 TYPE OF REPORT: Final PREPARED FOR: U.S. Army Medical Research and Material Command Fort Detrick, Maryland...9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Research and Materiel Command...healthy adults (31 men), ranging in age from 18-50 years, were also queried about their practice of medication . The sample included 28 individuals who

A Call for Innovation: Reflective Practices and Clinical Curricula of US Army Special Operations Forces Medics.

PubMed

Rocklein, Kate

2014-01-01

Special Operations Forces (SOF) medics have written and published numerous practice reflections that intricately describe their practice environments, clinical dilemmas, and suggestions for teaching and practice. The lack of translation of SOF medics experiential evidence to their curriculum has created a gap in evidence-based curriculum development. This study analyzed SOF medics learning and practice patterns and compared it to the evidence in the interdisciplinary clinical literature. After framing the problem, the literature was reviewed to determine appropriate tools by which perceptions and attitudes toward reflection-centered curricula could be measured. A recognizable practice reflection was extracted from the published SOF clinical literature and presented in writing to self-identified SOF medics and medic instructors via a descriptive crossover design, to ensure possible biases were mitigated. To measure SOF medics perceptions of reflection-based curricula, the Dundee Ready Education Environment Measure survey instrument was used, as it has validated psychometric properties and is used worldwide. SOF medics averaged scores of perceptions of their medic education indicated positive but not completely statistically significant preferences toward reflection-based curricula over traditional curriculum. Special Operations, medics, reflective practice, curricula BACKGROUND Special Operations Forces (SOF) medics practice in environments that are violent, austere, clandestine, and far removed from definitive hospital facilities. What was true almost 20 years ago?". . . academic demands of [Special Forces medic training] are roughly equivalent to those of an upper-level undergraduate curriculum in science or perhaps to those of first year medical school"?is even more challenging today. During this study, medics, physicians, and educators within the SOF medical community publicly and privately (ergo, names were redacted) expressed the need for curricular changes to teach SOF medics about the worst of clinical scenarios, such as situations in which evacuation of critically injured Soldiers to higher echelons of care is not possible or is prolonged, due to combat engagements or other complications. These experts consistently describe the need for curriculum derived from experienced medics practices, to guide force-wide knowledge acquisition and augment student medics professional development. Given the investigator?s clinical familiarity with SOF medics practice and evidence, senior, enlisted SOF medics and SOF medic instructors proposed that a doctoral-prepared nurse, whose clinical specialty was trauma, could spearhead academic focus and publication on the experiences and curriculum of SOF medics. 2014.

Teaching legal competencies through an individualized elective in medicine and law.

PubMed

Kapp, Marshall B

2016-10-14

Medical education, including education intended to prepare future physicians to care to older individuals, should include development and implementation of competencies relating to a physician's ability to understand and interact with the legal environment and legal actors who will affect the practice of medicine. The wisdom of integrating legal knowledge into the medical curriculum has been documented, and literature discusses the content and methods of teaching medical students and residents about law and the legal system. This article describes one unique but replicable, pedagogical approach to preparing future physicians to thrive in their inevitably interprofessional careers as they fulfill the fiduciary responsibilities that lie at the heart of their therapeutic and advocacy relationships with older patients.

Globalization, migration health, and educational preparation for transnational medical encounters

PubMed Central

Koehn, Peter H

2006-01-01

Unprecedented migration, a core dimension of contemporary globalization, challenges population health. In a world of increasing human mobility, many health outcomes are shaped by transnational interactions among care providers and care recipients who meet in settings where nationality/ethnic match is not an option. This review article explores the value of transnational competence (TC) education as preparation for ethnically and socially discordant clinical encounters. The relevance of TC's five core skill domains (analytic, emotional, creative, communicative, and functional) for migration health and the medical-school curriculum is elaborated. A pedagogical approach that prepares for the transnational health-care consultation is presented, with a focus on clinical-clerkship learning experiences. Educational preparation for contemporary medical encounters needs to include a comprehensive set of patient-focused interpersonal skills, be adaptable to a wide variety of service users and global practice sites, and possess utility in addressing both the quality of patient care and socio-political constraints on migration health. PMID:16441899

Maternal-Fetal Medicine Physician and Fellow Perceptions of Business in Medicine.

PubMed

Porter, Blake; Iriye, Brian; Ghamsary, Mark

2018-01-01

 Principles of practice management provide a foundation for clinical success and performance improvement. Scant data exist regarding maternal-fetal medicine (MFM) physicians' knowledge of these topics. We hypothesize that physicians enter practice with inadequate education in practice management.  Surveys were emailed to members of the Society for Maternal-Fetal Medicine rating their knowledge and capabilities in practice management topics, and respondents assessed their current institution's business in the medical curriculum.  A total of 325 (14.4%) physicians responded: 63 fellows in training and 262 MFM physician subspecialists. Practicing physicians reported learning most of their knowledge "in practice after fellowship" (85%) or "never at all" (10%). Only 3% of respondents had adequate business education during fellowship, and only 5% felt prepared to teach business principles. However, 85% of those surveyed agreed that this material should be taught during the fellowship. Among MFM subspecialists and fellows in training at institutions with fellowships, 60% reported no current curriculum for practice management, and those with current curricula reported it had "limited" or "no value" (76%).  There is a significant desire for practice management curricula during MFM fellowship, and current training is insufficient. With many MFM physicians ill-prepared to teach these principles, professional education from other financial fields, and standardized education in practice management from current expert sources is needed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Long-Term Effect of a Short Interprofessional Education Interaction between Medical and Physical Therapy Students

ERIC Educational Resources Information Center

Sytsma, Terin T.; Haller, Elizabeth P.; Youdas, James W.; Krause, David A.; Hellyer, Nathan J.; Pawlina, Wojciech; Lachman, Nirusha

2015-01-01

Medicine is increasingly focused on team-based practice as interprofessional cooperation leads to better patient care. Thus, it is necessary to teach teamwork and collaboration with other health care professionals in undergraduate medical education to ensure that trainees entering the workforce are prepared to work in teams. Gross anatomy provides…

Perceptions of U.S. Medical Residents Regarding Amount and Usefulness of Sexual Health Instruction in Preparation for Clinical Practice

ERIC Educational Resources Information Center

Criniti, Shannon; Crane, Betsy; Woodland, Mark B.; Montgomery, Owen C.; Urdaneta Hartmann, Sandra

2016-01-01

Despite patient demand for sexual health discussions with their physicians, sexuality instruction in residency is often lacking. This exploratory quantitative study assessed the amount and usefulness of sexuality instruction received by a sample of medical residents, as well as the residents' self-perceived readiness regarding addressing sexuality…

Self-reported study habits for enhancing medical students’ performance in the National Medical Unified Examination

PubMed Central

Idris, Amr; Al Saadi, Tareq; Edris, Basel; Sawaf, Bisher; Zakaria, Mhd. Ismael; Alkhatib, Mahmoud; Turk, Tarek

2016-01-01

Background: The National Medical Unified Examination (NMUE) is currently required for graduation, joining postgraduate medical training, and practicing medicine in Syria. Objective: To investigate self-reported study habits that correlate with high performance on the NMUE. Methods: First through 3rd year residents at the three main hospitals in Damascus, Syria, were asked to complete a retrospective cross-sectional survey investigating their study habits and previous scores. Results: Significantly higher score was associated with >15 study h/day and allocating 1–40% of study time for practicing questions. Mean NMUE score was not significantly different in relation to preparation months for examination or for those who reported spending all their time studying alone compared with spending any amount of time in a group setting. Scores of 231–240 on the Syrian scientific high school exam correlated with significantly higher NMUE performance compared with fewer scores, except scores of 221–230. For every 10 point increase in medical school cumulative grades, the NMUE score increased 3.6 (95% confidence interval 2.5–4.8). Conclusion: The NMUE score was significantly affected by hours spent studying per day, number of practice questions completed, percentage of study time allocated for doing questions, Syrian scientific high school exam scores, and the cumulative medical school class grades. It was not significantly affected by preparation months or studying in a group setting. More studies are needed to further describe and investigate the factors that might affect performance in the NMUE. PMID:27144140

Preparing the next generation of genomicists: a laboratory-style course in medical genomics.

PubMed

Linderman, Michael D; Bashir, Ali; Diaz, George A; Kasarskis, Andrew; Sanderson, Saskia C; Zinberg, Randi E; Mahajan, Milind; Shah, Hardik; Suckiel, Sabrina; Zweig, Micol; Schadt, Eric E

2015-08-12

The growing gap between the demand for genome sequencing and the supply of trained genomics professionals is creating an acute need to develop more effective genomics education. In response we developed "Practical Analysis of Your Personal Genome", a novel laboratory-style medical genomics course in which students have the opportunity to obtain and analyze their own whole genome. This report describes our motivations for and the content of a "practical" genomics course that incorporates personal genome sequencing and the lessons we learned during the first three iterations of this course.

En Route Care in Confined Spaces: Impact of Transport, Immobilization Practices, Space Constraints, and Medical Awareness Enhancements

DTIC Science & Technology

2017-10-01

Medical Awareness Enhancements PRINCIPAL INVESTIGATOR: Rachel Kinsler CONTRACTING ORGANIZATION: U.S. Army Aeromedical Research Laboratory Forth...Rucker, AL 36362 REPORT DATE: October 2017 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research and Materiel Command Fort Detrick...ORGANIZATION NAME(S) AND ADDRESS(ES) U.S. Army Aeromedical Research Laboratory Building 6901 Fort Rucker, AL 36362 8. PERFORMING ORGANIZATION REPORT NUMBER 9

Returning home to work: Malaysian students who studied medicine overseas.

PubMed

Chur-Hansen, Anna

2004-06-01

International students' medical training often includes an elective placement in their home country to prepare them for practice on graduation. Seven Malaysian students in their final year of medicine were interviewed pre- and post-graduation and asked to reflect on whether they felt adequately prepared for working in Malaysia. These seven international students, who studied medicine in Australia, all returned to Malaysia for six weeks for their elective, and the interviews canvassed their perceptions of this experience, along with their thoughts on how well their training in Australia had prepared them for working in their country of origin. The interview data were qualitatively analysed, and case studies were constructed. Main themes were identified and tabulated. Students voiced similar concerns about how ready they were for working at home. These included a lack of practical skills relative to their Malaysian-trained counterparts, language difficulties, medical communication skill incompatibilities across cultures, expectations to perform complex or unfamiliar tasks with minimal supervision and substantial burdens of responsibility with long working hours. These students did not feel greatly prepared for their return home to practise medicine. The elective placement was not well utilized by the majority of students in this study.

Patient-Centered Medical Home Knowledge and Attitudes of Residents and Faculty: Certification Is Just the First Step

PubMed Central

El Rayess, Fadya; Goldman, Roberta; Furey, Christopher; Chandran, Rabin; Goldberg, Arnold R.; Anandarajah, Gowri

2015-01-01

Background The patient-centered medical home (PCMH) is an accepted framework for delivering high-quality primary care, prompting many residencies to transform their practices into PCMHs. Few studies have assessed the impact of these changes on residents' and faculty members' PCMH attitudes, knowledge, and skills. The family medicine program at Brown University achieved Level 3 PCMH accreditation in 2010, with training relying primarily on situated learning through immersion in PCMH practice, supplemented by didactics and a few focused clinical activities. Objective To assess PCMH knowledge and attitudes after Level 3 PCMH accreditation and to identify additional educational needs. Methods We used a qualitative approach, with semistructured, individual interviews with 12 of the program's 13 postgraduate year 3 residents and 17 of 19 core faculty. Questions assessed PCMH knowledge, attitudes, and preparedness for practicing, teaching, and leading within a PCMH. Interviews were analyzed using the immersion/crystallization method. Results Residents and faculty generally had positive attitudes toward PCMH. However, many expressed concerns that they lacked specific PCMH knowledge, and felt inadequately prepared to implement PCMH principles into their future practice or teaching. Some exceptions were faculty and resident leaders who were actively involved in the PCMH transformation. Barriers included lack of time and central roles in PCMH activities. Conclusions Practicing in a certified PCMH training program, with passive PCMH roles and supplemental didactics, appears inadequate in preparing residents and faculty for practice or teaching in a PCMH. Purposeful curricular design and evaluation, with faculty development, may be needed to prepare the future leaders of primary care. PMID:26692970

Physician's practices and perspectives regarding tobacco cessation in a teaching hospital in Mysore City, Karnataka.

PubMed

Saud, Mohammed; Madhu, B; Srinath, K M; Ashok, N C; Renuka, M

2014-01-01

Tobacco is a leading cause of disease and premature death. Most of the smokers visit a doctor for various health related ailments and thus such clinic visits provide many opportunities for interventions and professional tobacco cessation advice. The primary aim of the following study is to assess the physician practices, perspectives, resources, barriers and education relating to tobacco cessation and their perceived need for training for the same. The secondary aim is to compare the physician's cessation practices from patient's perspective. A descriptive study was conducted in a hospital attached to Medical College in Mysore city, Karnataka. Information about doctor's practices, perspectives and their perceived need for training in tobacco cessation were collected using pre-structured self-administered Questionnaire, which were distributed in person. Patient's practices and perspectives were assessed using a pre-structured Oral Questionnaire. Almost 95% of physicians said that they ask patients about their smoking status and 94% advise them to quit smoking, but only 50% assist the patient to quit smoking and only 28% arrange follow-up visits. Thus, they do not regularly provide assistance to help patients quit, even though 98% of the physicians believed that helping patients to quit was a part of their role. Only 18% and 35% of the physicians said that Undergraduate Medical Education and Post Graduate Medical Education respectively prepared them very well to participate in smoking cessation activities. Tobacco cessation requires repeated and regular assistance. Such assistance is not being provided to patients by attending doctors. Our medical education system is failing to impart the necessary skills to doctors, needed to help patients quit smoking. Reforms in education are needed so as to prepare the physician to effectively address this problem.

Innovations in Medication Preparation Safety and Wastage Reduction: Use of a Workflow Management System in a Pediatric Hospital.

PubMed

Davis, Stephen Jerome; Hurtado, Josephine; Nguyen, Rosemary; Huynh, Tran; Lindon, Ivan; Hudnall, Cedric; Bork, Sara

2017-01-01

Background: USP <797> regulatory requirements have mandated that pharmacies improve aseptic techniques and cleanliness of the medication preparation areas. In addition, the Institute for Safe Medication Practices (ISMP) recommends that technology and automation be used as much as possible for preparing and verifying compounded sterile products. Objective: To determine the benefits associated with the implementation of the workflow management system, such as reducing medication preparation and delivery errors, reducing quantity and frequency of medication errors, avoiding costs, and enhancing the organization's decision to move toward positive patient identification (PPID). Methods: At Texas Children's Hospital, data were collected and analyzed from January 2014 through August 2014 in the pharmacy areas in which the workflow management system would be implemented. Data were excluded for September 2014 during the workflow management system oral liquid implementation phase. Data were collected and analyzed from October 2014 through June 2015 to determine whether the implementation of the workflow management system reduced the quantity and frequency of reported medication errors. Data collected and analyzed during the study period included the quantity of doses prepared, number of incorrect medication scans, number of doses discontinued from the workflow management system queue, and the number of doses rejected. Data were collected and analyzed to identify patterns of incorrect medication scans, to determine reasons for rejected medication doses, and to determine the reduction in wasted medications. Results: During the 17-month study period, the pharmacy department dispensed 1,506,220 oral liquid and injectable medication doses. From October 2014 through June 2015, the pharmacy department dispensed 826,220 medication doses that were prepared and checked via the workflow management system. Of those 826,220 medication doses, there were 16 reported incorrect volume errors. The error rate after the implementation of the workflow management system averaged 8.4%, which was a 1.6% reduction. After the implementation of the workflow management system, the average number of reported oral liquid medication and injectable medication errors decreased to 0.4 and 0.2 times per week, respectively. Conclusion: The organization was able to achieve its purpose and goal of improving the provision of quality pharmacy care through optimal medication use and safety by reducing medication preparation errors. Error rates decreased and the workflow processes were streamlined, which has led to seamless operations within the pharmacy department. There has been significant cost avoidance and waste reduction and enhanced interdepartmental satisfaction due to the reduction of reported medication errors.

Optimizing the Office Visit for Adolescents with Special Health Care Needs.

PubMed

Nathawad, Rita; Hanks, Christopher

2017-08-01

Youth with special health care needs (YSHCN) experience health care disparities and often need additional support to receive optimal medical care, particularly in adolescence as they prepare to transition to adult care. Many medical practices struggle to address their needs. Here, we discuss approaches to improve medical care in office-based settings for YSHCN. Office visits can be optimized by training staff in developmentally appropriate care and ensuring that the physical office space facilitates care. Participating in previsit preparation, including managing patient registries of YSHCN, engaging in regular team huddles, and incorporating previsit planning, can improve preparation and ensure that important needs are not overlooked. Additionally, approaches to improve patient and medical provider comfort with office visits with YSHCN, including approaches to measuring vital signs, examining patients, and communicating with patients with various disabilities, are reviewed. Finally, we discuss methods of supporting adolescents with special health care needs in developing self-management skills that will allow them to be better prepared to enter adult health care settings when appropriate. Although YSHCN can present challenges to medical teams, their care can be improved by developing office-based changes and processes to support improved care for these patients. This may help overcome the health care disparities they experience and increase comfort for all members of the medical team. Copyright © 2017. Published by Elsevier Inc.

Addressing the nation's physician workforce needs: The Society of General Internal Medicine (SGIM) recommendations on graduate medical education reform.

PubMed

Jackson, Angela; Baron, Robert B; Jaeger, Jeffrey; Liebow, Mark; Plews-Ogan, Margaret; Schwartz, Mark D

2014-11-01

The Graduate Medical Education (GME) system in the United States (US) has garnered worldwide respect, graduating over 25,000 new physicians from over 8,000 residency and fellowship programs annually. GME is the portal of entry to medical practice and licensure in the US, and the pathway through which resident physicians develop the competence to practice independently and further develop their career plans. The number and specialty distribution of available GME positions shapes the overall composition of our national workforce; however, GME is failing to provide appropriate programs that support the delivery of our society's system of healthcare. This paper, prepared by the Health Policy Education Subcommittee of the Society of General Internal Medicine (SGIM) and unanimously endorsed by SGIM's Council, outlines a set of recommendations on how to reform the GME system to best prepare a physician workforce that can provide high quality, high value, population-based, and patient-centered health care, aligned with the dynamic needs of our nation's healthcare delivery system. These recommendations include: accurate workforce needs assessment, broadened GME funding sources, increased transparency of the use of GME dollars, and implementation of incentives to increase the accountability of GME-funded programs for the preparation and specialty selection of their program graduates.

Visualizing the future: technology competency development in clinical medicine, and implications for medical education.

PubMed

Srinivasan, Malathi; Keenan, Craig R; Yager, Joel

2006-01-01

In this article, the authors ask three questions. First, what will physicians need to know in order to be effective in the future? Second, what role will technology play in achieving that high level of effectiveness? Third, what specific skill sets will physicians need to master in order to become effective? Through three case vignettes describing past, present, and potential future medical practices, the authors identify trends in major medical, technological and cultural shifts that will shape medical education and practice. From these cases, the authors generate a series of technology-related competencies and skill sets that physicians will need to remain leaders in the delivery of medical care. Physicians will choose how they will be end-users of technology, technology developers, and/or the interface between users and developers. These choices will guide the types of skills each physician will need to acquire. Finally, the authors explore the implications of these trends for medical educators, including the competencies that will be required of educators as they develop the medical curriculum. Examining historical and social trends, including how users adopt current and emerging technologies, allows us to anticipate changes in the practice of medicine. By considering market pressures, global trends and emerging technologies, medical educators and practicing physicians may prepare themselves for the changes likely to occur in the medical curriculum and in the marketplace.

Breaking bad medical news in a dental care setting.

PubMed

Güneri, Pelin; Epstein, Joel; Botto, Ronald W

2013-04-01

Dental care providers may diagnose diseases and conditions that affect a patient's general health. The authors reviewed issues related to breaking bad medical news to dental practice patients and provide guidance to clinicians about how to do so. To help reduce the potentially negative effects associated with emotionally laden communication with patients about serious health care findings, the authors present suggestions for appropriately and sensitively delivering bad medical news to both patients and their families in a supportive fashion. Preparing to deliver bad news by means of education and practice is recommended to help prevent or reduce psychological distress. One form of communication guidance is the ABCDE model, which involves Advance preparation, Building a therapeutic relationship or environment, Communicating well, Dealing with patient and family reactions, and Encouraging and validating emotions. An alternative model is the six-step SPIKES sequence-Setting, Perception, Invitation or Information, Knowledge, Empathy, and Strategize and Summarize. Using either model can assist in sensitive and empathetic communication. For both practitioners' and patients' well-being, empathetic and effective delivery of bad medical news should be included in dental school curricula and continuing education courses. Dental care providers should be familiar with the oral manifestations of diseases and the care needed before the patient undergoes medical treatment and use effective communication necessary to share bad news with patients.

An Interactive E-Learning Tutorial for Medical Students on How to Conduct the Performance-Oriented Mobility Assessment

ERIC Educational Resources Information Center

Ruiz, Jorge G.; Smith, Michael; Rodriguez, Osvaldo; Van Zuilen, Maria H.; Mintzer, Michael J.

2007-01-01

We evaluated the effectiveness of an e-learning tutorial (iPOMA) as a supplement to traditional teaching of the Performance-Oriented Mobility Assessment. Second-year medical students (137) completed the iPOMA, in preparation for a session on fall risk assessment consisting of a lecture, practice with elder volunteers and small group debriefing.…

Health promotion in medical education: lessons from a major undergraduate curriculum implementation.

PubMed

Wylie, Ann; Leedham-Green, Kathleen

2017-11-01

Despite the economic, environmental and patient-related imperatives to prepare medical students to become health promoting doctors, health promotion remains relatively deprioritised in medical curricula. This paper uses an in-depth case study of a health promotion curriculum implementation at a large UK medical school to provide insights into the experiences of teachers and learners across a range of topics, pedagogies, and teaching & assessment modalities. Topics included smoking cessation, behavioural change approaches to obesity, exercise prescribing, social prescribing, maternal and child health, public and global health; with pedagogies ranging from e-learning to practice-based project work. Qualitative methods including focus groups, analysis of reflective learning submissions, and evaluation data are used to illuminate motivations, frustrations, practicalities, successes and limiting factors. Over this three year implementation, a range of challenges have been highlighted including: how adequately to prepare and support clinical teachers; the need to establish relevance and importance to strategic learners; the need for experiential learning in clinical environments to support classroom-based activities; and the need to rebalance competing aspects of the curriculum. Conclusions are drawn about heterogeneous deep learning over standardised surface learning, and the impacts, both positive and negative, of different assessment modalities on these types of learning.

The role of paediatric nurses in medication safety prior to the implementation of electronic prescribing: a qualitative case study.

PubMed

Farre, Albert; Heath, Gemma; Shaw, Karen; Jordan, Teresa; Cummins, Carole

2017-04-01

Objectives To explore paediatric nurses' experiences and perspectives of their role in the medication process and how this role is enacted in everyday practice. Methods A qualitative case study on a general surgical ward of a paediatric hospital in England, one year prior to the planned implementation of ePrescribing. Three focus groups and six individual semi-structured interviews were conducted, involving 24 nurses. Focus groups and interviews were audio-recorded, transcribed, anonymized and subjected to thematic analysis. Results Two overarching analytical themes were identified: the centrality of risk management in nurses' role in the medication process and the distributed nature of nurses' medication risk management practices. Nurses' contribution to medication safety was seen as an intrinsic feature of a role that extended beyond just preparing and administering medications as prescribed and placed nurses at the heart of a dynamic set of interactions, practices and situations through which medication risks were managed. These findings also illustrate the collective nature of patient safety. Conclusions Both the recognized and the unrecognized contributions of nurses to the management of medications needs to be considered in the design and implementation of ePrescribing systems.

How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014

PubMed Central

Grundy, Lisa; Mann, Mala; John, Zoe; Panagoulas, Eleni; Bullock, Alison; Mattick, Karen

2017-01-01

Objective To understand how prepared UK medical graduates are for practice and the effectiveness of workplace transition interventions. Design A rapid review of the literature (registration #CRD42013005305). Data sources Nine major databases (and key websites) were searched in two timeframes (July–September 2013; updated May–June 2014): CINAHL, Embase, Educational Resources Information Centre, Health Management Information Consortium, MEDLINE, MEDLINE in Process, PsycINFO, Scopus and Web of Knowledge. Eligibility criteria for selecting studies Primary research or studies reporting UK medical graduates' preparedness between 2009 and 2014: manuscripts in English; all study types; participants who are final-year medical students, medical graduates, clinical educators, patients or NHS employers and all outcome measures. Data extraction At time 1, three researchers screened manuscripts (for duplicates, exclusion/inclusion criteria and quality). Remaining 81 manuscripts were coded. At time 2, one researcher repeated the process for 2013–2014 (adding six manuscripts). Data were analysed using a narrative synthesis and mapped against Tomorrow's Doctors (2009) graduate outcomes. Results Most studies comprised junior doctors' self-reports (65/87, 75%), few defined preparedness and a programmatic approach was lacking. Six themes were highlighted: individual skills/knowledge, interactional competence, systemic/technological competence, personal preparedness, demographic factors and transitional interventions. Graduates appear prepared for history taking, physical examinations and some clinical skills, but unprepared for other aspects, including prescribing, clinical reasoning/diagnoses, emergency management, multidisciplinary team-working, handover, error/safety incidents, understanding ethical/legal issues and ward environment familiarity. Shadowing and induction smooth transition into practice, but there is a paucity of evidence around assistantship efficacy. Conclusions Educational interventions are needed to address areas of unpreparedness (eg, multidisciplinary team-working, prescribing and clinical reasoning). Future research in areas we are unsure about should adopt a programmatic and rigorous approach, with clear definitions of preparedness, multiple stakeholder perspectives along with multisite and longitudinal research designs to achieve a joined-up, systematic, approach to understanding future educational requirements for junior doctors. PMID:28087554

An educational tool for teaching medication history taking to pharmacy students.

PubMed

Sando, Karen R; Elliott, Jennifer; Stanton, Melonie L; Doty, Randell

2013-06-12

To implement and evaluate the use of a situated-learning experience to prepare second-year pharmacy students to conduct medication history interviews in preparation for introductory pharmacy practice experiences (IPPE) at ambulatory clinic sites. Second-year doctor of pharmacy (PharmD) students (n=200) used the Medication Mysteries Infinite Case Tool, a game-like educational tool in which groups of 3 students assumed the roles of pharmacist, patient, and observer and rolled a die and drew cards to determine the drugs, patient personality, medication problems, and other variables that guided a medication history taking session. After the laboratory session, faculty members assessed students' medication history-taking skills. One hundred sixteen (58%) and 78 (39%) of 200 students achieved excellence or competence, respectively, on the final assessment. Two weeks after the assessment, 53 of 200 (26.5%) students completed a survey instrument. The respondents indicated that their self-confidence in conducting medical history taking significantly improved following completion of the learning experience. Using the Medication Mysteries Infinite Case Tool increased students' confidence and skills in conducting medication history taking prior to their clinical IPPE experience.

"Chance favors only the prepared mind": preparing minds to systematically reduce hazards in the testing process in primary care.

PubMed

Singh, Ranjit; Hickner, John; Mold, Jim; Singh, Gurdev

2014-03-01

Testing plays a vital role in primary care. Failures in the process are common and can be harmful. As the great 19th century microbiologist Louis Pasteur put it "chance favors only the prepared mind." Our objective is to prepare minds in primary care practices to improve safety in the testing process. Various principles from safety science can be applied. A prospective methodology that uses an anonymous practice survey based on concepts from failure modes and effects analysis is proposed. Responses are used to rank perceived hazards in the testing process, leading to prioritization of areas for intervention. Secondary data analysis (using data from a study of medication safety) was used to explore the value of this approach in the context of assessing the testing process. At 3 primary care practice sites, a total of 61 staff members completed 4 survey items examining the testing process. Comparison across practices shows that each has a distinct profile of hazards, which would lead each on a different path toward improvement. The proposed approach treats each practice as a unique complex adaptive system aiming to help it thrive by inculcating trust, mutual respect, and collaboration. Implications for patient safety research and practice are discussed.

The development and evaluation of a medical imaging training immersive environment

PubMed Central

Bridge, Pete; Gunn, Therese; Kastanis, Lazaros; Pack, Darren; Rowntree, Pamela; Starkey, Debbie; Mahoney, Gaynor; Berry, Clare; Braithwaite, Vicki; Wilson-Stewart, Kelly

2014-01-01

Introduction A novel realistic 3D virtual reality (VR) application has been developed to allow medical imaging students at Queensland University of Technology to practice radiographic techniques independently outside the usual radiography laboratory. Methods A flexible agile development methodology was used to create the software rapidly and effectively. A 3D gaming environment and realistic models were used to engender presence in the software while tutor-determined gold standards enabled students to compare their performance and learn in a problem-based learning pedagogy. Results Students reported high levels of satisfaction and perceived value and the software enabled up to 40 concurrent users to prepare for clinical practice. Student feedback also indicated that they found 3D to be of limited value in the desktop version compared to the usual 2D approach. A randomised comparison between groups receiving software-based and traditional practice measured performance in a formative role play with real equipment. The results of this work indicated superior performance with the equipment for the VR trained students (P = 0.0366) and confirmed the value of VR for enhancing 3D equipment-based problem-solving skills. Conclusions Students practising projection techniques virtually performed better at role play assessments than students practising in a traditional radiography laboratory only. The application particularly helped with 3D equipment configuration, suggesting that teaching 3D problem solving is an ideal use of such medical equipment simulators. Ongoing development work aims to establish the role of VR software in preparing students for clinical practice with a range of medical imaging equipment. PMID:26229652

Current trends in use of intracanal medications in dental care facilities: questionnaire-based survey on training dental hygienists at educational institutions.

PubMed

Furusawa, Masahiro; Yoshida, Takashi; Hosokawa, Souhei; Ariizumi, Yuugo

2013-01-01

The success of root canal therapy is dependent not only on removal of infected pulp (pulpectomy) followed by root canal enlargement, but also on the pharmacological effects of intracanal medications. Various intracanal medications are used. Formaldehyde preparations such as formocresol were common in the past, but these are no longer used in Europe or the US due to the biological toxicity of formaldehyde. In this study, a questionnaire was used to determine current trends in the use of intracanal medications at dental care facilities where dental hygiene students undergo practical training. The questionnaire comprised questions regarding the types of frequently used intracanal medications and their methods of application at dental care facilities in Saitama and Shizuoka prefectures. The results indicated that calcium hydroxide preparations were more commonly used in Europe or the US. However, these results also revealed that formaldehyde preparations were frequently used, which slightly differs from the scenario in Europe and the US. This study revealed that multiple intracanal medications were used for root canal therapy. Furthermore, it was also observed that cotton plugs were generally used as applicator tips for intracanal medications, whereas the use of absorbent paper points was relatively uncommon. The results suggest that the cost of absorbent paper points needs to be reduced.

Time trend of injection drug errors before and after implementation of bar-code verification system.

PubMed

Sakushima, Ken; Umeki, Reona; Endoh, Akira; Ito, Yoichi M; Nasuhara, Yasuyuki

2015-01-01

Bar-code technology, used for verification of patients and their medication, could prevent medication errors in clinical practice. Retrospective analysis of electronically stored medical error reports was conducted in a university hospital. The number of reported medication errors of injected drugs, including wrong drug administration and administration to the wrong patient, was compared before and after implementation of the bar-code verification system for inpatient care. A total of 2867 error reports associated with injection drugs were extracted. Wrong patient errors decreased significantly after implementation of the bar-code verification system (17.4/year vs. 4.5/year, p< 0.05), although wrong drug errors did not decrease sufficiently (24.2/year vs. 20.3/year). The source of medication errors due to wrong drugs was drug preparation in hospital wards. Bar-code medication administration is effective for prevention of wrong patient errors. However, ordinary bar-code verification systems are limited in their ability to prevent incorrect drug preparation in hospital wards.

How educational innovations and attention to competencies in postgraduate medical education relate to preparedness for practice: the key role of the learning environment.

PubMed

Dijkstra, Ids S; Pols, Jan; Remmelts, Pine; Rietzschel, Eric F; Cohen-Schotanus, Janke; Brand, Paul L P

2015-12-01

Many training programmes in postgraduate medical education (PGME) have introduced competency frameworks, but the effects of this change on preparedness for practice are unknown. Therefore, we explored how elements of competency-based programmes in PGME (educational innovations, attention to competencies and learning environment) were related to perceived preparedness for practice among new consultants. A questionnaire was distributed among 330 new consultants. Respondents rated how well their PGME training programme prepared them for practice, the extent to which educational innovations (portfolio, Mini-CEX) were implemented, and how much attention was paid to CanMEDS competencies during feedback and coaching, and they answered questions on the learning environment and general self-efficacy. Multiple regression and mediation analyses were used to analyze data. The response rate was 43 % (143/330). Controlling for self-efficacy and gender, the learning environment was the strongest predictor of preparedness for practice (B = 0.42, p < 0.001), followed by attention to competencies (B = 0.29, p < 0.01). Educational innovations were not directly related to preparedness for practice. The overall model explained 52 % of the variance in preparedness for practice. Attention to competencies mediated the relationship between educational innovations and preparedness for practice. This mediation became stronger at higher learning environment values. The learning environment plays a key role in determining the degree to which competency-based PGME prepares trainees for independent practice.

How the medical practice employee can get more from continuing education programs.

PubMed

Hills, Laura Sachs

2007-01-01

Continuing education can be a win-win situation for the medical practice employee and for the practice. However, in order education programs must become informed consumers of such programs. They must know how to select the right educational programs for their needs and maximize their own participation. Employees who attend continuing education programs without preparation may not get the full benefit from their experiences. This article suggests benchmarks to help determine whether a continuing education program is worthwhile and offers advice for calculating the actual cost of any continuing education program. It provides a how-to checklist for medical practice employees so they know how to get the most out of their continuing education experience before, during, and after the program. This article also suggests using a study partner system to double educational efforts among employees and offers 10 practical tips for taking and using notes at a continuing education program. Finally, this article outlines the benefits of becoming a regular student and offers three practical tips for maximizing the employee's exhibit hall experience.

Professional Medical Library Education in the United States in Relation to the Qualifications of Medical Library Manpower in Ohio *

PubMed Central

Rees, Alan M.; Rothenberg, Lesliebeth; Denison, Barbara

1968-01-01

The present system of education for medical library practice in the United States consists of four major components: graduate degree programs in library science with specialization in medical librarianship; graduate degree programs in library science with no such specialization; postgraduate internships in medical libraries; continuing education programs. Data are presented illustrating the flow of graduates along these several educational pathways into medical library practice. The relevance of these educational components to the current medical library work force is discussed with reference to manpower data compiled for Ohio. The total number of medical library personnel in Ohio in 1968 is 316. Of this total, only forty-two (approximately 14 percent) have received any formal library training. Seventy persons have only a high school education. From these figures, it is concluded that there is no standard or essential qualification which is universally accepted as educational preparation for work in medical libraries; that the comparative sophistication of the educational programs in medical librarianship has yet to be reflected widely in general medical library practice; that an increasingly large number of non-professional or ancillary personnel are being, and will continue to be, utilized in medical libraries; that large numbers of untrained persons have sole responsibility for medical libraries; and that appropriate educational programs will have to be designed specifically for this type of personnel. PMID:5702318

Reforming medical education: a review and synthesis of five critiques of medical practice.

PubMed

Sales, Christopher S; Schlaff, Anthony L

2010-06-01

For physicians to provide appropriate healthcare at a reasonable cost, health reform may not be enough. This essay discusses the scope of educational reform needed in the U.S. to train tomorrow's physicians to practice effectively in an increasingly complicated health care arena. We undertook a review and synthesis of five critiques of medical practice in the U.S.: of quality, evidence-based medicine, population medicine, health policy and heuristics. Our findings suggest that physicians are inadequately trained to function in the complex organizational and social systems that characterize modern practice. Successful health care reform in the U.S. will require physicians who are trained not only in bio-medicine, but also in the social sciences. Other developed countries, which have both greater government control of health care and a culture less oriented to individualism, may have less need for specific efforts to train physicians in the social sciences but could still benefit from considering an expanded curriculum. Effective educational reform must address the medical admissions process, academic and intellectual preparation, and professional and clinical training. Copyright 2010 Elsevier Ltd. All rights reserved.

Mentoring medical students in your general practice.

PubMed

Fraser, John

2016-05-01

Mentoring medical students in general practices is becoming more common in Australia due to formalised scholarship programs and informal approaches by students. This paper defines mentoring in Australian general practice. Practical suggestions are made on how to structure a mentorship program in your practice. Mentoring differs from leadership and teaching. It is a long-term relationship between a student and an experienced general practitioner. Avoiding summative assessment in mentorship is important to its success. Mentoring is about forming a safe place to confidentially discuss personal and professional issues between a mentor and student. This is based on defining roles and mutual trust. At the same time, students crave formative feedback. Unfortunately, present feedback models are based on teaching principles that can blur the differences between assessor, teacher and mentor. Mentorship can provide students with orientation and learning experiences so that they are prepared for practice as an intern.

Theory and practice in medical education--expectations and development of skills experienced by students of human medicine compared with students in other disciplines.

PubMed

Piedmont, Silke; Robra, Bernt-Peter

2015-01-01

The aim of this article is to compare students of human medicine (HM) with students specialising in the MINT disciplines (mathematics, computer science, natural sciences and engineering), the humanities and social sciences as well as law and economic sciences with regard to their expectations of their university study and career and the areas of competence where they feel they have been supported by their education. We present in detail issues particularly relevant to prospective physicians, which are discussed with the main focus on the "theoretical and practical orientation of medical education". We used the database in the Public Use File of the "11th Student Survey", a written survey of randomly selected students studying at 25 German tertiary institutions during the 2009/2010 winter term, which was supplied by the Tertiary Education Research working group at the University of Constance. Data on 7536 students was included, of which 488 (6.5%) were prospective physicians. Human medicine students have a clear career aim and want to complete their education quickly. They have a far above-average interest in working with and for people. About one student in two is interested in a career in science or research (53% in each case - close to the average for all subjects). Compared with the other disciplines, HM students are most likely to consider their university education to have practical and research relevance and are most likely to feel prepared for their profession. Yet over half of all students (Ø 53.3%; HM 54.5%) do not consider their education to have fostered their research skills. MINT students in particular are better able to enhance their skills through independent experimentation, while theory and practice are more likely to be communicated academically in the regular teaching of human medicine. Accordingly, the HM students feel less well supported in some areas of competence required for their later work than students in other disciplines, in developing independence, problem-solving ability, critical ability and capacity for teamwork for example. The high expectations held by human medicine students of being prepared for practical work with/on people are met to an above-average degree according to their assessments of the "practical relevance" and "career preparation" offered by their medical education. However the perceived development of skills in theory and practice does not respond sufficiently well to the demands of the complex, responsible profession they aspire to. Medical students should be better supported in developing both practical and academic independence.

Reactive airways dysfunction syndrome and considerations of irritant-induced Asthma.

PubMed

Brooks, Stuart M

2013-09-01

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.

After the Medication Error: Recent Nursing Graduates' Reflections on Adequacy of Education.

PubMed

Treiber, Linda A; Jones, Jackie H

2018-05-01

The purpose of this study was to better understand individual- and system-level factors surrounding making a medication error from the perspective of recent Bachelor of Science in Nursing graduates. Online survey mixed-methods items included perceptions of adequacy of preparatory nursing education, contributory variables, emotional responses, and treatment by employer following the error. Of the 168 respondents, 55% had made a medication error. Errors resulted from inexperience, rushing, technology, staffing, and patient acuity. Twenty-four percent did not report their errors. Key themes for improving education included more practice in varied clinical areas, intensive pharmacological preparation, practical instruction in functioning within the health care environment, and coping after making medication errors. Errors generally caused emotional distress in the error maker. Overall, perceived treatment after the error reflected supportive environments, where nurses were generally treated with respect, fair treatment, and understanding. Opportunities for nursing education include second victim awareness and reinforcing professional practice standards. [J Nurs Educ. 2018;57(5):275-280.]. Copyright 2018, SLACK Incorporated.

Clinical Study of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Severe Pelvic Fracture and Intra Abdominal Hemorrhagic Shock using Continuous Vital Signs

DTIC Science & Technology

2017-11-01

University of Maryland Baltimore, MD 21202 DATE OF REPORT: November 2017 TYPE OF REPORT: Final PREPARED FOR: U.S. Army Medical Research and Materiel...ES) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702-5014 11. SPONSOR/MONITOR’S REPORT...Prytime Medical , Boerne, TX )) in October 2015, we incorporated this catheter into our practice in February 2016. Our REBOA training course (Basic

Psycho-Motor and Error Enabled Simulations Modeling Vulnerable Skills in the Pre-Mastery Phase - Medical Practice Initiative Procedural Skill Decay and Maintenance (MPI-PSD)

DTIC Science & Technology

2015-04-01

and execution of Performance Review Tool; Organization, coding, and transcribing of collected data; Analysis of qualitative survey and quantitative...University of Wisconsin System Madison, WI 53715-1218 REPORT DATE: April 2015 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research and...MONITOR’S ACRONYM(S) U.S. Army Medical Research and Material Command Fort Detrick, Maryland 21702-5012 11. SPONSOR/MONITOR’S REPORT NUMBER

Quality Indicators for Safe Medication Preparation and Administration: A Systematic Review

PubMed Central

Maaskant, Jolanda M.; de Boer, Monica; Krediet, C. T. Paul; Nieveen van Dijkum, Els J. M.

2015-01-01

Background One-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used. Objectives The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration. Methods MEDLINE, EMBASE and CINAHL were searched for relevant studies published up to January 2015. Additionally, nine databases were searched to identify relevant grey literature. Two reviewers independently selected studies if (1) the method for quality indicator development combined a literature search with expert panel opinion, (2) the study contained quality indicators on medication safety, and (3) any of the quality indicators were applicable to hospital medication preparation and administration. A multidisciplinary team appraised the studies independently using the AIRE instrument, which contains four domains and 20 items. Quality indicators applicable to in-hospital medication preparation and administration were extracted using a structured form. Results The search identified 1683 studies, of which 64 were reviewed in detail and five met the inclusion criteria. Overall, according to the AIRE domains, all studies were clear on purpose; most of them applied stakeholder involvement and used evidence reasonably; usage of the indicator in practice was scarcely described. A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death). These quality indicators partially cover the 7 rights. Conclusion Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting point for further development of nursing specific quality indicators for medication safety. Especially on the right patient, right route, right time and right documentation there is room future development of quality indicators. PMID:25884623

An Interprofessional Rural Health Education Program

PubMed Central

MacDowell, Martin; Schriever, Allison E.; Glasser, Michael; Schoen, Marieke D.

2012-01-01

Objectives. To develop, implement, and assess an interprofessional rural health professions program for pharmacy and medical students. Design. A recruitment and admissions process was developed that targeted students likely to practice in rural areas. Pharmacy students participated alongside medical students in completing the Rural Health Professions program curriculum, which included monthly lecture sessions and assignments, and a capstone clinical requirement in the final year. Assessment. Fourteen pharmacy students and 33 medical students were accepted into the program during the first 2 years of the Rural Health Professions program. Approximately 90% of the rural health professions students were originally from rural areas. Conclusions. The rural health professions program is an interprofessional approach to preparing healthcare providers to practice in rural communities. PMID:23275664

Digital Literacy in the Medical Curriculum: A Course With Social Media Tools and Gamification.

PubMed

Mesko, Bertalan; Győrffy, Zsuzsanna; Kollár, János

2015-10-01

The profession of practicing medicine is based on communication, and as social media and other digital technologies play a major role in today's communication, digital literacy must be included in the medical curriculum. The value of social media has been demonstrated several times in medicine and health care, therefore it is time to prepare medical students for the conditions they will have to face when they graduate. The aim of our study was to design a new e-learning-based curriculum and test it with medical students. An elective course was designed to teach students how to use the Internet, with a special emphasis on social media. An e-learning platform was also made available and students could access material about using digital technologies on the online platforms they utilized the most. All students filled in online surveys before and after the course in order to provide feedback about the curriculum. Over a 3-year period, 932 students completed the course. The course did not increase the number of hours spent online but aimed at making that time more efficient and useful. Based on the responses of students, they found the information provided by the curriculum useful for their studies and future practices. A well-designed course, improved by constant evaluation-based feedback, can be suitable for preparing students for the massive use of the Internet, social media platforms, and digital technologies. New approaches must be applied in modern medical education in order to teach students new skills. Such curriculums that put emphasis on reaching students on the online channels they use in their studies and everyday lives introduce them to the world of empowered patients and prepare them to deal with the digital world.

Digital Literacy in the Medical Curriculum: A Course With Social Media Tools and Gamification

PubMed Central

Győrffy, Zsuzsanna; Kollár, János

2015-01-01

Background The profession of practicing medicine is based on communication, and as social media and other digital technologies play a major role in today’s communication, digital literacy must be included in the medical curriculum. The value of social media has been demonstrated several times in medicine and health care, therefore it is time to prepare medical students for the conditions they will have to face when they graduate. Objective The aim of our study was to design a new e-learning-based curriculum and test it with medical students. Method An elective course was designed to teach students how to use the Internet, with a special emphasis on social media. An e-learning platform was also made available and students could access material about using digital technologies on the online platforms they utilized the most. All students filled in online surveys before and after the course in order to provide feedback about the curriculum. Results Over a 3-year period, 932 students completed the course. The course did not increase the number of hours spent online but aimed at making that time more efficient and useful. Based on the responses of students, they found the information provided by the curriculum useful for their studies and future practices. Conclusions A well-designed course, improved by constant evaluation-based feedback, can be suitable for preparing students for the massive use of the Internet, social media platforms, and digital technologies. New approaches must be applied in modern medical education in order to teach students new skills. Such curriculums that put emphasis on reaching students on the online channels they use in their studies and everyday lives introduce them to the world of empowered patients and prepare them to deal with the digital world. PMID:27731856

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bridge, Pete, E-mail: pete.bridge@qut.edu.au; Gunn, Therese; Kastanis, Lazaros

A novel realistic 3D virtual reality (VR) application has been developed to allow medical imaging students at Queensland University of Technology to practice radiographic techniques independently outside the usual radiography laboratory. A flexible agile development methodology was used to create the software rapidly and effectively. A 3D gaming environment and realistic models were used to engender presence in the software while tutor-determined gold standards enabled students to compare their performance and learn in a problem-based learning pedagogy. Students reported high levels of satisfaction and perceived value and the software enabled up to 40 concurrent users to prepare for clinical practice.more » Student feedback also indicated that they found 3D to be of limited value in the desktop version compared to the usual 2D approach. A randomised comparison between groups receiving software-based and traditional practice measured performance in a formative role play with real equipment. The results of this work indicated superior performance with the equipment for the VR trained students (P = 0.0366) and confirmed the value of VR for enhancing 3D equipment-based problem-solving skills. Students practising projection techniques virtually performed better at role play assessments than students practising in a traditional radiography laboratory only. The application particularly helped with 3D equipment configuration, suggesting that teaching 3D problem solving is an ideal use of such medical equipment simulators. Ongoing development work aims to establish the role of VR software in preparing students for clinical practice with a range of medical imaging equipment.« less

Positioning Medical Assistants for a Greater Role in the Era of Health Reform.

PubMed

Chapman, Susan A; Marks, Angela; Dower, Catherine

2015-10-01

Medical assistants (MAs) are one of the fastest-growing occupations in the United States. As of 2014 there were about 585,000 MAs in the United States, and the Bureau of Labor Statistics projected the MA workforce to grow by 29% from 2012 to 2022. The MA population is primarily female, ethnically and racially diverse, and paid about $15.01 per hour. MAs are primarily educated in private schools, many at for-profit institutions. The MA curriculum and length of training can be quite varied and can lead to uneven preparation for practice. Traditionally, the MA role has involved a limited clinical role and little involvement with team care, particularly in larger practices or clinics. Medical groups, clinics, and health systems are now taking a new look at MAs and how they can play a greater role in reforming health care delivery models. Expanded roles for MAs might include health coach, referral coordinator, disease registry manager, and health screener using protocols. In expanding MA roles, education and regulatory issues need to be addressed by the provider community including current inconsistent regulation and certification requirements and the lack of preparation for expanded roles in traditional MA training programs. MAs are well positioned to help address challenges in the health care delivery system including improving access to care while reducing overall cost. Successful model practices using MAs in expanded roles need further formal evaluation and replication across practice settings.

An introduction to cost analysis.

PubMed

Camponovo, Ernest

2015-04-01

This article describes the basics of cost accounting for healthcare providers and how these concepts relate to decision making in medical practice. By understanding cost accounting and cost analysis, providers can be better prepared to compete and survive in a changing healthcare environment.

Does general surgery residency prepare surgeons for community practice in British Columbia?

PubMed Central

Hwang, Hamish

2009-01-01

Background Preparing surgeons for clinical practice is a challenging task for postgraduate training programs across Canada. The purpose of this study was to examine whether a single surgeon entering practice was adequately prepared by comparing the type and volume of surgical procedures experienced in the last 3 years of training with that in the first year of clinical practice. Methods During the last 3 years of general surgery training, I logged all procedures. In practice, the Medical Services Plan (MSP) of British Columbia tracks all procedures. Using MSP remittance reports, I compiled the procedures performed in my first year of practice. I totaled the number of procedures and broke them down into categories (general, colorectal, laparoscopic, endoscopic, hepatobiliary, oncologic, pediatric, thoracic, vascular and other). I then compared residency training with community practice. Results I logged a total of 1170 procedures in the last 3 years of residency. Of these, 452 were performed during community rotations. The procedures during residency could be broken down as follows: 392 general, 18 colorectal, 242 laparoscopic, 103 endoscopic, 85 hepatobiliary, 142 oncologic, 1 pediatric, 78 thoracic, 92 vascular and 17 other. I performed a total of 1440 procedures in the first year of practice. In practice the break down was 398 general, 15 colorectal, 101 laparoscopic, 654 endoscopic, 2 hepatobiliary, 77 oncologic, 10 pediatric, 0 thoracic, 70 vascular and 113 other. Conclusion On the whole, residency provided excellent preparation for clinical practice based on my experience. Areas of potential improvement included endoscopy, pediatric surgery and “other,” which comprised mostly hand surgery. PMID:19503663

A qualitative study describing nursing home nurses sensemaking to detect medication order discrepancies.

PubMed

Vogelsmeier, Amy; Anderson, Ruth A; Anbari, Allison; Ganong, Lawrence; Farag, Amany; Niemeyer, MaryAnn

2017-08-04

Medication reconciliation is a safety practice to identify medication order discrepancies when patients' transitions between settings. In nursing homes, registered nurses (RNs) and licensed practical nurses (LPNs), each group with different education preparation and scope of practice responsibilities, perform medication reconciliation. However, little is known about how they differ in practice when making sense of medication orders to detect discrepancies. Therefore, the purpose of this study was to describe differences in RN and LPN sensemaking when detecting discrepancies. We used a qualitative methodology in a study of 13 RNs and 13 LPNs working in 12 Midwestern United States nursing homes. We used both conventional content analysis and directed content analysis methods to analyze semi-structured interviews. Four resident transfer vignettes embedded with medication order discrepancies guided the interviews. Participants were asked to describe their roles with medication reconciliation and their rationale for identifying medication order discrepancies within the vignettes as well as to share their experiences of performing medication reconciliation. The analysis approach was guided by Weick's Sensemaking theory. RNs provided explicit stories of identifying medication order discrepancies as well as examples of clinical reasoning to assure medication order appropriateness whereas LPNs described comparing medication lists. RNs and LPNs both acknowledged competing demands, but when performing medication reconciliation, RNs were more concerned about accuracy and safety, whereas LPNs were more concerned about time. Nursing home nurses, particularly RNs, are in an important position to identify discrepancies that could cause resident harm. Both RNs and LPNs are valuable assets to nursing home care and keeping residents safe, yet RNs offer a unique contribution to complex processes such as medication reconciliation. Nursing home leaders must acknowledge the differences in RN and LPN contributions and make certain nurses in the most qualified role are assigned to ensure residents remain safe.

Genetic literacy and competency.

PubMed

Kaye, Celia; Korf, Bruce

2013-12-01

Since the sequencing of the human genome was completed, progress toward understanding the genetic contributions to both rare and common disorders has accelerated dramatically. That understanding will lead to new approaches to diagnosis and management, which will be incorporated into day-to-day medical practice. Moreover, the mindset with regard to genetic contributions to health and disease has shifted from 1 gene at a time to genome wide. However, most practicing pediatricians, and even many still in training, are likely to be unfamiliar with the concepts of genetics and genomics and their applications in medical practice. This article addresses the issues of genetic and genomic literacy and competencies for pediatricians and other primary care providers, as they prepare to work with their patients in the emerging world of genomic medicine.

[Microbiological validation of the composition of "decaceol", an antiseptic prolonged-release drug].

PubMed

Dykyĭ, I L; Zaĭtsev, O I; Filimonova, N I

2002-01-01

With the aid of different microbiological methods, antimicrobal properties of decametoxine, a home-produced antiseptic, were studied together with those of the synthetic zoelite NaA-base drug preparation. The antimicrobial activity of the above drug has been shown to be of a synergistic character that makes it a very promising medical agent which will, we believe, come to be widely used in medical practice.

An Educational Tool for Teaching Medication History Taking to Pharmacy Students

PubMed Central

Elliott, Jennifer; Stanton, Melonie L.; Doty, Randell

2013-01-01

Objective. To implement and evaluate the use of a situated-learning experience to prepare second-year pharmacy students to conduct medication history interviews in preparation for introductory pharmacy practice experiences (IPPE) at ambulatory clinic sites. Design. Second-year doctor of pharmacy (PharmD) students (n=200) used the Medication Mysteries Infinite Case Tool, a game-like educational tool in which groups of 3 students assumed the roles of pharmacist, patient, and observer and rolled a die and drew cards to determine the drugs, patient personality, medication problems, and other variables that guided a medication history taking session. Assessment. After the laboratory session, faculty members assessed students’ medication history-taking skills. One hundred sixteen (58%) and 78 (39%) of 200 students achieved excellence or competence, respectively, on the final assessment. Two weeks after the assessment, 53 of 200 (26.5%) students completed a survey instrument. The respondents indicated that their self-confidence in conducting medical history taking significantly improved following completion of the learning experience. Conclusion. Using the Medication Mysteries Infinite Case Tool increased students’ confidence and skills in conducting medication history taking prior to their clinical IPPE experience. PMID:23788816

Five Key Leadership Actions Needed to Redesign Family Medicine Residencies.

PubMed

Kozakowski, Stanley M; Eiff, M Patrice; Green, Larry A; Pugno, Perry A; Waller, Elaine; Jones, Samuel M; Fetter, Gerald; Carney, Patricia A

2015-06-01

New skills are needed to properly prepare the next generation of physicians and health professionals to practice in medical homes. Transforming residency training to address these new skills requires strong leadership. We sought to increase the understanding of leadership skills useful in residency programs that plan to undertake meaningful change. The Preparing the Personal Physician for Practice (P4) project (2007-2014) was a comparative case study of 14 family medicine residencies that engaged in innovative training redesign, including altering the scope, content, sequence, length, and location of training to align resident education with requirements of the patient-centered medical home. In 2012, each P4 residency team submitted a final summary report of innovations implemented, overall insights, and dissemination activities during the study. Six investigators conducted independent narrative analyses of these reports. A consensus meeting held in September 2012 was used to identify key leadership actions associated with successful educational redesign. Five leadership actions were associated with successful implementation of innovations and residency transformation: (1) manage change; (2) develop financial acumen; (3) adapt best evidence educational strategies to the local environment; (4) create and sustain a vision that engages stakeholders; and (5) demonstrate courage and resilience. Residency programs are expected to change to better prepare their graduates for a changing delivery system. Insights about effective leadership skills can provide guidance for faculty to develop the skills needed to face practical realities while guiding transformation.

Preparing Physicians for Practice in Managed Care Environments.

ERIC Educational Resources Information Center

Lurie, Nicole

1996-01-01

Discussion of managed health care looks at its evolution and characteristics, implications for medical education, and the competencies needed by physicians in this new environment, including epidemiological thinking, understanding of human and organizational behavior, familiarity with information technology, quality control skills, knowledge of…

[TO A QUESTION OF TREINING OF THE NEONATOLOGISTS IN RESIDENCY].

PubMed

Klimenko, T; Serdceva, E; Sandulak, T; Zakrevskyy, A; Karapetyan, O

2016-11-01

In recent years, the world and in Ukraine neonatology evolved into high-tech and quickly progressive section of the medicine, therefore preparation of experts is very important problem. Residency is the form of specialization of doctors on corresponding clinical chairs for reception of high qualifications of neonatology for possibility of competent rendering of competent and highly specialized medical care to newborns in hospitals of 3rd level. Term of training in residency is 2 years. Plan of the residency training offered by the department of neonatology Kharkiv medical academy of postgraduate education consists of sections on the basic speciality, adjacent clinical disciplines and additional programs. The great attention in training is given to innovative techniques: lectures and seminars with use of electronic presentations, seminars-trainings, seminars-discussions, seminars-conferences, and others. The majority of a practical training are spent in simulation center of the department neonatology with using of dummies, anatomic models for working off of practical skills. 1. Training of doctors in residency on neonatology can occupy a key position in a professional training for maintenance of high standards of the help with newborn and scientific researches in the field of medicine and occurrence Ukrainian neonatology in the European medical community. 2. At the basis of training of the resident on neonatology should be three components: the first - training in internship on pediatric (2-3 years), the second - presence of standard conditions of training on chair neonatology and the third - carrying out of practical preparation on clinical base which is equipped by the modern diagnostic equipment and medical technologies in conformity of the standard reports of rendering of medical aid in establishments of 3rd level.

Teaching About Climate Change in Medical Education: An Opportunity

PubMed Central

Maxwell, Janie; Blashki, Grant

2016-01-01

Climate change threatens many of the gains in development and health over the last century. However, it could also be a catalyst for a necessary societal transformation to a sustainable and healthy future. Doctors have a crucial role in climate change mitigation and health system adaptation to prepare for emergent health threats and a carbon-constrained future. This paper argues that climate change should be integrated into medical education for three reasons: first, to prepare students for clinical practice in a climate-changing world; secondly, to promote public health and eco-health literacy; and finally, to deepen existing learning and strengthen graduate attributes. This paper builds on existing literature and the authors’ experience to outline potential learning objectives, teaching methods and assessment tasks. In the wake of recent progress at the United Nations climate change conference, COP-21, it is hoped that this paper will assist universities to integrate teaching about climate change into medical education. Significance for public health There is a strong case for teaching about climate change in medical education. Anthropogenic climate change is accepted by scientists, governments and health authorities internationally. Given the dire implications for human health, climate change is of fundamental relevance to future doctors. Integrating climate change into medical education offers an opportunity for future doctors to develop skills and insights essential for clinical practice and a public health role in a climate-changing world. This echoes a broader call for improved public health literacy among medical graduates. This paper provides medical schools with a rationale and an outline for teaching on climate change. PMID:27190980

Teaching About Climate Change in Medical Education: An Opportunity.

PubMed

Maxwell, Janie; Blashki, Grant

2016-04-26

Climate change threatens many of the gains in development and health over the last century. However, it could also be a catalyst for a necessary societal transformation to a sustainable and healthy future. Doctors have a crucial role in climate change mitigation and health system adaptation to prepare for emergent health threats and a carbon-constrained future. This paper argues that climate change should be integrated into medical education for three reasons: first, to prepare students for clinical practice in a climate-changing world; secondly, to promote public health and eco-health literacy; and finally, to deepen existing learning and strengthen graduate attributes. This paper builds on existing literature and the authors' experience to outline potential learning objectives, teaching methods and assessment tasks. In the wake of recent progress at the United Nations climate change conference, COP-21, it is hoped that this paper will assist universities to integrate teaching about climate change into medical education. Significance for public healthThere is a strong case for teaching about climate change in medical education. Anthropogenic climate change is accepted by scientists, governments and health authorities internationally. Given the dire implications for human health, climate change is of fundamental relevance to future doctors. Integrating climate change into medical education offers an opportunity for future doctors to develop skills and insights essential for clinical practice and a public health role in a climate-changing world. This echoes a broader call for improved public health literacy among medical graduates. This paper provides medical schools with a rationale and an outline for teaching on climate change.

[What happens when medical students set their own exam papers?].

PubMed

Baerheim, A; Meland, E

2001-10-20

In the section for general practice at the University of Bergen, Norway, we want to emphasise learning more than control in our work with students. As a step in this direction we invited students to come up with proposals for exam papers, papers that usually include six to nine multiple steps for clinical reasoning. We guaranteed that one out of three proposals would be included as a paper in the written examination, possibly slightly modified. This article is an evaluation of the consequences of letting medical students set some of their own exam papers. The process was evaluated using 1) grades given, 2) students' assessment of whether this mode of setting papers influenced their exam preparations, and 3) students' free-text comments on the process. 57 out of 64 students (89%) took part in the evaluation. All knew that their fellow students had set one of the exam papers, but only 34 (60%) reported that this knowledge had changed the way they prepared for the exam. The mean grade was 9.9 (range 5-12, on a scale from 1 to 12, 6 being the lowest pass grade) for the paper set by students, and 9.5 (range 5-11) for all papers combined. Mean difference in score was 0.32 (95% confidence interval 0.08-0.64). Students' free-text comments showed that they specifically prepared for the three known paper topics. They drew comfort from knowing at least one of the papers set, and the student-set papers were found relevant for general practice. Letting medical students set one of the exam papers makes them feel more confident. Student-set papers were seen as relevant for clinical practice. The control function of the exam seemed to have been preserved.

Planning a pharmacy-led medical mission trip, part 2: servant leadership and team dynamics.

PubMed

Brown, Dana A; Brown, Daniel L; Yocum, Christine K

2012-06-01

While pharmacy curricula can prepare students for the cognitive domains of pharmacy practice, mastery of the affective aspects can prove to be more challenging. At the Gregory School of Pharmacy, medical mission trips have been highly effective means of impacting student attitudes and beliefs. Specifically, these trips have led to transformational changes in student leadership capacity, turning an act of service into an act of influence. Additionally, building team unity is invaluable to the overall effectiveness of the trip. Pre-trip preparation for teams includes activities such as routine team meetings, team-building activities, and implementation of committees, as a means of promoting positive team dynamics. While in the field, team dynamics can be fostered through activities such as daily debriefing sessions, team disclosure times, and provision of medical services.

[Clinical recommendations for sport practice in diabetic patients (RECORD Guide). Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN)].

PubMed

Gargallo-Fernández, Manuel; Escalada San Martín, Javier; Gómez-Peralta, Fernando; Rozas Moreno, Pedro; Marco Martínez, Amparo; Botella-Serrano, Marta; Tejera Pérez, Cristina; López Fernández, Judith

2015-01-01

Sporting activity is becoming a common practice in patients with diabetes mellitus (DM). This situation requires both a preliminary medical assessment and a wide range of changes in treatment which have scarcely been addressed in medical literature. To prepare a clinical guideline on the medical approach to patients with diabetes who practice sport regularly. An expert panel from the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) reviewed the most relevant literature in each of the sections. Based both on this review and on data from the experience of a number of athletes with DM, a number of recommendations were agreed within each section. Finally, the Working Group and representatives of the SEEN jointly discussed all these recommendations. The guideline provides recommendations ranging from medical assessment before patients with DM start to practice sport to actions during and after physical activity. Recommendations are also given on aspects such as the impact of sport on blood glucose control, training schemes, or special risk situations. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Teaching Prescribing: Just What the Doctor Ordered? A Thematic Analysis of the Views of Newly Qualified Doctors

PubMed Central

Hansen, Christina R.; Walsh, Elaine K.; Bradley, Colin P.; Sahm, Laura J.

2017-01-01

Undergraduate medical education has been criticised for failing to adequately prepare doctors for the task of prescribing. Pharmacists have been shown to improve medication use in hospitals. This study aims to elicit the views of intern doctors on the challenges of prescribing, and to suggest changes in education to enhance prescribing practice and potential role of the pharmacist. Semi-structured, qualitative interviews were conducted with intern doctors in their first year post qualification in an Irish hospital. Data collection was conducted until no new themes emerged and thematic analysis was performed. Thirteen interviews took place. Interns described training in practical prescribing as limited and felt the curriculum failed to convey the reality of actual prescribing. Pharmacists were perceived to be a useful, but underutilised, information source in the prescribing process. They requested an earlier introduction, and repeated exposure, to prescribing, and suggested the involvement of peers and pharmacists in this teaching. Intern doctors reported difficulties in applying knowledge gained in medical school to clinical practice. New strategies are needed to enhance the clinical relevance of the medical curriculum by rethinking the learning outcomes regarding prescribing practice and the involvement of pharmacists in prescribing education. PMID:28970444

Experts by experience; the views of service user educators providing feedback on medical students' work based assessments.

PubMed

Muir, Delia; Laxton, Julie Clare

2012-02-01

Assessment tools were designed to provide health and social care students with multi-sourced, interprofessional feedback in practice. This includes feedback from service users. Third year medical students at the University of Leeds were given accesses to 4 assessment tools whilst in practice. Completed assessments were then sent to the university where service users and carers worked with university tutors to give further feedback and comment on the overall development of students. Three service users then took part in a focus group and one provided written feedback. Four key themes were identified from the focus group: • Preparation and support • The design of the tools • The process of using the tools in practice • Feedback. We found that the project provided both challenges and rewards for all involved. The service user educators involved were able to bring a different and valuable perspective to formative feedback. The combination of their personal and professional experiences, along with the preparation they had received, helped bridge the gap between service users in practice and university based tutors. The findings from this study went on to inform a review of the assessment tools and revised versions are now being used. Copyright © 2011 Elsevier Ltd. All rights reserved.

Preparing the Future Dental Hygiene Workforce: Knowledge, Skills, and Reform.

PubMed

Fried, Jacquelyn L; Maxey, Hannah L; Battani, Kathryn; Gurenlian, JoAnn R; Byrd, Tammi O; Brunick, Ann

2017-09-01

With the health care delivery system in transition, the way in which oral health care services are delivered in 2040 will inevitably change. To achieve the aims of reduced cost, improved access, and higher quality and to advance population wellness, oral health care will likely become a more integrated part of medical care. An integrated primary care system would better meet the needs of an increasingly diverse and aging U.S. population with uneven access to health care services. By 2040, trends suggest that a smaller proportion of dental hygienists will work in traditional solo dental offices; many more will practice with multidisciplinary health care teams in large-group dental and medical practices and in a variety of non-traditional community settings. This integration will require changes in how dental hygienists are educated. To shape the skill sets, clinical judgment, and knowledge of future practitioners, current dental hygiene curricula must be reexamined, redirected, and enhanced. This article examines some of the factors that are likely to shape the future of dental hygiene practice, considers the strengths and weaknesses of current curricula, and proposes educational changes to prepare dental hygienists for practice in 2040. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Preparing Physicians for Rural-Based Primary Care Practice: A Preliminary Evaluation of Rural Training Initiatives at OSU-COM.

PubMed

Wheeler, Denna L; Hackler, Jeffrey B

2017-05-01

The physician shortage in Oklahoma coupled with geographic maldistribution of primary care physicians limits access to care in rural and underserved areas. One of the most effective strategies to recruit and retain physicians in rural areas is to create undergraduate and graduate medical education training sites in these locations. Oklahoma State University Center for Health Sciences College of Osteopathic Medicine has implemented a rural training program that begins with early recruitment of rural high school students, introduces medical students to rural practice options through rural clinical training opportunities, and provides opportunities to remain in rural Oklahoma for residency training through ongoing graduate medical education development. The purpose of this article is to provide a case study of the development of the college's Rural Medical Track. Preliminary findings indicate that rural-based clinical training for third- and fourth-year students strengthens performance on standardized tests.

Practical strategies for becoming a successful medical book author.

PubMed

Hales, Robert E; McDuffie, John J; Gabbard, Glen O; Phillips, Katharine; Oldham, John; Stewart, Donna E

2008-01-01

The authors, all senior editors in the Books Division of American Psychiatric Publishing, Inc., provide practical advice to authors who may be considering writing or editing a medical book. The authors summarize strategies for developing a book proposal and outline an approach to developing a focus for a book. They also list a number of common errors that authors frequently make when they develop a book proposal. The authors provide guidance on publishing research and discuss how authors can collaborate with a publisher's marketing department to publicize their book. By employing a systematic and well-considered approach to preparing a book proposal and writing or editing a book, authors may achieve professional success and personal satisfaction. Writing or editing a medical book requires a different series of steps than authoring a journal article.

Utilizing international medical graduates in health care delivery: brain drain, brain gain, or brain waste? A win-win approach at University of California, Los Angeles.

PubMed

Dowling, Patrick T; Bholat, Michelle Anne

2012-12-01

After identifying many unlicensed Hispanic international medical graduates (IMGs) legally residing in southern California, University of California, Los Angeles developed an innovative program to prepare these sidelined physicians to enter family medicine residency programs and become licensed physicians. On completion of a 3-year family medicine residency-training program, these IMGs have an obligation to practice in a federally designated underserved community in the state for 2 to 3 years. As the US health care system moves from physician-centered practices to patient-focused teams, with primary care serving as the foundation for building patient-centered medical homes, attention to educating IMGs in these concepts is crucial. Copyright © 2012 Elsevier Inc. All rights reserved.

How prepared are UK medical graduates for practice? A rapid review of the literature 2009-2014.

PubMed

Monrouxe, Lynn V; Grundy, Lisa; Mann, Mala; John, Zoe; Panagoulas, Eleni; Bullock, Alison; Mattick, Karen

2017-01-13

To understand how prepared UK medical graduates are for practice and the effectiveness of workplace transition interventions. A rapid review of the literature (registration #CRD42013005305). Nine major databases (and key websites) were searched in two timeframes (July-September 2013; updated May-June 2014): CINAHL, Embase, Educational Resources Information Centre, Health Management Information Consortium, MEDLINE, MEDLINE in Process, PsycINFO, Scopus and Web of Knowledge. Primary research or studies reporting UK medical graduates' preparedness between 2009 and 2014: manuscripts in English; all study types; participants who are final-year medical students, medical graduates, clinical educators, patients or NHS employers and all outcome measures. At time 1, three researchers screened manuscripts (for duplicates, exclusion/inclusion criteria and quality). Remaining 81 manuscripts were coded. At time 2, one researcher repeated the process for 2013-2014 (adding six manuscripts). Data were analysed using a narrative synthesis and mapped against Tomorrow's Doctors (2009) graduate outcomes. Most studies comprised junior doctors' self-reports (65/87, 75%), few defined preparedness and a programmatic approach was lacking. Six themes were highlighted: individual skills/knowledge, interactional competence, systemic/technological competence, personal preparedness, demographic factors and transitional interventions. Graduates appear prepared for history taking, physical examinations and some clinical skills, but unprepared for other aspects, including prescribing, clinical reasoning/diagnoses, emergency management, multidisciplinary team-working, handover, error/safety incidents, understanding ethical/legal issues and ward environment familiarity. Shadowing and induction smooth transition into practice, but there is a paucity of evidence around assistantship efficacy. Educational interventions are needed to address areas of unpreparedness (eg, multidisciplinary team-working, prescribing and clinical reasoning). Future research in areas we are unsure about should adopt a programmatic and rigorous approach, with clear definitions of preparedness, multiple stakeholder perspectives along with multisite and longitudinal research designs to achieve a joined-up, systematic, approach to understanding future educational requirements for junior doctors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

See More, Do More, Teach More: Surgical Resident Autonomy and the Transition to Independent Practice.

PubMed

Hashimoto, Daniel A; Bynum, William E; Lillemoe, Keith D; Sachdeva, Ajit K

2016-06-01

The graduate medical education system is tasked with training competent and autonomous health care providers while also improving patient safety, delivering more efficient care, and cutting costs. Concerns about resident autonomy and preparation for independent and safe practice appear to be growing, and the field of surgery faces unique challenges in preparing graduates for independent practice. Multiple factors are contributing to an erosion of resident autonomy and decreased operative experience, including differing views of autonomy, financial forces, duty hours regulations, and diverse community health care needs. Identifying these barriers and developing solutions to overcome them are vital first steps in reversing the trend of diminishing autonomy in surgical residency training. This Commentary highlights the problem of decreasing autonomy, outlines specific threats to resident autonomy, and discusses potential solutions to mitigate their impact on the successful transition to independent practice.

Preparing for Electronic Medical Record Implementation: Carolina Care Communication in an Electronic Environment.

PubMed

Carroll, Tracy; Tonges, Mary; Ray, Joel

2017-11-01

This article describes 1 organization's successful approach to mitigating the potential negative effects of a new electronic medical record on patient experience. The Carolina Care model, developed at the University of North Carolina Hospitals to actualize caring theory in practice, helped to structure and greatly facilitate this work. Seven focus areas were integrated to create the "Communication in an Electronic Environment" program with a strong emphasis on nurse-patient communication.

A Constructive Reframing of Student Roles and Systems Learning in Medical Education Using a Communities of Practice Lens.

PubMed

Gonzalo, Jed D; Thompson, Britta M; Haidet, Paul; Mann, Karen; Wolpaw, Daniel R

2017-12-01

Health systems are in the midst of a transformation that is being driven by a variety of forces. This has important implications for medical educators because clinical practice environments play a key role in learning and professional development, and evolving health systems are beginning to demand that providers have "systems-ready" knowledge, attitudes, and skills. Such implications provide a clear mandate for medical schools to modify their goals and prepare physicians to practice flexibly within teams and effectively contribute to the improvement of health care delivery. In this context, the concepts of value-added medical education, authentic student roles, and health systems science are emerging as increasingly important. In this Article, the authors use a lens informed by communities of practice theory to explore these three concepts, examining the implications that the communities of practice theory has in the constructive reframing of educational practices-particularly common student roles and experiences-and charting future directions for medical education that better align with the needs of the health care system. The authors apply several key features of the communities of practice theory to current experiential roles for students, then propose a new approach to students' clinical experiences-value-added clinical systems learning roles-that provides students with opportunities to make meaningful contributions to patient care while learning health systems science at the patient and population level. Finally, the authors discuss implications for professional role formation and anticipated challenges to the design and implementation of value-added clinical systems learning roles.

The value of mentorship in medical education.

PubMed

Dalgaty, Faith; Guthrie, Greg; Walker, Heather; Stirling, Kevin

2017-04-01

The transition from senior medical student to working safely and effectively as a new junior doctor is one of the biggest challenges that a new graduate will face. In 2014 the General Medical Council published The state of medical education and practice in the UK, reporting that some new doctors continue to struggle with increased responsibilities. We classify these instances as a 'performance gap', describing occasions in clinical practice where an individual exceeds their performance capacity. The Medical Mentorship Programme addressed identified performance gaps through a structured curriculum of simulation-based education and facilitated clinical practice. Programme content was based on the experiences of the authors and their peers in graduating from their undergraduate training programme and becoming junior doctors. A questionnaire was disseminated to junior doctors in their first clinical rotation. The questionnaire asked doctors to describe instances where they experienced a performance gap. These data informed the development of the Medical Mentorship Programme. The effect of this programme was then evaluated via focus group discussion. The Medical Mentorship Programme has been shown to be an effective conduit for supporting the transfer of learning needed to address performance gaps in students. The programme increased the confidence of students in preparation for clinical practice and allowed junior doctors to reflect on their professional development. The programme combined complementary teaching techniques - mentorship, simulation and direct clinical experience - to aid the professional development of both students and mentors. Some new doctors continue to struggle with increased responsibilities. © 2016 John Wiley & Sons Ltd.

Preparation courses for medical clerkships and the final clinical internship in medical education – The Magdeburg Curriculum for Healthcare Competence

PubMed Central

Spura, Anke; Werwick, Katrin; Feißel, Annemarie; Gottschalk, Marc; Winkler-Stuck, Kirstin; Robra, Bernt-Peter; Braun-Dullaeus, Rüdiger C.; Stieger, Philipp

2016-01-01

Background/Goals: Supporting medical students entering their internships – the clinical clerkship and the internship “final clinical year” (Praktisches Jahr, PJ) – the seminars “Ready for Clerkship” and “Ready for PJ” were held for the first time in 2014 and continued successfully in 2015. These seminars are part of the “Magdeburg Curriculum for Healthcare Competence” (Magdeburger Curriculum zur Versorgungskompetenz, MCV). The concept comprises three main issues: “Understanding interdisciplinary clinical procedures”, “Interprofessional collaboration”, and “Individual cases and their reference to the system.” The aim of the seminar series is to prepare students as medical trainees for their role in the practice-oriented clinical clerkship and PJ, respectively. Methods: Quality assurance evaluations and didactic research are integral parts of the seminars. In preparation for the “Ready for PJ” seminar a needs assessment was conducted. The seminars were rated by the participants using an anonymized questionnaire consisting of a 5-choice Likert scale (ranging from 1=fully agree to 5=fully disagree) and spaces for comments that was generated by the evaluation software Evasys. Results: The results are presented for the preparatory seminars “Ready for Clerkship” and “Fit für PJ” held in 2014 and 2015. Overall, the students regarded the facultative courses as very good preparation for the clerkship as well as for the PJ. The three-dimensional main curricular concept of the MCV was recognized in the evaluation as a valuable educational approach. Interprofessional collaboration, taught by instructors focussing in teamwork between disciplines, was scored positively and highly valued. Conclusions: The “Magdeburg Curriculum for Healthcare Competence” (MCV) integrates clerkship and PJ in a framing educational concept and allows students a better appreciation of their role in patient care and the tasks that they will face. The MCV concept can be utilized in other practice-oriented phases (nursing internship, bed-side teaching, block internships). PMID:27275505

Preparation courses for medical clerkships and the final clinical internship in medical education - The Magdeburg Curriculum for Healthcare Competence.

PubMed

Spura, Anke; Werwick, Katrin; Feißel, Annemarie; Gottschalk, Marc; Winkler-Stuck, Kirstin; Robra, Bernt-Peter; Braun-Dullaeus, Rüdiger C; Stieger, Philipp

2016-01-01

Supporting medical students entering their internships - the clinical clerkship and the internship "final clinical year" (Praktisches Jahr, PJ) - the seminars "Ready for Clerkship" and "Ready for PJ" were held for the first time in 2014 and continued successfully in 2015. These seminars are part of the "Magdeburg Curriculum for Healthcare Competence" (Magdeburger Curriculum zur Versorgungskompetenz, MCV). The concept comprises three main issues: "Understanding interdisciplinary clinical procedures", "Interprofessional collaboration", and "Individual cases and their reference to the system." The aim of the seminar series is to prepare students as medical trainees for their role in the practice-oriented clinical clerkship and PJ, respectively. Quality assurance evaluations and didactic research are integral parts of the seminars. In preparation for the "Ready for PJ" seminar a needs assessment was conducted. The seminars were rated by the participants using an anonymized questionnaire consisting of a 5-choice Likert scale (ranging from 1=fully agree to 5=fully disagree) and spaces for comments that was generated by the evaluation software Evasys. The results are presented for the preparatory seminars "Ready for Clerkship" and "Fit für PJ" held in 2014 and 2015. Overall, the students regarded the facultative courses as very good preparation for the clerkship as well as for the PJ. The three-dimensional main curricular concept of the MCV was recognized in the evaluation as a valuable educational approach. Interprofessional collaboration, taught by instructors focussing in teamwork between disciplines, was scored positively and highly valued. The "Magdeburg Curriculum for Healthcare Competence" (MCV) integrates clerkship and PJ in a framing educational concept and allows students a better appreciation of their role in patient care and the tasks that they will face. The MCV concept can be utilized in other practice-oriented phases (nursing internship, bed-side teaching, block internships).

Leadership training for undergraduate medical students.

PubMed

Maddalena, Victor

2016-07-04

Purpose Physicians play an important leadership role in the management and governance of the healthcare system. Yet, many physicians lack formal management and leadership training to prepare them for this challenging role. This Viewpoint article argues that leadership concepts need to be introduced to undergraduate medical students early and throughout their medical education. Design/methodology/approach Leadership is an integral part of medical practice. The recent inclusion of "Leader" competency in the CanMEDS 2015 represents a subtle but important shift from the previous "manager" competency. Providing medical students with the basics of leadership concepts early in their medical education allows them to integrate leadership principles into their professional practice. Findings The Faculty of Medicine at the Memorial University of Newfoundland (MUN) has developed an eight-module, fully online Physician Leadership Certificate for their undergraduate medical education program. This program is cited as an example of an undergraduate medical curriculum that offers leadership training throughout the 4 years of the MD program. Originality/value There are a number of continuing professional development opportunities for physicians in the area of management and leadership. This Viewpoint article challenges undergraduate medical education programs to develop and integrate leadership training in their curricula.

Plastic surgery residency graduate outcomes: a 43-year experience at a single institution and the first "integrated" training program in the United States.

PubMed

Noland, Shelley S; Lee, Gordon K

2012-04-01

The Accreditation Council for Graduate Medical Education emphasizes outcome-based residency education. This project is an outcomes study on graduates of the Stanford University Integrated Plastic Surgery Residency. A survey assessing various outcomes, including practice profile, financial, personal, and educational issues, was electronically distributed to all 130 graduates between 1966 and 2009. There was a 65% response rate. Nearly all respondents are currently in practice. Popular fellowships included hand and microsurgery. Most respondents participated in research and held leadership roles. Adequate residency education was noted in areas of patient care, board preparation, and ethical and legal issues. Inadequate residency education was noted in areas of managing a practice, coding, and cost-effective medicine. This is the first long-term outcomes study of plastic surgery graduates. Most are in active, successful practice. We have incorporated educational content related to running a small business, contract negotiating, and marketing to better prepare our residents for future practice.

Leadership, management and teamwork learning through an extra-curricular project for medical students: descriptive study.

PubMed

Jorge, Maria Lucia da Silva Germano; Coelho, Izabel Cristina Meister; Paraizo, Mariana Martins; Paciornik, Ester Fogel

2014-01-01

Professionalism in medicine requires preparation for the globalized world. Our objective was to describe a project that introduces medical students to the community, hospital and laboratory activities, thereby allowing them to gain experience in people management, leadership and teamwork. Descriptive study of the process applied at a philanthropic medical school in Curitiba, Paraná. Inclusion of management and leadership practices as part of the medical degree program. The study groups consisted of fifteen students. After six months, any of the participants could be elected as a subcoordinator, with responsibility for managing tasks and representing the team in hospital departments and the community. The activities required increasing levels of responsibility. In medical schools, students' involvement in practical activities is often limited to observation. They are not required to take responsibilities or to interact with other students and stakeholders. However, they will become accountable, which thus has an adverse effect on all involved. The learning space described here aims to fill this gap by bringing students closer to the daily lives and experiences of healthcare professionals. Being a physician requires not only management and leadership, but also transferrable competencies, communication and critical thinking. These attributes can be acquired through experience of teamwork, under qualified supervision from teaching staff. Students are thus expected to develop skills to deal with and resolve conflicts, learn to share leadership, prepare others to help and replace them, adopt an approach based on mutual responsibility and discuss their performance.

Program directors in surgery agree that residents should be formally trained in business and practice management.

PubMed

Lusco, Vincent C; Martinez, Serge A; Polk, Hiram C

2005-01-01

Surgical residents typically receive limited exposure to business and practice management during their training. As a result, residents are ill-prepared for issues related to starting a practice, coding, collecting, and taking a meaningful role within the medical community in promoting quality and safety and in containing health care costs. With the introduction of the core competencies and the current overhaul of surgical education, we believe there is an opportunity to include business and practice management into resident training. Program directors in general surgery (189 of 242) responded to a 9-question mailed survey inquiring about their opinions regarding training surgical residents in business and practice management. Most program directors agreed or strongly agreed (87%) that residents should be trained in business and practice management. Seventy percent believed that their current trainees were inadequately trained in this area. Over half (63%) believed that this training should begin during postgraduate years 2 to 5. Development of simple curricula aimed at preparing surgical residents for business and practice management could promote the contemporary education of surgeons.

Who will be the Radiologists of Tomorrow? A survey of radiology during the "Practical Year" in Germany.

PubMed

Dettmer, Sabine; Fischer, Volkhard; Paeßens, Carolin; Meyer, Simone; Wacker, Frank K; Rodt, Thomas

2017-10-01

Purpose  Aim of our study was to evaluate the motivation of medical students in their final year of medical school to choose radiology for further specialization by means of a Germany-wide survey. Materials and Methods  The survey was performed during the 2015/16 semester among German medical students in their four months radiology elective during the final year. Invitations for the study were distributed by the Student Secretariats of each university. The survey was web-based with EvaSys 7.0 software. Questions on radiology contents during medical studies and "practical year" were part of the survey. Plans for residency and possible advantages and disadvantages of radiology as medical specialty were inquired. Descriptive statistics and group comparisons were used as analysis methods. Results  89 students participated in the survey at the beginning and 60 students at the end of the practical year. Of these 39 students could be identified who answered both questionnaires. Most students were satisfied with their final year radiology elective (mean 1.8 on a range from 1 to 5). Nevertheless, they criticized mentoring during routine work (mean 2.1) and a lack of educational courses (mean 2.1). Most students (83 %) were uncertain about their residency choice at the beginning of their "practical year" and about one fifth changed their plans. From the students' point of view main advantages of radiology included contact with many other clinical disciplines (87 %) and the working conditions (68 %). The reduced patient contact (42 %), the large amount of work at a computer (43 %), and the dependency on referring physicians (42 %) were regarded as the main disadvantages. The students regarded the way radiology is taught during the studies as not practical enough. With regard to radiology the majority of students (63 %) felt poorly prepared for their future work. Conclusion  The "practical year" is important regarding the choice of future specialization. There was a high degree of satisfaction with the "practical year" in radiology. The mentoring during routine work and a lack of educational courses was mildly criticized. These factors provide room for improvement to foster students' interest in radiology. Key Points   · The "practical year" is important regarding the choice of further specialization.. · Criticisms of radiology in the "practical year" were mentoring and courses.. · Students feel poorly prepared for their future work regarding practical radiological skills.. Citation Format · Dettmer S, Fischer V, Paeßens C et al. Who will be the Radiologists of Tomorrow? A survey of radiology during the "Practical Year" in Germany. Fortschr Röntgenstr 2017; 189: 967 - 976. © Georg Thieme Verlag KG Stuttgart · New York.

Study Behaviors and USMLE Step 1 Performance: Implications of a Student Self-Directed Parallel Curriculum.

PubMed

Burk-Rafel, Jesse; Santen, Sally A; Purkiss, Joel

2017-11-01

To determine medical students' study behaviors when preparing for the United States Medical Licensing Examination (USMLE) Step 1, and how these behaviors are associated with Step 1 scores when controlling for likely covariates. The authors distributed a study-behaviors survey in 2014 and 2015 at their institution to two cohorts of medical students who had recently taken Step 1. Demographic and academic data were linked to responses. Descriptive statistics, bivariate correlations, and multiple linear regression analyses were performed. Of 332 medical students, 274 (82.5%) participated. Most students (n = 211; 77.0%) began studying for Step 1 during their preclinical curriculum, increasing their intensity during a protected study period during which they averaged 11.0 hours studying per day (standard deviation [SD] 2.1) over a period of 35.3 days (SD 6.2). Students used numerous third-party resources, including reading an exam-specific 700-page review book on average 2.1 times (SD 0.8) and completing an average of 3,597 practice multiple-choice questions (SD 1,611). Initiating study prior to the designated study period, increased review book usage, and attempting more practice questions were all associated with higher Step 1 scores, even when controlling for Medical College Admission Test scores, preclinical exam performance, and self-identified score goal (adjusted R = 0.56, P < .001). Medical students at one public institution engaged in a self-directed, "parallel" Step 1 curriculum using third-party study resources. Several study behaviors were associated with improved USMLE Step 1 performance, informing both institutional- and student-directed preparation for this high-stakes exam.

[Medical protection during radiation accidents: some results and lessons of the Chernobyl accident].

PubMed

Legeza, V I; Grebeniuk, A N; Zatsepin, V V

2011-01-01

Actions of medical radiation protection of liquidators of consequences of on Chernobyl atomic power station accident are analysed. It is shown, that during the early period of the accident medical protection of liquidators was provided by administration of radioprotectors, means of prophylaxis: of radioactive iodine incorporation and agent for preventing psychological and emotional stress. When carrying out decontamination and regenerative works, preparations which action is caused by increase of nonspecific resistance of an organism were applied. The lessons taken from the results of the Chernobyl accident, have allowed one to improve the system of medical protection and to introduce in practice new highly effective radioprotective agents.

Frequency and Severity of Parenteral Nutrition Medication Errors at a Large Children's Hospital After Implementation of Electronic Ordering and Compounding.

PubMed

MacKay, Mark; Anderson, Collin; Boehme, Sabrina; Cash, Jared; Zobell, Jeffery

2016-04-01

The Institute for Safe Medication Practices has stated that parenteral nutrition (PN) is considered a high-risk medication and has the potential of causing harm. Three organizations--American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), American Society of Health-System Pharmacists, and National Advisory Group--have published guidelines for ordering, transcribing, compounding and administering PN. These national organizations have published data on compliance to the guidelines and the risk of errors. The purpose of this article is to compare total compliance with ordering, transcription, compounding, administration, and error rate with a large pediatric institution. A computerized prescriber order entry (CPOE) program was developed that incorporates dosing with soft and hard stop recommendations and simultaneously eliminating the need for paper transcription. A CPOE team prioritized and identified issues, then developed solutions and integrated innovative CPOE and automated compounding device (ACD) technologies and practice changes to minimize opportunities for medication errors in PN prescription, transcription, preparation, and administration. Thirty developmental processes were identified and integrated in the CPOE program, resulting in practices that were compliant with A.S.P.E.N. safety consensus recommendations. Data from 7 years of development and implementation were analyzed and compared with published literature comparing error, harm rates, and cost reductions to determine if our process showed lower error rates compared with national outcomes. The CPOE program developed was in total compliance with the A.S.P.E.N. guidelines for PN. The frequency of PN medication errors at our hospital over the 7 years was 230 errors/84,503 PN prescriptions, or 0.27% compared with national data that determined that 74 of 4730 (1.6%) of prescriptions over 1.5 years were associated with a medication error. Errors were categorized by steps in the PN process: prescribing, transcription, preparation, and administration. There were no transcription errors, and most (95%) errors occurred during administration. We conclude that PN practices that conferred a meaningful cost reduction and a lower error rate (2.7/1000 PN) than reported in the literature (15.6/1000 PN) were ascribed to the development and implementation of practices that conform to national PN guidelines and recommendations. Electronic ordering and compounding programs eliminated all transcription and related opportunities for errors. © 2015 American Society for Parenteral and Enteral Nutrition.

Study of formulation of mild pharmaceutical forms of paracetamol in medical practice.

PubMed

Abdullahu, Bedri; Morina, Naim; Islami, Hilmi

2012-01-01

Paracetamol is one of the most used antipyretic- analgesic preparation, which can be found in different pharmaceutical forms and in different doses. Due to its wide utilization in the clinical practice, determination of paracetamol in pharmaceutical formulation is of a great importance since that over dosage with paracetamol may cause the hepatic fulminant necroses and other toxic effects. Study has included two formulations of paracetamol suppositories with doses of 125 mg widely used in the paediatric practice. Suppositories prepared according to these two formulations by the melting method and spilling into forms was subject to the quality control by implementing a series of trials and analyses for that aim, such are: reactions of identification, average mass, disintegration time, and homogeneity whilst quantitative determination was performed by applying two methods of instrumental analyze: spectrophotometry in UV zone and cromatography in liquid phase with high pressure. Results of these analyses, performed immediately following the preparation and 3 months after the preparation, showed that content of paracetamol in both of two formulations is within the norms of Pharmacopoeia. Suppositories of paracetamol in doses of 125 mg prepared as per formulation 1 are to be considered as more appropriate because it contains semi synthetic glycerides as excipient which has better features than other suppository excipients.

Implementation of targeted medication adherence interventions within a community chain pharmacy practice: The Pennsylvania Project.

PubMed

Bacci, Jennifer L; McGrath, Stephanie Harriman; Pringle, Janice L; Maguire, Michelle A; McGivney, Melissa Somma

2014-01-01

To identify facilitators and barriers to implementing targeted medication adherence interventions in community chain pharmacies, and describe adaptations of the targeted intervention and organizational structure within each individual pharmacy practice. Qualitative study. Central and western Pennsylvania from February to April 2012. Rite Aid pharmacists staffed at the 118 Pennsylvania Project intervention sites. Qualitative analysis of pharmacists' perceptions of facilitators and barriers experienced, targeted intervention and organizational structure adaptations implemented, and training and preparation prior to implementation. A total of 15 key informant interviews were conducted from February to April 2012. Ten pharmacists from "early adopter" practices and five pharmacists from "traditionalist" practices were interviewed. Five themes emerged regarding the implementation of targeted interventions, including all pharmacists' need to understand the relationship of patient care programs to their corporation's vision; providing individualized, continual support and mentoring to pharmacists; anticipating barriers before implementation of patient care programs; encouraging active patient engagement; and establishing best practices regarding implementation of patient care services. This qualitative analysis revealed that there are a series of key steps that can be taken before the execution of targeted interventions that may promote successful implementation of medication therapy management in community chain pharmacies.

How Christian ethics became medical ethics: the case of Paul Ramsey.

PubMed

Hauerwas, Stanley

1995-03-01

Over the last century Christian ethics has moved from an attempt to Christianize the social order to a quandary over whether being Christian unduly biases how medical ethics is done. This movement can be viewed as the internal development of protestant liberalism to its logical conclusion, and Paul Ramsey can be taken as one of the last great representatives of that tradition. By reducing the Christian message to the 'ethical upshot' of neighbour love, Ramsey did not have the resources to show how Christian practice might make a difference for understanding or forming the practice of medicine. Instead, medicine became the practice that exemplified the moral commitments of Christian civilization, and the goal of the ethicist was to identify the values that were constitutive of medicine. Ramsey thus prepared the way for the Christian ethicist to become a medical ethicist with a difference, and the difference simply involved vague theological presumptions that do no serious intellectual work other than explaining, perhaps, the motivations of the ethicist.

A simulated emergency department for medical students.

PubMed

Johnson, Patricia; Brazil, Victoria; Raymond-Dufresne, Éliane; Nielson, Tracy

2017-08-01

During their training, medical students often undertake a rotation in an emergency department (ED), where they are exposed to a wide variety of patient presentations. Simulation can be an effective teaching strategy to help prepare learners for the realities of the clinical environment. Simulating an ED shift can provide students with the opportunity to perform a range of clinical activities, within their scope of practice, in a supervised and supportive learning environment. Medical students often undertake a rotation in an emergency department CONTEXT: There is limited literature describing the structure, syllabus, feasibility and perceived usefulness of simulating a typical ED for medical student training. We developed a simulated ED (simED) teaching session for medical students at our university. Students were informed of the purpose and learning tasks of the session prior to attendance. At the start of their 2-hour simED shift students were allocated 'patients' by the Triage nurse. At the completion of their shift, students attended a debriefing discussion. Student feedback indicated that they felt that the simED: provided a good opportunity to practise skills and apply theory to practice; was realistic and challenging; highlighted the importance of teamwork; and enabled them to identify skills requiring further practise. Suggestions for improvements included a longer time spent in the simED and the opportunity to see more patients. The simED approach seemed to be well received and perceived by medical students as useful preparation for the ED. An overview of the structure, materials and resources used is provided to assist educators seeking to implement similar ED clinical scenarios in their curriculum. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

The future of continuing medical education: the roles of medical professional societies and the health care industry: Position paper prepared with contributions from the European Society of Cardiology Committees for Advocacy, Education and Industry Relations, Endorsed by the Board of the European Society of Cardiology.

PubMed

2018-02-28

In recent years, wide ranging biomedical innovation has provided powerful new approaches for prevention, diagnosis and management of diseases. In order to translate such innovation into effective practice, physicians must frequently update their knowledge base and skills through continuing medical education and training. Medical Professional Societies, run as not-for-profit organizations led by peers, are uniquely placed to deliver balanced, disease oriented and patient centred education. The medical industry has a major role in the development of new, improved technology, devices and medication. In fact, the best innovations have been achieved through collaboration with scientists, clinical academics and practicing physicians. Industry has for many years been committed to ensure the optimal and safe application of its products by providing unrestricted support of medical education developed and delivered by international and national learned societies. Recently adopted Codes of Practice for the Pharmaceutical and Device industry were intended to enhance public trust in the relationship between biomedical industry and physicians. Unexpectedly, changes resulting from adoption of the Codes have limited the opportunity for unconditional industry support of balanced medical education in favour of a more direct involvement of industry in informing physicians about their products. We describe the need for continuing medical education in Cardiovascular Medicine in Europe, interaction between the medical profession and medical industry, and propose measures to safeguard the provision of high quality, balanced medical education.

Nurses' Educational Preparation for a Medication Education Role: Findings from a National Survey.

ERIC Educational Resources Information Center

Latter, Sue; Rycroft-Malone, Joanne; Yerrell, Paul; Shaw, David

2001-01-01

A survey of nursing education programs in England revealed that the teaching of pharmacology is usually integrated into curriculum. Respondents felt insufficient time was devoted to it and that there were opportunities for integrating pharmacology knowledge and patient education in practice settings. (SK)

Team-Based Learning in a Physical Therapy Gross Anatomy Course

ERIC Educational Resources Information Center

Killins, Anita M.

2015-01-01

As medical knowledge grows exponentially and healthcare systems continue to utilize interdisciplinary care, it is essential that physical therapy (PT) graduates be prepared to practice efficiently and effectively on healthcare teams. Team-based learning (TBL) is a teaching pedagogy used in medicine to improve academic performance and teamwork…

Artificial Urine for Teaching Urinalysis Concepts and Diagnosis of Urinary Tract Infection in the Medical Microbiology Laboratory.

PubMed

Khan, Latifa B; Read, Hannah M; Ritchie, Stephen R; Proft, Thomas

2017-01-01

Dipstick urinalysis is an informative, quick, cost-effective and non-invasive diagnostic tool that is useful in clinical practice for the diagnosis of urinary tract infections (UTIs), kidney diseases, and diabetes. We used dipstick urinalysis as a hands-on microbiology laboratory exercise to reinforce student learning about UTIs with a particular focus on cystitis, which is a common bacterial infection. To avoid exposure to potentially contaminated human urine samples, we prepared artificial urine using easily acquired and affordable ingredients, which allowed less-experienced students to perform urinalysis without the risk of exposure to pathogenic organisms and ensured reliable availability of the urine samples. This practical class taught medical students how to use urinalysis data in conjunction with medical history to diagnose diseases from urine samples and to determine a treatment plan for clinical scenarios.

A survey of pharmacists' perceptions of the adequacy of their training for addressing mental health–related medication issues

PubMed Central

2017-01-01

Introduction: The purpose of this study was to conduct a survey of North Carolina pharmacists' perceptions of their pharmacy training in mental health–related medication issues and how this influenced their perceived ability to address these issues in the provision of pharmaceutical care to their patients. Methods: A survey consisting of 17 questions was developed and emailed to licensed pharmacists in North Carolina. Surveys that were returned were analyzed to see if conclusions could be made regarding the pharmacists' perceptions about their mental health–related medication training and its influence on their practice. Results: A total of 848 pharmacists completed the survey (response rate of 7.9%). Of the survey participants, 489 (58.2%) reported that pharmacy school training adequately prepared them to provide basic pharmaceutical care to patients taking mental health–related medications. However, 350 (41.4%) reported feeling less comfortable providing medication counseling for mental health–related medications compared to cardiac medications. Discussion: Despite the volume of prescriptions that mental health–related medications represent in day-to-day practice, a significant portion of licensed pharmacists responding to our survey indicate that the emphasis on mental health in their training may have been inadequate.

The views of doctors in their first year of medical practice on the lasting impact of a preparation for house officer course they undertook as final year medical students.

PubMed

Matheson, Catherine B; Matheson, David J; Saunders, John H; Howarth, Claire

2010-06-23

The UK General Medical Council recommends that medical students have the opportunity of shadowing the outgoing new doctor whose post they will soon undertake. At the University of Nottingham the two-week shadowing period was preceded by two weeks of lectures/seminars wherein students followed sessions on topics such as common medical/surgical emergencies, contracts, time management, surviving the first two years of clinical practice, careers advice and so on. The present study aimed to gain a better knowledge and understanding of the lasting impact of a four-week preparation course for new Foundation Year 1 doctors [F1 s - interns]. The objectives chosen to achieve this aim were: 1/ to determine the extent to which the lecture/seminar course and shadowing period achieved their stated aim of smoothing the transition from life as a medical student to work as a new doctor; 2/ to evaluate perceptions of the importance of various forms of knowledge in easing the transition between medical student and new doctor In the spring of 2007, 90 graduates from Nottingham were randomly selected and then emailed a link to a short, online survey of quantitative and qualitative questions. Of these 76 responded. Analysis of quantitative data was carried out using SPSS 16.0 and employed McNemar's test. Analysis of the qualitative data was carried out using the constant comparative method. Only 31% of respondents strongly agreed or agreed that the lecture/seminar part of the course prepared them well for their first FY1 post; 14% agreed that during their first job they drew on the knowledge gained during the lecture/seminar course; 94% strongly agreed or agreed that the shadowing part of the course was more useful than the lecture/seminar part. Experiential knowledge gained in the shadowing was the most highly valued, followed by procedural knowledge with propositional knowledge coming far behind. Our study shows that new doctors retrospectively value most the knowledge they are able to transfer to the workplace and value least material which seems to repeat what they had learned for their final exams.

Hypnosis for childbirth: a retrospective comparative analysis of outcomes in one obstetrician's practice.

PubMed

VandeVusse, Leona; Irland, Jacqueline; Healthcare, Wheaton Franciscan; Berner, Margaret A; Fuller, Shauna; Adams, Debra

2007-10-01

This exploratory, descriptive study, done retrospectively from perinatal medical records, compared childbirth outcomes in one obstetrician's caseload between 50 women who elected antepartal hypnosis preparation (usually a 5-class series) and 51 who did not. The groups were demographically similar. To achieve similar numbers to the hypnosis group, the control group was randomly selected from the women in the caseload who opted not to take hypnosis preparation, based on characteristics of parity and delivery mode. Prenatal hypnosis preparation resulted in significantly less use of sedatives, analgesia, and regional anesthesia during labor and in higher 1-minute neonatal Apgar scores. Other physiologic and outcome measures did not reveal statistical significance, although some trends were of clinical interest. Well-controlled studies are warranted for clinicians to offer hypnosis more frequently as a pain relief option for childbirth. Additional information provided includes pragmatic, clinical, and cost information about incorporating hypnosis into a physician's practice.

Mythbusting Medical Writing: Goodbye, Ghosts! Hello, Help!

PubMed

Hamilton, Cindy W; Gertel, Art; Jacobs, Adam; Marchington, Jackie; Weaver, Shelley; Woolley, Karen

To meet ethical and scientific obligations, authors should submit timely, high-quality manuscripts. Authors, however, can encounter ethical (e.g., authorship designation) and practical (e.g., time and resource limitations) challenges during manuscript preparation. Could professional medical writers-not ghostwriters-help authors address these challenges? This essay summarizes evidence countering three myths that may have hindered authors from considering the use of professional medical writers. Authors with sufficient time, writing expertise, and reporting guideline knowledge may meet their obligations without writing assistance. Unfortunately, not all authors are in this position. Decisions about writing support should be based on evidence, not myths.

Student-teacher education programme (STEP) by step: transforming medical students into competent, confident teachers.

PubMed

Erlich, Deborah R; Shaughnessy, Allen F

2014-04-01

While most medical schools have students teach other students, few offer formal education in teaching skills, and fewer provide teaching theory together with experiential teaching practice. Furthermore, curriculum evaluation of teaching education is lacking. This study aimed to examine effects of a novel didactic teaching curriculum for students embedded in a practical teaching experience. A longitudinal 12-week curriculum with complementary didactic and practical components for final-year students learning how to teach was developed, implemented and evaluated using a multi-level evaluation based on the Kirkpatrick approach with qualitative and quantitative methods. Thirteen student-teachers acquired measureable knowledge, skills and attitudes necessary for teaching excellence. Confidence in teaching increased (p < 0.001), particularly in four key areas: oral feedback, written feedback, mentoring, and the difficult learner. Student-teachers demonstrated teaching competence as determined by self-assessment, student feedback, and faculty observation. Top teachers impacted their first-year students' performance in patient interviewing as measured by Objective Structured Clinical Examination (OSCE). Reinforcing educational theory with practical teaching experience under direct faculty supervision promotes teaching competency for graduating medical students. The intertwined didactic plus practical model can be applied to various teaching contexts to fulfil the mandate that medical schools train graduates in core teaching knowledge, skills and attitudes in preparation for their future roles as clinical teachers.

End-of-life care policies and practices in pediatric skilled nursing facilities.

PubMed

Friedman, Sandra L; Helm, David T; Woodman, Ashley C

2014-11-01

Although most children with intellectual and developmental disabilities reside in the community, a subset of children with severe intellectual disability and complex medical needs reside in pediatric skilled nursing facilities. These children have elevated mortality with end-of-life care (EOLC) routinely provided. The present study explored policies and practice in such settings by surveying administrators, nursing directors, and medical directors in facilities across the United States. In addition to EOLC policies and practices, staff reported on their understanding of definitions of do-not-resuscitate orders, family involvement in EOLC planning, and the availability of in-service training. The presence of an official EOLC policy was associated with higher ratings of perception of effectiveness among staff. Staff felt more prepared and comfortable providing EOLC when in-service training was provided. © The Author(s) 2013.

Where Does Homeopathy Fit in Pharmacy Practice?

PubMed Central

Johnson, Teela

2007-01-01

Homeopathy has been the cause of much debate in the scientific literature with respect to the plausibility and efficacy of homeopathic preparations and practice. Nonetheless, many consumers, pharmacists, physicians, and other health care providers continue to use or practice homeopathic medicine and advocate its safety and efficacy. As drug experts, pharmacists are expected to be able to counsel their patients on how to safely and effectively use medications, which technically includes homeopathic products. Yet many pharmacists feel that the homeopathic system of medicine is based on unscientific theories that lack supporting evidence. Since consumers continue to use homeopathic products, it is necessary for pharmacists to have a basic knowledge of homeopathy and to be able to counsel patients about its general use, the current state of the evidence and its use in conjunction with other medications. PMID:17429507

If we keep doing what we're doing we'll keep getting what we're getting: A need to rethink "academic" medicine.

PubMed

Wilkes, Michael; Cassel, Christine; Klau, Marc

2018-04-01

For generations there have been warnings of the need to reform medical education at all levels. Today the voices pushing reform are louder, the need is greater, and there is an urgency not seen before. Approaches that have worked in the past to train physicians are no longer as relevant today as demographics, disease patterns, human resources, practice behaviors, technology, and attention to costs demand new collaborative approaches to clinical practice. To prepare for this practice tomorrow's doctors will need a different type of educational model, a different type of learning, in different environments, often taught by different faculty. This paper provides one innovative approach to redefine "academic medicine". After reviewing current trends in medical education, this paper describes one approach being taken by a large nonprofit American health care system to move medical education and discovery (research) out of traditional academic universities and placing it within a health care delivery system. The creation of a learning laboratory in a high functioning health care delivery system allows for leveraging the successes in quality health care delivery to transform medical education with a focus on prevention, improving health care quality, reducing disparities in health, and promoting practical evidence-based clinical and outcomes focused research.

E-Learning in Urology: Implementation of the Learning and Teaching Platform CASUS® - Do Virtual Patients Lead to Improved Learning Outcomes? A Randomized Study among Students.

PubMed

Schneider, Anna-Teresa; Albers, Peter; Müller-Mattheis, Volker

2015-01-01

E-learning is playing an increasing role in medical education, supporting a problem-based and practical oriented education without putting patients at risk and compensating for the decrease in instructor-centered teaching. Not much research has been done concerning learning effects and reaction on behalf of the students. We created computer-based cases for four important diagnoses in urology using the authoring system CASUS®. Fourth-year medical school students were randomized into two groups: (1) the CASUS® group, using the online cases for preparation, and (2) the book group, using a textbook. A multiple-choice test referring to the prepared topic had to be completed at the beginning of each lecture and the results were analyzed. Evaluation of the students concerning the acceptance of the program was done at the end of the semester. Members of the CASUS® group scored significantly higher with an average of 20% better test results than students using textbooks for preparation. Evaluation regarding the program showed a highly positive rating. Limitations include the small study population and the possibly biased test performance of the students. Computerized patient cases facilitate practice-oriented teaching and result in an interesting and engaging learning model with improved learning outcomes. © 2015 S. Karger AG, Basel.

Medicinal Plants Used by Traditional Healers in Sangurur, Elgeyo Marakwet County, Kenya

PubMed Central

Kigen, Gabriel; Kipkore, Wilson; Wanjohi, Bernard; Haruki, Boniface; Kemboi, Jemutai

2017-01-01

Background: Although herbal medical products are still widely used in Kenya, many of the medicinal plants used by traditional medical practitioners (TMPs) have not been documented, despite several challenges that are now threatening the sustainability of the practice. Objective: To document the medicinal plants and healing methods used by TMPs in a region of Kenya with several recognized herbalists for potential research. Materials and Methods: Semi-structured interviews, group discussions, and direct observations were used to collect ethnopharmacological information. The participant's bio-data, clinical conditions treated, methods of treatment, medicinal plants used, methods of preparation and administration, and dosage forms were recorded. Results: A total of 99 medicinal plants and 12 complementary preparations employed in the treatment of 64 medical conditions were identified. The most widely used plant was Rotala tenella which was used to treat nine medicinal conditions; seven each for Aloe tweediae and Dovyalis abyssinica; and six each for Basella alba and Euclea divinorum. The plants belonged to 55 families with Fabaceae family being the most frequently used (10), followed by Apocynaceae and Solanaceae, each with six species, respectively. We identified plants used to determine the sex of an unborn baby and those used to treat several conditions including anthrax and cerebral malaria and herbs used to detoxify meat from an animal that has died from anthrax. Of special interest was R. tenella which is used to prevent muscle injury. Conclusions: We have documented several plants with potential therapeutic effects. Further research may be conducted to determine their efficacy. SUMMARY The medicinal plants used by traditional healers in a community which still practices herbal medicine in Kenya were documented. A total of 99 medicinal plants and 12 complementary preparations employed in the treatment of 64 medical conditions were identified. Further research may be carried out in order to determine their therapeutic efficacies. Abbreviations Used: Fic: Informant consensus factor, Nur: Number of use reports in each category, Ns: Number of reported species, TMPs: Traditional medical practitioners. PMID:29263626

Medicinal Plants Used by Traditional Healers in Sangurur, Elgeyo Marakwet County, Kenya.

PubMed

Kigen, Gabriel; Kipkore, Wilson; Wanjohi, Bernard; Haruki, Boniface; Kemboi, Jemutai

2017-01-01

Although herbal medical products are still widely used in Kenya, many of the medicinal plants used by traditional medical practitioners (TMPs) have not been documented, despite several challenges that are now threatening the sustainability of the practice. To document the medicinal plants and healing methods used by TMPs in a region of Kenya with several recognized herbalists for potential research. Semi-structured interviews, group discussions, and direct observations were used to collect ethnopharmacological information. The participant's bio-data, clinical conditions treated, methods of treatment, medicinal plants used, methods of preparation and administration, and dosage forms were recorded. A total of 99 medicinal plants and 12 complementary preparations employed in the treatment of 64 medical conditions were identified. The most widely used plant was Rotala tenella which was used to treat nine medicinal conditions; seven each for Aloe tweediae and Dovyalis abyssinica ; and six each for Basella alba and Euclea divinorum . The plants belonged to 55 families with Fabaceae family being the most frequently used (10), followed by Apocynaceae and Solanaceae, each with six species, respectively. We identified plants used to determine the sex of an unborn baby and those used to treat several conditions including anthrax and cerebral malaria and herbs used to detoxify meat from an animal that has died from anthrax. Of special interest was R. tenella which is used to prevent muscle injury. We have documented several plants with potential therapeutic effects. Further research may be conducted to determine their efficacy. The medicinal plants used by traditional healers in a community which still practices herbal medicine in Kenya were documented. A total of 99 medicinal plants and 12 complementary preparations employed in the treatment of 64 medical conditions were identified. Further research may be carried out in order to determine their therapeutic efficacies. Abbreviations Used: F ic : Informant consensus factor, N ur : Number of use reports in each category, N s : Number of reported species, TMPs: Traditional medical practitioners.

General practice training environment and its impact on preparedness.

PubMed

Wiener-Ogilvie, Sharon; Bennison, Jenny; Smith, Victor

2014-01-01

The notion of preparedness for practice is poorly defined in medical education literature. It is unclear what preparedness means and how the training environment impacts on preparedness for practice. This paper aims to explore the meaning that GP trainees and newly qualified GPs attach to the notion of preparedness, and to examine the ways in which they perceive their training environment to impact on preparedness. We used a qualitative interpretive approach and conducted 27 in-depth semi-structured interviews with 15 newly qualified GPs and 12 GP trainees at the end of their training. Two central categories describing preparedness emerged; 'confidence' and 'adaptability'. Inclusive training practices, characterised by non-hierarchical relationships between the doctors, particularly vis-à-vis trainees, were reported to be more 'progressive' and were better at preparing trainees. The way the training practice can impact on preparedness can be explained drawing on Lave and Wenger's theory of 'situated learning'. The role of the trainer was also pivotal in preparing trainees. Supervision tailored to trainees' needs, and guided decision making enhanced confidence of trainees in their ability to work independently in the future. We suggest that for GP trainees to be better prepared it is not enough to extend GP training; rather it is important that GP trainees' time is spent in inclusive training environments.

Medication communication during ward rounds on medical wards: Power relations and spatial practices.

PubMed

Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

2013-03-01

Communication plays a crucial role in the management of medications. Ward rounds are sites where health professionals from different disciplines and patients come together to exchange medication information and make treatment decisions. This article examines power relations and spatial practices surrounding medication communication between patients and health professionals including doctors, nurses and pharmacists during ward rounds. Data were collected in two medical wards of a metropolitan teaching hospital in Melbourne, Australia. Data collection methods involved participant observations, field interviews, video-recordings, together with individual and group reflexive interviews. A critical discourse analysis was undertaken to identify the location sites where power relations were reproduced or challenged in ward rounds. Findings demonstrated that traditional medical hierarchies constructed the ways in which doctors communicated about medications during ward rounds. Nurses and pharmacists ventured into the ward round space by using the discourse of preparation and occupying a peripheral physical position. Doctors privileged the discourse of medication rationalization in their ward round discussions, competing with the discourse of inquiry taken up by patients and families. Ward rounds need to be restructured to provide opportunities for nurses and pharmacists to speak at dedicated times and in strategic locations. By critically reflecting upon the complex process of medication communication during ward rounds, greater opportunities exist for enhanced team communication among health professionals.

Medical School Factors That Prepare Students to Become Leaders in Medicine.

PubMed

Arnold, Louise; Cuddy, Paul G; Hathaway, Susan B; Quaintance, Jennifer L; Kanter, Steven L

2018-02-01

To identify medical school factors graduates in major leadership positions perceive as contributing to their leadership development. Using a phenomenological, qualitative approach, in August-November 2015 the authors conducted semistructured interviews with 48 medical leaders who were 1976-1999 baccalaureate-MD graduates of the University of Missouri-Kansas City School of Medicine (UMKC). At UMKC, they participated in longitudinal learning communities, the centerpiece for learning professional values and behaviors plus clinical skills, knowledge, and judgment, but received no formal leadership instruction. The authors subjected interview comments to directed, largely qualitative content analysis with iterative coding cycles. Most graduates said their experiences and the people at UMKC positively influenced their leadership growth. Medical school factors that emerged as contributing to that growth were the longitudinal learning communities including docents, junior-senior partners, and team experiences; expectations set for students to achieve; a clinically oriented but integrated curriculum; admission policies seeking students with academic and nonacademic qualifications; supportive student-student and student-faculty relationships; and a positive overall learning environment. Graduates viewed a combination of factors as best preparing them for leadership and excellence in clinical medicine; together these factors enabled them to assume leadership opportunities after graduation. This study adds medical leaders' perspective to the leadership development literature and offers guidance from theory and practice for medical schools to consider in shaping leadership education: Namely, informal leadership preparation coupled with extensive longitudinal clinical education in a nurturing, authentic environment can develop students effectively for leadership in medicine.

How Does an Occupational Neurologist Assess Welders and Steelworkers for a Manganese-Induced Movement Disorder? An International Team's Experiences in Guanxi, China, Part I

PubMed Central

Rutchik, Jonathan S.; Zheng, Wei; Jiang, Yueming; Mo, Xuean

2016-01-01

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney. PMID:23135302

Threading needles in the dark: the effect of the physical work environment on nursing practice.

PubMed

Simmons, Debora; Graves, Krisanne; Flynn, Elizabeth A

2009-01-01

Frequently, the most critical calculations, considerations, and preparations for patient care and medication administration are made in noisy, dimly lit, and chaotic areas of the nursing unit. Healthcare has begun to recognize the impact of the physical work environment plays in the ability of humans to perform reliably and safely. This article reviews the draft guidelines recently released by the United States Pharmacopeia for public comment for the physical environment to promote safe medication administration.

MO-AB-201-03: The Alphabet Soup of Regulatory Compliance: Being Prepared for Inspections

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kroger, L.

2015-06-15

The role of the Radiation Safety Officer at a medical facility can be complicated. The complexity of the position is based on the breadth of services provided at the institution and the nature of the radioactive materials license. Medical practices are constantly changing and the use of ionizing radiation continues to rise in this area. Some of the newer medical applications involving radiation have unique regulatory and safety issues that must be addressed. Oversight of the uses of radiation start at the local level (radiation safety officer, radiation safety committee) and are heavily impacted by outside agencies (i.e. Nuclear Regulatorymore » Commission, State Radiologic Health, The Joint Commission (TJC), etc). This session will provide both an overview of regulatory oversight and essential compliance practices as well as practical ways to assess and introduce some of the new applications utilizing radioactive materials into your medical facility. Learning Objectives: Regulatory Compliance and Safety with New Radiotherapies: Spheres and Ra-223 (Lance Phillips) Understand the radioactive materials license amendment process to add new radiotherapies (i.e., SIR-Spheres, Therasphere, Xofigo). Understand the AU approval process for microspheres and Xofigo. Examine the training and handling requirements for new procedures. Understand the process involved with protocol development, SOP in order to define roles and responsibilities. The RSO and The RSC: Challenges and Opportunities (Colin Dimock) Understand how to form an effective Committee. Examine what the Committee does for the Program and the RSO. Understand the importance of Committee engagement. Discuss the balance of the complimentary roles of the RSO and the Committee. The Alphabet Soup of Regulatory Compliance: Being Prepared for Inspections (Linda Kroger) Recognize the various regulatory bodies and organizations with oversight or impact in Nuclear Medicine, Radiology and Radiation Oncology. Examine 10CFR35 requirements as they relate to the everyday practice of Nuclear Medicine and Radiation Oncology. Understand the nature of available guidance documents (e.g., NUREG 1556). Examine the commonalities between TJC and CMS preparedness.« less

Physician Experiences With High Value Care in Internal Medicine Residency: Mixed-Methods Study of 2003-2013 Residency Graduates.

PubMed

Ryskina, Kira L; Holmboe, Eric S; Shea, Judy A; Kim, Esther; Long, Judith A

2018-01-01

Phenomenon: High healthcare costs and relatively poor health outcomes in the United States have led to calls to improve the teaching of high value care (defined as care that balances potential benefits of interventions with their harms including costs) to physicians-in-training. Numerous interventions to increase high value care in graduate medical education were implemented at the national and local levels over the past decade. However, there has been little evaluation of their impact on physician experiences during training and perceived preparedness for practice. We aimed to assess trends in U.S. physician experiences with high value care during residency over the past decade. This mixed-methods study used a cross-sectional survey mailed July 2014 to January 2015 to 902 internists who completed residency in 2003-2013, randomly selected from the American Medical Association Masterfile. Quantitative analyses of survey responses and content analysis of free-text comments submitted by respondents were performed. A total of 456 physicians (50.6%) responded. Fewer than one fourth reported being exposed to teaching about high value care at least frequently (23.6%, 106/450). Only 43.8% of respondents (193/446) felt prepared to use overtreatment guidelines in conversations with patients, whereas 85.8% (379/447) felt prepared to participate in shared decision making with patients at the conclusion of their training, and 84.4% (380/450) reported practicing generic prescribing. Physicians who completed residency more recently were more likely to report practicing generic prescribing and feeling well prepared to use overtreatment guidelines in conversations with patients (p < .01 for both). Insights: In a national survey, recent U.S. internal medicine residency graduates were more likely to experience high value care during training, which may reflect increased national and local efforts in this area. However, being exposed to high value care as a trainee may not translate into specific tools for practice. In fact, many U.S. internists reported inadequate exposure to prepare them for patient discussions about costs and the use of overtreatment guidelines in practice.

How innovative and conventional curricula prepare medical students for practice in Sub-Saharan Africa: A comparative study from Mozambique.

PubMed

Frambach, Janneke M; Manuel, Beatriz A F; Fumo, Afonso M T; Groosjohan, Bernard; Van Der Vleuten, Cees P M; Driessen, Erik W

2017-01-01

Medical education in Sub-Saharan Africa is in need of reform to promote the number and quality of physicians trained. Curriculum change and innovation in this region, however, face a challenging context that may affect curriculum outcomes. Research on outcomes of curriculum innovation in Sub-Saharan Africa is scarce. We investigated curriculum outcomes in a Sub-Saharan African context by comparing students' perceived preparedness for practice within three curricula in Mozambique: a conventional curriculum and two innovative curricula. Both innovative curricula used problem-based learning and community-based education. We conducted a comparative mixed methods study. We adapted a validated questionnaire on perceived professional competencies and administered it to 5th year students of the three curricula (n = 140). We conducted semi-structured interviews with 5th year students from these curricula (n = 12). Additional contextual information was collected. Statistical and thematic analyses were conducted. Perceived preparedness for practice of students from the conventional curriculum was significantly lower than for students from one innovative curriculum, but significantly higher than for students from the other innovative curriculum. Major human and material resource issues and disorganization impeded the latter's sense of preparedness. Both innovative curricula, however, stimulated a more holistic approach among students toward patients, as well an inquiring and independent attitude, which is valuable preparation for Sub-Saharan African healthcare. In Sub-Saharan Africa, risks and benefits of curriculum innovation are high. Positive outcomes add value to local healthcare in terms of doctors' meaningful preparedness for practice, but instead outcomes can be negative due to the implementation challenges sometimes found in Sub-Saharan African contexts. Before embarking on innovative curriculum reform, medical schools need to assess their capability and motivation for innovation.

Legal Issues for the Medical Director.

PubMed

Trulove, William G

2015-09-04

The nephrologist serving as medical director of a dialysis clinic must understand that the role of director is not simply an extension of being a good nephrologist. The two roles-nephrology practice and the leadership of a dialysis clinic-may be filled by a single person. However, each role contains unique tasks, requiring specific skill sets, and each role comes with inherent, associated legal risks. The medical director assumes a new level of responsibility and accountability defined by contractual obligations to the dialysis provider and by state and federal regulations. Hence, a medical director is accountable not only for providing standard-of-care treatment to his or her private practice patients dialyzed at the clinic but also for maintaining the safety of the dialysis clinic patient population and staff. Accordingly, a nephrologist serving in the role of medical director faces distinct legal risks beyond typical professional liability concerns. The medical director must also be mindful of regulatory compliance, unique avenues to licensure board complaints, and implications of careless communication habits. A thoughtful and prepared medical director can mitigate these risk exposures by understanding the sources of these challenges: contractual obligations, pertinent regulatory responsibilities, and the modern electronic communications environment. Copyright © 2015 by the American Society of Nephrology.

A framework for mentoring of medical students: thematic analysis of mentoring programmes between 2000 and 2015.

PubMed

Tan, Yin Shuen; Teo, Shao Wen Amanda; Pei, Yiying; Sng, Julia Huina; Yap, Hong Wei; Toh, Ying Pin; Krishna, Lalit K R

2018-03-17

A consistent mentoring approach is key to unlocking the full benefits of mentoring, ensuring effective oversight of mentoring relationships and preventing abuse of mentoring. Yet consistency in mentoring between senior clinicians and medical students (novice mentoring) which dominate mentoring processes in medical schools is difficult to achieve particularly when mentors practice in both undergraduate and postgraduate medical schools. To facilitate a consistent approach to mentoring this review scrutinizes common aspects of mentoring in undergraduate and postgraduate medical schools to forward a framework for novice mentoring in medical schools. Four authors preformed independent literature searches of novice mentoring guidelines and programmes in undergraduate and postgraduate medical schools using ERIC, PubMed, CINAHL, OVID and Science Direct databases. 25,605 abstracts were retrieved, 162 full-text articles were reviewed and 34 articles were included. The 4 themes were identified-preparation, initiating and supporting the mentoring process and the obstacles to effective mentoring. These themes highlight 2 key elements of an effective mentoring framework-flexibility and structure. Flexibility refers to meeting the individual and changing needs of mentees. Structure concerns ensuring consistency to the mentoring process and compliance with prevailing codes of conduct and standards of practice.

Legal Issues for the Medical Director

PubMed Central

2015-01-01

The nephrologist serving as medical director of a dialysis clinic must understand that the role of director is not simply an extension of being a good nephrologist. The two roles—nephrology practice and the leadership of a dialysis clinic—may be filled by a single person. However, each role contains unique tasks, requiring specific skill sets, and each role comes with inherent, associated legal risks. The medical director assumes a new level of responsibility and accountability defined by contractual obligations to the dialysis provider and by state and federal regulations. Hence, a medical director is accountable not only for providing standard-of-care treatment to his or her private practice patients dialyzed at the clinic but also for maintaining the safety of the dialysis clinic patient population and staff. Accordingly, a nephrologist serving in the role of medical director faces distinct legal risks beyond typical professional liability concerns. The medical director must also be mindful of regulatory compliance, unique avenues to licensure board complaints, and implications of careless communication habits. A thoughtful and prepared medical director can mitigate these risk exposures by understanding the sources of these challenges: contractual obligations, pertinent regulatory responsibilities, and the modern electronic communications environment. PMID:25492255

Laboratory quality management system: road to accreditation and beyond.

PubMed

Wadhwa, V; Rai, S; Thukral, T; Chopra, M

2012-01-01

This review attempts to clarify the concepts of Laboratory Quality Management System (Lab QMS) for a medical testing and diagnostic laboratory in a holistic way and hopes to expand the horizon beyond quality control (QC) and quality assurance. It provides an insight on accreditation bodies and highlights a glimpse of existing laboratory practices but essentially it takes the reader through the journey of accreditation and during the course of reading and understanding this document, prepares the laboratory for the same. Some of the areas which have not been highlighted previously include: requirement for accreditation consultants, laboratory infrastructure and scope, applying for accreditation, document preparation. This section is well supported with practical illustrations and necessary tables and exhaustive details like preparation of a standard operating procedure and a quality manual. Concept of training and privileging of staff has been clarified and a few of the QC exercises have been dealt with in a novel way. Finally, a practical advice for facing an actual third party assessment and caution needed to prevent post-assessment pitfalls has been dealt with.

Maude Abbott and the Origin and Mysterious Disappearance of the Canadian Medical War Museum.

PubMed

Wright, James R; Alberti, Samuel J M M; Lyons, Christopher; Fraser, Richard S

2018-05-07

- In the early 1900s, it was common practice to retain, prepare, and display instructive pathologic specimens to teach pathology to medical trainees and practitioners; these collections were called medical museums. Maude Abbott established her reputation by developing expertise in all aspects of medical museum work. She was a founder of the International Association of Medical Museums (later renamed the International Academy of Pathology) and became an internationally renowned expert on congenital heart disease. Her involvement in the Canadian Medical War Museum (CMWM) is less well known. - To explore Abbott's role in the development of the CMWM during and after World War I and to trace its history. - Available primary and secondary historical sources were reviewed. - Instructive pathologic specimens derived from Canadian soldiers dying during World War I were shipped to the Royal College of Surgeons in London, which served as a clearinghouse for museum specimens from Dominion forces. The Canadian specimens were repatriated to Canada, prepared by Abbott, and displayed at several medical meetings. Abbott, because she was a woman, could not enlist and so she reported to a series of enlisted physicians with no expertise in museology. Plans for a permanent CMWM building in Ottawa eventually failed and Abbott maintained the collection at McGill (Montreal, Quebec, Canada) until her death in 1940. We trace the CMWM after her death. - Sadly, after Abbott had meticulously prepared these precious teaching specimens so that their previous owners' ultimate sacrifice would continue to help their military brethren, the relics were bureaucratically lost.

Perceptions of medical school graduates and students regarding their academic preparation to teach.

PubMed

Henry, B W; Haworth, J G; Hering, P

2006-09-01

How medical students learn and develop the characteristics associated with good teaching in medicine is not well known. Information about this process can improve the academic preparation of medical students for teaching responsibilities. The purpose of this study was to determine how different experiences contributed to the knowledge, skills, and attitudes of medical school graduates and students regarding medical teaching. A questionnaire was developed, addressing reliability and validity considerations, and given to first year residents and third year medical students (taught by those residents). Completed questionnaires were collected from 76 residents and 110 students (81% of the sample group). Item responses were analysed using descriptive and inferential statistics. Most residents (n = 54; 71%) positively viewed opportunities they had to practice teaching when they were seniors. Residents rated three activities for learning to teach highest: (1) observing teachers as they teach; (2) reviewing the material to be taught; and (3) directly teaching students; representing both individual and participatory ways of learning. Residents' self ratings of teaching behaviours improved over time and this self assessment by the residents was validated by the students' responses. Comparison between residents' self ratings and students' views of typical resident teaching behaviours showed agreement on levels of competence, confidence, and motivation. The students rated characteristics of enthusiasm, organisation, and fulfilment lower (p<0.002) than residents rated themselves. The residents and students in this study viewed academic preparation for teaching responsibilities positively and showed agreement on characteristics of good teaching that may be helpful indicators in the process of developing medical teachers.

Recruiting American Indian/Alaska Native Students to Medical School: A Multi-Institutional Alliance in the U.S. Southwest.

PubMed

Ballejos, Marlene P; Olsen, Polly; Price-Johnson, Tanisha; Garcia, Cindy; Parker, Tassy; Sapién, Robert E; Romero-Leggott, Valerie

2018-01-01

Despite national efforts to diversify the physician workforce, American Indian/Alaska Native (AI/AN) individuals have the least representation of all major racial and ethnic groups. Limited resources at state medical schools present institution-level recruitment challenges. Unified efforts to engage AI/AN students in premedical education activities are needed. The medical schools at the Universities of Arizona (Phoenix and Tucson), Colorado, New Mexico, and Utah identified a collective need to increase student diversity, particularly with regard to AI/AN students. The schools partnered with the Association of American Indian Physicians to support AI/AN students applying to medical school and to grow the overall AI/AN applicant pool. Each year from 2011 to 2016, these institutions hosted a two-day preadmissions workshop (PAW) to prepare participants for applying to medical school. From 2011 to 2016, 130 AI/AN students participated in the PAWs. Of these, 113 were first-time attendees, 15 participated on two separate occasions, and 1 participated on three separate occasions. Nineteen (21%) of the 90 first-time participants from 2011 to 2015 matriculated to a U.S. medical school in the past five years. Twenty-two of 23 participants (96% response rate) in 2016 responded to the postworkshop survey. Results indicated that interview preparation, individual consultation, and writing preparation ranked as the three most beneficial sessions/activities. Standardized evaluation of future PAWs will identify best practices for recruiting AI/AN students to medical school, and future initiatives will include more robust measures of success.

How to write a medico-legal report.

PubMed

Bird, Sara

2014-11-01

The preparation and provision of medico-legal reports by the treating doctor is an inevitable but sometimes unwelcome part of general practice. This article outlines the steps involved in preparing a 'good' medico-legal report, including some of the common pitfalls to avoid. General practitioners play an important role in providing medico-legal reports about their patients for a wide variety of purposes. A medico-legal report may be seen by a diverse, non-medical audience. Once prepared, the report may be used as evidence in court proceedings and subjected to close scrutiny. A structured and comprehensive medico-legal report may minimise the chances of having to give evidence in court.

Treatment of diarrhoea in infants by medical doctors in Balochistan, Pakistan.

PubMed

Kasi, M; Kausar, P; Naz, R; Miller, L C

1995-12-01

Diarrhoea is an important public health problem in Balochistan, the westernmost province of Pakistan. Although the use of oral rehydration solutions (ORS) has been widely promoted, no studies have been reported on the actual uses of ORS in treating infant diarrhoea by the medical doctors in this region. The medical practices of 30 doctors in Balochistan were surveyed. The surveyors posed as the mothers of infants with diarrhoea. The questions asked by the doctors, the physical examinations performed, and the treatments prescribed were noted. The histories and physical examinations were incomplete, as performed by most practitioners. In addition, 80% of the doctors prescribed drugs, usually kaolin preparations to treat diarrhoea. However, 18 of the 30 (60%) practitioners also prescribed ORS for treating diarrhoea and most of them gave some recommendations about ORS use. It is concluded that many medical practitioners have incorporated ORS treatment into their practices. Ongoing educational programmes and refresher courses would likely improve the use of ORS further in this region.

Barriers and Strategies to Engaging Our Community-Based Preceptors.

PubMed

Graziano, Scott C; McKenzie, Margaret L; Abbott, Jodi F; Buery-Joyner, Samantha D; Craig, LaTasha B; Dalrymple, John L; Forstein, David A; Hampton, Brittany S; Page-Ramsey, Sarah M; Pradhan, Archana; Wolf, Abigail; Hopkins, Laura

2018-03-26

This article, from the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is a review of commonly cited barriers to recruiting and retaining community-based preceptors in undergraduate medical education and potential strategies to overcome them. Community-based preceptors have traditionally served as volunteer, nonsalaried faculty, with academic institutions relying on intrinsic teaching rewards to sustain this model. However, increasing numbers of learners, the burdens of incorporating the electronic medical record in practice, and increasing demands for clinical productivity are making recruitment and retention of community-based preceptors more challenging. General challenges to engaging preceptors, as well as those unique to women's health, are discussed. Potential solutions are reviewed, including alternative recruitment strategies, faculty development to emphasize efficient teaching practices in the ambulatory setting, offers of online educational resources, and opportunities to incorporate students in value-added roles. Through examples cited in this review, clerkship directors and medical school administrators should have a solid foundation to actively engage their community-based preceptors.

The politics of herbal drugs in Korea.

PubMed

Cho, B H

2000-08-01

Hanbang, the Korean medical practice with origins in classical Chinese texts, is a prominent part of the Korean health care system. Hanbang physicians, called hanuisas, are looked down on by biomedical doctors, but their practice has enjoyed increasing popularity for several decades. As the market for herbal preparations has become more lucrative, biomedical pharmacists have begun to participate in it. The Pharmaceutical Act in 1993 explicitly allowed pharmacists to prescribe and dispense herbal drugs. This provoked a bitter public conflict between hanuisas and pharmacists, involving street demonstrations and strikes. The hanuisas asserted that the pharmacists were unqualified to assume their traditional practice. They also agitated for recognition in the state-sponsored system of health care and for the state's support for developing Hanbang medicine. This paper attributes the conflicts concerning Hanbang to the expanding market for herbal preparations, Korean nationalism, and to the oversupply of biomedical pharmacists.

AFOMP Policy No 5: career progression for clinical medical physicists in AFOMP countries.

PubMed

Round, W H; Stefanoyiannis, A P; Ng, K H; Rodriguez, L V; Thayalan, K; Han, Y; Tang, F; Fukuda, S; Srivastava, R; Krisanachinda, A; Shiau, A C; Deng, X

2015-06-01

This policy statement, which is the fifth of a series of documents being prepared by the Asia-Oceania Federation of Organizations for Medical Physics Professional Development Committee, gives guidance on how clinical medical physicists' careers should progress from their initial training to career end. It is not intended to be prescriptive as in some AFOMP countries career structures are already essentially defined by employment awards and because such matters will vary considerably from country to country depending on local culture, employment practices and legislation. It is intended to be advisory and set out options for member countries and employers of clinical medical physicists to develop suitable career structures.

Medical education in an era of health-care reform.

PubMed

Cohen, Jordan J

2011-01-01

Medical educators are facing a challenge today that is quite analogous to that addressed by Abraham Flexner, namely how to transform a legacy system of education that is no longer preparing future physicians adequately to meet contemporary expectations and responsibilities. In facing up this challenge, however, today's educators not only must equip students to deal effectively with the rapidly changing paradigms in health care and medical practice, they also must adapt their curricula and pedagogical methods to the demanding new paradigms of medical education. Their success in addressing these dual imperatives will determine whether the educational transformations currently underway will have as momentous an effect on the public's health as did those stimulated by Flexner a century ago.

The German medical dissertation--time to change?

PubMed

Diez, C; Arkenau, C; Meyer-Wentrup, F

2000-08-01

German medical students must conduct a research project and write a dissertation in order to receive the title "Doctor." However, the dissertation is not required to graduate, enter a residency, or practice medicine. About 90% of practicing physicians hold the title "Doctor"; a career in academic medicine almost always requires it. Although no convincing evidence supports the usefulness of the dissertation, many regard its completion as important to maintaining a high level of scientific competence and patient care. In recent years, the number of successfully completed dissertations has declined. Lack of time during medical school, the perceived irrelevance of the dissertation to medical practice, and the poor design of many projects may be at least part of the problem. There is also increasing evidence that conducting research frequently delays graduation and may affect clinical skills because students working on projects attend fewer classes, ward rounds, and clinical tutorials and do not spent sufficient time preparing for examinations. The scientific value of students' research has also been criticized; critics point out that students do not have enough time or experience to critically analyze methods and data, and they often are not properly supervised. European unification will probably lead to standardized requirements for medical education and research. The authors hope this will eliminate the dissertation requirement in Germany.

[Improvement of medical processes with Six Sigma - practicable zero-defect quality in preparation for surgery].

PubMed

Sobottka, Stephan B; Töpfer, Armin; Eberlein-Gonska, Maria; Schackert, Gabriele; Albrecht, D Michael

2010-01-01

Six Sigma is an innovative management- approach to reach practicable zero- defect quality in medical service processes. The Six Sigma principle utilizes strategies, which are based on quantitative measurements and which seek to optimize processes, limit deviations or dispersion from the target process. Hence, Six Sigma aims to eliminate errors or quality problems of all kinds. A pilot project to optimize the preparation for neurosurgery could now show that the Six Sigma method enhanced patient safety in medical care, while at the same time disturbances in the hospital processes and failure costs could be avoided. All six defined safety relevant quality indicators were significantly improved by changes in the workflow by using a standardized process- and patient- oriented approach. Certain defined quality standards such as a 100% complete surgical preparation at start of surgery and the required initial contact of the surgeon with the patient/ surgical record on the eve of surgery could be fulfilled within the range of practical zero- defect quality. Likewise, the degree of completion of the surgical record by 4 p.m. on the eve of surgery and their quality could be improved by a factor of 170 and 16, respectively, at sigma values of 4.43 and 4.38. The other two safety quality indicators "non-communicated changes in the OR- schedule" and the "completeness of the OR- schedule by 12:30 a.m. on the day before surgery" also show an impressive improvement by a factor of 2.8 and 7.7, respectively, corresponding with sigma values of 3.34 and 3.51. The results of this pilot project demonstrate that the Six Sigma method is eminently suitable for improving quality of medical processes. In our experience this methodology is suitable, even for complex clinical processes with a variety of stakeholders. In particular, in processes in which patient safety plays a key role, the objective of achieving a zero- defect quality is reasonable and should definitely be aspirated. Copyright © 2010. Published by Elsevier GmbH.

Integrating Education on Addressing Health Disparities into the Graduate Social Work Curriculum

ERIC Educational Resources Information Center

Mitchell, Jamie Ann

2012-01-01

The purpose of this article is to propose an elective social work course as a means of better preparing social workers entering practice in healthcare to meet the challenges of promoting health and reducing health disparities in minority and underserved communities. Course offerings specifically targeting health or medical social work training…

Using Standardized Patients in Continuing Medical Education Courses on Proper Prescribing of Controlled Substances

ERIC Educational Resources Information Center

Swiggart, William H.; Ghulyan, Marine V.; Dewey, Charlene M.

2012-01-01

Controlled prescription drug (CPD) abuse is an increasing threat to patient safety and health care providers (HCPs) are not adequately prepared nor do they routinely employ proper screening techniques. Using standardized patients (SPs) as an instructional strategy, the trained physicians on proper prescribing practices and SBIRT (Screening, Brief…

Orientation to Health Occupations: Curriculum Guide for Health Occupations, Phase 3.

ERIC Educational Resources Information Center

Benedict, Mary; And Others

The document outlines a curriculum designed to prepare students for advanced health occupations. It is divided into four sections which offer basic information for: registered nurse and licensed practical nurse (32 units); dental assistant (19 units); medical assistant (26 units); and ward clerk (10 units). Each unit is divided into several topics…

OCCUPATIONAL EXPOSURES TO BODY FLUIDS AND BEHAVIORS REGARDING THEIR PREVENTION AND POST-EXPOSURE AMONG MEDICAL AND NURSING STUDENTS AT A BRAZILIAN PUBLIC UNIVERSITY

PubMed Central

de Souza-Borges, Fernanda Ribeiro Fagundes; Ribeiro, Larissa Araújo; de Oliveira, Luiz Carlos Marques

2014-01-01

A cross-sectional study was conducted to assess the frequencies and characteristics of occupational exposures among medical and nursing students at a Brazilian public university, in addition to their prevention and post-exposure behavior. During the second semester of 2010, a self-administered semi-structured questionnaire was completed by 253/320 (79.1%) medical students of the clinical course and 149/200 (74.5%) nursing students who were already performing practical activities. Among medical students, 53 (20.9%) suffered 73 injuries, which mainly occurred while performing extra-curricular activities (32.9%), with cutting and piercing objects (56.2%), in the emergency room (39.7%), and as a result of lack of technical preparation or distraction (54.8%). Among nursing students, 27 (18.1%) suffered 37 injuries, which mainly occurred with hollow needles (67.6%) in the operating room or wards (72.2%), and as a result of lack of technical preparation or distraction (62.1%). Among medical and nursing students, respectively, 96.4% and 48% were dissatisfied with the instructions on previously received exposure prevention; 48% and 18% did not always use personal protective equipment; 67.6% and 16.8% recapped used needles; 49.3% and 35.1% did not bother to find out the source patient's serological results post-exposure; and 1.4% and 18.9% officially reported injuries. In conclusion, this study found high frequencies of exposures among the assessed students, inadequate practices in prevention and post-exposure, and, consequently, the need for training in “standard precautions” to prevent such exposures. PMID:24626419

Occupational exposures to body fluids and behaviors regarding their prevention and post-exposure among medical and nursing students at a Brazilian public university.

PubMed

Souza-Borges, Fernanda Ribeiro Fagundes de; Ribeiro, Larissa Araújo; Oliveira, Luiz Carlos Marques de

2014-01-01

A cross-sectional study was conducted to assess the frequencies and characteristics of occupational exposures among medical and nursing students at a Brazilian public university, in addition to their prevention and post-exposure behavior. During the second semester of 2010, a self-administered semi-structured questionnaire was completed by 253/320 (79.1%) medical students of the clinical course and 149/200 (74.5%) nursing students who were already performing practical activities. Among medical students, 53 (20.9%) suffered 73 injuries, which mainly occurred while performing extra-curricular activities (32.9%), with cutting and piercing objects (56.2%), in the emergency room (39.7%), and as a result of lack of technical preparation or distraction (54.8%). Among nursing students, 27 (18.1%) suffered 37 injuries, which mainly occurred with hollow needles (67.6%) in the operating room or wards (72.2%), and as a result of lack of technical preparation or distraction (62.1%). Among medical and nursing students, respectively, 96.4% and 48% were dissatisfied with the instructions on previously received exposure prevention; 48% and 18% did not always use personal protective equipment; 67.6% and 16.8% recapped used needles; 49.3% and 35.1% did not bother to find out the source patient's serological results post-exposure; and 1.4% and 18.9% officially reported injuries. In conclusion, this study found high frequencies of exposures among the assessed students, inadequate practices in prevention and post-exposure, and, consequently, the need for training in "standard precautions" to prevent such exposures.

[The Results of Self-Assessment by Medical Organizations Their Correspondence to Proposals (Practical Recommendations) of the Roszdravnadzor Concerning Organization of Internal Control of Quality and Safety of Medical Activity].

PubMed

Ivanov, I V; Shvabsky, O R; Minulin, I B

2017-11-01

The article presents the analysis of the results of internal audits (self-rating) in medical organizations implemented on the basis of Proposals (practical guidelines) of the Roszdravnadzor concerning organization of inner control of quality and safety of medical activities in medical organization (hospital). The self-rating was implemented by the medical organizations themselves according the common criteria of the Proposals as provided the following plan: planning of self-rating, collection and processing of data, application of self-rating, analysis of obtained results, preparation of report. The article uses the results of self-rating of medical organizations corresponding to following criteria: profile of activity-multi-field hospital-number of beds more than 350-state property. The self-rating was implemented according to 11 basic parts of the Proposals. The criteria were developed for every part. The evaluation lists developed on the basis of the given Proposals permitted to medical organizations to independently establish problems in their activities. Within the framework of implemented self-rating medical organizations mentioned the directions of activity related to personnel management, identification of personality of patient, support of epidemiological and surgical safety as having significant discrepancies with the Proposals and requiring implementation of improvement measures.

Medical students' child oral-health-related knowledge, practices and attitudes.

PubMed

AlYousef, Y; Damiano, P; Weber-Gasparoni, K; Qian, F; Murph, J; Nothwehr, F

2013-11-01

This study evaluated medical interns' oral health knowledge, and other factors influencing their ability and willingness to perform oral-health-related practices for high-caries-risk children. A 15-item survey was emailed to all eligible graduating fifth-year medical students at King Khalid University Hospital to address these areas of interest. Chi-square statistics and logistic regression models were used to analyse data. One-hundred and twenty-one (49%) usable surveys were returned from two mailings. On questions regarding comfort levels when performing oral-health-related practices on children under age 3, physicians noted high levels of comfort with all specified oral health practices. Regarding satisfaction of students with medical training, the majority of respondents (87.5%) rated their medical training as fair or poor in preparing them for oral health assessments compared to only 35%, 29% and 7% of respondents giving fair or poor ratings to child abuse identification, caring for special needs patients and primary care paediatric practice, respectively. Additionally, although 90% of respondents noted that the role of primary physicians in counselling/referring children with oral health was important, 60% did not agree with the AAPD and AAP guidelines that state that all children should be referred to a dentist by 12 months of age. Multivariate logistic regression analyses revealed several statistically significant variables that predict the likelihood of performing various oral-health-related practices. The choice of public-health-oriented future clinical goals, the level of oral health knowledge, how interns rated their oral health training in medical school and the average number of children seen per week, all--to varying degrees--proved important predicator variables for the likelihood of performing them once in practice. More oral-health-related training of medical students seems warranted and could improve their interest in providing oral-health-related screening and referrals in practice. Increasing student exposure to child patients and increasing exposures to oral health knowledge and problems could be targeted towards students interested in primary care and public health to use resources most efficiently in the effort to combat the growing caries levels amongst young children in Saudi Arabia. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Hospitals prepare plans, drill staff to ensure that potential Ebola patients are identified, isolated, and managed safely.

PubMed

2014-12-01

Hospitals around the country have stepped up their efforts to train staff and implement procedures to ensure the safe identification and management of any patients with signs of Ebola virus disease (EVD). Ronald Reagan UCLA Medical Center in Los Angeles, CA, held an "Ebola preparedness exercise" to give staff an opportunity to walk through the hospital's protocol for handling a simulated patient with EVD. The University of Alabama at Birmingham (UAB) Medical Center has held similar exercises, and is now holding twice-weekly meetings of its leadership team to make sure that all new developments in the Ebola outbreak are communicated. UCLA Medical Center has prepared PPE kits based on the practices developed at Emory University Hospital, which has thus far had the most experience in this country in caring for patients with EVD. The UCLA Health System has adjusted its medical record system so that a red flag is placed on the electronic medical record [EMR] of any patient who has recently traveled to a high-risk area. UAB Medical Center has incorporated what had been a paper-and-pencil screening tool for EVD into its electronic medical record. Training on PPE as well as EVD screening is being provided to first-responders and 911 call center dispatchers in the UAB system.

Increasing the Accessibility of Sexual Assault Forensic Examinations: Evaluation of Texas Law SB 1191.

PubMed

Davis, Robert C; Auchter, Bernard; Howley, Susan; Camp, Torie; Knecht, Ilse; Wells, William

Texas SB 1191 was enacted in 2013 with the intent of increasing access to medical forensic examinations for sexual assault victims by requiring every hospital with an emergency department to be prepared to provide a medical forensic examination if requested by a sexual assault victim. To realize that goal, the law also required basic forensic training for medical professionals before conducting a medical forensic examination as well as a requirement that hospitals develop a "plan to train personnel on sexual assault forensic evidence collection." Interviews were conducted in 18 healthcare facilities (five with sexual assault nurse examiner [SANE] programs and 13 without SANE programs) in Dallas, Lubbock, and Austin to determine their awareness and compliance with SB 1191. The data suggest that the law had a little effect on actual practice, and sexual assault survivors still sought a SANE program for a medical forensic examination. Although SB 1191 is an important state level effort to make forensic examinations more readily available, it did not fully account for the challenges faced by smaller hospitals that do not see enough sexual assault victims to justify training staff to SANE standards and did not adequately address the training required by medical professionals to feel prepared to conduct a medical forensic examination.

What nurse practitioners should know about direct-to-consumer advertising of prescription medications.

PubMed

Viale, Pamela Hallquist

2003-07-01

To describe the marketing strategies of direct-to-consumer (DTC) advertising and the risks, benefits, and potential influence on the prescribing practices of nurse practitioners (NPs). Journal articles, media sources, and clinical experience. The effect of DTC advertising of prescription medications on NPs has not been well studied. Although there are studies that examine the effects of DTC advertising on physician prescribing as well as the effects of this practice on the consumer, opinions on the benefits of DTC advertising are varied. NPs need to recognize the potential influence of DTC advertising and to be prepared to guide patients toward appropriate medication choices by participating in a partnership with patients. Health care providers, including NPs, need to work with the pharmaceutical industry to encourage accountability of DTC advertising, thus improving dissemination of correct information and promoting positive outcomes for health consumers and patients.

Game theory: applications for surgeons and the operating room environment.

PubMed

McFadden, David W; Tsai, Mitchell; Kadry, Bassam; Souba, Wiley W

2012-11-01

Game theory is an economic system of strategic behavior, often referred to as the "theory of social situations." Very little has been written in the medical literature about game theory or its applications, yet the practice of surgery and the operating room environment clearly involves multiple social situations with both cooperative and non-cooperative behaviors. A comprehensive review was performed of the medical literature on game theory and its medical applications. Definitive resources on the subject were also examined and applied to surgery and the operating room whenever possible. Applications of game theory and its proposed dilemmas abound in the practicing surgeon's world, especially in the operating room environment. The surgeon with a basic understanding of game theory principles is better prepared for understanding and navigating the complex Operating Room system and optimizing cooperative behaviors for the benefit all stakeholders. Copyright © 2012 Mosby, Inc. All rights reserved.

Nursing faculty teaching a module in clinical skills to medical students: a Lebanese experience.

PubMed

Abdallah, Bahia; Irani, Jihad; Sailian, Silva Dakessian; Gebran, Vicky George; Rizk, Ursula

2014-01-01

Nursing faculty teaching medical students a module in clinical skills is a relatively new trend. Collaboration in education among medical and nursing professions can improve students' performance in clinical skills and consequently positively impact the quality of care delivery. In 2011, the Faculty of Medicine in collaboration with the Faculty of Health Sciences at the University of Balamand, Beirut, Lebanon, launched a module in clinical skills as part of clinical skills teaching to first-year medical students. The module is prepared and delivered by nursing faculty in a laboratory setting. It consists of informative lectures as well as hands-on clinical practice. The clinical competencies taught are hand-washing, medication administration, intravenous initiation and removal, and nasogastric tube insertion and removal. Around sixty-five medical students attend this module every year. A Likert scale-based questionnaire is used to evaluate their experience. Medical students agree that the module provides adequate opportunities to enhance clinical skills and knowledge and favor cross-professional education between nursing and medical disciplines. Most of the respondents report that this experience prepares them better for clinical rotations while increasing their confidence and decreasing anxiety level. Medical students highly appreciate the nursing faculties' expertise and perceive them as knowledgeable and resourceful. Nursing faculty participating in medical students' skills teaching is well perceived, has a positive impact, and shows nurses are proficient teachers to medical students. Cross professional education is an attractive model when it comes to teaching clinical skills in medical school.

Teaching medical management and operations engineering for systems-based practice to radiology residents.

PubMed

Brandon, Catherine J; Mullan, Patricia B

2013-03-01

To better prepare radiology residents for providing care within the context of the larger health care system, this study evaluated the feasibility and impact of a curriculum to enhance radiology residents' understanding and ability to apply concepts from medical management and industrial and operational engineering to systems-based practice problems in radiology practice. A multiprofessional team including radiology, medical education, and industrial and operational engineering professionals collaborated in developing a seven-module curriculum, including didactic lectures, interactive large-group analysis, and small-group discussions with case-based radiology examples, which illustrated real-life management issues and the roles physicians held. Residents and faculty participated in topic selection. Pre- and post-instruction formative assessments were administered, and results were shared with residents during teaching sessions. Attendance and participation in case-based scenario resolutions indicate the feasibility and impact of the interactive curriculum on residents' interest and ability to apply curricular concepts to systems-based practice in radiology. Paired t test analyses (P < .05) and effect sizes showed residents significantly increased their knowledge and ability to apply concepts to systems-based practice issues in radiology. Our iterative curriculum development and implementation process demonstrated need and support for a multiprofessional team approach to teach management and operational engineering concepts. Curriculum topics are congruent with Accreditation Council for Graduate Medical Education requirements for systems-based practice. The case-based curriculum using a mixed educational format of didactic lectures and small-group discussion and problem analysis could be adopted for other radiology programs, for both residents and continuing medical education applications. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

Learning With Reflection: Practices in an Osteopathic Surgery Clinical Clerkship Through an Online Module.

PubMed

Lewis, Kadriye O; Farber, Susan; Chen, Haiqin; Peska, Don N

2015-11-01

The value of reflective practices has gained momentum in osteopathic medical education. However, the use of reflective pedagogies has not been explored in the larger context of medical course delivery and design, to the authors' knowledge. To determine the types of reflection demonstrated by osteopathic medical students on an online discussion board and to explore differences in discussion engagement caused by the use of a reflective learning self-assessment tool. Using a mixed-method approach, reflection processes in an osteopathic surgery clinical clerkship online module were investigated in third-year osteopathic medical students. Discussion board messages were captured and coded. Both manual coding techniques and automated interrogation using NVivo9 (a computer program) for qualitative data were applied. Correlations of scores across 4 case-based discussion tasks and scores for self-reflection were computed as quantitative data. Twenty-eight students were included. Four main types of reflection (ie, content, contextual, dialogic, and personal) along with corresponding differentiated subthemes for each type of case-based discussion board group message were identified. Group collaboration revealed insights about the reflection process itself and also about the evidence of collective efforts, group engagements, and intragroup support among students. Student preparation revealed that students' metacognition was triggered when they judged their own contributions to group work. Challenges in completing readings and meeting deadlines were related to the students' long work hours. Reflective practices are essential to the practice of osteopathic medicine and medical education. Curricula can promote the development of reflective skills by integrating these deliberate practices in educational activities.

How to prepare a Research Proposal.

PubMed

Al-Riyami, Asya

2008-04-01

Health research, medical education and clinical practice form the three pillars of modern day medical practice. As one authority rightly put it: 'Health research is not a luxury, but an essential need that no nation can afford to ignore'. Health research can and should be pursued by a broad range of people. Even if they do not conduct research themselves, they need to grasp the principles of the scientific method to understand the value and limitations of science and to be able to assess and evaluate results of research before applying them. This review paper aims to highlight the essential concepts to the students and beginning researchers and sensitize and motivate the readers to access the vast literature available on research methodologies.

How to prepare a Research Proposal

PubMed Central

Al-Riyami, Asya

2008-01-01

Health research, medical education and clinical practice form the three pillars of modern day medical practice. As one authority rightly put it: ‘Health research is not a luxury, but an essential need that no nation can afford to ignore’. Health research can and should be pursued by a broad range of people. Even if they do not conduct research themselves, they need to grasp the principles of the scientific method to understand the value and limitations of science and to be able to assess and evaluate results of research before applying them. This review paper aims to highlight the essential concepts to the students and beginning researchers and sensitize and motivate the readers to access the vast literature available on research methodologies. PMID:22379539

Meeting Increasing Demands for Rural General Surgeons.

PubMed

Mccarthy, Mary C; Bowers, Howard E; Campbell, Damon M; Parikh, Priti P; Woods, Randy J

2015-12-01

Dynamic assessment of the effective surgical workforce recommends 27,300 general surgeons in 2030; 2,525 more than are presently being trained. Rural shortages are already critical and there has been insufficient preparation for this need. A literature review of the factors influencing the choice of rural practice was performed. A systematic search was conducted of PubMed and the Web of Science to identify applicable studies in rural practice, surgical training, and rural general surgery. These articles were reviewed to identify the pertinent reports. The articles chosen for review are directed to four main objectives: 1) description of the challenges of rural practice, 2) factors associated with the choice of rural practice, 3) interventions to increase interest and preparation for rural practice, and 4) present successful rural surgical practice models. There is limited research on the factors influencing surgeons in the selection of rural surgery. The family practice literature suggests that physicians are primed for rural living through early experience, with reinforcement during medical school and residency, and retained through community involvement, and personal and professional satisfaction. However, more research into the factors drawing surgeons specifically to rural surgery, and keeping them in the community, is needed.

A needle-free reconstitution and transfer system for compounded sterile intravenous drug solutions in compliance with United States Pharmacopeia Chapter <797> standards.

PubMed

Marks, Zach

2014-01-01

Today's health-system pharmacists and those in independent practice face risks, including exposure to potent cytotoxic drugs via needlesticks, that are associated with preparing intravenous compounded sterile preparations for immediate use. Healthcare givers who administer such medications also risk exposure to needlesticks. Those hazards can be minimized when the pharmacist thoroughly understands and complies with current standard operating procedures for preparing intravenous compounded sterile preparations and the healthcare giver uses a needle-free system for drug reconstitution and administration. The components of an overall needlestick risk-reduction strategy to ensure safety in the preparation (and eventual administration) of intravenous compounded sterile preparations should therefore include the use of needle-free connection and administration devices as well as hand-hygiene training, aseptic technique competency evaluation and training, and the maximum use of commercially available or ready-to-use dosage forms. This article, which focuses on the pharmacist's use of a needle-free reconstitution and transfer system for compounded sterile intravenous drug solutions, uses as an example the Vial2Bag (Medimop Medical Projects, Ltd., [a subsidiary of West Pharmaceutical Services, Inc., Exton, Pennsylvania], Ra'anana, Israel), which complies with United States Pharmacopeia Chapter <797> standards. Features of that system are summarized for easy reference.

Knowledge, attitude, practice, and management of traditional medicine among people of Burka Jato Kebele, West Ethiopia

PubMed Central

Gari, Akawak; Yarlagadda, Raghavendra; Wolde-Mariam, Messay

2015-01-01

Background: Traditional medicine (TM) has maintained its popularity in all regions of the developing world. Even though, the wide acceptance of TM is a well-established fact, its status in a population with access to modern health is not well clear in the whole country. This study was carried out to assess the knowledge, attitudes, practice and management of TM among the community of Burka Jato Kebele, West Ethiopia. Methodology: A descriptive cross-sectional study was conducted on a total of 282 sampled individuals’ selected using systematic random sampling from January 28, 2013 to February 8, 2013 in Burka Jato Kebele, Nekemte town, East Wollega Zone, West of Ethiopia. Results: The majority (94.22%) of people in the study area relied on TM. Most of them were aware of medicinal herbs (55.7%). About half (40.79%) of the respondents were aware of the major side-effects of TM such as diarrhea (36.64%). About 31.85% of them prefer traditional medical practices (TMP) because they are cheap. Most (50%) of the species were harvested for their leaves to prepare remedies, followed by seed (21.15%) and root (13.46%) and the methods of preparation were pounding (27.54%), crushing (18.84%), a concoction (15.95%) and squeezing (13.04%). About 53.84% of them were used as fresh preparations. Remedies were reported to be administered through oral (53.85%), dermal or topical (36.54%), buccal (3.85%) and anal (5.77%). Conclusion: The study revealed that the use of TMs were quite popular among the population and a large proportion of the respondents not only preferred, but also used TMs notwithstanding that they lived in the urban communities with better access to modern medical care and medical practitioners. To use TM as a valuable alternative to conventional western medicine, further investigation must be undertaken to determine the validity, efficacy of the plants to make it available as an alternative medicine to human beings. PMID:25883518

The Alpha Stem Cell Clinic: a model for evaluating and delivering stem cell-based therapies.

PubMed

Trounson, Alan; DeWitt, Natalie D; Feigal, Ellen G

2012-01-01

Cellular therapies require the careful preparation, expansion, characterization, and delivery of cells in a clinical environment. There are major challenges associated with the delivery of cell therapies and high costs that will limit the companies available to fully evaluate their merit in clinical trials, and will handicap their application at the present financial environment. Cells will be manufactured in good manufacturing practice or near-equivalent facilities with prerequisite safety practices in place, and cell delivery systems will be specialized and require well-trained medical and nursing staff, technicians or nurses trained to handle cells once delivered, patient counselors, as well as statisticians and database managers who will oversee the monitoring of patients in relatively long-term follow-up studies. The model proposed for Alpha Stem Cell Clinics will initially use the capacities and infrastructure that exist in the most advanced tertiary medical clinics for delivery of established bone marrow stem cell therapies. As the research evolves, they will incorporate improved procedures and cell preparations. This model enables commercialization of medical devices, reagents, and other products required for cell therapies. A carefully constructed cell therapy clinical infrastructure with the requisite scientific, technical, and medical expertise and operational efficiencies will have the capabilities to address three fundamental and critical functions: 1) fostering clinical trials; 2) evaluating and establishing safe and effective therapies, and 3) developing and maintaining the delivery of therapies approved by the Food and Drug Administration, or other regulatory agencies.

Manuscript containing a collection of medical recipes written in 1776 by a Catholic priest Petar Kastelan of Croatia.

PubMed

Kujundzic, Nikola; Glibota, Milan; Skrobonja, Ante; Gasparac, Petra

2008-01-01

Over the past centuries, manuscripts containing collections of folk recipes for the treatment of diseases were written mostly by Catholic priests in Croatia. They were used to prepare remedies and gave directions for their use. These writings provide valuable information for ethnographers and historians of pharmacy and medicine. They describe the types and frequency of diseases afflicting humans and domestic animals in the past, development of ethnopharmacology, folk medical terminology, names of medicinal herbs, and the interaction between folk and science medicine. This is why they need a multidisciplinary approach to be evaluated properly. This paper presents the 1776 Medicine Book by a priest Petar Kastelan from southern Croatia (Dalmatia). It was found in a private archive and has not yet been published. The collection is written in the Croatian Cyrillic script, which was mostly used from the Middle Ages to the second half of the 19th century by Catholic priests when they wanted to write in Croatian. The collection contains 250 recipes for human medical practice and 10 recipes for veterinary medical practice. Thirty recipes contain household advice. Materia medica of the manuscript is mostly composed of drugs of plant origin. Remedies of animal and mineral origin are also included, but to a smaller extent. Valuable information is given about the folk names for diseases and medicinal plants as well as descriptions of the ways of preparing remedies. Prayers for healing, void of sorcery and magic, are also included.

Educating for the 21st-Century Health Care System: An Interdependent Framework of Basic, Clinical, and Systems Sciences.

PubMed

Gonzalo, Jed D; Haidet, Paul; Papp, Klara K; Wolpaw, Daniel R; Moser, Eileen; Wittenstein, Robin D; Wolpaw, Terry

2017-01-01

In the face of a fragmented and poorly performing health care delivery system, medical education in the United States is poised for disruption. Despite broad-based recommendations to better align physician training with societal needs, adaptive change has been slow. Traditionally, medical education has focused on the basic and clinical sciences, largely removed from the newer systems sciences such as population health, policy, financing, health care delivery, and teamwork. In this article, authors examine the current state of medical education with respect to systems sciences and propose a new framework for educating physicians in adapting to and practicing in systems-based environments. Specifically, the authors propose an educational shift from a two-pillar framework to a three-pillar framework where basic, clinical, and systems sciences are interdependent. In this new three-pillar framework, students not only learn the interconnectivity in the basic, clinical, and systems sciences but also uncover relevance and meaning in their education through authentic, value-added, and patient-centered roles as navigators within the health care system. Authors describe the Systems Navigation Curriculum, currently implemented for all students at the Penn State College of Medicine, as an example of this three-pillar educational model. Simple adjustments, such as including occasional systems topics in medical curriculum, will not foster graduates prepared to practice in the 21st-century health care system. Adequate preparation requires an explicit focus on the systems sciences as a vital and equal component of physician education.

eMedOffice: a web-based collaborative serious game for teaching optimal design of a medical practice.

PubMed

Hannig, Andreas; Kuth, Nicole; Özman, Monika; Jonas, Stephan; Spreckelsen, Cord

2012-10-31

Preparing medical students for the takeover or the start-up of a medical practice is an important challenge in Germany today. Therefore, this paper presents a computer-aided serious game (eMedOffice) developed and currently in use at the RWTH Aachen University Medical School. The game is part of the attempt to teach medical students the organizational and conceptual basics of the medical practice of a general practitioner in a problem-based learning environment. This paper introduces methods and concepts used to develop the serious game and describes the results of an evaluation of the game's application in curricular courses at the Medical School. Results of the conducted evaluation gave evidence of a positive learning effect of the serious game. Educational supervisors observed strong collaboration among the players inspired by the competitive gaming aspects. In addition, an increase in willingness to learn and the exploration of new self-invented ideas were observed and valuable proposals for further prospective enhancements were elicited. A statistical analysis of the results of an evaluation provided a clear indication of the positive learning effect of the game. A usability questionnaire survey revealed a very good overall score of 4.07 (5=best, 1=worst). We consider web-based, collaborative serious games to be a promising means of improving medical education. The insights gained by the implementation of eMedOffice will promote the future development of more effective serious games for integration into curricular courses of the RWTH Aachen University Medical School.

eMedOffice: A web-based collaborative serious game for teaching optimal design of a medical practice

PubMed Central

2012-01-01

Background Preparing medical students for the takeover or the start-up of a medical practice is an important challenge in Germany today. Therefore, this paper presents a computer-aided serious game (eMedOffice) developed and currently in use at the RWTH Aachen University Medical School. The game is part of the attempt to teach medical students the organizational and conceptual basics of the medical practice of a general practitioner in a problem-based learning environment. This paper introduces methods and concepts used to develop the serious game and describes the results of an evaluation of the game's application in curricular courses at the Medical School. Results Results of the conducted evaluation gave evidence of a positive learning effect of the serious game. Educational supervisors observed strong collaboration among the players inspired by the competitive gaming aspects. In addition, an increase in willingness to learn and the exploration of new self-invented ideas were observed and valuable proposals for further prospective enhancements were elicited. A statistical analysis of the results of an evaluation provided a clear indication of the positive learning effect of the game. A usability questionnaire survey revealed a very good overall score of 4.07 (5=best, 1=worst). Conclusions We consider web-based, collaborative serious games to be a promising means of improving medical education. The insights gained by the implementation of eMedOffice will promote the future development of more effective serious games for integration into curricular courses of the RWTH Aachen University Medical School. PMID:23110606

Neonatal nurse practitioners: identity as advanced practice nurses.

PubMed

Beal, J A; Maguire, D; Carr, R

1996-06-01

To define how neonatal nurse practitioners (NNPs) perceive their identity as advanced practice nurses. Non-experimental descriptive and correlational survey. Nationwide random sample drawn from NNPs certified by the National Certification Corporation. Two hundred fifty-eight neonatal nurse practitioners practicing in neonatal intensive-care units across the United States. Neonatal Nurse Practitioners indicated on a visual analogue scale at which point their philosophy of practice fell on a continuum from nursing to medicine and specified on a 5-point bipolar Likert scale how various role socialization factors influenced their identity. The NNPs predominantly were certificate-prepared and aligned themselves with a medical philosophy. Those NNPs who were master's-prepared (p < .01), precepted by another NNP (p < .05), espoused a philosophy of nursing (p < .001), belonged to a professional nursing organization (p < .05), and had an NNP role model (p < .001) were more likely to have a strong nursing identity (95% confidence interval). The issues of role differentiation, socialization, and identity of advanced practice nurses in tertiary care need further exploration. These data support the American Nurses' Association mandate of graduate nursing education for advanced nurse practitioners.

Anchoring interprofessional education in undergraduate curricula: The Heidelberg story.

PubMed

Berger, Sarah; Goetz, Katja; Leowardi-Bauer, Christina; Schultz, Jobst-Hendrik; Szecsenyi, Joachim; Mahler, Cornelia

2017-03-01

The ability of health professionals to collaborate effectively has significant potential impact on patient safety and quality-care outcomes, especially given the increasingly complex and dynamic clinical practice environments of today. Educators of the health professions are faced with an immediate challenge to adapt curricula and traditional teaching methods to ensure graduates are equipped with the necessary interprofessional competencies and (inter)professional values for their future practice. The World Health Organization's "Framework for action in interprofessional education (IPE) and collaborative practice" promotes IPE as a key strategy to enhance patient outcomes by preparing a "collaborative practice-ready health workforce." Logistical and attitudinal barriers can hinder integration of IPE into curricula. Lessons learned through the implementation of a planned change to establish four interprofessional seminars (team communication, medical error communication, healthcare English, and small business management) at Heidelberg University Medical Faculty, Germany, are described. A key factor in successfully anchoring IPE seminars in the undergraduate curricula was the structured approach drawing on change management concepts.

Connecting Education to Quality: Engaging Medical Students in the Development of Evidence-Based Clinical Decision Support Tools.

PubMed

Crabtree, Elizabeth A; Brennan, Emily; Davis, Amanda; Squires, Jerry E

2017-01-01

Evidence-based practice (EBP) skills are crucial for delivering high-quality patient care. It is essential that medical students learn EBP concepts through a practical, in-depth research project. To date, literature on preparing students in this manner is limited. In academic year 2014-2015, the Medical University of South Carolina's (MUSC's) Center for Evidence-Based Practice (now known as the Value Institute) partnered with College of Medicine faculty to revitalize the undergraduate medical student EBP curriculum. Without adding to the number of the lecture hours, the curriculum was restructured to be more process driven, project based, and clinically relevant. The resulting yearlong EBP course partnered small teams of medical students with interprofessional clinical teams to engage the students in developing evidence-based clinical decision support tools. The content developed during the EBP projects is currently being used to develop evidence-based clinical practice guidelines and accompanying order sets. It is likely that this model will serve as a new framework for guideline development and will greatly expand the breadth of evidence-based content currently produced and available for clinicians at the MUSC. It would be feasible to offer a similar course within the MUSC to other disciplines and colleges, or at other institutions, if there were support from administration, interest on the part of clinicians and medical faculty, and individuals with the required expertise available to develop the curriculum and facilitate the course. It is worth considering how to improve the course and evaluating opportunities to implement it within other settings.

Risk evaluation and mitigation strategies: a focus on the mycophenolic acid preparations.

PubMed

Rostas, Sara; Kim, Miae; Gabardi, Steven

2014-03-01

To review risks associated with mycophenolic acid (MPA) preparations and evaluate their required risk evaluation and mitigation strategies (REMS) elements. Articles were identified through a non-date-limited MEDLINE and EMBASE search using the terms fetal toxicity, teratogenicity, risk evaluation and mitigation strategies, REMS, MPA, mycophenolate mofetil, entericcoated MPA, and organ transplant. Information from the Food and Drug Administration (FDA) and the manufacturers of the MPA preparations was also evaluated. The MPA preparations are associated with several potential risks, including gastrointestinal disturbances and myelosuppression; however, their impact on the fetus in pregnant patients taking 1 of these agents poses the greatest risk. The FDA approved REMS programs for all MPA products, both innovator and generic preparations, in September 2012. With evidence of increased risk of miscarriage and birth defects associated with MPA use, the FDA instituted a REMS program that contains both a medication guide and elements to assure safe use (ETASU). The medication guides for the MPA products, which were previously FDA approved, should continue to be distributed to patients who get either an initial prescription filled or a refill. The ETASU requires prescribers to complete training and obtain patient signatures on the Patient-Prescriber Acknowledgment Form. A single, national, voluntary pregnancy registry specific to this medication has been established, and pregnant patients should be encouraged to participate. Although the impact of the MPA REMS on clinical practice is not clear, it is a step toward increasing the understanding of fetal risks with MPA.

Lessons learned from a pharmacy practice model change at an academic medical center.

PubMed

Knoer, Scott J; Pastor, John D; Phelps, Pamela K

2010-11-01

The development and implementation of a new pharmacy practice model at an academic medical center are described. Before the model change, decentralized pharmacists responsible for order entry and verification and clinical specialists were both present on the care units. Staff pharmacists were responsible for medication distribution and sterile product preparation. The decentralized pharmacists handling orders were not able to use their clinical training, the practice model was inefficient, and few clinical services were available during evenings and weekends. A task force representing all pharmacy department roles developed a process and guiding principles for the model change, collected data, and decided on a model. Teams consisting of decentralized pharmacists, decentralized pharmacy technicians, and team leaders now work together to meet patients' pharmacy needs and further departmental safety, quality, and cost-saving goals. Decentralized service hours have been expanded through operational efficiencies, including use of automation (e.g., computerized provider order entry, wireless computers on wheels used during rounds with physician teams). Nine clinical specialist positions were replaced by five team leader positions and four pharmacists functioning in decentralized roles. Additional staff pharmacist positions were shifted into decentralized roles, and the hospital was divided into areas served by teams including five to eight pharmacists. Technicians are directly responsible for medication distribution. No individual's job was eliminated. The new practice model allowed better alignment of staff with departmental goals, expanded pharmacy hours and services, more efficient medication distribution, improved employee engagement, and a staff succession plan.

Comparing selection criteria of residency directors and physicians' employers.

PubMed

Villanueva, A M; Kaye, D; Abdelhak, S S; Morahan, P S

1995-04-01

In 1993, the Medical College of Pennsylvania (MCP), mindful of the rapidly changing environments of health care delivery, created three surveys to gather information from outside the school that would help the faculty plan how the curriculum and advising system could better prepare students and residents for the demands of twenty-first-century medicine. The first survey focused on the MCP seniors graduating that year and asked about their perceptions of their medical education and their specialty and residency choices. The second survey, directed to 40 medical residency program directors in family medicine, internal medicine, pediatrics, and surgery, sought to identify the characteristics of applicants that these directors valued when selecting entrants to their programs. The third survey, of 30 employers of physicians representing four practice environments (private practice, hospitals/other health systems, academic medical centers, and health maintenance organizations), sought information on hiring and recruitment practices and the skills, competencies, and attitudes these employers valued most when hiring recently graduated physicians. The responses showed several differences and/or misperceptions among the views held by the three groups surveyed and suggest that medical educators have not adapted as rapidly as have employers to changes in the health care environment. Academic health centers must broaden their missions and make changes in their own institutional cultures, both to maintain their own viability and to train physicians who have the balance between scientific and technical competency and essential personal characteristics (such as empathy) that the next century's practice will probably demand.

[Recognition of international ethics codes by physicians and biomedical investigators. Are we prepared for the 21st century challenges?].

PubMed

Ponce-de-León, Sergio

2004-01-01

International oaths and declarations (IOD) represent the essence of proposals or promises on a relevant global issue for which a social group stands for. Their appropriate spread is essential in order for them to have a significant impact. The purpose of this study was to determine the frequency of recognition of several medical practice and clinical research related IOD, among medical personnel differentiated by level of clinical experience and closeness to biomedical research. Five groups were surveyed: 35 undergraduate interns, 50 internal medicine residents, 19 graduate (masters and doctoral degrees) students at the outset of courses, 18 veteran graduate students and 70 biomedical investigators. Performance in the recognition of the 6 probed IOD was uniformly poor. Barely just an average of about one declaration per subject was adequately identified. The Declaration of Helsinki was recognized by more than 50% of those belonging to the groups in which theory and practice of medical research joined together. No other IOD was recognized beyond a 40% level in any group. Comparison of university of origin showed no substantial differences. The lack of knowledge of IOD as a framework in the analysis of ethical conflicts arising along medical practice or clinical research is a worrisome issue. Medical schools seem to neglect their role in divulging them. Institutional review boards should also contribute to divulge IOD. The optimal incorporation of the IOD message comes from its acquisition through a process that links theory and practice.

Climate change: what competencies and which medical education and training approaches?

PubMed

Bell, Erica J

2010-04-30

Much research has been devoted to identifying healthcare needs in a climate-changing world. However, while there are now global and national policy statements about the importance of health workforce development for climate change, little has been published about what competencies might be demanded of practitioners in a climate-changing world. In such a context, this debate and discussion paper aims to explore the nature of key competencies and related opportunities for teaching climate change in medical education and training. Particular emphasis is made on preparation for practice in rural and remote regions likely to be greatly affected by climate change. The paper describes what kinds of competencies for climate change might be included in medical education and training. It explores which curricula, teaching, learning and assessment approaches might be involved. Rather than arguing for major changes to medical education and training, this paper explores well established precedents to offer practical suggestions for where a particular kind of literacy--eco-medical literacy--and related competencies could be naturally integrated into existing elements of medical education and training. The health effects of climate change have, generally, not yet been integrated into medical education and training systems. However, the necessary competencies could be taught by building on existing models, best practice and innovative traditions in medicine. Even in crowded curricula, climate change offers an opportunity to reinforce and extend understandings of how interactions between people and place affect health.

Negotiation techniques for health care professionals.

PubMed

Berlin, Jonathan W; Lexa, Frank J

2007-07-01

Negotiation is an essential part of health care practice and is not formally taught during medical training. This article aims to improve the negotiation skills of readers by explaining the essential components of preparation before a negotiation and reviewing common techniques for optimizing negotiated agreements. The terms reservation point, target value, and best alternative to a negotiated agreement are defined, and their importance in negotiation preparation is explained. The concept of anchoring, or making the first offer, in a negotiation is reviewed, and important techniques for team negotiation are provided.

The need to incorporate health information technology into physicians' education and professional development.

PubMed

Graham-Jones, Pierce; Jain, Sachin H; Friedman, Charles P; Marcotte, Leah; Blumenthal, David

2012-03-01

Nationwide, as physicians and health care systems adopt electronic health records, health information technology is becoming integral to the practice of medicine. But current medical education and professional development curricula do not systematically prepare physicians to use electronic health records and the data these systems collect. We detail how training in meaningful use of electronic health records could be incorporated into physician training, from medical school, through licensure and board certification, to continuing medical education and the maintenance of licensure and board certification. We identify six near-term opportunities for professional organizations to accelerate the integration of health information technology into their requirements.

Cell Therapy Regulation in Taiwan

PubMed Central

Chen, Yuan-Chuan; Cheng, Hwei-Fang; Yeh, Ming-Kung

2017-01-01

Cell therapy is not only a novel medical practice but also a medicinal product [cell therapy product (CTP)]. More and more CTPs are being approved for marketing globally because of the rapid development of bio-medicine in cell culture, preservation, and preparation. However, regulation is the most important criterion for the development of CTPs. Regulations must be flexible to expedite the process of marketing for new CTPs. Recently, the Taiwan Food and Drug Administration (TFDA) updated the related regulations such as regulation of development, current regulatory framework and process, and the application and evaluation processes. When the quality of CTPs has been improved significantly, their safety and efficacy are further ensured. The treatment protocol, a new design for adaptive licensing to current clinical practice, is a rapid process for patients with life-threatening diseases or serious conditions for which there are no suitable drugs, medical devices, or other therapeutic methods available. The hospital can submit the treatment protocol to apply for cell therapy as a medical practice, which may result in easier and faster cell therapy development, and personalized treatment for individual patients will evolve quickly. PMID:27697103

Simulation laboratories for training in obstetrics and gynecology.

PubMed

Macedonia, Christian R; Gherman, Robert B; Satin, Andrew J

2003-08-01

Simulations have been used by the military, airline industry, and our colleagues in other medical specialties to educate, evaluate, and prepare for rare but life-threatening scenarios. Work hour limits for residents in obstetrics and gynecology and decreased patient availability for teaching of students and residents require us to think creatively and practically on how to optimize their education. Medical simulations may address scenarios in clinical practice that are considered important to know or understand. Simulations can take many forms, including computer programs, models or mannequins, virtual reality data immersion caves, and a combination of formats. The purpose of this commentary is to call attention to a potential role for medical simulation in obstetrics and gynecology. We briefly describe an example of how simulation may be incorporated into obstetric and gynecologic residency training. It is our contention that educators in obstetrics and gynecology should be aware of the potential for simulation in education. We hope this commentary will stimulate interest in the field, lead to validation studies, and improve training in and the practice of obstetrics and gynecology.

Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study.

PubMed

Muthaura, Patricia N; Khamis, Tashmin; Ahmed, Mushtaq; Hussain, Syeda Ra'ana

2015-10-21

Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates' registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns' competencies. Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns' responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. Findings included agreement across informants on deficiencies in interns' practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns' competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training. Perception of medical graduates' unpreparedness seemed to stem from a failure to implement the apprenticeship model of learning in medical school and lack of prior exposure to district hospitals. These findings will inform curriculum development to meet stakeholder requirements, improve the quality of graduates, and increase satisfaction with transition to practice.

National standards in pathology education: developing competencies for integrated medical school curricula.

PubMed

Sadofsky, Moshe; Knollmann-Ritschel, Barbara; Conran, Richard M; Prystowsky, Michael B

2014-03-01

Medical school education has evolved from department-specific memorization of facts to an integrated curriculum presenting knowledge in a contextual manner across traditional disciplines, integrating information, improving retention, and facilitating application to clinical practice. Integration occurs throughout medical school using live data-sharing technologies, thereby providing the student with a framework for lifelong active learning. Incorporation of educational teams during medical school prepares students for team-based patient care, which is also required for pay-for-performance models used in accountable care organizations. To develop learning objectives for teaching pathology to medical students. Given the rapid expansion of basic science knowledge of human development, normal function, and pathobiology, it is neither possible nor desirable for faculty to teach, and students to retain, this vast amount of information. Courses teaching the essentials in context and engaging students in the learning process enable them to become lifelong learners. An appreciation of pathobiology and the role of laboratory medicine underlies the modern practice of medicine. As such, all medical students need to acquire 3 basic competencies in pathology: an understanding of disease mechanisms, integration of mechanisms into organ system pathology, and application of pathobiology to diagnostic medicine. We propose the development of 3 specific competencies in pathology to be implemented nationwide, aimed at disease mechanisms/processes, organ system pathology, and application to diagnostic medicine. Each competency will include learning objectives and a means to assess acquisition, integration, and application of knowledge. The learning objectives are designed to be a living document managed (curated) by a group of pathologists representing Liaison Committee on Medical Education-accredited medical schools nationally. Development of a coherent set of learning objectives will assist medical students nationally to gain the basic competencies in pathology necessary for clinical practice. Having national standards for competencies preserves schools' independence in specific curriculum design while assuring all students meet the evolving needs of medical practice.

Advances in medical education and practice: student perceptions of the flipped classroom

PubMed Central

Ramnanan, Christopher J; Pound, Lynley D

2017-01-01

The flipped classroom (FC) approach to teaching has been increasingly employed in undergraduate medical education in recent years. In FC applications, students are first exposed to content via online resources. Subsequent face-to-face class time can then be devoted to student-centered activities that promote active learning. Although the FC has been well received by students in other contexts, the perceptions of medical students regarding this innovation are unclear. This review serves as an early exploration into medical student perceptions of benefits and limitations of the FC. Medical students have generally expressed strong appreciation for the pre-class preparation activities (especially when facilitated by concise, readily accessed online tools) as well as for interactive, engaging small group classroom activities. Some students have expressed concerns with the FC and noted that suboptimal student preparation and insufficient direction and structure during active learning sessions may limit the student-centered benefits. Although students generally perceive that FC approaches can improve their learning and knowledge, this has not been conclusively shown via performances on assessment tools, which may be related to caveats with the assessment tools used. In any case, lifelong self-directed learning skills are perceived by medical students to be enhanced by the FC. In conclusion, medical students have generally expressed strong satisfaction with early applications of the FC to undergraduate medical education, and generally prefer this method to lecture-based instruction. PMID:28144171

Advances in medical education and practice: student perceptions of the flipped classroom.

PubMed

Ramnanan, Christopher J; Pound, Lynley D

2017-01-01

The flipped classroom (FC) approach to teaching has been increasingly employed in undergraduate medical education in recent years. In FC applications, students are first exposed to content via online resources. Subsequent face-to-face class time can then be devoted to student-centered activities that promote active learning. Although the FC has been well received by students in other contexts, the perceptions of medical students regarding this innovation are unclear. This review serves as an early exploration into medical student perceptions of benefits and limitations of the FC. Medical students have generally expressed strong appreciation for the pre-class preparation activities (especially when facilitated by concise, readily accessed online tools) as well as for interactive, engaging small group classroom activities. Some students have expressed concerns with the FC and noted that suboptimal student preparation and insufficient direction and structure during active learning sessions may limit the student-centered benefits. Although students generally perceive that FC approaches can improve their learning and knowledge, this has not been conclusively shown via performances on assessment tools, which may be related to caveats with the assessment tools used. In any case, lifelong self-directed learning skills are perceived by medical students to be enhanced by the FC. In conclusion, medical students have generally expressed strong satisfaction with early applications of the FC to undergraduate medical education, and generally prefer this method to lecture-based instruction.

Growth behaviors and biocidal properties of titanium dioxide films depending on nucleation duration in liquid phase deposition

NASA Astrophysics Data System (ADS)

Park, Sohyeon; Park, Joohee; Heo, Jiwoong; Hong, Bo Young; Hong, Jinkee

2017-12-01

Liquid phase deposition (LPD), which is a method to directly form a titanium dioxide (TiO2) film on a substrate, is the most practical method for applying TiO2 films to medical devices because it is performed at lower temperatures than other methods. The TiO2 films to be applied to medical devices should offer excellent antibacterial effect, but should be stable to normal cells and have appropriate strength. In this research, we observed that the size, shape, and density of TiO2 particles varied with the nucleation duration in LPD and confirmed that these results caused changes in several properties including the mechanical properties, cytotoxicity and antibacterial effect of TiO2 films. From the analysis of these results, we established the conditions for the preparation of TiO2 films that are suitable for medical devices and suggest a new approach to the study of TiO2 films prepared by LPD.

A survey of manufacturing and handling practices for monoclonal antibodies by pharmacy, nursing and medical personnel.

PubMed

Alexander, M; King, J; Lingaratnam, S; Byrne, J; MacMillan, K; Mollo, A; Kirsa, S; Green, M

2016-04-01

There is a paucity of data available to assess the occupational health and safety risk associated with exposure to monoclonal antibodies. Industry standards and published guidelines are conflicting or outdated. Guidelines offer contrary recommendations based on an array of methodological approaches. This survey aimed to describe current practices, beliefs and attitudes relating to the handling of monoclonal antibodies by Australian medical, nursing and pharmacy clinicians. An electronic survey was distributed between June and September 2013. Respondents were surveyed on three focus areas: institutional guideline availability and content, current practices and attitudes. Demographic data relating to respondent and primary place of practice were also collected. A total of 222 clinicians completed the survey, with representation from all targeted professional groups and from a variety of geographic locations. 92% of respondents reported that their institution prepared or administered monoclonal antibodies, with 87% specifically handling anti-cancer monoclonal antibodies. Monoclonal antibodies were mostly prepared onsite (84-90%) and mostly within pharmacy clean-rooms (75%) and using cytotoxic cabinets (61%). 43% of respondents reported access to institutional monoclonal antibody handling guidelines with risk reduction strategies including training and education (71%), spill and waste management (71%), procedures for transportation (57%) and restricted handling (50%). Nurses had a stronger preference towards pharmacy manufacturing than both doctors and pharmacists for a range of clinical scenarios. 95% of all respondents identified that professional or regulatory body guidelines are an important resource when considering handling practices. Monoclonal antibodies are most commonly handled according to cytotoxic drug standards and often in the absence of formal guidelines. © The Author(s) 2014.

Simulation-based medical education: time for a pedagogical shift.

PubMed

Kalaniti, Kaarthigeyan; Campbell, Douglas M

2015-01-01

The purpose of medical education at all levels is to prepare physicians with the knowledge and comprehensive skills, required to deliver safe and effective patient care. The traditional 'apprentice' learning model in medical education is undergoing a pedagogical shift to a 'simulation-based' learning model. Experiential learning, deliberate practice and the ability to provide immediate feedback are the primary advantages of simulation-based medical education. It is an effective way to develop new skills, identify knowledge gaps, reduce medical errors, and maintain infrequently used clinical skills even among experienced clinical teams, with the overall goal of improving patient care. Although simulation cannot replace clinical exposure as a form of experiential learning, it promotes learning without compromising patient safety. This new paradigm shift is revolutionizing medical education in the Western world. It is time that the developing countries embrace this new pedagogical shift.

Estate and business planning for the retiring physician.

PubMed

Kingma, Kenneth W; Vaughn, Thomas D

2012-01-01

Retiring physicians have much to think about for estate planning purposes. The authors stand ready to help physicians sell or close their medical practice, navigate the 2010 Tax Act, take advantage of current planning opportunities, and prepare appropriate estate planning documents. Every estate is unique, so it is important to contact an estate planning advisor before taking any action.

Medication Errors in Pediatric Anesthesia: A Report From the Wake Up Safe Quality Improvement Initiative.

PubMed

Lobaugh, Lauren M Y; Martin, Lizabeth D; Schleelein, Laura E; Tyler, Donald C; Litman, Ronald S

2017-09-01

Wake Up Safe is a quality improvement initiative of the Society for Pediatric Anesthesia that contains a deidentified registry of serious adverse events occurring in pediatric anesthesia. The aim of this study was to describe and characterize reported medication errors to find common patterns amenable to preventative strategies. In September 2016, we analyzed approximately 6 years' worth of medication error events reported to Wake Up Safe. Medication errors were classified by: (1) medication category; (2) error type by phase of administration: prescribing, preparation, or administration; (3) bolus or infusion error; (4) provider type and level of training; (5) harm as defined by the National Coordinating Council for Medication Error Reporting and Prevention; and (6) perceived preventability. From 2010 to the time of our data analysis in September 2016, 32 institutions had joined and submitted data on 2087 adverse events during 2,316,635 anesthetics. These reports contained details of 276 medication errors, which comprised the third highest category of events behind cardiac and respiratory related events. Medication errors most commonly involved opioids and sedative/hypnotics. When categorized by phase of handling, 30 events occurred during preparation, 67 during prescribing, and 179 during administration. The most common error type was accidental administration of the wrong dose (N = 84), followed by syringe swap (accidental administration of the wrong syringe, N = 49). Fifty-seven (21%) reported medication errors involved medications prepared as infusions as opposed to 1 time bolus administrations. Medication errors were committed by all types of anesthesia providers, most commonly by attendings. Over 80% of reported medication errors reached the patient and more than half of these events caused patient harm. Fifteen events (5%) required a life sustaining intervention. Nearly all cases (97%) were judged to be either likely or certainly preventable. Our findings characterize the most common types of medication errors in pediatric anesthesia practice and provide guidance on future preventative strategies. Many of these errors will be almost entirely preventable with the use of prefilled medication syringes to avoid accidental ampule swap, bar-coding at the point of medication administration to prevent syringe swap and to confirm the proper dose, and 2-person checking of medication infusions for accuracy.

Statistics teaching in medical school: opinions of practising doctors.

PubMed

Miles, Susan; Price, Gill M; Swift, Louise; Shepstone, Lee; Leinster, Sam J

2010-11-04

The General Medical Council expects UK medical graduates to gain some statistical knowledge during their undergraduate education; but provides no specific guidance as to amount, content or teaching method. Published work on statistics teaching for medical undergraduates has been dominated by medical statisticians, with little input from the doctors who will actually be using this knowledge and these skills after graduation. Furthermore, doctor's statistical training needs may have changed due to advances in information technology and the increasing importance of evidence-based medicine. Thus there exists a need to investigate the views of practising medical doctors as to the statistical training required for undergraduate medical students, based on their own use of these skills in daily practice. A questionnaire was designed to investigate doctors' views about undergraduate training in statistics and the need for these skills in daily practice, with a view to informing future teaching. The questionnaire was emailed to all clinicians with a link to the University of East Anglia Medical School. Open ended questions were included to elicit doctors' opinions about both their own undergraduate training in statistics and recommendations for the training of current medical students. Content analysis was performed by two of the authors to systematically categorize and describe all the responses provided by participants. 130 doctors responded, including both hospital consultants and general practitioners. The findings indicated that most had not recognised the value of their undergraduate teaching in statistics and probability at the time, but had subsequently found the skills relevant to their career. Suggestions for improving undergraduate teaching in these areas included referring to actual research and ensuring relevance to, and integration with, clinical practice. Grounding the teaching of statistics in the context of real research studies and including examples of typical clinical work may better prepare medical students for their subsequent career.

Beyond the standard curriculum: a review of available opportunities for medical students to prepare for a career in radiation oncology.

PubMed

Agarwal, Ankit; DeNunzio, Nicholas J; Ahuja, Divya; Hirsch, Ariel E

2014-01-01

To review currently available opportunities for medical students to supplement their standard medical education to prepare for a career in radiation oncology. Google and PubMed were used to identify existing clinical, health policy, and research programs for medical students in radiation oncology. In addition, results publicly available by the National Resident Matching Program were used to explore opportunities that successful radiation oncology applicants pursued during their medical education, including obtaining additional graduate degrees. Medical students can pursue a wide variety of opportunities before entering radiation oncology. Several national specialty societies, such as the American Society for Radiation Oncology and the Radiological Society of North America, offer summer internships for medical students interested in radiation oncology. In 2011, 30% of allopathic senior medical students in the United States who matched into radiation oncology had an additional graduate degree, including PhD, MPH, MBA, and MA degrees. Some medical schools are beginning to further integrate dedicated education in radiation oncology into the standard 4-year medical curriculum. To the authors' knowledge, this is the first comprehensive review of available opportunities for medical students interested in radiation oncology. Early exposure to radiation oncology and additional educational training beyond the standard medical curriculum have the potential to create more successful radiation oncology applicants and practicing radiation oncologists while also promoting the growth of the field. We hope this review can serve as guide to radiation oncology applicants and mentors as well as encourage discussion regarding initiatives in radiation oncology opportunities for medical students. Copyright © 2014 Elsevier Inc. All rights reserved.

Anticholinergic Toxicity Secondary to Overuse of Topricin Cream, a Homeopathic Medication

PubMed Central

Regina, Angela; Jesin, Raphael C; Deeb, Liliane; Steinberg, Eric; Majlesi, Nima

2018-01-01

Adverse reactions from over-the-counter medications present a challenge to physicians. Homeopathic medicine is an alternative practice, originating in Germany and gaining popularity in the United States. It utilizes dilute preparations of substances in order to treat and cure disease. Patients may potentially suffer serious effects from the use of these products as the contents and concentrations are often unclear. Here, we describe a case of suspected atropine toxicity due to the overuse of a topical homeopathic cream, Topricin, which contains belladonna, a plant containing atropine. PMID:29736357

[THE EFFECTIVENESS OF THE MODERN IMMUNOACTIVE PREPARATION IMMUNOFAN FOR MEDICAL REHABILITATION OF PATIENTS WITH NONALCOHOLIC STEATOHEPATITISIS AGAINST NEUROCIRCULATORY DYSTONIA, AFTER INFECTIOUS MONONUCLEOSIS].

PubMed

Yugan, Y L; Sotskaya, Y A; Chabarova, A B

2015-01-01

The presence of the expressed changes of cellular immunity, namely T-lymphopenia, disbalance of subpopulation structure of T-lymphocytes with primary downstroke T-helpers/inductor (CD4+), decrease immunoregulatory index CD4/CD8, and functional activity of T-cells is characteristic for the patients with nonalcoholic steatohepatitis, against neurocirculatory dystonia, after infectious mononucleosis. Including in a medical rehabilitation of such patients immunofan promoted practically full correction of the revealed infringements on the part of a cellular link of immunity.

Building a workforce of physicians to care for underserved patients.

PubMed

Anthony, David; El Rayess, Fadya; Esquibel, Angela Y; George, Paul; Taylor, Julie

2014-09-02

There is a shortage of physicians to care for underserved populations. Medical educators at The Warren Alpert Medical School of Brown University have used five years of Health Resources and Services Administration funding to train medical students to provide outstanding primary care for underserved populations. The grant has two major goals: 1) to increase the number of graduating medical students who practice primary care in underserved communities ("Professional Development"); and 2) to prepare all medical school graduates to care for underserved patients, regardless of specialty choice ("Curriculum Development"). Professional Development, including a new scholarly concentration and an eight-year primary care pipeline, has been achieved in partnership with the Program in Liberal Medical Education, the medical school's Admissions Committee, and an Area Health Education Center. Curriculum Development has involved systematic recruitment of clinical training sites and disease-specific curricula including tools for providing care to vulnerable populations. A comprehensive, longitudinal evaluation is ongoing.

Design and Implementation of an Elective on the Ethnopharmacology of Appalachia for the PharmD Curriculum

PubMed Central

2017-01-01

Objective. To create and implement a class in ethnopharmacology that would educate student pharmacists on folk medicine, including home remedies and native plants that are used as alternative medicinal sources; active components of medicinal plants including toxicity issues and the mechanism of action of beneficial compounds, such as catechins and other flavonoids; and nutraceuticals and poisonous plants. Methods. In this three-credit hour class, herbal remedies are investigated from the standpoints of medical efficacy, potential toxicities and drug interactions with prescribed medications. Class discussions are conducted on the usefulness of remedies, the attitudes of practitioners toward traditional remedy use and the risks of relying on herbal preparations. Each student prepares a 15-minute presentation on a disease state, which covers modern pharmaceuticals and herbal or folk remedy alternatives used in that disease. Special emphasis is given to drug-herb interactions. Results. The class has gained popularity among students and consistently fills within the first hour of computerized registration. Students agree that being educated in the benefits and potential toxicities of herbal products will better prepare them to counsel their patients who use these remedies. The elective has been offered 10 times since 2007. Anecdotal comments from our alumni indicate that they have found the information to be very useful in their practice environments. Conclusion. Providing our students with a greater understanding of herbal remedies is essential to prepare them for practice. By including both the uses and potential toxicities, the student pharmacist is able to counsel her patients from a standpoint of expertise on these self-administered remedies. PMID:29367772

Ethnography in qualitative educational research: AMEE Guide No. 80.

PubMed

Reeves, Scott; Peller, Jennifer; Goldman, Joanne; Kitto, Simon

2013-08-01

Ethnography is a type of qualitative research that gathers observations, interviews and documentary data to produce detailed and comprehensive accounts of different social phenomena. The use of ethnographic research in medical education has produced a number of insightful accounts into its role, functions and difficulties in the preparation of medical students for clinical practice. This AMEE Guide offers an introduction to ethnography - its history, its differing forms, its role in medical education and its practical application. Specifically, the Guide initially outlines the main characteristics of ethnography: describing its origins, outlining its varying forms and discussing its use of theory. It also explores the role, contribution and limitations of ethnographic work undertaken in a medical education context. In addition, the Guide goes on to offer a range of ideas, methods, tools and techniques needed to undertake an ethnographic study. In doing so it discusses its conceptual, methodological, ethical and practice challenges (e.g. demands of recording the complexity of social action, the unpredictability of data collection activities). Finally, the Guide provides a series of final thoughts and ideas for future engagement with ethnography in medical education. This Guide is aimed for those interested in understanding ethnography to develop their evaluative skills when reading such work. It is also aimed at those interested in considering the use of ethnographic methods in their own research work.

A systems approach for implementing practice-based learning and improvement and systems-based practice in graduate medical education.

PubMed

Varkey, Prathibha; Karlapudi, Sudhakar; Rose, Steven; Nelson, Roger; Warner, Mark

2009-03-01

The Accreditation Council for Graduate Medical Education (ACGME) initiated its Outcome Project to better prepare physicians-in-training to practice in the rapidly changing medical environment and mandated assessment of competency in six outcomes, including Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP). Before the initiation of the Outcome Project, these competencies were not an explicit element of most graduate medical education training programs. Since 1999, directors of ACGME-accredited programs nationwide have been challenged to teach and assess these competencies. The authors describe an institution-wide curriculum intended to facilitate the teaching and assessment of PBLI and SBP competencies in the 115 ACGME-accredited residency and fellowship programs (serving 1,327 trainees) sponsored by Mayo School of Graduate Medical Education. Strategies to establish the curriculum in 2005 included development of a Quality Improvement (QI) curriculum Web site, one-on-one consultations with program directors, a three-hour program director workshop, and didactic sessions for residents and fellows on core topics. An interim program director self-assessment survey revealed a 13% increase in perceived ability to measure competency in SBP, no change in their perceived ability to measure competence in PBLI, a 15% increase in their ability to provide written documentation of competence in PBLI, and a 35% increase in their ability to provide written documentation of competence in SBP between 2005 and 2007. Nearly 70% of the programs had trainees participating in QI projects. Further research is needed to evaluate the cost-effectiveness of such a program and to measure its impact on learner knowledge, skills, and attitudes and, ultimately, on patient outcomes.

Disclosing medical mistakes: a communication management plan for physicians.

PubMed

Petronio, Sandra; Torke, Alexia; Bosslet, Gabriel; Isenberg, Steven; Wocial, Lucia; Helft, Paul R

2013-01-01

There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians' own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. The steps are 1) physician preparation, such as talking about the physician's emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.

Microbiological quality and safe handling of enteral diets in a hospital in Minas Gerais, Brazil.

PubMed

Pinto, Raquel Oliveira Medrado; Correia, Eliznara Fernades; Pereira, Keyla Carvalho; Costa Sobrinho, Paulo de Souza; da Silva, Daniele Ferreira

2015-06-01

Contamination of enteral diets represents a high risk of compromising the patient's medical condition. To assess the microbiological quality and aseptic conditions in the preparation and administration of handmade and industrialized enteral diets offered in a hospital in the Valley of Jequitinhonha, MG, Brazil, we performed a microbiological analysis of 50 samples of diets and 27 samples of surfaces, utensils, and water used in the preparation of the diets. In addition, we assessed the good handling practices of enteral diets according to the requirements specified by the Brazilian legislation. Both kinds of enteral diets showed contamination by coliforms and Pseudomonas spp. No sample was positive for Staphylococcus aureus and Salmonella spp. On the other hand, Listeria spp. was detected in only one sample of handmade diets. Contamination was significantly higher in the handmade preparations (p < 0.05). Nonconformities were detected with respect to good handling practices, which may compromise the diet safety. The results indicate that the sanitary quality of the enteral diets is unsatisfactory, especially handmade diets. Contamination by Pseudomonas spp. is significant because it is often involved in infection episodes. With regard to aseptic practices, it was observed the need of implementing new procedures for handling enteral diets.

Medication errors room: a simulation to assess the medical, nursing and pharmacy staffs' ability to identify errors related to the medication-use system.

PubMed

Daupin, Johanne; Atkinson, Suzanne; Bédard, Pascal; Pelchat, Véronique; Lebel, Denis; Bussières, Jean-François

2016-12-01

The medication-use system in hospitals is very complex. To improve the health professionals' awareness of the risks of errors related to the medication-use system, a simulation of medication errors was created. The main objective was to assess the medical, nursing and pharmacy staffs' ability to identify errors related to the medication-use system using a simulation. The secondary objective was to assess their level of satisfaction. This descriptive cross-sectional study was conducted in a 500-bed mother-and-child university hospital. A multidisciplinary group set up 30 situations and replicated a patient room and a care unit pharmacy. All hospital staff, including nurses, physicians, pharmacists and pharmacy technicians, was invited. Participants had to detect if a situation contained an error and fill out a response grid. They also answered a satisfaction survey. The simulation was held during 100 hours. A total of 230 professionals visited the simulation, 207 handed in a response grid and 136 answered the satisfaction survey. The participants' overall rate of correct answers was 67.5% ± 13.3% (4073/6036). Among the least detected errors were situations involving a Y-site infusion incompatibility, an oral syringe preparation and the patient's identification. Participants mainly considered the simulation as effective in identifying incorrect practices (132/136, 97.8%) and relevant to their practice (129/136, 95.6%). Most of them (114/136; 84.4%) intended to change their practices in view of their exposure to the simulation. We implemented a realistic medication-use system errors simulation in a mother-child hospital, with a wide audience. This simulation was an effective, relevant and innovative tool to raise the health care professionals' awareness of critical processes. © 2016 John Wiley & Sons, Ltd.

[Hygiene in Urological Surgeries - Results of the Health Authority's Visit to all Urological Surgeries in Braunschweig].

PubMed

Buhr-Riehm, B; Lenz, T

2015-07-01

Following a patient complaint, the Health Department carried out a hygiene inspection of a urological practice in Braunschweig in February 2013. The topic of the complaint was that a patient assumed having acquired a resistant pathogen in the practice. In the subsequent visit, significant hygiene defects were found, particularly with regard to the processing of medical devices. This led to a decision to commit all urological practices in Braunschweig to hygiene inspections as part of a priority project. In retrospect, the hygiene surveys were justified. Deficiencies included inadequate preparation of medical products, procedures in practice inconsistent with hygiene plans, poor knowledge of hygiene procedures among assistant staff and doctors, lack of expertise of assistant staff and lack of hygiene risk awareness by doctors. Positive experiences were: open communication in a good atmosphere with the Practice managers, willingness to change, good cooperation between the Health Authority and the Labor Inspectorate and Physicians' Association. The claimed deficits were corrected by spring 2014 by the practice operators. The consulting expertise of the health authorities was made use of continuously. © Georg Thieme Verlag KG Stuttgart · New York.

Pharmacy Practice and Education in Bulgaria

PubMed Central

Petkova, Valentina; Atkinson, Jeffrey

2017-01-01

Pharmacies in Bulgaria have a monopoly on the dispensing of medicinal products that are authorized in the Republic of Bulgaria, as well as medical devices, food additives, cosmetics, and sanitary/hygienic articles. Aptekari (pharmacists) act as responsible pharmacists, pharmacy owners, and managers. They follow a five year Masters of Science in Pharmacy (M.Sc. Pharm.) degree course with a six month traineeship. Pomoshnik-farmacevti (assistant pharmacists) follow a three year degree with a six month traineeship. They can prepare medicines and dispense OTC medicines under the supervision of a pharmacist. The first and second year of the M.Sc. Pharm. degree are devoted to chemical sciences, mathematics, botany and medical sciences. Years three and four center on pharmaceutical technology, pharmacology, pharmacognosy, pharmaco-economics, and social pharmacy, while year five focuses on pharmaceutical care, patient counselling, pharmacotherapy, and medical sciences. A six month traineeship finishes the fifth year together with redaction of a master thesis, and the four state examinations with which university studies end. Industrial pharmacy and clinical (hospital) pharmacy practice are integrated disciplines in some Bulgarian higher education institutions such as the Faculty of Pharmacy of the Medical University of Sofia. Pharmacy practice and education in Bulgaria are organized in a fashion very similar to that in most member states of the European Union. PMID:28970446

Exercise behaviour and attitudes among fourth-year medical students at the University of British Columbia.

PubMed

Holtz, Kaila A; Kokotilo, Kristen J; Fitzgerald, Barbara E; Frank, Erica

2013-01-01

To describe the physical activity (PA) levels and counseling attitudes of Canadian undergraduate medical students. Online or paper survey. The University of British Columbia (UBC). Fourth-year medical students at UBC from 2007 to 2010. Physical activity levels, relationship between exercise behaviour and attitudes toward counseling, and student perception of training in the area of exercise prescription. A total of 546 out of 883 students participated in the survey (62% response rate). Sixty-four percent of students met the Canadian Society for Exercise Physiology 2011 recommendations for PA. Attitudes toward healthy living were related to PA levels, but the rate of counseling patients about exercise was not; however, students who engaged in more strenuous PA were more likely to perceive exercise counseling as being highly relevant to future clinical practice (P = .018). Overall, 69% of students perceived exercise counseling to be highly relevant to clinical practice, but 86% thought that their training in this area was less than extensive. Fourth-year UBC medical students engage in more strenuous PA than average age-matched Canadians, which affects their attitudes toward perceived future counseling practices. Encouraging more student participation in strenuous PA and encouraging academic training in the area of exercise counseling might be important next steps in preparing future physicians to effectively prescribe exercise to their patients.

Pharmacy Practice and Education in Bulgaria.

PubMed

Petkova, Valentina; Atkinson, Jeffrey

2017-06-22

Pharmacies in Bulgaria have a monopoly on the dispensing of medicinal products that are authorized in the Republic of Bulgaria, as well as medical devices, food additives, cosmetics, and sanitary/hygienic articles. Aptekari (pharmacists) act as responsible pharmacists, pharmacy owners, and managers. They follow a five year Masters of Science in Pharmacy (M.Sc. Pharm.) degree course with a six month traineeship. Pomoshnik-farmacevti (assistant pharmacists) follow a three year degree with a six month traineeship. They can prepare medicines and dispense OTC medicines under the supervision of a pharmacist. The first and second year of the M.Sc. Pharm. degree are devoted to chemical sciences, mathematics, botany and medical sciences. Years three and four center on pharmaceutical technology, pharmacology, pharmacognosy, pharmaco-economics, and social pharmacy, while year five focuses on pharmaceutical care, patient counselling, pharmacotherapy, and medical sciences. A six month traineeship finishes the fifth year together with redaction of a master thesis, and the four state examinations with which university studies end. Industrial pharmacy and clinical (hospital) pharmacy practice are integrated disciplines in some Bulgarian higher education institutions such as the Faculty of Pharmacy of the Medical University of Sofia. Pharmacy practice and education in Bulgaria are organized in a fashion very similar to that in most member states of the European Union.

SIMULATION OF GENERAL ANESTHESIA ON THE "SIMMAN 3G" AND ITS EFFICIENCY.

PubMed

Potapov, A F; Matveev, A S; Ignatiev, V G; Ivanova, A A; Aprosimov, L A

2015-01-01

In recent years in medical educational process new innovative technologies are widely used with computer simulation, providing the reality of medical intervations and procedures. Practice-training teaching with using of simulation allows to improve the efficiency of learning material at the expense of creating imaginary professional activity and leading barring material to practical activity. The arm of the investigation is evaluation of the students training efficiency at the Medical Institute on the topic "General Anesthesia with using a modern simulation "SimMan 3 G". The material of the investigation is the results, carried out on the basis of the Centre of Practical skills and medical virtual educational technologies (Simulation Centre) at the Medical Institute of NEFU by M.K. Ammosov. The Object of the investigation was made up by 55 students of the third (3) course of the Faculty of General Medicine of the Medical Institute of NEFU. The investigation was hold during practical trainings (April-May 2014) of the General Surgery Department on the topic "General Anesthesia". A simulation practical course "General Anesthesia" consisted of 12 academic hours. Practical training was carried out using instruments, equipments and facilities to install anesthesia on the SimMan 3G with shooting the process and further discussions of the results. The methods of the investigations were the appreciation of students background knowledge before and after practical training (by 5 points scale) and the analysis of the results. The results of the investigation showed that before the practical course only 23 students (41.8%) had dot positive marks: "Good"--7 students (12.7%) and "Satisfactory"--16 (29.1%) students. The rest 22 (58.2%) students had bad results. The practical trainings using real instruments, equipments and facilities with imitation of installation of preparations for introductory anesthesia, main analgesics and muscle relaxants showed a patients reaction on the virtual trainer SimMan 3 G. Students were divided into anesthetic team, co-assisting of an anesthesiologist, an assistant and nurses anesthetist, who conducted general anesthesia (the mask anesthesia, intravenous anesthesia, endotracheal anesthesia). After finishing the practical course 16 students (29.1%) got 5 marks (Excellent), 35 students (63.6%)--4 (Good) and 4 students (7.3%)--3 mark (Satisfactory).

[Roman medical instruments from Lower Moesia].

PubMed

Aparaschivei, D; Matei, I

2010-01-01

To elucidate the evolution of society over time, ancient medicine is a very interesting and important researching field. Archaeological discoveries, such as the objects described by this article, but other ancient sources, also, are able to provide a complex framework of medical practice in Roman times. The geographic area that we have like target in this material is the province of Lower Moesia, which includes the territory between Danube and Black Sea (Romanian Dobrodja) and northern Bulgaria. In the present study we present nine ancient medical instruments, from a private collection: two tweezers, two ear probes, a probe-spatula, a probe-spoon, a spoon for pharmacy and two fragments of some kind of hooks used in surgical operations. Most likely, we have a mixed medical kit with tools used in general medicine, surgery, in preparation of the pharmaceutical treatments, but very possible, also, in cosmetic practices. Publication of these archaeological materials is, in addition to an extra page in the history of ancient medicine, a pretext for stepping up in a research field that, in other regions of the former Roman Empire, it is a great interest for researchers.

iPad experience during clinical rotations from seven medical schools in the United States: Lessons learned.

PubMed

Deutsch, Kalie; Gaines, Julie K; Hill, Janette R; Nuss, Michelle A

2016-11-01

Since 2010, many US medical schools have introduced the use of mobile technology into their curriculum. Preclinical use of mobile technologies has been well studied, but use in the clinical years has been less explored. Our objective was to identify the clinical uses and limitations of mobile technology in the clinical curriculum. Interviews were conducted with key personnel at seven U. S. medical schools who introduced iPad programs during the clinical years. Interviews were qualitatively analyzed using a constant comparison technique. Eight "best practices" for introducing mobile technology in the clinical years were identified: (1) plan before implementation, (2) define focused goals, (3) establish a tablet "culture," (4) recruit appropriate implementation team, (5) invest in training, (6) involve students in mentoring, (7) accept variable use, and (8) encourage innovation. There is growing interest in using mobile technology for teaching and learning in the clinical curriculum. Following the identified best practices may assist schools with the integration of the technology into the curriculum and better prepare medical students to handle the increasing use of technology.

How Health Humanities Will Save the Life of the Humanities.

PubMed

Klugman, Craig M

2017-12-01

In the last decade, the humanities have been shrinking in number of students, percent of faculty, and in number of degrees awarded. Humanities students also earn lower salaries than their STEM-prepared peers. At the same time, the health humanities have been in ascendance over the last fifteen years. The number of majors, minors and certificates has increased 266% in that time frame, attracting large numbers of students and preparing future patients, lay caregivers, and health care providers to interact with a complicated and dehumanized medical system. In 1982, British philosopher and educator Stephen Toulmin declared that medicine saved philosophy from irrelevance and possibly extinction. I propose that the health humanities can serve a similar function to stave off the decline of the broader humanities. The health humanities can (1) model an applied approach for the broader humanities to attract student interest; (2) develop students' capacity for critical reading, writing and reflection about health and medicine in society, practice, and their own lives and (3) inoculate all students against the influence of medicine, whether through preparing pre-health students to navigate the hidden medical curriculum or preparing future patients to navigate the health care system.

Can new doctors be prepared for practice? A review.

PubMed

Alexander, Cameron; Cameron, Alexander; Millar, James; Szmidt, Natasha; Hanlon, Katie; Cleland, Jennifer

2014-06-01

The transition from medical student to junior doctor is an important period of change. Research shows junior doctors often experience high levels of stress, and consequently burnout. Understanding how to prepare for the transition may allow individuals who are likely to struggle to be identified and assisted. The aim of this paper is to systematically review the literature on preparedness for practice in newly qualified junior doctors. This was a systematic review of literature concerning the transition from student to junior doctor, published in the last 10 years, and that measured or explored one or more factors affecting preparedness. Nine papers were included in this review. These varied in design and methodological quality. Most used survey methodology (n = 7). Six found knowledge and skills, particularly deficiencies in prescribing and practical procedures, relevant in terms of preparedness. Five looked at personal traits, with high levels of neuroticism and low confidence deemed to be important. Medical school and workplace factors, including early clinical experience and shadowing, positively affected preparedness. A lack of senior support proved detrimental. The influence of demographics was inconclusive. The studies reviewed indicate that both personal and organisational factors are pertinent to managing the transition from student to junior doctor. Further prospective studies, both qualitative and quantitative, drawing on theories of change, are required to identify what precise factors would make a difference to this transition. © 2014 John Wiley & Sons Ltd.

Aspects of the Patient-centered Medical Home currently in place: initial findings from preparing the personal physician for practice.

PubMed

Carney, Patricia A; Eiff, M Patrice; Saultz, John W; Douglass, Alan B; Tillotson, Carrie J; Crane, Steven D; Jones, Samuel M; Green, Larry A

2009-10-01

The Patient-centered Medical Home (PCMH) is a central concept in the evolving debate about American health care reform. We studied family medicine residency training programs' continuity clinics to assess baseline status of implementing PCMH components and to compare implementation status between community-based and university training programs. We conducted a survey 24 continuity clinics in 14 residency programs that are part of the Preparing the Personal Physicians for Practice (P(4)) program. We asked questions about aspects of P(4) that had been already implemented at the beginning of the P(4) program. We defined high implementation as aspects that were present in >50% of clinics and low implementation as those present in <50% of clinics. We compared features at university-based and community-based clinics. High areas of implementation were having an electronic health record (EHR), fully secured remote access, electronic patient notes/scheduling/billing, chronic disease management registries, and open-access scheduling. Low areas of implementation included hospital EHR with computerized physician order entry, asynchronous communication with patients, ongoing population-based QA using EHR, use of preventive registries, and practice-based research using EHR. Few differences were noted between university- and community-based residency programs. Many features of the PCMH were already established at baseline in programs participating in P(4).

SU-F-E-16: A Specific Training Package for Medical Physicists in Support to Nuclear and Radiological Emergency Situations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meghzifene, A; Berris, T

Purpose: To provide the professional medical physicists with adequate competencies and skills in order to help them get prepared to support Nuclear or Radiological Emergency (NRE) situations. Methods: Although clinical medical physicists working have in-depth knowledge in radiation dosimetry, including dose reconstruction and dose measurements, they are usually not involved in NRE situations. However, in a few instances where medical physicists were involved in NREs, it appeared that many lacked specific knowledge and skills that are required in such situations. This lack of specific knowledge and skills is probably due to the fact that most current medical physics curricula domore » not include a specific module on this topic. As a response to this finding, the IAEA decided to initiate a project to develop a specific training package to help prepare medical physicists to support NRE situations. The training package was developed with the kind support of the Government of Japan and in collaboration with Fukushima Medical University (FMU) and the National Institute of Radiological Sciences (NIRS). Results: The first International Workshop to test the training package was held in Fukushima, Japan in June 2015. It consisted of lectures, demonstrations, simulation, role play, and practical sessions followed by discussions. The training was delivered through 14 modules which were prepared with the support of 12 lecturers. A knowledge assessment test was done before the workshop, followed by the same test done at the end of the Workshop, to assess the knowledge acquired during the training. Conclusion: The Workshop was successfully implemented. The overall rating of the workshop by the participants was excellent and all participants reported that they acquired a good understanding of the main issues that are relevant to medical physics support in case of NRE situations. They are expected to disseminate the knowledge to other medical physicists in their countries.« less

Chronic disease management: teaching medical students to incorporate community.

PubMed

Dent, M Marie; Mathis, Mary W; Outland, Monita; Thomas, McKinley; Industrious, DeShawn

2010-01-01

As a response to the growing prevalence of chronic disease, models of chronic care have emerged as salient approaches to address dynamic health care changes and to manage the burden of suffering of these diseases. Concurrently, there has been a growing call to address chronic disease management within medical school curricula. This article describes the development and evaluation of a curricular intervention designed to prepare students to integrate patient-centered care with an understanding of the patients' community, provide care within rural settings, and experience clinical education specific to chronic disease management. Second-year medical students completed a chronic disease management project as part of a 4-week community visit in rural and/or medically underserved sites. Paired pre- and post-survey data were collected using the Community Oriented Health Care Competency Scale to assess the student's knowledge, intent to practice, and attitudes toward incorporating community-oriented primary care into future practice. Matched pre- and post-project surveys were identified for 170 respondents out of 219 students (77.6% response rate). Post-assessment items were found to be statistically different from measures collected prior to the students' entrance into the community: all knowledge questions indicated significant advancements toward community responsiveness, as did one question related to attitude and three of the intent to practice community-oriented health care questions. Community-based rotations can play a positive role in developing the competencies needed for future practice. The development of curricular opportunities designed to train future physicians on the value of incorporating models of chronic care within rural and underserved communities should remain at the forefront of medical education.

Compliance of camps in the United States with guidelines for health and safety practices.

PubMed

Olympia, Robert P; Hollern, Kaylee; Armstrong, Caitlin; Adedayo, Pelumi; Dunnick, Jennifer; Hartley, Jessica; Doshi, Bhavin

2015-03-01

To determine the compliance of US camps with guidelines for health and safety practices as set forth by the American Academy of Pediatrics and the US Department of Homeland Security. An electronic questionnaire was distributed to US camps during the summer of 2012 as identified by 3 online summer camp directories. Analysis was performed on 433 completed questionnaires. Fourteen percent of camps were considered medically related. Ninety-three percent of camps have established relationships with community emergency medical services, 34% with local orthodontists, and 37% with local mental health professionals. Camps reported the immediate availability of the following: automated external defibrillators (75%), respiratory rescue inhalers (44%), epinephrine autoinjectors (64%), cervical spine collars (62%), and backboard with restraints (76%). Camps reported the presence of the following written health policies: dehydration (91%), asthma and anaphylaxis (88%), head injuries (90%), seizures (78%), cardiac arrest (76%), and drowning (73%). Although 93% of camps have a disaster response plan, 15% never practice the plan. Sixty-eight percent of camps are familiar with community evacuation plans, and 67% have access to vehicles for transport. Camps reported the presence of the following written disaster policies: fire (96%), tornadoes (68%), arrival of suspicious individuals (84%), hostage situations (18%). Areas for improvement in the compliance of US camps with specific recommendations for health and safety practices were identified, such as medically preparing campers before their attendance, developing relationships with community health providers, increasing the immediate availability of several emergency medications and equipment, and developing policies and protocols for medical and disaster emergencies.

How well does midwifery education prepare for clinical practice? Exploring the views of Swedish students, midwives and obstetricians.

PubMed

Schytt, Erica; Waldenström, Ulla

2013-02-01

midwifery education in many countries has been adapted to the academic system by a stronger focus on research methodology and scientific evidence. This development has often taken place without extending the programs. We were interested in exploring views about current content of midwifery education in Sweden with a focus on clinical competencies and the new research components. to investigate views about Swedish midwifery education held by students prior to graduation and after 1 year of practice, and by experienced midwives and obstetricians, with special focus on clinical competency. nationwide surveys conducted between June 2007 and January 2008, and 1 year later (follow-up of students). self-administered questionnaires completed by 171 (83%) students and 121 (59%) of these participants after 1 year of midwifery practice, and by 162 (54%) midwives and 108 (40%) obstetricians with at least 5 years of clinical experience. The responders were asked to assess predefined intrapartum competencies, which components of the education were allocated too little and too much time, and how well the education prepared for clinical practise overall. Content analysis of open-ended questions and descriptive analyses was used. most students, midwives and obstetricians were 'very' or 'fairly' satisfied with how the education prepared midwives for clinical practice and 1.8%, 4.7% and 17.6%, respectively, were dissatisfied. About half of the obstetricians and one-third of the experienced midwives rated new midwives' ability to identify deviations from normal progress as low or lacking, compared with 10% of the students. A majority found that too little time, of the 60 weeks programme, was allocated to intrapartum care and medical complications and too much time to research and writing a minor thesis. although few were dissatisfied with how midwifery education prepared for clinical practice in general, the majority of participants would have liked more time for medical complications, intrapartum care, and emergency situations, and less for research. These findings suggest that the balance between clinical competency and research, and how the research component is integrated into clinical knowledge, should be further discussed and evaluated. Also the discrepancy between the views of newly educated midwives and those of more experienced midwives and obstetricians need further investigation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Risk Factors in the Pediatric Ward Recognized by Students Before Pediatric Nursing Practice －Basic Data for Medical Safety Education Based on Student's Learning Readiness－.

PubMed

Hirowatari, Kanako; Nakamura, Emi

2016-09-01

The purpose of this study was to extract the risk factors recognized by students before pediatric nursing practice in order to conduct medical safety education based on student's learning readiness. Third-year nursing students of A nursing college used the P-mSHELL model to find the risk factors in a simulated pediatric hospital room, and the researchers analyzed the contents. The students recognized four categories of risk factors: "burden on the family", "characteristics of the infant", "characteristics of children with disease", and "the family's cognition and understanding". There were three categories of risk factors related to "the environment": "environment that can cause a dangerous action", "unsafe environment", and "sickroom as a living space". There were four categories of risk factors related to "the student": "students' own physical/mental condition", "anxiety caused by pediatric nursing practice", "learning process in nursing practice" and "students' understanding of pediatric nursing". The students recognized that there were various risk factors in the child, the family, and the environment, and, by the P-mSHELL model, they recognized that they themselves could become a risk factor. Based on the risk factors that students extracted, teachers should think about what kind of preparation is necessary for students in pediatric nursing practice, and it is important to conduct medical safety education.

Sample Preparation for Mass Spectrometry Imaging of Plant Tissues: A Review

PubMed Central

Dong, Yonghui; Li, Bin; Malitsky, Sergey; Rogachev, Ilana; Aharoni, Asaph; Kaftan, Filip; Svatoš, Aleš; Franceschi, Pietro

2016-01-01

Mass spectrometry imaging (MSI) is a mass spectrometry based molecular ion imaging technique. It provides the means for ascertaining the spatial distribution of a large variety of analytes directly on tissue sample surfaces without any labeling or staining agents. These advantages make it an attractive molecular histology tool in medical, pharmaceutical, and biological research. Likewise, MSI has started gaining popularity in plant sciences; yet, information regarding sample preparation methods for plant tissues is still limited. Sample preparation is a crucial step that is directly associated with the quality and authenticity of the imaging results, it therefore demands in-depth studies based on the characteristics of plant samples. In this review, a sample preparation pipeline is discussed in detail and illustrated through selected practical examples. In particular, special concerns regarding sample preparation for plant imaging are critically evaluated. Finally, the applications of MSI techniques in plants are reviewed according to different classes of plant metabolites. PMID:26904042

Standardized Competencies for Parenteral Nutrition Order Review and Parenteral Nutrition Preparation, Including Compounding: The ASPEN Model.

PubMed

Boullata, Joseph I; Holcombe, Beverly; Sacks, Gordon; Gervasio, Jane; Adams, Stephen C; Christensen, Michael; Durfee, Sharon; Ayers, Phil; Marshall, Neil; Guenter, Peggi

2016-08-01

Parenteral nutrition (PN) is a high-alert medication with a complex drug use process. Key steps in the process include the review of each PN prescription followed by the preparation of the formulation. The preparation step includes compounding the PN or activating a standardized commercially available PN product. The verification and review, as well as preparation of this complex therapy, require competency that may be determined by using a standardized process for pharmacists and for pharmacy technicians involved with PN. An American Society for Parenteral and Enteral Nutrition (ASPEN) standardized model for PN order review and PN preparation competencies is proposed based on a competency framework, the ASPEN-published interdisciplinary core competencies, safe practice recommendations, and clinical guidelines, and is intended for institutions and agencies to use with their staff. © 2016 American Society for Parenteral and Enteral Nutrition.

Assessment of pathology instruction in U.S. Dental hygiene educational programs.

PubMed

Jacobs, Barbara B; Lazar, Ann A; Rowe, Dorothy J

2015-04-01

To assess the instruction of pathology content in entry-level and advanced practitioner dental hygiene educational programs and the program directors' perceptions whether their graduates are adequately prepared to meet the increasingly complex medical and oral health needs of the public. A 28-question survey of instructional content and perceptions was developed and distributed using Qualtrics® software to the 340 directors of entry-level and advanced practitioner dental hygiene programs in the US. Respondents rated their level of agreement to a series of statements regarding their perceptions of graduates' preparation to perform particular dental hygiene services associated with pathology. Descriptive statistics for all 28 categorical survey questions were calculated and presented as the frequency (percentage). Of the 340 directors surveyed, 130 (38%) responded. Most entry-level respondents (53%) agreed or strongly agreed (29%) that their graduates were adequately prepared to meet the complex medical and oral health needs of the public, while all respondents of advanced practitioner programs strongly agreed. More respondents strongly agreed to statements related to clinical instruction than to didactic courses. While 64% of respondents agreed that their graduates were prepared to practice unsupervised, if it were legally allowed, 21% were ambivalent. The extent of pathology instruction in entry-level programs varied, but most used traditional formats of instruction, educational resources and assessments of educational outcomes. Advanced practitioner programs emphasized histological and clinical examination of oral lesions and patient case studies. Strengthening pathology instruction would ensure that future generations of dental hygienists would be adequately prepared to treat medically compromised patients. Copyright © 2015 The American Dental Hygienists’ Association.

Patient Centered Medical Home: Creating a Blueprint for Quality Healthcare through Illustrative Simulation

ERIC Educational Resources Information Center

Sheingold, Brenda Helen; Chapa, Deborah W.; Ekmekci, Ozgur; Emard, Esther

2015-01-01

The advent of healthcare reform in the U.S. presents an unprecedented challenge to academic institutions that are striving to prepare a workforce to interact with individuals needing care in a variety of new practice settings. Patient-centered care is a core objective of these evolving settings which enhance access to a variety professionals and…

Health Occupations Education I. Module No. I-A to I-G.

ERIC Educational Resources Information Center

Dunmeyer, Kathryn; And Others

This set of 7 modules on medical and surgical asepsis is 1 of 11 sets in the Health Occupations Education I instructional package for the first year of a 2-year course of study. The materials are designed to prepare students through individualized instruction for entry-level job opportunities on health care teams in a variety of practice settings.…

Are We Throwing Histology out with the Microscope? A Look at Histology from the Physician's Perspective

ERIC Educational Resources Information Center

Pratt, Rebecca L.

2009-01-01

A trend in medical schools across the United States is the refurbishing of histology laboratories with digital microscopy systems. Although such systems may reduce curricular time, they do not teach basic microscope skills, and students who learn solely with these systems may be less prepared for their practices or specialties, particularly in…

Non-Transfusional Hemocomponents: From Biology to the Clinic-A Literature Review.

PubMed

Gasparro, Roberta; Qorri, Erda; Valletta, Alessandra; Masucci, Michele; Sammartino, Pasquale; Amato, Alessandra; Marenzi, Gaetano

2018-03-31

Non-transfusional hemocomponents for surgical use are autogenous products prepared through the centrifugation of a blood sample from a patient. Their potential beneficial outcomes include hard and soft tissue regeneration, local hemostasis, and the acceleration of wound healing. Therefore, they are suitable for application in different medical fields as therapeutic options and in surgical practices that require tissue regeneration.

Peer teaching in medical education: twelve reasons to move from theory to practice.

PubMed

Ten Cate, Olle; Durning, Steven

2007-09-01

To provide an estimation of how often peer teaching is applied in medical education, based on reports in the literature and to summarize reasons that support the use of this form of teaching. We surveyed the 2006 medical education literature and categorised reports of peer teaching according to educational distance between students teaching and students taught, group size, and level of formality of the teaching. Subsequently, we analysed the rationales for applying peer teaching. Most reports were published abstracts in either Medical Education's annual feature 'Really Good Stuff' or the AMEE's annual conference proceedings. We identified twelve distinct reasons to apply peer teaching, including 'alleviating faculty teaching burden', 'providing role models for junior students', 'enhancing intrinsic motivation' and 'preparing physicians for their future role as educators'. Peer teaching appears to be practiced often, but many peer teaching reports do not become full length journal articles. We conclude that specifically 'near-peer teaching' appears beneficial for student teachers and learners as well as for the organisation. The analogy of the 'journeyman', as intermediate between 'apprentice' and 'master', with both learning and teaching tasks, is a valuable but yet under-recognized source of education in the medical education continuum.

Mass shooting in Colorado: practice drills, disaster preparations key to successful emergency response.

PubMed

2012-10-01

While EDs are accustomed to preparing for mass-casualty events, the EDs responsible for caring for the victims of the mass shooting at an Aurora, CO, movie theater on July 20, 2012, say the emotional impact of dealing with such a senseless, horrific event remains challenging. Still, the ED directors from the two hospitals who cared for the most patients that night credit established disaster-response procedures and regular practice drills with helping them to successfully manage the crisis. Within a 30-minute time period, the University of Colorado's Anschutz Medical Campus in Aurora, CO, received 23 critically ill or injured patients, one of which was deceased upon arrival.There were no additional fatalities among the remaining 22 patients. The Medical Center of Aurora received 18 patients, 13 of which where suffering from gun shot wounds; all survived. Hospital administrators say ED providers and staff have responded in different ways to the tragedy, but the emotional impact has been difficult for some. Resources, ranging from spiritual support and grief counselors to psychiatric help, have been made available to help ED personnel access the kind of help they need.

[Characteristics of morphological manifestations of anaphylactic shock in response to the administration of pharmaceutical preparations encountered in the practice of forensic medical expert-histologist].

PubMed

Denisova, O P; Kul'bitskiĭ, B N; Putintsev, V A; Bogomolova, I N; Bogomolov, D V

2012-01-01

The authors report the results of a forensic medical investigation of 6 cases of death associated with the administration of pharmaceutical products documented by forensic medical experts of the Russian Centre of Forensic Medical Expertise. The results of the study are compared with the clinical data and summarized using the methods of tanatogenetic analysis. The following main clinical variants of iatrogenic anaphylactic shock (IAS) are distinguished: bronchospastic IAS (n = 1), asphyxic IAS (n = 1), hemodynamic IAS (n = 3), and combined (bronchospastic plus hemodynamic) IAS (n = 1). The signs of all these variants are described allowing for their diagnostics and differentiation diagnostics. These data can be used for the purpose of forensic medical diagnostics and elucidation of the mechanisms of tanatogenesis.

Type of oral solid medication packaging and medication preparation time in nursing homes: A direct observation study.

PubMed

Cready, C M; Hudson, C; Dreyer, K

2017-12-01

Medication administration is a substantial portion of the workday in nursing homes, with the medication preparation step being the most time-consuming. However, little is known about how medication preparation time is affected by the type of packaging used for oral solid medications (ie, tablets/capsules). We examined the effects of two types of packaging. As fewer steps are associated with strip packaging compared to bingo card packaging, we hypothesized that the increase in medication preparation seconds per resident with each additional oral solid medication would be smaller when strip packaging was used. A total of 430 medication preparations conducted by eight nurses during the regularly scheduled morning medication administration period in two nursing homes-using strip packaging and bingo card packaging, respectively-were observed. Each medication preparation observation was matched to its corresponding medication administration record and observations averaged across resident. Using the resident sample (N=149), we estimated three regression models (adjusting the standard errors for the clustering of resident by nurse). The first model regressed medication preparation seconds on the number of oral solid medications. The second model added the type of packaging used and the control variables (type of unit [long-term care, post-acute care], the number of one-half pills and the dosage form diversity in the preparation). To test our hypothesis, the third model added an interaction term between the number of oral solid medications and the type of packaging used. As hypothesized, all else equal, the number of oral solid medications tended to increase medication preparation time per resident in both nursing homes, but the increase was smaller in the strip packaging nursing home (P<.05). Each additional oral solid medication in the bingo card packaging nursing home increased medication preparation by an average of 13 seconds (b=13.077), whereas each oral solid medication administered in the strip packaging nursing home increased medication preparation by an average of only 8 seconds (13.077-5.092=7.985). This is a difference on average of about 5 seconds per oral solid medication. To our knowledge, we were the first to examine the effect of type of oral solid medication packaging on medication preparation time in nursing homes. Type of packaging matters. The time saved using strip packaging (vs bingo card packaging) has implications for quality of care and the movement towards person-centred care in the nursing home sector. Nurses (or other staff tasked with medication preparation) in nursing homes using strip packaging potentially have more time to devote to nurturing a relationship with the resident. However, time saved in medication preparation by strip packaging is counterproductive if a serious error results. Thus, future studies should investigate the effects of type of packaging on medication preparation errors. © 2017 John Wiley & Sons Ltd.

Introducing medical humanities in the medical curriculum in Saudi Arabia: A pedagogical experiment.

PubMed

Abdel-Halim, Rabie E; Alkattan, Khaled M

2012-05-01

In a marked shift from the modern positivist materialist philosophy that influenced medical education for more than a century, Western medical educators are now beginning to realize the significance of the spiritual element of human nature. Consensus is currently building up in Europe and North America on the need to give more emphasis to the study of humanities disciplines such as history of medicine, ethics, religion, philosophy, medically related poetry, literature, arts and medical sociology in medical colleges with the aim of allowing graduates to reach to the heart of human learning about meaning of life and death and to become kinder, more reflective practitioners. The medicine taught and practiced during the Islamic civilization era was a vivid example of the unity of the two components of medical knowledge: natural sciences and humanities. It was also a brilliant illustration of medical ethics driven by a divine moral code. This historical fact formed the foundation for the three medical humanities courses presented in this article reporting a pedagogical experiment in preparation for starting a humanities program in Alfaisal University Medical College in Riyadh. In a series of lectures alternating with interactive sessions, active learning strategies were employed in teaching a course on history of medicine during the Islamic era and another on Islamic medical ethics. Furthermore, a third course on medically relevant Arabic poetry was designed and prepared in a similar way. The end-of-the-course feedback comments reflected effectiveness of the courses and highlighted the importance of employing student-centered learning techniques in order to motivate medical students to become critical thinkers, problem solvers, life-long learners and self-learners.

Utilization of smart phones related medical applications among medical students at King Abdulaziz University, Jeddah: A cross-sectional study.

PubMed

Sayedalamin, Zaid; Alshuaibi, Abdulaziz; Almutairi, Osama; Baghaffar, Mariam; Jameel, Tahir; Baig, Mukhtiar

The present study explored the utility, attitude, and trends regarding Smartphone related Medical Applications (Apps) among medical students of King Abdulaziz University (KAU) Jeddah, Saudi Arabia (SA) and their perceptions of the impact of Medical Apps in their training activities. This survey was conducted at the Faculty of Medicine, Jeddah, and Rabigh campuses, KAU, Jeddah, SA. All participants were medical students of 2nd to 6th year. The data was collected by using an anonymous questionnaire regarding the perception of medical students about Medical Apps on the smart devices and the purpose of installation of the Apps. Additionally examined was the use of different Medical Apps by the students to investigate the impact of Medical Apps on the clinical training/practice. Data was analyzed on SPSS 21. The opinion of 330/460 medical students from all academic years was included in the study with a response rate of 72%. There were 170 (51.5%) males and 160 (48.5%) females with a mean age of 21.26±1.86 years. Almost all participating students 320 (97%) were well aware of Medical Apps for smart devices and 89.1% had installed different applications on their smart devices. The main usage was for either revision of courses (62.4%) or for looking up of medical information (67.3%), followed by preparing for a presentation (34.5%) and getting the medical news (32.1%). Regarding the impact of Medical Apps, most of the students considered these helpful in clinical decision-making, assisting in differential diagnosis, allowing faster access to Evidence-Based Medical practice, saving time and others. The practical use of these Apps was found to be minimal in medical students. Around 73% were occasional users of Medical Apps, and only 27% were using Medical Apps at least once a day. The regular use of Medical Apps on mobile devices is not common among medical students of KAU. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Platelet-rich preparations to improve healing. Part II: platelet activation and enrichment, leukocyte inclusion, and other selection criteria.

PubMed

Davis, Vicki L; Abukabda, Alaeddin B; Radio, Nicholas M; Witt-Enderby, Paula A; Clafshenkel, William P; Cairone, J Vito; Rutkowski, James L

2014-08-01

Multiple platelet-rich preparations have been reported to improve wound and bone healing, such as platelet-rich plasma (PRP) and platelet rich fibrin (PRF). The different methods employed during their preparation are important, as they influence the quality of the product applied to a wound or surgical site. Besides the general protocol for preparing the platelet-rich product (discussed in Part 1 of this review), multiple choices need to be considered during its preparation. For example, activation of the platelets is required for the release and enmeshment of growth factors, but the method of activation may influence the resulting matrix, growth factor availability, and healing. Additionally, some methods enrich leukocytes as well as platelets, but others are designed to be leukocyte-poor. Leukocytes have many important roles in healing and their inclusion in PRP results in increased platelet concentrations. Platelet and growth factor enrichment reported for the different types of platelet-rich preparations are also compared. Generally, TGF-β1 and PDGF levels were higher in preparations that contain leukocytes compared to leukocyte-poor PRP. However, platelet concentration may be the most reliable criterion for comparing different preparations. These and other criteria are described to help guide dental and medical professionals, in large and small practices, in selecting the best procedures for their patients. The healing benefits of platelet-rich preparations along with the low risk and availability of simple preparation procedures should encourage more clinicians to incorporate platelet-rich products in their practice to accelerate healing, reduce adverse events, and improve patient outcomes.

Quality improvement training for core medical and general practice trainees: a pilot study of project participation, completion and journal publication.

PubMed

McNab, Duncan; McKay, John; Bowie, Paul

2015-11-01

Small-scale quality improvement projects are expected to make a significant contribution towards improving the quality of healthcare. Enabling doctors-in-training to design and lead quality improvement projects is important preparation for independent practice. Participation is mandatory in speciality training curricula. However, provision of training and ongoing support in quality improvement methods and practice is variable. We aimed to design and deliver a quality improvement training package to core medical and general practice specialty trainees and evaluate impact in terms of project participation, completion and publication in a healthcare journal. A quality improvement training package was developed and delivered to core medical trainees and general practice specialty trainees in the west of Scotland encompassing a 1-day workshop and mentoring during completion of a quality improvement project over 3 months. A mixed methods evaluation was undertaken and data collected via questionnaire surveys, knowledge assessment, and formative assessment of project proposals, completed quality improvement projects and publication success. Twenty-three participants attended the training day with 20 submitting a project proposal (87%). Ten completed quality improvement projects (43%), eight were judged as satisfactory (35%), and four were submitted and accepted for journal publication (17%). Knowledge and confidence in aspects of quality improvement improved during the pilot, while early feedback on project proposals was valued (85.7%). This small study reports modest success in training core medical trainees and general practice specialty trainees in quality improvement. Many gained knowledge of, confidence in and experience of quality improvement, while journal publication was shown to be possible. The development of educational resources to aid quality improvement project completion and mentoring support is necessary if expectations for quality improvement are to be realised. © The Author(s) 2015.

Preparedness of government owned dental clinics for the management of medical emergencies: a survey of government dental clinics in Lagos.

PubMed

Gbotolorun, O M; Babatunde, L B; Osisanya, O; Omokhuale, E

2012-01-01

An emergency is a medical condition demanding immediate treatments. The aim of the study was to determine the knowledge and ability of dental surgeons in the management of medical emergencies and the availability of emergency drugs and equipment in government dental clinics and hospitals in Lagos State. The study was a descriptive cross-sectional study of knowledge and ability of Dental Surgeons in the management of medical emergencies, prevalence of medical emergencies in dental practice and availability of emergency drugs and equipment in dental practice in government dental clinics and hospitals in Lagos State. The study covered 22 government dental clinics and hospitals in Lagos State. Data obtained was entered into a computerand analyzed using Statistical Package for Social Science (SPSS) Version-16 data analysis software. Chi Square and cross-tabulations were used for the analysis. A 95% Confidence Level was used and a p-value of less than or equal to 0.05 was considered statistically significant. Of a population of 255 Dental Surgeons on the nominal rolls of all the health institutions, 224 (87%)responded.Of the total respondents, 204 (91.1%) stated they had no emergency kit in their dental clinics (p < 0.05) while 158 respondents (70.5%) stated they had no emergency drugs in their dental practice to manage medical emergencies (p < 0.05). The commonest emergencies reported was syncope 104 respondents (33.8%). 161 respondents (71.9%) claimed they are able to manage medical emergencies encountered in their dental practice if kits and drugs are available. The findings of the study show that government dental clinics/hospital in Lagos seem not to be adequately prepared to manage medical emergency. Although 71.9% of the dentist claimed they could mange such emergencies should they arise 91.1% and 70% of the respondent claimed they and no emergency kits and drugs to manage such emergencies in their hospital respectively should they arise.

‘I did try and point out about his dignity’: a qualitative narrative study of patients and carers’ experiences and expectations of junior doctors

PubMed Central

Kostov, Camille E; Rees, Charlotte E; Gormley, Gerard J

2018-01-01

Objectives For many years, the voice of patients has been understood as a critical element for the improvement of care quality in healthcare settings. How well medical graduates are prepared for clinical practice is an important question, but one that has rarely been considered from patient and public perspectives. We aimed to fill this gap by exploring patients and carers’ experiences and expectations of junior doctors. Design This comprises part of a wider study on UK medical graduates’ preparedness for practice. A qualitative narrative methodology was used, comprising four individual and six group interviews. Participants 25 patients and carers from three UK countries. Analysis Data were transcribed, anonymised and analysed using framework analysis. Main results We identified three themes pertinent to answering our research question: (1) sources of knowledge (sources of information contributing to patients and carers’ perceptions of junior doctors’ impacting on expectations); (2) desires for student/trainee learning (experiences and expectations of medical training); and (3) future doctors (experiences and expectations of junior doctors). We also highlight metaphorical talk and humour, where relevant, in the quotes presented to give deeper insights into participants’ perspectives of the issues. Participants focused on personal and interpersonal aspects of being a doctor, such as respect and communication. There was a strong assertion that medical graduates needed to gain direct experience with a diverse range of patients to encourage individualised care. Participants narrated their experiences of having symptoms ignored and attributed to an existing diagnosis (‘diagnostic overshadowing’) and problems relating to confidentiality. Conclusions Our findings support the view that patients and carers have clear expectations about junior doctors, and that patient views are important for preparing junior doctors for practice. There is a necessity for greater dialogue between patients, doctors and educators to clarify expectations and confidentiality issues around patient care. PMID:29358422

Training the intern: The value of a pre-intern year in preparing students for practice.

PubMed

Dare, Anna; Fancourt, Nicholas; Robinson, Elizabeth; Wilkinson, Tim; Bagg, Warwick

2009-08-01

To evaluate the clinical and professional development that occurs during a New Zealand trainee intern year in preparation for the first house officer role. A quantitative questionnaire was distributed to all trainee interns (year 6) and year 5 medical students in New Zealand at the end of the 2007 academic year. This survey assessed self-reported competency and performance across clinical, professional and role development domains. Response rate was 65% (457/702). Compared to year 5 students, trainee interns reported significantly greater competence and performance levels across all three domains. The greatest improvement occurred in the independent performance of procedural skills (trainee interns: 77%, year 5: 35%, p < 0.001) and clinical tasks (trainee interns: 94%, year 5: 56%, p < 0.001) and in the level of clinical responsibility taken (p < 0.001). At the end of the trainee intern year, 92% of students felt prepared to be a junior doctor, versus only 53% at the end of their 5th year (p < 0.0001). The trainee intern year is important in preparing graduates for the intern role. The year affords increased responsibility and practical experience, whilst retaining an educational focus, facilitating the move from competence towards performance. Preparedness for practice was substantially higher following the New Zealand trainee intern year than has been reported with other pre-intern placements.

Drama as a pedagogical tool for practicing death notification-experiences from Swedish medical students.

PubMed

Nordström, Anna; Fjellman-Wiklund, Anncristine; Grysell, Tomas

2011-09-28

One of the toughest tasks in any profession is the deliverance of death notification. Marathon Death is an exercise conducted during the fourth year of medical school in northern Sweden to prepare students for this responsibility. The exercise is designed to enable students to gain insight into the emotional and formal procedure of delivering death notifications. The exercise is inspired by Augusto Boal's work around Forum Theatre and is analyzed using video playback. The aim of the study was to explore reflections, attitudes and ideas toward training in delivering death notifications among medical students who participate in the Marathon Death exercise based on forum play. After participation in the Marathon Death exercise, students completed semi-structured interviews. The transcribed interviews were analyzed using the principles of qualitative content analysis including a deductive content analysis approach with a structured matrix based on Bloom's taxonomy domains. The Marathon Death exercise was perceived as emotionally loaded, realistic and valuable for the future professional role as a physician. The deliverance of a death notification to the next of kin that a loved one has died was perceived as difficult. The exercise conjured emotions such as positive expectations and sheer anxiety. Students perceived participation in the exercise as an important learning experience, discovering that they had the capacity to manage such a difficult situation. The feedback from the video playback of the exercise and the feedback from fellow students and teachers enhanced the learning experience. The exercise, Marathon Death, based on forum play with video playback is a useful pedagogical tool that enables students to practice delivering death notification. The ability to practice under realistic conditions contributes to reinforce students in preparation for their future professional role.

Survey of Clinical Laboratory Practices for 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea.

PubMed

Lee, Mi-Kyung; Kim, Sinyoung; Kim, Mi-Na; Kweon, Oh Joo; Lim, Yong Kwan; Ki, Chang-Seok; Kim, Jae-Seok; Seong, Moon-Woo; Sung, Heungsup; Yong, Dongeun; Lee, Hyukmin; Choi, Jong-Rak; Kim, Jeong-Ho

2016-03-01

It is crucial to understand the current status of clinical laboratory practices for the largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in the Republic of Korea to be well prepared for future emerging infectious diseases. We conducted a survey of 49 clinical laboratories in medical institutions and referral medical laboratories. A short questionnaire to survey clinical laboratory practices relating to MERS-CoV diagnostic testing was sent by email to the directors and clinical pathologists in charge of the clinical laboratories performing MERS-CoV testing. The survey focused on testing volume, reporting of results, resources, and laboratory safety. A total of 40 clinical laboratories responded to the survey. A total of 27,009 MERS-CoV real-time reverse transcription PCR (rRT-PCR) tests were performed. Most of the specimens were sputum (73.5%). The median turnaround time (TAT) was 5.29 hr (first and third quartile, 4.11 and 7.48 hr) in 26 medical institutions. The median TAT of more than a half of the laboratories (57.7%) was less than 6 hr. Many laboratories were able to perform tests throughout the whole week. Laboratory biosafety preparedness included class II biosafety cabinets (100%); separated pre-PCR, PCR, and post-PCR rooms (88.6%); negative pressure pretreatment rooms (48.6%); and negative pressure sputum collection rooms (20.0%). Clinical laboratories were able to quickly expand their diagnostic capacity in response to the 2015 MERS-CoV outbreak. Our results show that clinical laboratories play an important role in the maintenance and enhancement of laboratory response in preparation for future emerging infections.

Survey of Clinical Laboratory Practices for 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea

PubMed Central

Lee, Mi-Kyung; Kim, Sinyoung; Kim, Mi-Na; Kweon, Oh Joo; Lim, Yong Kwan; Ki, Chang-Seok; Kim, Jae-Seok; Seong, Moon-Woo; Sung, Heungsup; Yong, Dongeun; Lee, Hyukmin; Choi, Jong-Rak

2016-01-01

Background It is crucial to understand the current status of clinical laboratory practices for the largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in the Republic of Korea to be well prepared for future emerging infectious diseases. Methods We conducted a survey of 49 clinical laboratories in medical institutions and referral medical laboratories. A short questionnaire to survey clinical laboratory practices relating to MERS-CoV diagnostic testing was sent by email to the directors and clinical pathologists in charge of the clinical laboratories performing MERS-CoV testing. The survey focused on testing volume, reporting of results, resources, and laboratory safety. Results A total of 40 clinical laboratories responded to the survey. A total of 27,009 MERS-CoV real-time reverse transcription PCR (rRT-PCR) tests were performed. Most of the specimens were sputum (73.5%). The median turnaround time (TAT) was 5.29 hr (first and third quartile, 4.11 and 7.48 hr) in 26 medical institutions. The median TAT of more than a half of the laboratories (57.7%) was less than 6 hr. Many laboratories were able to perform tests throughout the whole week. Laboratory biosafety preparedness included class II biosafety cabinets (100%); separated pre-PCR, PCR, and post-PCR rooms (88.6%); negative pressure pretreatment rooms (48.6%); and negative pressure sputum collection rooms (20.0%). Conclusions Clinical laboratories were able to quickly expand their diagnostic capacity in response to the 2015 MERS-CoV outbreak. Our results show that clinical laboratories play an important role in the maintenance and enhancement of laboratory response in preparation for future emerging infections. PMID:26709263

Knowledge translation on dementia: a cluster randomized trial to compare a blended learning approach with a "classical" advanced training in GP quality circles.

PubMed

Vollmar, Horst C; Butzlaff, Martin E; Lefering, Rolf; Rieger, Monika A

2007-06-22

Thus far important findings regarding the dementia syndrome have been implemented into patients' medical care only inadequately. A professional training accounting for both, general practitioners' (GP) needs and learning preferences as well as care-relevant aspects could be a major step towards improving medical care. In the WIDA-study, entitled "Knowledge translation on dementia in general practice" two different training concepts are developed, implemented and evaluated. Both concepts are building on an evidence-based, GP-related dementia guideline and communicate the guideline's essential insights. Both development and implementation emphasize a procedure that is well-accepted in practice and, thus, can achieve a high degree of external validity. This is particularly guaranteed through the preparation of training material and the fact that general practitioners' quality circles (QC) are addressed. The evaluation of the two training concepts is carried out by comparing two groups of GPs to which several quality circles have been randomly assigned. The primary outcome is the GPs' knowledge gain. Secondary outcomes are designed to indicate the training's potential effects on the GPs' practical actions. In the first training concept (study arm A) GPs participate in a structured case discussion prepared for by internet-based learning material ("blended-learning" approach). The second training concept (study arm B) relies on frontal medical training in the form of a slide presentation and follow-up discussion ("classical" approach). This paper presents the outline of a cluster-randomized trial which has been peer reviewed and support by a national funding organization--Federal Ministry of Education and Research (BMBF)--and is approved by an ethics commission. The data collection has started in August 2006 and the results will be published independently of the study's outcome. Current Controlled Trials [ISRCTN36550981].

The transition to hospital consultant and the influence of preparedness, social support, and perception: A structural equation modelling approach.

PubMed

Westerman, Michiel; Teunissen, Pim W; Fokkema, Joanne P I; van der Vleuten, Cees P M; Scherpbier, Albert J J A; Siegert, Carl E H; Scheele, Fedde

2013-04-01

Insight into the transition from specialist registrar to hospital consultant is needed to better align specialty training with starting as a consultant and to facilitate this transition. This study investigates whether preparedness regarding medical and generic competencies, perceived intensity, and social support are associated with burnout among new consultants. A population-based study among all 2643 new consultants in the Netherlands (all specialties) was conducted in June 2010. A questionnaire covering preparedness for practice, intensity of the transition, social support, and burnout was used. Structural equation modelling was used for statistical analysis. Data from a third of the population were available (32% n = 840) (43% male/57% female). Preparation in generic competencies received lower ratings than in medical competencies. A total of 10% met the criteria for burnout and 18% scored high on the emotional exhaustion subscale. Perceived lack of preparation in generic competencies correlated with burnout (r = 0.15, p < 0.001). No such relation was found for medical competencies. Furthermore, social support protected against burnout. These findings illustrate the relevance of generic competencies for new hospital consultants. Furthermore, social support facilitates this intense and stressful stage within the medical career.

Beyond the Standard Curriculum: A Review of Available Opportunities for Medical Students to Prepare for a Career in Radiation Oncology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Agarwal, Ankit; DeNunzio, Nicholas J.; Ahuja, Divya

Purpose: To review currently available opportunities for medical students to supplement their standard medical education to prepare for a career in radiation oncology. Methods and Materials: Google and PubMed were used to identify existing clinical, health policy, and research programs for medical students in radiation oncology. In addition, results publicly available by the National Resident Matching Program were used to explore opportunities that successful radiation oncology applicants pursued during their medical education, including obtaining additional graduate degrees. Results: Medical students can pursue a wide variety of opportunities before entering radiation oncology. Several national specialty societies, such as the American Societymore » for Radiation Oncology and the Radiological Society of North America, offer summer internships for medical students interested in radiation oncology. In 2011, 30% of allopathic senior medical students in the United States who matched into radiation oncology had an additional graduate degree, including PhD, MPH, MBA, and MA degrees. Some medical schools are beginning to further integrate dedicated education in radiation oncology into the standard 4-year medical curriculum. Conclusions: To the authors' knowledge, this is the first comprehensive review of available opportunities for medical students interested in radiation oncology. Early exposure to radiation oncology and additional educational training beyond the standard medical curriculum have the potential to create more successful radiation oncology applicants and practicing radiation oncologists while also promoting the growth of the field. We hope this review can serve as guide to radiation oncology applicants and mentors as well as encourage discussion regarding initiatives in radiation oncology opportunities for medical students.« less

Extemporaneous formulations in Germany - relevance for everyday clinical practice.

PubMed

Staubach, Petra; Salzmann, Stefan; Peveling-Oberhag, Adriane; Weyer, Veronika; Zimmer, Sebastian; Gradl, Gabriele; Lang, Berenice M

2018-05-01

Extemporaneous formulations broaden the spectrum of therapeutic options for topical treatment in particular and thus improve patient care. The latest amendment to the Regulation on the Operation of Pharmacies issued in 2012 brought about changes in prescribing and manufacturing practices. The aim of the present study was to assess the relevance of extemporaneous formulations in everyday clinical practice. We used data from the German Institute for Drug Use Evaluation (DAPI) to analyze the prescribing practice for compounded preparations in Germany between the fourth quarter of 2011 and the third quarter of 2014. In doing so, we determined the total cost associated with extemporaneous formulations covered by statutory health insurance funds in the outpatient setting. Approximately three out of ten prescriptions (30.54 %) by German dermatologists during the observation period were extemporaneous formulations. While dermatologists make up only 2.7 % of physicians working in the statutory health care system in Germany, they prescribe more than half of all compounded preparations (53.6 %). Each dermatologist prescribed an average of 270.4 formulations per quarter; that number was 13.5 (1.3 %) for all other medical specialties. On average, 1,983,687 extemporaneous formulations overall (1.3 % of all prescriptions) were prescribed per quarter, corresponding to a total cost of € 40,944,982 (0.55 %). Apart from finished medicinal products, extemporaneous formulations play a key role in outpatient care. Based on the principles of evidence-based and patient-oriented medicine, the quality of compounded preparations and the prescribing practice of physicians (standardized vs. individual formulations) should be further investigated to optimize the quality of these preparations. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Medical students, spirituality and religiosity-results from the multicenter study SBRAME

PubMed Central

2013-01-01

Background To evaluate the relationship between spirituality/religiosity (S/R) and the attitudes, beliefs and experiences of medical students in Brazil with respect to S/R in their undergraduate training and clinical practice. Methods SBRAME (Spirituality and Brazilian Medical Education) is a multicenter study involving 12 Brazilian medical schools with 5950 medical students (MS). Participants completed a questionnaire that collected information on socio-demographic data and S/R in their undergraduate training and practice. Results Of all MS, 3630 participated in the survey (61.0%). The sample was 53.8% women and the mean age was 22.5 years. The majority of MS believed that spirituality has an impact on patients’ health (71.2%) and that this impact was positive (68.2%). The majority also wanted to address S/R in their clinical practice (58.0%) and considered it relevant (75.3%), although nearly one-half (48.7%) felt unprepared to do so. Concerning their training, most MS reported that they had never participated in a “spirituality and health” activity (81.0%) and that their medical instructors had never or rarely addressed this issue (78.3%). The majority also believed that they should be prepared to address spiritual issues related to the health of their patients (61.6%) and that this content should be included in the medical curriculum (62.6%). Conclusion There is a large gap between MS attitudes and expectations and the S/R training that they are receiving during their undergraduate training. The majority of MS surveyed believe that patients should have their beliefs addressed and that these beliefs could have important effects on their health and the doctor-patient relationship. These results should stimulate discussion about the place that S/R training should have in the medical curriculum. PMID:24314327

Training future physicians in the era of genomic medicine: trends in undergraduate medical genetics education.

PubMed

Plunkett-Rondeau, Jevon; Hyland, Katherine; Dasgupta, Shoumita

2015-11-01

Advances in genomic technologies are transforming medical practice, necessitating the expertise of genomically-literate physicians. This study examined 2013-2014 trends in genetics curricula in US and Canadian medical schools to ascertain whether and how curricula are keeping pace with this rapid evolution. Medical genetics course directors received a 60-item electronic questionnaire covering curriculum design, assessment, remediation of failing grades, and inclusion of specific topics. The response rate was 74%. Most schools teach the majority of genetics during the first 2 years, with an increase in the number of integrated curricula. Only 26% reported formal genetics teaching during years 3 and 4, and most respondents felt the amount of time spent on genetics was insufficient preparation for clinical practice. Most participants are using the Association of Professors of Human and Medical Genetics Core Curriculum(1) as a guide. Topics recently added include personalized medicine (21%) and direct-to-consumer testing (18%), whereas eugenics (17%), linkage analysis (16%), and evolutionary genetics (15%) have been recently eliminated. Remediation strategies were heterogeneous across institutions. These findings provide an important update on how genetics and genomics is taught at US and Canadian medical schools. Continuous improvement of educational initiatives will aid in producing genomically-literate physicians.

Closing the theory to practice gap for newly qualified doctors: evaluation of a peer-delivered practical skills training course for newly qualified doctors in preparation for clinical practice.

PubMed

Beane, A; Padeniya, A; De Silva, A P; Stephens, T; De Alwis, S; Mahipala, P G; Sigera, P C; Munasinghe, S; Weeratunga, P; Ranasinghe, D; Deshani, E M; Weerasinghe, T; Thilakasiri, K; Jayasinghe, Kas; Dondorp, A M; Haniffa, R

2017-10-01

The Good Intern Programme (GIP) in Sri Lanka has been implemented to bridge the 'theory to practice gap' of doctors preparing for their internship. This paper evaluates the impact of a 2-day peer-delivered Acute Care Skills Training (ACST) course as part of the GIP. The ACST course was developed by an interprofessional faculty, including newly graduated doctors awaiting internship (pre-intern), focusing on the recognition and management of common medical and surgical emergencies. Course delivery was entirely by pre-intern doctors to their peers. Knowledge was evaluated by a pre- and post-course multiple choice test. Participants' confidence (post-course) and 12 acute care skills (pre- and post-course) were assessed using Likert scale-based questions. A subset of participants provided feedback on the peer learning experience. Seventeen courses were delivered by a faculty consisting of eight peer trainers over 4 months, training 320 participants. The mean (SD) multiple choice questionnaire score was 71.03 (13.19) pre-course compared with 77.98 (7.7) post-course (p<0.05). Increased overall confidence in managing ward emergencies was reported by 97.2% (n=283) of respondents. Participants rated their post-course skills to be significantly higher (p<0.05) than pre-course in all 12 assessed skills. Extended feedback on the peer learning experience was overwhelmingly positive and 96.5% would recommend the course to a colleague. A peer-delivered ACST course was extremely well received and can improve newly qualified medical graduates' knowledge, skills and confidence in managing medical and surgical emergencies. This peer-based model may have utility beyond pre-interns and beyond Sri Lanka. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Analysis of theoretical knowledge and the practice of science among Brazilian otorhinolaryngologists.

PubMed

Mendonça, Vitor Rosa Ramos de; Alcântara, Thiago; Andrade, Nilvano; Andrade, Bruno Bezerril; Barral-Netto, Manoel; Boaventura, Viviane

2013-08-01

Physicians from all medical specialties are required to understand the principles of science and to interpret medical literature. Yet, the levels of theoretical and practical knowledge held by Brazilian otorhinolaryngologists has not been evaluated to date. To assess the background and level of scientific knowledge of Brazilian otorhinolaryngologists. Participants of two national ENT meetings were invited to answer a questionnaire to assess scientific practice and knowledge. This study included 73 medical doctors (52% otorhinolaryngologists and 38% residents) aged between 18 and 65 years. About two-thirds have been involved in some form of scientific activity during undergraduate education and/or reported to have written at least one scientific paper. Physicians who took part in research projects felt better prepared to interpret scientific papers and carry out research projects (p = 0.0103 and p = 0.0240, respectively). Respondents who claimed to have participated in research or to have written papers had higher scores on theoretical scientific concepts (p = 0.0101 and p = 0.0103, respectively). However, the overall rate of right answers on questions regarding scientific knowledge was 46.1%. Therefore, a deficiency was observed in the scientific education of Brazilian otorhinolaryngologists. Such deficiency may be mitigated through participation in research.

Effectiveness of lectures attended via interactive video conferencing versus in-person in preparing third-year internal medicine clerkship students for Clinical Practice Examinations (CPX).

PubMed

Bertsch, Tania F; Callas, Peter W; Rubin, Alan; Caputo, Michael P; Ricci, Michael A

2007-01-01

The current practice in medical education is to place students at off-site locations. The effectiveness of these students attending remote lectures using interactive videoconferencing needs to be evaluated. To determine whether lecture content covering clinical objectives is learned by medical students located at remote sites. During the University of Vermont medicine clerkship, 52 medical students attended lectures both in person and via 2-way videoconferencing over a telemedicine network. The study used a crossover design, such that all students attended half of the lectures in person and half using videoconferencing. At the end of the clerkship, students were assessed via a Clinical Practice Examination (CPX), with each student completing 1 exam for material learned in person and 1 for material learned over telemedicine. Exam scores did not differ for the 2 lecture modes, with a mean score of 76% for lectures attended in person and a mean score of 78% for lectures attended via telemedicine (p = 0.66). Students learn content focused on clinical learning objectives as well using videoconferencing as they do in the traditional classroom setting.

The West Virginia Occupational Safety and Health Initiative: practicum training for a new marketplace.

PubMed

Meyer, J D; Becker, P E; Stockdale, T; Ducatman, A M

1999-05-01

Occupational medicine practice has experienced a shift from larger corporate medical departments to organizations providing services for a variety of industries. Specific training needs will accompany this shift in practice patterns; these may differ from those developed in the traditional industrial or corporate medical department setting. The West Virginia Occupational Health and Safety Initiative involves occupational medicine residents in consultation to a variety of small industries and businesses. It uses the expertise of occupational physicians, health and safety extension faculty, and faculty in engineering and industrial hygiene. Residents participate in multidisciplinary evaluations of worksites, and develop competencies in team-building, workplace health and safety evaluation, and occupational medical consulting. Specific competencies that address requirements for practicum training are used to measure the trainee's acquisition of knowledge and skills. Particular attention is paid to the acquisition of group problem-solving expertise, skills relevant to the current market in practice opportunities, and the specific career interests of the resident physician. Preliminary evaluation indicates the usefulness of training in evaluation of diverse industries and worksites. We offer this program as a training model that can prepare residents for the challenges of a changing marketplace for occupational health and safety services.

Medical education and human trafficking: using simulation

PubMed Central

Stoklosa, Hanni; Lyman, Michelle; Bohnert, Carrie; Mittel, Olivia

2017-01-01

ABSTRACT Healthcare providers have the potential to play a crucial role in human trafficking prevention, identification, and intervention. However, trafficked patients are often unidentified due to lack of education and preparation available to healthcare professionals at all levels of training and practice. To increase victim identification in healthcare settings, providers need to be educated about the issue of trafficking and its clinical presentations in an interactive format that maximizes learning and ultimately patient-centered outcomes. In 2014, University of Louisville School of Medicine created a simulation-based medical education (SBME) curriculum to prepare students to recognize victims and intervene on their behalf. The authors share the factors that influenced the session’s development and incorporation into an already full third year medical curriculum and outline the development process. The process included a needs assessment for the education intervention, development of objectives and corresponding assessment, implementation of the curriculum, and finally the next steps of the module as it develops further. Additional alternatives are provided for other medical educators seeking to implement similar modules at their home institution. It is our hope that the description of this process will help others to create similar interactive educational programs and ultimately help trafficking survivors receive the care they need. Abbreviations: HCP: Healthcare professional; M-SIGHT: Medical student instruction in global human trafficking; SBME: Simulation-based medical education; SP: Standardized patient; TIC: Trauma-informed care PMID:29228882

Medical education and human trafficking: using simulation.

PubMed

Stoklosa, Hanni; Lyman, Michelle; Bohnert, Carrie; Mittel, Olivia

2017-01-01

Healthcare providers have the potential to play a crucial role in human trafficking prevention, identification, and intervention. However, trafficked patients are often unidentified due to lack of education and preparation available to healthcare professionals at all levels of training and practice. To increase victim identification in healthcare settings, providers need to be educated about the issue of trafficking and its clinical presentations in an interactive format that maximizes learning and ultimately patient-centered outcomes. In 2014, University of Louisville School of Medicine created a simulation-based medical education (SBME) curriculum to prepare students to recognize victims and intervene on their behalf. The authors share the factors that influenced the session's development and incorporation into an already full third year medical curriculum and outline the development process. The process included a needs assessment for the education intervention, development of objectives and corresponding assessment, implementation of the curriculum, and finally the next steps of the module as it develops further. Additional alternatives are provided for other medical educators seeking to implement similar modules at their home institution. It is our hope that the description of this process will help others to create similar interactive educational programs and ultimately help trafficking survivors receive the care they need. HCP: Healthcare professional; M-SIGHT: Medical student instruction in global human trafficking; SBME: Simulation-based medical education; SP: Standardized patient; TIC: Trauma-informed care.

Simulation of a mycological KOH preparation--e-learning as a practical dermatologic exercise in an undergraduate medical curriculum.

PubMed

Bernhardt, Johannes; Hye, Florian; Thallinger, Sigrid; Bauer, Pamela; Ginter, Gabriele; Smolle, Josef

2009-07-01

Mycological KOH preparation is one of the most popular practical laboratory skills in dermatology. The study addresses the question whether an interactive simulation program enhances knowledge of students about this procedure. 166 students, 107 female and 59 male, participated. We separated our study in three phases: pretest, completing the simulation three times and post-test. In the pre- and post-test we recorded the number of correct steps of the mycological KOH preparation listed by the students. The full text feedback was explored by content analysis. In the pre-test the students listed an average of 3.1 +/- 2.2 correct steps, compared to 8.8 +/- 1.2 correct steps after completing the simulation (p < 0.001). Furthermore, the improvement was significant for each individual step. There were no significant differences between male and female students. In content analysis of the feedback, positive statements prevailed with 78.3%, compared to only 1.8% critical items. Our study shows that an interactive computer simulation program of mycological KOH preparation results in a significant learning effectiveness as far as recall of the correct procedural steps is concerned. Furthermore, subjective acceptance by students is high.

Hypothermia in a Rural Setting: An Emergency Medicine Simulation Scenario

PubMed Central

Jong, Robert; Heroux, Aron; Dubrowski, Adam

2017-01-01

Patients presenting with hypothermia in a rural emergency department can be quite challenging to manage without significant mortality and morbidity. Standard medical school curricula do not fully prepare trainees for the unique aspects of practice in northern rural and remote communities. Training opportunities on site may provide a solution to this lack of experience. However, these communities often have limited simulation-based resources and expertise for conducting and developing simulation scenarios. In this technical report, we outline a hypothermia simulation that utilizes only basic resources and is, thus, practical for rural and remote facilities. The aim of this report is to better equip trainees, clinicians, and emergency department staff who may encounter such a scenario in their practice. While the simulation is specifically designed for medical students, resident doctors, and emergency department staff, it could also be applicable in other low-resource settings, such as military bases, search and rescue stations, and arctic travel and tourism infirmaries. PMID:29511605

Do calculation errors by nurses cause medication errors in clinical practice? A literature review.

PubMed

Wright, Kerri

2010-01-01

This review aims to examine the literature available to ascertain whether medication errors in clinical practice are the result of nurses' miscalculating drug dosages. The research studies highlighting poor calculation skills of nurses and student nurses have been tested using written drug calculation tests in formal classroom settings [Kapborg, I., 1994. Calculation and administration of drug dosage by Swedish nurses, student nurses and physicians. International Journal for Quality in Health Care 6(4): 389 -395; Hutton, M., 1998. Nursing Mathematics: the importance of application Nursing Standard 13(11): 35-38; Weeks, K., Lynne, P., Torrance, C., 2000. Written drug dosage errors made by students: the threat to clinical effectiveness and the need for a new approach. Clinical Effectiveness in Nursing 4, 20-29]; Wright, K., 2004. Investigation to find strategies to improve student nurses' maths skills. British Journal Nursing 13(21) 1280-1287; Wright, K., 2005. An exploration into the most effective way to teach drug calculation skills to nursing students. Nurse Education Today 25, 430-436], but there have been no reviews of the literature on medication errors in practice that specifically look to see whether the medication errors are caused by nurses' poor calculation skills. The databases Medline, CINAHL, British Nursing Index (BNI), Journal of American Medical Association (JAMA) and Archives and Cochrane reviews were searched for research studies or systematic reviews which reported on the incidence or causes of drug errors in clinical practice. In total 33 articles met the criteria for this review. There were no studies that examined nurses' drug calculation errors in practice. As a result studies and systematic reviews that investigated the types and causes of drug errors were examined to establish whether miscalculations by nurses were the causes of errors. The review found insufficient evidence to suggest that medication errors are caused by nurses' poor calculation skills. Of the 33 studies reviewed only five articles specifically recorded information relating to calculation errors and only two of these detected errors using the direct observational approach. The literature suggests that there are other more pressing aspects of nurses' preparation and administration of medications which are contributing to medication errors in practice that require more urgent attention and calls into question the current focus on calculation and numeracy skills of pre registration and qualified nurses (NMC 2008). However, more research is required into the calculation errors in practice. In particular there is a need for a direct observational study on paediatric nurses as there are presently none examining this area of practice.

Practicing doctors' perceptions on new learning objectives for Vietnamese medical schools.

PubMed

Hoat, Luu Ngoc; Dung, Do Van; Wright, E Pamela

2007-06-28

As part of the process to develop more community-oriented medical teaching in Vietnam, eight medical schools prepared a set of standard learning objectives with attention to the needs of a doctor working with the community. Because they were prepared based on government documents and the opinions of the teachers, it was necessary to check them with doctors who had already graduated and were working at different sites in the community. Each of the eight medical faculties asked 100 practising recent graduates to complete a questionnaire to check the relevance of the skills that the teachers considered most important. We used mean and standard deviation to summarize the scores rated by the respondents for each skill and percentile at four points: p50, p25, p10 and p5 to describe the variation of scores among the respondents. Correlation coefficient was used to measure the relationship between skill levels set by the teachers and the perception of practicing doctors regarding frequency of using skills and priority for each skill. Additional information was taken from the records of focus group discussions to clarify, explain or expand on the results from the quantitative data. In many cases the skills considered important by teachers were also rated as highly necessary and/or frequently used by the respondents. There were, however, discrepancies: some skills important to teachers were seldom used and not considered important by the doctors. In focus group discussions the doctors also identified skills that are not taught at all in the medical schools but would be needed by practising doctors. Although most of the skills and skill levels included in the learning objectives by the teachers were consistent with the opinions of their graduates, the match was not perfect. The experience of the graduates and their additional comments should be included as inputs to the definition of learning objectives for medical students.

The Air Force Nurse Intern Program.

PubMed

Smith, R H

1991-08-01

The Air Force Nurse Intern Program is a 5-month-long introduction to Air Force nursing for BSN-prepared graduate nurses. The program is designed to facilitate the transition from civilian nursing student to practicing Air Force Nurse Corps Officer. After attending Military Indoctrination for Medical Service Officers, newly commissioned nurses attend the program at one of 10 Air Force medical centers before going to their permanent duty stations. Preceptors guide and instruct the interns at each of four clinical rotation sites. The author, a former nurse intern, describes some of the many opportunities available to nurse interns.

[Survey of Literature on the Development of an Evidence Database for Hospital-prepared Drugs in Japan].

PubMed

Momo, Kenji

2018-01-01

　Hospital-prepared drugs (HP), known as In'Naiseizai in Japan, are custom-prepared formulations which offer medical professionals an alternative administration pathway by changing the formulation of existing drugs according to a patients' needs. Preparing the HP is one of several roles of pharmacists in providing personalized medicine at hospitals in Japan. In 2012, the Japanese Society of Hospital Pharmacists provided guidelines for the appropriate use of "Hospital-prepared drugs". The following information was included in this guide: 1) documentation of the proper procedures, materials, prescription practices, etc., 2) required approval from the institutional review board of each HP on the risk-based classifications, and 3) to assess the stability, efficacy, and safety of each HP. However, several problems persist for pharmacists trying to prepare or use HP appropriately; the most common is insufficient manpower to both assess and prepare these drugs during routine hospital work. To resolve this problem, we are developing an evidence database for HP based on surveys of the current literature. This database has been developed for 109 drugs to date. Data-driven assessment of the stability of HP showed that 52 out of 109 drugs examined (47.7%). Notably, only 6 of the 109 HP (5.5%) in the database had all three characteristics of "stability", "safety", and "efficacy". In conclusion, the application of this database will save manpower hours for hospital pharmacists in the preparation of HP. In the near future, we will make this database available to the wider medical community via the web or through literature.

Treatment of obesity in the primary care setting: are we there yet?

PubMed

Terre, Lisa; Hunter, Christine; Poston, Walker S Carlos; Haddock, C Keith; Stewart, Shani A

2007-01-01

Obesity is a significant public health issue in the US constituting an independent risk factor for morbidity and mortality as well as complicating the management of other medical conditions. Yet, traditionally most physicians receive little training in evidence-based obesity interventions. Previous literature suggests many physicians believe they do not have effective tools to address obesity and/or that obesity management is not within their scope of practice. Given the new emphasis from NIH and AAFP urging physicians to conceptualize and treat obesity as a chronic medical condition, we examined obesity-related knowledge and practices among military and civilian primary care physicians. Results were similar across these two physician groups in suggesting many physicians still may be ill-prepared to manage obesity in the primary care setting. Implications for patient care and future research are discussed.

Internship training adequately prepares South African medical graduates for community service - with exceptions.

PubMed

Nkabinde, T C; Ross, A; Reid, S; Nkwanyana, N M

2013-09-30

The 2-year internship period for medical graduates began in South Africa in 2005 and has never been formally evaluated. This study assessed the perceptions of community service medical officers (COSMOs) working at district hospitals (DHs) in KwaZulu-Natal (KZN) to determine whether the 2-year internship programme had adequately prepared them for community service (CS). A cross-sectional descriptive study was conducted regarding the perceptions of COSMOs working at 22 district hospitals in KZN. Data were collected in July 2012, using a questionnaire based on the core skills and knowledge detailed in the Health Professions Council of South Africa intern log book. All eight domains were self-assessed and a score of 4 out of 5 indicated an ability to work independently. Of the COSMOs, 78% (60 out of 89) completed the questionnaire. Most felt well-prepared for CS in all disciplines, but critical gaps in knowledge and skills were identified in paediatrics, orthopaedics, anaesthetics and obstetrics. In addition, 75% of respondents (45 out of 60) expressed a need for additional training in the disciplines of ear, nose and throat (ENT), urology, ophthalmology and dermatology. The 2-year internship has provided the basis for independent medical practice in DHs. However, certain critical skill gaps need urgent attention, particularly in obstetrics and anaesthesia. Areas of weakness in ENT, urology, ophthalmology and dermatology could be addressed by including these specialities as a compulsory rotation in surgery, medicine or family medicine during internship training.

Encouraging Student Interest in Teaching Through a Medical Student Teaching Competition.

PubMed

DeSimone, Ariadne K; Haydek, John P; Sudduth, Christopher L; LaBarbera, Vincent; Desai, Yaanik; Reinertsen, Erik; Manning, Kimberly D

2017-08-01

Clinician educators have realized the value not only of assigning teaching roles to medical students but also of offering explicit training in how to teach effectively. Despite this interest in the development of medical students' teaching skills, formal teaching instruction and opportunities for practice are lacking. To encourage medical student interest in teaching, the authors developed and implemented a medical student teaching competition (MSTC) at Emory University School of Medicine during the summers of 2014, 2015, and 2016. Each year, eight student finalists were each paired with a physician "teaching coach" and given one month to prepare for the MSTC. During the competition, each finalist delivered an eight-minute presentation to a panel of seven physician and resident judges. The authors describe the development, implementation, and assessment of the MSTC. Approximately 150 medical students and faculty members attended the MSTC each year. The students in attendance felt that the MSTC made them more likely to seek out opportunities to learn how to teach effectively and to practice teaching. Additionally, some students are now more interested in learning about a career in academic medicine than they were before the MSTC. Given the need for more formal initiatives dedicated to improving the teaching skills of doctors-in-training, including medical students, innovative solutions such as the MSTC may enhance a medical school's existing curriculum and encourage student interest in teaching. The MSTC model may be generalizable to other medical schools.

Theory and practice in medical education – expectations and development of skills experienced by students of human medicine compared with students in other disciplines

PubMed Central

Piedmont, Silke; Robra, Bernt-Peter

2015-01-01

Aim: The aim of this article is to compare students of human medicine (HM) with students specialising in the MINT disciplines (mathematics, computer science, natural sciences and engineering), the humanities and social sciences as well as law and economic sciences with regard to their expectations of their university study and career and the areas of competence where they feel they have been supported by their education. We present in detail issues particularly relevant to prospective physicians, which are discussed with the main focus on the “theoretical and practical orientation of medical education”. Methods: We used the database in the Public Use File of the “11th Student Survey”, a written survey of randomly selected students studying at 25 German tertiary institutions during the 2009/2010 winter term, which was supplied by the Tertiary Education Research working group at the University of Constance. Data on 7536 students was included, of which 488 (6.5%) were prospective physicians. Results: Human medicine students have a clear career aim and want to complete their education quickly. They have a far above-average interest in working with and for people. About one student in two is interested in a career in science or research (53% in each case – close to the average for all subjects). Compared with the other disciplines, HM students are most likely to consider their university education to have practical and research relevance and are most likely to feel prepared for their profession. Yet over half of all students (Ø 53.3%; HM 54.5%) do not consider their education to have fostered their research skills. MINT students in particular are better able to enhance their skills through independent experimentation, while theory and practice are more likely to be communicated academically in the regular teaching of human medicine. Accordingly, the HM students feel less well supported in some areas of competence required for their later work than students in other disciplines, in developing independence, problem-solving ability, critical ability and capacity for teamwork for example. Conclusion: The high expectations held by human medicine students of being prepared for practical work with/on people are met to an above-average degree according to their assessments of the “practical relevance” and “career preparation” offered by their medical education. However the perceived development of skills in theory and practice does not respond sufficiently well to the demands of the complex, responsible profession they aspire to. Medical students should be better supported in developing both practical and academic independence. PMID:25699111

Evaluating the Sensitivity of a Media-Fill Challenge Test Under Various Situations as a Reliable Method for Recommended Aseptic Technique Competency Assessment

PubMed Central

Moody, Colleen A.; Eckel, Stephen F.; Amerine, Lindsey B.

2015-01-01

Background: Microbial contamination of compounded medications is a serious concern within hospital pharmacies as it can lead to severe patient injury. The United States Pharmacopeia <797> mandates that pharmacy personnel responsible for preparing compounded sterile preparations must annually demonstrate competency in aseptic technique by performing a media-fill challenge test. Objective: The purpose of this study is to evaluate the sensitivity of a commonly used media-fill test through proper and improper compounding techniques. Methods: Two aseptically trained pharmacy technicians performed media-fill challenge testing by carrying out 5 separate manipulations 5 times each for a total of 25 trials. Sterile vials, syringes, and intravenous bags were prepared. The first manipulation followed best-practice aseptic technique and sterile compounding procedures. Each of the following 4 manipulations removed one aspect of best-practice aseptic technique. The prepared products were incubated at 20°C to 25°C. A positive result for microbial contamination is indicated by visible turbidity within the vials, syringes, and intravenous bags at the following check points: 24 hours, 72 hours, 7 days, 14 days, 21 days, and >30 days. Results: Twenty-five trials, each containing 10 distinct admixtures, resulted in a total of 250 compounded preparations. No single preparation showed signs of turbidity, sedimentation, or visible microbial growth at any of the 6 checkpoints yielding a 0% contamination rate. However, the positive controls inoculated with bacteria did have positive microbial growth results. Conclusion: A more sensitive test needs to be developed to provide assurances that all poor aseptic practices are detected in compounding personnel.

Current practice patterns and training status of selected graduates at the King Abdulaziz University College of Medicine, Saudi Arabia.

PubMed

Mira, S A; Fatani, H H; Abduljabbar, H S; Scott, C S; Strand, D A

1991-01-01

Graduate doctors are the primary output of medical education programmes. It is important for institutions to identify systematically the types of medical activities in which their former students are involved in order to determine the effectiveness of the curriculum, assessing academic standards and reviewing admissions policies. Information was obtained from a survey of men and women graduates from three of the early graduation classes of King Abdulaziz University College of Medicine in Saudi Arabia about postgraduate medical training, certification, practice patterns, and other curriculum issues. Information collected from 151 graduates (90%) indicated that 96% were practising medicine in a variety of medical specialties and subspecialties. Six were not practising at the time of the study. Significant differences were found in the specialties being practised when men and women were compared. Men tended to practise in medicine, surgery, dermatology, urology, ENT, ophthalmology and orthopaedics, while women concentrated in obstetrics and gynaecology and paediatrics. Certification beyond medical school was earned by 49% with no significant difference being found comparing men to women. Men earned the majority of their postgraduate certifications outside Saudi Arabia while most women earned theirs in Saudi Arabia. Graduates indicated that departments in the basic sciences were least helpful in preparing them as doctors, while selected clinical departments were most helpful. It was concluded from the study that the curriculum goals of the College of Medicine, namely a curriculum of international standards producing graduates to take leadership roles in both teaching and medical practice, were realized in part by the graduates surveyed.

Disclosing Medical Mistakes: A Communication Management Plan for Physicians

PubMed Central

Petronio, Sandra; Torke, Alexia; Bosslet, Gabriel; Isenberg, Steven; Wocial, Lucia; Helft, Paul R

2013-01-01

Introduction: There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians’ own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. Methods: This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. Results: The steps are 1) physician preparation, such as talking about the physician’s emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. Conclusion: This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested. PMID:23704848

Interprofessional communication and medical error: a reframing of research questions and approaches.

PubMed

Varpio, Lara; Hall, Pippa; Lingard, Lorelei; Schryer, Catherine F

2008-10-01

Progress toward understanding the links between interprofessional communication and issues of medical error has been slow. Recent research proposes that this delay may result from overlooking the complexities involved in interprofessional care. Medical education initiatives in this domain tend to simplify the complexities of team membership fluidity, rotation, and use of communication tools. A new theoretically informed research approach is required to take into account these complexities. To generate such an approach, we review two theories from the social sciences: Activity Theory and Knotworking. Using these perspectives, we propose that research into interprofessional communication and medical error can develop better understandings of (1) how and why medical errors are generated and (2) how and why gaps in team defenses occur. Such complexities will have to be investigated if students and practicing clinicians are to be adequately prepared to work safely in interprofessional teams.

Pre-Medical Education in the Physical Sciences for Tomorrow's Physicians

NASA Astrophysics Data System (ADS)

Long, Sharon

2009-05-01

Medical knowledge is being transformed by instrumentation advances and by research results including genomic and population level studies; at the same time, though, the premedical curriculum is constrained by a relatively unchanging overall content in the MCAT examination, which inhibits innovation on undergraduate science education. A committee convened jointly by the Association of American Medical Colleges and the Howard Hughes Medical Institute has examined the science and mathematics competencies that the graduating physician will need, and has asked which of these should be achieved during undergraduate study. The recommendations emphasize competency -- what the learner should be able to ``do'' at the end of the learning experience -- rather than dictating specific courses. Because the scientific content of modern medical practice is evolving, new science competencies are desirable for the entering medical student. An example is statistics, an increasingly prominent foundation for database and genomic analysis but which is not yet uniformly recommended as preparation for medical school. On the other hand, the committee believes that the value of a broad liberal arts education is enduring, and science coursework should not totally consume a premedical student's time. Thus if we recommend new areas of science and mathematics competency for pre-meds, we must find other areas that can be trimmed or combined. Indeed, at present there are some science topics mandated for premedical study, which may not be essential. For these reasons, the committee aims to state premedical recommendations in ways that can be met either through traditional disciplinary courses, or through innovative and/or interdisciplinary courses. Finally, we acknowledge that practice of medicine requires grounding in scientific principles and knowledge and in the practice of critical inquiry. These principles may be learned and practiced in undergraduate study through work in the physical sciences, as well as in biology, and such multidisciplinary training should be encouraged.

Transformational leadership in nursing and medication safety education: a discussion paper.

PubMed

Vaismoradi, Mojtaba; Griffiths, Pauline; Turunen, Hannele; Jordan, Sue

2016-10-01

This paper discusses the application of transformational leadership to the teaching and learning of safe medication management. The prevalence of adverse drug events (ADEs) and medication-related hospitalisations (one hundred thousand each year in the USA) are of concern. This discussion is based on a narrative literature review and scrutiny of international nursing research to synthesise pedagogical strategies for the application of transformational leadership to teaching medication safety. The four elements relating transformational leadership to medication safety education are: 'Idealised influence' or role modelling, both actual and exemplary, 'Inspirational motivation' providing students with commitment to medication safety, 'Intellectual stimulation' encouraging students to value improvement and change, and 'Individualised consideration' of individual students' educational goals, practice development and patient outcomes. The model lends itself to experiential learning and a case-study approach to teaching, offering an opportunity to reduce nursing's theory-practice gap. Transformational leadership for medication safety education is characterised by a focus on the role of nurse educators and mentors in the development of students' abilities, creation of a supportive culture, and enhancement of students' creativity, motivation and ethical behaviour. This will prepare nursing graduates with the competencies necessary to be diligent about medication safety and the prevention of errors. Teaching medication safety through transformational leadership requires the close collaboration of educators, managers and policy makers. Investigation of strategies to reduced medication errors and consequent patient harm should include exploration of the application of transformational leadership to education and its impact on the number and severity of medication errors. © 2016 John Wiley & Sons Ltd.

Unlicensed pharmaceutical preparations for clinical patient care: Ensuring safety.

PubMed

de Wilde, Sofieke; de Jong, Maria G H; Le Brun, Paul P H; Guchelaar, Henk-Jan; Schimmel, Kirsten J M

2018-01-01

Most medicinal products dispensed to patients have marketing authorization (MA) to ensure high quality of the product, safety, and efficacy. However, in daily practice, to treat patients adequately, there is a medical need for drugs that do not hold MA. To meet this medical need, medicinal products are used in clinical care without MA (unlicensed), such as products prepared by (local) pharmacies: the pharmaceutical preparations. Three types of pharmaceutical preparations are distinguished: (i) reconstitution in excess of summary of product characteristics; (ii) adaptation of a licensed medicinal product (outside its official labeling); (iii) medicinal products from an active pharmaceutical ingredient. Although unlicensed, patients may expect the same quality for these unlicensed pharmaceutical preparations as for the licensed medicinal products. To assure this quality, a proper risk-benefit assessment and proper documentation in (centralized) patient registries and linking to a national pharmacovigilance database should be in place. Based on a risk assessment matrix, requirements for quality assurance can be determined, which has impact on the level of documentation of a pharmaceutical preparation. In this paper, the approach for good documentation including quality assurance and benefit-risk assessment will be discussed and possibilities for patient registries are described to make these crucial preparations available for regular patient care. KEY POINTS Ensuring pharmaceutical quality and performing a proper benefit-risk assessment will guarantee safe use of pharmaceutical preparations. Good documentation of (ultra-)orphan treatments can be collected in centralized patient registries and should be combined with existing information in (inter)national databases and self-reflection of patients. Linking patient registries to a centralized database for adverse drug events is highly recommended as it increases safety control of the (ultra) orphan pharmaceutical preparations. Copyright © 2017 John Wiley & Sons, Ltd.

Medical students in their final six months of training: progress in self-perceived clinical competence, and relationship between experience and confidence in practical skills.

PubMed

Lai, N M; Sivalingam, N; Ramesh, J C

2007-11-01

We evaluated the progress in the self-perceived competence of medical students in a range of common clinical, practical and personal skills, in their final six months of training. The study was conducted on 65 final-year medical students undertaking their senior clerkship training at International Medical University, Malaysia. Questionnaire surveys were conducted at the beginning and the end of the six-month period, with 44 items covering clinical, practical, personal skills and readiness to work. Correlations were performed for experience and self-perceived competence, with the respective skills. 64 students returned the first survey and 63 returned the second survey. When the two survey results were compared, significant increases were found in self-perceived competence for the majority of the skills examined. The items with no significant improvement were divided into those which the students were already proficient in before senior clerkship, and those in which experience and confidence remained poor at the end of training. There were significant, but moderate, correlations between the experience and confidence of all common practical skills (correlation coefficients: 0.348-0.522, p-value is less than 0.001 for all items). At the end of training, students were, in general, more prepared to work as house officers (mean rating in the first survey: 3.05, second survey: 3.97, p-value is less than 0.001). Significant progresses in clinical experience and confidence can be observed in the final stages of medical training. The findings of inadequate improvements in some skills call for dedicated training sessions and strengthening of on-site supervision.

Preparing Pharmacy Graduates for Traditional and Emerging Career Opportunities

PubMed Central

Meyer, Susan M.; Belsey, Michele; Bednarczyk, Edward M.; Bilic, Sanela; Bullock, Julie; DeLander, Gary E.; Fiese, E.F.; Giroux, Stephen L.; McNatty, Danny; Nemire, Ruth; Prescott, William A.; Traynor, Andrew P.

2009-01-01

Educational programs in pharmacy must focus on educating pharmacists of the future who are prepared to serve as competent and confident health care “providers” whose “practice” can occur in any number of current and future settings; and whose expertise is essential to an interprofessional health care team. Graduates must be able to incorporate a scholarly approach to their practice in identifying patient care problems; practicing in an evidence-based manner; and ensuring safe, effective, and appropriate use of medications. It is time for colleges and schools of pharmacy to implement contemporary teaching and assessment strategies that facilitate effective and efficient student learning that is focused at the graduate professional level, to evolve the content around which the curriculum is organized, and clearly articulate the abilities graduates must have to function effectively in the myriad professional roles in which they may find themselves. PMID:20221350

[Research on survey analysis and development strategies of traditional Chinese preparations in Guangdong Province hospitals].

PubMed

Wang, Wen-ming; Yan, Zhen; Liu, Han-jiang; Zhang, Lei-hong; Xia, Li; Zhao, Zhen-dong

2013-12-01

To provide reference for the government to formulate policies and medical institution to formulate development plan, the present situation of medical institutions of traditional Chinese preparation and some countermeasures for developing the research of traditional Chinese preparation in Guangdong province were studied. Combined with development situation of traditional Chinese preparation of medical institutions in Guangdong province in recent years, the development countermeasure of traditional Chinese preparation was discussed. In order to promote the development of traditional Chinese preparation of medical institutions, suggestions and countermeasures for the government and related departments were proposed. Government departments should formulate policies to support the development of traditional Chinese preparation, the medical institutions should make scientific development planning, strengthen the construction of hardware and software and develop special traditional Chinese preparation to promote the healthy development of traditional Chinese preparation.

[Routine data from general practitioner's software systems - Export, analysis and preparation for research].

PubMed

Kersting, M; Gierschmann, A; Hauswaldt, J; H-Pradier, E

2010-06-01

An advanced and integrative information technology (IT)-landscape is needed for optimal support of future processes in health-care, including health services research. Most researches in the primary care sector are based on data collected for reimbursement. The aim of this study is to show the limits and options of secondary analysis based on data that was exported via the "Behandlungsdatentransfer" (treatment data transport) BDT-interface in the software systems of German general practitioners and afterwards prepared for further research in SPSS. From the middle of 2005 to the end of 2007 all 168 teaching practices of the Hannover Medical School (MHH) were invited to join the study. Finally routine data from 28 practices could be collected successfully. The data from 139 other practices which had been collected for the project "Health Care in Practice" ("Medizinische Versorgung in der Praxis" - MedViP) was also added to the pool. The process of data preparation included a complete cycle from data collection, merging the data in a relational database system, via statistics and analysis to publishing and generating a feedback report for the participating practices. During the whole study the limits and options of this method were systematically identified. Of the 168 practices, 68 (40.5%) were interested to participate. From 28 (16.7%) physicians the data could be exported from their software systems. In 15 (8.9%) cases no collection was possible due to technical and in 26 (15.5%) to administrative reasons. The method of data extraction varied, as the BDT-interface was differently implemented by the software companies. Together with the MedViP data, the database at the MHH now consists of 167 practices with 974 304 patients and 12 555 943 treatments. For 44.1% of the 11 497 899 prescription entries an anatomic therapeutic chemical (ATC) code could be applied, by matching the entries to the master data from the Scientific Institute of Local Health-Care Funds ("Wissenschaftliches Instituts der Ortskrankenkassen" - WIdO). Periodically consistent sets of SPSS files could successfully be created for further research and feedback reports for the participating practices were generated as portable document format (PDF) files. The BDT-interface seems quite out of date, but can still reveal interesting information, especially on data about medical treatments and findings. Much of the data is contained in fields based on free text, which makes analysis difficult. Coded information, like agents, as ATC, could partially be extracted from the data, which afterwards was easy to prepare for further research. Quality and content of the data depend mainly on the data enterer, the physicians and their practice staff. Future research could be improved by more classified and coded data, which would better be transported through an interface more advanced than BDT. Georg Thieme Verlag KG Stuttgart * New York.

Terminology for contrast-enhanced sonography: a practical glossary.

PubMed

Catalano, Orlando; Migaleddu, Vincenzo; Quaia, Emilio; Caruso, Giuseppe

2007-06-01

The purpose of this glossary is to offer an updated guide to the correct terminology for contrast-enhanced sonography. This report was prepared by a panel of radiologists from the Sonography Section of the Italian Association of Medical Radiology. A leading author prepared a list of terms based on a comprehensive literature survey. The draft was analyzed by 3 experts on the topic of contrast-enhanced sonography. These reviewers reached a consensus and prepared the final version. A list of 137 terms is included. These terms are briefly defined. Their proper application is discussed, with special reference to potential misleading uses. Contrast-enhanced sonography is a relatively new diagnostic tool, now entering clinical practice in several countries. Use of appropriate, universal terminology is mandatory in the scientific setting to allow comparison between different published experiences. Additionally, use of clear, standardized terminology is necessary in the clinical setting to facilitate report understanding by the referring physician. Standardized, nonequivocal nomenclature may also help future diffusion of sonographic contrast media in countries where their application is still not approved.

Microbiological quality and safe handling of enteral diets in a hospital in Minas Gerais, Brazil

PubMed Central

Pinto, Raquel Oliveira Medrado; Correia, Eliznara Fernades; Pereira, Keyla Carvalho; Costa, Paulo de Souza; da Silva, Daniele Ferreira

2015-01-01

Contamination of enteral diets represents a high risk of compromising the patient's medical condition. To assess the microbiological quality and aseptic conditions in the preparation and administration of handmade and industrialized enteral diets offered in a hospital in the Valley of Jequitinhonha, MG, Brazil, we performed a microbiological analysis of 50 samples of diets and 27 samples of surfaces, utensils, and water used in the preparation of the diets. In addition, we assessed the good handling practices of enteral diets according to the requirements specified by the Brazilian legislation. Both kinds of enteral diets showed contamination by coliforms and Pseudomonas spp. No sample was positive for Staphylococcus aureus and Salmonella spp. On the other hand, Listeria spp. was detected in only one sample of handmade diets. Contamination was significantly higher in the handmade preparations (p < 0.05). Nonconformities were detected with respect to good handling practices, which may compromise the diet safety. The results indicate that the sanitary quality of the enteral diets is unsatisfactory, especially handmade diets. Contamination by Pseudomonas spp. is significant because it is often involved in infection episodes. With regard to aseptic practices, it was observed the need of implementing new procedures for handling enteral diets. PMID:26273278

Brazilian dentists' attitudes about medical emergencies during dental treatment.

PubMed

Arsati, Franco; Montalli, Victor Angelo; Flório, Flavia Martão; Ramacciato, Juliana Cama; da Cunha, Fernanda Lopes; Cecanho, Rodrigo; de Andrade, Eduardo Dias; Motta, Rogério Heládio Lopes

2010-06-01

The main objective of this study was to evaluate the prevalence of emergencies in dental practices and the prepared-ness and the training experience in cardiopulmonary resuscitation (CPR) of Brazilian dentists in dealing with emergencies. The volunteer participants in the study were 498 Brazilian dentists who were present at the 27th International Congress of Dentistry in São Paulo. The most prevalent emergency was presyncope (reported by 54.20 percent of respondents), followed by orthostatic hypotension (44.37 percent), moderate allergic reactions (16.86 percent), hypertensive crisis (15.06 percent), asthma (15.06 percent), syncope (12.65 percent), angina (6.82 percent), convulsion (6.22 percent), hypoglycemia (5.62 percent), hyperventilation crisis (5.22 percent), choking (2.20 percent), and cerebrovascular accident (0.8 percent). Anaphylaxis, myocardial infarction, and cardiac arrest were the rarest emergencies, reported by only 0.4, 0.2, and 0.2 percent of dentists, respectively. Only 41 percent of the dentists judged themselves capable to diagnose the cause of an emergency during a dental visit. The majority responded that they would be capable of performing initial treatment of presyncope, syncope, orthostatic hypotension, convulsion, and choking. However, most of them felt unable to treat anaphylaxis, myocardial infarction, or cardiac arrest. Further, the majority felt unable to perform CPR or undertake an intravenous injection. It was concluded that the most prevalent medical emergencies in dental practice of Brazilian dentists are presyncope and orthostatic hypotension. The occurrence of life-threatening medical emergencies like anaphylaxis, myocardial infarction, cardiac arrest, and cerebrovascular accident is rare. Brazilian dentists are not fully prepared to manage medical emergencies and have insufficient experience training in CPR.

Giving feedback in medical teaching: a case of lung function laboratory/spirometry.

PubMed

Meo, Sultan Ayoub

2013-01-01

Feedback in medical teaching is an important part of medical education, it encourages and enhances the learners' knowledge, skills and professional performance at various stages of their schooling. A constructive feedback enhances the awareness of strength and areas for improvement. An adequate, meaningful and fruitful feedback needs motivation, emphasis, objectivity, expertise, and active participation in the session. Before giving feedback, the instructor should be well prepared and must have practice on the task. The instructor should utilize all means such as good oral presentation, eye contact, visual cues, utilize body language to actively involve the learners in a session, all these activities enhance the knowledge, skill and attitude of the learners. The aim of this commentary is to highlight the basic issues in giving an appropriate feedback in medical teaching with special emphasis on a lung function laboratory / Spirometry.

Health information literacy: hardwiring behavior through multilevels of instruction and application.

PubMed

Leasure, A Renee; Delise, Donna; Clifton, Shari C; Pascucci, Mary Ann

2009-01-01

To produce a healthcare provider who is competent in accessing health information, nursing faculty members, in tandem with medical librarians, play a crucial role in establishing the knowledge base for student competency in health information literacy. The time to prepare nursing students to meet the information challenges and opportunities of today's healthcare environment is not after graduation, but rather while they are in school. By incorporating health information literacy skill building throughout the curriculum, nursing faculty members can prepare their students to enter the workforce equipped with the skills they need to find, retrieve, appraise, and apply information to their clinical practice.

The impact of socially-accountable, community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce.

PubMed

Siega-Sur, J L; Woolley, T; Ross, S J; Reeve, C; Neusy, A-J

2017-10-01

Developing and retaining a high quality medical workforce, especially within low-resource countries has been a world-wide challenge exacerbated by a lack of medical schools, the maldistribution of doctors towards urban practice, health system inequities, and training doctors in tertiary centers rather than in rural communities. To describe the impact of socially-accountable health professional education on graduates; specifically: their motivation towards community-based service, preparation for addressing local priority health issues, career choices, and practice location. Cross-sectional survey of graduates from two medical schools in the Philippines: the University of Manila-School of Health Sciences (SHS-Palo) and a medical school with a more conventional curriculum. SHS-Palo graduates had significantly (p < 0.05) more positive attitudes to community service. SHS-Palo graduates were also more likely to work in rural and remote areas (p < 0.001) either at district or provincial hospitals (p = 0.032) or in rural government health services (p < 0.001) as Municipal or Public Health Officers (p < 0.001). Graduates also stayed longer in both their first medical position (p = 0.028) and their current position (p < 0.001). SHS-Palo medical graduates fulfilled a key aim of their socially-accountable institution to develop a health professional workforce willing and able, and have a commitment to work in underserved rural communties.

Impact of automated dispensing cabinets on medication selection and preparation error rates in an emergency department: a prospective and direct observational before-and-after study.

PubMed

Fanning, Laura; Jones, Nick; Manias, Elizabeth

2016-04-01

The implementation of automated dispensing cabinets (ADCs) in healthcare facilities appears to be increasing, in particular within Australian hospital emergency departments (EDs). While the investment in ADCs is on the increase, no studies have specifically investigated the impacts of ADCs on medication selection and preparation error rates in EDs. Our aim was to assess the impact of ADCs on medication selection and preparation error rates in an ED of a tertiary teaching hospital. Pre intervention and post intervention study involving direct observations of nurses completing medication selection and preparation activities before and after the implementation of ADCs in the original and new emergency departments within a 377-bed tertiary teaching hospital in Australia. Medication selection and preparation error rates were calculated and compared between these two periods. Secondary end points included the impact on medication error type and severity. A total of 2087 medication selection and preparations were observed among 808 patients pre and post intervention. Implementation of ADCs in the new ED resulted in a 64.7% (1.96% versus 0.69%, respectively, P = 0.017) reduction in medication selection and preparation errors. All medication error types were reduced in the post intervention study period. There was an insignificant impact on medication error severity as all errors detected were categorised as minor. The implementation of ADCs could reduce medication selection and preparation errors and improve medication safety in an ED setting. © 2015 John Wiley & Sons, Ltd.

Lessons learned from a history of perseverance and innovation in academic-practice partnerships.

PubMed

Libster, Martha Mathews

2011-01-01

Nurse leaders today are faced with a pressing concern to reevaluate established community resources and models for academic-practice partnerships that have been used in the preparation of new and advanced practice nurses. Nursing reform in education and practice is not achieved as a simple series of decisions in the present moment with future direction as its object. It is a process in which the outcome is ultimately evaluated within the context of history. Academic-practice partnerships are part of a nursing heritage that has persevered for hundreds of years. This article is a brief synopsis of examples from the historical records that evidence the lessons learned from the experiences of nurses who have formed innovative academic-practice partnerships with religious communities, medical colleges and physicians, government, hospitals, institutions of higher learning, and nursing organizations. Copyright © 2011 Elsevier Inc. All rights reserved.

Near-peer medical student simulation training.

PubMed

Cash, Thomas; Brand, Eleanor; Wong, Emma; Richardson, Jay; Athorn, Sam; Chowdhury, Faiza

2017-06-01

There is growing concern that medical students are inadequately prepared for life as a junior doctor. A lack of confidence managing acutely unwell patients is often cited as a barrier to good clinical care. With medical schools investing heavily in simulation equipment, we set out to explore if near-peer simulation training is an effective teaching format. Medical students in their third year of study and above were invited to attend a 90-minute simulation teaching session. The sessions were designed and delivered by final-year medical students using clinical scenarios mapped to the Sheffield MBChB curriculum. Candidates were required to assess, investigate and manage an acutely unwell simulated patient. Pre- and post-simulation training Likert scale questionnaires were completed relating to self-reported confidence levels. There is growing concern that medical students are inadequately prepared for life as a junior doctor RESULTS: Questionnaires were completed by 25 students (100% response rate); 52 per cent of students had no prior simulation experience. There were statistically significant improvements in self-reported confidence levels in each of the six areas assessed (p < 0.005). Thematic analysis of free-text comments indicated that candidates enjoyed the practical format of the sessions and found the experience useful. Our results suggest that near-peer medical student simulation training benefits both teacher and learner and that this simplistic model could easily be replicated at other medical schools. As the most junior members of the team, medical students are often confined to observer status. Simulation empowers students to practise independently in a safe and protected environment. Furthermore, it may help to alleviate anxiety about starting work as a junior doctor and improve future patient care. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Bowel preparation for colonoscopy: state of the art.

PubMed

Voiosu, Theodor; Voiosu, Andrei; Voiosu, Radu

2016-07-13

Bowel preparation for colonoscopy is a key quality indicator that impacts on all aspects of the procedure, such as patient comfort, diagnostic yield, and adverse events. Although most laxative regimens currently employed have been compared in a multitude of settings, the optimal preparation regimen still remains an open question. Recent studies have focused on developing new regimens by modifying dosage, timing of administration or by combining laxatives with synergic mechanisms of action with the purpose of increasing patient tolerability while maximizing bowel cleansing. Several low-volume preparations and combinations of laxatives and adjunctive medication have shown promise in delivering both adequate preparation of the colon and good patient tolerability. Also, we have gained a better understanding of the influence of patient-related factors such as health literacy and education on the quality of bowel preparation. Although several novel regimens have been tested in recent trials, it remains unclear which, if any, of these bowel preparations can replace the standard bowel cleansing regimens in clinical practice. Also, further data are required on how to improve bowel cleansing by choosing the appropriate regimen for the individual patient.

Medicine as It Should Be: Teaching Team and Teamwork during a Palliative Care Clerkship.

PubMed

Head, Barbara A; Furman, Christian Davis; Lally, Andrew M; Leake, Kimberly; Pfeifer, Mark

2018-05-01

Interprofessional Education (IPE) is an important component of medical education. Rotations with palliative care interdisciplinary teams (IDTs) provide an optimal environment for IPE and teaching teamwork skills. Our objective was to assess the learning of senior medical students during a palliative care rotation. A constant comparison method based on grounded theory was used in this qualitative study. Senior medical students completed a semi-structured reflective writing exercise after a required one-week palliative care clerkship. Sixty randomly selected reflective writings were analyzed. The reflective writings were analyzed to evaluate the student's experiences. Dominant themes identified were related to teams and teamwork. Eight specific themes were identified: value of IDT for team members; value of IDT for patient/family; importance of each team member; reliance on other team members; roles of team members; how teams work; team communication; and interdisciplinary assessment and care planning. Students described exposure to novel experiences and planned to incorporate newly learned behaviors in their future practice. By participating in palliative care IDTs, medical students consistently learned about teamwork within healthcare. Additionally, they learned the importance of such teamwork to patients and the team itself. Rotations with palliative care IDTs have a significant role to play in IPE and preparing medical students to practice on teams.

Innovative Approach to Preparing Radial Artery Cocktails in Response to Manufacturer Shortages of Nitroglycerin and Verapamil

PubMed Central

Parbhoo, Rupal K.; Wetz, Karen; Tschampel, Marva; Pompili, Vincent; Schenko, Elena; Mavko, Lou

2014-01-01

Abstract Background: Transradial access has gained popularity over transfemoral access for cardiac catheterization, because of the decreased risk of bleeding, time to ambulation, and length of stay leading to improved patient satisfaction. One disadvantage of the radial artery approach is vasospasm, which can be prevented with the administration of verapamil and nitroglycerin in a pre- and postradial cocktail. Unfortunately, there have been manufacturer shortages for both of these medications. Methods: The utilization of radial artery cocktails and other nitroglycerin compounding practices were evaluated in response to cost containment and waste reduction initiatives and to medication shortages. Results: A modified process for supplying verapamil and nitroglycerin for the transradial approach via separate syringes enabled physicians to have quick access to the medications and to customize the cocktail based on the patient’s needs. This process also decreased costs and minimized wastage. The change in practice decreased waste from 44% for preradial cocktail syringes and 66% for postradial cocktail syringes to 8.7%. Discussion: This process for supplying the medications necessary to perform a radial artery catheterization and intracoronary nitroglycerin has allowed for conservation of commercial product supply. PMID:25477581

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

PubMed Central

Chen, Ying; Zhu, Ling-Ling; Zhou, Quan

2014-01-01

Background Falls among the elderly are an issue internationally and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society. Falls prevention is an important measure of nursing quality and patient safety. Numerous studies have evaluated the association of medication use with fall risk in elderly patients. However, an up-to-date review has not been available to summarize the multifaceted pharmaceutical concerns in the prevention of medication-related falls. Materials and methods Relevant literature was identified by performing searches in PubMed, Web of Science, and the Cochrane Library, covering the period until February 2014. We included studies that described an association between medications and falls, and effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and pharmacological interventions on fall risk in elderly patients. The full text of each included article was critically reviewed, and data interpretation was performed. Results Fall-risk-increasing drugs (FRIDs) include central nervous system-acting agents, cough preparations, nonsteroidal anti-inflammatory drugs, anti-Alzheimer’s agents, antiplatelet agents, calcium antagonists, diuretics, α-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations. The degree of medication-related fall risk was dependent on one or some of the following factors: drug pharmacokinetic/pharmacodynamic properties (eg, elimination half-life, metabolic pathway, genetic polymorphism, risk rating of medications despite belonging to the same therapeutic class) and/or characteristics of medication use (eg, number of medications and drug–drug interactions, dose strength, duration of medication use and time since stopping, medication change, prescribing appropriateness, and medication adherence). Pharmacological interventions, including withdrawal of FRIDs, pharmacist-conducted clinical medication review, and computerized drug alerts, were effective in reducing fall risk. Conclusion Based on the literature review, clear practical recommendations for clinicians to prevent falls in the elderly included making a list of FRIDs, establishing a computerized alert system for when to e-prescribe FRIDs, seeking an alternative drug with lower fall risk, withdrawing FRIDs if clinically indicated, taking pertinent cautions when the use of FRIDs cannot be avoidable, paying attention to prescribing appropriateness, simplifying the medication regimen, strengthening pharmacist-conducted clinical medication review, ensuring the label of each FRID dispensed contains a corresponding warning sign, being careful when medication change occurs, enhancing medication adherence, and mandating for periodic reassessment of potential risk associated with the patient’s medication regimen. Further studies should be conducted in this area, such as investigating whether medication reconciliation and improving medication adherence could decrease the rate of falls. PMID:24966681

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients.

PubMed

Chen, Ying; Zhu, Ling-Ling; Zhou, Quan

2014-01-01

Falls among the elderly are an issue internationally and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society. Falls prevention is an important measure of nursing quality and patient safety. Numerous studies have evaluated the association of medication use with fall risk in elderly patients. However, an up-to-date review has not been available to summarize the multifaceted pharmaceutical concerns in the prevention of medication-related falls. Relevant literature was identified by performing searches in PubMed, Web of Science, and the Cochrane Library, covering the period until February 2014. We included studies that described an association between medications and falls, and effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and pharmacological interventions on fall risk in elderly patients. The full text of each included article was critically reviewed, and data interpretation was performed. Fall-risk-increasing drugs (FRIDs) include central nervous system-acting agents, cough preparations, nonsteroidal anti-inflammatory drugs, anti-Alzheimer's agents, antiplatelet agents, calcium antagonists, diuretics, α-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations. The degree of medication-related fall risk was dependent on one or some of the following factors: drug pharmacokinetic/pharmacodynamic properties (eg, elimination half-life, metabolic pathway, genetic polymorphism, risk rating of medications despite belonging to the same therapeutic class) and/or characteristics of medication use (eg, number of medications and drug-drug interactions, dose strength, duration of medication use and time since stopping, medication change, prescribing appropriateness, and medication adherence). Pharmacological interventions, including withdrawal of FRIDs, pharmacist-conducted clinical medication review, and computerized drug alerts, were effective in reducing fall risk. Based on the literature review, clear practical recommendations for clinicians to prevent falls in the elderly included making a list of FRIDs, establishing a computerized alert system for when to e-prescribe FRIDs, seeking an alternative drug with lower fall risk, withdrawing FRIDs if clinically indicated, taking pertinent cautions when the use of FRIDs cannot be avoidable, paying attention to prescribing appropriateness, simplifying the medication regimen, strengthening pharmacist-conducted clinical medication review, ensuring the label of each FRID dispensed contains a corresponding warning sign, being careful when medication change occurs, enhancing medication adherence, and mandating for periodic reassessment of potential risk associated with the patient's medication regimen. Further studies should be conducted in this area, such as investigating whether medication reconciliation and improving medication adherence could decrease the rate of falls.

Comments on Navarro's review of Health services research: an anthology.

PubMed

White, K L

1993-01-01

In preparing Health Services Research: An Anthology, the editors attempted to broaden the definition of health services research promulgated by the National Library of Medicine. Many articles in the Anthology focused on stemming the avalanche of medicine's unevaluated procedures and prescribing practices, and on broadening the horizons of the medical establishment. Another anthology is clearly needed to address Virchow's dictum that medicine is politics writ large.

Development Of Medical Technology For Contingency Response To Marrow Toxic Agents, Period 3

DTIC Science & Technology

2011-10-31

featured speaker on the response to the Fukushima Daiichi nuclear power plant incident by the HSCT community at the RITN State of the Science Meeting...Bioterrorism: Biodefense Strategy, Practice, and Science A manuscript in preparation for Leukemia on response to the Fukushima Daiichi nuclear power...from transplant centers, build awareness of the Transplant Center Contingency Planning Committee and educate the transplant community about the critical

Nutritional support and parenteral nutrition in cancer patients: An expert consensus report.

PubMed

Ocón Bretón, María Julia; Luengo Pérez, Luis Miguel; Virizuela, Juan Antonio; Álvarez Hernández, Julia; Jiménez Fonseca, Paula; Cervera Peris, Mercedes; Sendrós Madroño, María José; Grande, Enrique; Camblor Álvarez, Miguel

2018-03-01

Malnutrition is a common medical problem in cancer patients with a negative impact on quality of life. The aim of this study was to address different issues related to nutritional management of cancer patients in clinical practice. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Endocrinology and Nutrition prepared a list of topics related to the nutritional status of cancer patients and grouped them into three blocks: nutritional support, parenteral nutrition (PN), and home PN (HPN). A literature review was made of articles published in Spanish, English and French until April 2017. This consensus emphasizes several key elements that help physicians standardize management of the nutritional status of cancer patients in clinical practice, and establishes common guidelines for indication, monitoring, nutritional requirements, and access routes to PN. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Transforming the present--discovering the future: the University of Pittsburgh's NLM grant on education and training of health sciences librarians.

PubMed Central

Detlefsen, E G; Epstein, B A; Mickelson, P; Detre, T

1996-01-01

BACKGROUND: The University of Pittsburgh was awarded a grant by the National Library of Medicine to study the education and training needs of present and future medical librarians and health information specialists through a collaboration of the university's School of Information Sciences and Health Sciences Library System. Goals and objectives for the year-long project included (1) assessment of education and training needs of medical librarians, (2) development of a master of library science curriculum and an internship program that would prepare graduates to take leadership roles in medical librarianship or information management, (3) development of continuing education programs for medical librarians in different formats, and (4) development of targeted recruitment efforts to attract minority group members and individuals with undergraduate science majors. The importance of this project, present practice, and success factors for programs seeking excellence in the preparation of health sciences information professionals are reviewed. A needs assessment involving a national advisory panel and a follow-up study of individuals who have participated in previous specialized training programs in health sciences information, compared with a peer group of medical librarians who did not participate in such programs, is described. This paper presents the goals and objectives of the project, describes the methods used, and outlines a curriculum, continuing education initiatives, and recruitment activities. PMID:8913555

Exploring UK medical and social work students' legal literacy: comparisons, contrasts and implications.

PubMed

Preston-Shoot, Michael; McKimm, Judy

2013-05-01

To ensure acceptable practice standards both doctors and social workers should draw on relevant legal rules when reaching professional judgements concerning, for instance, children requiring protection, people with severe mental distress and adults at risk, information sharing, consent to intervention and service user involvement in their care and treatment. Many practitioners use the law to maintain high standards of professionalism. However, research has uncovered limited awareness of legal rules and poor standards of health and social care. Academic benchmarks and practice requirements for health and social care professions centrally position legal knowledge for secure decision-making. Model curricula exist. However, the outcomes of the taught curriculum on students' confidence in their legal knowledge and skills have been relatively overlooked. This article introduces the concept of legal literacy, a distillation of knowledge, understanding, skills and values that enables practitioners to connect relevant legal rules with their professional practice, to appreciate the roles and duties of other practitioners and to communicate effectively across organisational boundaries. It presents the outcomes for a 2006-2009 study of 1154 UK medical and 638 social work students of their law learning for practice, response rates of 46% and 68%. Significant differences were found between medical and social work students' attitudes towards the law, and in their self-ratings of legal knowledge and skills. Confidence levels were low and anxiety high, especially among medical students, although law teaching had some positive outcomes on knowledge and skill development. Social work and medical students associated different themes with the law, the latter especially foregrounding ethics, negligence and liability, which could affect inter-professional working. Students are not fully prepared for legally literate practice, with a consequent need to review the time allocated for, and the content of law learning and the subsequent availability of continuing professional development. © 2013 Blackwell Publishing Ltd.

Minnesota Pharmacists and Medical Cannabis: A Survey of Knowledge, Concerns, and Interest Prior to Program Launch

PubMed Central

Hwang, Joy; Arneson, Tom; St. Peter, Wendy

2016-01-01

Objectives To assess Minnesota pharmacists’ preparedness for the state’s medical cannabis program in terms of professional competency in policies and regulations and in pharmacotherapy, as well as their concerns and perceptions about the impact on their practice. The secondary objective was to identify pharmacists’ perceptions about ways to reduce potential gaps in knowledge. Methods A Web-based 14-item questionnaire was distributed to all pharmacists whose email addresses were registered with the Minnesota Board of Pharmacy. Results Pharmacists reported limited knowledge of Minnesota state-level cannabis policies and regulations and felt that they were inadequately trained in cannabis pharmacotherapy. Most pharmacists were unprepared to counsel patients on medical cannabis and had many concerns regarding its availability and usage. Only a small proportion felt that the medical cannabis program would impact their practice. Pharmacists’ leading topics of interest for more education included Minnesota’s regulations on the medical cannabis program, cannabis pharmacotherapy, and the types and forms of cannabis products available for commercialization. Preferred modes of receiving information were electronic-based, including email and online continuing education credit. Since the survey’s completion, educational presentations have been provided to pharmacists and health professionals in Minnesota. Conclusion Pharmacists need more training and education on the regulatory and clinical aspects of cannabis in preparation for their work with patients in the medical cannabis program. PMID:27904305

[Physicians and medicine in 16th century New Spain].

PubMed

de Micheli-Serra, A

2001-01-01

The more prominent physicians and surgeons, European, native and creole, who practiced their art in New Spain during the XVI century, are remembered. There were improvised surgeons among the Spanish soldiers, who faced the American natives in the name of universal empire and church. There were also native physicians, organized around an important cultural center: the Franciscan college of Holy Cross in Tlatelolco. They perpetuated the ancestral medical traditions. In the dawning of New Spain, arrived here some physicians and surgeons prepared in important medical centers, such Sevilla, Salamanca, and Alcalá de Henares. Soon after a noteworthy exchange of medicinal plants and, generally, of therapeutic products between the old and new world took place. Likewise arrived here medical books printed in Europe and, in the second half of such century, appeared Newspanish medical books. When the first chair of medicine was established in the Royal University of México (1578), the number of medical publications increased until, in 1598, appeared the first medical thesis printed in America.

Information on actual medication use and drug-related problems in older patients: questionnaire or interview?

PubMed

Willeboordse, Floor; Grundeken, Lucienne H; van den Eijkel, Lisanne P; Schellevis, François G; Elders, Petra J M; Hugtenburg, Jacqueline G

2016-04-01

Information on medication use and drug-related problems is important in the preparation of clinical medication reviews. Critical information can only be provided by patients themselves, but interviewing patients is time-consuming. Alternatively, patient information could be obtained with a questionnaire. In this study the agreement between patient information on medication use and drug-related problems in older patients obtained with a questionnaire was compared with information obtained during an interview. General practice in The Netherlands. A questionnaire was developed to obtain information on actual medication use and drug-related problems. Two patient groups ≥65 years were selected based on general practitioner electronic medical records in nine practices; I. polypharmacy and II. ≥1 predefined general geriatric problems. Eligible patients were asked to complete the questionnaire and were interviewed afterwards. Agreement on information on medication use and drug-related problems collected with the questionnaire and interview was calculated. Ninety-seven patients participated. Of all medications used, 87.6 % (95 % CI 84.7-90.5) was reported identically in the questionnaire and interview. Agreement for the complete medication list was found for 45.4 % (95 % CI 35.8-55.3) of the patients. On drug-related problem level, agreement between questionnaire and interview was 75 %. Agreement tended to be lower in vulnerable patients characterized by ≥4 chronic diseases, ≥10 medications used and low health literacy. Information from a questionnaire showed reasonable agreement compared with interviewing. The patients reported more medications and drug-related problems in the interview than the questionnaire. Taking the limitations into account, a questionnaire seems a suitable tool for medication reviews that may replace an interview for most patients.

Knowledge and attitudes of pain management among nursing faculty.

PubMed

Voshall, Barbara; Dunn, Karen S; Shelestak, Debra

2013-12-01

A descriptive correlational design was used in this study to examine nursing faculty knowledge and attitudes in pain management. Relationships between age, education level, pain management preparation, length of time practicing as a nurse, length of time teaching nursing, time teaching pain management in the classroom, taught pain guidelines in the classroom, and additional continuing education about pain management were explored. Ninety-six nursing faculty participated from 16 schools of nursing in one Midwestern U.S. region. Findings identified that most of the nursing faculty recalled being taught about pain management in their basic education, but less than one-half felt adequately prepared. Most respondents said that they taught pain management, yet fewer than one-half identified that they used specific pain management guidelines. Faculty demonstrated adequate knowledge of pain assessment, spiritual/cultural issues, and pathophysiology. Areas of weakness were found in medications, interventions, and addiction. Faculty that reported teaching pain management in the classroom and reported more continuing education missed fewer items. Older nursing faculty reported more years of practice, more years of teaching, and more continuing education in pain management than younger faculty. Younger nursing faculty remembered being taught pain management in nursing school and felt more adequately prepared than older nursing faculty. Faculty that reported practicing for longer periods of time felt less prepared in pain management than faculty who practiced for shorter periods of time. More continuing education in pain management may be needed for older nurses to meet the recommendations of the Institute of Medicines' report on relieving pain in the U.S. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

The use of virtual reality computer simulation in learning Port-A cath injection.

PubMed

Tsai, Sing-Ling; Chai, Sin-Kuo; Hsieh, Li-Feng; Lin, Shirling; Taur, Fang-Meei; Sung, Wen-Hsu; Doong, Ji-Liang

2008-03-01

Cost-benefit management trends in Taiwan healthcare settings have led nurses to perform more invasive skills, such as Port-A cath administration of medications. Accordingly, nurses must be well-prepared prior to teaching by the mentor and supervision method. The purpose of the current study was to develop a computer-assisted protocol using virtual reality (VR) in performing Port-A cath as a training program for novice nurses. A pre-tested and post-tested control group experimental design was used in this study. Seventy-seven novice nurses were invited from one large medical center hospital in North Taiwan. Thirty-seven and forty nurses were randomly assigned to experimental and control groups. First, we designed a 40 minute port-A cath injection VR simulation. Then, the experimental group practiced this simulation two times over 3 weeks. The control group attended the traditional class. The post-test 1 was right after completion of the simulation practice. The post-test 2 was after the second simulation practice in 3 weeks. The results showed that most novice nurses lacked Port-A cath experience both in the classroom and during the period of their practice training. The knowledge score regarding the Port-A cath technique was significantly higher in the nurses that participated in the simulation training than in the control group. The novice nurses were most satisfied with the reduction in their fear of performing the Port-A cath technique and their enhanced clinical skills. VR simulation significantly reduced error rates and increased correct equipment selection, showing that nurses who participated in the simulation may be better prepared for inserting Port-A cath.

[Concept analysis of medication adherence in patients with chronic disease].

PubMed

Huang, Jen-Ying; Chen, Hsing-Mei

2014-06-01

Pharmacotherapy plays an important role in the management of chronic diseases. However, many patients with chronic disease do not adhere to their medication regimen. This results in worsening symptoms and frequent re-hospitalizations. As a result, healthcare providers may view these patients as bad. Medication adherence is a complex concept. Analyzing this concept may assist nurses to improve patient-centered care. This paper uses Walker & Avant's method to conduct a concept analysis of medication adherence. Results show the defining attributes of medication adherence as: (1) knowing and agreeing to the medication; (2) communicating and negotiating the regimen; and (3) active, continuous involvement in and appraisal of the treatment effect. Identified antecedents of medication adherence included the patient having: (1) a prescribed medication regimen; (2) cognitive and action abilities in her / his role as a patient; and (3) level of preparation for medication treatment. Identified consequences of medication adherence include: (1) improving symptom control; (2) decreasing re-hospitalizations and mortality; (3) reducing medical care costs; (4) restoring self-esteem; and (5) diminishing depression. It is hoped that this concept analysis provides a reference for nurses to achieve a better understanding of medication adherence and further improve nursing practice.

A Mobile Device App to Reduce Medication Errors and Time to Drug Delivery During Pediatric Cardiopulmonary Resuscitation: Study Protocol of a Multicenter Randomized Controlled Crossover Trial.

PubMed

Siebert, Johan N; Ehrler, Frederic; Lovis, Christian; Combescure, Christophe; Haddad, Kevin; Gervaix, Alain; Manzano, Sergio

2017-08-22

During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusions is complex and time-consuming. The need for individual specific weight-based drug dose calculation and preparation places children at higher risk than adults for medication errors. Following an evidence-based and ergonomic driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. In a prior single center randomized controlled trial, medication errors were reduced from 70% to 0% by using PedAMINES when compared with conventional preparation methods. The purpose of this study is to determine whether the use of PedAMINES in both university and smaller hospitals reduces medication dosage errors (primary outcome), time to drug preparation (TDP), and time to drug delivery (TDD) (secondary outcomes) during pediatric CPR when compared with conventional preparation methods. This is a multicenter, prospective, randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drug infusion rate table in the preparation of continuous drug infusion. The evaluation setting uses a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin. The study involving 120 certified nurses (sample size) will take place in the resuscitation rooms of 3 tertiary pediatric emergency departments and 3 smaller hospitals. After epinephrine-induced return of spontaneous circulation, nurses will be asked to prepare a continuous infusion of dopamine using either PedAMINES (intervention group) or the infusion table (control group) and then prepare a continuous infusion of norepinephrine by crossing the procedure. The primary outcome is the medication dosage error rate. The secondary outcome is the time in seconds elapsed since the oral prescription by the physician to drug delivery by the nurse in each allocation group. TDD includes TDP. Stress level during the resuscitation scenario will be assessed for each participant by questionnaire and recorded by the heart rate monitor of a fitness watch. The study is formatted according to the Consolidated Standards of Reporting Trials Statement for Randomized Controlled Trials of Electronic and Mobile Health Applications and Online TeleHealth (CONSORT-EHEALTH) and the Reporting Guidelines for Health Care Simulation Research. Enrollment and data analysis started in March 2017. We anticipate the intervention will be completed in late 2017, and study results will be submitted in early 2018 for publication expected in mid-2018. Results will be reported in line with recommendations from CONSORT-EHEALTH and the Reporting Guidelines for Health Care Simulation Research . This paper describes the protocol used for a clinical trial assessing the impact of a mobile device app to reduce the rate of medication errors, time to drug preparation, and time to drug delivery during pediatric resuscitation. As research in this area is scarce, results generated from this study will be of great importance and might be sufficient to change and improve the pediatric emergency care practice. ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122 (Archived by WebCite at http://www.webcitation.org/6nfVJ5b4R). ©Johan N Siebert, Frederic Ehrler, Christian Lovis, Christophe Combescure, Kevin Haddad, Alain Gervaix, Sergio Manzano. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 22.08.2017.

Preparation for frontline end-of-life care: exploring the perspectives of paramedics and emergency medical technicians.

PubMed

Waldrop, Deborah P; Clemency, Brian; Maguin, Eugene; Lindstrom, Heather

2014-03-01

Prehospital emergency providers (emergency medical technicians [EMTs] and paramedics) who respond to emergency calls for patients near the end of life (EOL) make critical decisions in the field about initiating care and transport to an emergency department. To identify how a sample of prehospital providers learned about EOL care, their perceived confidence with and perspectives on improved preparation for such calls. This descriptive study used a cross-sectional survey design with mixed methods. One hundred seventy-eight prehospital providers (76 EMT-basics and 102 paramedics) from an emergency medical services agency participated. Multiple choice and open-ended survey questions addressed how they learned about EOL calls, their confidence with advance directives, and perspectives on improving care in the field. The response rate was 86%. Education about do-not-resuscitate (DNR) orders was formal (92%), experiential (77%), and self-directed (38%). Education about medical orders for life-sustaining treatment (MOLST) was formal (72%), experiential (67%), and self-directed (25%). Ninety-three percent were confident in upholding a DNR order, 87% were confident interpreting MOLST, and 87% were confident sorting out conflict between differing patient and family wishes. Qualitative data analysis yielded six themes on improving preparation of prehospital providers for EOL calls: (1) prehospital provider education; (2) public education; (3) educating health care providers on scope of practice; (4) conflict resolution skills; (5) handling emotional families; and (6) clarification of transfer protocols. These study results suggest the need for addressing the potential interrelationship between prehospital and EOL care through improved education and protocols for care in the field.

From problem solving to problem definition: scrutinizing the complex nature of clinical practice.

PubMed

Cristancho, Sayra; Lingard, Lorelei; Regehr, Glenn

2017-02-01

In medical education, we have tended to present problems as being singular, stable, and solvable. Problem solving has, therefore, drawn much of medical education researchers' attention. This focus has been important but it is limited in terms of preparing clinicians to deal with the complexity of the 21st century healthcare system in which they will provide team-based care for patients with complex medical illness. In this paper, we use the Soft Systems Engineering principles to introduce the idea that in complex, team-based situations, problems usually involve divergent views and evolve with multiple solution iterations. As such we need to shift the conversation from (1) problem solving to problem definition, and (2) from a problem definition derived exclusively at the level of the individual to a definition derived at the level of the situation in which the problem is manifested. Embracing such a focus on problem definition will enable us to advocate for novel educational practices that will equip trainees to effectively manage the problems they will encounter in complex, team-based healthcare.

Globalization of healthcare: case management in a 21st-century world.

PubMed

Craig, Kathy; Beichl, Lisa

2009-01-01

This article explains the current state of the global healthcare market with respect to international medical travel (medical tourism) and worldwide provider sourcing. Emphasis is placed on the traditional twin pillars of oversight: program accreditation and branding affiliation. These are discussed for their main strength, which is their ability to operate at a system-strata level. This strength also represents a primary weakness from the international patient's perspective, which is the functional gap between systemic oversight and bedside surveillance. International case management (ICM) is identified as the right conduit of patient-level service delivery that fills the gap between system and bedside. The ICM professional is introduced and defined as the provider of patient-centered quality and safety improvements, who coordinates and collaborates using international network connections and culture-sensitive in-country communication skills. The article's information is useful for healthcare practitioners who want to learn about the global medical marketplace. Practitioners who are preparing to or who already have business enterprises associated with the global healthcare market will also find the information helpful. Explanations and content are useful to case management generalists, specialists, and business developers. The content is intended for uptake by interested parties within and outside the healthcare practice arena. All research and syntheses were executed by the authors. Sources included business correspondences, medical tourism literature, corporate Internet profiles, news releases, and healthcare industry investigative and monitoring agencies. Clinical competencies stem from the international practice experiences of one author (K. Craig). International health insurance, economics, and financing expertise stems from other author (L. Beichl). This article launches the platform for development of checklists, tools, and guidelines for international case management practice. The article focuses on (1) the examination of traditional quality safeguards of accreditation and branding and (2) the introduction of patient-centered ICM practices. The article aims to identify sources of risk for individual medical consumers who travel across national borders to seek medical care and methods of risk mitigation, especially international case management.

The learning experiences of student nurses in pediatric medication management: a qualitative study.

PubMed

Lin, Fang-Yi; Wu, Wei-Wen; Lin, Hung-Ru; Lee, Tzu-Ying

2014-05-01

Traditionally, the 'five rights' (right patient, right route, right drug, right time, and right dose) principle is taught to be practiced during every medication administration process. Nursing educators use this principle to evaluate student performance. However, health care unit factors and education system characteristics that can contribute to student errors should not be underestimated. Students often felt stressed when medicating children during clinical practicum. The voices of these students are rarely represented. To understand students' experiences and perceptions of medication administration during their pediatric clinical practicum. A descriptive qualitative study design was adopted. A university in Northern Taiwan. A total of 34 undergraduate students who had completed a pediatric clinical practicum participated in a one-on-one interview. Each student was interviewed according to a semi-structured interview guide and was encouraged to disclose individual feelings and thoughts toward their experiences in pediatric medication administration. Eight themes emerged. The findings suggest that to decrease students' anxiety and increase their competence, pediatric instructors should improve their teaching strategies to better prepare students for clinical training. Providing self-directed learning activities and resources to improve students' familiarity with medication and medication safety knowledge is necessary. Instructors should provide students with a secure environment to discuss their medication errors. The 'nine rights' should be taught in fundamental nursing courses to enhance students' awareness during the medication administration process, and students should continue to practice the 'nine rights' in later pediatric clinical courses. Equal importance should be given to system failures that impact patient safety. © 2013.

Internal medicine residency graduates' perceptions of the systems-based practice and practice-based learning and improvement competencies.

PubMed

Didwania, Aashish; McGaghie, William C; Cohen, Elaine; Wayne, Diane B

2010-01-01

Resident education in Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI) is required but underemphasized. The objectives are to identify SBP and PBLI knowledge and skills with the most relevance to our graduates' practices and to determine how well they were prepared during residency training to address these issues. A survey was drafted based on Accreditation Council for Graduate Medical Education competency definitions and published literature on SBP and PBLI. Respondents indicated the extent to which each item is relevant to their practice and the adequacy of instruction received on a 5-point Likert scale. All topics had high perceived relevance to practice with most topics rated low for adequacy of training. Topics of practice management and health care economics contained the largest gaps between mean ratings of relevance and adequacy of training (p < .001). Few differences in ratings were seen based on graduate demographics. This survey has allowed us to prioritize SBP and PBLI curricula to meet the needs of our graduates.

Should forensic autopsies be a source for medical education? A preliminary study.

PubMed

Kucuker, Hudaverdi; Ozen, Oguz Aslan; Songur, Ahmet; Bas, Orhan; Demirel, Reha

2008-01-01

Practical anatomy sessions including dissection of cadavers are essential for anatomy courses. There are many difficulties in obtaining cadavers. In addition, hardened and discolored cadavers that are fixed with formaldehyde look unrealistic and generate apathy among students. We considered that forensic autopsies may be used as ancillary and supportive practice in anatomy education. We invited the participation of Year 2 medical students in suitable forensic autopsy cases during the course of one year. Specialists of forensic medicine and anatomy provided theoretical support through talks in their specialized fields during the autopsy. At the end of the semester, feedback questionnaire forms were prepared and the students were asked to evaluate these sessions. Forty students participated in the evaluation by completing the questionnaire. Students made positive statements about adequacy of the time of the application, consistency of the structures with theoretical and practical issues shown in anatomy lectures, and necessary explanations of the lecturers during and after the application. We think that forensic autopsies are an attractive supplementary educational model, and we have decided to continue the forensic autopsy practices. We believe that further studies on the evaluation of the sessions using a larger student population will lead to more conclusive results.

Preparing Pediatric Healthcare Professionals for End-of-Life Care Discussions: An Exploratory Study.

PubMed

Henderson, Amanda; Young, Jeanine; Herbert, Anthony; Bradford, Natalie; Pedersen, Lee-Anne

2017-06-01

Preparedness to initiate end-of-life (EoL) discussions is a confronting and daunting task for all healthcare professionals. We conducted a group interview to explore healthcare professionals' experiences of preparing for EoL discussions with the patient and their family in a pediatric context. To identify what pediatric healthcare professionals consider important when preparing for an EoL discussion. A qualitative design using a group interview. Two open-ended questions were asked: (1) How could preparedness to initiate EoL care discussions between healthcare professionals and the patient and family be enhanced? (2) What education resources/strategies could be developed to support preparation for EoL care discussions? Healthcare professionals, including medical, nursing, and allied health professionals working in pediatric palliative care settings across Queensland, Australia. These settings included major tertiary hospitals, general practice, community, and nongovernment organizations. A convenience sample of 36 healthcare professionals consented to participate in the study. An analysis of the data identified seven themes that had relevance for preparing for an EoL discussion: communication, healthcare professional perspectives, interdisciplinary team role, patient and family perspectives, practical issues, addressing mistakes, and healthcare professional education. Pediatric healthcare professionals confirmed that gaps exist in preparing for an EoL discussion. The findings support a need for further research in two areas. First, a systematic review of interdisciplinary resources that are available to support healthcare professionals in preparing for EoL discussions is recommended. Second, evidence-based interdisciplinary interventions to support pediatric EoL discussions need to be developed and evaluated.

Predictors of Osteopathic Medical Students' Readiness to Use Health Information Technology.

PubMed

Jacobs, Robin J; Iqbal, Hassan; Rana, Arif M; Rana, Zaid; Kane, Michael N

2017-12-01

The advent of health information technology (HIT) tools can affect the practice of modern medicine in many ways, ideally by improving quality of care and efficiency and reducing medical errors. Future physicians will play a key role in the successful implementation of HIT. However, osteopathic medical students' willingness to learn, adopt, and use technology in a health care setting is not well understood. To understand osteopathic medical students' knowledge, attitudes, and behaviors regarding HIT and to identify factors that may be related to their readiness to use HIT. Using a cross-sectional approach, quantitative surveys were collected from students attending a large osteopathic medical school. Multivariate regression modeling was used to determine whether knowledge, attitudes, behaviors, and personal characteristics were associated with students' readiness to use HIT in future clinical practice. Six hundred four students responded to at least 70% of the survey and were included in the analysis. Multivariate modeling successfully explained the 26% of variance in predicting students' readiness to use HIT (F8,506=22.6, P<.001, R2=0.263). Greater self-efficacy, openness to change (in academic/work settings), favorable attitudes toward HIT use, mobile technology use, younger age, being male, and prior exposure to technology were associated with readiness to use HIT. Understanding students' level of HIT readiness may help guide medical education intervention efforts to better prepare future osteopathic physicians for HIT engagement and use. Innovative approaches to HIT education in medical school curricula that include biomedical informatics may be necessary.

Separate Medication Preparation Rooms Reduce Interruptions and Medication Errors in the Hospital Setting: A Prospective Observational Study.

PubMed

Huckels-Baumgart, Saskia; Baumgart, André; Buschmann, Ute; Schüpfer, Guido; Manser, Tanja

2016-12-21

Interruptions and errors during the medication process are common, but published literature shows no evidence supporting whether separate medication rooms are an effective single intervention in reducing interruptions and errors during medication preparation in hospitals. We tested the hypothesis that the rate of interruptions and reported medication errors would decrease as a result of the introduction of separate medication rooms. Our aim was to evaluate the effect of separate medication rooms on interruptions during medication preparation and on self-reported medication error rates. We performed a preintervention and postintervention study using direct structured observation of nurses during medication preparation and daily structured medication error self-reporting of nurses by questionnaires in 2 wards at a major teaching hospital in Switzerland. A volunteer sample of 42 nurses was observed preparing 1498 medications for 366 patients over 17 hours preintervention and postintervention on both wards. During 122 days, nurses completed 694 reporting sheets containing 208 medication errors. After the introduction of the separate medication room, the mean interruption rate decreased significantly from 51.8 to 30 interruptions per hour (P < 0.01), and the interruption-free preparation time increased significantly from 1.4 to 2.5 minutes (P < 0.05). Overall, the mean medication error rate per day was also significantly reduced after implementation of the separate medication room from 1.3 to 0.9 errors per day (P < 0.05). The present study showed the positive effect of a hospital-based intervention; after the introduction of the separate medication room, the interruption and medication error rates decreased significantly.

Serving high-risk foods in a high-risk setting: survey of hospital food service practices after an outbreak of listeriosis in a hospital.

PubMed

Cokes, Carolyn; France, Anne Marie; Reddy, Vasudha; Hanson, Heather; Lee, Lillian; Kornstein, Laura; Stavinsky, Faina; Balter, Sharon

2011-04-01

Prepared ready-to-eat salads and ready-to-eat delicatessen-style meats present a high risk for Listeria contamination. Because no foodborne illness risk management guidelines exist specifically for US hospitals, a survey of New York City (NYC) hospitals was conducted to characterize policies and practices after a listeriosis outbreak occurred in a NYC hospital. From August through October 2008, a listeriosis outbreak in a NYC hospital was investigated. From February through April 2009, NYC's 61 acute-care hospitals were asked to participate in a telephone survey regarding food safety practices and policies, specifically service of high-risk foods to patients at increased risk for listeriosis. Five patients with medical conditions that put them at high risk for listeriosis had laboratory-confirmed Listeria monocytogenes infection. The Listeria outbreak strain was isolated from tuna salad prepared in the hospital. Fifty-four (89%) of 61 hospitals responded to the survey. Overall, 81% of respondents reported serving ready-to-eat deli meats to patients, and 100% reported serving prepared ready-to-eat salads. Pregnant women, patients receiving immunosuppressive drugs, and patients undergoing chemotherapy were served ready-to-eat deli meats at 77%, 59%, and 49% of hospitals, respectively, and were served prepared ready-to-eat salads at 94%, 89%, and 73% of hospitals, respectively. Only 4 (25%) of 16 respondents reported having a policy that ready-to-eat deli meats must be heated until steaming hot before serving. Despite the potential for severe outcomes of Listeria infection among hospitalized patients, the majority of NYC hospitals had no food preparation policies to minimize risk. Hospitals should implement policies to avoid serving high-risk foods to patients at risk for listeriosis.

Curriculum at the Scholl College. Toward mainstream medical education.

PubMed

Becker, J H

1992-06-01

The Dr. William M. Scholl College of Podiatric Medicine in Chicago recently affiliated with a teaching hospital, the Illinois Masonic Medical Center, and used this alliance as a catalyst to effect a change in the clinical curriculum. The affiliation set up a joint venture to operate two clinics, one on Scholl College's traditional campus and one at the teaching hospital. At the hospital site, Scholl College students rotate through clinical externships in areas such as internal medicine, emergency medicine, and podiatric elective; podiatric and general medical residents assist in the tutelage of the students. At the Scholl College campus, beginning clinical students learn basic skills in a teaching clinic, then refine and further their skills in a comprehensive clinic under the guidance of faculty members. The faculty and administration at Scholl College have embraced the concept of mainstream medical education, and are striving to prepare podiatric physicians to practice 21st century medicine.

Identifying strategies to assist final semester nursing students to develop numeracy skills: a mixed methods study.

PubMed

Ramjan, Lucie M; Stewart, Lyn; Salamonson, Yenna; Morris, Maureen M; Armstrong, Lyn; Sanchez, Paula; Flannery, Liz

2014-03-01

It remains a grave concern that many nursing students within tertiary institutions continue to experience difficulties with achieving medication calculation competency. In addition, universities have a moral responsibility to prepare proficient clinicians for graduate practice. This requires risk management strategies to reduce adverse medication errors post registration. To identify strategies and potential predictors that may assist nurse academics to tailor their drug calculation teaching and assessment methods. This project builds on previous experience and explores students' perceptions of newly implemented interventions designed to increase confidence and competence in medication calculation. This mixed method study surveyed students (n=405) enrolled in their final semester of study at a large, metropolitan university in Sydney, Australia. Tailored, contextualised interventions included online practice quizzes, simulated medication calculation scenarios developed for clinical practice classes, contextualised 'pen and paper' tests, visually enhanced didactic remediation and 'hands-on' contextualised workshops. Surveys were administered to students to determine their perceptions of interventions and to identify whether these interventions assisted with calculation competence. Test scores were analysed using SPSS v. 20 for correlations between students' perceptions and actual performance. Qualitative open-ended survey questions were analysed manually and thematically. The study reinforced that nursing students preferred a 'hands-on,' contextualised approach to learning that was 'authentic' and aligned with clinical practice. Our interventions assisted with supporting students' learning and improvement of calculation confidence. Qualitative data provided further insight into students' awareness of their calculation errors and preferred learning styles. Some of the strongest predictors for numeracy skill performance included (1) being an international student, (2) completion of an online practice quiz, scoring 59% or above and (3) students' self-reported confidence. A paradigm shift from traditional testing methods to the implementation of intensive, contextualised numeracy teaching and assessment within tertiary institutions will enhance learning and promote best teaching practices. Copyright © 2013 Elsevier Ltd. All rights reserved.

Establishment and Implementation of a Required Medication Therapy Management Advanced Pharmacy Practice Experience

PubMed Central

Gilliam, Eric; Thompson, Megan; Vande Griend, Joseph

2017-01-01

Objective. To develop a community pharmacy-based medication therapy management (MTM) advanced pharmacy practice experience (APPE) that provides students with skills and knowledge to deliver entry-level pharmacy MTM services. Design. The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences (SSPPS) partnered with three community pharmacy chains to establish this three-week, required MTM APPE. Students completed the American Pharmacists Association MTM Certificate Course prior to entering the APPE. Students were expected to spend 90% or more of their time at this experience working on MTM interventions, using store MTM platforms. Assessment. All 151 students successfully completed this MTM APPE, and each received a passing evaluation from their preceptor. Preceptor evaluations of students averaged above four (entry-level practice) on a five-point Likert scale. The majority of students reported engagement in MTM services for more than 80% of the time on site. Students’ self-reporting of their ability to perform MTM interventions improved after participation in the APPE. Conclusion. The SSPPS successfully implemented a required MTM APPE, preparing students for entry-level delivery of MTM services. PMID:28381896

Academic medicine: a key partner in strengthening the primary care infrastructure via teaching health centers.

PubMed

Rieselbach, Richard E; Crouse, Byron J; Neuhausen, Katherine; Nasca, Thomas J; Frohna, John G

2013-12-01

In the United States, a worsening shortage of primary care physicians, along with structural deficiencies in their training, threaten the primary care system that is essential to ensuring access to high-quality, cost-effective health care. Community health centers (CHCs) are an underused resource that could facilitate rapid expansion of the primary care workforce and simultaneously prepare trainees for 21st-century practice. The Teaching Health Center Graduate Medical Education (THCGME) program, currently funded by the Affordable Care Act, uses CHCs as training sites for primary-care-focused graduate medical education (GME).The authors propose that the goals of the THCGME program could be amplified by fostering partnerships between CHCs and teaching hospitals (academic medical centers [AMCs]). AMCs would encourage their primary care residency programs to expand by establishing teaching health center (THC) tracks. Modifications to the current THCGME model, facilitated by formal CHC and academic medicine partnerships (CHAMPs), would address the primary care physician shortage, produce physicians prepared for 21st-century practice, expose trainees to interprofessional education in a multidisciplinary environment, and facilitate the rapid expansion of CHC capacity.To succeed, CHAMP THCs require a comprehensive consortium agreement designed to ensure equity between the community and academic partners; conforming with this agreement will provide the high-quality GME necessary to ensure residency accreditation. CHAMP THCs also require a federal mechanism to ensure stable, long-term funding. CHAMP THCs would develop in select CHCs that desire a partnership with AMCs and have capacity for providing a community-based setting for both GME and health services research.

What are the critical success factors for team training in health care?

PubMed

Salas, Eduardo; Almeida, Sandra A; Salisbury, Mary; King, Heidi; Lazzara, Elizabeth H; Lyons, Rebecca; Wilson, Katherine A; Almeida, Paula A; McQuillan, Robert

2009-08-01

Ineffective communication among medical teams is a leading cause of preventable patient harm throughout the health care system. A growing body of literature indicates that medical teamwork improves the quality, safety, and cost-effectiveness of health care delivery, and expectations for teamwork in health care have increased. Yet few health care professions' curricula include teamwork training, and few medical practices integrate teamwork principles. Because of this knowledge gap, growing numbers of health care systems are requiring staff to participate in formal teamwork training programs. Seven evidence-based, practical, systematic success factors for preparing, implementing, and sustaining a team training and performance improvement initiative were identified. Each success factor is accompanied by tips for deployment and a real-world example of application. (1) Align team training objectives and safety aims with organizational goals, (2) provide organizational support for the team training initiative, (3) get frontline care leaders on board, (4) prepare the environment and trainees for team training, (5) determine required resources and time commitment and ensure their availability, (6) facilitate application of trained teamwork skills on the job; and (7) measure the effectiveness of the team training program. Although decades of research in other high-risk organizations have clearly demonstrated that properly designed team training programs can improve team performance, success is highly dependent on organizational factors such as leadership support, learning climate, and commitment to data-driven change. Before engaging in a teamwork training initiative, health care organizations should have a clear understanding of these factors and the strategies for their establishment.

Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low- and middle-income countries.

PubMed

Chandra-Mouli, Venkatraman; Patel, Sheila Vipul

2017-03-01

Menstruation is a natural physiological process that requires proper management. Unlike other normal bodily processes, menstruation is linked with religious and cultural meanings that can affect the perceptions of young girls as well as the ways in which the adults in the communities around them respond to their needs. This review aims to answer the following questions: (1) how knowledgeable are adolescent girls in low- and middle-income countries about menstruation and how prepared are they for reaching menarche, (2) who are their sources of information regarding menstruation, (3) how well do the adults around them respond to their information needs, (4) what negative health and social effects do adolescents experience as a result of menstruation, and (5) how do adolescents respond when they experience these negative effects and what practices do they develop as a result? Using a structured search strategy, articles that investigate young girls' preparedness for menarche, knowledge of menstruation and practices surrounding menstrual hygiene in LMIC were identified. A total of 81 studies published in peer-reviewed journals between the years 2000 and 2015 that describe the experiences of adolescent girls from 25 different countries were included. Adolescent girls in LMIC are often uninformed and unprepared for menarche. Information is primarily obtained from mothers and other female family members who are not necessarily well equipped to fill gaps in girls' knowledge. Exclusion and shame lead to misconceptions and unhygienic practices during menstruation. Rather than seek medical consultation, girls tend to miss school, self-medicate and refrain from social interaction. Also problematic is that relatives and teachers are often not prepared to respond to the needs of girls. LMIC must recognize that lack of preparation, knowledge and poor practices surrounding menstruation are key impediments not only to girls' education, but also to self-confidence and personal development. In addition to investment in private latrines with clean water for girls in both schools and communities, countries must consider how to improve the provision of knowledge and understanding and how to better respond to the needs of adolescent girls.

Rectal drug administration in adults: how, when, why.

PubMed

Lowry, Michael

Administering medication per rectum can be the most appropriate route for some patients may not always be considered by health professionals. Cultural sensitivities, as well as misinformation regarding insertion methods, may be barriers to the practice. This article explains how the rectal route functions in drug absorption, clarifies when this route is appropriate to use and outlines the steps nurses should follow to prepare patients adequately and safely to carry out the procedure.

Data security and patient confidentiality: the manager's role.

PubMed

Fisher, F; Madge, B

1996-10-01

The maintenance of patient confidentiality is of utmost importance in the doctor patient relationship. With the advent of networks such as the National Health Service Wide Area Network in the UK, the potential to transmit identifiable clinical data will become greater. Links between general practitioners (GPs) and hospitals will allow the rapid transmission of data which if intercepted could be potentially embarrassing to the patient concerned. In 1994 the British Medical Association launched a draft bill on privacy and confidentiality and in association with this bill it is pushing for encryption of all clinical data across electronic networks. The manager's role within an acute hospital, community units and general practice, is to ensure that all employees are aware of the principles of data protection, security of hospital computer systems and that no obvious breaches of security can occur at publicly accessible terminals. Managers must be kept up to date with the latest developments in computer security such as digital signatures and be prepared to instigate these developments where practically possible. Managers must also take responsibility for the monitoring of access to terminals and be prepared to deal severely with staff who breach the code of confidentiality. Each manager must be kept informed of employees status with regard to their 'need to know' clearance level and also to promote confidentiality of patient details throughout the hospital. All of the management team must be prepared to train new staff in the principles of data security as they join the organisation and recognise their accountability if the programme fails. Data security and patient confidentiality is a broad responsibility in any healthcare organisation, with the Chief Executive accountable. In family practice, the partners are responsible and accountable. The British Medical Association believes as a matter of policy, that allowing access to personal health data without the patients consent, except in a legally allowable situation, should be a statutory offence.

Measuring Value in Internal Medicine Residency Training Hospitals Using Publicly Reported Measures.

PubMed

Schickedanz, Adam; Gupta, Reshma; Arora, Vineet M; Braddock, Clarence H

2018-03-01

Graduate medical education (GME) lacks measures of resident preparation for high-quality, cost-conscious practice. The authors used publicly reported teaching hospital value measures to compare internal medicine residency programs on high-value care training and to validate these measures against program director perceptions of value. Program-level value training scores were constructed using Centers for Medicare & Medicaid Services Value-Based Purchasing (VBP) Program hospital quality and cost-efficiency data. Correlations with Association of Program Directors in Internal Medicine Annual Survey high-value care training measures were examined using logistic regression. For every point increase in program-level VBP score, residency directors were more likely to agree that GME programs have a responsibility to contain health care costs (adjusted odds ratio [aOR] 1.18, P = .04), their faculty model high-value care (aOR 1.07, P = .03), and residents are prepared to make high-value medical decisions (aOR 1.07, P = .09). Publicly reported clinical data offer valid measures of GME value training.

Chapter 8. Medical procedures. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Zimmerman, Janice L; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza pandemic or mass disaster with a specific focus on ensuring that adequate resources are available and appropriate protocols are developed to safely perform procedures in patients with and without influenza illness. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including performing medical procedures. Key recommendations include: (1) specify high-risk procedures (aerosol generating-procedures); (2) determine if certain procedures will not be performed during a pandemic; (3) develop protocols for safe performance of high-risk procedures that include appropriateness, qualifications of personnel, site, personal protection equipment, safe technique and equipment needs; (4) ensure adequate training of personnel in high-risk procedures; (5) procedures should be performed at the bedside whenever possible; (6) ensure safe respiratory therapy practices to avoid aerosols; (7) provide safe respiratory equipment; and (8) determine criteria for cancelling and/or altering elective procedures. Judicious planning and adoption of protocols for safe performance of medical procedures are necessary to optimize outcomes during a pandemic.

Transfer of knowledge and skills: some implications for nursing and nurse education.

PubMed

Lauder, W; Reynolds, W; Angus, N

1999-08-01

The construct of transfer has enormous importance to nursing as it begins to highlight potential problems in the transfer of knowledge and skills from the campus to the clinical area, from one part of the clinical area to another (e.g. surgical to medical), and from community to the clinical area. Thus, any adequate conceptualization of transfer must account for problems of practice-practice transfer as well as theory-practice transfer. These potential problems are the concern of educators, students and managers who have a responsibility for agency nurses and bank nurses who may find themselves in different specialities on a regular basis. Transfer has relevance to a whole raft of other issues ranging from the application of theories to nursing practice, through to the validity of claims that courses which develop intellectual skills prepare nurses for lifelong learning.

Ethical practice under fire: deployed physicians in the global war on terrorism.

PubMed

Sessums, Laura L; Collen, Jacob F; O'Malley, Patrick G; Jackson, Jeffery L; Roy, Michael J

2009-05-01

The Global War on Terrorism brings significant ethical challenges for military physicians. From Abu Ghraib to Guantanamo Bay, the actions of health care providers have come under considerable scrutiny. Military providers have dual roles as military officers and medical professionals, which have the potential to come into conflict. Often they are inadequately prepared to manage this conflict. We review pertinent historical precedents, applicable laws, ethical guidelines, and military regulations. We also present examples of ethical challenges deployed clinicians have faced and their ethical solution. Finally, we propose a practical strategy to educate physicians on how to manage complex ethical dilemmas in war time settings.

On the practicality of emergency surgery during long-duration space missions.

PubMed

Dawson, David L

2008-07-01

While discussions of the practicality of surgery in space often focus on technical issues, such as adapting instrumentation and procedures for use in microgravity, programmatic issues need to be addressed if meaningful capabilities for emergency surgery are to be considered for human exploration missions beyond low Earth orbit. Advanced technologies that have been evaluated, including simulation-enhanced training, telementoring, or robotic assistance, might help prepare or augment a crew medical officer, but a physician with advanced training and relevant experience will be needed if surgical capabilities beyond basic emergency aid are to be considered. Specific operational roles for physician-astronauts should be established.

Translating learning into practice

PubMed Central

Armson, Heather; Kinzie, Sarah; Hawes, Dawnelle; Roder, Stefanie; Wakefield, Jacqueline; Elmslie, Tom

2007-01-01

PROBLEM ADDRESSED The need for effective and accessible educational approaches by which family physicians can maintain practice competence in the face of an overwhelming amount of medical information. OBJECTIVE OF PROGRAM The practice-based small group (PBSG) learning program encourages practice changes through a process of small-group peer discussion—identifying practice gaps and reviewing clinical approaches in light of evidence. PROGRAM DESCRIPTION The PBSG uses an interactive educational approach to continuing professional development. In small, self-formed groups within their local communities, family physicians discuss clinical topics using prepared modules that provide sample patient cases and accompanying information that distils the best evidence. Participants are guided by peer facilitators to reflect on the discussion and commit to appropriate practice changes. CONCLUSION The PBSG has evolved over the past 15 years in response to feedback from members and reflections of the developers. The success of the program is evidenced in effect on clinical practice, a large and increasing number of members, and the growth of interest internationally. PMID:17872876

New preparations of the elemental diet and the clinical application.

PubMed

Ogoshi, S; Sato, H

1981-01-01

In 1978, we designed a new elemental diet, ED-AC, which modified after Vivonex-HN with the co-operation of Ajinomoto Co., Japan and Morton-Norwich Co., U.S.A.. ED-AC is now being used widely in Japan for enteral hyper-alimentation, even in case of pediatric surgery. We have new prepared another elemental diet, this time for infants, ED-P (pediatric). The ratio of amino acids in both ED was determined according the proposal of Professor Goro Inoue, Department of Nutrition, Tokushima University. The application of ED, particularly for surgical patients, has been most effective. the use of this diet for enteral hyperalimentation should find a wide application in surgical and medical practice.

Military medical modeling and simulation in the 21st century.

PubMed

Moses, G; Magee, J H; Bauer, J J; Leitch, R

2001-01-01

As we enter the 21st century, military medicine struggles with critical issues. One of the most important issues is how to train medical personnel in peace for the realities of war. In April, 1998, The General Accounting Office (GAO) reported, "Military medical personnel have almost no chance during peacetime to practice battlefield trauma care skills. As a result, physicians both within and outside the Department of Defense (DOD) believe that military medical personnel are not prepared to provide trauma care to the severely injured soldiers in wartime. With some of today's training methods disappearing, the challenge of providing both initial; and sustainment training for almost 100,000 military medical personnel is becoming insurmountable. The "training gap" is huge and impediments to training are mounting. For example, restrictions on animal use are increasing and the cost of conducting live mass casualty exercises is prohibitive. Many medical simulation visionaries believe that four categories of medical simulation are emerging to address these challenges. These categories include PC-based multimedia, digital mannequins, virtual workbenches, and total immersion virtual reality (TIVR). The use of simulation training can provide a risk = free realistic learning environment for the spectrum of medical skills training, from buddy-aid to trauma surgery procedures. This will, in turn, enhance limited hands on training opportunities and revolutionize the way we train in peace to deliver medicine in war. High-fidelity modeling will permit manufacturers to prototype new devices before manufacture. Also, engineers will be able to test a device for themselves in a variety of simulated anatomical representations, permitting them to "practice medicine".

A systematic review of nursing administration of medication via enteral tubes in adults.

PubMed

Phillips, Nicole M; Nay, Rhonda

2008-09-01

This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults. Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown. Systematic review. CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised-controlled trials; data were presented in a narrative summary. Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small-diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. The evidence was limited. There was a lack of high-quality research on many important issues relating to giving enteral medication. Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a need for further studies to strengthen these findings.

Knowledge translation on dementia: a cluster randomized trial to compare a blended learning approach with a "classical" advanced training in GP quality circles

PubMed Central

Vollmar, Horst C; Butzlaff, Martin E; Lefering, Rolf; Rieger, Monika A

2007-01-01

Background Thus far important findings regarding the dementia syndrome have been implemented into patients' medical care only inadequately. A professional training accounting for both, general practitioners' (GP) needs and learning preferences as well as care-relevant aspects could be a major step towards improving medical care. In the WIDA-study, entitled "Knowledge translation on dementia in general practice" two different training concepts are developed, implemented and evaluated. Both concepts are building on an evidence-based, GP-related dementia guideline and communicate the guideline's essential insights. Methods/Design Both development and implementation emphasize a procedure that is well-accepted in practice and, thus, can achieve a high degree of external validity. This is particularly guaranteed through the preparation of training material and the fact that general practitioners' quality circles (QC) are addressed. The evaluation of the two training concepts is carried out by comparing two groups of GPs to which several quality circles have been randomly assigned. The primary outcome is the GPs' knowledge gain. Secondary outcomes are designed to indicate the training's potential effects on the GPs' practical actions. In the first training concept (study arm A) GPs participate in a structured case discussion prepared for by internet-based learning material ("blended-learning" approach). The second training concept (study arm B) relies on frontal medical training in the form of a slide presentation and follow-up discussion ("classical" approach). Discussion This paper presents the outline of a cluster-randomized trial which has been peer reviewed and support by a national funding organization – Federal Ministry of Education and Research (BMBF) – and is approved by an ethics commission. The data collection has started in August 2006 and the results will be published independently of the study's outcome. Trial Registration Current Controlled Trials [ISRCTN36550981] PMID:17587452

Exploring emergency nurse practitioners' perceptions of their role.

PubMed

Bagley, Sue

2018-02-21

Since the 1980s, the emergency nurse practitioner (ENP) role has evolved as increasing socioeconomic pressures and changing government policy have led to new working practices in emergency departments. Similarly, a lack of consensus regarding educational support for ENPs and the regulation of ENP training, mean that variations remain in the scope of practice, role description and academic requirements for ENPs. To explore ENPs' perceptions of their changing role, including their educational requirements and whether their training needs are being met. This qualitative phenomenological study examined the views of six ENPs using semi-structured interviews. The study identified four themes: inadequate protected time for continuing professional development (CPD); importance of senior medical support in role expansion and CPD; inconsistent educational preparation for expanded roles; and the ENPs' perceived reasons for role expansion. Although all the participants stated that it was challenging to find time for CPD when working in busy clinical environments, this was regarded as less important than the positive effect of senior medical support for advanced roles. Over the past three decades, the ENP role has become well established, which has led to increased confidence, and the development of collaborative ways of working, among ENPs and their colleagues. However, while ENPs have embraced the challenges of their changing role, educational support has not been consistent. There are still disparities in ENPs' scope of practice, expectations of the role between services, and the educational preparation required to undertake the role. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

OSHA medical and workplace surveillance requirements and NIOSH recommendations (for employees exposed to toxic substances and other work hazards)

NASA Technical Reports Server (NTRS)

Cooper, L. P.

1983-01-01

Both OSHA medical and work place surveillance requirements and NIOSH recommendations were prepared as a desk reference to help occupational health professionals to perform their duties. The medical surveillance information focuses on frequency of physical examinations, specific problems that may arise as a result of exposure (e.g., decreased immunocompetence, weight loss, ets.), conditions that intensify the harmful effects of exposure (e.g., medication an exposed employee may be taking, cigarette smoking, etc.), the areas that should be scrutinized in medical and work histories and during the physical exam, and specific clinical tests that should be conducted. Recordkeeping requirements are also specified. The workplace surveillance information consists of monitoring requirements, personal protective equipment requirements, and recordkeeping requirements. Such details as the sampling devices that should be used, the type of respirators that should be worn, and the frequency of inspections are included. This document does not specify the training, labeling and posting, and safe work practice requirements and recommendations due to space considerations.

Academic competencies for medical faculty.

PubMed

Harris, Dona L; Krause, Katherine C; Parish, David C; Smith, Mike U

2007-05-01

Physicians and basic scientists join medical school faculties after years of education. These individuals are then required to function in roles for which they have had little preparation. While competencies needed to perform in medical school, residency, and practice are defined, there is little guidance for faculty. An expert advisory group of the Faculty Futures Initiative developed a document delineating competencies required for successful medical faculty. The proportion of time faculty in various roles should allocate to activities related to each competency was also identified. Competencies and time allocations were developed for various teacher/administrators, teacher/educators, teacher/researchers, and teacher/clinicians. This work was validated by multiple reviews by an external panel. Trial implementation of the products has occurred in faculty development programs at four medical schools to guide in planning, career guidance, and evaluations of faculty fellows. The competencies and time allocations presented here help faculty and institutions define skills needed for particular faculty roles, plan for faculty evaluation, mentoring and advancement, and design faculty development programs based on identified needs.

Journey toward a patient-centered medical home: readiness for change in primary care practices.

PubMed

Wise, Christopher G; Alexander, Jeffrey A; Green, Lee A; Cohen, Genna R; Koster, Christina R

2011-09-01

Information is limited regarding the readiness of primary care practices to make the transformational changes necessary to implement the patient-centered medical home (PCMH) model. Using comparative, qualitative data, we provide practical guidelines for assessing and increasing readiness for PCMH implementation. We used a comparative case study design to assess primary care practices' readiness for PCMH implementation in sixteen practices from twelve different physician organizations in Michigan. Two major components of organizational readiness, motivation and capability, were assessed. We interviewed eight practice teams with higher PCMH scores and eight with lower PCMH scores, along with the leaders of the physician organizations of these practices, yielding sixty-six semistructured interviews. The respondents from the higher and lower PCMH scoring practices reported different motivations and capabilities for pursuing PCMH. Their motivations pertained to the perceived value of PCMH, financial incentives, understanding of specific PCMH requirements, and overall commitment to change. Capabilities that were discussed included the time demands of implementation, the difficulty of changing patients' behavior, and the challenges of adopting health information technology. Enhancing the implementation of PCMH within practices included taking an incremental approach, using data, building a team and defining roles of its members, and meeting regularly to discuss the implementation. The respondents valued external organizational support, regardless of its source. The respondents from the higher and lower PCMH scoring practices commented on similar aspects of readiness-motivation and capability-but offered very different views of them. Our findings suggest the importance of understanding practice perceptions of the motivations for PCMH and the capability to undertake change. While this study identified some initial approaches that physician organizations and practices have used to prepare for practice redesign, we need much more information about their effectiveness. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Should Dental Schools Train Dentists to Routinely Provide Limited Preventive Primary Medical Care? Two Viewpoints: Viewpoint 1: Dentists Should Be Trained to Routinely Provide Limited Preventive Primary Care and Viewpoint 2: Dentists Should Be Trained in Primary Care Medicine to Enable Comprehensive Patient Management Within Their Scope of Practice.

PubMed

Giddon, Donald B; Donoff, R Bruce; Edwards, Paul C; Goldblatt, Lawrence I

2017-05-01

This Point/Counterpoint acknowledges the transformation of dental practice from a predominantly technically based profession with primary emphasis on restoration of the tooth and its supporting structures to that of a more medically based specialty focusing on the oral and maxillofacial complex. While both viewpoints accept the importance of this transformation, they differ on the ultimate desired outcome and how changes should be implemented during training of dentists as oral health professionals. Viewpoint 1 argues that, in response to a shortage of both primary care providers and access to affordable oral health care, dentists need to be able and willing to provide limited preventive primary care (LPPC), and dental educators should develop and implement training models to prepare them. Among changes proposed are consideration of three types of practitioners: oral physicians with sufficient training to provide LPPC; dentists with excellent technical proficiency but minimal medical and surgical training; and mid-level providers to provide simple restorative and uncomplicated surgical care. Viewpoint 2 argues that the objective of dentists' education in primary care medicine is to help them safely and effectively provide all aspects of oral health care, including appropriate preventive medical care, that already fall within their scope of knowledge and practice. Dental educators should encourage students to use this knowledge to take full ownership of non-tooth-related pathologic conditions of the oral and maxillofacial complex not currently managed in the dental setting, but encouraging graduates to expand into non-dental LPPC outside the recognized scope of practice will only further exacerbate fragmentation of care.

Assessment of perceived needs and preferences with regard to the education of residents in Medical Ethics in King Abdulaziz University Hospital.

PubMed

Ghamri, Ranya A; Al-Raddadi, Rajaa M

2017-01-01

Medical ethics is the branch of ethics that deals with moral issues in medical practice. Many postgraduate training programs have developed educational interventions in ethics to meet accreditation standards and prepare learners for certification examinations and clinical practice. The aim of this study was to assess the attitude of residents in King Abdulaziz University Hospital (KAUH) toward the need for ethics education and identify the most effective methods of teaching ethical issues. A cross-sectional study of residents in different specialties at KAUH was conducted using a self-administered questionnaire. The questionnaire consisted of four parts: demographic data, assessment of the educational need for ethics education, assessment of the impact of various learning methods, and assessment of the need for ethically important practices and behavior. SPSS version 16.0 was used for data entry and analysis. Descriptive analysis included frequency distribution, percentages, mean, and standard deviation (SD); Chi-square test and t -test were employed to determine statistical significance. Eighty-eight of the 102 residents invited to participate in the study returned completed questionnaires, providing a response rate of 86.3%. Their ages ranged between 24 and 38 years with a mean of 27.7 (standard deviation 2.8) years. Approximately two-thirds of the residents (65.9%) agreed that medical ethics can be taught and learned while only 19.3% of them disagreed. The most effective methods of ethical education according to the residents were discussion groups of peers led by a knowledgeable clinician (78.4%), clinical rounds (72.7%), and an incorporation of ethical issues into lectures and teaching rounds (69.3%). This study documents the importance residents placed on ethics education directed at practical, real-world dilemmas and ethically important professional developmental issues.

Managing clinical education through understanding key principles.

PubMed

Cunningham, Joanne; Wright, Caroline; Baird, Marilyn

2015-01-01

Traditionally, a practicum facilitated the integration of on-campus learning and practical workplace training. Over the past 3 decades, an educative practicum has evolved that promotes clinical reasoning, including analytical and evaluative abilities, through reflective practice. Anecdotal evidence indicates that the delivery of clinical education within medical radiation science entry-level programs continues to vacillate between traditional practicums and the new reflective practicums. To review the literature about clinical education within the medical radiation sciences and identify key principles for practitioners seeking to reflect upon and improve their approach to teaching and supporting students in the clinical environment. A search of 3 major journal databases, Internet searches, and hand searches of reference lists were conducted to identify literature about clinical education in the medical radiation sciences from January 1, 2000, to December 31, 2012. Twenty-two studies were included in this review. The 5 key elements associated with clinical education include the clinical support model and quality, overcoming the theory-practice gap, learning outcomes and reliable and valid assessment, preparing and supporting students, and accommodating differing teaching and learning needs. Many factors influence the quality of clinical education, including the culture of the clinical environment and clinical leadership roles. Several approaches can help students bridge the theory-practice gap, including simulators, role-playing activities, and reflective journals. In addition, clinical educators should use assessment strategies that objectively measure student progress, and they should be positive role models for their students. The successful clinical education of students in the medical radiation sciences depends upon the systems, structures, and people in the clinical environment. Clinical education is accomplished through the collaborative efforts of the clinical practitioner, the academic, and the student. Universities should include introductory material on clinical learning and teaching in their radiologic science curriculum.

Preparation for practice in family medicine: before and after duty hours.

PubMed

Carek, Peter J; Diaz, Vanessa; Dickerson, Lori M; Peterson, Lars; Johnson, Sharleen

2012-09-01

In July of 2003, the Accreditation Council for Graduate Medical Education (ACGME) adopted requirements limiting the duty hours of resident physicians. The impact of these restrictions on education and patient care activities is not clear. The purpose of this study is to examine the perception of graduates of family medicine residency programs immediately prior to and following implementation of duty hours regarding preparedness to practice and board certification status, as well as current patient care activities. Surveys of graduates of family medicine residency programs in South Carolina were conducted. Preparation for practice and professional activities of program graduates prior to (1999--2003) and following (2005--2009) implementation of duty hours were compared. Response rates were 54.4% and 53.1%, respectively. No significant differences by survey years in the average age, gender, or race was noted. Recent graduates felt as well prepared for practice in most curricular areas except surgery (OR=0.50 [0.27, 0.91]) and performed similar procedures with the following exceptions: central line placement (OR=0.32 [0.11, 0.95]), flexible sigmoidoscopy (OR=0.12 [0.02, 0.80]), ICU care (OR=0.39 [0.22, 0.70]), and ventilator management (OR=0.54 [0.29, 0.99]). Higher proportion of recent graduates do not take after hours call (22.3% versus 8.6%). Similarly, fewer recent graduates care for patients in nursing homes (22.0% versus 44.9%) and hospitals (46.2% versus 68.0%). Implementation of resident duty hours appears to have little overall association with self-reported preparedness for practice. An association was noted in the patient care services and procedures performed.

ACCESS, SOURCES AND VALUE OF NEW MEDICAL INFORMATION - VIEWS OF FINAL YEAR MEDICAL STUDENTS AT THE UNIVERSITY OF NAIROBI

PubMed Central

Gituma, Adrian; Masika, Moses; Muchangi, Eric; Nyagah, Lily; Otieno, Vincent; Irimu, Grace; Wasunna, Aggrey; Ndiritu, Moses; English, Mike

2009-01-01

Background Globally many doctors, particularly in low-income countries, have no formal training in using new information to improve their practice. As a first step clinicians must have access to information and so we explored reported access in graduating medical students in Nairobi. Objectives To evaluate final year medical students’ access to new medical information. Methods A cross-sectional survey of fifth (final) year medical students at the University of Nairobi using anonymous, self-administered questionnaires. Findings Questionnaires were distributed to 291 (85%) of a possible 343 students and returned by 152 (44%). Within the previous 12 months half reported accessing some form of new medical information most commonly from books and the internet. However, only a small number reported regular access and specific, new journal articles were rarely accessed. Absence of internet facilities, slow internet speeds and cost were common barriers to access while current training seems rarely to encourage students to seek new information. Conclusion Almost half the students had not accessed any new medical information in their final year in medical school suggesting they are ill prepared for a career that may increasingly demand life-long, self-learning. PMID:19152558

Quality Assurance Program for Molecular Medicine Laboratories

PubMed Central

Hajia, M; Safadel, N; Samiee, S Mirab; Dahim, P; Anjarani, S; Nafisi, N; Sohrabi, A; Rafiee, M; Sabzavi, F; Entekhabi, B

2013-01-01

Background: Molecular diagnostic methods have played and continuing to have a critical role in clinical laboratories in recent years. Therefore, standardization is an evolutionary process that needs to be upgrade with increasing scientific knowledge, improvement of the instruments and techniques. The aim of this study was to design a quality assurance program in order to have similar conditions for all medical laboratories engaging with molecular tests. Methods: We had to design a plan for all four elements; required space conditions, equipments, training, and basic guidelines. Necessary guidelines was prepared and confirmed by the launched specific committee at the Health Reference Laboratory. Results: Several workshops were also held for medical laboratories directors and staffs, quality control manager of molecular companies, directors and nominees from universities. Accreditation of equipments and molecular material was followed parallel with rest of program. Now we are going to accredit medical laboratories and to evaluate the success of the program. Conclusion: Accreditation of medical laboratory will be succeeding if its basic elements are provided in advance. Professional practice guidelines, holding training and performing accreditation the molecular materials and equipments ensured us that laboratories are aware of best practices, proper interpretation, limitations of techniques, and technical issues. Now, active external auditing can improve the applied laboratory conditions toward the defined standard level. PMID:23865028

Quality assurance program for molecular medicine laboratories.

PubMed

Hajia, M; Safadel, N; Samiee, S Mirab; Dahim, P; Anjarani, S; Nafisi, N; Sohrabi, A; Rafiee, M; Sabzavi, F; Entekhabi, B

2013-01-01

Molecular diagnostic methods have played and continuing to have a critical role in clinical laboratories in recent years. Therefore, standardization is an evolutionary process that needs to be upgrade with increasing scientific knowledge, improvement of the instruments and techniques. The aim of this study was to design a quality assurance program in order to have similar conditions for all medical laboratories engaging with molecular tests. We had to design a plan for all four elements; required space conditions, equipments, training, and basic guidelines. Necessary guidelines was prepared and confirmed by the launched specific committee at the Health Reference Laboratory. Several workshops were also held for medical laboratories directors and staffs, quality control manager of molecular companies, directors and nominees from universities. Accreditation of equipments and molecular material was followed parallel with rest of program. Now we are going to accredit medical laboratories and to evaluate the success of the program. Accreditation of medical laboratory will be succeeding if its basic elements are provided in advance. Professional practice guidelines, holding training and performing accreditation the molecular materials and equipments ensured us that laboratories are aware of best practices, proper interpretation, limitations of techniques, and technical issues. Now, active external auditing can improve the applied laboratory conditions toward the defined standard level.

Transferable skills of incoming medical students and their development over the first academic year: The United Arab Emirates experience.

PubMed

McLean, Michelle; Shaban, Sami; Murdoch-Eaton, Deborah

2011-01-01

Increasingly, it is being recognised in higher and medical education that learners should be adequately prepared for the unpredictable nature of professional practice. Several generic or transferable skills or capabilities (e.g., communication, information handling) that will enable graduates to function in an ever-changing professional world have been identified. Using a validated inventory comprising six categories of transferable skills, three cohorts of incoming male and female medical students at a Gulf university documented their level of practice and confidence for 31 skills. The exercise was repeated a year later. New medical students identified computer and organisational skills and the ability to manage their learning as strengths, but scores for technical and numeracy, information handling and presentation and communication skills suggested that learners generally required guidance. A year later, despite considerable self-reported information handling and communication skills development, learners generally did not consider themselves self-sufficient. A significant gender difference emerged, with incoming males reporting less experience and confidence in many skills. This gap was reduced but did not disappear over the first academic year. An audit such as this may be useful for identifying individual skills levels as well as providing insight into shortcomings in the academic programme in terms of opportunities for transferable skills development.

The liberal arts physician.

PubMed

Burrow, G N

1999-10-01

The United States is in the midst of the second revolution in American health care to occur during this century, as Kenneth Ludmerer makes clear in his book Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. The "Flexnerian revolution" eventually led to the closing of a third of the medical schools. Although such closures are not likely this time, familiar arrangements are collapsing, without a clear picture of the shape of things to come. Whatever the outcome of the current revolution, well-trained physicians will be needed to care for the sick. Academic medical centers truly are at risk and increasingly require public support to flourish or even to survive, but medical schools and their teaching hospitals must demonstrate that they deserve this support. These institutions have responded by focusing on the business aspects of medicine, perhaps to the detriment of medical education. Lost in this focus is teaching time, and perhaps even more important, the time for mentoring. Often lacking too is a clear vision of the preparation needed by the student to practice medicine successfully in the future: different specialty mixes, interdisciplinary group practice; vastly increased use of information technologies, and overwhelming amounts of relevant and interrelated information. Yet the answer is the same as it was 75 years ago when Yale introduced the first radical medical curricular reform--the "liberal arts physician," trained in science, the values of medicine, and particularly for uncertainly and with the capacity to adapt.

Curriculum Development of a Research Laboratory Methodology Course for Complementary and Integrative Medicine Students

PubMed Central

Vasilevsky, Nicole; Schafer, Morgan; Tibbitts, Deanne; Wright, Kirsten; Zwickey, Heather

2015-01-01

Training in fundamental laboratory methodologies is valuable to medical students because it enables them to understand the published literature, critically evaluate clinical studies, and make informed decisions regarding patient care. It also prepares them for research opportunities that may complement their medical practice. The National College of Natural Medicine's (NCNM) Master of Science in Integrative Medicine Research (MSiMR) program has developed an Introduction to Laboratory Methods course. The objective of the course it to train clinical students how to perform basic laboratory skills, analyze and manage data, and judiciously assess biomedical studies. Here we describe the course development and implementation as it applies to complementary and integrative medicine students. PMID:26500806

'It's Fast, It's Quick, It Stops Me Being Sick': How to influence preparation of opioid tablets for injection.

PubMed

Lafferty, Lise; Treloar, Carla; van Breda, Nick; Steele, Maureen; Hiley, Sarah; Flaherty, Ian; Salmon, Allison

2017-09-01

Injection of pharmaceutical opioids (PO) among people who inject drugs has increased in many countries. The common method for preparing PO tablets for injection uses heat, resulting in greater particulate matter and therefore increased risk of local infection risk and damage to veins and organs. A cold preparation process has fewer risks, but this preparation method is not commonly used. This study seeks to explore how people who inject PO learn to prepare injections and how health promotion efforts could influence practice. Between March and December 2013, qualitative interviews were undertaken with 33 clients of Sydney's Medically Supervised Injecting Centre who inject PO tablets regarding sources of knowledge and current preparation methods for injection of POs. Overwhelmingly, the most commonly reported source of knowledge around injection of tablets was others who inject. Most participants reported heating the solution as the quickest way to administer the drug. Attitudes to the use of wheel filters varied, with some participants reporting that they would use the filters if they were shown how, while others reported a number of barriers to using filters, including complexity of use. Harnessing the power of social connections may provide avenues for education about safer injecting of tablets, including the use of wheel filters. Further work is required to debunk myths about the relative potencies of cold versus hot drug solution. Collaborations between harm reduction workers and peer workers would assist in knowledge dissemination regarding safer injecting practices. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Clinical case management and navigation for colonoscopy screening in an academic medical center.

PubMed

Cavanagh, Mary F; Lane, Dorothy S; Messina, Catherine R; Anderson, Joseph C

2013-08-01

One of 5 nationally funded Centers for Disease Control and Prevention Colorectal Cancer (CRC) Screening Demonstration Programs, Project SCOPE, was conducted at an academic medical center and provided colonoscopy screening at no cost to underserved minority patients from local community health centers. Established barriers to CRC screening (eg, financial, language, transportation) among the target population were addressed through clinical coordination of care by key project staff. The use of a clinician with a patient navigator allowed for the performance of precolonoscopy "telephone visits" instead of office visits to the gastroenterologist in virtually all patients. The clinician elicited information relevant to making screening decisions (eg, past medical and surgical history, focused review of systems, medication/supplement use, CRC screening history). The patient navigator reduced barriers, including, but not limited to, scheduling, transportation, and physical navigation of the medical center on the day of colonoscopy. Preprogram preparation was vital in laying groundwork for the project, yet enhancements to the program were ongoing throughout the screening period. Detailed referral forms from primary care physicians, coupled with information obtained during telephone interviews, facilitated high colonoscopy completion rates and excellent patient satisfaction. Similarly valuable was the employment of a bilingual patient navigator, who provided practical and emotional patient support. Academic medical centers can be efficient models for providing CRC screening to disadvantaged populations. Coordination of care by a preventive medicine department, directing the recruitment, scheduling, prescreening education, and the evaluation and preparation of target populations had an overall positive effect on CRC screening with colonoscopy among patients from a community health center. © 2013 American Cancer Society.

[The Contribution of GMP-grade Hospital Preparation to Translational Research].

PubMed

Yonezawa, Atsushi; Kajiwara, Moto; Minami, Ikuko; Omura, Tomohiro; Nakagawa, Shunsaku; Matsubara, Kazuo

2015-01-01

Translational research is important for applying the outcomes of basic research studies to practical medical treatments. In exploratory early-phase clinical trials for an innovative therapy, researchers should generally manufacture investigational agents by themselves. To provide investigational agents with safety and high quality in clinical studies, appropriate production management and quality control are essential. In the Department of Pharmacy of Kyoto University Hospital, a manufacturing facility for sterile drugs was established, independent of existing manufacturing facilities. Manuals on production management and quality control were developed according to Good Manufacturing Practices (GMP) for Investigational New Drugs (INDs). Advanced clinical research has been carried out using investigational agents manufactured in our facility. These achievements contribute to both the safety of patients and the reliability of clinical studies. In addition, we are able to do licensing-out of our technique for the manufacture of investigational drugs. In this symposium, we will introduce our GMP grade manufacturing facility for sterile drugs and discuss the role of GMP grade hospital preparation in translational research.

An analysis of contextual information relevant to medical care unexpectedly volunteered to researchers by asthma patients.

PubMed

Black, Heather L; Priolo, Chantel; Gonzalez, Rodalyn; Geer, Sabrina; Adam, Bariituu; Apter, Andrea J

2012-09-01

To describe and categorize contextual information relevant to patients' medical care unexpectedly volunteered to research personnel as part of a patient advocate (PA) intervention to facilitate access health care, communication with medical personnel, and self-management of a chronic disease such as asthma. We adapted a patient navigator intervention, to overcome barriers to access and communication for adults with moderate or severe asthma. Informed by focus groups of patients and providers, our PAs facilitated preparation for a visit with an asthma provider, attended the visit, confirmed understanding, and assisted with post-visit activities. During meetings with researchers, either for PA activities or for data collection, participants frequently volunteered personal and medical information relevant for achieving successful self-management that was not routinely shared with medical personnel. For this project, researchers journaled information not captured by the structured questionnaires and protocol. Using a qualitative analysis, we describe (1) researchers' journals of these unique communications; (2) their relevance for accomplishing self-management; (3) PAs' formal activities including teach-back, advocacy, and facilitating appointment making; and (4) observations of patients' interactions with the clinical practices. In 83 journals, patients' social support (83%), health (68%), and deportment (69%) were described. PA assistance with navigating the medical system (59%), teach-back (46%), and observed interactions with patient and medical staff (76%) were also journaled. Implicit were ways patients and practices could overcome barriers to access and communication. These journals describe the importance of seeking contextual and medically relevant information from all patients and, especially, those with significant morbidities, prompting patients for barriers to access to health care, and confirming understanding of medical information.

An analysis of contextual information relevant to medical care unexpectedly volunteered to researchers by asthma patients

PubMed Central

Black, Heather L.; Priolo, Chantel; Gonzalez, Rodalyn; Geer, Sabrina; Adam, Bariituu; Apter, Andrea J.

2012-01-01

Objective To describe and categorize contextual information relevant to patients’ medical care unexpectedly volunteered to research personnel as part of a patient advocate intervention to facilitate access health care, communication with medical personnel, and self-management of a chronic disease like asthma. Methods We adapted a patient navigator intervention, to overcome barriers to access and communication for adults with moderate or severe asthma. Informed by focus groups of patients and providers, our Patient Advocates facilitated preparation for a visit with an asthma provider, attended the visit, confirmed understanding, and assisted with post-visit activities. During meetings with researchers, either for PA activities or data collection, participants frequently volunteered personal and medical information relevant for achieving successful self-management that was not routinely shared with medical personnel. For this project, researchers journaled information not captured by the structured questionnaires and protocol. Using a qualitative analysis, we describe 1) researchers’ journals of these unique communications, 2) their relevance for accomplishing self-management, 3) Patient Advocates’ formal activities including teach-back, advocacy, and facilitating appointment-making, and 4) observations of patients’ interactions with the clinical practices. Results In 83 journals, patients’ social support (83%), health (68%), and deportment (69%) were described. Patient Advocate assistance with navigating the medical system (59%), teach-back (46%), and observed interactions with patient and medical staff (76%) were also journaled. Implicit were ways patients and practices could overcome barriers to access and communication. Conclusions These journals describe the importance of seeking contextual and medically relevant information from all patients and especially those with significant morbidities, prompting patients for barriers to accessing care, and confirming understanding of medical information. PMID:22788543

In defense of genuine ignorance: supporting vitality and relevance in graduate curricula.

PubMed

Goren, S; Peter, L; Fischer, S

1992-01-01

Genuine ignorance, defined by John Dewey as curiosity and openmindedness in opposition to repetition of catch phrases and familiar propositions, is nurtured in graduate nursing curricula in which the educational process is congruent with course content. Preparation for advanced practice in the mental health environment of the foreseeable future required abandonment of the familiar medical model in favor of conceptual models consistent with current thinking in psychiatric nursing and exposure to current problems (homelessness, family violence, AIDS) and current problem solving strategies (brief treatment, family preservation). Involvement in practice-based research and operationalizing new perspectives on familiar clinical problems, are suggested as strategies for developing the advanced practitioner. Two of the authors, former graduate students, describe the impact of changed perspectives and research activity on their own practice.

Cost Analysis of the Military Medical Care System

DTIC Science & Technology

1994-09-01

Appliance Clinic Psychiatric Care AFA Psychiatrics AFB Substance Abuse Rehabilitation AGF FamilN Practice Psychiatry IV-5 The MIEPRS cost data come from...Levine Joseph-Paul Wilusz r)TIC, September 1994 ; 1. o [, iC 9’,• 00f 0 ,199;4 U Prepared for Office of the Director ( Program Analysis and Evaluation...on decisions effecting major programs . (b) address issues at signiticant concern to the Executiv3 Branch, the Congress and/or the public, or (c

JPRS Report, Science and Technology, USSR: Science and Technology Policy.

DTIC Science & Technology

1990-07-23

complex jobs, which are now "nobody’s." For precisely these intermediate directions are the most promising with respect to future discoveries. At the...34Of course! I work as an aircraft designer, while the invention applies to medical equipment. The coopera- tive is prepared to pay all the necessary...the introduction and practical appli - cation of useful technical innovations. The main principle is "from the idea to the finished product." We

[Study thought of pharmaceutical preparations quality standards by dynamic quality control technology].

PubMed

Yu, Dan-Hong; Mao, Chen-Mei; Lv, Cheng-Zhe; Jin, Hui-Zhen; Yao, Xin; Jia, Xiao-Bin

2014-07-01

Pharmaceutical preparations, particularly as a "secret recipe" of traditional Chinese medicine in medical institutions, are the product of China's medical and health industry, and they are also an important means of competing of different medical institutions. Although pharmaceutical preparations have advantages and characteristics than institutes for drug and pharmaceutical companies, the quality standards of pharmaceutical preparations in medical institutions has not reached the desired level over the years. As we all know, the quality of pharmaceutical preparations is important to ensure the efficacy, especially under the environment of people pay more sttention on drug safety and effectiveness and contry increase emphasis on the stste of pharmaceutical preparations. In view of this, we will improve the grade, stability, and clinical efficacy of pharmaceutical preparations by the advanced equipment, testing instruments and the process dynamic quality control technology. Finally, we hope we can provide new ideas for the quality control of pharmaceutical preparations.

From primary care to public health: using Problem-based Learning and the ecological model to teach public health to first year medical students.

PubMed

Hoover, Cora R; Wong, Candice C; Azzam, Amin

2012-06-01

We investigated whether a public health-oriented Problem-Based Learning case presented to first-year medical students conveyed 12 "Population Health Competencies for Medical Students," as recommended by the Association of American Medical Colleges and the Regional Medicine-Public Health Education Centers. A public health-oriented Problem-Based Learning case guided by the ecological model paradigm was developed and implemented among two groups of 8 students at the University of California, Berkeley-UCSF Joint Medical Program, in the Fall of 2010. Using directed content analysis, student-generated written reports were coded for the presence of the 12 population health content areas. Students generated a total of 29 reports, of which 20 (69%) contained information relevant to at least one of the 12 population health competencies. Each of the 12 content areas was addressed by at least one report. As physicians-in-training prepare to confront the challenges of integrating prevention and population health with clinical practice, Problem-Based Learning is a promising tool to enhance medical students' engagement with public health.

Medical students' use of Facebook for educational purposes.

PubMed

Ali, Anam

2016-06-01

Medical students use Facebook to interact with one another both socially and educationally. This study investigates how medical students in a UK medical school use Facebook to support their learning. In particular, it identifies the nature of their educational activities, and details their experiences of using an educational Facebook group. Twenty-four medical students who self-identified as being Facebook users were invited to focus groups to attain a general overview of Facebook use within an educational context. A textual analysis was then conducted on a small group of intercalating medical students who used a self-created Facebook group to supplement their learning. Five of these students participated in semi-structured interviews. Six common themes were generated. These included 'collaborative learning', 'strategic uses for the preparation for assessment', 'sharing experiences and providing support', 'creating and maintaining connections', 'personal planning and practical organization' and 'sharing and evaluating educational resources'. Evidence from this study shows that medical students are using Facebook informally to enhance their learning and undergraduate lives. Facebook has enabled students to create a supportive learning community amongst their peers. Medical educators wishing to capitalize on Facebook, as a platform for formal educational initiatives, should remain cautious of intruding on this peer online learning community.

Momordica charantia for type 2 diabetes mellitus.

PubMed

Ooi, Cheow Peng; Yassin, Zaitun; Hamid, Tengku-Aizan

2012-08-15

Momordica charantia (bitter gourd) is not only a nutritious vegetable but it is also used in traditional medical practices to treat type 2 diabetes mellitus. Experimental studies with animals and humans suggested that the vegetable has a possible role in glycaemic control. To assess the effects of mormodica charantia for type 2 diabetes mellitus. Several electronic databases were searched, among these were The Cochrane Library (Issue 1, 2012), MEDLINE, EMBASE, CINAHL, SIGLE and LILACS (all up to February 2012), combined with handsearches. No language restriction was used. We included randomised controlled trials (RCTs) that compared momordica charantia with placebo or a control intervention, with or without pharmacological or non-pharmacological interventions. Two authors independently extracted data. Risk of bias of the trials was evaluated using the parameters of randomisation, allocation concealment, blinding, completeness of outcome data, selective reporting and other potential sources of bias. A meta-analysis was not performed given the quality of data and the variability of preparations of momordica charantia used in the interventions (no similar preparation was tested twice). Four randomised controlled trials with up to three months duration and investigating 479 participants met the inclusion criteria. Risk of bias of these trials (only two studies were published as a full peer-reviewed publication) was generally high. Two RCTs compared the effects of preparations from different parts of the momordica charantia plant with placebo on glycaemic control in type 2 diabetes mellitus. There was no statistically significant difference in the glycaemic control with momordica charantia preparations compared to placebo. When momordica charantia was compared to metformin or glibenclamide, there was also no significant change in reliable parameters of glycaemic control. No serious adverse effects were reported in any trial. No trial investigated death from any cause, morbidity, health-related quality of life or costs. There is insufficient evidence on the effects of momordica charantia for type 2 diabetes mellitus. Further studies are therefore required to address the issues of standardization and the quality control of preparations. For medical nutritional therapy, further observational trials evaluating the effects of momordica charantia are needed before RCTs are established to guide any recommendations in clinical practice.

Momordica charantia for type 2 diabetes mellitus.

PubMed

Ooi, Cheow Peng; Yassin, Zaitun; Hamid, Tengku-Aizan

2010-02-17

Momordica charantia is not only a nutritious vegetable, but is also used in traditional medical practices to treat type 2 diabetes mellitus. Experimental studies with animals and humans suggested that the vegetable has a possible role in glycaemic control. To assess the effects of mormodica charantia for type 2 diabetes mellitus. Several electronic databases were searched, among these The Cochrane Library (issue 4, 2009), MEDLINE, EMBASE, CINAHL, SIGLE and LILACS (all up to November 2009), combined with handsearches. No language restriction was used. Randomized controlled trials that compared momordica charantia with a placebo or a control intervention with or without pharmacological or non-pharmacological interventions were included. Two authors independently extracted the data. Risk of bias of trials was evaluated using the parameters of randomization, allocation concealment, blinding, completeness of outcome data, selective reporting and other potential sources of bias. A meta-analysis was not performed given the quality of data and the variability of preparations of momordica charantia used in interventions (no similar preparation was tested twice). Three randomised controlled trials with up to three months duration and investigating 350 participants met the inclusion criteria. Risk of bias of these trials (only one study was published as a full peer-reviewed publication) was generally high. Two RCTs compared the effect of preparations from different parts of the momordica charantia plants and placebo on the glycemic control in type 2 diabetes mellitus. There was no statistically significant difference compared to placebo. The effects of preparation from the leaves of the plant and glibenclamide were comparable in the third trial. No serious adverse effects were reported in all the trials. There were no documentations of death from any cause, morbidity, (health-related) quality of life and costs. There is insufficient evidence to recommend momordica charantia for type 2 diabetes mellitus. Further studies are therefore required to address the issues of standardization and the quality control of preparations. For medical nutritional therapy, further observational trials evaluating the effects of momordica charantia are needed before RCTs are established to guide any recommendations in clinical practice.

Evaluating the impact of a pre-rotation workshop on student preparation for clinical advanced pharmacy practice experiences.

PubMed

Medina, Melissa S; Stark, Jennifer E; Vesta, Kimi S; Lockhart, Staci M

2008-10-01

This pilot study was designed to evaluate the impact of a pre-rotation workshop (PRW) on pharmacy students' clinical skills and preparation for clinical Advanced Pharmacy Practice Experiences (APPE) involving direct patient care. Randomized controlled trial of an educational intervention with Institutional Review Board approval. PRW activities designed to simulate rotation activities around five competencies, patient charts, medication histories, SOAP notes, patient presentations, and professionalism. Endpoints were evaluated using clinical rotation preceptors' evaluation of performance and students' performance on objective structured clinical exams (OSCE). Eight fourth-year students and eight GPA matched controls (20% of the total class) were selected to voluntarily participate. The PRW demonstrated a positive impact on students' clinical skills and preparation for rotations by improving OSCE performance. However, no significant differences were found between groups when comparing preceptor evaluations of skills on rotations. These results are limited by the small sample size, potential OSCE "test-wiseness" effects, lack of OSCE evaluator blinding to study groups, potential case specificity effects due to the limited number of cases used on the OSCE and possible lack of sensitivity of the rotation evaluation tool to capture true differences among the experimental and control group participants. The PRW was successful at advancing students' clinical skills and preparation for rotations and may be considered as a tool to help bridge didactic to clinical experiences in the Pharm.D. curriculum.

Deficient crisis-probing practices and taken-for-granted assumptions in health organisations.

PubMed

Canyon, Deon V; Adhikari, Ashmita; Cordery, Thomas; Giguère-Simmonds, Philippe; Huang, Jessica; Nguyen, Helen; Watson, Michael; Yang, Daniel

2011-04-18

The practice of crisis-probing in proactive organisations involves meticulous and sustained investigation into operational processes and management structures for potential weaknesses and flaws before they become difficult to resolve. In health organisations, crisis probing is a necessary part of preparing to manage emerging health threats. This study examined the degree of pre-emptive probing in health organisations and the type of crisis training provided to determine whether or not they are prepared in this area. This evidence-based study draws on cross-sectional responses provided by executives from chiropractic, physiotherapy, and podiatry practices; dental and medical clinics; pharmacies; aged care facilities; and hospitals. The data show a marked lack of mandatory probing and a generalised failure to reward crisis reporting. Crisis prevention training is poor in all organisations except hospitals and aged care facilities where it occurs at an adequate frequency. However this training focuses primarily on natural disasters, fails to address most other crisis types, is mostly reactive and not designed to probe for and uncover key taken-for-granted assumptions. Crisis-probing in health organisations is inadequate, and improvements in this area may well translate into measurable improvements in preparedness and response outcomes.

Deficient crisis-probing practices and taken-for-granted assumptions in health organisations

PubMed Central

Canyon, Deon V.; Adhikari, Ashmita; Cordery, Thomas; Giguère-Simmonds, Philippe; Huang, Jessica; Nguyen, Helen; Watson, Michael; Yang, Daniel

2011-01-01

The practice of crisis-probing in proactive organisations involves meticulous and sustained investigation into operational processes and management structures for potential weaknesses and flaws before they become difficult to resolve. In health organisations, crisis probing is a necessary part of preparing to manage emerging health threats. This study examined the degree of pre-emptive probing in health organisations and the type of crisis training provided to determine whether or not they are prepared in this area. This evidence-based study draws on cross-sectional responses provided by executives from chiropractic, physiotherapy, and podiatry practices; dental and medical clinics; pharmacies; aged care facilities; and hospitals. The data show a marked lack of mandatory probing and a generalised failure to reward crisis reporting. Crisis prevention training is poor in all organisations except hospitals and aged care facilities where it occurs at an adequate frequency. However this training focuses primarily on natural disasters, fails to address most other crisis types, is mostly reactive and not designed to probe for and uncover key taken-for-granted assumptions. Crisis-probing in health organisations is inadequate, and improvements in this area may well translate into measurable improvements in preparedness and response outcomes. PMID:24149030

A practical guide for nurses in diluent selection for subcutaneous infusion using a syringe driver.

PubMed

McLeod, Fiona; Flowers, Charne

2006-12-01

Appropriate diluent selection in continuous subcutaneous infusion optimises symptom management and client well-being. The responsibility of diluent selection is commonly one of the attending nurse. This paper was developed with the intention of providing nurses with practical instruction for diluent selection when preparing medications for administration subcutaneously using a syringe driver. A literature review was undertaken of published journal databases and published guidelines sites. Recommendations regarding diluent choice were reviewed in two iterations by an expert panel of palliative care nurse clinicians. The principles for diluent selection are presented. They are based primarily on expert opinion level of evidence given a lack of primary research evidence in the area of diluent selection. There is a pressing need for manufacturers' guidance on diluent selection and independent research to establish the impact of diluents on drug and drug combinations when using syringe drivers. Until such time that this evidence is available to guide practice, clinicians need to be trained to inspect solutions and assess the effectiveness of the medication in controlling symptoms. The capacity of this paper to provide practical instruction has been limited by the lack of rigorous evidence available, and indeed, the process of developing this guide identified perhaps more questions than answers available at the present time.

Community-based clinical education increases motivation of medical students to medicine of remote area: comparison between lecture and practice.

PubMed

Tani, Kenji; Yamaguchi, Harutaka; Tada, Saaya; Kondo, Saki; Tabata, Ryo; Yuasa, Shino; Kawaminami, Shingo; Nakanishi, Yoshinori; Ito, Jun; Shimizu, Nobuhiko; Obata, Fumiaki; Shin, Teruki; Bando, Hiroyasu; Kohno, Mitsuhiro

2014-01-01

In this study, we administered a questionnaire to medical students to evaluate the effect of community-based clinical education on their attitudes to community medicine and medicine in remote area. Questionnaires were given 4 times to all the students from first-year to sixth-year. Of 95 students, 65 students (68.4%) who completed all questionnaires, were used in this study. The intensity of students' attitudes was estimated by using visual analogue scale. The intensity of interest, a sense of fulfillment and passion in medicine of remote area was significantly increased after the community-based practice. On the other hand, the level of understanding in medicine in remote area was increased by the lecture not by the practice. The intensity of desire both to become a generalist and a specialist was significantly increased when the grade went up. Most of sixth-year students desired to have abilities of a generalist and a specialist simultaneously. This study shows that the community-based practice is more meaningful in increasing motivation in medicine in remote area than the lecture, and suggests that it is important to prepare more courses to experience community medicine to increase the number of physicians who desire to work in remote area.

[Patient-centred prescription model to improve adequate prescription and therapeutic adherence in patients with multiple disorders].

PubMed

Espaulella-Panicot, Joan; Molist-Brunet, Núria; Sevilla-Sánchez, Daniel; González-Bueno, Javier; Amblàs-Novellas, Jordi; Solà-Bonada, Núria; Codina-Jané, Carles

Patients with multiple disorders and on multiple medication are often associated with clinical complexity, defined as a situation of uncertainty conditioned by difficulties in establishing a situational diagnosis and decision-making. The patient-centred care approach in this population group seems to be one of the best therapeutic options. In this context, the preparation of an individualised therapeutic plan is the most relevant practical element, where the pharmacological plan maintains an important role. There has recently been a significant increase in knowledge in the area of adequacy of prescription and adherence. In this context, we must find a model must be found that incorporates this knowledge into clinical practice by the professionals. Person-centred prescription is a medication review model that includes different strategies in a single intervention. It is performed by a multidisciplinary team, and allows them to adapt the pharmacological plan of patients with clinical complexity. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

VI. Uterine fibroid embolization: developing a clinical service.

PubMed

Chrisman, Howard B; Smith, Steven J; Sterling, Keith M; Vogelzang, Robert; Bonn, Joseph; Andrews, Robert T; Worthington-Kirsch, Robert L; Goodwin, Scott C; Lipman, John C; Siskin, Gary P; Hovsepian, David M

2002-03-01

Building a uterine fibroid embolization (UFE) practice can be a complex process. Choices must be made regarding whether to align oneself with a gynecologist or to accept direct referrals. For the interventional radiologist, the responsibilities of evaluation and patient care pose unique and time-consuming administrative and clinical challenges. Physician extenders, either nurse practitioners or physician's assistants, play key roles as clinical coordinators by guiding the patient through the medical system and making certain that she is cleared for the procedure medically and logistically. In some settings, they may also assist in many of the technical aspects of the procedure and postoperative care. Interventional radiologists must be prepared for battles with insurance companies and be willing to go through the appeals process. Business officers must also be trained to properly code for the procedures to insure optimal reimbursement. The success of building a UFE practice may also be bolstered by directly marketing to patients and by providing them with access via the Internet. Copyright 2002, Elsevier Science (USA). All rights reserved.

Learning basic surgical skills with mental imagery: using the simulation centre in the mind.

PubMed

Sanders, Charles W; Sadoski, Mark; van Walsum, Kim; Bramson, Rachel; Wiprud, Robert; Fossum, Theresa W

2008-06-01

Although surgeons and athletes frequently use mental imagery in preparing to perform, mental imagery has not been extensively researched as a learning technique in medical education. A mental imagery rehearsal technique was experimentally compared with textbook study to determine the effects of each on the learning of basic surgical skills. Sixty-four Year 2 medical students were randomly assigned to 2 treatment groups in which they undertook either mental imagery or textbook study. Both groups received the usual skills course of didactic lectures, demonstrations, physical practice with pigs' feet and a live animal laboratory. One group received additional training in mental imagery and the other group was given textbook study. Performance was assessed at 3 different time-points using a reliable rating scale. Analysis of variance on student performance in live rabbit surgery revealed a significant interaction favouring the imagery group over the textbook study group. The mental imagery technique appeared to transfer learning from practice to actual surgery better than textbook study.

Can the tools of activity theory help us in advancing understanding and organisational change in undergraduate medical education?

PubMed

Reid, Anne-Marie; Ledger, Alison; Kilminster, Sue; Fuller, Richard

2015-08-01

Continued changes to healthcare delivery in the UK, and an increasing focus on patient safety and quality improvement, require a radical rethink on how we enable graduates to begin work in challenging, complex environments. Professional regulatory bodies now require undergraduate medical schools to implement an 'assistantship' period in the final year of study, where senior medical students 'shadow' the work of junior doctors, with an expectation that they will be better 'prepared' for work. However, there is little guidance about what an 'assistantship' entails and the current emphasis on preparedness of students arguably underplays the importance of contextualised learning within the workplace environment. This paper will describe a modified Development Work Research (DWR) (Engeström in Developmental work research: activity theory in practice. Lehmanns Media, Berlin, 2005) approach to organisational change, enabling academic, clinical and administrative partners to develop assistantship placements in different hospitals. Our findings indicate that a modified DWR approach can reveal factors indicating organisational readiness to support change within a locally contextualised framework. The process has significant practical applications across a range of healthcare disciplines, as all professions seek to engage with the challenge of enabling successful transitions of graduates to the workplace.

[Education Program of Kampo-medicine for Undergraduates in Preparation for Clinical Setting].

PubMed

Homma, Masato

2016-01-01

Kampo-medicine has become popular in Japanese medical practice combined with western medicine. For example, Daikenchu-To for intestinal obstruction after surgical operation, Shakuyakukanzo-To and Goshajinki-Gan for anti-cancer agents-induced neuropathy, and Yokkan-San for behavioral psychological symptoms of dementia are alternatively used in addition to conventional treatments in Japan. However, combined use of Kampo-medicine and western medicine may cause unexpected adverse events including undesirable drug-drug interactions because Kampo-medicine was not originally developed to be used with western medicine. Although adverse effects of Kampo-medicine are rare compared with those of western medicine, severe events such as liver dysfunction and interstitial pneumonia have been reported in increasing trends. Medical staff including pharmacists, therefore, should be aware of the onset of adverse events before the patients' symptoms become severe. Several adverse effects are caused by chemical constituents such as glycyrrhizin in licorice for pseudoaldosteronism and geniposide in Gardeniae fructus for mesenteric phlebosclerosis. To understand the adverse effects of Kampo-medicine, pharmacists should learn trends in current medication as well as pharmacology and toxicology of the chemical constituents in pharmacognosy. These issues should also be addressed in educational materials for students of clinical pharmacy and pharmacy practice.

Preparing to take the USMLE Step 1: a survey on medical students' self-reported study habits.

PubMed

Kumar, Andre D; Shah, Monisha K; Maley, Jason H; Evron, Joshua; Gyftopoulos, Alex; Miller, Chad

2015-05-01

The USA Medical Licensing Examination Step 1 is a computerised multiple-choice examination that tests the basic biomedical sciences. It is administered after the second year in a traditional four-year MD programme. Most Step 1 scores fall between 140 and 260, with a mean (SD) of 227 (22). Step 1 scores are an important selection criterion for residency choice. Little is known about which study habits are associated with a higher score. To identify which self-reported study habits correlate with a higher Step 1 score. A survey regarding Step 1 study habits was sent to third year medical students at Tulane University School of Medicine every year between 2009 and 2011. The survey was sent approximately 3 months after the examination. 256 out of 475 students (54%) responded. The mean (SD) Step 1 score was 229.5 (22.1). Students who estimated studying more than 8-11 h per day had higher scores (p<0.05), but there was no added benefit with additional study time. Those who reported studying <40 days achieved higher scores (p<0.05). Those who estimated completing >2000 practice questions also obtained higher scores (p<0.01). Students who reported studying in a group, spending the majority of study time on practice questions or taking >40 preparation days did not achieve higher scores. Certain self-reported study habits may correlate with a higher Step 1 score compared with others. Given the importance of achieving a high Step 1 score on residency choice, it is important to further identify which characteristics may lead to a higher score. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Safety of patient meals in 2 hospitals in Alexandria, Egypt before and after training of food handlers.

PubMed

El Derea, H; Salem, E; Fawzi, M; Abdel Azeem, M

2008-01-01

We assessed the food safety knowledge and food handling practices of 23 food handlers in 2 hospitals in Alexandria, Egypt [Gamal Abdel Nasser (GAN) and Medical Research Institute (MRI)] before and after a food safety training programme, and also the bacteriological quality of patient meals and kitchen equipment. There was a significant improvement in all knowledge-associated parameters except for personal hygiene in GAN. There was an improvement in the food safety practices in both hospitals. The bacteriological quality of most patient meals and food preparation surfaces and utensils improved after training. The bacteriological quality of patients' meals served in GAN was generally better than that in MRI.

Nurse practitioners and physician assistants: preparing new providers for hospital medicine at the mayo clinic.

PubMed

Spychalla, Megan T; Heathman, Joanne H; Pearson, Katherine A; Herber, Andrew J; Newman, James S

2014-01-01

Hospital medicine is a growing field with an increasing demand for additional healthcare providers, especially in the face of an aging population. Reductions in resident duty hours, coupled with a continued deficit of medical school graduates to appropriately meet the demand, require an additional workforce to counter the shortage. A major dilemma of incorporating nonphysician providers such as nurse practitioners and physician assistants (NPPAs) into a hospital medicine practice is their varying academic backgrounds and inpatient care experiences. Medical institutions seeking to add NPPAs to their hospital medicine practice need a structured orientation program and ongoing NPPA educational support. This article outlines an NPPA orientation and training program within the Division of Hospital Internal Medicine (HIM) at the Mayo Clinic in Rochester, MN. In addition to a practical orientation program that other institutions can model and implement, the division of HIM also developed supplemental learning modalities to maintain ongoing NPPA competencies and fill learning gaps, including a formal NPPA hospital medicine continuing medical education (CME) course, an NPPA simulation-based boot camp, and the first hospital-based NPPA grand rounds offering CME credit. Since the NPPA orientation and training program was implemented, NPPAs within the division of HIM have gained a reputation for possessing a strong clinical skill set coupled with a depth of knowledge in hospital medicine. The NPPA-physician model serves as an alternative care practice, and we believe that with the institution of modalities, including a structured orientation program, didactic support, hands-on learning, and professional growth opportunities, NPPAs are capable of fulfilling the gap created by provider shortages and resident duty hour restrictions. Additionally, the use of NPPAs in hospital medicine allows for patient care continuity that is otherwise missing with resident practice models.

The pattern of prescribing of glucose modulating agents for type 2 diabetes in general practices in England 2016/17.

PubMed

Heald, Adrian H; Livingston, Mark; Bien, Zuzanna; Moreno, Gabriela Y C; Laing, Ian; Stedman, Mike

2018-03-14

In the financial year 2016/17 there were 52.0 million items prescribed for diabetes at a total net ingredient cost of £983.7 million - up from 28.9 million prescription items and £572.4 million in 2006/07. Anti-diabetes drugs (British National Formulary section 6.1.2) make up 45.1 per cent of the total £983.7 million net ingredient cost of drugs used in diabetes and account for 72.0 per cent of prescription items for all diabetes prescribing. We examined the way that agents licensed to treat type 2 diabetes were used across GP practices in England in the year 2016/2017. Analysis was at a GP practice level not at the level of patient data. Annual prescribing costs / patient / medication type for monotherapy varied considerable from £11/year for gliclazide and glimepiride to £885/year for Liraglutide. The use of SGLT-2i agents grew strongly at 70% per annum to around 100,000 DDD with prescriptions seen in 95% of GP practices. Liraglutide expenditure (11% of total) was high for a relatively small number of patients (1.3% of Defined Daily Doses), with still significant spend on exenatide. Liraglutide use significantly exceeded that of other glucagon-like peptide-1 (GLP-1) agonists. Our work demonstrates the significant cost of medication to modulate tissue glucose levels in type 2 diabetes and the dominance of some non-generic preparations in terms of number of prescriptions and overall spend. There are some older sulphonylureas in use, which should not generally be prescribed. Regular audit of patient treatment at a general practice level will ensure appropriate targeted use of licensed medications and of their cost effectiveness. © 2018 John Wiley & Sons Ltd.

Collaborative research in medical education: a discussion of theory and practice.

PubMed

O'Sullivan, Patricia S; Stoddard, Hugh A; Kalishman, Summers

2010-12-01

Medical education researchers are inherently collaborators. This paper presents a discussion of theoretical frameworks, issues and challenges around collaborative research to prepare medical education researchers to enter into successful collaborations. It gives emphasis to the conceptual issues associated with collaborative research and applies these to medical education research. Although not a systematic literature review, the paper provides a rich discussion of issues which medical education researchers might consider when undertaking collaborative studies. Building on the work of others, we have classified collaborative research in three dimensions according to: the number of administrative units represented; the number of academic fields present, and the manner in which knowledge is created. Although some literature on collaboration focuses on the more traditional positivist perspective and emphasises outcomes, other literature comes from the constructivist framework, in which research is not driven by hypotheses and the approaches emphasised, but by the interaction between investigator and subject. Collaborations are more effective when participants overtly clarify their motivations, values, definitions of appropriate data and accepted methodologies. These should be agreed upon prior to commencing a study. The way we currently educate researchers should be restructured if we want them to be able to undertake interdisciplinary research. Despite calls for researchers to be educated differently, most training programmes for developing researchers have demonstrated a limited, if not contrary, response to these calls. Collaborative research in medical education should be driven by the problem being investigated, by the new knowledge gained and by the interpersonal interactions that may be achieved. Success rests on recognising that many of the research problems we, as medical educators, address are fundamentally interdisciplinary in nature. This represents a transition to bridge the dichotomy often presented in medical education between theory building and addressing practical needs. © Blackwell Publishing Ltd 2010.

Short-term volunteer health trips: aligning host community preferences and organizer practices

PubMed Central

Rozier, Michael D.; Lasker, Judith N.; Compton, Bruce

2017-01-01

ABSTRACT Background: Short-term medical missions (STMMs) are quite common and largely understood to be a response to health needs in low-income countries. Yet most information about STMM practices is anecdotal. Even less is known about the preferences of in-country host communities regarding STMMs. Objective: We aimed to gather enough quantitative and qualitative information from both STMM organizers and host community staff to compare dominant practices of organizers as well as preferences of host community staff. We use these data to discover differences between practices and preferences and suggest ways in which STMMs can be more responsive to the communities they serve. Methods: Researchers gathered online survey responses from 334 STMM organizers and conducted interviews to determine existing practices. Similar methods were used to collect 49 online survey responses from, and conduct 75 interviews with, host community staff. Results: Organizer practices and host community staff preferences are different in several areas. Organizers admit to minimal screening and preparation of volunteers whereas host staff have clear ideas of topics that should be covered in preparation, including culture and basic language skills. Organizers prioritize provision of clinical care during trips whereas host staff prioritize capacity building. Practices and preferences also differ in relation to the length of STMMs, the nature of the partnership itself, and the type of assessment and evaluation that is needed. Conclusions: The large amount of data gathered for this study allows us to confidently say that organizer practices are often not aligned with host community staff preferences. Several concrete changes can be made to STMMs to bring practices more in line with the desires of the communities they serve. PMID:28218547

[Recommendations for overcoming interface problems in medical rehabilitation of federal pension funds and statutory health insurance].

PubMed

Pohontsch, N; Träder, J-M; Scherer, M; Deck, R

2013-10-01

Interface problems in medical rehabilitation are a consequence of problems with communication and cooperation, lack of information and transparency. Different stakeholders are trying to solve these problems since many years or decades respectively. Following a series of deficit-oriented studies we tried to develop recommendations for possible solutions of important interface problems together with affected people based on a qualitative analysis of main problem areas. 10 separate group discussions with rehabilitation patients, general practitioners and specialists in private practices, representatives of the federal pension fund and statutory health insurance as well as clinicians from rehabilitation clinics and 3 mixed group discussions (all before mentioned groups excluding rehabilitation patients) were conducted. These group discussions served to prepare a semidiurnal final conference. All meetings were recorded and content analyzed or summarized in protocols respectively. Results are recommendations on strategies to reduce interface problems in medical rehabilitation. Those are: development of a rehabilitation-information-website for insurees and general practitioners and specialists in private practices; changes in forms, applications, notifications; advanced training for general practitioners and specialists in private practices und support in detecting rehabilitation need. Due to divided structures of care provision and increasing specialization, overcoming interface problems is one of the main challenges in the provision of medical rehabilitation. It can be met if different stakeholder approach each other without prejudices, share instead of demarcate competencies and are willing to strike new paths. Our recommendations represent the first step to reaching this goal. © Georg Thieme Verlag KG Stuttgart · New York.

Drug policy in Nicaragua, between need-oriented activities and aggression.

PubMed

Laporte, J R; Tognoni, G

1985-01-01

In this case study from Nicaragua, an account is given of how the Essential Drugs Program developed in a context which relectss exceptional political, economic and military pressures. The overall picture could provide a useful guide to the issues behind such an apparently simple concept as the essential drugs list. The criteria for including drugs in the National Formulary were those of the WHO report on essential drugs: proven efficacy, acceptable risks associated with their use, favorable cost, and need. A proposal of the basic list of drugs, classified in therapeutic groups and according to their priority and level of use, was prepared by a central Committee for the National Drug Formulary. An annotated Formulary was prepared to ensure consistency with rigorous scientific standards and to meet the needs of daily practice. The annotated therapeutic formulary has been distributed to all physicians, other health workers responsible for peripheral health centers, pharmacists, and medical students. It has been adopted as the main reference textbook for teaching clinical pharmacology and therapeutics to medical students. A training program in clinical pharmacology has been started at the University Autonoma de Barcelona. It pays particular attention to drug evaluation, drug epidemiology methods, and retrieval and preparation of drug information for health workers.

Knowledge, attitude and use of alternative medical therapy amongst urban residents of Osun State, southwestern Nigeria.

PubMed

Bamidele, James Olusegun; Adebimpe, Wasiu Olalekan; Oladele, Edward Adekola

2009-05-07

Alternate medicine which has a long history has been relegated to the background by the evolution of modern medicine. In recent times, however, alternative medical therapy has been growing in popularity and getting increasing attention and interest. This study assessed the knowledge, attitude and use by urban dwellers of alternative medical therapies. This was a cross-sectional descriptive study which used a semi-structured questionnaire to gather information from 812 randomly selected urban respondents. Majority 734 (90.4%) of the respondents were aware of an alternative way of getting treatment for their ailments apart from the orthodox medicine. The forms of alternative medical therapy (AMT) respondents were aware of include: concoction (herbal preparations) 683 (94.2%); herbalists/traditionalists 616 (85.0%); traditional bone setters therapy 434 (59.9%); among others. The main source of information was through radio 439 (70.9%). About half 403 (54.9%) of the respondents were aware of side effects from AMT and these include diarrhea, abdominal pain and vomiting which accounts for 69.7%; 42.2% and 40.2% respectively. About 347 (47.3%) think AMT could be injurious to health. About a third 262 (35.7%) of the respondents who were aware of AMT prefers it to orthodox medicine. Reasons given for the preference were that: AMT is cheap 56 (21.4%); accessible 43 (16.4%) and acceptable 35 (13.4%) to them. About half 367 (50.0%) also believed AMT alone could cure their illness without resort to orthodox medical therapy (OMT). Over half 401 (54.6%) of the 734 respondents that were aware of AMT had patronized or taken one form of alternative medical therapy or the other in the last 12 months prior to the study. Of these number, 323 (80.5%) had taken concoction (herbal preparations). However, there was no relationship between respondents' age, sex, educational level or religion and the patronage of AMT as all test of associations were not statistically significant p>0.05. This study has revealed that the use of alternative medical therapies is quite popular among the studied population and a high proportion of the respondents use AMT notwithstanding that they live in the urban communities where they have better access to orthodox medical care and medical practitioners. Regulations should be made concerning the advertisement of alternative medicine and practices as orthodox medicine and practices are usually not advertised.

Precision medicine in oncology: New practice models and roles for oncology pharmacists.

PubMed

Walko, Christine; Kiel, Patrick J; Kolesar, Jill

2016-12-01

Three different precision medicine practice models developed by oncology pharmacists are described, including strategies for implementation and recommendations for educating the next generation of oncology pharmacy practitioners. Oncology is unique in that somatic mutations can both drive the development of a tumor and serve as a therapeutic target for treating the cancer. Precision medicine practice models are a forum through which interprofessional teams, including pharmacists, discuss tumor somatic mutations to guide patient-specific treatment. The University of Wisconsin, Indiana University, and Moffit Cancer Center have implemented precision medicine practice models developed and led by oncology pharmacists. Different practice models, including a clinic, a clinical consultation service, and a molecular tumor board (MTB), were adopted to enhance integration into health systems and payment structures. Although the practice models vary, commonalities of three models include leadership by the clinical pharmacist, specific therapeutic recommendations, procurement of medications for off-label use, and a research component. These three practice models function as interprofessional training sites for pharmacy and medical students and residents, providing an important training resource at these institutions. Key implementation strategies include interprofessional involvement, institutional support, integration into clinical workflow, and selection of model by payer mix. MTBs are a pathway for clinical implementation of genomic medicine in oncology and are an emerging practice model for oncology pharmacists. Because pharmacists must be prepared to participate fully in contemporary practice, oncology pharmacy residents must be trained in genomic oncology, schools of pharmacy should expand precision medicine and genomics education, and opportunities for continuing education in precision medicine should be made available to practicing pharmacists. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

A parenteral nutrition use survey with gap analysis.

PubMed

Boullata, Joseph I; Guenter, Peggi; Mirtallo, Jay M

2013-03-01

Parenteral nutrition (PN) is a high-alert medication for which safe practice guidelines are available. Recent adverse events associated with PN have been widely reported. A survey of current practices was indicated as new guidelines are being considered. A web-based survey consisting of 70 items was made available for the month of August 2011. Respondents provided answers to questions that addressed all aspects of the PN use process. There were a total of 895 respondents to the survey, including dietitians, nurses, pharmacists, and physicians. They predominantly represented hospital settings (89%), with 44% from academic institutions. Most organizations use a once-daily PN admixture with 21% outsourcing preparation. Electronic PN order entry is available in one-third of organizations, and the use of standardized order sets prevails. Unfortunately, electronic interfaces between computer systems remain infrequent, meaning that at least one transcription step is required by most in the PN use process. There are a wide variety of methods for ordering PN components, many of which are inconsistent with safe practices. Most organizations dedicate a pharmacist to review the PN orders, many of which require clarifications. Documentation at each step of the PN use process with oversight to identify deviations from best practice recommendations is infrequent. A significant proportion (44%) does not track PN-related medication errors. The survey data are a valuable snapshot of current practices with PN. Poor compliance with some of the safe practice guidelines continues. This will help guide new safety initiatives for the PN use process.

Practical Problems with Medication Use that Older People Experience: A Qualitative Study

PubMed Central

Notenboom, Kim; Beers, Erna; van Riet-Nales, Diana A; Egberts, Toine C G; Leufkens, Hubert G M; Jansen, Paul A F; Bouvy, Marcel L

2014-01-01

Objectives To identify the practical problems that older people experience with the daily use of their medicines and their management strategies to address these problems and to determine the potential clinical relevance thereof. Design Qualitative study with semistructured face-to-face interviews. Setting A community pharmacy and a geriatric outpatient ward. Participants Community-dwelling people aged 70 and older (N = 59). Measurements Participants were interviewed at home. Two researchers coded the reported problems and management strategies independently according to a coding scheme. An expert panel classified the potential clinical relevance of every identified practical problem and associated management strategy using a 3-point scale. Results Two hundred eleven practical problems and 184 management strategies were identified. Ninety-five percent of the participants experienced one or more practical problems with the use of their medicines: problems reading and understanding the instructions for use, handling the outer packaging, handling the immediate packaging, completing preparation before use, and taking the medicine. For 10 participants, at least one of their problems, in combination with the applied management strategy, had potential clinical consequences and 11 cases (5% of the problems) had the potential to cause moderate or severe clinical deterioration. Conclusion Older people experience a number of practical problems using their medicines, and their strategies to manage these problems are sometimes suboptimal. These problems can lead to incorrect medication use with clinically relevant consequences. The findings pose a challenge for healthcare professionals, drug developers, and regulators to diminish these problems. PMID:25516030

Automatic delineation and 3D visualization of the human ventricular system using probabilistic neural networks

NASA Astrophysics Data System (ADS)

Hatfield, Fraser N.; Dehmeshki, Jamshid

1998-09-01

Neurosurgery is an extremely specialized area of medical practice, requiring many years of training. It has been suggested that virtual reality models of the complex structures within the brain may aid in the training of neurosurgeons as well as playing an important role in the preparation for surgery. This paper focuses on the application of a probabilistic neural network to the automatic segmentation of the ventricles from magnetic resonance images of the brain, and their three dimensional visualization.

Sensitive and controversial ethical issues subject of groundbreaking Toronto exhibit.

PubMed Central

Kezwer, G; Kramer, D

1996-01-01

Medical research and practice have always posed many ethical dilemmas for scientists and physicians, but technologic advances mean that the questions are becoming even more difficult. That is why an exhibit, A Question of Truth, that is being prepared at Toronto's Ontario Science Centre is so timely. It examines the biases and political climates in which science operates, as well as the relative subjectivity of truth, knowledge and reality. Images p1484-a p1485-a p1486-a PMID:8943940

Adult care providers' perspectives on the transition to adult care for emerging adults with Type 1 diabetes: a cross-sectional survey.

PubMed

Michaud, S; Dasgupta, K; Bell, L; Yale, J-F; Anjachak, N; Wafa, S; Nakhla, M

2018-03-25

To assess adult diabetes care providers' current transition practices, knowledge about transition care, and perceived barriers to implementation of best practices in transition care for emerging adults with Type 1 diabetes mellitus. We administered a 38-item web-based survey to adult diabetes care providers identified through the Québec Endocrinologist Medical Association and Diabetes Québec. Fifty-three physicians responded (35%). Fewer than half of all respondents (46%) were familiar with the American Diabetes Association's transition care position statement. Approximately one-third of respondents reported a gap of >6 months between paediatric and adult diabetes care. Most (83%) believed communication with the paediatric team was adequate; however, only 56% reported receiving a medical summary and 2% a psychosocial summary from the paediatric provider. Respondents believed that the paediatric team should improve emerging adults' preparation for transition care by developing their self-management skills and improve teaching about the differences between paediatric and adult-oriented care. Only 31% had a system for identifying emerging adults lost to follow-up in adult care. Perceived barriers included difficulty accessing psychosocial services, emerging adults' lack of motivation, and inadequate transition preparation. Most (87%) were interested in having additional resources, including a self-care management tool and a registry to track those lost to follow-up. Our findings highlight the need to better engage adult care providers into transition care practices. Despite adult physicians' interest in transition care, implementation of transition care recommendations and resources in clinical care remains limited. Enhanced efforts are needed to improve access to mental health services within the adult healthcare setting. © 2018 Diabetes UK.

Preparing a cost analysis for the section of medical physics-guidelines and methods.

PubMed

Mills, M D; Spanos, W J; Jose, B O; Kelly, B A; Brill, J P

2000-01-01

Radiation oncology is a highly complex medical specialty, involving many varied routine and special procedures. To assure cost-effectiveness and maintain support for the medical physics program, managers are obligated to analyze and defend all aspects of an institutional billing and cost-reporting program. Present standards of practice require that each patient's radiation treatments be customized to fit his/her particular condition. Since the use of personnel time and other resources is highly variable among patients, graduated levels of charges have been established to allow for more precise billing. Some radiation oncology special procedures have no specific code descriptors; so existing codes are modified or additional information attached in order to avoid payment denial. Recent publications have explored the manpower needs, salaries, and other resources required to perform radiation oncology "physics" procedures. This information is used to construct a model cost-based resource use profile for a radiation oncology center. This profile can be used to help the financial officer prepare a cost report for the institution. Both civil and criminal penalties for Medicare fraud and abuse (intentional or unintentional) are included in the False Claims Act and other statutes. Compliance guidelines require managers to train all personnel in correct billing procedures and to review continually billing performance.

Sources of information on postgraduate medical training programs and medical specialty career resources-2006 update.

PubMed

Brazin, Lillian R

2006-01-01

This is the final biennial update listing directories, journal articles, Web sites, and general books that aid the librarian, house officer, or medical student in finding information on medical residency and fellowship programs. The World Wide Web provides the most complete and up-to-date source of information about postgraduate training programs and specialties. This update continues to go beyond postgraduate training resources to include selected Web sites and books on curriculum vitae writing, practice management, personal finances, the "Match," certification and licensure examination preparation, lifestyle issues, job hunting, and the DEA license application process. Print resources are included if they provide information not on the Internet, have features that are particularly useful, or cover too many relevant topics in depth to be covered in a journal article or on a Web site. The Internet is a major marketing tool for hospitals seeking to recruit the best and brightest physicians for their training programs. Even the smallest community hospital has a Web site.

Pharmacology and Therapeutics Education in the European Union Needs Harmonization and Modernization: A Cross‐sectional Survey Among 185 Medical Schools in 27 Countries

PubMed Central

Tichelaar, J; Okorie, M; Bissell, L; Christiaens, T; Likic, R; Mačìulaitis, R; Costa, J; Sanz, EJ; Tamba, BI; Maxwell, SR; Richir, MC; van Agtmael, MA

2017-01-01

Effective teaching in pharmacology and clinical pharmacology and therapeutics (CPT) is necessary to make medical students competent prescribers. However, the current structure, delivery, and assessment of CPT education in the European Union (EU) is unknown. We sent an online questionnaire to teachers with overall responsibility for CPT education in EU medical schools. Questions focused on undergraduate teaching and assessment of CPT, and students' preparedness for prescribing. In all, 185 medical schools (64%) from 27 EU countries responded. Traditional learning methods were mainly used. The majority of respondents did not provide students with the opportunity to practice real‐life prescribing and believed that their students were not well prepared for prescribing. There is a marked difference in the quality and quantity of CPT education within and between EU countries, suggesting that there is considerable scope for improvement. A collaborative approach should be adopted to harmonize and modernize the undergraduate CPT education across the EU. PMID:28295236

Meaning-Making among Medical Students: Development of a Quantitative Measure of Self-Authorship

ERIC Educational Resources Information Center

Fallar, Robert

2014-01-01

Preparation for and application to medical school, as well as the subsequent medical training of matriculating students, can have an important impact on psychosocial development. The premedical baccalaureate is the traditional preparation for medical school, although many medical schools also offer a separate entry path through early assurance…

Beliefs, practices, and experiences of Korean women in relation to childbirth.

PubMed

Park, K J; Peterson, L M

1991-01-01

Korean women's health beliefs and childbirth experiences in the United States were examined. A convenience sampling procedure was used, and face-to-face interviews were conducted in Korean. Interviews were audiotaped, typed, and translated from Korean to English. These women had a holistic concept of health. Some practices were influence by ancient Chinese medicine. Childbirth experiences indicated that language is a barrier requiring specific interventions. Recommendations include (a) development of an assessment tool with which health-care professionals can identify individual health beliefs early in pregnancy; (b) development of a bilingual pamphlet about medical terms and the U.S. health-care system; (c) development of a short bilingual dictionary of common foods for use in menu selection during hospitalization; and (d) provision of English practice periods based on anticipatory guidance principles to prepare women to ask for specific assistance.

Developing a comprehensive faculty development program to promote interprofessional education, practice and research at a free-standing academic health science center.

PubMed

Shrader, Sarah; Mauldin, Mary; Hammad, Sammar; Mitcham, Maralynee; Blue, Amy

2015-03-01

There is an on-going transformation in health professions education to prepare students to function as competent members of an interprofessional team in order to increase patient safety and improve patient care. Various methods of health education and practice directed toward students have been implemented, yet descriptions of faculty development initiatives designed to advance interprofessional education and practice are scarce. This article describes a faculty development program at the Medical University of South Carolina, USA, based on the conceptual framework of adult transformational learning theory. Three components comprise the faculty development program: an institute, fellowship and teaching series. Evaluations of the three components indicate that the faculty development program aided in the sustainability of the university's interprofessional program, and built capacity for improvement and growth in interprofessional endeavors.

Embedded Librarian as Research Team Member.

PubMed

Brahmi, Frances A; Kaplan, F Thomas D

2017-03-01

Adding a librarian to an upper extremity surgical and therapy practice has many advantages (educational, research, remaining on the cutting edge of technology). As an embedded team member, the librarian at the Indiana Hand to Shoulder Center prepares literature reviews, creates Google Scholar Alerts for individual clinicians, and introduces developing technologies such as 3-dimensional printers, Smartphone Apps, and online access to nontraditional resources. With the librarian relieving clinicians of these responsibilities, surgeons can devote more time to clinical and research activities. Private practices unable to support their own librarian could share access to a librarian via Skype, Face Time, and video conferencing. Another small practice alternative is contracting services from a local medical school library that designates a librarian as its liaison. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Foundations, Core Principles, Values, and Necessary Competencies of Interprofessional Team-Based Health Care.

PubMed

Vogt, H Bruce; Vogt, Jeremy J

2017-01-01

Health care reform has focused on improving health care delivery, quality, and patient safety. An interprofessional, team-based approach to health care is considered by many experts to be essential to meeting these goals. The evidence for this is growing. Core principles for team-based care and the interprofessional competencies necessary for a team to function effectively have been identified and can be taught. Resources for interprofessional education, which must begin at the health professions student level, are available to academic institutions, healthcare systems, and professional organizations to prepare students and current health care professionals for this cultural change. Models of successful collaborative practices exist in many forms and will continue to evolve as our expertise in best practices for interprofessional education and practice advance. Copyright© South Dakota State Medical Association.

Comparisons between the attitudes of medical and dental students toward the clinical importance of gross anatomy and physiology.

PubMed

Olowo-Ofayoku, Anthony; Moxham, Bernard John

2014-10-01

Marked changes are occurring within both the medical and dental curricula and new ways of teaching the basic sciences have been devised and traditional methods (e.g., dissection for gross anatomy and of bench-based animal preparations for physiology) are increasingly no longer the norm. Although there is much anecdotal evidence that students are not in favor of such changes, there is little evidence for this based on quantitative analyses of students' attitudes. Using Thurstone and Chave attitude analyses, we assessed the attitudes of first year medical and dental students at Cardiff University toward gross anatomy and physiology in terms of their perceived clinical importance. In addition, we investigated the appropriateness ("fitness for purpose") of teaching methodologies used for anatomy and physiology. The hypotheses tested recognized the possibility that medical and dental students differed in their opinions, but that they had a preference to being taught gross anatomy through the use of dissection and had no preference for physiology teaching. It was found that both medical and dental students displayed positive attitudes toward the clinical relevance of gross anatomy and that they preferred to be taught by means of dissection. Although both medical and dental students displayed positives attitudes toward the clinical relevance of physiology, this was greater for the medical students. Both medical and dental students showed a preference for being taught physiology through didactic teaching in small groups but the medical students also appreciated being taught by means of practicals. Overall, this study highlights the expectations that students have for the basic science foundation teaching within their professional training and signals a preference for being taught experientially/practically. Differences were discerned between medical and dental students that might reflect the direct association between systems physiology and pathophysiology and the application of this knowledge within the medical field in comparison to the dental field, which is heavily skill-based. © 2014 Wiley Periodicals, Inc.

Outcome analysis in lumbar spine: instabilities/degenerative disease.

PubMed

Fessler, R G

1997-01-01

In summary, expectations for outcome analysis have changed over the last several years. It is no longer the case that outcome analysis is expected to be done by academic institutions alone. Surgeons in private practice are rapidly approaching the time when outcome analysis of personal results will be necessary for competitive marketing purposes. In addition, the definition of outcome analysis has been considerably expanded from medical outcome to include functional outcome, return to work, quality of life, patient satisfaction, and cost-effectiveness. The above discussion has considered several aspects of data outcome analysis for degenerative disease of the lumbar spine. It is the intent of this review to help surgeons prepare themselves for changing expectations in their new medical environment.

How we tackled the problem of assessing humanities, social and behavioural sciences in medical education.

PubMed

Goodwin, Dawn; Machin, Laura

2016-01-01

Assessment serves as an important motivation for learning. However, multiple choice and short answer question formats are often considered unsatisfactory for assessment of medical humanities, and the social and behavioural sciences. Little consensus exists as to what might constitute 'best' assessment practice. What we did: We designed an assessment format closely aligned to the curricular approach of problem-based learning which allows for greater assessment of students' understanding, depth of knowledge and interpretation, rather than recall of rote learning. The educational impact of scenario-based assessment has been profound. Students reported changing their approach to PBL, independent learning and exam preparation by taking a less reductionist, more interpretative approach to the topics studied.

Medical cannabis in the treatment of cancer pain and spastic conditions and options of drug delivery in clinical practice.

PubMed

Landa, Leos; Jurica, Jan; Sliva, Jiri; Pechackova, Monika; Demlova, Regina

2018-03-01

The use of cannabis for medical purposes has been recently legalised in many countries including the Czech Republic. As a result, there is increased interest on the part of physicians and patients in many aspects of its application. This mini review briefly covers the main active substances of the cannabis plant and mechanisms of action. It focuses on two conditions, cancer pain and spasticity in multiple sclerosis, where its effects are well-documented. A comprehensive overview of a few cannabis-based products and the basic pharmacokinetics of marijuana's constituents follows. The review concludes with an outline for preparing cannabis (dried inflorescence) containing drug dosage forms that can be produced in a hospital pharmacy.

The pharmacist's role in promoting preconception health.

PubMed

El-Ibiary, Shareen Y; Raney, Erin C; Moos, Merry-K

2014-01-01

To review the pharmacist's role in preconception health. PubMed search using the terms preconception, immunizations, epilepsy, diabetes, depression, tobacco, asthma, hypertension, anticoagulation, pharmacist, pregnancy, and current national guidelines. Preconception health has become recognized as an important public health focus to improve pregnancy outcomes. Pharmacists have a unique role as accessible health care providers to optimize preconception health by screening women for tobacco use, appropriate immunizations, and current medication use. Counseling patients on preconception risk factors and adequate folic acid supplementation as well as providing recommendations for safe and effective management of chronic conditions are also critical and within the scope of practice for pharmacists. Pharmacists play an important role in medication screening, chronic disease state management, and preconception planning to aid women in preparing for healthy pregnancies.

Integrating psychology and obstetrics for medical students: shared labour ward teaching.

PubMed

Chalmers, B E; McIntyre, J A

1993-01-01

Two studies relating to the inclusion of psycho-social issues in the training of obstetricians are reported here. The first reports on the extent to which currently practising obstetricians have received training in these aspects. The second explored the value of an innovative teaching approach combining psychological and obstetric training for medical students in the labour ward. A postal survey with responses from 220 obstetricians and paediatricians revealed that little information on psychological aspects of obstetric practice had been included in their undergraduate or postgraduate training or obtained from voluntary continuing education programmes. Experience was the primary source of training in these subjects. The second study explored the impact of joint psychological and obstetric teaching ward rounds for medical students. Students attending these integrated sessions reported being better prepared for the psycho-social aspects of obstetrics and showed a greater awareness of cross-cultural differences in needs of women during birth.

[Prevention of medico-legal conflicts in medical practice].

PubMed

Minossi, José Guilherme

2009-02-01

Generally, medico-legal conflicts which occur in surgical and medical practice are a source of worry for both the medical profession and the society as a whole, because on one hand, they could cause high emotional stress for doctors, and on the other hand, patients could be rejected. Once consolidated, defensive medicine increases treatment costs and the doctor-patient relationship could transform into a tragedy. There are many causes for this, including non-treatment factors, such as an unsupported and disorganized health system, lack of participation from society and the doctor in improving this system, the training machine which launches a large number of young unprepared doctors to practice in this noble profession, along with a lack of continuing training, as there are few public or private institutions providing preparation, or further medical training. The related treatment factors are generally, a deficient doctor-patient relationship, poor work condition, power abuse by the doctor, a lack of clear agreement, and poor medical record keeping. These conflicts cannot be solved by simple creating legislation, or by denying the existence of medical error, which occurs at higher frequency than the actual conflicts. It is very important to improve the doctor-patient relationship because an effective fraternal relationship reduces the chance of a judicial demand. The doctor still needs to fully understand his/her conduct obligations and mainly to avoid power abuse. Doctors must also professionally link themselves with politicians who fight for the individual's rights against the system. Society must also understand that health is not just an issue exclusive for doctors, and people must fight to improve living conditions. Society must seriously show its frustration with the increasing disparity between scientific possibilities and actual wellbeing. The training machine needs immediate profound changes to produce professionals with the highest qualifications equipped for the needs of our population.

[Preparation and effect of a behavioral science-based education program for sleep improvement among medical students].

PubMed

Ueda, Masumi; Adachi, Yoshiko; Hayama, Junko; Yamagami, Toshiko

2008-01-01

The present study aimed to investigate a simple education program that is effective for sleep improvement among medical students who will be medical doctors in the future. The education program applied in the present study was developed for sleep improvement based on behavioral science and changes in knowledge and sleeping habits were observed. Subjects were 6th-year medical students of 2002 and 2003. Students of 2002 attended a program including a 90-minute lecture and a 2-week practice learning session, and students of 2003 attended only the lecture. In the lecture, behavior therapy for chronic insomnia was explained using a booklet. In the practice learning session, students set a target behavior for improvement and conducted self-monitoring of their sleep and the targeted behavior. Changes in knowledge about sleep, attitude toward the therapy, sleep, and sleep-related habits were observed and compared between the 2 groups of subjects immediately and 2-weeks after the lecture. It was found that after both programs subjects had more knowledge about sleep than before. In the program including practice learning session, subjects' attitude for managing patients changed from before the lecture to after the lecture, and after the practice learning session. It was found that more than half of the students thought that they could provide sleep guidance based on the behavior therapy. Regarding the subjects' sleep, significant improvements were observed for "having nightmares upon falling asleep," "sleepiness during daytime," "sense of getting a sound sleep," and "mood upon waking up." Regarding sleep-related habits, significant improvements were observed for "taking a nap," "dozing off," and "eating breakfast." On the other hand, only the lecture subjects improved irregularity of bedtime and sleeping time. Although an increase in knowledge and improvement of sleep were observed among students who attended only the lecture, a further increase in knowledge and improvement of sleeping habits were observed among students who also attended the practice learning session. The results described herein suggest developing and providing a simple and convenient education program for sleep improvement was effective for increasing students' knowledge about sleep, developing improved coping methods regarding sleep, and improving sleep. It is also suggested that behavioral scientific instructive methods, including practice learning, are effective for medical education.

How Trainees Would Disclose Medical Errors: Educational Implications for Training Programs

PubMed Central

White, Andrew A.; Bell, Sigall K.; Krauss, Melissa J; Garbutt, Jane; Dunagan, W. Claiborne; Fraser, Victoria J.; Levinson, Wendy; Larson, Eric B.; Gallagher, Thomas H.

2012-01-01

Background Disclosing harmful errors to patients is recommended, but appears to be uncommon. Understanding how trainees disclose errors and how those practices evolve during training could help educators design programs to address this gap. Purpose To determine how trainees would disclose medical errors. Methods A survey of 758 trainees (488 students and 270 residents) in internal medicine at two academic medical centers. Surveys depicted one of two harmful error scenarios that varied by how apparent the error would be to the patient. We measured attitudes and disclosure content using scripted responses. Results Trainees reported their intent to disclose the error as “definitely” (43%) “probably” (47%) “only if asked by patient” (9%), and “definitely not” (1%). Trainees were more likely to disclose obvious errors in comparison with ones patients were unlikely to recognize (55% vs. 30%, P<0.01). Respondents varied widely in what information they would disclose. Fifty percent of trainees chose statements explicitly stating an error occurred rather than only an adverse event. Regarding apologies, trainees were split between a general expression of regret (52%) and an explicit apology (46%). Respondents at higher levels of training were less likely to use explicit apologies (Trend P<0.01). Prior disclosure training was associated with increased willingness to disclose errors (OR 1.40, P=0.03). Conclusions Trainees may not be prepared to disclose medical errors to patients, and worrisome trends in trainee apology practices were observed across levels of training. Medical educators should intensify efforts to enhance trainees’ skills at meeting patients’ expectations for open disclosure of harmful medical errors. PMID:21401685

A faculty development workshop in narrative-based reflective writing.

PubMed

Boudreau, J Donald; Liben, Stephen; Fuks, Abraham

2012-08-01

Narrative approaches are used increasingly in the health professions with a range of objectives. We must acquaint educators with this burgeoning field and prepare them for the incorporation of story-telling in their pedagogical practices. The authors describe a template for a faculty development workshop designed to foster self-reflection through the use of narrative techniques and prepare clinical teachers to deploy such approaches. The design is based on a six-year experience in delivering introductory workshops in narrative approaches to medical teachers. The workshops, which served as a model for the template, have been offered to a total of 92 clinicians being trained to mentor medical students. A generic template is described. It includes a table of core concepts from narrative theory, a set of probing questions useful in a basic technical analysis of texts and a list of initiating prompts for exercises in reflective writing. A workshop organized and deployed using this template is deliverable over a half-day. The model has proven to be feasible and highly valued by participants. It can be adapted for other contexts by educators across the continuum of health professional education.

A model "go-kit" for use at Strategic National Stockpile Points of Dispensing.

PubMed

May, Larissa; Cote, Timothy; Hardeman, Bernard; Gonzalez, Gabriela R; Adams, Sherry B; Blair, Roderick K; Pane, Gregg

2007-01-01

The Strategic National Stockpile (SNS) is a national repository of pharmaceuticals and other medical supplies forseeably needed during a medical disaster. In the event of SNS deployment, state and local public health authorities must be prepared to receive, distribute, and dispense the materials. We propose a cache of supplies, termed the "POD go-kit," prepared in advance and locally available prior to the establishment of Points of Dispensing (POD) for SNS material. Characteristics of the preassembled go-kit are its multiplicity of use, ease of storage and transportation, minimal redundancy with SNS material, and packaging in a manner consistent with POD function. The POD go-kit is assembled into 4 separate "subkits": administrative supplies, patient routing supplies, dispensing supplies, and POD staff protection supplies. Incorporating existing practices from the SNS Listserv, this article itemizes the contents of the POD go-kit and its subkits and provides a rationale for its packaging. The Division of Strategic National Stockpile (DSNS) has not certified the proposed "POD go-kit" as a standardized POD go-kit.

Preparing Academic Medical Centers for the Clinical Learning Environment Review: Alliance of Independent Academic Medical Centers National Initiative IV Outcomes and Evaluation

PubMed Central

Wehbe-Janek, Hania; Markova, Tsveti; Polis, Rachael L.; Peters, Marguerite; Liu, Yang

2016-01-01

Background: Driven by changes to improve quality in patient care and population health while reducing costs, evolvement of the health system calls for restructuring health professionals' education and aligning it with the healthcare delivery system. In response to these changes, the Accreditation Council for Graduate Medical Education's Clinical Learning Environment Review (CLER) encourages the integration of health system leadership, faculty, and residents in restructuring graduate medical education (GME). Innovative approaches to achieving this restructuring and the CLER objectives are essential. Methods: The Alliance of Independent Academic Medical Centers National Initiative (NI) IV provided a multiinstitutional learning collaborative focused on supporting GME redesign. From October 2013 through March 2015, participants conducted relevant projects, attended onsite meetings, and participated in teleconferences and webinars addressing the CLER areas. Participants shared best practices, resources, and experiences. We designed a pre/post descriptive study to examine outcomes. Results: Thirty-three institutions completed NI IV, and at its conclusion, the majority reported greater CLER readiness compared with baseline. Twenty-two (88.0%) institutions reported that NI IV had a great impact on advancing their efforts in the CLER area of their project focus, and 15 (62.5%) reported a great impact in other CLER focus areas. Opportunities to share progress with other teams and the national group meetings were reported to contribute to teams' success. Conclusion: The NI IV learning collaborative prepared institutions for CLER, suggesting successful integration of the clinical and educational enterprises. We propose that national learning collaboratives of GME-sponsoring health systems enable advancement of their education mission, leading ultimately to better healthcare outcomes. This learning model may be generalizable to newfound programs for academic medical centers. PMID:27303228

Accreditation the Education Development Centers of Medical-Sciences Universities: Another Step toward Quality Improvement in Education

PubMed Central

Haghdoost, AA; Momtazmanesh, N; Shoghi, F; Mohagheghi, M; Mehrolhassani, MH

2013-01-01

Background: In order to improve the quality of education in universities of medical sciences (UMS), and because of the key role of education development centers (EDCs), an accreditation scheme was developed to evaluate their performance. Method: A group of experts in the medical education field was selected based on pre-defined criteria by EDC of Ministry of Health and Medical education. The team, worked intensively for 6 months to develop a list of essential standards to assess the performance of EDCs. Having checked for the content validity of standards, clear and measurable indicators were created via consensus. Then, required information were collected from UMS EDCs; the first round of accreditation was carried out just to check the acceptability of this scheme, and make force universities to prepare themselves for the next factual round of accreditation. Results: Five standards domains were developed as the conceptual framework for defining main categories of indicators. This included: governing and leadership, educational planning, faculty development, assessment and examination and research in education. Nearly all of UMS filled all required data forms precisely with minimum confusion which shows the practicality of this accreditation scheme. Conclusion: It seems that the UMS have enough interest to provide required information for this accreditation scheme. However, in order to receive promising results, most of universities have to work intensively in order to prepare minimum levels in all required standards. However, it seems that in long term, implementation of a valid accreditation scheme plays an important role in improvement of the quality of medical education around the country. PMID:23865031

Accreditation the Education Development Centers of Medical-Sciences Universities: Another Step toward Quality Improvement in Education.

PubMed

Haghdoost, Aa; Momtazmanesh, N; Shoghi, F; Mohagheghi, M; Mehrolhassani, Mh

2013-01-01

In order to improve the quality of education in universities of medical sciences (UMS), and because of the key role of education development centers (EDCs), an accreditation scheme was developed to evaluate their performance. A group of experts in the medical education field was selected based on pre-defined criteria by EDC of Ministry of Health and Medical education. The team, worked intensively for 6 months to develop a list of essential standards to assess the performance of EDCs. Having checked for the content validity of standards, clear and measurable indicators were created via consensus. Then, required information were collected from UMS EDCs; the first round of accreditation was carried out just to check the acceptability of this scheme, and make force universities to prepare themselves for the next factual round of accreditation. Five standards domains were developed as the conceptual framework for defining main categories of indicators. This included: governing and leadership, educational planning, faculty development, assessment and examination and research in education. Nearly all of UMS filled all required data forms precisely with minimum confusion which shows the practicality of this accreditation scheme. It seems that the UMS have enough interest to provide required information for this accreditation scheme. However, in order to receive promising results, most of universities have to work intensively in order to prepare minimum levels in all required standards. However, it seems that in long term, implementation of a valid accreditation scheme plays an important role in improvement of the quality of medical education around the country.

Preparing medical students for obstetrics and gynecology milestone level one: a description of a pilot curriculum

PubMed Central

Morgan, Helen; Marzano, David; Lanham, Michael; Stein, Tamara; Curran, Diana; Hammoud, Maya

2014-01-01

Background The implementation of the Accreditation Council for Graduate Medical Education (ACGME) Milestones in the field of obstetrics and gynecology has arrived with Milestones Level One defined as the level expected of an incoming first-year resident. Purpose We designed, implemented, and evaluated a 4-week elective for fourth-year medical school students, which utilized a multimodal approach to teaching and assessing the Milestones Level One competencies. Methods The 78-hour curriculum utilized traditional didactic lectures, flipped classroom active learning sessions, a simulated paging curriculum, simulation training, embalmed cadaver anatomical dissections, and fresh-frozen cadaver operative procedures. We performed an assessment of student knowledge and surgical skills before and after completion of the course. Students also received feedback on their assessment and management of eight simulated paging scenarios. Students completed course content satisfaction surveys at the completion of each of the 4 weeks. Results Students demonstrated improvement in knowledge and surgical skills at the completion of the course. Paging confidence trended toward improvement at the completion of the course. Student satisfaction was high for all of the course content, and the active learning components of the curriculum (flipped classroom, simulation, and anatomy sessions) had higher scores than the traditional didactics in all six categories of our student satisfaction survey. Conclusions This pilot study demonstrates a practical approach for preparing fourth-year medical students for the expectations of Milestones Level One in obstetrics and gynecology. This curriculum can serve as a framework as medical schools and specific specialties work to meet the first steps of the ACGME's Next Accreditation System. PMID:25430640

Anaphylaxis in the allergist's office: preparing your office and staff for medical emergencies.

PubMed

Wallace, Dana V

2013-01-01

All allergists who administer subcutaneous immunotherapy (SCIT) experience anaphylaxis in their offices and must devote proper planning, preparation, and practice to ensure that all staff members recognize the early signs and symptoms of anaphylaxis and can respond appropriately. Educating staff and patients, preparing an anaphylaxis emergency cart, developing and following selection criteria for SCIT and high-risk procedures, and customizing an "Action Plan for Anaphylaxis Management" create the foundation for mounting an adequate response to anaphylaxis. Strategies to prevent near-fatal and fatal reactions include (1) avoiding, when possible, the administration of SCIT to patients on beta-blockers; (2) using a preinjection questionnaire to review changes in the patient's medical condition, e.g., episodes of asthma since the previous injection; (3) using standardized forms and procedures for SCIT; (4) one might also consider an objective measure of airway function (e.g., peak flow measurement) for the asthmatic patient before allergy injections; (5) insisting on a 30-minute waiting time after SCIT; and (6) giving consideration to prescribing a dual-pack epinephrine autoinjector to all SCIT patients. Treatment of anaphylaxis should start with epinephrine administered intramuscularly at the first sign of anaphylaxis. Oxygen and i.v. fluids may be needed for moderate-to-severe anaphylaxis or anaphylaxis that is quickly developing or unresponsive to the first injection of epinephrine. Emergency medical services should be called for all patients who are experiencing moderate-to-severe (grade 2 or higher) anaphylaxis, if they require more than 1 dose of epinephrine and/or i.v. fluids, or if they do not immediately respond to treatment.

Pharmaceutical care in community pharmacies: practice and research in Sweden.

PubMed

Westerlund, Lo Tommy; Björk, H Thony

2006-06-01

To describe the organization and delivery of community pharmacy and medical care, as well as pharmaceutical care practice and research, in Sweden. The Swedish retail pharmacy system of 800 community pharmacies and nearly 80 hospital pharmacies is unique in that it is organized into one single, government-owned chain, known as Apoteket AB. The pharmacy staff consists of pharmacists, prescriptionists, and pharmacy technicians. Some activities related to pharmaceutical care have been directed toward specific patient groups during annual theme campaigns. In the past few years, there has been a growing emphasis on the identification, resolution, and documentation of drug-related problems (DRPs) in Swedish pharmacy practice. A classification system for documenting DRPs and pharmacy interventions was developed in 1995 and incorporated into the software of all community pharmacies in 2001. A national DRP database (SWE-DRP) was established in 2004 to collect and analyze DRPs and interventions on a nationwide basis. Recently, a new counseling technique composed of key questions to facilitate the detection of DRPs has been tested successfully. Patient medication profiles are kept in 160 pharmacies, and a new national register of drugs dispensed to patients became available in 2006. Most pharmaceutical care studies in Sweden have focused on DRPs and resulting pharmacy interventions. Swedish community pharmacy DRP work is in the international forefront but there is a potential for further developing cognitive services, given the beneficial organization of the country's pharmacies into one single pharmacy chain. The introduction of patient medication profiles has been both late and slow and has only had a marginal effect on pharmaceutical care practice so far. The universities do not appear to have any desire to influence the practice of pharmacy and could potentially take on a more active role in preparing pharmacy students for patient-oriented services. Current threats to pharmaceutical care practice and research include organizational changes, budget cuts, and reduced manpower of Apoteket AB. The identification, resolution, and documentation of DRPs are central to community pharmacy practice in Sweden, resulting in a number of research studies. A national DRP database, patient medication profiles, and a new national register of drugs dispensed to patients provide opportunities for growth in pharmaceutical care practice and research in the country.

An investor perspective on forming and funding your medical device start-up.

PubMed

Mas, Juan-Pablo; Hsueh, Brian

2017-06-01

Novel and transformative medical technologies of all forms have the potential to make a significant positive impact on the lives of patients and on the health care system, and one common pathway for guiding such innovations from concept through commercialization is via the formation of a company. For entrepreneurs looking to build a medical technology company, several common challenges await, including questions around how and where to raise funding. Here, we review key considerations for the formation of medical technology companies as viewed through the lens of an investor. We survey common sources of capital for early-stage companies, including grants, angel investors, and venture capital, and offer insights into how to differentiate among them to select the best partners for your start-up׳s needs. Finally, we discuss the critical components of pitching your ideas to potential investors, and offer guidance on best practices and common mistakes. We hope this primer on fundamental concepts and the various health care funding alternatives will prepare entrepreneurs to achieve their mission to improve patients׳ lives through commercialization of their medical innovations. Copyright © 2017 Elsevier Inc. All rights reserved.

Improving communication of medication changes using a pharmacist-prepared discharge medication management summary.

PubMed

Ooi, Choon Ean; Rofe, Olivia; Vienet, Michelle; Elliott, Rohan A

2017-04-01

Background Discontinuity of care between hospital and primary care is often due to poor information transfer. Medication information in medical discharge summaries (DS) is often incomplete or incorrect. The effectiveness and feasibility of hospital pharmacists communicating medication information, including changes made in the hospital, is not clearly defined. Objective To explore the impact of a pharmacist-prepared Discharge Medication Management Summary (DMMS) on the accuracy of information about medication changes provided to patients' general practitioners (GPs). Setting Two medical wards at a major metropolitan hospital in Australia. Method An intervention was developed in which ward pharmacists communicated medication change information to GPs using the DMMS. Retrospective audits were conducted at baseline and after implementation of the DMMS to compare the accuracy of information provided by doctors and pharmacists. GPs' satisfaction with the DMMS was assessed through a faxed survey. Main outcome measure Accuracy of medication change information communicated to GPs; GP satisfaction and feasibility of a pharmacist-prepared DMMS. Results At baseline, 263/573 (45.9%) medication changes were documented by doctors in the DS. In the post-intervention audit, more medication changes were documented in the pharmacist-prepared DMMS compared to the doctor-prepared DS (72.8% vs. 31.5%; p < 0.001). Most GPs (73.3%) were satisfied with the information provided and wanted to receive the DMMS in the future. Completing the DMMS took pharmacists an average of 11.7 minutes. Conclusion The accuracy of medication information transferred upon discharge can be improved by expanding the role of hospital pharmacists to include documenting medication changes.

Student perceptions of a video-based blended learning approach for improving pediatric physical examination skills.

PubMed

Lehmann, Ronny; Seitz, Anke; Bosse, Hans Martin; Lutz, Thomas; Huwendiek, Sören

2016-11-01

Physical examination skills are crucial for a medical doctor. The physical examination of children differs significantly from that of adults. Students often have only limited contact with pediatric patients to practice these skills. In order to improve the acquisition of pediatric physical examination skills during bedside teaching, we have developed a combined video-based training concept, subsequently evaluating its use and perception. Fifteen videos were compiled, demonstrating defined physical examination sequences in children of different ages. Students were encouraged to use these videos as preparation for bedside teaching during their pediatric clerkship. After bedside teaching, acceptance of this approach was evaluated using a 10-item survey, asking for the frequency of video use and the benefits to learning, self-confidence, and preparation of bedside teaching as well as the concluding OSCE. N=175 out of 299 students returned survey forms (58.5%). Students most frequently used videos, either illustrating complete examination sequences or corresponding focus examinations frequently assessed in the OSCE. Students perceived the videos as a helpful method of conveying the practical process and preparation for bedside teaching as well as the OSCE, and altogether considered them a worthwhile learning experience. Self-confidence at bedside teaching was enhanced by preparation with the videos. The demonstration of a defined standardized procedural sequence, explanatory comments, and demonstration of infrequent procedures and findings were perceived as particularly supportive. Long video segments, poor alignment with other curricular learning activities, and technical problems were perceived as less helpful. Students prefer an optional individual use of the videos, with easy technical access, thoughtful combination with the bedside teaching, and consecutive standardized practice of demonstrated procedures. Preparation with instructional videos combined with bedside teaching, were perceived to improve the acquisition of pediatric physical examination skills. Copyright © 2016 Elsevier GmbH. All rights reserved.

Keeping granny safe on July 1: a consensus on minimum geriatrics competencies for graduating medical students.

PubMed

Leipzig, Rosanne M; Granville, Lisa; Simpson, Deborah; Anderson, M Brownell; Sauvigné, Karen; Soriano, Rainier P

2009-05-01

Competency-based education prepares trainees to perform tasks occurring within the context of practice. There are currently no geriatrics-specific, competency-based consensus performance standards for medical students.The authors present the results of a systematic, multimethod process to identify and define the minimum geriatrics-specific competencies needed by a new intern to adequately care for older adults. An alpha draft was crafted by geriatricians, identifying measurable performance subtasks associated with accepted standards of evidence-based geriatric care, patient safety, and "do no harm" within the first-year resident's expected scope of practice. The competencies were then assessed for content validity by key stakeholders and informants. Of the 315 respondents, 26% were geriatricians, 21% family physicians, 24% general internists, 6% neurology program directors, 14% surgery program directors, and 9% other. Twenty-four were decanal appointees. Faculty from almost half (44%) of U.S. medical schools and representatives of several major medical education organizations were present at the working conference.The final document consists of 26 competencies nested within eight content domains: Medication Management; Self-Care Capacity; Falls, Balance and Gait Disorders; Hospital Care for Elders; Cognitive and Behavioral Disorders; Atypical Presentation of Disease; Health Care Planning and Promotion; and Palliative Care.Setting minimum geriatric competency standards establishes the performance benchmarks for medical school graduates who as first-year residents will care for geriatric patients. Only half-facetiously, they are referred to as the "Don't Kill Granny" competencies. Achievement of these minimum competencies by medical students, grounded in evidence-based principles of quality care for older adults, will assure that, each year, older patients are in safer hands on July 1.

ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2011.

PubMed

Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

2012-05-01

Results of the 2011 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. A stratified random sample of pharmacy directors at 1401 general and children's medical-surgical hospitals in the United States were surveyed by mail. In this national probability sample survey, the response rate was 40.1%. Decentralization of the medication-use system continues, with 40% of hospitals using a decentralized system and 58% of hospitals planning to use a decentralized model in the future. Automated dispensing cabinets were used by 89% of hospitals, robots were used by 11%, carousels were used in 18%, and machine-readable coding was used in 34% of hospitals to verify doses before dispensing. Overall, 65% of hospitals had a United States Pharmacopeia chapter 797 compliant cleanroom for compounding sterile preparations. Medication administration records (MARs) have become increasingly computerized, with 67% of hospitals using electronic MARs. Bar-code-assisted medication administration was used in 50% of hospitals, and 68% of hospitals had smart infusion pumps. Health information is becoming more electronic, with 67% of hospitals having partially or completely implemented an electronic health record and 34% of hospitals having computerized prescriber order entry. The use of these technologies has substantially increased over the past year. The average number of full-time equivalent staff per 100 occupied beds averaged 17.5 for pharmacists and 15.0 for technicians. Directors of pharmacy reported declining vacancy rates for pharmacists. Pharmacists continue to improve medication use at the dispensing and administration steps of the medication-use system. The adoption of new technology is changing the philosophy of medication distribution, and health information is rapidly becoming electronic.

Prevalence of pain medication prescriptions in France, Germany, and the UK - a cross-sectional study including 4,270,142 patients.

PubMed

Jacob, Louis; Kostev, Karel

2018-01-01

The goal of the present study was to analyze the prevalence of pain medication prescriptions in general practices in France, Germany, and the UK. This study included all patients aged ≥18 years followed in 2016 in general practitioner practices in France, Germany and the UK. The primary outcome was the prevalence of patients receiving prescriptions for pain medications in France, Germany, and the UK in 2016. The following drugs were included in the analysis: anti-inflammatory and antirheumatic products, non-steroids and analgesics including opioids, antimigraine preparations, and other analgesics and antipyretics. Demographic variables included age and gender. This study included 4,270,142 patients. The prevalences of pain medication prescriptions were 57.3% in France, 29.6% in Germany, and 21.7% in the UK. Although this prevalence generally remained consistent between age groups in France (54.3%-60.3%), it increased with age in Germany (18-30 years: 23.8%; >70 years: 35.8%) and in the UK (18-30 years: 9.3%; >70 years: 43.8%). Finally, the prevalence of pain medication prescriptions was higher in women than in men in all three countries. Paracetamol was prescribed to 82.3% and 60.1% of patients receiving pain medication in France and the UK, respectively, whereas ibuprofen was prescribed to 46.5% of individuals in Germany. The prevalence of pain medication prescriptions was higher in France than in Germany and the UK. Further research is needed to gain a better understanding of the differences in the prescription patterns between these three European countries.

The training and professional expectations of medical students in Angola, Guinea-Bissau and Mozambique

PubMed Central

2011-01-01

Background The purpose of this paper is to describe and analyze the professional expectations of medical students during the 2007-2008 academic year at the public medical schools of Angola, Guinea-Bissau and Mozambique, and to identify their social and geographical origins, their professional expectations and difficulties relating to their education and professional future. Methods Data were collected through a standardised questionnaire applied to all medical students registered during the 2007-2008 academic year. Results Students decide to study medicine at an early age. Relatives and friends seem to have an especially important influence in encouraging, reinforcing and promoting the desire to be a doctor. The degree of feminization of the student population differs among the different countries. Although most medical students are from outside the capital cities, expectations of getting into medical school are already associated with migration from the periphery to the capital city, even before entering medical education. Academic performance is poor. This seems to be related to difficulties in accessing materials, finances and insufficient high school preparation. Medical students recognize the public sector demand but their expectations are to combine public sector practice with private work, in order to improve their earnings. Salary expectations of students vary between the three countries. Approximately 75% want to train as hospital specialists and to follow a hospital-based career. A significant proportion is unsure about their future area of specialization, which for many students is equated with migration to study abroad. Conclusions Medical education is an important national investment, but the returns obtained are not as efficient as expected. Investments in high-school preparation, tutoring, and infrastructure are likely to have a significant impact on the success rate of medical schools. Special attention should be given to the socialization of students and the role model status of their teachers. In countries with scarce medical resources, the hospital orientation of students' expectations is understandable, although it should be associated with the development of skills to coordinate hospital work with the network of peripheral facilities. Developing a local postgraduate training capacity for doctors might be an important strategy to help retain medical doctors in the home country. PMID:21473778

Initializing concordance in frail elderly patients via a medicines organizer.

PubMed

Ryan-Woolley, Bernadette M; Rees, Judith A

2005-05-01

Concordance, which involves prescribing with rather than for patients, should result in less drug wastage (non-use), but is proving hard to put into practice. One possible way of easing elderly people and prescribers toward concordance is to use a medicines organizer (MO). To document medication wastage, using a pharmacy-prepared reusable MO, and explore, using a qualitative approach, use of this information on communication of individuals' drug regimens. Sixty-two sheltered housing residents, aged > or =60 years, participated in an exploratory controlled, matched study. The intervention group received medication in the MO, and the control group continued with standard packaging. Community pharmacists recorded details of wasted drugs returned during the 3-month study and, for the intervention group, 6, 9, and 12 months after the study. Medicines management data were collected from participants. Qualitative interviews were conducted with a sample of general practitioners (GPs) and community pharmacists to explore views on the role of the MO. Intervention group wastage was reduced from 18.1% (prestudy) to 1% at 12 months. No data on wastage were collected for the control group after the prestudy assessment. Sixty-one percent more prescription changes, including significant decreases in the number of prescribed drugs and dosages, were reported for the intervention group. GPs and pharmacists reported improvements in communication concerning medication-related dialog. This small exploratory study has shown that a pharmacy-prepared reusable MO provided visual, objective insights into medication wastage. This resulted in improved communication of drug needs and reduced wastage-the foundation for concordance.

Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness.

PubMed

Toivo, Terhi; Dimitrow, Maarit; Puustinen, Juha; Savela, Eeva; Pelkonen, Katariina; Kiuru, Valtteri; Suominen, Tuula; Kinnunen, Sirkka; Uunimäki, Mira; Kivelä, Sirkka-Liisa; Leikola, Saija; Airaksinen, Marja

2018-03-16

The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources. The study is registered in the Clinical Trials.gov ( NCT02545257 ). Registration date September 9 2015.

Teacher Preparation Practices in Kenya and the 21st Century Learning: A Moral Obligation

ERIC Educational Resources Information Center

Kafwa, Nabwire Opata; Gaudience, Obondo; Kisaka, Sella Terrie

2015-01-01

Teacher preparation practices are indices used to measure quality teacher besides other variables. Whereas the current teacher preparation is test scores based inclining to cognitive knowledge, a good teacher preparation practices is a holistic development in nature oriented towards character, skills and knowledge. To embed teacher preparation in…

How Medical School Did and Did Not Prepare Me for Graduate Medical Education.

ERIC Educational Resources Information Center

Mangione, Carol M.

1986-01-01

Four areas in which a resident felt least prepared by medical school are outlined: teaching medical students; working as an effective ambulatory care doctor; discussing the psycho-social issues that surround terminal illness, death, and dying; and functioning as a cost-conscious health care provider. (MLW)

Disaster preparation in kidney transplant recipients: a questionnaire-based cohort study from a large United States transplant center
.

PubMed

Sharief, Shimi; Freitas, Daniel; Adey, Deborah; Wiley, James

2018-04-01

Few quantitative assessments have assessed disaster preparation in kidney transplant patients. This is a survey-based assessment of disaster preparedness of 200 patients at the University of California San Francisco, USA. Patients answered questionnaires assessing their level of preparedness as well as barriers to preparation. Preparedness was scored based on response to 7 questions. Univariate analyses compared participant characteristics extracted from the medical chart against three tertiles of preparedness: low (scores 0 - 2), medium (scores 3 - 4), and high (scores 5 - 7). California counties were coded and mapped by average preparedness scores. Only 30% of patients were highly prepared for disasters. Participants were prepared with available medication for 2 weeks (78.5%) and least prepared in having a medical ID bracelet (13%). Significant minorities of patients (40% of patients or more) were unprepared with lists of medications, important phone numbers and disaster kits. Preparedness was not associated with demographic and clinical characteristics. Monterey County was the most prepared of the 31 California counties sampled (score of 4.25 out of 7). All patients should be educated regarding disaster preparation. County and medical services should collaborate to address specialized populations in general preparedness planning.
.

Video-based instructions for surgical hand disinfection as a replacement for conventional tuition? A randomised, blind comparative study.

PubMed

Weber, Uwe; Constantinescu, Mihai A; Woermann, Ulrich; Schmitz, Felix; Schnabel, Kai

2016-01-01

Various different learning methods are available for planning tuition regarding the introduction to surgical hand disinfection. These learning methods should help to organise and deal with this topic. The use of a video film is an alternative to conventional tuition due to the real presentation possibilities of practical demonstration. This study examines by way of comparison which form of communication is more effective for learning and applying surgical hand disinfection for medical students in their first year of studies: video-based instruction or conventional tuition. A total of 50 first-year medical students were randomly allocated either to the "Conventional Instruction" (CI) study group or to the "Video-based Instruction" (VI) study group. The conventional instruction was carried out by an experienced nurse preceptor/nurse educator for the operating theatre who taught the preparatory measures and the actual procedure in a two-minute lesson. The second group watched a two-minute video sequence with identical content. Afterwards, both groups demonstrated practically the knowledge they had acquired at an individual practical test station. The quality (a) of the preparation and (b) of the procedure as well as (c) the quality of the results was assessed by 6 blind experts using a check list. The acceptability of the respective teaching method was also asked about using a questionnaire. The group performance did not differ either in the preparation (t=-78, p<0.44) or in the quality (t=-99, p<0.34). With respect to performance, it was possible to demonstrate a strong treatment effect. In the practical (t=-3.33, p<0.002, d=0.943) and in the total score (t=-2.65, p<0.011, d=0.751), the group with video-based instruction achieved a significantly better result. In response to the question as to which of the two learning methods they would prefer, the significant majority (60.4%) of students stated video instruction. In this study, the use of the video-based instruction emerged as the more effective teaching method for learning surgical hand disinfection for medical students and is preferable to conventional instruction. The video instruction is associated with a higher learning effectiveness, efficiency and acceptability.

The writer's guide to education scholarship in emergency medicine: Education innovations (part 3).

PubMed

Hall, Andrew K; Hagel, Carly; Chan, Teresa M; Thoma, Brent; Murnaghan, Aleisha; Bhanji, Farhan

2018-05-01

The scholarly dissemination of innovative medical education practices helps broaden the reach of this type of work, allowing scholarship to have an impact beyond a single institution. There is little guidance in the literature for those seeking to publish program evaluation studies and innovation papers. This study aims to derive a set of evidence-based features of high-quality reports on innovations in emergency medicine (EM) education. We conducted a scoping review and thematic analysis to determine quality markers for medical education innovation reports, with a focus on EM. A search of MEDLINE, EMBASE, ERIC, and Google Scholar was augmented by a hand search of relevant publication guidelines, guidelines for authors, and website submission portals from medical education and EM journals. Study investigators reviewed the selected articles, and a thematic analysis was conducted. Our search strategy identified 14 relevant articles from which 34 quality markers were extracted. These markers were grouped into seven important themes: goals and need for innovation, preparation, innovation development, innovation implementation, evaluation of innovation, evidence of reflective practice, and reporting and dissemination. In addition, multiple outlets for the publication of EM education innovations were identified and compiled. The publication and dissemination of innovations are critical for the EM education community and the training of health professionals. We anticipate that our list of innovation report quality markers will be used by EM education innovators to support the dissemination of novel educational practices.

Redesigning journal club in residency.

PubMed

Al Achkar, Morhaf

2016-01-01

The gap between production and implementation of knowledge is the main reason for the suboptimal quality of health care. To eliminate this gap and improve the quality of patient care, journal club (JC) in graduate medical education provides an opportunity for learning the skills of evidence-based medicine. JC, however, continues to face many challenges mainly due to poorly defined goals, inadequate preparation, and lack of interest. This article presents an innovative model to prepare and present JC based on three pillars: dialogical learning through group discussion, mentored residents as peer teachers, and including JC as part of a structured curriculum to learn evidence-based medicine. This engaging model has the potential to transform JC from a moribund session that is daunting for residents into a lively discussion to redefine clinical practice using the most current evidence.

Hydrogels in endovascular embolization. III. Radiopaque spherical particles, their preparation and properties.

PubMed

Horák, D; Metalová, M; Svec, F; Drobník, J; Kálal, J; Borovicka, M; Adamyan, A A; Voronkova, O S; Gumargalieva, K Z

1987-03-01

The synthesis and properties of spherical radiopaque hydrogel particles designed for endovascular occlusion are reported. These particles were prepared by the hydroxyl acylation of low crosslinked poly (2-hydroxyethyl methacrylate) beads with a nontoxic radiopaque compound based on triiodobenzoic acid, without affecting their properties which are advantages in medical practice. The effect of the iodine content on the size of dry and swollen particles is discussed. It has been found that an iodine content of about 25-30 wt% is desirable in order to obtain an easily recognizable X-ray image. These particles make the immediate control of embolus application easy and enable periodical inspection of the polymer to check the successful blockage of the vessel. They also open up the method of endovascular occlusion to further improvement.

Competencies of Career-Entry Medical Technology Graduates of Lyceum of Batangas: Basis for Enhancement of the Internship Training Program

ERIC Educational Resources Information Center

Valdez, Anacleta P.

2010-01-01

The role of medical technologists in the years due to changes in the laboratory environment. curriculum is needed to prepare graduates for changes in laboratory medicine. It is the ultimate goal of the College to prepare students for career entry positions as medical technology professionals. The curriculum should be designed to prepare the…

The Effect of Directed Medical Play on Young Children's Pain and Distress during Burn Wound Care

PubMed Central

Moore, Elizabeth R.; Bennett, Katherine; Dietrich, Mary S.; Wells, Nancy

2015-01-01

Directed medical play is used to reduce children's pain and distress during medical treatment. In this pilot study, young children who attended the burn clinic received either directed medical play provided by a child life specialist or standard preparation from the burn clinic nurse, to prepare for their first dressing change. Data were collected using validated instruments. Children who participated in medical play experienced less distress during their dressing change (M= 0.5, n=12) than those receiving standard preparation (M=2.0, n=9). Children who received standard care reported a 2 point increase in pain during the procedure whereas children who participated in medical play reported a 1 point increase. Change in parental anxiety was similar for both groups. Parent satisfaction was higher for caregivers who observed medical play than standard preparation. Although all findings were in the hypothesized direction, none were statically significant, most likely because of the small sample size. PMID:25631102

Iron deficiency anemia: diagnosis and management.

PubMed

Clark, Susan F

2009-03-01

Iron deficiency anemia (IDA) still remains universally problematic worldwide. The primary focus of this review is to critique articles published over the past 18 months that describe strategies for the diagnosis and management of this prevalent condition. The medical community continues to lack consensus when identifying the optimal approach for the diagnosis and management of IDA. Current diagnostic recommendations revolve around the validity and practicality of current biomarkers such as soluble transferrin-receptor concentrations and others, and cause-based diagnostics that potentially include endoscopy. Management of IDA is based on supplementation combined with effective etiological treatment. Advances in oral and parenteral low-molecular-weight iron preparations has expanded and improved treatment modalities for IDA. Since the introduction of low versus high-molecular-weight intravenous iron administration, there have been fewer serious adverse events associated with parenteral iron preparations. Best practice guidelines for diagnosing and managing IDA should include the design of an algorithm that is inclusive of multiple biomarkers and cause-based diagnostics, which will provide direction in managing IDA, and distinguish between IDA from the anemia of chronic disease.

Implementing practice-linked pre-visit electronic journals in primary care: patient and physician use and satisfaction

PubMed Central

Businger, Alexandra; Gandhi, Tejal K; Grant, Richard W; Poon, Eric G; Schnipper, Jeffrey L; Volk, Lynn A; Middleton, Blackford

2010-01-01

Electronic health records (EHRs) and EHR-connected patient portals offer patient–provider collaboration tools for visit-based care. During a randomized controlled trial, primary care patients completed pre-visit electronic journals (eJournals) containing EHR-based medication, allergies, and diabetes (study arm 1) or health maintenance, personal history, and family history (study arm 2) topics to share with their provider. Assessment with surveys and usage data showed that among 2027 patients invited to complete an eJournal, 70.3% submitted one and 71.1% of submitters had one opened by their provider. Surveyed patients reported they felt more prepared for the visit (55.9%) and their provider had more accurate information about them (58.0%). More arm 1 versus arm 2 providers reported that eJournals were visit-time neutral (100% vs 53%; p<0.013), helpful to patients in visit preparation (66% vs 20%; p=0.082), and would recommend them to colleagues (78% vs 22%; p=0.0143). eJournal integration into practice warrants further study. PMID:20819852

[Implementation of a remote oncology-monitoring program for cancer patients in outpatient care unit: A major challenge for the different actors].

PubMed

Peyrilles, Elodie; Lepage-Seydoux, Coralie; Sejean, Karine; Bonan, Brigitte

2018-04-01

The development of outpatient departments requires health professionals to reorganize practices for a better patient monitoring and a better patient care pathway. To evaluate, using indicators, the impact of an oncology-monitoring program on activity and organizational fluidity in a Cytotoxic Preparation Unit and clinical departments. Method the clinical and biological data are collected between two injections by calling the patient two days prior chemotherapy is performed by a specialist nurse of an outsourced medical call center. After medical and pharmaceutical validation, early preparations (D-1) for expensive and non-expensive molecules are performed. The program is started in February 2016. After 3 months, 382 patients were included into the program. Twenty-three patients on average are called per day related to 1162 completed clinical questionnaires (87%). Among the files, 47% are complete at D-2 (biological and clinical data). The early preparation rate of expensive drugs, zero before the program for financial reasons, has reached 40% at 3 months. The destroyed preparation rate because of non-administration decreased from 5 to 2%. Preliminary results show a significant patient compliance, feasibility of early preparation of expensive and non-expensive chemotherapy. These are preliminary results of a one-year study. They will be completed by an evaluation of patients' and health professionals' satisfaction, evaluation of length of stay, optimization of operations for clinical departments and CPU. The D-2 biological data collection must be improved. A strong doctor/pharmacist collaboration is essential for better patient care pathway. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Do differentials in the support and advice available at UK schools and colleges influence candidate performance in the medical school admissions interview? A survey of direct school leaver applicants to a UK medical school.

PubMed

Lambe, Paul; Waters, Catherine; Bristow, David

2013-09-01

To our knowledge, nothing is known about whether differentials in support and advice during preparation for the interview influence candidate performance and thereby contribute to bias in selection for medical school. To assess if differences in advice and support with preparation for the medical school admissions interview given type of school last attended influence interview score achieved by direct school leaver applicants to study on an undergraduate UK medical degree course. Confidential self-completed on-line questionnaire survey. Interview performance was positively related to whether a teacher, tutor or career advisors at the School or College last attended had advised a respondent to prepare for the interview, had advised about the various styles of medical interview used and the types of questions asked, and what resources were available to help in preparation. Respondents from Private/Independent schools were more likely than those from State schools to have received such advice and support. Differentials in access to advice on and support with preparation for the medical school interview may advantage some candidates over others. This inequity would likely be ameliorated by the provision of an authoritative and comprehensive guide to applying to medical school outlining admission requirements and the preparation strategy applicants should use in order to best meet those requirements. The guide could be disseminated to the Principals of all UK schools and colleges and freely available electronic versions signposted in medical school prospectuses and the course descriptor on the Universities and Colleges Admissions Service.