The United Kingdom's experience with and future plans for revalidation.

PubMed

Archer, Julian; de Bere, Sam Regan

2013-01-01

Assuring fitness to practice for doctors internationally is increasingly complex. In the United Kingdom, the General Medical Council (GMC) has recently launched revalidation, which has been designed to bring all doctors into a governed environment. Since December 2012, all doctors who wish to practice are required to submit and reflect on supporting documentation against a framework of best practice, Good Medical Practice. These documents are brought together in an annual appraisal. Evidence of practice includes clinical governance activities such as significant events, complaints and audits, continuing professional development and feedback from colleagues and patients. Revalidation has been designed to support professionalism and identify early doctors in difficulty to support their remediation and so assure patient safety. The appraiser decides annually if the doctor has met the standard which is shared with the most senior doctor in the area, the responsible officer (RO). The RO's role is to make a recommendation for revalidation every 5 years for each doctor to the GMC. Revalidation is unique in that it is national, compulsory, involves all doctors regardless of position or training, and is linked to the potentially performance moderating process of appraisal. However, it has a long and troubled history that is shaped by high-profile medical scandals and delays from the profession, the GMC, and the government. Revalidation has been complicated further by rhetoric around patient care and driving up standards but at the same time identifying poor performance. The GMC have responded by commissioning a national evaluation which is currently under development. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Never Good Enough: The Educational Journey of a Vietnamese American Woman

ERIC Educational Resources Information Center

Nguyen, Annie T.

2014-01-01

In this article, author Annie Nguyen describes her personal encounters with the "Model Minority Myth" as a young Vietnamese American in a doctoral program. This myth assumes that all Asian Americans are inherently smart and high achieving, which is problematic when in fact there are many Asian American individuals who perform poorly.…

How do international medical graduates and colleagues perceive and deal with difficulties in everyday collaboration? A qualitative study.

PubMed

Skjeggestad, Erik; Norvoll, Reidun; Sandal, Gro M; Gulbrandsen, Pål

2017-06-01

Many medical doctors work outside their countries of origin. Consequently, language barriers and cultural differences may result in miscommunication and tension in the workplace, leading to poor performance and quality of treatment and affecting patient safety. However, there is little information about how foreign doctors and their colleagues perceive their collaboration and handle situations that can affect the quality of health services. Individual, semi-structured in-depth interviews were conducted with two groups of informants: 16 doctors who had recently started working in Norway and 12 unrelated Norwegian-born healthcare providers who had extensive experience of working with doctors from foreign countries. The interviews were analysed according to the systematic text condensation method. The foreign doctors described themselves as newcomers and found it difficult to speak with their colleagues about their shortcomings because they wanted to be seen as competent. Their Norwegian colleagues reported that many new foreign doctors had demanding work schedules and therefore they were reluctant to give them negative feedback. They also feared that foreign doctors would react negatively to criticism. All participants, both the new foreign doctors and their colleagues, reported that they took responsibility for the prevention of misunderstandings and errors; nevertheless, they struggled to discuss such issues with each other. Silence was the coping strategy adopted by both the foreign doctors and native healthcare professionals when facing difficulties in their working relationships. In such situations, many foreign doctors are socialized into a new workplace in which uncertainty and shortcomings are not discussed openly. Effective leadership and procedures to facilitate communication may alleviate this area of concern.

The importance of a supportive environment in clinical audit: a pilot study of doctors' engagement with the NHS National PET-CT audit programme.

PubMed

Ross, Peter; Hubert, Jane; Saunders, Mike; Wong, Wai Lup

2014-10-01

The NHS National PET-CT Audit Programme was launched in 2008 as part of a national NHS programme to widen patient access to PET-computed tomography (CT) imaging in England. However, to implement clinical audit effectively, healthcare professionals need to be fully engaged with the process. The purpose of the pilot study was to identify and explore the different factors that influence doctors' engagement with the National NHS PET-CT Audit Programme. A single embedded case study was undertaken, which centred on the NHS National PET-CT Audit Programme. Seven theoretical propositions drawn from a review of the literature were tested and their influence evaluated. A purposeful sample of 13 semistructured interviews with consultant doctors was taken from different hospitals over a 6-month period. The data were analysed using directed thematic content analysis, with the themes compared against the study's propositions. Doctors' perspectives of clinical audit changed in response to the way in which the audit was implemented. The main barriers to engagement were the lack of a common vision and poor communication, which contributed to poor interprofessional relationships and a perceived culture of blame. In contrast, factors that facilitated engagement centred on the adoption of a more supportive and collaborative approach, which in turn facilitated higher levels of trust between professionals. The dissemination of performance data was found to be a key influencing factor. The study makes use of a unique data set and to the best of our knowledge is one of the first studies to document how the dissemination of doctors' performance data positively influences engagement with clinical audit in England. In addition, the study also shows how, contrary to some studies in the literature, clinical audit can reduce professional anxiety by providing a validation of professional competence. The study supports the premise that clinical audit will be fully embraced by doctors only if they are sufficiently involved in the process so as to be able to redefine and clarify its purpose and meaning. The preliminary findings of this pilot study provide the theoretical underpinning for a national survey into reporter perspectives of the National PET-CT Audit Programme.

[Attrition and poor performance in general practice training: age, competence and knowledge play a role].

PubMed

Vermeulen, Margit I; Kuyvenhoven, Marijke M; Zuithoff, N P A Peter; van der Graaf, Yolanda; Pieters, H M Ron

2011-01-01

To investigate which determinants are related to poor performance and forced attrition in the first year residency in general practice (GP). Observational retrospective cohort study. We collected data relating to personal characteristics such as age, sex and clinical experience from residents who started the GP training in Utrecht, the Netherlands, in the period March 2005-August 2007. We also collected competence scores from the domains 'medical expertise', 'doctor-patient communication' and 'professionalism', as well as scores on a national GP knowledge test. The outcome measures were 'poor performance' and 'forced attrition'. Multivariate logistic regression was used to analyse correlations between personal characteristics, competence scores on the 3 domains and knowledge scores in the first trimester on the one hand and poor performance or forced attrition on the other. 215 residents started the GP training. In the first trimester a quarter of the residents had an insufficient score in 1 or more of the domains. Competence scores were mutually correlated, but did not correlate with the knowledge score. 18 residents showed poor performance and 3 were forced to stop their training. Poor performance and forced attrition were correlated with age (adjusted odds ratio (OR): 1.1; 95% CI: 1.0-1.3), insufficient knowledge (adjusted OR: 8.9; 3.0-26.3) and medical expertise (adjusted OR: 2.1; 1.1-4.0) at the beginning of the training. Age, insufficient knowledge of general practice, and insufficient competence in the domain of 'medical expertise' at the beginning of the training are risk factors for poor performance by residents and attrition from their GP training.

'Why didn't you write a not-for-cardiopulmonary resuscitation order?' Unexpected death or failure of process?

PubMed

Levinson, Michele; Mills, Amber; Barrett, Jonathan; Sritharan, Gaya; Gellie, Anthea

2018-02-01

Objective The aim of the present study was to understand the reasons for the delivery of non-beneficial cardiopulmonary resuscitation (CPR) attempts in a tertiary private hospital over 12 months. We determined doctors' expectations of survival after CPR for their patient, whether they had considered a not-for-resuscitation (NFR) order and the barriers to completion of NFR orders. Methods Anonymous questionnaires were sent to the doctors primarily responsible for a given patient's care in the hospital within 2 weeks of the unsuccessful CPR attempt. The data were analysed quantitatively where appropriate and qualitatively for themes for open-text responses Results Most doctors surveyed in the present study understood the poor outcome after CPR in the older person. Most doctors had an expectation that their own patient had a poor prognosis and a poor likely predicted outcome after CPR. This implied that the patient's death was neither unexpected nor likely to be reversible. Some doctors considered NFR orders, but multiple barriers to completion were cited, including the family's wishes, being time poor and diffusion or deferral of responsibility. Conclusions It is likely that futile CPR is provided contrary to policy and legal documents relating to end-of-life care, with the potential for harms relating to both patient and family, and members of resuscitation teams. The failure appears to relate to process rather than recognition of poor patient outcome. What is known about the topic? Mandatory CPR has been established in Australian hospitals on the premise that it will save lives. The outcome from in-hospital cardiac arrest has not improved despite significant training and resources. The outcome for those acutely hospitalised patients aged over 80 years has been repeatedly demonstrated to be poor with significant morbidity in the survivors. There is emerging literature on the extent of the delivery of non-beneficial treatments at the end of life, including futile CPR, the recognition of harms incurred by patients, families and members of the resuscitation teams and on the opportunity cost of the inappropriate use of resources. What does this paper add? This is the first study, to our knowledge, that has demonstrated that doctors understood the outcomes for CPR, particularly in those aged 80 years and older, and that failure to recognise poor outcome and prognosis in their own patients is not a barrier to writing NFR orders. What are the implications for practitioners? Recognition of the poor outcomes from CPR for the elderly patient for whom the doctor has a duty of care should result in a discussion with the patients, allowing an exploration of values and expectations of treatment. This would promote shared decision making, which includes the use of CPR. Facilitation of these discussions should be the focus of health service review.

Perceived bullying among Norwegian doctors in 1993, 2004 and 2014–2015: a study based on cross-sectional and repeated surveys

PubMed Central

Rosta, Judith; Aasland, Olaf G

2018-01-01

Objectives To examine 12-month prevalence of perceived bullying at work for doctors in different job categories and medical disciplines in 1993, 2004 and 2014–2015, and personality traits, work-related and health-related factors associated with perceived workplace bullying. Design Cross-sectional questionnaire surveys in 1993, 2004 and 2014–2015 where the 2004 and the 2012–2015 samples are partly overlapping. Setting Norway. Participants Response rates were 72.8% (2628/3608) in 1993, 67% (1004/1499) in 2004 and 78.2% (1261/1612) in 2014–2015. 485 doctors responded both in 2004 and 2014–2015. Outcome measure Perceived bullying at work from colleagues or superiors at least a few times a month during the last year. Results Between the samples from 1993, 2004 and 2014–2015, there were no significant differences in the prevalence of perceived bullying at work. More senior hospital doctors and surgeons reported being bullied. Doctors with higher scores on the personality trait neuroticism were more likely to perceive bullying, as were female doctors, doctors with poor job satisfaction and poor self-rated health. Conclusions The fraction of doctors who experienced bullying at work was stable over a 20-year period. Psychological, psychosocial and cultural factors are predictors of perceived bullying. PMID:29431127

Learning needs in clinical biochemistry for doctors in foundation years.

PubMed

Khromova, Victoria; Gray, Trevor A

2008-01-01

Most medical school curricula have reduced the amount of time available for teaching in pathology despite the fact that junior staff in the early stages of their training were responsible for requesting the majority of pathology tests on acutely ill hospital patients. So, the lack of specific training in this area means that test requesting may be poorly performed and the results ill understood by these staff. This paper describes a questionnaire, which was designed to assist laboratory staff providing targeted teaching in this area. Doctors in Foundation year 1 (F1) and Foundation year 2 (F2) in Sheffield teaching hospitals were given a questionnaire to ascertain how confident they were in requesting and interpreting the results of clinical biochemistry tests. The doctors were also asked about which areas of laboratory medicine they would like to be taught. Responses were received from 82 doctors, about half those in F1 and F2. The survey revealed areas where juniors are less confident in requesting tests and interpreting results. Despite lack of confidence in interpreting the result, 18% were confident about requesting tests. Doctors were also unsure of the effects of common problems like haemolysis on the interpretation of results. More than 70% of the doctors requested specific teaching in these areas. Foundation doctors have learning needs in clinical biochemistry, addressing which would assist them in patient care. While better training in medical school may help in future, there are specific needs for those on the wards now that require targeted teaching.

The doctor-patient relationship as a toolkit for uncertain clinical decisions.

PubMed

Diamond-Brown, Lauren

2016-06-01

Medical uncertainty is a well-recognized problem in healthcare, yet how doctors make decisions in the face of uncertainty remains to be understood. This article draws on interdisciplinary literature on uncertainty and physician decision-making to examine a specific physician response to uncertainty: using the doctor-patient relationship as a toolkit. Additionally, I ask what happens to this process when the doctor-patient relationship becomes fragmented. I answer these questions by examining obstetrician-gynecologists' narratives regarding how they make decisions when faced with uncertainty in childbirth. Between 2013 and 2014, I performed 21 semi-structured interviews with obstetricians in the United States. Obstetricians were selected to maximize variation in relevant physician, hospital, and practice characteristics. I began with grounded theory and moved to analytical coding of themes in relation to relevant literature. My analysis renders it evident that some physicians use the doctor-patient relationship as a toolkit for dealing with uncertainty. I analyze how this process varies for physicians in different models of care by comparing doctors' experiences in models with continuous versus fragmented doctor-patient relationships. My key findings are that obstetricians in both models appealed to the ideal of patient-centered decision-making to cope with uncertain decisions, but in practice physicians in fragmented care faced a number of challenges to using the doctor-patient relationship as a toolkit for decision-making. These challenges led to additional uncertainties and in some cases to poor outcomes for doctors and/or patients; they also raised concerns about the reproduction of inequality. Thus organization of care delivery mitigates the efficacy of doctors' use of the doctor-patient relationship toolkit for uncertain decisions. These findings have implications for theorizing about decision-making under conditions of medical uncertainty, for understanding how the doctor-patient relationship and model of care affect physician decision-making, and for forming policy on the optimal structure of medical work. Copyright © 2016 Elsevier Ltd. All rights reserved.

Contrasting the Socialization Experiences of Doctoral Students in High- and Low-Completing Departments: A Qualitative Analysis of Disciplinary Contexts at One Institution

ERIC Educational Resources Information Center

Gardner, Susan K.

2010-01-01

Socialization has become the common theoretical framework used to better understand the complexity of the doctoral student experience. In particular, theories of socialization have been connected to the issue of attrition in doctoral education, with researchers often attributing poor or inappropriate socialization to a student's decision to depart…

Assessing the capacity for newborn resuscitation and factors associated with providers’ knowledge and skills: a cross-sectional study in Afghanistan

PubMed Central

2013-01-01

Background Resuscitation with bag and mask is a high-impact intervention that can reduce neonatal deaths in resource-poor countries. This study assessed the capacity to perform newborn resuscitation at facilities offering comprehensive emergency obstetric and newborn care (EmONC) in Afghanistan, as well as individual and facility characteristics associated with providers’ knowledge and clinical skills. Methods Assessors interviewed 82 doctors and 142 midwives at 78 facilities on their knowledge of newborn resuscitation and observed them perform the procedure on an anatomical model. Supplies, equipment, and infrastructure were assessed at each facility. Descriptive statistics and simple and multivariate regression analyses were performed using STATA 11.2 and SAS 9.1.3. Results Over 90% of facilities had essential equipment for newborn resuscitation, including a mucus extractor, bag, and mask. More than 80% of providers had been trained on newborn resuscitation, but midwives were more likely than doctors to receive such training as part of pre-service education (59% and 35%, respectively, p < 0.001). No significant differences were found between doctors and midwives on knowledge, clinical skills, or confidence in performing newborn resuscitation. Doctors and midwives scored 71% and 66%, respectively, on knowledge questions and 66% and 71% on the skills assessment; 75% of doctors and 83% of midwives felt very confident in their ability to perform newborn resuscitation. Training was associated with greater knowledge (p < 0.001) and clinical skills (p < 0.05) in a multivariable model that adjusted for facility type, provider type, and years of experience offering EmONC services. Conclusions Lack of equipment and training do not pose major barriers to newborn resuscitation in Afghanistan, but providers’ knowledge and skills need strengthening in some areas. Midwives proved to be as capable as doctors of performing newborn resuscitation, which validates the major investment made in midwifery education. Competency-based pre-service and in-service training, complemented by supportive supervision, is an effective way to build providers’ capacity to perform newborn resuscitation. This kind of training could also help skilled birth attendants based in the community, at private clinics, or at primary care facilities save the lives of newborns. PMID:24020392

Burnout among public doctors in Hong Kong: cross-sectional survey.

PubMed

Siu, Christina F Y; Yuen, S K; Cheung, Andy

2012-06-01

The stressful life of doctors makes them prone to burnout. We evaluated the prevalence of burnout among Hong Kong public hospital doctors and correlated burnout with job characteristics, working hours, stressors, and stress-relieving strategies. Cross-sectional survey. Hong Kong. One thousand doctors were randomly sampled from the Hong Kong Public Doctors' Association registry. Self-administered, anonymous questionnaires with postage-paid envelopes were mailed twice in early 2009. The Maslach Burnout Inventory-Human Services Survey was used for burnout assessment. According to this scale, burnout is defined as emotional exhaustion, depersonalisation, and a reduced sense of personal accomplishment. Correlation analysis, as well as univariate and multivariate analyses, were performed to assess factors associated with high degrees of burnout. RESULTS. A total of 226 questionnaires were analysed, of which 31.4% of the respondents satisfied the criteria for high burnout. They were younger and needed to work shifts, and their median year of practice was 8.5. High-burnout doctors worked similar hours per week to non-high-burnout doctors (mean ± standard deviation, 56.2 ± 12.7 vs 54.7 ± 10.9; P=0.413) and reported suicidal thoughts more often (9.9% vs 2.6%; P=0.033). Moreover, 52.2% of high-burnout doctors were dissatisfied or very dissatisfied with their jobs. 'Excessive stress due to global workload' and 'feeling that their own work was not valued by others' were the most significant stressors associated with high emotional exhaustion and depersonalisation, while 'feeling that their own work was not valued by others' and 'poor job security' correlated with low personal accomplishment. A high proportion of public doctors who responded to our survey endured high burnout. Trainees with some experience were at heightened risk. Stressors identified in this study should be addressed, so as to improve job satisfaction.

Doctoring in Eastern Europe

PubMed Central

Wilde, Henry

1983-01-01

Health care in Eastern Europe has not achieved world standards nor the goals of planners of socialist societies. With luck, perseverance, bribes or good connections, it is possible to obtain good medical and surgical care in Eastern Europe for a major illness. Primary and even secondary care usually are substandard, however, and often completely unacceptable to most Western foreigners. The reasons for this are complex but mainly rooted in different attitudes of health workers towards their patients, poor physical plants, poor salary structures, inadequate advancement opportunities for health care workers, poor social status and professional recognition for nurses and almost complete isolation of the average primary care doctor from hospital medicine. PMID:6659504

[Nurses and doctors turnover: an impasse in the implementation of the Family Health Strategy].

PubMed

Medeiros, Cássia Regina Gotler; Junqueira, Alvaro Gustavo Wagner; Schwingel, Glademir; Carreno, Ioná; Jungles, Lúcia Adriana Pereira; Saldanha, Olinda Maria de Fátima Lechmann

2010-06-01

The research analyzed the causes for turnover rate of doctors and nurses in family health strategy teams with at least two years of implementation on March 2006 in Vale do Taquari, Rio Grande do Sul State. It is a quantitative and qualitative study identifying 31 teams in 25 towns, and the turnover rate was established by year from 1999 to 2005 by professional category. There was no turnover for doctors and nurses in 1999 and 2000. Doctor turnover was 5.9% in 2002; 32.1% in 2003; 25.8% in 2004; and 64.5% in 2005. Regarding nurses, it was 27.7% in 2001; 47% in 2002; 17.8% in 2003; 41.9% in 2004; and 22.6% in 2005. The analysis of semi-structured interviews with 7 doctors and 7 nurses appointed as main causes for turnover: poor work links, fragmented education, authoritarian way of managing, no links with the community, and poor work conditions. Thus, it is necessary to make changes regarding labor links, work conditions, and education for health workers and managers, seeking for the integrality in health practices.

The union doctor

PubMed Central

Bloor, D. U.

1980-01-01

The appointment, terms of service, and work of the Poor Law medical officer, the union doctor, is described to illustrate one of the roles of the mid-nineteenth century general practitioner. It was this role which laid the foundation of modern general practice. PMID:6997483

Nosological Inaccuracies in death certification in Northern Ireland. A comparative study between hospital doctors and general practitioners.

PubMed Central

Armour, A.; Bharucha, H.

1997-01-01

We aimed to audit nosological inaccuracies in death certification in Northern Ireland and to compare performance of hospital doctors and general practitioners. Nosology is the branch of medicine which treats of the classification of disease. 1138 deaths were registered in Northern Ireland in a 4-week period commencing 3/10/94. 195 of these were either registered by HM Coroners (HMC) or required further investigation by their staff; these cases were excluded from the study. The remaining 943 were analysed for wording and formulation inaccuracies according to the revised notes (1974), Northern Ireland Medical Certificate of Cause of Death. These are issued in book form by the Registrar of Births and Deaths. The commonest inaccuracies in death certification occur in the areas of poor terminology, sequence errors and unqualified mode. One or more inaccuracies were found in 317 (33.6%) of cases. In 13 of these (4%) cases, the inaccuracies were serious enough to warrant referral by the Registrar of Deaths to HM Coroner. The numbers of general practitioners and hospital doctors were recorded, with general practitioners being responsible for 122 (38%) and hospital doctors being responsible for 195 (62%) of inaccuracies. PMID:9185484

Bearing witness through medicine: an exploratory study of attitudes to service among Australian evangelical Christian doctors.

PubMed

Jensen, Sarah B; Phillips, Christine B

2013-12-01

This study explores the attitudes of Australian evangelical Christian doctors to healing, suffering and good practice, using in-depth interviews. Doctors described an intellectualised faith, in which medical care was conceived in itself as a way of bearing witness. The alleviation of suffering, for these doctors, included supporting patients to rediscover purpose and meaning in their lives. There was diversity of opinion about evangelising, with many feeling that this was a contingent activity best conducted outside the consultation. This cohort of doctors, mostly non-denominational, had consciously engaged in work with the poor and marginalised as an expression of their faith.

Unmet needs of patients with chronic obstructive pulmonary disease (COPD): a qualitative study on patients and doctors.

PubMed

Wong, Stalia S L; Abdullah, Nurdiana; Abdullah, Adina; Liew, Su-May; Ching, Siew-Mooi; Khoo, Ee-Ming; Jiwa, Moyez; Chia, Yook-Chin

2014-04-16

Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease with repeated exacerbations resulting in gradual debilitation. The quality of life has been shown to be poor in patients with COPD despite efforts to improve self-management. However, the evidence on the benefit of self-management in COPD is conflicting. Whether this could be due to other unmet needs of patients have not been investigated. Therefore, we aimed to explore unmet needs of patients from both patients and doctors managing COPD. We conducted a qualitative study with doctors and patients in Malaysia. We used convenience sampling to recruit patients until data saturation. Eighteen patients and eighteen doctors consented and were interviewed using a semi-structured interview guide. The interviews were audio-recorded, transcribed verbatim and checked by the interviewers. Data were analysed using a thematic approach. The themes were similar for both the patients and doctors. Three main themes emerged: knowledge and awareness of COPD, psychosocial and physical impact of COPD and the utility of self-management. Knowledge about COPD was generally poor. Patients were not familiar with the term chronic obstructive pulmonary disease or COPD. The word 'asthma' was used synonymously with COPD by both patients and doctors. Most patients experienced difficulties in their psychosocial and physical functions such as breathlessness, fear and helplessness. Most patients were not confident in self-managing their illness and prefer a more passive role with doctors directing their care. In conclusion, our study showed that knowledge of COPD is generally poor. There was mislabelling of COPD as asthma by both patients and physicians. This could have resulted in the lack of understanding of treatment options, outcomes, and prognosis of COPD. The misconception that cough due to COPD was contagious, and breathlessness that resulted from COPD, had important physical and psychosocial impact, and could lead to social isolation. Most patients and physicians did not favour self-management approaches, suggesting innovations based on self-management may be of limited benefit.

The Drop-Outs and the Dilatory on the Road to the Doctorate.

ERIC Educational Resources Information Center

Rudd, Ernest

1986-01-01

Results of a survey of British doctoral students not completing their graduate programs are reported. Students' reasons for dropping out include individual characteristics, personal problems and accidents, problems inherent in research projects, and poor supervision. Faculty attitudes and government policy are discussed. (MSE)

Do poor people sue doctors more frequently? Confronting unconscious bias and the role of cultural competency.

PubMed

McClellan, Frank M; White, Augustus A; Jimenez, Ramon L; Fahmy, Sherin

2012-05-01

There is a perception that socioeconomically disadvantaged patients tend to sue their doctors more frequently. As a result, some physicians may be reluctant to treat poor patients or treat such patients differently from other patient groups in terms of medical care provided. We (1) examined existing literature to refute the notion that poor patients are inclined to sue doctors more than other patients, (2) explored unconscious bias as an explanation as to why the perception of the poor being more litigious may exist despite evidence to the contrary, and (3) assessed the role of culturally competent awareness and knowledge in confronting physician bias. We reviewed medical and social literature to identify studies that have examined differences in litigation rates and related medical malpractice claims among socioeconomically disadvantaged patients versus other groups of patients. Contrary to popular perception, existing studies show poor patients, in fact, tend to sue physicians less often. This may be related to a relative lack of access to legal resources and the nature of the contingency fee system in medical malpractice claims. Misperceptions such as the one examined in this article that assume a relationship between patient poverty and medical malpractice litigation may arise from unconscious physician bias and other social variables. Cultural competency can be helpful in mitigating such bias, improving medical care, and addressing the risk of medical malpractice claims.

A day in the life of a junior doctor: everyday ethical encounters.

PubMed

Quarini, Catherine J

2010-11-01

This paper presents a hypothetical 'day in the life' of junior doctors working on a busy hospital ward. It illustrates the fact that, although the everyday ethical encounters faced by doctors are generally not as dramatic as some of the ethical issues discussed at medical school, the underlying principles, such as consent, confidentiality and resource allocation, are highly relevant to daily practice. After presenting some of the ethical challenges faced by junior doctors, from patients confused by poor explanations to inadequate consent procedures, the paper ends with suggestions on how to improve the situation.

Disorganized junior doctors fail the MRCP (UK).

PubMed

Stanley, Adrian G; Khan, Khalid M; Hussain, Walayat; Tweed, Michael

2006-02-01

Career progression during undergraduate and early postgraduate years is currently determined by successfully passing examinations. Both academic factors (secondary school examination results, learning style and training opportunities) and non-academic factors (maturity, ethnic origin, gender and motivation) have been identified as predicting examination outcome. Few studies have examined organization skills. Disorganized medical students are more likely to perform poorly in end-of-year examinations but this observation has not been examined in junior doctors. This study asked whether organization skills relate to examination outcome amongst junior doctors taking the clinical Part II examination for the Membership of the Royal College of Physicians (Practical Assessment of Clinical Examination Skills). The study was conducted prospectively at four consecutive clinical courses that provided clinical teaching and practice to prepare trainees for the examination. Arrival time at registration for the course was the chosen surrogate for organization skills. Trainees were advised that they should arrive promptly at 8.00 a.m. for registration and it was explained that the course would start at 8.30 a.m. Recorded arrival times were compared with the pass lists published by the Royal College of Physicians. The mean arrival time was 8.17 a.m. A total of 81 doctors (53.3%) passed the examination with a mean arrival time of 8.14 a.m. However, 71 doctors failed the exam and arrived, on average, six minutes later than doctors who passed (p?=?0.006). Better-prepared junior doctors were more likely to pass the final examination. Arriving on time represents a composite of several skills involved in the planning of appropriate travel arrangements and is therefore a valid marker of organization skills and preparation. This novel study has shown that good time-keeping skills are positively associated with examination outcome.

What drives the 'August effect'? A observational study of the effect of junior doctor changeover on out of hours work.

PubMed

Blakey, John D; Fearn, Andrew; Shaw, Dominick E

2013-01-01

To investigate whether measurements of junior doctor on-call workload and performance can clarify the mechanisms underlying the increase in morbidity and mortality seen after junior doctor changeover: the 'August effect'. Quantitative retrospective observational study of routinely collected data on junior doctor workload. Two large teaching hospitals in England. Task level data from a wireless out of hours system (n = 29,885 requests) used by medical staff, nurses, and allied health professionals. Number and type of tasks requested by nurses, time to completion of tasks by junior doctors. There was no overall change in the number of tasks requested by nurses out of hours around the August changeover (median requests per hour 15 before and 14 after, p = 0.46). However, the number of tasks classified as urgent was greater (p = 0.016) equating to five more urgent tasks per day. After changeover, doctors took less time to complete tasks overall due to a reduction in time taken for routine tasks (median 74 vs. 66 min; p = 3.9 × 10(-9)). This study suggests that the 'August effect' is not due to new junior doctors completing tasks more slowly or having a greater workload. Further studies are required to investigate the causes of the increased number of urgent tasks seen, but likely factors are errors, omissions, and poor prioritization. Thus, improved training and quality control has the potential to address this increased duration of unresolved patient risk. The study also highlights the potential of newer technologies to facilitate quantitative study of clinical activity.

[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.

Brain drain adds to AIDS crisis in developing world.

PubMed

Green, Stanley

2006-01-01

Thousands of desperately needed doctors and other medical professionals leave poor countries because no one there can pay them, or provide safe and effective working conditions. Many go to English-speaking countries that do not train enough medical professionals themselves--such as the U.S., where a quarter of the doctors are foreign trained.

Improving the Working Relationship between Doctors and Pharmacists: Is Inter-Professional Education the Answer?

ERIC Educational Resources Information Center

Gallagher, Ruth M.; Gallagher, Helen C.

2012-01-01

Despite their common history, there are many cultural, attitudinal and practical differences between the professions of medicine and pharmacy that ultimately influence patient care and health outcomes. While poor communication between doctors and pharmacists is a major cause of medical errors, it is clear that effective, deliberate…

Medical Student and Junior Doctors' Tolerance of Ambiguity: Development of a New Scale

ERIC Educational Resources Information Center

Hancock, Jason; Roberts, Martin; Monrouxe, Lynn; Mattick, Karen

2015-01-01

The practice of medicine involves inherent ambiguity, arising from limitations of knowledge, diagnostic problems, complexities of treatment and outcome and unpredictability of patient response. Research into doctors' tolerance of ambiguity is hampered by poor conceptual clarity and inadequate measurement scales. We aimed to create and pilot a…

Shifts in Doctor-Patient Communication during a Series of Outpatient Consultations in Non-Insulin-Dependent Diabetes Mellitus.

ERIC Educational Resources Information Center

van Dulmen, Alexandra M.; Verhaak, Peter F. M.; Bilo, Henk J. G.

1997-01-01

The first three consultations between 18 new patients with poorly controlled non-insulin-dependent diabetes mellitus and their medical specialist were videotaped. Changes in doctors' and patients' verbal and nonverbal communication behaviors were analyzed, and those most strongly related to patient satisfaction were distinguished. Discussion…

Dissatisfaction with traditional birth attendants in rural Tanzania.

PubMed

Mbaruku, Godfrey; Msambichaka, Beverly; Galea, Sandro; Rockers, Peter C; Kruk, Margaret E

2009-10-01

To assess women's satisfaction with traditional birth attendants (TBAs) in rural Tanzania. A population-representative sample of households in Kasulu district was used to collect data on demographics, childbirth history, and perception of TBAs and doctors/nurses from women who had recently had a child and from their partners. Two-thirds of women who gave birth in a health facility reported being very satisfied with the experience, compared with 21.2% of women who delivered at home with TBAs. A sizeable proportion of women felt that TBAs had poor medical skills (23.1%), while only 0.3% of women felt the same about doctors' and nurses' skills. Of women who delivered with a TBA, 16.0% reported that TBAs had poor medical skills whereas 0.5% stated the same for doctors and nurses. Although many women delivered at home in this rural study district, women and their partners reported higher confidence in doctors and nurses than in TBAs. Policymakers and program managers should not assume that women prefer TBAs to trained professionals for delivery but should consider system barriers to facility delivery in interventions aimed at reducing maternal mortality.

General population and medical student perceptions of good and bad doctors in Mozambique.

PubMed

Pfeiffer, Annett; Noden, Bruce H; Walker, Zoë A; Aarts, Rembrant; Ferro, Josefo

2011-04-01

A key element of the doctor-patient relationship is to understand the patient's and doctor's perceptions of quality care. To assess the perceptions of good and bad doctors among first-year medical students and local community members in a semi-urban, African settings. Using open-ended and closed dichotomous questions, 115 first-year medical students in Beira, Mozambique were surveyed regarding their perceptions of a 'good' and 'bad' doctor. Students then surveyed 611 community members in a predominately poor, semi-urban neighbourhood. Answers to open-ended questions provided by both groups produced the same four most important positive characteristics, with good diagnostic and therapeutic skills and dedication ranked highest. Closed-ended questions revealed that local community members felt that being concerned/considerate and diagnosing well were equally important (19.5% and 17.5%, respectively) compared to students (17.5% and 41.2%, respectively). The most important negative characteristics to the open-ended question for both groups were discrimination and contemptuous behaviour: 29.3% for community members and 27.4% for medical students. The biggest difference between groups was poor attending skills: 17.3% by community members and 3.9% by medical students. This study highlights differences and similarities between the perceptions of medical students and community members concerning a 'good' and a 'bad' doctor. Our data suggest that perceptions are guided by the experiences and values of those interviewed. Results indicate that medical education in developing countries should focus on patient-centered care, including communication skills and attitudes, besides training knowledgeable doctors.

Job satisfaction among Australian doctors: the use of latent class analysis.

PubMed

Joyce, Catherine; Wang, Wei Chun

2015-10-01

To identify patterns of job satisfaction among Australian doctors using latent class analysis, and to determine the relationships of these patterns to personal and professional characteristics so as to improve satisfaction and minimize medical wastage. MABEL (Medicine in Australia: Balancing Employment and Life) data in 2011 were used. The study collected information on 5764 doctors about their job satisfaction, demographic characteristics, their health, country of medical training, opportunities for professional development and social interaction, taking time off work, views of patients' expectations, unpredictable working hours, hours worked per week, preference to reduce hours and intention to leave the medical workforce. Four latent classes of job satisfaction were identified: 5.8% had high job satisfaction; 19.4% had low satisfaction with working hours; 16.1% had high satisfaction with working hours but felt undervalued; and 6.5% had low job satisfaction. Low job satisfaction was associated with reporting poor health, having trained outside Australia, having poor opportunities for professional development and working longer hours. Low satisfaction was associated with a preference to reduce work hours and an intention to leave the medical workforce. To improve job satisfaction and minimize medical wastage, policies need to address needs of overseas trained doctors, provide continuing professional development and provide good health care for doctors. © The Author(s) 2015.

Doctors and managers: poor relationships may be damaging patients—what can be done?

PubMed Central

Edwards, N

2003-01-01

The problem of poor relationships between doctors and managers is a common feature of many healthcare systems. This problem needs to be explicitly addressed and there are a number of positive steps that could be taken. Firstly, there would be value in working to improve the quality of relationships and better mutual understanding of the necessarily different positions of doctors and managers. Finding a common approach to managing resources, accountability, autonomy, and the creation of more systematic ways of working seems to be important. The use of costed clinical pathways may be one approach. Rather than seeing guidelines and accountability systems as a threat to autonomy there is an argument that they are an essential adjunct to it. Redefining autonomy in order to preserve it and to ensure that it encompasses accountability and responsibility will be an important step. A key step is the development of clinical leadership. PMID:14645744

Crew referrals to dentists and medical specialist ashore: a descriptive study of practice on three passenger vessels during one year.

PubMed

Dahl, Eilif

2006-01-01

To study crew referrals to out-patient port services from 3 passenger ships during 12 months (2004), with focus on dentist appointments. The median number of crew on Ship A was 561, on Ship B 534 and on Ship C 614. Crew referrals were registered continuously and after each cruise segment recorded in the ship's doctor's medical cruise report, from which the data were retrieved and reviewed. During 2004 the doctors of the 3 sister ships had a total of 8888 crew consultations (Table 1). Mean number of doctor consultations for crew was 17.5 a day. On Ship A 50%, on B 59% and on C 70% of the port referrals were dentist appointments. A crew member was referred to a dentist every 7 (Ship C) to 10 days (Ships A + B). Among the specified dental referrals, 18% were extraction requests. The ship's doctors had a busy crew practice, but were neither trained nor equipped to do elective dentistry aboard. Crew referral rate to services ashore was low, but 50-70% of the referrals for out-patient port services concerned dentistry. Inadequate health insurance caused low-wage crew to request free extractions instead of expensive repair in high-cost ports. As dentistry in local ports is a poor substitute for the person's own dentist, doctors performing seafarer examinations should ensure that dental problems are solved before sign-on.

Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan

PubMed Central

Shah, Sayed Masoom; Zaidi, Shehla; Ahmed, Jamil; Rehman, Shafiq Ur

2016-01-01

Background: Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan’s health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. Methods: An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Results: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. Conclusion: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies, and medical facilities contributed to lack of motivation in physicians in our study. Our study advocates that by addressing the retention and motivation challenges, service delivery can be made more responsive to the patients and communities in Pakistan and other similar settings. PMID:27694660

Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan.

PubMed

Shah, Sayed Masoom; Zaidi, Shehla; Ahmed, Jamil; Rehman, Shafiq Ur

2016-04-09

Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies, and medical facilities contributed to lack of motivation in physicians in our study. Our study advocates that by addressing the retention and motivation challenges, service delivery can be made more responsive to the patients and communities in Pakistan and other similar settings. © 2016 by Kerman University of Medical Sciences

Burnout and Doctors: Prevalence, Prevention and Intervention

PubMed Central

Kumar, Shailesh

2016-01-01

Doctors are exposed to high levels of stress in the course of their profession and are particularly susceptible to experiencing burnout. Burnout has far-reaching implications on doctors; patients and the healthcare system. Doctors experiencing burnout are reported to be at a higher risk of making poor decisions; display hostile attitude toward patients; make more medical errors; and have difficult relationships with co-workers. Burnout among doctors also increases risk of depression; anxiety; sleep disturbances; fatigue; alcohol and drug misuse; marital dysfunction; premature retirement and perhaps most seriously suicide. Sources of stress in medical practice may range from the emotions arising in the context of patient care to the environment in which doctors practice. The extent of burnout may vary depending on the practice setting; speciality and changing work environment. Understanding dynamic risk factors associated with burnout may help us develop strategies for preventing and treating burnout. Some of these strategies will be reviewed in this paper. PMID:27417625

Numeracy skills of undergraduate entry level nurse, midwife and pharmacy students.

PubMed

Arkell, Sharon; Rutter, Paul M

2012-07-01

The ability of healthcare professionals to perform basic numeracy and therefore dose calculations competently is without question. Research has primarily focused on nurses, and to a lesser extent doctors, ability to perform this function with findings highlighting poor aptitude. Studies involving pharmacists are few but findings are more positive than other healthcare staff. To determine first year nursing, midwifery and pharmacy students ability to perform basic numeracy calculations. All new undergraduate entrants to nursing, midwifery and pharmacy sat a formative numeracy test within the first two weeks of their first year of study. Test results showed that pharmacy students significantly outperformed midwifery and nursing students on all questions. In turn midwifery students outperformed nurses, although this did not achieve significance. When looking at each cohorts general attitude towards mathematics, pharmacy students were more positive and confident compared to midwifery and nursing students. Pharmacy students expressed greater levels of enjoyment and confidence in performing mathematics and correspondingly showed the greatest proficiency. In contrast nurse, and to a lesser extent midwifery students showed poor performance and low confidence levels. Copyright © 2012 Elsevier Ltd. All rights reserved.

Combining parenthood with a medical career: questionnaire survey of the UK medical graduates of 2002 covering some influences and experiences

PubMed Central

Smith, Fay; Goldacre, Michael J

2017-01-01

Objectives To report the self-assessed views of a cohort of medical graduates about the impact of having (or wanting to have) children on their specialty choice and the extent to which their employer was supportive of doctors with children. Setting United Kingdom (UK). Participants UK medical graduates of 2002 surveyed by post and email in 2014. Results The response rate was 64.2% (2057/3205). Most respondents were living with a spouse or partner (86%) and, of these, 49% had a medical spouse. Having children, or wanting to have children, had influenced specialty choice for 47% of respondents; for 56% of doctors with children and 29% of doctors without children; for 59% of women and 28% of men; and for 78% of general practitioners compared with 27% of hospital doctors and 18% of surgeons. 42% of respondents regarded the National Health Service as a family-friendly employer, and 64% regarded their specialty as family-friendly. More general practitioners (78%) than doctors in hospital specialties (56%) regarded their specialty as family-friendly, while only 32% of surgeons did so. Of those who had taken maternity/paternity/adoption leave, 49% rated the level of support they had received in doing so as excellent/good, 32% said it was acceptable and 18% said the support had been poor/very poor. Conclusions Having children is a major influence when considering specialty choice for many doctors, especially women and general practitioners. Surgeons are least influenced in their career choice by the prospect of parenthood. Almost half of doctors in hospital specialties regard their specialty as family-friendly. PMID:28838899

Combining parenthood with a medical career: questionnaire survey of the UK medical graduates of 2002 covering some influences and experiences.

PubMed

Lambert, Trevor W; Smith, Fay; Goldacre, Michael J

2017-08-23

To report the self-assessed views of a cohort of medical graduates about the impact of having (or wanting to have) children on their specialty choice and the extent to which their employer was supportive of doctors with children. United Kingdom (UK). UK medical graduates of 2002 surveyed by post and email in 2014. The response rate was 64.2% (2057/3205). Most respondents were living with a spouse or partner (86%) and, of these, 49% had a medical spouse. Having children, or wanting to have children, had influenced specialty choice for 47% of respondents; for 56% of doctors with children and 29% of doctors without children; for 59% of women and 28% of men; and for 78% of general practitioners compared with 27% of hospital doctors and 18% of surgeons. 42% of respondents regarded the National Health Service as a family-friendly employer, and 64% regarded their specialty as family-friendly. More general practitioners (78%) than doctors in hospital specialties (56%) regarded their specialty as family-friendly, while only 32% of surgeons did so.Of those who had taken maternity/paternity/adoption leave, 49% rated the level of support they had received in doing so as excellent/good , 32% said it was acceptable and 18% said the support had been poor/very poor . Having children is a major influence when considering specialty choice for many doctors, especially women and general practitioners. Surgeons are least influenced in their career choice by the prospect of parenthood. Almost half of doctors in hospital specialties regard their specialty as family-friendly. © 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.

Risk Factors for Reporting Poor Cultural Competency Among Patients with Diabetes in Safety-Net Clinics

PubMed Central

Seligman, Hilary K.; Fernandez, Alicia; Stern, Rachel J.; Weech-Maldonado, Robert; Quan, Judy; Jacobs, Elizabeth A.

2012-01-01

Background The Consumer Assessment of Healthcare Providers and Systems Cultural Competency (CAHPS-CC) Item Set assesses patient perceptions of aspects of the cultural competence of their health care. Objective To determine characteristics of patients who identify the care they receive as less culturally competent Research Design Cross-sectional survey consisting of face-to-face interviews Subjects Safety-net population of patients with type 2 diabetes (n=600) receiving ongoing primary care Measures Participants completed the CAHPS-CC and answered questions about their race/ethnicity, gender, age, education, health status, depressive symptoms, insurance coverage, English proficiency, duration of relationship with primary care provider, and co-morbidities. Results In adjusted models, depressive symptoms were significantly associated with poor cultural competency in the Doctor Communication – Positive Behaviors domain (OR 1.73, 95%CI 1.11, 2.69). African-Americans were less likely than Whites to report poor cultural competence in the Doctor Communication – Positive Behaviors domain (OR 0.52, 0.28–0.97). Participants who reported a longer relationship (≥3 years) with their primary care provider were less likely to report poor cultural competence in the Doctor Communication – Health Promotion (OR 0.35, 0.21–0.60) and Trust domains (OR 0.4, 0.24–0.67), while participants with lower educational attainment were less likely to report poor cultural competence in the Trust domain (OR 0.51, 0.30–0.86). Overall, however, sociodemographic and clinical differences in reports of poor cultural competence were insignificant or inconsistent across the various domains of cultural competence examined. Conclusions Cultural competence interventions in safety-net settings should be implemented across populations, rather than being narrowly focused on specific sociodemographic or clinical groups. PMID:22895232

Risk factors for reporting poor cultural competency among patients with diabetes in safety net clinics.

PubMed

Seligman, Hilary K; Fernandez, Alicia; Stern, Rachel J; Weech-Maldonado, Robert; Quan, Judy; Jacobs, Elizabeth A

2012-09-01

The Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set assesses patient perceptions of aspects of the cultural competence of their health care. To determine characteristics of patients who identify the care they receive as less culturally competent. Cross-sectional survey consisting of face-to-face interviews. Safety-net population of patients with type 2 diabetes (n=600) receiving ongoing primary care. Participants completed the Consumer Assessment of Healthcare Providers and Systems Cultural Competency and answered questions about their race/ethnicity, sex, age, education, health status, depressive symptoms, insurance coverage, English proficiency, duration of relationship with primary care provider, and comorbidities. In adjusted models, depressive symptoms were significantly associated with poor cultural competency in the Doctor Communication--Positive Behaviors domain [odds ratio (OR) 1.73, 95% confidence interval, 1.11-2.69]. African Americans were less likely than whites to report poor cultural competence in the Doctor Communication--Positive Behaviors domain (OR 0.52, 95% CI, 0.28-0.97). Participants who reported a longer relationship (≥ 3 y) with their primary care provider were less likely to report poor cultural competence in the Doctor Communication--Health Promotion (OR 0.35, 95% CI, 0.21-0.60) and Trust domains (OR 0.4, 95% CI, 0.24-0.67), whereas participants with lower educational attainment were less likely to report poor cultural competence in the Trust domain (OR 0.51, 95% CI, 0.30-0.86). Overall, however, sociodemographic and clinical differences in reports of poor cultural competence were insignificant or inconsistent across the various domains of cultural competence examined. Cultural competence interventions in safety-net settings should be implemented across populations, rather than being narrowly focused on specific sociodemographic or clinical groups.

Club practice

PubMed Central

Bloor, D. U.

1982-01-01

There were many forms of club or contract practice in the nineteenth century, but the friendly societies were the most important. A brief history of the friendly societies is given. As they grew in numbers and importance so did the dissatisfaction of the doctors who worked with them. Discontent among the doctors led at the end of the century to a battle between the medical profession and the clubs. The issues which divided the clubs and the doctors were clearly defined but, although the battle was protracted, the doctors did not win or manage to change the system of medical provision for the poor. The club system was ended by Lloyd George when he introduced his National Insurance Act, 1911. PMID:7050375

Effect of UK policy on medical migration: a time series analysis of physician registration data

PubMed Central

2012-01-01

Background Economically developed countries have recruited large numbers of overseas health workers to fill domestic shortages. Recognition of the negative impact this can have on health care in developing countries led the United Kingdom Department of Health to issue a Code of Practice for National Health Service (NHS) employers in 1999 providing ethical guidance on international recruitment. Case reports suggest this guidance had limited influence in the context of other NHS policy priorities. Methods The temporal association between trends in new professional registrations from doctors qualifying overseas and relevant United Kingdom government policy is reported. Government policy documents were identified by a literature review; further information was obtained, when appropriate, through requests made under the Freedom of Information Act. Data on new professional registration of doctors were obtained from the General Medical Council (GMC). Results New United Kingdom professional registrations by doctors trained in Africa and south Asia more than doubled from 3105 in 2001 to 7343 in 2003, as NHS Trusts sought to achieve recruitment targets specified in the 2000 NHS Plan; this occurred despite ethical guidance to avoid active recruitment of doctors from resource-poor countries. Registration of such doctors declined subsequently, but in response to other government policy initiatives. A fall in registration of South African-trained doctors from 3206 in 2003 to 4 in 2004 followed a Memorandum of Understanding with South Africa signed in 2003. Registrations from India and Pakistan fell from a peak of 4626 in 2004 to 1169 in 2007 following changes in United Kingdom immigration law in 2005 and 2006. Since 2007, registration of new doctors trained outside the European Economic Area has remained relatively stable, but in 2010 the United Kingdom still registered 722 new doctors trained in Africa and 1207 trained in India and Pakistan. Conclusions Ethical guidance was ineffective in preventing mass registration by doctors trained in resource-poor countries between 2001 and 2004 because of competing NHS policy priorities. Changes in United Kingdom immigration laws and bilateral agreements have subsequently reduced new registrations, but about 4000 new doctors a year continue to register who trained in Africa, Asia and less economically developed European countries. PMID:23009665

Effect of UK policy on medical migration: a time series analysis of physician registration data.

PubMed

Blacklock, Claire; Heneghan, Carl; Mant, David; Ward, Alison M

2012-09-25

Economically developed countries have recruited large numbers of overseas health workers to fill domestic shortages. Recognition of the negative impact this can have on health care in developing countries led the United Kingdom Department of Health to issue a Code of Practice for National Health Service (NHS) employers in 1999 providing ethical guidance on international recruitment. Case reports suggest this guidance had limited influence in the context of other NHS policy priorities. The temporal association between trends in new professional registrations from doctors qualifying overseas and relevant United Kingdom government policy is reported. Government policy documents were identified by a literature review; further information was obtained, when appropriate, through requests made under the Freedom of Information Act. Data on new professional registration of doctors were obtained from the General Medical Council (GMC). New United Kingdom professional registrations by doctors trained in Africa and south Asia more than doubled from 3105 in 2001 to 7343 in 2003, as NHS Trusts sought to achieve recruitment targets specified in the 2000 NHS Plan; this occurred despite ethical guidance to avoid active recruitment of doctors from resource-poor countries. Registration of such doctors declined subsequently, but in response to other government policy initiatives. A fall in registration of South African-trained doctors from 3206 in 2003 to 4 in 2004 followed a Memorandum of Understanding with South Africa signed in 2003. Registrations from India and Pakistan fell from a peak of 4626 in 2004 to 1169 in 2007 following changes in United Kingdom immigration law in 2005 and 2006. Since 2007, registration of new doctors trained outside the European Economic Area has remained relatively stable, but in 2010 the United Kingdom still registered 722 new doctors trained in Africa and 1207 trained in India and Pakistan. Ethical guidance was ineffective in preventing mass registration by doctors trained in resource-poor countries between 2001 and 2004 because of competing NHS policy priorities. Changes in United Kingdom immigration laws and bilateral agreements have subsequently reduced new registrations, but about 4000 new doctors a year continue to register who trained in Africa, Asia and less economically developed European countries.

Working as a doctor when chronically ill or disabled: comments made by doctors responding to UK surveys.

PubMed

Smith, Fay; Goldacre, Michael J; Lambert, Trevor W

2016-07-01

To report a qualitative study of themes doctors raised spontaneously, in a large-scale prospective cohort study covering many aspects of their medical careers, when referring to their own chronic illness or disability. Questionnaire survey. UK. Questionnaires were sent one, five and 10 years after graduation to 44,539 doctors who qualified between 1993 and 2012 in the UK: 38,613 questionnaires were returned and 11,859 respondents provided comments made by doctors about their training or work. The comments of 123 doctors about their own chronic illness or disability. Main themes raised included poor support for doctors with chronic illness or disability, delays in and changes to careers (either planned ahead or imposed), the impact of pressure at work, difficulties returning to work after illness, limitations on career choices and inadequate careers advice for doctors with chronic illness or disabilities. More needs to be done to ensure that doctors with chronic illness or disability receive appropriate support. Occupational health guidance should be monitored closely, with more support for ill doctors including adjustments to the job, help if needed with morale and mental health, and advice on career options. Further studies should establish the prevalence of long-term health conditions among doctors.

Are the General Medical Council's Tests of Competence fair to long standing doctors? A retrospective cohort study.

PubMed

Mehdizadeh, Leila; Sturrock, Alison; Dacre, Jane

2015-04-21

The General Medical Council's Fitness to Practise investigations may involve a test of competence for doctors with performance concerns. Concern has been raised about the suitability of the test format for doctors who qualified before the introduction of Single Best Answer and Objective Structured Clinical Examination assessments, both of which form the test of competence. This study explored whether the examination formats used in the tests of competence are fair to long standing doctors who have undergone fitness to practise investigation. A retrospective cohort design was used to determine an association between year of primary medical qualification and doctors' test of competence performance. Performance of 95 general practitioners under investigation was compared with a group of 376 volunteer doctors. We analysed performance on knowledge test, OSCE overall, and three individual OSCE stations using Spearman's correlation and regression models. Doctors under investigation performed worse on all test outcomes compared to the comparison group. Qualification year correlated positively with performance on all outcomes except for physical examination (e.g. knowledge test r = 0.48, p < 0.001 and OSCE r = 0.37, p < 0.001). Qualification year was associated with test performance in doctors under investigation even when controlling for sex, ethnicity and qualification region. Regression analyses showed that qualification year was associated with knowledge test, OSCE and communication skills performance of doctors under investigation when other variables were controlled for. Among volunteer doctors this was not the case and their performance was more strongly related to where they qualified and their ethnic background. Furthermore, volunteer doctors who qualified before the introduction of Single Best Answer and OSCE assessments, still outperformed their peers under investigation. Earlier graduates under fitness to practise investigation performed less well on the test of competence than their more recently qualified peers under investigation. The performance of the comparator group tended to stay consistent irrespective of year qualified. Our results suggest that the test format does not disadvantage early qualified doctors. We discuss findings in relation to the GMC's fitness to practise procedures and suggest alternative explanations for the poorer performance of long standing doctors under investigation.

Theory in Practice: Why "Good Medicine" and "Scientific Medicine" Are Not Necessarily the Same Thing

ERIC Educational Resources Information Center

De Camargo, Kenneth, Jr.; Coeli, Claudia Medina

2006-01-01

The term "scientific medicine", ubiquitous in medical literature although poorly defined, can be traced to a number of assumptions, three of which are examined in this paper: that medicine is a form of knowledge-driven practice, where the established body of proven medical knowledge determines what doctors do; if what doctors do is either…

Why nutrition education is inadequate in the medical curriculum: a qualitative study of students' perspectives on barriers and strategies.

PubMed

Mogre, Victor; Stevens, Fred C J; Aryee, Paul A; Amalba, Anthony; Scherpbier, Albert J J A

2018-02-12

The provision of nutrition care by doctors is important in promoting healthy dietary habits, and such interventions can lead to reductions in disease morbidity, mortality, and medical costs. However, medical students and doctors report inadequate nutrition education and preparedness during their training at school. Previous studies investigating the inadequacy of nutrition education have not sufficiently evaluated the perspectives of students. In this study, students' perspectives on doctors' role in nutrition care, perceived barriers, and strategies to improve nutrition educational experiences are explored. A total of 23 undergraduate clinical level medical students at the 5th to final year in the School of Medicine and Health Sciences of the University for Development Studies in Ghana were purposefully selected to participate in semi-structured individual interviews. Students expressed their opinions and experiences regarding the inadequacy of nutrition education in the curriculum. Each interview was audio-recorded and later transcribed verbatim. Using the constant comparison method, key themes were identified from the data and analysis was done simultaneously with data collection. Students opined that doctors have an important role to play in providing nutrition care to their patients. However, they felt their nutrition education was inadequate due to lack of priority for nutrition education, lack of faculty to provide nutrition education, poor application of nutrition science to clinical practice and poor collaboration with nutrition professionals. Students opined that their nutrition educational experiences will be improved if the following strategies were implemented: adoption of innovative teaching and learning strategies, early and comprehensive incorporation of nutrition as a theme throughout the curriculum, increasing awareness on the importance of nutrition education, reviewing and revision of the curriculum to incorporate nutrition, and involving nutrition/dietician specialists in medical education. Though students considered nutrition care as an important role for doctors they felt incapacitated by non-prioritisation of nutrition education, lack of faculty for teaching of nutrition education, poor application of nutrition science and poor collaboration with nutrition professionals. Incorporation of nutrition as a theme in medical education, improving collaboration, advocacy and creating enabling environments for nutrition education could address some of the barriers to nutrition education.

Methods of appointment and qualifications of club doctors and physiotherapists in English professional football: some problems and issues.

PubMed

Waddington, I; Roderick, M; Naik, R

2001-02-01

To examine the methods of appointment, experience, and qualifications of club doctors and physiotherapists in professional football. Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. In almost all clubs, methods of appointment of doctors are informal and reflect poor employment practice: posts are rarely advertised and many doctors are appointed on the basis of personal contacts and without interview. Few club doctors had prior experience or qualifications in sports medicine and very few have a written job description. The club doctor is often not consulted about the appointment of the physiotherapist; physiotherapists are usually appointed informally, often without interview, and often by the manager without involving anyone who is qualified in medicine or physiotherapy. Half of all clubs do not have a qualified (chartered) physiotherapist; such unqualified physiotherapists are in a weak position to resist threats to their clinical autonomy, particularly those arising from managers' attempts to influence clinical decisions. Almost all aspects of the appointment of club doctors and physiotherapists need careful re-examination.

Burnout syndrome among non-consultant hospital doctors in Ireland: relationship with self-reported patient care.

PubMed

Sulaiman, Che Fatehah Che; Henn, Patrick; Smith, Simon; O'Tuathaigh, Colm M P

2017-10-01

Intensive workload and limited training opportunities for Irish non-consultant hospital doctors (NCHDs) has a negative effect on their health and well-being, and can result in burnout. Burnout affects physician performance and can lead to medical errors. This study examined the prevalence of burnout syndrome among Irish NCHDs and its association with self-reported medical error and poor quality of patient care. A cross-sectional quantitative survey-based design. All teaching hospitals affiliated with University College Cork. NCHDs of all grades and specialties. The following instruments were completed by all participants: Maslach Burnout Inventory-Human Service Survey (MBI-HSS), assessing three categories of burnout syndrome: Emotional exhaustion (EE), Personal Achievement (PA) and Depersonalization (DP); questions related to self-reported medical errors/poor patient care quality and socio-demographic information. Self-reported measures of burnout and poor quality of patient care. Prevalence of burnout among physicians (n = 265) was 26.4%. There was a significant gender difference for EE and DP, but none for PA. A positive weak correlation was observed between EE and DP with medical error or poor patient care. A negative association was reported between PA and medical error and reduced quality of patient care. Burnout is prevalent among NCHDs in Ireland. Burnout syndrome is associated with self-reported medical error and quality of care in this sample population. Measures need to be taken to address this issue, with a view to protecting health of NCHDs and maintaining quality of patient care. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement.

PubMed

Powell, Arfon G M T; Paterson-Brown, Simon; Drummond, Gordon B

2014-02-20

Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used. We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics. The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as "too esoteric", the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate. Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and "fitness for purpose", and avoid omission of vital knowledge.

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

PubMed Central

2014-01-01

Background Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used. Methods We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics. Results The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate. Conclusions Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge. PMID:24555812

From novice to proficient general practitioner: a critical incident study.

PubMed

Sim, M G; Kamien, M; Diamond, M R

1996-09-01

To obtain information about any change in the performance or perceptions of doctors undertaking the Royal Australian College of General Practitioners (RACGP) Training Program, with advancing general practice experience. The critical incident technique' was used, which is a comparative qualitative analysis. It involved interviews at 12 to 18 months after the basic term interview. Eighteen Western Australian doctors, who had been interviewed in 1992, at the end of their first 6 months of general practice training and were now completing their advanced or mentor terms in the RACGP Training Program took part in the study. Doctors reported an average of 4.4 critical incidents in their first interview and 5.0 in their second interview. The major areas of positive change included relationships with patients and other health care professionals, including supervisors; paediatrics and orthopaedics skills; the skills of developing a therapeutic relationship to enhance patient compliance and the ability to manage complex cardiovascular and psychiatric problems without reliance on specialist referral; attitudes of responsibility for and enjoyment of long term care of patients and families; and reduced levels of anxiety over difficult problems. New or continuing areas of difficulty were found in gynaecology; pharmacotherapy and dermatology; the diagnosis of common complaints with uncommon presentations; the skill of managing difficult or angry patients; the organisation for the follow-up of patients with potentially severe disorders; and in managing feelings of guilt over missed diagnoses or poor management. An analysis of commonly occurring positive and negative critical incidents shows that RACGP Training Program doctors develop competence, confidence and reduced levels of performance anxiety with advancing experience. All but one doctor found the Training Program helpful in achieving these proficiencies. However, many ongoing areas of difficulty remain. The Critical Incident method is a useful tool for learning and assessment in a vocational training program.

Methods of appointment and qualifications of club doctors and physiotherapists in English professional football: some problems and issues

PubMed Central

Waddington, I; Roderick, M; Naik, R

2001-01-01

Objective—To examine the methods of appointment, experience, and qualifications of club doctors and physiotherapists in professional football. Methods—Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. Results—In almost all clubs, methods of appointment of doctors are informal and reflect poor employment practice: posts are rarely advertised and many doctors are appointed on the basis of personal contacts and without interview. Few club doctors had prior experience or qualifications in sports medicine and very few have a written job description. The club doctor is often not consulted about the appointment of the physiotherapist; physiotherapists are usually appointed informally, often without interview, and often by the manager without involving anyone who is qualified in medicine or physiotherapy. Half of all clubs do not have a qualified (chartered) physiotherapist; such unqualified physiotherapists are in a weak position to resist threats to their clinical autonomy, particularly those arising from managers' attempts to influence clinical decisions. Conclusions—Almost all aspects of the appointment of club doctors and physiotherapists need careful re-examination. Key Words: football clubs; doctors; physiotherapists; qualifications PMID:11157462

Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust

PubMed Central

Umotong, Eno

2016-01-01

Abstract The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability. PMID:27893528

Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust: Audit.

PubMed

Umotong, Eno

2016-12-01

The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability.

Incentives could induce Ethiopian doctors and nurses to work in rural settings.

PubMed

Hanson, Kara; Jack, William

2010-08-01

What would best motivate more doctors and nurses to work in rural areas of poor countries, where they are badly needed? We presented doctors and nurses in Ethiopia with a series of hypothetical job combinations of wages, working conditions, housing benefits, and training opportunities. For doctors, we found that higher wages and quality housing incentives had the biggest impact on their willingness to practice in towns in rural areas. For nurses, improvements in the availability of medical equipment and supplies were the factors most likely to bring about a move to a rural village. Choosing the right incentive package requires a consideration of both the effects of different packages on health workers' choices and the cost of those packages.

What Are the Major Impact Factors on Research Performance of Young Doctorate Holders in Science in China: A USTC Survey

ERIC Educational Resources Information Center

Gu, Jibao; Lin, Yu; Vogel, Doug; Tian, Wen

2011-01-01

Doctoral graduate research performance (DRP) is recognized as one of the most critical indices for evaluation of the success of doctoral education. Doctoral graduates with high research performance directly reflect a higher ability in academic research and academic achievement. Consequently, identifying which factors influence DRP is potentially…

Sexual minorities in England have poorer health and worse health care experiences: a national survey.

PubMed

Elliott, Marc N; Kanouse, David E; Burkhart, Q; Abel, Gary A; Lyratzopoulos, Georgios; Beckett, Megan K; Schuster, Mark A; Roland, Martin

2015-01-01

The health and healthcare of sexual minorities have recently been identified as priorities for health research and policy. To compare the health and healthcare experiences of sexual minorities with heterosexual people of the same gender, adjusting for age, race/ethnicity, and socioeconomic status. Multivariate analyses of observational data from the 2009/2010 English General Practice Patient Survey. The survey was mailed to 5.56 million randomly sampled adults registered with a National Health Service general practice (representing 99 % of England's adult population). In all, 2,169,718 people responded (39 % response rate), including 27,497 people who described themselves as gay, lesbian, or bisexual. Two measures of health status (fair/poor overall self-rated health and self-reported presence of a longstanding psychological condition) and four measures of poor patient experiences (no trust or confidence in the doctor, poor/very poor doctor communication, poor/very poor nurse communication, fairly/very dissatisfied with care overall). Sexual minorities were two to three times more likely to report having a longstanding psychological or emotional problem than heterosexual counterparts (age-adjusted for 5.2 % heterosexual, 10.9 % gay, 15.0 % bisexual for men; 6.0 % heterosexual, 12.3 % lesbian and 18.8 % bisexual for women; p < 0.001 for each). Sexual minorities were also more likely to report fair/poor health (adjusted 19.6 % heterosexual, 21.8 % gay, 26.4 % bisexual for men; 20.5 % heterosexual, 24.9 % lesbian and 31.6 % bisexual for women; p < 0.001 for each). Adjusted for sociodemographic characteristics and health status, sexual minorities were about one and one-half times more likely than heterosexual people to report unfavorable experiences with each of four aspects of primary care. Little of the overall disparity reflected concentration of sexual minorities in low-performing practices. Sexual minorities suffer both poorer health and worse healthcare experiences. Efforts should be made to recognize the needs and improve the experiences of sexual minorities. Examining patient experience disparities by sexual orientation can inform such efforts.

The role of the psychiatrist in improving patient compliance.

PubMed

Hotujac, Ljubomir

2007-02-01

Compliance, usually referring to how well the patient takes the medication as prescribed, is an important issue in clinical practice. However, many patients, especially those with a psychiatric illness, stop taking their medications despite physician advice to continue. This cessation can lead to a deterioration in the condition, a relapse, or a recurrence of the illness. In the literature, many different factors contributing to poor compliance have been described, but the doctor's role and responsibilities are hardly mentioned. These factors will be discussed here with special emphasis on what a doctor should do and what a doctor should avoid.

Implementing medical revalidation in the United Kingdom: Findings about organisational changes and impacts from a survey of Responsible Officers

PubMed Central

Boyd, Alan; Bryce, Marie; Luscombe, Kayleigh; Tazzyman, Abigail; Tredinnick-Rowe, John; Archer, Julian

2017-01-01

Objective To describe the implementation of medical revalidation in healthcare organisations in the United Kingdom and to examine reported changes and impacts on the quality of care. Design A cross-sectional online survey gathering both quantitative and qualitative data about structures and processes for medical revalidation and wider quality management in the organisations which employ or contract with doctors (termed ‘designated bodies’) from the senior doctor in each organisation with statutory responsibility for medical revalidation (termed the ‘Responsible Officer’). Setting United Kingdom Participants Responsible Officers in designated bodies in the United Kingdom. Five hundred and ninety-five survey invitations were sent and 374 completed surveys were returned (63%). Main outcome measures The role of Responsible Officers, the development of organisational mechanisms for quality assurance or improvement, decision-making on revalidation recommendations, impact of revalidation and mechanisms for quality assurance or improvement on clinical practice and suggested improvements to revalidation arrangements. Results Responsible Officers report that revalidation has had some impacts on the way medical performance is assured and improved, particularly strengthening appraisal and oversight of quality within organisations and having some impact on clinical practice. They suggest changes to make revalidation less ‘one size fits all’ and more responsive to individual, organisational and professional contexts. Conclusions Revalidation appears primarily to have improved systems for quality improvement and the management of poor performance to date. There is more to be done to ensure it produces wider benefits, particularly in relation to doctors who already perform well. PMID:28084166

Implementing medical revalidation in the United Kingdom: Findings about organisational changes and impacts from a survey of Responsible Officers.

PubMed

Walshe, Kieran; Boyd, Alan; Bryce, Marie; Luscombe, Kayleigh; Tazzyman, Abigail; Tredinnick-Rowe, John; Archer, Julian

2017-01-01

Objective To describe the implementation of medical revalidation in healthcare organisations in the United Kingdom and to examine reported changes and impacts on the quality of care. Design A cross-sectional online survey gathering both quantitative and qualitative data about structures and processes for medical revalidation and wider quality management in the organisations which employ or contract with doctors (termed 'designated bodies') from the senior doctor in each organisation with statutory responsibility for medical revalidation (termed the 'Responsible Officer'). Setting United Kingdom Participants Responsible Officers in designated bodies in the United Kingdom. Five hundred and ninety-five survey invitations were sent and 374 completed surveys were returned (63%). Main outcome measures The role of Responsible Officers, the development of organisational mechanisms for quality assurance or improvement, decision-making on revalidation recommendations, impact of revalidation and mechanisms for quality assurance or improvement on clinical practice and suggested improvements to revalidation arrangements. Results Responsible Officers report that revalidation has had some impacts on the way medical performance is assured and improved, particularly strengthening appraisal and oversight of quality within organisations and having some impact on clinical practice. They suggest changes to make revalidation less 'one size fits all' and more responsive to individual, organisational and professional contexts. Conclusions Revalidation appears primarily to have improved systems for quality improvement and the management of poor performance to date. There is more to be done to ensure it produces wider benefits, particularly in relation to doctors who already perform well.

Doctoral Writing in the Visual and Performing Arts: Two Ends of a Continuum

ERIC Educational Resources Information Center

Paltridge, Brian; Starfield, Sue; Ravelli, Louise; Nicholson, Sarah

2012-01-01

Doctoral degrees in the visual and performing arts are a fairly recent entrant in the research higher degree landscape in Australian universities. At the same time, a new kind of doctorate is evolving, a doctorate in which significant aspects of the claim for the doctoral characteristics of originality, mastery and contribution to the field are…

Evaluation of proficiency in using different inhaler devices among intern doctors.

PubMed

Kshatriya, Ravish M; Khara, Nimit V; Paliwal, Rajiv P; Patel, Satish N

2016-01-01

Doctors may have deficiencies in the ability to use different inhalers, which in turn, can result in improper technique by the patients and poorly controlled asthma and chronic obstructive pulmonary disease (COPD). To evaluate intern doctors' proficiency in using various inhaler devices. Seventy interns were evaluated for their proficiency in using pressurized metered dose inhaler (pMDI), pMDI with spacer, rotahaler, turbuhaler, and nebulizer. A structured assessment sheet was scored for identification and preparation of device, administration, coordination, and skill of explanation on a scale of 0-5. Common errors such as failure to shake pMDI before use, inability to identify the empty device, inadequate breath holding, and failure to advise gargles after use were recorded. pMDI and pMDI with spacer were identified correctly by 89% and 79% of interns. Over 90% could identify rotahaler and nebulizer whereas only 9% could identify turbuhaler. 79% and 60% could prepare pMDI and pMDI with spacer appropriately. Nebulizer preparation was performed correctly by 79% and almost all interns could not prepare turbuhaler. Only one intern administered turbuhaler correctly. About half of the participants knew the correct co-ordination for pMDI and pMDI with spacer. Two interns showed proper co-ordination in using turbuhaler. None could provide correct explanation for turbuhaler usage; whereas 76% and 70% did it for nebulizer and rotahaler, respectively. Only 43% of interns remembered to shake pMDI before use. Proficiency in using different inhaler devices amongst interns is poor. It is essential to provide adequate training for inhaler devices usage to medical graduates for proper management of asthma and COPD patients by those future primary care physicians and specialists.

"What do you know?"--knowledge among village doctors of lead poisoning in children in rural China.

PubMed

Huang, Ruixue; Ning, Huacheng; Baum, Carl R; Chen, Lei; Hsiao, Allen

2017-11-23

This study evaluates the extent of village doctors' knowledge of lead poisoning in children in rural China and assesses the characteristics associated with possessing accurate knowledge. A cross-sectional, questionnaire-based survey of 297 village doctors in Fenghuang County, Hunan Province, China was conducted. All village doctors were interviewed face-to-face using a "What do you know" test questionnaire focusing on prevention strategies and lead sources in rural children. A total of 287 (96.6%) village doctors completed the survey in full. Most village doctors had an appropriate degree of general knowledge of lead poisoning; however, they had relatively poor knowledge of lead sources and prevention measures. Village doctors with an undergraduate level education scored an average of 2.7 points higher than those who had a junior college level education (p = 0.033). Village doctors with an annual income ≤ 10,000 RMB yuan scored 1.03 points lower than those whose income was >10,001 RMB yuan. Ethnic Han village doctors scored 1.12 points higher, on average, than ethnic Tujia village doctors (p = 0.027). This study identified important gaps in knowledge concerning lead poisoning in children among a rural population of village doctors. There is a clear need for multifaceted interventions that target village doctors to improve their knowledge regarding lead poisoning in children. The "What do you know" questionnaire is a new tool to evaluate lead poisoning knowledge and education projects.

Gender role stereotype and poor working condition pose obstacles for female doctors to stay in full-time employment: alumnae survey from two private medical schools in Japan.

PubMed

Izumi, Miki; Nomura, Kyoko; Higaki, Yuko; Akaishi, Yu; Seki, Masayasu; Kobayashi, Shizuko; Komoda, Takayuki; Otaki, Junji

2013-03-01

The shortage of physicians has become a serious problem in Japan. It has been pointed out that an increase in the number of female doctors may contribute to the aggravation of this shortage because it is known that women work fewer hours than male doctors. Here, we investigated how many female doctors had ever resigned from a full-time position, and elucidated the reasons why female doctors find it difficult to stay in full-time employment. An alumnae survey of 2 private medical schools was conducted in 2007. A self-administered questionnaire was sent to 1423 graduates and 711 responded with informed consent (response rate, 50%; mean age, 39 years). Overall, 55% of the respondents had previously resigned from full-time employment, of which 90% resigned within 10 years of graduating from medical school. The difficulty in balancing work, childbirth and child rearing (45%) were the top 2 reasons for resignation, followed by physical problems (12%) and long working hours (8%). Among those who resigned, only 33% returned to full-time employment. Women who had at least 1 child were only 30% of those who had never resigned and 84% of those who had previously resigned. The majority of study subjects, regardless of experience of resignation (88%), agreed that women should continue to work even after childbirth. In conclusion, the results of this study suggested that many female doctors resigned from a full-time position within 10 years of graduating from medical school, largely because of the gender role stereotype and poor working conditions.

Relationships between academic performance of medical students and their workplace performance as junior doctors.

PubMed

Carr, Sandra E; Celenza, Antonio; Puddey, Ian B; Lake, Fiona

2014-07-30

Little recent published evidence explores the relationship between academic performance in medical school and performance as a junior doctor. Although many forms of assessment are used to demonstrate a medical student's knowledge or competence, these measures may not reliably predict performance in clinical practice following graduation. This descriptive cohort study explores the relationship between academic performance of medical students and workplace performance as junior doctors, including the influence of age, gender, ethnicity, clinical attachment, assessment type and summary score measures (grade point average) on performance in the workplace as measured by the Junior Doctor Assessment Tool. There were two hundred participants. There were significant correlations between performance as a Junior Doctor (combined overall score) and the grade point average (r = 0.229, P = 0.002), the score from the Year 6 Emergency Medicine attachment (r = 0.361, P < 0.001) and the Written Examination in Year 6 (r = 0.178, P = 0.014). There was no significant effect of any individual method of assessment in medical school, gender or ethnicity on the overall combined score of performance of the junior doctor. Performance on integrated assessments from medical school is correlated to performance as a practicing physician as measured by the Junior Doctor Assessment Tool. These findings support the value of combining undergraduate assessment scores to assess competence and predict future performance.

Assessing the Progress and the Underlying Nature of the Flows of Doctoral and Master Degree Candidates Using Absorbing Markov Chains

ERIC Educational Resources Information Center

Nicholls, Miles G.

2007-01-01

In this paper, absorbing markov chains are used to analyse the flows of higher degree by research candidates (doctoral and master) within an Australian faculty of business. The candidates are analysed according to whether they are full time or part time. The need for such analysis stemmed from what appeared to be a rather poor completion rate (as…

Supervised Machine Learning Algorithms Can Classify Open-Text Feedback of Doctor Performance With Human-Level Accuracy.

PubMed

Gibbons, Chris; Richards, Suzanne; Valderas, Jose Maria; Campbell, John

2017-03-15

Machine learning techniques may be an effective and efficient way to classify open-text reports on doctor's activity for the purposes of quality assurance, safety, and continuing professional development. The objective of the study was to evaluate the accuracy of machine learning algorithms trained to classify open-text reports of doctor performance and to assess the potential for classifications to identify significant differences in doctors' professional performance in the United Kingdom. We used 1636 open-text comments (34,283 words) relating to the performance of 548 doctors collected from a survey of clinicians' colleagues using the General Medical Council Colleague Questionnaire (GMC-CQ). We coded 77.75% (1272/1636) of the comments into 5 global themes (innovation, interpersonal skills, popularity, professionalism, and respect) using a qualitative framework. We trained 8 machine learning algorithms to classify comments and assessed their performance using several training samples. We evaluated doctor performance using the GMC-CQ and compared scores between doctors with different classifications using t tests. Individual algorithm performance was high (range F score=.68 to .83). Interrater agreement between the algorithms and the human coder was highest for codes relating to "popular" (recall=.97), "innovator" (recall=.98), and "respected" (recall=.87) codes and was lower for the "interpersonal" (recall=.80) and "professional" (recall=.82) codes. A 10-fold cross-validation demonstrated similar performance in each analysis. When combined together into an ensemble of multiple algorithms, mean human-computer interrater agreement was .88. Comments that were classified as "respected," "professional," and "interpersonal" related to higher doctor scores on the GMC-CQ compared with comments that were not classified (P<.05). Scores did not vary between doctors who were rated as popular or innovative and those who were not rated at all (P>.05). Machine learning algorithms can classify open-text feedback of doctor performance into multiple themes derived by human raters with high performance. Colleague open-text comments that signal respect, professionalism, and being interpersonal may be key indicators of doctor's performance. ©Chris Gibbons, Suzanne Richards, Jose Maria Valderas, John Campbell. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.03.2017.

The use of medical quality indices as a performance-enhancement tool for community clinics.

PubMed

Elhayany, A

2001-12-01

One of the most important issues for a country, its population and doctors is the effective use of its health system. The extensive variation in doctors' performance leads to a tremendous waste of resources. To combat this, and at the same time ensure that medical quality plays a role when making decisions on interventions, it is essential to equip doctors and clinic directors with information on the quality of the medical care they are providing. In order to assist clinic directors in maintaining medical quality, Clalit Health Services has developed comparative medical indices enabling doctors to compare their performance to that of their colleagues, as well as to the standard and their performance over time. The development of an index to evaluate the quality of medical treatment offered in clinics provides doctors and the health system with an essential tool to lessen the existing variation among doctors and to enhance and evaluate performance.

Predicting performance of junior doctors: Association of workplace based assessment with demographic characteristics, emotional intelligence, selection scores, and undergraduate academic performance.

PubMed

Carr, Sandra E; Celenza, Antonio; Mercer, Annette M; Lake, Fiona; Puddey, Ian B

2018-01-21

Predicting workplace performance of junior doctors from before entry or during medical school is difficult and has limited available evidence. This study explored the association between selected predictor variables and workplace based performance in junior doctors during their first postgraduate year. Two cohorts of medical students (n = 200) from one university in Western Australia participated in the longitudinal study. Pearson correlation coefficients and multivariate analyses utilizing linear regression were used to assess the relationships between performance on the Junior Doctor Assessment Tool (JDAT) and its sub-components with demographic characteristics, selection scores for medical school entry, emotional intelligence, and undergraduate academic performance. Grade Point Average (GPA) at the completion of undergraduate studies had the most significant association with better performance on the overall JDAT and each subscale. Increased age was a negative predictor for junior doctor performance on the Clinical management subscale and understanding emotion was a predictor for the JDAT Communication subscale. Secondary school performance measured by Tertiary Entry Rank on entry to medical school score predicted GPA but not junior doctor performance. The GPA as a composite measure of ability and performance in medical school is associated with junior doctor assessment scores. Using this variable to identify students at risk of difficulty could assist planning for appropriate supervision, support, and training for medical graduates transitioning to the workplace.

Sports physicians, ethics and antidoping governance: between assistance and negligence.

PubMed

Dikic, Nenad; McNamee, Michael; Günter, Heinz; Markovic, Snezana Samardzic; Vajgic, Bojan

2013-07-01

Recent positive doping cases and a series of mistakes of medical doctors of the International Federation of Basketball have reopened the debate about the role of medical doctor in elite sport. This study shows that some sports physicians involved in recent positive doping cases are insufficiently aware of the nuances of doping regulations and, most importantly, of the list of prohibited substances. Moreover, several team doctors are shown to have exercised poor judgement in relation to these matters with the consequence that athletes are punished for doping offences on the basis of doctors' negligence. In such circumstances, athletes' rights are jeopardised by a failure of the duty of care that (sports) physicians owe their athlete patients. We argue that, with respect to the World Anti Doping Code, antidoping governance fails to define, with sufficient clarity, the role of medical doctors. There is a need for a new approach emphasising urgent educational and training of medical doctors in this domain, which should be considered prior to the revision of the next World Anti Doping Code in 2013 in order to better regulate doctor's conduct especially in relation to professional errors, whether negligent or intentional.

Telemedicine for epilepsy support in resource-poor settings.

PubMed

Patterson, Victor

2014-01-01

Epilepsy is a common disease worldwide causing significant physical and social disability. It is one of the most treatable neurological diseases. Yet, in rural, poorer countries like much of India and Nepal, most people with epilepsy are not undergoing any treatment often because they cannot access doctors. Conventional Approaches: It is being appreciated that perhaps doctors are not the solution and that enabling health workers to treat epilepsy may be better. Few details, however, have been put forward about how that might be achieved. Thinking Differently: Untreated epilepsy should be considered a public health problem like HIV/AIDS, the various steps needed for treatment identified and solutions found. Telemedicine Approaches: Telemedicine might contribute to two steps - diagnosis and review. A tool that enables non-doctors to diagnose episodes as epileptic has been developed as a mobile phone app and has good applicability, sensitivity, and specificity for the diagnosis. There are a number of ways in which the use of phone review or short messaging service can improve management. Telemedicine, as part of a public health program, can potentially help the millions of people in the resource-poor world with untreated epilepsy.

What happens when doctors are patients? Qualitative study of GPs.

PubMed

Fox, Fiona; Harris, Michael; Taylor, Gordon; Rodham, Karen; Sutton, Jane; Robinson, Brian; Scott, Jenny

2009-11-01

Current evidence about the experiences of doctors who are unwell is limited to poor quality data. To investigate GPs' experiences of significant illness, and how this affects their own subsequent practice. Qualitative study using interpretative phenomenological analysis to conduct and analyse semi-structured interviews with GPs who have experienced significant illness. Two primary care trusts in the West of England. A total of 17 GPs were recruited to take part in semi-structured interviews which were conducted and analysed using interpretative phenomenological analysis Results: Four main categories emerged from the data. The category, 'Who cares when doctors are ill?' embodies the tension between perceptions of medicine as a 'caring profession' and as a 'system'. 'Being a doctor-patient' covers the role ambiguity experienced by doctors who experience significant illness. The category 'Treating doctor-patients' reveals the fragility of negotiating shared medical care. 'Impact on practice' highlights ways in which personal illness can inform GPs' understanding of being a patient and their own consultation style. Challenging the culture of immunity to illness among GPs may require interventions at both individual and organisational levels. Training and development of doctors should include opportunities to consider personal health issues as well as how to cope with role ambiguity when being a patient and when treating doctor-patients. Guidelines about being and treating doctor-patients need to be developed, and GPs need easy access to an occupational health service.

The Association between Care Experiences and Parent Ratings of Care for Different Racial, Ethnic, and Language Groups in a Medicaid Population

PubMed Central

Wilkins, Victoria; Elliott, Marc N; Richardson, Andrea; Lozano, Paula; Mangione-Smith, Rita

2011-01-01

Objective To examine the association between care experiences and parent ratings of care within racial/ethnic/language subgroups. Data Source National Consumer Assessment of Healthcare Providers and Systems Benchmarking Database 3.0 (2003–2006). Sample Characteristics 111,139 parents of minor Medicaid managed care enrollees. Study Design Cross-sectional observational study predicting “poor” (0–5 on 0–10 scale) parent ratings of personal doctor, specialist, health care, and health plan from care experiences for different parent race/ethnicity/language subgroups (Latino/Spanish, Latino/English, white, and black). Principal Findings Care experiences had similar associations with the probability of poor parent ratings of care across the four racial/ethnic/language subgroups (p>.20). A one standard deviation improvement in the doctor communication care experience was associated with about half the frequency of poor ratings of care for personal doctor and health care in all subgroups (p<.05). Sensitivity analysis of individual communication items found that failure to provide explanations to children predicted poor ratings of care only among whites, who also weighed the length of physician interaction more heavily than other subgroups. Conclusions Communication-based interventions may improve experiences and ratings of care for all subgroups, although implementation of these interventions may need to consider preferences associated with race, ethnicity, and language. PMID:21275987

The intention to disclose medical errors among doctors in a referral hospital in North Malaysia.

PubMed

Hs, Arvinder-Singh; Rashid, Abdul

2017-01-23

In this study, medical errors are defined as unintentional patient harm caused by a doctor's mistake. This topic, due to limited research, is poorly understood in Malaysia. The objective of this study was to determine the proportion of doctors intending to disclose medical errors, and their attitudes/perception pertaining to medical errors. This cross-sectional study was conducted at a tertiary public hospital from July- December 2015 among 276 randomly selected doctors. Data was collected using a standardized and validated self-administered questionnaire intending to measure disclosure and attitudes/perceptions. The scale had four vignettes in total two medical and two surgical. Each vignette consisted of five questions and each question measured the disclosure. Disclosure was categorised as "No Disclosure", "Partial Disclosure" or "Full Disclosure". Data was keyed in and analysed using STATA v 13.0. Only 10.1% (n = 28) intended to disclose medical errors. Most respondents felt that they possessed an attitude/perception of adequately disclosing errors to patients. There was a statistically significant difference (p < 0.001) when comparing the intention of disclosure with perceived disclosures. Most respondents were in common agreement that disclosing an error would make them less likely to get sued, that minor errors should be reported and that they experienced relief from disclosing errors. Most doctors in this study would not disclose medical errors although they perceived that the errors were serious and felt responsible for it. Poor disclosure could be due the fear of litigations and improper mechanisms/procedures available for disclosure.

Knowledge of medical imaging radiation dose and risk among doctors.

PubMed

Brown, Nicholas; Jones, Lee

2013-02-01

The growth of computed tomography (CT) and nuclear medicine (NM) scans has revolutionised healthcare but also greatly increased population radiation doses. Overuse of diagnostic radiation is becoming a feature of medical practice, leading to possible unnecessary radiation exposures and lifetime-risks of developing cancer. Doctors across all medical specialties and experience levels were surveyed to determine their knowledge of radiation doses and potential risks associated with some diagnostic imaging. A survey relating to knowledge and understanding of medical imaging radiation was distributed to doctors at 14 major Queensland public hospitals, as well as fellows and trainees in radiology, emergency medicine and general practice. From 608 valid responses, only 17.3% correctly estimated the radiation dose from CT scans and almost 1 in 10 incorrectly believed that CT radiation is not associated with any increased lifetime risk of developing cancer. There is a strong inverse relationship between a clinician's experience and their knowledge of CT radiation dose and risks, even among radiologists. More than a third (35.7%) of doctors incorrectly believed that typical NM imaging either does not use ionising radiation or emits doses equal to or less than a standard chest radiograph. Knowledge of CT and NM radiation doses is poor across all specialties, and there is a significant inverse relationship between experience and awareness of CT dose and risk. Despite having a poor understanding of these concepts, most doctors claim to consider them prior to requesting scans and when discussing potential risks with patients. © 2012 The Authors. Journal of Medical Imaging and Radiation Oncology © 2012 The Royal Australian and New Zealand College of Radiologists.

Analysis of team types based on collaborative relationships among doctors, home-visiting nurses and care managers for effective support of patients in end-of-life home care.

PubMed

Fujita, Junko; Fukui, Sakiko; Ikezaki, Sumie; Otoguro, Chizuru; Tsujimura, Mayuko

2017-11-01

To define the team types consisting of doctors, home-visiting nurses and care managers for end-of-life care by measuring the collaboration relationship, and to identify the factors related to the team types. A questionnaire survey of 43 teams including doctors, home-visiting nurses and care managers was carried out. The team types were classified based on mutual evaluations of the collaborative relationships among the professionals. To clarify the factors between team types with the patient characteristics, team characteristics and collaboration competency, univariate analysis was carried out with the Fisher's exact test or one-way analysis and multiple comparison analysis. Three team types were classified: the team where the collaborative relationships among all healthcare professionals were good; the team where the collaborative relationships between the doctors and care managers were poor; and the team where the collaborative relationships among all of the professionals were poor. There was a statistically significant association between the team types and the following variables: patient's dementia level, communication tool, professionals' experience of working with other team members, home-visiting nurses' experience of caring for dying patients, care managers' background qualifications, doctor's face-to-face cooperation with other members and home-visiting nurses' collaborative practice. It is suggested that a collaborative relationship would be fostered by more experience of working together, using communication tools and enhancing each professional's collaboration competency. Geriatr Gerontol Int 2017; 17: 1943-1950. © 2017 Japan Geriatrics Society.

The patient-doctor relationship: a synthesis of the qualitative literature on patients' perspectives.

PubMed

Ridd, Matthew; Shaw, Alison; Lewis, Glyn; Salisbury, Chris

2009-04-01

The patient-doctor relationship is an important but poorly defined topic. In order to comprehensively assess its significance for patient care, a clearer understanding of the concept is required. To derive a conceptual framework of the factors that define patient-doctor relationships from the perspective of patients. Systematic review and thematic synthesis of qualitative studies. Medline, EMBASE, PsychINFO and Web of Science databases were searched. Studies were screened for relevance and appraised for quality. The findings were synthesised using a thematic approach. From 1985 abstracts, 11 studies from four countries were included in the final synthesis. They examined the patient-doctor relationship generally (n = 3), or in terms of loyalty (n = 3), personal care (n = 2), trust (n = 2), and continuity (n = 1). Longitudinal care (seeing the same doctor) and consultation experiences (patients' encounters with the doctor) were found to be the main processes by which patient-doctor relationships are promoted. The resulting depth of patient-doctor relationship comprises four main elements: knowledge, trust, loyalty, and regard. These elements have doctor and patient aspects to them, which may be reciprocally related. A framework is proposed that distinguishes between dynamic factors that develop or maintain the relationship, and characteristics that constitute an ongoing depth of relationship. Having identified the different elements involved, future research should examine for associations between longitudinal care, consultation experiences, and depth of patient-doctor relationship, and, in turn, their significance for patient care.

Changing beliefs about past public events with believable and unbelievable doctored photographs.

PubMed

Nash, Robert A

2018-04-01

Doctored photographs can shape what people believe and remember about prominent public events, perhaps due to their apparent credibility. In three studies, subjects completed surveys about the 2012 London Olympic torch relay (Experiment 1) or the 2011 Royal Wedding of Prince William and Kate Middleton (Experiments 2-3). Some were shown a genuine photo of the event; others saw a doctored photo that depicted protesters and unrest. A third group of subjects saw a doctored photo whose inauthenticity had been made explicit, either by adding a written disclaimer (Experiment 1) or by making the digital manipulation deliberately poor (Experiments 2-3). In all three studies, doctored photos had small effects on a subset of subjects' beliefs about the events. Of central interest though, comparable effects also emerged when the photos were overtly inauthentic. These findings suggest that cognitive mechanisms other than credibility - such as familiarity misattribution and mental imagery - can rapidly influence beliefs about past events even when the low credibility of a source is overt.

How do rural placements affect urban-based Australian junior doctors' perceptions of working in a rural area?

PubMed

Brodribb, Wendy; Zadoroznyj, Maria; Martin, Bill

2016-01-01

Objectives The aim of the present study was to provide qualitative insights from urban-based junior doctors (graduation to completion of speciality training) of the effect of rural placements and rotations on career aspirations for work in non-metropolitan practices. Methods A qualitative study was performed of junior doctors based in Adelaide, Brisbane and Melbourne. Individual face-to-face or telephone semistructured interviews were held between August and October 2014. Thematic analysis focusing on participants' experience of placements and subsequent attitudes to rural practice was undertaken. Results Most participants undertook rural placements in the first 2 years after graduation. Although experiences varied, positive perceptions of placements were consistently linked with the degree of supervision and professional support provided. These experiences were linked to attitudes about working outside metropolitan areas. Participants expressed concerns about being 'forced' to work in non-metropolitan hospitals in their first postgraduate year; many received little warning of the location or clinical expectations of the placement, causing anxiety and concern. Conclusions Adequate professional support and supervision in rural placements is essential to encourage junior doctors' interests in rural medicine. Having a degree of choice about placements and a positive and supported learning experience increases the likelihood of a positive experience. Doctors open to working outside a metropolitan area should be preferentially allocated an intern position in a non-metropolitan hospital and rotated to more rural locations. What is known about the topic? The maldistribution of the Australian medical workforce has led to the introduction of several initiatives to provide regional and rural experiences for medical students and junior doctors. Although there have been studies outlining the effects of rural background and rural exposure on rural career aspirations, little research has focused on what hinders urban-trained junior doctors from pursuing a rural career. What does this paper add? Exposure to medical practice in regional or rural areas modified and changed the longer-term career aspirations of some junior doctors. Positive experiences increased the openness to and the likelihood of regional or rural practice. However, junior doctors were unlikely to aspire to non-metropolitan practice if they felt they had little control over and were unprepared for a rural placement, had a negative experience or were poorly supported by other clinicians or health services. What are the implications for practitioners? Changes to the process of allocating junior doctors to rural placements so that the doctors felt they had some choice, and ensuring these placements are well supervised and supported, would have a positive impact on junior doctors' attitudes to non-metropolitan practice.

Intrinsic motivation: how can it play a pivotal role in changing clinician behaviour?

PubMed

Nantha, Yogarabindranath Swarna

2013-01-01

In the light of an increasing healthcare burden, this paper seeks to offer insight about how intrinsic motivation could play a pivotal role in improving the pre-existing healthcare service delivery systems by altering clinician behaviour. The paper argues the case for four salient dimensions worth exploring through the lens of intrinsic motivation--non-financial incentives, positive affective states, organizational culture and prescribing quality. This article reviews literature from both social sciences and health management practices to provide rationale on how intrinsic motivational approaches could optimize healthcare service delivery systems. The scrutiny of the body of evidence leads to the assertion that there is neglect in the initiatives to reinforce intrinsic motivation as a method to address the ailing morale of doctors. This seems to have exacerbated negative outcomes that include job dissatisfaction, compromise in the quality of care and poor patient-doctor relationships. Diminution in positive affective states amongst doctors, largely controlled by intrinsic motivation, led to strained doctor-patient communication and poor quality of care. Barriers in a healthcare organizational culture that restricts autonomy and empowerment seem to directly undermine job satisfaction. The article argues that it is crucial to shift away from the conventional tendencies promoting tangible rewards. A more holistic approach should be adopted by conducting formal research into intrinsic motivation and how it could aid the formulation of policies tailored to meet the current demands of the healthcare system.

Complaints against doctors in an accident and emergency department: a 10-year analysis.

PubMed Central

Kadzombe, E A; Coals, J

1992-01-01

We carried out an analysis of complaints against doctors in our Accident and Emergency Department received from 1 January 1979 to 31 December 1988. There were 66 complainants in all, comprising 37 relatives, 21 patients and eight persons acting in a professional capacity. The majority of complaints (80 out of 125) were about poor communication and dissatisfaction with diagnosis and treatment. A small number of complainants had unrealistic expectations of the Accident and Emergency service. A total of 83.3% of complaints were against Senior House Officers who saw 61.3% of all patients. We concluded that an improvement in the communicative, diagnostic and therapeutic skills of doctors would minimize justified complaints. PMID:1388487

Factors influencing trust in doctors: a community segmentation strategy for quality improvement in healthcare

PubMed Central

Gopichandran, Vijayaprasad; Chetlapalli, Satish Kumar

2013-01-01

Background Trust is a forward-looking covenant between the patient and the doctor where the patient optimistically accepts his/her vulnerability. Trust is known to improve the clinical outcomes. Objectives To explore the factors that determine patients’ trust in doctors and to segment the community based on factors which drive their trust. Setting Resource-poor urban and rural settings in Tamil Nadu, a state in southern India. Participants A questionnaire was administered to a sample of 625 adult community-dwelling respondents from four districts of Tamil Nadu, India, chosen by multistage sampling strategy. Outcome measures The outcomes were to understand the main domains of factors influencing trust in doctors and to segment the community based on which of these domains predominantly influenced their trust. Results Factor analysis revealed five main categories, namely, comfort with the doctor, doctor with personal involvement with the patient, behaviourally competent doctor, doctor with a simple appearance and culturally competent doctor, which explained 49.3% of the total variance. Using k-means cluster analysis the respondents were segmented into four groups, namely, those who have ‘comfort-based trust’, ‘emotionally assessed trust’, who were predominantly older and belonging to lower socioeconomic status, those who had ‘personal trust’, who were younger people from higher socioeconomic strata of the community and the group who had ‘objectively assessed trust’, who were younger women. Conclusions Trust in doctors seems to be influenced by the doctor's behaviuor, perceived comfort levels, personal involvement with the patient, and to a lesser extent by cultural competence and doctor's physical appearance. On the basis of these dimensions, the community can be segmented into distinct groups, and trust building can happen in a strategic manner which may lead to improvement in perceived quality of care. PMID:24302512

Doctors for Tribal Areas: Issues and Solutions

PubMed Central

Mavalankar, Dileep

2016-01-01

Health parameters of tribal population had always been a concern for India's march towards Millennium development Goals (MDG's). Tribal population contributes 8.6% of total population, in spite of efforts and commitment of Government of India towards MGD, India lagged far behind from achieving and optimal health of tribal population will be a concern for achieving Sustainable development Goals SDG's also. Some of the common health problems of the tribal population face are deficiency of essential components in diet like energy malnutrition, protein calorie malnutrition and micronutrient deficiencies. Goiter, Gastrointestinal disorders, particularly dysentery and parasitic infections are very common. High prevalence of genetic disorders like sickle cell anemia and others are endemic in few tribes of India. Tribal Health is further compounded issues by social issues like excessive consumption of alcohol, poor access to contraceptive, substance abuse and gender based violence. Besides other reasons, like poor budget allocation, difficult to reach, poor access to health care facility, severe shortage of qualified health workers and workforce led to poor governance of health sector in tribal areas. Present view point reflects on the issues of inadequacy of doctors in tribal area and suggests possible solutions. PMID:27385868

Managing poorly performing clinicians: health care providers' willingness to pay for independent help.

PubMed

Watson, Verity; Sussex, Jon; Ryan, Mandy; Tetteh, Ebenezer

2012-03-01

To determine the willingness to pay (WTP) of senior managers in the UK National Health Service (NHS) for services to help manage performance concerns with doctors, dentists and pharmacists. A discrete choice experiment (DCE) was used to elicit senior managers' preferences for a support service to help manage clinical performance concerns. The DCE was based on: a literature review; interviews with support service providers and clinical professional bodies; and discussion groups with managers. From the DCE responses, we estimate marginal WTP for aspects of support services. 451 NHS managers completed the DCE questionnaire. NHS managers are willing to pay for: advice, 'facilitation', and behavioural, health, clinical and organisational assessments. Telephone advice with written confirmation was valued most highly. NHS managers were willing to pay £161.56 (CI: £160.81-£162.32) per year per whole time equivalent doctor, dentist or pharmacist, for support to help manage clinical performance concerns. Marginal WTP varied across respondent subgroups but was always positive. Health care managers valued help in managing the clinicians' performance, and were willing to pay for it from their organisations' limited funds. Their WTP exceeds the current cost of a UK body providing similar support. Establishing a central body to provide such services across a health care system, with the associated economies of scale including cumulative experience, is an option that policy makers should consider seriously. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Clinical judicial syndrome: The impact of judicial proceedings on doctors.

PubMed

Arimany-Manso, Josep; Vizcaíno, Marta; Gómez-Durán, Esperanza L

2018-04-28

Complaints of alleged malpractice are a concern for doctors, however the impact these complaints have on them receives little attention. We present a systematic review of the scientific literature by searching the MEDLINE database, without no time limit, of manuscripts on doctors' reaction to a malpractice claim, carried out in Spanish, English and French. Their methodological quality was evaluated, and the results were analysed. The search identified a total of 18 articles, mostly without empirical sample analysis, which described the clinical judicial syndrome construct, its symptomatology, prevalence, etiopathogenesis and issues of prevention and approach. The literature on this subject is very scarce and has poor empirical foundation. However, the available data underscored the relevance of the impact that these complaints have on doctors and highlight the need to establish preventive measures and approaches to the so-called clinical judicial syndrome. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Attachment styles and clinical communication performance in trainee doctors.

PubMed

Fletcher, Ian; McCallum, Rachel; Peters, Sarah

2016-11-01

To investigate the relationship between trainee doctors' attachment style and their performance in qualifying clinical and communication skills assessments. Participants were 190 undergraduate medical students whose performance was assessed by examiners across two areas (communication and clinical skills) during their qualifying Objective Structured Clinical Examination (OSCE). Simulated patients also rated communication skills. Participants' attachment style was rated across two dimensions, avoidance and anxiety, using the Relationship Questionnaire (RQ). Lower levels of attachment avoidance and anxiety significantly predicted higher performance in both communication and clinical skills. Trainee doctors' attachment styles are associated with patient communication and clinical performance. Further research is needed to investigate the impact of attachment on consultations between doctors and patients within clinical settings. Attachment theory can inform our understanding why, for some student doctors, interacting with patients may be particularly challenging and require additional support by medical educators. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The involvement of medical doctors in hospital governance and implications for quality management: a quick scan in 19 and an in depth study in 7 OECD countries.

PubMed

Rotar, A M; Botje, D; Klazinga, N S; Lombarts, K M; Groene, O; Sunol, R; Plochg, T

2016-05-24

Hospital governance is broadening its orientation from cost and production controls towards 'improving performance on clinical outcomes'. Given this new focus one might assume that doctors are drawn into hospital management across OECD countries. Hospital performance in terms of patient health, quality of care and efficiency outcomes is supposed to benefit from their involvement. However, international comparative evidence supporting this idea is limited. Just a few studies indicate that there may be a positive relationship between medical doctors being part of hospital boards, and overall hospital performance. More importantly, the assumed relationship between these so-called doctor managers and hospital performance has remained a 'black-box' thus far. However, there is an increasing literature on the implementation of quality management systems in hospitals and their relation with improved performance. It seems therefore fair to assume that the relation between the involvement of doctors in hospital management and improved hospital performance is partly mediated via quality management systems. The threefold aim of this paper is to 1) perform a quick scan of the current situation with regard to doctor managers in hospital management in 19 OECD countries, 2) explore the phenomenon of doctor managers in depth in 7 OECD countries, and 3) investigate whether doctor involvement in hospital management is associated with more advanced implementation of quality management systems. This study draws both on a quick scan amongst country coordinators in OECD's Health Care Quality Indicator program, and on the DUQuE project which focused on the implementation of quality management systems in European hospitals. This paper reports two main findings. First, medical doctors fulfil a broad scope of managerial roles at departmental and hospital level but only partly accompanied by formal decision making responsibilities. Second, doctor managers having more formal decision making responsibilities in strategic hospital management areas is positively associated with the level of implementation of quality management systems. Our findings suggest that doctors are increasingly involved in hospital management in OECD countries, and that this may lead to better implemented quality management systems, when doctors take up managerial roles and are involved in strategic management decision making.

Barriers to Screening and Possibilities for Active Detection of Family Medicine Attendees Exposed to Intimate Partner Violence.

PubMed

Kopčavar Guček, Nena; Petek, Davorina; Švab, Igor; Selič, Polona

2016-03-01

In 1996 the World Health Organization declared intimate partner violence (IPV) the most important public health problem. Meta-analyses in 2013 showed every third female globally had been a victim of violence. Experts find screening controversial; family medicine is the preferred environment for identifying victims of violence, but barriers on both sides prevent patients from discussing it with doctors. In July 2014, a qualitative study was performed through semi-structured interviews with ten family doctors of different ages and gender, working in rural or urban environments. Sound recordings of the interviews were transcribed, and the record verified. The data were interpreted using content analysis. A coding scheme was developed and later verified and analysed by two independent researchers. The text of the interviews was analysed according to the coding scheme. Two coding schemes were developed: one for screening, and the other for the active detection of IPV. The main themes emerging as barriers to screening were lack of time, staff turnover, inadequate finance, ignorance of a clear definition, poor commitment to screening, obligatory follow-up, risk of deterioration of the doctor-patient relationship, and insincerity on the part of the patient. Additionally, cultural aspects of violence, uncertainty/ helplessness, fear, lack of competence and qualifications, autonomy/negative experience, and passive role/stigma/ fear on the part of the patients were barriers to active detection. All the participating doctors had had previous experience with active detection of IPV and were aware of its importance. Due to several barriers to screening for violence they preferred active detection.

Barriers to Screening and Possibilities for Active Detection of Family Medicine Attendees Exposed to Intimate Partner Violence

PubMed Central

KOPČAVAR GUČEK, Nena; PETEK, Davorina; ŠVAB, Igor; SELIČ, Polona

2016-01-01

Introduction In 1996 the World Health Organization declared intimate partner violence (IPV) the most important public health problem. Meta-analyses in 2013 showed every third female globally had been a victim of violence. Experts find screening controversial; family medicine is the preferred environment for identifying victims of violence, but barriers on both sides prevent patients from discussing it with doctors. Methods In July 2014, a qualitative study was performed through semi-structured interviews with ten family doctors of different ages and gender, working in rural or urban environments. Sound recordings of the interviews were transcribed, and the record verified. The data were interpreted using content analysis. A coding scheme was developed and later verified and analysed by two independent researchers. The text of the interviews was analysed according to the coding scheme. Results Two coding schemes were developed: one for screening, and the other for the active detection of IPV. The main themes emerging as barriers to screening were lack of time, staff turnover, inadequate finance, ignorance of a clear definition, poor commitment to screening, obligatory follow-up, risk of deterioration of the doctor-patient relationship, and insincerity on the part of the patient. Additionally, cultural aspects of violence, uncertainty/ helplessness, fear, lack of competence and qualifications, autonomy/negative experience, and passive role/stigma/ fear on the part of the patients were barriers to active detection. Conclusion All the participating doctors had had previous experience with active detection of IPV and were aware of its importance. Due to several barriers to screening for violence they preferred active detection. PMID:27647084

Midwives' and doctors' perceptions of their preparation for and practice in managing the perineum in the second stage of labour: a cross-sectional survey.

PubMed

East, Christine E; Lau, Rosalind; Biro, Mary Anne

2015-01-01

to identify the perceptions of midwives and doctors at Monash Women's regarding their educational preparation and practices used for perineal management during the second stage of labour. anonymous cross-sectional semi-structured questionnaire ('The survey'). the three maternity hospitals that form Monash Women's Maternity Services, Monash Health, Victoria, Australia. midwives and doctors attending births at one or more of the three Monash Women's maternity hospitals. a semi-structured questionnaire was developed, drawing on key concepts from experts and peer-reviewed literature. surveys were returned by 17 doctors and 69 midwives (37% response rate, from the 230 surveys sent). Midwives and doctors described a number of techniques they would use to reduce the risk of perineal trauma, for example, hands on the fetal head/perineum (11.8% of doctors, 61% of midwives), the use of warm compresses (45% of midwives) and maternal education and guidance with pushing (49.3% of midwives). When presented with a series of specific obstetric situations, respondents indicated that they would variably practice hands on the perineum during second stage labour, hands off and episiotomy. The majority of respondents indicated that they agreed or strongly agreed that an episiotomy should sometimes be performed (midwives 97%, doctors 100%). All the doctors had training in diagnosing severe perineal trauma involving anal sphincter injury (ASI), with 77% noting that they felt very confident with this. By contrast, 71% of the midwives reported that they had received training in diagnosing ASI and only 16% of these reported that they were very confident in this diagnosis. All doctors were trained in perineal repair, compared with 65% of midwives. Doctors were more likely to indicate that they were very confident in perineal repair (88%) than the midwives (44%). Most respondents were not familiar with the rates of perineal trauma either within their workplace or across Australia. Midwives and doctors indicated that they would use the hands on or hands off approach or episiotomy depending on the specific clinical scenario and described a range of techniques that they would use in their overall approach to minimising perineal trauma during birth. Midwives were more likely than doctors to indicate their lack of training and/or confidence in conducting perineal repair and diagnosing ASI. many midwives indicated that they had not received training in diagnosing ASI, perineal repair and midwives' and doctors' knowledge of the prevalence of perineal outcomes was poor. Given the importance of these skills to women cared for by midwives and doctors, the findings may be used to inform the development of quality improvement activities, including training programs and opportunities for gaining experience and expertise with perineal management. The use of episiotomy and hands on/hands off the perineum in the survey scenarios provides reassurance that doctors and midwives take a number of factors into account in their clinical practice, rather than a preference for one or more interventions over others. Copyright © 2014 Elsevier Ltd. All rights reserved.

What do health workers in Timor-Leste want, know and do? Findings from a national health labour market survey.

PubMed

Hou, Xiaohui; Witter, Sophie; Zaman, Rashid U; Engelhardt, Kay; Hafidz, Firdaus; Julia, Fernanda; Lemiere, Christophe; Sullivan, Eileen B; Saldanha, Estanislau; Palu, Toomas; Lievens, Tomas

2016-11-18

The objectives of this study were to understand the labour market dynamics among health workers, including their preferences and concerns, and to assess the skills, competence and performance (i.e. the 'know-do gap') of doctors working in Timor-Leste. This cross-sectional survey was implemented in all 13 districts of Timor-Leste in 2014. We surveyed 443 health workers, including 175 doctors, 150 nurses and 118 midwives (about 20% of the health workers in the country). We also observed 632 clinical consultations with doctors, including 442 direct clinical observations, and tested 190 vignettes. The study highlights some positive findings, including the gender balance of health workers overall, the concentration of doctors in rural areas, the high overall reported satisfaction of staff with their work and high motivation, the positive intention to stay in the public sector, the feeling of being well prepared by training for work, the relatively frequent and satisfactory supervisions, and the good attitudes towards patients as identified in observations and vignettes. However, some areas require more investigations and investments. The overall clinical performance of the doctors was very good in terms of attitude and moderate in regard to history taking, health education and treatment. However, the average physical examination performance score was low. Doctors performed better with simulated cases than the real cases in general, which means they have better knowledge and skills than they actually demonstrated. The factors that were significantly associated with the clinical performance of doctors were location of the health facility (urban doctors were better) and consultation time (cases with more consultation time were better). Regression analysis suggests that lack of knowledge was significantly associated with lack of performance, while lack of motivation and equipment were not significant. The survey provides essential information for workforce planning and for developing training policies and terms and conditions that will attract and retain health workers in rural service. Improving the work environment and performance of doctors working in rural health facilities and ensuring compliance with clinical protocols are two priority areas needed to improve the performance of doctors in Timor-Leste.

Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa

PubMed Central

2017-01-01

Background Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. Aim This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. Setting The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. Methods The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Results Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. Conclusion South Africa’s HRH strategy for the Health Sector 2012/13–2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised. PMID:28828878

Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa.

PubMed

Mburu, Grace; George, Gavin

2017-07-31

Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. South Africa's HRH strategy for the Health Sector 2012/13-2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.

An analysis of reported motivational orientation in students undertaking doctoral studies in the biomedical sciences

PubMed Central

2014-01-01

Background As the source of a sizeable percentage of research output and the future arbiters of science policy, practice and direction, doctoral (Ph.D.) students represent a key demographic in the biomedical research community. Despite this, doctoral learning in the biomedical sciences has, to date, received little research attention. Methods In the present study we aimed to qualitatively describe the motivational orientations present in semi-structured interview transcripts from a cohort of seventeen biomedical Ph.D. students drawn from two research intensive Australian Group of Eight universities. Results Applying elements of self-determination theory, external and introjected control loci (both strongly associated with alienation, disengagement and poor learning outcomes) were identified as common motivational determinants in this cohort. Conclusions The importance of these findings to doctoral learning is discussed in light of previous research undertaken in higher education settings in the United States and the European Union. With motivation accepted as a malleable, context-sensitive factor, these data provide for both a better understanding of doctoral learning and highlight a potential avenue for future research aimed at improving outcomes and promoting meaningful learning processes in the biomedical doctorate. PMID:24571918

Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia.

PubMed

Vijay, Aishwarya; Earnshaw, Valerie A; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L; Wickersham, Jeffrey A

2018-01-01

Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings.

Factors influencing the recommendation of the Human Papillomavirus vaccine by South African doctors working in a tertiary hospital.

PubMed

Hoque, Muhammad Ehsanul

2016-06-01

In South Africa, HPV vaccination programme has been incorporated recently in the school health system. Since doctors are the most trusted people regarding health issues in general, their knowledge and attitudes regarding HPV infections and vaccination are very important for HPV vaccine program nationally. The objective of this study was to investigate factors contributing to recommendation of HPV vaccines to the patients. This was a quantitative cross-sectional study conducted among 320 doctors, using a self-administered anonymous questionnaire. All the doctors were aware of HPV and knew that HPV is transmitted sexually. Their overall level of knowledge regarding HPV infections and HPV vaccine was poor. But the majority intended to prescribe the vaccine to their patients. It was found that doctors who knew that HPV 6 and 11 are responsible for >90% of anogenital warts, their patients would comply with the counselling regarding HPV vaccination, and received sufficient information about HPV vaccination were 5.68, 4.91 and 4.46 times respectively more likely to recommend HPV vaccination to their patients, compared to their counterparts (p<0.05). There was a knowledge gap regarding HPV infection and HPV vaccine among the doctors.

Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia

PubMed Central

Vijay, Aishwarya; Earnshaw, Valerie A.; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M.; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L.

2018-01-01

Abstract Purpose: Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. Methods: A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Results: Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Conclusions: Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings. PMID:29227183

Workplace violence against resident doctors in a tertiary care hospital in Delhi.

PubMed

Anand, Tanu; Grover, Shekhar; Kumar, Rajesh; Kumar, Madhan; Ingle, Gopal Krishna

2016-01-01

Healthcare workers particularly doctors are at high risk of being victims of verbal and physical violence perpetrated by patients or their relatives. There is a paucity of studies on work-related violence against doctors in India. We aimed to assess the exposure of workplace violence among doctors, its consequences among those who experienced it and its perceived risk factors. This study was done among doctors working in a tertiary care hospital in Delhi. Data were collected by using a self-administered questionnaire containing items for assessment of workplace violence against doctors, its consequences among those who were assaulted, reporting mechanisms and perceived risk factors. Of the 169 respondents, 104 (61.4%) were men. The mean (SD) age of the study group was 28.6 (4.2) years. Sixty-nine doctors (40.8%) reported being exposed to violence at their workplace in the past 12 months. However, there was no gender-wise difference in the exposure to violence (p=0.86). The point of delivery of emergency services was reported as the most common place for experiencing violence. Verbal abuse was the most common form of violence reported (n=52; 75.4%). Anger, frustration and irritability were the most common symptoms experienced by the doctors who were subjected to violence at the workplace. Only 44.2% of doctors reported the event to the authorities. 'Poor communication skills' was considered to be the most common physician factor responsible for workplace violence against doctors. A large proportion of doctors are victims of violence by their patients or relatives. Violence is being under-reported. There is a need to encourage reporting of violence and prepare healthcare facilities to tackle this emerging issue for the safety of physicians.

The Function Analysis of Informationization in New Rural Cooperatives Medical Service Management

NASA Astrophysics Data System (ADS)

Zhou, Yuefeng; Liu, Min

The establishment of new rural cooperative medical system is an important action for comprehensive affluent society. It is an important measure for Central Party Committee and State Council to solve "three rural" issue effectively and to overall urban and rural, regional, coordinated economic and social development, building a well-off society in the new situation. It has important role to alleviate farmers to see a doctor expensively, see a doctor difficultly, reduce the burden on farmers and improve their level of health protection and quality of life, solve the problem of poor because of illness and the problem of returning poor due to illness, promote the production and rural economic development and stability in the rural areas. This article will analyze the function of informationization in new rural cooperative medical service management selectively.

Three Women's Educational Doctoral Program Experiences: A Case Study of Performances and Journeys

ERIC Educational Resources Information Center

Selmer, Sarah; Graham, Meadow; Goodykoontz, Erin

2011-01-01

Three academic women joined to write this piece to explore individual doctoral program experiences and to establish common understandings. They collectively analyzed their experiences using the conceptual approach of doctoral program performances and journeys. This case study shares their experiences within the conceptual approach through emerging…

Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Eastern China.

PubMed

Wu, Dan; Wang, Yun; Lam, Kwok Fai; Hesketh, Therese

2014-12-31

To explore the factors influencing doctors' job satisfaction and morale in China, in the context of the ongoing health system reforms and the deteriorating doctor-patient relationship. Cross-sectional survey using self-completion questionnaires. The survey was conducted from March to May 2012 among doctors at the provincial, county and primary care levels in Zhejiang Province, China. The questionnaire was completed by 202 doctors. Factors which contributed most to low job satisfaction were low income and long working hours. Provincial level doctors were most dissatisfied while primary care doctors were the least dissatisfied. Three per cent of doctors at high-level hospitals and 27% of those in primary care were satisfied with the salary. Only 7% at high-level hospitals were satisfied with the work hours, compared to 43% in primary care. Less than 10% at high levels were satisfied with the amount of paid vacation time (3%) and paid sick leave (5%), compared with 38% and 41%, respectively, in primary care. Overall, 87% reported that patients were more likely to sue and that patient violence against doctors was increasing. Only 4.5% wanted their children to be doctors. Of those 125 who provided a reason, 34% said poor pay, 17% said it was a high-risk profession, and 9% expressed concerns about personal insecurity or patient violence. Doctors have low job satisfaction overall. Recruitment and retention of doctors have become major challenges for the Chinese health system. Measures must be taken to address this, in order to ensure recruitment and retention of doctors in the future. These measures must first include reduction of doctors' workload, especially at provincial hospitals, partly through incentivisation of appropriate utilisation of primary care, increase in doctors' salary and more effective measures to tackle patient violence against doctors. 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.

The working relationship between midwives and junior doctors: a questionnaire survey of Yorkshire trainees.

PubMed

Pinki, P; Sayasneh, A; Lindow, S W

2007-05-01

Recruitment to obstetrics and gynaecology has fallen dramatically over the last decade. Surveys of medical students and junior doctors have suggested that apart from work/life imbalance, other factors such as poor job satisfaction and an unfriendly environment can significantly affect the choice of career. We conducted a questionnaire survey for Yorkshire trainees to evaluate current working and professional relationships between junior doctors and midwives. A total of 68 trainees participated in the study. Some 22% of trainees found midwives to be disrespectful to and argumentative with junior doctors. A total of 69% did not get a chance to examine patients on the labour wards because of the midwives. Midwives when compared with consultants were less courteous towards trainees and 53% of trainees felt that there is a communication problem that needs to be addressed. Our study results suggest a high level of dissatisfaction among trainees of the Yorkshire region and point at an area that needs further work to bring about a change to a better work environment for future junior doctors.

Burnout, psychological morbidity, job stress, and job satisfaction in Chinese neurologists.

PubMed

Zhou, Xinyu; Pu, Juncai; Zhong, Xiaoni; Zhu, Dan; Yin, Dinghong; Yang, Lining; Zhang, Yuqing; Fu, Yuying; Wang, Haiyang; Xie, Peng

2017-05-02

To investigate the prevalence of and personal and professional characteristics associated with burnout, psychological morbidity, job stress, and job satisfaction in Chinese neurologists. The China Neurologist Association conducted a national cross-sectional study from September 2014 to March 2015. A questionnaire including the Maslach Burnout Inventory, the 12-item General Health Questionnaire, the Consultants' Mental Health Questionnaire, and questions assessing personal and professional characteristics, career satisfaction, and current doctor-patient relationships was administered. A total of 693 directors of neurology departments and 6,111 neurologists in 30 Chinese provinces returned surveys. Overall, 53.2% of responding neurologists experienced burnout, 37.8% had psychological morbidity, 50.7% had high levels of job stress, 25.7% had low levels of job satisfaction, 76.9% had poor doctor-patient relationships, and 58.1% regretted becoming a doctor. Factors independently associated with burnout were lower income, more hours worked per week, more nights on call per month, working in public hospitals, psychological morbidity, high levels of job stress, low levels of job satisfaction, and poor doctor-patient relationships. Factors independently associated with psychological morbidity included lower income, more nights on call per month, working in enterprise-owned hospitals, burnout, high levels of job stress, and low levels of job satisfaction. Burnout and psychological morbidity are common in Chinese neurologists. Burnout is the single greatest predictor of neurologists' psychological morbidity, high job stress, and low job satisfaction. © 2017 American Academy of Neurology.

Knowledge, attitude and practices regarding Crimean-Congo haemorrhagic fever among healthcare workers in Balochistan.

PubMed

Sheikh, Nadeem S; Sheikh, Azeem S; Sheikh, Aqleem A

2004-01-01

The objective of this study was to determine the knowledge, attitude and practices regarding Crimean-Congo Haemorrhagic Fever (CCHF) among healthcare workers at a tertiary care referral hospital in Balochistan. A cross-sectional survey was conducted in April-May 2000 among the doctors, nurses and laboratory technicians of Sandeman Provincial Teaching Hospital, Quetta, Balochistan. A questionnaire was formulated which included the demographic data of the respondents and their knowledge, attitude and practices towards CCHF. A total of 235 healthcare personnel including 150 (63.8%) doctors, 50 (21.2%) nurses and 35 (15%) laboratory technicians were interviewed during the survey. Seventy percent (164) of the subjects were males while 30% (71) were females. One fifty-five (66%) of the total respondents claimed to know what CCHF was. By designation 120 (80%) of doctors, 30 (60%) of nurses and 5 (14%) of laboratory technicians had a prior knowledge about CCHF. One twenty (80%) of the doctors knew the most common presentations of CCHF. All categories of the respondents had a poor knowledge regarding the burial procedure of dead patients. This study was an indicator of the poor level of knowledge of healthcare workers regarding the clinical presentations and the modes of spread of CCHF. It is the dire need of the time to educate the healthcare workers about the common preventive measures of this disease, which has resulted in the loss of several important lives in the past in this region.

Medical leadership, a systematic narrative review: do hospitals and healthcare organisations perform better when led by doctors?

PubMed Central

Clay-Williams, Robyn; Ludlow, Kristiana; Testa, Luke; Li, Zhicheng; Braithwaite, Jeffrey

2017-01-01

Introduction Despite common assumptions that doctors are well placed to lead hospitals and healthcare organisations, the peer-reviewed literature contains little evidence on the performance of doctors in leadership roles in comparison with that of non-medical managers. Objectives To determine whether there is an association between the leader’s medical background and management performance in terms of organisational performance or patient outcomes. Methods We searched for peer-reviewed, English language studies using Medline, Embase and Emerald Management between 2005 and 2017. We included quantitative, qualitative and mixed method empirical studies on the performance of senior healthcare managers where participants were described as doctors or leaders and where comparative performance data were provided on non-medical leaders. Studies without full text available, or no organisational, leadership behaviour or patient measures, were excluded. Results The search, conducted in Medline (n=3395), Embase (n=1913) and Emerald Management (n=454) databases, yielded 3926 entries. After the application of inclusion and exclusion criteria, 16 studies remained. Twelve studies found that there were positive differences between medical and non-medical leaders, and eight studies correlated those findings with hospital performance or patient outcomes. Six studies examined the composition of boards of directors; otherwise, there were few common areas of investigation. Five inter-related themes emerged from a narrative analysis: the impact of medical leadership on outcomes; doctors on boards; contribution of qualifications and experience; the medical leader as an individual or part of a team and doctors transitioning into the medical leadership role. Discussion and conclusion A modest body of evidence supports the importance of including doctors on organisational governing boards. Despite many published articles on the topic of whether hospitals and healthcare organisations perform better when led by doctors, there were few empirical studies that directly compared the performance of medical and non-medical managers. This is an under-researched area that requires further funding and focus. PMID:28947438

[A questionnaire survey of medical cooperation by the Iwaki Medical Association].

PubMed

Midorikawa, Yasuhiko

2013-12-01

It has been pointed out that currently, Iwaki City faces an insufficiency of doctors working at hospitals, compared with before. Such an insufficiency became more remarkable after the 2011 Tohoku Earthquake and Fukushima Nuclear Disaster, as about 30,000 people relocated to Iwaki City from the evacuation areas. In this regard, the Iwaki Medical Association conducted a questionnaire survey to investigate the problems of medical cooperation and utilize the data to improve medical cooperation within hospitals and clinics. A total of 159 doctors answered the questionnaires: 64% were community physicians, 36% were doctors working at hospitals, and 42% were physicians. About 60% of the doctors were satisfied with the present medical cooperation. Home health care was performed by 25% of the doctors working at hospitals and 45% of the community physicians. Approximately 80% of the doctors felt the need for additional physicians to perform home health care, although more than half of the doctors answered that they do not perform it. Various problems exist in the context of medical cooperation, but many doctors still hope for its improvement, according to the answers in the questionnaires. Efforts have to be exerted further in order to enhance medical cooperation among the health care team.

[Stress at work among military doctors: a preliminary study].

PubMed

Knezević, Bojana; Belosević, Ljiljana

2006-09-01

This preliminary study examined the sources of work stress in military physicians. Forty-eight medical doctors (24 military and 24 civilian) completed a questionnaire on stressors at the work place. The participation in the study was anonymous and voluntary. Out of 24 military physicians, 14 were military general practitioners (mean age 40.5, 14 female), and 10 were consultants of different specialties (mean age 43.5, 7 male and 3 female). Civilian physicians included 13 general practitioners working at primary health care system (mean age 37, 3 male and 10 female), and 11 consultants of different specialties working at out of hospital practice (average age 37, 6 male and 5 female). The questionnaire included items aiming to obtain demographic characteristics (sex, age, marital status, children, academic degree, clinical specialty, work place, average time in practice, average time at current position) and 37 items to determine occupational stressors. The stressors were related to work management, professional demands, interpersonal and patient-doctor relationship. Differences in recognizing work stressors between the groups of civilian and military physicians were statistically analyzed by using chi-squared-test. The leading work stressors identified by military physicians were inadequate salary, being bypassed for promotion, inadequate continuous education, poor resources, poor communication with superiors, poor management, trouble with superiors, excessive paperwork, unpredictable situations, and 24-hour standby. Civilian physicians reported inadequate salary, poor resources, poor management, misinformed patients, lack of co-workers, lack of time, unpredictable situations, exposure to indictment, dealing with incurable patients and exposure to public criticism and judgment. In comparison with civilian physicians, military physicians significantly more frequently reported inadequate salary (p<0.01), being bypassed for promotion (p<0.005), poor communication with superiors (p<0.05) and inadequate continuing education (p<0.025). In the group of military physicians, military general practitioners identified more stressors with a higher frequency. Nine out of top ten stressors were reported by at least one half of military general practitioners. Poor communication with superiors (12/14), lack of appropriate continuing education (10/14) and trouble with superiors (9/14) were predominantly reported by military general practitioners. Our preliminary study has suggested that military physicians, especially military general practitioners, recognize more stressors and at higher frequency than civilian physicians. The ten leading stressors reported by the two study groups differed, however, both groups reported inadequate salary, poor resources, poor management and unpredictable situations among the first ten. Many studies tackling occupational stress in physicians, suggest that they are at risk of work stress. Several studies have found job stress to be a significant source of distress for military personnel during peacetime assignment. However, to our knowledge, no studies on work stress in military physicians have been published. Some of the most important stressors identified by our military physicians, such as poor resources, poor management, excessive paperwork, unpredictable situations and 24-hour standby are well known stressors the physicians are dealing with. Compared with studies on work stress in military personnel, our group more frequently reported inadequate salary, being bypassed to promotion, poor communication and trouble with their superiors. Our preliminary results suggest that military physicians recognize different stressors and to a greater extent than civilian physicians. The reported stressors suggest specific professional environment of military physicians. Stress at work needs careful and thorough consideration, not only because it can cause health problems and emotional suffering in military physicians, but also because it can diminish the quality of medical care that they are expected to provide. The stressors that are remediable should be identified and the job stress reduction procedures should be performed.

Doctors' views about their work, education and training three years after graduation in the UK: questionnaire survey.

PubMed

Lambert, Trevor; Smith, Fay; Goldacre, Michael J

2015-12-01

Doctors who graduated in the UK after 2005 have followed a restructured postgraduate training programme (Modernising Medical Careers) and have experienced the introduction of the European Working Time Regulation and e-portfolios. In this paper, we report the views of doctors who graduated in 2008 three years after graduation and compare these views with those expressed in year 1. Questionnaires about career intentions, destinations and views sent in 2011 to all medical graduates of 2008. 3228 UK medical graduates. Comments on work, education and training. Response was 49% (3228/6538); 885 doctors wrote comments. Of these, 21.8% were unhappy with the standard of their training; 8.4% were positive. Doctors made positive comments about levels of supervision, support, morale and job satisfaction. Many doctors commented on poor arrangements for rotas, cover and leave, which had an adverse effect on work-life balance, relationships, morale and health. Some doctors felt pressured into choosing their future specialty too early, with inadequate career advice. Themes raised in year 3 that were seldom raised in year 1 included arrangements for flexible working and maternity leave, obtaining posts in desired locations and having to pay for courses, exams and conferences. Many doctors felt training was available, but that European Working Time Regulation, rotas and cover arrangements made it difficult to attend. Three years after graduation, doctors raised similar concerns to those they had raised two years earlier, but the pressures of career decision making, family life and job seeking were new issues.

Adolescent health--a descriptive study of a school doctor clinic.

PubMed

Chavasse, M; North, D; McAvoy, B

1995-07-14

To describe a school doctor clinic at a New Zealand secondary school. A three phase study was designed and conducted at a coeducational secondary school in Auckland. Firstly, a health questionnaire was developed to assess adolescents' perceptions of their health status and use of primary health care services. The second phase was descriptive study of a newly established school doctor clinic. The doctor clinic was run twice weekly over a 3 month period in 1993. The third phase of the study was a clinic-based satisfaction survey. A 75% response rate was achieved, with a total of 221 health questionnaires completed from 292. Although the majority of students (n = 184, 84%) considered themselves healthy, 16% (n = 36) described their health as only 'fair' or 'poor'. Seventy one percent (n = 157) of students had seen their general practitioner in the preceeding twelve months. Thirteen percent (n = 142) of the school population consulted the school doctor clinic. Significantly more female, Maori and European students attended the school doctor clinic compared with the school demography. The commonest diagnoses for the doctor clinic were respiratory, skin and musculoskeletal problems. Thirty one percent of the diagnoses related to recognised adolescent health needs such as contraception, sexual health, nutrition, and psychosocial problems. Over two thirds of students at the first consultation had not seen another health provider. Students perceived that the doctor clinic overcame barriers such as access, cost and confidentiality. The school doctor clinic was well utilised, overcame some barriers to access and addressed many recognised adolescent health needs.

Supervised Machine Learning Algorithms Can Classify Open-Text Feedback of Doctor Performance With Human-Level Accuracy

PubMed Central

2017-01-01

Background Machine learning techniques may be an effective and efficient way to classify open-text reports on doctor’s activity for the purposes of quality assurance, safety, and continuing professional development. Objective The objective of the study was to evaluate the accuracy of machine learning algorithms trained to classify open-text reports of doctor performance and to assess the potential for classifications to identify significant differences in doctors’ professional performance in the United Kingdom. Methods We used 1636 open-text comments (34,283 words) relating to the performance of 548 doctors collected from a survey of clinicians’ colleagues using the General Medical Council Colleague Questionnaire (GMC-CQ). We coded 77.75% (1272/1636) of the comments into 5 global themes (innovation, interpersonal skills, popularity, professionalism, and respect) using a qualitative framework. We trained 8 machine learning algorithms to classify comments and assessed their performance using several training samples. We evaluated doctor performance using the GMC-CQ and compared scores between doctors with different classifications using t tests. Results Individual algorithm performance was high (range F score=.68 to .83). Interrater agreement between the algorithms and the human coder was highest for codes relating to “popular” (recall=.97), “innovator” (recall=.98), and “respected” (recall=.87) codes and was lower for the “interpersonal” (recall=.80) and “professional” (recall=.82) codes. A 10-fold cross-validation demonstrated similar performance in each analysis. When combined together into an ensemble of multiple algorithms, mean human-computer interrater agreement was .88. Comments that were classified as “respected,” “professional,” and “interpersonal” related to higher doctor scores on the GMC-CQ compared with comments that were not classified (P<.05). Scores did not vary between doctors who were rated as popular or innovative and those who were not rated at all (P>.05). Conclusions Machine learning algorithms can classify open-text feedback of doctor performance into multiple themes derived by human raters with high performance. Colleague open-text comments that signal respect, professionalism, and being interpersonal may be key indicators of doctor’s performance. PMID:28298265

[Association of Japanese doctors' sleep habits with working environments and lifestyle].

PubMed

Tamura, Yoshiyuki; Chiba, Shigeru

2011-01-01

To clarify the association of Japanese doctors' sleep habits with working environments and lifestyle, a survey was performed using a self-administered questionnaire in February 2002, targeting a population of 2,455 Asahikawa Medical University alumni. A total of 881 subjects completed questionnaires, yielding a response rate of 35.9%. The mean+/-SD sleep duration on workdays was 410.4+/-60.5 minutes, approximately 30 minutes shorter than that of the general Japanese population. The prevalence of subjective insufficient sleep (SIS) on workdays was 64.5%, significantly higher than that in the general Japanese population. The estimated overall prevalences of various sleep problems are as follows: difficulty initiating sleep, 14.7%; difficulty maintaining sleep, 15.3%; poor perceived quality of sleep, 15.6%; waking without feeling refreshed (WWFR), 30.0%; and excessive daytime sleepiness (EDS), 30.8%. SIS had a significant positive association with WWFR and EDS. Doctors' sleeplessness differed depending on their working style. The prevalence of SIS among doctors working at hospitals and clinics with inpatient wards was significantly higher than that among those working in environments without inpatient wards. The prevalence of SIS was significantly associated with the number of working hours, fatigue, and an irregular lifestyle. Habitual exercise did not appear to affect SIS. A multiple logistic regression model revealed that working in hospitals, long working hours (more than 9 hours a day), fatigue, and an irregular lifestyle were independently associated with SIS [OR=2.19 (95% CI=1.29-3.70); OR=1.95 (95% CI=1.37-2.77); OR=1.93 (95% CI=1.38-2.69); OR=3.27 (95% CI=2.21-4.84)]. Sleep duration on holidays was approximately 60 minutes longer than that on workdays, and the prevalence of SIS decreased to 32.3%. These results demonstrate that the prevalence of SIS is higher among doctors working at hospitals and clinics with inpatient wards, who tend to have long working hours and irregular lifestyles.

Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Eastern China

PubMed Central

Wu, Dan; Wang, Yun; Lam, Kwok Fai; Hesketh, Therese

2014-01-01

Objective To explore the factors influencing doctors’ job satisfaction and morale in China, in the context of the ongoing health system reforms and the deteriorating doctor–patient relationship. Design Cross-sectional survey using self-completion questionnaires. Study setting The survey was conducted from March to May 2012 among doctors at the provincial, county and primary care levels in Zhejiang Province, China. Results The questionnaire was completed by 202 doctors. Factors which contributed most to low job satisfaction were low income and long working hours. Provincial level doctors were most dissatisfied while primary care doctors were the least dissatisfied. Three per cent of doctors at high-level hospitals and 27% of those in primary care were satisfied with the salary. Only 7% at high-level hospitals were satisfied with the work hours, compared to 43% in primary care. Less than 10% at high levels were satisfied with the amount of paid vacation time (3%) and paid sick leave (5%), compared with 38% and 41%, respectively, in primary care. Overall, 87% reported that patients were more likely to sue and that patient violence against doctors was increasing. Only 4.5% wanted their children to be doctors. Of those 125 who provided a reason, 34% said poor pay, 17% said it was a high-risk profession, and 9% expressed concerns about personal insecurity or patient violence. Conclusions Doctors have low job satisfaction overall. Recruitment and retention of doctors have become major challenges for the Chinese health system. Measures must be taken to address this, in order to ensure recruitment and retention of doctors in the future. These measures must first include reduction of doctors’ workload, especially at provincial hospitals, partly through incentivisation of appropriate utilisation of primary care, increase in doctors’ salary and more effective measures to tackle patient violence against doctors. PMID:25552614

[Carl Gillmeister: the first Doctor of veterinary medicine in Mecklenburg--and in Germany (1834)].

PubMed

Kuhlmann, W; Schäffer, J

2004-02-01

German schools and faculties of veterinary medicine did not receive the sovereign right to award the degree "Doctor medicinae veterinarae" until the early twentieth century. Until then, in the nineteenth century there were two possibilities for veterinarians to earn a doctoral degree, usually referred to as the title of "Doctor": 1. On the basis of an exceptionally excellent dissertation and after very stringent examination a candidate could be awarded the degree "Dr. med." by the faculty of a medical school, or, if the candidate had studied at a philosophical faculty, the degree "Dr. phil." 2. A doctoral degree specifically in veterinary medicine could be earned only at a medical faculty. The Medical Faculty of the University of Giessen awarded the degree "Doctor in arte veterinaria" for the first time in 1832. In this study we prove that Giessen was not the first German university to award a doctorate in veterinary medicine, a priority which has never been questioned in the literature. As early as 1829, veterinarians could earn the degree "Doctor artis veterinariae" at the Medical Faculty of the University of Rostock, where three such awards are documented between 1829 and 1831. The designation "medicina" was also intially avoided in Rostock. Therefore, of particular significance is the discovery of a fourth such document from the Rostock University Archives, the doctoral diploma of Carl Jacob Friedrich Gillmeister, who at the age of 22 was awarded the degree "Doctor medicinae veterinariae" in Rostock after a successful defense. This is the earliest, but also the last archival record of the German doctoral degree in veterinary medicine in the modern sense, because after Gillmeister no veterinarian could earn a doctoral degree in Rostock further more. Gillmeisters vita sheds light on the times and the difficulties of the veterinary profession in the poor agricultural area of Mecklenburg.

Diagnosis of Irritable Bowel Syndrome

MedlinePlus

... doctors may order tests to rule out other health problems. Review of your symptoms Your doctor will ask about your symptoms and look for ... Doctors may perform other tests to rule out health problems that cause ... IBS symptoms. Your doctor will decide whether you need other tests based ...

A critical ethnography of doctor-patient interaction in southern Iran.

PubMed

Sadati, Ahmad Kalateh; Iman, Mohammad Taghi; Lankarani, Kamran Bagheri; Derakhshan, Soghra

2016-01-01

Doctor-patient interaction is a subject with ethical ramifications, besides being an important issue in medical sociology. The main goal of this critical study is to explore the interactional experience of hospital admitted patients. For this reason, the study, carried out in an educational hospital in southern Iran, entailed 156 recorded clinical consultations, 920 hours of participant observation, and six focus groups consisting of patients and their families. The research method used is Critical Ethnography, which was introduced by PF Carspecken. The results showed that negative interactional experience was common among the participants. Six related themes were: doctors' inattentiveness; weak interaction; violation of patients' privacy; unjustified pain; long waiting period and ambiguity; and faceless physicians. According to the participants' observations, poor interaction with doctors has led to these negative experiences. The findings showed that doctors were inconsiderate about patients' concerns and due to this, patients were dissatisfied. Theoretically, this form of fragmented collaboration has deep roots in the framework of modern medicine, but in the context of this study, the intensity of the fragmentation between doctors and patients was observed to be intolerable. To solve this problem, models of patient-centredness and narrative medicine are recommended. In addition, the health system should monitor and evaluate the observance of ethics by physicians.

Pay for performance of Estonian family doctors and impact of different practice- and patient-related characteristics on a good outcome: A quantitative assessment.

PubMed

Merilind, Eero; Salupere, Rauno; Västra, Katrin; Kalda, Ruth

2016-01-01

Several practice- and patient-related characteristics are reported to have an influence on a good quality outcome. Estonia started the pay-for-performance (P4P) system for family doctors (FDs) in 2006. Every year the number of FDs participating in P4P has increased, but only half of the FDs achieved good outcome. The aim of this study was to find out which practice- and patient-related characteristics could have an impact on a good outcome. The study was conducted using the database from the Estonian Health Insurance Fund. All working FDs were divided into two groups (with "good" and "poor" outcomes) according their achievements in P4P. We chose characteristics which described structure (practice list size, number of doctors, composition of FDs list: age, number of chronically ill patients) during the observation period 2006-2012. During the observation period 2006-2012, the number of FDs with a good outcome in P4P increased from 6% (2006) to 53% (2012). The high number of FDs in primary care teams, longer experience of participation in P4P and the smaller number of patients on FDs' lists all have an impact on a good outcome. The number of chronically ill patients in FDs lists has no significant effect on an outcome, but P4P increases the number of disease-diagnosed patients. Different practice and patient-related characteristics have an impact on a good outcome. As workload increases, smaller lists of FDs patients or increased staff levels are needed in order to maintain a good outcome. Copyright © 2016 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Bodily Writing and Performative Inquiry: Inviting an Arts-Based Research Methodology into Collaborative Doctoral Research Vocabularies

ERIC Educational Resources Information Center

Buono, Alexia; Gonzalez, Charles H.

2017-01-01

In this article, the authors (then two doctoral students) describe their methodology of engaging in an interdisciplinary, collaborative doctoral arts-based research (ABR) project. Education and the arts were integrated utilizing dance methods of bodily writing and performative inquiry to strengthen the analysis of dissertation findings in the…

Hypertension: adherence to treatment in rural Bangladesh – findings from a population-based study

PubMed Central

Khanam, Masuma Akter; Lindeboom, Wietze; Koehlmoos, Tracey Lynn Perez; Alam, Dewan Shamsul; Niessen, Louis; Milton, Abul Hasnat

2014-01-01

Background Poor adherence has been identified as the main cause of failure to control hypertension. Poor adherence to antihypertensive treatment is a significant cardiovascular risk factor, which often remains unrecognized. There are no previous studies that examined adherence with antihypertensive medication or the characteristics of the non-adherent patients in Bangladesh. Objective This paper aims to describe hypertension and factors affecting adherence to treatment among hypertensive persons in rural Bangladesh. Design The study population included 29,960 men and women aged 25 years and older from three rural demographic surveillance sites of the International Center for Diarrheal Disease Research, Bangladesh (icddr,b): Matlab, Abhoynagar, and Mirsarai. Data was collected by a cross-sectional design on diagnostic provider, initial, and current treatment. Discontinuation of medication at the time of interview was defined as non-adherence to treatment. Results The prevalence of hypertension was 13.67%. Qualified providers diagnosed only 53.5% of the hypertension (MBBS doctors 46.1 and specialized doctors 7.4%). Among the unqualified providers, village doctors diagnosed 40.7%, and others (nurse, health worker, paramedic, homeopath, spiritual healer, and pharmacy man) each diagnosed less than 5%. Of those who started treatment upon being diagnosed with hypertension, 26% discontinued the use of medication. Age, sex, education, wealth, and type of provider were independently associated with non-adherence to medication. More men discontinued the treatment than women (odds ratio [OR] 1.74, confidence interval [CI] 1.48–2.04). Non-adherence was greater when hypertension was diagnosed by unqualified providers (OR 1.52, CI 1.31–1.77). Hypertensive patients of older age, least poor quintile, and higher education were less likely to be non-adherent. Patients with cardiovascular comorbidity were also less likely to be non-adherent to antihypertensive medication (OR 0.79, CI 0.64–0.97). Conclusions Although village doctors diagnose 40% of hypertension, their treatments are associated with a higher rate of non-adherence to medication. The hypertension care practices of the village doctors should be explored by additional research. More emphasis should be placed on men, young people, and people with low education. Health programs focused on education regarding the importance of taking continuous antihypertensive medication is now of utmost importance. PMID:25361723

Doctoral Assistants = Critical Friends: A Simple yet Complex Equation

ERIC Educational Resources Information Center

Hay, John; Laguerre, Fabrice; Moore, Eric; Reedy, Katherine; Rose, Scott; Vickers, Jerome

2015-01-01

The Carnegie Project on the Education Doctorate (CPED) encourages doctoral candidates volunteering in order to give back and continue their relationship with the university after completing their dissertation. Volunteering can take on many forms, from acting as doctoral assistants to performing the role of critical friends on future doctoral…

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.

Medical leadership, a systematic narrative review: do hospitals and healthcare organisations perform better when led by doctors?

PubMed

Clay-Williams, Robyn; Ludlow, Kristiana; Testa, Luke; Li, Zhicheng; Braithwaite, Jeffrey

2017-09-24

Despite common assumptions that doctors are well placed to lead hospitals and healthcare organisations, the peer-reviewed literature contains little evidence on the performance of doctors in leadership roles in comparison with that of non-medical managers. To determine whether there is an association between the leader's medical background and management performance in terms of organisational performance or patient outcomes. We searched for peer-reviewed, English language studies using Medline, Embase and Emerald Management between 2005 and 2017. We included quantitative, qualitative and mixed method empirical studies on the performance of senior healthcare managers where participants were described as doctors or leaders and where comparative performance data were provided on non-medical leaders. Studies without full text available, or no organisational, leadership behaviour or patient measures, were excluded. The search, conducted in Medline (n=3395), Embase (n=1913) and Emerald Management (n=454) databases, yielded 3926 entries. After the application of inclusion and exclusion criteria, 16 studies remained. Twelve studies found that there were positive differences between medical and non-medical leaders, and eight studies correlated those findings with hospital performance or patient outcomes. Six studies examined the composition of boards of directors; otherwise, there were few common areas of investigation. Five inter-related themes emerged from a narrative analysis: the impact of medical leadership on outcomes; doctors on boards; contribution of qualifications and experience; the medical leader as an individual or part of a team and doctors transitioning into the medical leadership role. A modest body of evidence supports the importance of including doctors on organisational governing boards. Despite many published articles on the topic of whether hospitals and healthcare organisations perform better when led by doctors, there were few empirical studies that directly compared the performance of medical and non-medical managers. This is an under-researched area that requires further funding and focus. © 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.

The knowledge and attitude of non-ophthalmic medical doctors towards glaucoma in two tertiary institutions in south eastern Nigeria.

PubMed

Achigbu, E O; Chuka-Okosa, C M

2014-06-01

This study is aimed at determining how much knowledge of glaucoma the non-ophthalmic medical doctors still possess and their personal attitudes toward glaucoma. Self- administered questionnaires were randomly distributed to the non-ophthalmic medical doctors in two specialist hospitals in south eastern Nigeria: The data obtained were the age, sex, professional and number of years of practice of the participants, their knowledge of the symptoms/ aetiology/risk factors, examination/investigation, treatment of glaucoma as well as their personal attitude towards glaucoma. There were two hundred respondents; one hundred and forty two males and fifty eight females (M:F=2.4:1); comprising 82.5% Resident doctors; 51% of whom had been in practice for less than 5 years.All the doctors had heard of glaucoma; approximately seventy two per cent (72.5%) had a good knowledge of glaucoma symptoms and 52.0% of these had been in practice for only 5 years or less. Similarly, of the 83% of the doctors who correctly answered the questions on the aetiology of glaucoma, majority (84.3%) had been in practice for 5 years or less. Only 24.5% and 38.5% respectively of the doctors had a good knowledge of the basic examination and treatment required for the management of glaucoma.There was no statistically significant relationship between most variables tested. Only the relationship between the knowledge of the symptoms of glaucoma and the duration of practice of the doctors was statistically significant (p< 0.005). Most of the non-ophthalmic medical doctors have a basic knowledge of glaucoma and how to investigate it but showed a poor knowledge of examination and treatment modalities. They also acknowledged the importance of regular eye checks but only very few had had their eyes examined.

Reasons doctors provide futile treatment at the end of life: a qualitative study.

PubMed

Willmott, Lindy; White, Benjamin; Gallois, Cindy; Parker, Malcolm; Graves, Nicholas; Winch, Sarah; Callaway, Leonie Kaye; Shepherd, Nicole; Close, Eliana

2016-08-01

Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patient's life. Semistructured in-depth interviews. Three large tertiary public hospitals in Brisbane, Australia. 96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling. Doctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the main reasons for futile care. Doctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level. 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/

Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study.

PubMed

Woolf, Katherine; Rich, Antonia; Viney, Rowena; Needleman, Sarah; Griffin, Ann

2016-11-25

Explore trainee doctors' experiences of postgraduate training and perceptions of fairness in relation to ethnicity and country of primary medical qualification. Qualitative semistructured focus group and interview study. Postgraduate training in England (London, Yorkshire and Humber, Kent Surrey and Sussex) and Wales. 137 participants (96 trainees, 41 trainers) were purposively sampled from a framework comprising: doctors from all stages of training in general practice, medicine, obstetrics and gynaecology, psychiatry, radiology, surgery or foundation, in 4 geographical areas, from white and black and minority ethnic (BME) backgrounds, who qualified in the UK and abroad. Most trainees described difficult experiences, but BME UK graduates (UKGs) and international medical graduates (IMGs) could face additional difficulties that affected their learning and performance. Relationships with senior doctors were crucial to learning but bias was perceived to make these relationships more problematic for BME UKGs and IMGs. IMGs also had to deal with cultural differences and lack of trust from seniors, often looking to IMG peers for support instead. Workplace-based assessment and recruitment were considered vulnerable to bias whereas examinations were typically considered more rigorous. In a system where success in recruitment and assessments determines where in the country you can get a job, and where work-life balance is often poor, UK BME and international graduates in our sample were more likely to face separation from family and support outside of work, and reported more stress, anxiety or burnout that hindered their learning and performance. A culture in which difficulties are a sign of weakness made seeking support and additional training stigmatising. BME UKGs and IMGs can face additional difficulties in training which may impede learning and performance. Non-stigmatising interventions should focus on trainee-trainer relationships at work and organisational changes to improve trainees' ability to seek social support outside work. 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/.

When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship.

PubMed

Bell, Sigall K; Mejilla, Roanne; Anselmo, Melissa; Darer, Jonathan D; Elmore, Joann G; Leveille, Suzanne; Ngo, Long; Ralston, James D; Delbanco, Tom; Walker, Jan

2017-04-01

Patient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals. Presurveys and postsurveys from 99 volunteer doctors at three US sites who participated in OpenNotes and postsurveys from 4592 patients who read at least one note and submitted a survey. Patients read notes to be better informed and because they were curious; about a third read them to check accuracy. In total, 7% (331) of patients reported contacting their doctor's office about their note. Of these, 29% perceived an error, and 85% were satisfied with its resolution. Nearly all patients reported feeling better (37%) or the same (62%) about their doctor. Patients who were older (>63), male, non-white, had fair/poor self-reported health or had less formal education were more likely to report feeling better about their doctor. Among doctors, 26% anticipated documentation errors, and 44% thought patients would disagree with notes. After a year, 53% believed patient satisfaction increased, and 51% thought patients trusted them more. None reported ordering more tests or referrals. Despite concerns about errors, offending language or defensive practice, transparent notes overall did not harm the patient-doctor relationship. Rather, doctors and patients perceived relational benefits. Traditionally more vulnerable populations-non-white, those with poorer self-reported health and those with fewer years of formal education-may be particularly likely to feel better about their doctor after reading their notes. Further informing debate about OpenNotes, the findings suggest transparent records may improve patient satisfaction, trust and safety. 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/.

Intolerance and Violence Against Doctors.

PubMed

Singh, Meharban

2017-10-01

Intolerance and grouse against doctors is a global phenomenon but India seems to lead the world in violence against doctors. According to World Health Organization, about 8-38% healthcare workers suffer physical violence at some point in their careers. Many more are verbally abused or threatened. Public is almost behaving like health sector terrorists. The spate of increasing attacks on doctors by damaging their property and causing physical injury is not acceptable by any civilized society. The public is becoming increasingly intolerant to a large number of social issues because of poor governance and vote bank politics. There is a need to arrest the development of further distrust between doctors and their patients/relatives, otherwise it will compromise all achievements of medical science and adversely affect healing capabilities of doctors. Rude and aggressive behavior of the patients or their family members, and arrogant and lackadaisical approach of the doctor, adversely affects the doctor-patient relationship and the outcome of the patient. The doctors, hospital administration and government must exercise "zero tolerance" with respect to acts of violence against healthcare professionals. It is possible to reduce the incidence of intolerance against doctors but difficult to eliminate it completely. The healthcare providers should demonstrate greater compassion and empathy with improved communication skills. The hospitals must have adequate infrastructure, facilities and staff to handle emergencies without delay and with due confidence and skills. The security of healthcare providers, especially in sensitive areas, should be improved by having adequate number of security guards, frisking facilities, extensive CCTV network and availability of "Quick response team" to handle unruly mob. In case of any grievances for alleged mismanagement, the public should handle the situation in a civilized manner and seek redressal through Medical Protection Act and legal avenues. Laws to prevent violence against doctors do exist but they need to be made more stringent and implemented properly.

Doctors’ views about their work, education and training three years after graduation in the UK: questionnaire survey

PubMed Central

Smith, Fay; Goldacre, Michael J

2015-01-01

Objectives Doctors who graduated in the UK after 2005 have followed a restructured postgraduate training programme (Modernising Medical Careers) and have experienced the introduction of the European Working Time Regulation and e-portfolios. In this paper, we report the views of doctors who graduated in 2008 three years after graduation and compare these views with those expressed in year 1. Design Questionnaires about career intentions, destinations and views sent in 2011 to all medical graduates of 2008. Participants 3228 UK medical graduates. Main outcome measures Comments on work, education and training. Results Response was 49% (3228/6538); 885 doctors wrote comments. Of these, 21.8% were unhappy with the standard of their training; 8.4% were positive. Doctors made positive comments about levels of supervision, support, morale and job satisfaction. Many doctors commented on poor arrangements for rotas, cover and leave, which had an adverse effect on work-life balance, relationships, morale and health. Some doctors felt pressured into choosing their future specialty too early, with inadequate career advice. Themes raised in year 3 that were seldom raised in year 1 included arrangements for flexible working and maternity leave, obtaining posts in desired locations and having to pay for courses, exams and conferences. Conclusions Many doctors felt training was available, but that European Working Time Regulation, rotas and cover arrangements made it difficult to attend. Three years after graduation, doctors raised similar concerns to those they had raised two years earlier, but the pressures of career decision making, family life and job seeking were new issues. PMID:26664735

A BEME (Best Evidence in Medical Education) systematic review of the use of workplace-based assessment in identifying and remediating poor performance among postgraduate medical trainees.

PubMed

Barrett, Aileen; Galvin, Rose; Steinert, Yvonne; Scherpbier, Albert; O'Shaughnessy, Ann; Horgan, Mary; Horsley, Tanya

2015-05-08

Workplace-based assessments were designed to facilitate observation and structure feedback on the performance of trainees in real-time clinical settings and scenarios. Research in workplace-based assessments has primarily centred on understanding psychometric qualities and performance improvement impacts of trainees generally. An area that is far less understood is the use of workplace-based assessments for trainees who may not be performing at expected or desired standards, referred to within the literature as trainees 'in difficulty' or 'underperforming'. In healthcare systems that increasingly depend on service provided by junior doctors, early detection (and remediation) of poor performance is essential. However, barriers to successful implementation of workplace-based assessments (WBAs) in this context include a misunderstanding of the use and purpose of these formative assessment tools. This review aims to explore the impact - or effectiveness - of workplace-based assessment on the identification of poor performance and to determine those conditions that support and enable detection, i.e. whether by routine or targeted use where poor performance is suspected. The review also aims to explore what effect (if any) the use of WBA may have on remediation or on changing clinical practice. The personal impact of the detection of poor performance on trainees and/or trainers may also be explored. Using BEME (Best Evidence in Medical Education) Collaboration review guidelines, nine databases will be searched for English-language records. Studies examining interventions for workplace-based assessment either routinely or in relation to poor performance will be included. Independent agreement (kappa .80) will be achieved using a randomly selected set of records prior to commencement of screening and data extraction using a BEME coding sheet modified as applicable (Buckley et al., Med Teach 31:282-98, 2009) as this has been used in previous WBA systematic reviews (Miller and Archer, BMJ doi:10.1136/bmj.c5064, 2010) allowing for more rigorous comparisons with the published literature. Educational outcomes will be evaluated using Kirkpatrick's framework of educational outcomes using Barr's adaptations (Barr et al., Evaluations of interprofessional education; a United Kingdom review of health and social care, 2000) for medical education research. Our study will contribute to an ongoing international debate regarding the applicability of workplace-based assessments as a meaningful formative assessment approach within the context of postgraduate medical education. The review has been registered by the BEME Collaboration www.bemecollaboration.org .

Peripheral Angiogram

MedlinePlus

... doctor tells you to. Tell your doctor or nurse if you are allergic to anything, especially iodine, ... training performs the test with a team of nurses and technicians. The test is performed in a ...

Patients' poor communication with their doctors in the first visit of the gynecological endocrinology outpatient clinics.

PubMed

Li, Xiao-Hong; Han, Zi-Yan; She, Wen-Jing; Lei, Hai-Ke

2016-01-01

To investigate patients' communication with their gynecologists in the first visit of the gynecological endocrinology outpatient clinics. We developed a questionnaire to evaluate 379 women' expectations of their first visit, information-giving about illness, and understanding of the consultation they encountered from April to August 2010. Descriptive statistics and multiple linear regression analysis were used to analyze the data. Before the first visit, 55% (208/379) of participants hoped to get the doctors' special attention, and 60% (227/379) of patients expected a very satisfying consultation. During the consultation, only 34% (129/379) of patients provided their case history clearly according to physicians' inquiry, 21% (81/379) of patients understood the examination and 28% (105/379) of patients understood the therapeutic regime after doctors' explanation. Correlation analysis showed that sociodemographic characteristics such as young age (under 20 years old), low level of education (primary school or less), and lack of medical knowledge affected patients' information-giving about illness and understanding of their first visit (all ps < 0.05). Patients expected a patient-centered doctor-patient communication in gynecological endocrinology outpatient clinics. They could not communicate well with their doctors, which was affected by age, education, and medical background.

Online patient safety education programme for junior doctors: is it worthwhile?

PubMed

McCarthy, S E; O'Boyle, C A; O'Shaughnessy, A; Walsh, G

2016-02-01

Increasing demand exists for blended approaches to the development of professionalism. Trainees of the Royal College of Physicians of Ireland participated in an online patient safety programme. Study aims were: (1) to determine whether the programme improved junior doctors' knowledge, attitudes and skills relating to error reporting, open communication and care for the second victim and (2) to establish whether the methodology facilitated participants' learning. 208 junior doctors who completed the programme completed a pre-online questionnaire. Measures were "patient safety knowledge and attitudes", "medical safety climate" and "experience of learning". Sixty-two completed the post-questionnaire, representing a 30 % matched response rate. Participating in the programme resulted in immediate (p < 0.01) improvement in skills such as knowing when and how to complete incident forms and disclosing errors to patients, in self-rated knowledge (p < 0.01) and attitudes towards error reporting (p < 0.01). Sixty-three per cent disagreed that doctors routinely report medical errors and 42 % disagreed that doctors routinely share information about medical errors and what caused them. Participants rated interactive features as the most positive elements of the programme. An online training programme on medical error improved self-rated knowledge, attitudes and skills in junior doctors and was deemed an effective learning tool. Perceptions of work issues such as a poor culture of error reporting among doctors may prevent improved attitudes being realised in practice. Online patient safety education has a role in practice-based initiatives aimed at developing professionalism and improving safety.

Health and disability: partnerships in health care.

PubMed

Tracy, Jane; McDonald, Rachael

2015-01-01

Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving high-quality health care. This paper outlines health inequalities experienced by people with intellectual disability and focuses on the opportunities medical education provides to address these. Strategies to ensure that health professional education is inclusive of and relevant to people with disabilities are highlighted. The barriers experienced by people with intellectual disabilities to the receipt of high-quality health care include the attitudes, knowledge and skills of doctors. Improving medical education to ensure doctors are better equipped is one strategy to address these barriers. Improving health enhances quality of life, enables engagement and optimizes opportunities to participate in and contribute to the social and economic life of communities. People with intellectual disabilities sometimes find it difficult to get the healthcare they need to stay well. Teaching student doctors about what people with disabilities want and need can help these students become better doctors. Good doctors help people get well and stay healthy and active. When people feel well they can enjoy their lives and join in activities in their community. This article talks about some of the things doctors need to learn, and some ways to teach them. People with disabilities have a very important role in teaching student doctors. © 2014 John Wiley & Sons Ltd.

Rural Organization of Australian Stroke Teams: Emergency Department project.

PubMed

Wright, A; McGrail, M; Disler, P

2008-08-01

Many junior doctors have poor stroke assessment skills. Although major efforts have gone in to changing the attitudes of clinicians to stroke through the development of guidelines and implementation strategies, the most important step may be to make sure that medical schools include appropriate teaching of this important topic in their curricula. The Rural Organization of Australian Stroke Teams Emergency Department (ROASTED) project sought to determine the effectiveness of a practical intervention to improve the assessment and education of stroke knowledge among our junior emergency department doctors. We used a prospective before and after study of two separate cohorts (intervention vs no intervention) to assess the stroke knowledge of our junior emergency department doctors and to test the effectiveness of an educational intervention. The project took place at five sites in rural Victoria in November 2006. Both cohorts undertook the same two validated quizzes 1 month apart. At the intervention sites two 1-h tutorials were conducted between the quizzes and participants were encouraged to use a web-based educational tool. Pre-project stroke knowledge was shown to be poor at all of the participating sites. At the sites where no intervention took place no improvement in knowledge was shown (z = 0.83, P = 0.41, two-sided Mann-Whitney U-test). The median score for quiz 1 was 8.1 (41%, interquartile range (IQR) 6.5-9.4) and for quiz 2, 7.2 (36%, IQR 5.1-9.3). At the intervention sites, participants significantly improved their stroke knowledge between quiz 1 and quiz 2 (z = 4.75, P < 0.001). The median score for quiz 1 in this cohort was 8.3 (42%, IQR 6.5-10.0) and for quiz 2, 12.8 (64%, IQR 12.0-14.8). This project showed that junior doctors have an inadequate knowledge of stroke and that among our junior emergency department doctors there is a need for the ROASTED intervention and other innovative educational measures.

Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice.

PubMed

Essers, Geurt; van Dulmen, Sandra; van Weel, Chris; van der Vleuten, Cees; Kramer, Anneke

2011-12-13

Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance levels, on average, do not appear adequate. The context of daily practice may require different skills or specific ways of handling these skills, whereas communication skills are mostly treated as generic. So far no empirical analysis of the context has been made. Our aim was to identify context factors that could be related to GP communication. A purposive sample of real-life videotaped GP consultations was analyzed (N = 17). As a frame of reference we chose the MAAS-Global, a widely used assessment instrument for medical communication. By inductive reasoning, we analyzed the GP behaviour in the consultation leading to poor item scores on the MAAS-Global. In these cases we looked for the presence of an intervening context factor, and how this might explain the actual GP communication behaviour. We reached saturation after having viewed 17 consultations. We identified 19 context factors that could potentially explain the deviation from generic recommendations on communication skills. These context factors can be categorized into doctor-related, patient-related, and consultation-related factors. Several context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings.

Diagnosis of Constipation in Children

MedlinePlus

... you can share it with the doctor. Physical exam During a physical exam, a doctor may check your child’s blood pressure , ... or pain masses, or lumps perform a rectal exam During a physical exam, a doctor may check ...

Doctor-Shopping Behavior among Patients with Eye Floaters

PubMed Central

Tseng, Gow-Lieng; Chen, Cheng-Yu

2015-01-01

Patients suffering from eye floaters often resort to consulting more than one ophthalmologist. The purpose of this study, using the Health Belief Model (HBM), was to identify the factors that influence doctor-shopping behavior among patients with eye floaters. In this cross-sectional survey, 175 outpatients who presented floaters symptoms were enrolled. Data from 143 patients (77 first time visitors and 66 doctor-shoppers) who completed the questionnaire were analyzed. Descriptive and logistic regression analyses were performed. We found that women and non-myopia patients were significantly related with frequent attendance and doctor switching. Though the HBM has performed well in a number of health behaviors studies, but most of the conceptual constructors of HBM did not show significant differences between the first time visitors and true doctor-shoppers in this study. Motivation was the only significant category affecting doctor-shopping behavior of patients with eye floaters. PMID:26184266

Doctor-Shopping Behavior among Patients with Eye Floaters.

PubMed

Tseng, Gow-Lieng; Chen, Cheng-Yu

2015-07-13

Patients suffering from eye floaters often resort to consulting more than one ophthalmologist. The purpose of this study, using the Health Belief Model (HBM), was to identify the factors that influence doctor-shopping behavior among patients with eye floaters. In this cross-sectional survey, 175 outpatients who presented floaters symptoms were enrolled. Data from 143 patients (77 first time visitors and 66 doctor-shoppers) who completed the questionnaire were analyzed. Descriptive and logistic regression analyses were performed. We found that women and non-myopia patients were significantly related with frequent attendance and doctor switching. Though the HBM has performed well in a number of health behaviors studies, but most of the conceptual constructors of HBM did not show significant differences between the first time visitors and true doctor-shoppers in this study. Motivation was the only significant category affecting doctor-shopping behavior of patients with eye floaters.

Data and Performativity in Doctoral Education: Information Gaps and Suggestions for Overcoming Them

ERIC Educational Resources Information Center

Wainerman, Catalina; Matovich, Iván

2016-01-01

Since the mid-1990s, there has been an abrupt growth of doctoral enrollments and doctoral programs in Argentina and Latin America. However, completion rates at this education level are far from satisfying. Attrition rates in Social Sciences doctoral programs "are known" to be high, and higher in Social Sciences and Humanities (which will…

The need for a prescribing competency framework to address the burden of complex polypharmacy among multiple long-term conditions.

PubMed

Picton, Catherine; Loughrey, Claire; Webb, Andrew

2016-10-01

The original requirement for a competency framework for prescribers was to identify the essential skills for non-medical prescribers. However, core prescribing competencies are relevant to any prescriber. The new, revised version is especially relevant for doctors/physicians. Doctors are the most frequent prescribers - prescribing is the most common therapeutic intervention. The quantity and complexity of medicine use is increasing through multiple treatment strategies/pathways for multiple comorbidities, resulting in polypharmacy - especially with long-term conditions. This is against a background of the ongoing introduction of new drugs with novel mechanisms of action with increased risks of adverse effects, compounded by drug-drug and disease-drug interactions. This has increased the need for monitoring and follow-up, including identification and management of poor adherence. It is challenging for doctors to maintain safe and effective prescribing and train other doctors and non-medical prescribers within the multidisciplinary team. The prescribing competency framework provides a systematic approach to support doctors to prescribe safely and effectively. It can be used by medical schools to teach prescribing, including preparation for the prescribing safety assessment; by F1/F2 doctors to support prescribing in early years; as part of prescribing quality improvement initiatives and as a continuing professional development framework in general practice or acute care settings. © Royal College of Physicians 2016. All rights reserved.

Medical student and junior doctors' tolerance of ambiguity: development of a new scale.

PubMed

Hancock, Jason; Roberts, Martin; Monrouxe, Lynn; Mattick, Karen

2015-03-01

The practice of medicine involves inherent ambiguity, arising from limitations of knowledge, diagnostic problems, complexities of treatment and outcome and unpredictability of patient response. Research into doctors' tolerance of ambiguity is hampered by poor conceptual clarity and inadequate measurement scales. We aimed to create and pilot a measurement scale for tolerance of ambiguity in medical students and junior doctors that addresses the limitations of existing scales. After defining tolerance of ambiguity, scale items were generated by literature review and expert consultation. Feedback on the draft scale was sought and incorporated. 411 medical students and 75 foundation doctors in Exeter, UK were asked to complete the scale. Psychometric analysis enabled further scale refinement and comparison of scale scores across subgroups. The pilot study achieved a 64% response rate. The final 29 item version of the Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale had good internal reliability (Cronbach's α 0.80). Tolerance of ambiguity was higher in foundation year 2 doctors than first, third and fourth year medical students (-5.23, P = 0.012; -5.98, P = 0.013; -4.62, P = 0.035, for each year group respectively). The TAMSAD scale offers a valid and reliable alternative to existing scales. Further work is required in different settings and in longitudinal studies but this study offers intriguing provisional insights.

Chronic disease detection and access: does access improve detection, or does detection make access more difficult?

PubMed

Anwar, Mohammed Saqib; Baker, Richard; Walker, Nicola; Mainous, Arch G; Bankart, M John

2012-05-01

The recorded detection of chronic disease by practices is generally lower than the prevalence predicted by population surveys. To determine whether patient-reported access to general practice predicts the recorded detection rates of chronic diseases in that setting. A cross-sectional study involving 146 general practices in Leicestershire and Rutland, England. The numbers of patients recorded as having chronic disease (coronary heart disease, chronic obstructive pulmonary disease, hypertension, diabetes) were obtained from Quality and Outcomes Framework (QOF) practice disease registers for 2008-2009. Characteristics of practice populations (deprivation, age, sex, ethnicity, proportion reporting poor health, practice turnover, list size) and practice performance (achievement of QOF disease indicators, patient experience of being able to consult a doctor within 2 working days and book an appointment >2 days in advance) were included in regression models. Patient characteristics (deprivation, age, poor health) and practice characteristics (list size, turnover, QOF achievement) were associated with recorded detection of more than one of the chronic diseases. Practices in which patients were more likely to report being able to book appointments had reduced recording rates of chronic disease. Being able to consult a doctor within 2 days was not associated with levels of recorded chronic disease. Practices with high levels of deprivation and older patients have increased rates of recorded chronic disease. As the number of patients recorded with chronic disease increased, the capacity of practices to meet patients' requests for appointments in advance declined. The capacity of some practices to detect and manage chronic disease may need improving.

Children and their parents assessing the doctor-patient interaction: a rating system for doctors' communication skills.

PubMed

Crossley, Jim; Eiser, Christine; Davies, Helena A

2005-08-01

Only a patient and his or her family can judge many of the most important aspects of the doctor-patient interaction. This study evaluates the feasibility and reliability of children and their families assessing the quality of paediatricians' interactions using a rating instrument developed specifically for this purpose. A reliability analysis using generalisability theory on the ratings from 352 doctor-patient interactions across different speciality clinics. Ratings were normally distributed. They were highest for 'overall' performance, and lowest for giving time to discuss the families' agenda. An appropriate sample of adults' ratings provided a reliable score (G = 0.7 with 15 raters), but children's ratings were too idiosyncratic to be reproducible (G = 0.36 with 15 raters). CONCLUSIONS AND FURTHER WORK: Accompanying adults can provide reliable ratings of doctors' interactions with children. Because an adult is usually present at the consultation their ratings provide a highly feasible and authentic approach. Sampling doctors' interactions from different clinics and with patients of both genders provides a universal picture of performance. The method is ideal to measure performance for in-training assessment or revalidation. Further work is in progress to evaluate the educational impact of feeding ratings back to the doctors being assessed, and their use in a range of clinical contexts.

Empathy and the application of the 'unbearable suffering' criterion in Dutch euthanasia practice.

PubMed

van Tol, Donald G; Rietjens, Judith A C; van der Heide, Agnes

2012-05-01

A pivotal due care criterion for lawful euthanasia in the Netherlands is that doctors must be convinced that a patient requesting for euthanasia, suffers unbearably. Our study aims to find out how doctors judge if a patient suffers unbearably. How do doctors bridge the gap from 3rd person assessment to 1st person experience? We performed a qualitative interview study among 15 physicians, mainly general practitioners, who participated earlier in a related quantitative survey on the way doctors apply the suffering criterion. Results show that doctors follow different 'cognitive routes' when assessing a patients suffering in the context of a euthanasia request. Sometimes doctors do this imagining how she herself would experience the situation of the patient ('imagine self'). Doctors may also try to adopt the perspective of the patient and imagine what the situation is like for this particular patient ('imagine other'). Besides this we found that the (outcome of the) assessment is influenced by a doctor's private norms, values and emotions considering (the performance of) euthanasia. We conclude by arguing why doctors should be aware of both the 'cognitive route' followed as well as the influence of their own personal norms on the assessment of suffering in the context of euthanasia requests. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Experience of Primary Care Services Among Early Adolescents in England and Association With Health Outcomes.

PubMed

Yassaee, Arrash A; Hargreaves, Dougal S; Chester, Kayleigh; Lamb, Stephanie; Hagell, Ann; Brooks, Fiona M

2017-04-01

The aim of this study was to investigate adolescents' (11-15 years) experience of their general practitioner (GP), whether poor reported GP experience was associated with worse physical and mental health measures and whether poor previous GP experience was linked to lower utilization of these services. We used logistic regression to analyze data from the 2014 Health Behaviour in School-aged Children study. Four aspects of recent care experience were studied: feeling at ease, feeling treated with respect, satisfaction with doctor's explanation, and feeling able to discuss personal matters. Five dichotomized measures of health status were used: ever self-harmed; fair or poor self-reported health; frequent (at least weekly) low mood; sleeping problems; or headaches. Of 5,335 students, 4,149 reported having visiting their GP within the past year. Of these, 91.8% felt treated with respect, 78.7% felt at ease, 85.7% were satisfied with explanation, and 53.9% felt able to discuss personal matters. After adjusting for ethnicity, age, gender, and family affluence score, poor experience on any indicator was strongly associated with increased risk of self-harm (adjusted odds ratio range, 2.01-2.70; all p < .001); feeling low (AOR range, 1.53-2.11; all p < .001); and sleeping problems (AOR range, 1.49-1.91; all p ≤ .001). Poor experience on all indicators, except discussing personal matters, was associated with worse self-reported health. Nearly half of this large, national study of adolescents did not feel able to discuss personal matters with their doctor. There was a consistent, strong association between reported lack of good GP experience and poor health measures. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Does feedback matter? Practice-based learning for medical students after a multi-institutional clinical performance examination.

PubMed

Srinivasan, Malathi; Hauer, Karen E; Der-Martirosian, Claudia; Wilkes, Michael; Gesundheit, Neil

2007-09-01

Achieving competence in 'practice-based learning' implies that doctors can accurately self- assess their clinical skills to identify behaviours that need improvement. This study examines the impact of receiving feedback via performance benchmarks on medical students' self-assessment after a clinical performance examination (CPX). The authors developed a practice-based learning exercise at 3 institutions following a required 8-station CPX for medical students at the end of Year 3. Standardised patients (SPs) scored students after each station using checklists developed by experts. Students assessed their own performance immediately after the CPX (Phase 1). One month later, students watched their videotaped performance and reassessed (Phase 2). Some students received performance benchmarks (their scores, plus normative class data) before the video review. Pearson's correlations between self-ratings and SP ratings were calculated for overall performance and specific skill areas (history taking, physical examination, doctor-patient communication) for Phase 1 and Phase 2. The 2 correlations were then compared for each student group (i.e. those who received and those who did not receive feedback). A total of 280 students completed both study phases. Mean CPX scores ranged from 51% to 71% of items correct overall and for each skill area. Phase 1 self-assessment correlated weakly with SP ratings of student performance (r = 0.01-0.16). Without feedback, Phase 2 correlations remained weak (r = 0.13-0.18; n = 109). With feedback, Phase 2 correlations improved significantly (r = 0.26-0.47; n = 171). Low-performing students showed the greatest improvement after receiving feedback. The accuracy of student self-assessment was poor after a CPX, but improved significantly with performance feedback (scores and benchmarks). Videotape review alone (without feedback) did not improve self-assessment accuracy. Practice-based learning exercises that incorporate feedback to medical students hold promise to improve self-assessment skills.

Knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses from a resource poor setting, Nepal.

PubMed

Adhikari, Samaj; Paudel, Kumar; Aro, Arja R; Adhikari, Tara Ballav; Adhikari, Bipin; Mishra, Shiva Raj

2016-11-08

Healthcare ethics is neglected in clinical practice in LMICs (Low and Middle Income Countries) such as Nepal. The main objective of this study was to assess the current status of knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses in a tertiary teaching hospital in Nepal. This was a cross sectional study conducted among resident doctors (n = 118) and ward nurses (n = 86) in the largest tertiary care teaching hospital of Nepal during January- February 2016 with a self-administered questionnaire. A Cramer's V value was assessed to ascertain the strength of the differences in the variables between doctors and nurses. Association of variables were determined by Chi square and statistical significance was considered if p value was less than 0.05. Our study demonstrated that a significant proportion of the doctors and nurses were unaware of major documents of healthcare ethics: Hippocratic Oath (33 % of doctors and 51 % of nurses were unaware), Nuremberg code (90 % of both groups were unaware) and Helsinki Declaration (85 % of doctors and 88 % of nurses were unaware). A high percentage of respondents said that their major source of information on healthcare ethics were lectures (67.5 % doctors versus 56.6 % nurses), books (62.4 % doctors versus 89.2 % nurses), and journals (59 % doctors versus 89.2 % nurses). Attitude of doctors and nurses were significantly different (p < 0.05) in 9 out of 22 questions pertaining to different aspects of healthcare ethics. More nurses had agreement than doctors on the tested statements pertaining to different aspects of healthcare ethics except for need of integration of medical ethics in ungraduate curricula (97.4 % doctors versus 81.3 % nurses),paternalistic attitude of doctor was disagreed more by doctors (20.3 % doctors versus 9.3 % nurses). Notably, only few (9.3 % doctors versus 14.0 % nurses) doctors stood in support of physician-assisted dying. Significant proportion of doctors and nurses were unaware of three major documents on healthcare ethics which are the core principles in clinical practice. Provided that a high percentage of respondents had motivation for learning medical ethics and asked for inclusion of medical ethics in the curriculum, it is imperative to avail information on medical ethics through subscription of journals and books on ethics in medical libraries in addition to lectures and training at workplace on medical ethics which can significantly improve the current paucity of knowledge on medical ethics.

[Prof. Giuseppe Moscati (1880-1927). A special issue on his scientific production].

PubMed

Cascella, Marco

2016-08-01

Professor Giuseppe Moscati (1880-1927) was canonized by the Catholic Church in 1987. This act recognized the extraordinary qualities of a doctor who, considering his work as a "sublime mission", dedicated his life to helping the sick. The fame of the "Holy doctor" or "doctor of the poor", as people called him, was soon widespread and, immediately after his death, made him the subject of several biographies. These treatises, mainly written by religious hagiographers, have little analyzed Moscati as a doctor and scientist, or, in rare cases, privileged the description of his medical career, touching only marginally salient aspects of his work as a scientist and researcher. The purpose of this paper is to provide an insight into the figure of Moscati as a scientist, contextualizing his research activities in the scientific fields of biochemistry and physiology, which were flourishing in the early twentieth century. By a more careful analysis, his scientific production appears original for the resource-poor context and the innovative research method. The Italian scientist, combining physiological chemistry and biochemistry at the clinic, anticipated the birth of modern branches as the "Laboratory Medicine" and the "Clinical Pathology". In particular, he carried out studies on diabetes, storage diseases, metabolism, toxicology, pathology, nephrology and occupational diseases. Moreover, he anticipated the concept of modern laboratory in the oncological field as means for the characterization of the "nature" of neoplasms and related therapeutic approaches. Therefore, even if Moscati was rarely mentioned by the sources of the history of medicine, it is safe to assume that the fame of the Saint has paradoxically eclipsed that of the scientist, preventing him from receiving the necessary reward.

Getting rid of patients: contradictions in the socialisation of internists to the doctor-patient relationship.

PubMed

Mizrahi, T

1985-07-01

This article examines the impact of the professional socialisation of internists on the doctor-patient relationship. Utilising observation and interviews, the study found that the world of house staff (interns and residents) was defined by a paradoxical perspective on patients--characterised as a "Get Rid of patients' (GROP) orientation. This perspective was shaped by the poor conditions of public institutions, administrative mandates, demographic and disease factors, a narrow definition of professional practice and normative standards of professional conduct. There was active support and reinforcement from colleagues for GROP behaviour; peers, rather than attending faculty became the most important socialisers. To implement the GROP perspective, coping strategies emerged within the house-staff culture. These included the utilisation of the hierarchy and techniques such as negotiation, objectification, intimidation, omission and avoidance. No time in their training was identified as the right time to acquire humanistic doctor-patient relationship skills. Contrarily, the structure of the socialising institution was organised into a hierarchy in which the most obvious criterion and consequence of status was autonomy over or removal from the establishment of meaningful doctor-patient relationships.

Where have all the doctors gone? (2). Intraurban trends: changes in the geographic distribution of general practitioners in Auckland, 1980-7.

PubMed

Barnett, J R

1991-08-14

During the 1980s the Auckland metropolitan area increased its share of all general practitioners in New Zealand at a much faster rate than its share of the population, resulting in a high level of availability by 1987. In the light of such trends, neoclassical theory would predict a diffusion of general practitioners into areas with fewer doctors where there is less competition for patients. Data for 1980-7, however, indicates that for every FTE general practitioner who located in doctor poor areas of the city, 1.87 general practitioners continued to open practices in areas already well provided for. Or, for every extra consultation that took place in low income suburbs, 1.51 extra consultations occurred in more affluent localities. These results do not provide strong support for a market led diffusion of doctors into areas of need and any gains in increased equity appear to have been achieved at the expense of considerable inefficiency given the likely presence of induced demand.

Attitudes of oncologists toward euthanasia in Turkey.

PubMed

Mayda, Atilla Senih; Ozkara, Erdem; Corapçioğlu, Funda

2005-09-01

There have been intensive debates about euthanasia and attempts to change laws on euthanasia in all countries. What doctors and particularly oncologists think about euthanasia must be taken into consideration, as their voices are crucial in this dialogue. The aim of this study was to find out how Turkish doctors approach euthanasia in the context of cancer. A questionnaire was used to collect data from 85 oncologists out of a total 800 in active oncology practice. Of the oncologists surveyed, 43.8% did not object to euthanasia. Some 33.7% had been asked to perform euthanasia and 41.5% believed that euthanasia was performed secretly although it is against the law in Turkey. Forty-two doctors (50.6%) noted that they had withdrawn treatment in patients. Doctors who encounter terminally ill patients with cancer should update their knowledge about patients' rights and euthanasia. Doctors, who are often asked to perform euthanasia, especially in the cancer setting, can help to illuminate the debates about euthanasia.

Knowledge and awareness of medical doctors, medical students and nurses about dentistry in Nigeria.

PubMed

Oyetola, Elijah Olufemi; Oyewole, Taiwo; Adedigba, Micheal; Aregbesola, Stephen Tunde; Umezudike, Kehinde; Adewale, Adedotun

2016-01-01

Various studies have reported poor awareness and knowledge of dentistry in the Nigerian population. There is, however, paucity of information assessing the knowledge and awareness of medical doctors/students and nurses about dentistry. The present study is aimed at determining the knowledge and awareness of medical doctors/students and nurses about dentistry. Self-administered questionnaires were randomly distributed among medical doctors/students, and nurses of Obafemi Awolowo Teaching Hospitals' Complex, Ile-Ife, Nigeria. Information collected using the questionnaire included participants' biodata, questions evaluating dental awareness, knowledge of systemic and oral health connections as well as referral practices. The data analysis was done with STATA version 11 software. A total of 300 questionnaires were randomly distributed among doctors/students and nurses, 206 were returned (response rate of 69%). Of the returned questionnaires, 129(63%) were males and 77(37%) were females. There were 42 medical doctors, 49 nurses and 115 medical students. The mean age of the participants was 26.7 years (SD 5.2). Majority (99.5%) was aware of dental profession, but 92% had never referred patients for dental consultation. One third (31%) of medical doctors believed that Ludwig angina was a cardiac disease. A large proportion of the respondents (61%) see no need for routine dental visit while 27% would want to visit the dentist only when they had a dental complaint. Although a large percentage of the participants claimed to be aware of dentistry, our findings revealed low level of knowledge and attitude to Dentistry. Efforts should be made towards closing this knowledge gap to achieve efficient oral health.

From medical doctor to medical director: leadership style matters.

PubMed

Williams, Geraint; Wood, Edward V; Ibram, Ferda

2015-07-01

Leadership is a skill to be developed by all doctors from the foundation trainee to the director of the board. This article explores the impact of leadership style on performance and considers techniques to develop doctors' leadership skills and personal effectiveness.

Using Performance Measures to Motivate ‘Report-Averse’ and ‘Report-Loving’ Agents

PubMed Central

Glazer, Jacob; McGuire, Thomas G.; Newhouse, Joseph P.

2013-01-01

In designing a quality report, a health plan needs to account for the report's effect on the doctor, hospital or other provider. This paper proposes a simple model of how quality reporting affects a health care provider, using the example of a doctor subject to reporting with a “cut point” that designates the doctor as above or below some standard. Choice of cut point affects the doctor's welfare through the doctor's preferences about income and by affecting market demand for the doctor's services. These factors lead doctors to be “report-averse” or “report-loving,” a determination that affects a health plan's cost to enlist a doctor in a contract with reporting and that guides choice of a cut point to maximize the doctors' effort to improve her quality. PMID:17996319

The "new normal": Adapting doctoral trainee career preparation for broad career paths in science.

PubMed

St Clair, Rebekah; Hutto, Tamara; MacBeth, Cora; Newstetter, Wendy; McCarty, Nael A; Melkers, Julia

2017-01-01

Doctoral recipients in the biomedical sciences and STEM fields are showing increased interest in career opportunities beyond academic positions. While recent research has addressed the interests and preferences of doctoral trainees for non-academic careers, the strategies and resources that trainees use to prepare for a broad job market (non-academic) are poorly understood. The recent adaptation of the Social Cognitive Career Theory to explicitly highlight the interplay of contextual support mechanisms, individual career search efficacy, and self-adaptation of job search processes underscores the value of attention to this explicit career phase. Our research addresses the factors that affect the career search confidence and job search strategies of doctoral trainees with non-academic career interests and is based on nearly 900 respondents from an NIH-funded survey of doctoral students and postdoctoral fellows in the biomedical sciences at two U.S. universities. Using structural equation modeling, we find that trainees pursuing non-academic careers, and/or with low perceived program support for career goals, have lower career development and search process efficacy (CDSE), and receive different levels of support from their advisors/supervisors. We also find evidence of trainee adaptation driven by their career search efficacy, and not by career interests.

The “new normal”: Adapting doctoral trainee career preparation for broad career paths in science

PubMed Central

St. Clair, Rebekah; Hutto, Tamara; MacBeth, Cora; Newstetter, Wendy; McCarty, Nael A.

2017-01-01

Doctoral recipients in the biomedical sciences and STEM fields are showing increased interest in career opportunities beyond academic positions. While recent research has addressed the interests and preferences of doctoral trainees for non-academic careers, the strategies and resources that trainees use to prepare for a broad job market (non-academic) are poorly understood. The recent adaptation of the Social Cognitive Career Theory to explicitly highlight the interplay of contextual support mechanisms, individual career search efficacy, and self-adaptation of job search processes underscores the value of attention to this explicit career phase. Our research addresses the factors that affect the career search confidence and job search strategies of doctoral trainees with non-academic career interests and is based on nearly 900 respondents from an NIH-funded survey of doctoral students and postdoctoral fellows in the biomedical sciences at two U.S. universities. Using structural equation modeling, we find that trainees pursuing non-academic careers, and/or with low perceived program support for career goals, have lower career development and search process efficacy (CDSE), and receive different levels of support from their advisors/supervisors. We also find evidence of trainee adaptation driven by their career search efficacy, and not by career interests. PMID:28542304

An ethnographic investigation of junior doctors' capacities to practice interprofessionally in three teaching hospitals.

PubMed

Milne, Jacqueline; Greenfield, David; Braithwaite, Jeffrey

2015-01-01

Collaborative practice among early career staff is at the bedrock of interprofessional care. This study investigated factors influencing the enactment of interprofessional practice by using the day-to-day role of six junior doctors in three teaching hospitals as a gateway to understand the various professions' interactive behaviours. The contextual framework used for the study was Strauss' theory of negotiated order. Ethnographic techniques were applied to observe the actions and interactions of participants on typical working days in their hospital environments. Field notes were created and thematic analysis was applied to the data. Three themes explored were culture, communication, and collaboration. Issues identified highlight the bounded organisational and professional cultures within which junior doctors work, and systemic problems in interprofessional interaction and communication in the wards of hospitals. There are indications that early career doctors are interprofessional isolates. The constraints of short training terms and pressure from multi-faceted demands on junior doctors can interfere with the establishment of meaningful relationships with nurses and other health professionals. The realisation of sustained interprofessional practice is, therefore, practically and structurally difficult. Enabling factors supporting the sharing of expertise are outweighed by barriers associated with professional and hospital organisational cultures, poor interprofessional communication, and the pressure of competing individual task demands in the course of daily practice.

The demand for doctorally prepared public health personnel in institutions of higher education.

PubMed

Scutchfield, F D; Quimson, S; Williams, S J; Hofstetter, R

1988-01-01

We examined the demand for doctorally prepared public health personnel in academia. We developed an unduplicated list of positions advertised during 1983 in several of the nation's public health journals. Based on this, we identified a total of 217 available positions. We surveyed the persons who placed the advertisements regarding their perceptions of the applicant pool, their experiences in filling the positions, and their perceptions of the future supply of doctorally prepared public health personnel. Of the respondents, 93% were in institutions of higher education. Based on their response, it appears that the current supply of doctorally prepared public health personnel is short and is likely to continue to be limited. Respondents had difficulty filling the advertised positions, based on the amount of time necessary to fill the position, and a number of positions had to be modified in order to be filled. Thirty-two percent of the respondents replied that the pool of applicants was low or poor. Thirty-four percent felt there was a shortage of such personnel, and a similar percentage felt there would be a future shortage. Based on our data, we believe that there is now a shortage of doctorally educated public health personnel for academic positions and that this shortage is likely to continue.

Career choices of junior doctors: is the physician an endangered species?

PubMed

Chaudhuri, Ella; Mason, Nicola C; Newbery, Nina; Goddard, Andrew F

2013-08-01

There are increasing concerns regarding the recruitment and retention within general medicine. National surveys were conducted among foundation year 2 doctors (FY2), year 1 and year 2 core medical trainees (CT1 and CT2) and medical registrars (StR/ST3+) exploring their enjoyment of medicine, overall satisfaction, career aspirations, influencing factors and perceptions of the medical registrar. The results highlight that many doctors at the FY2, CT1 and CT2 levels are being deterred from general medicine by the perceived unmanageable workload and poor work-life balance of the medical registrar. Medical registrars themselves are less satisfied in general internal medicine than they are in their main specialties. Therefore, priority needs to be placed on clarifying the roles, and improving the morale, of medical registrars. If current trends persist, these will have a significant impact on patient safety, patient care and workforce planning.

"Robin Hood" of techno-Turkey or organ trafficking in the state of ethical beings.

PubMed

Sanal, Aslihan

2004-09-01

Dr S. is a famous transplant surgeon in the Middle East. He operates "underground" on wealthy patients in different countries, from Israel to Turkey to Russia. The media refer to him as the "Organ Mafia doctor," and patients diagnosed with renal failure speak of him sardonically as "Robin Hood," acknowledging that he takes organs from the poor to give to the rich. But ethical issues of organ trafficking are not limited to marginal private clinics and "Mafia" doctors. All-living related organ transplants in Turkey involve similar ethical dilemmas: many related or nonrelated organ recipients pay their donors, and demand continues to rise. This paper explores practices in state and university hospitals and the ethical dilemmas doctors encounter to understand where and how judicial, cultural, and social categories of "human rights" and "crime" are constructed in our high-tech world.

[Lack of correlation between performances in a simulator and in reality].

PubMed

Konge, Lars; Bitsch, Mikael

2010-12-13

Simulation-based training provides obvious benefits for patients and doctors in education. Frequently, virtual reality simulators are expensive and evidence for their efficacy is poor, particularly as a result of studies with poor methodology and few test participants. In medical simulated training- and evaluation programmes it is always a question of transfer to the real clinical world. To illustrate this problem a study comparing the test performance of persons on a bowling simulator with their performance in a real bowling alley was conducted. Twenty-five test subjects played two rounds of bowling on a Nintendo Wii and 25 days later on a real bowling alley. Correlations of the scores in the first and second round (test-retest-reliability) and of the scores on the simulator and in reality (criterion validation) were studied and there was tested for any difference between female and male performance. The intraclass correlation coefficient equalled 0.76, i.e. the simulator fairly accurately measured participant performance. In contrast to this there was absolutely no correlation between participants' real bowling abilities and their scores on the simulator (Pearson's r = 0.06). There was no significant difference between female and male abilities. Simulation-based testing and training must be based on evidence. More studies are needed to include an adequate number of subjects. Bowling competence should not be based on Nintendo Wii measurements. Simulated training- and evaluation programmes should be validated before introduction, to ensure consistency with the real world.

Applying sport psychology to improve clinical performance.

PubMed

Church, Helen R; Rumbold, James L; Sandars, John

2017-12-01

Preparedness for practice has become an international theme within Medical Education: for healthcare systems to maintain their highest clinical standards, junior doctors must "hit the ground running" on beginning work. Despite demonstrating logical, structured assessment and management plans during their undergraduate examinations, many newly qualified doctors report difficulty in translating this theoretical knowledge into the real clinical environment. "Preparedness" must constitute more than the knowledge and skills acquired during medical school. Complexities of the clinical environment overwhelm some junior doctors, who acknowledge that they lack strategies to manage their anxieties, under-confidence and low self-efficacy. If uncontrolled, such negative emotions and behaviors may impede the delivery of time-critical treatment for acutely unwell patients and compound junior doctors' self-doubt, thus impacting future patient encounters. Medical Education often seeks inspiration from other industries for potential solutions to challenges. To address "preparedness for practice," this AMEE Guide highlights sport psychology: elite sportspeople train both physically and psychologically for their discipline. The latter promotes management of negative emotions, distractions and under-confidence, thus optimizing performance despite immense pressures of career-defining moments. Similar techniques might allow junior doctors to optimize patient care, especially within stressful situations. This AMEE Guide introduces the novel conceptual model, PERFORM, which targets the challenges faced by junior doctors on graduation. The model applies pre-performance routines from sport psychology with the self-regulatory processes of metacognition to the clinical context. This model could potentially equip junior doctors, and other healthcare professionals facing similar challenges, with strategies to optimize clinical care under the most difficult circumstances.

A Medical School in Cuba Trains Doctors for Poor Countries.

ERIC Educational Resources Information Center

Lloyd, Marion

2001-01-01

Describes how the Latin American Medical School in Cuba attracts foreign students, including Americans, with a free course of study. Supporters say it shows Castro's commitment to humanitarian ideals, while critics see it as an attempt to curry favor with Central and Latin America. (EV)

Evidence, Emotion and Eminence: A Qualitative and Evaluative Analysis of Doctors' Skills in Macroallocation.

PubMed

Gallagher, Siun; Little, Miles; Hooker, Claire

2018-03-24

In this analysis of the ethical dimensions of doctors' participation in macroallocation we set out to understand the skills they use, how they are acquired, and how they influence performance of the role. Using the principles of grounded moral analysis, we conducted a semi-structured interview study with Australian doctors engaged in macroallocation. We found that they performed expertise as argument, bringing together phronetic and rhetorical skills founded on communication, strategic thinking, finance, and health data. They had made significant, purposeful efforts to gain skills for the role. Our findings challenge common assumptions about doctors' preferences in argumentation, and reveal an unexpected commitment to practical reason. Using the ethics of Paul Ricoeur in our analysis enabled us to identify the moral meaning of doctors' skills and learning. We concluded that Ricoeur's ethics offers an empirically grounded matrix for ethical analysis of the doctor's role in macroallocation that may help to establish norms for procedure.

mHealth to the Rescue: Growing use of wireless and mobile technologies improves community health, even in rural areas.

PubMed

Mertz, Leslie

2016-01-01

In rural areas, it is not unusual for patients to travel 50 miles or more to reach their doctors? offices or for doctors to refer patients to specialists whose offices are 80, 100, even 200-plus miles away. The sheer distance is a major obstacle for patients of all kinds: those who need urgent specialist care, those who have a chronic condition that requires regular visits, those who live in areas prone to poor weather-related driving conditions-really, anyone who has better things to do than spend hours traveling to and from a medical appointment.

How Six Sigma Methodology Improved Doctors' Performance

ERIC Educational Resources Information Center

Zafiropoulos, George

2015-01-01

Six Sigma methodology was used in a District General Hospital to assess the effect of the introduction of an educational programme to limit unnecessary admissions. The performance of the doctors involved in the programme was assessed. Ishikawa Fishbone and 5 S's were initially used and Pareto analysis of their findings was performed. The results…

Doctors in society. Medical professionalism in a changing world.

PubMed

2005-01-01

Medicine bridges the gap between science and society. Indeed, the application of scientific knowledge to human health is a crucial aspect of clinical practice. Doctors are one important agent through which that scientific understanding is expressed. But medicine is more than the sum of our knowledge about disease. Medicine concerns the experiences, feelings, and interpretations of human beings in often extraordinary moments of fear, anxiety, and doubt. In this extremely vulnerable position, it is medical professionalism that underpins the trust the public has in doctors. This Working Party was established to define the nature and role of medical professionalism in modern society. Britain's health system is undergoing enormous change. The entry of multiple health providers, the wish for more equal engagement between patients and professionals, and the ever-greater contribution of science to advances in clinical practice all demand a clear statement of medicine's unifying purpose and doctors' common values. What is medical professionalism and does it matter to patients? Although evidence is lacking that more robust professionalism will inevitably lead to better health outcomes, patients certainly understand the meaning of poor professionalism and associate it with poor medical care. The public is well aware that an absence of professionalism is harmful to their interests. The Working Party's view, based on the evidence it has received, is that medical professionalism lies at the heart of being a good doctor. The values that doctors embrace set a standard for what patients expect from their medical practitioners. The practice of medicine is distinguished by the need for judgement in the face of uncertainty. Doctors take responsibility for these judgements and their consequences. A doctor's up-to-date knowledge and skill provide the explicit scientific and often tacit experiential basis for such judgements. But because so much of medicine's unpredictability calls for wisdom as well as technical ability, doctors are vulnerable to the charge that their decisions are neither transparent nor accountable. In an age where deference is dead and league tables are the norm, doctors must be clearer about what they do, and how and why they do it. We define medical professionalism as a set of values, behaviours, and relationships that underpin the trust the public has in doctors. We go on to describe what those values, behaviours, and relationships are, how they are changing, and why they matter. This is the core of our work. We have also identified six themes where our definition has further implications: leadership, teams, education, appraisal, careers, and research. The Working Party's definition and description of medical professionalism, and the recommendations arising from them, can be found in Section 5 of this report. If our recommendations are acted upon, we believe that professionalism could flourish and prosper to the benefit of patients and doctors alike. However, the exercise of medical professionalism is hampered by the political and cultural environment of health, which many doctors consider disabling. The conditions of medical practice are critical determinants for the future of professionalism. We argue that doctors have a responsibility to act according to the values we set out in this report. Equally, other members of the healthcare team--notably managers--have a reciprocal duty to help create an organisational infrastructure to support doctors in the exercise of their professional responsibilities. Just as the patient-doctor partnership is a pivotal therapeutic relationship in medicine, so the interaction between doctor and manager is central to the delivery of professional care. High-quality care depends on both effective health teams and efficient health organisations. Professionalism therefore implies multiple commitments--to the patient, to fellow professionals, and to the institution or system within which healthcare is provided, to the extent that the system supports patients collectively. A doctor's corporate responsibility, shared as it is with managers and others, is a frequently neglected aspect of modern practice. The audience for this report is, first and foremost, doctors. But we believe it should be of equal interest to patients, policy-makers, members of other health professions, and the media. All these groups have a vital part to play in discussing and advancing medical professionalism. This report is only the beginning of an effort by the Royal College of Physicians, together with others, to initiate a public dialogue about the role of the doctor in creating a healthier and fairer society. Medical professionalism has roots in almost every aspect of modern healthcare. This Working Party could not hope to solve all the issues and conflicts surrounding professionalism in practice today. But our collective and abiding wish is to put medical professionalism back onto the political map of health in the UK.

Meeting the challenge in performance management: the diffusion and implementation of the balanced scorecard in Chinese hospitals.

PubMed

Gao, Tian; Gurd, Bruce

2015-03-01

The bonus system used in Chinese hospitals has been criticized for eroding doctors' professional ethics and aggravating patient expense. This research article focuses on one system to improve hospital performance, the balanced scorecard (BSC). We use three data sources to examine the diffusion and implementation of the BSC in China: a questionnaire survey in Shandong Province, a print-media indicators and content analysis of the published BSC papers and semi-structured interviews with managers of Chinese hospitals that use the BSC. The research evidence shows that bonus systems are important, partially because of the poor pay of hospital professionals, and the BSC is perceived as providing a fair system to award such bonuses. This helps explain the relative endurance of the BSC in Chinese hospitals. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Exploring newly qualified doctors' workplace stressors: an interview study from Australia

PubMed Central

Tallentire, Victoria R; Smith, Samantha E; Facey, Adam D; Rotstein, Laila

2017-01-01

Purpose Postgraduate year 1 (PGY1) doctors suffer from high levels of psychological distress, yet the contributory factors are poorly understood. This study used an existing model of workplace stress to explore the elements most pertinent to PGY1 doctors. In turn, the data were used to amend and refine the conceptual model to better reflect the unique experiences of PGY1 doctors. Method Focus groups were undertaken with PGY1 doctors working at four different health services in Victoria, Australia. Transcripts were coded using Michie's model of workplace stress as the initial coding template. Remaining text was coded inductively and the supplementary codes were used to modify and amplify Michie's framework. Results There were 37 participants in total. Key themes included stressors intrinsic to the job, such as work overload and long hours, as well as those related to the context of work such as lack of role clarity and relationships with colleagues. The main modification to Michie's framework was the addition of the theme of uncertainty. This concept related to most of the pre-existing themes in complex ways, culminating in an overall sense of anxiety. Conclusions Michie's model of workplace stress can be effectively used to explore the stressors experienced by PGY1 doctors. Pervasive uncertainty may help to explain the high levels of psychological morbidity in this group. While some uncertainty will always remain, the medical education community must seek ways to improve role clarity and promote mutual respect. PMID:28801411

Improving organizational climate for quality and quality of care: does membership in a collaborative help?

PubMed

Nembhard, Ingrid M; Northrup, Veronika; Shaller, Dale; Cleary, Paul D

2012-11-01

The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. To evaluate the impact of collaborative membership on organizational climate for quality and service quality. Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement. Pre-post design. Preassessments occurred 2 months before the collaborative began in January 2009. Postassessments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality. Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor's office as indicators of service quality. There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics. Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.

The role of doctors' religious faith and ethnicity in taking ethically controversial decisions during end-of-life care.

PubMed

Seale, Clive

2010-11-01

The prevalence of religious faith among doctors and its relationship with decision-making in end-of-life care is not well documented. The impact of ethnic differences on this is also poorly understood. This study compares ethnicity and religious faith in the medical and general UK populations, and reports on their associations with ethically controversial decisions taken when providing care to dying patients. A postal survey of 3733 UK medical practitioners, of whom 2923 reported on the care of their last patient who died. Specialists in care of the elderly were somewhat more likely to be Hindu or Muslim than other doctors; palliative care specialists were somewhat more likely to be Christian, religious and 'white' than others. Ethnicity was largely unrelated to rates of reporting ethically controversial decisions. Independently of speciality, doctors who described themselves as non-religious were more likely than others to report having given continuous deep sedation until death, having taken decisions they expected or partly intended to end life, and to have discussed these decisions with patients judged to have the capacity to participate in discussions. Speciality was independently related to wide variations in the reporting of decisions taken with some intent to end life, with doctors in 'other hospital' specialities being almost 10 times as likely to report this when compared with palliative medicine specialists, regardless of religious faith. Greater acknowledgement of the relationship of doctors' values with clinical decision-making is advocated.

Access, continuity of care and consultation quality: which best predicts urgent cancer referrals from general practice?

PubMed

Rogers, Stephen; Gildea, Carolynn; Meechan, David; Baker, Richard

2014-12-01

For some cancers, late presentation is associated with poor survival. In England, less than half of patients are diagnosed following a general practitioner-initiated urgent referral. We explore whether particular practice or practitioner characteristics are associated with use of the urgent referral system. The study sample was 603/614 practices in the East Midlands. Logistic regression models were fitted to investigate relationships between cancer detection rate, how easy it is to book appointments quickly, in advance or with a preferred doctor, and whether patients have confidence and trust in the doctor. The percentage of patients who definitely have confidence and trust in the doctor was positively associated with the cancer detection rate [odds ratio = 1.08 (95% confidence interval (CI) 1.01, 1.15) per 10 percentage points]. When all four survey variables were modelled together, the percentage of patients who were able to see a preferred doctor was negatively associated with the cancer detection rate [odds ratio = 0.93 (95% CI 0.88, 0.98) per 10 percentage points]. Our analyses suggest that in the UK National Health Service, confidence and trust in the doctor may be more important in cancer detection than the ease of access or whether there is choice of doctor. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The good doctor: the carer's perspective.

PubMed

Levine, Carol

2004-01-01

Carers are family members, friends, and neighbours who perform medical tasks and personal care, manage housekeeping and financial affairs, and provide emotional support to people who are ill, disabled, or elderly. From a carer's perspective, the primary requisite for a good doctor is competence. Assuming equal technical skills and knowledge, the difference between 'good' and 'bad' doctors comes down to attitudes and behaviour-communication. An important aspect of communication is what doctors say to carers, and how they interpret what carers say to them. Body language-stances, gestures and expression-communicates as well. Good doctors are surrounded by courteous, helpful and efficient assistants. Doctors can make two types of errors in dealing with carers. Type 1 errors occur when doctors exclude the carer from decision making and information. Type 2 errors occur when doctors speak only to the carer and ignore the patient. Good doctors, patients and carers confront the existential meaning of illness together.

The quality dilemma.

PubMed

Lucassen, Peter

2007-06-01

In the language and logic of the free market, providers of health care will have to demonstrate the quality of their work. However, in this setting quality is only interpreted in quantitative ways and consequently does not necessarily do justice to good physicians. Moreover, both outcome measures and process measures have serious drawbacks. An emphasis on outcome measures will disadvantage physicians working in deprived areas and doctors managing more complicated cases. Although process measures give the most direct information on the physician's performance, their evidence base is not always as straightforward as commonly supposed. Finally, measurement of quality indicators is complicated and time consuming. Physicians should be aware of the drawbacks of quality measurement and of the poor effects of quality improvement strategies on patient outcomes.

Doctor-patient relationship. Islamic perspective.

PubMed

Chamsi-Pasha, Hassan; Albar, Mohammed A

2016-02-01

The doctor-patient relationship is an intricate concept in which patients voluntarily approach a doctor and become part of a contract by which they tend to abide by doctor's instructions. Over recent decades, this relationship has changed dramatically due to privatization and commercialization of the health sector. A review of the relevant literature in the database of MEDLINE published in English between 1966 and August 2015 was performed with the following keywords: doctor-patient relationship, physician-patient relationship, ethics, and Islam. The Muslim doctor should be familiar with the Islamic teachings on the daily issues faced in his/her practice and the relationship with his/her patients.

Reviewing the Review: An Assessment of Dissertation Reviewer Feedback Quality

ERIC Educational Resources Information Center

Lehan, Tara; Hussey, Heather; Mika, Eva

2016-01-01

Throughout the dissertation process, the chair and committee members provide feedback regarding quality to help the doctoral candidate to produce the highest-quality document and become an independent scholar. Nevertheless, results of previous research suggest that overall dissertation quality generally is poor. Because much of the feedback about…

Educating for Service: Black Studies for Premeds.

ERIC Educational Resources Information Center

Henderson, Algo; Gumas, Natalie

Traditional undergraduate liberal arts courses, required of most premedical and predental students, have failed dismally to motivate doctors and dentists to become concerned with the health problems of the poor, be they black or white. Examination of black studies programs leads the authors to believe that these programs, if planned with the…

Gender Contentedness in Aspirations to Become Engineers or Medical Doctors

ERIC Educational Resources Information Center

Koul, Ravinder; Lerdpornkulrat, Thanita; Poondej, Chanut

2017-01-01

Medical doctor and engineer are highly esteemed STEM professions. This study investigates academic and motivational characteristics of a sample of high school students in Thailand who aspire to become medical doctors or engineers. We used logistic regression to compare maths performance, gender typicality, gender contentedness, and maths and…

THE DOCTORATE IN ADULT EDUCATION, 1935-1965.

ERIC Educational Resources Information Center

BUSKEY, JOHN H.; HOULE, CYRIL O.

COMPLETED QUESTIONNAIRES SUBMITTED BY 480 HOLDERS OF AMERICAN ADULT EDUCATION DOCTORATES WERE ANALYZED, PRIMARILY BY KINDS OF WORK PERFORMED AND TYPES OF EMPLOYING INSTITUTIONS. TOTAL DOCTORATES AWARDED BY 30 INSTITUTIONS DURING 1935-65 WERE INDICATED, TOGETHER WITH TOTALS FOR SPECIFIC YEARS. DATA WERE OBTAINED ON (1) AGE DISTRIBUTION OF…

The training and expectations of medical students in Mozambique

PubMed Central

Sousa, Fernando; Schwalbach, João; Adam, Yussuf; Gonçalves, Luzia; Ferrinho, Paulo

2007-01-01

Background This paper describes the socio-economic profile of medical students in the 1998/99 academic year at the Universidade Eduardo Mondlane (UEM) Medical Faculty in Maputo. It aims to identify their social and geographical origins in addition to their expectations and difficulties regarding their education and professional future. Methods The data were collected through a questionnaire administered to all medical students at the faculty. Results Although most medical students were from outside Maputo City and Maputo Province, expectations of getting into medical school were already associated with a migration from the periphery to the capital city, even before entering medical education. This lays the basis for the concentration of physicians in the capital city once their term of compulsory rural employment as junior doctors is completed. The decision to become a doctor was taken at an early age. Close relatives, or family friends seem to have been an especially important variable in encouraging, reinforcing and promoting the desire to be a doctor. The academic performance of medical students was dismal. This seems to be related to several difficulties such as lack of library facilities, inadequate financial support, as well as poor high school preparation. Only one fifth of the students reported receiving financial support from the Mozambican government to subsidize their medical studies. Conclusion Medical students seem to know that they will be needed in the public sector, and that this represents an opportunity to contribute to the public's welfare. Nevertheless, their expectations are, already as medical students, to combine their public sector practice with private medical work in order to improve their earnings. PMID:17445263

[The prevalence of burnout and the related factors among some medical students in Korea].

PubMed

Choi, Jaewon; Son, Shill Lee; Kim, Suh Hee; Kim, Hyunsoo; Hong, Jee-Young; Lee, Moo-Sik

2015-12-01

This study was conducted to examine the relationship between the prevalence of burnout and its related factors in medical students in Korea. All available medical students in the metropolitan city of Daejeon, Korea, were asked to answer self-administered questionnaires from July 1 to July 26 in 2013. A total of 534 medical students participated. The Maslach Burnout Inventory-Student Survey (MBI-SS) and structured questionnaires on related factors were used. Confirmatory factor analysis and Cronbach's α were used to verify the applicability of the MBI-SS to medical students in Korea. We also performed chi-square test and logistic regression analysis to identify the factors that were associated with burnout. The MBI-SS was reliable and valid in measuring burnout in Korean medical students. Our confirmatory factor analysis approved and explained the appropriateness of the model fit. The prevalence of burnout among medical students was 26.4% (n=141). Suchrates were higher in students who were female, experienced greater levels of depression, had poor academic performance, feared dropping out, and were stressed by the poor quality of the class facilities. The MBI-SS is a valid instrument to measure academic burnout in Korean medical students. Further studies should be performed, because improvements in the mental health of medical students will benefit these doctors-to-be and their future patients.

Work-family conflict and burnout among Chinese doctors: the mediating role of psychological capital.

PubMed

Wang, Yang; Liu, Li; Wang, Jiana; Wang, Lie

2012-01-01

The aim of this study was to investigate the relation between work-family conflict and burnout, and the mediating role of psychological capital (PsyCap) in the relation between work-family conflict and burnout, among Chinese doctors. This cross-sectional study was performed during the period of September/October 2010. A questionnaire that comprised work-family conflict assessed by the work-family conflict scale, PsyCap assessed by the PCQ-24 scale and burnout assessed by the Maslach Burnout Inventory-General Survey (MBI-GS), as well as age and gender, was distributed to 1,300 doctors in Liaoning Province, China. A total of 1,011 effective respondents became our final study subjects. Hierarchical linear regression analyses were performed by using SPSS 17.0 to explore the mediating role of PsyCap in the relation between work-family conflict and burnout. Both work interfering family conflict (WIF) and family interfering work conflict (FIW) were positively related with emotional exhaustion and cynicism among both male and females doctors. However, WIF was positively related with professional efficacy only among male doctors, whereas FIW was negatively related with professional efficacy among both male and female doctors. PsyCap partially mediated the relation between WIF and professional efficacy among male doctors and partially mediated the relations of FIW with emotional exhaustion, cynicism and professional efficacy among female doctors. Work-family conflict was associated with burnout among Chinese doctors. PsyCap was a mediator between work-family conflict and burnout. PsyCap might be a positive resource to reduce the negative effect of work-family conflict on burnout of doctors, especially female doctors, in China.

Doctors' opinion on the contribution of coordination mechanisms to improving clinical coordination between primary and outpatient secondary care in the Catalan national health system.

PubMed

Aller, Marta-Beatriz; Vargas, Ingrid; Coderch, Jordi; Vázquez, Maria-Luisa

2017-12-22

Clinical coordination is considered a health policy priority as its absence can lead to poor quality of care and inefficiency. A key challenge is to identify which strategies should be implemented to improve coordination. The aim is to analyse doctors' opinions on the contribution of mechanisms to improving clinical coordination between primary and outpatient secondary care and the factors influencing their use. A qualitative descriptive study in three healthcare networks of the Catalan national health system. A two-stage theoretical sample was designed: in the first stage, networks with different management models were selected; in the second, primary care (n = 26) and secondary care (n = 24) doctors. Data were collected using semi-structured interviews. Final sample size was reached by saturation. A thematic content analysis was conducted, segmented by network and care level. With few differences across networks, doctors identified similar mechanisms contributing to clinical coordination: 1) shared EMR facilitating clinical information transfer and uptake; 2) mechanisms enabling problem-solving communication and agreement on clinical approaches, which varied across networks (joint clinical case conferences, which also promote mutual knowledge and training of primary care doctors; virtual consultations through EMR and email); and 3) referral protocols and use of the telephone facilitating access to secondary care after referrals. Doctors identified organizational (insufficient time, incompatible timetables, design of mechanisms) and professional factors (knowing each other, attitude towards collaboration, concerns over misdiagnosis) that influence the use of mechanisms. Mechanisms that most contribute to clinical coordination are feedback mechanisms, that is those based on mutual adjustment, that allow doctors to exchange information and communicate. Their use might be enhanced by focusing on adequate working conditions, mechanism design and creating conditions that promote mutual knowledge and positive attitudes towards collaboration.

Knowledge and awareness of medical doctors, medical students and nurses about dentistry in Nigeria

PubMed Central

Oyetola, Elijah Olufemi; Oyewole, Taiwo; Adedigba, Micheal; Aregbesola, Stephen Tunde; Umezudike, Kehinde; Adewale, Adedotun

2016-01-01

Introduction Various studies have reported poor awareness and knowledge of dentistry in the Nigerian population. There is, however, paucity of information assessing the knowledge and awareness of medical doctors/students and nurses about dentistry. The present study is aimed at determining the knowledge and awareness of medical doctors/students and nurses about dentistry. Methods Self-administered questionnaires were randomly distributed among medical doctors/students, and nurses of Obafemi Awolowo Teaching Hospitals’ Complex, Ile-Ife, Nigeria. Information collected using the questionnaire included participants’ biodata, questions evaluating dental awareness, knowledge of systemic and oral health connections as well as referral practices. The data analysis was done with STATA version 11 software. Results A total of 300 questionnaires were randomly distributed among doctors/students and nurses, 206 were returned (response rate of 69%). Of the returned questionnaires, 129(63%) were males and 77(37%) were females. There were 42 medical doctors, 49 nurses and 115 medical students. The mean age of the participants was 26.7 years (SD 5.2). Majority (99.5%) was aware of dental profession, but 92% had never referred patients for dental consultation. One third (31%) of medical doctors believed that Ludwig angina was a cardiac disease. A large proportion of the respondents (61%) see no need for routine dental visit while 27% would want to visit the dentist only when they had a dental complaint. Conclusion Although a large percentage of the participants claimed to be aware of dentistry, our findings revealed low level of knowledge and attitude to Dentistry. Efforts should be made towards closing this knowledge gap to achieve efficient oral health. PMID:27303588

Predictors of hospitalised patients' preferences for physician-directed medical decision-making.

PubMed

Chung, Grace S; Lawrence, Ryan E; Curlin, Farr A; Arora, Vineet; Meltzer, David O

2012-02-01

Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions. To examine the associations between a preference for physician-directed decision-making and patient health status and sociodemographic characteristics. Sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center were examined. The primary objectives were to (1) assess the extent to which patients prefer an active role in clinical decision-making, and (2) determine whether religious service attendance, the importance of religion, self-rated spirituality, Charlson Comorbidity Index, self-reported health, Vulnerable Elder Score and several demographic characteristics were associated with these preferences. Data were collected from 8308 of 11,620 possible participants. Ninety-seven per cent of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor. In multiple regression analyses, preferring to leave decisions to the doctor was associated with older age (per year, OR=1.019, 95% CI 1.003 to 1.036) and frequently attending religious services (OR=1.5, 95% CI 1.1 to 2.1, compared with never), and it was inversely associated with female sex (OR=0.6, 95% CI 0.5 to 0.8), university education (OR=0.6, 95% CI 0.4 to 0.9, compared with no high school diploma) and poor health (OR=0.6, 95% CI 0.3 to 0.9). Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small.

Effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medication regimen (EMPATHy): study protocol for a randomized controlled trial.

PubMed

Billimek, John; Guzman, Herlinda; Angulo, Marco A

2015-04-10

Low-income, Mexican-American patients with diabetes exhibit high rates of medication nonadherence, poor blood sugar control and serious complications, and often have difficulty communicating their concerns about the medication regimen to physicians. Interventions led by community health workers, non-professional community members who are trained to work with patients to improve engagement and communication during the medical visit, have had mixed success in improving outcomes. The primary objective of this project is to pilot test a prototype software toolkit called "EMPATHy" that a community health worker can administer to help patients identify the most important barriers to adherence that they face and discuss these barriers with their doctor. The EMPATHy toolkit will be piloted in an ongoing intervention (Coached Care) in which community health workers are trained to be "coaches" to meet with patients before the medical visit and help them prepare a list of important questions for the doctor. A total of 190 Mexican-American patients with poorly controlled type 2 diabetes will be recruited from December 2014 through June 2015 and will be randomly assigned to complete either a single Coached Care intervention visit with no software tools or a Coached Care visit incorporating the EMPATHy software toolkit. The primary endpoints are (1) the development of a "contextualized plan of care" (i.e., a plan of care that addresses a barrier to medication adherence in the patient's daily life) with the doctor, determined from an audio recording of the medical visit, and (2) attainment of a concrete behavioral goal set during the intervention session, assessed in a 2-week follow-up phone call to the patient. The statistical analysis will include logistic regression models and is powered to detect a 50% increase in the primary endpoints. The study will provide evidence regarding the effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medications. ClinicalTrials.gov NCT02324036 Registered 16 December 2014.

Maternity care providers' perceptions of women's autonomy and the law.

PubMed

Kruske, Sue; Young, Kate; Jenkinson, Bec; Catchlove, Ann

2013-04-04

Like all health care consumers, pregnant women have the right to make autonomous decisions about their medical care. However, this right has created confusion for a number of maternity care stakeholders, particularly in situations when a woman's decision may lead to increased risk of harm to the fetus. Little is known about care providers' perceptions of this situation, or of their legal accountability for outcomes experienced in pregnancy and birth. This paper examined maternity care providers' attitudes and beliefs towards women's right to make autonomous decisions during pregnancy and birth, and the legal responsibility of professionals for maternal and fetal outcomes. Attitudes and beliefs around women's autonomy and health professionals' legal accountability were measured in a sample of 336 midwives and doctors from both public and private health sectors in Queensland, Australia, using a questionnaire available online and in paper format. Student's t-test was used to compare midwives' and doctors' responses. Both maternity care professionals demonstrated a poor understanding of their own legal accountability, and the rights of the woman and her fetus. Midwives and doctors believed the final decision should rest with the woman; however, each also believed that the needs of the woman may be overridden for the safety of the fetus. Doctors believed themselves to be ultimately legally accountable for outcomes experienced in pregnancy and birth, despite the legal position that all health care professionals are responsible only for adverse outcomes caused by their own negligent actions. Interprofessional differences were evident, with midwives and doctors significantly differing in their responses on five of the six items. Maternity care professionals inconsistently supported women's right to autonomous decision making during pregnancy and birth. This finding is further complicated by care providers' poor understanding of legal accountability for outcomes experienced in pregnancy and birth. The findings of this study support the need for guidelines on decision making in pregnancy and birth for maternity care professionals, and for recognition of interprofessional differences in beliefs around the rights of the woman, her fetus and health professionals in order to facilitate collaborative practice.

Development of village doctors in China: financial compensation and health system support.

PubMed

Hu, Dan; Zhu, Weiming; Fu, Yaqun; Zhang, Minmin; Zhao, Yang; Hanson, Kara; Martinez-Alvarez, Melisa; Liu, Xiaoyun

2017-07-01

Since 1968, China has trained about 1.5 million barefoot doctors in a few years' time to provide basic health services to 0.8 billion rural population. China's Ministry of Health stopped using the term of barefoot doctor in 1985, and changed policy to develop village doctors. Since then, village doctors have kept on playing an irreplaceable role in China's rural health, even though the number of village doctors has fluctuated over the years and they face serious challenges. United Nations declared Sustainable Development Goals in 2015 to achieve universal health coverage by 2030. Under this context, development of Community Health workers (CHWs) has become an emerging policy priority in many resource-poor developing countries. China's experiences and lessons learnt in developing and maintaining village doctors may be useful for these developing countries. This paper aims to synthesis lessons learnt from the Chinese CHW experiences. It summarizes China's experiences in exploring and using strategic partnership between the community and the formal health system to develop CHWs in the two stages, the barefoot doctor stage (1968 -1985) and the village doctor stage (1985-now). Chinese and English literature were searched from PubMed, CNKI and Wanfang. The information extracted from the selected articles were synthesized according to the four partnership strategies for communities and health system to support CHW development, namely 1) joint ownership and design of CHW programmes; 2) collaborative supervision and constructive feedback; 3) a balanced package of incentives, both financial and non-financial; and 4) a practical monitoring system incorporating data from the health system and community. The study found that the townships and villages provided an institutional basis for barefoot doctor policy, while the formal health system, including urban hospitals, county health schools, township health centers, and mobile medical teams provided training to the barefoot doctors. But After 1985, the formal health system played a more dominant role in the CHW system including both selection and training of village doctors. China applied various mechanisms to compensate village doctors in different stages. During 1960s and 1970s, the main income source of barefoot doctors was from their villages' collective economy. After 1985 when the rural collective economy collapsed and barefoot doctors were transformed to village doctors, they depended on user fees, especially from drug sale revenues. In the new century, especially after the new round of health system reform in 2009, government subsidy has become an increasing source of village doctors' income. The barefoot doctor policy has played a significant role in providing basic human resources for health and basic health services to rural populations when rural area had great shortages of health resources. The key experiences for this great achievement are the intersection between the community and the formal health system, and sustained and stable financial compensation to the community health workers.

Original Knowledge, Gender and the Word's Mythology: Voicing the Doctorate

ERIC Educational Resources Information Center

Carter, Susan

2012-01-01

Using mythology as a generative matrix, this article investigates the relationship between knowledge, words, embodiment and gender as they play out in academic writing's voice and, in particular, in doctoral voice. The doctoral thesis is defensive, a performance seeking admittance into discipline scholarship. Yet in finding its scholarly voice,…

Hidden Rules, Secret Agendas: Challenges Facing Contemporary Women Doctoral Students.

ERIC Educational Resources Information Center

Smith, Bobbi

Studies indicate that, although enrollment and degree production by women doctoral students have increased, fewer women than men complete doctorates and women generally take longer than men to finish, in spite of the fact that women demonstrate equal if not superior performance levels on virtually every objective measure. Women who complete the…

Learning Networks and the Journey of "Becoming Doctor"

ERIC Educational Resources Information Center

Barnacle, Robyn; Mewburn, Inger

2010-01-01

Scholars such as Kamler and Thompson argue that identity formation has a key role to play in doctoral learning, particularly the process of thesis writing. This article builds on these insights to address other sites in which scholarly identity is performed within doctoral candidature. Drawing on actor-network theory, the authors examine the role…

The intellectual challenges and emotional consequences of equipoise contributed to the fragility of recruitment in six randomized controlled trials.

PubMed

Donovan, Jenny L; de Salis, Isabel; Toerien, Merran; Paramasivan, Sangeetha; Hamdy, Freddie C; Blazeby, Jane M

2014-08-01

The aim of the study was to investigate how doctors considered and experienced the concept of equipoise while recruiting patients to randomized controlled trials (RCTs). In-depth interviews with 32 doctors in six publicly funded pragmatic RCTs explored their perceptions of equipoise as they undertook RCT recruitment. The RCTs varied in size, duration, type of complex intervention, and clinical specialties. Interview data were analyzed using qualitative content and thematic analytical methods derived from grounded theory and synthesized across six RCTs. All six RCTs suffered from poor recruitment. Doctors wanted to gather robust evidence but experienced considerable discomfort and emotion in relation to their clinical instincts and concerns about patient eligibility and safety. Although they relied on a sense of community equipoise to justify participation, most acknowledged having "hunches" about particular treatments and patients, some of which undermined recruitment. Surgeons experienced these issues most intensely. Training and support promoted greater confidence in equipoise and improved engagement and recruitment. Recruitment to RCTs is a fragile process and difficult for doctors intellectually and emotionally. Training and support can enable most doctors to become comfortable with key RCT concepts including equipoise, uncertainty, patient eligibility, and randomization, promoting a more resilient recruitment process in partnership with patients. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Easing the transition from student to doctor: how can medical schools help prepare their graduates for starting work?

PubMed

Cave, Judith; Woolf, Katharine; Jones, Alison; Dacre, Jane

2009-05-01

In 2000/1, a survey found that 42% of newly qualified UK doctors felt their medical training had not prepared them well for starting work. To determine factors associated with preparedness. A questionnaire to all 5143 newly qualified doctors in May 2005. The response rate was 2062/4784 = 43.1%. 15% of respondents felt poorly prepared by medical school for starting work. There were no associations between gender or graduate entry status and preparedness. The personality traits of conscientiousness (r=0.14; p < 0.001) and extraversion (r=0.15; p < 0.001) were associated with high preparedness. Neuroticism was associated with low preparedness (r= -0.16; p < 0.001).Respondents who had done shadowing attachments were more likely to feel prepared (58.6% vs 48.5% felt prepared; 2=4.0; p=0.05), as were graduates of problem based learning courses (61.3% vs 56.1%; 2=5.0; p=0.03). Preparedness correlated with agreement with the statements 'My teaching was relevant to real life as a doctor' (rho=0.36; p < 0.001), and 'As a house officer I found it easy to get help when I needed it' (rho=0.29; p < 0.001). Improvements in the preparedness of UK medical school graduates may be due to increased relevance of undergraduate teaching to life as a junior doctor and increased support in the workplace.

A critical incident study of general practice trainees in their basic general practice term.

PubMed

Diamond, M R; Kamien, M; Sim, M G; Davis, J

1995-03-20

To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Meeting and treating cultural difference in primary care: a qualitative interview study.

PubMed

Wachtler, Caroline; Brorsson, Annika; Troein, Margareta

2006-02-01

Primary care doctors see patients from diverse cultural backgrounds and communication plays an important role in diagnosis and treatment. Communication problems can arise when patient and doctor do not share the same cultural background. The aim of this study was to examine how consultations with immigrant patients are understood by GPs and how GPs manage these consultations. Semi-structured interviews with GPs about their experiences with immigrant patients were recorded on audio-tape, transcribed and analysed using a qualitative thematic analysis methodology. A constructivist approach was taken to analysis and interpretation. Culture is not in focus when GPs meet immigrant patients. The consultation is seen as a meeting between individuals, where cultural difference is just one of many individual factors that influence how well doctor and patient understand each other. However, when mutual understanding is poor and the consultation not successful, cultural differences are central. The GPs try to conduct their consultations with immigrant patients in the same way that they conduct all their consultations. There is no specific focus on culture, instead, GPs tend to avoid addressing even pronounced cultural differences. This study indicates that cultural difference is not treated in GPs consultation with immigrant patients. Learning about cultural difference's effect on mutual understanding between doctor and patient could improve GPs cross-cultural communication. Increased awareness of the culture the doctor brings to the consultation could facilitate management of cross-cultural consultations.

Updating on Italian stroke units: the "CCM study".

PubMed

Guidetti, D; Spallazzi, M; Toni, D; Rota, E; Morelli, N; Immovilli, P; Baldereschi, M; Polizzi, B M; Ferro, S; Inzitari, D

2013-07-01

The stroke units (SUs) have been demonstrated to be efficient and cost effective for acute stroke care. Nevertheless, the level of stroke unit implementation in Italy does not correspond to expectations yet. This study is a survey, which aims at assessing the current status of in-hospital stroke care in the Italian regions and at updating SUs. The survey was conducted by means of a semi-structured questionnaire, based on 18 stroke care "quality indicators", submitted to all the Italian centres that had taken part in the SITS-MOST study, and to other centres advised by the coordinator of SITS studies and by regional opinion leaders of stroke. SUs were defined as acute wards, with stroke-dedicated beds and dedicated teams that had been formally authorised to administer rt-PA. A statistical analysis was performed by a descriptive statistics and logistic regression model. The study was carried out from November 2009 to September 2010. A total of 168 forms were sent out and 153 replies received. Seven centres, which had not performed any thrombolytic treatment, and 16 which did not fulfil the criteria for the definition of SU were excluded from the study. Most of the centres reported more than 100 stroke patient admissions per year, i.e., 122 (84%) from 100 to 500, 18 (12%) more than 500. The 19% of the centres admitted more than 30% of patients within 3 h from the symptom onset and only 30% admitted more than 30% of patients within 4.5 h. The mean number of thrombolyses performed in the last 6 months was 10 for centres with a doctor on duty 24 h a day, 6 for those that have a doctor on duty from 8 a.m. to 8 p.m. and a doctor on call for night, and 5 for centres with a doctor on call 24 h a day. The territorial distribution of the SUs is remarkably heterogeneous: 87 SUs (67%) are located in the North of Italy, 28 (22%) in the central part of Italy and only 15 (11%) in the South. The last few years have witnessed a rise in both the diffusion of SUs and access to thrombolytic therapy in Italy. Despite this, there are a few large areas, mostly in the south, where the requirements of healthcare legislation are not met, and access to a dedicated SU and thrombolytic treatment is still limited and poor.

Time to audit.

PubMed

Smyth, L G; Martin, Z; Hall, B; Collins, D; Mealy, K

2012-09-01

Public and political pressures are increasing on doctors and in particular surgeons to demonstrate competence assurance. While surgical audit is an integral part of surgical practice, its implementation and delivery at a national level in Ireland is poorly developed. Limits to successful audit systems relate to lack of funding and administrative support. In Wexford General Hospital, we have a comprehensive audit system which is based on the Lothian Surgical Audit system. We wished to analyse the amount of time required by the Consultant, NCHDs and clerical staff on one surgical team to run a successful audit system. Data were collected over a calendar month. This included time spent coding and typing endoscopy procedures, coding and typing operative procedures, and typing and signing discharge letters. The total amount of time spent to run the audit system for one Consultant surgeon for one calendar month was 5,168 min or 86.1 h. Greater than 50% of this time related to work performed by administrative staff. Only the intern and administrative staff spent more than 5% of their working week attending to work related to the audit. An integrated comprehensive audit system requires a very little time input by Consultant surgeons. Greater than 90% of the workload in running the audit was performed by the junior house doctors and administrative staff. The main financial implications for national audit implementation would relate to software and administrative staff recruitment. Implementation of the European Working Time Directive in Ireland may limit the time available for NCHD's to participate in clinical audit.

Views of oncology patients, their relatives and oncologists on cardiopulmonary resuscitation (CPR): questionnaire-based study.

PubMed

Ackroyd, Rajeena; Russon, Lynne; Newell, Rob

2007-03-01

Doctors are justified withholding a treatment, such as cardiopulmonary resuscitation (CPR), if it is unlikely to benefit a patient. The success rates for CPR in patients with cancer is <1%. Guidelines produced in 2001 recommended that CPR should be discussed with patients, even when it is unlikely to be successful. Therefore, should oncologists always discuss resuscitation, even when it is likely to be futile? Sixty oncology in-patients and 32 of their relatives were asked their views on CPR, and their views were compared with the oncologist involved in their care. Some 58% of patients wanted to be resuscitated. There was a moderate-strong correlation between patients and their next of kin and the desire for resuscitation. There was also a positive correlation between the doctor's views on suitability for resuscitation, patient's prognostic score, and World Health Organisation (WHO) performance score. Most patients wanted to be resuscitated despite being given the likely poor survival rates from CPR. They also wanted to be involved in the decision-making process, and wanted their next of kin involved, even when, medically, the procedure was unlikely to be successful. The findings that patient and next of kin views correlated well shows that relatives' views are a good representation of patient views. In contrast, consultant's decisions were strongly correlated with the patient's performance status and clinical state. No patients were upset by the study, although nine patients declined to participate.

Safe Handover : Safe Patients - The Electronic Handover System.

PubMed

Till, Alex; Sall, Hanish; Wilkinson, Jonathan

2014-01-01

Failure of effective handover is a major preventable cause of patient harm. We aimed to promote accurate recording of high-quality clinical information using an Electronic Handover System (EHS) that would contribute to a sustainable improvement in effective patient care and safety. Within our hospital the human factors associated with poor communication were compromising patient care and unnecessarily increasing the workload of staff due to the poor quality of handovers. Only half of handovers were understood by the doctors expected to complete them, and more than half of our medical staff felt it posed a risk to patient safety. We created a standardised proforma for handovers that contained specific sub-headings, re-classified patient risk assessments, and aided escalation of care by adding prompts for verbal handover. Sources of miscommunication were removed, accountability for handovers provided, and tasks were re-organised to reduce the workload of staff. Long-term, three-month data showed that each sub-heading achieved at least 80% compliance (an average improvement of approximately 40% for the overall quality of handovers). This translated into 91% of handovers being subjectively clear to junior doctors. 87% of medical staff felt we had reduced a risk to patient safety and 80% felt it increased continuity of care. Without guidance, doctors omit key information required for effective handover. All organisations should consider implementing an electronic handover system as a viable, sustainable and safe solution to handover of care that allows patient safety to remain at the heart of the NHS.

Safe Handover : Safe Patients – The Electronic Handover System

PubMed Central

Till, Alex; Sall, Hanish; Wilkinson, Jonathan

2014-01-01

Failure of effective handover is a major preventable cause of patient harm. We aimed to promote accurate recording of high-quality clinical information using an Electronic Handover System (EHS) that would contribute to a sustainable improvement in effective patient care and safety. Within our hospital the human factors associated with poor communication were compromising patient care and unnecessarily increasing the workload of staff due to the poor quality of handovers. Only half of handovers were understood by the doctors expected to complete them, and more than half of our medical staff felt it posed a risk to patient safety. We created a standardised proforma for handovers that contained specific sub-headings, re-classified patient risk assessments, and aided escalation of care by adding prompts for verbal handover. Sources of miscommunication were removed, accountability for handovers provided, and tasks were re-organised to reduce the workload of staff. Long-term, three-month data showed that each sub-heading achieved at least 80% compliance (an average improvement of approximately 40% for the overall quality of handovers). This translated into 91% of handovers being subjectively clear to junior doctors. 87% of medical staff felt we had reduced a risk to patient safety and 80% felt it increased continuity of care. Without guidance, doctors omit key information required for effective handover. All organisations should consider implementing an electronic handover system as a viable, sustainable and safe solution to handover of care that allows patient safety to remain at the heart of the NHS. PMID:26734244

Occupational stress among staff nurses: Controlling the risk to health

PubMed Central

Sharma, Parul; Davey, Anuradha; Davey, Sanjeev; Shukla, Arvind; Shrivastava, Kajal; Bansal, Rahul

2014-01-01

Introduction: Nursing has been identified as an occupation that has high levels of stress. Job stress brought about hazardous impacts not only on nurses’ health but also on their abilities to cope with job demands. Objectives: This study aimed at finding out the degree of work-related stress among the staff nurses and various determinants, which have a impact on it. Materials and Methods: Institutional-based cross-sectional study conducted on GNM qualified nurses. Predesigned and pre-tested questionnaire covering their sociodemographic variables in part I and professional life stress scale by David Fontana in part II. Analysis used was Chi-square test and logistic regression for various factors. Results: Risk for professional stress due to poor and satisfactory doctor's attitude was found about 3 and 4 times more than with excellent attitude of doctors toward the staff nurses. A statistically significant association (P < 0.024) between department of posting and level of stress. Nurses reported that they had no time for rest, of whom 42% were suffering from moderate-to-severe stress. The nurses who felt that the job was not tiring were found to be less stressed as those who perceived job as tiring (OR = 0.43). Conclusion: The main nurses’ occupational stressors were poor doctor's attitude, posting in busy departments (emergency/ICU), inadequate pay, too much work, and so on. Thus, hospital managers should initiate strategies to reduce the amount of occupational stress and should provide more support to the nurses to deal with the stress. PMID:25568598

Evaluation of knowledge, practices, and possible barriers among healthcare providers regarding medical waste management in Dhaka, Bangladesh.

PubMed

Sarker, Mohammad Abul Bashar; Harun-Or-Rashid, Md; Hirosawa, Tomoya; Abdul Hai, Md Shaheen Bin; Siddique, Md Ruhul Furkan; Sakamoto, Junichi; Hamajima, Nobuyuki

2014-12-09

Improper handling of medical wastes, which is common in Bangladesh, could adversely affect the hospital environment and community at large, and poses a serious threat to public health. We aimed to assess the knowledge and practices regarding medical waste management (MWM) among healthcare providers (HCPs) and to identify possible barriers related to it. A cross-sectional study was carried out during June to September, 2012 including 1 tertiary, 3 secondary, and 3 primary level hospitals in Dhaka division, Bangladesh through 2-stage cluster sampling. Data were collected from 625 HCPs, including 245 medical doctors, 220 nurses, 44 technologists, and 116 cleaning staff who were directly involved in MWM using a self-administered (researcher-administered for cleaning staff), semi-structured questionnaire. Nearly one-third of medical doctors and nurses and two-thirds of technologists and cleaning staff had inadequate knowledge, and about half of medical doctors (44.0%) and cleaning staff (56.0%) had poor practices. HCPs without prior training on MWM were more likely to have poor practices compared to those who had training. Lack of personal protective equipment, equipment for final disposal, MWM-related staff, proper policy/guideline, and lack of incinerator were identified as the top 5 barriers. Strengthening and expansion of ongoing educational programs/training is necessary to improve knowledge and practices regarding MWM. The government should take necessary steps and provide financial support to eliminate the possible barriers related to proper MWM.

Revisiting current “barefoot doctors” in border areas of China: system of services, financial issue and clinical practice prior to introducing integrated management of childhood illness (IMCI)

PubMed Central

2012-01-01

Background Under-5-years child mortality remains high in rural China. Integrated management of childhood illness (IMCI) was introduced to China in 1998, but only a few rural areas have been included. This study aimed at assessing the current situation of the health system of rural health care and evaluating the clinical competency of village doctors in management of childhood illnesses prior to implementing IMCI programme in remote border rural areas. Methods The study was carried out in the border areas of Puer prefecture of Yunnan province. There were 182 village doctors in the list of the health bureau in these border areas. Of these, 154 (84.6%) were recruited into the study. The local health system components were investigated using a qualitative approach and analyzed with triangulation of information from different sources. The clinical component was assessed objectively and quantitatively presented using descriptive statistics. Results The study found that the New Rural Cooperative Medical Scheme (NRCMS) coordinated the health insurance system and the provider service through 3 tiers: village doctor, township and county hospitals. The 30 RMB per person per year premium did not cover the referral cost, and thereby decreased the number of referrals. In contrast to available treatment facilities and drug supply, the level of basic medical education of village doctors and township doctors was low. Discontent among village doctors was common, especially concerning low rates of return from the service, exceptions being procedures such as injections, which in fact may create moral hazards to the patients. Direct observation on the assessment and management of paediatric patients by village doctors revealed inadequate history taking and physical examination, inability to detect potentially serious complications, overprescription of injection and antibiotics, and underprescription of oral rehydration salts and poor quality of counseling. Conclusion There is a need to improve health finance and clinical competency of the village doctors in the study area. PMID:22871045

Doctors' experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data

PubMed Central

Bourne, Tom; Vanderhaegen, Joke; Vranken, Renilt; Wynants, Laure; De Cock, Bavo; Peters, Mike; Timmerman, Dirk; Van Calster, Ben; Jalmbrant, Maria; Van Audenhove, Chantal

2016-01-01

Objectives To examine doctors' experiences of complaints, including which aspects are most stressful. We also investigated how doctors felt complaints processes could be improved. Design and methods A qualitative study based on a cross-sectional survey of members of the British Medical Association (BMA). We asked the following: (1) Try to summarise as best as you can your experience of the complaints process and how it made you feel. (2) What were the most stressful aspects of the complaint? (3) What would you improve in the complaints system? Participants We sent the survey to 95 636 doctors, and received 10 930 (11.4%) responses. Of these, 6146 had a previous, recent or current complaint and 3417 (31.3%) of these respondents answered questions 1 and 2. We randomly selected 1000 answers for analysis, and included 100 using the saturation principle. Of this cohort, 93 responses for question 3 were available. Main results Doctors frequently reported feeling powerless, emotionally distressed, and experiencing negative feelings towards both those managing complaints and the complainants themselves. Many felt unsupported, fearful of the consequences and that the complaint was unfair. The most stressful aspects were the prolonged duration and unpredictability of procedures, managerial incompetence, poor communication and perceiving that processes are biased in favour of complainants. Many reported practising defensively or considering changing career after a complaint, and few found any positive outcomes from complaints investigations. Physicians suggested procedures should be more transparent, competently managed, time limited, and that there should be an open dialogue with complainants and policies for dealing with vexatious complaints. Some felt more support for doctors was needed. Conclusions Complaints seriously impact on doctors' psychological wellbeing, and are associated with defensive practise. This is not beneficial to patient care. To improve procedures, doctors propose they are simplified, time limited and more transparent. PMID:27377638

The prices people pay for medicines in Zimbabwe.

PubMed

Gavaza, P; Simoyi, T; Makunike, B; Maponga, C C

2009-01-01

To collect, analyse and compare prices of medicines in different sectors and parts of the country and to compare them with the medicine prices in other countries. A prospective cross sectional study. Pharmacy outlets in Zimbabwe comprising 27 retail pharmacies, 23 dispensing doctors, eight public hospital pharmacies and seven municipal clinics. Median price ratios, 25th percentiles and 75th percentiles. Innovator brands in the private sector were priced 10 times the International References Prices (IRP) and more than three times the price of generic medicines. Dispensing doctors were charging the highest prices for medicines and the public sector had the least prices. The national procurement agency, NatPharm, procured medicines at prices slightly below the Management Sciences for Health (MSH) prices. Prices of medicines in the public sector were higher than average prices for medicines from seven other African countries. Medicine prices in Zimbabwe are high, a scenario that may compromise affordability and accessibility to medicines especially by the poor. Urgent steps are needed to reduce the level and effect of the high prices on the population, especially the poor.

Collusion in doctor-patient communication about imminent death: an ethnographic study

PubMed Central

The, Anne-Mei; Hak, Tony; Koëter, Gerard; van der Wal, Gerrit

2000-01-01

Objective To discover and explore the factors that result in “false optimism about recovery” observed in patients with small cell lung cancer. Design A qualitative observational (ethnographic) study in two stages over four years. Setting Lung diseases ward and outpatient clinic in university hospital in the Netherlands. Participants 35 patients with small cell lung cancer. Results “False optimism about recovery” usually developed during the (first) course of chemotherapy and was most prevalent when the cancer could no longer be seen in the x ray pictures. This optimism tended to vanish when the tumour recurred, but it could develop again, though to a lesser extent, during further courses of chemotherapy. Patients gradually found out the facts about their poor prognosis, partly because of physical deterioration and partly through contact with fellow patients who were in a more advanced stage of the illness and were dying. “False optimism about recovery” was the result an association between doctors' activism and patients' adherence to the treatment calendar and to the “recovery plot,” which allowed them not to acknowledge explicitly what they should and could know. The doctor did and did not want to pronounce a “death sentence” and the patient did and did not want to hear it. Conclusion Solutions to the problem of collusion between doctor and patient require an active, patient oriented approach from the doctor. Perhaps solutions have to be found outside the doctor-patient relationship itself   —   for example, by involving “treatment brokers.” PMID:11099281

Improving the working relationship between doctors and pharmacists: is inter-professional education the answer?

PubMed

Gallagher, Ruth M; Gallagher, Helen C

2012-05-01

Despite their common history, there are many cultural, attitudinal and practical differences between the professions of medicine and pharmacy that ultimately influence patient care and health outcomes. While poor communication between doctors and pharmacists is a major cause of medical errors, it is clear that effective, deliberate doctor-pharmacist collaboration within certain clinical settings significantly improves patient care. This may be particularly true for those patients with chronic illnesses and/or requiring regular medication reviews. Moreover, in hospitals, clinical and antibiotic pharmacists are successfully influencing prescribing and infection control policy. Under the new Irish Pharmacy Act (2007), pharmacists are legally obliged to provide pharmaceutical care to their patients, thus fulfilling a more patient-centred role than their traditional 'dispensing' one. However, meeting this obligation relies on the existence of good doctor-pharmacist working relationships, such that inter-disciplinary teamwork in monitoring patients becomes the norm in all healthcare settings. As discussed here, efforts to improve these relationships must focus on the strategic introduction of agreed changes in working practices between the two professions and on educational aspects of pharmaceutical care. For example, standardized education of doctors/medical students such that they learn to prescribe in an optimal manner and ongoing inter-professional education of doctors and pharmacists in therapeutics, are likely to be of paramount importance. Here, insights into the types of factors that help or hinder the improvement of these working relationships and the importance of education and agreed working practices in defining the separate but inter-dependent professions of pharmacy and medicine are reviewed and discussed.

Changes in the lifetime prevalence of suicidal feelings and thoughts among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples

PubMed Central

2013-01-01

Background Thinking about suicide is an indicator of suicide risk. Suicide rates are higher among doctors than in the population. The main aims of this study are to describe the changes in the lifetime prevalence of suicidal feelings from 2000 to 2010 and the possible predictors of serious suicidal thoughts in 2010 among Norwegian doctors. Differences in lifetime prevalence of suicidal feelings between Norwegian doctors in 2010 and German doctors in 2006 will be also described. Methods Longitudinal and cross-sectional study based on questionnaire data from 2000 and 2010, including approximately 1,600 Norwegian doctors. In Germany, cross-sectional study based on questionnaire data from 2006 among a sample of 3,295 doctors. The main outcome measures were the lifetime prevalence of suicidal feelings (felt life was not worth living, wished own death, had thoughts of taking own life). Results The prevalences in 2000 and 2010 of ever had feelings of life not worth living were 48 (44 to 52) % and 45 (41 to 49) %, of ever wished own death 27 (23 to 30) % and 23 (20 to 26) %, and of ever had thoughts of taking own life 29 (16 to 33) % and 24 (21 to 27) %. Paired t-tests among those who responded both in 2000 and 2010 show significant reductions for felt life not worth living (t = −3.4; p = 0.001), wished own death (t = −3.1; p = 0.002) and had thoughts of taking own life (t = −3.5; p < 0.0001). In 2010, significant predictors of serious suicidal thoughts in a multivariate model were low subjective well-being (OR 0.68; 95% CI 0.52-0.90), poor or average self-rated health (2.36; 1.25-4.45) and high psychosocial work stress (1.92; 1.06-3.46), controlled for age, gender, speciality and job satisfaction. Norwegian doctors in 2010 compared with their German counterparts in 2006 reported quite similar prevalences of suicidal feelings. Conclusions Suicidal feelings among Norwegian doctors decreased from 2000 to 2010. Individual and work-related factors may to certain explain these findings. Compared with other professionals in Norway and doctors in Germany, Norwegian doctors showed no higher risk of suicidal thoughts. PMID:24286517

Changes in the lifetime prevalence of suicidal feelings and thoughts among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples.

PubMed

Rosta, Judith; Aasland, Olaf G

2013-11-28

Thinking about suicide is an indicator of suicide risk. Suicide rates are higher among doctors than in the population. The main aims of this study are to describe the changes in the lifetime prevalence of suicidal feelings from 2000 to 2010 and the possible predictors of serious suicidal thoughts in 2010 among Norwegian doctors. Differences in lifetime prevalence of suicidal feelings between Norwegian doctors in 2010 and German doctors in 2006 will be also described. Longitudinal and cross-sectional study based on questionnaire data from 2000 and 2010, including approximately 1,600 Norwegian doctors. In Germany, cross-sectional study based on questionnaire data from 2006 among a sample of 3,295 doctors. The main outcome measures were the lifetime prevalence of suicidal feelings (felt life was not worth living, wished own death, had thoughts of taking own life). The prevalences in 2000 and 2010 of ever had feelings of life not worth living were 48 (44 to 52) % and 45 (41 to 49) %, of ever wished own death 27 (23 to 30) % and 23 (20 to 26) %, and of ever had thoughts of taking own life 29 (16 to 33) % and 24 (21 to 27) %. Paired t-tests among those who responded both in 2000 and 2010 show significant reductions for felt life not worth living (t = -3.4; p = 0.001), wished own death (t = -3.1; p = 0.002) and had thoughts of taking own life (t = -3.5; p < 0.0001). In 2010, significant predictors of serious suicidal thoughts in a multivariate model were low subjective well-being (OR 0.68; 95% CI 0.52-0.90), poor or average self-rated health (2.36; 1.25-4.45) and high psychosocial work stress (1.92; 1.06-3.46), controlled for age, gender, speciality and job satisfaction. Norwegian doctors in 2010 compared with their German counterparts in 2006 reported quite similar prevalences of suicidal feelings. Suicidal feelings among Norwegian doctors decreased from 2000 to 2010. Individual and work-related factors may to certain explain these findings. Compared with other professionals in Norway and doctors in Germany, Norwegian doctors showed no higher risk of suicidal thoughts.

Does a competitive voucher program for adolescents improve the quality of reproductive health care? A simulated patient study in Nicaragua.

PubMed

Meuwissen, Liesbeth E; Gorter, Anna C; Kester, Arnold D M; Knottnerus, J Andre

2006-08-07

Little is known about how sexual and reproductive (SRH) health can be made accessible and appropriate to adolescents. This study evaluates the impact and sustainability of a competitive voucher program on the quality of SRH care for poor and underserved female adolescents and the usefulness of the simulated patient (SP) method for such evaluation. 28,711 vouchers were distributed to adolescents in disadvantaged areas of Managua that gave free-of-charge access to SRH care in 4 public, 10 non-governmental and 5 private clinics. Providers received training and guidelines, treatment protocols, and financial incentives for each adolescent attended. All clinics were visited by female adolescent SPs requesting contraception. SPs were sent one week before, during (with voucher) and one month after the intervention. After each consultation they were interviewed with a standardized questionnaire. Twenty-one criteria were scored and grouped into four categories. Clinics' scores were compared using non-parametric statistical methods (paired design: before-during and before-after). Also the influence of doctors' characteristics was tested using non-parametric statistical methods. Some aspects of service quality improved during the voucher program. Before the program started 8 of the 16 SPs returned 'empty handed', although all were eligible contraceptive users. During the program 16/17 left with a contraceptive method (p = 0.01). Furthermore, more SPs were involved in the contraceptive method choice (13/17 vs.5/16, p = 0.02). Shared decision-making on contraceptive method as well as condom promotion had significantly increased after the program ended. Female doctors had best scores before- during and after the intervention. The improvements were more pronounced among male doctors and doctors older than 40, though these improvements did not sustain after the program ended. This study illustrates provider-related obstacles adolescents often face when requesting contraception. The care provided during the voucher program improved for some important outcomes. The improvements were more pronounced among providers with the weakest initial performance. Shared decision-making and condom promotion were improvements that sustained after the program ended. The SP method is suitable and relatively easy to apply in monitoring clinics' performance, yielding important and relevant information. Objective assessment of change through the SP method is much more complex and expensive.

[Nursing Workforce Characteristics and Control of Diabetes Mellitus in Primary Care: a Multilevel Analysis].

PubMed

Parro Moreno, Ana; Santiago Pérez, M Isolina; Abraira Santos, Victor; Aréjula Torres, José Luis Aréjula Torres; Díaz Holgado, Antonio; Gandarillas Grande, Ana; Morales Asencio, José Miguel; Serrano Gallardo, Pilar

2016-03-04

Nurse activity is determined by the characteristics of nursing staff. The objective was to determine the impact of Primary Health Care (PHC) nursing workforce characteristics on the control of Diabetes Mellitus (DM) in adults. Cross-sectional analytical study. Administrative and clinical registries and questionnaire PES-Nursing Work Index from PHC nurses. Participants 44.214 diabetic patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with higher socioeconomic situation and South-West Zone (SWZ) with lower socioeconomic situation, and their 507 reference nurses. Analyses were performed to multivariate multilevel logistic regression models. Poor DM control (figures equal or higher than 7% HbA1c). The prevalence of poor DM control was 40.1% [CI95%: 38.2-42.1]. There was a risk of 25% more of poor control if the patient changed centre and of 27% if changed of doctor-nurse pair. In the multilevel multivariate regression models: in SWZ increasing the ratio of patients over 65 years per nurse increased the poor control (OR=1.00008 [CI95%:1.00006-1.001]); and higher proportion of patients whose Hb1Ac was not measured at the centre contributed to poor DM control (OR=5.1 [CI95%:1.6-15.6]). In two models for health zone, the economic immigration condition increased poor control, in SWZ (OR=1.3 [CI95%:1.03-1.7]); and in NWZ (OR=1.29 [CI95%:1.03-1.6]). Higher 65 years old patients ratio per nurse, economic immigration condition and a higher proportion of patients whose Hb1Ac was not measured contribute to worse DM control.

Doctors' trustworthiness, practice orientation, performance and patient satisfaction.

PubMed

Van Den Assem, Barend; Dulewicz, Victor

2015-01-01

The purpose of this paper is to provide a greater understanding of the general practitioner (GP)-patient relationship for academics and practitioners. A new model for dyadic professional relationships specifically designed for research into the doctor-patient relationship was developed and tested. Various conceptual models of trust and related constructs in the literature were considered and assessed for their relevance as were various related scales. The model was designed and tested using purposefully designed scales measuring doctors' trustworthiness, practice orientation performance and patient satisfaction. A quantitative survey used closed-ended questions and 372 patients responded from seven GP practices. The sample closely reflected the profile of the patients who responded to the DoH/NHS GP Patient Survey for England, 2010. Hierarchical regression and partial least squares both accounted for 74 per cent of the variance in "overall patient satisfaction", the dependent variable. Trust accounted for 39 per cent of the variance explained, with the other independent variables accounting for the other 35 per cent. ANOVA showed good model fit. The findings on the factors which affect patient satisfaction and the doctor-patient relationship have direct implications for GPs and other health professionals. They are of particular relevance at a time of health reform and change. The paper provides: a new model of the doctor-patient relationship and specifically designed scales to test it; a greater understanding of the effects of doctors' trustworthiness, practice orientation and performance on patient satisfaction; and a new framework for examining the breadth and meaning of the doctor-patient relationship and the management of care from the patient's viewpoint.

Intervening in the local health system to improve diabetes care: lessons from a health service experiment in a poor urban neighborhood in India.

PubMed

Bhojani, Upendra; Kolsteren, Patrick; Criel, Bart; De Henauw, Stefaan; Beerenahally, Thriveni S; Verstraeten, Roos; Devadasan, Narayanan

2015-01-01

Many efficacious health service interventions to improve diabetes care are known. However, there is little evidence on whether such interventions are effective while delivered in real-world resource-constrained settings. To evaluate an intervention aimed at improving diabetes care using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. A quasi-experimental study was conducted in a poor urban neighborhood in South India. Four health facilities delivered the intervention (n=163 diabetes patients) and the four matched facilities served as control (n=154). The intervention included provision of culturally appropriate education to diabetes patients, use of generic medications, and standard treatment guidelines for diabetes management. Patients were surveyed before and after the 6-month intervention period. We did field observations and interviews with the doctors at the intervention facilities. Quantitative data were used to assess the reach of the intervention and its effectiveness on patients' knowledge, practice, healthcare expenditure, and glycemic control through a difference-in-differences analysis. Qualitative data were analyzed thematically to understand adoption, implementation, and maintenance of the intervention. Reach: Of those who visited intervention facilities, 52.3% were exposed to the education component and only 7.2% were prescribed generic medications. The doctors rarely used the standard treatment guidelines for diabetes management. The intervention did not have a statistically and clinically significant impact on the knowledge, healthcare expenditure, or glycemic control of the patients, with marginal reduction in their practice score. Adoption: All the facilities adopted the education component, while all but one facility adopted the prescription of generic medications. There was poor implementation of the intervention, particularly with regard to the use of generic medications and the standard treatment guidelines. Doctors' concerns about the efficacy, quality, availability, and acceptability by patients of generic medications explained limited prescriptions of generic medications. The patients' perception that ailments should be treated through medications limited the use of non-medical management by the doctors in early stages of diabetes. The other reason for the limited use of the standard treatment guidelines was that these doctors mainly provided follow-up care to patients who were previously put on a given treatment plan by specialists. Maintenance: The intervention facilities continued using posters and television monitors for health education after the intervention period. The use of generic medications and standard treatment guidelines for diabetes management remained very limited. Implementing efficacious health service intervention in a real-world resource-constrained setting is challenging and may not prove effective in improving patient outcomes. Interventions need to consider patients' and healthcare providers' experiences and perceptions and how macro-level policies translate into practice within local health systems.

An empirical analysis of public and private medical practice in Australia.

PubMed

Cheng, Terence C; Joyce, Catherine M; Scott, Anthony

2013-06-01

The combination of public and private medical practice is widespread in many health systems and has important consequences for health care cost and quality. However, its forms and prevalence vary widely and are poorly understood. This paper examines factors associated with public and private sector work by medical specialists using a nationally representative sample of Australian doctors. We find considerable variations in the practice patterns, remuneration contracts and professional arrangements across doctors in different work sectors. Both specialists in mixed practice and private practice differ from public sector specialists with regard to their annual earnings, sources of income, maternity and other leave taken and number of practice locations. Public sector specialists are likely to be younger, to be international medical graduates, devote a higher percentage of time to education and research, and are more likely to do after hours and on-call work compared with private sector specialists. Gender and total hours worked do not differ between doctors across the different practice types. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Barriers to Effective Doctor-Patient Relationship Based on PRECEDE PROCEED Model

PubMed Central

Ghaffarifar, Saeideh; Ghofranipour, Fazlollah; Ahmadi, Fazlollah; Khoshbaten, Manouchehr

2015-01-01

Objective: This study intends to investigate interns and faculty members’ insights into constructing relationship between physicians and patients at 3 more accredited Iranian universities of medical sciences. Method: Applying PRECEDE PROCEED model, semi-structured interviews were completed with 7 interns and 14 faculty members and two themes were emerged from directed content analysis. The meaning units of the first theme, barriers to effective doctor-patient relationship, are discussed in this paper. Results: According to the participants, building doctor-patient relationship is influenced by many contextual and regulatory factors as well as content, process and perceptual skills of physicians. Conclusions: Faculty and curriculum development, as well as foundation of the department of communication skills at medical schools are recommended to eliminate the impact of poor communication on patients’ satisfaction and physicians’ self-efficacy specific to their communication skills. Practice Implications: Applying theories and models of health education and health promotion, researchers and educators can use the most predictive constructs of theories to design and implement effective interventions. PMID:26153160

[Equity of Health Resources Allocation in Minority Regions of Sichuan Province].

PubMed

Chen, Nan; Tang, Wen; Liang, Zhi; Zou, Bo; Li, Xiao-song

2016-03-01

To determine equity of health resources allocation in minority regions of Sichuan province from 2009 to 2013. Health resources distribution equity among populations and across geographic catchments were measured using coefficients of Inter-Individual differences and Individual-Mean differences. Health resources, especially human resources, in minority regions increased slowly over the years. Poorer allocation equity was found in nursing resources compared with doctors and hospital beds. Better distribution equity was found among populations than across geographic catchments. High levels of equity in resource distributions among populations and across geographic catchments were found in Aba. In Liangshan, more equitable distributions were found in doctors and hospital beds compared with nurses. The rest of minority regions had poor absolute allocation equity in doctors and hospital beds among populations. Appropriate allocation of health resources can promote health development. Health resources allocation in minority regions of Sichuan province is unreasonable. The government and relevant departments should take actions to optimize health resources allocations.

Prevalence of HBsAg, knowledge, and vaccination practice against viral hepatitis B infection among doctors and nurses in a secondary health care facility in Lagos state, South-western Nigeria.

PubMed

Abiola, Abdul-Hakeem Olatunji; Agunbiade, Adebukola Bola; Badmos, Kabir Bolarinwa; Lesi, Adenike Olufunmilayo; Lawal, Abdulrazzaq Oluwagbemiga; Alli, Quadri Olatunji

2016-01-01

Hepatitis B Virus, a highly infectious blood-borne virus poses a major threat to public health globally due to its high prevalence rate and grave consequence in causing liver cirrhosis and hepatocelullar carcinoma, the third cause of cancer death worldwide. The aim is determine the prevalence of HBsAg, knowledge, and vaccination practices against viral hepatitis B infection among doctors and nurses in a health care facility. Study design was a descriptive cross-sectional study among all the doctors and nurses in the health care facility. Data was collected using pre-tested, structured, self-administered questionnaire and blood samples were taken from respondents and tested using commercial enzyme-linked immunosorbent assay (ELIZA) test kit to determine prevalence of hepatitis B surface antigen after informed consent. Ethical approval was obtained from Health Research and Ethics Committee of the Lagos University Teaching Hospital. Responses of the respondents to the knowledge and vaccination practices against viral hepatitis B infection were scored and graded as poor (<50%), fair (50-74%) and good (≥75%). The study was carried out in January, 2014. A total of 134 out of the 143 recruited respondents participated in the study. Prevalence of HBsAg was 1.5%. Among the respondents, 56.7% had good knowledge and 94.8% reported poor practice of vaccination against viral hepatitis B infection. Mean knowledge and vaccination practices scores (%) were 72.54+7.60 and 29.44+14.37 respectively. Only 29% of the respondents did post vaccination testing for anti HBsAg. Prevalence of HBsAg was low. Knowledge of viral hepatitis B was fair, and practice of post hepatitis B vaccination testing was poor. It is therefore recommended that the state ministry of health should organise further health education programme, institute compulsory occupational hepatitis B vaccination programme and post vaccination anti-HBS testing to ensure adequate antibody level in this adult population.

Doctor-patient relationship

PubMed Central

Chamsi-Pasha, Hassan; Albar, Mohammed A.

2016-01-01

The doctor-patient relationship is an intricate concept in which patients voluntarily approach a doctor and become part of a contract by which they tend to abide by doctor’s instructions. Over recent decades, this relationship has changed dramatically due to privatization and commercialization of the health sector. A review of the relevant literature in the database of MEDLINE published in English between 1966 and August 2015 was performed with the following keywords: doctor-patient relationship, physician-patient relationship, ethics, and Islam. The Muslim doctor should be familiar with the Islamic teachings on the daily issues faced in his/her practice and the relationship with his/her patients. PMID:26837392

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.

UK Policy on Doctor Remediation: Trajectories and Challenges.

PubMed

Price, Tristan; Archer, Julian

2017-01-01

Around the world, policy-makers, academics, and health service professionals have become increasingly aware of the importance of remediation, the process by which poor performance is "remedied," as part of the changing landscape of medical regulation. It is, therefore, an opportune time to critique the UK experience with remediation policy. This article frames, for the first time, the UK remediation policy as developing from a central policy aim that was articulated in the 1990s: to accelerate the identification of underperformance and, subsequently, remedy any problems identified as soon as possible. In pursuit of this aim, three policy trajectories have emerged: professionalizing and standardizing remediation provision; linking remediation with other forms of regulation, namely relicensure (known in the UK as medical revalidation); and fostering obligations for doctors to report themselves and others for remediation needs. The operationalization of policy along these trajectories, and the challenges that have arisen, has relevance for anyone seeking to understand or indeed improve remediation practices within any health care system. It is argued here that the UK serves as an example of the more general challenges posed by seeking to integrate remediation policy within broader frameworks of medical governance, in particular systems of relicensure, and the need to develop a solid evidence base for remediation practices.

Self-reported medical, medication and laboratory error in eight countries: risk factors for chronically ill adults.

PubMed

Scobie, Andrea

2011-04-01

To identify risk factors associated with self-reported medical, medication and laboratory error in eight countries. The Commonwealth Fund's 2008 International Health Policy Survey of chronically ill patients in eight countries. None. A multi-country telephone survey was conducted between 3 March and 30 May 2008 with patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the UK and the USA who self-reported being chronically ill. A bivariate analysis was performed to determine significant explanatory variables of medical, medication and laboratory error (P < 0.01) for inclusion in a binary logistic regression model. The final regression model included eight risk factors for self-reported error: age 65 and under, education level of some college or less, presence of two or more chronic conditions, high prescription drug use (four+ drugs), four or more doctors seen within 2 years, a care coordination problem, poor doctor-patient communication and use of an emergency department. Risk factors with the greatest ability to predict experiencing an error encompassed issues with coordination of care and provider knowledge of a patient's medical history. The identification of these risk factors could help policymakers and organizations to proactively reduce the likelihood of error through greater examination of system- and organization-level practices.

Job satisfaction and its modeling among township health center employees: a quantitative study in poor rural China.

PubMed

Liu, Jun A; Wang, Qi; Lu, Zu X

2010-05-10

Job satisfaction is important to staff management of township health centers (THCs), as it is associated with organizational performance, quality of care and employee retention. The purpose of this study was to measure job satisfaction level of THC employees in poor rural China and to identify relevant features in order to provide policy advice on human resource development of health service institutions in poor regions. A self-completion questionnaire was used to assess the job satisfaction and relevant features (response rate: 90.5%) among 172 employees (i.e., clinic doctors, medico-technical workers and public health workers) of 17 THCs in Anhui and Xinjiang provinces of China. The study covered a time period of two months in 2007. The mean staff job satisfaction scored 83.3, which was in the category of "somewhat satisfied" on a scale ranging from 0 (extremely dissatisfied) to 100 (extremely satisfied) by employing Likert's transformation formula. Exploratory factor analysis (EFA) revealed eight domains involved in modeling of job satisfaction, among which, the caregivers were more satisfied with job significance (88.2), job competency (87.9) and teamwork (87.7), as compared with work reward (72.9) and working conditions (79.7). Mean job satisfaction in Xinjiang (89.7) was higher than that in Anhui (75.5). Employees of THCs have moderate job satisfactions in poor areas, which need to be raised further by improving their working conditions and reward.

Factors affecting turnover intentions among public hospital doctors in a middle-level city in central China.

PubMed

Zhang, Fengfan; Luo, Zhenni; Chen, Ting; Min, Rui; Fang, Pengqian

2017-05-01

Objective The aim of the present study was to explore prominent factors affecting turnover intentions among public hospital doctors in urban areas, particularly in Xiangyang City, Hubei Province, a middle-level city in central China. Methods Questionnaires were used to collect data from 284 public hospital doctors. Pearson's Chi-squared was used to assess whether sociodemographic and other factors were related to the turnover intentions of public hospital doctors. Binary logistic regression was performed to determine the significant factors that influence turnover intentions. Results The analysis revealed that 28.2% of public hospital doctors intended to leave the hospital where they were currently employed. Dissatisfaction with working conditions and hospital management processes, as well as work pressures, were significant factors contributing to the turnover intentions of public hospital doctors. Conclusion Research into turnover intentions indicates that public hospital doctors surveyed in urban China give greater weight to their professional environment and career development rather than salary in their employment decisions. What is known about the topic? Turnover of medical staff is a concern to hospital administrators because it is costly and detrimental to organisational performance and quality of care. Most studies have focused on the effects of individual and organisational factors on nurses' intentions to leave their employment. Income dissatisfaction was one of the determining factors of turnover intentions in previous studies. What does this paper add? The satisfaction of public hospital doctors with regard to income is not a determining factor of turnover intentions. In contrast with findings of previous studies, the doctors in public hospitals in urban China in the present study gave greater weight to their professional environment and career development in their employment decisions. What are the implications for practitioners? The findings suggest that health service managers and policy makers should pay greater attention to the factors affecting public hospital doctors' turnover intentions. This study will be useful for optimising public hospital management and minimising the turnover of doctors in China.

Permission to Be Looked At: A Collaboration between Theatre Siperia and Wärjäämö, the Centre for Arts and Activity for Disabled People

ERIC Educational Resources Information Center

Papunen, Riikka

2017-01-01

The article describes the author's subjective experience -- as an actor-researcher -- of being part of the performance "Toinen katse." The performance was the first artistic part of her artistic doctoral research conducted for a doctoral degree at the University of Tampere. The article explores carefully two scenes from the performance,…

Technical Division | Fermilab

Science.gov Websites

Martinello wins 2018 IEEE PAST Doctoral Student Award November 28, 2017 PAST has awarded Fermilab scientist Martina Martinello the 2018 IEEE PAST Doctoral Student Award. Performance recognition awards go to

Effective Practices in Providing Online, In-Service Training to Health Professionals in Low-Resource Settings

ERIC Educational Resources Information Center

Chio, Karen Sherk

2012-01-01

As doctors, nurses and public health professionals are promoted into management and leadership positions in resource-poor countries around the world, they are tasked with leading teams and managing drugs and financial and material resources. These responsibilities require a set of skills and knowledge different from that needed for their clinical…

The continuing medical education activities and attitudes of Australian doctors working in different clinical specialties and practice locations.

PubMed

Stewart, Grant D; Khadra, Mohamed H

2009-02-01

Currently, it is not clear which continuing medical education (CME) methods are being used by senior doctors and what their attitudes towards them are. The aims of this study were to investigate which modes of CME delivery senior Australian doctors utilise, to assess doctors' attitudes towards CME and to determine any differences in modes used and attitudes between clinical specialties and practice locations. A 52-statement questionnaire enquiring about doctors' current CME activities and their attitudes towards CME was distributed to 1336 senior Australian doctors. 494 doctors responded to the questionnaire. Traditional forms of CME (eg, meetings, conferences, journals and lectures) were most commonly used. Doctors thought CME involving face-to-face interaction was superior to electronic forms of CME. All doctors, especially those in hospital practice, had a positive attitude towards CME but found lack of time a barrier to learning. Rural doctors found CME sessions more difficult to attend than did their metropolitan colleagues. Traditional forms of CME were more popular than modern CME approaches, such as e-learning. Australian doctors had a positive attitude towards undertaking CME despite struggling to find time to perform CME. The differences in attitudes towards CME demonstrated between specialties and different practice location will aid future CME planning.

Training of midwives in advanced obstetrics in Liberia.

PubMed

Dolo, Obed; Clack, Alice; Gibson, Hannah; Lewis, Naomi; Southall, David P

2016-05-01

The shortage of doctors in Liberia limits the provision of comprehensive emergency obstetric and neonatal care. In a pilot project, two midwives were trained in advanced obstetric procedures and in the team approach to the in-hospital provision of advanced maternity care. The training took two years and was led by a Liberian consultant obstetrician with support from international experts. The training took place in CB Dunbar Maternity Hospital. This rural hospital deals with approximately 2000 deliveries annually, many of which present complications. In February 2015 there were just 117 doctors available in Liberia. In the first 18 months of training, the trainees were involved with 236 caesarean sections, 35 manual evacuations of products of conception, 25 manual removals of placentas, 21 vaginal breech deliveries, 14 vacuum deliveries, four repairs of ruptured uteri, the management of four cases of shoulder dystocia, three hysterectomies, two laparotomies for ruptured ectopic pregnancies and numerous obstetric ultrasound examinations. The trainees also managed 41 cases of eclampsia or severe pre-eclampsia, 25 of major postpartum haemorrhage and 21 of shock. Although, initially they only assisted senior doctors, the trainees subsequently progressed from direct to indirect supervision and then to independent management. To compensate for a shortage of doctors able to undertake comprehensive emergency obstetric and neonatal care, experienced midwives can be taught to undertake advanced obstetric care and procedures. Their team work with doctors can be particularly valuable in rural hospitals in resource-poor countries.

Educational History, Employment Characteristics, and Desired Competencies of Doctoral-Educated Athletic Trainers

PubMed Central

West, Thomas F.; Buckley, W. E.; Denegar, Craig R.

2001-01-01

Objective: The study had 3 objectives: (1) to assess the educational history of doctoral-educated certified athletic trainers (ATCs) who work at academic institutions, (2) to determine the current employment characteristics of doctoral-educated ATCs who work at academic institutions, and (3) to identify which competencies doctoral-educated ATCs feel are important for new doctoral graduates to possess upon graduation. Design and Setting: Multiple sources were used to identify doctoral-educated ATCs who work at academic institutions. These individuals were surveyed to assess their educational histories, current employment characteristics, and opinions on desired competencies for new doctoral graduates. Data were analyzed using descriptive and inferential statistics. Subjects: Surveys were sent to 130 individuals, and the response rate was 89.2% (n = 116). Measurements: Subjects answered questions regarding their educational history and employment characteristics. A 5-point Likert scale was used to assess the importance of 22 competencies for new doctoral graduates to possess upon graduation. Comparisons were made between program directors and non–program directors, respondents employed at doctoral-granting institutions and non–doctoral-granting institutions, and doctoral student advisors and non-advisors. Results: Subjects reported several different educational backgrounds, job titles, and job responsibilities. Significant differences in job responsibilities and assessment of desired competencies were found between program directors and non–program directors, employees of doctoral-granting institutions and non–doctoral-granting institutions, and doctoral student advisors and non-advisors. Conclusions: As new doctoral programs are established in athletic training, students should receive training as classroom instructors and program administrators, in addition to learning the skills necessary to perform independent research in athletic training. PMID:12937515

Rural Doctors' Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study.

PubMed

Hisham, Ranita; Liew, Su May; Ng, Chirk Jenn; Mohd Nor, Kamaliah; Osman, Iskandar Firzada; Ho, Gah Juan; Hamzah, Nurazira; Glasziou, Paul

2016-01-01

Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice. This study aimed to explore the views and experiences of rural doctors' about evidence-based medicine in their daily clinical practice in a rural primary care setting. Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach. Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings. The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers.

Do doctors understand the test characteristics of lung cancer screening?

PubMed

Schmidt, Richard; Breyer, Marie; Breyer-Kohansal, Robab; Urban, Matthias; Funk, Georg-Christian

2018-04-01

Screening for lung cancer with a low-dose computed tomography (CT) scan is estimated to prevent 3 deaths per 1000 individuals at high risk; however, false positive results and radiation exposure are relevant harms and deserve careful consideration. Screening candidates can only make an autonomous decision if doctors correctly inform them of the pros and cons of the method; therefore, this study aimed to evaluate whether doctors understand the test characteristics of lung cancer screening. In a randomized trial 556 doctors (members of the Austrian Respiratory Society) were invited to answer questions regarding lung cancer screening based on online case vignettes. Half of the participants were randomized to the group 'solutions provided' and received the correct solutions in advance. The group 'solutions withheld' had to rely on prior knowledge or estimates. The primary endpoint was the between-group difference in the estimated number of deaths preventable by screening. Secondary endpoints were the between-group differences in the prevalence of lung cancer, prevalence of a positive screening results, sensitivity, specificity, positive predictive value, and false negative rate. Estimations were also compared with current data from the literature. The response rate was 29% in both groups. The reduction in the number of deaths due to screening was overestimated six-fold (95% confidence interval CI: 4-8) compared with the actual data, and there was no effect of group allocation. Providing the correct solutions to doctors had no systematic effect on their answers. Doctors poorly understand the test characteristics of lung cancer screening. Providing the correct solutions in advance did not improve the answers. Continuing education regarding lung cancer screening and the interpretation of test characteristics may be a simple remedy. Clinical trial registered with www.clinicaltrials.gov (NCT02542332).

Removal of doctors from practice for professional misconduct in Australia and New Zealand.

PubMed

Elkin, Katie; Spittal, Matthew J; Elkin, David; Studdert, David M

2012-12-01

To examine how disciplinary tribunals assess different forms of misconduct in deciding whether to remove doctors from practice for professional misconduct. Multivariable regression analysis of 485 cases in which tribunals found doctors guilty of professional misconduct. The cases came from four Australian states (New South Wales, Victoria, Queensland and Western Australia) and New Zealand and were decided over a 10-year period (1 January 2000 - 30 September 2009). Type of misconduct, the tribunal's explanation for why the misconduct occurred, and the disciplinary measure imposed. 43% of the cases resulted in removal of the offending doctor from practice, 37% in restrictions on practice and 19% in non-restrictive sanctions. The odds of removal were very high in cases involving sexual relationships with patients (OR 22.59; 95% CI 10.18 to 50.14) and moderately high in cases involving inappropriate sexual conduct (not in the context of a relationship), commission of criminal offences, and forms of inappropriate conduct unrelated to patients. Cases in which the misconduct was judged to be due to willful wrongdoing (OR 17.14; 95% CI 8.62 to 34.09), incompetence (OR 6.02; 95% CI 2.87 to 12.63) and issues in the doctor's personal life (OR 4.17; 95% CI 2.07 to 8.41) also had higher odds removal from practice. Tribunals in Australia and New Zealand tend to remove doctors from practice for behaviours indicative of character flaws and lack of insight, rather than behaviours exhibiting errors in care delivery, poor clinical judgement or lack of knowledge. The generalisability of these findings to regulatory regimes for health practitioners in other countries should be tested.

The Impact of the Internet on Health Consultation Market Concentration: An Econometric Analysis of Secondary Data

PubMed Central

2016-01-01

Background Many markets have traditionally been dominated by a few best-selling products, and this is also the case for the health care industry. However, we do not know whether the market will be more or less concentrated when health care services are delivered online (known as E-consultation), nor do we know how to reduce the concentration of the E-consultation market. Objective The aim of this study was to investigate the concentration of the E-consultation market and how to reduce its concentration through information disclosure mechanisms (online reputation and self-representation). Methods We employed a secondary data econometric analysis using transaction data obtained from an E-consultation Website (haodf.com) for three diseases (infantile pneumonia, diabetes, and pancreatic cancer) from 2008 to 2015. We included 2439 doctors in the analysis. Results The E-consultation market largely follows the 20/80 principle, namely that approximately 80% of orders are fulfilled by nearly 20% of doctors. This is much higher than the offline health care market. Meanwhile, the market served by doctors with strong online reputations (beta=0.207, P<.001) or strong online self-representation (beta=0.386, P<.001) is less concentrated. Conclusions When health care services are delivered online, the market will be more concentrated (known as the “Superstar” effect), indicating poor service efficiency for society as a whole. To reduce market concentration, E-consultation websites should provide important design elements such as ratings of doctors (user feedback), articles contributed by doctors, and free consultation services (online representation). A possible and important way to reduce the market concentration of the E-consultation market is to accumulate enough highly rated or highly self-represented doctors. PMID:27793793

Comparative attitude and plans of the medical students and young Nepalese doctors.

PubMed

Lakhey, M; Lakhey, S; Niraula, S R; Jha, D; Pant, R

2009-01-01

Many doctors are leaving Nepal to work abroad. To understand this problem better, we decided to study the attitude and plans of young doctors and medical students. This cross-sectional study was conducted at Kathmandu Medical College involving 65 first year medical students, 100 interns and 100 house officers. The data collected was entered in Microsoft excel and analysed by SPSS (Statistical Package for Social Sciences) programme. Chi-square test was used to compare two proportions. Significance level was set at 5%. Only 2% house officers said that their job prospects were excellent as compared to 22.4% of students, whereas 20% house officers as compared to 9% students thought job prospects in Nepal were poor (p= 0.003). Eighty two percent of students thought that a doctor's service to his country was very important as compared to 51% of interns (p= 0.001) and 58% of house officers. Forty percent of students, 58% of interns and 48% of house officers (no statistical significance between the three groups) planned to migrate to a developed country after graduation. Eighty eight percent of students, 89% interns and 74% of house officers (no statistical significant differences between the three groups) were of the opinion that improving career opportunities or working environment of the doctor could make the profession more attractive. Although majority of students, interns and house officers were of the opinion that a doctor's service to his community/country was very important, almost half of them still planned to migrate to a developed country after graduation. Improving the chances of professional advancement and professional working environment can make the profession more attractive, and therefore, may decrease this tendency for brain drain from our country.

"You Know Doctor, I Need to Tell You Something": A Discourse Analytical Study of Patients' Voices in the Medical Consultation

ERIC Educational Resources Information Center

Cordella, Marisa

2004-01-01

Most studies in the area of doctor-patient communication focus on the talk that doctors perform during the consultation, leaving under-researched the discourse developed by patients. This article deconstructs and identifies the functions and forms of the voices (i.e. specific forms of talk) that Chilean patients employ in their interactions with…

When the Governmental Tail Wags the Disciplinary Dog: Some Consequences of National Funding Policy on Doctoral Research in New Zealand

ERIC Educational Resources Information Center

Sampson, Kaylene A.; Comer, Keith

2010-01-01

This paper explores disciplinary approaches to knowledge production and the supervision of doctoral students in the context of New Zealand's current Performance Based Research Fund (PBRF). In the last decade New Zealand has experienced significant changes to the way doctoral students are funded by central government. Funding has moved away from a…

Impact of workplace based assessment on doctors' education and performance: a systematic review.

PubMed

Miller, Alice; Archer, Julian

2010-09-24

To investigate the literature for evidence that workplace based assessment affects doctors' education and performance. Systematic review. The primary data sources were the databases Journals@Ovid, Medline, Embase, CINAHL, PsycINFO, and ERIC. Evidence based reviews (Bandolier, Cochrane Library, DARE, HTA Database, and NHS EED) were accessed and searched via the Health Information Resources website. Reference lists of relevant studies and bibliographies of review articles were also searched. Review methods Studies of any design that attempted to evaluate either the educational impact of workplace based assessment, or the effect of workplace based assessment on doctors' performance, were included. Studies were excluded if the sampled population was non-medical or the study was performed with medical students. Review articles, commentaries, and letters were also excluded. The final exclusion criterion was the use of simulated patients or models rather than real life clinical encounters. Sixteen studies were included. Fifteen of these were non-comparative descriptive or observational studies; the other was a randomised controlled trial. Study quality was mixed. Eight studies examined multisource feedback with mixed results; most doctors felt that multisource feedback had educational value, although the evidence for practice change was conflicting. Some junior doctors and surgeons displayed little willingness to change in response to multisource feedback, whereas family physicians might be more prepared to initiate change. Performance changes were more likely to occur when feedback was credible and accurate or when coaching was provided to help subjects identify their strengths and weaknesses. Four studies examined the mini-clinical evaluation exercise, one looked at direct observation of procedural skills, and three were concerned with multiple assessment methods: all these studies reported positive results for the educational impact of workplace based assessment tools. However, there was no objective evidence of improved performance with these tools. Considering the emphasis placed on workplace based assessment as a method of formative performance assessment, there are few published articles exploring its impact on doctors' education and performance. This review shows that multisource feedback can lead to performance improvement, although individual factors, the context of the feedback, and the presence of facilitation have a profound effect on the response. There is no evidence that alternative workplace based assessment tools (mini-clinical evaluation exercise, direct observation of procedural skills, and case based discussion) lead to improvement in performance, although subjective reports on their educational impact are positive.

Evaluation of Competencies Related to Personal Attributes of Resident Doctors by 360 Degree.

PubMed

Jani, Harsha; Narmawala, Wasea; Ganjawale, Jaishree

2017-06-01

Postgraduate teaching involves training the residents in all spheres including professionalism, communication and interpersonal skills in addition to the basic clinical skills. Therefore, 360 degree evaluation has gained focus due to increased standards of medical care as shown in this study. To evaluate interpersonal and communication skills and professionalism in residents doctors using 360 degree evaluation method. The present study was a descriptive study conducted at a tertiary care hospital affiliated with a medical college. Taking up as a pilot project, 26 residents from four departments were recruited in this study. A five point likert scale (1 to 5,1 meaning poor, 5 meaning excellent) was used for scoring them on for their interpersonal and communication skills and professionalism by the persons working around their sphere like teachers, peers, nursing staff, undergraduate students and patients/or relatives (360 degree). Though the ratings by the peers and consultants were found to be slightly lower compared with nursing staff, undergraduate students and patients, there was good agreement between all of them. The mean score of all traits showed an increasing trend over the years of residency. Regular orientation programs for professionalism with 360 degree evaluation and subsequent feedback to the resident doctor about their strength and weaknesses can definitely bring out behavioural change in the resident doctor in practice.

Doctors and the causes of neonatal death in Scotland in the second half of the nineteenth century

PubMed Central

Reid, Alice; Garrett, Eilidh

2015-01-01

This paper examines causes of neonatal death in two contrasting Scottish communities in the second half of the nineteenth century. Individual death certificates allow comparison of the causes as recorded by different doctors and by lay informants. The paper finds that doctors almost always offer a medical-sounding cause of death, but that causes offered by individual doctors varied according to the nature of their practice, developments in medical terminology, and individual preference. Lay people were much more likely to offer no cause at all, or to suggest a non-medical term. Large percentages of deaths in the not-known category can therefore indicate poor medical provision, and are more likely to be found in remote rural areas and may be accompanied by an under-registration of very early neonatal infant deaths and their corresponding births, and by ‘disguise’ of certain causes of death. The paper examines the unusual age pattern of neonatal deaths on Skye and concludes that, although there is no mention of neonatal tetanus in the death registers, there is a substantial probability that the disease was present on the island. Comparisons of cause-of-death statistics between places and over time should therefore be made with extreme caution. PMID:26166908

Evaluation of Effective Factors on the Clinical Performance of General Surgeons in Tehran University of Medical Science, 2015.

PubMed

Farzianpour, Fereshteh; Mohamadi, Efat; Najafpour, Zhila; Yousefinezhadi, Taraneh; Forootan, Sara; Foroushani, Abbas Rahimi

2016-09-01

Existence of doctors with high performance is one of the necessary conditions to provide high quality services. There are different motivations, which could affect their performance. Recognizing Factors which effect the performance of doctors as an effective force in health care centers is necessary. The aim of this article was evaluate the effective factors which influence on clinical performance of general surgery of Tehran University of Medical Sciences in 2015. This is a cross-sectional qualitative-quantitative study. This research conducted in 3 phases-phases I: (use of library studies and databases to collect data), phase II: localization of detected factors in first phase by using the Delphi technique and phase III: prioritizing the affecting factors on performance of doctors by using qualitative interviews. 12 articles were analyzed from 300 abstracts during the evaluation process. The output of assessment identified 23 factors was sent to surgeons and their assistants for obtaining their opinions. Quantitative analysis of the findings showed that "work qualification" (86.1%) and "managers and supervisors style" (50%) have respectively the most and the least impact on the performance of doctors. Finally 18 effective factors were identified and prioritized in the performance of general surgeons. The results showed that motivation and performance is not a single operating parameter and it depends on several factors according to cultural background. Therefore it is necessary to design, implementation and monitoring based on key determinants of effective interventions due to cultural background.

Towards a framework for business model innovation in health care delivery in developing countries.

PubMed

Castano, Ramon

2014-12-02

Uncertainty and information asymmetries in health care are the basis for a supply-sided mindset in the health care industry and for a business model for hospitals and doctor's practices; these two models have to be challenged with business model innovation. The three elements which ensure this are standardizability, separability, and patient-centeredness. As scientific evidence advances and outcomes are more predictable, standardization is more feasible. If a standardized process can also be separated from the hospital and doctor's practice, it is more likely that innovative business models emerge. Regarding patient centeredness, it has to go beyond the oversimplifying approach to patient satisfaction with amenities and interpersonal skills of staff, to include the design of structure and processes starting from patients' needs, expectations, and preferences. Six business models are proposed in this article, including those of hospitals and doctor's practices. Unravelling standardized and separable processes from the traditional hospital setting will increase hospital expenditure, however, the new business models would reduce expenses. The net effect on efficiency could be argued to be positive. Regarding equity in access to high-quality care, most of the innovations described along these business models have emerged in developing countries; it is therefore reasonable to be optimistic regarding their impact on access by the poor. These models provide a promising route to achieve sustainable universal access to high quality care by the poor. Business model innovation is a necessary step to guarantee sustainability of health care systems; standardizability, separability, and patient-centeredness are key elements underlying the six business model innovations proposed in this article.

Poverty and violence, frustration and inventiveness: hospital ward life in Bangladesh.

PubMed

Zaman, Shahaduz

2004-11-01

An ethnographic exploration was done in an orthopaedic ward of a government teaching hospital in Bangladesh to understand the nature of hospital culture in the context of Bangladeshi society at large. Life and work in the ward result in a culture that is simultaneously created by its inhabitants and the conditions in which they are situated. The study shows that biomedicine is a product of particular social conditions and that the hospital reflects features of its society. Behind the injuries and broken limbs in the ward are stories of violence, crime, and intolerance occurring in a society where masses of people fight over limited resources. In the ward people interact in an extremely hierarchical manner. The patients, who are mainly from poor economic backgrounds, remain at the bottom of the hierarchy. Doctors and other staff members are often professionally frustrated. Strikes related to hospital staff's various professional demands hamper the regular flow of work in the ward. Family members are engaged in nursing and provide various kinds of support to their hospitalized relatives. Patients give small bribes to ward boys and cleaners to obtain their day-to-day necessities. Patients joke with each other and mock senior doctors. Thus, they neutralize their powerlessness and drive away the monotony of their stay. Doctors develop 'indigenous' solutions to orthopaedic problems. Instead of using high-tech devices, they employ instruments made of bamboo, bricks, and razor blades. This study shows how medical practice takes shape in an understaffed, under-resourced and poorly financed hospital operating in a low-income country.

How do doctors in training react to seizures?

PubMed

Seneviratne, Udaya; Ma, Henry; Phan, Thanh G

2016-01-01

There are scant data on how doctors approach seizures in the acute setting. We sought to study (a) exposure to seizure disorders as well as relevant training and (b) reactions to seizures in the acute setting, among medical residents undergoing physician training. The exposure to and training on seizure disorders were assessed using a structured questionnaire first. Then, they were tested with 20 videos consisting of 10 epileptic seizures (ESs) and 10 psychogenic nonepileptic seizures (PNESs). After each video, we asked three questions to test (a) the diagnosis and the practice of administration of benzodiazepines to terminate the seizure, (b) the estimation of seizure duration, and (c) the practice of intubation. The accuracy of diagnosis was measured by the area under the summary receiver operating characteristics curve (AUC). The difference between true seizure duration and estimated duration was evaluated using paired-sample t-test. A total of 48 trainees participated in the study. The majority witnessed seizures in movies (37, 77.1%) and television (35, 72.9%). Only 12 (25%) received bedside teaching on seizure disorders. Their diagnostic accuracy of seizures was very poor (AUC=0.54). Participants significantly underestimated the duration of seizures. Thirty-five doctors made an illogical decision to intubate but not to terminate the seizure with intravenous benzodiazepine. The diagnostic accuracy of seizures is poor among trainees, and their estimates of seizure duration are unreliable. Our study highlights potential pitfalls in the acute management of seizures and the need for more training on seizure disorders. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Rural exposure during medical education and student preference for future practice location - a case of Botswana.

PubMed

Arscott-Mills, Tonya; Kebaabetswe, Poloko; Tawana, Gothusang; Mbuka, Deogratias O; Makgabana-Dintwa, Orabile; Sebina, Kagiso; Kebaetse, Masego; Mokgatlhe, Lucky; Nkomazana, Oathokwa

2016-06-10

Botswana's medical school graduated its first class in 2014. Given the importance of attracting doctors to rural areas the school incorporated rural exposure throughout its curriculum. This study explored the impact of rural training on students' attitudes towards rural practice. The University of Botswana family medicine rural training sites, Maun and Mahalapye. The study used a mixed-methods design. After rural family medicine rotations, third- and fifth-year students were invited to complete a questionnaire and semi-structured interview. Data were analysed using descriptive statistics and thematic analysis. The thirty-six participants' age averaged 23 years and 48.6% were male. Thirtythree desired urban practice in a public institution or university. Rural training did not influence preferred future practice location. Most desired specialty training outside Botswana but planned to practice in Botswana. Professional stagnation, isolation, poorly functioning health facilities, dysfunctional referral systems, and perceived lack of learning opportunities were barriers to rural practice. Lack of recreation and poor infrastructure were personal barriers. Many appreciated the diversity of practice and supportive staff seen in rural practice. Several considered monetary compensation as an enticement for rural practice. Only those with a rural background perceived proximity to family as an incentive to rural practice. The majority of those interviewed plan to practice in urban Botswana, however, they did identify factors that, if addressed, may increase rural practice in the future. Establishing systems to facilitate professional development, strengthening specialists support, and deploying doctors near their home towns are strategies that may improve retention of doctors in rural areas.Keyords: rural health, student perceptions.

Assessment of screening practices for gestational hyperglycaemia in public health facilities: a descriptive study in bangalore, India.

PubMed

Babu, Giridhara R; Tejaswi, B; Kalavathi, M; Vatsala, G M; Murthy, G V S; Kinra, Sanjay; Neelon, Sara E Benjamin

2015-02-20

Screening and timely treatment of gestational hyperglycaemia (GH) is proved to be beneficial and improves maternal and foetal health outcomes. To understand screening practices, we explored the knowledge and perceptions of doctors working in public health facilities in Bangalore, India. We also studied participation factors by examining whether undergoing glucose estimation tests affects morning sickness in pregnant women. We aimed to understand the screening practices and knowledge of doctors. A semi-structured questionnaire was self-administered by the 50 participant doctors, selected from the sampling frame comprising of all the doctors working in public health facilities. We included 105 pregnant women for baseline assessment, in whom a well-structured questionnaire was used. We reported that gestational diabetes mellitus (GDM) screening was done in nearly all the health centres (96%). However, only 12% of the doctors could provide all components of GDM diagnosis and management correctly and 46% would diagnose by using a random blood glucose test. A majority (92%) of the doctors had poor knowledge (68%) about the cut-off values of glucose tests. More than 80% of pregnant women experienced some discomfort mostly due to rapid ingestion glucose in short span of time. Our study established that screening for GH is done in most public health facilities. Nonetheless, knowledge of doctors on the glucose tests and their interpretation needs improvement. Re-orientation trainings of the doctors can improve their knowledge and thereby can efficiently screen for GH. Further, adequate planning prior to the tests can aid successful completion of them. Significance for public healthRising burden of hyperglycaemia in pregnancy is a cause for concern and is associated with short and long term deleterious consequences for mother and offspring. Hence, there is an urgent need to explore the screening practices for gestational hyperglycaemia (GH). The current study considers patient and doctors' perspectives regarding GH screening. The results from our study indicate several issues during screening of gestational hyperglycaemia in public health facilities in Bangalore, India. These included low awareness levels among doctors, lack of standard operating procedures and lack of adequate care and attention provided to pregnant women. Re-orientation trainings of the doctors within public health facilities can improve their knowledge and thereby can efficiently screen for GH. Further, adequate planning and preparation of the patient prior to the tests can help ensure successful completion of the tests. The findings of the study are comparable with the practices of public health hospitals in India.

An Exploratory Investigation of the Periodic Performance Evaluation Processes for Marketing Faculty: A Comparison of Doctoral-Granting and Non-Doctoral-Granting Universities

ERIC Educational Resources Information Center

Shepherd, C. David; Carley, Susan S.; Stuart, Randy S.

2009-01-01

Whether a first entrant into the academic job market or a seasoned professional, career outcomes for marketing educators depend heavily on the evaluation process used at their institutions. This research explores the periodic performance evaluation process for marketing faculty members using data collected from a national sample of marketing…

Multisource feedback questionnaires in appraisal and for revalidation: a qualitative study in UK general practice

PubMed Central

Hill, Jacqueline J; Asprey, Anthea; Richards, Suzanne H; Campbell, John L

2012-01-01

Background UK revalidation plans for doctors include obtaining multisource feedback from patient and colleague questionnaires as part of the supporting information for appraisal and revalidation. Aim To investigate GPs' and appraisers' views of using multisource feedback data in appraisal, and of the emerging links between multisource feedback, appraisal, and revalidation. Design and setting A qualitative study in UK general practice. Method In total, 12 GPs who had recently completed the General Medical Council multisource feedback questionnaires and 12 appraisers undertook a semi-structured, telephone interview. A thematic analysis was performed. Results Participants supported multisource feedback for formative development, although most expressed concerns about some elements of its methodology (for example, ‘self’ selection of colleagues, or whether patients and colleagues can provide objective feedback). Some participants reported difficulties in understanding benchmark data and some were upset by their scores. Most accepted the links between appraisal and revalidation, and that multisource feedback could make a positive contribution. However, tensions between the formative processes of appraisal and the summative function of revalidation were identified. Conclusion Participants valued multisource feedback as part of formative assessment and saw a role for it in appraisal. However, concerns about some elements of multisource feedback methodology may undermine its credibility as a tool for identifying poor performance. Proposals linking multisource feedback, appraisal, and revalidation may limit the use of multisource feedback and appraisal for learning and development by some doctors. Careful consideration is required with respect to promoting the accuracy and credibility of such feedback processes so that their use for learning and development, and for revalidation, is maximised. PMID:22546590

Multisource feedback questionnaires in appraisal and for revalidation: a qualitative study in UK general practice.

PubMed

Hill, Jacqueline J; Asprey, Anthea; Richards, Suzanne H; Campbell, John L

2012-05-01

UK revalidation plans for doctors include obtaining multisource feedback from patient and colleague questionnaires as part of the supporting information for appraisal and revalidation. To investigate GPs' and appraisers' views of using multisource feedback data in appraisal, and of the emerging links between multisource feedback, appraisal, and revalidation. A qualitative study in UK general practice. In total, 12 GPs who had recently completed the General Medical Council multisource feedback questionnaires and 12 appraisers undertook a semi-structured, telephone interview. A thematic analysis was performed. Participants supported multisource feedback for formative development, although most expressed concerns about some elements of its methodology (for example, 'self' selection of colleagues, or whether patients and colleagues can provide objective feedback). Some participants reported difficulties in understanding benchmark data and some were upset by their scores. Most accepted the links between appraisal and revalidation, and that multisource feedback could make a positive contribution. However, tensions between the formative processes of appraisal and the summative function of revalidation were identified. Participants valued multisource feedback as part of formative assessment and saw a role for it in appraisal. However, concerns about some elements of multisource feedback methodology may undermine its credibility as a tool for identifying poor performance. Proposals linking multisource feedback, appraisal, and revalidation may limit the use of multisource feedback and appraisal for learning and development by some doctors. Careful consideration is required with respect to promoting the accuracy and credibility of such feedback processes so that their use for learning and development, and for revalidation, is maximised.

Appraisal of doctors: problems with terminology and a philosophical tension.

PubMed

Taylor, C Mark; Wall, David W; Taylor, C Luke

2002-07-01

The term appraisal lacks useful definition. It is used to describe both the summative assessment which forms part of performance management, as well as an educational process sometimes referred to as formative assessment. In this analysis we trace the purpose of each of these components as applied to career grade doctors. In the first, authority for the process, and the motive for applying it, lies with management. Within a publicly funded health service the purpose of this is directed towards equality of health care, and to obtain the greatest performance available with the resources available. By contrast, appraisal which supports a doctor's self-directed learning is likely to address issues of quality. The two processes exist in tension with each other, and are mutually informative. We argue that in the appraisal of doctors the two processes and purposes should be made explicit.

Communicating under medical patriarchy: gendered doctor-patient communication between female patients with overactive bladder and male urologists in Hong Kong.

PubMed

Siu, Judy Yuen-Man

2015-05-29

Gender differences between patients and doctors markedly influence the quality of communication in treatment processes. Previous studies have shown that communication between patients and doctors of the same gender is usually more satisfactory, particularly for female patients. However, in Hong Kong, where urology is a male-dominated specialty, female patients typically require medical care from male doctors for diseases such as overactive bladder (OAB). The literature about gender-related doctor-patient communication predominantly involves people in non-Chinese communities, with few studies conducted with Chinese populations. However, the differences between Western and Chinese cultures are expected to result in different treatment and communication experiences. Furthermore, OAB has received little attention in many Chinese communities; few studies in the literature address the communication quality between OAB patients and their urologists in Chinese communities, particularly regarding female OAB patients' experiences when seeking treatment from male urologists. This study, therefore, investigated the doctor-patient communication between female OAB patients and male urologists in Hong Kong. This study adopted a qualitative research approach by conducting semistructured interviews with 30 female OAB patients on an individual basis from April 2012 to July 2012. The participants were purposively sampled from a patient self-help group for OAB patients in Hong Kong. The participants' communication experiences with male urologists were unpleasant. Embarrassment, feelings of not being treated seriously, not being understood, and not being given the autonomy to choose treatment approaches prevailed among the participants. Furthermore, the perceived lack of empathy from their urologists made the participants' communication experiences unpleasant. The gender and power differential between the participants and their urologists, which was contributed by the social and cultural values of patriarchy and doctors' dominance in Hong Kong, made the participants' communication with the urologists unpleasant and difficult. Poor doctor-patient communication can endanger patients' treatment compliance and thus the treatment outcome. Although altering such social and cultural values would be difficult, providing complementary chronic care services, such as nurse-led clinics as well as support and sharing from patient self-help groups, might be a possible solution.

Doctors' experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data.

PubMed

Bourne, Tom; Vanderhaegen, Joke; Vranken, Renilt; Wynants, Laure; De Cock, Bavo; Peters, Mike; Timmerman, Dirk; Van Calster, Ben; Jalmbrant, Maria; Van Audenhove, Chantal

2016-07-04

To examine doctors' experiences of complaints, including which aspects are most stressful. We also investigated how doctors felt complaints processes could be improved. A qualitative study based on a cross-sectional survey of members of the British Medical Association (BMA). We asked the following: (1) Try to summarise as best as you can your experience of the complaints process and how it made you feel. (2) What were the most stressful aspects of the complaint? (3) What would you improve in the complaints system? We sent the survey to 95 636 doctors, and received 10 930 (11.4%) responses. Of these, 6146 had a previous, recent or current complaint and 3417 (31.3%) of these respondents answered questions 1 and 2. We randomly selected 1000 answers for analysis, and included 100 using the saturation principle. Of this cohort, 93 responses for question 3 were available. Doctors frequently reported feeling powerless, emotionally distressed, and experiencing negative feelings towards both those managing complaints and the complainants themselves. Many felt unsupported, fearful of the consequences and that the complaint was unfair. The most stressful aspects were the prolonged duration and unpredictability of procedures, managerial incompetence, poor communication and perceiving that processes are biased in favour of complainants. Many reported practising defensively or considering changing career after a complaint, and few found any positive outcomes from complaints investigations. Physicians suggested procedures should be more transparent, competently managed, time limited, and that there should be an open dialogue with complainants and policies for dealing with vexatious complaints. Some felt more support for doctors was needed. Complaints seriously impact on doctors' psychological wellbeing, and are associated with defensive practise. This is not beneficial to patient care. To improve procedures, doctors propose they are simplified, time limited and more transparent. 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/

[Advancement of the medical doctorate].

PubMed

Baum, C; Förster, R; Schmidt, R E

2009-08-01

The medical doctorate and the subsequent advanced research qualification in medicine have an exceptional position within the natural sciences. While, in the German system, graduation to the degree of a medical doctor is often an initiation into scientific practice, the in-depth scientific education of medical doctors may be achieved in various configurations. In recent years, structured programs for doctorates in medicine and natural sciences have found increasing acceptance, following recommendations of national scientific councils ("Deutsche Forschungsgemeinschaft" and "Hochschulrat"). Hannover Medical School has been offering such programs for a number of years. The StrucMed program increases the quality of medical doctorate studies, typically performed in the third and fourth years of university studies. The Hannover Biomedical Research School (HBRS) combines several programs for a doctorate in natural sciences, creating a platform for an internationally oriented education of post-graduates in various disciplines of life sciences. Evaluating the achievements and career paths of the trainees will contribute to the successful integration of research work in an efficiency-oriented clinical environment.

Getting seamless care right from the beginning - integrating computers into the human interaction.

PubMed

Pearce, Christopher; Kumarpeli, Pushpa; de Lusignan, Simon

2010-01-01

The digital age is coming to the health space, behind many other fields of society. In part this is because health remains heavily reliant on human interaction. The doctor-patient relationship remains a significant factor in determining patient outcomes. Whilst there are many benefits to E-Health, there are also significant risks if computers are not adequately integrated into this interaction and accurate data are consequently not available on the patient's journey through the health system. Video analysis of routine clinical consultations in Australian and UK primary care. We analyzed 308 consultations (141+167 respectively) from these systems, with an emphasis on how the consultation starts. Australian consultations have a mean duration of 12.7 mins, UK 11.8 mins. In both countries around 7% of consultations are computer initiated. Where doctors engaged with computer use the patient observed the computer screen much more and better records were produced. However, there was suboptimal engagement and poor records and no coding in around 20% of consultations. How the computer is used at the start of the consultation can set the scene for an effective interaction or reflect disengagement from technology and creation of poor records.

A quantitative analysis of the quality and content of the health advice in popular Australian magazines.

PubMed

Wilson, Amanda; Smith, David; Peel, Roseanne; Robertson, Jane; Kypri, Kypros

2017-06-01

To examine how health advice is provided in popular magazines and the quality of that advice. A prospective quantitative analysis of the quality of health advice provided in Australian magazines between July and December 2011 was conducted. A rating instrument was adapted from the Media Doctor Australia rating tool used to assess quality of health news reporting. Criteria included: recommends seeing a doctor; advice based on reliable evidence; advice clear and easily applied; benefits presented meaningfully; potential harms mentioned; evidence of disease mongering; availability and cost of treatments; obvious advertising; vested interest, and anecdotal evidence. 163 health advice articles were rated showing a wide variation in the quality of advice presented between magazines. Magazines with 'health' in the title, rated most poorly with only 36% (26/73) of these articles presenting clear and meaningful advice and 52% (38/73) giving advice based on reliable evidence. Australian magazines, especially those with health in the title, generally presented poor quality, unreliable health advice. Teen magazine Dolly provided the highest quality advice. Consumers need to be aware of this when making health choices. © 2016 Public Health Association of Australia.

Appendicectomy deferred to a CEPOD list: the patients' opinion.

PubMed

Sideso, E; Richards, T; Galland, R B

2008-08-01

Implementation of NCEPOD guidelines to avoid out-of-hours operating, Junior doctors' 'New Deal' and EWTD have significantly altered surgical practice. Patients admitted 'out of hours', who need an emergency procedure, are often deferred until the next day. We have attempted to assess patients' opinions of this management plan. Consecutive patients admitted with uncomplicated appendicitis and operation deferred to the next day according to NCEPOD guidelines were studied. A surgeon, other than the one carrying out the initial assessment, performed the operation on a scheduled morning emergency list. A full explanation was given to patients regarding reasons for deferring operation, and they found out that a different surgeon would be performing their operation. Patients completed a questionnaire post-operatively. 42 patients were studied; median age 24 years (range 17-69); 32 men, 10 women. Thirty presented after 6 p.m. and eight after midnight. The remaining four were admitted during the day. Only one third of the patients recalled reasons for deferred operation with seven not remembering being given an explanation. Two thirds (n=27) of the patients slept poorly pre-operatively, principally due to pain (17) and ward noise (10). Operation on the same night as their admission was the preferred option in 24 patients. All of these slept poorly. Some 22 patients would have preferred the admitting surgeon to have performed their operation; 16 expressed no preference. Only four patients preferred a 'new' surgeon the following day. Of the 42 patients, 28 did not know who had performed their operation. Despite being told why their operation was delayed most patients would prefer not to have their procedure delayed. Lack of sleep pre-operatively is a major determinant of patient opinion. Few patients wanted a 'new' surgeon to perform their operation.

Key performance indicators in British military trauma.

PubMed

Stannard, Adam; Tai, Nigel R; Bowley, Douglas M; Midwinter, Mark; Hodgetts, Tim J

2008-08-01

Key performance indicators (KPI) are tools for assessing process and outcome in systems of health care provision and are an essential component in performance improvement. Although KPI have been used in British military trauma for 10 years, they remain poorly defined and are derived from civilian metrics that do not adjust for the realities of field trauma care. Our aim was to modify current trauma KPI to ensure they more faithfully reflect both the military setting and contemporary evidence in order to both aid accurate calibration of the performance of the British Defence Medical Services and act as a driver for performance improvement. A workshop was convened that was attended by senior, experienced doctors and nurses from all disciplines of trauma care in the British military. "Speciality-specific" KPI were developed by interest groups using evidence-based data where available and collective experience where this was lacking. In a final discussion these were streamlined into 60 KPI covering each phase of trauma management. The introduction of these KPI sets a number of important benchmarks by which British military trauma can be measured. As part of a performance improvement programme, these will allow closer monitoring of our performance and assist efforts to develop, train, and resource British military trauma providers.

Doctor-patient communications in the Aboriginal community: towards the development of educational programs.

PubMed

Towle, Angela; Godolphin, William; Alexander, Ted

2006-09-01

Aboriginal people in Canada have poorer health than the rest of the population. Reasons for health disparities are many and include problems in communication between doctor and patient. The objective of this study was to understand doctor-patient communication in Aboriginal communities in order to design educational interventions for medical students based on the needs and experiences of patients. Experiences of good and poor communication were studied by semi-structured interviews or focus groups with 22 Aboriginal community members, 2 community health representatives and 2 Aboriginal trainee physicians. Transcribed data were coded and subjected to thematic analysis. Positive and negative experiences of communicating with physicians fell into three broad and interrelated themes: their histories as First Nations citizens; the extent to which the physician was trusted; time in the medical interview. Aboriginal peoples' history affects their communication with physicians; barriers may be overcome when patients feel they have a voice and the time for it to be heard. Physicians can improve communication with Aboriginal patients by learning about their history, building trust and giving time.

Addressing learner disorientation: give them a roadmap.

PubMed

Crossley, James G M

2014-08-01

This article describes the problem of disorientation in students as they become doctors. Disorientation arises because students have a poor or inaccurate understanding of what they are training to become. If they do not know what they are becoming it is hard for them to prioritise and contextualise their learning, to make sense of information about where they are now (assessment and feedback) or to determine the steps they need to take to develop (formative feedback and "feedforward"). It is also a barrier to the early development of professional identity. Using the analogy of a map, the paper describes the idea of a curriculum that is articulated as a developmental journey--a "roadmap curriculum". This is not incompatible with a competency-based curriculum, and certainly requires the same integration of knowledge, skills and attitudes. However, the semantic essence of a roadmap curriculum is fundamentally different; it must describe the pathway or pathways of development toward being a doctor in ways that are both authentic to qualified doctors and meaningful to learners. Examples from within and outside medicine are cited. Potential advantages and implications of this kind of curricular reform are discussed.

Medical scribes in emergency medicine produce financially significant productivity gains for some, but not all emergency physicians.

PubMed

Walker, Katherine J; Ben-Meir, Michael; Phillips, David; Staples, Margaret

2016-06-01

The present study aims to determine if a scribe in an Australian ED can assist emergency physicians to work with increased productivity and to investigate when and where to allocate a scribe and to whom. This was a prospective observational single-centre study conducted at a private ED in Melbourne. It evaluated one American scribe and five doctors over 6 months. A scribe is a trained assistant who performs non-clinical tasks usually performed by the doctor. The primary outcomes were patients/hour/doctor and billings/patient. Additional analyses included individual doctor productivity, productivity by ED region, shift time, day of the week and physician learning curves. Door-to-doctor time, time spent on ambulance bypass and door-to-discharge time were examined, also complaints or issues with the scribe. There was an overall increase in doctor consultations of 0.11 (95%CI 0.07-0.15) primary consultations per hour (13%). There was variation seen between individual doctors (lowest increase 0.06 [6%] to highest increase 0.12 [15%]). Billings per patients, door-to-doctor, door-to-discharge and ambulance bypass times remained the same. There was no advantage to allocating a scribe to a specific time of day, day of week or region of the ED. There was no learning period found. In the present study, scribe usage was associated with overall improvements in primary consultations per hour of 13% per scribed hour, and this varied depending on the physician. There is an economic argument for allocating scribes to some emergency physicians on days, evenings and weekends, not to trainees. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Improving the public health/physician partnership for influenza vaccination.

PubMed

Russell, Margaret L; Yau, Annie; Baptiste, Beverley; Rowntree, Carol; Robb, Jonathan; Hill, Shirley

2005-01-01

Alberta doctors can request supplies of publicly funded influenza vaccine to administer to patients who meet provincial program criteria. To describe the proportions of Alberta family doctors who vaccinate patients, the sources from which they obtain vaccine and their evaluation of public health influenza vaccination program components. Cross-sectional postal survey, 2003. Doctors were asked to complete a nine-page questionnaire or to answer a one-page "mini-survey". The proportion of physicians who vaccinated patients against influenza was estimated separately for the main questionnaire and the mini-survey. Frequencies and cross-tabulations were used to examine sources of vaccine supply and physician ratings of five aspects of influenza vaccine program services provided by Regional Health Authorities (RHA). The survey response rate was 52.3% (1387/2650); an additional 14% (372) returned a mini-survey. The proportion of respondents who vaccinated one or more patients against influenza in the fall of 2002 was 81.5% for the main questionnaire and 83.1% for the mini-survey. Vaccine was most commonly obtained from the RHA. Three items were rated as poor/fair by more than 10% of respondents: provision of information for distribution to patients (37%), timeliness of vaccine delivery to offices (16%) and vaccine availability over the entire influenza season (18%). Item ratings varied by RHA but provision of information for distribution to patients was consistently a problem. A high priority should be placed on improving resources for doctors to give to patients, timeliness of vaccine deliveries to doctors' offices and vaccine availability over the entire season.

The consequences of Ireland's culture of medical migration.

PubMed

Humphries, Niamh; Crowe, Sophie; McDermott, Cian; McAleese, Sara; Brugha, Ruairi

2017-12-28

In recent years, Ireland has experienced a large-scale, outward migration of doctors. This presents a challenge for national policy makers and workforce planners seeking to build a self-sufficient medical workforce that trains and retains enough doctors to meet demand. Although, traditionally, medical migration has been considered beneficial to the Irish health system, austerity has brought a greater level of uncertainty to the health system and, with it, a need to reappraise the professional culture of migration and its impact on the Irish health system. This paper illustrates how a culture of migration informs career and migration plans. It draws on quantitative data-registration and migration data from source and destination countries-and qualitative data-in-depth interviews with 50 doctors who had undertaken postgraduate medical training in Ireland. Of 50 respondents, 42 highlighted the importance of migration. The culture of medical migration rests on two assumptions-that international training/experience is beneficial to all doctors and that those who emigrate will return to Ireland with additional skills and experience. This assumption of return is challenged by a new generation of doctors whose professional lives have been shaped by globalisation and by austerity. Global comparisons reveal the comparatively poor working conditions, training and career opportunities in Ireland and the relative attractiveness of a permanent career abroad. In light of these changes, there is a need to critically appraise the culture of medical migration to determine if and in what circumstances migration is appropriate to the needs of the Irish health system. The paper considers the need to reappraise the culture of medical migration and the widespread emigration that it promotes.

Use of cancer-specific mental health resources-is there an urban-rural divide?

PubMed

Beraldi, Anna; Kukk, Ene; Nest, Alexandra; Schubert-Fritschle, Gabriele; Engel, Jutta; Heußner, Pia; Herschbach, Peter

2015-05-01

The purpose of this study is to establish whether mental health (MH) outcomes, attitudes towards cancer-specific MH (CSMH) resources, and the availability of such resources differ between rural and urban cancer patients. Three months after surgery for colorectal cancer, patients received a questionnaire for completion at home assessing distress, depression, anxiety, acceptance, knowledge and use of CSMH resources and the doctor-patient relationship. We adjusted our sample to reference data of the Munich Cancer Registry and documented CSMH resources (e.g. cancer-specific information centres and cancer support groups) using a systematic Internet search. Five hundred thirty-four patients participated with a mean age of 68.9 years; 44.5 % were female. Urban patients talked less with their doctor about their emotional state (65 %, p < 0.01) and showed poorer knowledge of CSMH resources (60 %, p < 0.002). A good doctor-patient relationship was associated with a better MH outcome. A significant predictor for acceptance was distress. Ninety-four percent of patients without a nearby support facility lived in rural areas (p < 0.001). There were no group differences concerning distress, MH outcomes, or acceptance of CSMH resources. Despite a higher availability of CSMH resources, urban patients showed poorer doctor-patient relationships and less knowledge of such resources than rural patients. Overall, knowledge and use of these resources were poor. The amount of support facilities available therefore appears to be less important than establishing an efficient communication network between patients, doctors and providers of CSMH resources to achieve satisfaction with treatment of urban and rural cancer patients.

The influence of performance-based payment on childhood immunisation coverage.

PubMed

Merilind, Eero; Salupere, Rauno; Västra, Katrin; Kalda, Ruth

2015-06-01

Pay-for-performance, also called the quality system (QS) in Estonia, was implemented in 2006 and one indicator for achievement is the childhood immunisation coverage rate. The WHO vaccination coverage in Europe for diphtheria, tetanus and pertussis, and measles in children aged around one year old should meet or exceed 90 per cent. The study was conducted using a database from the Estonian Health Insurance Fund. The study compared childhood immunisation coverage rates of all Estonian family physicians in two groups, joined and not joined to the quality system during the observation period 2006-2012. Immunisation coverage was calculated as the percentage of persons in the target age group who received a vaccine dose by a given age. The target level of immunisations in Estonia is set at 90 per cent and higher. Immunisation coverage rates of family doctors (FD) in Estonia showed significant differences between two groups of doctors: joined to the quality system and not joined. Doctors joined to the quality system met the 90 per cent vaccination criterion more frequently compared to doctors not joined to the quality system. Doctors not joined to the quality system were below the 90 per cent vaccination criterion in all vaccinations listed in the Estonian State Immunisation Schedule. Pay-for-performance as a financial incentive encourages higher levels of childhood immunisations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Physicians working under the influence of alcohol: An analysis of past disciplinary proceedings and their outcomes.

PubMed

Sendler, Damian Jacob

2018-04-01

The intoxicated person may cause harm to others, often requiring expert evaluation for the determination of guilt. The primary aim of this study was to determine the mechanisms of mistakes that led 17 doctors accused of working under the influence of alcohol to face malpractice. We also wanted to clarify what were the legal, professional, and financial consequences - depending on specific patient outcomes. We based analysis on the review and meta-analysis of the past forensic evaluation reports of institution-run forensics programs. Furthermore, we apply thematic analysis using combination of grounded theory and Pierre Bourdieu's theoretical framework. During the 2010-2016 timeframe, the regional forensic service opinionated on 17 physicians (3F, 14M) subjected to disciplinary action due to providing treatment under the influence of alcohol. In total, there were 157 patients potentially affected by malpractice - out of those, four were harmed; only one qualified for compensation. In the remaining 153 patients - only 11 persons reported having had awareness about the doctors' intoxication and apparent inability to perform the job, yet they agreed to receive care. Overall, in over 90% of patients, the physician did not harm anyone to a degree threatening patient's life. The supporting staff did not report experiencing distress either. The results of a blood test for the presence of alcohol were available for only four cases. Therefore, it was impossible to analyze the correlation between intoxication level and performance in providing care. All in all, in our analysis - less than 10% of 157 patients' care were compromised by provider's intoxication, either due to a mistake in diagnosis, medical procedure, or lacking communication skills. For physicians, working under the influence of alcohol is an uncommon phenomenon, but when it occurs - patients are at risk for receiving poor treatment. Presented analysis indicates that patients - just as much as supporting staff - frequently agree to receive supervision and care from a drunk doctor, despite possible harm. Therefore, it is evident that patients as much as supporting staff fear retaliation, leading to underreporting of these cases. Copyright © 2018 Elsevier B.V. All rights reserved.

Joining a discourse community: How graduate students learn to speak like astronomers

NASA Astrophysics Data System (ADS)

Baleisis, Audra

Almost half of all graduate students leave their doctoral programs without finishing. Who leaves, taking which skills and strengths with them, is still poorly understood, however, because it is hard to measure exactly what graduate students learn in their doctoral programs. Since the expertise required of a PhD holder is highly dependent on discipline, the development of a better understanding of graduate education and attrition requires studying the process at the departmental level. This is a qualitative study of the cultural values and norms of academic astronomy, as transmitted through the socialization of graduate students in to giving talks, asking questions, and participating in departmental speaking events. This study also looks at the conflicts that arise when implicit cultural norms, which are practiced but remain unacknowledged, are inconsistent with the official, explicit values and norms for speaking in astronomy. Doctoral students and faculty members in a single astronomy department, at a large western university, filled out a short survey about the stakes involved in astronomy speaking events. A subset of these individuals was interviewed in- depth about the goals of, and their experiences with, five departmental speaking events: Coffee Hour, Journal Club, research talks, Thesis defense talks, and Colloquia. These interviewees were: (1) graduate students who had given a verbal presentation at one of these events, and (2) graduate students and faculty members who were in the audience at a graduate student's presentation. The desired outcomes which were expressed for these speaking events included: (1) lively, informal discussion among all participants, (2) increasing graduate student verbal participation in these events as they "learn to speak like astronomers," and (3) the utility of these events in helping graduate students learn and practice their speaking and reasoning skills related to astronomy research. In practice these goals were not achieved due to: (1) the ubiquitous, but unacknowledged practice of judging others' speech performance to come to negative conclusions about those individuals' intentions, intellectual abilities or efforts, (2) a lack of feedback for graduate students on their verbal performances, and (3) a lack of faculty members making explicit their own solutions to the inherent dilemmas of academic speaking.

Surgery for Cervical Cancer

MedlinePlus

... laparoscope, which makes it easier for the doctor. Robotic-assisted surgery: In this approach, the laparoscopy is done with special tools attached to robotic arms that are controlled by the doctor to help perform precise surgery. General or epidural (regional) anesthesia is used for ...

[Effect of doctor-patient communication education on oral clinical practice].

PubMed

Wang, Yi; Tang, Yu; He, Yan; Zhu, Ya-qin

2012-08-01

To evaluate the effect of doctor-patient communication education on dental clinical practice. The process of 61 dental interns' clinical practice was divided into two stages. The dental interns were taught with traditional teaching method in the first stage. Doctor-patient communication and communication skill training were added to the second stage. Scale of medical student's doctor-patient communication behavior was used to evaluate the dental interns' behavior by themselves after two stages. The SEGUE frame work was used to evaluate the dental interns' behavior by teachers after two stages. All statistical analysis was performed using SPSS 13.0 software package. The result of scale of medical student's doctor-patient communication behavior was analyzed using Fisher exact test or Chi-square test. The score of the SEGUE frame work was analyzed using Student's t test. The result of Scale of medical student's doctor-patient communication behavior showed only 37.71% of dental interns could establish good doctor-patient relationship in the first stage. After doctor-patient communication and communication skill training, the percentage became 75.4%. The result of the SEGUE frame work showed the score was raised from 16.066±3.308 to 21.867±2.456, and a significant difference was found between the two stages. Doctor-Patient communication education can improve dental interns' communication skills and help to establish a good doctor-patient relationship.

[Cultural interests of doctors, accountants and lawyers; art, culture and interface with the profession].

PubMed

Algra, Annemijn M; Cleyndert, Lisette; Drenth, Joost P H

2011-01-01

To investigate the role of art and culture in the recreational activities of doctors, accountants and lawyers. Descriptive questionnaire study. In this study, doctors, accountants and lawyers were asked to respond to an online questionnaire. They were presented with 13 questions or statements concerning their recreational activities and their active or passive involvement with art and culture. To gain an impression in which respect doctors, accountants and lawyers could be distinguished from each other, predictive models based on logistic regression with possible results 'doctor', 'accountant' or 'lawyer' were generated. On the basis of these models, a miniquiz was created, which could distinguish the typical doctor, accountant or lawyer after answering of dichotomous questions. Among all respondents, museum and cinema visits were popular, sports or gardening were favourite activities, and apart from newspapers, the Internet was frequently consulted for news. It was remarkable that doctors and lawyers resembled each other in most of the areas investigated, whereas the accountants differed significantly. Doctors and lawyers particularly visited museums and dance, opera or theatre performances, and two-thirds themselves played music. The majority of these 2 groups also had an above average interest in art and culture, this being a significant part of the recreational activity. Therefore, we were able to differentiate between a doctor or lawyer and an accountant, but the difference between doctors and lawyers was less clear. Doctors and lawyers seemed to have comparable interests in art and culture, but accountants differed in important respects.

[When and how is medical teleconsultation to doctors practising in remote areas of developing countries convenient and reliable? About eight clinical cases].

PubMed

Campanella, Nando; Francioni, Orestina; Taus, Marina; Giovagnoli, Moreno; Morosini, Pierpaolo

2004-01-01

A poorly equipped internal medicine doctor (IMD), practising in remote areas of developing countries, can be assisted with expertise teleconsultations by using the common analogical telephone lines. By that way, the clinical cases he challenges became multidisciplinary and the success of the treatment enhanced. Eight cases are reported as examples. The expertise is made up by eight remote-access experts on different medical fields. The effectiveness of the support of the consultants is compared one to the other. In laboratory, dermatology and, partly, cyto-pathology fields the teleconsultations are reliable and not time-consuming, for the key tool is the digital picture sent by e-mailing. In cardiology (heart ultrasound scan) and radiology fields both effectiveness and benefit-cost ratio are disputable. Heart ultrasound scan is a dynamic test and filming is needed to provide the consultant with good records. In radiology field, the upper digestive tract X-ray scan is usually carried out with few shots, due to the unsustainable charges on the patient. That matter impairs the consultant's effectiveness to support. Although the black-outs of the transmission were common throughout IMD-consultant videoconferences, the physical examination of the patient, performed by the IMC under consultant's direct supervision, is highly supportive both in neurology and paediatric fields. The physiotherapist's show of physical rehabilitation exercises by videoconference is highly supportive as well.

Surgical treatment of neglected congenital idiopathic talipes equinovarus after walking age in Eritrea: an Italo-Eritrean cooperation.

PubMed

Faldini, C; Prosperi, L; Traina, F; Nanni, M; Tesfaghiorghi, S; Tsegay, S; Yosief, M; Pungetti, C; Sanzarello, I

2016-08-01

An Italian team of orthopaedic surgeons joined Eritrean colleagues to perform a clinical study in ambulating children affected by neglected idiopathic congenital talipes equinovarus (clubfoot). This study reports the surgical strategy as well as clinical outcomes, early complications and relapse at a mid-term follow-up. Four expeditions of 7 days were organized between 2012 and 2015 from Italy to the Halibet Hospital of Asmara in Eritrea. In each expedition were included two experienced surgeons, two assistants and one anaesthesiologist. During these expeditions, a total of 468 patients were evaluated together with Eritrean colleagues and 45 cases of neglected talipes equinovarus in ambulating children were diagnosed and selected for surgery. Follow-up range was 1-3 years. During the four expeditions, the Eritrean team of orthopaedic surgeons learned to manage most cases of neglected talipes equinovarus. No major complications were reported. Sixteen feet were considered excellent, 25 good and four poor. No overcorrections were observed. Neglected congenital talipes equinovarus is the result of delayed treatment of congenital deformity in developing countries, and its treatment often requires extensive surgery. Collaboration with foreign expert surgeons may help local doctors to learn how to treat this disease. The current study demonstrates that surgical expeditions in developing countries, when organized in collaboration with local doctors, help to manage on site this severe deformity.

Evaluating the content of the communication items in the CAHPS(®) clinician and group survey and supplemental items with what high-performing physicians say they do.

PubMed

Quigley, Denise D; Martino, Steven C; Brown, Julie A; Hays, Ron D

2013-01-01

A doctor's ability to communicate effectively is key to establishing and maintaining positive doctor-patient relationships. The Consumer Assessment of Healthcare Providers and System (CAHPS(®)) Clinician and Group Survey is the standard for collecting and reporting information about patients' experiences of care in the USA. To evaluate how well CAHPS(®) Clinician and Group 2.0 core and supplemental survey items (CG-CAHPS) with a 12-month reference capture doctor-patient communication. Eleven of the 40 highest-rated physicians on the CG-CAHPS survey treating patients in a Midwest commercial health plan. Data were obtained via semi-structured interviews. Specific behaviors, practices, and opinions about doctor communication were coded and compared to the CG-CAHPS items. CG-CAHPS fully captures six of the nine behaviors most commonly mentioned by high-performing physicians: employing office staff with good people skills; involving office staff in communication with patients; spending enough time with patients; listening carefully; providing clear, simple explanations; and devising an action plan with each patient. Three physician behaviors identified as key were not captured in CG-CAHPS items: use of nonverbal communication; greeting patients and introducing oneself; and tracking personal information about patients. CG-CAHPS survey items capture many of the most commonly mentioned doctor-patient communication behaviors and practices identified by high-performing physicians. Nonverbal communication, greeting patients, and tracking personal information about patients were identified as key aspects of doctor-patient communication, but are not captured by the current CG-CAHPS. We recommend further research to assess patients' perceptions of specific verbal and nonverbal behaviors (such as leaning forward in a chair, casually asking about other family members), followed by the development of new items (if needed) that aim to capture what these specific behaviors represent to patients (e.g., listens attentively, seems to care about me as a person, empathy). We also recommend including items about greeting and tracking personal information about patients in future CAHPS item sets addressing doctor-patient communication. Enriching the content of the CAHPS communication measure can help health-care organizations improve doctor-patient communication and interactions.

Patients' Expectations as to Doctors' Behaviors During Appointed Visits.

PubMed

Sobczak, Krzysztof; Leoniuk, Katarzyna; Janaszczyk, Agata; Pietrzykowska, Małgorzata

2017-04-01

Numerous guidelines for students and medical professionals provide the instructions of proper behavior during encounters with patients in a doctor's office. However, they quite often do not consider cultural differences that may affect the doctor-patient relationship. In our study we analyzed Polish patients' expectations (N = 976) for their physicians' actual behavior. We compared our results with analogue studies performed in the United States. We determined that patient expectations concerning a desirable form of verbal and nonverbal communication with a physician vary to a considerable degree. Relatively universal, however, is the wish that the doctors introduce themselves and apply personalized forms of contact.

[Screening for rehabilitation needs of patients in care of family practitioners].

PubMed

Pullwitt, D H; Krause, O; Hildebrand, F; Fischer, G C

1997-11-01

Family doctors play an important role in promoting the access of patients to rehabilitation. On the one hand they are very often the first professionals to be contacted if patients want to take part in rehabilitation procedures whereas on the other hand there are also many patients whose need for rehabilitation remains undisclosed. No detailed estimates are available on how many of such patients exist in German GP-practices although it should be an important task of family doctors to discuss the pros and cons of rehabilitation particularly with their patients who are in need of it. We performed a non-representative pilot study in three GP offices during ten working days. patients older than 29 years were screened for their "rehabilitation status" with an instrument frequently used in German rehabilitation clinics. The patients were also asked whether or not they would like to participate in a rehabilitation procedure and what was the reason for their decision. Not knowing the patients' answers their doctors rated whether or not it would be appropriate for their patients to take part in rehabilitation. Additionally the doctors stated what kind of rehabilitation should be performed and what could be ist aims. In a sample of 181 patients about one-third was found to be in a severe "rehabilitation status", about one third in a state with higher than normal values--although not severe--and also approx. another third had a normal status. Family doctors stated that for one-third of their patients rehabilitation would be undoubtedly suitable at the time of the screening. In about two thirds of the cases the results of the questionnaire and the doctors' ratings corresponded. Some patients felt completely healthy although the results of the questionnaire and the doctors' statements rated them as being in need of rehabilitation. Other patients in need of rehabilitation rejected it for other than health-related reasons. The results of our study give evidence to the family doctors' key role for patients' access to rehabilitation. A representative study with a larger sample should be performed in the future because it could yield more detailed figures on the rehabilitation needs of family doctors' patients. Possibilities of standardised screening for rehabilitation needs in primary medical are should also be studied. The results of our pilot study also indicate the need for studies concerning non-medical causes of underutilised rehabilitation facilities. Family doctors should discuss these problems with their patients.

A brief history of dermatovenereology in Dubrovnik.

PubMed

Bakija-Konsuo, Ana; Marlais, Matko

2012-01-01

Since its inception, Dubrovnik has been associated with medicine. The citizens of Dubrovnik have felt the need for the development and improvement of public health conditions in their city as the basic conditions of their existence. In this context, we focused our attention on the development of dermatology and venereology to date; from the first hospital Domus Christi to the modern hospital Medarevo; from the first doctors to specialist doctors, who have marked dermatovenereology in Dubrovnik and Croatia. Domus Christi started accepting patients in 1540 as a public sector hospital and operated for more than 350 years. In 1847, doctors Pinelli and Lopišić operated on breast cancer in this hospital with the use of ether narcosis (one year after ether narcosis had been discovered). A doctor is first mentioned in Dubrovnik in 1280, until this time it could be said that there were no doctors. Medical operations were performed by barbers. The first written records of a doctor in Dubrovnik practicing in dermatovenereology are those of military doctor Marko Bibica. In the context of Dubrovnik dermatovenereology, we must mention doctor Luko Stulli, who was the first to describe Mal de Meleda.

[Working style among regular general practitioners and other doctors in the out-of-hours services].

PubMed

Sandvik, Hogne; Hunskår, Steinar

2010-01-28

RGPs (regular general practitioners) are obliged to take on duties in the out-of-hours services in Norway, but they actually perform less than half of this work. We wished to compare remuneration claims for out-of-hours work from RGPs with those from other doctors. The Norwegian Labour and Welfare administration provided information about all doctors working in the out-of-hours services in Norway in 2006 (4 729 of whom 2 220 were RGPs) and coupled this with the remuneration they had claimed in this period. RGPs had 46.6 % of all patient contacts in the out-of-hours services, but more telephone contacts (57.4 %) and simple/short contacts (50.7 %) than other doctors. Other doctors had most contacts in the largest (59.8 %) and most central (56.7 %) municipalities and used general and unspecific diagnoses more often than the RGPs (12.6 % of all consultations vs. 11.0 %). Older doctors used fewer fees than younger doctors, but otherwise the total number of fees only differed slightly between various groups of doctors. Newly qualified doctors serving their compulsory practice period claimed extra remuneration for long consultations in 41.2 % of the cases, RGPs who are also general practice specialists in 20.2 % of cases, and other doctors in 35.7 % of the consultations. RGPs wrote sick notes more often (7.1 % of consultations) than newly qualified doctors (5.7 %) and other doctors (6.6 %). General practice specialists wrote sick notes most often (7.4 %). Experienced RGPs and general practice specialists spend less time per patient than other doctors in the out-of-hours services.

Improving Weekend Out Of hours Surgical Handover (WOOSH).

PubMed

Boyer, Melissa; Tappenden, Janine; Peter, Mark

2016-01-01

An effective surgical handover is imperative to optimise patient care and safety, whilst ensuring progression of clinical management and the delivery of an efficient service. The introduction of full-shift working, as a response to progressive implementation of the European Working Time Directive (EWTD), has placed the spotlight on patient and doctor safety. Effective handover between shifts is vital to protect patient safety and assist doctors with clinical governance. The weekend is a critical point where the transfer of patient care to the ongoing weekend team is efficient, thorough and informative, as this is a point in the patient journey where the patient is the most vulnerable. The weekend team is often not responsible for the management of the patient throughout the week and poor or incomplete information can have disastrous consequences on patient safety. (1,2,3) There is a general consensus and anecdotal evidence that this process is variable, occasionally unsafe or of poor quality, and can be improved. (4,5,6,7,8,9,10,11) However, no standardised format is deemed optimal or available. The aim therefore, was to design and implement a weekend handover proforma, in order to deliver a more efficient and safer system for patient care over the weekend without increasing junior doctor workload. The Weekend Out Of Hours Surgical Handover (WOOSH) form was designed following consultation with medical, nursing and allied health professionals. All staff were instructed how to complete the form, with pre- and post-intervention questionnaires undertaken. The results of the study enforce and advocate the permanent practice of the WOOSH form with 93.33% endorsing the permanent introduction of the form and 100% finding the form useful.

Where Is Medical Practice In India Heading?

PubMed Central

Pandya, Sunil K.

2006-01-01

Medical practice is based on teaching, learning and examples set by seniors. Past and present practices are briefly analysed. Current trends do not justify optimism. The poor patient is likely to be sidelined as doctors reach out to the rich and powerful in this country and those bringing in American dollars from abroad. While corrective steps are possible, it is unlikely that they will be implemented. PMID:22013332

A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh.

PubMed

Darkwa, Emmanuel Kwame; Newman, M Sophia; Kawkab, Mahmud; Chowdhury, Mahbub Elahi

2015-08-27

Bangladesh is a highly populous country with three-quarters rural population. Pressing national shortages in health professionals has resulted in high vacancy rates in rural areas. These are compounded by excessive absenteeism and low retention among nurses and doctors posted to rural locations. This study attempts to ascertain reasons for providers' reluctance to work in rural and remote areas and to identify ways in which these barriers to appropriate staffing might be resolved. This is a qualitative study based on in-depth interviews with healthcare providers (n = 15) and facility managers (n = 4) posted in rural areas, and key informant interviews with health policymakers at the national level (n = 2). Interview guides were written in English and translated and administered in Bengali. The collected data were re-translated and analyzed in English. Braun and Clarke's thematic analysis approach (data familiarization, coding, identifying and reviewing themes, and producing a final report) was used. Participants reported poor living conditions in rural areas (e.g., poor housing facilities and unsafe drinking water); overwhelming workloads with poor safety and insufficient equipment; and a lack of opportunities for career development, and skill enhancement. They reported insufficient wages and inadequate opportunities for private practice in rural areas. Managers described their lack of sufficient authority to undertake disciplinary measures for absenteeism. They also pointed at the lack of fairness in promotion practices of the providers. Policymakers acknowledged unavailability or insufficient allowances for rural postings. There is also a lack of national policy on rural retention. The findings revealed a complex interplay of factors influencing doctors' and nurses' availability in rural and remote public health facilities from the perspective of different players in the healthcare delivery system of Bangladesh. In addition, the study generated several possibilities for improvement, including increased allowances and incentives for rural posting; a transparent and fair promotion system for serving in rural areas; enhanced authority of the local managers for reducing worker absenteeism; and improved national policies on rural retention.

Medical doctors in healthcare leadership: theoretical and practical challenges.

PubMed

Denis, Jean-Louis; van Gestel, Nicolette

2016-05-24

While healthcare systems vary in their structure and available resources, it is widely recognized that medical doctors play a key role in their adaptation and performance. In this article, we examine recent government and organizational policies in two different health systems that aim to develop clinical leadership among the medical profession. Clinical leadership refers to the engagement and guiding role of physicians in health system improvement. Three dimensions are defined to conduct our analysis of engaging medical doctors in healthcare leadership: the position and status of medical doctors within the system; the broader institutional context of governmental and organizational policies to engage medical doctors in clinical leadership roles; and the main factors that may facilitate or limit achievements. Our aim in this study is exploratory. We selected two contrasting cases according to their level of institutional pluralism: one national health insurance system, Canada, and one etatist social insurance system, the Netherlands. We documented the institutional dynamics of medical doctors' engagement and leadership through secondary sources, such as government websites, key policy reports, and scholarly literature on health policies in both countries. Initiatives across Canadian provinces signal that the medical profession and governments search for alternatives to involve doctors in health system improvement beyond the limitations imposed by their fundamental social contract and formal labour relations. These initiatives suggest an emerging trend toward more joint collaboration between governments and medical associations. In the Dutch system, organizational and legal attempts for integration over the past decades do not yet fit well with the ideas and interests of medical doctors. The engagement of medical doctors requires additional initiatives that are closer to their professional values and interests and that depart from an overly focus on top down performance indicators and competition. Different institutional contexts have different policy experiences regarding the engagement and leadership of medical doctors but seem to face similar policy challenges. Achieving alignment between soft (trust, collaboration) and hard (financial incentives) levers may require facilitative conditions at the level of the health system, like clarity and stability of broad policy orientations and openness to local experimentation.

'I Used to Fight with Them but Now I Have Stopped!': Conflict and Doctor-Nurse-Anaesthetists' Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital.

PubMed

Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han

2015-01-01

This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers and health workers on conflict management should be put in place. Additionally promoting communication and interaction among health workers can foster team spirit. Also resolving conflicts using the collaborating response may help to create a conducive work environment that will promote healthy work relations, which can facilitate the delivery of quality maternal and neonatal health care. However, such an approach requires that unequal power relations, which is a root cause of the conflicts is addressed.

Early EEG for outcome prediction of postanoxic coma: prospective cohort study with cost-minimization analysis.

PubMed

Sondag, Lotte; Ruijter, Barry J; Tjepkema-Cloostermans, Marleen C; Beishuizen, Albertus; Bosch, Frank H; van Til, Janine A; van Putten, Michel J A M; Hofmeijer, Jeannette

2017-05-15

We recently showed that electroencephalography (EEG) patterns within the first 24 hours robustly contribute to multimodal prediction of poor or good neurological outcome of comatose patients after cardiac arrest. Here, we confirm these results and present a cost-minimization analysis. Early prognosis contributes to communication between doctors and family, and may prevent inappropriate treatment. A prospective cohort study including 430 subsequent comatose patients after cardiac arrest was conducted at intensive care units of two teaching hospitals. Continuous EEG was started within 12 hours after cardiac arrest and continued up to 3 days. EEG patterns were visually classified as unfavorable (isoelectric, low-voltage, or burst suppression with identical bursts) or favorable (continuous patterns) at 12 and 24 hours after cardiac arrest. Outcome at 6 months was classified as good (cerebral performance category (CPC) 1 or 2) or poor (CPC 3, 4, or 5). Predictive values of EEG measures and cost-consequences from a hospital perspective were investigated, assuming EEG-based decision- making about withdrawal of life-sustaining treatment in the case of a poor predicted outcome. Poor outcome occurred in 197 patients (51% of those included in the analyses). Unfavorable EEG patterns at 24 hours predicted a poor outcome with specificity of 100% (95% CI 98-100%) and sensitivity of 29% (95% CI 22-36%). Favorable patterns at 12 hours predicted good outcome with specificity of 88% (95% CI 81-93%) and sensitivity of 51% (95% CI 42-60%). Treatment withdrawal based on an unfavorable EEG pattern at 24 hours resulted in a reduced mean ICU length of stay without increased mortality in the long term. This gave small cost reductions, depending on the timing of withdrawal. Early EEG contributes to reliable prediction of good or poor outcome of postanoxic coma and may lead to reduced length of ICU stay. In turn, this may bring small cost reductions.

Mobile and fixed computer use by doctors and nurses on hospital wards: multi-method study on the relationships between clinician role, clinical task, and device choice.

PubMed

Andersen, Pia; Lindgaard, Anne-Mette; Prgomet, Mirela; Creswick, Nerida; Westbrook, Johanna I

2009-08-04

Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions. We aimed to investigate the relationships between clinician role, clinical task, and selection of a computer hardware device in hospital wards. Twenty-seven nurses and eight doctors were observed for a total of 80 hours as they used a range of computing devices to access a computerized provider order entry system on two wards at a major Sydney teaching hospital. Observers used a checklist to record the clinical tasks completed, devices used, and location of the activities. Field notes were also documented during observations. Semi-structured interviews were conducted after observation sessions. Assessment of the physical attributes of three devices-stationary PCs, computers on wheels (COWs) and tablet PCs-was made. Two types of COWs were available on the wards: generic COWs (laptops mounted on trolleys) and ergonomic COWs (an integrated computer and cart device). Heuristic evaluation of the user interfaces was also carried out. The majority (93.1%) of observed nursing tasks were conducted using generic COWs. Most nursing tasks were performed in patients' rooms (57%) or in the corridors (36%), with a small percentage at a patient's bedside (5%). Most nursing tasks related to the preparation and administration of drugs. Doctors on ward rounds conducted 57.3% of observed clinical tasks on generic COWs and 35.9% on tablet PCs. On rounds, 56% of doctors' tasks were performed in the corridors, 29% in patients' rooms, and 3% at the bedside. Doctors not on a ward round conducted 93.6% of tasks using stationary PCs, most often within the doctors' office. Nurses and doctors were observed performing workarounds, such as transcribing medication orders from the computer to paper. The choice of device was related to clinical role, nature of the clinical task, degree of mobility required, including where task completion occurs, and device design. Nurses' work, and clinical tasks performed by doctors during ward rounds, require highly mobile computer devices. Nurses and doctors on ward rounds showed a strong preference for generic COWs over all other devices. Tablet PCs were selected by doctors for only a small proportion of clinical tasks. Even when using mobile devices clinicians completed a very low proportion of observed tasks at the bedside. The design of the devices and ward space configurations place limitations on how and where devices are used and on the mobility of clinical work. In such circumstances, clinicians will initiate workarounds to compensate. In selecting hardware devices, consideration should be given to who will be using the devices, the nature of their work, and the physical layout of the ward.

How do nursing home doctors involve patients and next of kin in end-of-life decisions? A qualitative study from Norway.

PubMed

Romøren, Maria; Pedersen, Reidar; Førde, Reidun

2016-01-14

Ethically challenging critical events and decisions are common in nursing homes. This paper presents nursing home doctors' descriptions of how they include the patient and next of kin in end-of-life decisions. We performed ten focus groups with 30 nursing home doctors. Advance care planning; aspects of decisions on life-prolonging treatment, and conflict with next of kin were subject to in-depth analysis and condensation. The doctors described large variations in attitudes and practices in all aspects of end-of-life decisions. In conflict situations, many doctors were more concerned about the opinion of next of kin than ensuring the patient's best interest. Many end-of-life decisions appear arbitrary or influenced by factors independent of the individual patient's values and interests and are not based on systematic ethical reflections. To protect patient autonomy in nursing homes, stronger emphasis on legal and ethical knowledge among nursing home doctors is needed.

UK doctors' views on the implementation of the European Working Time Directive as applied to medical practice: a quantitative analysis.

PubMed

Maisonneuve, Jenny J; Lambert, Trevor W; Goldacre, Michael J

2014-02-06

To report on doctors' views, from all specialty backgrounds, about the European Working Time Directive (EWTD) and its impact on the National Health Service (NHS), senior doctors and junior doctors. All medical school graduates from 1999 to 2000 were surveyed by post and email in 2012. The UK. Among other questions, in a multipurpose survey on medical careers and career intentions, doctors were asked to respond to three statements about the EWTD on a five-point scale (from strongly agree to strongly disagree): 'The implementation of the EWTD has benefited the NHS', 'The implementation of the EWTD has benefited senior doctors' and 'The implementation of the EWTD has benefited junior doctors'. The response rate was 54.4% overall (4486/8252), 55.8% (2256/4042) of the 1999 cohort and 53% (2230/4210) of the 2000 cohort. 54.1% (2427) of all respondents were women. Only 12% (498/4136 doctors) agreed that the EWTD has benefited the NHS, 9% (377) that it has benefited senior doctors and 31% (1289) that it has benefited junior doctors. Doctors' views on EWTD differed significantly by specialty groups: 'craft' specialties such as surgery, requiring extensive experience in performing operations, were particularly critical. These cohorts have experience of working in the NHS before and after the implementation of EWTD. Their lack of support for the EWTD 4 years after its implementation should be a concern. However, it is unclear whether problems rest with the current ceiling on hours worked or with the ways in which EWTD has been implemented.

Teaching of clinical pharmacology and therapeutics in UK medical schools: current status in 2009.

PubMed

O'Shaughnessy, Lelia; Haq, Inam; Maxwell, Simon; Llewelyn, Martin

2010-07-01

Junior doctors feel poorly prepared by their training in Clinical Pharmacology and Therapeutics and commonly make prescribing errors. Since 1993 the General Medical Council's guidance on undergraduate medical education 'Tomorrow's Doctors' has emphasized the integration of Clinical Pharmacology and Therapeutics teaching within the medical curriculum. With the publication of a new version of Tomorrow's Doctors in 2009, medical schools will be further revising their Clinical Pharmacology and Therapeutics teaching. Although we know what the recommendations for undergraduate teaching of Clinical Pharmacology and Therapeutics teaching are, there are no published data describing what is currently happening in UK medical schools. This paper describes the course structures, volume and range of teaching and assessment of Clinical Pharmacology and Therapeutics in the UK in 2009. Our data provide a foundation for schools looking to revise the Clinical Pharmacology and Therapeutics Teaching in the light of Tomorrow's Doctors 2009. To describe the current structure, delivery and assessment of Clinical Pharmacology and Therapeutics (CPT) teaching in UK medical schools. An online questionnaire was distributed to the person with overall responsibility for CPT teaching at all UK medical schools in June 2009. Thirty of the 32 UK medical schools responded. 60% of schools have a CPT course although in 72% this was an integrated vertical theme. At 70% of schools pharmacologists have overall responsibility for CPT teaching (clinical 67%, non-clinical 33%); at 20% teaching is run by a non-specialist clinician and at 7% by a pharmacist. Teaching is commonly delivered by NHS clinicians (87%) and clinical pharmacists (80%) using lectures (90%) but additionally 50% of schools use e-Learning and 63% have a student formulary. CPT is assessed throughout the curriculum at many schools through written, practical examinations and course work. 90% of schools have specific CPT content in their written examinations. 90% of respondents believed that their students were 'fairly' to 'well' prepared for the foundation year but only 37% of schools gather data on the competence of their graduates. CPT teaching in UK medical schools is very diverse. Most schools do not assess the performance of their graduates as prescribers and there is a lack of evidence that many of the teaching approaches employed are suitable for the development of prescribing skills. It is vital that developments in CPT teaching are driven by validated, real-world assessments of the prescribing skills of medical students and newly qualified doctors.

The Impact of the Internet on Health Consultation Market Concentration: An Econometric Analysis of Secondary Data.

PubMed

Li, Jia; Zhang, Ya; Ma, Ling; Liu, Xuan

2016-10-28

Many markets have traditionally been dominated by a few best-selling products, and this is also the case for the health care industry. However, we do not know whether the market will be more or less concentrated when health care services are delivered online (known as E-consultation), nor do we know how to reduce the concentration of the E-consultation market. The aim of this study was to investigate the concentration of the E-consultation market and how to reduce its concentration through information disclosure mechanisms (online reputation and self-representation). We employed a secondary data econometric analysis using transaction data obtained from an E-consultation Website (haodf.com) for three diseases (infantile pneumonia, diabetes, and pancreatic cancer) from 2008 to 2015. We included 2439 doctors in the analysis. The E-consultation market largely follows the 20/80 principle, namely that approximately 80% of orders are fulfilled by nearly 20% of doctors. This is much higher than the offline health care market. Meanwhile, the market served by doctors with strong online reputations (beta=0.207, P<.001) or strong online self-representation (beta=0.386, P<.001) is less concentrated. When health care services are delivered online, the market will be more concentrated (known as the "Superstar" effect), indicating poor service efficiency for society as a whole. To reduce market concentration, E-consultation websites should provide important design elements such as ratings of doctors (user feedback), articles contributed by doctors, and free consultation services (online representation). A possible and important way to reduce the market concentration of the E-consultation market is to accumulate enough highly rated or highly self-represented doctors. ©Jia Li, Ya Zhang, Ling Ma, Xuan Liu. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 28.10.2016.

Differences in sickness absence between self-employed and employed doctors: a cross-sectional study on national sample of Norwegian doctors in 2010

PubMed Central

2014-01-01

Background Doctors have a low prevalence of sickness absence. Employment status is a determinant in the multifactorial background of sickness absence. The effect of doctors’ employment status on sickness absence is unexplored. The study compares the number of sickness absence days during the last 12 months and the impact of employment status, psychosocial work stress, self-rated health and demographics on sickness absence between self-employed practitioners and employed hospital doctors in Norway. Methods The study population consisted of a representative sample of 521 employed interns and consultants and 313 self-employed GPs and private practice specialists in Norway, who received postal questionnaires in 2010. The questionnaires contained items on sickness absence days during the last 12 months, employment status, demographics, self-rated health, professional autonomy and psychosocial work stress. Results 84% (95% CI 80 to 88%) of self-employed and 60% (95% CI 55 to 64%) of employed doctors reported no absence at all last year. In three multivariate logistic regression models with sickness absence as response variable, employment category was a highly significant predictor for absence vs. no absence, 1 to 3 days of absence vs. no absence and 4 to 99 days of absence vs. no absence), while in a model with 100 or more days of absence vs. no absence, there was no difference between employment categories, suggesting that serious chronic disease or injury is less dependent on employment category. Average or poor self-rated health and low professional autonomy, were also significant predictors of sickness absence, while psychosocial work stress, age and gender were not. Conclusion Self-employed GPs and private practice specialist reported lower sickness absence than employed hospital doctors. Differences in sickness compensation, and organisational and individual factors may to a certain extent explain this finding. PMID:24885230

Dual practice by doctors working in South and East Asia: a review of its origins, scope and impact, and the options for regulation.

PubMed

Hipgrave, David Barry; Hort, Krishna

2014-09-01

Health professionals often undertake private work whilst also employed by government. Such dual practice (DP) is found in both high-income and lower- and middle-income countries (LMIC) around the world, with varying degrees of tolerance. This review focuses on DP in South and East Asia in the context of the rapidly expanding mixed health systems in this region. Although good data are lacking, health service uptake in South and East Asia is increasing, particularly in the private sector. Appropriately regulated, DP can improve health service access, the range of services offered and doctors' satisfaction. By contrast, weakly regulated DP can negatively affect public health service access, quality, efficiency and equity, as doctors often pursue the balance of public and private work that maximizes their income and other benefits. The environment for regulation of DP is changing rapidly, with improved communications opportunities, increasing literacy and rising civil society, particularly in this region. Currently, the options for regulating DP include (1) those which restrict the opportunities for dual practitioners to prioritize income and other benefits over their responsibility to the public; these require a level of regulatory capacity often missing in LMIC governments; and (2) those which not only tolerate public-sector doctors' private work but also encourage adequate health services for the general public. Growth of the private sector and weak regulation in South and East Asia increases the risk that dual practitioners will ignore the poor. Responsive and decentred regulation of doctors involving professional associations, civil society and other stakeholders is increasingly recommended. Moreover, as governments in LMIC strive for universal health coverage, market and financing opportunities for regulation of DP may arise, particularly involving insurers. This may also help to improve the current imbalance in the urban-rural distribution of doctors. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

[Forensic aspect of acute drunkenness].

PubMed

de Lentaigne de Logiviere, Xavier; Gignon, Maxime; Amsallem, Carole; Jarde, Olivier; Manaouil, Cécile

2015-06-01

Alcohol consumption in itself is not forbidden in France. Two situations are reprehended by the law: public drunkenness - where only the behavior is sanctioned and not the alcohol level - and driving with a level of alcohol superior to 0.5g per liter. The management of a severe state of drunkenness - even though frequent - is on the one hand poorly managed and on the other hands badly mastered by doctors. The management of drunken patients lies essentially in a strong monitoring of the possible complications. The inherent question of the returning-back-home for a drunken patient should be approached according to the state of consciousness rather than the alcohol rate in the blood. No matter what the rate is, the authorization to release a patient depends on the preservation of his judgmental capacities. If those are altered, the doctor can then decide to keep - even against his will - the patient temporarily and until he has recovered his discernment. Patients still keep their right to refuse any medical treatment. Indeed, the law does not provide any answer concerning the particular issue of the refusal of medical care by the patient, especially in case of a severe alcoholic intoxicated state that let the patient incapable to express his will and to understand the range of the given information. There is no legal measure that can able a doctor to firmly forbid a drunk patient to be released and to take the wheel. Doctors have to try to dissuade them by proposing other alternatives but they cannot physically oppose themselves to the patient decision. However, proofs that the doctor tried his best to convince the patient not to drive while under the influence of alcohol can be demanded. Doctors have the duty to inform patients on every risk that alcohol can bring while driving but do not have any measure of pressure. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Audit on the Quality of Handovers of a Psychiatric Liaison Team in the UK: a Short Report.

PubMed

Koli, Trupti; Filippidou, Maria

2017-09-01

The importance of handovers has been recognised and proven in clinical practice. In liaison psychiatry, this is particularly important due to the high turnover of patients seen, the shift work pattern and the number of member staff engaging in this process. An Audit on the Quality of Handovers was carried out within a Psychiatric Liaison team of a General hospital in UK with an intention to review and improve this. Handovers were evaluated against the gold standard of the SBAR tool (Situation/Background/Assessment/Recommendations) over a period of 4 weeks. Handovers were assessed by 2 members of staff (a Consultant & a Specialty doctor). Data was analysed using Microsoft Excel. Results showed that the team's handover practice is mostly "Good" but there was also an amount of "Poor" under "Situation & Background", mostly presented by mid-grade doctors & trainees. Nurses scored higher than medics on overall rating, nearly 50%.This could be attributed to the fact that handovers form an essential & integral part of Nurse's training & culture. Also mid-grade (staff grade) doctors have had a significant amount of "excellent" scoring that other groups didn't have, mostly on the Assessment & Recommendations domains, which can be attributed to the fact that importance is stressed more on the assessment & treatment module by the doctors. The multi-disciplinary composition of the liaison psychiatry team has a positive impact on the patient care. This audit has revealed overall good communication amongst the members of the team, nevertheless one that needs some improvement, particularly amongst the doctors. Doctors tend to focus on the remedial (assessment & treatment) module rather than the holistic approach. SBAR remains an effective & handy tool to improve the handover quality. A re-audit will be carried out in 6 months time to assess the improvements observed following the implementation of this new tool.

An Australian government dental scheme: Doctor-dentist-patient tensions in the triangle.

PubMed

Weerakoon, Arosha; Fitzgerald, Lisa; Porter, Suzette

2014-11-30

Autonomy of participants is challenged when legislation to provide a public health service is weakly designed and implemented. Australia's Chronic Disease Dental Scheme was instigated to provide a government subsidy for private dental treatment for people suffering chronic illness impacting their oral health or vice versa. They were allocated AUD$4250 towards comprehensive treatment over 2 years with their eligibility determined by their general medical doctor. A qualitative research study was conducted to explore the experiences from the perspectives of the patient, medical and dental practitioner. One of the research outcomes identified a frequently reported level of discomfort in the patient/doctor/dentist triangle. Doctors and dentists reported feeling forced by patients into positions that compromised their autonomy in obeying the intent (if not the law) of the scheme. Additionally, dentists felt under pressure from doctors and patients to provide subsidized treatment to those eligible. In turn, the patients reported difficulties in gaining access to the scheme and in some cases, experiencing full or partially unmet oral health needs. REASON FOR CONFLICT: Poor inter-professional communication and lack of understanding about profession-unique patient-driven pressures, ultimately contributed to dissonance. Ill-defined eligibility guidelines rendered the doctor's ability to gate-keep challenging. OUTCOME OF CONFLICT: Inefficient gate-keeping led to exponential increase in referrals, resulting in unprecedented cost blow-outs. Ensuing government-led audits caused political tensions and contributed to the media-induced vilification of dentists. In December 2013, government financing of dental treatment through Chronic Disease Dental Scheme was discontinued, leaving many Australians without a viable alternative. There is a need for qualitative research methods to help identify social issues that affect public health policy process. In order to succeed, new health policies should respect, consider and attempt to understand the autonomy of key participants, prior to and throughout.

Doctor, Teacher, and Stethoscope: Neural Representation of Different Types of Semantic Relations.

PubMed

Xu, Yangwen; Wang, Xiaosha; Wang, Xiaoying; Men, Weiwei; Gao, Jia-Hong; Bi, Yanchao

2018-03-28

Concepts can be related in many ways. They can belong to the same taxonomic category (e.g., "doctor" and "teacher," both in the category of people) or be associated with the same event context (e.g., "doctor" and "stethoscope," both associated with medical scenarios). How are these two major types of semantic relations coded in the brain? We constructed stimuli from three taxonomic categories (people, manmade objects, and locations) and three thematic categories (school, medicine, and sports) and investigated the neural representations of these two dimensions using representational similarity analyses in human participants (10 men and nine women). In specific regions of interest, the left anterior temporal lobe (ATL) and the left temporoparietal junction (TPJ), we found that, whereas both areas had significant effects of taxonomic information, the taxonomic relations had stronger effects in the ATL than in the TPJ ("doctor" and "teacher" closer in ATL neural activity), with the reverse being true for thematic relations ("doctor" and "stethoscope" closer in TPJ neural activity). A whole-brain searchlight analysis revealed that widely distributed regions, mainly in the left hemisphere, represented the taxonomic dimension. Interestingly, the significant effects of the thematic relations were only observed after the taxonomic differences were controlled for in the left TPJ, the right superior lateral occipital cortex, and other frontal, temporal, and parietal regions. In summary, taxonomic grouping is a primary organizational dimension across distributed brain regions, with thematic grouping further embedded within such taxonomic structures. SIGNIFICANCE STATEMENT How are concepts organized in the brain? It is well established that concepts belonging to the same taxonomic categories (e.g., "doctor" and "teacher") share neural representations in specific brain regions. How concepts are associated in other manners (e.g., "doctor" and "stethoscope," which are thematically related) remains poorly understood. We used representational similarity analyses to unravel the neural representations of these different types of semantic relations by testing the same set of words that could be differently grouped by taxonomic categories or by thematic categories. We found that widely distributed brain areas primarily represented taxonomic categories, with the thematic categories further embedded within the taxonomic structure. Copyright © 2018 the authors 0270-6474/18/383303-15$15.00/0.

AME survey-003 A1-part 2: the motivation factors of medical doctors in China

PubMed Central

Káplár, Zoltán; Lǐ, Yáo T.

2015-01-01

Background The professional moral and job satisfaction of medical profession remain highly disputed in media in China. On the other hand, there is wide disaffection of patients toward doctors in China. This survey aims to obtain a better understanding of the motivation of Chinese medical professionals. Methods An anonymous online cross-sectional survey, AME survey III, was conducted using the platform provided by DXY (www.dxy.cn) during the period of September 10-23, 2015. In total 2,356 DXY users completed the survey, including 1,740 males and 617 females, with a mean age of 31.96±7.03 yrs. Results The reasons (multiple choices) for career disaffection included poor patient/doctor relationship (88.6%), imbalance between workload and pay (79.5%), could not enter the preferred specialty (14.14%), and working in small clinics with no career progress (11.17%). If given the choice to enter the specialty as well as the hospital grade of their choice, 73.8% dissatisfied respondents replied they would like to be a doctor. For the dis-satisfied respondents, university teacher appeared to be the most popular career choice. The cited high workload was considered to be due to (I) imbalance in geographical allocation of doctors and insufficient training of doctors; (II) many red-tapism formalities; (III) Chinese patients often have unreasonable requests; (IV) over-examination and over-treatment; (V) high pressure to publish papers. One hundred and twelve respondents have their child/children attending university or graduated from university, 25.0% of them are pursuing a career in medicine. Nine hundred and ninety respondents have child/children while did not reach university age yet, among them 23.62% would like their child/children to study medicine. 64.87% of the 2,356 participants favor China to open up medical market to qualified foreign medical organizations to take part in fair competition, and 57.91% favor the government supporting regulated private hospitals. Conclusions The moral and motivation of medical doctors in China are likely to be similar to other continuously evolving societies. Cost-effective use of existing resources should be explored as the first priority. PMID:26807373

AME survey-003 A1-part 2: the motivation factors of medical doctors in China.

PubMed

Wáng, Yì-Xiáng J; Káplár, Zoltán; L, Yáo T

2015-12-01

The professional moral and job satisfaction of medical profession remain highly disputed in media in China. On the other hand, there is wide disaffection of patients toward doctors in China. This survey aims to obtain a better understanding of the motivation of Chinese medical professionals. An anonymous online cross-sectional survey, AME survey III, was conducted using the platform provided by DXY (www.dxy.cn) during the period of September 10-23, 2015. In total 2,356 DXY users completed the survey, including 1,740 males and 617 females, with a mean age of 31.96±7.03 yrs. The reasons (multiple choices) for career disaffection included poor patient/doctor relationship (88.6%), imbalance between workload and pay (79.5%), could not enter the preferred specialty (14.14%), and working in small clinics with no career progress (11.17%). If given the choice to enter the specialty as well as the hospital grade of their choice, 73.8% dissatisfied respondents replied they would like to be a doctor. For the dis-satisfied respondents, university teacher appeared to be the most popular career choice. The cited high workload was considered to be due to (I) imbalance in geographical allocation of doctors and insufficient training of doctors; (II) many red-tapism formalities; (III) Chinese patients often have unreasonable requests; (IV) over-examination and over-treatment; (V) high pressure to publish papers. One hundred and twelve respondents have their child/children attending university or graduated from university, 25.0% of them are pursuing a career in medicine. Nine hundred and ninety respondents have child/children while did not reach university age yet, among them 23.62% would like their child/children to study medicine. 64.87% of the 2,356 participants favor China to open up medical market to qualified foreign medical organizations to take part in fair competition, and 57.91% favor the government supporting regulated private hospitals. The moral and motivation of medical doctors in China are likely to be similar to other continuously evolving societies. Cost-effective use of existing resources should be explored as the first priority.

Trainers, Illusionists, Tricksters, and Escapists: Changing the Doctoral Circus

ERIC Educational Resources Information Center

Mullen, Carol A.

2007-01-01

The success of doctoral student mentoring is largely dependent upon faculty members, but structural and institutional obstacles compound deficiencies in the performance of all participants. University leaders must emphasize the value of mentorship in stimulating positive learning conditions and stress the importance of recognizing faculty members…

[Dieffenbachia poisoning in an infant].

PubMed

Mocking, Roel J T; Schene, Kiry M; Maingay-Visser, Dianne A P G F

2015-01-01

Plant poisoning is becoming an increasingly common reason to consult a doctor. A 7-month-old infant was sent to the emergency room by her general practitioner with a suspected apparent life-threatening event (ALTE). Her parents reported the sudden development of fluctuating restlessness and listlessness, superficial breathing, vomiting, drowsiness and episodes of loss of consciousness. On physical examination we saw a pale, listless and variably responsive girl. During admission for observation, she improved within a few hours, although she had one episode of blood admixture with the stool. After discharge from hospital, the infant's grandmother suggested that the symptoms could be due to poisoning from a Dieffenbachia plant. The literature supports this explanation. Young parents and doctors appear to know little about plant toxicity in general and Dieffenbachia in particular. In small children with poorly-understood symptoms, the possibility plant poisoning should be considered.

The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers

PubMed Central

Moosa, Shabir; Wojczewski, Silvia; Hoffmann, Kathryn; Poppe, Annelien; Nkomazana, Oathokwa; Peersman, Wim; Willcox, Merlin; Derese, Anselme; Mant, David

2014-01-01

Background Many low-income and middle-income countries globally are now pursuing ambitious plans for universal primary care, but are failing to deliver adequate care quality because of intractable human resource problems. Aim To understand why migrant nurses and doctors from sub-Saharan Africa did not wish to take up available posts in primary and first-contact care in their home countries. Design and setting Qualitative study of migrant health workers to Europe (UK, Belgium, and Austria) or southern Africa (Botswana and South Africa) from sub-Saharan Africa. Method Semi-structured interviews with 66 health workers (24 nurses and 42 doctors) from 18 countries between July 2011 and April 2012. Transcripts were analysed thematically using a framework approach. Results The reasons given for choosing not to work in primary care were grouped into three main analytic streams: poor working environment, difficult living experiences, and poor career path. Responders described a lack of basic medicines and equipment, an unmanageable workload, and lack of professional support. Many had concerns about personal security, living conditions (such as education for children), and poor income. Primary care was seen as lower status than hospital medicine, with lack of specialist training opportunities and more exposure to corruption. Conclusions Clinicians are reluctant to work in the conditions they currently experience in primary care in sub-Saharan Africa and these conditions tend to get worse as poverty and need for primary care increases. This inverse primary care law undermines achievement of universal health coverage. Policy experience from countries outside Africa shows that it is not immutable. PMID:24868069

The inverse primary care law in sub-Saharan Africa: a qualitative study of the views of migrant health workers.

PubMed

Moosa, Shabir; Wojczewski, Silvia; Hoffmann, Kathryn; Poppe, Annelien; Nkomazana, Oathokwa; Peersman, Wim; Willcox, Merlin; Derese, Anselme; Mant, David

2014-06-01

Many low-income and middle-income countries globally are now pursuing ambitious plans for universal primary care, but are failing to deliver adequate care quality because of intractable human resource problems. To understand why migrant nurses and doctors from sub-Saharan Africa did not wish to take up available posts in primary and first-contact care in their home countries. Qualitative study of migrant health workers to Europe (UK, Belgium, and Austria) or southern Africa (Botswana and South Africa) from sub-Saharan Africa. Semi-structured interviews with 66 health workers (24 nurses and 42 doctors) from 18 countries between July 2011 and April 2012. Transcripts were analysed thematically using a framework approach. The reasons given for choosing not to work in primary care were grouped into three main analytic streams: poor working environment, difficult living experiences, and poor career path. Responders described a lack of basic medicines and equipment, an unmanageable workload, and lack of professional support. Many had concerns about personal security, living conditions (such as education for children), and poor income. Primary care was seen as lower status than hospital medicine, with lack of specialist training opportunities and more exposure to corruption. Clinicians are reluctant to work in the conditions they currently experience in primary care in sub-Saharan Africa and these conditions tend to get worse as poverty and need for primary care increases. This inverse primary care law undermines achievement of universal health coverage. Policy experience from countries outside Africa shows that it is not immutable. © British Journal of General Practice 2014.

A geriatric assessment in general practice: prevalence, location, impact and doctor-patient perceptions of pain.

PubMed

Kruschinski, Carsten; Wiese, Birgitt; Dierks, Marie-Luise; Hummers-Pradier, Eva; Schneider, Nils; Junius-Walker, Ulrike

2016-01-28

To investigate what a geriatric assessment in general practice adds towards previous findings of prevalence, location, impact and the dyadic doctor-patient perception of pain in this age group. Cross-sectional study. Consecutive patients aged 70 and over underwent a comprehensive geriatric assessment in general practice that included a basic pain assessment (severity, sites and impact). Patients with pain and their doctors then independently rated its importance. Pain was correlated with further findings from the assessment, such as overall health, physical impairments, everyday function, falls, mood, health related lifestyle, social circumstances, using bivariate and multivariate statistics. Patient-doctor agreement on the importance of pain was calculated using kappa statistics. 219 out of 297 patients (73.7 %) reported pain at any location. Pain was generally located at multiple sites. It was most often present at the knee (33.9%), the lumbar spine (33.5%) as well as the hip (13.8%) and correlated with specific impairments such as restrictions of daily living (knee) or sleep problems (spine). Patients with pain and their physicians poorly agreed on the importance of the pain problem. A basic pain assessment can identify older patients with pain in general practice. It has resulted in a high prevalence exceeding that determined by encounters in consultations. It has been shown that a geriatric assessment provides an opportunity to address pain in a way that is adapted to older patients' needs - addressing all sites, its specific impact on life, and the patients' perceived importance of pain. Since there is little doctor-patient agreement, this seems a valuable strategy to optimize concrete treatment decisions and patient centered care. This study is registered in the German Clinical Trial Register ( DRKS00000792 ).

Malaysian primary care doctors' views on men's health: an unresolved jigsaw puzzle.

PubMed

Tong, Seng Fah; Low, Wah Yun; Ismail, Shaiful Bahari; Trevena, Lyndal; Willcock, Simon

2011-05-12

Men have been noted to utilise health care services less readily then women. Primary care settings provide an opportunity to engage men in health care activities because of close proximity to the target group (men in the community). Understanding attitudes towards men's health among Malaysian primary care doctors is important for the effective delivery of health services to men. We aimed to explore the opinions and attitudes of primary care doctors (PCDs) relating to men's health and help-seeking behaviour. A qualitative approach to explore the opinions of 52 PCDs was employed, using fourteen in-depth interviews and eight focus group discussions in public and private settings. Purposive sampling of PCDs was done to ensure maximum variation in the PCD sample. Interviews were recorded and transcribed verbatim for analysis. Open coding with thematic analysis was used to identify key issues raised in the interview. The understanding of the concept of men's health among PCDs was fragmented. Although many PCDs were already managing health conditions relevant and common to men, they were not viewed by PCDs as "men's health". Less attention was paid to men's help-seeking behaviour and their gender roles as a potential determinant of the poor health status of men. There were opposing views about whether men's health should focus on men's overall health or a more focused approach to sexual health. There was also disagreement about whether special attention was warranted for men's health services. Some doctors would prioritise more common conditions such as hypertension, diabetes and hypercholesterolaemia. The concept of men's health was new to PCDs in Malaysia. There was wide variation in understanding and opposing attitudes towards men's health among primary care doctors. Creating awareness and having a systematic approach would facilitate PCDs in delivering health service to men.

Marcel Proust's fictional diseases and doctors.

PubMed

Bogousslavsky, Julien

2013-01-01

Marcel Proust (1875-1922), the son and brother of famous physicians, had close and continuous contact with medicine and doctors in connection with chronic asthma, neurasthenia, medical 'tourism', and self-medication. This proximity to medical issues is obvious in his work, particularly his novel In Search of Lost Time, which today is still considered one of the most important literary works ever. In this novel, medicine, patients, and doctors are everywhere, and it can be claimed that while it is often considered to be the great novel of memory, medicine in itself also can be seen as a true character of the story, in which Proust displays surprisingly extensive knowledge. Neurasthenia and asthma (i.e. Proust's diseases), as well as specific neurological disorders, such as stroke, migraine, epilepsy, and dementia, appear in the novel. The disease of the narrator's grandmother remains a piece of anthology, and probably remains the best literary report of a progressive stroke leading to death. Proust also quoted neurological conditions which were virtually unreported in his time, such as phantom limb syndrome and poststroke depression associated with aphasia in Baron Charlus. Doctors are nearly systematically depicted as incompetent and superficial, characteristics which appear to increase with academic titles and glory. The main physician of the novel, Professor Cottard, even ends up writing fake certificates for his rich friend Mrs. Verdurin during World War I so that she can obtain fresh croissants for breakfast, while poor people around her are starving. When called to examine a dying patient, one of the real doctors of the novel, Professor Dieulafoy, says and does nothing except ask for his fees. This defiance and criticism of physicians were indeed those of Proust in real life. Copyright © 2013 S. Karger AG, Basel.

Evidence-based medicine knowledge, attitudes, and practices among doctors in Sri Lanka.

PubMed

Abeysena, Chrishantha; Jayawardana, Pushpa; Wickremasinghe, Rajitha; Wickramasinghe, Uthpala

2010-05-01

To assess knowledge, attitudes, and practices on evidence-based medicine (EBM) among doctors in selected hospitals in Sri Lanka. A cross-sectional descriptive study was conducted among 315 doctors in five government hospitals in Sri Lanka between December 2007 and January 2008. A pre-tested self-administered questionnaire was used to gather information on knowledge, attitudes, and practices. Of the 407 invited, 315 doctors participated, among whom, 87% (271) had heard the term EBM, 30% (n= 94) were aware of the Cochrane Library, and 8.5% (n= 27) were current users of it. Forty-seven per cent (n= 148) claimed to understand the terms systematic review and 37% (n= 115) meta-analysis. Twenty-four per cent (n= 77) had been exposed to some form of EBM training. All three components of EBM were known by 18% (n= 56) of participants. Attitudes toward EBM were positive among 76% (n= 239), 80% (n= 251) believed the practice of EBM would lead to improved patient care, and 77% (n= 243) considered EBM to be fundamental to professional practice. Just 3% (n= 13) considered it unimportant. EBM was used in clinical practice by 54% (n= 169) of participants. Thirty-six per cent (n= 114) referred to EBM sources when relevant. Available clinical guidelines were referred to by 56% (n= 176), and 34% (n= 107) thought that available guidelines provide sufficient support for the practice of EBM. The main barriers to practicing EBM were insufficient resources, overwork, lack of exposure to EBM, and lack of time and lack of endorsement of the need to practice EBM. Knowledge and practices of EBM among Sri Lanka doctors were poor. However, attitudes toward EBM were relatively good. © 2010 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Communication skills in context: trends and perspectives.

PubMed

van Dalen, Jan

2013-09-01

Doctor-patient communication has been well researched. Less is known about the educational background of communication skills training. Do we aim for optimal performance of skills, or rather attempt to help students become skilled communicators? An overview is given of the current view on optimal doctor-patient communication. Next we focus on recent literature on how people acquire skills. These two topics are integrated in the next chapter, in which we discuss the optimal training conditions. A longitudinal training design has more lasting results than incidental training. Assessment must be in line with the intended learning outcomes. For transfer, doctor-patient communication must be addressed in all stages of health professions training. Elementary insights from medical education are far from realised in many medical schools. Doctor-patient communication would benefit strongly from more continuity in training and imbedding in the daily working contexts of doctors. When an educational continuum is realised and attention for doctor-patient communication is embedded in the working context of doctors in training the benefits will be strong. Training is only a part of the solution. In view of the current dissatisfaction with doctor-patient communication a change in attitude of course directors is strongly called for. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Doctors as managers of healthcare resources in Nigeria: Evolving roles and current challenges

PubMed Central

Ojo, Temitope Olumuyiwa; Akinwumi, Adebowale Femi

2015-01-01

Over the years, medical practice in Nigeria has evolved in scope and practice, in terms of changing disease patterns, patients' needs, and social expectations. In addition, there is a growing sentiment especially among the general public and some health workers that most doctors are bad managers. Besides drawing examples from some doctors in top management positions that have performed less creditably, critics also harp on the fact that more needs to be done to improve the training of doctors in health management. This article describes the role of doctors in this changing scene of practice and highlights the core areas where doctors' managerial competencies are required to improve the quality of healthcare delivery. Areas such as health care financing, essential drugs and supplies management, and human resource management are emphasized. Resources to be managed and various skills needed to function effectively at the different levels of management are also discussed. To ensure that doctors are well-skilled in managerial competencies, the article concludes by suggesting a curriculum review at undergraduate and postgraduate levels of medical training to include newer but relevant courses on health management in addition to the existing ones, whereas also advocating that doctors be incentivized to go for professional training in health management and not only in the core clinical specialties. PMID:26903692

Evaluation of a Professional Practice Model in the Ambulatory Care Setting

DTIC Science & Technology

2014-03-10

were truly grotesque! (FM T2); Communication about rescheduling is very poor. When messages are left for doctors or nurses 98% there is not return... Nursing Research TSNRP Program, 4301 Jones Bridge RD Bethesda, MD 20814 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 12. DISTRIBUTION...across three time periods. Sample/Methods: Nursing staff (n=42) and patients (n=1220) were recruited using non-purposive sampling for the satisfaction

A proposal for health care management and leadership education within the UK undergraduate medical curriculum.

PubMed

Mafe, Cecilia; Menyah, Effie; Nkere, Munachi

2016-01-01

Health care management and leadership education is an important gap in the undergraduate medical curriculum. Lack of training promotes poor decision making and may lead to inadequate health services, adversely affecting patients. We propose an integrated approach to health care management and leadership education at undergraduate level, to enable doctors to be effective leaders and manage resources appropriately and to ultimately improve patient care.

Can economic deprivation protect health? Paradoxical multilevel effects of poverty on Hispanic children's wheezing.

PubMed

Collins, Timothy W; Kim, Young-an; Grineski, Sara E; Clark-Reyna, Stephanie

2014-08-06

Prior research suggests that economic deprivation has a generally negative influence on residents' health. We employ hierarchical logistic regression modeling to test if economic deprivation presents respiratory health risks or benefits to Hispanic children living in the City of El Paso (Texas, USA) at neighborhood- and individual-levels, and whether individual-level health effects of economic deprivation vary based on neighborhood-level economic deprivation. Data come from the US Census Bureau and a population-based survey of El Paso schoolchildren. The dependent variable is children's current wheezing, an established respiratory morbidity measure, which is appropriate for use with economically-deprived children with an increased likelihood of not receiving a doctor's asthma diagnosis. Results reveal that economic deprivation (measured based on poverty status) at both neighborhood- and individual-levels is associated with reduced odds of wheezing for Hispanic children. A sensitivity analysis revealed similar significant effects of individual- and neighborhood-level poverty on the odds of doctor-diagnosed asthma. Neighborhood-level poverty did not significantly modify the observed association between individual-level poverty and Hispanic children's wheezing; however, greater neighborhood poverty tends to be more protective for poor (as opposed to non-poor) Hispanic children. These findings support a novel, multilevel understanding of seemingly paradoxical effects of economic deprivation on Hispanic health.

Psychosocial risks and stress as predictors of burnout in junior doctors performing emergency guards

PubMed

Fernández-Prada, María; González-Cabrera, Joaquín; Iribar-Ibabe, Concepción; Peinado, José María

2017-01-01

To study the stress, the psychosocial risks associated to the job and the burnout, in a group of junior doctors working at the emergency ward; and to analyze what of those variables could predict and are better related with burnout. Cross-sectional study, with a sample of 42 junior doctors which are on duty in the emergency ward of the University Hospital San Cecilio, Granada (Spain). The Spanish adapted version of the Perceived Stress Scale was used to evaluate stress, the Maslach Burnout Inventory (MBI) to evaluate the professional burnout and the adapted and scaled questionnaire for the self-evaluation of psychosocial risks at work (CopSoQ-ISTAS21). 78% of the junior doctors are in the unfavorable or intermediate range for all CopSoQ-ISTAS21 dimensions, being particularly relevant that 90% of them display unfavorable score in psychological demands. In addition, MBI results show that 45% of our population presents high emotional exhaustion simultaneously to high depersonalization. ISTAS21 psychological demands dimensions (ß = 0.393; p < 0.003) and stress scores (ß = 0.451; p < 0.001) significantly predict emotional exhaustion (r 2 = 0.443). Finally, 38% of junior doctors experienced a threat/aggression during their work in the emergency ward urgencies. Junior doctors develop its professional activity under adverse circumstances probably due to the high psychosocial risk associated to the job. Psychological demands are suggested as the main predicting factor of burnout. These results indicate the need of psychological and structural interventions in order to improve the professional performance of junior doctors at the emergency ward. Copyright: © 2017 SecretarÍa de Salud

Design of an Online Curriculum Promoting Transformative Learning in Post Professional Doctoral Students

ERIC Educational Resources Information Center

Provident, Ingrid; Salls, Joyce; Dolhi, Cathy; Schreiber, Jodi; Mattila, Amy; Eckel, Emily

2015-01-01

Written reflections of 113 occupational therapy clinical doctoral students who graduated from an online program between 2007 and 2013 were analyzed for themes which reflected transformative learning and characteristics of curricular design which promoted transformative learning. Qualitative analyses of written reflections were performed. Several…

Is Fly in/Fly out (FIFO) a viable interim solution to address remote medical workforce shortages?

PubMed

Margolis, Stephen A

2012-01-01

Geographically remote regions of Australia experience a higher degree of socioeconomic inequality and health inequity, amid poor resourcing and extreme climatic conditions, when compared with their more urban counterparts. Doctors with the knowledge, skills and interest in remote work remain a scarce resource, with only 58 practitioners per 100,000 people versus 196/100,000 in metropolitan areas. Pending the arrival of the full complement of long-term remote medical workforce, an alternative solution that has so far received little attention but could provide near equivalence to resident doctors is the 'fly in/fly out' (FIFO) model. Specifically, where one doctor has a continuous relationship with one town or community, albeit spending their rostered time off away from this location, rather than continuity of service with different doctors each time. In this model, doctors spend a fixed number of days at work geographically remote from their home and families, with logistical support (eg housing, transport) provided, followed by a fixed number of days back at home not working. This provides a the doctor with the benefits of remote clinical work plus guaranteed time off at home, a more acceptable roster than in many remote locations at present. This also avoids the complex issue of experienced doctors having to leave remote areas mid-career for the well-documented reasons of spouse employment and children's education, as well as providing easier access to professional development activities. The author followed this path and remains a FIFO doctor after 7 years of continuous service. For FIFO to be effective, there needs to be a commitment from the sponsoring organisation for short, balanced, flexible, family friendly rosters and a positive organizational structure with effective communication between management and front line staff. Evidence shows that families and children with healthy family functioning, who are able to balance separateness and togetherness and are able to readily adjust when circumstances move from stability through change, and have strong communication skills, cope well with FIFO work. The author's employer actively supports his FIFO work arrangements. Although FIFO presents challenges and is not for everyone, it may be time for organisations providing medical care to remote Australia to further consider this option. Allowing mid-career doctors experienced in remote medicine to continue remote clinical practice when they move to the city for family reasons would provide an immediate benefit to remote communities. Notwithstanding the challenges, perhaps it is time to consider the option of FIFO to address ongoing workforce shortages?

FM-MAP: A Novel In-Training Examination Predicts Success on Family Medicine Certification Examination.

PubMed

Iglar, Karl; Leung, Fok-Han; Moineddin, Rahim; Herold, Jodi

2017-05-01

The objective of our study was to assess the correlation between a locally developed In-Training Examination (ITE) and the certification examination in family medicine in Canada. The ITE was taken twice yearly, which corresponded for most residents to the fifth, ninth, 17th, and 21st month of training. The results for the ITE were correlated to the CFPC certification examination taken in the 23rd month of residency. The scores on each of the four iterations of the ITE correlated moderately well with performance relating to problem solving skills and knowledge on the certification examination. The ITE showed a trend to an increased correlation with duration in the training program with a Spearman correlation coefficient increasing from 0.45 on the first test to 0.54 on the fourth test. The correlation of the ITE with performance on the component assessing the doctor- patient relationship on the certification examination was poor (r=0.26 on the last test). Our in-training examination is a useful predictor of performance in problem solving and knowledge domains of the family medicine expert role on the certification examination.

The Southeast Scotland Foundation Doctor Teaching Programme--is "near-peer" teaching feasible, efficacious and sustainable on a regional scale?

PubMed

Rodrigues, Jeremy; Sengupta, Anshuman; Mitchell, Alana; Kane, Christopher; Kane, Clare; Maxwell, Simon; Cameron, Helen; Ross, Michael; Ford, Michael

2009-02-01

Peer-assisted learning has advantages for students and tutors. We aimed to establish a novel 'near-peer' teaching scheme delivered by junior doctors for final-year medical students in Southeast Scotland. We report feedback from students regarding the perceived utility of this scheme, the results of a randomized controlled trial (RCT) of its impact, and mechanisms for quality assurance and sustainability. The scheme was devised by newly qualified doctors. Following open recruitment and tutor training, junior doctor-led sessions were provided on clinical examination and practical prescribing in 2006-2008. Feedback was sought using anonymized questionnaires. An RCT was performed to assess the effect of attendance at a prescribing tutorial on performance in a mock assessment. Of 271 students in 2006-2007, 234 (86%) completed voluntary feedback and 233 (99%) expressed interest in attending more tutorials. In the RCT, students who received a tutorial made fewer dosing errors (9 vs. 22, p = 0.049). The majority of tutors attending the training symposium felt the experience was useful and helped prepare them for teaching. 'Near-peer' teaching is a popular adjunct to the undergraduate programme and may promote junior doctors' professional development. Such schemes can be devised and delivered by juniors in conjunction with university staff.

Attachment in the doctor-patient relationship in general practice: a qualitative study.

PubMed

Frederiksen, Heidi Bøgelund; Kragstrup, Jakob; Dehlholm-Lambertsen, Birgitte

2010-09-01

To explore why interpersonal continuity with a regular doctor is valuable to patients. A qualitative study based on 22 interviews with patients, 12 who saw their regular general practitioner (GP) and 10 who saw an unfamiliar GP. The patients were selected after an observed consultation and sampled purposively according to reason for encounter, age, and sex. The research question was answered by means of psychological theory. A need for attachment was a central issue for the understanding of the value of interpersonal continuity for patients. The patients explained that they preferred to create a personal relationship with their GP and the majority expressed a degree of vulnerability in the doctor-patient relationship. The more sick or worried they were the more vulnerable and the more in need of a regular GP. Furthermore, patients stated that it was difficult for them to change GP even if they had a poor relationship. Attachment theory may provide an explanation for patients' need to see a regular GP. The vulnerability of being a patient creates a need for attachment to a caregiver. This need is fundamental and is activated in adults when they are sick or scared.

They say it runs in the family: diabetes and inheritance in Oaxaca, Mexico.

PubMed

Everett, Margaret

2011-06-01

The globalization of genetic discourses, especially where ethnicity is treated as a "risk factor" for disease, deserves special attention and concern. In countries such as Mexico, with large indigenous populations, the consequences of the Thrifty Genotype hypothesis and/or the attribution of type 2 diabetes to "family history" may be especially detrimental to poor rural communities, playing as they do into existing racial hierarchies. Based on semi-structured interviews with doctors and patients in a public clinic in a community near Oaxaca, Mexico, the study examines etiologies for type 2 diabetes. While notions of genetic inheritance and family history figure prominently in government and public health discourse, the "explanatory model" of patients places most emphasis on strong emotions, traumatic events, and dietary factors. Clinic doctors emphasize diet and lifestyle factors. The diffusion of "genetic risk" has had little impact on doctor-patient interactions in this community, but can be clearly seen in academic research, government policy, and medical specialties in the region, raising concerns about whether or not interventions will be directed at the social determinants of this growing health concern. Copyright © 2011 Elsevier Ltd. All rights reserved.

Shades of difference: theoretical underpinnings of the medical controversy on black/white differences in the United States, 1830-1870.

PubMed

Krieger, N

1987-01-01

The resonance between scientific theory and ideology is starkly revealed by the medical debate on slavery, alleged black inferiority, and racial differences in disease: opposing doctors invoked the same science, but relied on contrary assumptions, to reach antagonistic conclusions. Reductionist, biological determinist, and ahistorical premises underlay the dominant belief that innate racial differences led to black bondage and racial disparities in health; an anti-reductionist and historical approach supported the minority view that social factors rooted in the planters' need for cheap labor explained both. From 1830 to 1850, doctors debated the accuracy, validity, and interpretation of their findings. In the 1850s, "apolitical" doctors sought to purge medicine of politics to regain scientific objectivity, yet the first generation of black physicians argued that politics inevitably affected medical inquiry. The Civil War and Emancipation spurred studies relating the health of blacks and poor whites to social conditions, while the destruction of Reconstruction led to the resurgence of racist medicine. Comprehending how politics set the terms and tempo of this polemic can provide insight into current controversies on racial differences in disease.

Preferences for Depression Help-Seeking Among Vietnamese American Adults.

PubMed

Kim-Mozeleski, Jin E; Tsoh, Janice Y; Gildengorin, Ginny; Cao, Lien H; Ho, Tiffany; Kohli, Sarita; Lam, Hy; Wong, Ching; Stewart, Susan; McPhee, Stephen J; Nguyen, Tung T

2017-11-11

Culture impacts help-seeking preferences. We examined Vietnamese Americans' help-seeking preferences for depressive symptoms, through a telephone survey (N = 1666). A vignette describing an age- and gender-matched individual with depression was presented, and respondents chose from a list of options and provided open-ended responses about their help-seeking preferences. Results showed that 78.3% would seek professional help, either from a family doctor, a mental health provider, or both; 54.4% preferred to seek help from a family doctor but not from a mental health provider. Most (82.1%) would prefer to talk to family or friends, 62.2% would prefer to look up information, and 50.1% would prefer to get spiritual help. Logistic regression analysis revealed that preferences for non-professional help-seeking options (such as talking to friends or family, looking up information, and getting spiritual help), health care access, and perceived poor health, were associated with increased odds of preferring professional help-seeking. This population-based study of Vietnamese Americans highlight promising channels to deliver education about depression and effective help-seeking resources, particularly the importance of family doctors and social networks. Furthermore, addressing barriers in access to care remains a critical component of promoting professional help-seeking.

Online information search behaviour of physicians.

PubMed

Mikalef, Patrick; Kourouthanassis, Panos E; Pateli, Adamantia G

2017-03-01

Although doctors increasingly engage in online information seeking to complement their medical practice, little is known regarding what online information sources are used and how effective they are. Grounded on self-determination and needs theory, this study posits that doctors tend to use online information sources to fulfil their information requirements in three pre-defined areas: patient care, knowledge development and research activities. Fulfilling these information needs is argued to improve doctors' perceived medical practice competence. Performing PLS-SEM analysis on primary survey data from 303 medical doctors practicing in four major Greek hospitals, a conceptual model is empirically tested. Using authoritative online information sources was found to fulfil all types of information needs. Contrarily, using non-authoritative information sources had no significant effect. Satisfying information requirements relating to patient care and research activities enhanced doctors' perceptions about their medical practice competence. In contrast, meeting knowledge development information needs had the opposite result. Consistent with past studies, outcomes indicate that doctors tend to use non-authoritative online information sources; yet their use was found to have no significant value in fulfilling their information requirements. Authoritative online information sources are found to improve perceived medical practice competence by satisfying doctors' diverse information requirements. © 2017 Health Libraries Group.

Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study

PubMed Central

Viney, Rowena; Needleman, Sarah; Griffin, Ann

2016-01-01

Objectives Explore trainee doctors’ experiences of postgraduate training and perceptions of fairness in relation to ethnicity and country of primary medical qualification. Design Qualitative semistructured focus group and interview study. Setting Postgraduate training in England (London, Yorkshire and Humber, Kent Surrey and Sussex) and Wales. Participants 137 participants (96 trainees, 41 trainers) were purposively sampled from a framework comprising: doctors from all stages of training in general practice, medicine, obstetrics and gynaecology, psychiatry, radiology, surgery or foundation, in 4 geographical areas, from white and black and minority ethnic (BME) backgrounds, who qualified in the UK and abroad. Results Most trainees described difficult experiences, but BME UK graduates (UKGs) and international medical graduates (IMGs) could face additional difficulties that affected their learning and performance. Relationships with senior doctors were crucial to learning but bias was perceived to make these relationships more problematic for BME UKGs and IMGs. IMGs also had to deal with cultural differences and lack of trust from seniors, often looking to IMG peers for support instead. Workplace-based assessment and recruitment were considered vulnerable to bias whereas examinations were typically considered more rigorous. In a system where success in recruitment and assessments determines where in the country you can get a job, and where work–life balance is often poor, UK BME and international graduates in our sample were more likely to face separation from family and support outside of work, and reported more stress, anxiety or burnout that hindered their learning and performance. A culture in which difficulties are a sign of weakness made seeking support and additional training stigmatising. Conclusions BME UKGs and IMGs can face additional difficulties in training which may impede learning and performance. Non-stigmatising interventions should focus on trainee–trainer relationships at work and organisational changes to improve trainees’ ability to seek social support outside work. PMID:27888178

Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis

PubMed Central

Potts, Henry W W; McManus, I C

2011-01-01

Objective To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance. Design Systematic review and meta-analysis. Data sources Online databases PubMed, Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and medical education conference abstracts. Study selection The included quantitative reports measured the performance of medical students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes. Results 23 reports comparing the academic performance of medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports (n=23 742) indicated candidates of “non-white” ethnicity underperformed compared with white candidates (Cohen’s d=−0.42, 95% confidence interval −0.50 to −0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses. Conclusion Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors. PMID:21385802

Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis.

PubMed

Woolf, Katherine; Potts, Henry W W; McManus, I C

2011-03-08

To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance. Systematic review and meta-analysis. Online databases PubMed, Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and medical education conference abstracts. The included quantitative reports measured the performance of medical students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes. Results 23 reports comparing the academic performance of medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports (n = 23,742) indicated candidates of "non-white" ethnicity underperformed compared with white candidates (Cohen's d = -0.42, 95% confidence interval -0.50 to -0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses. Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors.

Application of the Safety Attitudes Questionnaire (SAQ) in Albanian hospitals: a cross-sectional study

PubMed Central

Gabrani, Adriatik; Hoxha, Adrian; Simaku, Artan; Gabrani, Jonila (Cyco)

2015-01-01

Objective To establish the reliability and validity of the translated version of the Safety Attitudes Questionnaire (SAQ) by evaluating its psychometric properties and to determine possible differences among nurses and physicians regarding safety attitudes. Design A cross-sectional study utilising the Albanian version of the SAQ and a demographic questionnaire. Setting Four regional hospitals in Albania. Participants 341 healthcare providers, including 132 nurses and 209 doctors. Main outcome measure(s) The translation, construct validity and internal validity of the SAQ. The SAQ includes six scales and 30 items. Results A total of 341 valid questionnaires were returned, for a response rate of 70%. The confirmatory factor analysis and its goodness-of-fit indices (standardised root mean square residual 0.075, root mean square error of approximation 0.044 and comparative fit index 0.97) showed good model fit. The Cronbach's α values for each of the scales of the SAQ ranged from 0.64 to 0.82. The percentage of hospital healthcare workers who had a positive attitude was 60.3% for the teamwork climate, 57.2% for the safety climate, 58.4% for job satisfaction, 37.4% for stress recognition, 59.3% for the perception of management and 49.5% for working conditions. Intercorrelations showed that the subscales had moderate-to-high correlations with one another. Nurses were more hesitant to admit and report errors; only 55% of physicians and 44% of nurses endorsed this statement (χ2=4.9, p=0.02). Moreover, nurses received lower scores on team work compared with doctors (N 45.7 vs D 52.3, p=0.01). Doctors denied the effects of stress and fatigue on their performance (N 46.7 vs D 39.5, p<0.01), neglecting the workload. Conclusions The SAQ is a useful tool for evaluating safety attitudes in Albanian hospitals. In light of the health workforce's poor recognition of stress, establishing patient safety programmes should be a priority among policymakers in Albania. PMID:25877270

Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine

PubMed Central

Fritsche, L; Greenhalgh, T; Falck-Ytter, Y; Neumayer, H-H; Kunz, R

2002-01-01

Objective To develop and validate an instrument for measuring knowledge and skills in evidence based medicine and to investigate whether short courses in evidence based medicine lead to a meaningful increase in knowledge and skills. Design Development and validation of an assessment instrument and before and after study. Setting Various postgraduate short courses in evidence based medicine in Germany. Participants The instrument was validated with experts in evidence based medicine, postgraduate doctors, and medical students. The effect of courses was assessed by postgraduate doctors from medical and surgical backgrounds. Intervention Intensive 3 day courses in evidence based medicine delivered through tutor facilitated small groups. Main outcome measure Increase in knowledge and skills. Results The questionnaire distinguished reliably between groups with different expertise in evidence based medicine. Experts attained a threefold higher average score than students. Postgraduates who had not attended a course performed better than students but significantly worse than experts. Knowledge and skills in evidence based medicine increased after the course by 57% (mean score before course 6.3 (SD 2.9) v 9.9 (SD 2.8), P<0.001). No difference was found among experts or students in absence of an intervention. Conclusions The instrument reliably assessed knowledge and skills in evidence based medicine. An intensive 3 day course in evidence based medicine led to a significant increase in knowledge and skills. What is already known on this topicNumerous observational studies have investigated the impact of teaching evidence based medicine to healthcare professionals, with conflicting resultsMost of the studies were of poor methodological qualityWhat this study addsAn instrument assessing basic knowledge and skills required for practising evidence based medicine was developed and validatedAn intensive 3 day course on evidence based medicine for doctors from various backgrounds and training level led to a clinically meaningful improvement of knowledge and skills PMID:12468485

Declining conventional cancer treatment and using complementary and alternative medicine: a problem or a challenge?

PubMed

Verhoef, M J; Rose, M S; White, M; Balneaves, L G

2008-08-01

Several studies have shown that a small but significant percentage of cancer patients decline one or more conventional cancer treatments and use complementary and alternative medicine (CAM) instead. Here, drawing on the literature and on our own ongoing research, we describe why cancer patients decide to decline conventional cancer treatments, who those patients are, and the response by physicians to patients who make such decisions. Poor doctor-patient communication, the emotional impact of the cancer diagnosis, perceived severity of conventional treatment side effects, a high need for decision-making control, and strong beliefs in holistic healing appear to affect the decision by patients to decline some or all conventional cancer treatments. Many patients indicate that they value ongoing follow-up care from their oncologists provided that the oncologists respect their beliefs. Patients declining conventional treatments have a strong sense of internal control and prefer to make the final treatment decisions after considering the opinions of their doctors. Few studies have looked at the response by physicians to patients making such a decision. Where research has been done, it found that a tendency by doctors to dichotomize patient decisions as rational or irrational may interfere with the ability of the doctors to respond with sensitivity and understanding. Declining conventional treatment is not necessarily an indicator of distrust of the medical system, but rather a reflection of many personal factors. Accepting and respecting such decisions may be instrumental in "keeping the door open."

Doctors who considered but did not pursue specific clinical specialties as careers: questionnaire surveys.

PubMed

Goldacre, Michael J; Goldacre, Raph; Lambert, Trevor W

2012-04-01

To report doctors' rejection of specialties as long-term careers and reasons for rejection. Postal questionnaires. United Kingdom. Graduates of 2002, 2005 and 2008 from all UK medical schools, surveyed one year after qualification. Current specialty choice; any choice that had been seriously considered but not pursued (termed 'rejected' choices) with reasons for rejection. 2573 of 9155 respondents (28%) had seriously considered but then not pursued a specialty choice. By comparison with positive choices, general practice was under-represented among rejected choices: it was the actual choice of 27% of respondents and the rejected choice of only 6% of those who had rejected a specialty. Consideration of 'job content' was important in not pursuing general practice (cited by 78% of those who considered but rejected a career in general practice), psychiatry (72%), radiology (69%) and pathology (68%). The surgical specialties were the current choice of 20% of respondents and had been considered but rejected by 32% of doctors who rejected a specialty. Issues of work-life balance were the single most common factor, particularly for women, in not pursuing the surgical specialties, emergency medicine, the medical hospital specialties, paediatrics, and obstetrics and gynaecology. Competition for posts, difficult examinations, stressful working conditions, and poor training were mentioned but were mainly minority concerns. There is considerable diversity between doctors in their reasons for finding specialties attractive or unattractive. This underlines the importance of recruitment strategies to medical school that recognize diversity of students' interests and aptitudes.

Stress and sleep quality in doctors working on-call shifts are associated with functional gastrointestinal disorders.

PubMed

Lim, Soo-Kyung; Yoo, Seung Jin; Koo, Dae Lim; Park, Chae A; Ryu, Han Jun; Jung, Yong Jin; Jeong, Ji Bong; Kim, Byeong Gwan; Lee, Kook Lae; Koh, Seong-Joon

2017-05-14

To investigate the role of sleep quality and psychosocial problems as predictors of functional gastrointestinal disorders (FGIDs) in doctors that work 24 hour-on-call shifts. In this cross-sectional observation study, using the Rome III Questionnaire and Pittsburgh Sleep Quality Index (PSQI), we analyzed 170 doctors with 24 hour-on-call shifts. Among the participants that had experienced a 24 hour-on-call shift within the last 6 mo, 48 (28.2%) had FGIDs. Overall prevalence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) were 16.5% and 17.1%, respectively, with 5.3% exhibiting both. Sleep scores (PSQI) (8.79 ± 2.71 vs 7.30 ± 3.43, P = 0.008), the presence of serious psychosocial alarm (83.3% vs 56.6%, P = 0.004), and the proportion of doctors who experienced over two months of recent on-call work (81.2% vs 68.9%, P = 0.044) were significantly different between individuals with or without FGIDs. Multivariate analysis revealed that presenting serious psychosocial alarm was an independent risk factor for prevalence of FD (OR = 5.47, 95%CI: 1.06-28.15, P = 0.042) and poor sleep quality (PSQI ≥ 6) was a predictor of IBS (OR = 4.17, 95%CI: 1.92-19.02, P = 0.016). Physicians should recognize the role of sleep impairment and psychological stress in the development of FGIDs and a comprehensive approach should be considered to manage patients with FGIDs.

An examination of the factors fueling migration amongst Community Service practitioners.

PubMed

Reardon, Candice; George, Gavin

2014-11-07

Research is needed in order to understand the potential influence of the Bilateral Agreement between South Africa and the United Kingdom (UK), as well as other more recent international and local policies restricting movement of South African health workers abroad; and to determine what effect they have on the migration intentions and plans of health professionals in South Africa. The aims were to (1) explore the migration intentions and the factors that influence these intentions amongst Community Service (CS) nurses and doctors; (2) explore their views and opinions about the Bilateral Agreement between the UK and South Africa (SA) and other UK policies around the recruitment and employment of foreign health professionals; and (3) understand the impact of these policies on the migration plans of these CS doctors and nurses. Qualitative focus groups and interviews were conducted with 23 CS doctors and nurses. To supplement this, 6 interviews were conducted with nurses and a doctor who had worked in the UK. A higher disposition toward moving abroad was apparent amongst those who had experienced a challenging and frustrating CS year. Poor working conditions, including long work hours, high patient loads and inadequate resources and equipment, as well as low salaries and the perceived ambivalence of the government to the complaints of health practitioners, were influencing decisions to migrate abroad. The findings suggest that government efforts to better manage, recognise and respect the work and contribution of health professionals to the country would go a long way toward retaining health professionals.

The glaucoma research foundation patient survey: patient understanding of glaucoma and its treatment.

PubMed

Herndon, Leon W; Brunner, Thomas M; Rollins, Jane Neff

2006-01-01

Determine patients' understanding of glaucoma and its treatment, their sources of information about glaucoma, their preferences for treatment, their experience with medication side effects, and their reasons for changing eye doctors. Prospective, nonrandomized patient survey study. A questionnaire was developed and sent to the 22,000 subscribers of the Gleams newsletter who have glaucoma. Questionnaires were returned by 4310 glaucoma patients. Most respondents received glaucoma information from their eye doctor. Only 28% of respondents reported having changed eye doctors for reasons related to their glaucoma. Of those who had, 60% cited poor communication as the reason. When queried about specific side effects associated with their medication, over 85% of responding patients were never or rarely bothered by headaches and eyelid darkening. Most respondents (67% and 55%, respectively) were rarely or never disturbed by red eye or burning and stinging. Most respondents understood the importance of intraocular pressure (IOP) lowering in glaucoma, and of those patients who expressed a preference, 92% reported that they would prefer the medication that lowers IOP the most, even if it caused red eye for a few weeks, over a medication that caused no red eye but did not get IOP as low. Patients who subscribe to Gleams and responded to the survey rely most on their doctors for information about glaucoma and its treatment. Most understand the importance of maintaining low IOP to decrease the risk of vision loss, and most will tolerate temporary ocular side effects to achieve low IOP.

An audit to assess awareness and knowledge of nutrition in a UK spinal cord injuries centre.

PubMed

Wong, S; Derry, F; Graham, A; Grimble, G; Forbes, A

2012-06-01

A single centre survey. To test: (i) awareness of nutrition screening tools and related care plans and; (ii) nutrition knowledge of doctors, nurses and dietitians working in spinal cord injuries (SCI) centres. The 14-item questionnaire was sent to 102 nurses, 17 doctors and 15 dietitians working in UK SCI centres during January-March 2010. Sixty-two (46.5%) questionnaires were completed and returned for analysis. The present audit demonstrated that awareness of the need for nutritional screening is good: 83% of staff reported that they are aware there is a nutrition screening tool. This audit also demonstrated areas of poor knowledge, such as calorie content of intravenous fluids, indicators of malnutrition, and choice of nutritional support in malnourished patients. All doctors, but only 38% of nurses, knew how to calculate body mass index. Surprisingly, nearly half (49%) of the participants thought that at least 20% weight loss was required to indicate malnutrition. This high-perceived cut-off point suggests that malnutrition is likely to continue to be undetected and unmanaged. The overall scores (median) showed clear differences in nutritional knowledge between groups (median: dietitians 92.8%; doctors 53.5%; nurses 35.7; P<0.01). This suggests that dietitians could have an important role in training healthcare professionals about nutrition. This study highlights the need for further education in SCI medicine in order to improve the efficacy of feeding and nutrition therapy for SCI patients.

Factors influencing the provision of public health services by village doctors in Hubei and Jiangxi provinces, China.

PubMed

Ding, Yan; Smith, Helen J; Fei, Yang; Xu, Biao; Nie, Shaofa; Yan, Weirong; Diwan, Vinod K; Sauerborn, Rainer; Dong, Hengjin

2013-01-01

The Chinese central government launched the Health System Reform Plan in 2009 to strengthen disease control and health promotion and provide a package of basic public health services. Village doctors receive a modest subsidy for providing public health services associated with the package. Their beliefs about this subsidy and providing public health services could influence the quality and effectiveness of preventive health services and disease surveillance. To understand village doctors' perspectives on the subsidy and their experiences of delivering public health services, we performed 10 focus group discussions with village doctors, 12 in-depth interviews with directors of township health centres and 4 in-depth interviews with directors of county-level Centers for Disease Control and Prevention. The study was conducted in four counties in central China, two in Hubei province and two in Jiangxi province. Village doctors prioritize medical services but they do their best to manage their time to include public health services. The willingness of township health centre directors and village doctors to provide public health services has improved since the introduction of the package and a minimum subsidy, but village doctors do not find the subsidy to be sufficient remuneration for their efforts. Improving the delivery of public health services by village doctors is likely to require an increase in the subsidy, improvement in the supervisory relationship between village clinics and township health centres and the creation of a government pension for village doctors.

Infection control implementations at forensic medicine practice: a national survey in Turkey.

PubMed

Aydin, Berna; Tanyel, Esra; Colak, Basar; Fisgin, Nuriye; Tulek, Necla

2009-06-01

Because forensic medicine workers have a greater occupational risk for infectious diseases, strict rules and measures against infections must be implemented at every stage of forensic medicine practices. In this study, we aim to evaluate the infection control implementations in forensic medicine practices in Turkey.A questionnaire survey was mailed to forensic medicine specialists and residents between April and June 2005. The questionnaire consisted of 36 questions whose designed was based on standard precautions and protective barriers against infectious risks.In all, 111 doctors from 27 different cities responded to the questionnaire. Of those doctors who responded, 43.2% reported performing external examination anywhere. The percentage of doctors performing external examinations who regularly wore gloves, masks, and gowns, and washed hands with a disinfectant were 81.5%, 24.7%, 30.9%, and 81.5%, respectively. The percentage of doctors performing autopsies who regularly wore masks, protective eye-wear, gloves, special gloves, and special boots were 59.6%, 10.6%, 98.9%, 71.3%, and 36.2%, respectively. Only 2 negative pressure rooms were reported.According to these results, precautionary measures against infectious risks in forensic medicine practice in our country are insufficient. Conditions to facilitate and to improve the compliance with infection control procedures must be prepared.

Ethical issues concerning New Zealand sports doctors

PubMed Central

Anderson, L; Gerrard, D

2005-01-01

Success in sport can provide a source of national pride for a society, and vast financial and personal rewards for an individual athlete. It is therefore not surprising that many athletes will go to great lengths in pursuit of success. The provision of healthcare for elite sports people has the potential to create many ethical issues for sports doctors; however there has been little discussion of them to date. This study highlights these issues. Respondents to a questionnaire identified many ethical matters, common to other areas of medicine. However they also raised problems unique to sports medicine. Some of these ethical difficulties arise out of the place of the sports doctor within the hierarchy of sport. Yet others arise out of the special relationship between sports doctors and individual players/athletes. This study raises some important questions regarding the governance of healthcare in sport, and what support and guidance is available to sports doctors. As medical and scientific intervention in sport escalates, there is a risk that demands for enhanced performance may compromise the health of the athlete, and the role the sports doctor plays remains a critical question. PMID:15681672

A Handbook for Doctoral Supervisors Stan Taylor and Nigel Beasley A Handbook for Doctoral Supervisors Routledge 256 £24.99 0415335450 0415335450 [Formula: see text].

PubMed

2006-07-01

It can often be an enlightening affair to be made aware of the limitations of one's knowledge on a subject in which one is gainfully employed - having read this book, I am grateful for such a salutary experience. As a doctoral supervisor, I feel justified in considering myself better informed and equipped to perform a role for which, there is very little contemporary literature available. The manner in which Taylor and Beasley have comprehensively tackled this omission, going beyond the usual checklist for supervisors, is a huge strength of the book, bringing to life the real world of doctoral supervision. This text is a timely publication given the momentous changes of the past decade in terms of the doctorate, modes and methods of study, the candidate population and new demands upon supervisors. Although the book appears to be primarily written for a UK audience it is relevant to all those involved in helping the doctoral candidate achieve their goal.

Doctors' service orientation in public, private, and foreign hospitals.

PubMed

Andaleeb, Syed Saad; Siddiqui, Nazlee; Khandakar, Shahjahan

2007-01-01

The purpose of this study is to propose a doctors' service orientation (DSO) scale and uses it to compare the services received in public, private and foreign hospitals in a developing country from the patient's perspective. The scale was derived from the service quality literature and qualitative research. A questionnaire was designed next. Data were collected from patients who had used the services of doctors in a hospital. The scale demonstrated appropriate psychometric properties. Two clear patterns emerge from the study results: on 10 out of 12 measures of doctors' service orientation, there was no significant difference in their perceived behaviors between public and private hospitals and foreign doctors were "always" rated significantly higher. This study focused on one major city because of time and resource constraints. The findings are thus not generalizable to hospitals across the country. Also, because of translation and retranslation issues, the scale ought to be further tested for wider use. The scale may be used periodically in a comprehensive quality assurance program to exhort doctors to become more service oriented and to improve their performance over time.

Completion Mindsets and Contexts in Doctoral Supervision

ERIC Educational Resources Information Center

Green, Pam; Bowden, John

2012-01-01

Purpose: Doctoral candidates are now located within a research context of performativity where the push to successfully complete in a timely manner is central. The purpose of this paper is to develop a model of completion mindset within a completion context to assist research students and supervisors. Design/methodology/approach: The research was…

Gender Performativity in Physics: Affordances or Only Constraints?

ERIC Educational Resources Information Center

Danielsson, Anna T.; Lundin, Mattias

2014-01-01

In this forum we engage in a dialogue with Allison Gonsalves's paper '"Physics and the girly girl--there is a contradiction somewhere": Doctoral students' positioning around discourses of gender and competence in physics'. In her paper Gonsalves uses a sociocultural approach to examine women doctoral students'…

Athletes, Doctors, and Lawyers with First Names Beginning with "D" Die Sooner

ERIC Educational Resources Information Center

Abel, Ernest L.; Kruger, Michael L.

2010-01-01

For many people, names have symbolic power that extends to their timing of death. This study examined the relationship between the symbolic significance of the first letters in the names of professional athletes (baseball, football, hockey, and basketball) and their longevity. A similar analysis was performed for doctors (radiologists,…

Interruptions and multitasking in surgery: a multicentre observational study of the daily work patterns of doctors and nurses.

PubMed

Bellandi, Tommaso; Cerri, Alessandro; Carreras, Giulia; Walter, Scott; Mengozzi, Cipriana; Albolino, Sara; Mastrominico, Eleonora; Renzetti, Fernando; Tartaglia, Riccardo; Westbrook, Johanna

2018-01-01

The aim of this study was to obtain baseline data on doctors' and nurses' work activities and rates of interruptions and multitasking to improve work organisation and processes. Data were collected in six surgical units with the WOMBAT (Work Observation Method by Activity Timing) tool. Results show that doctors and nurses received approximately 13 interruptions per hour, or one interruption every 4.5 min. Compared to doctors, nurses were more prone to interruptions in most activities, while doctors performed multitasking (33.47% of their time, 95% CI 31.84-35.17%) more than nurses (15.23%, 95% CI 14.24-16.25%). Overall, the time dedicated to patient care is relatively limited for both professions (37.21%, 95% CI 34.95-39.60% for doctors, 27.22%, 95% CI 25.18-29.60% for nurses) compared to the time spent for registration of data and professional communication, that accounts for two-thirds of doctors' time and nearly half of nurses' time. Further investigation is needed on strategies to manage job demands and professional communications. Practitioner Summary: This study offers further findings on the characteristics and frequency of multitasking and interruptions in surgery, with a comparison of how they affect doctors and nurses. Further investigation is needed to improve the management of job demands and communications according to the results.

Locum doctors in general practice: motivation and experiences.

PubMed Central

McKevitt, C; Morgan, M; Hudson, M

1999-01-01

BACKGROUND: There is evidence of dissatisfaction with locum doctors' performance, but little is known about doctors who work as locums in general practice or about their experiences of this work. AIM: To describe the motivations and experiences of doctors providing locum cover in general practices. METHOD: A postal questionnaire survey distributed to locums through organizations such as locum groups, commercial agencies, and general practices. RESULTS: Questionnaires were returned by 111 doctors currently working as locums in general practice. Four main reasons for working as a locum GP were: as a short-term option while between posts, to gain experience of different practices before commitment to one practice, to balance work and family or other commitments, to continue part-time work after retirement. One-quarter of responders intended to continue working as a locum indefinitely. The drawbacks of locum work included frustration with low status, lack of security, and difficulty accessing structured training and education. CONCLUSION: Locum doctors in general practice are a heterogeneous group that includes those who have chosen this type of work. The doctors who intend to continue as locums indefinitely represent a useful resource in primary care whose ability to provide short-term cover could be maximized. The need to control the quality of 'freelance' doctors should not overshadow the need to control the quality of their working environments. PMID:10621983

A review of cost-effectiveness, cost-containment and economics curricula in graduate medical education.

PubMed

Varkey, Prathibha; Murad, Mohammad H; Braun, Chad; Grall, Kristi J H; Saoji, Vivek

2010-12-01

Numerous studies performed over the last 30 years suggest that doctors have poor knowledge of the costs of medical care. In most graduate medical education programmes, trainees do not receive formal training in cost-effective medical practice. Comprehensive literature search of electronic bibliographic databases for articles that describe health economics, cost-containment and cost-effectiveness curricula in graduate medical education. Critical appraisal of the literature and qualitative description is presented. Heterogeneity of curricula precluded quantitative summary of data. We identified 40 articles that met the inclusion criteria for this review. Internal medicine residents were the targeted learners in 27 studies (68%); Family Medicine and Surgery residents were each targeted in five studies (13%); Rehabilitation, Paediatrics and Emergency Medicine residents were each targeted in one study. In general, the methodological quality of the included studies was poor to moderate and mostly targeted knowledge of health economics or cost-containment as opposed to targeting cost-effectiveness. In terms of describing the standard curricular components, studies sufficiently described the different educational strategies (e.g. didactics, interactive, experiential, self-directed) and the component of learner assessment, but lacked the description of other elements such as needs assessment and curriculum evaluation. Cost-effectiveness curricula in graduate medical education are lacking and clearly needed. © 2010 Blackwell Publishing Ltd.

Is there just one lesion? The need for whole body skin examination in patients presenting with non-melanocytic skin cancer.

PubMed

Terrill, Patricia Jane; Fairbanks, Sian; Bailey, Michael

2009-10-01

In patients presenting with non-melanoma skin cancer (NMSC) the frequency of concurrently presenting tumours is poorly documented. Whole body skin examination is recommended but in a recent survey of Australian General Practitioners and skin cancer clinics doctors it was infrequently performed. The aim of this study was to examine the incidence of concurrent skin cancer at initial presentation and therefore to examine the need for whole body skin examination for NMSC presentations. One hundred consecutive patients with a referral diagnosis indicative of NMSC were examined. Data was analysed as to the referring doctor's diagnosis, whole body skin examination findings and histology of excised lesions. Epidemiological data was obtained by patient questionnaire. One hundred patients, 41 males and 59 females, with a mean age of 70 years (range 39-91 years) underwent whole body skin examination. Sixty-seven per cent of patients were found to have additional lesions requiring treatment, 46% sin cancers (30 patients basal cell carcinomas, five squamous cell carcinomas, seven basal and squamous cell carcinomas, two lentigo maligna, two adenexal tumours) and 21% solar keratoses. Thirty-four of the additional lesions detected were in areas covered by clothing. Sixty-eight patients had a past history of skin cancer excision. In the Australian patient population, the need for whole body skin examination is essential to avoid missing concurrent lesions. Ongoing surveillance is also essential as these patients have a high risk of developing future NMSC.

Doctors on the move: a European case study on the key characteristics of national recertification systems.

PubMed

Sehlbach, Carolin; Govaerts, Marjan J; Mitchell, Sharon; Rohde, Gernot G U; Smeenk, Frank W J M; Driessen, Erik W

2018-04-17

With increased cross-border movement, ensuring safe and high-quality healthcare has gained primacy. The purpose of recertification is to ensure quality of care through periodically attesting doctors' professional proficiency in their field. Professional migration and facilitated cross-border recognition of qualifications, however, make us question the fitness of national policies for safeguarding patient care and the international accountability of doctors. We performed document analyses and conducted 19 semistructured interviews to identify and describe key characteristics and effective components of 10 different European recertification systems, each representing one case (collective case study). We subsequently compared these systems to explore similarities and differences in terms of assessment criteria used to determine process quality. Great variety existed between countries in terms and assessment formats used, targeting cognition, competence and performance (Miller's assessment pyramid). Recertification procedures and requirements also varied significantly, ranging from voluntary participation in professional development modules to the mandatory collection of multiple performance data in a competency-based portfolio. Knowledge assessment was fundamental to recertification in most countries. Another difference concerned the stakeholders involved in the recertification process: while some systems exclusively relied on doctors' self-assessment, others involved multiple stakeholders but rarely included patients in assessment of doctors' professional competence. Differences between systems partly reflected different goals and primary purposes of recertification. Recertification systems differ substantially internationally with regard to the criteria they apply to assess doctors' competence, their aims, requirements, assessment formats and patient involvement. In the light of professional mobility and associated demands for accountability, we recommend that competence assessment includes patients' perspectives, and recertification practices be shared internationally to enhance transparency. This can help facilitate cross-border movement, while guaranteeing high-quality patient care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Understanding of elder abuse and neglect among health care professionals in Malaysia: An exploratory survey.

PubMed

Ahmed, Ayesha; Choo, Wan-Yuen; Othman, Sajaratulnisah; Hairi, Noran Naqiah; Hairi, Farizah Mohd; Mohd Mydin, Fadzilah Hanum; Illiani Jaafar, Siti Nur

2016-01-01

Elder abuse and neglect (EAN) is a hidden public health challenge for Malaysia. This cross-sectional survey studied the awareness of EAN among 148 doctors and nurses from two neighboring states in Malaysia using a self-administered questionnaire exploring their knowledge, perceptions, practices, and experience concerning EAN. Both doctors and nurses demonstrated poor understanding of signs of EAN and exhibited misperceptions on reporting requirements. Both groups perceived EAN as a national burden and reporting it as their responsibility; but most felt they had not been trained to diagnose it. Many were unsure of procedures and whether their own intervention could be effective. Only four (nurses) of 41 participants who suspected abuse during the past year reported the cases. Targeted education and uniform protocols are mandatory to ensure best practice with regards to EAN. Further research is crucial to extend this inquiry into the broader health care workforce.

Poison or cure: meanings of medication in schizophrenia.

PubMed

Rosenfield, Paul J

2007-01-01

Antipsychotic medications provide tremendous relief to many individuals with schizophrenia, but can have significant costs, including adverse metabolic, neurological, and psychological effects. Prescribers and consumers of these medications often have different perceptions of the safety and utility of medications, ranging from "poison" to "cure." While much of the literature on the meaning of medication in schizophrenia discusses patients' negative perceptions of medication, poor insight, and other risk factors for nonadherence, a variety of additional factors should be considered, including both doctors' and patients' perspectives. Historical, cultural, and scientific, as well as individual factors, influence both the prescribing and taking of antipsychotic medications. The relationship between doctors and patients, as informed by these factors, plays a central role in the creation of the meanings of medications. An understanding of this relationship can help to establish more collaborative treatment relationships, beyond the dichotomy of poison or cure.

General practitioners and work in the Third World.

PubMed

Holden, J D

1991-04-01

In recent years the number of general practitioners who have worked in the third world before entering general practice has fallen. The reasons for this are not clear but may include worries about future career prospects. Ninety four doctors who had entered general practice since 1984, after previously working in the third world, completed a questionnaire about their career experience and views about the value of such work. They were generally widely experienced and well-qualified and work abroad had not apparently harmed their careers, rather, many believed it had enhanced it. Work in the usually arduous conditions of poor countries was often considered by the respondents to lead to a wider perspective, increased maturity, confidence, self-reliance, adaptability and initiative. Doctors who are interested and suitable for work in the third world prior to entering general practice should be encouraged to pursue this possibility.

Paternity leave experiences of NHS doctors.

PubMed

Gordon, Hannah; Szram, Joanna

2013-10-01

This study assesses NHS doctors' experiences of paternity leave and evaluates whether practices have changed since the introduction of additional paternity leave (APL) in April 2011. An anonymised online survey designed to discover experiences and uptake of APL and ordinary paternity leave (OPL) was distributed to all members of the London Deanery Synapse® network. In total, 364 fathers responded. Their seniority ranged from foundation trainees to consultants. Following the formal introduction of OPL in 2003, the number of fathers taking any paternity leave increased (from 50% to 95.6%). The majority of respondents (76.7%) felt well supported by their employer. Since the introduction of APL, 3% of respondents took additional leave. Reasons for the low uptake of APL included the impracticalities of the law, poor awareness and perceived attitudes and implications for training. Problems with OPL included the inadequate provision of cover and difficulties in timing the leave appropriately.

Interprofessional problem-based learning project outcomes between prelicensure baccalaureate of science in nursing and doctor of pharmacy programs.

PubMed

Hodges, Helen F; Massey, Ann T

2015-04-01

Persistently high medical error rates, caregiver dissatisfaction, and compromised patient safety often result from poorly coordinated, increasingly complex health care. Barriers to interprofessional health professions education persist despite the urgent calls for improved quality and safety. Investigators explored the effects of a problem-based learning (PBL) strategy between prelicensure doctorate of pharmacy (PharmD) and baccalaureate nursing (BSN) students. A descriptive design was used to compare the learning gains and satisfaction with a PBL hybrid approach for BSN and PharmD prelicensure student groups over three academic terms. Consistent with earlier works, content-based learning gains and student satisfaction were not significantly different between groups. Narrative data provide insight into perceived benefits, barriers, and perspectives of participating students and facilitators. Attributes of this pedagogical approach provide opportunity for prelicensure students to explore professional interdependence while adequately mastering fact-based content. Copyright 2015, SLACK Incorporated.

[Smoking and doctors: from 'therapeutic panacea' to 'tobacco use discouragement in the individual'].

PubMed

Mulder, W J

2008-06-28

In The Netherlands smoking will be prohibited in bars, restaurants, pubs and enclosed public spaces on 1 July 2008, in accordance with European legislation. Smoking is already not allowed in most Dutch hospitals. Europeans have a long history of tobacco smoking, going back to the introduction of this habit by Columbus. For centuries tobacco was used as a medicine, and later as a recreational drug, especially after the introduction of the cigarette. There was no scientific understanding of the harmful effects of smoking until the 19th century, when nicotine was isolated and recognised as a poison. Despite the fact that health care professionals represent a valuable resource for tobacco control, doctors have generally shown a poor appreciation of their critical role in smoking control. A decreasing smoking prevalence in the general population however, will emphasize the function of physicians as role model.

Changes in performance: a 5-year longitudinal study of participants in a multi-source feedback programme.

PubMed

Violato, Claudio; Lockyer, Jocelyn M; Fidler, Herta

2008-10-01

Multi-source feedback (MSF) enables performance data to be provided to doctors from patients, co-workers and medical colleagues. This study examined the evidence for the validity of MSF instruments for general practice, investigated changes in performance for doctors who participated twice, 5 years apart, and determined the association between change in performance and initial assessment and socio-demographic characteristics. Data for 250 doctors included three datasets per doctor from, respectively, 25 patients, eight co-workers and eight medical colleagues, collected on two occasions. There was high internal consistency (alpha > 0.90) and adequate generalisability (Ep(2) > 0.70). D study results indicate adequate generalisability coefficients for groups of eight assessors (medical colleagues, co-workers) and 25 patient surveys. Confirmatory factor analyses provided evidence for the validity of factors that were theoretically expected, meaningful and cohesive. Comparative fit indices were 0.91 for medical colleague data, 0.87 for co-worker data and 0.81 for patient data. Paired t-test analysis showed significant change between the two assessments from medical colleagues and co-workers, but not between the two patient surveys. Multiple linear regressions explained 2.1% of the variance at time 2 for medical colleagues, 21.4% of the variance for co-workers and 16.35% of the variance for patient assessments, with professionalism a key variable in all regressions. There is evidence for the construct validity of the instruments and for their stability over time. Upward changes in performance will occur, although their effect size is likely to be small to moderate.

Relatively speaking: contrast effects influence assessors' scores and narrative feedback.

PubMed

Yeates, Peter; Cardell, Jenna; Byrne, Gerard; Eva, Kevin W

2015-09-01

In prior research, the scores assessors assign can be biased away from the standard of preceding performances (i.e. 'contrast effects' occur). This study examines the mechanism and robustness of these findings to advance understanding of assessor cognition. We test the influence of the immediately preceding performance relative to that of a series of prior performances. Further, we examine whether assessors' narrative comments are similarly influenced by contrast effects. Clinicians (n = 61) were randomised to three groups in a blinded, Internet-based experiment. Participants viewed identical videos of good, borderline and poor performances by first-year doctors in varied orders. They provided scores and written feedback after each video. Narrative comments were blindly content-analysed to generate measures of valence and content. Variability of narrative comments and scores was compared between groups. Comparisons indicated contrast effects after a single performance. When a good performance was preceded by a poor performance, ratings were higher (mean 5.01, 95% confidence interval [CI] 4.79-5.24) than when observation of the good performance was unbiased (mean 4.36, 95% CI 4.14-4.60; p < 0.05, d = 1.3). Similarly, borderline performance was rated lower when preceded by good performance (mean 2.96, 95% CI 2.56-3.37) than when viewed without preceding bias (mean 3.55, 95% CI 3.17-3.92; p < 0.05, d = 0.7). The series of ratings participants assigned suggested that the magnitude of contrast effects is determined by an averaging of recent experiences. The valence (but not content) of narrative comments showed contrast effects similar to those found in numerical scores. These findings are consistent with research from behavioural economics and psychology that suggests judgement tends to be relative in nature. Observing that the valence of narrative comments is similarly influenced suggests these effects represent more than difficulty in translating impressions into a number. The extent to which such factors impact upon assessment in practice remains to be determined as the influence is likely to depend on context. © 2015 John Wiley & Sons Ltd.

Did You Hear the One About the Doctor? An Examination of Doctor Jokes Posted on Facebook

PubMed Central

Haney, Carol Sue; Weeks, William B; Sirovich, Brenda E; Anthony, Denise L

2014-01-01

Background Social networking sites such as Facebook have become immensely popular in recent years and present a unique opportunity for researchers to eavesdrop on the collective conversation of current societal issues. Objective We sought to explore doctor-related humor by examining doctor jokes posted on Facebook. Methods We performed a cross-sectional study of 33,326 monitored Facebook users, 263 (0.79%) of whom posted a joke that referenced doctors on their Facebook wall during a 6-month observation period (December 15, 2010 to June 16, 2011). We compared characteristics of so-called jokers to nonjokers and identified the characteristics of jokes that predicted joke success measured by having elicited at least one electronic laugh (eg, an LOL or “laughing out loud”) as well as the total number of Facebook “likes” the joke received. Results Jokers told 156 unique doctor jokes and were the same age as nonjokers but had larger social networks (median Facebook friends 227 vs 132, P<.001) and were more likely to be divorced, separated, or widowed (P<.01). In 39.7% (62/156) of unique jokes, the joke was at the expense of doctors. Jokes at the expense of doctors compared to jokes not at the expense of doctors tended to be more successful in eliciting an electronic laugh (46.5% vs 37.3%), although the association was statistically insignificant. In our adjusted models, jokes that were based on current events received considerably more Facebook likes (rate ratio [RR] 2.36, 95% CI 0.97-5.74). Conclusions This study provides insight into the use of social networking sites for research pertaining to health and medicine, including the world of doctor-related humor. PMID:24550095

Consultation behaviour of doctor-shopping patients and factors that reduce shopping.

PubMed

Ohira, Yoshiyuki; Ikusaka, Masatomi; Noda, Kazutaka; Tsukamoto, Tomoko; Takada, Toshihiko; Miyahara, Masahito; Funakoshi, Hiraku; Basugi, Ayako; Keira, Katsunori; Uehara, Takanori

2012-04-01

To investigate the subsequent behaviour of doctor-shopping patients (defined as those attending multiple hospitals for the same complaint) who consulted our department and factors related to cessation of doctor shopping. Patients who presented without referral to the Department of General Medicine at Chiba University Hospital in Japan (our department) completed a questionnaire at their first visit. A follow-up questionnaire was also sent to them in order to assess doctor shopping after 3 months. Then items in the questionnaires were investigated for significant differences between patients who continued or stopped doctor shopping. Logistic regression analysis was performed with items showing a significant difference between patients who stopped doctor shopping and those who continued it, in order to identify independent determinants of the cessation of shopping. A total of 978 patients who presented spontaneously to our department consented to this study, and 929 patients (95.0%) completed questionnaires correctly. Among them, 203 patients (21.9%) were identified as doctor shoppers. The follow-up survey was completed correctly by 138 patients (68.0%). Among them, 25 patients (18.1%) were found to have continued doctor shopping, which was a significantly lower rate than before (P < 0.001). Logistic regression analysis selected the following factors as independent determinants of the cessation of doctor shopping: 'confirmation of the diagnosis' (odds ratio: 8.12, 95% confidence interval: 1.46-45.26), and 'satisfaction with consultation' (odds ratio: 2.07, 95% confidence interval: 1.42-3.01). Doctor shopping decreased significantly after patients consulted our department, with 'confirmation of the diagnosis' and 'satisfaction with consultation' being identified as contributing factors. © 2010 Blackwell Publishing Ltd.

Did you hear the one about the doctor? An examination of doctor jokes posted on Facebook.

PubMed

Davis, Matthew A; Haney, Carol Sue; Weeks, William B; Sirovich, Brenda E; Anthony, Denise L

2014-02-13

Social networking sites such as Facebook have become immensely popular in recent years and present a unique opportunity for researchers to eavesdrop on the collective conversation of current societal issues. We sought to explore doctor-related humor by examining doctor jokes posted on Facebook. We performed a cross-sectional study of 33,326 monitored Facebook users, 263 (0.79%) of whom posted a joke that referenced doctors on their Facebook wall during a 6-month observation period (December 15, 2010 to June 16, 2011). We compared characteristics of so-called jokers to nonjokers and identified the characteristics of jokes that predicted joke success measured by having elicited at least one electronic laugh (eg, an LOL or "laughing out loud") as well as the total number of Facebook "likes" the joke received. Jokers told 156 unique doctor jokes and were the same age as nonjokers but had larger social networks (median Facebook friends 227 vs 132, P<.001) and were more likely to be divorced, separated, or widowed (P<.01). In 39.7% (62/156) of unique jokes, the joke was at the expense of doctors. Jokes at the expense of doctors compared to jokes not at the expense of doctors tended to be more successful in eliciting an electronic laugh (46.5% vs 37.3%), although the association was statistically insignificant. In our adjusted models, jokes that were based on current events received considerably more Facebook likes (rate ratio [RR] 2.36, 95% CI 0.97-5.74). This study provides insight into the use of social networking sites for research pertaining to health and medicine, including the world of doctor-related humor.

Got Skills? On-the-Job Activities of Physicists

NASA Astrophysics Data System (ADS)

Ivie, Rachel

2011-03-01

It goes almost without saying that physics doctorates do a lot more than just physics research or teaching at their jobs. But what exactly do they do? First, I will share basic data showing where physics doctorates are employed. Then I will present data from two of AIP's surveys about the employment of physicists. The first set of data comes from our survey of physics PhDs one year after doctorate. We will consider how often physics doctorates do a variety of activities on the job, including management, technical writing, teamwork, design and development, programming, and advanced mathematics. The second set of data comes from AIP's new survey of PhDs in physics 10 to 13 years after graduation. Data for many of the same activities will be shown for physics doctorates who have been in the workplace about a decade. Depending on the type of job, most industrially employed physics doctorates do some type of physics at work, but they are also very likely to report managing projects, writing for technical audiences, working on a team, and collaborating with non-physicists, among many other activities. This examination of the types of activities physics doctorates perform in the workplace will provide insight on the non-scientific training that would benefit graduate students the most.

Evaluating laboratory key performance using quality indicators in Alexandria University Hospital Clinical Chemistry Laboratories.

PubMed

Rizk, Mostafa M; Zaki, Adel; Hossam, Nermine; Aboul-Ela, Yasmin

2014-12-01

The performance of clinical laboratories plays a fundamental role in the quality and effectiveness of healthcare. To evaluate the laboratory performance in Alexandria University Hospital Clinical Laboratories using key quality indicators and to compare the performance before and after an improvement plan based on ISO 15189 standards. The study was carried out on inpatient samples for a period of 7 months that was divided into three phases: phase I included data collection for evaluation of the existing process before improvement (March-May 2012); an intermediate phase, which included corrective, preventive action, quality initiative and steps for improvement (June 2012); and phase II, which included data collection for evaluation of the process after improvement (July 2012-September 2012). In terms of the preanalytical indicators, incomplete request forms in phase I showed that the total number of received requests were 31 944, with a percentage of defected request of 33.66%; whereas in phase II, there was a significant reduction in all defected request items (P<0.001) with a percentage of defected requests of 9.64%. As for the analytical indicators, the proficiency testing accuracy score in phase I showed poor performance of 10 analytes in which total error (TE) exceeded total error allowable (TEa), with a corresponding sigma value of less than 3, which indicates test problems and an unreliable method. The remaining analytes showed an acceptable performance in which TE did not exceed the TEa, with a sigma value of more than 6. Following an intervention of 3 months, the performance showed marked improvement. Error tracking in phase I showed a TE of (5.11%), whereas in phase II it was reduced to 2.48% (P<0.001).For the postanalytical indicators, our results in phase I showed that the percentage of nonreported critical results was 26.07%. In phase II, there was a significant improvement (P<0.001). The percentage of nonreported results was 11.37%, the reasons were either inability to contact the authorized doctor (8.24%), wrong patient identification (1.0%), lack of reporting by lab doctor (1.11%), and finally, lack of reporting by the lab technician (1.03%). Standardization and monitoring of each step in the total testing process is very important and is associated with the most efficient and well-organized laboratories.

On Doctors and Their Operas: A Critical (and Lyrical) Analysis of Medicine in Opera.

PubMed

Soriano, Joan B

2018-03-22

The goal of this research was to analyze the opera repertoire in terms of contents of physician roles. An additional goal was to pinpoint significant characters and passages that exemplify the changing role and perception of medicine in society over five centuries. A systematic search was performed. Musical characteristics and performing roles, and their determinants, were tabulated and formally analyzed. Of 493 operas listed, 53 (10.7%) were identified as having either a patient and/or doctor as characters. These operas span 239 years, from 1777 to 2016. Beyond unspecified Family Medicine and Generalists, some operas could be attributed to medical specialties, including 3 (5.7%) to Respiratory. Most interestingly, the 34 operas (6.9%) with physician roles are all represented by male characters, distributed by voice register mostly in the grave chords. Overall, the composer that appears with the highest interest in reporting disease is Giuseppe Verdi, with nine operas that include medical doctors. Finally, a trend can be observed regarding the evolving role of doctors, from mostly minor, buffal roles, either with magical or comical components in the 18th century, to a professional/technical physician more recently. Opera depicts a changing perception of the roles of doctors throughout history, with a blatant gender bias that still persists. Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

An exploration of opportunities and challenges facing cervical cancer managers in Kenya

PubMed Central

2013-01-01

Background Kenya like other developing countries is low in resource setting and is facing a number of challenges in the management of cervical cancer. This study documents opportunities and challenges encountered in managing cervical cancer from the health care workers’ perspectives. A qualitative study was conducted among cervical cancer managers who were defined as nurses and doctors involved in operational level management of cervical cancer. The respondents were drawn from four provincial hospitals and the only two main National public referral hospitals in Kenya. Twenty one [21] nurse managers and twelve [12] medical doctors were interviewed using a standardized interview guide. The responses were audio recorded, transcribed verbatim and the content analyzed in emerging themes. Findings Four themes were identified. Patient related challenges included a large number of patients, presenting in the late stage of disease, low levels of knowledge on cancer of the cervix, low levels of screening and a poor attitude towards screening procedure. Individual health care providers identified a lack of specialised training, difficulty in disclosure of diagnosis to patients, a poor attitude towards cervical cancer screening procedure and a poor attitude towards cervical cancer patients. Health facilities were lacking in infrastructure and medical supplies. Some managers felt ill-equipped in technological skills while the majority lacked access to the internet. Mobile phones were identified as having great potential for improving the management of cervical cancer in Kenya. Conclusion Kenya faces a myriad of challenges in the management of cervical cancer. The peculiar negative attitude towards screening procedure and the negative attitude of some managers towards cervical cancer patients need urgent attention. The potential use of mobile phones in cervical cancer management should be explored. PMID:23566436

Postoperative pain assessment using four behavioral scales in Pakistani children undergoing elective surgery

PubMed Central

Shamim, Faisal; Ullah, Hameed; Khan, Fauzia A.

2015-01-01

Background: Several measurement tools have been used for assessment of postoperative pain in pediatric patients. Self-report methods have limitations in younger children and parent, nurse or physician assessment can be used as a surrogate measure. These tools should be tested in different cultures as pain can be influenced by sociocultural factors. The objective was to assess the inter-rater agreement on four different behavioral pain assessment scales in our local population. Materials and Methods: This prospective, descriptive, observational study was conducted in Pakistan. American Society of Anesthesiologists I and II children, 3-7 years of age, undergoing elective surgery were enrolled. Four pain assessment scales were used, Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), Toddler Preschool Postoperative Pain Scale (TPPPS), objective pain scale (OPS), and Face, Legs, Activity, Cry, Consolability (FLACC). After 15 and 60 min of arrival in the postanesthesia care unit (PACU), each child evaluated his/her postoperative pain by self-reporting and was also independently assessed by the PACU nurse, PACU anesthetist and the parent. The sensitivity and specificity of the responses of the four pain assessment scales were compared to the response of the child. Results: At 15 min, sensitivity and specificity were >60% for doctors and nurses on FLACC, OPS, and CHEOPS scales and for FLACC and CHEOPS scale for the parents. Parents showed poor agreement on OPS and TPPS. At 60 min, sensitivity was poor on the OPS scale by all three observers. Nurses showed a lower specificity on FLACC tool. Parents had poor specificity on CHEOPS and rate of false negatives was high with TPPS. Conclusions: We recommend the use of FLACC scale for assessment by parents, nurses, and doctors in Pakistani children aged between 3 and 7. PMID:25829906

The impact of a structured clinical training course on interns' self-reported confidence with core clinical urology skills.

PubMed

Browne, C; Norton, S; Nolan, J M; Whelan, C; Sullivan, J F; Quinlan, M; Sheikh, M; Mc Dermott, T E D; Lynch, T H; Manecksha, R P

2018-02-01

Undergraduate training in core urology skills is lacking in many Irish training programmes. Our aim was to assess newly qualified doctors' experience and confidence with core urological competencies. A questionnaire survey covering exposure to urology and confidence with core clinical skills was circulated to all candidates. The group then attended a skills course covering male/female catheterisation, insertion of three-way catheters, bladder irrigation and management of long-term suprapubic catheters. The groups were re-surveyed following the course. Forty-five interns completed the pre-course questionnaire (group 1) and 27 interns completed the post-course questionnaire (group 2). 24/45 (53%) had no experience of catheter insertion on a patient during their undergraduate training. 26/45 (58%) were unsupervised during their first catheter insertion. 12/45 (27%) had inserted a female catheter. 18/45 (40%) had inserted a three-way catheter. 12/45 (27%) had changed a suprapubic catheter. 40/45 (89%) in group 1 reported 'good' or 'excellent' confidence with male urinary catheterisation, compared to 25/27 (92.5%) in group 2. 18/45 (40%) in group 1 reported 'none' or 'poor' confidence with female catheterisation, compared to 7/27 (26%) in group 2. 22/45 (49%) in group 1 reported 'none' or 'poor' confidence with insertion of three-way catheters, compared to 2/27 (7%) in group 2. 32/45 (71%) in group 1 reported 'none' or 'poor' confidence in changing long-term suprapubic catheters, falling to 3/27 (11%) in group 2. This study raises concerns about newly qualified doctors' practical experience in urology. We suggest that this course improves knowledge and confidence with practical urology skills and should be incorporated into intern induction.

Surveys of Ph.D. Thesis: Review of Doctoral Research in Language Assessment in Canada (2006-2011)

ERIC Educational Resources Information Center

Cheng, Liying; Fox, Janna

2013-01-01

This paper reviews a selected sample of 24 doctoral dissertations in language assessment (broadly defined), completed between 2006 and 2011 in Canadian universities. These dissertations fall into five thematic categories: 1) reliability, validity and factors affecting test performance; 2) washback (impact) and ethics; 3) raters, rating and rating…

Exploring the safety measures by doctors on after-hours house call services.

PubMed

Ifediora, Chris

2015-01-01

Aggression against doctors involved in after-hours house calls (AHHC) is widely perceived to be high. It is, however, unclear how doctors who perform this service manage the risk of aggressive patients during home visits. The aim of this paper is to explore if and how doctors manage the risk of violence against them during AHHC. A survey was designed and administered to all 300 Australian-based doctors engaged in AHHC under the National Home Doctor Service (NHDS). The survey was conducted from September 2014 to November 2014. There were 172 responses (57.3 per cent). Only 43 per cent of respondents adopted personal protective measures. The remaining 57 per cent had none; of those 6 per cent had never considered protective measures, and 31.8 per cent were aware of the risk of violence, but were unsure of what to do. Measures adopted include the use of chaperones/security personnel (34.1 per cent), dependence on surgery policies (31.2 per cent), de-escalation techniques (15.2 per cent), panic buttons (7.2 per cent), personal alarms (6.1 per cent), and others (6.5 per cent). Females were more likely to adopt personal protective measures than males (OR 4.94; p<0.01; CI 1.70-14.34), and Australian-trained doctors were less likely to do so relative to overseas-trained doctors (OR 0.35; p=0.04; CI 0.12-0.99). Just over half of the doctors involved in AHHC took no precautions against aggressive attacks while on duty, and nearly one-third relied on the policies of their employing surgeries.

Medical records and issues in negligence

PubMed Central

Thomas, Joseph

2009-01-01

It is very important for the treating doctor to properly document the management of a patient under his care. Medical record keeping has evolved into a science of itself. This will be the only way for the doctor to prove that the treatment was carried out properly. Moreover, it will also be of immense help in the scientific evaluation and review of patient management issues. Medical records form an important part of the management of a patient. It is important for the doctors and medical establishments to properly maintain the records of patients for two important reasons. The first one is that it will help them in the scientific evaluation of their patient profile, helping in analyzing the treatment results, and to plan treatment protocols. It also helps in planning governmental strategies for future medical care. But of equal importance in the present setting is in the issue of alleged medical negligence. The legal system relies mainly on documentary evidence in a situation where medical negligence is alleged by the patient or the relatives. In an accusation of negligence, this is very often the most important evidence deciding on the sentencing or acquittal of the doctor. With the increasing use of medical insurance for treatment, the insurance companies also require proper record keeping to prove the patient's demand for medical expenses. Improper record keeping can result in declining medical claims. It is disheartening to note that inspite of knowing the importance of proper record keeping it is still in a nascent stage in India. It is wise to remember that “Poor records mean poor defense, no records mean no defense”. Medical records include a variety of documentation of patient's history, clinical findings, diagnostic test results, preoperative care, operation notes, post operative care, and daily notes of a patient's progress and medications. A properly obtained consent will go a long way in proving that the procedures were conducted with the concurrence of the patient. A properly written operative note can protect a surgeon in case of alleged negligence due to operative complications. It is important that the prescription for drugs should be legible with the name of the patient, date, and the signature of the doctor. An undated prescription can land a doctor in trouble if the patient misuses it. There are also many records that are indirectly related to patient management such as accounts records, service records of the staff, and administrative records, which are also useful as evidences for litigation purposes. Medical recording needs the concerted effort of a number of people involved in patient care. The doctor is the prime person who has to oversee this process and is primarily responsible for history, physical examination, treatment plans, operative records, consent forms, medications used, referral papers, discharge records, and medical certificates. There should be proper recording of nursing care, laboratory data, reports of diagnostic evaluations, pharmacy records, and billing processes. This means that the paramedical and nursing staff also should be trained in proper maintenance of patient records. The medical scene in India extends from smaller clinics to large hospitals. Medical record keeping is a specialized area in bigger teaching and corporate hospitals with separate medical records officers handling these issues. However, it is yet to develop into a proper process in the large number of smaller clinics and hospitals that cater to a large section of the people in India. PMID:19881136

Development of a telepresence robot for medical consultation

NASA Astrophysics Data System (ADS)

Bugtai, Nilo T.; Ong, Aira Patrice R.; Angeles, Patrick Bryan C.; Cervera, John Keen P.; Ganzon, Rachel Ann E.; Villanueva, Carlos A. G.; Maniquis, Samuel Nazirite F.

2017-02-01

There are numerous efforts to add value for telehealth applications in the country. In this study, the design of a telepresence doctor to facilitate remote medical consultations in the wards of Philippine General Hospital is proposed. This includes the design of a robot capable of performing a medical consultation with clear audio and video information for both ends. It also provides the operating doctor full control of the telepresence robot and gives a user-friendly interface for the controlling doctor. The results have shown that it provides a stable and reliable mobile medical service through the use of the telepresence robot.

'It gives you an understanding you can't get from any book.' The relationship between medical students' and doctors' personal illness experiences and their performance: a qualitative and quantitative study.

PubMed

Woolf, Katherine; Cave, Judith; McManus, I Chris; Dacre, Jane E

2007-12-05

Anecdotes abound about doctors' personal illness experiences and the effect they have on their empathy and care of patients. We formally investigated the relationship between doctors' and medical students' personal illness experiences, their examination results, preparedness for clinical practice, learning and professional attitudes and behaviour towards patients. Newly-qualified UK doctors in 2005 (n = 2062/4784), and two cohorts of students at one London medical school (n = 640/749) participated in the quantitative arm of the study. 37 Consultants, 1 Specialist Registrar, 2 Clinical Skills Tutors and 25 newly-qualified doctors participated in the qualitative arm. Newly-qualified doctors and medical students reported their personal illness experiences in a questionnaire. Doctors' experiences were correlated with self-reported preparedness for their new clinical jobs. Students' experiences were correlated with their examination results, and self-reported anxiety and depression. Interviews with clinical teachers, newly-qualified doctors and senior doctors qualitatively investigated how personal illness experiences affect learning, professional attitudes, and behaviour. 85.5% of newly-qualified doctors and 54.4% of medical students reported personal illness experiences. Newly-qualified doctors who had been ill felt less prepared for starting work (p < 0.001), but those who had only experienced illness in a relative or friend felt more prepared (p = 0.02). Clinical medical students who had been ill were more anxious (p = 0.01) and had lower examination scores (p = 0.006). Doctors felt their personal illness experiences helped them empathise and communicate with patients. Medical students with more life experience were perceived as more mature, empathetic, and better learners; but illness at medical school was recognised to impede learning. The majority of the medical students and newly qualified doctors we studied reported personal illness experiences, and these experiences were associated with lower undergraduate examination results, higher anxiety, and lower preparedness. However reflection on such experiences may have improved professional attitudes such as empathy and compassion for patients. Future research is warranted in this area.

Reviews Opera: Doctor Atomic DVD: Doctor Atomic Equipment: Digital stopclock with external trigger Book: I Cyborg Book: Flat Earth: The History of an Infamous Idea Book: Mere Thermodynamics Book: CGP revision guides Book: Hiding the Elephant: How Magicians Invented the Impossible Book: Back of the Envelope Physics Web Watch

NASA Astrophysics Data System (ADS)

2009-07-01

WE RECOMMEND Doctor Atomic The new Doctor Atomic opera provkes discussion on ethics I Cyborg The world's first human cyborg shares his life story in I Cyborg Flat Earth: The History of an Infamous Idea Flat Earth gives us a different perspective on creationism Mere Thermodynamics An introductory text on the three laws CGP revision guides This revision guide suits all courses and every pocket Hiding the Elephant: How Magicians Invented the Impossible The mystery of many illusions are solved in this book Back of the Envelope Physics This reference deserves a place on your bookshelf WORTH A LOOK Doctor Atomic The DVD doesn't do justice to the live performance Digital stopclock with external trigger Use these stopclocks when you need an external trigger WEB WATCH Webcasts reach out to an online audience

[Practical use of doctor's assistant].

PubMed

Honda, Jiro

2012-07-01

Many researchers have focused on the introduction of mid-level providers (MLP) in order to reduce the number of doctors treating patients in the hospital. However, the establishment of MLPs in Japan still takes time. The process could be accelerated by relieving doctors of clerical work by employing auxiliary personnel. This hospital employs 22 auxiliary people to perform clerical work for the doctors, which are referred to as "doctor's assistants (DA)". The system is connected with the medical treatment fee system. Two DA are assigned cardiovascular surgery and conduct various other activities. These activities include: 1. Temporary creation of various medical documents. 2. Vicarious execution of electronic medical recoding system input. 3. Support of scientific activity. 4. Input of all data into the JACVSD Database. In addition, they participate in a round of cardiovascular surgery and inform the patient or family of the surgical schedule. They also cooperate with personnel from other specialties or department. The DA thus plays a crucial role in "team medical treatment."

A case of iatrogenic stress? Results of the RCOG August rotation survey.

PubMed

Cooke, M; Morris, E

2014-10-01

Although there are a number of studies of patient safety during the August rotation, they often focus on newly qualified doctors. It remains unclear whether negative impacts are due to doctors' inexperience, lack of technical skill or other aspects of rotation. This study used an electronic survey to seek the views of doctors working in obstetrics and gynaecology in the UK. A total of 1,879 responses were received. The August rotation was felt to be a stressful time, with a negative effect on patient care (82%) and safety (73%), lasting up to 1 month (62%). Although reducing services was thought to be helpful, there was strong support for staggering the rotation by grade (80%). This would ensure availability of doctors to cover services during the induction period, which should improve patient care and reduce staff stress. In addition, intensive skills training for junior staff and a supportive culture during the 1st month could optimise the integration and performance of doctors of all grades.

Process evaluation of the systematic medical appraisal, referral and treatment (SMART) mental health project in rural India.

PubMed

Tewari, Abha; Kallakuri, Sudha; Devarapalli, Siddhardha; Jha, Vivekanand; Patel, Anushka; Maulik, Pallab K

2017-12-04

Availability of basic mental health services is limited in rural areas of India. Health system and individual level factors such as lack of mental health professionals and infrastructure, poor awareness about mental health, stigma related to help seeking, are responsible for poor awareness and use of mental health services. We implemented a mental health services delivery model that leveraged technology and task sharing to facilitate identification and treatment of common mental disorders (CMDs) such as stress, depression, anxiety and suicide risk in rural areas of the state of Andhra Pradesh, India. The intervention was delivered by lay village health workers (Accredited Social Health Activists - ASHAs) and primary care doctors. An anti-stigma campaign was implemented prior to this activity. This paper reports the process evaluation of the intervention using mixed methods. A mixed methods pre-post evaluation assessed the intervention using quantitative service usage analytics from the server, and qualitative interviews with different stakeholders. Barriers and facilitators in implementing the intervention were identified. Health service use increased significantly at post-intervention, ASHAs could followup 78.6% of those who had screened positive, and 78.6% of the 1243 Interactive Voice Response System calls made, were successful. Most respondents were aware of the intervention. They indicated that knowledge received through the intervention empowered them to approach ASHAs and share their mental health symptoms. ASHAs and doctors opined that EDSS was useful and easy to use. Medical camps organized in villages to increase access to the doctor were received positively by all. However, some aspects or facilitators of the intervention need to be improved, including network connectivity, booster training, anti-stigma campaigns, quality of mental health services provided by doctors, provision of psychotropic medications at primary health centers and frequency of health camps. The respondents' views helped to understand the barriers and facilitators for improving the likely effectiveness of the intervention using Andersen's Modified Behavioral Model of Health Services Use, and identify the mechanisms by which those factors affected mental health services uptake in the community. The study is registered with Clinical Trials Registry India (Applied - 16/07/14-Ref2014/07/007256; registration received - 04/10/17-CTRI/2017/10/009992 ).

'I Used to Fight with Them but Now I Have Stopped!': Conflict and Doctor-Nurse-Anaesthetists' Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital

PubMed Central

Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han

2015-01-01

Background and Objectives This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethics Statement Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Results Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. Conclusion To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers and health workers on conflict management should be put in place. Additionally promoting communication and interaction among health workers can foster team spirit. Also resolving conflicts using the collaborating response may help to create a conducive work environment that will promote healthy work relations, which can facilitate the delivery of quality maternal and neonatal health care. However, such an approach requires that unequal power relations, which is a root cause of the conflicts is addressed. PMID:26285108

Strengths and weaknesses of parent–staff communication in the NICU: a survey assessment

PubMed Central

2013-01-01

Background Parents of infants hospitalized in the neonatal intensive care unit (NICU) find themselves in a situation of emotional strain. Communication in the NICU presents special challenges due to parental stress and the complexity of the highly technologized environment. Parents’ need for communication may not always be met by the NICU staff. This study aimed to describe strengths and weaknesses of parent–nurse and parent–doctor communication in a large level III NICU in Sweden in order to improve our understanding of parents’ communication needs. Methods Parents were asked to complete a survey consisting of sixteen questions about their experiences of communication with nurses and doctors in the NICU. In each question the parents evaluated some aspect of communication on a five- or six-point Likert scale. They also had the opportunity on each question to comment on their experiences in their own words. Data were analyzed using IBM SPSS Statistics 20.0 and qualitative manifest content analysis. Results 270 parents (71.4%) completed the survey. Parents generally rated communication with the staff in the NICU positively and appreciated having received emotional support and regular information about their child´s care. Although a large majority of the parents were satisfied with their communication with doctors and nurses, only about half of the parents felt the nurses and doctors understood their emotional situation very well. Some parents would have desired easier access to conversations with doctors and wanted medical information to be given directly by doctors rather than by nurses. Parents’ communication with the staff was hampered when many different nurses were involved in caring for the infant or when the transfer of information in connection with shift changes or between the maternity ward and NICU was poor. Parents also desired to be present during doctors’ rounds on their infant. Conclusions Training both doctors and nurses in communication skills, especially in how to meet parents’ emotional needs better, could make communication at the NICU more effective and improve parental well-being. Creating a framework for the parents of what to expect from NICU communication might also be helpful. In addition, our results support the use of primary nurse teams to improve continuity of care and thereby promote successful communication. PMID:23651578

Patient education - A route to improved patient experience in Chinese hospitals?

PubMed

Hu, Yinhuan; Zhang, Zixia

2015-06-23

Poor patient experience may trigger serious doctor-patient conflicts in China. Health system challenges related to access and financing may cause frustration in patients, but inadequate health literacy is an additional factor. This letter argues from two aspects that patient education is an effective and feasible pathway to improve patient experience, but its effects are influenced by underlying systemic problems and contextual factors in China. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The Doctor's and the Patient's Problems in Treating Obesity

PubMed Central

Keegan, D. L.

1977-01-01

The major difficulties for physicians and patients alike in the management of obesity are lack of goals, poor understanding of their roles in diet therapy and often a negative, helpless attitude toward therapy itself. Physicians clearly have a key role as coordinators of a weight reduction program, through their skills in assessing overweight problems. In addition, the physician plays an important role in education, communication, motivation and organization of the weight reduction therapy. PMID:21304867

Chartbook. Quality checkup.

PubMed

Hudson, T

1999-08-01

With hospital quality programs, the reach is broad, not deep. So says the National Hospital Quality Improvement Survey, conducted by health care researcher Stephen Shortell for Arthur Andersen and the American Hospital Association. Though 93 percent of responding hospitals and health systems use CQI and TQM methods is some fashion, they've taught them to only 35 percent of employees and a scant 22 percent of doctors on their medical staffs. Those poor showings leave health care lagging behind most other industries.

Health literacy, computer skills and quality of patient-physician communication in Chinese patients with cataract.

PubMed

Lin, Xianchai; Wang, Mei; Zuo, Yajing; Li, Mingge; Lin, Xiaofeng; Zhu, Siping; Zheng, Yongxin; Yu, Minbin; Lamoureux, Ecosse L

2014-01-01

The aim of the study was to assess levels of health literacy and computer skills in Chinese patients with cataract, and their impact on the doctor-patient relationship. We undertook a cross-sectional study of cataract patients scheduled for cataract extraction procedures in Guangdong Province, China. Generic health literacy was assessed using 3 established screening questions. Adequate computer skills was determined if patients had used a computer and routinely used search engines on the Internet. Socio-demographic measures (e.g., age, sex, education) were obtained from a standardized interview. Participants who indicated that they could not understand what their doctors mean were considered to have had poor patient-physician communications. Of the 211 participants, 92 (43.6%) had inadequate health literacy and 204 (96.7%) inadequate computer skills. In multivariate analysis, females were more likely to have inadequate health literacy (odds ratio = 2.5, 95% confidence intervals [CI]: 1.3 to 4.7). People with inadequately health literacy were more likely to have a poor patient-physician communication (odds ratio = 3.5, 95% CIs: 1.3 to 9.0). Similar associations were found for inadequate computer skills. Chinese elderly patients with cataract have inadequate health literacy and very limited computer skills, which place them at high risk of misunderstanding and mismanaging their ocular conditions. Patient education information other than online materials may improve the eye care and outcomes of these patients.

Getting women to hospital is not enough: a qualitative study of access to emergency obstetric care in Bangladesh.

PubMed

Pitchforth, E; van Teijlingen, E; Graham, W; Dixon-Woods, M; Chowdhury, M

2006-06-01

To explore what happened to poor women in Bangladesh once they reached a hospital providing comprehensive emergency obstetric care (EmOC) and to identify support mechanisms. Mixed methods qualitative study. Large government medical college hospital in Bangladesh. Providers and users of EmOC. Ethnographic observation in obstetrics unit including interviews with staff and women using the unit and their carers. Women had to mobilise significant financial and social resources to fund out of pocket expenses. Poorer women faced greater challenges in receiving treatment as relatives were less able to raise the necessary cash. The official financial support mechanism was bureaucratic and largely unsuitable in emergency situations. Doctors operated a less formal "poor fund" system to help the poorest women. There was no formal assessment of poverty; rather, doctors made "adjudications" of women's need for support based on severity of condition and presence of friends and relatives. Limited resources led to a "wait and see" policy that meant women's condition could deteriorate before help was provided. Greater consideration must be given to what happens at health facilities to ensure that (1) using EmOC does not further impoverish families; and (2) the ability to pay does not influence treatment. Developing alternative finance mechanisms to reduce the burden of out of pocket expenses is crucial but challenging. Increased investment in EmOC must be accompanied by an increased focus on equity.

Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana.

PubMed

Ganle, John Kuumuori; Fitzpatrick, Raymond; Otupiri, Easmon; Parker, Michael

2016-10-01

Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care-seeking behaviours have focused on identifying the norms of non-use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expectant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity caregivers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor-patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non-state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor-patient relational practices that positively influence women's healthcare-seeking behaviours. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

The Analysis of Slovenian Political Party Programs Regarding Doctors and Health Workers from 1992 to 2014.

PubMed

Maksuti, Alem; Rotar Pavlič, Danica; Deželan, Tomaž

2016-03-01

The study focuses on the programmatic bases of Slovenian political parties since independence. It presents an analysis of party programs and their preferences regarding doctors and other health workers, as well as the contents most commonly related to them. At the same time, the study also highlights the intensity of the presence of doctors on the policy agenda through time. In the study, 83 program documents of political parties have been analysed. The study includes programmes of political parties that have occurred in parliamentary elections in Slovenia between 1992 and 2014 and have exceeded the parliamentary threshold. The data were analysed using the content analysis method, which is suitable for analysing policy texts. The analysis was performed using ATLAS.ti, the premier software tool for qualitative data analysis. The results showed that doctors and other health workers are an important political topic in non-crisis periods. At that time, the parties in the context of doctors mostly dealt with efficiency and the quality of services in the health system. They often criticize doctors and expose the need for their control. In times of economic crisis, doctors and other health workers are less important in normative commitments of parties. Slovenian political parties and their platforms cannot be distinguished ideologically, but primarily on the principle of access to government. It seems reasonable to conclude that parties do not engage in dialogue with doctors, and perceive the latter aspassive recipients of government decisions-politics.

Boosting medical diagnostics by pooling independent judgments

PubMed Central

Kurvers, Ralf H. J. M.; Herzog, Stefan M.; Hertwig, Ralph; Krause, Jens; Carney, Patricia A.; Bogart, Andy; Argenziano, Giuseppe; Zalaudek, Iris; Wolf, Max

2016-01-01

Collective intelligence refers to the ability of groups to outperform individual decision makers when solving complex cognitive problems. Despite its potential to revolutionize decision making in a wide range of domains, including medical, economic, and political decision making, at present, little is known about the conditions underlying collective intelligence in real-world contexts. We here focus on two key areas of medical diagnostics, breast and skin cancer detection. Using a simulation study that draws on large real-world datasets, involving more than 140 doctors making more than 20,000 diagnoses, we investigate when combining the independent judgments of multiple doctors outperforms the best doctor in a group. We find that similarity in diagnostic accuracy is a key condition for collective intelligence: Aggregating the independent judgments of doctors outperforms the best doctor in a group whenever the diagnostic accuracy of doctors is relatively similar, but not when doctors’ diagnostic accuracy differs too much. This intriguingly simple result is highly robust and holds across different group sizes, performance levels of the best doctor, and collective intelligence rules. The enabling role of similarity, in turn, is explained by its systematic effects on the number of correct and incorrect decisions of the best doctor that are overruled by the collective. By identifying a key factor underlying collective intelligence in two important real-world contexts, our findings pave the way for innovative and more effective approaches to complex real-world decision making, and to the scientific analyses of those approaches. PMID:27432950

The Analysis of Slovenian Political Party Programs Regarding Doctors and Health Workers from 1992 to 2014

PubMed Central

MAKSUTI, Alem; ROTAR PAVLIČ, Danica; DEŽELAN, Tomaž

2016-01-01

Introduction The study focuses on the programmatic bases of Slovenian political parties since independence. It presents an analysis of party programs and their preferences regarding doctors and other health workers, as well as the contents most commonly related to them. At the same time, the study also highlights the intensity of the presence of doctors on the policy agenda through time. Methods In the study, 83 program documents of political parties have been analysed. The study includes programmes of political parties that have occurred in parliamentary elections in Slovenia between 1992 and 2014 and have exceeded the parliamentary threshold. The data were analysed using the content analysis method, which is suitable for analysing policy texts. The analysis was performed using ATLAS.ti, the premier software tool for qualitative data analysis. Results The results showed that doctors and other health workers are an important political topic in non-crisis periods. At that time, the parties in the context of doctors mostly dealt with efficiency and the quality of services in the health system. They often criticize doctors and expose the need for their control. In times of economic crisis, doctors and other health workers are less important in normative commitments of parties. Conclusions Slovenian political parties and their platforms cannot be distinguished ideologically, but primarily on the principle of access to government. It seems reasonable to conclude that parties do not engage in dialogue with doctors, and perceive the latter aspassive recipients of government decisions—politics. PMID:27647091

Doctor-patient communication without family is most frequently practiced in patients with malignant tumors in home medical care settings.

PubMed

Kimura, Takuma; Imanaga, Teruhiko; Matsuzaki, Makoto

2014-01-01

Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.

Patient agency and contested notions of disability in social assistance applications in South Africa.

PubMed

Kelly, Gabrielle

2017-02-01

Problems in fairly allocating welfare and health resources are very often located in the spaces where citizens interact directly with state workers. This study draws on observations of doctor-patient encounters in disability assessments for the South African disability grant (DG) to examine how doctor-patient interactions and patient agency shape social welfare allocation in a context of high poverty and inequality. Data were gathered via interviews with healthcare workers and observations of doctor-patient interactions in twelve clinics and three hospitals in the Western Cape province between October 2013 and August 2014. Twenty-four doctors were interviewed, of whom seventeen were observed conducting a total of 216 consultations with patients. Two training sessions of DG assessors were also observed. Findings show that interactions between doctors and patients are sites of negotiation and contestation over rights to social assistance. Claimants' understanding of disability differed from biomedical and bureaucratic definitions. Patients attempted to influence doctors' decisions through narratives of suffering and performances of disability. Others used verbal or physical abuse as a form of protest against perceived unfair treatment. To defend themselves from these pressures and maintain authority in these interactions, doctors employed coping strategies that distanced and objectified claimants. This resulted in strained doctor-patient relationships and made the DG system confusing to the public. This demonstrates the importance of considering trust, power dynamics and the exercise of agency by both patients and providers in understanding policy implementation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Work related stress and its anticipated solutions among post-graduate medical resident doctors: a cross-sectional survey conducted at a tertiary municipal hospital in Mumbai, India.

PubMed

Rajan, Pavithra; Bellare, Bharati

2011-03-01

It is now known that resident doctors registered for postgraduate studies are prone to work related stress and eventual burnout. Though stress can happen in any profession, reduced performance of resident doctors due to vocational stress could cause an increase in medical errors and thus affect the quality of life of the patients. Resident doctors at a Municipal hospital in India form a unique population as number of stresses they undergo are many and varied. To study the prevalence of work-related stress and its anticipated solutions among the resident doctors registered for postgraduate studies in clinical subjects at a tertiary Municipal hospital. A stratified sampling cross-sectional survey was conducted at the Inpatient, Outpatient, and Intensive Care Units at a tertiary Municipal hospital in Mumbai, India. Data collection was done using a validated 20-point questionnaire to assess the factors causing stress and their anticipated solutions. Simple percentage analysis of stress questionnaire. 71 resident doctors completed the survey. The major stressors in this cohort were inadequate hostel/quarter facilities (92.1%), and the need to perform extra duties (80.0%). Also, non-conducive environment for clinical training and studies (81.7%), inadequate study (78.9%) and break (81.2%), threat from deadly infections (74.6%), and overburdening with work (69.0%) were the other major stress causing factors. The perceived stress busters were good music (40.8%) and family and friends (40.8%). Eighty-seven percent of the respondents perceived regular physical exercise to be an effective mode of stress management and 83.8% expressed their need to have a simple therapeutic gymnasium established within the campus with a qualified trainer. There is a high level of work related stress among the resident doctors registered for postgraduate clinical studies at a tertiary Municipal hospital in Mumbai. One of the perceived stress busters is regular physical exercise that is structured and under supervision.

Knowledge assessment regarding secondary prevention of coronary heart disease- a multi centre survey

PubMed Central

2014-01-01

Background Cardiovascular Disease (CVD) is a major cause of mortality worldwide. Control and reduction of cardiovascular risk factors such as elevated blood pressure, high cholesterol levels, excess of body weight, smoking and lack of exercise can contribute to a reduction of CVD mortality. Methods A standardized questionnaire was administered to all medical officers willing to participate in the study, who were working in the Cardiology Units all over Sri Lanka to assess the source of continuous medical education, attitudes on secondary prevention, barriers to secondary prevention and knowledge assessment of secondary prevention of cardiovascular diseases. Chi square was used to compare groups and p < 0.05 was considered significant. Results 132 participants with equal numbers of males and female doctors participated. While 56 doctors have had no training in cardiology, 75 doctors have had some training in a cardiology unit. The barriers for secondary prevention were, poor knowledge/understanding of patients 3.82 (1.06), too many drugs 3.74 (0.98), presence of co-morbid conditions 3.68(0.97), cost of medications 3.69 (0.97) and poor adherence to prevention strategies by patients 3.44 (1.15). Routine clinic visits 85 (65%) and public awareness day seminars 30 (22.2%) were the most effective methods of secondary prevention. Guidelines were the most popular method of continuous medical education. Those who have had some training in cardiology did not differ in their knowledge from those who have never had training in cardiology. Knowledge about prevention with regard to diet was inadequate and exercise and lipids were adequate but not good. Rates of knowledge on smoking cessation were much higher than for other CVD risk factors. Conclusion There needs to be more adherences to clinical guidelines and attention paid to CVD prevention, in particular, the importance of dietary modifications, adequate exercise, and lipid control. PMID:24903262

Scope of information communications technology in the health of diabetes patients in poor rural zones of panama through holistic, interactive, and persuasive model to facilitate self-care of diabetes patients.

PubMed

Vargas-Lombardo, Miguel; Jipsion, Armando; Alvarez, Humberto; Ruiz, Ernestina Mensalva; Mora, Elena Villalba

2010-09-01

In Latin America, public health systems that manage and warrant the health of the population lack mechanisms and technological capabilities that enable them to accept and adopt initiatives focused to guide, look after, and improve the quality of life of millions of patients with diabetes who need attention and special care. However, the proposal presented here for a holistic, interactive, and persuasive model to facilitate self-care of diabetes patients (hiPAPD) is the first proposal in Panama, Central America, and the Caribbean Region to develop and implement information communications technology (ICT) platforms for the care of patients with chronic diseases such as diabetes. The process of experimentation was initiated with an agreement with all the staff of the project to comply with the international biomedical studies stipulations, having as reference the Declaration of Helsinki of the World Medical Association (Recommendations to Guide to Doctors in Biomedical Research on People). After several months of evaluation and ongoing work the study obtained successful validation of the hiPAPD model. The project had the support of 107 patients with diabetes, their families, friends, doctors, nurses and nursing assistants, and social groups in rural communities. Finally, the project contributed to society with a highly innovative ICT environment that facilitates self-care of diabetes patients without financial resources and health. A timely health treatment at a decisive moment may be the difference in care for patients. Through the validation process conducted in this research initiative, it was demonstrated that the hiPAPD model, from the perspective of the patient with diabetes, relatives, friends, health workforce (nurses and nursing assistants), doctors, and societal contexts, allowed the improvement of the quality of life of patients with diabetes in poor rural zones of Panama.

Knowledge assessment regarding secondary prevention of coronary heart disease--a multi centre survey.

PubMed

Matthias, Anne Thushara; Lokunarangoda, Niroshan C; Ekanayaka, Ruvan

2014-06-06

Cardiovascular Disease (CVD) is a major cause of mortality worldwide. Control and reduction of cardiovascular risk factors such as elevated blood pressure, high cholesterol levels, excess of body weight, smoking and lack of exercise can contribute to a reduction of CVD mortality. A standardized questionnaire was administered to all medical officers willing to participate in the study, who were working in the Cardiology Units all over Sri Lanka to assess the source of continuous medical education, attitudes on secondary prevention, barriers to secondary prevention and knowledge assessment of secondary prevention of cardiovascular diseases. Chi square was used to compare groups and p < 0.05 was considered significant. 132 participants with equal numbers of males and female doctors participated. While 56 doctors have had no training in cardiology, 75 doctors have had some training in a cardiology unit. The barriers for secondary prevention were, poor knowledge/understanding of patients 3.82 (1.06), too many drugs 3.74 (0.98), presence of co-morbid conditions 3.68(0.97), cost of medications 3.69 (0.97) and poor adherence to prevention strategies by patients 3.44 (1.15). Routine clinic visits 85 (65%) and public awareness day seminars 30 (22.2%) were the most effective methods of secondary prevention. Guidelines were the most popular method of continuous medical education. Those who have had some training in cardiology did not differ in their knowledge from those who have never had training in cardiology. Knowledge about prevention with regard to diet was inadequate and exercise and lipids were adequate but not good. Rates of knowledge on smoking cessation were much higher than for other CVD risk factors. There needs to be more adherences to clinical guidelines and attention paid to CVD prevention, in particular, the importance of dietary modifications, adequate exercise, and lipid control.

Evaluation of a Web-based intervention providing tailored advice for self-management of minor respiratory symptoms: exploratory randomized controlled trial.

PubMed

Yardley, Lucy; Joseph, Judith; Michie, Susan; Weal, Mark; Wills, Gary; Little, Paul

2010-12-15

There has been relatively little research on the role of web-based support for self-care in the management of minor, acute symptoms, in contrast to the wealth of recent research into Internet interventions to support self-management of long-term conditions. This study was designed as an evaluation of the usage and effects of the "Internet Doctor" website providing tailored advice on self-management of minor respiratory symptoms (eg, cough, sore throat, fever, runny nose), in preparation for a definitive trial of clinical effectiveness. The first aim was to evaluate the effects of using the Internet Doctor webpages on patient enablement and use of health services, to test whether the tailored, theory-based advice provided by the Internet Doctor was superior to providing a static webpage providing the best existing patient information (the control condition). The second aim was to gain an understanding of the processes that might mediate any change in intentions to consult the doctor, by comparing changes in relevant beliefs and illness perceptions in the intervention and control groups, and by analyzing usage of the Internet Doctor webpages and predictors of intention change. Participants (N = 714) completed baseline measures of beliefs about their symptoms and self-care online, and were then automatically randomized to the Internet Doctor or control group. These measures were completed again by 332 participants after 48 hours. Four weeks later, 214 participants completed measures of enablement and health service use. The Internet Doctor resulted in higher levels of satisfaction than the control information (mean 6.58 and 5.86, respectively; P = .002) and resulted in higher levels of enablement a month later (median 3 and 2, respectively; P = .03). Understanding of illness improved in the 48 hours following use of the Internet Doctor webpages, whereas it did not improve in the control group (mean change from baseline 0.21 and -0.06, respectively, P = .05). Decline in intentions to consult the doctor between baseline and follow-up was predicted by age (beta = .10, P= .003), believing before accessing the website that consultation was necessary for recovery (beta = .19, P < .001), poor understanding of illness (beta = .11, P = .004), emotional reactions to illness (beta = .15, P <.001), and use of the Diagnostic section of the Internet Doctor website (beta = .09, P = .007). Our findings provide initial evidence that tailored web-based advice could help patients self-manage minor symptoms to a greater extent. These findings constitute a sound foundation and rationale for future research. In particular, our study provides the evidence required to justify carrying out much larger trials in representative population samples comparing tailored web-based advice with routine care, to obtain a definitive evaluation of the impact on self-management and health service use.

Completion of Limitation of Medical Treatment forms by junior doctors for patients with dementia: clinical, medicolegal and education perspectives.

PubMed

Yoong, Jaclyn; MacPhail, Aleece; Trytel, Gael; Rajendram, Prashanti Yalini; Winbolt, Margaret; Ibrahim, Joseph E

2017-10-01

Objective Limitation of Medical Treatment (LMT) forms are an essential element of end-of-life care. Decision making around LMT is complex and often involves patients with dementia. Despite the complexity, junior doctors frequently play a central role in completing LMT forms. The present study sought perspectives from a range of stakeholders (hospital clinicians, medical education personnel, legal and advocacy staff) about junior doctors' roles in completing LMT forms in general and for patients with dementia. Methods Qualitative data were gathered in semi-structured interviews (SSI) and theoretical concepts were explored in roundtable discussion (RD). Participants were recruited through purposive and convenience sampling drawing on healthcare and legal personnel employed in the public hospital and aged care systems, selected from major metropolitan hospitals, healthcare and legal professional bodies and advocacy organisations in Victoria, Australia. The contents of the SSIs and RD were subject to thematic analysis using a framework approach. Data were indexed according to the topics established in the study aim; categories were systematically scrutinised, from which key themes were distilled. Results Stakeholders reported that completing LMT forms was difficult for junior doctors because of a lack of medical and legal knowledge, as well as clinical inexperience and inadequate training. Healthcare organisations (HCOs) either lacked policies about the role of junior doctors or had practices that were discordant with policy. In this process, there were substantial gaps pertaining to patients with dementia. Recommendations made by the study participants included the provision of supervised clinical exposure and additional training for junior doctors, strengthening HCO policies and explicit consideration of the needs of patients with dementia. Conclusions LMT forms should be designed for clarity and consistency across HCOs. Enhancing patient care requires appropriate and sensitive completion of LMT. Relevant HCO policy and clinical practice changes are discussed herein, and recommendations are made for junior doctors in this arena, specifically in the context of patients with dementia. What is known about the topic? Junior doctors continue to play a central role in LMT orders, a highly complex decision-making task that they are poorly prepared to complete. LMT decision making in Australia's aging population and for people with dementia is especially challenging. What does this paper add? A broad range of stakeholders, including hospital clinicians, medical education personnel and legal and advocacy staff, identified ongoing substantial gaps in education and training of junior doctors (despite what is already known in the literature). Furthermore, LMT decision making for patients with dementia is not explicitly considered in policy of practice. What are the implications for practitioners? Current policy and practice are not at the desired level to deliver appropriate end-of-life care with regard to LMT orders, especially for patients with dementia. Greater involvement of executives and senior clinicians is required to improve both practice at the bed side and the training and support of junior doctors, as well as creating more robust policy.

The impact of preventive health behaviour and social factors on visits to the doctor.

PubMed

Yom Din, Gregory; Zugman, Zinaida; Khashper, Alla

2014-01-01

The aim of this study is to examine the joint impact of preventive health behavior (PHB) and social and demographic factors on the utilization of primary and secondary medical care under a universal health care system, as measured by visits to the doctor, who were categorized as either a General Practitioner (GP) or Specialist Doctor (SD). An ordered probit model was utilized to analyze data obtained from the 2009 Israeli National Health Survey. The problem of endogeneity between PHB factors and visits to GP was approached using the two-stage residuals inclusion and instrumental variables method. We found a positive effect of PHB on visits to the doctor while the addition of the PHB factors to the independent variables resulted in important changes in explaining visits to GP (in values of the estimates, in their sign, and in their statistical significance), and only in slight changes for visits to SD. A 1% increase in PHB factors results in increasing the probability to visit General Practitioner in the last year in 0.6%. The following variables were identified as significant in explaining frequency of visits to the doctor: PHB, socio-economic status (pro-poor for visits to GP, pro-rich for visits to SD), location (for visits to SD), gender, age (age 60 or greater being a negative factor for visits to GP and a positive factor for visits to SD), chronic diseases, and marital status (being married was a negative factor for visits to GP and a positive factor for visits to SD). There is a need for allowing for endogeneity in examining the impact of PHB, social and demographic factors on visits to GP in a population under universal health insurance. For disadvantaged populations with low SES and those living in peripheral districts, the value of IndPrev is lower than for populations with high SES and living in the center of the country. Examining the impact of these factors, significant differences in the importance and sometimes even in the sign of their influence on visits to different categories of doctors - GP and SD, are found.

Health-seeking behaviour of male foreign migrant workers living in a dormitory in Singapore.

PubMed

Lee, Weixian; Neo, Andy; Tan, Sandra; Cook, Alex R; Wong, Mee Lian; Tan, Joshua; Sayampanathan, Andrew; Lim, Daniel; Tang, Shin Yong; Goh, Wei Leong; Chen, Mark I-Cheng; Ho, Chwin

2014-07-10

Foreign workers' migrant status may hinder their utilisation of health services. This study describes the health-seeking behaviour and beliefs of a group of male migrant workers in Singapore and the barriers limiting their access to primary healthcare. A cross-sectional study of 525 male migrant workers, ≥ 21 years old and of Indian, Bangladeshi or Myanmar nationality, was conducted at a dormitory via self-administered questionnaires covering demographics, prevalence of medical conditions and health-seeking behaviours through hypothetical scenarios and personal experience. 71% (95%CI: 67 to 75%) of participants did not have or were not aware if they had healthcare insurance. 53% (95%CI: 48 to 57%) reported ever having had an illness episode while in Singapore, of whom 87% (95%CI: 82 to 91%) saw a doctor. The number of rest days was significantly associated with higher probability of having consulted a doctor for their last illness episode (p = 0.026), and higher basic monthly salary was associated with seeing a doctor within 3 days of illness (p = 0.002). Of those who saw a doctor, 84% (95%CI: 79 to 89%) responded that they did so because they felt medical care would help them to work better. While 55% (95%CI: 36 to 73%) said they did not see a doctor because the illness was not serious, those with lower salaries were significantly more likely to cite inadequate finances (55% of those earning < S$500/month). In hypothetical injury or illness scenarios, most responded that they would see the doctor, but a sizeable proportion (15% 95%CI: 12 to 18%) said they would continue to work even in a work-related injury scenario that caused severe pain and functional impairment. Those with lower salaries were significantly more likely to believe they would have to pay for their own healthcare or be uncertain about who would pay. The majority of foreign workers in this study sought healthcare when they fell ill. However, knowledge about health-related insurance was poor and a sizeable minority, in particular those earning < S$500 per month, may face significant issues in accessing care.

Learning how to learn using simulation: Unpacking disguised feedback using a qualitative analysis of doctors' telephone talk.

PubMed

Eppich, Walter J; Rethans, Jan-Joost; Dornan, Timothy; Teunissen, Pim W

2018-05-04

Telephone talk between clinicians represents a substantial workplace activity in postgraduate clinical education, yet junior doctors receive little training in goal-directed, professional telephone communication. To assess educational needs for telephone talk and develop a simulation-based educational intervention. Thematic analysis of 17 semi-structured interviews with doctors-in-training from various training levels and specialties. We identified essential elements to incorporate into simulation-based telephone talk, including common challenging situations for junior doctors as well as explicit and informal aspects that promote learning. These elements have implications for both junior doctors and clinical supervisors, including: (a) explicit teaching and feedback practices and (b) informal conversational interruptions and questions. The latter serve as "disguised" feedback, which aligns with recent conceptualizations of feedback as "performance relevant information". In addition to preparing clinical supervisors to support learning through telephone talk, we propose several potential educational strategies: (a) embedding telephone communication skills throughout simulation activities and (b) developing stand-alone curricular elements to sensitize junior doctors to "disguised" feedback during telephone talk as a mechanism to augment future workplace learning, i.e. 'learning how to learn' through simulation.

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

Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India.

PubMed

Saurabh, Suman; Sarkar, Sonali; Selvaraj, Kalaiselvi; Kar, Sitanshu Sekhar; Kumar, S Ganesh; Roy, Gautam

2014-01-01

The burden of diabetes and its foot complications is increasing in India. Prevention of these complications through foot care education should be explored. The objective of our study was to assess the risk factors of poor diabetic foot care and to find the effectiveness of health education in improving foot care practice among diabetes patients. A structured pre-tested questionnaire was administered to the outpatients of a rural health center with type 2 diabetes. Awareness regarding diabetes, care of diabetes and foot care practice ware assessed and scored. Individual and group health education focusing on foot care was performed. Foot care practice was reassessed after 2 weeks of education. Only 54% were aware that diabetes could lead to reduced foot sensation and foot ulcers. Nearly 53% and 41% of the patients had good diabetes awareness and good diabetes care respectively. Only 22% of the patients had their feet examined by a health worker or doctor. The patients with poor, satisfactory and good practice scores were 44.7%, 35.9% and 19.4% respectively. Low education status, old age and low awareness regarding diabetes were the risk factors for poor practice of foot care. Average score for practice of foot care improved from 5.90 ± 1.82 to 8.0 ± 1.30 after 2 weeks of health education. Practice related to toe space examination, foot inspection and foot wear inspection improved maximally. Foot care education for diabetics in a primary care setting improves their foot care practice and is likely to be effective in reducing the burden of diabetic foot ulcer.

Stress and sleep quality in doctors working on-call shifts are associated with functional gastrointestinal disorders

PubMed Central

Lim, Soo-Kyung; Yoo, Seung Jin; Koo, Dae Lim; Park, Chae A; Ryu, Han Jun; Jung, Yong Jin; Jeong, Ji Bong; Kim, Byeong Gwan; Lee, Kook Lae; Koh, Seong-Joon

2017-01-01

AIM To investigate the role of sleep quality and psychosocial problems as predictors of functional gastrointestinal disorders (FGIDs) in doctors that work 24 hour-on-call shifts. METHODS In this cross-sectional observation study, using the Rome III Questionnaire and Pittsburgh Sleep Quality Index (PSQI), we analyzed 170 doctors with 24 hour-on-call shifts. RESULTS Among the participants that had experienced a 24 hour-on-call shift within the last 6 mo, 48 (28.2%) had FGIDs. Overall prevalence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) were 16.5% and 17.1%, respectively, with 5.3% exhibiting both. Sleep scores (PSQI) (8.79 ± 2.71 vs 7.30 ± 3.43, P = 0.008), the presence of serious psychosocial alarm (83.3% vs 56.6%, P = 0.004), and the proportion of doctors who experienced over two months of recent on-call work (81.2% vs 68.9%, P = 0.044) were significantly different between individuals with or without FGIDs. Multivariate analysis revealed that presenting serious psychosocial alarm was an independent risk factor for prevalence of FD (OR = 5.47, 95%CI: 1.06-28.15, P = 0.042) and poor sleep quality (PSQI ≥ 6) was a predictor of IBS (OR = 4.17, 95%CI: 1.92-19.02, P = 0.016). CONCLUSION Physicians should recognize the role of sleep impairment and psychological stress in the development of FGIDs and a comprehensive approach should be considered to manage patients with FGIDs. PMID:28566894

Doctors who considered but did not pursue specific clinical specialties as careers: questionnaire surveys

PubMed Central

Goldacre, Michael J; Goldacre, Raph; Lambert, Trevor W

2012-01-01

Objectives To report doctors' rejection of specialties as long-term careers and reasons for rejection. Design Postal questionnaires. Setting United Kingdom. Participants Graduates of 2002, 2005 and 2008 from all UK medical schools, surveyed one year after qualification. Main outcome measures Current specialty choice; any choice that had been seriously considered but not pursued (termed ‘rejected’ choices) with reasons for rejection. Results 2573 of 9155 respondents (28%) had seriously considered but then not pursued a specialty choice. By comparison with positive choices, general practice was under-represented among rejected choices: it was the actual choice of 27% of respondents and the rejected choice of only 6% of those who had rejected a specialty. Consideration of ‘job content’ was important in not pursuing general practice (cited by 78% of those who considered but rejected a career in general practice), psychiatry (72%), radiology (69%) and pathology (68%). The surgical specialties were the current choice of 20% of respondents and had been considered but rejected by 32% of doctors who rejected a specialty. Issues of work-life balance were the single most common factor, particularly for women, in not pursuing the surgical specialties, emergency medicine, the medical hospital specialties, paediatrics, and obstetrics and gynaecology. Competition for posts, difficult examinations, stressful working conditions, and poor training were mentioned but were mainly minority concerns. Conclusions There is considerable diversity between doctors in their reasons for finding specialties attractive or unattractive. This underlines the importance of recruitment strategies to medical school that recognize diversity of students' interests and aptitudes. PMID:22532656

Evaluation of request forms submitted to the haematology laboratory in a Ghanaian tertiary hospital.

PubMed

Olayemi, Edeghonghon; Asiamah-Broni, Rebecca

2011-01-01

Laboratory request forms provide information about the laboratory test being requested for. They carry demographic data and other information such as location of patient, laboratory number, doctor's name, signature of the doctor, telephone number of the requesting doctor. Omission of information on the forms may lead to laboratory errors. The aim of this study was to evaluate the level of completion of laboratory request forms at the haematology department of a Ghanaian tertiary hospital. Three thousand request forms submitted to the haematology department between January and April 2010 were retrieved and studied. The information provided on each request form was recorded in a spread sheet and analyzed. The patient's age and sex were missing in 25.6% and 32.7% of the forms respectively. About half of the request forms did not have the patient's location. No clinical detail was provided on 22.7% of the forms. Doctors were more likely to sign their request forms and provide a name but they all failed to provide an address or a contact telephone number. This study demonstrates that, the standard of completion of request forms was poor. Essential information required on the forms was often missing. This can lead to limited advice given by laboratory physicians and may increase the potential for errors. Conversely, provision of all the information needed on the forms will aid laboratory diagnosis and enhance patient care and save time and resources. There should be closer interaction between clinicians and laboratory personnel to improve quality of services.

The impact of pecuniary and non-pecuniary incentives for attracting young doctors to rural general practice.

PubMed

Holte, Jon Helgheim; Kjaer, Trine; Abelsen, Birgit; Olsen, Jan Abel

2015-03-01

Shortages of GPs in rural areas constitute a profound health policy issue worldwide. The evidence for the effectiveness of various incentives schemes, which can be specifically implemented to boost recruitment to rural general practice, is generally considered to be poor. This paper investigates young doctors' preferences for key job attributes in general practice (GP), particularly concerning location and income, using a discrete choice experiment (DCE). The subjects were all final year medical students and interns in Norway (N = 1562), of which 831 (53%) agreed to participate in the DCE. Data was collected in November-December 2010. Policy simulations were conducted to assess the potential impact of various initiatives that can be used to attract young doctors to rural areas. Most interestingly, the simulations highlight the need to consider joint policy programs containing several incentives if the policies are to have a sufficient impact on the motivation and likelihood to work in rural areas. Furthermore, we find that increased income seem to have less impact as compared to improvements in the non-pecuniary attributes. Our results should be of interest to policy makers in countries with publicly financed GP systems that may struggle with the recruitment of GPs in rural areas. Copyright © 2014 Elsevier Ltd. All rights reserved.

Summative assessment of undergraduates' communication competence in challenging doctor-patient encounters. Evaluation of the Düsseldorf CoMeD-OSCE.

PubMed

Mortsiefer, Achim; Immecke, Janine; Rotthoff, Thomas; Karger, André; Schmelzer, Regine; Raski, Bianca; Schmitten, Jürgen In der; Altiner, Attila; Pentzek, Michael

2014-06-01

To evaluate the summative assessment (OSCE) of a communication training programme for dealing with challenging doctor-patient encounters in the 4th study year. Our OSCE consists of 4 stations (breaking bad news, guilt and shame, aggressive patients, shared decision making), using a 4-item global rating (GR) instrument. We calculated reliability coefficients for different levels, discriminability of single items and interrater reliability. Validity was estimated by gender differences and accordance between GR and a checklist. In a pooled sample of 456 students in 3 OSCEs over 3 terms, total reliability was α=0.64, reliability coefficients for single stations were >0.80, and discriminability in 3 of 4 stations was within the range of 0.4-0.7. Except for one station, interrater reliability was moderate to strong. Reliability on item level was poor and pointed to some problems with the use of the GR. The application of the GR on regular undergraduate medical education shows moderate reliability in need of improvement and some traits of validity. Ongoing development and evaluation is needed with particular regard to the training of the examiners. Our CoMeD-OSCE proved suitable for the summative assessment of communication skills in challenging doctor-patient encounters. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Junior doctor-led ‘near-peer’ prescribing education for medical students

PubMed Central

Gibson, Kyle R; Qureshi, Zeshan U; Ross, Michael T; Maxwell, Simon R

2014-01-01

Aims Prescribing errors are common and inadequate preparation of prescribers appears to contribute. A junior doctor-led prescribing tutorial programme has been developed for Edinburgh final year medical students to increase exposure to common prescribing tasks. The aim of this study was to assess the impact of these tutorials on students and tutors. Methods One hundred and ninety-six tutorials were delivered to 183 students during 2010–2011. Each student completed a questionnaire after tutorial attendance which explored their previous prescribing experiences and the perceived benefits of tutorial attendance. Tutors completed a questionnaire which evaluated their teaching experiences and the impact on their prescribing practice. Student tutorial attendance was compared with end-of-year examination performance using linear regression analysis. Results The students reported increased confidence in their prescribing knowledge and skills after attending tutorials. Students who attended more tutorials also tended to perform better in end-of-year examinations (Drug prescribing: r = 0.16, P = 0.015; Fluid prescribing: r = 0.18, P = 0.007). Tutors considered that participation enhanced their own prescribing knowledge and skills. Although they were occasionally unable to address student uncertainties, 80% of tutors reported frequently correcting misconceptions and deficits in student knowledge. Ninety-five percent of students expressed a preference for prescribing training delivered by junior doctors over more senior doctors. Conclusions A ‘near-peer’ junior doctor-led approach to delivering prescribing training to medical students was highly valued by both students and tutors. Although junior doctors have relatively less clinical experience of prescribing, we believe that this can be addressed by training and academic supervision and is outweighed by the benefits of these tutorials. PMID:23617320

Junior doctors' extended work hours and the effects on their performance: the Irish case.

PubMed

Flinn, Fiona; Armstrong, Claire

2011-04-01

To explore the relationship between junior doctors' long working hours and their performance in a variety of cognitive and clinical decision-making tests. Also, to consider the implications of performance decrements in such tests for healthcare quality. A within-subject design was used to eliminate variation related to individual differences. Each participant was tested twice, once post call and once rested. At each session, participants were tested on cognitive functioning and clinical decision-making. The study was based on six acute Irish hospitals during 2008. Thirty junior hospital doctors, ages ranged from 23 to 30 years; of them, 17 of the participants were female and 13 were male. Measures Cognitive functioning was measured by the MindStreams Global Assessment Battery (NeuroTrax Corp., NY, USA). This is a set of computerized tests, designed for use in medical settings, that assesses performance in memory, executive function, visual spatial perception, verbal function, attention, information processing speed and motor skills. Clinical decision-making was tested using Key Features Problems. Each Key Features Problem consists of a case scenario and then three to four questions about this scenario. In an effort to make it more realistic, the speed with which participants completed the three problems was also recorded. Participants' global cognitive scores, attention, information processing speed and motor skills were significantly worse post call than when rested. They also took longer to complete clinical decision-making questions in the post-call condition and obtained lower scores than when rested. There are significant negative changes in doctors' cognitive functioning and clinical decision-making performance that appear to be attributable to long working hours. This therefore raises the important question of whether working long hours decreases healthcare quality and compromises patient safety.

Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments.

PubMed

Kerätär, Raija; Taanila, Anja; Jokelainen, Jari; Soukainen, Jouko; Ala-Mursula, Leena

2016-12-01

Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers. Community-level, cross-sectional analysis with multidimensional clinical work ability assessments. Paltamo, Finland. Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n = 230, 81%). Based on data from theme interviews, patient records, supervisors' observations of work performance and clinical examinations, a physician concluded the individual's work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated. Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability. Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed. KEY POINTS Although the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce. Work disabilities are common among the unemployed. Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to work. Context sensitivity may add to the accuracy of the doctor's conclusions on work ability.

To what extent do clinical notes by general practitioners reflect actual medical performance? A study using simulated patients.

PubMed Central

Rethans, J J; Martin, E; Metsemakers, J

1994-01-01

BACKGROUND. Review of clinical notes is used extensively as an indirect method of assessing doctors' performance. However, to be acceptable it must be valid. AIM. This study set out to examine the extent to which clinical notes in medical records of general practice consultations reflected doctors' actual performance during consultations. METHOD. Thirty nine general practitioners in the Netherlands were consulted by four simulated patients who were indistinguishable from real patients and who reported on the consultations. The complaints presented by the simulated patients were tension headache, acute diarrhoea and pain in the shoulder, and one presented for a check up for non-insulin dependent diabetes. Later, the doctors forwarded their medical records of these patients to the researchers. Content of consultations was measured against accepted standards for general practice and then compared with content of clinical notes. An index, or content score, was calculated as the measure of agreement between actions which had actually been recorded and actions which could have been recorded in the clinical notes. A high content score reflected a consultation which had been recorded well in the medical record. The correlation between number of actions across the four complaints recorded in the clinical notes and number of actions taken during the consultations was also calculated. RESULTS. The mean content score (interquartile range) for the four types of complaint was 0.32 (0.27-0.37), indicating that of all actions undertaken, only 32% had been recorded. However, mean content scores for the categories 'medication and therapy' and 'laboratory examination' were much higher than for the categories 'history' and 'guidance and advice' (0.68 and 0.64, respectively versus 0.29 and 0.22, respectively). The correlation between number of actions across the four complaints recorded in the clinical notes and number of actions taken during the consultations was 0.54 (P < 0.05). CONCLUSION. The use of clinical notes to audit doctors' performance in Dutch general practice is invalid. However, the use of clinical notes to rank doctors according to those who perform many or a few actions in a consultation may be justified. PMID:8185988

How personality traits affect clinician-supervisors' work engagement and subsequently their teaching performance in residency training.

PubMed

Scheepers, Renée A; Arah, Onyebuchi A; Heineman, Maas Jan; Lombarts, Kiki M J M H

2016-11-01

Clinician-supervisors often work simultaneously as doctors and teachers. Supervisors who are more engaged for their teacher work are evaluated as better supervisors. Work engagement is affected by the work environment, yet the role of supervisors' personality traits is unclear. This study examined (i) the impact of supervisors' personality traits on work engagement in their doctors' and teachers' roles and (ii) how work engagement in both roles affects their teaching performance. Residents evaluated supervisors' teaching performance, using the validated System for Evaluation of Teaching Qualities. Supervisors' reported work engagement in doctor and teacher roles separately using the validated Utrecht Work Engagement Scale. Supervisors' personality traits were measured using the Big Five Inventory's five factor model covering conscientiousness, agreeableness, extraversion, emotional stability and openness. Overall, 549 (68%) residents and 636 (78%) supervisors participated. Conscientiousness, extraversion and agreeableness were positively associated with supervisors' engagement in their teacher work, which was subsequently positively associated with teaching performance. Conscientious, extraverted, and agreeable supervisors showed more engagement with their teacher work, which made them more likely to deliver adequate residency training. In addition to optimizing the work environment, faculty development and career planning could be tailor-made to fit supervisors' personality traits.

Benzodiazepines prescription in Dakar: a study about prescribing habits and knowledge in general practitioners, neurologists and psychiatrists.

PubMed

Dièye, Amadou Moctar; Sylla, Mbaye; Ndiaye, Awa; Ndiaye, Mamadou; Sy, Guata Yoro; Faye, Babacar

2006-06-01

Benzodiazepines are relatively well-tolerated medicines but can induce serious problems of addiction and that is why their use is regulated. However, in developing countries like Senegal, these products are used without clear indications on their prescription, their dispensation or their use. This work focuses on the prescription of these medicines with a view to make recommendations for their rational use. Benzodiazepine prescription was studied with psychiatrists or neurologists and generalists in 2003. Specialist doctors work in two Dakar university hospitals and generalists in the 11 health centres in Dakar. We did a survey by direct interview with 29 of 35 specialists and 23 of 25 generalists. All doctors were interviewed in their office. The questionnaire focused on benzodiazepine indications, their pharmacological properties, benzodiazepines prescribed in first intention against a given disease and the level of training in benzodiazepines by doctors. Comparisons between specialists and generalists were made by chi-square test. Benzodiazepines were essentially used for anxiety, insomnia and epilepsy. With these diseases, the most benzodiazepines prescribed are prazepam against anxiety and insomnia and diazepam against epilepsy. About 10% of doctors do not know that there is a limitation for the period of benzodiazepine use. The principal reasons of drugs choice are knowledge of the drugs, habit and low side effects of drugs. All generalists (100%) said that their training on benzodiazepines is poor vs. 62.1% of specialists, and doctors suggest seminars, journals adhesions and conferences to complete their training in this field. There are not many differences between specialists and generalists except the fact that specialists prefer prazepam in first intention in the insomnia treatment where generalists choose bromazepam. In addition, our survey showed that specialists' training in benzodiazepines is better than that of generalists. Overall, benzodiazepine prescription poses problems particularly in training, and national authorities must take urgent measures for rational use of these drugs.

Scaling up family medicine training in Gezira, Sudan - a 2-year in-service master programme using modern information and communication technology: a survey study.

PubMed

Mohamed, Khalid G; Hunskaar, Steinar; Abdelrahman, Samira Hamid; Malik, Elfatih M

2014-01-21

In 2010 the Gezira Family Medicine Project (GFMP) was initiated in Gezira state, Sudan, designed as an in-service training model. The project is a collaboration project between the University of Gezira, which aims to provide a 2-year master's programme in family medicine for practicing doctors, and the Ministry of Health, which facilitates service provision and funds the training programme. This paper presents the programme, the teaching environment, and the first batch of candidates enrolled. In this study a self-administered questionnaire was used to collect baseline data at the start of the project from doctors who joined the programme. A checklist was also used to assess the health centres where they work. A total of 188 out of 207 doctors responded (91%), while data were gathered from all 158 health centres (100%) staffed by the programme candidates. The Gezira model of in-service family medicine training has succeeded in recruiting 207 candidates in its first batch, providing health services in 158 centres, of which 84 had never been served by a doctor before. The curriculum is community oriented. The mean age of doctors was 32.5 years, 57% were males, and 32% were graduates from the University of Gezira. Respondents stated high confidence in practicing some skills such as asthma management and post-abortion uterine evacuation. They were least confident in other skills such as managing depression or inserting an intrauterine device. The majority of health centres was poorly equipped for management of noncommunicable diseases, as only 10% had an electrocardiography machine (ECG), 5% had spirometer, and 1% had a defibrillator. The Gezira model has responded to local health system needs. Use of modern information and communication technology is used to facilitate both health service provision and training. The GFMP represents an example of a large-volume scaling-up programme of family medicine in Africa.

Malaysian primary care doctors' views on men's health: an unresolved jigsaw puzzle

PubMed Central

2011-01-01

Background Men have been noted to utilise health care services less readily then women. Primary care settings provide an opportunity to engage men in health care activities because of close proximity to the target group (men in the community). Understanding attitudes towards men's health among Malaysian primary care doctors is important for the effective delivery of health services to men. We aimed to explore the opinions and attitudes of primary care doctors (PCDs) relating to men's health and help-seeking behaviour. Methods A qualitative approach to explore the opinions of 52 PCDs was employed, using fourteen in-depth interviews and eight focus group discussions in public and private settings. Purposive sampling of PCDs was done to ensure maximum variation in the PCD sample. Interviews were recorded and transcribed verbatim for analysis. Open coding with thematic analysis was used to identify key issues raised in the interview. Results The understanding of the concept of men's health among PCDs was fragmented. Although many PCDs were already managing health conditions relevant and common to men, they were not viewed by PCDs as "men's health". Less attention was paid to men's help-seeking behaviour and their gender roles as a potential determinant of the poor health status of men. There were opposing views about whether men's health should focus on men's overall health or a more focused approach to sexual health. There was also disagreement about whether special attention was warranted for men's health services. Some doctors would prioritise more common conditions such as hypertension, diabetes and hypercholesterolaemia. Conclusions The concept of men's health was new to PCDs in Malaysia. There was wide variation in understanding and opposing attitudes towards men's health among primary care doctors. Creating awareness and having a systematic approach would facilitate PCDs in delivering health service to men. PMID:21569395

Improving hospital weekend handover: a user-centered, standardised approach.

PubMed

Mehra, Avi; Henein, Christin

2014-01-01

Clinical Handover remains one of the most perilous procedures in medicine (1). Weekend handover has emerged as a key area of concern with high variability in handover processes across hospitals (1,2,4, 5-10). Studying weekend handover processes within medicine at an acute teaching hospital revealed huge variability in documented content and structure. A total of 12 different pro formas were in use by the medical day-team to handover to the weekend team on-call. A Likert-survey of doctors revealed 93% felt the current handover system needed improvement with 71% stating that it did not ensure patient safety (Chi-squared, p-value <0.001, n=32). Semi-structured interviews of doctors identified common themes including "a lack of consistency in approach" "poor standardization" and "high variability". Seeking to address concerns of standardization, a standardized handover pro forma was developed using Royal College of Physician (RCP) guidelines (2), with direct end-user input. Results following implementation revealed a considerable improvement in documented ceiling of care, urgency of task and team member assignment with 100% uptake of the new proforma at both 4-week and 6-month post-implementation analyses. 88% of doctors surveyed perceived that the new proforma improved patient safety (p<0.01, n=25), with 62% highlighting that it allowed doctors to work more efficiently. Results also revealed that 44% felt further improvements were needed and highlighted electronic solutions and handover training as main priorities. Handover briefing was subsequently incorporated into junior doctor induction and education modules delivered, with good feedback. Following collaboration with key stakeholders and with end-user input, integrated electronic handover software was designed and funding secured. The software is currently under final development. Introducing a standardized handover proforma can be an effective initial step in improving weekend handover. Handover education and end-user involvement are key in improving the process. Electronic handover solutions have been shown to significantly increase the quality of handover and are worth considering (9, 10).

Improving hospital weekend handover: a user-centered, standardised approach

PubMed Central

Mehra, Avi; Henein, Christin

2014-01-01

Clinical Handover remains one of the most perilous procedures in medicine (1). Weekend handover has emerged as a key area of concern with high variability in handover processes across hospitals (1,2,4, 5–10). Studying weekend handover processes within medicine at an acute teaching hospital revealed huge variability in documented content and structure. A total of 12 different pro formas were in use by the medical day-team to handover to the weekend team on-call. A Likert-survey of doctors revealed 93% felt the current handover system needed improvement with 71% stating that it did not ensure patient safety (Chi-squared, p-value <0.001, n=32). Semi-structured interviews of doctors identified common themes including “a lack of consistency in approach” “poor standardization” and “high variability”. Seeking to address concerns of standardization, a standardized handover pro forma was developed using Royal College of Physician (RCP) guidelines (2), with direct end-user input. Results following implementation revealed a considerable improvement in documented ceiling of care, urgency of task and team member assignment with 100% uptake of the new proforma at both 4-week and 6-month post-implementation analyses. 88% of doctors surveyed perceived that the new proforma improved patient safety (p<0.01, n=25), with 62% highlighting that it allowed doctors to work more efficiently. Results also revealed that 44% felt further improvements were needed and highlighted electronic solutions and handover training as main priorities. Handover briefing was subsequently incorporated into junior doctor induction and education modules delivered, with good feedback. Following collaboration with key stakeholders and with end-user input, integrated electronic handover software was designed and funding secured. The software is currently under final development. Introducing a standardized handover proforma can be an effective initial step in improving weekend handover. Handover education and end-user involvement are key in improving the process. Electronic handover solutions have been shown to significantly increase the quality of handover and are worth considering (9, 10). PMID:26734248

What is appropriate to post on social media? Ratings from students, faculty members and the public.

PubMed

Jain, Anuja; Petty, Elizabeth M; Jaber, Reda M; Tackett, Sean; Purkiss, Joel; Fitzgerald, James; White, Casey

2014-02-01

The purpose of this study was to ascertain what medical students, doctors and the public felt was unprofessional for medical students, as future doctors, to post on a social media site, Facebook(®) . The significance of this is that unprofessional content reflects poorly on a student, which in turn can significantly affect a patient's confidence in that student's clinical abilities. An online survey was designed to investigate the perceptions of University of Michigan medical students, attending physicians and non-health care university-wide employees (that serves as a subset of the public) regarding mock medical students' Facebook(®) profile screenshots. For each screenshot, respondents used a 5-point Likert scale to rate 'appropriateness' and whether they would be 'comfortable' having students posting such content as their future doctors. Compared with medical students, faculty members and public groups rated images as significantly less appropriate (p < 0.001) and indicated that they would be less comfortable (p < 0.001) having posting students as future doctors. All three groups rated screenshots containing derogatory or private information about patients, followed by images suggesting marijuana use, as least appropriate. Images conveying intimate heterosexual couples were rated as most appropriate. Overall, the doctor group, females and older individuals were less permissive when compared with employee and student groups, males and younger individuals, respectively. The most significant conclusion of our study is that faculty members, medical students and the 'public' have different thresholds of what is acceptable on a social networking site. Our findings will prove useful for students to consider the perspectives of patients and faculty members when considering what type of content to post on their social media sites. In this way, we hope that our findings provide insight for discussions, awareness and the development of guidelines related to online professionalism for medical students. © 2014 John Wiley & Sons Ltd.

[Primary care in France].

PubMed

Sánchez-Sagrado, T

2016-01-01

The poor planning of health care professionals in Spain has led to an exodus of doctors leaving the country. France is one of the chosen countries for Spanish doctors to develop their professional career. The French health care system belongs to the Bismarck model. In this model, health care system is financed jointly by workers and employers through payroll deduction. The right to health care is linked to the job, and provision of services is done by sickness-funds controlled by the Government. Primary care in France is quite different from Spanish primary care. General practitioners are independent workers who have the right to set up a practice anywhere in France. This lack of regulation has generated a great problem of "medical desertification" with problems of health care access and inequalities in health. French doctors do not want to work in rural areas or outside cities because "they are not value for money". Medical salary is linked to professional activity. The role of doctors is to give punctual care. Team work team does not exist, and coordination between primary and secondary care is lacking. Access to diagnostic tests, hospitals and specialists is unlimited. Duplicity of services, adverse events and inefficiencies are the norm. Patients can freely choose their doctor, and they have a co-payment for visits and hospital care settings. Two years training is required to become a general practitioner. After that, continuing medical education is compulsory, but it is not regulated. Although the French medical Health System was named by the WHO in 2000 as the best health care system in the world, is it not that good. While primary care in Spain has room for improvement, there is a long way for France to be like Spain. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Scaling up family medicine training in Gezira, Sudan – a 2-year in-service master programme using modern information and communication technology: a survey study

PubMed Central

2014-01-01

Background In 2010 the Gezira Family Medicine Project (GFMP) was initiated in Gezira state, Sudan, designed as an in-service training model. The project is a collaboration project between the University of Gezira, which aims to provide a 2-year master’s programme in family medicine for practicing doctors, and the Ministry of Health, which facilitates service provision and funds the training programme. This paper presents the programme, the teaching environment, and the first batch of candidates enrolled. Methods In this study a self-administered questionnaire was used to collect baseline data at the start of the project from doctors who joined the programme. A checklist was also used to assess the health centres where they work. A total of 188 out of 207 doctors responded (91%), while data were gathered from all 158 health centres (100%) staffed by the programme candidates. Results The Gezira model of in-service family medicine training has succeeded in recruiting 207 candidates in its first batch, providing health services in 158 centres, of which 84 had never been served by a doctor before. The curriculum is community oriented. The mean age of doctors was 32.5 years, 57% were males, and 32% were graduates from the University of Gezira. Respondents stated high confidence in practicing some skills such as asthma management and post-abortion uterine evacuation. They were least confident in other skills such as managing depression or inserting an intrauterine device. The majority of health centres was poorly equipped for management of noncommunicable diseases, as only 10% had an electrocardiography machine (ECG), 5% had spirometer, and 1% had a defibrillator. Conclusions The Gezira model has responded to local health system needs. Use of modern information and communication technology is used to facilitate both health service provision and training. The GFMP represents an example of a large-volume scaling-up programme of family medicine in Africa. PMID:24443978

What do UK doctors in training value in a post? A discrete choice experiment.

PubMed

Cleland, Jennifer; Johnston, Peter; Watson, Verity; Krucien, Nicolas; Skåtun, Diane

2016-02-01

Many individual and job-related factors are known to influence medical careers decision making. Medical trainees' (residents) views of which characteristics of a training post are important to them have been extensively studied but how they trade-off these characteristics is under-researched. Such information is crucial for the development of effective policies to enhance recruitment and retention. Our aim was to investigate the strength of UK foundation doctors' and trainees' preferences for training post characteristics in terms of monetary value. We used an online questionnaire study incorporating a discrete choice experiment (DCE), distributed to foundation programme doctors and doctors in training across all specialty groups within three UK regions, in August-October 2013. The main outcome measures were monetary values for training-post characteristics, based on willingness to forgo and willingness to accept extra income for a change in each job characteristic, calculated from regression coefficients. The questionnaire was answered by 1323 trainees. Good working conditions were the most influential characteristics of a training position. Trainee doctors would need to be compensated by an additional 49.8% above the average earnings within their specialty to move from a post with good working conditions to one with poor working conditions. A training post with limited rather than good opportunities for one's spouse or partner would require compensation of 38.4% above the average earnings within their specialty. Trainees would require compensation of 30.8% above the average earnings within their specialty to move from a desirable to a less desirable locality. These preferences varied only to a limited extent according to individual characteristics. Trainees place most value on good working conditions, good opportunities for their partners and desirable geographical location when making career-related decisions. This intelligence can be used to develop alternative models of workforce planning or to develop information about job opportunities that address trainees' values. © 2016 John Wiley & Sons Ltd.

Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study

PubMed Central

Illing, Jan; Kasim, Adetayo S; McLachlan, John C

2014-01-01

Objective To determine whether use of the Professional and Linguistic Assessments Board (PLAB) examination system used to grant registration for international medical graduates results in equivalent postgraduate medical performance, as evaluated at Annual Review of Competence Progression (ARCP), between UK based doctors who qualified overseas and those who obtained their primary medical qualification from UK universities. Design Observational study linking ARCP outcome data from the UK deaneries with PLAB test performance and demographic data held by the UK General Medical Council (GMC). Setting Doctors in postgraduate training for a medical specialty or general practice in the UK and doctors obtaining GMC registration via the PLAB system. Participants 53 436 UK based trainee doctors with at least one competency related ARCP outcome reported during the study period, of whom 42 017 were UK medical graduates and 11 419 were international medical graduates who were registered following a pass from the PLAB route. Main outcome measure Probability of obtaining a poorer versus a more satisfactory category of outcome at ARCP following successful registration as a doctor in the UK. Results International medical graduates were more likely to obtain a less satisfactory outcome at ARCP compared with UK graduates. This finding persisted even after adjustment for the potential influence of sex, age, years of UK based practice, and ethnicity and exclusion of outcomes associated with postgraduate examination failure (odds ratio 1.63, 95% confidence interval 1.30 to 2.06). However, international medical graduates who scored in the highest twelfth at part 1 of the PLAB (at least 32 points above the pass mark) had ARCP outcomes that did not differ significantly from those of UK graduates. Conclusions These findings suggest that the PLAB test used for registration of international medical graduates is not generally equivalent to the requirements for UK graduates. The differences in postgraduate performance, as captured at ARCP, following the two routes to registration might be levelled out by raising the standards of English language competency required as well as the pass marks for the two parts of the PLAB test. An alternative might be to introduce a different testing system. PMID:24742539

Mobile and Fixed Computer Use by Doctors and Nurses on Hospital Wards: Multi-method Study on the Relationships Between Clinician Role, Clinical Task, and Device Choice

PubMed Central

Andersen, Pia; Lindgaard, Anne-Mette; Prgomet, Mirela; Creswick, Nerida

2009-01-01

Background Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions. Objective We aimed to investigate the relationships between clinician role, clinical task, and selection of a computer hardware device in hospital wards. Methods Twenty-seven nurses and eight doctors were observed for a total of 80 hours as they used a range of computing devices to access a computerized provider order entry system on two wards at a major Sydney teaching hospital. Observers used a checklist to record the clinical tasks completed, devices used, and location of the activities. Field notes were also documented during observations. Semi-structured interviews were conducted after observation sessions. Assessment of the physical attributes of three devices—stationary PCs, computers on wheels (COWs) and tablet PCs—was made. Two types of COWs were available on the wards: generic COWs (laptops mounted on trolleys) and ergonomic COWs (an integrated computer and cart device). Heuristic evaluation of the user interfaces was also carried out. Results The majority (93.1%) of observed nursing tasks were conducted using generic COWs. Most nursing tasks were performed in patients’ rooms (57%) or in the corridors (36%), with a small percentage at a patient’s bedside (5%). Most nursing tasks related to the preparation and administration of drugs. Doctors on ward rounds conducted 57.3% of observed clinical tasks on generic COWs and 35.9% on tablet PCs. On rounds, 56% of doctors’ tasks were performed in the corridors, 29% in patients’ rooms, and 3% at the bedside. Doctors not on a ward round conducted 93.6% of tasks using stationary PCs, most often within the doctors’ office. Nurses and doctors were observed performing workarounds, such as transcribing medication orders from the computer to paper. Conclusions The choice of device was related to clinical role, nature of the clinical task, degree of mobility required, including where task completion occurs, and device design. Nurses’ work, and clinical tasks performed by doctors during ward rounds, require highly mobile computer devices. Nurses and doctors on ward rounds showed a strong preference for generic COWs over all other devices. Tablet PCs were selected by doctors for only a small proportion of clinical tasks. Even when using mobile devices clinicians completed a very low proportion of observed tasks at the bedside. The design of the devices and ward space configurations place limitations on how and where devices are used and on the mobility of clinical work. In such circumstances, clinicians will initiate workarounds to compensate. In selecting hardware devices, consideration should be given to who will be using the devices, the nature of their work, and the physical layout of the ward. PMID:19674959

Predicting doctor performance outcomes of curriculum interventions: problem-based learning and continuing competence.

PubMed

Norman, Geoffrey R; Wenghofer, Elizabeth; Klass, Daniel

2008-08-01

Problem-based learning (PBL) is an educational strategy designed to enhance self-assessment, self-directed learning and lifelong learning. The present study examines a peer review programme to determine whether the impact of PBL on continuing competence can be detected in practice. This study aimed to establish whether McMaster graduates who graduated between 1972 and 1991 were any less likely to be identified as having issues of competence by a systematic peer review programme than graduates of other Ontario medical schools. We identified a total of 1166 doctors who had graduated after 1972 and had completed a mandated peer review programme. Of these, 108 had graduated from McMaster and 857 from other Canadian schools. School of graduation was cross-tabulated against peer rating. A secondary analysis examined predictors of ratings using multiple regression. We found that 4% of McMaster graduates and 5% of other graduates were deemed to demonstrate cause for concern or serious concern, and that 24% of McMaster doctors and 28% of other doctors were rated as excellent. These differences were not significant. Multiple regression indicated that certification by family medicine or a specialty, female gender and younger age were all predictors of practice outcomes, but school of graduation was not. There is no evidence from this study that PBL graduates are better able to maintain competence than graduates of conventional schools. The study highlights potential problems in attempting to link undergraduate educational interventions to doctor performance outcomes.

The "doctor-customer" relationship: Hippocrates in the modern marketplace.

PubMed

Mulhall, Kevin J; Ahmed, Aftab; Masterson, Eric

2002-01-01

We performed a consecutive survey of 100 people presenting to a hospital injury clinic to ascertain their attitude to terminology currently used to describe them in our own institution and in the international literature. The results of this demonstrated that the subjects significantly preferred the traditional assignation "patient" rather than terms such as client or customer. This finding reflects the need to remember peoples' attitudes and expectations from their consultation with their doctor. Although business models undoubtedly help in the provision of an efficient health care service, remaining at the centre of this encounter is a doctor-patient relationship that involves a more complex interaction than simply a market transaction.

Optimization of TiO{sub 2} photoelectrode with titanium isopropoxide for flexible dye sensitized solar cells

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

Anggraini, Putri Nur, E-mail: putr014@lipi.go.id; Retnaningsih, Lilis; Muliani, Lia

2016-04-19

Flexible DSSC uses plastic substrate such as polyethylene terephthalate (PET) to deposit photoelectrode, resulting in poor photoconversion efficiency of the solar cell due to the low temperature applied in the fabrication process. In this research, optimization process was examined in order to optimize the performance of flexible DSSC by adding titanium isopropoxide (TTIP) as a binder to TiO{sub 2} paste for DSSC photoelectrode. Small portion of TTIP with molar percentages of 0%, 5%, and 10% were added to a mixture of TiO{sub 2} nanocrystaline, butanol, DI water, and reflector powder. The mixtures were stirred using a magnetic stirrer for 24more » hours. Each of various pastes was then deposited on a plastic substrate with doctor blade method on 1 cm{sup 2} area. The films were sintered at temperature of 150 °C for 4 hours and soaked in dye solution for 24 hours. Furthermore, TiO{sub 2} photoelectrode and Pt counter electrode were assembled and injected by electrolyte. Flexible DSSCs were characterized by SEM and XRD to determine their morphological structures. J-V measurement was performed by sun simulator to calculate DSSC photoconversion efficiency. The optimum performance of flexible DSSC was achieved by DSSC with 10 mol% TTIP content.« less

AIDS directors seek help to fight epidemic in the South. Call to action for more money, resources, research.

PubMed

2003-05-01

As AIDS spreads rapidly in the South, a new picture is emerging, which shows the epidemic is becoming increasingly rural, female, African-American, and poor. Two new studies are helping identifying why so many rural Southerners avoid the health care systems and don't trust their doctors about HIV infection. Clinicians need to address high rates of depression and post-traumatic stress syndrome in HIV-infected patients living in the rural South.

Factors influencing the provision of public health services by village doctors in Hubei and Jiangxi provinces, China

PubMed Central

Ding, Yan; Smith, Helen J; Fei, Yang; Xu, Biao; Nie, Shaofa; Yan, Weirong; Diwan, Vinod K; Sauerborn, Rainer

2013-01-01

Abstract Problem The Chinese central government launched the Health System Reform Plan in 2009 to strengthen disease control and health promotion and provide a package of basic public health services. Village doctors receive a modest subsidy for providing public health services associated with the package. Their beliefs about this subsidy and providing public health services could influence the quality and effectiveness of preventive health services and disease surveillance. Approach To understand village doctors’ perspectives on the subsidy and their experiences of delivering public health services, we performed 10 focus group discussions with village doctors, 12 in-depth interviews with directors of township health centres and 4 in-depth interviews with directors of county-level Centers for Disease Control and Prevention. Local setting The study was conducted in four counties in central China, two in Hubei province and two in Jiangxi province. Relevant changes Village doctors prioritize medical services but they do their best to manage their time to include public health services. The willingness of township health centre directors and village doctors to provide public health services has improved since the introduction of the package and a minimum subsidy, but village doctors do not find the subsidy to be sufficient remuneration for their efforts. Lessons learnt Improving the delivery of public health services by village doctors is likely to require an increase in the subsidy, improvement in the supervisory relationship between village clinics and township health centres and the creation of a government pension for village doctors. PMID:23397352

Improvements urban and rural women wish to see in their health care services.

PubMed

Walton, V A; Romans-Clarkson, S E; Mullen, P E

1988-02-24

This study asked 2000 women randomly selected from the community to comment on their health services. Three-quarters did so; one-quarter were satisfied with currently available services but 45% specified changes they would like to see. The criticisms fell into three broad groups: (a) hospital services where delays, centralisation and referral paths were criticised; (b) general practice where doctor-patient communication was mentioned; and (c) cost of certain health services. Women who criticised currently available services tended to be younger, better educated with higher socioeconomic status, to be in paid employment and to have more often poor health or a close relative with poor health than the women who made no comment. These findings are seen as constructive comments from a thoughtful and informed group of health consumers.

The Australian government's review of positron emission tomography: evidence-based policy-making in action.

PubMed

Ware, Robert E; Francis, Hilton W; Read, Kenneth E

2004-06-21

The Commonwealth Government constituted the Medicare Services Advisory Committee (MSAC) to implement its commitment to entrench the principles of evidence-based medicine in Australian clinical practice. With its recent review of positron emission tomography (PETReview), the Commonwealth intervened in an established MSAC process, and sanctioned the stated objective to restrict expenditure on the technology. In our opinion: The evaluation of evidence by PETReview was fundamentally compromised by a failure to meet the terms of reference, poor science, poor process and unique decision-making benchmarks. By accepting the recommendations of PETReview, the Commonwealth is propagating information which is not of the highest quality. The use of inferior-quality information for decision-making by doctors, patients and policy-makers is likely to harm rather than enhance healthcare outcomes.

Snakebite in bedroom kills a physician in Cameroon: a case report.

PubMed

Nkwescheu, Armand; Mbasso, Leopold Cyriaque Donfack; Pouth, Franky Baonga Ba; Dzudie, Anastase; Billong, Serge Clotaire; Ngouakam, Hermann; Diffo, Joseph Le Doux; Eyongorock, Hanny; Mbacham, Wilfred

2016-01-01

The World Health Organization (WHO) classifies snake bites as neglected public health problem affecting mostly tropical and subtropical countries. In Africa there are an estimated 1 million snake bites annually with about half needing a specific treatment. Women, children and farmers in poor rural communities in developing countries are the most affected. Case management of snake bites are not adequate in many health facilities in developing countries where personnel are not always abreast with the new developments in snake bite management and in addition, quite often the anti-venom serum is lacking. We report the case of a medical doctor bitten by a cobra in the rural area of Poli, Cameroon while asleep in his bedroom. Lack of facilities coupled with poor case management resulted in a fatal outcome.

Drama and Oral Interpretation: Abstracts of Doctoral Dissertations Published in "Dissertation Abstracts International," January through June 1978 (Vol. 38 Nos. 7 through 12).

ERIC Educational Resources Information Center

ERIC Clearinghouse on Reading and Communication Skills, Urbana, IL.

This collection of abstracts is part of a continuing series providing information on recent doctoral dissertations. The 16 titles deal with the following topics: an examination of inexperienced actors performing the plays of William Shakespeare; an investigation of the philosophies and practices of a summer theatre producer and manager; the…

Rhetoric and Public Address: Abstracts of Doctoral Dissertations Published in "Dissertation Abstracts International," January through June 1980 (Vol. 40 Nos. 7 through 12).

ERIC Educational Resources Information Center

ERIC Clearinghouse on Reading and Communication Skills, Urbana, IL.

This collection of abstracts is part of a continuing series providing information on recent doctoral dissertations. The 20 titles deal with a variety of topics, including the following: (1) the campaign communication during the Carter-Ford television debates; (2) apprehensiveness and performance in public speaking; (3) a history and criticism of…

Excellence in Doctoral Supervision: An Examination of Authoritative Sources across Four Countries in Search of Performance Higher than Competence

ERIC Educational Resources Information Center

McCulloch, Alistair; Kumar, Vijay; van Schalkwyk, Susan; Wisker, Gina

2016-01-01

Supervision is generally recognised as playing a crucial role in the quality of a research student's doctoral experience and their academic outcomes and, in common with most areas of higher education, there is an oft-stated desire to pursue excellence in this important area. Excellence in research degree supervision is, however, an elusive concept…

Lessons Learned by a Faculty Member Working in an Education Doctorate Program with Students Performing Action Research

ERIC Educational Resources Information Center

Zambo, Debby; Isai, Shelley

2012-01-01

This manuscript provides insight into a new education doctorate program where action research is taught in core courses and used as signature pedagogy and capstone experience. To contextualize action research in this program, a brief introduction as to how it fits into its mission, goals, and needs is provided. Although this fit carries promises,…

Theory in the Service of Practice: Theories in Action Research Dissertations Written by Students in Education Doctorate Programs

ERIC Educational Resources Information Center

Zambo, Debby

2014-01-01

Educational leaders are enrolling in second-generation education doctorate (EdD) programs because these are allowing them to remain in the field as they pursue their degree and perform action research within their workplace. As part of degree requirements, students in these programs are challenged to cross the theory-to-practice divide. However,…

Language Use, Language Ability, and Language Development: Abstracts of Doctoral Dissertations Published in "Dissertation Abstracts International," July through December 1977 (Vol. 38 No. 1 through 6).

ERIC Educational Resources Information Center

ERIC Clearinghouse on Reading and Communication Skills, Urbana, IL.

This collection of abstracts is part of a continuing series providing information on recent doctoral dissertations. The 27 titles deal with a variety of topics, including the following: facilitation of language development in disadvantaged preschool children; auditory-visual discrimination skills, language performance, and development of manual…

The Relationship between the Physical Therapist Clinical Performance Instrument Scores and Doctor of Physical Therapy Student Learning Styles

ERIC Educational Resources Information Center

Courtright, Joachim

2017-01-01

INTRODUCTION. The learning style of a student is an important factor in their ability to gain knowledge. This is especially important in challenging curriculums such as the Doctor of Physical Therapy (DPT) program. A common tool to assess one's learning style is The Kolb Learning Styles Inventory (LSI). A common tool used to measure the…

Doctoral profile of the medical radiation sciences: a baseline for Australia and New Zealand.

PubMed

Ekpo, Ernest U; Snaith, Beverly; Harris, Martine A; McEntee, Mark F

2017-09-01

Research is critical to evidence-based practice, and the rapid developments in technology provide opportunities to innovate and improve practice. Little is known about the research profile of the medical radiation science (MRS) profession in Australia and New Zealand (NZ). This study provides a baseline of their doctoral activity. A cross-sectional survey of MRS professionals in Australia and NZ holding a doctorate or undertaking doctoral studies, was performed using an online tool (Bristol Online Survey ® , Bristol, UK). A chain-referral sampling technique was adopted for data collection. An email invitation with a link to the survey was generated and distributed through email and social media. The survey contained questions related to participant demographics, doctoral status, qualification route, funding and employment. There were 63 responses to the survey comprising 50.8% diagnostic radiographers (DRs; n = 32), 23.8% radiation therapists (RTs; n = 15), with the remaining 25.4% (n = 16) equally split between sonographers and nuclear medicine technologists (NMTs). A total of 40 (63.5%) of respondents had completed their doctoral qualification. In NZ, only DRs held a doctoral award constituting 0.3% of DRs and 0.2% of the total registered MRS population. In Australia, there was a greater proportion of doctoral NMTs (n = 8/1098; 0.7%) than RTs (n = 15/2394; 0.6%) and DRs (n = 27/12,001; 0.2%). Similar to other countries, findings show a very small percentage of doctoral MRS professionals in Australia and NZ. Strategies to engage and support individuals in research, up to and beyond doctoral study, need to be embedded in practice. © 2017 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.

The examination of problems experienced by nurses and doctors associated with exposure to surgical smoke and the necessary precautions.

PubMed

Ilce, Arzu; Yuzden, Ganime Esra; Yavuz van Giersbergen, Meryem

2017-06-01

This study aims to investigate the problems experienced by nurses and doctors as a result of exposure to surgical smoke and the precautions that need to be taken. Electrosurgery is carried out in almost all operating rooms, and all of those who work in these rooms are exposed to surgical smoke, especially doctors and nurses. A review of the literature reveals that there are very few studies that have been carried out on surgical smoke, and there are no studies researched on the problems experienced by those working in operating rooms. This descriptive study was conducted between April and June 2015. The study was carried out in the operating rooms of Training and Research Hospital with 81 nurses and doctors. Descriptive statistical analyses were performed using the IBM SPSS Statistics 23 (Windows), Hacettepe University, Ankara. The problems experienced by the nurses and doctors as a result of exposure to surgical smoke included: headache (nurses: 48·9%, doctors: 58·3%), watering of the eyes (nurses: 40·0%, doctors: 41·7%), cough (nurses: 48·9%, doctors: 27·8%), sore throat, bad odours absorbed in the hair, nausea, drowsiness, dizziness, sneezing and rhinitis. Regarding the precautions taken to protect themselves from surgical smoke, 91·1% of the nurses and 86·1% of the doctors reported using surgical masks. It was found that they did not report taking any effective protective measures, and only a few of the nurses reported using special filtration masks. It was observed that the participants widely used surgical masks, which are ineffective in protecting from the effects of surgical smoke. Attention brought to the effects of surgical smoke. Presentation of the harmful effects of surgical smoke reported by doctors and nurses. Identification of the precautions that can be taken against surgical smoke. © 2016 John Wiley & Sons Ltd.

Details for Manuscript Number SSM-D-07-00339R2 “When there is no doctor: Reasons for the disappearance of primary care physicians in the US during the early 21st century”

PubMed Central

McKinlay, John; Marceau, Lisa

2008-01-01

Primary care doctoring in the USA today (2007) bears little resemblance to what existed just 25 years ago. We focus on what is likely to unfold in the U.S. over the next several decades and suggest that by about 2025, primary care doctoring in the U.S. could be rare, possibly unrecognizable and even nonexistent. Seven reasons for the probable disappearance of primary care doctoring are identified. The most important reason is medicine’s loss of state sponsorship: the U.S. state has shifted from a pluralistic orientation to a New Right approach. With less state protection medicine has become even more attractive for private interests. Six additional reasons include: • The epidemiological transition (chronic diseases reduce doctors to a palliative role and monitoring of incurable conditions); • The overcrowded health care playing field (non–physician clinicians are supplanting primary care doctors); • The unintended consequences of clinical guidelines (the art of doctoring is reduced to formulaic tasks, easily codified and performed by non-physician clinicians); • The demise of the in-person examination (in-person examination is being replaced by impersonal testing); • Primary care doctoring is becoming unattractive (physicians are dissatisfied, alienated and experiencing income declines. Applications by U.S. graduates to primary care programs continue to decline); • Patients are not what they used to be (internet access and direct-to-consumer advertising are changing the doctor-patient relationship). By 2025, many everyday illnesses in the U.S. will be managed via the internet or by non-physician clinicians working out of retail clinics. Some medical problems will still require a physician’s attention, but this will be provided by specialists rather than by primary care doctors (general practitioners). PMID:18701201

[Doctoral thesis projects for medical students? Retrospective estimation of the fraction of successfully completed medical doctoral thesis projects at Witten/Herdecke University].

PubMed

Scharfenberg, Janna; Schaper, Katharina; Krummenauer, Frank

2014-01-01

The German "Dr med" plays a specific role in doctoral thesis settings since students may start the underlying doctoral project during their studies at medical school. If a Medical Faculty principally encourages this approach, then it should support the students in performing the respective projects as efficiently as possible. Consequently, it must be ensured that students are able to implement and complete a doctoral project in parallel to their studies. As a characteristic efficiency feature of these "Dr med" initiatives, the proportion of doctoral projects successfully completed shortly after graduating from medical school is proposed and illustrated. The proposed characteristic can be estimated by the time period between the state examination (date of completion of the qualifying medical examination) and the doctoral examination. Completion of the doctoral project "during their medical studies" was then characterised by a doctoral examination no later than 12 months after the qualifying medical state examination. To illustrate the estimation and interpretation of this characteristic, it was retrospectively estimated on the basis of the full sample of all doctorates successfully completed between July 2009 and June 2012 at the Department of Human Medicine at the Faculty of Health of the University of Witten/Herdecke. During the period of investigation defined, a total number of 56 doctoral examinations were documented, 30 % of which were completed within 12 months after the qualifying medical state examination (95% confidence interval 19 to 44 %). The median duration between state and doctoral examination was 27 months. The proportion of doctoral projects completed parallel to the medical studies increased during the investigation period from 14 % in the first year (July 2009 till June 2010) to 40 % in the third year (July 2011 till June 2012). Only about a third of all "Dr med" projects at the Witten/Herdecke Faculty of Health were completed during or close to the qualifying medical studies. This proportion, however, increased after the introduction of a curriculum on research methodology and practice in 2010; prospective longitudinal studies will have to clarify whether this is causal or mere chronological coincidence. In summary, the proposed method for determining the process efficiency of a medical faculty's "Dr med" programme has proven to be both feasible and informative. Copyright © 2014. Published by Elsevier GmbH.

Consequences of low birth weight, maternal illiteracy and poor access to medical care in rural India: infantile iatrogenic Cushing syndrome.

PubMed

Karande, Sunil

2015-08-21

Home delivery, low birth weight babies and maternal illiteracy among the poor in rural India are frequent. The rural poor prefer to seek healthcare from private providers, most of whom have no formal medical training and buy medicines from private pharmacies without a prescription owing to a weakly regulated environment. This report is of a 4-month-old baby from a remote village in northern India, who presented with exogenous Cushing syndrome. This baby was a full-term low birth weight home delivery. As the baby was not growing well, treatment was started at 1 month by a private doctor with betamethasone drops The mother on her own volition continued giving the betamethasone drops by buying the medicine over the counter from a private pharmacy. This case highlights the gaps in essential health services in rural India and the steps being taken to improve the situation. 2015 BMJ Publishing Group Ltd.

Consequences of low birth weight, maternal illiteracy and poor access to medical care in rural India: infantile iatrogenic Cushing syndrome

PubMed Central

Karande, Sunil

2015-01-01

Home delivery, low birth weight babies and maternal illiteracy among the poor in rural India are frequent. The rural poor prefer to seek healthcare from private providers, most of whom have no formal medical training and buy medicines from private pharmacies without a prescription owing to a weakly regulated environment. This report is of a 4-month-old baby from a remote village in northern India, who presented with exogenous Cushing syndrome. This baby was a full-term low birth weight home delivery. As the baby was not growing well, treatment was started at 1 month by a private doctor with betamethasone drops The mother on her own volition continued giving the betamethasone drops by buying the medicine over the counter from a private pharmacy. This case highlights the gaps in essential health services in rural India and the steps being taken to improve the situation. PMID:26297767

Mental Health and Migration: Depression, Alcohol Abuse, and Access to Health Care among Migrants in Central Asia

PubMed Central

Ismayilova, Leyla; Lee, Hae Nim; Shaw, Stacey; El-Bassel, Nabila; Gilbert, Louisa; Terlikbayeva, Assel; Rozental, Yelena

2014-01-01

Background One fifth of Kazakhstan’s population is labor migrants working in poor conditions with limited legal rights. This paper examines self-rated health, mental health and access to health care among migrant workers. Methods Using geo-mapping, a random sample of internal and external migrant market workers was selected in Almaty (N=450). We used survey logistic regression adjusted for clustering of workers within stalls. Results Almost half of participants described their health as fair or poor and reported not seeing a doctor when needed, 6.2% had clinical depression and 8.7% met criteria for alcohol abuse. Female external migrants were at higher risk for poor health and underutilization of health services. High mobility was associated with depression among internal migrants and with alcohol abuse among female migrant workers. Conclusions This study demonstrates the urgent need to address health and mental health needs and improve access to health care among labor migrants in Central Asia. PMID:24186359

Mental health and migration: depression, alcohol abuse, and access to health care among migrants in Central Asia.

PubMed

Ismayilova, Leyla; Lee, Hae Nim; Shaw, Stacey; El-Bassel, Nabila; Gilbert, Louisa; Terlikbayeva, Assel; Rozental, Yelena

2014-12-01

One-fifth of Kazakhstan's population is labor migrants working in poor conditions with limited legal rights. This paper examines self-rated health, mental health and access to health care among migrant workers. Using geo-mapping, a random sample of internal and external migrant market workers was selected in Almaty (N = 450). We used survey logistic regression adjusted for clustering of workers within stalls. Almost half of participants described their health as fair or poor and reported not seeing a doctor when needed, 6.2% had clinical depression and 8.7% met criteria for alcohol abuse. Female external migrants were at higher risk for poor health and underutilization of health services. High mobility was associated with depression among internal migrants and with alcohol abuse among female migrant workers. This study demonstrates the urgent need to address health and mental health needs and improve access to health care among labor migrants in Central Asia.

Artificial intelligence in medicine: humans need not apply?

PubMed

Diprose, William; Buist, Nicholas

2016-05-06

Artificial intelligence (AI) is a rapidly growing field with a wide range of applications. Driven by economic constraints and the potential to reduce human error, we believe that over the coming years AI will perform a significant amount of the diagnostic and treatment decision-making traditionally performed by the doctor. Humans would continue to be an important part of healthcare delivery, but in many situations, less expensive fit-for-purpose healthcare workers could be trained to 'fill the gaps' where AI are less capable. As a result, the role of the doctor as an expensive problem-solver would become redundant.

Inter-unit Doctoral Program in Nursing of the University of São Paulo: characterization of graduates and theses defended in a decade.

PubMed

Garbin, Livia Maria; de Castro Sajioro Azevedo, Ana Lídia; da Silva, Leandra Terezinha Roncolato; Laus, Ana Maria; Chaves, Lucieli Dias Pedreschi; Gualda, Dulce Maria Rosa; Rossi, Lídia Aparecida

2010-01-01

This descriptive study aimed to characterize the graduates of the Inter-unit Doctoral Program in Nursing of the School of Nursing of the University of São Paulo, who defended their theses in the period 1998-2008, in relation to the location they developed their Masters and their pre and post-doctoral employment, also to investigate the theses defended in relation to the thematic areas and methodological approaches used. Data were collected from the Fenix-USP System and the Lattes Curriculum System. Of the 190 graduates, 178 had curricula available online. Of those, 58.4% performed teaching and research activities when they entered the doctoral program, which were activities mainly developed at Federal Universities (34.8%). This predominance was maintained after the conclusion of the doctoral studies. The thematic areas most studied were Women's Health (20.5%) and Adults/Elderly Health (13.2%). Regarding the methodological approach, 68.4% used qualitative methods. The data evidenced the contributions of this Program to research.

Pi-pi* orbital transitions and photo-degeneracy of C.acuminata sensitized solar cells

NASA Astrophysics Data System (ADS)

Abodunrin, T.; Boyo, A.; Usikalu, M.; Obafemi, L.; Oladapo, O.; Kotsedi, L.; Yenus, Z.; Maaza, M.

2017-04-01

Dye-sensitized solar cells (DSSCs) have acquired great prominence as favourable low-cost photovoltaics due to their ease of fabrication, all- year -availability, ease of obtaining raw materials and adjustable optical properties like transparency and colour. These advantages coupled with the ability to work under poor lighting makes them a suitable candidate for next generation of research. In this research, C.acuminata-sensitized photo anodes play an important role for achieving high performance since the porous metal oxide films provide a large specific surface area for dye loading and the possibility to extend the absorption threshold of past studies of sensitizers. The doctor blade method and high-temperature sintering were some of the methods used in the fabrication of the photo anode. A study of the performance of the C.acuminata-DSSCs with four different electrolyte sensitizers based on iodide redox mediator is determined. The result is DSSCs that exhibit a maximum power output of 39.37 W, fill factor of 0.7 and a power conversion efficiency of 0.6% under unfavourable sunlight intensity conditions and photo-degradation of about 37.5 % in absorbance after 425 suns.

Gender contentedness in aspirations to become engineers or medical doctors

NASA Astrophysics Data System (ADS)

Koul, Ravinder; Lerdpornkulrat, Thanita; Poondej, Chanut

2017-11-01

Medical doctor and engineer are highly esteemed STEM professions. This study investigates academic and motivational characteristics of a sample of high school students in Thailand who aspire to become medical doctors or engineers. We used logistic regression to compare maths performance, gender typicality, gender contentedness, and maths and physics self-concepts among students with aspirations for these two professions. We found that high levels of felt gender contentedness in men had positive association with aspirations for engineering irrespective of the levels of maths or physics self-concept. We found that high levels of felt gender contentedness combined with high levels of maths or physics self-concept in women had positive associations with aspirations to become a medical doctor. These findings are evidence that student views of self are associated with uneven gendered patterns in career aspirations and have implications for the potential for future participation.

Nursing Doctorates in Brazil: research formation and theses production.

PubMed

Scochi, Carmen Gracinda Silvan; Gelbcke, Francine Lima; Ferreira, Márcia de Assunção; Lima, Maria Alice Dias da Silva; Padilha, Katia Grillo; Padovani, Nátali Artal; Munari, Denize Bouttelet

2015-01-01

to analyze the formation of nursing doctorates in Brazil, from theses production, disciplines and other strategies focusing on research offered by courses. a descriptive and analytical study of the performance of 18 doctoral courses in nursing, running from 1982 to 2010, and defended their theses between 2010-2012. 502 theses were defended in this period, most linked to the online research process of health and nursing care. There are gaps in the knowledge of theoretical and philosophical foundations of care, nursing history and ethics. There are also weaknesses in the methodological design of the theses, with a predominance of descriptive and/or exploratory studies. This was consistent with international standards set with regards to the proposition of research of disciplines and complementary strategies in forming the doctorate. despite the efforts and advances in research formation, it is essential to expand to more robust research designs with a greater impact on production knowledge that is incorporated into practice.

A generic discrete-event simulation model for outpatient clinics in a large public hospital.

PubMed

Weerawat, Waressara; Pichitlamken, Juta; Subsombat, Peerapong

2013-01-01

The orthopedic outpatient department (OPD) ward in a large Thai public hospital is modeled using Discrete-Event Stochastic (DES) simulation. Key Performance Indicators (KPIs) are used to measure effects across various clinical operations during different shifts throughout the day. By considering various KPIs such as wait times to see doctors, percentage of patients who can see a doctor within a target time frame, and the time that the last patient completes their doctor consultation, bottlenecks are identified and resource-critical clinics can be prioritized. The simulation model quantifies the chronic, high patient congestion that is prevalent amongst Thai public hospitals with very high patient-to-doctor ratios. Our model can be applied across five different OPD wards by modifying the model parameters. Throughout this work, we show how DES models can be used as decision-support tools for hospital management.

Ultrasound-Induced Organogel Formation Followed by Thin Film Fabrication via Simple Doctor Blading Technique for Field-Effect Transistor Applications.

PubMed

Xu, Jiaju; Wang, Yulong; Shan, Haiquan; Lin, Yiwei; Chen, Qian; Roy, V A L; Xu, Zongxiang

2016-07-27

We demonstrate doctor blading technique to fabricate high performance transistors made up of printed small molecular materials. In this regard, we synthesize a new soluble phthalocyanine, tetra-n-butyl peripheral substituted copper(II) phthalocaynine (CuBuPc), that can easily undergo gel formation upon ultrasonic irradiation, leading to the formation of three-dimensional (3D) network composed of one-dimensional (1D) nanofibers structure. Finally, taking the advantage of thixotropic nature of the CuBuPc organogel, we use the doctor blade processing technique that limits the material wastage for the fabrication of transistor devices. Due to the ultrasound induced stronger π-π interaction, the transistor fabricated by doctor blading based on CuBuPc organogel exhibits significant increase in charge carrier mobility in comparison with other solution process techniques, thus paving a way for a simple and economically viable preparation of electronic circuits.

The business of medicine: how to overcome financial obstacles and secure financing for your private practice and ancillary services business.

PubMed

Nayor, David

2012-01-01

Doctors across the country who operate private medical practices are facing increasing financial obstacles, namely shrinking income as a result of rising costs and lower reimbursements. In addition, as hospitals have become overburdened many physicians have opened up private surgical centers; magnetic resonance imaging and computed tomography and positron emission tomography scanning facilities; pathology labs; colonoscopy/endoscopy suites; lithotripsy centers; and other medical businesses typically performed within the hospital. Moreover, many doctors seek loans to purchase existing practices or for their capital contribution in medical partnerships. The past decade has thus seen a significant increase in the number of doctors taking out small business loans. Indeed, banks view the healthcare industry as a large growth market. This article includes practical information, advice, and resources to help doctors to secure bank financing for their practices, ancillary services business, real estate, and equipment on the best possible market terms.

Training doctors to manage patients with multimorbidity: a systematic review.

PubMed

Lewis, Cliona; Wallace, Emma; Kyne, Lorraine; Cullen, Walter; Smith, Susan M

2016-01-01

Patients with multimorbidity (two or more chronic conditions) are now the norm in clinical practice, and place an increasing burden on the healthcare system. Management of these patients is challenging, and requires doctors who are skilled in the complexity of multiple chronic diseases. To perform a systematic review of the literature to ascertain whether there are education and training formats which have been used to train postgraduate medical doctors in the management of patients with multimorbidity in primary and/or secondary care, and which have been shown to improve knowledge, skills, attitudes, and/or patient outcomes. Overall, 75,110 citations were screened, of which 65 full-text articles were then independently assessed for eligibility by two reviewers, and two studies met the inclusion criteria for the review. The two included studies implemented and evaluated multimorbidity workshops, and highlight the need for further research addressing the learning needs of doctors tasked with managing patients with multimorbidity in their daily practice. While much has been published about the challenges presented to medical staff by patients with multimorbidity, published research regarding education of doctors to manage these problems is lacking. Further research is required to determine whether there is a need for, or benefit from, specific training for doctors to manage patients with multimorbidity. PROSPERO registration number: CRD42013004010.

Managing the delivery of bad news: an in-depth analysis of doctors' delivery style.

PubMed

Shaw, Joanne; Dunn, Stewart; Heinrich, Paul

2012-05-01

The purpose of this study was to identify and describe the delivery styles doctors typically use when breaking bad news (BBN). Thirty one doctors were recruited to participate in two standardised BBN consultations involving a sudden death. Delivery styles were determined using time to deliver the bad news as a standardised differentiation as well as qualitative analysis of interaction content and language style. Communication performance was also assessed. Analysis of BBN interactions revealed three typical delivery styles. A blunt style characterised by doctors delivering news within the first 30 s of the interaction; Forecasting, a staged delivery of the news within the first 2 min and a stalling approach, delaying news delivery for more than 2 min. This latter avoidant style relies on the news recipient reaching a conclusion about event outcome without the doctor explicitly conveying the news. Three typical bad news delivery styles used by doctors when BBN were confirmed both semantically and operationally in the study. The relationship between delivery style and the overall quality of BBN interactions was also investigated. This research provides a new template for approaching BBN training and provides evidence for a need for greater flexibility when communicating bad news. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Vision Screening

MedlinePlus

... testing when performed at a doctor's office. Corneal light reflex testing This simple test can be performed ... focuses on a penlight, the position of the light reflection from the front surface (cornea) of the ...

Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in 3 cities in Brazil.

PubMed

Medeiros, Eduardo A; Grinberg, Gorki; Rosenthal, Victor D; Bicudo Angelieri, Daniela; Buchner Ferreira, Iselde; Bauer Cechinel, Raquel; Zanandrea, Bruna Boaria; Rohnkohl, Carolina; Regalin, Marcos; Spessatto, Jamile Leda; Scopel Pasini, Ricardo; Ferla, Shaline

2015-01-01

Hand hygiene (HH) is the main tool for cross-infection prevention, but adherence to guidelines is low in limited-resource countries, and there are not available published data from Brazil. This is an observational, prospective, interventional, before-and-after study conducted in 4 intensive care units in 4 hospitals, which are members of the International Nosocomial Infection Control Consortium (INICC), from June 2006-April 2008. The study was divided into a 3-month baseline period and a follow-up period. A multidimensional HH approach was introduced, which included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback. Health care workers were observed for HH practices in each intensive care unit during randomly selected 30-minute periods. We recorded 4,837 opportunities for HH, with an overall HH compliance that increased from 27%-58% (P < .01). Multivariate analysis showed that some variables were associated with poor HH compliance: men versus women (49% vs 38%, P < .001), nurses versus doctors (55% vs 48%, P < .02), among others. With the implementation of the INICC approach, adherence to HH was significantly increased. Programs should be aimed at improving HH in variables found to be predictors of poor HH compliance. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The description of cough sounds by healthcare professionals

PubMed Central

Smith, Jaclyn A; Ashurst, H Louise; Jack, Sandy; Woodcock, Ashley A; Earis, John E

2006-01-01

Background Little is known of the language healthcare professionals use to describe cough sounds. We aimed to examine how they describe cough sounds and to assess whether these descriptions suggested they appreciate the basic sound qualities (as assessed by acoustic analysis) and the underlying diagnosis of the patient coughing. Methods 53 health professionals from two large respiratory tertiary referral centres were recruited; 22 doctors and 31 staff from professions allied to medicine. Participants listened to 9 sequences of spontaneous cough sounds from common respiratory diseases. For each cough they selected patient gender, the most appropriate descriptors and a diagnosis. Cluster analysis was performed to assess which cough sounds attracted similar descriptions. Results Gender was correctly identified in 93% of cases. The presence or absence of mucus was correct in 76.1% and wheeze in 39.3% of cases. However, identifying clinical diagnosis from cough was poor at 34.0%. Cluster analysis showed coughs with the same acoustics properties rather than the same diagnoses attracted the same descriptions. Conclusion These results suggest that healthcare professionals can recognise some of the qualities of cough sounds but are poor at making diagnoses from them. It remains to be seen whether in the future cough sound acoustics will provide useful clinical information and whether their study will lead to the development of useful new outcome measures in cough monitoring. PMID:16436200

Impact of weight bias and stigma on quality of care and outcomes for patients with obesity.

PubMed

Phelan, S M; Burgess, D J; Yeazel, M W; Hellerstedt, W L; Griffin, J M; van Ryn, M

2015-04-01

The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care. © 2015 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of International Association for the Study of Obesity (IASO).

A comparison of doctors', parents' and children's reports of health states and health-related quality of life in children with chronic conditions.

PubMed

Morrow, A M; Hayen, A; Quine, S; Scheinberg, A; Craig, J C

2012-03-01

Health-related quality of life is an important outcome. Self-report is the gold standard, but in the paediatric setting we often rely on proxy reporting. Our understanding of the differences between self- and proxy reports and the factors that influence them is limited. These differences can impact on treatment choices and the patient-doctor relationship. To evaluate differences between children's, parents' and doctors' perceptions of health states and health-related quality of life in children with chronic illness and explore factors which explain these differences. Consecutive families attending eligible clinics at a tertiary paediatric centre were invited to complete the Health Utilities Index (HUI) 23 questionnaire. Percentage agreement and kappas were calculated as a measure of the agreement between pairs. Chi-squared tests or Fisher's exact test, if appropriate, were performed to determine if there was an association between level of agreement and participant variables. Data were collected for 130 parent-doctor pairs, 59 child-parent pairs and 59 child-doctor pairs. Overall health-related quality of life scores did not differ between responders, but there was poorer agreement for subjective domains. Doctor-child agreement was lower than parent-child agreement. Children with a diagnosis of cerebral palsy or chronic neurological condition were more likely to have lower inter-rater agreement for both subjective and objective domains. On the HUI2, agreement was lower for parent-child pairs when the father was the respondent. For child-doctor pairs, an increased frequency of patient-doctor visits and doctors' seniority were predictors of poorer agreement on the HUI3 and HUI2 respectively. We identified factors associated with level of agreement for self- and proxy reporting on the HUI23. Parent-child agreement was higher than doctor-child agreement. Patients with significant pain or emotional distress and patients with a diagnosis of severe cerebral palsy or chronic neurological conditions were more susceptible to under-reporting of subjective aspects of well-being by doctors and parents and may benefit from formal assessment of health-related quality of life in the clinical setting. © 2011 Blackwell Publishing Ltd.

Prevalence and associated factors of depressive symptoms among Chinese doctors: a cross-sectional survey.

PubMed

Wang, Jia-Na; Sun, Wei; Chi, Tie-Shuang; Wu, Hui; Wang, Lie

2010-12-01

Doctors, the major workforce in hospitals, are doing heavy emotional and physical work which may lead to depressive symptoms. However, in China, few studies are available pertaining to the prevalence and associated factors of depressive symptoms among doctors. The aim of this study was to evaluate the prevalence of depressive symptoms and to explore its associated factors among Chinese doctors in public hospitals. This cross-sectional study was performed during the period of September/October 2008. The study population comprised of 1,890 doctors registered and working in the 20 national hospitals in Liaoning province, northeast of China. A questionnaire that comprised depressive symptoms assessed by the Chinese Version of the Center for Epidemiologic Studies Depression Scale (CES-D), demographic factors, work conditions, occupational stress, and coping strategies was distributed to these doctors. A total of 1,488 effective respondents became our subjects (effective response rate 78.7%). Multivariate logistic regression was used to explore the factors related to depressive symptoms. The prevalence of depressive symptoms among doctors was 65.3%. Multivariate logistic analyses showed that high role insufficiency (OR 2.15, 95% CI 1.66-2.78), worse doctor-patient relationship (OR 2.07, 95% CI 1.62-2.64), having a chronic disease (OR 1.73, 95% CI 1.31-2.27), serious role boundary (OR 1.54, 95% CI 1.21-2.00), and role overload (OR 1.42, 95% CI 1.11-1.81) were positively associated with depressive symptoms; whereas adequate rational coping (OR 0.58, 95% CI 0.45-0.76) and social support (OR 0.75, 95% CI 0.57-0.98) were negatively associated with depressive symptoms. Most Chinese doctors probably have depressive symptoms. Role insufficiency, doctor-patient relationship, and rational coping seemed to be crucial in relation to depressive symptoms. Efficient interventions such as taking further education course, improving communications with patients, and improving the ability of rational coping should be considered by health administrators aiming at improving the quality of Chinese doctors' mental health from the view point of depressive symptoms.

The Effect of Doctor-Consumer Interaction on Social Media on Consumers’ Health Behaviors: Cross-Sectional Study

PubMed Central

Wu, Tailai; Deng, Zhaohua; Gaskin, Darrell J; Zhang, Donglan; Wang, Ruoxi

2018-01-01

Background Both doctors and consumers have engaged in using social media for health purposes. Social media has changed traditional one-to-one communication between doctors and patients to many-to-many communication between doctors and consumers. However, little is known about the effect of doctor-consumer interaction on consumers’ health behaviors. Objective The aim of this study was to investigate how doctor-consumer interaction in social media affects consumers’ health behaviors. Methods On the basis of professional-client interaction theory and social cognitive theory, we propose that doctor-consumer interaction can be divided into instrumental interaction and affective interaction. These two types of interactions influence consumers’ health behaviors through declarative knowledge (DK), self-efficacy (SE), and outcome expectancy (OE). To validate our proposed research model, we employed the survey method and developed corresponding measurement instruments for constructs in our research model. A total of 352 valid answers were collected, and partial least square was performed to analyze the data. Results Instrumental doctor-consumer interaction was found to influence consumers’ DK (t294=5.763, P<.001), SE (t294=4.891, P<.001), and OE (t294=7.554, P<.001) significantly, whereas affective doctor-consumer interaction also impacted consumers’ DK (t294=4.025, P<.001), SE (t294=4.775, P<.001), and OE (t294=4.855, P<.001). Meanwhile, consumers’ DK (t294=3.838, P<.001), SE (t294=3.824, P<.001), and OE (t294=2.985, P<.01) all significantly affected consumers’ health behaviors. Our mediation analysis showed that consumers’ DK, SE, and OE partially mediated the effect of instrumental interaction on health behaviors, whereas the three mediators fully mediated the effect of affective interaction on health behaviors. Conclusions Compared with many intentional intervention programs, doctor-consumer interaction can be treated as a natural cost-effective intervention to promote consumers’ health behaviors. Meanwhile, both instrumental and affective interaction should be highlighted for the best interaction results. DK, SE, and OE are working mechanisms of doctor-consumer interaction. PMID:29490892

Evaluation of a Web-based Intervention Providing Tailored Advice for Self-management of Minor Respiratory Symptoms: Exploratory Randomized Controlled Trial

PubMed Central

Joseph, Judith; Michie, Susan; Weal, Mark; Wills, Gary; Little, Paul

2010-01-01

Background There has been relatively little research on the role of web-based support for self-care in the management of minor, acute symptoms, in contrast to the wealth of recent research into Internet interventions to support self-management of long-term conditions. Objective This study was designed as an evaluation of the usage and effects of the “Internet Doctor” website providing tailored advice on self-management of minor respiratory symptoms (eg, cough, sore throat, fever, runny nose), in preparation for a definitive trial of clinical effectiveness. The first aim was to evaluate the effects of using the Internet Doctor webpages on patient enablement and use of health services, to test whether the tailored, theory-based advice provided by the Internet Doctor was superior to providing a static webpage providing the best existing patient information (the control condition). The second aim was to gain an understanding of the processes that might mediate any change in intentions to consult the doctor, by comparing changes in relevant beliefs and illness perceptions in the intervention and control groups, and by analyzing usage of the Internet Doctor webpages and predictors of intention change. Methods Participants (N = 714) completed baseline measures of beliefs about their symptoms and self-care online, and were then automatically randomized to the Internet Doctor or control group. These measures were completed again by 332 participants after 48 hours. Four weeks later, 214 participants completed measures of enablement and health service use. Results The Internet Doctor resulted in higher levels of satisfaction than the control information (mean 6.58 and 5.86, respectively; P = .002) and resulted in higher levels of enablement a month later (median 3 and 2, respectively; P = .03). Understanding of illness improved in the 48 hours following use of the Internet Doctor webpages, whereas it did not improve in the control group (mean change from baseline 0.21 and -0.06, respectively, P = .05). Decline in intentions to consult the doctor between baseline and follow-up was predicted by age (beta = .10, P= .003), believing before accessing the website that consultation was necessary for recovery (beta = .19, P < .001), poor understanding of illness (beta = .11, P = .004), emotional reactions to illness (beta = .15, P <.001), and use of the Diagnostic section of the Internet Doctor website (beta = .09, P = .007). Conclusions Our findings provide initial evidence that tailored web-based advice could help patients self-manage minor symptoms to a greater extent. These findings constitute a sound foundation and rationale for future research. In particular, our study provides the evidence required to justify carrying out much larger trials in representative population samples comparing tailored web-based advice with routine care, to obtain a definitive evaluation of the impact on self-management and health service use. PMID:21159599

Decalogue of the Spanish Society of Arteriosclerosis to reduce therapeutic inertia.

PubMed

Blasco, Mariano; Pérez-Martínez, Pablo; Lahoz, Carlos

Therapeutic inertia (TI) is defined as the failure of the physician to initiate or intensify a treatment when the therapeutic goal has not been achieved. TI can be of 2types: inertia due to lack of prescription of drugs and inertia in the absence of control of a risk factor. The consequences of TI are poor control of risk factors, an increase in potentially preventable events and an increase in costs. There are factors of the doctor himself, the patient and the care organization that determine the presence of TI. Ten measures are proposed to reduce TI: to promote continuing education, to define clearly therapeutic objectives, to establish audits, to implement computerized medical records with alerts, to encourage research in this field, to disseminate clinical practice guidelines, to create motivational incentives, to organize care, to improve the doctor-patient relationship and to involve other health care providers. Copyright © 2017 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria.

PubMed

Alajlani, Mohannad; Clarke, Malcolm

2013-04-01

We investigated issues that affect the use and adoption of telemedicine in Middle Eastern countries, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as case studies. Our study is based on interviews with key stakeholders (including doctors, technicians, engineers, and decision makers) and questionnaires administered to key stakeholders (including patients), ensuring opinion was gained from people from a full range of backgrounds and roles in the healthcare system. We found doctor and patient resistance was a major issue preventing the adoption of telemedicine in both countries, followed by poor infrastructure, lack of funding, and lack of information technology training. Our research identifies that culture is a greater issue than technical matters for the adoption of telemedicine in Middle Eastern countries. Based on our preliminary results we developed a guideline framework for each country that might be applied to telemedicine projects at the pre-implementation phase. The proposed guideline framework was validated through a return visit to the stakeholders and seeking further opinion.

Sexual assault nurse examiners' perceptions of their relationship with doctors, rape victim advocates, police, and prosecutors.

PubMed

Maier, Shana L

2012-05-01

In response to the negative and inefficient treatment of rape victims by emergency room personnel, the first Sexual Assault Nurse Examiner (SANE) programs began in the late 1970s. While SANEs, doctors, rape victim advocates, police officers and prosecutors work together to ensure the most comprehensive and sensitive care of rape victims, they all have very different roles and objectives. This research explores SANEs' perceptions of their relationships with other professionals who treat or interact with rape victims. Data from interviews with 39 Sexual Assault Nurse Examiners from four East Coast states indicate positive relationships are marked by open communication, respect shown towards SANEs as well as rape victims, and a sense of appreciation among SANEs. On the contrary, negative relationships result when SANEs believe police treat victims poorly, when advocates overstep boundaries and question SANEs about evidence collection or the exam, and when prosecutors fail to properly prepare them to testify during a trial.

Should there be greater exposure to interventional radiology in the undergraduate curriculum?

PubMed

Ojha, Utkarsh; Mohammed, Raihan; Vivekanantham, Sayinthen

2017-01-01

Medical imaging has been one of the most revolutionary innovations in medicine. Today, as health care professionals shift their focus toward more sophisticated technology and minimally invasive procedures, interventional radiology (IR) has become a rapidly expanding specialty. Despite these advances, there is a lack of doctors specializing in this field. A growing body of evidence suggests that the low number of applicants for posts may be due to poor exposure to the specialty at medical school. In this article, we outline the importance of IR in today's health care system. Next, we evaluate the evidence that there is a lack of knowledge of IR not only among medical students in the UK but globally. We further discuss how a more effective incorporation of IR in the undergraduate curriculum can enhance medical students' interest in the field and subsequently increase the number of doctors specializing in IR. Finally, we suggest alternative strategies to gauge medical students' interest in IR, including teaching via e-learning and virtual reality.

Why do people consult the doctor?

PubMed

Campbell, S M; Roland, M O

1996-02-01

Symptoms are an everyday part of most peoples' lives and many people with illness do not consult their doctor. The decision to consult is not based simply on the presence or absence of medical problems. Rather it is based on a complex mix of social and psychological factors. This literature review seeks to explore some of the pathways to care and those factors associated with low and high rates of consultation. The paper examines the impact of socioeconomic and demographic factors on consultation rates and, using a revised version of the Health Belief Model, it highlights the psychological factors which influence decisions to seek medical care. Barriers which can inhibit consultation are discussed, as the decision to seek care will only result in a consultation if there is adequate access to care. Whilst poor health status and social disadvantage increase both "objective" medical need and in turn, consultation rates, a range of other social and psychological factors have been shown to influence consulting behaviour.

Effects of a computerized feedback intervention on safety performance by junior doctors: results from a randomized mixed method study

PubMed Central

2013-01-01

Background The behaviour of doctors and their responses to warnings can inform the effective design of Clinical Decision Support Systems. We used data from a University hospital electronic prescribing and laboratory reporting system with hierarchical warnings and alerts to explore junior doctors’ behaviour. The objective of this trial was to establish whether a Junior Doctor Dashboard providing feedback on prescription warning information and laboratory alerting acceptance rates was effective in changing junior doctors’ behaviour. Methods A mixed methods approach was employed which included a parallel group randomised controlled trial, and individual and focus group interviews. Junior doctors below the specialty trainee level 3 grade were recruited and randomised to two groups. Every doctor (N = 42) in the intervention group was e-mailed a link to a personal dashboard every week for 4 months. Nineteen participated in interviews. The 44 control doctors did not receive any automated feedback. The outcome measures were the difference in responses to prescribing warnings (of two severities) and laboratory alerting (of two severities) between the months before and the months during the intervention, analysed as the difference in performance between the intervention and the control groups. Results No significant differences were observed in the rates of generating prescription warnings, or in the acceptance of laboratory alarms. However, responses to laboratory alerts differed between the pre-intervention and intervention periods. For the doctors of Foundation Year 1 grade, this improvement was significantly (p = 0.002) greater in the group with access to the dashboard (53.6% ignored pre-intervention compared to 29.2% post intervention) than in the control group (47.9% ignored pre-intervention compared to 47.0% post intervention). Qualitative interview data indicated that while junior doctors were positive about the electronic prescribing functions, they were discriminating in the way they responded to other alerts and warnings given that from their perspective these were not always immediately clinically relevant or within the scope of their responsibility. Conclusions We have only been able to provide weak evidence that a clinical dashboard providing individualized feedback data has the potential to improve safety behaviour and only in one of several domains. The construction of metrics used in clinical dashboards must take account of actual work processes. Trial registration ISRCTN: ISRCTN72253051 PMID:23734871

Remedial and Compensatory Reading Instruction: Abstracts of Doctoral Dissertations Published in "Dissertation Abstracts International," January through June 1985 (Vol. 45 Nos. 7 through 12).

ERIC Educational Resources Information Center

ERIC Clearinghouse on Reading and Communication Skills, Urbana, IL.

This collection of abstracts is part of a continuing series providing information on recent doctoral dissertations. The 18 titles deal with a variety of topics, including the following: (1) the effects of phonemic segmentation and blending training on the word recognition performance of learning disabled readers; (2) a comparison of two remedial…

Junior doctor strike model of care: Reduced access block and predominant Fellow of the Australasian College for Emergency Medicine staffing improve emergency department performance.

PubMed

Thornton, Vanessa; Hazell, Wayne

2008-10-01

To describe the response and analyse ED performance during a 5-day junior doctor strike. Data were collected via the patient information management computer system. Key performance indicators included percentage seen within maximum waiting times per triage category (TC), ED length of stay, emergency medicine patients who did not wait to be seen, hospital bed occupancy and access block percentage. Comparisons were made for the same 5 days before the strike (BS), during the strike (S) and after the strike. Total doctor's shifts BS were 78.66 with 25% of these shifts being Fellow of the Australasian College for Emergency Medicine (FACEM) shifts. FACEM shifts were more common during the S period at 75% (P < 0.001). Total attendances (BS 631 vs S 596, P = 0.22) and TC percentages (P-values for TC 1, 2, 3, 4, 5, respectively, 1.0, 0.55, 0.88, 0.97, 0.46) in the BS, S and after-the-strike periods were not significantly different. Despite fewer total doctor shifts, the FACEM predominant model of care during the strike resulted in better percentages seen within the maximum waiting times for TC3 (66%), TC4 (78%) and TC5 (86%) (all P < 0.001). There was a reduction in patients who did not wait to be seen (28 BS vs 5 S, P < 0.001), ED length of stay (admissions: BS 451 min vs S 258 min, P < 0.001; discharges: BS 233 min vs S 144 min, P < 0.02) and referrals to inpatient services (P = 0.02). This occurred with reduced bed point occupancy of 66% and a consequent reduction in access block. FACEM staffing and reduced access block were significant factors in improved ED performance.

French pediatricians' knowledge, attitudes, beliefs towards and practices in the management of weight problems in children.

PubMed

Franc, Carine; Van Gerwen, Maaike; Le Vaillant, Marc; Rosman, Sophia; Pelletier-Fleury, Nathalie

2009-07-01

A representative sample of 611 French pediatricians was interviewed on their knowledge, attitudes, beliefs towards and practices regarding childhood obesity through a 39-item Likert format questionnaire. A vast majority of the respondents regarded obesity as an illness (86.4%), 70.2% were aware that without any treatment an obese child has a high risk to remain obese in adulthood, 84% reported that managing obesity is part of their responsibility in the routine practice and 89.3% affirmed to systematically inform parents of obese children on health risks associated with obesity. At the same time, 82.4% were convinced that managing obesity is bound to fail and only 46.5% that it is professionally gratifying. However, doctors who followed a vocational training dedicated to obesity felt themselves more efficient in managing childhood obesity (p<0.01), those who knew the national recommendations were also less likely to report that the management of childhood obesity leads to a failure (p<0.05). Probably one of the main result of our study concerns doctors' perception of the relative impact of the different etiologic factors of obesity. Beside sedentary life, poor eating behavior, lack of parental concern and heredity which are cited by more than three-fourth of the pediatricians, an economic situation more and more insecure and a food industry increasingly more powerful are reported for the first time by doctors themselves, respectively by 59.9% and 60.8% of them, to kill the goodwill of health professionals. These findings reinforce the idea that the solution to the obesity problem does not lie just within the doctor's office and stress the need for prompt regulatory actions to curb obesity.

Determinants of patient satisfaction in ambulatory oncology: a cross sectional study based on the OUT-PATSAT35 questionnaire

PubMed Central

2011-01-01

Background The aim of this study was to identify factors associated with satisfaction with care in cancer patients undergoing ambulatory treatment. We investigated associations between patients' baseline clinical and socio-demographic characteristics, as well as self-reported quality of life, and satisfaction with care. Methods Patients undergoing ambulatory chemotherapy or radiotherapy in 2 centres in France were invited, at the beginning of their treatment, to complete the OUT-PATSAT35, a 35 item and 13 scale questionnaire evaluating perception of doctors, nurses and aspects of care organisation. Additionally, for each patient, socio-demographic variables, clinical characteristics and self-reported quality of life using the EORTC QLQ-C30 questionnaire were recorded. Results Among 692 patients included between January 2005 and December 2006, only 6 were non-responders. By multivariate analysis, poor perceived global health strongly predicted dissatisfaction with care (p < 0.0001). Patients treated by radiotherapy (vs patients treated by chemotherapy) reported lower levels of satisfaction with doctors' technical and interpersonal skills, information provided by caregivers, and waiting times. Patients with primary head and neck cancer (vs other localisations), and those living alone were less satisfied with information provided by doctors, and younger patients (< 55 years) were less satisfied with doctors' availability. Conclusions A number of clinical of socio-demographic factors were significantly associated with different scales of the satisfaction questionnaire. However, the main determinant was the patient's global health status, underlining the importance of measuring and adjusting for self-perceived health status when evaluating satisfaction. Further analyses are currently ongoing to determine the responsiveness of the OUT-PATSAT35 questionnaire to changes over time. PMID:22204665

Vital Signs: Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation - United States, 2013-2015.

PubMed

Barbour, Kamil E; Helmick, Charles G; Boring, Michael; Brady, Teresa J

2017-03-10

In the United States, doctor-diagnosed arthritis is a common and disabling chronic condition. Arthritis can lead to severe joint pain and poor physical function, and it can negatively affect quality of life. CDC analyzed 2013-2015 data from the National Health Interview Survey, an annual, nationally representative, in-person interview survey of the health status and behaviors of the noninstitutionalized civilian U.S. adult population, to update previous prevalence estimates of arthritis and arthritis-attributable activity limitations. On average, during 2013-2015, 54.4 million (22.7%) adults had doctor-diagnosed arthritis, and 23.7 million (43.5% of those with arthritis) had arthritis-attributable activity limitations (an age-adjusted increase of approximately 20% in the proportion of adults with arthritis reporting activity limitations since 2002 [p-trend <0.001]). Among adults with heart disease, diabetes, and obesity, the prevalences of doctor-diagnosed arthritis were 49.3%, 47.1%, and 30.6%, respectively; the prevalences of arthritis-attributable activity limitations among adults with these conditions and arthritis were 54.5% (heart disease), 54.0% (diabetes), and 49.0% (obesity). The prevalence of arthritis is high, particularly among adults with comorbid conditions, such as heart disease, diabetes, and obesity. Furthermore, the prevalence of arthritis-attributable activity limitations is high and increasing over time. Approximately half of adults with arthritis and heart disease, arthritis and diabetes, or arthritis and obesity are limited by their arthritis. Greater use of evidence-based physical activity and self-management education interventions can reduce pain and improve function and quality of life for adults with arthritis and also for adults with other chronic conditions who might be limited by their arthritis.

Patients’ preferences for GP consultation for perceived cancer risk in primary care: a discrete choice experiment

PubMed Central

Whitaker, Katriina L; Ghanouni, Alex; Zhou, Yin; Lyratzopoulos, Georgios; Morris, Stephen

2017-01-01

Background Contacting a doctor for advice when experiencing a potential cancer symptom is an important step in early diagnosis, but barriers to consultation are commonly reported. Understanding barriers to consulting in primary care within the cancer context provides opportunities to improve earlier diagnosis of cancer Aim To investigate patients’ GP consultation preferences when presented with a potential cancer symptom, and to describe whether these preferences are mediated by variable levels of cancer risk. Design and setting A UK-wide online survey of adults ≥50 years old, using quota sampling to reflect general population characteristics. Method A discrete choice experiment examined participants’ preferences for primary care consultation for three cancer symptom scenarios: risk level not mentioned, risk designated as ‘low’, or risk designated as ‘high’. Scenarios based on length of consultation, time to getting an appointment, convenience, choice of GP, and GP listening skills were presented in a self-completed online questionnaire. Results A total of 9616 observations were obtained from 601 participants. Participants expressed preferences for doctors with better listening skills, the ability to see a GP of their choice, and shorter waiting times. These findings were the same across risk conditions and demographic groups. Participants were willing to wait an extra 3.5 weeks for an appointment with a doctor with good/very good listening skills (versus very poor listening skills) and an extra week for an appointment with a GP of their choice (versus any GP). Conclusion Patient decisions about help seeking seem to be particularly influenced by the anticipated listening skills of doctors. Improving doctors’ communication skills may in the longer term encourage people to seek prompt medical help when they experience a cancer symptom. PMID:28483824

[The quality of medication orders--can it be improved?].

PubMed

Vaknin, Ofra; Wingart-Emerel, Efrat; Stern, Zvi

2003-07-01

Medication errors are a common cause of morbidity and mortality among patients. Medication administration in hospitals is a complicated procedure with the possibility of error at each step. Errors are most commonly found at the prescription and transcription stages, although it is known that most errors can easily be avoided through strict adherence to standardized procedure guidelines. In examination of medication errors reported in the hospital in the year 2000, we found that 38% reported to have resulted from transcription errors. In the year 2001, the hospital initiated a program designed to identify faulty process of orders in an effort to improve the quality and effectiveness of the medication administration process. As part of this program, it was decided to check and evaluate the quality of the written doctor's orders and the transcription of those orders to the nursing cadre, in various hospital units. The study was conducted using a questionnaire which checked compliance to hospital standards with regard to the medication administration process, as applied to 6 units over the course of 8 weeks. Results of the survey showed poor compliance to guidelines on the part of doctors and nurses. Only 18% of doctors' orders in the study and 37% of the nurses' transcriptions were written according to standards. The Emergency Department showed an even lower compliance with only 3% of doctors' orders and 25% of nurses' transcriptions complying to standards. As a result of this study, it was decided to initiate an intensive in-service teaching course to refresh the staff's knowledge of medication administration guidelines. In the future it is recommended that hand-written orders be replaced by computerized orders in an effort to limit the chance of error.

Vital Signs: Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation — United States, 2013–2015

PubMed Central

Helmick, Charles G.; Boring, Michael; Brady, Teresa J.

2017-01-01

Background In the United States, doctor-diagnosed arthritis is a common and disabling chronic condition. Arthritis can lead to severe joint pain and poor physical function, and it can negatively affect quality of life. Methods CDC analyzed 2013–2015 data from the National Health Interview Survey, an annual, nationally representative, in-person interview survey of the health status and behaviors of the noninstitutionalized civilian U.S. adult population, to update previous prevalence estimates of arthritis and arthritis-attributable activity limitations. Results On average, during 2013–2015, 54.4 million (22.7%) adults had doctor-diagnosed arthritis, and 23.7 million (43.5% of those with arthritis) had arthritis-attributable activity limitations (an age-adjusted increase of approximately 20% in the proportion of adults with arthritis reporting activity limitations since 2002 [p-trend <0.001]). Among adults with heart disease, diabetes, and obesity, the prevalences of doctor-diagnosed arthritis were 49.3%, 47.1%, and 30.6%, respectively; the prevalences of arthritis-attributable activity limitations among adults with these conditions and arthritis were 54.5% (heart disease), 54.0% (diabetes), and 49.0% (obesity). Conclusions and Comments The prevalence of arthritis is high, particularly among adults with comorbid conditions, such as heart disease, diabetes, and obesity. Furthermore, the prevalence of arthritis-attributable activity limitations is high and increasing over time. Approximately half of adults with arthritis and heart disease, arthritis and diabetes, or arthritis and obesity are limited by their arthritis. Greater use of evidence-based physical activity and self-management education interventions can reduce pain and improve function and quality of life for adults with arthritis and also for adults with other chronic conditions who might be limited by their arthritis. PMID:28278145

Knowledge and Attitude of Patients with Psychiatric Disorders and their Relatives Toward Electroconvulsive Therapy

PubMed Central

Dan, Amitava; Grover, Sandeep; Chakrabarti, Subho

2014-01-01

Objective: Knowledge and attitude regarding electroconvulsive therapy (ECT) is one of the important parameters for acceptance of ECT as a safe and effective treatment option. Several factors shape the knowledge and attitude of general people such as previous experience of ECT, sources of their information about ECT and prevailing myths about ECT. The present study attempted to examine the knowledge and attitude concerning ECT among patients with psychiatric disorders and their relatives. Materials and Methods: Knowledge and attitudes regarding ECT were assessed using the Bengali version of the ECT knowledge and attitude questionnaires, between 100 clinically stable patients with mental illnesses and their healthy relatives. Results: Majority of the patients and relatives were unaware of the basic facts about ECT. Relatives were somewhat better informed and more positive about ECT than patients, but the differences between the two groups were not significant. Previous experience of ECT did not have any major impact in knowledge and attitude in both patients and relative groups. Patients obtained information, mostly from media (44%), doctors (23%), and from personal experiences (13%). On the other hand, relatives obtained information almost equally from media (26%), doctors (27%), and experience of friends or relatives (28%). No significant difference was observed in knowledge and attitude in patients who had obtained their facts from doctors (n=23) and from other sources (n=77). Among relatives, those who had obtained their information from doctors (n=27) were better informed than those who had obtained so from other sources (n=73). Conclusions: Since patients and relatives have poor knowledge and negative attitude toward ECT, medical professionals should impart proper information about ECT to patients and relatives to increase the acceptability of this treatment. PMID:25035549

Understanding rehospitalization risk: can hospital discharge be modified to reduce recurrent hospitalization?

PubMed

Strunin, Lee; Stone, Meg; Jack, Brian

2007-09-01

A high rate of unnecessary rehospitalization has been shown to be related to a poorly managed discharge processes. A qualitative study was conducted in order to understand the phenomenon of frequent rehospitalization from the perspective of discharged patients and to determine if activities at the time of discharge could be designed to reduce the number of adverse events and rehospitalization. Semistructured, open-ended interviews were conducted with 21 patients during their hospital stay at Boston Medical Center. Interviews assessed continuity of care after discharge, need for and availability of social support, and ability to obtain follow-up medical care. Difficult life circumstances posed a greater barrier to recuperation than lack of medical knowledge. All participants were able to describe their medical condition, the reasons they were admitted to the hospital, and the discharge instructions they received. All reported the types of medications being taken or the conditions for which the medications were prescribed. Recuperation was compromised by factors that contribute to undermining the ability of patients to follow their doctors' recommendations including support for medical and basic needs, substance use, and limitations in the availability of transportation to medical appointments. Distress, particularly depression, further contributed to poor health and undermined the ability to follow doctors' recommendations and the discharge plans. Discharge interventions that assess the need for social support and provide access and services have the potential to reduce chronic rehospitalization. (c) 2007 Society of Hospital Medicine.

Knowledge, attitude and practice of standard precautions of infection control by hospital workers in two tertiary hospitals in Nigeria

PubMed Central

Pondei, Kemebradikumo; Adetunji, Babatunde; Chima, George; Isichei, Christian; Gidado, Sanusi

2015-01-01

Background: Standard precautions are recommended to prevent transmission of infection in hospitals. However, their implementation is dependent on the knowledge and attitudes of healthcare workers (HCW). This study describes the knowledge, attitude and practice (KAP) of standard precautions of infection control among HCW of two tertiary hospitals in Nigeria is described. Methods: A cross-sectional study was undertaken in 2011/2012 among HCW in two tertiary hospitals in Nigeria. Data was collected via a structured self-administered questionnaire assessing core elements of KAP of standard precautions. Percentage KAP scores were calculated and professional differences in median percentage KAP scores were ascertained. Results: A total of 290 HCW participated in the study (76% response rate), including 111 (38.3%) doctors, 147 (50.7%) nurses and 32 (11%) laboratory scientists. Overall median knowledge and attitude scores toward standard precautions were above 90%, but median practice score was 50.8%. The majority of the HCW had poor knowledge of injection safety and complained of inadequate resources to practise standard precautions. House officers, laboratory scientists and junior cadres of nurses had lower knowledge and compliance with standard precautions than more experienced doctors and nurses. Conclusion: Our results suggest generally poor compliance with standard precautions of infection control among HCW in Nigeria. Policies that foster training of HCW in standard precautions and guarantee regular provision of infection control and prevention resources in health facilities are required in Nigeria. PMID:28989394

Knowledge and perceptions on antibiotic use and resistance among high school students and teachers in New Delhi, India: A qualitative study.

PubMed

Kotwani, Anita; Wattal, Chand; Joshi, P C; Holloway, Kathleen

2016-01-01

To explore the perceptions and knowledge of school teachers and students about antibiotic use, resistance, and suggestions for practical interventions for the rational use of antibiotics. Five focus group discussions (FGDs) with high school students (Class: 9-11) and five with teachers were conducted in two private and three public schools (one teacher and one student FGD per school) in five municipal wards of Delhi. Qualitative data on antibiotic knowledge, resistance, and behaviors with respect to antibiotics use were collected. There were 4-8 persons per teacher FGD and 15-20 persons per student FGD. FGDs were analyzed using "thematic analyses." Students had poor knowledge regarding antibiotics and antibiotic resistance, while only some teachers had a basic understanding. Four broad themes needing attention emerged: definition of antibiotic and antibiotic resistance, antibiotic use behavior, doctor-patient relationship, and interventional strategies suggested to curtail the misuse of antibiotics and to spread awareness. In order to tackle these problems, both groups suggested a multipronged approach including robust public awareness campaigns also involving schools, better doctor-patient relationships, and stronger regulations. Although students and teachers exhibited poor knowledge about antibiotic use and resistance, they were keen to learn about these issues. School education programs and public education could be used to shape correct perceptions about antibiotic use among all stakeholders including children. This may help in the containment of antibiotic resistance and thus preservation of antibiotics for future generations.

Getting women to hospital is not enough: a qualitative study of access to emergency obstetric care in Bangladesh

PubMed Central

Pitchforth, E; van Teijlingen, E; Graham, W; Dixon‐Woods, M; Chowdhury, M

2006-01-01

Objective To explore what happened to poor women in Bangladesh once they reached a hospital providing comprehensive emergency obstetric care (EmOC) and to identify support mechanisms. Design Mixed methods qualitative study. Setting Large government medical college hospital in Bangladesh. Sample Providers and users of EmOC. Methods Ethnographic observation in obstetrics unit including interviews with staff and women using the unit and their carers. Results Women had to mobilise significant financial and social resources to fund out of pocket expenses. Poorer women faced greater challenges in receiving treatment as relatives were less able to raise the necessary cash. The official financial support mechanism was bureaucratic and largely unsuitable in emergency situations. Doctors operated a less formal “poor fund” system to help the poorest women. There was no formal assessment of poverty; rather, doctors made “adjudications” of women's need for support based on severity of condition and presence of friends and relatives. Limited resources led to a “wait and see” policy that meant women's condition could deteriorate before help was provided. Conclusions Greater consideration must be given to what happens at health facilities to ensure that (1) using EmOC does not further impoverish families; and (2) the ability to pay does not influence treatment. Developing alternative finance mechanisms to reduce the burden of out of pocket expenses is crucial but challenging. Increased investment in EmOC must be accompanied by an increased focus on equity. PMID:16751473

Understanding how appraisal of doctors produces its effects: a realist review protocol.

PubMed

Brennan, Nicola; Bryce, Marie; Pearson, Mark; Wong, Geoff; Cooper, Chris; Archer, Julian

2014-06-23

UK doctors are now required to participate in revalidation to maintain their licence to practise. Appraisal is a fundamental component of revalidation. However, objective evidence of appraisal changing doctors' behaviour and directly resulting in improved patient care is limited. In particular, it is not clear how the process of appraisal is supposed to change doctors' behaviour and improve clinical performance. The aim of this research is to understand how and why appraisal of doctors is supposed to produce its effect. Realist review is a theory-driven interpretive approach to evidence synthesis. It applies realist logic of inquiry to produce an explanatory analysis of an intervention that is, what works, for whom, in what circumstances, in what respects. Using a realist review approach, an initial programme theory of appraisal will be developed by consulting with key stakeholders in doctors' appraisal in expert panels (ethical approval is not required), and by searching the literature to identify relevant existing theories. The search strategy will have a number of phases including a combination of: (1) electronic database searching, for example, EMBASE, MEDLINE, the Cochrane Library, ASSIA, (2) 'cited by' articles search, (3) citation searching, (4) contacting authors and (5) grey literature searching. The search for evidence will be iteratively extended and refocused as the review progresses. Studies will be included based on their ability to provide data that enable testing of the programme theory. Data extraction will be conducted, for example, by note taking and annotation at different review stages as is consistent with the realist approach. The evidence will be synthesised using realist logic to interrogate the final programme theory of the impact of appraisal on doctors' performance. The synthesis results will be written up according to RAMESES guidelines and disseminated through peer-reviewed publication and presentations. The protocol is registered with PROSPERO 2014:CRD42014007092. 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.

Doctor shopping by overweight and obese patients is associated with increased healthcare utilization.

PubMed

Gudzune, Kimberly A; Bleich, Sara N; Richards, Thomas M; Weiner, Jonathan P; Hodges, Krista; Clark, Jeanne M

2013-07-01

Negative interactions with healthcare providers may lead patients to switch physicians or "doctor shop." We hypothesized that overweight and obese patients would be more likely to doctor shop, and as a result, have increased rates of emergency department (ED) visits and hospitalizations as compared to normal weight nonshoppers. We combined claims data from a health plan in one state with information from beneficiaries' health risk assessments. The primary outcome was "doctor shopping," which we defined as having outpatient claims with ≥5 different primary care physicians (PCPs) during a 24-month period. The independent variable was standard NIH categories of weight by BMI. We performed multivariate logistic regression to evaluate the association between weight categories and doctor shopping. We conducted multivariate zero-inflated negative binominal regression to evaluate the association between weight-doctor shopping categories with counts of ED visits and hospitalizations. Of the 20,726 beneficiaries, the mean BMI was 26.3 kg m(-2) (SD 5.1), mean age was 44.4 years (SD 11.1) and 53% were female. As compared to normal weight beneficiaries, overweight beneficiaries had 23% greater adjusted odds of doctor shopping (OR 1.23, 95%CI 1.04-1.46) and obese beneficiaries had 52% greater adjusted odds of doctor shopping (OR 1.52, 95%CI 1.26-1.82). As compared to normal weight non-shoppers, overweight and obese shoppers had higher rates of ED visits (IRR 1.85, 95%CI 1.37-2.45; IRR 1.83, 95%CI 1.34-2.50, respectively), which persisted during within weight group comparisons (Overweight IRR 1.50, 95%CI 1.10-2.03; Obese IRR 1.54, 95%CI 1.12-2.11). Frequently changing PCPs may impair continuity and result in increased healthcare utilization. Copyright © 2012 The Obesity Society.

All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time.

PubMed

Westbrook, Johanna I; Ampt, Amanda; Kearney, Leanne; Rob, Marilyn I

2008-05-05

To quantify time doctors in hospital wards spend on specific work tasks, and with health professionals and patients. Observational time and motion study. 400-bed teaching hospital in Sydney. 19 doctors (seven registrars, five residents, seven interns) in four wards were observed between 08:30 and 19:00 for a total of 151 hours between July and December 2006. Proportions of time in categories of work; proportions of tasks performed with health professionals and patients; proportions of tasks using specific information tools; rates of multitasking and interruptions. The greatest proportions of doctors' time were in professional communication (33%; 95% CI, 29%-38%); social activities, such as non-work communication and meal breaks (17%; 95% CI, 13%-21%), and indirect care, such as planning care (17%; 95% CI, 15%-19%). Multitasking involved 20% of time, and on average, doctors were interrupted every 21 minutes. Most tasks were completed with another doctor (56%; 95% CI, 55%-57%), while 24% (95% CI, 23%-25%) were undertaken alone and 15% (95% CI, 15%-16%) with a patient. Interns spent more time completing documentation and administrative tasks, and less time in direct care than residents and registrars. The time interns spent documenting (22%) was almost double the time they were engaged in direct patient care. Two-thirds of doctors' time was consumed by three work categories: professional communication, social activities and indirect care. Doctors on wards are interrupted at considerably lower rates than those in emergency and intensive care units. The results confirm interns' previously reported dissatisfaction with their level of administrative work and documentation.

Doctors' learning experiences in end-of-life care - a focus group study from nursing homes.

PubMed

Fosse, Anette; Ruths, Sabine; Malterud, Kirsti; Schaufel, Margrethe Aase

2017-01-31

Doctors often find dialogues about death difficult. In Norway, 45% of deaths take place in nursing homes. Newly qualified medical doctors serve as house officers in nursing homes during internship. Little is known about how nursing homes can become useful sites for learning about end-of-life care. The aim of this study was to explore newly qualified doctors' learning experiences with end-of-life care in nursing homes, especially focusing on dialogues about death. House officers in nursing homes (n = 16) participated in three focus group interviews. Interviews were audiotaped and transcribed verbatim. Data were analysed with systematic text condensation. Lave & Wenger's theory about situated learning was used to support interpretations, focusing on how the newly qualified doctors gained knowledge of end-of-life care through participation in the nursing home's community of practice. Newly qualified doctors explained how nursing home staff's attitudes taught them how calmness and acceptance could be more appropriate than heroic action when death was imminent. Shifting focus from disease treatment to symptom relief was demanding, yet participants comprehended situations where death could even be welcomed. Through challenging dialogues dealing with family members' hope and trust, they learnt how to adjust words and decisions according to family and patient's life story. Interdisciplinary role models helped them balance uncertainty and competence in the intermediate position of being in charge while also needing surveillance. There is a considerable potential for training doctors in EOL care in nursing homes, which can be developed and integrated in medical education. This practice based learning arena offers newly qualified doctors close interaction with patients, relatives and nurses, teaching them to perform difficult dialogues, individualize medical decisions and balance their professional role in an interdisciplinary setting.

A longitudinal study of well-being, confidence and competence in junior doctors and the impact of emergency medicine placements.

PubMed

Mason, Suzanne; O'Keeffe, Colin; Carter, Angela; Stride, Chris

2016-02-01

To measure levels of, and change in junior doctor well-being, confidence and self-reported competence over their second postgraduate training year and the impact of emergency department (ED) placements on these outcomes. A longitudinal study using an online survey administered at four time points (2010-2011). 28 Acute Hospital Trusts, drawn from nine participating Postgraduate Deaneries in England. Junior doctors who had a placement in an ED as part of their second postgraduate training year. Levels of anxiety, depression, motivation, job satisfaction, confidence and self-reported competence, collected at four time points spread over the period of the doctor's second training year (F2). 217 junior doctors were recruited to the study. Over the year there was a significant increase in their overall job satisfaction, confidence and self-reported competence. Junior doctors also reported significantly increased levels of motivation and anxiety, and significantly decreased levels of extrinsic job satisfaction when working in ED compared with other specialties. There were also significant increases in both junior doctor confidence and self-reported competence after their placement in ED relative to other specialties. While elements of junior doctor well-being worsened in their ED placement compared with their time spent in other specialties, the increased levels of anxiety and reduced extrinsic job satisfaction were within the normal range for other healthcare workers. These deficits were also balanced by greater improvements in motivation, confidence in managing common acute clinical conditions and perceived competence in performing acute procedures compared with benefits offered by placements in other specialties. 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/

Predictors of Satisfaction With Doctor and Nurse Communication: A National Study.

PubMed

McFarland, Daniel C; Johnson Shen, Megan; Holcombe, Randall F

2017-10-01

Prior research indicates that effective communication between medical providers and patients is associated with a number of positive patient outcomes, yet little research has examined how ecological factors (e.g., hospital size, local demographics) influence patients' reported satisfaction with doctor and nurse communication. Given the current emphasis on improving patient satisfaction in hospitals across the United States, understanding these factors is critical to interpreting patient satisfaction and improving patient-centered communication, particularly in diverse and dense populations. As such, this study examined county-level data including population density, population diversity, and hospital structural factors as predictors of patient satisfaction with doctor and nurse communication. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), U.S. Census data, and number of hospital beds were obtained from publicly available Hospital Compare, U.S. Census, and American Hospital Directory websites, respectively. Multivariate regression modeling was performed for the individual dimensions of HCAHPS scores assessing doctor and nurse communication. Standardized partial regression coefficients were used to assess strengths of county-level predictors. County-level factors accounted for 30% and 16% of variability in patient satisfaction with doctor and nurse communication, respectively. College education (β = 0.45) and White ethnicity (β = 0.25) most strongly predicted a favorable rating of doctor and nurse communication, respectively. Primary language (non-English speaking; β = -0.50) most strongly predicted an unfavorable rating of doctor communication, while number of hospital beds (β = -0.16) and foreign-born (β = -0.16) most strongly predicted an unfavorable rating of nurse communication. County-level predictors should be considered when interpreting patient satisfaction with doctor and nurse communication and designing multilevel patient-centered communication improvement strategies. Discordant findings with individual-level factors should be explored further.

A longitudinal study of well-being, confidence and competence in junior doctors and the impact of emergency medicine placements

PubMed Central

Mason, Suzanne; O'Keeffe, Colin; Carter, Angela; Stride, Chris

2016-01-01

Objectives To measure levels of, and change in junior doctor well-being, confidence and self-reported competence over their second postgraduate training year and the impact of emergency department (ED) placements on these outcomes. Design A longitudinal study using an online survey administered at four time points (2010–2011). Setting 28 Acute Hospital Trusts, drawn from nine participating Postgraduate Deaneries in England. Participants Junior doctors who had a placement in an ED as part of their second postgraduate training year. Main outcome measures Levels of anxiety, depression, motivation, job satisfaction, confidence and self-reported competence, collected at four time points spread over the period of the doctor's second training year (F2). Results 217 junior doctors were recruited to the study. Over the year there was a significant increase in their overall job satisfaction, confidence and self-reported competence. Junior doctors also reported significantly increased levels of motivation and anxiety, and significantly decreased levels of extrinsic job satisfaction when working in ED compared with other specialties. There were also significant increases in both junior doctor confidence and self-reported competence after their placement in ED relative to other specialties. Conclusions While elements of junior doctor well-being worsened in their ED placement compared with their time spent in other specialties, the increased levels of anxiety and reduced extrinsic job satisfaction were within the normal range for other healthcare workers. These deficits were also balanced by greater improvements in motivation, confidence in managing common acute clinical conditions and perceived competence in performing acute procedures compared with benefits offered by placements in other specialties. PMID:26338523