Internists for nursing homes.

The causes of death are the pathologies that physicians fill on death certificates. The causes of death quality is a mandatory requirement for useful mortality statistics. To train physicians is essential for the correct fulfillment of death causes. The objective of this paper was to evaluate the efficacy of courses on causes of death certification to all physicians in specialty training. A descriptive observational epidemiological study was conducted to evaluate the efficacy of medical death certification in eighteen in-person courses using a quasi-experimental pre- and posttest design aimed to all physicians during their specialty training in Spain. We assessed: legible handwriting; logical sequence; absence of abbreviations and acronyms; causal sequence, no added causes, no omitted causes; immediate, intermediate, fundamental causes, other conditions, and underlying cause. Correct toll was the achievement of 2/3 of the maximum score; and Suitable, the achievement of the correct score in logical and causal sequences, without added or omitted causes, and the three underlying causes of initial and final paired cases. We applied bivariate statistics to paired/unpaired indicators between individual/grouped pre-posttests, and multivariate statistics adjusting for evaluator and course. 96% of cases were included, and the 85% paired pre-posttests. The individual indicators grouped into Form, Concept, Result, and Total, improved significantly from the pretest. The matched and adjusted analysis showed a 26% to 80% increase of Suitable physicians in specialty training. The efficacy of the courses on medical certification is assessed. Systematic courses on certification of causes of death for all physicians in specialty training should be implemented.

Why Physicians Can Be ‘Like That’

ObjectiveClinicians need trustworthy clinical practice guidelines to succeed with evidence-based diagnosis and treatment at the bedside. The BMJ Rapid Recommendations explore innovative ways to enhance dissemination and uptake, including multilayered...

To determine the type, extent and effects of workplace violence among residents during postgraduate speciality training in various departments of medical schools in Turkey. A cross-sectional survey was conducted in seven medical schools representing all geographical regions of Turkey. All physicians in speciality training in the selected medical schools were asked to complete a semi-structured 'violence questionnaire' addressing the type (emotional, physical and sexual) and extent of violence experienced, the perpetrators of the violence and the victim's reactions to the experience. A total of 1712 residents out of 2442 completed the questionnaire. In all, 68% indicated they had experienced some form of workplace violence, 67% had experienced verbal violence, 16% had experienced physical violence and 3% had experienced sexual violence. The victims' most prevalent reactions to violence included being deeply disturbed but feeling they had to cope with it for the sake of their career (39%), being distressed (26%) but considering that such events are common in all occupations and discounting it and being confused and bewildered and unsure how to respond (19%). The most frequently named perpetrators of verbal violence were relatives/friends of patients (36%) and academic staff (36%), followed by other residents/senior residents (21%), patients (20%), heads of department (13%) and non-medical hospital staff (6%). Physicians in speciality training in medical schools in Turkey are subject to significant verbal, physical or sexual violence. Precautions to prevent such exposure are urgently needed.

A Systematic Review of Training in Symptom Management in Palliative Care Within Postgraduate Medical Curriculums

Chronic pain involves a complex mechanism that afflicts 50 million adults in the United States and incurs societal costs upwards of $560 billion annually. The consequences of this epidemic have resulted in an epidemic of its own, with the opioid crisis becoming a top priority in healthcare. Historically, the sub-optimal practices of overprescribing opioids and inadequate monitoring of iatrogenic addiction have contributed to this problem. If progress is to be made in this area, it is imperative that we examine how future physicians are being trained to manage pain. We examined internal medicine resident knowledge regarding pain as well as their satisfaction with medical school preparation in this regard using two surveys: The Knowledge and Attitudes Survey Regarding Pain (KASRP) and The Medical School Pain Curriculum Survey (MSPCS). Residents scored an overall 60.7% on the knowledge assessment survey, and less than 50% of respondents agreed that their medical school curriculum had prepared them sufficiently. This suggests that improvements can be made in medical school curricula regarding pain management education to better train physicians on how to manage pain, particularly in an era that demands expertise in this area.

Aiming to join academic excellence and an ethical and Christian approach to medical profession, the Medical School of the Pontifical Catholic University of Chile initiated its activities in 1930. Since then, the associated Health Care Network has incorporated all the technological breakthroughs in medicine and developed all the specialties. Undergraduate teaching is oriented to promote creativity and innovation. There is also a special concern about humanity of Medicine, throught the Program of Humanistic Medical Studies and the Bioethics Center. Post graduate education is also an important activity of the School, through specialty training, Master and Doctorate programs. Researchers have also obtained important grants and generated a great number of publications in high impact journals. Our University is defined as "complex", meaning that we must take important challenges, be creative and lead knowledge generation. We must also improve ourselves to serve in the best possible way our students and the Country. Paraphrasing the words of our founder, Monsignor Carlos Casanueva, we must train physicians that will serve our community not only with science but also with humanity.

The opioid crisis continues to affect many areas worldwide, raising questions regarding prescribing indications. There is no consensus on negotiating the need for pain relief and the potential for medically prescribed opioid-related harm/addiction. These issues present an enormous educational challenge to physicians in training, particularly those whose mandate is to understand and respond to varying forms of pain. This article examines the perspectives and educational challenges faced by two psychiatry residents from different parts of the globe during the crisis. Is the educational experience of future psychiatrists sufficient to prepare them for the responsibilities that lie ahead?

In This Issue/Abstract Thinking: Sleep

OP0249-PARE High Demand of RA-Instructor Training Program of Healthcare Staff

Background and method Intercostal chest drain (ICD) insertion has long been considered a core skill for the general physician to master. The NPSA alert in 2008 highlighted potential hazards associated with this procedure, whilst recent guidelines 1 advocate the use of thoracic ultrasound to reduce complications. These developments have occurred at a time when trainees report a growing lack of confidence in their clinical experience and procedural capabilities, alongside a decline in training opportunities 2 that might address the latter concern. Nonetheless, competence in ICD insertion remains a compulsory or highly desirable procedural skill to acquire on a number of UK specialty training curricula including that for general (internal) medicine. We carried out a survey of consultants and trainees who contribute to general medical services in hospitals across the Thames Valley region. This survey assessed factors including physicians’ attitudes towards ICD insertion; prior and recent procedural experience; training opportunities; and clinical knowledge. Results 90 clinicians (26 consultants; 41 registrars (ST3+); 23 core medical trainees (CT1/2)) responded to the survey. Most clinicians (94% of responses) felt that placing >5 ICDs was necessary to attain initial competence at the procedure; before continuing to place >5 ICDs on an annual basis in order to maintain that competence (78% of responses). However, only 17% of medical registrars surveyed reached this basic combined standard. Other key findings are summarised in Table 1. Conclusion Our findings demonstrate a disparity between clinical reality and the expectations junior doctors and consultants have of the physician in training with regards to ICD competence. Most trainees cannot achieve the number of procedures they feel are required to attain independence, nor maintain that independence on an annual basis; whilst access to training in thoracic ultrasound is limited outside certain specialties. This inexperience is manifest in variable clinical understanding and procedural confidence. Consideration needs to be given as to how medical training programmes might address these issues, and whether ICD insertion is even a skill that all general physicians can maintain competence in performing in the modern clinical environment. References Thorax 2010;65 Suppl 2:ii61–76 Clin Med 2013;13(5):434–9

<p>Background: Precision medicine, sometimes referred to as personalized medicine, is rapidly changing the possibilities for how people will engage health care in the near future. As technology to support precision medicine exponentially develops, there is an urgent need to proactively improve our understanding of precision medicine and pose important research questions (RQs) related to its inclusion in the education and training of future emergency physicians.</p> <p>Methods: A seven-step process was employed to develop a research agenda exploring the intersection of precision and emergency medicine education/training. A literature search of articles about precision medicine was conducted first, which informed the creation of future four scenarios in which trainees and practicing physicians regularly discuss and incorporate precision medicine tools into their discussions and work. Based on these futurist narratives, potential education RQs were generated by an expert panel. A total of 59 initial questions were subsequently categorized and refined to a priority list through a nominal group voting method. The top/priority questions were presented at the 2023 SAEM Consensus Conference on Precision Medicine, Austin, Texas, for further input.</p> <p>Results: Eight high-value education RQs were developed, reflecting a holistic view of the challenges and opportunities for precision medicine education in the knowledge, skills, and attitudes relevant to emergency medicine. These questions contend with topics such as most effective pedagogical methods; intended resulting outcomes and behaviors; the generational differences between practicing emergency physicians, educators, and future trainees; and the desires and expectations of patients.</p> <p>Conclusions: Emergency medicine and emergency physicians must be prepared to understand precision medicine and incorporate this information into their "toolbox" of thinking, problem solving, and communication with patients and colleagues. This research agenda on how best to educate future emergency physicians in </p>

A PHYSICIAN MUST BE ABLE TO DIAGNOSE AND TREAT patients. The clinical skills required to be successful include gathering data, differentiating important from unimportant facts, making decisions about further investigations and treatments, implementing therapy, and providing follow-up, education, and counseling. These skills cannot be learned through reading or in classrooms alone; practical experience is required. The present method of exposing physicians-intraining to practical experience involves a hierarchical team approach with graded levels of responsibility whereby the decisions of the most junior members of the team are reviewed by physicians with more experience and seniority. These practical experiences impart content knowledge and also allow trainees to become comfortable with decision making and to learn the consequences of these decisions. Although there may be better ways to train future physicians, this apprenticeship method seems to work, as evidenced by the relatively low failure rate in medical schools and training programs. Part of the apprenticeship experience also includes having members at higher levels of the hierarchy evaluate those at lower levels. As such, the supervising individuals are both coaches (instructing and assisting trainees in improving their clinical skills) and judges (responsible for performance assessment of the same trainees). In this Commentary we discuss some of the problems created by this dual role and offer potential solutions.

192 Background: Understanding gender equity (GE) as it pertains to patient care as well as the healthcare workforce is essential to the education of future physicians. However, the landscape of GE education in hematology-oncology (HO) fellowship programs is not well-characterized. The purpose of this study was to examine if and how current HO fellows receive training about GE for both patients and physicians. Furthermore, we aimed to identify barriers to providing such training and establish opportunities for educational initiatives regarding GE in HO. Methods: We conducted an online survey of program directors (PDs) of adult HO fellowship programs in the United States. We asked for PD perceptions of how important GE is for patients and physicians and whether their training programs currently offer GE training. For programs without such training, PDs were asked about reasons for lack of current training and level of interest in providing it in the future. Responses were recorded using Likert scales, multiple choice, and open-ended responses. Data were analyzed using descriptive statistics, and open-ended questions were analyzed with thematic analysis. Results: Of 172 PDs contacted, 57 PDs completed the survey (33.1%). Most PDs felt that training in GE issues is “somewhat important” or “very important” regarding patient care (n = 39, 68.4%) and the physician workforce (n = 45, 80.4%). However, most PDs reported that their program does not provide formal training in GE issues regarding patient care (n = 48, 84.2%) or the physician workforce (n = 44, 78.6%). Common reasons listed for lack of GE training include lack of resources (regarding patients: n = 28, 68.3% and regarding physicians: n = 24, 54.5%). Most PDs were interested in resources for patient and physician GE (n = 46, 93.9% and n = 39, 88.6%, respectively). Several programs were open to sharing their training materials for patient (n = 3, 44.4%) and physician GE (n = 8, 66.7%). Conclusions: While most HO PDs feel that GE training is important for patient care and the physician workforce, most reported their fellowship does not offer such training primarily due to lack of resources. Given the interest of many PDs for more educational GE resources, there are opportunities to share existing materials and create new resources to enhance the GE training for future HO physicians.[Table: see text]

Physician specialists are under-represented in communities in northern Ontario, even in larger communities of approximately 100 000 population. The positive association between postgraduate training in northern or rural areas and eventual practice in these locations has been well documented in the literature, but only for family medicine/general practice. Few, if any, studies have explored the association for other specialties. The objective of this study was to determine if there was an association between northern training and northern practice location for physicians who were enrolled in the Northeastern Ontario Postgraduate Specialty (NOPS) program, which offers placements in northeastern Ontario in specialties such as anesthesiology, internal medicine and surgery. METHODS; A national medical human resources database provided the 31 December 2006 practice location of all 50 participants in the NOPS program since its inception in 2000 until 2006. Program records provided data on participants' specialty rotations in northeastern Ontario, including number, location, and duration of rotations. Non-NOPS participants (n=50) were randomly selected for comparison, matched one for one to the NOPS group on sex, year of birth, language, medical school, year of graduation from medical school, age at the time of graduation, and specialty. Hierarchical log-linear models and 2 tests were used to assess differences between NOPS and non-NOPS participants in geographic location and population size of practice community. Chi-square tests were used to analyze the relationship between the duration of northeastern rotations and practice location of NOPS participants. NOPS and the matched non-NOPS groups did not differ significantly for age or age at graduation from medical school (paired t-tests, p>0.80) and matched exactly for sex, medical school location and specialty group. Forty-six percent of NOPS participants were female and 80% came from Ontario residency programs. Seventy-two percent of the program participants were enrolled in medical specialties (the remainder were in surgical specialties) and this differed significantly by sex: 83% of females vs 63% of males (Χ (2)=4.76, df=1, p=0.03). A majority completed residency training at 31-35 years of age. Fifty percent of NOPS participants obtained medical degrees from Ontario universities, 34% from other Canadian universities and 16% from other universities. Significantly more NOPS participants than non-participants were located in northeastern Ontario (9 vs 0), significantly fewer were in other provinces (13 vs 22) and identical numbers were located in southern Ontario (28 vs 28) (=11.61, df=2, p<0.01). Significantly more NOPS participants than non-participants were practicing in communities of 10 000-99 999 people (15 vs 4), approximately equal numbers in communities of 100 000-499 999 (9 vs11) and non-significantly fewer were practicing in areas of 500 000 or more (26 vs 35) (Χ (2)=7.90, df=2, p=0.02), though this interaction was not significant in the hierarchical log-linear model. The NOPS participants located in northeastern Ontario were more likely to have longer northeastern rotations (>4 weeks) than those located in southern Ontario (Χ (2)=7.81, df=2, p=0.02). However, a longer northeastern rotation was no guarantee of a northeastern practice location because roughly equal numbers of participants with longer rotations were spread throughout the 3 geographic practice locations. Conversely, a shorter rotation was strongly associated with a southern Ontario practice location (18/25). The NOPS participants located in communities of ≥ 500 000 people were more likely to have shorter rotations than longer rotations, but this difference was only marginally statistically significant Χ (2)=5.13, df=2, p=0.08). The study found that specialists who participated in NOPS postgraduate specialty training in northeastern Ontario were more likely to practice in northeastern Ontario than non-participants. There was also a strong association between the duration of training in the northeast and northeastern practice and avoidance of practice in metropolitan areas. It is not clear yet whether longer northeastern rotations encourage northeastern practice or whether this reflects an existing disposition; it is clear, however, that specialists with longest specialty training rotations in the northeast were more likely to practice in the northeast. The results from this study provide the first empirical evidence of positive association between postgraduate specialty training in the northeast and eventual practice in northeastern Ontario and smaller cities.