Using the computer-based feedback (CBF) system to investigate the juniorphysicians’s and clinical-instructors perceptions for the benefits of general medicine clinical-instructors training program

Background: The purpose of this study is to examine the clinical-instructors and junior-physicians (residents and interns) perceptions for the general-medicine training program by using bi-directional interactive and self-assessments computer-based feedback (CBF) and paper-based multisource feedback assessment (PBMFA) systems for the efficiency and benefit evaluation.Methods: Between 2011 January to 2013 December, junior-physicians and their clinical-instructors in the same medical team were enrolled consecutively for monitoring the CBF scores gave by each other after each clinical course. A total of 321 residents, 298 interns and 110 clinical-instructors who participated in the core competency general-medicine training program in 6-months period were included in the study. The CBF and PBMFA evaluations are undergone paralleled to gather the suggested information in different levels of Kirkpatrick evolutional theory.Results: The results showed that lecturers, being 5-10 years as attending physicians, internal medicine sub-specialty clinical-instructors are most benefit from the general medicine training program. Accordingly, the CBF scores of junior-physicians was positively correlated with the times (> 3-times) of exposure to the medical teams that leaded by qualified clinical-instructors. Both clinical-instructors and junior-physicians have positive attitude to the value of the general-medicine training program. Interestingly, a good consistency was existed between residents CBF scores and PBMFA grades for their core-competency performance. Comparatively, the overall perception of clinical-instructors and junior-physicians for the general-medicine training was very positive.Conclusions: Clinical-instructors and junior-physicians had positive perception of CBF and PBMFA systems which could give us different information to improve and strength the further core-competency general-medicine training program by appropriate utilization

What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals?

BACKGROUND: We conducted this analysis to determine i) which journals publish high-quality, clinically relevant studies in internal medicine, general/family practice, general practice nursing, and mental health; and ii) the proportion of clinically relevant articles in each journal. METHODS: We performed an analytic survey of a hand search of 170 general medicine, general healthcare, and specialty journals for 2000. Research staff assessed individual articles by using explicit criteria for scientific merit for healthcare application. Practitioners assessed the clinical importance of these articles. Outcome measures were the number of high-quality, clinically relevant studies published in the 170 journal titles and how many of these were published in each of four discipline-specific, secondary "evidence-based" journals (ACP Journal Club for internal medicine and its subspecialties; Evidence-Based Medicine for general/family practice; Evidence-Based Nursing for general practice nursing; and Evidence-Based Mental Health for all aspects of mental health). Original studies and review articles were classified for purpose: therapy and prevention, screening and diagnosis, prognosis, etiology and harm, economics and cost, clinical prediction guides, and qualitative studies. RESULTS: We evaluated 60,352 articles from 170 journal titles. The pass criteria of high-quality methods and clinically relevant material were met by 3059 original articles and 1073 review articles. For ACP Journal Club (internal medicine), four titles supplied 56.5% of the articles and 27 titles supplied the other 43.5%. For Evidence-Based Medicine (general/family practice), five titles supplied 50.7% of the articles and 40 titles supplied the remaining 49.3%. For Evidence-Based Nursing (general practice nursing), seven titles supplied 51.0% of the articles and 34 additional titles supplied 49.0%. For Evidence-Based Mental Health (mental health), nine titles supplied 53.2% of the articles and 34 additional titles supplied 46.8%. For the disciplines of internal medicine, general/family practice, and mental health (but not general practice nursing), the number of clinically important articles was correlated withScience Citation Index (SCI) Impact Factors. CONCLUSIONS: Although many clinical journals publish high-quality, clinically relevant and important original studies and systematic reviews, the articles for each discipline studied were concentrated in a small subset of journals. This subset varied according to healthcare discipline; however, many of the important articles for all disciplines in this study were published in broad-based healthcare journals rather than subspecialty or discipline-specific journals

Factors Determining Pakistani Medical Students\u27 Career Preference for General Practice Residency Training.

Background Few studies have explored factors affecting preference of medical students towards general practice as a career choice. We conducted a survey in Karachi across various public and private sector medical colleges to examine factors associated with students’ general practice career aspirations in Karachi, Pakistan. Methods From January to March 2018, we distributed a 21-item questionnaire to final year medical students in eight medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. Results A total of 1400 responses were obtained. The top five specialty fields chosen by students with their numbers were: internal medicine, 898 (64.2%); general practice, 337 (24.1%); pediatrics, 449 (32.1%); surgery, 380 (27.2%); and emergency medicine, 243 (17.4%). The “intent to inherit existing practice” and “other academic or professional experiences prior to medical school” had a positive association with choosing general practice while “having a physician parent’’ had a negative association among the medical students demographics after adjusting for other covariates in the multivariable logistic regression. Medical students who ranked “clinical diagnostic reasoning”, “community-oriented practice”, “involvement in preventive medicine”, and “frequent patient communication” as highly important were more likely to choose general practice, whereas, “access to advanced medical fields”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration. Conclusion The study’s results depicted limited interest of family medicine as a career option in graduating students, and pointed out the factors that likely influence the choice of general practice as a career are clinical diagnostic reasoning, community-oriented practice and preventive medicine

Referring physicians underestimate the extent of abnormalities in final reports from myocardial perfusion imaging

BACKGROUND: It is important that referring physicians and other treating clinicians properly understand the final reports from diagnostic tests. The aim of the study was to investigate whether referring physicians interpret a final report for a myocardial perfusion scintigraphy (MPS) test in the same way that the reading nuclear medicine physician intended. METHODS: After viewing final reports containing only typical clinical verbiage and images, physicians in nuclear medicine and referring physicians (physicians in cardiology, internal medicine, and general practitioners) independently classified 60 MPS tests for the presence versus absence of ischemia/infarction according to objective grades of 1–5 (1 = No ischemia/infarction, 2 = Probably no ischemia/infarction 3 = Equivocal, 4 = Probable ischemia/infarction, and 5 = Certain ischemia/infarction). When ischemia and/or infarction were thought to be present in the left ventricle, all physicians were also asked to mark the involved segments based on the 17-segment model. RESULTS: There was good diagnostic agreement between physicians in nuclear medicine and referring physicians when assessing the general presence versus absence of both ischemia and infarction (median squared kappa coefficient of 0.92 for both). However, when using the 17-segment model, compared to the physicians in nuclear medicine, 12 of 23 referring physicians underestimated the extent of ischemic area while 6 underestimated and 1 overestimated the extent of infarcted area. CONCLUSIONS: Whereas referring physicians gain a good understanding of the general presence versus absence of ischemia and infarction from MPS test reports, they often underestimate the extent of any ischemic or infarcted areas. This may have adverse clinical consequences and thus the language in final reports from MPS tests might be further improved and standardized

Assessment and analysis of H.pylori infection treatment strategies of St. Vincent Hospital\u27s family and internal medicine clinics

Helicobacter pylori is a gram-negative bacteria that is responsible for causing chronic gastritis, ulcers in the stomach and intestine, and eventually even gastric lymphoma or cancer. Multiple treatment options have been recommended for treating an H. pylori infection based on kidney function, previous antibiotic exposure, and whether or not the infection is recurrent. The most common regimens used at St. Vincent\u27s primary care centers closely mimic the American College of Gastroenterology\u27s clinical guidelines. However, these medications (clarithromycin and levofloxacin) have been associated with high rates of resistance in other countries. The United States has very limited data on H. pylori\u27s resistance rates to these medications and there is not sufficient data to prove the efficacy of these regimens. This project aims to identify what percentage of H. pylori infections diagnosed at St. Vincent\u27s Family Medicine and Internal Medicine clinics are being successfully treated with current, guideline-directed therapy. It also aims to obtain a general understanding of H. pylori resistance rates to clarithromycin and levofloxacin in the Indianapolis area based on treatment failure rates

Mapping Postgraduate Research at the University of Zambia: A review of dissertations for the Master of Medicine Programme

Background: The publication of a dissertation is an integral part of the four-year postgraduate degree of Master of Medicine (in clinical disciplines) within the School of Medicine at the University of Zambia. The governing research policy states that the subject matter of the dissertation is expected to cover a topic relevant to health care in the Zambian context, that it be conducted in a way that is consistent with international ethical guidelines for biomedical research involving human subjects, and that research outcomes should be maximally utilized. The aim of the study is to explore the characteristics of the Masters of Medicine research at the University of Zambia.Methodology: This descriptive study explores the subject matter and research methodology by type of clinical specialty of all dissertations from 1986 to 2009.Results: The 132 dissertations included 36 (27.3%) in Surgery, 35 (26.5%) in Paediatrics, 32 (24.2%) in Internal Medicine, 24 (18.2%) in Obstetrics and Gynaecology, and 5 (3.8%) in Orthopaedic Surgery. Only 7 (5.3%) were interventional/experimental studies (4 of which were randomized controlled trials). Cross-sectional studies were the predominant type of the 125 observational studies (n=112, 84.8%). Thirty-three dissertations (25.0%) predominantly addressed HIV (16 Internal Medicine, 10 Paediatrics, 6 Surgery and 1 Obstetrics and Gynaecology); and 18 (13.6%) predominantly addressed infections, excluding TB (11 in Paediatrics). Other subjects included malignancy (n=6), TB (n=5), and diabetes mellitus (n=4). Over half of the dissertations (76, 57.6%) addressed the determinants of the cause, risk and development of diseases; and a third dealt with management and evaluation of diseases (26 and 18, respectively).Conclusions: Few dissertations were based on experimental designs and most addressed determinants of the cause of diseases through crosssectional studies. HIVand infections predominate as diseases reflecting the prevailing disease patterns in Lusaka in particular, and Zambia in general. Keywords: UNZA, Postgraduate, Researc

A Review of Outcome of Postgraduate Medical Training in Zambia

The University of Zambia School of Medicine was opened in 1966. Since inception, over 1200 undergraduate students have graduated with Bachelor of Medicine and Bachelor of Surgery. The postgraduate Master of Medicine (M.Med)programme was started in 19822 with the intention of providing district specialists in the rural and semi urban communities of Zambia. Additional hope was to stem the brain drain to other countries. This is a study to describe the deployment of graduates of the M.Med training programs at the University of Zambia School Of Medicine in relation to the objectives defined by the University of Zambia senate in 1981. It was found that the School of Medicine has produced 118 Master of Medicine graduates in 5 clinical programs over a period of 22 years. The average graduation rate is 5 students per annum. The largest specialist group has been in General surgery with 34 (29% ) of all graduates. The ratio of men to women was 3 to 1. The ratio of Zambian to Non Zambian ratio was 10:1. Of all students who have graduated over this period 13 (11%) have gone abroad and 7(6%) have died., Eighty-eight (75%) of the graduates are working along the line of rail in the 5 most urbanized towns in the country. Twenty-five ( 21%) are doing non clinical jobs which involve health programs administration and 12 (10%) are working in private practice. We concluded that external migration is not a major problem and, overall, the creation of a local postgraduate training program has reduced brain drain. The key challenge is internal brain drain

Assessing medical student empathy in a family medicine clinical test: validity of the CARE measure

Introduction: The Consultation and Relational Empathy (CARE) measure developed and validated in primary care settings and used for general practitioner appraisal is a 10-item instrument used by patients to assess doctors’ empathy. The aim of this study is to investigate the validity of the CARE measure in assessing medical students’ empathy during a formative family medicine clinical test. Method: All 158 final-year medical students were assessed by trained simulated patients (SPs) – who completed the CARE measure, the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and a global rating score to assess students’ empathy and history-taking ability. Results: Exploratory and confirmatory factor analysis identified a unidimensional structure. The CARE measure strongly correlated with both convergent measures: global rating (ρ=0.79 and <0.001) and JSPPPE (ρ=0.77 and <0.001) and weakly correlated with the divergent measure: history-taking score (ρ=0.28 and <0.001). Internal consistency was excellent (Cronbach’s α=0.94). Conclusion: The CARE measure had strong construct and internal reliability in a formative, undergraduate family medicine examination. Its role in higher stakes examinations and other educational settings should be explored.published_or_final_versio

Telehealth for the Internal Medicine Resident: A 3-Year Longitudinal Curriculum

Aims: Across the United States of America, patients are increasingly receiving healthcare using innovative telehealth technologies. As healthcare continues to shift away from traditional office-based visits, providers face new challenges. Telehealth champions are needed to adapt technologies to meet the needs of patients, providers and communities, especially within the realm of primary care specialties. Given these challenges, this intervention aimed to incorporate telemedicine into internal medicine resident training across multiple training years to prepare them for practice in the current and changing healthcare system. Methods: Education and telehealth leaders at the Medical University of South Carolina identified key topics relevant to telehealth and the provision of general internal medicine services. With this as a framework, we developed a 3-year longitudinal telehealth curriculum for internal medicine resident physicians, consisting of an introduction to telemedicine equipment in the first year, didactic learning through in-person education and online modules in the second year and experiential learning through remote monitoring of chronic disease in the third year. Participants included approximately 100 internal medicine residents per year (2016–2019). Self-perceived knowledge, comfort and ability to provide telehealth services was assessed via a survey completed before and after participation in the curriculum. Results: Resident physicians’ self-reported knowledge of telehealth history, access to care, contributions of telehealth applications and quality of care and communication each improved after completion of the online curriculum. There were also significant improvements in resident comfort and perceived ability to provide telehealth services after participation in the curriculum, as assessed via a survey. Overall, 41% of residents felt their ability to utilize telehealth as part of their current or future practice was greater than average after completion of the online modules compared to only 2% at baseline (p\u3c0.01). Results also show residents accurately identify barriers to telehealth adoption at the healthcare system level, including the lack of clinical time to implement services (67% post- vs 47% pre-curriculum, p = 0.02), unfamiliarity with concepts (65% post- vs 21% pre-curriculum, p\u3c−0.01) and concerns about consistent provider reimbursement (74% post- vs 39% pre-curriculum, p \u3c 0.01). Conclusion: Telemedicine and remote patient monitoring are an increasingly prevalent form of healthcare delivery. Internal medicine residents must be adept in caring for patients utilizing this technology. This curriculum was effective in improving resident comfort and self-efficacy in providing care through telehealth and provided residents with hands-on opportunities through supervised inclusion in remote patient-monitoring services. This curriculum model could be employed and evaluated within other internal medicine residency programmes to determine the feasibility at institutions with and without advanced telehealth centres