How well are Swiss French physicians prepared for future practice in primary care?

Abstract Background Moving from postgraduate training into independent practice represents a major transition in physicians’ professional life. Little is known about how Swiss primary care graduates experience such a transition. The aim of this study was to explore the extent to which primary care physicians who recently set up private practice felt prepared to work as independent practitioners. Methods We conducted 7 focus groups among recently established (≤ 5 years) primary care physicians in Switzerland. Questions focused on positive and negative aspects of setting up a practice, and degree of preparedness. Transcripts were analysed according to organisational socialisation and work role transition frameworks. Results Participants felt relatively well prepared for most medical tasks except for some rheumatologic, minor traumatology, ENR, skin and psychiatric aspects. They felt unprepared for non clinical tasks such as office, insurance and medico-legal management issues and did not anticipate that the professional networking outside the hospital would be so important to their daily work. They faced dilemmas opposing professional values to the reality of practice which forced them to clarify their professional roles and expectations. Adjustment strategies were mainly informal. Conclusion Although the postgraduate primary care curriculum is longer in Switzerland than in most European countries, it remains insufficiently connected with the reality of transitioning into independent practice, especially regarding role development and management tasks. A greater proportion of postgraduate training, with special emphasis on these issues, should take place directly in primary care

Ice caves as an indicator of winter climate evolution: a case study from the Jura Mountains

Subsurface ice fillings were first described in the Jura Mountains at the end of the sixteenth century. In order to assess the impact of climate change on low-altitude cave ice a detailed inventory has been drawn up and more than 50 objects have been identified. Comparisons between older cave maps, photographic documents and present-day observations outline a negative trend in ice mass balances, a trend that increased at the end of the 1980s. As most of these ice caves act as cold air traps, this negative mass balance is mainly attributed to higher winter temperatures and to reduced snow precipitation at low altitudes. The equilibrium line altitude of ice caves is believed to have increased several hundred metres between AD 1978 and 2004. Photographic comparisons and proxy records in some of the caves studied provide evidence of a rapid mass turnover. Ice ages range between less than a few decades and a millennium. Climatic records in these ice fillings will therefore present only short time series compared with other cave sediments. However, indications of former ice fillings have been found in different caves of the Jura Mountains and outline their potential role as palaeoclimatic markers