Reclaiming physician identity: It’s time to integrate ‘Doctor as Person’ into the CanMEDS framework

In 1996, the Royal College of Physicians & Surgeons of Canada (RCPSC) adopted the CanMEDS framework with seven key roles: medical expert, communicator, collaborator, health advocate, manager, professional, and scholar. For many years, CanMEDS has been recognized around the world for defining what patients need from their physicians. From the start, the RCPSC acknowledged that these roles should  evolve over time to continue to meet patient and societal needs (updates in 2005 & 2015).  We propose that  an 8th role is now needed in the framework: “Doctor as Person”. Interestingly, this role was present in the foundational work through the Educating Future Physicians for Ontario (EFPO) project that the RCPSC drew upon in creating CanMEDS more than 20 years ago. Given today’s challenges of providing care in an increasingly stressed Canadian healthcare system, physicians are struggling more than ever with health and wellness, burnout, and the deterioration of the clinical environment. From the patient perspective, there is growing concern that physician-patient interactions are becoming increasingly impersonal and decreasingly patient-centered. The crack emerging in the foundation of physician identity needs to be remedied. We need to pay close attention to how we define ourselves as physicians, by better identifying the competencies required to navigate the personal and professional challenges we face. Only in so doing can we ward off the threat that exists in losing authentic human to human care interactions. Formalizing Doctor as Person as an 8th role in the CanMEDS framework will help patients and physicians create the space to have essential conversations about the humanity of medical care.&nbsp

Varietà del'italiano nei corsi li lingua per stranieri

Dottorato di ricerca in Modelli di formazione, analisi teorica e comparazione, XXIII ciclo, A.a. 2009-2010Università della Calabria, Dipartimento di scienze dell'educazion

Duty hour restrictions: organizational dynamics, systems issues, and the impact on faculty

Abstract The potential impact of resident duty hour restrictions on faculty is likely significant; however, the extent of this impact has still not been well documented. We undertook a narrative review of the literature to determine the magnitude of that potential impact and the nature of the evolving discourse related to faculty members as individuals. The literature provides an inconsistent picture of the impact of duty hour restrictions on faculty. While some studies have reported a significant increase in faculty workload, others suggest that the impact of duty hour restrictions has been minimal. Some papers suggest that duty hour restrictions may fundamentally change the nature of resident–teacher interactions and, as a result, will necessitate significant changes to the way education is delivered. Overall, the majority of issues of concern relate to one of the following: volume and composition of work, impact on faculty career choice, evolving perceptions of residents as learners, and the need to find an appropriate balance between learning and the quality and quantity of patient care. In describing these themes we identify some potential solutions and future directions for reconciling duty hour restrictions with faculty perceptions, anxieties, and desired outcomes

Processi di biomineralizzazione microbica e dolomitizzazione nel contesto deposizionale delle piattaforme carbonatiche norico-retiche della Calabria settentrionale

Dottorato di Ricerca in Scienze della Terra, Ciclo XIX SSD,a.a.2006Università della Calabri

The multicenter ITALIAN trial assess the performance of FDG-PET/CT related to pre-test cancer risk in patients with solitary pulmonary nodules and introduces a segmental thoracic diagnostic strategy

The Italian Tailored Assessment of Lung Indeterminate Accidental Nodule (ITALIAN) trial is a trial drawn to determine the performance of 18F-FDG-PET/CT in patients with solitary pulmonary nodules (SPN) , stratified for different kind of risk. An additional end-point was to compare the diagnostic information and estimated dosimetry, provided by a segmental PET/CT (s-PET/CT) acquisition instead of a whole body PET/CT (wb-PET/CT), in order to evaluate if segmental thoracic PET/CT can be used in patients with SPN

La finanza nel governo dell'azienda

Nell’ambito del sistema di relazioni istaurate dall’azienda con l’ambiente, il rapporto con i mercati finanziari tende oggigiorno ad assumere un’importanza cruciale; nel contempo si vanno modificando le logiche gestionali con cui le imprese si confrontano in chiave competitiva sul mercato dei capitali. Partendo da queste premesse il volume approfondisce il ruolo svolto dalla “finanza” nella moderna gestione delle aziende, con l’intento di delineare le dinamiche proprie delle strategie economico-finanziarie ed i connessi strumenti tecnico-operativi. La prima parte del testo affronta le problematiche strategiche della gestione finanziaria. In particolare si occupa di delineare il nuovo contesto competitivo dei mercati finanziari, l’evoluzione della finanza aziendale ed il ruolo delle strategie economico finanziarie nel sistema delle strategie aziendali. In questo quadro il Business Plan emerge quale strumento fondamentale per la formulazione e la valutazione delle strategie, ma soprattutto come mezzo per comunicare agli interlocutori finanziari i processi aziendali di creazione del valore. La seconda parte del volume è dedicata all’analisi delle variabili caratterizzanti le strategie finanziarie (fabbisogno finanziario, valore degli investimenti, fonti di finanziamento, costo dei capitali) ed all’esame delle connesse politiche finanziarie (decisioni di investimento, decisioni finanziamento, risk management). Nelle parte finale sono affrontati gli strumenti di analisi, valutazione e rappresentazione delle strategie economico finanziarie d’azienda

Trypanosoma cruzi Necrotizing Meningoencephalitis in a Venezuelan HIV+-AIDS Patient: Pathological Diagnosis Confirmed by PCR Using Formalin-Fixed- and Paraffin-Embedded-Tissues

Coinfections with human immunodeficiency virus (HIV) and infectious agents have been recognized since the early 90s. In the central nervous system (CNS) of HIV+ patients, parasitic protozoans like Toxoplasma gondii have been described as responsible for the space occupying lesions (SOL) developed. However, the involvement of Trypanosoma cruzi is also described but appears to be less frequent in acquired immunodeficiency syndrome (AIDS) and transplant recipients, associated with necrotizing myocarditis and neurological symptoms related to the occurrence of necrotizing pseudotumoral encephalitis (NPE) and meningoencephalitis (NME). The present work aims to present a Venezuelan case of NME associated with the coinfection of HIV and a T. cruzi-like trypanosomatid as well as its evolution and diagnosis by histopathological techniques, electron microscopy, and PCR methods using formalin-fixed- (FF-) and paraffin-embedded- (PE-) tissues. Postmortem cytological studies of leptomeninges imprints reveal the presence of trypomastigotes of Trypanosoma sp. Histopathological and electron microscopy studies allowed us to identify an amastigote stage and to reject the involvement of other opportunistic microorganisms as the etiological agent of the SOL. The definitive confirmation of T. cruzi as the etiological agent was achieved by PCR suggesting that the NME by T. cruzi was due to a reactivation of Chagas’ disease