Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study

Summary Objectives To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors. Design Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis. Setting Eight acute hospitals, England. Participants 36 medical directors, consultants, junior doctors, nurses and manager, 198 documents. Results Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates. Conclusions The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.

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REVIEW OF INDEPENDENT NURSE PRESCRIBING IN A PAEDIATRIC CYSTIC FIBROSIS (CF) AND RESPIRATORY POPULATION

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-311535.14 ◽

2016 ◽

Vol 101 (9) ◽

pp. e2.6-e2

Author(s):

Gabis Chana ◽

Michelle Tabberner ◽

Wendy Nixon ◽

Sue Frost ◽

Leslie Barrett ◽

...

Keyword(s):

Cystic Fibrosis ◽

Medical Condition ◽

Junior Doctors ◽

Positive Contribution ◽

Oral Antibiotics ◽

Prescribing Practices ◽

National Guidelines ◽

Exclusion Criteria ◽

Patient Journey ◽

Telephone Advice

AimWith pressures on junior doctors' availability in the NHS, non-medical prescribing is topical. Independent Nurse Prescribers (INPs) can prescribe any licensed medicine for any medical condition within their level of competence.1 An audit was undertaken of the four INPs employed by the Respiratory Department evaluating current prescribing practices.MethodThe requirement for this audit was identified by the multidisciplinary team (MDT) and Trust approval was obtained. A data collection form was designed capturing patient demographics and full details of prescribed items.Over a 3 month period (August to October 2014) outpatient cystic fibrosis (CF) and respiratory prescriptions were studied using cluster sampling. Over a 6 week period prescription requests by CF INPs faxed to General Practitioners (GPs) were reviewed. INPs also prescribe via telephone, documenting advice on trust forms; these were preliminarily audited. All data was analysed using Microsoft Excel. Legality of prescriptions and adherence to national and local guidelines were evaluated. Reference keys were used to designate non-adherence post-application of exclusion criteria.ResultsA total of 77 outpatient prescriptions (45 CF and 32 respiratory) were completed by the 4 INPs, containing 122 items (72 CF and 50 respiratory). Of the CF prescribed items 21 were oral antibiotics (29%). Respiratory INPs mainly prescribed 14 inhaler devices (28%) and 12 inhaled bronchodilators (24%).All INP prescriptions met legal requirements. Basic details of medicinal products (drug name and dose) were documented for all items. A key finding was that duration/quantity was not indicated for 27 (54%) respiratory items.After applying exclusion criteria, of the CF prescribed items, 56/59 (95%) adhered to national guidelines and 47/66 (71%) followed local guidelines. The leading reason for not following local guidelines was not documenting allergy status. Of the respiratory prescribed items, 34 (100%) adhered to national guidelines and 31/32 (97%) followed local guidelines.A total of 33 faxes (with 38 items) were completed and 35 items (92%) were oral antibiotics. Drug name, dose and frequency were stated for all items. From the faxed items, 38 (100%) adhered to national guidelines and 32/33 (97%) followed local guidelines.Over 5 days, CF INPs provided telephone advice for 12 patients. Of these, 6 patients had respiratory exacerbation. Telephone advice led to faxes being sent to GPs for 9 patients. This was preliminary data with a re-audit planned after amendment of trust form.ConclusionOverall INP prescribing was found to be safe and effective. This review enabled education of the respiratory team of prescribing practices via a local audit meeting. The positive contribution that INPs provide to patient care was highlighted as they improve the patient journey and support the MDT. The demand for INP prescribing in particular with CF has provided opportunity for a pharmacist prescriber to join the CF MDT. It is recommended medical and pharmacist prescribing to be reviewed.

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Senior medical students as assistants in medicine in COVID-19 crisis: a realist evaluation protocol

BMJ Open ◽

10.1136/bmjopen-2020-045822 ◽

2021 ◽

Vol 11 (9) ◽

pp. e045822

Author(s):

Lynn V Monrouxe ◽

Peter Hockey ◽

Priya Khanna ◽

Christiane Klinner ◽

Lise Mogensen ◽

...

Keyword(s):

Medical Students ◽

Success Factors ◽

Realist Review ◽

Physician Assistants ◽

Realist Evaluation ◽

Health Practitioner ◽

Local Health ◽

Medical Council ◽

Programme Theory ◽

Quantitative Evidence

IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and analysisThe intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might ‘work’ to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders.Ethics and disseminationEthics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.

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Despesas públicas e o nível de desenvolvimento humano dos estados brasileiros: uma análise do IDHM 2000 e 2010

RACE - Revista de Administração Contabilidade e Economia ◽

10.18593/race.v17i1.10296 ◽

2018 ◽

Vol 17 (1) ◽

pp. 29-54

Author(s):

Taíse Fatima Mattei ◽

Fernanda Mendes Bezerra ◽

Gilmar Ribeiro de Mello

Keyword(s):

Human Development ◽

Public Expenditure ◽

Least Squares Method ◽

Positive Impact ◽

Ordinary Least Squares ◽

Public Expenditures ◽

Positive Contribution ◽

Development Level ◽

Per Capita ◽

Ordinary Least Squares Method

Resumo: Uma das formas de um governo atuar na economia é na alocação dos gastos públicos. Os gastos públicos têm o objetivo de contribuir para o fornecimento de serviços públicos para a população, e também para a geração de investimentos na economia. Muitas vezes, questiona-se se esses gastos podem, de fato, contribuir para a melhoraria da vida das pessoas. Dessa forma, entender se as despesas públicas têm relação com o nível de desenvolvimento humano é importante para a tomada de decisão dos governantes e para melhorar a gestão dos gastos públicos, principalmente para direcionar em quais áreas devem ser gastos os recursos. Diante disso, o objetivo com este artigo foi verificar qual a contribuição das despesas públicas per capita por funções para o nível de desenvolvimento humano dos estados brasileiros. O método adotado é a regressão múltipla estimada pelo método de mínimos quadrados ordinários utilizando dados em painel. Os dados são provenientes do IBGE, PNUD e IPEA DATA. Os resultados sugerem que algumas despesas possuem contribuição positiva para o desenvolvimento dos estados. Analisando o modelo com todas as despesas na mesma regressão, saúde e educação apresentaram relação positiva para aumentar o IDHM. Analisando os modelos em regressões isoladas, as despesas com assistência e previdência, educação, saúde e segurança e transporte confirmaram impacto positivo sobre o nível de desenvolvimento dos estados. Destaca-se a importância das despesas com saúde e educação, as quais se apresentaram influenciáveis no desenvolvimento nas duas abordagens realizadas.Palavras-chave: Despesas Públicas. Índice de Desenvolvimento Humano. Estados brasileiros. Public expenditure and human development level of Brazilian states: an analysis of IDHM 2000 and 2010 Abstract: One of the ways for a government to act in the economy is in the allocation of public expenditures. Public expenditures aim to contribute to the provision of public services to the population, as well as to the generation of investments in the economy. It is often questioned whether such expenditures can actually contribute to the improvement of people's lives. Thus, understanding whether public expenditures arerelated to the level of human development is important for government decision-making, and to improve the management of public expenditures, mainly to target the areas in which resources should be spent. Therefore, the objective of this article is to verify the contribution of public expenditure per capita by functions to the level of human development of the Brazilian states. The method adopted is the multiple regression estimated by the ordinary least squares method using panel data. The data comes from IBGE, UNDP and IPEA DATA. The results suggest that some expenses have a positive contribution to the development of the states. Analyzing the model with all expenses in the same regression, health and education presented positive relation to increase the HDI. Analyzing the models in isolated regressions, assistance and pension, education, health, safety and transportation expenses confirmed a positive impact on the level of development of the states. It is important to highlight the importance of health and education expenditures, which were influential in the development of the two approaches.Keywords: Public Expenditure. Human Development Index. Brazilian states.

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Redesigning the psychiatry induction

BJPsych Open ◽

10.1192/bjo.2021.450 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S162-S162

Author(s):

Sharadha Wisidagama ◽

Martin Schmidt

Keyword(s):

Junior Doctor ◽

General Medical Council ◽

Electronic Record ◽

Junior Doctors ◽

Medical Council ◽

Education Department ◽

Record System ◽

Training Requirements ◽

Regulatory Bodies ◽

Service Gap

AimsTo analyse the current psychiatry induction programme with regards to national guidance, local requirements, trainee and trainer feedback and implement recommendations to streamline where possible.BackgroundJunior doctors in training rotate every 4 or 6 months depending on the grade/programme group. GP and FY trainees are often new to psychiatry therefore require a comprehensive induction.Our Trust has had a three day induction for new junior doctors comprised of 1 day Corporate Induction, 1 day Electronic Records Training and 1 day Local induction.During the 3 day induction programme there is often a service gap with covering out of hours and acute services. Trainees and trainers have expressed concern regarding the service gap.We therefore embarked on a review of the induction programme to investigate whether it could be improved in content and length of time to deliver.MethodReview the regulatory bodies requirements for junior doctor induction.Gain an understanding of the trainees and trainers perspective of the induction programme.Review the items in the induction programme according to the requirements of the regulatory bodies.Tailor the induction programme for junior doctors’ needs whilst complying with the regulatory bodies requirements.ResultThe General Medical Council (GMC), British Medical Association (BMA), Gold Guide, Health Education England (HEE) and National Health Service (NHS) employment have no specific statutory and mandatory training requirements for induction.The regulatory bodies have generic standards for junior doctor induction.Induction is the responsibility of the Trust.Trainee perspective: Electronic record system, Mental Health Act (MHA) and pharmacy training were agreed as needing review in terms of its content and length.Trainees also requested extra items to be included in the induction programme to support successful transition in to their work placements.The education department met with the Digital Team, MHA Team and Pharmacy Team to develop new and more relevant course content and add in the requested items.The new induction programme was launched in December 2019 and was reduced in length from 3 to 2 and a half days. Trainee satisfaction improved as evidence by trainee feedback.ConclusionThe review was helpful in establishing the requirements for a good induction and highlighting areas for improvement.The new induction was more focussed, shorter in duration and had improved trainee feedback.The Medical Education Department will assess the changes following the December 2019 induction and continue to review its induction programme.

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Medical student confidence in care of the dying and their family: a systematic review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-001977 ◽

2020 ◽

pp. bmjspcare-2019-001977

Author(s):

Geoffrey Wells ◽

Elaney Youssef ◽

Rebecca Winter ◽

Juliet Wright ◽

Carrie Llewellyn

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Medical Student ◽

Cochrane Review ◽

Assessment Tools ◽

Junior Doctors ◽

Medical Council ◽

Dying Patients ◽

Medical Undergraduate ◽

Student Confidence

BackgroundThe General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying.AimThis systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients.DesignA systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools and details of applied educational interventions. Pre/postintervention confidence comparisons were made. Factors influencing confidence levels were explored.Data sourcesMEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsycINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms ‘medical student’, ‘confidence’ and ‘dying’, alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool.ResultsFifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased postinterventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence.ConclusionThis review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning.PROSPERO registration numberCRD42019119057.

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Integration and retention of American physician assistants/associates working in English hospitals: A qualitative study

Health Policy ◽

10.1016/j.healthpol.2020.03.001 ◽

2020 ◽

Vol 124 (5) ◽

pp. 525-530 ◽

Cited By ~ 1

Author(s):

Francesca Taylor ◽

Vari M Drennan ◽

Mary Halter ◽

Melania Calestani

Keyword(s):

Qualitative Study ◽

Physician Assistants ◽

American Physician

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An audit cycle of consent form completion: A useful tool to improve junior doctor training

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.182246 ◽

2016 ◽

Vol 49 (01) ◽

pp. 72-75 ◽

Cited By ~ 1

Author(s):

Catherine Leng ◽

Kavita Sharma

Keyword(s):

Junior Doctor ◽

General Medical Council ◽

Consent Form ◽

Junior Doctors ◽

Medical Council ◽

Emergency Setting ◽

Consent Forms ◽

Surgical Practice ◽

Audit Cycle ◽

Practice Methods

ABSTRACT Background: Consent for surgical procedures is an essential part of the patient's pathway. Junior doctors are often expected to do this, especially in the emergency setting. As a result, the aim of our audit was to assess our practice in consenting and institute changes within our department to maintain best medical practice. Methods: An audit of consent form completion was conducted in March 2013. Standards were taken from Good Surgical Practice (2008) and General Medical Council guidelines. Inclusion of consent teaching at a formal consultant delivered orientation programme was then instituted. A re-audit was completed to reassess compliance. Results: Thirty-seven consent forms were analysed. The re-audit demonstrated an improvement in documentation of benefits (91–100%) and additional procedures (0–7.5%). Additional areas for improvement such as offering a copy of the consent form to the patient and confirmation of consent if a delay occurred between consenting and the procedure were identified. Conclusion: The re-audit demonstrated an improvement in the consent process. It also identified new areas of emphasis that were addressed in formal teaching sessions. The audit cycle can be a useful tool in monitoring, assessing and improving clinical practice to ensure the provision of best patient care.

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Service-Based Advanced Practice Providers: The Surgeon's Perspective

The American Surgeon ◽

10.1177/000313481908500736 ◽

2019 ◽

Vol 85 (7) ◽

pp. 747-751 ◽

Cited By ~ 1

Author(s):

Barbara Eaton ◽

Lindsay O'Meara ◽

Anthony V. Herrera ◽

Ronald Tesoriero ◽

Jose Diaz ◽

...

Keyword(s):

Clinical Judgment ◽

Best Practice ◽

Positive Impact ◽

Advanced Practice ◽

Near Misses ◽

Tertiary Referral Center ◽

Practice Level ◽

Resident Work ◽

Surgical Teams ◽

Surgery Resident

The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.

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Do junior doctors practise to the UK General Medical Council standards?

The Clinical Teacher ◽

10.1111/j.1743-498x.2009.00339.x ◽

2010 ◽

Vol 7 (1) ◽

pp. 32-36 ◽

Cited By ~ 2

Author(s):

Robert Palmer ◽

Robert Cragg ◽

David Wall

Keyword(s):

General Medical Council ◽

Junior Doctors ◽

Medical Council ◽

The Uk

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THE IMPACT OF INNOVATION ON ECONOMIC GROWTH: THE SPILLOVER EFFECT OF FOREIGN DIRECT INVESTMENT

Humanities & Social Sciences Reviews ◽

10.18510/hssr.2020.8279 ◽

2020 ◽

Vol 8 (2) ◽

pp. 708-714

Author(s):

Nguyen Tran Thai Ha ◽

Sobar M. Johari ◽

Trinh Thi Huyen Thuong ◽

Nguyen Thi Minh Phuong ◽

Le Thi Hong Anh

Keyword(s):

Economic Growth ◽

Foreign Direct Investment ◽

Research And Development ◽

Direct Investment ◽

Positive Impact ◽

Spillover Effect ◽

Empirical Method ◽

Convincing Evidence ◽

Positive Contribution ◽

The Impact

Purpose of the study: Innovation is seen as the key to improving quality and productivity, thereby promoting competition and economic growth. This study analyzes the impact of innovation on economic growth through various measures, such as research and development spending, the number of researchers, number of patents as well as trademark registrations. Research results are evidence to recommend policies for intellectual-based economic growth. Methodology: Literature review and empirical analysis conducted in the study. The empirical method is a two-step System Generalize Methods of Moments (GMM), aiming at reliable results. Accessing the World Bank Database, research data from 64 developed and developing countries are collected from 2006 to 2014. Main Findings: The empirical findings show that innovation plays a crucial contribution in promoting economic growth, similar to national openness and government spending on education. This study also finds a positive impact on foreign investment flows and their spillover role in enhancing the correlation between innovation and economic growth. Applications of this study: The findings of this study focus on the contributions of innovation, foreign direct investment inflows, and other macro factors that can be enforced to improve economic growth by policymakers. Novelty/Originality of this study: The study uses different measures of innovation, including inputs such as the number of researchers, research and development expenditure, and outputs as the number of patents and number of trademark registrations. Empirical findings are found consistently, thus confirming that innovation is very important for economic growth. The study also shows convincing evidence confirming the positive contribution of foreign direct investment as well as its spillover effect on innovation and economic growth.

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