Optimism and Myths

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 578-578
Author(s):  
JOSEPH W.ST. GEME
Keyword(s):  
Internal Medicine ◽  
Family Medicine ◽  
Family Physician ◽  
Clinical Competence ◽  
Educational Program ◽  
Clinical Performance ◽  
Point Of View

In Reply.— Klein expresses his point of view with clarity and intensity. That is important. I am optimistic about pediatrics and its future. That is important to me. I also believe that the optimism is reasonable. There is an increasing sense of competition between pediatrics and family medicine. The same seems to be true for internal medicine and family medicine. The competition in the spheres of educational program and clinical performance is healthy. We will continue to learn from each other and the roles of the pediatrician, internist, and family physician will evolve as a function of our knowledge, our clinical competence, the desires of our patients, and, perhaps, our enthusiasm about what we do.

52. Simulation based training improves resident competence in the performance of critical resuscitation procedures

2007 ◽  
Vol 30 (4) ◽  
pp. 56
Author(s):  
I. Rigby ◽  
I. Walker ◽  
T. Donnon ◽  
D. Howes ◽  
J. Lord
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Medical Education ◽  
Family Medicine ◽  
Training Program ◽  
Correlation Coefficient ◽  
Training Programs ◽  
Self Assessment ◽  
Procedural Skills ◽  
Simulation Based

We sought to assess the impact of procedural skills simulation training on residents’ competence in performing critical resuscitation skills. Our study was a prospective, cross-sectional study of residents from three residency training programs (Family Medicine, Emergency Medicine and Internal Medicine) at the University of Calgary. Participants completed a survey measuring competence in the performance of the procedural skills required to manage hemodynamic instability. The study intervention was an 8 hour simulation based training program focused on resuscitation procedure psychomotor skill acquisition. Competence was criterion validated at the Right Internal Jugular Central Venous Catheter Insertion station by an expert observer using a standardized checklist (Observed Structured Clinical Examination (OSCE) format). At the completion of the simulation course participants repeated the self-assessment survey. Descriptive Statistics, Cronbach’s alpha, Pearson’s correlation coefficient and Paired Sample t-test statistical tools were applied to the analyze the data. Thirty-five of 37 residents (9 FRCPC Emergency Medicine, 4 CCFP-Emergency Medicine, 17 CCFP, and 5 Internal Medicine) completed both survey instruments and the eight hour course. Seventy-two percent of participants were PGY-1 or 2. Mean age was 30.7 years of age. Cronbach’s alpha for the survey instrument was 0.944. Pearson’s Correlation Coefficient was 0.69 (p < 0.001) for relationship between Expert Assessment and Self-Assessment. The mean improvement in competence score pre- to post-intervention was 6.77 (p < 0.01, 95% CI 5.23-8.32). Residents from a variety of training programs (Internal Medicine, Emergency Medicine and Family Medicine) demonstrated a statistically significant improvement in competence with critical resuscitation procedural skills following an intensive simulation based training program. Self-assessment of competence was validated using correlation data based on expert assessments. Dawson S. Procedural simulation: a primer. J Vasc Interv Radiol. 2006; 17(2.1):205-13. Vozenilek J, Huff JS, Reznek M, Gordon JA. See one, do one, teach one: advanced technology in medical education. Acad Emerg Med. 2004; 11(11):1149-54. Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003; 78(8):783-8.

scholarly journals How do we assess resilience and grit among internal medicine residents at the Mayo Clinic? A longitudinal validity study including correlations with medical knowledge, professionalism and clinical performance

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040699
Author(s):  
Fares Alahdab ◽  
Andrew J Halvorsen ◽  
Jayawant N Mandrekar ◽  
Brianna E Vaa ◽  
Victor M Montori ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Internal Consistency ◽  
Test Performance ◽  
Mayo Clinic ◽  
Clinical Performance ◽  
Medical Knowledge ◽  
Internal Consistency Reliability ◽  
Validity Study ◽  
Training Environment ◽  
Conference Attendance

BackgroundThere has been limited research on the positive aspects of physician wellness and to our knowledge there have been no validity studies on measures of resilience and grit among internal medicine (IM) residents.ObjectivesTo investigate the validity of resilience (10 items Connor-Davidson Resilience Scale (CD-RISC 10)) and grit (Short Grit Scale (GRIT-S)) scores among IM residents at a large academic centre, and assess potential associations with previously validated measures of medical knowledge, clinical performance and professionalism.MethodsWe evaluated CD-RISC 10 and GRIT-S instrument scores among IM residents at the Mayo Clinic Rochester, Minnesota between July 2017 and June 2019. We analysed dimensionality, internal consistency reliability and criterion validity in terms of relationships between resilience and grit, with standardised measures of residents’ medical knowledge (in-training examination (ITE)), clinical performance (faculty and peer evaluations and Mini-Clinical Evaluation Examination (mini-CEX)) and professionalism/dutifulness (conference attendance and evaluation completion).ResultsA total of 213 out of 253 (84.2%) survey-eligible IM residents provided both CD-RISC 10 and GRIT-S survey responses. Internal consistency reliability (Cronbach alpha) was excellent for CD-RISC 10 (0.93) and GRIT-S (0.82) overall, and for the GRIT subscales of consistency of interest (0.84) and perseverance of effort (0.71). CD-RISC 10 scores were negatively associated with ITE percentile (β=−3.4, 95% CI −6.2 to −0.5, p=0.02) and mini-CEX (β=−0.2, 95% CI −0.5 to −0.02, p=0.03). GRIT-S scores were positively associated with evaluation completion percentage (β=2.51, 95% CI 0.35 to 4.67, p=0.02) and conference attendance (β=2.70, 95% CI 0.11 to 5.29, p=0.04).ConclusionsThis study revealed favourable validity evidence for CD-RISC 10 and GRIT-S among IM residents. Residents demonstrated resilience within a competitive training environment despite less favourable test performance and grittiness that was manifested by completing tasks. This initial validity study provides a foundation for further research on resilience and grit among physicians in training.

scholarly journals Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees

2021 ◽  
Vol 18 (11) ◽  
pp. 6122
Author(s):  
Ryuichi Ohta ◽  
Yoshinori Ryu ◽  
Chiaki Sano
Keyword(s):  
Family Medicine ◽  
Rural Areas ◽  
Clinical Performance ◽  
Rural Hospital ◽  
Scope Of Practice ◽  
Quantitative Aspect ◽  
Educational Systems ◽  
Theory Approach ◽  
Community Hospitals ◽  
Medicine Education

Family medicine is vital in Japan as its society ages, especially in rural areas. However, the implementation of family medicine educational systems has an impact on medical institutions and requires effective communication with stakeholders. This research—based on a mixed-method study—clarifies the changes in a rural hospital and its medical trainees achieved by implementing the family medicine educational curriculum. The quantitative aspect measured the scope of practice and the change in the clinical performance of family medicine trainees through their experience of cases—categorized according to the 10th revision of the International Statistical Classification of Disease and Related Health Problems. During the one-year training program, the trainees’ scope of practice expanded significantly in both outpatient and inpatient departments. The qualitative aspect used the grounded theory approach—observations, a focus group, and one-on-one interviews. Three themes emerged during the analysis—conflicts with the past, driving unlearning, and organizational change. Implementing family medicine education in rural community hospitals can improve trainees’ experiences as family physicians. To ensure the continuity of family medicine education, and to overcome conflicts caused by system and culture changes, methods for the moderation of conflicts and effective unlearning should be promoted in community hospitals.

Psychosocial Beliefs of Medical Students Planning to Specialize in Family Medicine

1997 ◽  
Vol 80 (3) ◽  
pp. 987-992 ◽  
Author(s):  
Fred W. Markham ◽  
James J. Diamond
Keyword(s):  
Internal Medicine ◽  
Medical Students ◽  
Family Medicine ◽  
Family Physicians ◽  
Female Students ◽  
Further Training ◽  
Senior Year ◽  
Family Doctors ◽  
Fourth Year Medical Students ◽  
Belief Scale

The psychosocial orientation of fourth-year medical students planning careers in family medicine was compared to those selecting other specialities using the Physician Belief Scale. This scale has shown that practicing family physicians have a greater psychosocial orientation than those in other specialities such as internal medicine. The current study was done to see whether students choosing family medicine already have this greater orientation before they begin training as residents. 664 fourth-year medical students received surveys during their senior year and 378 (57%) returned completed surveys. Female students had a significantly greater psychosocial orientation than their male peers, but there were no significant differences between students planning residencies in family medicine and those selecting other residencies. The greater orientation of family doctors would appear to be a product of further training and experience either during residency or later during the actual practice of family medicine.

Legal Challenges for Romanian Family Medicine Practitioners in Times of ‘COVID-19’

2021 ◽  
Vol 28 (1) ◽  
pp. 71-75
Author(s):  
Silviu Dumitru PAUN ◽  
◽  
Sinziana-Elena BIRSANU ◽  
Codrut Andrei NANU ◽  
◽  
...  
Keyword(s):  
Family Medicine ◽  
General Practitioners ◽  
Point Of View ◽  
Insurance Policy ◽  
Roles And Responsibilities ◽  
Applicable Law ◽  
Professional Activities ◽  
Legal Challenges ◽  
The Law ◽  
Special Circumstances

The general practitioners (GPs’) practice faced serious challenges as a result of COVID-19 pandemic, including from a legal point of view. In this context, a series of questions related to the GPs’ professional activities might arise such as: (i) what happens if a doctor makes a mistake because he/she is exhausted, as a result of overtime or (ii) if he/she performs medical acts outside the boundaries of his/her own specialty or without consent, as requested by his/her own conscience, by the situation, by the authorities and by his/her principal? In all these special circumstances this could mean that the doctor fails to comply with the applicable law. Moreover, because he/she breaches the law, the professional insurance policy will cease to be applicable. With new roles and responsibilities, the GPs should adjust their practice to the current conditions.

scholarly journals Out-of-Match Residency Offers: The Possible Extent and Implications of Prematching in Graduate Medical Education

2010 ◽  
Vol 2 (3) ◽  
pp. 327-333 ◽  
Author(s):  
Robert V. Wetz ◽  
Charles B. Seelig ◽  
Georges Khoueiry ◽  
Kera F. Weiserbs
Keyword(s):  
Internal Medicine ◽  
United States ◽  
Primary Care ◽  
Medical Education ◽  
Family Medicine ◽  
Rank Order ◽  
Medical Doctors ◽  
Spearman Rank ◽  
Fellowship Programs ◽  
Career Preferences

Abstract Background When the data from the National Resident Matching Program (NRMP) are used to analyze trends in medical students' career preferences, positions offered outside the match are omitted. The purpose of the study was to evaluate the extent and nature of out-of-match residency offers. Methods We obtained total resident complements and postgraduate year-1 positions offered in 7 specialties in 2007 and compared these with the 2007 NRMP match data. We compared the percentage of positions offered outside the match to “success” in matching United States medical doctors (USMDs) and to the availability of fellowship positions, using the Spearman rank order test (SROT). Results A total of 18 030 postgraduate year-1 positions were offered in 9 specialty areas. Of 15 205 positions offered in the match, 54% were taken by USMDs. The percentage of outside-the-match offers was found to vary by specialty, from 7% in obstetrics-gynecology to 23% in internal medicine, and was inversely correlated with the specialty's “success” in matching USMDs (SROT  =  −0.87). The 3 nonprocedural primary care specialties (internal medicine, family medicine, and pediatrics) accounted for 10 091 (46.2%) of the 21 845 total positions offered in the match, with 4401 (43.6%) offered almost entirely to non-USMDs. Another 2467 positions were offered outside the match, resulting in 6868 positions offered to non-USMDs (55% of all primary care positions). In internal medicine, the percentage of outside-the-match offers was significantly and inversely associated with the availability of intrainstitutional fellowship programs (P &lt; .0001). Prematching of independent applicants was significantly higher in primary care than in procedural-lifestyle programs (P &lt; .0001). Conclusion The NRMP's match data do not account for positions filled outside the match, a finding that appears to be significant. In 2007, 1 in 5 positions in primary care was offered outside the match.

scholarly journals Are multiple-choice questions a good tool for the assessment of clinical competence in Internal Medicine?

2018 ◽  
Vol 12 (2) ◽  
pp. 88 ◽  
Author(s):  
Flavio Tangianu ◽  
Antonino Mazzone ◽  
Franco Berti ◽  
Giuliano Pinna ◽  
Irene Bortolotti ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Clinical Practice ◽  
Clinical Competence ◽  
Reliable Method ◽  
Professional Competence ◽  
Multiple Choice ◽  
Multiple Choice Questions ◽  
High Quality ◽  
Good Tool ◽  
Design Review

There are many feasible tools for the assessment of clinical practice, but there is a wide consensus on the fact that the simultaneous use of several different methods could be strategic for a comprehensive overall judgment of clinical competence. Multiple-choice questions (MCQs) are a well-established reliable method of assessing knowledge. Constructing effective MCQ tests and items requires scrupulous care in the design, review and validation stages. Creating high-quality multiple-choice questions requires a very deep experience, knowledge and large amount of time. Hereby, after reviewing their construction, strengths and limitations, we debate their completeness for the assessment of professional competence.

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