scholarly journals Delivering on the Promise: Exploring Training Characteristics and Graduate Career Pursuits of Primary Care Internal Medicine Residency Programs and Tracks

2019 ◽  
Vol 11 (4) ◽  
pp. 447-453
Author(s):  
Robin Klein ◽  
Samantha Alonso ◽  
Caitlin Anderson ◽  
Akanksha Vaidya ◽  
Nour Chams ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Clinical Experiences ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Training Time ◽  
Residency Programs ◽  
Primary Care Internal Medicine ◽  
Ambulatory Training ◽  
Curricular Content

ABSTRACT Background Specialized primary care internal medicine (PC IM) residency programs and tracks aim to provide dedicated PC training. How programs deliver this is unclear. Objective We explored how PC IM programs and tracks provide ambulatory training. Methods We conducted a cross-sectional survey from 2012 to 2013 of PC IM program and track leaders via a search of national databases and program websites. We reported PC IM curricular content, clinical experiences, and graduate career pursuits, and assessed correlation between career pursuits and curricular content and clinical experiences. Results Forty-five of 70 (64%) identified PC IM programs and tracks completed the survey. PC IM programs provide a breadth of curricular content and clinical experiences, including a mean 22.8 weeks ambulatory training and a mean 69.4 continuity clinics per year. Of PC IM graduates within 5 years, 55.8% pursue PC or general internal medicine (GIM) careers and 23.1% pursue traditional subspecialty fellowship training. Curricular content and clinical experiences correlate weakly with career choices. PC IM graduates pursuing PC or GIM careers correlated with ambulatory rotation in women's health (correlation coefficient [rho] = 0.36, P = .034) and mental health (rho = 0.38, P = .023) and curricular content in teaching and medical education (rho = 0.35, P = .035). PC IM graduates pursuing subspecialty fellowship negatively correlated with curricular content in leadership and teams (rho = -0.48, P = .003) and ambulatory training time (rho = -0.38, P = .024). Conclusions PC IM programs and tracks largely deliver on the promise to provide PC training and education and produce graduates engaged in PC and GIM.

scholarly journals Ophthalmology training and competency levels in caring for patients with ophthalmic complaints among United States internal medicine, emergency medicine, and family medicine residents

2019 ◽  
Vol 16 ◽  
pp. 25 ◽  
Author(s):  
Christopher Daniel Gelston ◽  
Jennifer Landrigan Patnaik
Keyword(s):  
Internal Medicine ◽  
United States ◽  
Emergency Medicine ◽  
Family Medicine ◽  
Educational Training ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Residency Programs ◽  
Confidence Levels ◽  
Family Medicine Residents

Purpose: To evaluate ophthalmic educational training and confidence in caring for patients with ophthalmic complaints among internal, emergency, and family medicine residents in the United States.Methods: A 41-item cross-sectional survey was sent to the directors of 529 internal medicine, 237 emergency medicine, and 629 family medicine residency programs, who distributed it to residents in those programs. The survey included the number of ophthalmic education hours residents received. Respondents were asked to rate their confidence in performing an ophthalmic exam and treating patients with ocular conditions using a 5-point Likert scale ranging from “not confident” to “very confident.”Results: In total, 92.5% of internal medicine, 66.8% of emergency medicine, and 74.5% of family medicine residents received less than 10 hours of ophthalmic education during residency. Most respondents (internal medicine, 59.1%; emergency medicine, 76.0%; family medicine, 65.7%) reported that patients with ocular complaints constituted 1%–5% of visits. Mean±standard deviation confidence levels in performing an eye exam and treating patients with ophthalmic conditions were highest in emergency medicine residency programs (2.9±0.7), followed by family medicine (2.3±0.6) and internal medicine (2.2±0.6). A higher reported number of ophthalmic education hours in residency was associated with greater confidence among emergency (P<0.001), family (P<0.001), and internal (P=0.005) medicine residents.Conclusion: Internal, emergency, and family medicine residents receive limited ophthalmic education, as reflected by their overall low confidence levels in performing an ophthalmic exam and treating patients with ocular complaints. An increase in ophthalmic educational hours during their residencies is recommended to improve upon this knowledge gap.

scholarly journals Hidden bedside rationing in the Netherlands: a cross-sectional survey among physicians in internal medicine

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ursula W. de Ruijter ◽  
Hester F. Lingsma ◽  
Willem A. Bax ◽  
Johan Legemaate
Keyword(s):  
Internal Medicine ◽  
The Netherlands ◽  
Patient Choice ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Physician Characteristics ◽  
Distribution Of Resources ◽  
Healthcare Rationing ◽  
Do So

Abstract Background Healthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result in conflicting loyalties for physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim is to establish whether bedside rationing occurs in the Netherlands, whether it qualifies as hidden and what physician characteristics are associated with its practice. Methods Cross-sectional online questionnaire on knowledge of -, experience with -, and opinion on rationing among physicians in internal medicine within the Dutch healthcare system. Multivariable ordinal logistic regression was used to explore relations between hidden bedside rationing and physician characteristics. Results The survey was distributed among 1139 physicians across 11 hospitals with a response rate of 18% (n = 203). Most participants (n = 129; 64%) had experience prescribing a cheaper course of treatment while a more effective but more expensive alternative was available, suggesting bedside rationing. Subsequently, 32 (24%) participants never disclosed this decision to their patient, qualifying it as hidden. The majority of participants (n = 153; 75%) rarely discussed treatment cost. Employment at an academic hospital was independently associated with more bedside rationing (OR = 17 95%CI 6.1–48). Furthermore, residents were more likely to disclose rationing to their patients than internists (OR = 3.2, 95%CI 2.1–4.7), while salaried physicians were less likely to do so than physicians in private practice (OR = 0.5, 95%CI 0.4–0.8). Conclusion Hidden bedside rationing occurs in the Netherlands: patient choice is on occasion limited with costs as rationale and this is not always disclosed. To what extent distribution of healthcare should include bedside rationing in the Netherlands, or any other country, remains up for debate.

scholarly journals Prepared and highly committed despite the risk of COVID-19 infection: a cross-sectional survey of primary care physicians’ concerns and coping strategies in Singapore

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jerrald Lau ◽  
David Hsien-Yung Tan ◽  
Gretel Jianlin Wong ◽  
Yii-Jen Lew ◽  
Ying-Xian Chua ◽  
...  
Keyword(s):  
Primary Care ◽  
Coping Strategies ◽  
Stress Management ◽  
Primary Care Physicians ◽  
Well Being ◽  
Pandemic Preparedness ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Accessible Information ◽  
And Coping

Abstract Background Primary care physicians (PCPs) are first points-of-contact between suspected cases and the healthcare system in the current COVID-19 pandemic. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak. Methods Two hundred and sixteen PCPs actively practicing in either a public or private clinic were cluster sampled via email invitation from three primary care organizations in Singapore from 6th to 29th March 2020. Participants completed a cross-sectional online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19. Results A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection (89.9%), and a source of risk (74.7%) and concern (71.5%) to loved ones. PCPs reported acceptance of these risks (91.1%) and the need to care for COVID-19 patients (85.4%). Overall perceived pandemic preparedness was extremely high (75.9 to 89.9%). PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors. Conclusions PCPs continue to serve willingly on the frontlines of this pandemic despite the high perception of risk to themselves and loved ones. Healthcare organizations should continue to support PCPs by managing both their psychosocial (e.g. stress management) and professional (e.g. pandemic preparedness) needs.

Current Models for Inpatient and Emergency Room Ophthalmology Consultation in U.S. Residency Programs

2020 ◽  
Vol 12 (02) ◽  
pp. e171-e174
Author(s):  
Donna H. Kim ◽  
Dongseok Choi ◽  
Thomas S. Hwang
Keyword(s):  
Emergency Department ◽  
Medical Education ◽  
Emergency Room ◽  
Program Directors ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Direct Supervision ◽  
Residency Programs ◽  
Residency Program Directors ◽  
Competency Assessments

Abstract Objective This article examines models of patient care and supervision for hospital-based ophthalmology consultation in teaching institutions. Design This is a cross-sectional survey. Methods An anonymous survey was distributed to residency program directors at 119 Accreditation Council for Graduated Medical Education accredited U.S. ophthalmology programs in the spring of 2018. Survey questions covered consult volume, rotational schedules of staffing providers, methods of supervision (direct vs. indirect), and utilization of consult-dedicated didactics and resident competency assessments. Results Of the 119 program directors, 48 (41%) completed the survey. Programs most frequently reported receiving 4 to 6 consults per day from the emergency department (27, 55.1%) and 4 to 6 consults per day from inpatient services (26, 53.1%). Forty-seven percent of programs reported that postgraduate year one (PGY-1) or PGY-2 residents on a dedicated consult rotation initially evaluate patients. Supervising faculty backgrounds included neuro-ophthalmology, cornea, comprehensive, or a designated chief of service. Staffing responsibility is typically shared by multiple faculty on a daily or weekly rotation. Direct supervision was provided for fewer of emergency room consults (1–30%) than for inpatient consults (71–99%). The majority of programs reported no dedicated didactics for consultation activities (27, 55.1%) or formal assessment for proficiency (33, 67.4%) prior to the initiation of call-related activities without direct supervision. Billing submission for consults was inconsistent and many consults may go financially uncompensated (18, 36.7%). Conclusion The majority of hospital-based ophthalmic consultation at academic centers is provided by a rotating pool of physicians supervising a lower level resident. Few programs validate increased levels of graduated independence using specific assessments.

scholarly journals Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries

2021 ◽  
Vol 22 ◽  
Author(s):  
Peter P. Groenewegen ◽  
Wienke G. W. Boerma ◽  
Peter Spreeuwenberg ◽  
Bohumil Seifert ◽  
Willemijn Schäfer ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Professional Training ◽  
Institutional Development ◽  
Task Shifting ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Independent Variables ◽  
Nurse Prescribing ◽  
Number Of Patients

Abstract Aim: To describe variation in task shifting from general practitioners (GPs) to practice assistants/nurses in 34 countries, and to explain differences by analysing associations with characteristics of the GPs, their practices and features of the health care systems. Background: Redistribution of tasks and responsibilities in primary care are driven by changes in demand for care, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill mix of primary care teams. However, these developments are hampered by barriers between professional domains, which can be rigid as a result of strict regulation, traditional attitudes and lack of trust. Methods: Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7200 GPs in 34 countries. The dependent variable ‘task shifting’ is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are: institutional development of primary care; demand for and supply of care; nurse prescribing as an indicator for professional boundaries; professionalisation of practice assistants/nurses (indicated by professional training, professional associations and journals). Multilevel analysis is used to account for the clustering of GPs in countries. Findings: Countries vary in the degree of task shifting by GPs. Regarding GP and practice characteristics, use of electronic health record applications (as an indicator for innovativeness) and age of the GPs are significantly related to task shifting. These variables explain only little variance at the level of GPs. Two country variables are positively related to task shifting: nurse prescribing and professionalisation of primary care nursing. Professionalisation has the strongest relationship, explaining 21% of the country variation.

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