Sub-Specialization Among Nigerian Ophthalmologists: Status, Disposition and Barriers.

Purpose: To determine the status of sub-specialization among Nigerian ophthalmologists as well as their dispositions and barriers against sub-specialization with a view to providing valuable information for the purpose of human resources for eye care planning thereby providing useful insight into the future of ophthalmic practice in Nigeria. Methods: This was a web-based, cross-sectional study conducted among Ophthalmologists in Nigeria. An online questionnaire was distributed through e-mails using Qualtrics software (Qualtrics, Provo, UT, USA). Information concerning socio-demographic characteristics, type of practice, location of practice, years of practice, status and disposition to sub-specialization as well as barriers to sub-specialization were obtained through the questionnaire.Results: two hundred and four Nigerian Ophthalmologists participated in the study out of which 118 (57.8%) were females. One hundred and ten (54.0%) respondents had undergone sub-specialty training. The sub-specialties with the highest number of patronage was Paediatric Ophthalmology and Strabismus (14.2%). Respondents older than 46 years were three times more likely to have undergone subspecialty training compared to respondents who were aged 46 years and below [odds ratio (OR) = 3.01, 95% Confidence interval (CI) = 1.33 – 6.83, p = 0.01]. The main barriers to the availability and uptake of sub-specialty services as well as the challenges of sub-specialty services at the centres with established sub-specialty practice were non-availability/inadequate trained specialist and inadequate equipment. Conclusion: Nigerian Ophthalmologists are well disposed to sub-specialization although the extent of sub-specialization among them was a little above average. The main barriers to the availability and uptake of sub-specialty services as well as the challenges of sub-specialty services at the centres with established sub-specialty practice in this study were non-availability/inadequate trained specialist and inadequate equipment.

Entrustable professional activities for pharmacy students: A primer for solid organ transplant preceptors

Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The role of a solid organ transplant pharmacist is multifaceted and translates to diverse experiential and elective learning experiences that can be provided to pharmacy learners. Here we provide a guide to integrating pharmacy students into patient care and other pharmacist activities in solid organ transplantation. Summary Thoughtful incorporation of learners into clinical practice and clinical research creates a positive learning environment for pharmacy students that can foster the development of core skills necessary for students to become “practice-ready” and “team-ready” pharmacy graduates and can equip them with valuable skills to incorporate into the specialty practice areas and careers they pursue. To help develop these educational experiences, attention to the list of core entrustable professional activities (EPAs) established by the American Association of Colleges of Pharmacy can help create a rich environment of learning with carefully cultivated tasks. Furthermore, learners can serve as transplant pharmacist extenders to assist in overall patient care and multidisciplinary involvement on the transplant team. This article serves as a “how-to” guide for applying the EPA framework to integrating pharmacy students in patient care and other pharmacist activities in solid organ transplantation and other specialty practice areas. Conclusion As pharmacy preceptors design and operationalize their teaching to incorporate EPAs, they can benefit from recommendations tailored to specialty practice areas such as solid organ transplantation. Students may start and finish these experiences at different EPA levels, but continuance of training will allow them to achieve the final EPA level across the 6 EPA domains.

Multi-site practice and physician travel burden by oncology specialty.

e13513 Background: Having physicians who practice at multiple sites may increase patients’ access to care, but also burden physicians Gynecologic oncologists (GO) are increasingly practicing at more sites across a larger geographic area, but the degree to which medical oncologists (MO), surgical oncologists (SO) or radiation oncologists (RO) are also doing so is unknown. Methods: We conducted a retrospective, observational study using data from the 2020 Physician Compare National Dataset. We included GO, MO, SO, RO, as determined by self-reported specialty. Practice sites with incomplete street addresses were excluded. For each specialty, we calculated the number of practice sites per physician, geographic practice dispersion (median driving distance required to go to each practice site), and temporal practice dispersion (median travel time required to go to each practice site). We used linear regression to compare the number of practice sites, geographic practice dispersion, and temporal practice dispersion by specialty. Results: The number of physicians, mean number of practice sites, along with geographic and temporal practice dispersion by specialty are shown in the table. MO practiced at a smaller number of practice sites compared to GO (p<0.001) and RO (p<0.001). Compared to MO, SO had a smaller geographic dispersion (median driving distance 22 miles vs. 38 miles, p=<0.001) and temporal practice dispersion (median driving time 27 minutes vs. 43 minutes, p<0.001), whereas RO had a larger geographic dispersion (median RO driving distance 58 minutes, p<0.001) and temporal practice dispersion (median RO driving time 63 minutes, p<0.001). Conclusions: Oncologic specialties vary in the number of practice sites and practice dispersion per oncologist. In particular, GO and RO practice at more sites than MO, with MO practices more geographically concentrated than RO practices. While SO practice at a similar number of practice sites compared to MO, their practices are the most geographically concentrated. While these practice patterns may represent increased patient access to specialty oncology care, the impact on quality of care and physician wellness is unknown.[Table: see text]

Moral distress, organizational climate, and the risk of burnout among oncology physician assistants.

11018 Background: Moral Distress (MD) is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care and has been associated with burnout. Advances have been made in our understanding of burnout in the oncology (Onc) workforce but our understanding of MD remains limited. This study was initiated to explore associations between moral distress, burnout, and the organizational climate (OC) for Onc Physician Assistants (PAs). Methods: A national survey of onc PAs was conducted in 2020. MD and Burnout were assessed with the Maslach Burnout Inventory and the Measure of MD – Healthcare Professionals (MMD-HP). To assess OC, the Nurse Practitioner Primary Care OC Questionnaire (NP-PCOCQ) was revised for Onc PAs and assessed professional visibility (PV), administrative relations (AR), physician relations (PR), and professional autonomy and support (PAS). A robust Poisson regression model was used to estimate risk ratios (RR) for burnout associated with MD and OC variables. Results: Respondents who completed the survey included 146 Onc PAs that were mostly female (90%), White/Caucasian (84%), married/partnered (78%), and in medical Onc (73%). Mean MMD-HP score was 71.5 and burnout was reported by 39.7% of PAs. MMD-HP scores did not differ based on specialty, practice setting or practice type. PCOCQ subscale scores were lower for PAs with burnout vs. without burnout (p=0.003 to p < 0.001). Increasing levels of MD were associated with increased levels of emotional exhaustion (p<0.001), depersonalization (p<0.001) and a higher overall rate of burnout. For Low, Medium and High MMD, burnout rates were 10%, 44% and 66% respectively (p<0.001). Risk of burnout was associated with increasing levels of MD, which remained when adjusted for the PCOCQ subscales. An interaction model with the PCOCQ subscales and the association between burnout and MD was not significant. Conclusions: Higher levels of MD and unfavorable organizational climate are associated with Onc PA burnout. The relationship between MD and burnout does not appear to be moderated by organizational climate. Additional research is needed to identify potential moderators of the MD/Burnout relationship. Risk Ratio estimate for Burnout.[Table: see text]

Introducing Lifestyle Medicine Within the Mayo Clinic Alix School of Medicine in Arizona

Purpose: High-value care is becoming increasingly important as the United States shifts toward a more sustainable health care system. Lifestyle medicine (LM) may be the highest-value model of care. Surprisingly, however, it is taught in a minority of medical schools. In this article, we describe a pilot project of introducing a brief LM course taught within the Mayo Clinic Alix School of Medicine in Arizona. The main purpose of the course was to introduce the students to LM as a specialty practice and to provide students with foundational knowledge of the pillars of LM. Results: Students reported improved personal health habits and increased confidence in LM competencies.