Physician Competence Research Articles

Enhancing knowledge mastery in resident students through peer-teaching: a study in respiratory medicine

AimThe transition from medical students to competent physicians requires comprehensive training during residency programs. In China, resident students typically undergo 2- or 3-year training programs. While they learn from patient interactions under the guidance of experienced doctors, integrating theoretical knowledge from textbooks into practical cases remains a challenge. This study aimed to explore the impact of medical interns acting as peer-students on the knowledge mastery of resident students.MethodThe participants of this study consisted of resident students specializing in respiratory medicine at the Second Affiliated Hospital of Zhejiang University, School of Medicine. Resident students were given the opportunity to volunteer as peer-teachers for medical interns in the respiratory department. Those who chose to instruct interns were automatically placed into the test group, while those who opted not to partake in intern instruction formed the control group. In their role as peer-teachers, resident students assumed the responsibility of guiding interns in patient management throughout the entire continuum, spanning from initial engagement to discharge, a commitment that extended over a minimum period of 2 weeks. The resident students' academic performance was evaluated through a departmental examination consisting of 50 multiple-choice questions, which was administered upon completing their rotation. Statistical analysis was performed to assess the impact of peer-teaching on the resident students’ performance.ResultsBetween January 2023 and June 2023, a total of 158 resident students completed their rotation in the respiratory department. Among them, 40 resident students willingly took on the responsibility of instructing medical interns, while 118 resident students did not participate in intern teaching. With a "one-to-one" teaching policy in place, the overall satisfaction rate of the interns was an impressive 95.35%. Pre-rotation test scores for the test group averaged 81.66 ± 8.325 (Mean ± SD) and the control group averaged 81.66 ± 8.002, without significance. The departmental examination scores of the test group averaged 85.60 ± 7.886, while the control group scored an average of 82.25 ± 8.292, with a statistically significant difference (p = 0.027).ConclusionIn conclusion, our study underscores the positive influence of peer-teaching on the knowledge mastery of resident students.

EVALUATION OF SELF-COMPETENCY OF FAMILY PHYSICIANS AND FAMILY HEALTH WORKERS IN PROVIDING HEALTH SERVICES TO SYRIAN CHILDREN: AN EXAMPLE FROM ANKARA, TÜRKİYE

Objective: Türkiye is an immigrant-intensive country and primary health care services are the first health institution to apply for migrant children. In this research, it is aimed to evaluate how competent family physicians and family health workers working at where high Syrian migration population live consider themselves in providing health services to Syrian children. 
 Methods:This research was conducted among 224 family health physician and 250 family health workers in seven districts with a high migrant population in Ankara, Türkiye. Language knowledge and abroad experience was asked to the participants. The questionnaire included the participants’ education on migrant health, their experience in providing health care to migrant people. Multinomial logistic regression analysiswas used to evaluate factors associated with experiencing difficulties in servingimmigrant children.
 Results:Over the third-four of the family physicians (78.9%) and more than one-third of the family health workers (31.6%) knew at least one foreign language (p

Redefining excellence in health care: uniting inclusive compassion and shared humanity within a transformative physician competency model.

Redefining excellence in health care: uniting inclusive compassion and shared humanity within a transformative physician competency model.

Anatomical Ignorance Resulting in Iatrogenic Causes of Human Morbidity.

This article discusses how inadequate anatomy education contributes to iatrogenic causes of human morbidity and mortality. Through a review of the relevant literature, high-yield clinical cases were identified in which a lack of sufficient anatomical knowledge contributed to patient morbidity, such as abscess formation and neuropathy as a result of improper intramuscular injections, superior gluteal nerve injuries due to surgical procedures, and misdiagnoses due to physicians' inability to examine and correlate clinical and radiological findings. The importance of a multimodal learning approach in anatomy education for medical students, which includes the utilization of the cadaveric dissection approach to emphasize spatial understanding, is crucial for the development of competent physicians with a deep-rooted foundational knowledge of anatomy and related concepts, such as physiology, pathology, and radiology. It cannot be understated that anatomy education and a lack of knowledge of anatomy and related concepts may influence iatrogenic causes of human morbidity and mortality. Therefore, all efforts should be made to ensure that students develop a strong foundational anatomy knowledge during their preclinical years.

Self-Perceived Nutritional Competency of Primary Healthcare Physicians in Qassim, Saudi Arabia.

Overnutrition plays a vital role in the development of a spectrum of non-communicable diseases. Diet-related disorders have a huge impact on personal health as well as the country's economy for the management of such disorders. The study aims to assess the primary healthcare physicians' nutrition competency, which will be beneficial for evaluating the current situation and future strategies, training, nutrition care, and disease prevention. Among 147 primary healthcare physicians by simple random sampling from four cities and two rural areas of Qassim, Saudi Arabia, from December 2022 to December 2023 using a validated (NUTCOMP) tool. Data were entered, cleaned, and analyzed with SPSS software version 21.0 (IBM Corp., Armonk, NY). Informed consent was obtained from all study participants. Chi-square and ANOVA tests were applied to draw the significant differences. A total of 147 participants enrolled in this study, andthe mean age and standard deviation (SD) of the study population were 34.38 ± 6.57. More than half of the physicians (n = 76, 51.7%) continued education on nutrition. Significant mean differences were observed between some and focused nutrition content received physicians versus no nutrition content received physicians concerning nutrition skill, communication, and nutrition attitude consecutively (P < 0.0001, P < 0.0001, and P < 0.0001). The mean nutrition knowledge, skill, communication, attitude score, and SD of PHCC physicians were 26.91 ± 5.42 (maximum 35), 31.19 ± 6.18 (maximum 40), 36.73 ± 7.48 (maximum 45), and 34.74 ± 6.23 (maximum 40), respectively. Our study results show primary healthcare physicians perceive themselves to have good nutritional competency.

Interprofessional Post-Graduate Training Model for Nurse Practitioners and Physician Trainees

ContextPeople living with serious illness and their care partners rely on team-based specialty hospice and palliative care (HPC) in order to achieve high quality end of life outcomes. In HPC, physician and nurse practitioner (NP) scope of practice has significant overlap so training together may offer benefits to clinicians and patients. ObjectivesAssessment of clinical competencies in a post-graduate training program consisting of NPs and physicians training and learning side-by-side. MethodsA crosswalk assured NP and physician HPC clinical competencies were captured in evaluation questions used by interprofessional program faculty to observe and assess trainees. Six clinical competencies were calculated based on aggregated evaluations for each physician and NP HPC post-graduate trainee at 3, 6, 9, and 12 months annually for 3 years. For NPs and physicians, the mean slopes of the best fit lines, the final numeric score, and the mean net change between 12 and three month competencies were compared. Learner experience was captured qualitatively. ResultsThere was no statistical difference in the change of competency scores, the final competency scores, or the trajectory of improvement in the six competencies between physician to NP trainees. Adding NP trainees was considered by post-graduate trainees as a strength of the program, and did not detract from physician competence achievement. ConclusionAssessing an IPE post-graduate training program in HPC was possible using a shared clinical competency framework, and revealed similar clinical gains for NPs and physicians enrolled in the program.

Teaching medical ethics and medical professionalism in Saudi public and private medical schools.

Medical ethics and professionalism are two essential parts of building up the identity of a competent physician. This study was conducted to determine the nature, content, and methods of medical ethics and professionalism education in Saudi public and private medical schools. It also sought to identify the challenges and obstacles in teaching and assessing medical ethics and professionalism and suggest appropriate changes. A cross-sectional study was carried out in Saudi private and public medical schools. To achieve the study's aim, an assessment tool in the form of a novel self-administered questionnaire was developed, piloted, and then used. A representative from each of the 28 Saudi medical schools participated in the study. Twenty-four (82.1%) responding medical schools have no medical ethics department. Most of the medical schools (64.2%) have 25% or less of their faculty staff who teach ethics holding a qualification in medical ethics. Most schools have a specific course for medical ethics and professionalism (85.7% and 57.1%, respectively). Multiple-choice questioning is the most popular assessment method in medical ethics and professionalism courses (89.3% and 60.7%, respectively). The need for more qualified staff and clear guidelines/resources is a significant drawback to the teaching of medical ethics. Therefore, the study recommends developing national guidelines dedicated to the undergraduate teaching curriculum from which courses would be designed to enhance medical ethics and medical professionalism.

The Association Between Well-Being and Empathy in Medical Residents: A Cross-Sectional Survey.

Objective: To evaluate the extent to which personal well-being may be associated with empathy, while controlling for potential confounders. Settings/Location: Residency programs throughout the United States. Subjects: A total of 407 medical residents from residencies including general medicine, surgery, specialized and diagnostic medicine participated in this study. Outcome Measures: Well-being was measured using the modified existential well-being subscale of the spiritual well-being scale. Empathy was measured using the Jefferson Scale of Empathy. Results: Well-being was found to be positively correlated with empathy when adjusted for possible confounders (p < 0.001). In addition to well-being, other factors noted to be statistically significant contributors to higher empathy scores while controlling for the others included age, gender, year in residency, specialty, and work-hours (p < 0.05 for each). After controlling for these factors, a resident's year in residency was not found to be a statistically significant contributor to empathy score. Conclusions: In this study, well-being was associated with empathy in medical and surgical residents. Empathy is a fundamental component of physician competency, and its development is an essential aspect of medical training. These findings suggest that efforts to increase well-being may promote empathy among medical residents.

From Contract Surgeon to Town Doctor: The Life and Legacy of Dr. Martin Light Herr

Objectives The life and legacy of Dr. Martin L. Herr of Lancaster, PA helps to correct the popular perception that contract surgeons in the Civil War were nothing more than quacks and butchers when in fact they proved to be courageous and competent physicians essential to give medical care to overwhelming numbers of casualties. Methods Personal papers and archives of ML Herr in the Lancaster Historical Society (Lancaster, PA) were reviewed. Results ML Herr obtained his medical training and degree while serving as a contract surgeon during the Civil War. He transformed that experience to become a community leader and town physician and surgeon. His legacy helps to restore the reputation of contract surgeons to the honor they deserve. Conclusions Dr. ML Herr served both his fellow man and his community with distinction during the Civil War and in civilian life. He left the army, his country, the people of Lancaster, his family, and his profession better off because of his presence.

Explainable deep-neural-network supported scheme for tuberculosis detection from chest radiographs.

Chest radiographs are examined in typical clinical settings by competent physicians for tuberculosis diagnosis. However, this procedure is time consuming and subjective. Due to the growing usage of machine learning techniques in applied sciences, researchers have begun applying comparable concepts to medical diagnostics, such as tuberculosis screening. In the period of extremely deep neural nets which comprised of hundreds of convolution layers for feature extraction, we create a shallow-CNN for screening of TB condition from Chest X-rays so that the model is able to offer appropriate interpretation for right diagnosis. The suggested model consists of four convolution-maxpooling layers with various hyperparameters that were optimized for optimal performance using a Bayesian optimization technique. The model was reported with a peak classification accuracy, F1-score, sensitivity and specificity of 0.95. In addition, the receiver operating characteristic (ROC) curve for the proposed shallow-CNN showed a peak area under the curve value of 0.976. Moreover, we have employed class activation maps (CAM) and Local Interpretable Model-agnostic Explanations (LIME), explainer systems for assessing the transparency and explainability of the model in comparison to a state-of-the-art pre-trained neural net such as the DenseNet.

Training program for primary care physicians in medical rehabilitation at the Pacifi c Medical University

This article describes the experience of training primary care physicians in the field of medical rehabilitation. The existing procedure for the arrangement of medical rehabilitation prescribes its rules and order of implementation in medical primary health care organizations both in outpatient and day patient settings. The Pacific State Medical University (PSMU) runs training programs for primary care physicians within the 31.05.01 educational program “General Medicine”, direction “02 Healthcare”. In accordance with the curriculum, a training program “Medical Rehabilitation” that includes both lectures and training sessions was developed. This program is aimed at forming the necessary competencies of future primary care physicians in implementing and monitoring the effectiveness of the patient’s medical rehabilitation. Training is carried out at the facilities of the PSMU Institute of Clinical Neurology and Rehabilitation Medicine by specialists having experience in medical rehabilitation and having completed the program “Modern aspects of specialist training in the field of physical and rehabilitation medicine”.

Curriculum-based education in insomnia significantly improves primary care physician knowledge, competence and confidence

Curriculum-based education in insomnia significantly improves primary care physician knowledge, competence and confidence

The Value of Board Recertification Among Physicians.

An ongoing challenge among healthcare certifying organizations is identifying an effective manner of evaluating a physician's competency. The medical field is constantly changing, with new technology, research and pharmacology available, and physicians must be kept up to date in order to properly care for their patients. Maintenance of certification and specifically, recertification exams, are used to verify that a high standard of care is consistently met across all medical specialties. However, different countries have different structures in place to ensure physicians are kept abreast of the latest medical knowledge. For instance, American physicians must recertify themselves every ten years by passing a standardized exam to maintain their credentials. In comparison, Canadian physicians are not required to pass a formal examination. This contrast puts into question the value of the recertification exam in medical professional development programs. We outline the rectification situation in both Canada and the US and recommend MOC programs similar to Canada's, which does not require a recertification examination.

ОПЫТ ИСПОЛЬЗОВАНИЯ SWOT-АНАЛИЗА КАК ИНСТРУМЕНТА ПОВЫШЕНИЯ ЭФФЕКТИВНОСТИ УПРАВЛЕНИЯ МЕДИЦИНСКОЙ ОРГАНИЗАЦИЕЙ ПРИ ПРОВЕДЕНИИ СТРОИТЕЛЬСТВА, РЕКОНСТРУКЦИИ И КАПИТАЛЬНОГО РЕМОНТА

Significance. The principal attention of the Government of the Russian Federation and the Russian Ministry of Health is focused on health preservation and health promotion, development of conditions for increasing access to and quality of medical care, including infrastructure development, renewal and upgrade of material and technical resources of medical organizations, and introduction of new modern medical technologies. Construction, reconstruction, and capital repair of health care facilities are implemented within the framework of state programs and projects through budgetary funding with direct participation of head physicians as customers of project and construction works and responsible for the upkeep of medical organizations. The purpose of the study was to conduct a SWOT analysis and substantiate its use as a tool for increasing management efficiency of a medical organization during construction, reconstruction and capital repair. Material and methods. Research methods: analytical, classical methodology of SWOT analysis, content analysis, statistical, expert assessments. The study used the 2021-2022 data of the federal statistical observation form No. 30 “Information about a medical organization”, audit materials of the Accounts Chamber of the Russian Federation, and reports of the pilot constituent entities of the Russian Federation. A SWOT analysis of 20 state medical organizations participating in healthcare modernization programs was carried out in the following constituent entities of the Russian Federation: the Republics of Tatarstan, Crimea, the cities of Moscow and Sevastopol. Results of the study identified groups of factors that influence the current state of meeting the need for construction, reconstruction, and capital repair of medical organizations: external influence (opportunities and threats) that are not directly controlled by the management of a medical organization, as well as strengths and weaknesses, manageable at the local level. Conclusion. The conducted SWOT analysis of the current state of medical organizations show that efficient management of infrastructure development at a modern level, ensuring safe provision of accessible and high-quality medical care, is possible by improving the quality of initial decisions for pre-project documentation and construction (reconstruction) assignments, capital repair of medical organizations with the participation of head physicians. We consider it important to increase the level of competency of head physicians and their teams for implementing the above processes.

Impact Of Micro-education On Physician Knowledge, Competence, And Confidence Related To The Diagnosis And Treatment Of Transthyretin Cardiac Amyloidosis In Underserved Patient Populations

Impact Of Micro-education On Physician Knowledge, Competence, And Confidence Related To The Diagnosis And Treatment Of Transthyretin Cardiac Amyloidosis In Underserved Patient Populations

Formative key feature examinations as innovative teaching approach in dental education: A project report.

Clinical reasoning ability is one of the core competencies of physicians. It should already be trained during undergraduate medical education. At University Medical Center Göttingen (UMG), medical students can participate in formative key feature examinations in which they work on virtual patient cases in order to apply and deepen the procedural knowledge acquired in lectures and seminars. While this teaching format is already established in the medical curriculum at the UMG, it has not yet been implemented in the dental curriculum at the same institution. Therefore, the current project aimed to evaluate the feasibility of formative key feature examinations in dental education. In 2022, new key feature cases focusing on dental-surgical teaching content were created. For pilot testing, the new cases were worked on by two cohorts of dental students via an online learning platform in February 2023. The students were also asked to complete an anonymous online questionnaire in order to evaluate the new teaching format. Overall, the formative key feature examinations were evaluated positively by the dental students, and they demanded for further dental key feature cases. However, descriptive analyses of item characteristics as well as students' comments in the questionnaire revealed some potential for improvements, so that a few cases were partly revised afterwards. This project shows that formative key feature examinations are feasible in dental education and that dental students can benefit from working on virtual case scenarios. Whether dental students' clinical reasoning competence can be improved by completing formative key feature examinations is being investigated in an ongoing study at the UMG.

Medical-Legal Partnership Education Impacts Resident Physician Competencies Relating to Social Drivers of Health.

Medical-legal partnerships (MLPs) support patients and clinicians by streamlining legal and medical care and helping identify and address a subset of social drivers of health (SDOH). Less is known on the effect of MLPs on the competency of residents regarding SDOH. The aim of this study was to identify how integration of an MLP into a pediatric residency training program affected residents' experience understanding and addressing SDOH.

Development of Core Entrustable Professional Activities for Indonesian Undergraduate Medical Education: The Experience of Universitas Muhammadiyah Jakarta

Indonesia has implemented Competency-Based Education (CBE) since 2006 based on a national standard for physician competencies. This study aimed to develop Core Entrustable Professional Activities (EPAs) for Indonesian undergraduate medical programs to remedy the challenge of translating competencies into professional activities in CBE. Two rounds of modified Delphi were employed in October-November 2022. The research subjects selected were (i) experts in medicine such as internal medicine, surgery, medical education, etc., and (ii) medical teachers in the preclinical/clinical stage for two years or more. Fifteen experts were involved in both Delphi rounds. The first Delphi instrument referring to literature frameworks included 34 professional activities for individual healthcare tasks and 17 for family-community medicine/public health. The second Delphi instruments used were based on the first-round results. After the first Delphi, 31 individual healthcare tasks and all family-community medicine/public health tasks reached a consensus. One expert suggested two additional family-community medicine/public health activities. The second Delphi instrument listed the percentage of agreement for individual healthcare tasks and family-community medicine/public health tasks, including the two additional activities. After the second-round of Delphi, two individual healthcare tasks and one family-community medicine/public health task had not reached a consensus However, 94.7% of activities were still acceptable as Core EPAs in family-community medicine and public health services. In conclusion, developing EPAs for undergraduate medical programs using two rounds of the Delphi method resulted in 32 individual medical service activities and 18 family medicine-community/public health tasks. These core EPAs were expected to facilitate the translation of competencies into professional activities.

Sexual health preparedness among medical students

It has been found that many medical students and early career physicians express feelings of being unprepared and undereducated on topics relating to patient sexual health. Based on previous reports on the topic, the quality and quantity of sexual health education in medical school has been minimally improved over the last several years. Aim of the work is to identify possible deficiencies in sexual health preparation within current medical education curriculum among United States allopathic, osteopathic, and Caribbean medical programs. Medical students (n=100) from three different medical program types, including United States allopathic (n=31), United States osteopathic (n=23), and Caribbean allopathic program (n=46), and years of study (1-4), were recruited informally and participated in a 15-question survey regarding their perceptions and experience of sexual health education, training, and preparation at their respective medical school. After obtaining informed consent, students completed this survey through a private form and the data was compared to students of different years, different programs, and different intended specialties. With a sample size of 100 students from three different medical school programs, it was clear that most schools provide some level of sexual health education to students, however, in most cases, the education received was overall perceived as less than adequate by the students. Additionally, it was seen that almost every student indicated a need for their respective institution to provide additional training in both basic sciences as well as in their clinical education to feel more confident in their ability to discuss sexual health priorities with their patients. Current practices in medical education continue to fail to meet student expectations. To create more competent and confident physicians to adequately assist patients in their sexual health needs, more positive curriculum changes need to be made in order to establish a new, higher standard for quality of sexual health care. Small changes at the pre-clinical and clinical level can improve overall student preparedness and confidence when discussing sexual health with patients.

Family Medicine Residents' Knowledge and Attitudes About End-of-Life Care in Taif City, Saudi Arabia.

Background End-of-life care is essential for individuals with advanced illness and their families, providing comfort, symptom control, and dignity in the final year of life. Additionally, physician competence requires the ability to communicate, make decisions, and create relationships in end-of-life care. This study assesses family physicians' knowledge and attitude regarding end-of-life care in Taif, Saudi Arabia. Methods Thisdescriptive cross-sectional study conducted between October and November 2021 assessed the knowledge and attitudes of 163 family physicians in Taif City, Saudi Arabia, regarding end-of-life care. Using a convenient sampling technique, an adapted and validated questionnaire was administered electronically, collecting sociodemographic information and assessing participants' knowledge and attitudes. Data were analyzed using descriptive statistics in Statistical Product and Service Solutions (SPSS, version 28) (IBM SPSS Statistics for Windows, Armonk, NY). Results Findings included that 41.1% of residents believed the patient and family should be informed about diagnoses and prognoses in advanced diseases. At the same time, attitudes varied, with 45.4% agreeing that discussing such information could lead to patient depression and 42.9% believing it held no privilege for patients. Additionally, 57.7% recognized that grief reactions would occur, but patients would eventually adjust, and 44.8% agreed that discussing diagnoses would decrease patient anxiety. However, limited awareness of advance directives was evident, with 12.3% reporting being well aware and 45.4% having never heard of them. There was uncertainty and hesitancy regarding Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, with 39.9% being well aware and 46% having heard of it without a strong understanding. Conclusion The findings revealed a mixed landscape, with physicians demonstrating awareness of the importance of transparent communication but needing more knowledge in areas such as advance directives and complex decision-making. The study highlighted the need for targeted education to address these gaps and promote a more informed and consistent approach to end-of-life care.