Development Of Subspecialties Research Articles

New Directions, New Perspectives, and New Pathways in the Development of Subspecialties in General Medicine

Research Background: General medicine integrates content from clinical medicine, rehabilitation medicine, and social humanities. In the field of clinical medicine, its horizontal scope encompasses internal medicine, surgery, obstetrics and gynecology, pediatrics, emergency medicine, and other related disciplines. Research Objectives: The subspecialty development of general medicine aims to establish a specialized field with distinctive features based on the foundation of general medicine. It provides an explanation for the in-depth development and research in general medicine. This approach makes it easier to retain and attract outstanding talents, fully unleashing the interests of general practitioners. The development of subspecialties in general medicine aligns with the practical needs of China's primary healthcare institutions. It seeks to break the deadlock of general medicine being broad but not precise, addressing issues such as reducing patient medical expenses, improving patient satisfaction, and truly solving difficulties in seeking medical care. This allows large specialized hospitals to focus on researching tumor diseases and various specialized surgical procedures, thereby enhancing the diagnosis and treatment rates of tumors and rare diseases. Research Results: With the progress and practical experiences in society, the development of subspecialties in general medicine is set to become a goal, a new direction, a new perspective, and a new pathway for the global development of primary healthcare institutions. Research Conclusions: Cultivating doctors with expertise in subspecialties of general medicine for grassroots healthcare is essential to address the spectrum of specialized diseases, truly embodying a patient-centric approach and ensuring tangible benefits for patients. Currently, the development of subspecialties in general medicine is still in the exploration stage.

A Brief Discussion on the Specialty Development System of Chinese Medicine Practitioners in Hong Kong

Since the Subsidiary Law on Chinese Medicine Registration has been implemented by the Legislative Council of Hong Kong (HK) in 2000, the status of Chinese medicine (CM) has gradually improved. In addition, the first Chinese medicine hospital in HK will be operated in 2025. More and more HK citizens and Chinese medicine practitioners (CMPs) believe that there is a need to develop CM specialties. However, over the years, no major breakthrough in the HK CM specialty system development due to disagreements among CMPs on how to divide CM into specialties. This article aims to find out a possible CM specialty system by discussing the reasonable study time of specialties, treatment methods and diseases, sustainable development of subspecialties, and characteristics of CM. It is recommended that a three-year basic training on CM treatment skills, which are "Chinese Materia Medica", "Acupuncture and Moxibustion" and "Tuina", plus three-year advanced training on a disease basis by an independent specialist college. This structure provides a comparable structure to the current Western medicine specialty system with the possibility and feasibility for continuing development of the CM specialists that can temporarily satisfy the opinions of all parties. This suggested structure may act as a foundation to facilitate the discussion in the CM industry.

A journal as a mirror of continued progress in internal medicine. A century of <i>Polish Archives of Internal Medicine</i>

Internal medicine emerged as a new medical specialty in the second half of the 19th century. It was based on a novel diagnostic and therapeutic paradigm, and included pathophysiologic interpretation of physical examination, laboratory tests, and imaging techniques, in contrast with previous descriptive approach to clinical problems. Professor Edward J. Sas-Korczyński in 1891 proposed to organize Polish meetings on internal medicine. The proposal was implemented only in 1906 by Antoni W. Gluziński, a famous Polish internist. Despite obstacles set by the partitioning powers, the Society of Internists of the Polish Lands was founded. The name of the association was changed to the Polish Society of Internal Medicine during the congress held in Vilna (now Vilnius) in 1923, the first one organized in the independent Poland. The journal of the Society, Polish Archives of Internal Medicine, was founded and Antoni W. Gluziński was its first editor-in-chief. Later, the journal was edited by Władysław Janowski, Witold E. Orłowski, Andrzej Biernacki, Tadeusz Orłowski, Artur Czyżyk, and Anetta Undas. Witold E. Orłowski was a father of modern Polish internal medicine, and contributed to the development of its subspecialties and their societies. Most of them had roots in the specialist sections of the Polish Society of Internal Medicine. The journal supported the newly founded societies by publication of issues focused on selected subspecialties. Despite the development of subspecialties, the role of internal medicine as a holistic discipline covering the diagnosis and therapy of many organs does not decrease.

Emergency medicine: past, present, and future challenges

Emergency medicine: past, present, and future challenges

Awareness and Attitudes Around the New Subspecialty Within Ob/Gyn Called Complex Family Planning: A CERA Survey of Family Medicine Chairs.

Family physicians play an important role in delivery of family planning services, but many factors impact scope of practice. One important factor is the development of subspecialties, such as the new subspecialty within obstetrics and gynecology called complex family planning (CFP). In 2019, we conducted a survey of family medicine department chairs as part of the Council of Academic Family Medicine Educational Research Alliance survey. We used descriptive statistics and logistic regression to test for associations between program and chair characteristics, knowledge of CFP, and attitudes regarding family planning services (complex contraceptive counseling, pregnancy options counseling, first trimester miscarriage management, and pregnancy termination). The survey response rate was 54% (105/193). Only 8% of respondents were aware of the CFP subspecialty. The majority of chairs considered all queried family planning services as part of family medicine's scope of practice, including pregnancy termination by medication abortion (77%) and by uterine aspiration (60%). Chairs of departments with a faculty champion in family planning had higher odds of advocating for all queried family planning services as part of family medicine scope of practice (OR 3.0, 1.1-8.2) than those without a faculty champion. Few chairs are aware of the new subspecialty of CFP, but most would advocate to maintain some form of abortion care in family medicine's scope of practice. Given family medicine's role in the health care safety net, supporting faculty champions in family planning is important to preserve access to family planning services for marginalized communities.

Counterpoint: The 21st-century paradigm for recognition of dental specialties is not much different than the existing paradigm

BackgroundThe basis and rationale for recognition of specialties in the health care–related professions are similar. Recognition criteria are common across health care–related professions and include the demonstrated ability to form a certifying board, a distinct and well-defined field that requires unique knowledge and skills beyond general professional education, knowledge and skills that are separate and distinct from any other specialty, active contribution to research needs of the profession, direct benefit to some aspect of patient care, and the existence of formal, advanced education programs. A new paradigm that has been outlined does not appear to be significantly different from this existing paradigm. MethodsThe authors used archived, historic transcripts, transactions, and reports from the American Dental Association House of Delegates that are housed in the American Dental Association Library and Archives. In addition, information on specialty recognition from other health care–related professions was cited from the respective health care–related profession Web sites. ResultsThe authors believe the current paradigm of specialty recognition in dentistry comports with the paradigm of other health care–related professions. ConclusionsThe new paradigm that has been outlined does not appear to be significantly different from the existing paradigm. Subspecialization may be right for medicine but not necessarily needed for dentistry. Given that specialty recognition standards are virtually identical in all the health care–related professions, it begs the question as to what other factors unique to other health care–related professions have driven the development of subspecialties. Practical ImplicationsThere is no need to radically restructure the criteria or process of specialty recognition in dentistry.

Pediatric Endocrinology in India: Development, Progress, Problems and Challenges.

The exponential growth of biological sciences and biotechnology has promoted the development of subspecialties / super specialties in medicine. In developing countries, socioeconomic factors influence and determine competing health priorities, often delaying the development of subspecialties in medicine. Tracing the history of development and progress of Endocrinology in general and Pediatric Endocrinology in particular, provides an overall perspective of the problems and challenges which lie ahead.

Diagnosis and treatment of allergic diseases in Zhejiang Province: a cross-sectional survey.

The specialty of allergy developed quickly in western countries because of the rapid increase of allergic diseases, whereas it developed relatively slowly in China. The prevalence of allergen sensitization and allergic diseases in Zhejiang Province of China is high and improving the medical services for these diseases is critically needed. To investigate the working status of the diagnosis and treatment of allergic diseases, including doctor resources, diagnostic methods, and allergen-specific immunotherapy in patients of Zhejiang Province, and to provide instructions for the strategic development of subspecialties of allergic diseases. First we defined the doctors who treat allergic diseases, and designed a comprehensive questionnaire to collect personal and hospital information for these doctors. The questionnaires were distributed to hospitals with different ranks and from different areas in the province. The general condition of doctor's resources, carryout of diagnostic methods, and allergen-specific immunotherapy were described and variations in the different specialties, hospitals, and areas were further analyzed. Doctors in their thirties with bachelor's degrees were the mainstream for diagnosing and treating allergic diseases. The main specialties of the doctor resources were the specialties of Ear, Nose and Throat (ENT), Respirology, Pediatrics, and Dermatology. The Pediatrics specialty had a more reasonable infrastructure of doctor resources with more young doctors working in this subspecialty. The development of allergy subspecialty varied within hospitals at different levels or from different areas. The carryout of the skin prick test (SPT), serum specific IgE (ssIgE), and subcutaneous immunotherapy (SCIT) was best performed in provincial hospitals, while sublingual immunotherapy (SLIT) was prescribed most commonly in municipal hospitals. The performance of SPT and ssIgE in Hangzhou, Jiaxing, and Wenzhou areas was much better than that in other places. The performance of SCIT and SLIT was best in Wenzhou. Our survey revealed a very initial and unbalanced development for the allergy subspecialty in Zhejiang Province. Doctor resources for allergic diseases were mainly from the specialties of ENT, Respirology, and Pediatrics, and the performance of diagnosis and treatment was mainly focused on provincial and municipal hospitals. Continuous education of allergies could be extended to primary healthcare centers and more efforts should be directed to those areas with poor medical resources.

Setting up clinical nurse specialist services: what does our research tell us?

Over the past 50 years life expectancy in Britain has increased substantially, resulting in an increasing number of elderly people with long term conditions (Rosengren, 2012). Over the same timeframe we have seen the advent of cardiac care units, thrombolysis and more recently primary angioplasty for acute ST-segment elevation myocardial infarction (Walker et al, 2012). This has increased survival rates but there are potentially more elderly patients with complex cardiac disease including atrial fibrillation (Jernberg et al, 2011). The subsequent development of sub-specialties in heart disease has in turn given rise to the highly skilled clinical nurse specialist (CNS) role in areas including heart failure and arrhythmia management (Department of Health (DH), 2000a; DH, 2000b; DH, 2000c).

Urology in Asia – Malaysia

Urology in Asia – Malaysia

Addiction Medicine in Canada: Challenges and Prospects

ABSTRACT In Canada, the qualification of physicians is the jurisdiction of the College of Family Physicians and the Royal College of Physicians and Surgeons. The Colleges have promoted the training of “generalists” in family medicine and “sophisticated generalists” among the traditional specialties, and the development of subspecialties has not been encouraged. Nevertheless, due to the increasing number of family physicians and specialists practicing a range of new subspecialties, including addiction medicine, the College of Family Physicians has recognized special interest or focused practices, whereas the Royal College has recognized, in psychiatry, 3 subspecialties (child, geriatric, forensic) requiring an extra year of training and may offer others a diploma recognition. These new opportunities will shape the training requirements of addiction medicine leading to available certification through the International and American Medical Societies of Addiction Medicine.

In memorium: Rafael Gosalbez, MD

Our esteemed colleague and dear friend Dr. Rafael Gosalbez Jorda passed away on February 8th in Barcelona, Spain where he practiced medicine most of his life. Considered by many the forefather of Pediatric Urology in Spain he was born in Cocentaina, Alicante in 1929. His father Francisco, a physician and mother Rosa, a teacher clearly influenced his life long passion for reading and classical music. His early childhood was marked by the Spanish Civil War an experience that undoubtedly influenced him and fueled his passion for life.

Hyperbaric Medicine: A Potential Subspecialty for Emergency Medicine in Hong Kong?

As a clinical specialty matures, the development of subspecialties inevitably follows the subsequent explosion in knowledge. Even though Emergency Medicine is the youngest specialty in Hong Kong, it is no exception. As a model, the Society for Academic Emergency Medicine has formed dozens of interest groups, some of which have already been developed into Fellowship or subspecialty programmes by the American College of Emergency Physicians. Potential fields for subspecialty development in Emergency Medicine are summarised in Table 1.

Musings from Mayo

When I began my career in the Department of Neurology at Mayo in 1955, I was the 13th neurologist in the department. Although individual neurologists had special interests, every neurologist...

Subspecialty Training in Pediatric Anesthesiology

Subspecialty Training in Pediatric Anesthesiology

Which patients does the neurologist assist? Basis for a curriculum in neurology

To present the most frequent diagnosis of patients referred to a neurologist and to discuss the importance of this finding for the definition of the curriculum in Neurology. The development of subspecialties of Neurology is interfering in the definition of what should be taught to train a physician or a neurologist. The knowledge of which are the most common neurological diseases may contribute to construct these curricula. The initial diagnosis in 1815 outpatients referred to the neurologic service of an university-affiliated public hospital in São Paulo, Brazil, were analyzed. The most common diagnosis, in decreasing order of frequency were: headache, epilepsy, mental disorders, cerebrovascular disease, head injury, polyneuropathy, vestibular syndrome, spastic crural paraparesis, extrapyramidal syndrome, dementia, intracranial hypertension and facial palsy. The importance of the subspecialties in the curriculum should be related to the frequency of the neurologic diseases in the community.

The impact of subspecialties on obstetrics and gynecology: Presidential address

The role of subspecialties in obstetrics and gynecology was evaluated by a mail questionnaire to department chairpersons, members of the American Gynecological and Obstetrical Society, nonuniversity directors of obstetrics and gynecology residency programs, and others. Results from the questionnaire were evaluated by conventional statistical methods. The issues identified included subspecialties and the further development of our specialty in role modeling, enhanced education for both residents and students, and the recruitment of a higher-quality resident for our speciatly. Additional issues included: Were subspecialties a mistake, and have they fragmented our specialty? Some of the results include the following: (1) More than 90% of respondents agree that subspecialties have helped in the development of obstetrics and gynecology. (2) The subspecialties have enhanced our image in medical schools (88%) and in the community hospitals (77%). (3) The education of medical students (73%) and of residents (86%) has been enhanced by the development of subspecialties. (4) As predicted, the subspecialties have fragmented our specialty (69%), but patient care has not suffered. (5) Disagreement is noted between chairpersons and other respondents that a higher-quality resident is going into subspecialties, but all agreed that the improved quality of residents was due to the development of subspecialties. (6) Only 10% of respondents wished subspecialties had never been developed as contrasted to 82% of all respondents who felt they were commendable. (7) If another subspecialty area is to be identified, more respondents prefer reproductive urology than the next two areas combined.

Primary Care Physicians Performing Biopsy Procedures

To the Editor. —We read with great interest the editorial in the July issue of theArchives, Is It Appropriate for Primary Care Physicians to Perform Skin Biopsies? by Weinstein and coworkers. 1 The authors discuss the issues involved with performing procedures commonly utilized by both primary care and physicians. Our concern is the bias expressed at the beginning of their editorial, which states that skin biopsy is traditionally a subspecialty procedure. Generalist physicians have been performing skin biopsy procedures for many years and, certainly, prior to the development of subspecialties. The tradition of this procedure clearly lies with generalist physicians. Although much primary care training is relatively new, and there are controversies regarding the extent of training in procedures for new primary care physicians, a procedure such as skin biopsy is fundamental to the generalist physician. Skin biopsy is an essential procedure taught to family practice residents.

Family practice: quality and credibility.

The decline of general practice as an acceptable mode of medical-care delivery began with the publication of the Flexner Report. This decline was further accelerated by the emergence of the specialty boards in the 1930's. Because of increasing doubts concerning the competence and qualifications of general practitioners, the rapid development of subspecialties and the geometric increase in medical knowledge, the decades after World War II almost killed general practice. The passing of the family physician was a real and distinct possibility. The decline was slowed by the emergence of the American Academy of General Practice in 1948. Reversal of the . . .

Subspecialization in obstetrics and gynecology

The formal development of subspecialties within obstetrics and gynecology has focused attention on problems of physician supply and demand. The need for subspecialized practitioners appears to be 750 in maternal-fetal medicine and 350 each in reproductive endocrinology and gynecologic oncology. Taken together, this number represents about 10 per cent of presently certified specialists. As supply is now developing, the demand in gynecologic oncology should soon be saturated, but there will be a longer term demand in maternal-fetal medicine and in reproductive endocrinology. However, the expectation of 30 per cent of present residents that they will enter subspecialties is far in excess of available fellowships or ultimate need. Fellowships leading to subspecialty certification should be approved by the Residency Review Committee, and numbers should be limited to best estimate of need.