European Federation Of Internal Medicine Research Articles

Applications to augment patient care for Internal Medicine specialists: a position paper from the EFIM working group on telemedicine, innovative technologies & digital health.

Telemedicine applications present virtually limitless prospects for innovating and enhancing established and new models of patient care in the field of Internal Medicine. Although there is a wide range of innovative technological solutions in Europe, there are overarching elements associated with such technologies when applied to the practices of Internal Medicine specialists. The European Federation of Internal Medicine (EFIM) strongly advocates for active leadership and influence from the Internal Medicine societies and specialist physicians across Europe in the development and application of telemedicine and digital technologies in healthcare. This position paper's conclusions were drawn via Delphi method, which was developed collaboratively from July 2021 to December 2023. The panel, consisting of experts in clinical medicine, public health, health economics and statistics, assessed various aspects related to telemedicine. Participants assigned scores on a Likert scale reflecting perceived value and potential risks. The findings were consolidated in a comprehensive checklist aligning with relevant literature and a SWOT analysis. Specifically, key issues that need to be addressed include promoting the professional development of e-health competencies in the healthcare and medical workforce, using educational campaigns to promote digital literacy among patients and caregivers, designing and implementing telemedicine applications tailored to local conditions and needs and considering the ethical and legal contexts under which these applications are employed. Importantly, there is currently no consensus on care models or standardized protocols among European Internal Medicine specialists regarding the utilization of telemedicine. This position paper aims to outline the opportunities and challenges associated with the application of telemedicine in Internal Medical practice in Europe.

Development and validation of a new self-assessment tool to measure professionalism among medical students.

Professionalism is a key quality that medical students should possess, but it is difficult to define and assess. Current assess-ment tools have room for improvement. This study aimed to design and validate a self-assessment tool to assess professionalism among medical students. A questionnaire was created based on 10 tenets of professionalism from the Charter on Medical Professionalism jointly published by the American Board of Internal Medicine Foundation, American College of Physicians Foundation and European Federation of Internal Medicine, along with input from Singapore guides. The self-administered questionnaire was administered to Year 2 to 5 students from Yong Loo Lin School of Medicine, National University of Singapore in a voluntary, anonymised manner in the academic year of 2019/2020. Construct validity and internal reliability were evaluated using Principal Component Analysis (PCA) and Cronbach's alpha, respectively. There was a total of 541 respondents. After removing incomplete responses, 504 responses were included. Following PCA, a 17-item questionnaire titled "Medical Professionalism: A Self-assessment Tool" (MPAST) with a 5-component solution was obtained. The 5 components were commit-ment to: (1) patient's best interest, (2) honesty and integrity, (3) professional competency, (4) patient safety and care, and (5) educational responsibilities. Their Cronbach's alpha value ranged from 0.540 to 0.714, with an overall Cronbach's alpha value of 0.777. MPAST is valid, reliable, practical, and is the first validated self-assessment tool to assess professional attributes and behaviours among medical students, to our knowledge.

7-й день Европейской Федерации внутренней медицины (EFIM)

7-й день Европейской Федерации внутренней медицины (EFIM)

General health check-ups: To check or not to check? A question of choosing wisely

In high-income countries, regular general health check-ups are part of the fabric of the health care systems. The hidden concept of general health check-ups, promoted for more than a century, is to identify diseases at a stage at which early intervention can be effective. However, there has been little evidence to support the benefits of such checkups. Choosing wisely (CW) campaigns may represent a tremendous opportunity to eventually shift patients and physicians away from the non–evidence based yet firmly entrenched practice of the general health check-up. As campaign leaders and members of the CW working group of the European Federation of Internal Medicine, we want to join the discussion by giving our perspective based on the best available evidence.

Physicians’ responsibility toward environmental degradation and climate change: A position paper of the European Federation of Internal Medicine

The current data on climate change and environmental degradation are dramatic. The consequences of these changes are already having a significant impact on people's health. Physicians — as advocates of the patients, but also as citizens — have an ethical obligation to be involved in efforts to stop these changes. The European Federation of Internal Medicine (EFIM) strongly encourages the Internal Medicine societies and internists across Europe to play an active role in matters related to climate change and environmental degradation. At a national level, this includes advocating the adoption of measures that reduce greenhouse gas (GHG) emissions and environmental degradation and contributing to policy decisions related to these issues. At a hospital level and in clinical practice, supporting actions by the health sector to reduce its ecological footprint is vital. At the level of EFIM and its associated internal societies, promoting educational activities and developing a toolkit to prepare internists to better care for citizens who suffer from the consequences of climate change. In addition to advocating and implementing effective actions to reduce the ecological footprint of the health industry, recommending the introduction of these themes in scientific programs of Internal Medicine meetings and congresses and the pre- and postgraduate medical training. At a personal level, internists must be active agents in advocating sustainable practices for the environment, increasing the awareness of the community about the health risks of climate change and environmental degradation, and being role models in the adoption of environmentally friendly behaviour.

Awareness of sex and gender dimensions among physicians: the European federation of internal medicine assessment of gender differences in Europe (EFIM-IMAGINE) survey

Sociocultural gender is a complex construct encompassing different aspects of individuals’ life, whereas sex refers to biological factors. These terms are often misused, although they impact differently on individuals’ health. Recognizing the role of sex and gender on health status is fundamental in the pursuit of a personalized medicine. Aim of the current study was to investigate the awareness in approaching clinical and research questions on the impact of sex and gender on health among European internists. Clinicians affiliated with the European Federation of Internal Medicine from 33 countries participated to the study on a voluntary basis between January 1st, 2018 and July 31st, 2019. Internists’ awareness and knowledge on sex and gender issues in clinical medicine were measured by an online anonymized 7-item survey. A total of 1323 European internists responded to the survey of which 57% were women, mostly young or middle-aged (78%), and practicing in public general medicine services (74.5%). The majority (79%) recognized that sex and gender are not interchangeable terms, though a wide discrepancy exists on what clinicians think sex and gender concepts incorporate. Biological sex and sociocultural gender were recognized as determinants of health mainly in cardiovascular and autoimmune/rheumatic diseases. Up to 80% of respondents acknowledged the low participation of female individuals in trials and more than 60% the lack of sex-specific clinical guidelines. Internists also express the willingness of getting more knowledge on the impact of sex and gender in cerebrovascular/cognitive and inflammatory bowel diseases. Biological sex and sociocultural gender are factors influencing health and disease. Although awareness and knowledge remain suboptimal across European internists, most acknowledge the underrepresentation of female subjects in trials, the lack of sex-specific guidelines and the need of being more informed on sex and gender-based differences in diseases.

2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report

2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report

How physicians can empower patients with digital tools

BackgroundWhile there is broad consensus that the use of digital tools would significantly improve patient empowerment, to date, an improvement in health outcomes has been elusive.ObjectiveThe objective of this study was to assess how to improve the ability of physicians to empower patients with digital tools.MethodsWe conducted a web-based survey using SurveyMonkey over nearly 6 months. A questionnaire was sent with an email, explaining the aims of the survey and providing a link to complete the web-based questionnaire, to the heads of each of the 37 medical national societies adhering to the EFIM (European Federation of Internal Medicine), inviting them to disseminate the questionnaire among their members.ResultsTwo hundred and eighteen responses were received. They suggest that the main success factors in increasing and improving patient empowerment with digital tools and realizing health goals are clinical evidence, followed by patient/physician involvement in the design, tools designed around the real needs of the patient, and reimbursement. Most of the respondents who have already prescribed digital tools for patient empowerment are just enough satisfied with the results achieved by their patients. Interestingly, 18% of the respondents had spent more than 30 min on the visit of patient to doctor. However, the majority devoted only 5–9 min to illustrating the suggested digital tools.ConclusionsAccording to the respondents, clinical evidence, motivation, physician and patient’s involvement in design, and reimbursement, as well as organizations’ appropriate business models and support, are the main determinants of the diffusion and effective adoption of digital tools for successful patient empowerment in internal medicine.

Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine

Point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. It has many uses in daily clinical practice, including improved diagnostic timeliness and accuracy, and providing information about a patient's prognosis and follow-up. It has been integrated into numerous specialities, but remains relatively undefined in internal medicine training programs. Ultrasonography is a useful tool in the standard clinical practice of internists in numerous clinical scenarios (Emergency Department, hospital ward, general and specific consultations, and home care). Although POCUS has been recently included in the European curriculum of internal medicine, there are differences between European internists in its use, ranging from not at all to well structured educational programs. The use of POCUS needs to be widespread in internal medicine departments, and to accomplish this we must encourage structured training. This document details the consensus-based recommendations by the European Federation of Internal Medicine (EFIM) Ultrasound working group. We establish POCUS core competencies and clinical settings for internists in a symptom-based approach. We also propose training requirements, providing a framework for training programs at a national level.

2018 ESC Guidelines for the diagnosis and management of syncope

The Task Force for the diagnosis and management of syncope of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) Endorsed by: European Academy of Neurology (EAN), European Federation of Autonomic Societies (EFAS), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), European Society of Emergency Medicine (EuSEM) (text is available in electronic version doi:10.15829/1560-4071-2019-7-130-194)

The Romanian Society of Internal Medicine’s Choosing Wisely Campaign

Quality of care in medicine is not necessarily proportional to quantity of care and excess is often useless or even more, potentially detrimental to our patients. Adhering to the European Federation of Internal Medicine's initiative, the Romanian Society of Internal Medicine (SRMI) launched the Choosing Wisely in Internal Medicine Campaign, aiming to cut down diagnostic procedures or therapeutics overused in our country. A Working Group was formed and from 200 published recommendations from previous international campaigns, 36 were voted as most important. These were submitted for voting to the members of the SRMI and posted on a social media platform. After the two voting rounds, the top six recommendations were established. These were: 1. Stop medicines when no further benefit is achieved or the potential harms outweigh the potential benefits for the individual patient. 2. Don't use antibiotics in patients with recent C. difficile without convincing evidence of need. 3. Don't regularly prescribe bed rest and inactivity following injury and/or illness unless there is scientific evidence that harm will result from activity. Promote early mobilization. 4. Don't initiate an antibiotic without an identified indication and a predetermined length of treatment or review date. 5. Don't prescribe opioids for treatment of chronic or acute pain for sensitive jobs such as operating motor vehicles, forklifts, cranes or other heavy equipment. 6. Transfuse red cells for anemia only if the hemoglobin concentration is less than 7 g/dL or if the patient is hemodynamically unstable or has significant cardiovascular or respiratory comorbidity. Don't transfuse more units of blood than absolutely necessary.

Medical and surgical co-management – A strategy of improving the quality and outcomes of perioperative care

With the increase of ageing population, rates of chronic diseases and complex medical conditions, the management of high-risk surgical patients is likely to become a great concern in most countries. Considering all these factors, it is certainly rational and intuitive that internists should be included into a collaborative model of medical and surgical co-management, where their multi-potentiality and synthesis capacity require them to coordinate the multidisciplinary team and to be the leading agent of change. In this regard, our aim was to present the official position and approach of the Working Group on Professional Issues and Quality of Care of the European Federation of Internal Medicine (EFIM), for implementation of this strategy of care, encouraging internists to assume an important role and to provide continuity of multidisciplinary care, from the decision to operate through to rehabilitation and recovery. Moving from the traditional model of medical care of the surgical patients to the co-management model, from a reactive simple consultation to a new pro-active continued service, may optimize the quality and perioperative care, improving the survival, shortening hospital stays, replacing the old strategy of late and complication treatment to an early and preventive one.

Hospital ambulatory medicine: A leading strategy for Internal Medicine in Europe

Addressing the current collision course between growing healthcare demands, rising costs and limited resources is an extremely complex challenge for most healthcare systems worldwide. Given the consensus that this critical reality is unsustainable from staff, consumer, and financial perspectives, our aim was to describe the official position and approach of the Working Group on Professional Issues and Quality of Care of the European Federation of Internal Medicine (EFIM), for encouraging internists to lead a thorough reengineering of hospital operational procedures by the implementation of innovative hospital ambulatory care strategies. Among these, we include outpatient and ambulatory care strategies, quick diagnostic units, hospital-at-home, observation units and daycare hospitals. Moving from traditional ‘bed-based’ inpatient care to hospital ambulatory medicine may optimize patient flow, relieve pressure on hospital bed availability by avoiding hospital admissions and shortening unnecessary hospital stays, reduce hospital-acquired complications, increase the capacity of hospitals with minor structural investments, increase efficiency, and offer patients a broader, more appropriate and more satisfactory spectrum of delivery options.

The physician charter on medical professionalism; A perspective from the Arab world

Professionalism is the basis of medicine’s contract with society. In 2002 the American board of Internal Medicine foundation, American College of Physicians-American society of Internal Medicine foundation and the European Federation of Internal Medicine listed three fundamental principles and 10 professional responsibilities that characterize professionalism in the Physician charter. The three fundamental principles described in the charter were; principle of patient welfare, principle of patient autonomy and principle of social justice . However, the application of such principles has its own challenges whether it is a Western culture or an Eastern culture with Religion playing a significant role on the definition of medical professionalism in the Arab and Muslim world compared to the western world. A better understanding of medical professionalism in all cultures and religions is of key importance. Being aware of this concept and applying it into practice will need proper training and adaptability. It is imperative that we respect the patients’ cultural and religious backgrounds when treating our patients. In the Muslim and Arab world we face challenges in practicing and teaching medical professionalism that will require establishing a medical professionalism physician charter that is unique to the Muslim and Arab world.

Moving to high-value care: more thoughtful use of cardiopulmonary resuscitation.

In this commentary, leaders of the European Federation of Internal Medicine and American College of Physicians remind physicians of the importance of discussing patient preferences for cardiopulmon...

ESIM Winter School 2015, Riga, Latvia

Of course we were delighted to have ‘won’ something for our efforts although neither of us really new what we had ‘won’. A trip to the ESIM Winter School in Riga, Latvia we were told was our prize courtesy of the Society for Acute Medicine (SAM). But what is ESIM? It stands for the European School of Internal Medicine (ESIM), an educational part of a larger organisation the European Federation of Internal Medicine (EFIM). We both have to confess we knew nothing about either organisation.

What is the role of general internists in the tertiary or academic setting?

The changing demography of European populations mandates a vital role for internists in caring for patients in each level of healthcare. Internists in the tertiary or academic setting are highly ranked in terms of their responsibilities: they are clinicians, educators, researchers, role models, mentors and administrators. Contrary to the highly focused approach of sub-specialties, general internists working in academic settings can ensure that coordinated care is delivered in the most cost-conscious and efficient way. Moreover, internal medicine is one of the most appropriate specialties in which to teach clinical reasoning skills, decision-making and analytical thinking, as well as evidence based, patient oriented medicine. Internists deal with challenging patients of the new millennium with a high burden of chronic diseases and polypharmacy; practice personalised medicine with a wide scientific background and so they are the perfect fit to establish and implement new tools for scientific research.In conclusion, internal medicine is developing a new identity as a specialty in its own right. The European Federation of Internal Medicine supports the concept of academic internists and calls upon the member countries to construct academic (general) internal medicine departments in their respective countries. As ‘internal medicine is the cornerstone of every national healthcare system’, academic (general) internal medicine should strive to be the cornerstone of every integrated, patient-centred, modern medical care and training system.

Fellowship Engagement in Hematology/Oncology Professionalism Training

DOI: 10.1200/JCO.2013.54.6879 The patient, Mr J (all names changed to protect privacy), presented late to the medical system with advanced disease, and his condition was rapidly deteriorating. Despite a biopsy that resulted in a large tumor sample, extensive necrosis made a pathologic diagnosis difficult. The oncology fellow on service, Dr A, spent a large amount of time at the patient’s bedside, talking to multiple family members, who did not seem to be communicating well with each other. Estranged family members had appeared and were asking for “everything” to be done. The patient and his wishes were becoming lost in the turmoil. As the prognosis became clear—a meaningful response to therapy was not expected and Mr J would soon die as a result of his cancer—the oncology attending, Dr Z, called for a family meeting. Because the patient was no longer communicative, the meeting would take place without him present. The only time that could be mutually agreed upon as being best for the family was while the fellow, Dr A, was in the clinic. Dr Z had met the patient and family on several occasions, but Dr A had taken the lead and provided almost all of the communication of critical information to the family. As Dr Z led the family meeting, she outlined the clinical information, discussed the patient’s rapid decline, and reviewed Mr J’s wishes. Because Mr J was actively dying, Dr Z recommended a transition to a focus on palliation and supportive care. She had expected to meet denial or anger, but instead she was met with resigned acceptance. The family’s greatest concern was continuity of care for their patriarch. Dr Z reassured the family that the palliative care team was excellent. Mr J’s oldest son then made one final request, “As long as Dr A will stay involved. Dr A has met with us every day, sometimes very late into the evening. He’s met with my siblings and cousins and has been a source of information and comfort to us during this difficult time. He always treats Dad with respect, and Dad trusts him.” In the preceding vignette, the behavior of the oncology fellow, Dr A, is an example of the type of professionalism we wish to foster and ensure in the next generation of practicing oncologists. But how do we teach this? The accrediting body for residency training programs in the United States, the Accreditation Council for Graduate Medical Education (ACGME), established professionalism as one of the six core competencies that all residency and fellowship programs should be imparting. This competency requires that residents and fellows demonstrate compassion, integrity, and respect for others; responsiveness to patient needs that supersedes self-interest; respect for patient privacy and autonomy; accountability to patients, society, and the profession; and sensitivity and responsiveness to a diverse patient population. In 2002, the American Board of Internal Medicine, the American College of Physicians, and the European Federation of Internal Medicine jointly authored a decree, a physician charter, establishing a contemporary definition of medical professionalism and outlining a set of fundamental principles. These principles echo those of the ACGME core competency, including a commitment to the primacy of patient welfare, patient autonomy, and the principle of social justice. And, although professionalism is not a domain specific to the subspecialty of oncology, following the basic tenets of medical professionalism—patient autonomy, social justice, and the importance of patient welfare—is an imperative in the daily practice of all medical specialties. For example, two key aspects of professionalism that are essential in oncology are the need to maintain trust by avoiding conflicts of interest and the commitment to the proper use of knowledge on the basis of scientific evidence and guidelines, reinforced by lifelong learning. In most hematology/oncology (HemOnc) fellowship training programs, professionalism is cultivated by setting clear performance expectations, documenting and evaluating supervised behaviors, and providing direct feedback to trainees. Expectations can be established through the use of programmatic rules and policies such as the adoption of the American Medical Association’s Code of Ethics and hospital staff bylaws. Documentation of appropriate conference attendance and JOURNAL OF CLINICAL ONCOLOGY A R T O F O N C O L O G Y VOLUME 32 NUMBER 11 APRIL 1

Bushido and Medical Professionalism in Japan

Medical professionalism has become a core topic in medical education. As it has been considered mostly from a Western perspective, there is a need to examine how the same or similar concepts are reflected in a wider range of cultural contexts. To gain insights into medical professionalism concepts in Japanese culture, the authors compare the tenets of a frequently referenced Western guide to professionalism (the physician charter proposed by the American Board of Internal Medicine Foundation, American College of Physicians Foundation, and the European Federation of Internal Medicine) with the concepts of Bushido, a Japanese code of personal conduct originating from the ancient samurai warriors. The authors also present survey evidence about how a group of present-day Japanese doctors view the values of Bushido.Cultural scholars have demonstrated Bushido’s continuing influence on Japanese people today. The authors explain the seven main virtues of Bushido (e.g., rectitude), describe the similarities and differences between Bushido and the physician charter, and speculate on factors that may account for the differences, including the influence of religion, how much the group versus the individual is emphasized in a culture, and what emphasis is given to virtue-based versus duty-based ethics.The authors suggest that for those who are teaching and practicing in Japan today, Bushido’s virtues are applicable when considering medical professionalism and merit further study. They urge that there be a richer discussion, from the viewpoints of different cultures, on the meaning of professionalism in today’s health care practice.

The practice of internal medicine in Europe: organisation, clinical conditions and procedures

BackgroundCurrent information on the role of internists in the European countries is scarce. This report describes the results of a survey of the practice of internists in Europe. MethodsTwo online questionnaire-based surveys were carried out by the European Board of Internal Medicine, one on the practice of internists and the other on postgraduate training in internal medicine. The national internal medicine societies of all 30 member countries of the European Federation of Internal Medicine were invited to participate. The responses were reviewed by internal medicine trainees from the respective countries and summaries of the data were sent to the national societies for approval. Descriptive analysis of the data on the practice of internists was carried out. ResultsTwenty-seven countries (90%) completed the questionnaire and approved their datasets. In 8 European countries, most internists practised internal medicine alone and in 7 countries at least half of physicians practised internal medicine together with a subspecialty. Internal medicine was considered a hospital-based specialty in most countries. The majority of selected presenting problems and diagnoses were rated as commonly encountered in all countries. More variability between countries was observed in the performance of diagnostic and therapeutic procedures. ConclusionMany similarities exist in the practice of internal medicine between the European countries, while some differences are present that likely reflect the variable impact of subspecialisation. The results of the survey should prove valuable for the definition of specific competencies and development of a common curriculum for internal medicine at the European level.