Generation Of Doctors Research Articles

Professor Solomon Posen, MD, FRACP, FRCP: 1924–2016—Physician, Scientist, Mentor

Professor Solomon Posen, MD, FRACP, FRCP: 1924–2016—Physician, Scientist, Mentor

Medical students developing confidence and patient centredness in diverse clinical settings: a longitudinal survey study.

BackgroundMedical student clinical confidence and positive attitudes to patient centredness are important outcomes of medical education. The clinical placement setting is regarded as a critical support to these outcomes, so understanding how the setting is influential is important. The aim of this study was to compare students’ attitudes towards patient-centredness and clinical confidence as they progressed through their medical course, and understand the influence of diverse clinical placement zones.MethodsStudents at one Australian medical school completed a questionnaire at the beginning of second year and at the end of their third year of medical training. The questionnaire measured attitudes to patient centred care, clinical confidence, role modelling experiences and clinical learning experiences. Descriptive analyses investigated change in these attitudes over time. Repeated measures analysis of variance was used to assess the influence of placement location on each variable of interest. Responses to two open-ended questions were also coded by two researchers and themes were identified.ResultsStudent confidence increased over the course of two years of clinical training (p < 0.001), but attitudes to patient centredness (p = 0.933) did not change. The location of clinical placements (urban, outer urban and rural) was unrelated to levels of confidence or patient centredness. Students had positive attitudes towards patient-centredness throughout, and noted its importance in contributing to quality care. Patient-centred care was encouraged within the clinical placements, and was influenced by positive and negative role modelling, direct teaching, and opportunities to practise patient-centred care.ConclusionsA new generation of doctors with a strong patient-centred focus is emerging. Medical schools have a responsibility to facilitate clinical placements that will support the acquisition and maintenance of skills in patient centred care through positive role modelling.

Creating an open door for all talent

For too long, the United Kingdom has relied on a plentiful supply of privileged and affluent young students to supply its next generation of doctors. This week Patrice Baptiste argues that more needs to be done to encourage students from a wider range of backgrounds to apply to medical school (http://careers.bmj.com/careers/advice/Medical\_school\_should\_not\_be\_the\_preserve\_of\_the_elite). At the moment …

Books: The Coalbrookdale Doctors. A Family Practice In Shropshire, 1770-1870

The Coalbrookdale Doctors: A Family Practice in Shropshire, 1770–1870 Richard Moore YouCaxton Publications, 2014, PB, 198pp, £12.99, 978-1909644304 Coalbrookdale is a small village in Shropshire that contributed to the development of the manufacturing industry through production of iron ore and was home to the famous industrialist Abraham Darby. Richard Moore takes a fascinating look at the life and work of three generations of doctors from the same family who lived and worked in Coalbrookdale between 1770 and 1870. The village, and the …

Residents values in a rational decision-making model: an interest in academics in emergency medicine

Academic physicians train the next generation of doctors. It is important to understand the factors that lead residents to choose an academic career to continue to effectively recruit residents who will join the national medical faculty. A decision-making theory-driven, large scale assessment of this process has not been previously undertaken. To examine the factors that predict an Emergency resident's interest in pursuing an academic career at the conclusion of training. This study employs the ABEM Longitudinal Survey (n=365). A logistic regression model was estimated using an interest in an academic career in residency as the dependent variable. Independent variables include gender, under-represented minority status, survey cohort, number of dependent children, possession of an advanced degree, ongoing research, publications, and the appeal of science, independence, and clinical work in choosing EM. Logistic regression resulted in a statistically significant model (p<0.001). Residents who chose EM due to the appeal of science, had peer-reviewed publications and ongoing research were more likely to be interested in an academic career at the end of residency (p<0.05). An increased number of children (p<0.05) was negatively associated with an interest in academics. Individual resident career interests, research productivity, and lifestyle can help predict an interest in pursuing an academic career. Recruitment and enrichment of residents who have similar values and behaviors should be considered in programs interested in generating more graduates who enter an academic career.

Integrating global health with medical education.

Globalisation has implications for the next generation of doctors, and thus for medical education. Increasingly, global health is being taught in medical schools, although its incorporation into an already full curriculum presents challenges. Global health was introduced into the MBChB curriculum at the University of Aberdeen through a student-selected component (SSC) as part of an existing medical humanities block. The Global Health and Humanities (GHH) module was first delivered in the autumn of 2013 and will shortly enter its third year. This student-led study used quantitative and qualitative methods to assess the module's appropriateness and effectiveness for strengthening learning on global health, consisting of online surveys for course participants and semi-structured interviews with faculty members. Integrating global health into the undergraduate medical curriculum by way of an SSC was regarded by teaching staff as an effective and realistic approach. A recognised strength of delivering global health as part of the medical humanities block was the opportunity to expose students to the social determinants of health through interdisciplinary teaching. Participating students all agreed that the learning approach strengthened both their knowledge of global health and a range of generic skills. SSCs are, by definition, self-selecting, and will have a tendency to attract students already with an interest in a topic - here global health. A wide range of learning opportunities is needed to integrate global health throughout medical curricula, and to reach all students.

Access to palliative care: insights into ground realities post-2014 amendment to NDPS Act

Medical practice today is disease-focused, ignoring the universally accepted definition of health as not just the absence of disease, but the promotion of complete physical, social and mental well-being. Generations of doctors in India have not studied modern pain management, and palliative care is practically unknown in most parts of the country, causing patients to be rejected by hospitals and doctors when they need help the most. The draconian Narcotic Drugs and Psychotropic Substances (NDPS) Act of 1985, outdated medical and nursing education, lack of public awareness and lack of clear governmental policy are responsible for this sorry state of affairs. The development of a community-oriented palliative care network eventually led to the formulation of a state palliative care policy in Kerala. The acceptance of palliative care as a medical specialty by the Medical Council of India and introduction of a postgraduate degree course in palliative medicine in 2010, the development of a National Programme for Palliative Care in 2012 by the Ministry of Health of the Government of India, and the amendment of the NDPS Act in 2014 have been major positive developments which have the potential to change the current state of affairs. However, these recent achievements represent but one step in the right direction. An improvement in palliative care education, a realistic palliative care policy and implementation of the NDPS Amendment Act are necessary for doing away with the gross, needless violation of the human right to life with dignity.

A Journey from Surgeon to Surgeon Entrepreneur

We all have the idea that entrepreneurship is something best left to the businessmen community, and doctors, being in a profession that demands so much of personal time and effort, and without any formal training in business management, should steer clear of it. However, our society demands that people from all walks of life, doctors included, should show innovation and enterprise, and be capable of making the best of available opportunities so as to commercialize new technologies, create new jobs, open new markets and create value by combining resources in exciting new ways. Here, I share my own experiences and also express my thoughts and ideas which I feel can help the newer generation of doctors become successful entrepreneurs.

Making Meaning From Scientific Investigations and Living With the Uncertainties of Teaching Science as Inquiry

In the push to ensure basic literacy and numeracy skills in all the world's children (a target of the Millennium Development Goals), education in other areas, including science, music, and art, has been overlooked. To produce the next generation of doctors, researchers, and engineers needed to address the global health, governance, and climate change challenges that predate them, science education must be of the highest quality. That means going beyond memorization of facts to include lessons in the process of science. This scientific learning builds the skills of inquiry, investigation, and intellectual flexibility that encourage children to solve problems instead of tolerating the status quo. In this article, the author contrasts the process of true scientific learning with typical “science” lessons and calls for inquiry-based learning for lasting, meaningful science education.

The Impact of Medical Student Participation in Emergency Medicine Patient Care on Departmental Press Ganey Scores.

IntroductionPress Ganey (PG) scores are used by public entities to gauge the quality of patient care from medical facilities in the United States. Academic health centers (AHCs) are charged with educating the new generation of doctors, but rely heavily on PG scores for their business operation. AHCs need to know what impact medical student involvement has on patient care and their PG scores.PurposeWe sought to identify the impact students have on emergency department (ED) PG scores related to overall visit and the treating physician’s performance.MethodsThis was a retrospective, observational cohort study of discharged ED patients who completed PG satisfaction surveys at one academic, and one community-based ED. Outcomes were responses to questions about the overall visit assessment and doctor’s care, measured on a five-point scale. We compared the distribution of responses for each question through proportions with 95% confidence intervals (CIs) stratified by medical student participation. For each question, we constructed a multivariable ordinal logistic regression model including medical student involvement and other independent variables known to affect PG scores.ResultsWe analyzed 2,753 encounters, of which 259 (9.4%) had medical student involvement. For all questions, there were no appreciable differences in patient responses when stratifying by medical student involvement. In regression models, medical student involvement was not associated with PG score for any outcome, including overall rating of care (odds ratio [OR] 1.10, 95% CI [0.90–1.34]) or likelihood of recommending our EDs (OR 1.07, 95% CI [0.86–1.32]). Findings were similar when each ED was analyzed individually.ConclusionWe found that medical student involvement in patient care did not adversely impact ED PG scores in discharged patients. Neither overall scores nor physician-specific scores were impacted. Results were similar at both the academic medical center and the community teaching hospital at our institution.

Why medicine? Analyzing students' motives for studying medicine

Despite increasing numbers of physicians, shortage of doctors is a predominant problem in the German health care system. AIM of the present study is a detailed and gendered analysis of current motives to study medicine in order to deduce implications for securing medical care in the future. Study motives of medical students from Duisburg-Essen and Muenster were assessed using an online questionnaire. 13 given motives had to be rated on a 5 point Likert-scale according to their relevance for the decision to study medicine. Descriptive analysis regarding age, gender, location and study period was performed and a dichotomization of data (agreement vs. disagreement) was undertaken for logistic regression analysis. 1545 medical students took part in the survey (64.5% female). "Many-faceted workspaces", "varied tasks", "helping patients", "scientific interest" and "good career prospects" - backward-sorted - were the most frequent study motives indicated by medical students. The aspect "helping patients" was more important to female than to male students, the latter rated career-associated motives e. g. income, reputation etc. as more relevant. Only for about 8% of the respondents - independently of gender - compatibility of job and family was a motive to study medicine. Perspectively, results of this study could help to shape medicine in a way that will appeal to the growing up generation of doctors: a sophisticated, demanding and fulfilling occupation compatible with family with options to carve out a career for those who want to - regardless of gender. Furthermore, coaching programs paralleling either medical studies or work as clinician should be considered to improve the matching of gender-specific study motives and careers.

Stigma and Attitudes towards Psychiatric Patients in Portuguese Medical Students.

This study aims to assess the impact of psychiatric education on attitudes of medical students towards psychiatric patients. A cross-sectional survey of medical students was conducted at the biggest Portuguese medical school. The students completed an anonymous self-report questionnaire, including sociodemographic data, family history of psychiatric illness, and the Community Attitudes toward the Mentally Ill scale. Of the 2 178 students, 398 answered the survey, representing 18.2% of the whole medical school. There was a significant improvement in all Community Attitudes toward the Mentally Ill scale dimensions along the medical course. The higher scores were in Restrictiveness subscale (38.01), and the lower scores were for Authoritarianism (36.13). The best improvement along the course was for Authoritarianism (5th year score - 1st year score = 2.03), and the worse was for Benevolence (5th year score - 1st year score = 0.39). The biggest improvement, in all scores, was found at the end of the 3rd year. The authors propose that the better attitudes found on third year students were due to a very specific anti-stigma module on the theoretical discipline 'Introduction to Mental Health'. After that, this positive effect was lost, with fourth and fifth year medical students showing a worsening of their attitudes. Our results highlight the importance of anti-stigma specific education modules in order to improve students' attitudes toward mental health. Thus more anti-stigma preventive measures can be taken onward, on preparing the best way possible, the next generation of doctors.

Is dissection the only way to learn anatomy? Thoughts from students at a non-dissecting based medical school.

Anatomical teaching has been centred around dissection for centuries. Generations of doctors have been initiated into the medical profession by cutting into their first cadavers. With the number of donor cadavers available decreasing and medical student numbers increasing, the emphasis placed on dissection has changed dramatically over the past 15 years. However, a solid appreciation of human anatomy is still a necessary part of understanding pathology and treatments. Therefore in light of these changes we ask, is dissection the only option? Or are there other options which students can undertake to develop anatomical knowledge?

Vývoj České gastroenterologické společnosti a gastroenterologie z pohledu tří generací lékařů

Vývoj České gastroenterologické společnosti a gastroenterologie z pohledu tří generací lékařů

Praca lekarska dr Wandy Błeńskiej jako przykład holistycznego podejścia do pacjenta

The World Health Organization defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ This definition promotes holistic approach towards patients. New discoveries and developments in medical science, lead to breaking up medicine into narrow specialities. New generation of health workers needs role models that are able to enhance the status of medical profession and to oppose negative consequences of fragmentation of medicine and commercialization in health sector. The author of the article proposed Dr Wanda Blenska – doctor of leprosy patients from Uganda - as a role model of holistic approach in medicine. Doctor Wanda Blenska took efforts to understand her leprosy patients and support them in all their needs. Her service not only included treatment of ‘leprosy’ as infectious disease, but also physical and psychological rehabilitation of patients, orthopaedic and cosmetic surgery, or even changing the patient’s environment to ensure their highest possible physical, mental and social well-being. Doctor Wanda Blenska left a message to the new generation of doctors: first of all, medical profession is a vocation; care for patients should be motivated by desire to relief the patients’ suffering and not only by own financial benefits; doctors should see a human being in every patient and respect and treat them in a holistic way.

How to fix evidence based medicine for the next generation of doctors

How to fix evidence based medicine for the next generation of doctors

Prof. Ioan Jianu: founding member of SICOT.

At the beginning of the twentieth century, Romania witnessed the rise of some brilliant doctors. One of them was Prof. Ioan Jianu, also known in the scientific world as Jean Jiano, whose career was dedicated to medicine and training young generations of doctors. He was one of the founding members of SICOT, at the first meeting held in 1929 at the Hotel de Crillon in Paris, representing Romania. He was a main figure in Romanian surgery, pioneering in the fields of traumatology, reconstructive and plastic surgery and also showing interest in replantation surgery. He also founded the first laboratory of experimental surgery in Romania and two professional associations.

Training the next generation of doctors in palliative care is the key to the new era of value-based care.

There is a common misperception that palliative care is just another term for hospice care. Although it includes hospice, palliative care is also the long-term coordinated care of the chronically ill, which is delivered at a cost savings. Why does it matter that the average American understand what palliative care means? Because the evidence shows that U.S. patients near the end of life are spending exorbitant amounts of money on health care they do not want and the country cannot afford. To better understand why palliative care is an important issue in the current debate about health care reform, the authors first briefly review landmark legal cases in the area of end-of-life care. They then discuss the role of palliative care in conversations in the current health care climate and conclude by emphasizing the importance of integrating palliative care into the standard medical curriculum. The authors predict that palliative care will be accepted in the United States as a much-needed and desirable field of medicine. Getting there, however, will require a multifaceted approach including payment reform, encouraging an open conversation among the U.S. public, and training physicians to offer the best possible care and guidance until a patient's last breath.

Should emergency medicine registrars focus on seeing patients and leave the teaching of medical students to others? No.

Should emergency medicine registrars focus on seeing patients and leave the teaching of medical students to others? No.

What motivates surgeons to teach dissection anatomy to medical students and surgical trainees?

IntroductionAlthough a fading tradition in some institutions, having clinicians teach anatomy by whole-body dissection provides a clinical context to undergraduate and postgraduate medical students, increasing their depth of learning. The reasons for a clinician’s motivation to teach may be articulated in accordance with self-determination theory (SDT). SDT proposes that for individuals to be intrinsically motivated, three key elements are needed: 1) autonomy, 2) competence, and 3) relatedness.Materials and methodsData were collected through semistructured interviews with eight surgeons who were supervisors/facilitators in the anatomy by whole-body dissection course for undergraduate students in the Bachelor of Medicine, Bachelor of Surgery program and postgraduate students in the Master of Surgery program at the University of Sydney. Qualitative analysis methods were used to code and categorize data into themes.ResultsOur study used SDT as a conceptual framework to explore surgeons’ motivation to supervise students in the anatomy by whole-body dissection courses. Elements that facilitated their desire to teach included satisfaction derived from teaching, a sense of achievement in providing students with a clinical context, a strong sense of community within the dissection courses, and a sense of duty to the medical/surgical profession and to patient welfare.ConclusionThe surgeons’ motivation for teaching was largely related to their desire to contribute to the training of the next generation of doctors and surgeons, and ultimately to future patient welfare.