Junior Physicians Research Articles

MONGOLIAN MEDICAL EDUCATION: THE PAST, PRESENT AND FUTURE

The ancient traditional system of medicine and medical education has a long history of several hundred years, whereas it has been merely 80 years since modern medical education developed in Mongolia. Beginning in the 17 th century when Mongolia was under the rule of Manchu Qing dynasty and had suffered for over 220 years, a Mongolian traditional medical school named Mamba Datsan was founded and has been developing ever since. In 1911 the National liberation movement abolished Manchu ruling and the nation stepped onto the path towards independence. As Manchu Qing dynasty laws and rules were abandoned, Manchu Tibetan script fell out of use and monasteries were closed down, the country’s shift into a new system caused the old system of medical education to be demolished and altered. In 1921 People’s revolution won in Mongolia, feudalism was abolished and Soviet style culture started flourishing. Overcoming obstacles is a difficult and a time consuming challenge while transitioning from an old system to a new one. Through the relations built with the USSR, the first steps were built for Europian Medicine and the Europian Medical Education [EME] system started to pervade. In specific, preparation of junior physicians and nurses commenced in Mongolia. In 1942 the government of the Mongolian People’s Republic made the historically pivotal decision to found National University of Mongolia (NUM) with three faculties including Faculty of Medicine . Initially the Faculty of Medicine had a shortage of teaching staffs, textbooks, laboratories and other resources, but thanks to the contributions made by Russian teachers the Medical Institute of Mongolia (MIM of) became an integral part of the curriculum. This is how the contemporary medical education system developed in Mongolia scince 1942 until 2022. By starting to select and train the first graduates as the teaching human resource base by 1942-1961, the faculty of medicine stood on its feet as an independent Medical Institute of Mongolia . At that time Russian style curriculum for preparing physicians was still being used. In 1990, the Medical Institute of Mongolia expanded and became the Medical University of Mongolia (MUM). From the founding of NUM and until mid 1990s, MUM single handedly fulfilled the role of preparing generations of medical doctors in the healthcare system in Mongolia.

Orthopedics and trauma surgery-Decathlon of medicine : Is a full education possible during resident education?

When the specialties of orthopedics and trauma surgery were merged in 2006 in Germany, the learning content significantly increased while the training time remained the same. Less and less junior doctors learn the whole spectrum of orthopedics and trauma surgery for diagnosis, treatment and aftercare options. How can continuing education concepts be designed to meet the wide range of theoretical and practical content required in residency training to become an orthopedic and trauma surgeon? Orthopedics and trauma surgery is one of the most diverse specialties in terms of patients, clinical pictures and fields of activity. Accordingly, residency training must also be broadly based. This can be achieved through structured and well-planned training concepts. Furthermore, digital simulators could be used to prepare residents for working with patients. Rotation models in the outpatient area could also be beneficial in order to gain an insight into the outpatient care of musculoskeletal diseases. In addition to the active involvement of the resident in the training, the interest and participation of the trainers is also important in order to actively promote junior physicians and prepare them for their later work.

A multi-perspective information aggregation network for automated T-staging detection of nasopharyngeal carcinoma

Accurate T-staging is important when planning personalized radiotherapy. However, T-staging via manual slice-by-slice inspection is time-consuming while tumor sizes and shapes are heterogeneous, and junior physicians find such inspection challenging. With inspiration from oncological diagnostics, we developed a multi-perspective aggregation network that incorporated various diagnosis-oriented knowledge which allowed automated nasopharyngeal carcinoma T-staging detection (TSD Net). Specifically, our TSD Net was designed in multi-branch architecture, which can capture tumor size and shape information (basic knowledge), strongly correlated contextual features, and associations between the tumor and surrounding tissues. We defined the association between the tumor and surrounding tissues by a signed distance map which can embed points and tumor contours in higher-dimensional spaces, yielding valuable information regarding the locations of tissue associations. TSD Net finally outputs a T1–T4 stage prediction by aggregating data from the three branches. We evaluated TSD Net by using the T1-weighted contrast-enhanced magnetic resonance imaging database of 320 patients in a three-fold cross-validation manner. The results show that the proposed method achieves a mean area under the curve (AUC) as high as 87.95%. We also compared our method to traditional classifiers and a deep learning-based method. Our TSD Net is efficient and accurate and outperforms other methods.

Machine Learning-Based Technique for the Severity Classification of Sublingual Varices according to Traditional Chinese Medicine.

Tongue diagnosis, a noninvasive examination, is an essential step for syndrome differentiation and treatment in traditional Chinese medicine (TCM). Sublingual vein (SV) is examined to determine the presence of blood stasis and blood stasis syndrome. Many studies have shown that the degree of SV stasis positively correlates with disease severity. However, the diagnoses of SV examination are often subjective because they are influenced by factors such as physicians' experience and color perception, resulting in different interpretations. Therefore, objective and scientific diagnostic approaches are required to determine the severity of sublingual varices. This study aims at developing a computer-assisted system based on machine learning (ML) techniques for diagnosing the severity of sublingual varicose veins. We conducted a comparative study of the performance of several supervised ML models, including the support vendor machine, K-neighbor, decision tree, linear regression, and Ridge classifier and their variants. The main task was to differentiate sublingual varices into mild and severe by using images of patients' SVs. To improve diagnostic accuracy and to accelerate the training process, we proposed using two model reduction techniques, namely, the principal component analysis in conjunction with the slice inverse regression and the convolution neural network (CNN), to extract valuable features during the preprocessing of data. Our results showed that these two extraction methods can reduce the training time for the ML methods, and the Ridge-CNN method can achieve an accuracy rate as high as 87.5%, which is similar to that of experienced TCM physicians. This computer-aided tool can be used for reference clinical diagnosis. Furthermore, it can be employed by junior physicians to learn and to use in clinical settings.

The Experience of Health Professionals With Misinformation and Its Impact on Their Job Practice: Qualitative Interview Study.

Misinformation is often disseminated through social media, where information is spread rapidly and easily. Misinformation affects many patients' decisions to follow a treatment prescribed by health professionals (HPs). For example, chronic patients (eg, those with diabetes) may not follow their prescribed treatment plans. During the recent pandemic, misinformed people rejected COVID-19 vaccines and public health measures, such as masking and physical distancing, and used unproven treatments. This study investigated the impact of health-threatening misinformation on the practices of health care professionals in the United Kingdom, especially during the outbreaks of diseases where a great amount of health-threatening misinformation is produced and released. The study examined the misinformation surrounding the COVID-19 outbreak to determine how it may have impacted practitioners' perceptions of misinformation and how that may have influenced their practice. In particular, this study explored the answers to the following questions: How do HPs react when they learn that a patient has been misinformed? What misinformation do they believe has the greatest impact on medical practice? What aspects of change and intervention in HPs' practice are in response to misinformation? This research followed a qualitative approach to collect rich data from a smaller subset of health care practitioners working in the United Kingdom. Data were collected through 1-to-1 online interviews with 13 health practitioners, including junior and senior physicians and nurses in the United Kingdom. Research findings indicated that HPs view misinformation in different ways according to the scenario in which it occurs. Some HPs consider it to be an acute incident exacerbated by the pandemic, while others see it as an ongoing phenomenon (always present) and address it as part of their daily work. HPs are developing pathways for dealing with misinformation. Two main pathways were identified: first, to educate the patient through coaching, advising, or patronizing and, second, to devote resources, such as time and effort, to facilitate 2-way communication between the patient and the health care provider through listening and talking to them. HPs do not receive the confidence they deserve from patients. The lack of trust in health care practitioners has been attributed to several factors, including (1) trusting alternative sources of information (eg, social media) (2) patients' doubts about HPs' experience (eg, a junior doctor with limited experience), and (3) limited time and availability for patients, especially during the pandemic. There are 2 dimensions of trust: patient-HP trust and patient-information trust. There are 2 necessary actions to address the issue of lack of trust in these dimensions: (1) building trust and (2) maintaining trust. The main recommendations of the HPs are to listen to patients, give them more time, and seek evidence-based resources.

Facilitators and Barriers for Initiating Conversations About End of Life.

Conducting a conversation about wishes for treatment at end of life (EOL) has been shown to improve EOL care for patients and relatives. Still, only a minority of physicians conduct the conversation, which might lead to unwanted interventions and treatments. The purpose of this survey was to examine which factors facilitate and hinder physicians across a wide range of health care facilities to initiate the conversation about wishes for treatment at EOL. A questionnaire survey based on a Delphi-developed questionnaire. The questionnaire was sent to both hospital physicians and general practitioners (GPs) in a Danish region. More than 3000 physicians were invited to participate in the survey. Of these, 782 responded, 622 working at a hospital department, and 160 from general practice clinics. Results showed that senior physicians, GPs, and physicians working in a medical department feel best equipped to conduct the conversation. Moreover, senior physicians pointed to their experience as physicians as being of great importance for conducting the conversation, whereas junior physicians found training in conducting the conversation as an important factor. Our study indicates that different factors depending on the health care setting and the seniority of the physician facilitate or hinder physicians from conducting the conversation about wishes for treatment at EOL. Being aware of these differences and making a concerted effort depending on setting and seniority might help implement and conduct the conversation.

3D printed kidney model could be an important educational tool for residents.

This study aimed to evaluate whether it is useful for junior physicians to use a three-dimensional (3D) kidney model when evaluating the R.E.N.A.L. nephrometry score. An expert and four urology residents retrospectively evaluated the R.E.N.A.L. nephrometry scores of 64 renal tumors (62 patients) that underwent robot-assisted partial nephrectomy at our hospital. The expert evaluated 64 R.E.N.A.L. nephrometry scores with computed tomography (CT), whereas four residents evaluated 32 cases using CT alone and the other 32 cases using CT and a 3D kidney model. The consistency between the expert and residents was assessed by Cohen's kappa score. Patient-specific 3D kidney models were created in a gird style using a 3D printer based on CT or magnetic resonance imaging of the patient. For all four residents, the accuracy of the overall R.E.N.A.L. nephrometry score was significantly higher with the 3D model and CT than with CT alone (P < .001). Regarding the individual components of the R.E.N.A.L. nephrometry score, the accuracy rates of "E," "N," "A," and "L" scores were higher with the 3D model and CT than with the CT alone (P=.020-.089). Patient-specific 3D-printed kidney models could improve the resident's understanding of the renal tumor complexity and could be an important educational tool for residents.

Difficulties Facing Junior Physicians and Solutions Toward Delivering End-of-Life Care for Patients with Cancer: A Nationwide Survey in Japan.

Junior physicians' perceived difficulty in end-of-life care of patients with cancer has not been structurally investigated; therefore, current challenges and solutions in this area remain unknown. To identify some difficulties junior physicians face in delivering end-of-life care for patients with cancer and to clarify the support required to reduce these difficulties. A nationwide survey was conducted in over 300 institutions selected randomly from 1037 clinical training hospitals in Japan. From each of these institutions, two resident physicians of postgraduate year (PGY) 1 or 2, two clinical fellows of PGY 3-5, and an attending physician were requested to respond to the survey. The survey investigated issues regarding end-of-life care using the palliative care difficulties scale with two additional domains ("discussion about end-of-life care" and "death pronouncement"). Items related to potential solutions for alleviating the difficulties as well were investigated. A total of 198 resident physicians, 134 clinical fellows, and 96 attending physicians responded to the survey (response rate: 33.0%, 22.3%, and 32.0%). The results revealed that junior physicians face difficulties within specific domains of end-of-life care. The most challenging domain comprised communication and end-of-life discussion with patients and family members, symptom alleviation, and death pronouncement. The most favored supportive measure for alleviating these difficulties was mentorship, rather than educational opportunities or resources regarding end-of-life care. The findings of this study reveal the need for further effort to enrich the mentorship and support systems for junior physicians delivering end-of-life care.

Agreement between patients and physicians on scores of inflammatory bowel disease activity and burden assessed on a telemonitoring platform

Background and aims Telemonitoring is increasingly used in the management of IBD patients. We investigated the agreement between patients and physicians on scores of disease activity and burden. Methods Consecutive outpatients at one IBD clinic were recruited between February and December 2021. Enrolled patients completed a questionnaire for disease activity (Harvey-Bradshaw Index [HBI] for Crohn’s disease or Simple Clinical Colitis Activity Index [SCCAI] for ulcerative colitis) and a test of disease burden (Pictorial Representation of Illness and Self Measure [PRISM]). They did the tests within 5 days of an outpatient visit, working independently on IBD Tool, a new web-based telemonitoring application. Concomitantly, the senior and junior physicians who examined them completed the same tests. The agreement was tested for every pair of scores. Results Five hundred and sixty patients (289 Crohn’s disease; 271 ulcerative colitis) completed disease questionnaires on IBD Tool (in total, 742 times). By Spearman’s correlation, the agreement was substantial both for HBI (rho 0.685–0.837) and SCCAI (rho 0.694–0.888) for comparisons between patients, junior and senior physicians. The agreement was moderate-to-substantial for PRISM (rho 0.406–0.725) for the same comparisons. The correlation between disease activity (HBI/SCCAI) and PRISM scores was substantial for senior (rho 0.757–0.788) or junior (rho 0.746–0.753) physicians and moderate for patients (rho 0.458–0.486). The median PRISM score difference was 2.3–1.6 points lower between patients and senior-junior physicians. Conclusion Agreement between IBD patients and physicians was substantial for disease activity and moderate for disease impact. The inclusion of disease burden scoring in telemonitoring platforms provides important information for the management of IBD patients. Study highlights What IS known •Continuous response to treatments and patient-reported outcomes became an essential goal for IBD patient management. •The use of tele-monitoring and eHealth technologies allows for regular disease assessments and for managing more efficiently IBD patients; disease questionnaires and tests are key to support eHealth tools. What is new here •Agreement between IBD patients and physicians was substantial for disease activity and moderate for disease burden, while agreement among junior and senior physicians was substantial for both. •PRISM performs as well for ulcerative colitis as for Crohn’s patients. •The inclusion of disease burden tests might add to eHealth platforms valuable information, complemental to disease activity questionnaires.

3D printing in the planning and teaching of endovascular procedures.

The introduction of 3D printing in the medical field led to new possibilities in the planning of complex procedures, as well as new ways of training junior physicians. Especially in the field of vascular interventions, 3D printing has awide range of applications. 3D-printed models of aortic aneurysms can be used for procedural training of endovascular aortic repair (EVAR), which can help boost the physician's confidence in the procedure, leading to abetter outcome for the patient. Furthermore, it allows for abetter understanding of complex anatomies and pathologies. In addition to teaching applications, the field of pre-interventional planning benefits greatly from the addition of 3D printing. Especially in the preparation for acomplex endovascular aortic repair, prior orientation and test implantation of the stent grafts can further improve outcomes and reduce complications. For both teaching and planning applications, high-quality imaging datasets are required that can be transferred into adigital 3D model and subsequently printed in 3D. Thick slice thickness or suboptimal contrast agent phase can reduce the overall detail of the digital model, possibly concealing crucial anatomical details. Based on the digital 3D model created for 3D printing, another new visualization technique might see future applications in the field of vascular interventions: virtual reality (VR). It enables the physician to quickly visualize adigital 3D model of the patient's anatomy in order to assess possible complications during endovascular repair. Due to the short transfer time from the radiological dataset into the VR, this technique might see use in emergency situations, where there is no time to wait for aprinted model.

Does experience affect physicians’ attitude towards assisted suicide? A snapshot of Swedish doctors’ opinions

Assisted dying is a current and controversial topic that seems to be gaining more support among both physicians as well as the general public. This paper aims to provide a snapshot of Swedish physicians’ opinions regarding AS, including their opinion concerning experience and to evaluate whether a correlation between opinion and experience exists. A poll was conducted through a panel of members of the Swedish Medical Association. The panel is representative of the association's members regarding age and gender. The response rate was 49% Of the respondents 41% stated that AS and/or euthanasia should be legalized. Doctors with great experience in working with dying patients express most strongly against AS and/or euthanasia. More than half of the respondents (54%) stated that AS if it would be legal, should be performed within specific health care units. Approximately the same proportion (48%) were willing to write a statement on health status, knowing that it would be used in decisions regarding AS. Similarly, 44% could not consider performing AS and 27% were indecisive on the question. A majority (41%) thought that a physician should be responsible for approving applications for AS. A few more physicians express a positive attitude toward AS than against it, but many cannot express a certain opinion. In our material, no side in the “debate” for or against AS reaches the majority. The most junior physicians are the most uncertain ones.

Medication Review and Enhanced Information Transfer at Discharge of Older Patients with Polypharmacy: a Cluster-Randomized Controlled Trial in Swiss Hospitals

BackgroundMedication safety in patients with polypharmacy at transitions of care is a focus of the current Third WHO Global Patient Safety Challenge. Medication review and communication between health care professionals are key targets to reduce medication-related harm.ObjectiveTo study whether a hospital discharge intervention combining medication review with enhanced information transfer between hospital and primary care physicians can delay hospital readmission and impact health care utilization or other health-related outcomes of older inpatients with polypharmacy.DesignCluster-randomized controlled trial in 21 Swiss hospitals between January 2019 and September 2020, with 6 months follow-up.ParticipantsSixty-eight senior physicians and their blinded junior physicians included 609 patients ≥ 60 years taking ≥ 5 drugs.InterventionsParticipating hospitals were randomized to either integrate a checklist-guided medication review and communication stimulus into their discharge processes, or follow usual discharge routines.Main MeasuresPrimary outcome was time-to-first-readmission to any hospital within 6 months, analyzed using a shared frailty model. Secondary outcomes covered readmission rates, emergency department visits, other medical consultations, mortality, drug numbers, proportions of patients with potentially inappropriate medication, and the patients’ quality of life.Key ResultsAt admission, 609 patients (mean age 77.5 (SD 8.6) years, 49.4% female) took a mean of 9.6 (4.2) drugs per patient. Time-to-first-readmission did not differ significantly between study arms (adjusted hazard ratio 1.14 (intervention vs. control arm), 95% CI [0.75–1.71], p = 0.54), nor did the 30-day hospital readmission rates (6.7% [3.3–10.1%] vs. 7.0% [3.6–10.3%]). Overall, there were no clinically relevant differences between study arms at 1, 3, and 6 months after discharge.ConclusionsThe combination of a structured medication review with enhanced information transfer neither delayed hospital readmission nor improved other health-related outcomes of older inpatients with polypharmacy. Our results may help researchers in balancing practicality versus stringency of similar hospital discharge interventions.Study RegistrationISRCTN18427377, https://doi.org/10.1186/ISRCTN18427377

Differential diagnosis and feature visualization for thyroid nodules using computer-aided ultrasonic diagnosis system: initial clinical assessment

BackgroundTo assess the diagnostic efficacy of the computer-aided ultrasonic diagnosis system (CAD system) in differentiating benign and malignant thyroid nodules.MethodsThe images of 296 thyroid nodules were included in validation sets. The diagnostic efficacy of the CAD system was compared with that of junior physicians and senior physicians, as well as that of the combination diagnosis of the CAD system with junior physicians. The diagnostic efficacy of the CAD system for different sizes of thyroid nodules was compared.ResultsThe diagnostic sensitivity and accuracy of the CAD system were higher than those of junior physicians (83.4% vs. 72.2%, 73.0% vs. 69.6%), but the diagnostic specificity of the CAD system was lower than that of junior physicians (62.1% vs. 66.9%). The diagnostic accuracy of the CAD system was lower than that of senior physicians (73.0% vs. 83.8%). However, the combination diagnosis of the CAD system with junior physicians had higher accuracy (81.8%) and AUC (0.842) than those of either the CAD system or junior physicians alone, and comparable diagnostic performance with those of senior physicians. The Kappa was 0.635 in the combination diagnosis of the CAD system with junior physicians, showing good consistency with the pathological results. The accuracy (76.4%) of the CAD system was the highest for nodules of 1–2 cm.ConclusionThe CAD system can effectively assist physicians to identify malignant and benign thyroid nodules, reduce the overdiagnosis and overtreatment of thyroid nodules, avoid unnecessary invasive fine needle aspiration, and improve the diagnostic accuracy of junior physicians.

Management of Low Back Pain in Primary Health-Care Settings: Physician's Awareness and Practices Based on Red Flags.

BackgroundLow back pain (LBP) is one of the most common health problems. Red flags (RFs) of LBP are risk factors that are reported during clinical assessment to determine serious illness. This study aimed to assess primary health-care physicians’ knowledge of and practices for RFs of LBP and identify variables associated with a high level of knowledge and awareness about it.MethodsAn observational cross-sectional survey was conducted in 2021 among a random sample of 261 primary health care (PHC) physicians in the Jazan Region in southwest Saudi Arabia. A web-based questionnaire was used to collect data on LBP red flags awareness and practices. Descriptive (frequency and percentage) and inferential statistics were used for data analysis.ResultsThe overall mean score of RFs knowledge among physicians was 82.33 ± 36.3, with 95% confidence interval (CI); (77.7–86.9). Regarding the Physician’s practices, more than 95% of the participants would refer patients to higher levels in the presence of symptoms or signs of RFs. General practitioners and residents were significantly more likely to ask for an Xray, even with symptoms that had persisted for less than 2 weeks without RF signs (p = 0.006). The overall percentage of patients with nonspecific LBP referrals was as high as 57.8%. The number of patients with LBP seen per month (fewer than 15) and female physician were associated with an increased level of knowledge (OR = 2.2, 95%, P < 0.05) and (OR = 2.2, 95%, P < 0.05) respectively.ConclusionOverall, awareness of RFs for LBP and referring critical patients who present with LBP is good among PHC physicians in the Jazan Region. Junior physicians have a low threshold to request images. The referral rate for nonspecific LBP is still high, which could overwhelm spinal clinics. Further educational programs for back pain management are recommended.

Value of ultrasonic S-Detect technique in diagnosis of breast masses

To evaluate the value of ultrasound S-Detect in the diagnosis of breast masses. A total of 85 breast masses in 62 female patients were diagnosed by S-Detect technique and conventional ultrasound. The diagnostic efficacy of conventional ultrasound and S-Detect technique was analyzed and compared with postoperative pathological results as the gold standard. When operated by junior physicians, the diagnostic efficacy of conventional ultrasound was significantly lower than that of S-Detect technique (P < 0.05), but this difference was not observed in moderately experienced and senior physicians (P>0.05). S-Detect technique was positively correlated with the diagnostic results of senior physicians (r=0.97). Using S-Detect technique, the diagnostic efficacy did not differ significantly between the long axis section and its vertical section (P>0.05). Routine ultrasound showed a better diagnostic efficacy than S-Detect for breast masses with a diameter below 20 mm (P < 0.05), but for larger breast masses, its diagnostic efficacy was significantly lower than that of SDetect (P < 0.05). S-Detect can be used in differential diagnosis of benign and malignant breast masses, and its diagnostic efficiency can be comparable with that of BI-RADS classification for moderately experienced and senior physicians, but its diagnostic efficacy can be low for breast masses less than 20 mm in diameter.

A Comparative Study of Multiple Deep Learning Models Based on Multi-Input Resolution for Breast Ultrasound Images.

PurposeThe purpose of this study was to explore the performance of different parameter combinations of deep learning (DL) models (Xception, DenseNet121, MobileNet, ResNet50 and EfficientNetB0) and input image resolutions (REZs) (224 × 224, 320 × 320 and 488 × 488 pixels) for breast cancer diagnosis.MethodsThis multicenter study retrospectively studied gray-scale ultrasound breast images enrolled from two Chinese hospitals. The data are divided into training, validation, internal testing and external testing set. Three-hundreds images were randomly selected for the physician-AI comparison. The Wilcoxon test was used to compare the diagnose error of physicians and models under P=0.05 and 0.10 significance level. The specificity, sensitivity, accuracy, area under the curve (AUC) were used as primary evaluation metrics.ResultsA total of 13,684 images of 3447 female patients are finally included. In external test the 224 and 320 REZ achieve the best performance in MobileNet and EfficientNetB0 respectively (AUC: 0.893 and 0.907). Meanwhile, 448 REZ achieve the best performance in Xception, DenseNet121 and ResNet50 (AUC: 0.900, 0.883 and 0.871 respectively). In physician-AI test set, the 320 REZ for EfficientNetB0 (AUC: 0.896, P < 0.1) is better than senior physicians. Besides, the 224 REZ for MobileNet (AUC: 0.878, P < 0.1), 448 REZ for Xception (AUC: 0.895, P < 0.1) are better than junior physicians. While the 448 REZ for DenseNet121 (AUC: 0.880, P < 0.05) and ResNet50 (AUC: 0.838, P < 0.05) are only better than entry physicians.ConclusionBased on the gray-scale ultrasound breast images, we obtained the best DL combination which was better than the physicians.

Ward-round-based online clinical cardiology course: a resource for junior physicians in cardiology rotation

Ward-round-based online clinical cardiology course: a resource for junior physicians in cardiology rotation

Factors influencing the quality and functioning of oncological multidisciplinary team meetings: results of a systematic review

BackgroundDiscussing patients with cancer in a multidisciplinary team meeting (MDTM) is customary in cancer care worldwide and requires a significant investment in terms of funding and time. Efficient collaboration and communication between healthcare providers in all the specialisms involved is therefore crucial. However, evidence-based criteria that can guarantee high-quality functioning on the part of MDTMs are lacking. In this systematic review, we examine the factors influencing the MDTMs’ efficiency, functioning and quality, and offer recommendations for improvement.MethodsRelevant studies were identified by searching Medline, EMBASE, and PsycINFO databases (01–01-1990 to 09–11-2021), using different descriptions of ‘MDTM’ and ‘neoplasm’ as search terms. Inclusion criteria were: quality of MDTM, functioning of MDTM, framework and execution of MDTM, decision-making process, education, patient advocacy, patient involvement and evaluation tools. Full text assessment was performed by two individual authors and checked by a third author.ResultsSeventy-four articles met the inclusion criteria and five themes were identified: 1) MDTM characteristics and logistics, 2) team culture, 3) decision making, 4) education, and 5) evaluation and data collection. The quality of MDTMs improves when the meeting is scheduled, structured, prepared and attended by all core members, guided by a qualified chairperson and supported by an administrator. An appropriate amount of time per case needs to be established and streamlining of cases (i.e. discussing a predefined selection of cases rather than discussing every case) might be a way to achieve this. Patient centeredness contributes to correct diagnosis and decision making. While physicians are cautious about patients participating in their own MDTM, the majority of patients report feeling better informed without experiencing increased anxiety. Attendance at MDTMs results in closer working relationships between physicians and provides some medico-legal protection. To ensure well-functioning MDTMs in the future, junior physicians should play a prominent role in the decision-making process. Several evaluation tools have been developed to assess the functioning of MDTMs.ConclusionsMDTMs would benefit from a more structured meeting, attendance of core members and especially the attending physician, streamlining of cases and structured evaluation. Patient centeredness, personal competences of MDTM participants and education are not given sufficient attention.

Bullying Among Medical Residents: Gender, Social Norms, and Reporting Behavior.

Bullying behavior in residency is common, with prevalence rates ranging from 10% to 48%. Negative acts adversely impact junior physicians. The aims of this study were to examine (a) gender differences in experiences of bullying and/or negative acts while working as a medical resident, (b) residents' perceptions of injunctive (ie, approval of) and descriptive (ie, behavior) norms related to reporting bullying behaviors, and (c) whether greater self-other differences predict greater engagement in reporting bullying behavior by others in the workplace. Self-report surveys were administered to family medicine, internal medicine, surgical, and emergency medicine residents (N=61). Female residents reported experiencing significantly more bullying than males. Overall, resident physicians held inaccurate beliefs, and thought other residents reported bullying more often than they did. Finally, the degree of inaccuracy was associated with reporting bullying behavior. These findings are an initial indication that normative interventions may be applicable with this population. In a field that struggles with high rates of burnout, finding ways to improve the culture of an organization may assist with addressing at least part of these systemic issues.

Knowledge and perception of doctors regarding antibiotic stewardship in a tertiary care hospital of Southern Punjab.

Background: Pakistan has been working on Antimicrobial Resistance (AMR) for a decade; unfortunately, there is a lack of concept of antibiotic stewardship in most health setups, especially in the public sector. This study aims to analyze the knowledge and perception of junior physicians towards antibiotic stewardship programs. The need for this knowledge and impact of antimicrobial resistance on antibiotic stewardship ascertain barriers to stewardship acceptance. Methodology: A cross-sectional study was conducted at different clinical departments of Sheikh Zayed Hospital, Rahim Yar Khan, including 50 junior physicians recruited via convenience sampling technique. The data was collected using a structured questionnaire comprising physician's hospital associated data and questions regarding the knowledge, perspectives, and practices concerning antibiotic stewardship programs (ASP) to reduce AMR. Statistical analysis was done using SPSS version 22.0, and data were presented using frequencies and percentages. Results: Most of the enrolled physicians knew AMR and agreed that it is a serious global health issue. However, all the medical officers were completely unaware of the antibiotic stewardship program, while 42.9% of house officers and only 25.7% of PGs knew about the program. Conclusion: Our study shows support from doctors for expanded stewardship implementation and provides an important understanding of the current attitudes of doctors regarding stewardship execution. A better understanding of perceptions and attitudes is dire for healthcare stakeholders to expand stewardship activities into healthcare settings.