Medical Education Initiatives Research Articles

Could a Dean of Creativity Enrich Nontraditional Medical Education Initiatives?

Educational reform efforts aim to modernize curricula with competency‐based and technology‐enriched approaches. However, cultural traditionalism limits the potential impacts of these complex change efforts. Creative leaders could challenge the status quo and foster the conditions needed to sustain novel education initiatives. The following commentary proposes an implementable action plan that could promote creative solutions and remove institutional barriers.

Powerful Lessons from Cuban Medical Education Programs: Fostering the Social Contract in Athletic Training Programs

ContextThe Cuban medical education and health care systems provide powerful lessons to athletic training educators, clinicians, and researchers to guide educational reform initiatives and professional growth.ObjectiveThe purpose of this paper is to provide a brief overview of the Cuban medical education system to create parallels for comparison and growth strategies to implement within athletic training in the United States.BackgroundCubans have experienced tremendous limitations in resources for decades yet have substantive success in medical education and health care programs. As a guiding practice, Cubans focus on whole-patient care and have established far-reaching research networks to help substantiate their work.SynthesisCuban medical education programs emphasize prevention, whole-patient care, and public health in a unique approach that reflects disablement models recently promoted in athletic training in the United States. Comprehensive access and data collection provide meaningful information for quality improvement of education and health care processes. Active community engagement, education, and interventions are tailored to meet the biopsychosocial needs of individuals and communities.ResultsCuban medical education and health care systems provide valuable lessons for athletic training programs to consider in light of current educational reform initiatives. Strong collaborations and rich integration of disablement models in educational programs and clinical practice may provide meaningful outcomes for athletic training programs. Educational reform should be considered an opportunity to expand the athletic training profession by embracing the evolving role of the athletic trainer in the competitive health care arena.Recommendation(s)Through careful consideration of Cuban medical education and health care initiatives, athletic training programs can better meet the contract with society as health care professionals by integrating the Accreditation Council for Graduate Medical Education's core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice now promoted in the Commission on Accreditation of Athletic Training Education's 2020 Standards for Accreditation of Professional Athletic Training Programs.Conclusion(s)Educational and health care outcomes drive change. Quality improvement efforts transcend both education and health care. Athletic training can learn valuable lessons from the Cubans about innovation, preventative medicine, patient-centered community outreach, underserved populations, research initiatives, and globalization. Not unlike Cuba, athletic training has a unique opportunity to embrace the challenges associated with change to create a better future for athletic training students and professionals.

2889 Upper and Lower Gastrointestinal Endoscopy and Concomitant Anesthesia in a Central Canadian Province: A Population-Based Study

INTRODUCTION: There are limited data on upper and lower gastrointestinal endoscopy (GIE) and concomitant anesthesia in universal health care systems, despite their increasing use. All Canadian provinces advocate for fecal occult blood test based colorectal cancer screening, which theoretically should lead to less lower GIE use. We evaluated the time trends and variations in use of upper and lower GIE and concomitant anesthesia in the province of Manitoba between April 1, 1984 and March 31, 2017. METHODS: Physicians claims reimbursement data from the provincial health ministry were used to ascertain upper, lower GIE and anesthesia use. Provincial population in each year was determined from the registrants’ database. Hospitalization discharge database was used to identify procedures performed in hospitals. Generalized linear models with generalized estimating equations were used to test the linear trend over time and differences amongst age groups, health regions, income quintiles. Logistic regression analysis with generalized estimating equations was used to assess predictors of anesthesia use. RESULTS: 410, 685 individuals had at least one procedure between 1984-2017. Although approximately half of the procedures were performed outside the recommended CRC screening age group of 50-74 years (38% among those less than 50 years), the rate of increase stabilized among the > 75 years group over the last 5 years of the study (Figure 1). There were marked regional differences in the last ten years, with the slowest increase in the largest urban region (Figure 2). There were much more marked variation in anesthesia use, ranging from 1% in the largest region to 80% in a rural region (Figure 3). CONCLUSION: There are marked variations in GIE use and concomitant anesthesia use in a universal health care system. The potential good news is that the rate of GIE use is no longer increasing among the older individuals. We have identified several endoscopist factors which could lead to targeted information dissemination, individual provider review and feedback and continuing medical education initiatives.

The rapid scale up of medical education in Ethiopia: Medical student experiences and the role of e-learning at Addis Ababa University.

BackgroundIn response to a physician shortage in Ethiopia, the number of medical students admitted to public universities was rapidly increased through a “flooding” policy.ObjectivesTo assess medical student perceptions on the impact of the “flooding” policy on medical education and e-learning initiatives, as well as plans for future emigration.DesignA cross-sectional survey of medical students at AAU was implemented in 2014. Attitude and practice items were assessed using a Likert scale. Logistic regression analysis was performed to identify characteristics associated with an interest in future emigration.Results673 (99.6%) of 676 students approached completed the survey, representing 39.5% of all 1705 medical students enrolled at AAU in 2014. Most students felt the “flooding” policy had a negative impact on their medical education and >90% felt there was not adequate infrastructure to support the increased student body. E-learning activities to accommodate increased class size included distribution of electronic tablets, but at the time of the survey only 34.8% of students still had a working tablet and 82.3% reported problems with internet connectivity. Most preclinical students (85.1%) who had attended live-streamed lectures preferred traditional classroom lectures. Half of the students (49.5%) intended to practice medicine in Ethiopia. Independent risk factors for planning to emigrate included age <21 years (aOR = 1.30, 95% CI 1.04, 1.97); having applied to medical school for reasons other than “wanting to be a physician” (aOR = 1.55, 95% CI 1.14, 2.20), and not believing that “flooding” policy would increase the number of physicians working in Ethiopia (aOR = 1.87, 95% CI 1.33, 2.58).ConclusionsThe “flooding” policy lead to significant educational challenges that were not fully alleviated by e-learning initiatives. Concomitant increases in resources for infrastructure development and faculty expansion are needed to maintain quality medical education. Additional research is needed on factors that influence medical graduates decision to emigrate.

Preparing Future Medical Educators: Development and Pilot Evaluation of a Student-Led Medical Education Elective.

Although all medical school graduates are expected to be educators as residents, and subsequently as faculty, most students receive no formal education on how to teach. At the Uniformed Services University (USU), no formal educational training previously existed for senior medial students as they prepared for residency. A novel Medical Education Elective for MS4s was developed and run by MS4s with faculty mentoring at USU with implementation between January and June 2018. The overall goal of the 4-week course was to provide a forum for MS4s to gain exposure to educational theories and teaching methods with an opportunity to practice learned skills in the underclass curriculum. The course's three core components were: didactics, observed teaching, and independent teaching. The course was evaluated via multiple methods including verbal and survey feedback from both first and fourth year medical students. The preliminary outcomes revealed the course had a positive impact on both first-year medical students (MS1s) and MS4s. As of May 2018, 100% (n = 59) of MS1s surveyed reported that having an MS4 teacher contributed positively to their learning experience. All MS4s surveyed (n = 12) agreed that the course enhanced their confidence in teaching. Medical education courses not only offer an opportunity for senior students to cultivate educational theoretical knowledge and teaching skills in preparation for residency but also contribute positively to the learning experiences of underclass students. Now that the elective has been piloted with initial data suggesting feasibility and benefit to both MS4 and MS1 students, the next steps are to focus on ensuring longevity of the course offering at USU and to consider working with senior students at other institutions that lack formal training in education to start similar student run medical education initiatives.

Applications of the reflective practice questionnaire in medical education

BackgroundWe sought to determine whether the Reflective Practice Questionnaire (RPQ) is a reliable measure of reflective capacity and related characteristics in medical students. We also planned to learn how the RPQ could be used in medical education.MethodsThe RPQ is a 40 item self-report questionnaire that includes a multi-faceted approach to measuring reflective capacity. It also includes sub-scales on several other theoretically relevant constructs such as desire for improvement, confidence, stress, and job satisfaction. The reliabilities of reflective capacity and other sub-scales were determined by calculating their Cronbach alpha reliability values. In the present study, the RPQ was answered by 98 graduating fourth-year medical students from an American University, and these RPQ scores were compared with general public and mental health practitioner samples from a prior study using ANOVA and Bonferroni adjusted comparisons.ResultsMedical students reported a higher reflective capacity than the general public sample, but students were statistically indistinguishable from the mental health practitioner sample. For medical students, reflective capacity was associated with features of confidence, stress, and desire for improvement. Job satisfaction was positively associated with confidence in communication with patients, and negatively associated with stress when interacting with patients. A cluster analysis revealed that around 19% of the medical students exhibited a relatively high level of anxiety interacting with patients, 23% were less engaged, 5% were dissatisfied, and 7% expressed a level of over-confidence in their knowledge and skills that was concerning.ConclusionsThe RPQ is a reliable measure of reflective capacity (Chronbach’s alpha value = 0.84) and related characteristics (Cronbach’s alpha values from 0.75 to 0.83) in medical students. The RPQ can be used as part of pre-post evaluations of medical education initiatives, to complement student self-reflection activities in the curriculum, and to identify students who might benefit from targeted intervention.

Reflections on a community health elective in Native Hawaiian Health: a community-centred vision for health and the medical profession in Indigenous contexts.

The medical profession is fundamentally thought of as a vocation and calling, one that requires the translation of knowledge and skill into counselling, diagnosis and interventions that benefit the lives of patients. Physicians and healthcare professionals have the immense privilege to compassionately use their vocation to improve the health of communities. What does this commitment look like in an Indigenous health setting? Using the author's own experience as a participant-observer in the University of Hawaii's John A. Burns School of Medicine's Native Hawaiian Health elective, an example is provided of an educational curriculum that seeks to integrate community health in Native Hawaiian settings. This paper shows the ways that the author's understanding of health broadened to include environmental stewardship and healthcare professionals' compassion and involvement in the life of the community throughout the elective. By providing this example, the author seeks to shed light on how a medical education initiative can change the way students approach Indigenous health.

The Impact of a National Competency-Based Medical Education Initiative in Family Medicine

Triple C is the Canadian competency-based medical education (CBME) initiative for family medicine. The authors report on a study exploring the impacts Triple C has had across Canada. A multi-institutional team conducted a realist study to explore the impact of Triple C implementation in different programs across Canada. Data were collected between March and June 2016 from interviews and focus groups with key medical school stakeholders. Data were analyzed using thematic and template analysis techniques. Data were acquired from 16 of the 17 Canadian medical schools from a combination of program leaders, educators, and trainees. Triple C was implemented in different ways and to different extents depending on context. Newer sites tended to have a more comprehensive implementation than established sites. Urban sites afforded different opportunities to implement Triple C from those afforded by rural sites. Although it was too early to assess its impact on the quality of graduating residents, Triple C was seen as having had a positive impact on identifying and remediating failing learners and on energizing and legitimizing the educational mission in family medicine. Negative impacts included greater costs and tensions in the relationships with other specialties. A principles-based approach to CBME offered flexibility to programs to incorporate variation in their interpretation and implementation of Triple C. Although there was a degree of normalization of practice, it was not standardized across sites or programs. Triple C has been successfully implemented across Canada but in differing ways and with different impacts.

Graduate medical education scholarly activities initiatives: a systematic review and meta-analysis

BackgroundAccording to the Accreditation Council for Graduate Medical Education residents “should participate in scholarly activity.” The development of a sustainable, successful resident scholarship program is a difficult task faced by graduate medical education leadership.MethodsA medical librarian conducted a systematic literature search for English language articles published on scholarly activities initiatives in Graduate Medical Education (GME) between January 2003 and March 31 2017. Inclusion criteria included implementing a graduate medical education research curriculum or initiative designed to enhance intern, resident, or fellow scholarly activities using a control or comparison group. We defined major outcomes as increases in publications or presentations. Random effects meta-analysis was used to compare the rate of publications before and after implementation of curriculum or initiative.ResultsWe identified 32 relevant articles. Twenty-nine (91%) reported on resident publications, with 35% (10/29) reporting statistically significant increases. Fifteen articles (47%) reported on regional, national, or international presentations, with only 13% (2/15) reporting a statistically significant increase in productivity. Nineteen studies were eligible for inclusion in the meta-analysis; for these studies, the post-initiative publication rate was estimated to be 2.6 times the pre-intervention rate (95% CI: 1.6 to 4.3; p < 0.001).ConclusionsOur systematic review identified 32 articles describing curricula and initiatives used by GME programs to increase scholarly activity. The three most frequently reported initiatives were mentors (88%), curriculum (59%), and protected time (59%). Although no specific strategy was identified as paramount to improved productivity, meta-analysis revealed that the publication rate was significantly higher following the implementation of an initiative. Thus, we conclude that a culture of emphasis on resident scholarship is the most important step. We call for well-designed research studies with control or comparison groups and a power analysis focused on identifying best practices for future scholarly activities curricula and initiatives.

Advancing Health Professions Education Research by Creating a Network of Networks.

Producing the best evidence to show educational outcomes, such as competency achievement and credentialing effectiveness, across the health professions education continuum will require large multisite research projects and longitudinal studies. Current limitations that must be overcome to reach this goal include the prevalence of single-institution study designs, assessments of a single curricular component, and cross-sectional study designs that provide only a snapshot in time of a program or initiative rather than a longitudinal perspective.One solution to overcoming these limitations is to develop a network of networks that collaborates, using longitudinal approaches, across health professions and regions of the United States. Currently, individual networks are advancing educational innovation toward understanding the effectiveness of educational and credentialing programs. Examples of such networks include (1) the American Medical Association's Accelerating Change in Medical Education initiative, (2) the National Center for Interprofessional Practice and Education, and (3) the Accreditation Council for Graduate Medical Education's Accreditation System. In this Invited Commentary, the authors briefly profile these existing networks, identify their progress and the challenges they have encountered, and propose a vigorous way forward toward creating a national network of networks designed to determine the effectiveness of health professions education and credentialing.

Role of the general practitioner in improving rural healthcare access: a case from Nepal

BackgroundThere is a global health workforce shortage, which is considered critical in Nepal, a low-income country with a predominantly rural population. General practitioners (GPs) may play a key role improving access to essential health services in rural Nepal, though they are currently underrepresented at the district hospital level. The objective of this paper is to describe how GPs are adding value in rural Nepal by exploring clinical, leadership, and educational roles currently performed in a rural district-level hospital.Case presentationWe perform a descriptive case study of clinical and non-clinical services offered at Bayalpata Hospital prior to and following the initiation of GP-level services in 2013. Bayalpata is a district-level public hospital managed through a public private partnership by the nonprofit healthcare organization Possible. We found that after general practitioners were hired, additional clinical services included continuous emergency obstetric care, major orthopedic surgeries, appendectomy, tubal ligation, and vasectomy. This time period was associated with increased emergency department visits, inpatient admissions, and institutional birth rate in the hospital’s catchment area. Non-clinical contributions included the development of a continuing medical education curriculum and implementation of a series of quality improvement initiatives.ConclusionsGPs have potential to bring significant value to rural district hospitals in Nepal. Clinical impact may include expanded access to surgical and emergency obstetric services, which would more fully align with local health needs, and could further reduce Nepal’s maternal mortality rate. Task-shifting and structured training programs would be required to increase orthopedic surgery capacity, but this would contribute to meeting local healthcare needs. Non-clinical impact may include supervision of health workers and leadership in continuing medical education and quality improvement initiatives. These changes can lead to improved health worker recruitment and retention in rural posts. Limitations include generalizability of our results to other district hospitals in Nepal and lack of data from control hospitals. This analysis provides an additional perspective on the potential value GPs can add in rural Nepal, through provision of a wide range of clinical and non-clinical services. It supports the expansion of GPs to additional district hospitals in Nepal’s public sector.

The American Society of Hematology (ASH) Medical Educators Institute: a Pilot Faculty Development Project for Hematology Educators.

Clinician educators at academic medical centers often lack the community, mentorship, and faculty development to support their missions around education scholarship and teaching. Inadequate support for clinician educators can lead to professional dissatisfaction and slowed academic advancement. In 2014, ASH conducted a needs assessment of medical school hematology course directors, hematology-oncology fellowship program directors, and other ASH members identified as educators to determine this community's desire for faculty development in medical education. These data furthered the development of an annual faculty development program for hematology educators offering an interactive curriculum and support for an educational scholarly project. The needs assessment indicated that over 70% of respondents would be personally interested in a faculty development opportunity for hematology educators and only 11% had previously participated in such a program. A steering committee designed an intervention blending didactics, interactive small group exercises, webinars, mentorship for a scholarly project, 360-degree feedback for each participant, and a forum to discuss common career development goals. Of 42 applicants, 20 participants were chosen for the inaugural workshop. Following successful execution of the workshop, participants reported significant increase in confidence in the knowledge, skills, and attitudes targeted by the curriculum. A series of follow-up webinars have been developed to deliver additional content not covered during the workshop and to continue mentorship relationships. The curriculum will be further refined based on feedback from faculty and participants. Long-term outcome measurement will include tracking all participants' publications and presentations, time to promotion, and involvement in national medical education initiatives.

A model for faculty engagement in distributed medical education: Crafting a paddle

Distributed medical education initiatives are now a key component of all Canadian medical schools. The success of these initiatives requires engaged community-based faculty who are able to successfully balance both their clinical and educational responsibilities. Present understanding of faculty engagement within distributed medical education is limited. Faculty engagement is a complex and multifaceted construct that includes a reciprocal relationship between a Faculty of Medicine and their faculty. Clarification of both the extrinsic and intrinsic motivators of distributed faculty provide opportunities for Faculties of Medicine to more fully engage their faculty and sustain distributed medical education programs.

WHO Backs Palestinian Psychologist’s Efforts to Integrate MH Care Into Jerusalem Schools

WHO Backs Palestinian Psychologist’s Efforts to Integrate MH Care Into Jerusalem Schools

Implementation of point of care ultrasound curriculum in pediatric intensive care unit

Background : Point-of-care ultrasound (POCUS) is expanding across all medical specialties. As the benefits of US technology are becoming apparent, efforts to integrate US into bedside decision making is underway. The established benefits of point-of-care ultrasound have given rise to multiple new and innovative curriculums to incorporate ultrasound teaching into medical education and quality improvement initiative. Methods : This study was done in a 24 bedded tertiary PICU in Bangalore with availability of a portable ultrasound machine in the unit. We integrated a curriculum consisting of traditional didactics combined with hands-on sessions given to the fellows over a period of 4 weeks. Following this, the PICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. They were required to fill a proforma which asked them to document the reason for the use of POCUS, their findings and the decision made based on the findings for each system examined, namely, Cardiovascular (CVS) and Hemodynamics, Lung and Abdomen. The images of the POCUS scans were stored and reviewed by experts consisting of senior PICU physicians and Radiologists every week where the proforma along with images were examined and evaluated for their quality of images, correlation of findings and justification for decisions on a weekly basis. The improvement in skill level of fellows based on the evidence of quality of images, their interpretation and decisions and also the impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of 2 months after training. Results : Fifty POC ultrasound studies were done in the 2 months period and were reviewed for analysis. The most common exams performed were CVS and hemodynamic assessment (32) followed by lung/pleural exams (15) and abdominal exams (3). The examination supported the clinical assessment in 80 % (40/50) of instances. It changed the management. It led to a significant change of management in 20% (10/50) of the cases. In CVS and Hemodynamic assessment, the major use was for determining fluid responsiveness (22/32) followed by need of optimizing inotropy (9/32) and pericardial drainage (1/32). In Lung/Pleura assessment, determining the area of the lung involved and differentiating atelectasis and consolidation was the most common use (9/15) which led to change in position (proning/lateral position) followed by documenting the residual fluid in the pleural cavity (4/15) and identifying pneumothorax (2/15). Abdominal scan was done only in cases of trauma to look for fluid collection. As a quality training initiative, on evaluation we also found that the quality of images improved during the period of study with experience of the fellows and also their interpretation of the US findings were correct. Conclusion : Implementation of POC ultrasound in the ICU with a structured fellowship curriculum is feasible and may successfully equip fellows with a fundamental understanding of ultrasound physics, anatomy, and disease recognition. The periodic evaluation of the findings by experts helps maintain the quality of the curriculum. In our study, it resulted in change of management in 1/5th of the cases.

Improving outcomes in the treatment of opioid dependence (IOTOD): reflections on the impact of a medical education initiative on healthcare professionals’ attitudes and clinical practice

ABSTRACTSince 2011, the annual improving outcomes in the treatment of opioid dependence (IOTOD) meeting has brought together a broad range of primarily European healthcare professionals as part of an ongoing effort to promote best practice for this particularly vulnerable patient population. IOTOD, a comprehensive educational initiative, includes the annual Continuing Medical Education (CME)-accredited IOTOD conference, which is dedicated to measuring practice change and outcomes resulting from attendance at its educational sessions. Following each session, delegates are asked to vote for or against incorporating specified changes into their clinical practice. These “commitments to change” have formed one measure of the effectiveness and impact of the IOTOD conference. Here, we look at why educational initiatives like the IOTOD conference are valuable, examine our methods for conducting a CME-accredited event, and highlight individualised treatment plans and delivery. We examine this approach – increasingly seen as best practice – as an example of how it may be changing attitudes and eventually affecting clinical applications in the field of opioid dependence. The measured commitments to change offer insight into HCPs’ attitudes towards opioid dependence management and show that attitudes towards individualised treatment plans seem to be progressively positive, with a general consensus to incorporate psychosocial interventions.

Engaging the Transgender Community to Improve Medical Education and Prioritize Healthcare Initiatives

ABSTRACTPhenomenon: Transgender patients experience discrimination, limited access to care, and inadequate provider knowledge in healthcare settings. Medical education to address transgender-specific disparities is lacking. Research that engages transgender community members may help address health disparities by empowering patients, increasing trust, and informing medical curricula to increase competence. Approach: A 2015 Community Forum on Transgender Health Care was hosted at the University of Louisville School of Medicine, which included healthcare professionals and transgender community members to facilitate dialogue among mixed-participant groups using a World Café model. Fifty-nine participants discussed the status of transgender healthcare and made recommendations for local improvements. A follow-up survey was administered to 100 individuals, including forum participants and their referrals. The forum discussion and survey responses were analyzed to determine common perceptions of transgender healthcare, priorities for improvement interventions, and themes to inform curriculum. Findings: The community forum discussion showed that local transgender care is overwhelmingly underdeveloped and unresponsive to the needs of the transgender community. The follow-up survey revealed that priorities to improve transgender care included a multidisciplinary clinic for lesbian, gay, bisexual, and transgender (LGBT) patients, an LGBT-friendly network of physicians, and more training for providers and support staff. This mutually constructive engagement experience influenced reform in undergraduate curricula and continuing education opportunities. Insights: Community engagement in healthcare disparities research can cultivate improbable discussions, yield innovative insight from marginalized populations, and build relationships with community members for future collaborations and interventions. Societal acceptance of transgender identities, which could be promoted through healthcare providers, could stimulate significant progress in transgender healthcare. Supplemental educational interventions for practicing physicians will improve the current conditions of transgender healthcare, but a comprehensive medical school curriculum specifically for transgender health that includes interactions between the transgender community and medical students could be particularly impactful.

Building a local medical workforce in Tasmania: where are international fee-paying medical graduates likely to work?

Much of regional Australia continues to face challenges in recruitment and retention of medical practitioners, despite the apparently successful rural medical education initiatives funded by the Commonwealth Government. International fee-paying (IFP) medical students are a significant component of Australian medical education, contributing additional income and more diverse learning environments for universities. Their contribution to the Australian medical workforce is harder to determine. After obtaining registration, IFP graduates may apply to remain in Australia as skilled migrants. Since 1999 there has been a 325% increase in the number of international medical students in Australia, with approximately 73% of IFP graduates remaining in Australia for at least some postgraduate training. Recognising the potential contribution of IFP students to the Tasmanian medical workforce, the authors sought better understanding of the career intentions and work locations of IFP graduates from the medical program in Tasmania, Australia, through two studies. Firstly, a quantitative study was conducted of the locations of all IFP graduates from the Tasmanian medical program, and then a qualitative study exploring graduating students' intentions and factors that contribute to their decisions about work location choices. This was a cohort study of IFP students who graduated from the University of Tasmania School of Medicine over the period 2000-2015. Work locations for 2016 were mapped to a Modified Monash rurality classification. Semi-structured interviews were held with 15 final year IFP medical students, exploring career intentions and location preferences. There were 261 IFP graduates, 54.4% male. The most common country of origin was Malaysia (55.2%). In 2016, 189 (72.4 %) were working in Australia, 42 (16.1%) in Tasmania and 126 (66.7%) in areas categorised as Modified Monash 1. Recent graduates in postgraduate year 1/2 (71.3%) were more likely to be working in Tasmania but most left for specialty training. All 15 interview participants intended to remain in Australia for at least their intern year, although at enrolment only six had planned to remain. Factors influencing workplace location decisions were (1) 'professional': greater appeal of Australian medical workplaces, intention to pursue a speciality, and to complete this at an Australian metropolitan hospital; (2) 'social': proximity to family/partner or opportunity to meet a prospective partner, family obligations, positive rural experiences; and (3) 'location': direct travel access to family. IFP graduates from the Tasmanian medical program make an important contribution to the Australian mainland metropolitan medical workforce, but play only a small role in workforce development for both Tasmania and the broader Australian rural and remote context. Most IFPs do not choose to work rurally. Rurally focused medical programs need to consider how they place IFP students to meet both the learning and career needs of IFP students and the goal of the rural medical programs in developing a rural workforce.

Clinical practices and attitudes regarding the diagnosis and management of heart failure: findings from the CORE Needs Assessment Survey.

AimsCORE is a continuing medical education initiative designed to support the evidence‐based management of heart failure (HF) in the primary and secondary care settings. The goal of the CORE Needs Assessment Survey is to describe current clinical practice patterns and attitudes among global stakeholders in HF care.Methods and resultsThe CORE Steering Committee guided the development of survey questions to assess clinical practice, confidence, and attitudes/perceptions among cardiologists, primary care physicians, and nurses involved in HF management. In total, 346 healthcare professionals from Australia (n = 59), Austria (n = 59), Canada (n = 60), Spain (n = 58), Sweden (n = 52), and the UK (n = 58) contributed survey data. Results revealed multiple gaps over the spectrum of HF care, including diagnosis (low recognition of the signs and symptoms of HF and limited use of diagnostic tests), treatment planning (underuse of recommended agents and subtherapeutic dosing), treatment monitoring and adjustment (lack of adherence to recommendations), and long‐term management (low confidence in providing patient education). Although primary care and specialist physicians and nurses shared common unmet needs, healthcare professional‐specific clinical gaps were also identified.ConclusionsThe CORE Needs Assessment Survey provides timely data describing current clinical practices and attitudes among physicians and nurses regarding key aspects of HF care. These findings will be useful for guiding the development of interventions tailored to the specific educational needs of different provider types and designed to support the evidence‐based care of patients with HF.

The Latino Physician Shortage: How the Affordable Care Act Increases the Value of Latino Spanish-Speaking Physicians and What Efforts Can Increase Their Supply.

The United States Latino population is growing at a rapid pace and is set to reach nearly 30% by 2050. The demand for culturally and linguistically competent health care is increasing in lockstep with this growth; however, the supply of doctors with skills and experience suited for this care is lagging. In particular, there is a major shortage of Latino Spanish-speaking physicians, and the gap between demand and supply is widening. The implementation of the Affordable Care Act (ACA) has increased the capacity of the US healthcare system to care for the growing Latino Spanish-speaking population, through health insurance exchanges, increased funding for safety net institutions, and efforts to improve efficiency and coordination of care, particularly with Accountable Care Organizations and the Hospital Readmissions Reduction Program. With these policies in mind, the authors discuss how the value of Latino Spanish-speaking physicians to the healthcare system has increased under the environment of the ACA. In addition, the authors highlight key efforts to increase the supply of this physician population, including the implementation of the Deferred Action for Childhood Arrivals Act, premedical pipeline programs, and academic medicine and medical school education initiatives to increase Latino representation among physicians.