Non-physician Health Professionals Research Articles

Physician Humility: A Review and Call to Revive Virtue in Medicine.

Physician virtues, including humility, are crucial for shaping a physician's identity and practice. The health care literature offers varied views on humility, and the rising call for discussing virtues as a framing for professional identity formation underscores the need for a clearer understanding of physician humility. This review aimed to develop a cohesive conceptualization of physician humility and to define how it functions in medical practice. To achieve this, a comprehensive search was done across PubMed, Ovid MEDLINE, Web of Science, Embase, ERIC, and PsycInfo, covering all records up to 30 October 2023. Articles were included if they discussed physician humility and excluded if they were unrelated to physician humility, focused on nonphysician health professionals, lacked conceptual depth, or focused solely on cultural humility. An applied thematic analysis was conducted. The results provide a synthesized conceptualization of physician humility across stances toward self, others, and the profession. The included articles identified the pivotal role of physician humility within the following 5 domains of medical practice: learning and professional growth, navigating error, uncertainty tolerance, trust and entrustment, and teamwork and communication. The authors highlight some of the intrapersonal, interpersonal, and sociocontextual challenges to cultivating and practicing physician humility. These findings highlight the importance of promoting humility in shaping physicians' actions, thoughts, and relationships with patients, colleagues, and their profession. Integrating such virtues as humility into medical education is essential for upholding the ideals of the medical profession and cultivating moral agents who engage in self-reflection and embody the principles of exemplary physicians.

Assessing the Quality and Reliability of Cardiac Rehabilitation Information on YouTube: A Systematic Evaluation.

This study aims to systematically evaluate the quality and reliability of YouTube videos on cardiac rehabilitation, addressing a gap in the literature regarding the assessment of online health resources in this field. The study is a cross-sectional analysis. This research was conducted entirely online, utilizing the YouTube platform for data collection. The videos were assessed for educational quality and reliability using modified versions of the DISCERN, Journal of the American Medical Association (JAMA), and Global Quality Scale (GQS) benchmarks. Specific data points such as upload date, length, uploader and narrator identity, and engagement metrics (views, likes, and dislikes) were also collected. Out of 300 videos initially reviewed, 140 met the inclusion criteria. The majority of videos were of low quality (67.9%), with medium (12.9%) and high-quality (19.3%) content being less common. Videos were predominantly uploaded by academic, university, or hospital sources (63.6%) and narrated by non-physician health professionals (41.4%). The content mainly provided general information about cardiac rehabilitation. The study revealed a concerning predominance of low-quality YouTube content on cardiac rehabilitation, underscoring the necessity for healthcare professionals and academic institutions to enhance the quality of online resources.

Development of Research Core Competencies for Academic Practice Among Health Professionals: A Mixed-Methods Approach.

Of the 4 pillars of academic practice for nursing and allied health, research has been the least developed and no standard competency framework exists that is embedded in health professional scopes of practice. The objective of this article is to report on the preliminary development and pilot-testing of research and academic scholarship core competencies for nonphysician health professionals working within a large urban academic health sciences center. We conducted an internal and external environmental scan and multiphase consultation process to develop research and academic core competencies for health professionals working within an interprofessional setting. The final framework outlines 3 levels of research proficiency (novice, proficient, and advanced) and the relevant roles, specific competencies, and observable actions and/or activities for each proficiency level. Organizations should consider the integration of the framework within performance management processes and the development of a road map and self-assessment survey to track progress over time and support health professionals with their academic practice goals.

YouTube as a Source of Patient Information for Cubital Tunnel Syndrome: An Analysis of Video Reliability, Quality, and Content.

This study seeks to examine the reliability, quality, and content of YouTube videos on cubital tunnel syndrome, on which there is presently a paucity of information. The top 50 unique YouTube videos by relevance resulting from the Boolean search term "cubital tunnel + cubital tunnel syndrome" were identified, with video properties for analysis including source, upload date, duration, views, and comments. Content was assessed using the Journal of American Medical Association (JAMA) criteria, the Global Quality Score (GQS), and a "Cubital Tunnel-Specific Score" (CTSS). The average video saw 72 108 ± 199 362 views, with videos produced by allied (nonphysician) health professionals demonstrating the highest mean views (111 789 ± 294 471 views). Videos demonstrated low mean JAMA scores (2.4/4 ± 0.7), GQS (2.8/5 ± 1.3), and CTSS (7.5/21 ± 4.3), with academic and nonacademic physician videos demonstrating significantly greater mean GQS and CTSS scores when compared with videos by allied health professionals. Positive independent predictors for GQS included academic sources (β = 1.871), nonacademic physician sources (β = 1.651), and video duration (β = 0.102), which were likewise positive predictors for CTSS (β = 4.553, 4.639, 0.374). Content relating to surgical techniques or approaches for cubital tunnel decompression had the greatest CTSS scores (11.2 [4.2]). YouTube is a source of highly accessible information on cubital tunnel syndrome, although the average video presents generally poor and inadequate information. Directing patients toward higher quality video resources can be a meaningful component of patient education.

Exploring barriers to stroke coordinator roles in Australia: A national survey

<h2>ABSTRACT</h2><h3>Background</h3> Coordinator roles are integral to delivering best practice stroke care. Evidence related to the challenges faced by clinicians working in these positions is lacking. <h3>Aim</h3> To explore the barriers to working in acute stroke coordinator roles. <h3>Methods</h3> Self-administered online national survey (including closed and open-text questions) of clinicians in coordinator roles in Australia. Non-physician health professionals who worked in a formal or informally recognised clinical leadership position for acute stroke were eligible. Participants were identified from the National Audit (Australia), and advertising via national networks/associations. Quantitative data were analysed descriptively, inductive thematic analysis was used for open-text responses, with all results triangulated. <h3>Findings</h3> A total of 141 eligible clinicians were identified; 105 in coordinator roles responded (103 hospitals); and 96 answered questions related to barriers (91% female, 89% registered nurses). Having insufficient time to perform the role was a major barrier. In particular, having too many responsibilities (55%) and limited staffing allocation (45%) was perceived to impact care delivery. Inequity in classifications and remuneration, both within and across different states of Australia, were common concerns. Environmental barriers, particularly related to managerial support (31%), and associated acknowledgement and recognition of the role especially from executive/management, were frequently raised. Other challenges included limited professional development opportunities and funding support for ongoing education, and inadequate orientation to the role (27%). <h3>Conclusion</h3> To develop and retain clinicians in coordinator roles for optimising stroke care, hospitals should address the modifiable barriers faced by those working in these positions, including greater formal recognition and sufficient employment fractions.

To which non-physician health professionals do French general practitioners refer their patients to and what factors are associated with these referrals? Secondary analysis of the French national cross-sectional ECOGEN study

BackgroundMultiprofessional practice is a key component in primary care. Examining general practitioner (GP) referral frequency to non-physician health professionals (NPHP) can provide information about how primary care is organised and works which is useful for policymakers. Our study aimed to describe French GP referral frequency to various NPHPs in France and identify associated factors.MethodsThis is an ancillary study to the observational, cross-sectional (ECOGEN) study conducted in 2011/2012 in France among 128 GPs. Data about consultations using the standardised International Classification of Primary Care (ICPC-2), and patient and GP characteristics were collected from 20,613 GP consultations. Referrals were identified through inductive and deductive approaches using ICPC-2 codes, keywords, and deep, open manual searches. Referral frequency was described overall and per NPHP. Patient, GP, and consultation-related factors associated with referral rates were described for the three most frequently identified NPHPs. To minimise potential sources of bias, this observational study followed the STROBE guidelines.ResultsFrench GPs referred 6.8% of patients to NPHPs, with physiotherapists, podiatrists, and nurses accounting for 85.2% of referrals. Older patients, retired patients, multiple health problems managed, and longer consultation durations were found to be associated with higher referral rates (p < 0.001). Specific trends were observed for nurse, physiotherapist, and podiatrist referrals. Women (p < 0.001) and regular patients (p = 0.002) were more likely to receive physiotherapy referrals while people with no professional activity were less likely (p < 0.001). Female GPs and those working in urban practices were more likely to issue a physiotherapy referral (p < 0.001), while GPs working in rural practices (p < 0.001) and those with higher annual consultation numbers (p = 0.002) were more likely to refer to a nurse. Working in multiprofessional centres appeared to have little impact on referral rates, being only slightly associated with podiatrist referrals (p = 0.003).ConclusionsReferral frequency is more associated with patient characteristics and clinical situations than GP-related factors suggesting patients needing referral most are most often referred. Furthermore, the three NPHPs that GPs refer to the most are those for which a referral is required for reimbursement in France, suggesting that health system legislation and NPHP reimbursement are strong determinants for referrals.

Reorganizing Hospital Cancer Care In Nepal.

While mortality rates for major common cancers- of the lung, breast, stomach, ovary, and lymphomas-- have declined significantly in high-income countries over the last decade, comparable rates for these malignancies have not fallen in Nepal. The explanations for the high-income country mortality trends are multiple and certainly include incidence reductions, but better treatments are also contributory. How to bring to Nepal the global lessons in achieving better cancer care is uncertain. We need to create an environment of ideas and a powerful vision to meet the needs for better major cancer management for Nepalis. Broadly, the Nepalese challenges are in creating more accessible and affordable care of sufficiently high-quality to make a difference. Hospitals are the major places where these issues have to be considered. To address these challenges, we offer a vision and suggest here strategies of major organizational changes in: Innovative staffing models, emphasizing teamwork, with increases in responsibilities, activities and work force percentages of non-physician health professionals; Increased outpatient care and tele-health; 3.Creating and following evidence-based diagnostic pathway and treatment clinical practice guidelines and checklists; 4. Increased application of information technology tools, particularly electronic medical records; and 5. Service implementation research evaluating quality based on structure, process and outcomes of care. Developing such effective changes requires strong community linkages, local institutional-specific coalition initiatives and experimentation, and national and international collaborations and financial support to effect practical and data-based plans and budgets. Keywords: Guidelines; improving treatment; information technology tools; outpatient services; staffing models; tele-health.

Adapting Interdisciplinary Transitional Ambulatory Practice to Meet the Challenges of COVID-19.

COVID-19 restructured the health care delivery process, catapulting telemedicine to the mainstream. The Johns Hopkins After Care Clinic (JHACC) continued transprofessional health care delivery in the telemedicine space by shifting to remote, asynchronous collaboration and a triage system. In 1 month after starting telemedicine, the JHACC had 907 encounters for 376 unique patients. Most patients reported satisfaction with their visits. Telemedicine lengthened visit completion times. Providers encountered many failed call attempts and limited access to videoconferencing. Barriers to sustainable interprofessional telemedicine include poor social determinants of health, limited reimbursement for nonphysician health professionals, and increased clinical and administrative time.

Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study

BackgroundAntimicrobial resistance is an important global health issue. In Germany, the national agenda supports various interventions to convert habits of antibiotic use. In the CHANGE-3 (Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care) study, digital tools were applied for information delivery: tablet computers in primary care practices, e-learning platforms for medical professionals, and a public website to promote awareness and health literacy among primary care physicians, their teams, and their patients.ObjectiveThis study is embedded in the process evaluation of the CHANGE-3 study. The aim of this study was to evaluate the acceptance and uptake of digital devices for the delivery of health-related information to enhance awareness and change habits of antibiotic use in primary care in Germany.MethodsThis study used a convergent-parallel mixed-methods design. Audio-recorded semistructured telephone interviews were conducted with physicians, nonphysician health professionals, and patients in the CHANGE-3 program. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was performed based on the inductive category of information provision via digital information tools. Identified themes were related to the main postulates of Diffusion of Innovations theory (DIT) to provide an explanatory frame. In addition, data generated through a structured survey with physicians and nonphysician health professionals in the program were analyzed descriptively and integrated with the qualitative data to explore the complementarity of the findings.ResultsFindings regarding the acceptance and uptake of digital devices were related to three postulates of DIT: innovation characteristics, communication channels, and unanticipated consequences. Participants considered the provided digital educative solutions to be supportive for promoting health literacy regarding conversion of habits of antibiotic use. However, health care professionals found it challenging to integrate these solutions into existing routines in primary care and to align them with their professional values. Low technology affinity was a major barrier to the use of digital information in primary care. Patients welcomed the general idea of introducing health-related information in digital formats; however, they expressed concerns about device-related hygiene and the appropriateness of the digital tools for older patients.ConclusionsPatients and medical professionals in German primary care are reluctant to use digital devices for information and education. Using a Diffusion of Innovations approach can support assessment of existing barriers and provide information about setting-specific preconditions that are necessary for future tailoring of implementation strategies.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 15061174; http://www.isrctn.com/ISRCTN15061174.

S3190 #COVID19: Twitter as a Resource for IBD Patients During a Global Pandemic

INTRODUCTION: In December 2019, a novel corona virus (COVID-19) emerged from Wuhan, China and within 3 months caused a global pandemic with high morbidity and mortality. Inflammatory bowel disease (IBD) patients may be at particular risk given immunocompromised state. Since Twitter is a source of information sharing, this study evaluated frequency, content, and origin of Twitter messaging focused on COVID-19 and IBD. METHODS: Social Feed Manager software (version 2.0.0: GWU Libraries, 2019) accessed Twitter’s application programming interface to obtain user information, origin and content of social media posts related to COVID-19 and IBD between March 11 and 18, 2020. SFM queried Twitter for #COVID19 #CoronaVirus or #CoronaOutbreak AND any comment containing “inflammatory bowel disease”, “IBD”, “Crohn’s” or “Ulcerative Colitis.” Messages that did not reference key terms and non-English messages were excluded. Individual user descriptions, tweets, and linked websites were analyzed for content. Analysis was performed using Chi-square, with significance set at P < 0.05. RESULTS: 1623 of 1648 (98.5%) were analyzed. 938 (57%) were personal user accounts, 444 (27%) physician, 109 (7%) non-physician health professionals, 51 (3%) support groups, 43 (3%) professional organizations, remainder were commercial or unclassified. More tweets were from personal versus medical associated accounts (P < 0.0001). Content was mostly informational (76%, n = 1226, P < 0.0001), 7% (n = 89) were treatment related, 24% (n = 296) related to the IBD-Covid registry and 3% (n = 34) were symptom related. The remainder were 8% (n = 128) concerns, 4% (n = 67) support, 3% (n = 51) inquiry and 9% (n = 151) other. 327 tweets attached links; primarily linked to established medical resources (67%, n = 204, P < 0.0001). Tweeters spanned 6 continents with most common from United States (n = 524), United Kingdom (n = 316), European Union (n = 120), Canada (n = 116). There was a significant difference (P = 0.0001) in the rate of messaging from US users compared to others. CONCLUSION: This study revealed that Twitter is used globally to share information on IBD and COVID-19. While most tweets came from personal accounts, the majority of content was informational and links more often came from established sources. Twitter provided opportunities for patient advocacy, support, and up to date information on disease prevention and treatment in a rapidly changing environment. Twitter can be an easily accessible healthcare education tool in a global pandemic to disseminate information.

Awareness and Use of Community Services among Primary Care Physicians.

Primary care physicians play an important role in care coordination, including initiating referrals to community resources. Yet, it is unclear how awareness and use of community resources vary between physicians practising with and without an extended healthcare team. We conducted a cross-sectional survey of primary care physicians practising in Toronto, Canada, to compare awareness and use of community services between physicians practising in team- and non-team-based practice models. Team-based models included Community Health Centres and Family Health Teams - settings in which the government provides funding for the practice to hire non-physician health professionals, such as social workers, pharmacists, nurse practitioners, registered nurses and others. The survey was mailed to physicians, and reminders were done by phone, fax and e-mail. We used logistic regression to compare awareness between physicians in team-based (N = 89) and non-team-based (N = 138) models after controlling for confounders. We found that fewer than half of the physicians were aware of five of eight centralized intake services (e.g., ConnexOntario, Telehomecare). For most services, team-based physicians had at least twice the odds of being aware of the service compared to non-team-based physicians. Our findings suggest that patients in team-based practices may be doubly advantaged, with access to non-physician health professionals within the practice as well as to physicians who are more aware of community resources.

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older

ObjectiveTo establish European League Against Rheumatism (EULAR) points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.MethodsPoints to consider were developed...

Promoting rational antibiotic prescribing for non-complicated infections: understanding social influence in primary care networks in Germany

BackgroundPrimary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified.MethodsFor this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories ‘social support’, ‘social learning’, ‘social normative pressures’ and ‘social contagion’ to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks’ potential impact on antibiotic prescribing.ResultsSocial influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as a great asset, the main reason for membership and affirmative for own perspectives. All interviewed physicians (n = 27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflective management of antibiotic prescribing. Non-physician health professionals (n = 11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n = 7) expected networks and their members to be drivers for care optimization.ConclusionPrimary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotic prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics.Trial registrationISRCTN, ISRCTN58150046. Registered 24 August 2017.

Prevention and management of osteoporotic fractures by non-physician health professionals: a systematic literature review to inform EULAR points to consider

ObjectiveTo perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures.MethodsEight clinical questions based on two criteria...

Does task delegation to non-physician health professionals improve quality of diabetes care? Results of a scoping review.

ObjectiveAs a result of unhealthy lifestyles, reduced numbers of healthcare providers are having to deal with an increasing number of diabetes patients. In light of this shortage of physicians and nursing staff, new concepts of care are needed. The aim of this scoping review is to review the literature and examine the effects of task delegation to non-physician health professionals, with a further emphasis on inter-professional care.Research design and methodsSystematic searches were performed using the PubMed, Embase and Google Scholar databases to retrieve papers published between January 1994 and December 2017. Randomised/non-randomised controlled trials and studies with a before/after design that described the delegation of tasks from physicians to non-physicians in diabetes care were included in the search. This review is a subgroup analysis that further assesses all the studies conducted using a team-based approach.ResultsA total of 45 studies with 12,092 patients met the inclusion criteria. Most of the interventions were performed in an outpatient setting with type-2 diabetes mellitus patients. The non-physician healthcare professionals involved in the team were nurses, pharmacists, community health workers and dietitians. Most studies showed significant improvements in glycaemic control and high patient satisfaction, while there were no indications that the task delegation affected quality of life scores.ConclusionsThe findings of the review suggest that task delegation can provide equivalent glycaemic control and potentially lead to an improvement in the quality of care. However, this review revealed a lack of clinical endpoints, as well as an inconsistency between the biochemical outcome parameters and the patient-centred outcome parameters. Given the vast differences between the individual healthcare systems used around the world, further high-quality research with an emphasis on long-term outcome effects and the expertise of non-physicians is needed.

Intentions of Canadian health professionals towards recommending exercise for people living with ALS

BackgroundTo provide a nationwide overview of the attitudes, social pressure, perceived ability and intentions of health professionals toward exercise prescription for people living with ALS (pALS).MethodsAn online survey of physician and non-physician health professionals (HPs) working in academic ALS clinics across Canada.ResultsThe response rate was 48% (84/176) with 30% of respondents identifying as physicians, 63% as other HPs and the remainder as administrative or research personnel. Respondents were sharply divided in their intentions to provide exercise counsel: 24% unlikely and 45% likely. Respondents with low intentions were HPs that considered this activity outside their scope of practice. Measures of intention and attitude were more positive for flexibility compared to strength and aerobic exercise. Perceptions of social pressure and ability to provide exercise counsel were significantly correlated with intention across the three exercise modes in all respondents. Qualitative themes identified as barriers to exercise prescription were lack of confidence or competence (31% physicians, 32% HP), patient tolerance (30% HP), lack of evidence (22% physicians) and lack of infrastructure (22% physicians).ConclusionsWhile “lack of evidence” for the benefit of exercise was a deterrent for physicians, the larger issue for all respondents was building competence and confidence in exercise prescription for pALS.

Texas bill to require mental health curriculum in public schools

Texas Gov. Greg Abbott signed House Bill 18, an omnibus bill that requires Texas school districts to offer mental health and suicide prevention curricula if they do the same with physical health, ABC 8 News reported June 3. The curricula and training will include signs of mental health conditions and substance abuse, strategies for maintaining student‐to‐student positive relations, conflict resolution and information about how grief and trauma affect student learning. School districts will be partnering with local mental health authorities for specific content. Advocates hope these curricula and training will help identify and respond to mental health issues and bullying before they become larger problems. HB 18 now allows school districts to employ or contract with one or more nonphysician mental health professionals: a psychologist, registered nurse with a master's degree in psychiatric nursing or a licensed social worker. It also requires online training in Mental Health First Aid to be public and encouraged in schools. Next school year, training videos will be offered in public schools around the state as part of new coursework, teaching students what to look for in their classmates and how to get them help. The focus is on suicide prevention and grief counseling.

Skill mix in Swiss primary care group practices - a nationwide online survey

BackgroundIncreasing chronic conditions and multimorbidity is placing growing service pressures on health care, especially primary care services. This comes at a time when GP workforce shortages are starting to be felt across Switzerland, placing a threat on the sustainability of good access to primary care. By establishing multiprofessional teams in primary care, service capacity is increased and the pressures on the GP workforce can be alleviated. The roles of non-medical health professions in primary care are not established so far in Switzerland and the personnel composition of primary care group practices is not known. Therefore this study aims to provide insights into the current composition, educational background and autonomy of the these new professional roles in primary care.MethodsFor this descriptive exploratory study a web-based online survey methodology was used. Group practices were defined as being a medical practice with any specialisation where at least three physicians work together in a team. Based on this restriction 240 eligible group practices were identified in Switzerland. The following four tertiary-level health professions were included in the study: nurses, physiotherapists, occupational therapists and dietitians. Additionally medical practice assistants with couselling competencies were included.ResultsA total of 102 practices answered the questionnaire which is equivalent to an answer rate of 43%. The sample included data from 17 cantons. 46.1% of the practices employed non-physician health professionals. Among the tertiary-level health professions, physiotherapists were the most frequent profession with a total of 78 physiotherapists over all group practices, followed by nurses (43), dietitians (34) and occupational therapists (3). In practices which employ those professionals their average number per practice was 3.4. 25.5% of the practices had health professionals employed with advanced roles and competencies.ConclusionThe results from this study demonstrate that while nearly 50% of groups practices have established non-physician professionals, only 25% of practices integrate these professionals with advanced roles. Compared with other countries, there would appear to be significant scope to extent and broaden the uptake of non-physician professionals in primary care in Switzerland. Clear policy direction along with supporting regulation and financing arrangements are required.

Improving Trust Between Learners and Teachers in Medicine.

Improving Trust Between Learners and Teachers in Medicine.

Non-Physician vs. Physician: Cross-Disciplinary Expert Testimony in Medical Negligence Litigation—Who Knows the Standard of Care?

This paper explores whether non-physician health professionals should be permitted to testify in medical negligence litigation regarding the medical standard of care applicable to physician-defendants. Can non-physician health professionals acquire the knowledge necessary to know and appreciate the standard of care despite the lack of classical medical education and medical degrees? Is it relevant that a significant amount of health care is provided by non-physicians, such as nurses, nurse practitioners, physician assistants and nurse anesthetists? Other non-physicians work with and may assist in the training of physicians. Are they able to know the medical standard of care? These timely topics will be discussed.