Physician Competence Research Articles

Physicians' required competencies in AI-assisted clinical settings: a systematic review.

Utilizing Artificial Intelligence (AI) in clinical settings may offer significant benefits. A roadblock to the responsible implementation of medical AI is the remaining uncertainty regarding requirements for AI users at the bedside. An overview of the academic literature on human requirements for the adequate use of AI in clinical settings is therefore of significant value. A systematic review of the potential implications of medical AI for the required competencies of physicians as mentioned in the academic literature. Our findings emphasize the importance of physicians' critical human skills, alongside the growing demand for technical and digital competencies. Concrete guidance on physicians' required competencies in AI-assisted clinical settings remains ambiguous and requires further clarification and specification. Dissensus remains over whether physicians are adequately equipped to use and monitor AI in clinical settings in terms of competencies, skills and expertise, issues of ownership regarding normative guidance, and training of physicians' skills. Our review offers a basis for subsequent further research and normative analysis on the responsible use of AI in clinical settings. Future research should clearly outline (i) how physicians must be(come) competent in working with AI in clinical settings, (ii) who or what should take ownership of embedding these competencies in a normative and regulatory framework, (iii) investigate conditions for achieving a reasonable amount of trust in AI, and (iv) assess the connection between trust and efficiency in patient care.

Evaluation of Peer Review of Percutaneous Coronary Intervention Operator Performance.

Case-based peer review of percutaneous coronary intervention (PCI) is used by many hospitals for quality improvement and to make decisions regarding physician competency. However, there are no studies testing the reliability or validity of peer review for PCI performance evaluation. We recruited interventional cardiologists from 12 Veterans Affairs Health System facilities throughout the United States to provide PCI cases for review. Ten reviewers performed blinded reviews such that each case was reviewed twice. Cases were rated on a scale of 1 to 5 (with 5 being the best) for 6 care domains (Appropriateness, Lesion Suitability, Strategy, Technical Performance, Outcome, and Documentation) with a summary performance score calculated as the average of all domains. Separately, reviewers determined whether the standard of care was met. Interobserver reliability of the summary performance score was calculated using interclass correlation coefficient. We examined procedural complications and 30-day mortality and major adverse cardiac events for all PCIs performed by these operators from 2019 to 2022 when stratified in tertiles by summary performance score. Of the 65 cases provided by 13 operators, the mean summary performance score was 3.90 (SD=0.78) out of 5. The interclass correlation coefficient was 0.53, indicating moderate interobserver reliability. For 19 cases (29.2%), 1 reviewer indicated that the performance did not meet the standard of care; however, the second reviewer disagreed in all these cases. Average performance scores ranged from 3.35 to 4.38. Among the 3390 PCIs performed by reviewed cardiologists from 2019 to 2022, the lowest-rated tertile had higher rates of complications (2.9% versus 1.8%, P<0.01) and major adverse cardiac events (10.6% versus 8.0%, P<0.01) compared with the highest-rated tertile. Case-based peer review identifies variation in physician performance that is correlated with PCI outcomes. However, reviewer disagreements about the standard of care raise concerns about the use of peer review for high-stakes assessments of physician competency.

Using case-based role-play to learn professionalism in Pharmacology

Background: Professionalism has been identified as a key competency for physicians to conduct, effective and ethical practice. The current competency-based medical education curriculum lays great emphasis on the development of attitude, ethics, and communication (AETCOM) among medical students which is embedded in the core concepts of professionalism. Comprehending these concepts early in the course of medical training is especially important as such a change may lead to reducing future incidents of professional misconduct. However, teaching this complex topic to undergraduate students through routine didactic lectures alone is challenging. Methods: To address this, we divided the batch of second-year MBBS students into 5 random groups and assigned 1 case scenario for role play to each group with sub-questions for discussion and reflection. After a short introductory lecture on professionalism, each group presented their role-play and discussed the sub-questions. Assessment for the improvement in knowledge was done using pre and post-test multiple choice questions. Results: Our findings show a statistically significant improvement in the mean (± Standard Deviation) scores for post-test (16.76±3.00) vs the pre-test (11.56±2.81) (p&lt; 0.0001). Participant feedback was overwhelmingly positive based on the 5-point Likert scale. Conclusion: This shows that an interactive and engaging model, such as relevant case scenarios and role-play with reflection, along with assessment and feedback, could be effective for medical students, in learning the complex topic of professionalism.

Development of a Japanese version of the Fresno test for family physicians to measure evidence‐based medicine competence

AbstractBackgroundThe Fresno test is a useful instrument for measuring the evidence‐based medicine (EBM) competence of family physicians and others. This study aimed to develop a Japanese version of the Fresno test.MethodsFirst, the original version of the Fresno test was translated into Japanese following the standard instrument translation procedure. Subsequently, family medicine residents and certified physicians took the Japanese version of the Fresno test to assess its validity and reliability.ResultsTranslation of the Fresno test into Japanese was completed successfully. A total of 39 participants took the test to verify reliability and validity. Family medicine specialists scored higher than majors (129.7 ± 36.0 vs. 100.6 ± 45.1, p = 0.036), which indicated high construct validity. Intra‐class correlation coefficient and Kappa value of all questions were above 0.7, which suggested sufficient reliability. Item difficulty and floor/ceiling effect also fulfilled pre‐determined criteria.ConclusionsThis study successfully developed a Japanese version of the Fresno test. This test has sufficient reliability and validity and is expected to be useful as an instrument in EBM education for physicians in the future.

Development and validation of situational judgement test for assessment of behavioural competencies required for effective medical practice in Nigeria

BackgroundThe personal qualities of health workers determine the way health services are provided to clients. Some key personal qualities (also called behavioural competencies) of physicians that contribute to quality healthcare delivery include ethical responsibility, empathy, patient-centeredness, diligence, good judgment, respectful, teamwork, team leadership/conflict management, ability to take correction and tolerance. In this study, we developed and validated clinical scenarios (dilemmas) for assessing priority behavioural competencies for medical practice in Nigeria.MethodsDrawing on prioritized competencies generated via a scoping review and nominal group technique (NGT) exercises in a previous study in the study series, Faculty members from the University of Nigeria Teaching Hospital were consulted to develop or adapt clinical scenarios that could be used to assess these competencies in a physician. The clinical scenarios and options were framed as situational judgement tests (SJTs) and these tests were administered to a random sample of 192 undergraduate and 111 postgraduate medical doctors in a tertiary hospital in Enugu State. Using Kane’s validity argument framework, we assessed scoring and generalization inferences of situational judgment tests (SJT) based on the developed scenarios.ResultScoring inference – difficulty and discrimination index – shows that most of the SJT items are good test items and can differentiate between high and low performers. The corrected point biserial correlations show positive correlation for most of the items. Generalization inference shows the items represent the domains of interest and are internally consistent. However, few items that show poor difficulty and discrimination index were subjected to re-evaluation and possible elimination.ConclusionThis study has produced a set of valid clinical scenarios that can be used to evaluate specific behavioural competencies among trainee medical doctors. It demonstrates that SJTs can be used to assess behavioural competencies for medical practice. However, further research is needed to establish the applicability of SJT beyond the immediate context, such as the medical school, in which it is developed.

Exploring Spiritual Care Competency in Palliative Medicine: A Narrative Inquiry of Physician Care Notes on Spiritual Distress.

Background: Spiritual care is a critical component of hospice and palliative medicine; however, physicians frequently lack the necessary competencies to adequately address patients' spiritual needs. This study aims to examine the spiritual care competencies of physicians as reflected in their care notes, thereby providing insights into their approaches for managing spiritual distress. Methods: A narrative inquiry approach was employed to qualitatively analyze interaction notes from 30 palliative care patients experiencing spiritual distress. Data were collected from a medical university professor's care notes between April 2019 and February 2024. Results: The most common form of spiritual distress observed was reluctance to leave life, followed by loss of dignity. Physicians demonstrated expertise in holistic care, addressing physical, psychological, and spiritual needs with a comprehensive approach. Their demeanor reflects acceptance of mortality and acknowledgment of the limitations of medical care, helping foster gratitude and contentment in patients. Effective communication was pivotal, involving the conveyance of information, empathetic engagement, and active listening. Compassionate interactions emphasized the importance of spiritual care in patient-centered care delivery. Conclusions: Spiritual care competencies are essential for improving patient outcomes and advancing comprehensive palliative care. Future efforts should integrate these competencies into communication training within medical education to more effectively enhance health care providers' competencies.

Unmet medical needs in otorhinolaryngology

Unfulfilled medical wishes and the resulting disappointments often have infrastructural causes and are the result of inadequate services or limited available resources in amedical practice. As annoying as these might be, they can hardly be influenced by the individual therapeutic competence of the ENT physician. The situation is different in the case of unfulfilled medical wishes of patients who cannot be adequately helped for avariety of reasons, whether because of the severity of their illness or because of the particular, predominantly psychosomatic constellations. This can lead to disappointment and unfulfilled expectations on both sides. This article focuses on diseases for which there are no clear organic findings and therefore no clear treatment options, such as surgery or medication, or in which the organic findings are tangible but do not sufficiently explain the underlying condition. In such cases, the treatment measures initiated are not sufficient and do not satisfy the patient. The patient feels misunderstood, which puts additional strain on the relationship between physician and patient. Abasic psychosomatic understanding of underlying and subjectively dominant organic complaints-by physicians and patients-is helpful here. In this way, the symptom can also be understood and recognized as apossible expression of psychogenic distress in order to pave way to the necessary initiation of causal therapy. The article is intended to reflect on this and make suggestions for dealing with the topic, using the example of tinnitus suffering in particular.

The Dark Horse: Introducing a Comparative Hematology Course into the Post-Clerkship Phase of Medical School

Introduction: Developing a deep understanding of pathophysiology is integral to training competent physicians. Although the basic sciences are taught primarily in preclinical curriculum, revisiting these concepts during the fourth year of medical school promotes integration into clinical medicine (Spencer et. al, 2008). Immersive comparative physiology courses increase trainee appreciation of physiology and its incorporation into patient care (Herzig et al, 2012). We introduced comparative physiology curriculum during a fourth-year medical student course at University of Texas Southwestern (UTSW) Medical School. Our course aimed to deepen students' understanding of human pathophysiology and its clinical applications by highlighting evolutionarily conserved and adaptive changes among diverse species. Methods: We developed a one-week comparative physiology curriculum to present to fourth-year medical students in April 2024. The curriculum utilized the four stages of Kolb's Experiential Learning Theory through multimodal methodologies, including introductory lectures, case-based learning, laboratory experiments on human and animal blood with integrated case studies and group projects, and evolutionary biology group presentations at the Fort Worth Zoo. The UTSW Institutional Review Board approved the dissemination of pre- and post-course surveys. The surveys incorporated a 7-point Likert scale (1= strongly disagree, 2= disagree, 3= somewhat disagree, 4= neither agree nor disagree, 5= somewhat agree, 6= agree, 7= strongly agree). Anonymous six-digit identifiers tracked changes in individual perceptions. Scores were calculated by summing responses to series of questions evaluating perceptions of construct and knowledge. Paired samples t-tests through Microsoft Excel assessed the significance of differences between pre- and post-course mean perception of construct and confidence in knowledge scores. Results: Fifteen fourth-year medical students enrolled, and 93% completed both surveys. Self-assessed confidence in knowledge significantly increased (p =1.02x10-5) in multiple concepts, including interpretation of the peripheral blood smear and of the complete blood count. In the post-course survey, 79% of respondents agreed or strongly agreed that comparative physiology models should be incorporated into medical education, 79% agreed or strongly agreed that the course increased their interest in hematology, and 100% strongly agreed to recommend the course. Conclusion: Incorporating immersive comparative physiology curriculum into the post-clerkship phase of medical school can enhance understanding of core hematologic physiology principles and promote interest in hematology.

#WhatWouldYouDo? A cross-sectional study of sports medicine physicians assessing their competency in managing harassment and abuse in sports

ObjectivesTo assess the clinical competence of sports medicine physicians to recognise and report harassment and abuse in sports, and to identify barriers to reporting and the need for safeguarding education.MethodsWe...

Leadership opportunities to mitigate challenges and barriers of precision health

Abstract Background Precision health, encompassing personalized and proactive health solutions, aims to address this gap by integrating genetic, behavioral, and environmental factors. However, challenges persist in its integration, necessitating new healthcare competencies, particularly in leadership, to expedite the transition. Our goal is to identify barriers and solutions for the implementation of precision health and build a core curriculum of leadership competencies to mitigate challenges and barriers for the implementation of precision health. Methods A systematic literature review of qualitative primary studies on barriers and facilitators to precision health implementation was conducted. Data extracted from included articles were analyzed thematically, adapting leadership competencies outlined in the CanMEDS Physician Competency Framework. This approach identified key leadership traits crucial for precision health implementation. Results 51 articles meeting inclusion criteria yielded 985 barriers and facilitators. Thematic analysis identified 9 primary leadership competencies essential for precision health implementation: application of quality improvement science (30%); fostering a culture of patient safety in data use (10%); advocacy for innovative data management (4%); resource allocation advocacy (9%); evidence-based cost management (4%); driving practice change (8%); prioritization and time management (11%); and optimization of healthcare workforce practices (14%). Discussion The synthesized leadership competencies provide a useful framework for addressing barriers and fostering precision health implementation among healthcare professionals. The high representation of competency related to quality improvement science is emblematic of how cultural elements specific to leadership and management in medicine could represent a strategic asset to foster the implementation of innovative solutions, like precision health, in healthcare. Key messages • Leadership skills are a crucial element in the curriculum of health professionals to support the implementation of precision health in clinical practice. • Incorporating elements of ‘quality improvement science’ in the healthcare professionals education emerged as essential to foster precision health implementation.

Assessment of an Antimicrobial Stewardship Program for Enhancing Clinical Knowledge in Neonatal Care Settings With High Antimicrobial Resistance.

Antimicrobial resistance (AMR) is a global problem, which is particularly challenging in developing countries like India. This study attempts to determine the competencies of health care professionals and to update evidence-based policies to address AMR. A survey-based educational interventional study was conducted using a validated structured survey and knowledge questionnaire under 3 domains through an antimicrobial stewardship program. Pooled data were analyzed using SPSS version 16.0. Out of 58 participants, 53 (91%) have observed an increasing trend of multidrug-resistant infections over the last 5years. There is a significant difference between the overall pretest mean scores (8.12±2.10) and posttest mean scores (12.5±1.49) of clinicians' knowledge with a mean difference of 4.38±0.61, 95% CI of 5.003-3.92, t(57)=16.62, P <.001). The antimicrobial stewardship program was effective in improving the competencies of clinical physicians to improve antimicrobial prescribing and reduce AMR. Moreover, improving the knowledge and competencies among health care professionals will minimize neonatal morbidity and mortality.

Redefining professionalism to improve health equity in competency based medical education (CBME): A qualitative study.

There is a pressing need to address all forms of anti-oppression in medicine, given systemic harm and inequities in care and outcomes for patients and health care professionals from equity-deserving groups. Revising definitions of professionalism used in competency-based education can incorporate new professional competencies for physicians to identify and eliminate the root causes of these inequities. This study redefined the CanMEDS Professionalism definition to centre perspectives of equity-deserving groups. In this qualitative study there were two phases. The authors conducted individual semi-structured interviews with participants representing equity-deserving population groups to understand their perspectives on and iteratively build a definition of medical professionalism. Then, the authors undertook a consensus-building process, a modified nominal group technique, using focus groups with community members from equity-deserving groups and healthcare providers to verify findings and arrive at an updated definition of medical professionalism. Four main themes were identified: 1) healthcare at the margins; 2) equity-oriented domains of professionalism; 3) structural professionalism; and 4) supporting improved professionalism. These themes were incorporated into a consensus-based definition of medical professionalism, with a focus on anti-oppression, anti-racism, accountability, safety, and equity. The authors propose a new definition of medical professionalism that embeds anti-oppression, including anti-racism, as critical competencies in clinical practice and education.

Association between physicians’ maldistribution and core clinical competency of resident physicians: a nationwide cross-sectional study

ObjectivesWith physician maldistribution recognised as a global issue, Japan implemented the physician uneven distribution (PUD) index as a strategic measure. Currently, there is a lack of objective assessment of core...

Knowledge and competence of primary healthcare physicians in the management of diabetes-related chronic kidney disease.

Diabetes mellitus (DM) is a primary cause of chronic kidney disease (CKD), a significant and growing global health issue. Primary healthcare physicians (PHPs) are crucial in detecting, managing, and preventing CKD, but many lack the necessary knowledge and skills to effectively diagnose and manage the disease. This study assessed the knowledge and competence of PHPs in managing diabetes-related CKD. This cross-sectional study was conducted among all Primary Healthcare Physicians (PHPs) working at Primary Healthcare Center (PHC) in King Abdulaziz Medical City of the National Guard, Jeddah, Saudi Arabia. An online questionnaire was sent to all PHPs and data were collected from January 2024 to February 2024. Data analysis performed utilizing RStudio (version 4.3.1). Categorical variables were expressed as frequencies and percentages, whereas mean and standard deviations were computed for continuous variables. Kruskal-Wallis rank sum test was used to determine differences in confidence scores across various demographic and occupational characteristics. A multivariable linear regression analysis was performed to identify factors related to confidence. Of 141 PHPs, 122 filled online questionnaire yielding a response rate of 86.5%. responded. The majority (90.2%) were 18-45 years of age, 68.0% were qualified as family physicians, 38.0% belonged to the specialized poly clinic, and 54.9% had less than 5 years of experience. PHPs showed a varied levels of confidence and knowledge. While 76.2% were confident about the stages of kidney disease and 65.6% acknowledged the importance of the urine albumin-creatinine ratio (uACR) test, 58.1% were uncertain of interpreting uACR results and CKD diagnostic criteria. More than 60.0% were uncertain of the treatment steps postdiagnosis and prediction of CKD prognosis. Age, qualification, specialization in family medicine, and clinic affiliation were significantly related to confidence levels. The study underscores notable gaps in PHPs' knowledge and confidence concerning CKD screening, diagnosis, and management. Continuous education and targeted interventions are essential for the improvement of PHPs' competence and patient outcomes in the management of CKD.

Conceptualization and teaching health advocacy in undergraduate medical education:a document analysis.

Health advocacy is considered to be a core competence for physicians, but it remains unclear how the health advocacy role, despite being described in overarching competency frameworks, is operationalized in undergraduate medical education (UME). This study aimed to identify how health advocacy is conceptualized and taught in undergraduate medical curricula. We performed a qualitative analysis of curriculum documents from all eight medical schools in the Netherlands, all of which offered competency-based UME. Thematic analysis was used to code all the documents and generate themes on health advocacy conceptualization and teaching. To categorize the emerging themes, we used the framework of Van Melle et al. for evaluating the implementation of competency-based medical educational programs. Health advocacy was mostly conceptualized in mission statements about social responsibility of future physicians, related to prevention and promoting health. We found key concepts of health advocacy to be taught mainly in public health and social medicine courses in the bachelor stage and in community-based clerkships in the master stage. Specific knowledge, skills and attitudes related to health advocacy were taught mostly in distinct longitudinal learning pathways in three curricula. Health advocacy is conceptualized mostly as related to social responsibility for future physicians. Its teaching is mostly embedded in public health and social medicine courses and community-based settings. A wider implementation is warranted, extending its teaching to the full width of medical teaching, with longitudinal learning pathways providing a promising route for more integrative health advocacy teaching.

Enhancing medical training in conflict zones and remote areas through innovation: introducing the Canadian Virtual Medical University Initiative

The WHO projects a global shortage of 4.3 million physicians by 2030, with the largest deficits in developing and conflict-affected regions. Our aim is to train competent physicians rapidly and affordably through remote education programs. We developed an online medical training curriculum with four levels, focusing on different aspects of human body systems using a competency-based, student-centered approach. This study evaluates the first three levels; level four (internship) is outside this scope. The 105 medical students from eight Afghan universities were randomly assigned to nine groups. The curriculum includes Entrustable Professional Activities (EPA) for the cardiovascular system: level 1 covers basic medical sciences, level 2 pathology and basic clinical skills, and level 3 full clinical competencies. EPAs were delivered asynchronously online via Lecturio, CyberPatient, and Zoom. The 30-day intervention included 4h of weekly online classes for formative assessment, collaborative learning, and evaluation, supervised by medical faculty members. Virtual pre- and post-intervention evaluations used multiple-choice questions and objective structured clinical examination (OSCE). We also conducted a satisfaction survey and open interview forum. Data triangulation from observations, surveys, and interviews validated curriculum effectiveness. The benchmarking method assessed cost-effectiveness. Pre- and post-intervention analysis showed a significant increase in clinical competencies and knowledge acquisition (P<0.0001). The CyberPatient intervention improved clinical competency quality (P<0.0001) and shortened decision-making time (P<0.001). Cost analysis revealed that a virtual medical university would be 95% more cost-effective than traditional medical education. Integrating virtual technology with modern curriculum concepts in pre-internship years can effectively address healthcare training gaps and enhance education quality for healthcare workers at a low cost. Provided by CanHealth International. A UBC spin-off not-for-profit organization.

FAILURE OF CARE STANDARD IN RELATION TO PFIZER BNT162b2 modRNA

This article explains two core physician competencies required for licensure, and the recent widespread failure of physicians to provide safe medical care for the communities which they serve.

Gamification approach to addiction education for internal medicine residents

Background: People with a substance use disorder (SUD) outnumber the trained provider workforce. The Accreditation Council for Graduate Medical Education (ACGME) recognized this gap in 2022 and now requires addiction education for internal medicine (IM) residents. However, traditional lecture formats struggle to deliver education on this stigmatized condition with meaningful retention and changes in attitudes. Gamification is an evidence-based educational strategy with positive outcomes in graduate medical education, but to our knowledge, has not been used for an entire addiction curriculum. Intervention: This six session IM-focused, stigma-free, interactive curriculum used published physician competencies for content selection. Games were matched to topics based on complexity and need for skill practice. Each hourly session included 10 minutes on introduction, 45 minutes on gameplay, and 5 minutes on feedback. This addiction curriculum was incorporated into existing didactics for IM residents where participants’ comfort, psychological safety, and learning expectations were pre-established. Methods: Sixteen IM residents participated in the curriculum. Curriculum evaluation was conducted using Kirkpatrick’s four levels of evaluation. Resident feedback was obtained via online survey software at the conclusion of each session and behavior impact through an anonymous single question prompt. We used descriptive statistics and summative content analysis to evaluate findings, respectively. Results: All residents were highly satisfied with the curriculum design and use of gamification. Residents reported high levels of engagement and learning, despite use of various games. Findings support an increase in medication prescribing and utilization of harm reduction strategies following curriculum implementation. Conclusion: Gamification may be a preferred educational strategy for addiction curriculum for IM residents. We plan to distribute our curriculum widely for further evaluation in health professions’ programs.

FAILURE OF CARE STANDARD IN RELATION TO PFIZER BNT162b2 modRNA

This article explains two core physician competencies required for licensure, and the recent widespread failure of physicians to provide safe medical care for the communities which they serve.

Mental health in postgraduate medicine: an urgency in the systematization of strategies

Several studies about mental health report a higher illness prevalence in physicians than in general population. Mental health Illness is multifactorial, and its negative consequences range from stress, anxiety, depression, burnout, somatic manifestation to suicide. Health professionals are educators and know the importance of creating and training compassionate and competent physicians. The aim of this study was to describe mental health strategies in postgraduate doctors. Out of a total of 494 articles, only 9 were analyzed which mentioned some strategy for mental health improvement, such as diffusion, timely detection of mental health conditions, in-person or online training, integral care, support groups, socialization, pairing, physical activity, follow-up and support, reinforcement of institutional norms and values, including strategies from the Puebla Decentralized Administrative Operating Body. The strategies implemented in the optimization of mental health in trainee doctors increase resilience and optimism while simultaneously reduce the prevalence of mental health conditions. In addition, they provide the necessary tools for self-care. The Mexican Institute for Social Security (IMSS, according to its initialism in Spanish) is aware of this, which is why it systematizes the different strategies.