Qualification Of Physicians Research Articles

The Integral Evaluation of Level of Qualification of Physicians in the Irkutskaia Oblast

The originally developed technique of integral evaluation of level of qualification of physicians is applied for establishing the level of the given criterion in municipal physicians of the Irkutskaia oblast. The levels of criterion in 2005-2015 were calculated. The results are ranked on the level of criterion. The integral evaluation was implemented to particular medical specialties and subsequent ranking of obtained results was made.

Patient preference in primary care provider type

BackgroundGiven the growing roles of nurse practitioners (NPs) and physician assistants (PAs), patients are increasingly able to choose their primary care provider type. Studies examining patient preferences among provider types are limited and ours is the first to examine reasons for patients’ provider type preferences. MethodsUsing data from the 2014 Association of American Medical Colleges’ (AAMC) Consumer Survey of Health Care Access, we used qualitative analysis to identify themes in open text responses of reasons for respondents’ provider type preference (N = 4220). After coding responses for themes, we used chi-square tests to assess whether there were statistically significant differences in respondents’ reasons for their provider preference, and whether reasons vary by the gender, race, or age of the respondent. ResultsThose preferring physicians were more likely to cite physician qualifications (75%) and trust (7%) than those preferring NP/PAs (qualifications = 36%; trust = 4%). Those preferring NP/PAs were more likely to cite bedside manner (20%) and convenience (9%) than those preferring physicians (bedside manner = 5%; convenience = 4%). Both groups of respondents were equally likely to mention previous experience with their provider type as a reason for their preference (prefer physician = 19%; prefer NP/PA = 21%). ConclusionsProvider qualifications and previous health care experiences are cited as key reasons for preferring all provider types. Additionally, physicians are more often preferred for their qualifications and technical skills, whereas NP/PAs are more often preferred for their interpersonal skills. ImplicationsOur results could help providers, health system administrators, workforce planners, and policy makers better understand patient perspectives and design care that enhances patient satisfaction.

A systematic survey on the diagnosis strategy and patient management of type 1 diabetes by Chinese physicians.

The qualification of physicians is a key factor in controlling type 1 diabetes (T1D) since they provide crucial information to their patients about self-management. To investigate whether Chinese physicians' medical strategies influence the control of T1D in their patients, we designed a questionnaire to survey Chinese physicians, which covered their diagnosis and patient-management strategies for T1D. A total of 442 completed questionnaires were received from 35 public hospitals in 12 cities. The results showed Chinese physicians mainly diagnosed T1D based on the clinical features and islet dysfunction. One-third of physicians in this study still prescribed non-basal-bolus insulin regimens to their T1D patients. More than 80% of the doctors prescribed alpha-glucosidase inhibitors as adjunctive therapy, in addition to insulin therapy. Moreover, most of the physicians in China did not pay attention to identify coexistent autoimmune diseases. T1D patients in China were not armed with self-management knowledge and skills, which should be provided by their doctors. One of the circumstances leading to insufficient disease control in Chinese T1D patients is the ineffective therapeutic strategy prescribed by their physicians. We need to promote knowledge of efficient strategies among physicians in China to achieve better disease control in Chinese T1D patients in the future.

English

The importance of death certification goes beyond the benefits to the health facility as they also provide invaluable legal and epidemiological benefits. Errors in filling Medical Certificates of Cause of Death (MCCD) greatly affect global mortality statistics and hence create challenges for public health programs to be executed effectively. The present study used both retrospective and prospective study design to review 617 death certificates. Male mortality rate was prevalent, accounting for 54.0% (p=0.033), modal age range was from 40 to 59 years (p=0.000), while most certificates were issued in January (p=0.000). Most death cases and errors were from the medicine specialty with Bachelor of Medicine, Bachelor of Surgery/Chirurgery (MBCHB) qualification. Single, double and multiple errors were recorded in the present study. Absence of time interval of cause of death, incomplete cause of death and abbreviations were the prevailing errors. Others include absence of physician qualification and department/ward, handwriting and cause of death queries (p=0.000). Errors can be reduced by organizing periodic seminar on death certification for clinicians, especially trainees/interns. Key words: Death certification, errors, benefits, clinician.

Comparison of Medical Education between Germany and Poland Considering Internal Medicine, General Medicine, and Anaesthesia

With the continuing shortage of physicians in Germany, healthcare is increasingly being sustained by foreign physicians. The present paper addresses the comparability of medical education curricula in Germany and Poland and the qualification of physicians having Polish exams and specialist medical training for clinics and practices in Germany. The Medical Licensing Act and the Model Specialty Training Regulation of the German Medical Association were compared to the respective Polish regulations for medical education. In orienting surveys, physicians with Polish exams were questioned and they provided information regarding their current situation in German healthcare. Based on educational criteria, physicians with Polish exams and specialist training are well suited to work in medicine in Germany. They receive theoretical education comparable to that of German physicians; practical education during specialist medical training is more extensive in Germany. The survey could yield that Germany, as a job market, is very appealing for physicians with Polish exams. The primary reasons for this are better opportunities for training as well as better compensation. The solicitation of physicians equates to an economic loss for Poland. Nevertheless, the solicited physicians benefit from working in Germany. The European Union lacks common, detailed European standards for medical education.

Nationwide Registries Associated with Cardiovascular Medical Devices in Japan

Background: Nationwide medical device registries have the potential to provide real world data for regulatory purposes. The objective of this article is to assess how to develop and manage Nationwide Registries Associated with Cardiovascular Medical Devices (NRACMD). Methods: A questionnaire comprising of 43 items was designed to clarify the quality, characteristics, utility and sustainability of existing NRACMD in Japan. It was then sent to various organizing bodies. Findings: Eight organizations responded to the questionnaire. Three NRACMD were device-specific registries in which the patient was registered when a device was used. The others were procedure-specific registries. Six registries covered more than 95% of target population and two covered 80-95%. Five registries were associated with specialty board certification systems or with physician qualification for using priority devices. No NRACMD was linked to medical re-imbursement. All NRACMD were used for academic purposes related to scientific papers. Two registries were currently in use for all case surveillance under the provision of the Japanese PMD-ACT. One registry provided a historical control group for a device in clinical trial for pre-market application. The analytical output was provided to participating institutions in all registries and to manufacturers in five registries. In terms of registry management sustainability, different funding sources including public funding, funding from institutions or from physicians and manufacturers were used for NRACMD. Accuracy of registered data was verified by institutional site visit and collation of extracted sample data. Interpretation: Japan currently has eight NRACMD are in operation. Although mainly used for academic purposes, there are several examples where data have been used for regulatory purposes and shared with the manufacturers. Cooperation between the academic sector, industry and regulatory bodies is essential for efficient use of NRACMD data.

Barriers to Practicing Continuous Medical Education among Primary Health Care Physicians in Alahsa, Kingdom of Saudi Arabia

Objectives: To identify barriers to the practice of continuous medical education (CME) by primary health care physicians in Alahsa region, Saudi Arabia. Methods: In this analytic cross-sectional study, 121 participants answered a self-administered questionnaire which measures the level of practice of CME and the prevalence of a number of factors that affect CME practice. The prevalence of the factors that affect CME practice was compared between those who practice CME frequently and those who do not, using appropriate statistical methods. Results: 93 participants (76.9%) practice CME frequently and 28 participants (23.1%) practice CME rarely/never. The factors that have impact on CME practice include the physician's qualification (p-value 0.03), medical knowledge (p-value<0.001), satisfaction with available CME methods (p-value<0.001), CME method preference (pvalue 0.021), belief that group CME activities are provided with poor teaching technique (p-value 0.011), patient load (p-value<0.001) and job satisfaction (p-value 0.014). Conclusion: The most important barriers to practicing CME include lack of post-graduate education, dissatisfaction with the medical information, dissatisfaction with available CME methods, preference for self-taught CME, group CME activities with poor teaching technique, low patient load and job dissatisfaction. The Ministry of health and the Saudi Commission for Health Specialties should work on those factors to improve the practice of continuous medical education by primary health care physicians.

Study of hand hygiene requirements in the operation skill of physician qualification examination

Objective To explore the difference of hand hygiene requirement between guide-line of skill practice for national examinations of doctors’ qualification（clinical practitioners） and stan-dard for hand hygiene for healthcare workers in health care settings for some sterile techniques. Methods Eight sterile techniques in guideline of skill practice for national examinations of doctors’ qualification（clinical practitioners） such as changing a dress and taking out stitches, aspiration, ure-thral catheterization, arteriovenous puncture, thoracentesis, abdominal puncture, lumbar puncture and bone marrow puncture were chosen and the results were compared with standard for hand hygiene for healthcare workers in health care settings. Results Three of eight sterile technics mentioned hand-washing, six of eight mentioned wearing sterile gloves, and zero of eight mentioned antiseptic han-drubbing; however, only one of six （16.67%） before wearing sterile gloves mentioned handwashing. Conclusion The requests of hand hygiene between guideline of skill practice for national examina-tions of doctors’ qualification （clinical practitioners） and standard for hand hygiene for healthcare workers in healthcare settings are not concordant , which from the root leads to the inconsistence of doctors’ learning at different stages of education and training . It is suggested that the examination organization departments should refer to the relevant provisions of the state in the preparation of guidelines, and regulate medical practice behavior with consistent standards. Key words: Qualification examinations for doctors; Skill practice; Guideline; Standard for hand hygiene

Choosing a cancer surgeon: analyzing factors in patient decision making using a best-worst scaling methodology.

Surgeon experience has been shown to influence outcomes for many types of cancer. The factors that patients consider when selecting a hospital or surgeon for cancer treatment remain poorly defined. All patients with a cancer diagnosis seeking treatment at a surgical clinic at Johns Hopkins Hospital were asked to participate. A survey utilizing a best-worst scaling methodology was constructed to elicit the importance of various factors when selecting a cancer surgeon. Attributes were grouped into four categories: surgeon reputation, surgeon qualifications, hospital-related factors, and nonclinical factors. Two hundred fourteen patients with a cancer diagnosis participated in the study (82.0% response rate). Patients placed the highest value on physician qualifications and hospital-related factors. Specifically, surgeon case-specific experience (coefficient 2.56, SE 0.06) and the receipt of specialized training by the surgeon (coefficient 2.32, SE 0.06) ranked highest (both P<0.001). Among hospital-related factors, hospital case-specific volume (coefficient 1.32, SE 0.06; P<0.001) was most important. The lowest rated factors were parking availability (coefficient -2.81, SE 0.06) and home-to-clinic distance (coefficient -2.12, SE 0.06) (both P<0.001). The majority of patients reported their ideal surgeon to have at least 6years of experience (n=143, 68.1%) and to have performed their specific procedure at least 50 times (n=156, 75.3%). Patients consider several factors when choosing a cancer surgeon. Surgeon qualifications and hospital-related factors appear to be most influential in their decision. Easier and more widespread dissemination of surgeon and hospital cancer data such as case volume may be useful for patients.

Notärztliche Einschätzung der klinischen Weiterversorgung von Notfallpatienten

Prehospital assessment of illness and injury severity with the National Advisory Committee for Aeronautics (NACA) score and hospital pre-arrival notification of a patient who is likely to need intensive care unit (ICU) or intermediate care unit (IMC) admission are both common in Germany's physician-staffed emergency medical services (EMS) system. This study aimed at comparing the prehospital evaluation of severity of disease or injuries by EMS physicians and the subsequent clinical treatment in unselected emergency department (ED) patients. This study involved a prospective observational analysis of patients transported to the ED of an academic level I hospital escorted by an EMS physician over a period of 6 months (February-July 2011). The physician's qualification and the patient's NACA score were documented and the EMS physician was asked to predict whether the patient would need hospital admission and, if so, to the general ward, IMC or ICU. After the ED treatment, discharge or admission, outcome and length of hospital and ICU or IMC stay were documented. A total of 378 mostly non-trauma patients (88 %) treated by experienced EMS physicians could be enrolled. The number of patients discharged from the ED decreased, while the number of patients admitted to the ICU increased with higher NACA scores. Prehospital prediction of discharge or admission, IMC or ICU treatment by EMS physicians was accurate in 47 % of the patients. In 40 % of patients a lower level of care was sufficient while 12 % needed treatment on a higher level of care than that predicted by EMS physicians. Of the patients 39 % who were predicted to be discharged after ED treatment, were admitted to hospital and 48 % of patients predicted to be admitted to the IMC were admitted to the general ward. Patients predicted to be admitted to the ICU were admitted to the ICU in 75 %. Higher NACA scores were associated with increased mortality and a longer hospital IMC or ICU length of stay, but significant differences were only found between patients with NACA V versus VI scores or patients predicted to be treated on the IMC versus the ICU. Prehospital NACA scores indicate the need for inpatient treatment, but neither hospital discharge or admission nor need of IMC or ICU admission after initial ED treatment could be sufficiently predicted by EMS physicians. Thus, hospital prenotification in order to predispose IMC or ICU capacities does not seem to be useful in cases where an ED can reassess admitted EMS patients.

Maintenance of certification: How does it affect cytopathologists?

Maintenance of certification: How does it affect cytopathologists?

Entwicklung des Notarztwesens in Deutschland – Westdeutschland

Initially the premise of the rescue services was to deliver patients to medical care as quickly as possible. Due to the demands of the Heidelberger surgeon Kirchner a rethinking was initiated prior to World War 2. It was not until the 1960s that this concept was taken up again and physicians were incorporated into the rescue services. A prerequisite for this in the technical field was the development of physician escorted rescue vehicles for the prehospital management of road accident victims. After the economic and medical benefits of the deployment of emergency physicians had been demonstrated, the mandatory participation of emergency physicians was laid down in the laws on rescue services by the West German federal states. With increasing acceptance, there was a shift of the patient collective from accident victims to acute internal medical and neurological emergency cases. In order to realize the necessary efficacy of the cost-intensive organization the German Medical Council formulated guidelines for the qualification of emergency physicians.

The effect of including a ‘psychooncological statement’ in the discharge summary on patient-physician communication: a randomized controlled trial

The objective of this study is to determine whether the inclusion of a 'psychooncological statement' (PO-statement) in the discharge summary enhances patient-physician communication about psychosocial issues across the inpatient and outpatient sector. A total of 1416 cancer patients were randomly assigned to the intervention (with PO-statement in the discharge summary) or control group (discharge summary without PO-statement). Shortly before discharge from the hospital (T1), patients from the intervention group were screened for psychosocial distress. Based on the electronic clinical documentation system, screening results were subsequently integrated into the discharge summary, which automatically generated a PO-statement. To determine the effect of the PO-statement, patients as well as their primary care physicians (n = 596) were asked during follow-up care (T2) whether psychosocial distress was discussed during the last consultation. Including a PO-statement in the discharge summary did not result in more frequent discussions about psychosocial issues compared with the control group from the patients' and physicians' perspectives. Instead, discussions about psychosocial well-being were significantly associated with women of the patient (p = <0.001) and the physician (p = 0.011), medical discipline (gynecologists; p = 0.002), cancer diagnosis (gynecological cancer; p = 0.002), metastases (p = <0.001), professional training of patients (none, p = 0.026), and psychosocial qualification of physicians (p = 0.018). Written information on psychosocial distress in the discharge summary alone does not affect communication.

Structural barriers in the context of opiate substitution treatment in Germany - a survey among physicians in primary care

BackgroundOpiate substitution treatment (OST) is the most widely used treatment for opioid dependence in Germany with substantial long-term benefits for the patient and for society. Due to lessened restrictive admission criteria, the number of registered OST patients in Germany has increased continuously in the recent years, whereas the number of physicians providing OST has remained constant. Previous data already indicated a deteriorating situation in the availability or quality of OST delivered and that structural barriers impede physicians in actively providing OST. The present survey among a sample of primary care physicians in Germany aimed to identify and assess potential structural barriers for the provision of health care in the context of OST.MethodsAn anonymous written questionnaire was sent out to a sample of 2,332 physicians across Germany providing OST. Physicians contacted were identified through databases of the Federal State Chambers of Physicians and/or of the Federal Associations of Statutory Health Insurance Physicians. Data obtained were analysed descriptively.ResultsThe response rate was 25,5% and the majority of 596 physicians sampled viewed substantial problems in terms of the regulatory framework of OST care in the German context. Furthermore, financial remuneration, insufficient qualification, as well as inadequate interdisciplinary cooperation in the treatment of comorbidities of opiate substituted patients were regarded as problematic. The number of physicians providing OST in Germany is expected to substantially decrease in the near future.ConclusionDespite less restrictive admission criteria for OST in Germany, the legal regulation framework for OST is still a limiting factor through raising concerns on the provider and consumer side to be unable to adhere to the strict rules. To avoid future shortages in the provision of OST care on the system level in Germany, revisions to the legal framework seem to be necessary. In regards to adequate care for drug use-related infectious diseases and psychiatric comorbidities commonly found in opiate substituted patients, efforts are required to improve professional qualifications of physicians providing OST as well as respective interdisciplinary collaboration.

Factors Associated With Traditional Chinese Medicine Utilization Among Urban Community Health Centers in Hubei Province of China

This study aims to examine resources and utilization of traditional Chinese medicine (TCM) and factors influencing TCM utilization in urban community health centers (CHCs) in Hubei Province of China. A cross-sectional survey including 234 government-owned CHCs was conducted in 2009. One-way analysis of variance analysis and a Poisson regression model were used to examine distribution of TCM resources and factors influencing TCM utilization. This study found unequal distribution of TCM resources among districts. TCM outpatient visits were positively associated with higher economic development districts, lower initial capital investment of the CHCs, health services covered by health insurance, higher qualification of TCM physicians, provision of TCM health records and rehabilitation, and greater availability of herbal medicine. To achieve equal access to TCM services, policy makers should consider the socioeconomic differences and income groups, provide training for TCM physicians, build pathway to recruit senior TCM physicians, and cover more TCM therapies by health insurance.

Knowledge, attitude and practice of family physicians regarding smoking cessation counseling in family practice centers, suez canal university, Egypt

Introduction:Family physicians are the first point of medical contact for most patients, and they come into contact with a large number of smokers. Also, they are well suited to offer effective counseling to people, because family physicians already have some knowledge of patients and their social environments.Aims:The present study was conducted to assess family physicians’ knowledge, attitude and practice of smoking cessation counseling aiming to improve quality of smoking cessation counseling among family physicians.Materials and Methods:The study was descriptive analytic cross sectional study. It was conducted within family medicine centers. Sample was comprehensive. it included 75 family physicians. They were asked to fill previously validated anonymous questionnaire to collect data about their personal characteristics, knowledge, attitude and practice of smoking cessation counseling, barriers and recommendations of physicians. Equal or above the mean scores were used as cut off point of the best scores for knowledge, attitude and practice.Statistical Analysis:SPSS version 18 was used for data entry and statistical analysis.Results:The best knowledge, attitude and practice scores among family physicians in the study sample were (45.3 %, 93.3% and 44% respectively). Age (P = 0.039) and qualification of family physicians (P = 0.04) were significant variables regarding knowledge scores while no statistically significance between personal characteristics of family physicians and their attitude or practice scores regarding smoking cessation counseling. More than half of the family physicians recommended training to improve their smoking cessation counseling.Conclusions:Favorable attitude scores of family physicians exceed passing knowledge scores or practice scores. Need for knowledge and training are stimulus to design an educational intervention to improve quality of smoking cessation counseling.

National Physician Qualification Program in Cardiovascular Disease Prevention and Integral Care

Das 57 milhoes de mortes que ocorreram no mundo, em 2008, 63% ou 36 milhoes foram causadas por doencas cronicas nao transmissiveis (DCNT), sendo que, destas, 48% (ou 30% de todas as mortes) foram provocadas por doencas cardiovasculares. Aproximadamente, 80% das mortes por DCNT foram registradas em paises de baixa e media renda. Um terco dessas mortes ocorreu em pessoas com idade inferior a 60 anos1.

Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town.

To determine the current door-to-needle time for the administration of fibrinolytics for acute myocardial infarction (AMI) in emergency centres (ECs) at three hospitals in Cape Town, and to compare it with the American Heart Association/American College of Cardiology (AHA/ACC) recommendation of 30 minutes as a marker of quality of care. A retrospective review of case notes from January 2008 to July 2010 of all patients receiving thrombolytics for AMI in the ECs of three Cape Town hospitals. The total door-to-needle time was calculated and patient demographics and presentation, physician qualification, clinical symptomology and reasons for delays in thromobolytic administration were analysed. A total of 372 patients with acute ST elevation myocardial infarction (STEMI) were identified; 161 patients were eligible for the study. The median door-to-needle time achieved was 54 minutes (range 13 - 553 mins). A door-to-needle time of 30 minutes or less was achieved in 33 (20.5%) patients; 51.3% of the patients arrived by ambulance; 34% of patients had a pre-hospital 12-lead ECG; and 88.8% had typical symptoms of myocardial infarction. Medical officers administered thrombolytics to 44.7% of the patients. The predominant infarct location on ECG was inferior (55.9%). A significant number of patients were not thrombolysed within 30 minutes of presentation. The lack of senior doctors, difficulty interpreting ECGs, atypical presentations and EC system delays prolonged the door-to-needle time in this study.

The Core Content of Emergency Medical Services Medicine

On September 23, 2010, the American Board of Medical Specialties (ABMS) approved emergency medical services (EMS) as a subspecialty of emergency medicine. As a result, the American Board of Emergency Medicine (ABEM) is planning to award the first certificates in EMS medicine in the fall of 2013. The purpose of subspecialty certification in EMS, as defined by ABEM, is to standardize physician training and qualifications for EMS practice, to improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and to facilitate integration of prehospital patient treatment into the continuum of patient care. In February 2011, ABEM established the EMS Examination Task Force to develop the Core Content of EMS Medicine (Core Content) that would be used to define the subspecialty and from which questions would be written for the examinations, to develop a blueprint for the examinations, and to develop a bank of test questions for use on the examinations. The Core Content defines the training parameters, resources, and knowledge of the treatment of prehospital patients necessary to practice EMS medicine. Additionally, it is intended to inform fellowship directors and candidates for certification of the full range of content that might appear on the examinations. This article describes the development of the Core Content and presents the Core Content in its entirety.

3. Certification of Physician Qualification in Japan -From the Stand Point of the Japan Medical Association-

3. Certification of Physician Qualification in Japan -From the Stand Point of the Japan Medical Association-