Shortage Of Physicians Research Articles

Usability of an App for Medical History Taking in General Practice From the Patients' Perspective: Cross-Sectional Study.

A future shortage of physicians, especially in general practice, will result in an increasing workload for health care providers as a whole. Therefore, it is important to optimize patient-encounter processes to increase time efficiency related to visits. Utilizing digital tools to record patients' medical histories prior to a consultation offers great potential to achieve this goal. The collected information can be stored into the practice's electronic medical record, allowing for the general practitioner to review structured information of the patients' complaints and related medical history beforehand, thereby saving time during the encounter. However, the low usability of new digital developments in this setting often hinders implementation. The aim of this study was to evaluate the usability of an app designed for medical history taking in general practice to capture the patients' perspective. Between November 2021 and January 2022, we recruited 406 patients with acute complaints in one out-of-hour urgent care and seven general practice clinics. These study participants used the app during their waiting time and subsequently assessed its usability by completing the System Usability Scale (SUS), a robust and well-established 10-question survey measuring the perceived usability of products and technologies. Additionally, we collected general participant information, including age, sex, media usage, health literacy, and native language. Descriptive and inferential statistics were applied to identify patient characteristics associated with low or high SUS scores. We analyzed data from 397 patients (56.7% female, 43.3% male). The mean total SUS score was 77.8 points; 54.4% (216/397) of participants had SUS scores of 80 points or higher, indicating high usability of the app. In a multiple linear regression predicting SUS score, male sex and higher age (65 years or older) were significantly negatively associated with the SUS score. Conversely, a higher health literacy score and German as the native language were significantly positively associated with the SUS score. Usability testing based on the SUS anticipates successful implementation of the app. However, not all patients will easily adapt to utilizing the app, as exemplified by the participants of older age in this study who reported lower perceived usability. Further research should examine these groups of people, identify the exact problems in operating such an app, and provide targeted solutions. German Clinical Trials Register World Health Organization Trial Registration Data Set DRKS00026659; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00026659.

The advanced practice nurse role's development and identity: an international review

Healthcare is changing; the physician shortage continues to grow and the complexity of health care continues to increase in relation to aging populations, lower reimbursement rates, and increased documentation requirements; an alternative has to be addressed. Globally, the advanced practice nurse (APN) role has grown enormously. Despite the growing use of APN practitioners worldwide, many facilitators and barriers exist to role implementation. Many countries face similar issues, including a lack of clarity and regulation regarding the APN role. Despite these barriers, APNs continue to make headway. This narrative will review barriers and challenges to role advancement across countries and offer opportunities to facilitate APN role development.

Labor shortage of physicians in rural areas and surgical specialties caused by Work Style Reform Policies of the Japanese government: a quantitative simulation analysis.

Objective: The Japanese government's physician workforce reform, which commenced in April 2024, introduced regulations on physicians' working hours. However, in areas facing physician shortages such as rural regions and surgical medical specialties, healthcare provision relies heavily on the extended working hours of each physician. The anticipated impact of this reform, when implemented, was significant. Materials and Methods: Using publicly available government data, we estimated the current working hours of physicians in various medical specialties in each prefecture across Japan. Subsequently, we calculated the ratio of surplus or deficit physicians when hypothetically assuming that all physicians adhered to the regulatory upper limit of 58.4 working hours per week nationwide. Results: Assuming that all physicians work to the regulated maximum, there would be a shortage of doctors in various medical specialties across Japan, such as surgery, neurosurgery, orthopedic surgery, obstetrics and gynecology, and emergency medicine. Geographically, shortages of doctors are observed in rural prefectures such as those in the Tohoku region, particularly in emergency- and surgery-related specialties, indicating a critical shortage of physicians in rural areas. Additionally, it has become evident that even in medical specialties with a calculated surplus of physicians nationwide, the margin of surplus is generally only a few percentage points. Conclusion: Currently, rural areas and surgical medical specialties in Japan have limited leeway in the physician workforce, and the strict application of workforce reform may lead to a severe shortage of physicians in these areas. It is noteworthy that as similar reforms may subsequently be implemented in other countries, analogous challenges would arise. Thus, the implementation of workforce reform requires a flexible approach to minimize its negative effects, which widen the existing disparity in the workforce.

Changing the Clock in Medical Education: Addressing Physician Shortages and Patient Outcomes.

Despite the shortage of physicians in the United States, there is no consensus among medical educators as to how to address the nation's unmet needs. A growing but unfulfilled argument is to revisit the configuration of medical education and the time required to complete medical training. Pilot programs, such as shortened programs or advancement-in-place structures to accelerate the practice capability of trainees, have been attempted. This manuscript addresses underlying economic and human considerations that medical educators must reconcile, drawing on lessons from international educational structures, as we advance toward a system that supports the needs of the communities that our graduates will serve.

'There is no such word as palliative care for us at the moment': A mixed-method study exploring the perceptions of healthcare professionals on the need for palliative care in Bhutan.

The need for palliative care is ever-increasing globally. However, it is least developed or not available in most low-and-middle-income-countries including Bhutan. This study was aimed at exploring the perspectives of Bhutanese healthcare professionals on the need for palliative care in the country. This is a cross-sectional, mixed-method study. The study sites included all levels of healthcare in Bhutan and involved doctors, nurses, physiotherapists, pharmacists, health assistants and Drungtshos (traditional physicians). Data were collected through surveys, focus group discussions and in-depth interviews. While the majority of the participants were directly involved in taking care of terminally ill and dying patients, only 14% had received some form of palliative care training for a duration ranging from 1 day to 6 weeks. Ninety-five percent of the participants reported that they faced challenges related to lack of palliative care knowledge and skills; limited resources including analgesics; shortage of doctors and nurses and lack of a palliative care team; issues with low illiteracy and financial challenges among patients; and policies and other systemic issues. The qualitative data generated four major themes: past adverse experiences; unique and complex needs for palliative care; challenges faced while caring for terminally ill and dying patients; and the urgent need for palliative care in Bhutan. Bhutanese healthcare professionals had very limited exposure to palliative care. This study identified a crucial need for palliative care and informs the development of an appropriate palliative care model for Bhutan.

Developing Healthcare using Internet of Things (IoT): A Survey of Applications, Challenges and Future Directions

The importance of each person's healthcare should be viewed as fundamental in the modern world due to the rise in various health issues. A decrease in the proportion of doctors is caused by an increase in the number of cases. The diagnosis is consequently delayed, or some patients are overlooked. As a result, people become more reliant on doctors for checkups. In order to retain each patient's digital identification, in light of all these worries, health and medical care systems have begun to connect and interact with the internet of things (IoT). Many health disorders in the healthcare system go undiagnosed resulting from a shortage of doctors and other medical experts, as well as a lack of access to healthcare services. These IoT-based healthcare options, on the other hand, have made it possible for patients and medical professionals to continuously track and analyze patient data. In this study, IoT for healthcare systems is discussed. These included applications, structures, and potential design snags and issues. It has been demonstrated that these systems could be very beneficial to people, especially during the (Covid-19) pandemic's global isolation and the growing challenges in treating patients intelligently. This paper also presents a survey study on the use of IoT in smart healthcare, its applicability, the future directions for its development, and a review of past researchers' applications.

Shortage of Black physicians: Florida Black medical student enrollment from 2013 to 2021

On average, Black patients have substantially better health outcomes when they are under the care of Black physicians. The percentage of Black physicians in America has remained at approximately 5% for nearly half a century, even though Black people comprise 14% of the United States population. We used data from the Association of American Medical Colleges and Florida medical schools to examine two important research questions. First, we hypothesized that since the state of Florida has the twelfth largest percentage of Black residents, Florida medical schools enrolled a higher percentage of Black first-year students compared to the national average. We found that Florida medical schools that provided data enrolled a higher percentage of Black first-year students (13.5%) than the national average (9%), which supported our first hypothesis. Second, we hypothesized that the percentage of Black first-year medical students enrolled nationally was higher in 2021 compared to 2013, correlating with the emergence and rise of social justice movements, including Black Lives Matter. We found that the national average of enrolled Black first-year medical students was 6% in 2013 and 9% in 2021, which supported our second hypothesis. An increase in the percentage of Black medical students and physicians could help diminish race-based health and class inequity in America, leading to a significant increase in the health of many Black people.

Professional identity and its associated psychosocial factors among physicians from standardized residency training programs in China: a national cross-sectional study.

Shortage and high turnover intention rate of physicians are concerning problems in China. Professional identity has been shown as an influential factor for physicians' turnover intention. Enhancing physicians' professional identity in their early phase of career, standardized residency training program (SRTP), may help reduce the turnover rate. This study aimed to investigate the current status of professional identity and explore its associated psychosocial factors among Chinese SRTP trainees, hoping to provide evidence in strengthening the available medical human resources in China. The final sample was comprised of 2,267 Chinese SRTP trainees in this cross-sectional survey conducted from 9 March to 20 March in 2023. Descriptive statistics were calculated. Bivariate analyses and hierarchical multiple linear regression were used to analyze potential associated factors of Chinese SRTP trainees' professional identity. The average score of respondents' professional identity was 47.68 (standard deviation, SD = 8.61). Results from hierarchical multiple linear regression analysis showed that being married (β = 0.066, p < 0.01), having work experience before SRTP (β = 0.036, p < 0.05), being satisfied with annual income (β = 0.062, p < 0.01), psychological distress (β = -0.144, p < 0.001), depersonalization (β = -0.053, p < 0.05), emotional exhaustion (β = -0.380, p < 0.001) and resilience (β = 0.169, p < 0.001) were associated with professional identity (F = 114.301, p < 0.001). All associated factors can explain 41.1% of the variance in professional identity, and individual psychological variables make up a substantial portion (28.6%) of this influence. Individual psychological variables are strongly associated with professional identity. Helping SRTP trainees reduce psychological distress, alleviate burnout and enhance resilience may be effective ways to promote the formation of their professional identity.

Telemedicine in civil protection: A controlled simulation study for the analysis of patient care.

More and more disasters are occurring and there will be an increasing shortage of physicians in the future. Telemedicine could be a solution here to offer medical care despite the lack of physicians in the area of operation. This study analyzes whether telemedicine for lower-qualified paramedics is comparable to conventional disaster medicine. A simulation study was conducted in which one conventional and two telemedicine groups cared for thermal-traumatically injured in a stressful situation. The telemedicine was conducted on tablets with integrated vital sign monitoring or on smartphones. The physician engagement time, the number of physician contacts, the time for relevant measures and the usage behavior of telemedicine were examined between these groups. One telemedicine group showed significantly fewer patient contacts. This can be attributed to the ongoing consultation in the intervention group with more contacts. There are no significant differences in the relevant measures. Telemedicine is comparable to conventional disaster medicine in civil protection. Due to potential technical failures, it should primarily be used to compensate for the lack of physicians, and training should focus on an exit-strategy in case of a failure of the telemedicine.

Development of a surgical skills course for preclinical medical students

BackgroundPreclinical students have limited exposure and training in surgical skills. As a result, many students report negative experiences during their surgery clerkship from a lack of confidence in their technical abilities and, thus, lower participation in cases. Moreover, in fields such as vascular surgery, where a shortage of physicians persists, the absence of surgery and field-specific exposure for medical students could limit recruitment. To address these gaps, we designed a surgical skills curriculum for preclinical medical students using surgical simulators to develop fundamental surgical skills, introduce students to vascular surgery early, and provide training on vascular surgery-specific procedures. We hypothesize that a surgical skills course can significantly enhance preclinical students' surgical abilities before they enter their surgical clerkship and increase interest in pursuing a surgical specialty. MethodsA total of 26 students took part in a structured surgical skills curriculum comprising three sections: fundamental surgical skills, application of skills in a clinical context, and a surgical skills competition. During the course of six workshops, the students received formative feedback from proctors using task-specific standardized rubrics and assessments through the Objective Standardized Assessment of Technical Skills. Additionally, students' attitudes and perceptions toward surgical training and vascular surgery were evaluated using the modified Vascular Surgery Interest Forum. The summative performance of the preclinical students enrolled in the surgical skills course was compared with their initial performance after the skills workshop and with that of third-year medical students who had completed surgical rotations. Differences in responses and attitudes were analyzed at the beginning and conclusion of the course using bivariate analysis. ResultsOf the 26 students, most were women (61.5%) and in their second year of medical school (76.9%). Also, 23.1% identified as underrepresented minorities in medicine, 7.7% had physician family members, and 19.2% reported they had decided on a specialty. Following the knot-tying and suturing workshops, students reported a statistically significant increase in their self-rated understanding, comfort, and knowledge of tasks. Third-year medical students outperformed the preclinical students in knot-tying and instrument-tying tasks. However, no difference was found in the performance of these tasks between the third-year medical students and the top three preclinical students who completed the course. Both groups performed similarly on the anastomosis challenge (29.25 vs 28.42; P = .9) and the vascular simulation challenge (27.25 vs 26.83; P = .6). At the program's conclusion, the students demonstrated an increased mean interest in vascular surgery (from 2.3 ± 1.1 to 2.9 ± 1.2; P = .39), an enhanced interest in surgery due to its hands-on nature (from 4.5 ± 0.8 to 4.7 ± 0.6; P = .06), a preference for surgical simulation in teaching fundamental skills (from 3.7 ± 1.0 to 3.9 ± 0.8; P = .31), and an increased awareness of radiation exposure in surgical practice (from 2.5 ± 1.0 to 3.0 ± 1.3; P = .11). Students cited personality fit, exposure during medical school, and identification of a mentor as the most influential factors for pursuing a surgical career. The competitiveness of a residency program and resident workload and lifestyle were least influential. ConclusionsA structured surgical skills curriculum for preclinical medical students increased students' technical skills and fostered a greater appreciation for the hands-on and technical nature of surgery. Moreover, early exposure to vascular surgery enhanced their interest and knowledge of the field. Notably, students believed that medical school does not adequately prepare them for success on surgical rotations and emphasized the importance of personality fit, early exposure, and mentorship in considering a surgical career.

Моделирование процесса привлечения кадров в медицинские организации, оказывающие медицинскую помощь сельскому населению.

The shortage of medical specialists and their disproportionate distribution both across territories and specialties is a global health problem. According to the Russian Federal State Statistics Service, the shortage of medical personnel as of 2022 is 84.7 thousand people, of which 26.5 thousand are doctors; compared to 2021, the problem of shortage of nursing staff is less acute, but the shortage of doctors remains. An integral part of personnel policy is the process of retaining qualified specialists. The complex motivations of employees to stop or continue working in an organization interact with the personnel decisions of a healthcare organization, which in turn requires a joint study of both the characteristics of the employees and the characteristics of the organization. Purpose of the study is to model the process of attracting personnel to medical organizations providing medical care to the rural population. Materials and methods. Data on 151 students of targeted training who entered the Orenburg State Medical University in 2011 were studied. Using machine learning methods, a mathematical model was built that allows identifying students of targeted training with a higher probability of attraction to the medical organization. Results. The presented data set is unbalanced in terms of the target variable, since only 16.8% of students continued to work in the organization. Among all the options, the most optimal in cross-validation was the use of a decision tree using weights to balance the classes. All studied medical organizations can be divided into 3 groups: organizations with a low level of attraction of specialists, organizations with an average level of attraction of specialists and organizations with a high level of attraction of specialists. Based on the data obtained and analysis of publications, measures were proposed to improve the personnel policy of medical organizations of each type. Findings. Therefore, healthcare organizations have the opportunity to monitor the attraction process of targeted students through factors related to the characteristics of the organization, such as working conditions, reputation and image, career opportunities, and others.

Organizational Learning and Primary Care Nurses’ Work Performance and Well‐Being: A Multilevel Linear Analysis in a Developing Country

Aim. This study aims to investigate the level of organizational learning within urban Chinese Community Health Centres and reveal its potential association with primary care nurses’ work performance and well‐being. Background. Globally, there is a push to establish learning healthcare systems for complex health reform challenges. Existing studies on organizational learning mainly focus on North American and European hospital settings, offering limited insights into primary care environments, particularly in developing countries. Design. Cross‐sectional study. Methods. We recruited 175 nurses from 38 community health centres in four Chinese cities (Shanghai, Shenzhen, Tianjin, and Jinan) using convenience sampling. Trained research assistants conducted face‐to‐face surveys, measuring organizational learning with the Learning Orientation Scale. Nurse‐level outcomes included self‐directed learning, quality of care, organizational commitment, and work stress. Data analysis employed multilevel linear modelling. Results. The 38 community health centres displayed a relatively high level of organizational learning, and there was a positive and significant association between organizational learning within community health centres and nurses’ self‐directed learning as well as the quality of care. However, there was no significant association between organizational learning and nurses’ organizational commitment or work stress. Conclusion. This study demonstrates a high‐level organizational learning capacity in urban community health centres in China. It provides a new perspective on the potential relationship between CHCs’ organizational learning and primary care nurses’ well‐being and work performance. Further research is needed to clarify unexpected findings and identify factors promoting organizational learning in primary care settings. Implications for Nursing Management. In China’s evolving primary care system, nurses play a vital role amidst physician shortages. Policy should prioritize internal management reform alongside structural changes. This study highlights the importance of fostering organizational learning in primary care settings. Strategic interventions should promote a learning culture in CHCs, which may enhance nurses’ self‐directed learning and improve the quality of care.

Understanding telemedicine strategies through field-based observations, interviews and benchmarking activities

The imperative for telehealth and telemedicine has become increasingly pronounced in addressing and alleviating health inequalities exacerbated by provider shortages and limited access to healthcare, particularly in underserved regions. The pandemic laid bare the vulnerabilities within traditional healthcare models, prompting a paradigmatic shift towards more resilient and inclusive systems. Telehealth has become a critical tool for connecting patients with healthcare providers, especially in areas plagued by shortages of physicians and specialists. In a world where geographical barriers often limit access to medical expertise, telehealth serves as a bridge, enabling patients to consult with a diverse array of doctors and specialists without the burdensome constraints of time-consuming and expensive travel. Moreover, telemedicine has proven instrumental in mitigating the shortage of healthcare personnel by empowering them to deliver remote care. This not only optimizes resource allocation but also enables healthcare professionals to reach patients in remote or rural areas where physical presence might be impractical. The significance of this development in a post-COVID-19 world is underscored by the imperative to build more resilient, adaptable, and equitable healthcare systems.The paper delves into the multifaceted impacts of this revolution, shedding light on its far-reaching consequences for patient care, healthcare systems, and the broader healthcare landscape, especially for small medical practices through field based-observations. Beyond the reactive curative model that has traditionally characterized healthcare, telehealth is propelling a shift towards a proactive, preventive approach. This shift is not only essential for managing and preventing the spread of contagious diseases but also for fostering a more comprehensive and patient-centric approach to healthcare.

Government Health Care Financing and Health Care Outcomes in Africa

This paper uses the World Bank data on healthcare expenditures as a percentage of gross domestic product to analyze the funding available to the public health care sectors in 54 African countries. In the 2001 Abuja Declaration, these African countries vowed to allocate at least 15 percent of their annual budgets to improving their health care sectors and infrastructures. We developed the Compliance with Abuja Declaration Index (CAD Index) to gauge the extent to which African governments complied with the pledge. Our empirical results reveal that health care financing is grossly inadequate in Africa. The failure to finance the health care sectors at or above the 15 percent pledged in the 2001 Abuja Declaration has undoubtedly slowed Africa’s march towards providing improved health care for its citizens. Furthermore, African countries face acute shortages of medical doctors, nurses, and medical infrastructures to provide the robust health care sectors required for sustainable economic growth and development. African governments must implement policies to attract health care professionals by providing the necessary medical infrastructures.

Independent Practice as a Nursing Practitioner in Pakistan: “Opportunities and Misconceptions

Independent Practice as a Nursing Practitioner in Pakistan: “Opportunities and Misconceptions

Primary Care Physicians in Nova Scotia: Are They Where They Need To Be?

Purpose: Accessible primary health care (PHC) is a key area of interest for policy and research as accessible PHC is associated with better health outcomes and lower health system costs. A critical dimension of accessible PHC is an adequate supply of family physicians (FPs) or general practitioners (GPs). Our study sought to analyze the geographic distribution of FP/GPs practicing in Nova Scotia (NS) and to provide an in-depth analysis of the distribution of FP/GPs in relation to population PHC needs. Methods: Using data from the College of Physicians &amp; Surgeons of Nova Scotia’s registry and 2019 annual license renewal survey, we provide a descriptive analysis of physician distribution, demographics and practice structure characteristics across the four Nova Scotia Health management zones (Central, Eastern, Northern, Western) for the population of FP/GPs practicing in NS in 2019. Additionally, we provided a descriptive analysis of PHC demand indicators and population demographics derived from the Canadian Institute for Health Information, the Canadian Community Health Survey, and the Canadian Census. These population PHC need indicators include hospitalization rates for ambulatory care sensitive conditions (ACSC), perceived health, the Canadian Index of Multiple Deprivation (CIMD), and the percentage of the population aged 65 and over across Nova Scotia Health management zones. Results: FP/GPs practising outside the Central zone are less numerous, older, and more likely to be male and international medical graduates. FP/GPs practicing outside the Central zone are more likely to have solo practices, practice in rural areas and not provide care through technology. Additionally, there is a greater potential demand for PHC outside of the Central zone, indicated by lower physician-to-100,000 population ratios, higher rates of hospitalizations for ACSC, a larger percentage of individuals living in rural areas, aged 65 and over, rating their health as fair or poor, and in the most deprived quintile of the situational vulnerability and economic dependency dimensions of the CIMD. Conclusions: These findings indicate a geographic maldistribution of physicians across NS and potential gaps in access to FP/GPs compared to population health needs across Nova Scotia Health management zones. The findings have implications for targeted physician resources planning and policy.

Interventions of eHealth technologies integrated with non-physician health workers for improving management of hypertension: Systematic review and meta-analysis

Hypertension is a major public health problem, accounting for 7.5 million deaths and 57 million disability-adjusted life years annually worldwide. The majority of hypertension-related deaths occur in low- and middle-income countries (LMICs). Despite the escalating prevalence of hypertension in many LMICs, only one-third of those affected are aware of their hypertension status. The rapid proliferation of eHealth technologies presents an opportunity to improve the detection and management of hypertension. Many LMICs face a critical shortage of physicians, and their services often come at a considerable cost to the health system. Non-physician health workers could be a cost-effective alternative to improve the detection and management of hypertension, particularly in LMICs. In this systematic review, we aim to synthesize and evaluate the effectiveness of interventions that integrated eHealth technologies with non-physician health workers to reduce blood pressure. A diverse range of eHealth technologies, such as mobile-based applications, telemonitoring, short text messaging and electronic decision support systems, are being used by non-physician health workers for the management of hypertension. We found that eHealth technologies integrated with non-physician health workers reduced overall mean systolic blood pressure by -4.09 mmHg (95%CI: -5.87 to -2.32) compared to usual care. Similarly, such an integrated approach also reduced diastolic blood pressure by -1.25 mmHg (-2.31 to -0.81) in the intervention group than usual care. Therefore, leveraging the use of cost-effective eHealth technologies to support task-sharing with non-physicians presents an effective strategy for enhancing blood pressure management, applicable to both high- and low-income countries.

Hospital transformation into regional health care

Hospitals in Germany are under enormous pressure. Legal reforms and shortages of nurses and doctors are forcing hospitals to review inpatient services to assess whether they can be provided on an outpatient basis. Legislation is now promoting such transformation processes through changes in hospital planning and financ-ing. Hospitals, thus, have become attractive partners and designers of regional integrated care solutions.&#x0D; OptiMedis is currently supporting various hospitals in the planning and conceptualization of regional, inte-grated health care with more centralized inpatient services and increased outpatient care options Smaller hospitals, which are no longer needed for inpatient care after the centralization of inpatient services, can be transitioned towards regional outpatient care. Here, outpatient practices, rehabilitative facilities, therapists, CHN, social workers, case and care managers, among others, can then work together intersectorally under one roof. There are already some concepts and German words describing this: Intersectoral Health Center, Primary Care Center, and Extended Outpatient Care. It is important to determine what needs exist in each region.&#x0D; This presentation will describe the different concepts pertaining to the transformation of smaller hospitals into regional outpatient intersectoral health care centers and discuss the implications for further development of integrated healthcare in Germany.

The evolution of the medicine course at the Institute of Health and Biotechnology of the Federal University of Amazonas in the municipality of Coari/AM, and its current implementation status

The implementation of the medicine course in Coari-AM is a recent achievement for the city and the entire Middle Solimões region, crucial to addressing the shortage of doctors in the Northern Region, which has an average of about 1.4 doctors per thousand inhabitants across all its states, representing some of the worst indicators in Brazil. Thus, aiming to understand the history of the implementation of the medicine course at the Institute of Health and Biotechnology (ISB) in Coari at the Federal University of Amazonas (UFAM) and the current state of implementation, the objective of this work was to report the historical facts about the implementation of this course based on a substantiated analysis of the current work reality offered to the medical faculty involved. For this purpose, the perspectives of the faculty who worked on the implementation of the course were investigated, the causes leading to the attrition of medical professionals from the ISB were diagnosed, and measures were proposed to retain these professionals in this Institute. This work is justified because conducting a historical survey of the implementation of the medicine course at the ISB in Coari is necessary to obtain an accurate diagnosis of the current causes of attrition among faculty in this medical undergraduate program. As a result, it was found that for the purpose of implementing the course, only one building was constructed, but it was not equipped. There was institutional failure in developing a job profile for the hiring of faculty for this course, so only twelve professors with a medical background were hired. The same happened with administrative staff, so there are only two permanent employees specifically supporting this course.

Real-Time Virtual Support as an Emergency Department Strategy for Rural, Remote, and Indigenous Communities in British Columbia: Descriptive Case Study.

British Columbia has over 200 rural, remote, and Indigenous communities that have limited health care resources due to physician isolation, sparsity in clinical resources, the lack of collegial support, and provider burnout. Real-time virtual support (RTVS) peer-to-peer pathways provide support to patients and providers. Amid the COVID-19 pandemic exacerbating existing health care disparities and equitable access to timely care, RTVS presents a portable and additional opportunity to be deployed in a hospital or patient home setting in rural communities. We highlight the story of the Rural Urgent Doctor in-aid (RUDi) pathway within RTVS that successfully supported the Dawson Creek District Hospital (DCDH) emergency department (ED) in 2021. This study aims to describe the rapid implementation process and identify facilitators and barriers to successful implementation. This case study is grounded in the Quadruple Aim and Social Accountability frameworks for health systems learning. The entire study period was approximately 6 months. After 1 week of implementation, we interviewed RUDi physicians, DCDH staff, health authority leadership, and RTVS staff to gather their experiences. Content analysis was used to identify themes that emerged from the interviews. RUDi physicians covered 39 overnight shifts and were the most responsible providers (MRPs) for 245 patients who presented to the DCDH ED. A total of 17 interviews with key informants revealed important themes related to leadership and relationships as facilitators of the coverage's success, the experience of remote physician support, providing a "safety net," finding new ways of interprofessional collaboration, and the need for extensive IT support throughout. Quality improvement findings identified barriers and demonstrated tangible recommendations for how this model of support can be improved in future cases. By acting as the MRP during overnight ED shifts, RUDi prevented the closure of the DCDH ED and the diversion of patients to another rural hospital. Rapid codevelopment and implementation of digital health solutions can be leveraged with existing partnerships and mutual trust between RTVS and rural EDs to ease the pressures of a physician shortage, particularly during COVID-19. By establishing new and modified clinical workflows, RTVS provides a safety net for rural patients and providers challenged by burnout. This case study provides learnings to be implemented to serve future rural, remote, and Indigenous communities in crisis.