Training In Clinical Medicine Research Articles

Improving healthcare delivery at a district hospital through teaching interns - A short report.

Every district in Malawi has at least two doctors managing the social and healthcare needs of the local population. The medical doctors at the district are involved in administrative work and have minimal time for clinical practice. As such in most district hospitals, clinical officers (COs) form the backbone of patient care provision. These are cadres that have a 3-year training in clinical medicine; they work side by side with medical assistants (MAs) and nurses. Apart from the Ministry of Health (MoH) workforce, the Department of Family Medicine (FM) of Kamuzu University of Health Sciences (KUHeS) has its main district site at Mangochi. Family physicians and residents from FM department assist in provision of mentorship and teaching to other cadres. Work-based learning requires various strategies and approaches. The experience reported here involves deliberate mentorship and support to enhance the learning of other cadres. Family medicine residents learn through the active participation in these sessions to become future consultants and leaders in primary health care.

The status of the use of traditional and modern methods in the management of malaria in some communities in Badagry Division, Lagos State, Nigeria

Malaria is a leading parasitic disease in Nigeria and the risk exist throughout the country. This study examined the status and use of traditional and modern methods in malaria management in five communities in Badagry Division of Lagos State, Nigeria. Structured questionnaires were used to collect data from 100 participants, with 20 randomly selected from each community. Data analysis revealed that 85% of the respondents were knowledgeable of the relationship between malaria and mosquitoes. 66% believed that modern methods is better for preventing mosquitoes. 44% believed that traditional methods work faster and 56% felt that this method is cheaper for mosquito control while 15% nurture mosquito’ repellant plants within their vicinity. 43% considered malaria to be a serious disease with fever as the most recognized symptom among 50%. 35% preferred the home treatment by nurses due to promptness and cheaper charges while 59% practiced self-medication. 55% preferred treating malaria with modern medicines because of safety and specificity. 41% preferred both herbal and modern medicines which they believed work together to manage malaria better. 7% never used modern drugs because they believe herbs are more effective. Amatem (11%) was the most preferred drug among 12 commonly used modern drugs. 12% still used chloroquine because of its affordability and 21% preferred injections. Health care workers are needed to reduce long waiting times in hospitals in order to curb self -medication. Herbal treatment appears as alternative to modern treatment so traditional practitioners should receive standard training in clinical medicine. Modern health practitioners should appreciate the potential of traditional practitioners and collaborate in malaria management.

The Future of Occupational and Environmental Medicine.

Occupational and environmental medicine (OEM) is an ACGME-accredited preventive medicine specialty focused on work as a social determinant of health and population health. OEM providers recognize and mitigate workplace and environmental hazards, treat resultant injuries and illnesses, and promote the health, wellness and resiliency of workers and communities. Multidisciplinary residency training in clinical medicine, epidemiology, public and population health, toxicology, exposure and risk assessment, and emergency preparedness equips them with the skill set needed for leadership roles in diverse settings. These include clinical practice, academia, corporate settings, and governmental agencies. Despite robust job opportunities, a shortage of formally trained OEM physicians remains and is expected to worsen given a declining number of training programs. We examine root causes of the system-level issues impacting the supply of OEM physicians and potential solutions.

Whoever Does Image-Guided Palliative Care Needs to Be Properly Trained to Do So.

Vascular and interventional radiologists (VIRs) often offer image-guided palliative care procedures, despite having little training in clinical medicine, let alone in palliative medicine. Informed consent tends to be inadequate, as does postprocedure patient care. This article proposes that VIRs who perform image-guided palliative procedures be sufficiently trained in palliative care or that surgeons or internists subspecialized in palliative care be sufficiently trained to provide image-guided techniques.

COVID-19 Readiness and Career Aspirations of South Indian Medical Students: A Cross-Sectional Survey Study.

PurposeThe second wave of COVID-19 devastated the medical sector on India and the government has implored medical students to aid the frontline workforce. This study aims to assess the knowledge, attitude and practice (KAP) of South Indian Medical students regarding the COVID-19 pandemic and their career aspirations.Patients and MethodsThis is an online questionnaire based, cross-sectional study featuring a pre-validated questionnaire with a KAP section and a career aspiration survey section, which was distributed to South Indian medical schools between November and December 2020. Three hundred and four responses were included for analysis.ResultsGood knowledge levels were seen in 65.5% of participants, 51% had good attitude scores and 80.6% had good practice scores. The mean KAP score was 14.81 ± 1.77. 1.3% of the respondents had low level KAP scores, 57.2% had moderate level KAP scores and 41.4% of them had good level KAP scores. Majority aspired to continue post graduate medical training in Clinical medicine in India (n = 116, 38.2%), followed by Clinical Medicine outside India (n = 80, 26.3%). Students who chose “Research Work” (average rank [AR] = 192.70), “Clinical Medicine outside India” (AR =173.64) “Undecided” (AR = 148.59) and “Clinical Medicine in India” (AR = 146.63) as career aspiration featured better KAP scores compared to those students who preferred non-clinical specialties (AR = 96.73) and or a career change (AR =76.69) (p = 0.001).ConclusionThe KAP questionnaire revealed inadequate readiness amongst the majority of student participants. Targeted, structured educational interventions may be recommended in order to rapidly rectify the situation and deploy medical students to supplement the frontline workers in the COVID pandemic.

A novel near-peer reflective writing workshop.

Training in clinical medicine involves exposure to complex ethical and emotional situations. Reflection aids in the development of personal belief systems and improves self-awareness. Students may be reluctant to participate when reflection is mandatory and may be concerned about retaliation when the facilitator has a role in evaluations. Near-peers are institutional equals with more experience than the participants and may be well suited to facilitate reflection. A quarterly near-peer-facilitated reflective writing workshop (RWW) was implemented in the mandatory clinical curriculum at a single institution. Qualitative feedback forms were solicited and were analysed through an iterative and inductive consensus process. An end-of-year web-based survey was distributed to test the hypotheses generated from our analysis of the feedback forms. There were 82 responses (80%) to the web-based survey and 266 (65%) feedback forms were collected. Although few students reported using writing as a coping mechanism, the RWW was viewed favourably, with 62% indicating that they would attend if optional. The structured prompts aided reflection. Students reported a higher likelihood of discussing difficult topics (doubts about medicine as a career, personal shortcomings, harassment and burnout) in sessions led by a near-peer than by a faculty member. The workshop created a safe space to reflect, increased a sense of camaraderie and helped normalise experiences. [The workshop] humanised the clinical experience, gave new perspective and reminded students of their positive personal accomplishments DISCUSSION: The near-peer-facilitated RWW is a novel intervention aimed at developing reflective practice and coping with the challenges of entering clinical medicine. It is highly structured and has been incorporated into the mandatory curriculum. It was well received by students, is generalisable and is easily implementable.

Training Pathways to Working as a General Practitioner in China

To achieve the goal of 300,000 general practitioners by 2020-an increase of 215,200 in a decade-China is utilizing multiple training pathways. To comprehensively illustrate general practitioner training strategies in China, this article introduces and describes these pathways. We used descriptive policy analysis. This involved taking an inventory of existing literature and source documents and developing a model to illustrate pathways for training general practice physicians. The rural doctor pathway represents rural clinicians who had only basic training and practiced multiple years prior to training reforms. The 3+2 pathway to assistant general practitioners requires 3 years of junior college and 2 years of clinical training. The transfer pathway for current physicians requires 1-2 years of training. The 5+3 pathway comprises 5 years of bachelor of science degree training in clinical medicine and 3 years of standardized residency training. Despite the development of advanced degree programs, their use remains limited. These pathways illustrate significant heterogeneity in training of general practitioners. Training ranges from a 2-year technical degree to a doctorate with research. Emphasis on the 5+3 track shows promise for China's goals of improved quality and new goal of 500,000 additional general practitioners by 2030.

Improving the Medical Curriculum in Predoctoral Dental Education: Recommendations From the American Association of Oral and Maxillofacial Surgeons Committee on Predoctoral Education and Training

Dental procedures are often performed on patients who present with some level of medical fragility. In many dental schools, the exercise of taking a medical history is all too often a transcription of information to the dental chart, with little emphasis on the presurgical risk assessment and the development of a treatment plan appropriate to the medical status of the dental patient. Changes in dentistry, driven by an increasingly medically complex population of dental patients, combined with treatment advances rooted in the biomedical sciences necessitate the adaptation of our dental education to include a stronger background in systemic health. Many predoctoral educators in the American Association of Oral and Maxillofacial Surgeons (AAOMS) have expressed concern about the medical preparedness of our dental students; therefore, the AAOMS and its Committee on Predoctoral Education and Training have provided recommendations for improving the medical curriculum in predoctoral dental education, including a strengthening of training in clinical medicine and biomedical sciences, with specific recommendations for improved training of our dental students and dental faculty.

Recognition of Stressors in Postgraduate Students of a Teaching University in Pakistan

Objective: To recognize postgraduate stressors and their intensity among doctors doing post-graduation in the fields of academic and clinical medicine, using the Postgraduate Stressor Questionnaire (PSQ). Methods : A cross sectional study was conducted where the target population was postgraduate students. The PSQ was administered, a twenty-eight item questionnaire to identify and measure intensities of stressors. Questionnaires were administered to ninety post-graduate students, forty-five from each field. Data was entered on SPSS version 20. After descriptive analysis and checking the data for normality independent sample t-test and ANOVA were applied for numerical data, and chi square was applied for categorical data. P-value less than 0.05 were taken as significant level. Results : The mean age of the students was 30.97 (SD=6.52) years. Majority of the students were females. It was seen that academic related stressors were greatest among the two fields of medicine. Higher levels of stress were seen in students who were training in clinical medicine (mean=13.30, SD=4.84) than academic medicine (mean=12.27, SD=5.47). Conclusion : Postgraduate medical training is a highly stressful environment to students. Academic related stressors were found to have its greatest impact in both the fields of medicine; this stress arises from scholastic, academic or educational events. Greatest amounts of stress were seen in students enrolled in clinical medicine.

The road not taken or how I learned to love the liver: A personal perspective on hepatitis history

The road not taken or how I learned to love the liver: A personal perspective on hepatitis history

Analysis of relation of sports schools employees to modern system of payment

159 8. Kulinenkov, O.S. (2004), Pharmacology and Physiology of strength, MedPress, Moscow, Russian Federation. 9. Lebedev, V.P. “Design and rationale for therapeutic use transcranial electrical protective mechanisms of the brain using the principles of evidence-based medicine (results of twenty studies)” available at: http://revimed.do.am/publ/metod_tehs_terapii_transkranialnoj_ehlektrostimuljacii_zashhitnykh _mekhanizmov_mozga/1-1-0-347 (accessed 01 of February 2012). 10. Levshin, I.V. and Litoshko, I.A. (1998), “The oxygen regime of the body with hyperbaric oxygenation”, Diagnosis, treatment and rehabilitation of patients in the sanatorium conditions, pp. 43-45. 11. Sapov, I.A and Solodkov, A.S. (1980), Condition of body functions and performance of sailors, Medicine, St.-Petersburg, Russian Federation. 12. Solodkov, A.S. (1995), Physical performance athlete, publishing house SPbGAFC, St.-Petersburg, Russian Federation. 13. Tumanyan, G.S. (2006), School of Excellence wrestlers, judokas and wrestlers: studies. Guide for students, Academia, Moscow, Russian Federation. 14. Kovalenko, E.A. (1993), “Hypoxic training in clinical medicine. Mechanisms of interval hypoxic training effects”, Hyp. Med. J., No. 1, pp. 3-4. 15. Oriani, G. (1995), “Hyperbaric Therapy in Italy”, Hyperbaric Physiology and Medicine, No. 1, pp. 3-11. Контактная информация: 7144554@mail.ru

Interview: Professor Andrew Feinberg Speaks To Epigenomics

Andrew Feinberg studied mathematics and humanities at Yale University (CT, USA) in the Directed Studies honors program, and he received his BA (1973) and MD (1976) from the accelerated medical program at Johns Hopkins University (MD, USA), as well as an MPH from Johns Hopkins (1981). He performed a postdoctoral fellowship in developmental biology at the University of California, San Diego (UCSD, CA, USA), clinical training in medicine and medical genetics at the University of Pennsylvania (PA, USA) and genetics research with Bert Vogelstein at Johns Hopkins, discovering altered DNA methylation in human cancer. Dr Feinberg continued to perform seminal work in cancer epigenetics as a Howard Hughes investigator at the University of Michigan (MI, USA), discovering human imprinted genes and loss of imprinting in cancer, and the molecular basis of Beckwith-Wiedemann syndrome. He returned to John Hopkins in 1994 as King Fahd Professor of Medicine, Molecular Biology & Genetics and Oncology, and he holds an Adjunct Professorship at the Karolinska Institute in Sweden. Dr Feinberg is Director of the Center for Epigenetics, a National Human Genome Research Institute-designated Center of Excellence in Genome Sciences. The Center is pioneering genome-scale tools in molecular, statistical and epidemiological epigenetics, and is applying them to the study of cancer, neuropsychiatric disease and aging. As part of the center, Dr Feinberg has organized a highly innovative program to bring gifted minority high-school students into genetics and genomics. Dr Feinberg has also invented a number of widely used molecular tools, including random priming. His honors include election to the American Society for Clinical Investigation, the Association of American Physicians, the Institute of Medicine of the National Academy of Sciences, and the American Academy of Arts and Sciences, as well as membership on the ISI most-cited authors list, a MERIT Award of the National Cancer Institute, a Doctor of Philosophy (Hon. Caus.) from Uppsala University (Sweden), and the President's Diversity Recognition Award of Johns Hopkins University.

Historical Perspectives

Robert McCance and Elsie Widdowson have a special place in the history of neonatal science. Their use of experimentation and observation of human infants and many other species built much of the knowledge of perinatal physiology, particularly that related to nutrition and renal function, which underpins modern neonatology. Neither was a clinical pediatrician, but they had a major influence on the first wave of neonatologists trained in the United Kingdom in the 1960s and 1970s. Their stories show how the combination of intellectual curiosity and practical skill can lead to new knowledge in unexpected directions. Robert McCance was born in Northern Ireland in 1898. He joined the newly formed Royal Naval Air Service in the First World War and flew an observation aircraft launched from a gun turret on a battleship. After the war, he worked on a farm for 6 months before studying natural sciences at the University of Cambridge from 1919 to 1922. He joined the biochemistry laboratory of Fredrick Gowland Hopkins (1929 Nobel laureate in Medicine for his work on vitamins and beriberi) and obtained his PhD. In 1926, McCance moved to King's College Hospital, London, to complete his clinical training in medicine and worked part-time in the biochemical and diabetic department. This was the era before insulin, and he worked on separating different carbohydrates in cooked fruits and vegetables. It was important to know which carbohydrates could be metabolized as fuel (eg, glucose, fructose, sucrose) and which could not (eg, polysaccharides now classed as fiber). He progressed to analyzing the content of meat and fish. In 1933, while sampling joints of meat in the hospital kitchens, he met Elsie Widdowson, a trainee dietitian, and their 60-year scientific partnership began. Elsie Widdowson was born in 1906 in southeast London. She was inspired by her chemistry teacher at …

Two Differentiated Programs of Veterinary Medical Education at the University of Veterinary and Pharmaceutical Sciences in the Czech Republic

This article describes the two separate programs of veterinary education offered at the University of Veterinary and Pharmaceutical Sciences in Brno, Czech Republic, which are directed to clinical veterinary medicine and to veterinary food safety, hygiene, and ecology, respectively. Both programs provide a level of training such that all graduates are competent for veterinary practice in any area of veterinary medicine; however, each offers an extended and deepened emphasis of training in clinical medicine, on the one hand, and food safety, on the other. A key feature is that the cohort of students for each program enters having pre-selected a career in one of these two areas. One of the important end results of this structure is that it fulfills the growing and important mission of providing a critical number of veterinarians in food safety and all of its allied fields.

An Invitation to Bolivia

An Invitation to Bolivia

A novel foundation-year-two post in academic medicine

A decline in the number of doctors pursuing careers in academic medicine poses a risk to medical research and training in the UK. This is happening at a time of major changes to postgraduate training, with the introduction of the Foundation Programme for newly qualified medical graduates in August 2005 and further changes to basic and higher specialist training expected thereafter.1,2 This paper describes an innovative training programme in academic medicine for foundation-year-two (F2) trainees. The 12-month programme provides training and practice in research, audit and medical undergraduate teaching in addition to traditional clinical training in medicine. Although in part dependent on the local infrastructure, it has key components that can be adapted by any academic unit in the UK. The impending changes to postgraduate medical training were driven by several reports highlighting the lack of formal training and career progression for senior house officers (SHOs).3-5 Although some of the changes have yet to be fully confirmed, training is likely to become shorter, more intensive and competency based. All newly qualified UK graduates will enter a two-year foundation that equips them with the skills to enter higher specialist training.6 These reforms offer new opportunities to address the growing reluctance of middle-grade junior doctors to take an academic career path.7 The Academy of Medical Sciences has pointed to lack of infrastructure, inadequate funding and the complexity of legal and ethical governance frameworks as reasons for a declining base8 together with the personal academic disincentives of insufficient flexibility, prolonged insecurity and lack of career structure.9 A British Medical Association (BMA) report indicates that, of specialist registrars working towards a postgraduate research degree, two-thirds are doing so primarily for reasons of career progression and only 17% because of an interest in research. It is possible that some of those who begin with career motives have their interest ignited and switch to academic medicine; consequently, the Academy argued for preservation of key appointments at specialist registrar grades along with new opportunities for senior SHOs at the completion of their general professional training.9 The National Health Service, as the main provider of UK healthcare, depends on a healthy research environment.11 In addition to research, medical academics provide leadership in healthcare delivery and teaching.13 Teaching is becoming increasingly important as medical undergraduate numbers rise. The two-year foundation programme provides an opportunity to develop innovative F2 posts in academic medicine. The Leicestershire, Northamptonshire and Rutland Deanery has funded two pilot posts, which started in August 2004 for one year, with further programmes planned for August 2005. Trainees are based in the Academic Medical Unit at the Leicester Royal Infirmary and the Department of Cardiovascular Sciences at the University of Leicester. The basic 40-hour week is split equally between clinical medicine and academic pursuits. In addition, trainees participate in emergency out-of-hours work on a rota identical to that of their SHO colleagues. The specific aims of this programme are: To achieve all competencies in the Foundation Programme in preparation for higher specialist training To provide exposure to academic medicine, clinical science and evidence-based clinical practice as a foundation for a career in academic medicine To provide training and practice in bedside and tutorial-based undergraduate teaching To provide continuing professional development, including preparation for successful completion of part I of the MRCP examination Effectively, these posts offer a 'taster' of academic medicine—ideal for trainees who contemplate embarking on a clinical research training fellowship as a prelude to academic study as well as for those who are unsure whether they should commit themselves to such a career. Whatever the level of commitment, the trainee will get comprehensive clinical training in an academic environment. Importantly, he or she will be excluded from the Research Assessment Exercise, so this period can be specifically dedicated to training. The educational supervisors, the trainees and the postgraduate deanery will all contribute to the continuous assessment and evaluation of these posts.

Arthur C. Corcoran Memorial Lecturer 2003

Willa A. Hsueh, MD, is professor of medicine and chief of the Division of Endocrinology, Diabetes and Hypertension, University of California, Los Angeles. She received her BS summa cum laude from Ohio State University and her MD cum laude from the same institution. Dr Hsueh received her clinical training in medicine at Johns Hopkins Hospital; this was followed by fellowships in endrocrinology at both …

Introducing residents to a career in management: the Physician Management Pathway.

To prepare their students and residents for the practice of medicine in a rapidly changing environment, medical educators must teach the business of medicine as well as the science and art of medicine. Recognizing the value of and demand for physician leaders, the authors sought to introduce residents to diverse aspects of medical administration within the context of an academically rigorous internal medicine residency program. The Physician Management Pathway (PMP) was developed in 1997 to expose interested residents to the management concepts employed by physician managers; to help physician trainees begin to develop the leadership and technical skills they will use as physician managers; to provide career mentoring; to provide experiences that enrich the resident's training in clinical medicine; to enhance resident-directed educational activities; and to produce physicians who can successfully work in any health care environment. The PMP curriculum consists of a monthly seminar series, a preceptorship experience in the second year of residency, and a supervised project in the third year. The program was not designed to provide competency in management, but rather is intended to provide an opportunity for new physicians to explore options in this exciting and changing profession.

Fellowship training programs in blood banking and transfusion medicine: results of a national survey.

This report details the results of a 1995 survey of the 40 fellowship training programs in blood banking and transfusion medicine in the United States approved by the Accreditation Council for Graduate Medical Education. Fellows primarily enter transfusion medicine training after completing a pathology residency, and are subsequently employed in an academic or university setting, or a blood donor center. Program directors indicated that either the current level, or fewer, transfusion medicine specialists will be needed in the future. The educational content of fellowship training was examined, as well as aspects of proficiency and competency in several areas. Research is an important part of most fellowship programs, and a majority of program directors felt that some formal training in clinical medicine should be a part of fellowship training in transfusion medicine. The information obtained from this survey should be helpful to both fellowship applicants and program directors in delineating important aspects of fellowship training in blood banking and transfusion medicine.

Specialty training in clinical medicine

Specialty training in clinical medicine