Training Of Medical Doctors Research Articles

Narrative Medicine: theory, clinical practice and education - a scoping review

BackgroundThe origin of Narrative Medicine dates back to more than 20 years ago at an international level. Narrative Medicine is not an alternative to evidence-based medicine, however these two approaches are integrated. Narrative Medicine is a methodology based on specific communication skills where storytelling is a fundamental tool to acquire, understand and integrate several points of view related to persons involving in the disease and in the healthcare process. Narrative Medicine, henceforth NM, represents a union between disease and illness between the doctor’s clinical knowledge and the patient’s experience. According to Byron Good, “we cannot have direct access to the experience of others’ illness, not even through in-depth investigations: one of the ways in which we can learn more from the experience of others is to listen to the stories of what has happened to other people.” Several studies have been published on NM; however, to the best of our knowledge, no scoping review of the literature has been performed.ObjectiveThis paper aims to map and synthetize studies on NM according to theory, clinical practice and education/training.MethodThe scoping review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist. A search was conducted in PubMed, APA PsycNet and Jstor. Two authors independently assessed the eligibility and methodological quality of the studies and extracted the data. This review refers to the period from 1998 to 2022.ResultsA total of 843 abstracts were identified of which 274 papers were selected based on the title/abstract. A total of 152 papers in full text were evaluated and 76 were included in the review. Papers were classified according to three issues:✘ Nineteen studies focused on the definition and concept of NM (Theoretical).✘ Thirty-eight papers focused on the collection of stories, projects and case reports (Clinical practice).✘ Nineteen papers focused on the implementation of the Narrative Medicine approach in the education and training of medical doctors (Education and training).ConclusionsThis scoping review presents an overview of the state of the art of the Narrative Medicine. It collect studies performed mainly in Italy and in the United States as these are the countries developing the Narrative Medicine approach in three identified areas, theoretical, clinical practice and education and training. This scoping review will help to promote the power of Narrative Medicine in all three areas supporting the development of methods to evaluate and to measure the Narrative Medicine approach using key performance indicators.

Clinical Simulation for Procedural Expertise: State of Education and Application

Procedural skills are a core component in the health care practice that extends across all medical practitioners, from novice trainees to specialists. Medical institutions have widely adopted simulation to develop the clinical and procedural skills of health profession students. This review evaluates the evidence regarding simulation-based training for developing procedural expertise among medical students and junior doctors. For this purpose, Google Scholar and MEDLINE/PubMed databases were searched for articles published on simulation-based procedural training between January 2000 and October 2023. Reviews or studies published in languages other than English and research that showed evidence on communication, critical thinking, teamwork, decision-making, and cognitive skills were excluded from the search. The focus was placed on clinical and psychomotor skills as this review intends to inform clinical skills teaching and research practice. The results reveal that simulation-based training has been utilized increasingly to train medical students and junior doctors in procedural skills. Varying levels of fidelity have been incorporated to train psychomotor skills about a multitude of common and rare procedures. The evidence supports the acquisition of knowledge and procedural skills via simulation. Evidence also supports the transfer of skills from the simulated environment to clinical practice and live patients. However, resource intensiveness has limited the implementation of this method of education in developing countries. When used consciously, simulation can complement clinical training to produce competent doctors capable of effective patient care.

Testing a new method for training medical doctors in percutaneous endoscopic gastrostomy in palliative pediatrics

Testing a new method for training medical doctors in percutaneous endoscopic gastrostomy in palliative pediatrics

Standardised Competency-Based Training of Medical Doctors and Associate Clinicians in Inguinal Repair with Mesh in Sierra Leone

IntroductionIn low-income settings, there is a high unmet need for hernia surgery, and most procedures are performed with tissue repair techniques. In preparation for a randomized clinical trial, medical doctors and associate clinicians received a short-course competency-based training on inguinal hernia repair with mesh under local anaesthesia. The aim of this study was to evaluate feasibility, safety and effectiveness of the training.MethodsAll trainees received a one-day theoretical module on mesh hernia repair under local anaesthesia followed by hands-on training. Performance was assessed using the American College of Surgeon’s Groin Hernia Operative Performance Rating System. Patients were followed up two weeks and one year after surgery. Outcomes of the patients operated on during the training trial were compared to the 229 trial patients operated on after the training.ResultsDuring three surgical camps, seven medical doctors and six associate clinicians were trained. In total, 129 patients were operated on as part of the training. Of the 13 trainees, 11 reached proficiency. Patients in the training group had more wound infections after two weeks (8.5% versus 3.1%; p = 0.041). There was no difference in recurrence and mortality after one year, and none of the deaths were attributed to the surgery.Discussion and conclusionMesh repair is the international standard for inguinal hernia repair worldwide. Nevertheless, this is not widely accessible in low-income settings. This study has demonstrated that short-course intensive hands-on training of MDs and ACs in mesh hernia repair is effective and safe.Trial Registration: International Clinical Trial Registry ISRCTN63478884.

Training in psychosomatic medicine and psychotherapy for medical doctors in China: A field report.

The high prevalence rates of mental disorders in China contrast a comparatively low care capacity from qualified trained medical doctors in the mental health field. The main objective of our cooperation project was to develop and implement advanced postgraduate training for medical doctors for their acquisition of knowledge, skills, and attitudes in the field of psychosomatic medicine and psychotherapy in China. Monitoring and evaluation as part of the advanced training in Beijing were conducted following the Kirkpatrick training approach using four levels of evaluation: reaction, learning, behavior and results. We performed a continuous course evaluation, assessed the respective learning goal attainment, conducted a pre-post evaluation of reasons and goals for participation in the training, and measured the treatment effects on the patient side. The implementation of training standards in the field of psychosomatic medicine and psychotherapy for medical doctors and the transfer of didactic knowledge and skills for Chinese lecturers were achieved. A total of 142 mainly medical doctors attended the 2-year training. Ten medical doctors were trained as future teachers. All learning goals were reached. The content and didactics of the curriculum were rated with an overall grade of 1.23 (1 = very good to 5 = very bad). The highest rated elements were patient life interviews, orientation on clinical practice and communication skills training. The achievement of learning objectives for each block (depression, anxiety disorders, somatic symptom disorder, coping with physical diseases) was rated between 1 and 2 (1 = very well achieved to 5 = not achieved) for all items from participants' perspectives. On the patient side (n = 415), emotional distress decreased and quality of life and the doctor-patient alliance improved significantly. Advanced training in psychosomatic medicine and psychotherapy was successfully implemented. The results of the evaluation show high participant satisfaction and the successful achievement of all learning objectives. A more detailed and extensive evaluation of the data, such as an analysis of the development of the participants as psychotherapists, is in preparation. The continuation of the training under Chinese guidance is guaranteed.

Harnessing the disruption on medical trainee education due to COVID-19 in New South Wales, Australia.

The coronavirus disease (COVID-19) pandemic has caused disruption and uncertainty for junior medical doctor training and education. This has compounded the existing stress experienced by this cohort. However, by choosing appropriate educational models, as well as using novel educational approaches and advancing our online technology capabilities, we may be able to provide acceptable and even, superior solutions for educational training moving forward, as well as promote trainee wellbeing during these uncertain times.

Putting nutrition education on the table: development of a curriculum to meet future doctors’ needs

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between...

Harnessing the disruption on medical trainee education due to COVID-19 in New South Wales, Australia

The coronavirus disease (COVID-19) pandemic has caused disruption and uncertainty for junior medical doctor training and education. This has compounded the existing stress experienced by this cohort. However, by choosing appropriate educational models, as well as using novel educational approaches and advancing our online technology capabilities, we may be able to provide acceptable and even, superior solutions for educational training moving forward, as well as promote trainee wellbeing during these uncertain times.

IMPLEMENTATION OF CONTINUING MEDICAL EDUCATION OF PHYSICIANS ON THE TREATMENT OF PATIENTS WITH CORONARY ARTERY DISEASE AND COMORBIDITIES

Objective: to evaluate current approaches to the training of physicians on comorbidity and multimorbidity and to develop and implement a training module “Comorbidity in patients with coronary artery disease: current approaches to treatment” in the Training Center "Institute of Postgraduate Education" of the State Institution of Sciences “Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department (SIS “RPC PCM” SAD).
 Material and methods. We carried out an analysis and generalization of recent publications on the topic of the management challenges in patients with coronary artery disease and comorbidities and review the literature focusing on postgraduate training of medical doctors in the area of multimorbidity After the implementation of the training module we made a survey of 60 physicians on their assessment of the information provided.
 Results and discussion: Current scientific research substantiates the feasibility of introducing both face-to-face trainings and master classes, as well as distance learning to optimize the training programmes for doctors in managing patients with multimorbidity and comorbidity. We developed and implemented a training module “Comorbidity in patients with coronary artery disease: current approaches to treatment” in the Training Center "Institute of Postgraduate Education" of SIS “RPC PCM” SAD. We identified major theoretical issues and practical skills that should be acquired by the physician, we worked out the methodology for presenting information during full-time and distance learning. The educational process includes lectures (including the use of distance learning), and a workshop format and master classes with the analysis of specific clinical cases.
 Conclusions: 97.1% of respondents rated positively the implementation of continuing medical education on the topic of coronary artery disease management in patients with comorbidities with the use of distance learning and the appliance of master classes with the analysis of clinical cases. Optimal educational format is a significant issue which needs further research. Any training on the management of multimorbidity in practice must be outcome-oriented, in order to change practice and improve clinical outcomes for complex patients.

What made the Mais Médicos (More Doctors) Program possible?

The article analyzes which were the actors who participated in the insertion in the governmental agenda of the issue of insufficiencies in the supply and training of medical doctors for the SUS and the adoption of the Mais Médicos Program (PMM) as a solution. Documental and bibliographic analysis and semi-structured interviews were carried out in the methodological perspective of process tracing. Theoretical resources from studies on political processes and from the theories of gradual institutional change and multiple streams were used. Outstanding results were the identification of factors related to the entry of the issue on the agenda, such as the aggravation of the issue, increase in its public perception and change of government. It was found that the action of the President and policy entrepreneurs was decisive for the process of formulating the PMM based on historical legacies of previous policies. We challenge studies that regard the PMM as a hastily formulated solution to an old problem to respond the street demonstrations known as "June Journeys". The inauguration of municipal governments, in 2013, and the electoral calendar were also important factors and taken into account in the strategic action of the actors who led the formulation of the PMM, with strong opposition from medical entities.

Patient perceptions of surgical training in the private sector in South Africa - a single centre survey

As the worldwide demand for specialist surgeons increases, and to complement surgical training provided through governmental institutions, private hospitals are increasingly hosting trainees. Wits Donald Gordon Medical Centre (WDGMC) is a private academic hospital in Johannesburg with a Colorectal Unit (CRU) that hosts several trainees. While published studies demonstrate that the involvement of trainees in surgery does not adversely impact outcomes, private patients' perceptions of the role of trainees in their care have not been as widely researched.This was a prospective, cross-sectional study using a self-administered questionnaire hosted on a REDCap database. Statistical analysis was performed using SPSS version 26.One hundred and seventy-four patients participated in the study, and 74.1% of respondents felt that training of doctors should occur in private hospitals in South Africa. Of the sample, 83.3% would allow a supervised trainee to perform a part of their operation, provided they had been made aware of trainee participation in advance (78%). Sixty per cent of patients felt that interaction with a trainee enhanced their care, and 52.3% of patients suggested that seeing more than one doctor a day improved their experience.Our results suggest that privately funded patients support the surgical training of medical doctors in private academic training hospitals, and they are willing to be participants in the training process. Moreover, training programmes in this setting appear to enhance the patient experience. We are optimistic that these findings could be used to advocate for expanded training opportunities across the private sector in South Africa.

O que fez com que o Programa Mais Médicos fosse possível?

Abstract The article analyzes which were the actors who participated in the insertion in the governmental agenda of the issue of insufficiencies in the supply and training of medical doctors for the SUS and the adoption of the Mais Médicos Program (PMM) as a solution. Documental and bibliographic analysis and semi-structured interviews were carried out in the methodological perspective of process tracing. Theoretical resources from studies on political processes and from the theories of gradual institutional change and multiple streams were used. Outstanding results were the identification of factors related to the entry of the issue on the agenda, such as the aggravation of the issue, increase in its public perception and change of government. It was found that the action of the President and policy entrepreneurs was decisive for the process of formulating the PMM based on historical legacies of previous policies. We challenge studies that regard the PMM as a hastily formulated solution to an old problem to respond the street demonstrations known as “June Journeys”. The inauguration of municipal governments, in 2013, and the electoral calendar were also important factors and taken into account in the strategic action of the actors who led the formulation of the PMM, with strong opposition from medical entities.

Развитие последипломного медицинского образования в Украине

Актуальность. Эксперты ВОЗ отмечают, что сегодня в Европе не существует общепризнанного подхода к непрерывному медицинскому образованию, однако существует общее мнение, что качество медицинских услуг напрямую зависит от постоянного развития и оценки профессиональных компетенций врачей в процессе их повышения квалификации. Особое внимание всегда уделялось обеспечению (и постоянному совершенствованию) академического уровня поставщиков образовательных услуг или программ, на основе которых врачи согласовывают собственные планы по получению необходимых профессиональных знаний и навыков. Важнейшей предпосылкой обеспечения повышения квалификации является создание единой системы аккредитации поставщиков образовательных услуг или программ, а также "коллективная ответственность" всех участников медицинского образования. Цель: исследовать развитие системы последипломного и непрерывного образования в Украине на примере ведущего национального учреждения последипломного образования – Национальной медицинской академии последипломного образования имени П. Л. Шупика (НМАПО). Материалы и методы. Архивные материалы. В исследовании мы использовали общий (универсальный) метод, исторический и логический методы. Результаты. Согласно определению Всемирной федерации медицинского образования (WFME), последипломное медицинское образование – это фаза медицинского образования, на которой врачи развивают свои компетенции после завершения базовой медицинской квалификации. Этот этап обучения проводится в соответствии с определенными правилами и инструкциями. Последипломное медицинское образование включает подготовку к сертификации и/или лицензирования, производственную/профессиональную подготовку, специализацию и узкую специализацию, а также другие формализованные учебные программы для развития определенных экспертных функций. Будучи частью непрерывного медицинского образования, последипломное образование включается в непрерывное медицинское образование (НМО) или непрерывное профессиональное развитие (НПР). Согласно определению WFME, НПР касается подготовки врачей, которая начинается после окончания базового и последипломного медицинского образования и продолжается в дальнейшем в течение профессиональной жизни каждого врача. Сейчас развитие современной медицины происходит чрезвычайно быстрыми темпами, а навыки и знания врачей быстро устаревают. В статье прослеживается внедрение последипломной медицинской подготовки в Украине на примере НМАПО. Выводы. Внедрение последипломной подготовки врачей в Украине изучается на примере более 100-летней деятельности НМАПО, что позволяет утверждать, что сочетание исследований и инноваций, обучения и медицинской практики позволило учебному заведению стать примером для подражания в учебно-методической деятельности в условиях последипломного медицинского и фармацевтического образования.

Technology Enabled Delivery of Medical Programmes through ODL : A Case of Training Medical Doctors in Geriatric Medicine

COVID-19 provided an opportunity to experiment with alternative delivery mechanisms for a medical education programme offered through open and distance learning with face-to-face training as an essential component of the programme. Non-availability of hard copies of the course material (92%) and lack of communication from the university (32%) as well as training centres (42%) were some of the challenges faced by students of the Geriatric Medicine programme of the Indira Gandhi National Open University (IGNOU) during the COVID pandemic. Around 90% were willing to attend online classes and 65% to 77% were willing to present cases online for discussion. A programme-specific web portal containing all resource material and information was visited by 85% of students. Most students attended the online classes and 68% attempted the formative assessments based on the online classes. Online classes were recorded and uploaded and were found useful by 90% of students. The experiment successfully demonstrated the feasibility and acceptance of delivering practical skills using online technological tools. Further integrating technology to complement some of the face-to-face component could be used as a permanent and effective delivery strategy, which could also reduce resource requirements.

Studying Brain Activation during Skill Acquisition via Robot-Assisted Surgery Training.

Robot-assisted surgery systems are a recent breakthrough in minimally invasive surgeries, offering numerous benefits to both patients and surgeons including, but not limited to, greater visualization of the operation site, greater precision during operation and shorter hospitalization times. Training on robot-assisted surgery (RAS) systems begins with the use of high-fidelity simulators. Hence, the increasing demand of employing RAS systems has led to a rise in using RAS simulators to train medical doctors. The aim of this study was to investigate the brain activity changes elicited during the skill acquisition of resident surgeons by measuring hemodynamic changes from the prefrontal cortex area via a neuroimaging sensor, namely, functional near-infrared spectroscopy (fNIRS). Twenty-four participants, who are resident medical doctors affiliated with different surgery departments, underwent an RAS simulator training during this study and completed the sponge suturing tasks at three different difficulty levels in two consecutive sessions/blocks. The results reveal that cortical oxygenation changes in the prefrontal cortex were significantly lower during the second training session (Block 2) compared to the initial training session (Block 1) (p < 0.05).

Mental health education in undergraduate medical curricula across Nepalese universities

BackgroundMental and substance use disorders account for 30 % of the non-fatal disease burden and 10 % of the overall disease burden but the treatment gap is daunting. With just one psychiatrist per 200,000 populations in Nepal, the only convincing way to improve access to the services quickly is by mobilizing non-specialized medical practitioner. A robust mental health component within the training curriculum of general medical doctors could produce medical graduates with adequate knowledge and skills to deliver basic mental health service. We reviewed the mental health curricula for medical students of all the medical universities in Nepal.MethodsInformation on existing mental health curricula was collected from the faculty of the respective universities with respect to content coverage, teaching methods and evaluation patterns. The mental health curricula were described in relation to teaching duration, duration of clinical rotation, duration of internship, and the relative weight of mental health in examination marks. Teaching methods were classified broadly as passive and active. Assessment methods were documented. Content coverage of the curricula was evaluated with respect to history taking and general physical examination, the priority mental health conditions, topics on behavioural sciences, and child mental health or other topics.ResultsThe duration of teaching on mental health in general medical doctor training in Nepalese medical universities ranges from 25 to 92 h. All medical universities have a relative focus on the priority mental neurological and substance use disorders. The clinical rotation on mental health is mostly two weeks, except in one university where it can be extended up to 4 weeks with an elective clinical rotation. The relative weight of summative assessment ranges from 0.21 to 2.5 % total marks of the entire training.ConclusionsConsiderable disparities exist in course content, teaching/learning modalities and assessments for mental health across Nepalese medical universities. The relative proportion of mental health in medical curricula as well as teaching/learning and assessments are far below ideal in these universities. These findings suggest a need for increasing time allocation, adopting newer teaching learning methods, and also having a mandatory clinical rotation during training and during internship.

Oral Presentation

Oral Presentation

Development of computer-based methodology for remote advanced training of medical doctors

Aim. To formulate the methodology for developing the interactive virtual computer simulations with a rating assessment of trainees’ decisions and the capability of remote access.Material and Methods. The methods of knowledge engineering were used to extract and formalize expert knowledge about the structure, significance, and relevance of clinical diagnostic information. The materials for creating virtual computer simulations were based on texts from the archival medical records, laboratory data, and multimedia results of instrumental methods of study. A three-tier network architecture was applied to provide the capabilities of remote access. It was organizationally represented by three components: a client layer, a business logic layer, and a data layer. Data transfer was provided by the Web protocols while microservices represented the infrastructure.Results. The information was formalized and structured after expert analysis and identification of significant diagnostic and prognostic data. The process included defining the domain model, identifying the aggregates and connections between them, and designing software and user interfaces. Possible solutions for trainees are now presented in the form of interactive reference lists. The artifacts of the user’s work are saved in the storage represented by the module for working with the server file system and the object-relational database management system. Each task module contains static and interactive blocks of information. The purpose of static blocks is to provide trainees with the necessary information for making clinical and diagnostic decisions. The interactive blocks allow selecting one or more solutions from the list. The content and sequence of further information presentation are determined by the trainees’ answers to the questions of an interactive block. Trainees’ decision-making competencies are evaluated using the rating system. The final personal rating is calculated as a multiplication of all coefficients related to the trainees’ decisions. This approach integrates a rating system with the trajectory chosen by the trainee for task completion.Conclusions. The distance learning technologies, developed for clinical disciplines in this study, are quite new and innovative. The repository of virtual computer simulations is under development to improve the methodological support of remote clinical training.

INTERACTIVE LEARNING IN THE COURSE OF INTERNAL MEDICINE: STEPS IN MAKING DIAGNOSIS

Current trends in the development of the Ukrainian education system provide a new approach to the organization of educational process. A doctor must know the algorithm of the diagnostic process and medical decision-making peculiarities underlying the making diagnosis. This requires constant improvement as the number of law cases has demonstrated that diagnostic errors are merely not due to physician’s insufficient medical qualification but often as a consequence of violation of the basic procedural laws. Studying the theory of medial diagnosis stimulates the development of clinical thinking. The purpose of this work was to systematize the main stages in making diagnosis and to outline the ways of their implementation through the interactive learning. The study involved the medical students of Zaporizhzhia State Medical University. The methodology included theoretical systematic analysis of scientific and methodological literature as well as own experience in applying interactive learning. The main motivating factor in the professional training organization should be focused on the professionally oriented use of material and fostering students’ own experience. Under these conditions, the importance of a semiotic approach to the diagnosis of diseases is increasing, i.e. the process of disease identification relies on the ability to catch and to recognise its signs. When making a diagnosis, the doctor has to rely on facts only. This is described as "clinical thinking." The interactive learning in the courses of various disciplines in the program of medical doctor training is being actively implemented at Zaporszhzhia State Medical University. It provides the opportunity for more pronounced pedagogical influence, which induces students to be more active in mastering the program, as well as to demonstrate creativity and research for solving various tasks in daily class practice. Deep understanding the theory of medical decision-making process and making diagnosis greatly contributes to clinical thinking.

Lipodystrophy at the insulin injection sites: current trends in epidemiology, diagnostics and prevention

Lipodystrophy at the injection sites is most common local complication of insulin therapy. The history of its study started in 1926, when first cases of lipoatrophy at the sites of insulin injections were described. As we moved to human insulin and insulin analogues, immune mediated atrophic form of lipodystrophy has been replaced by hypertrophic one, which reflects anabolic and mitogenic effect of insulin.&#x0D; Lipohypertrophy at the injection sites is detected by physical examination in 40-70% of insulin-treated subjects. The detection efficiency depends on health care provider`s skills. Therefore, training of medical doctors and nurses in physical examination of injection sites seems to be reasonable.&#x0D; In recent years, ultrasound was introduced for diagnostics of insulin-induced lipohypertrophy. The method is more sensitive compared to palpation; ultrasound-verified lipohypertropthy was detected in more than 80% of cases. In patients with wide-spread lipohypertrophy ultrasound can be used to find suitable sites for injections (ultrasound injection map). Strain sonoelastography and 3D-power Doppler ultrasound can be used for quantitative estimation of rigidity and vascularization of lipohypertrophy. Both MRI and infrared images are considered as promising diagnostic tools.&#x0D; In a number of studies, it has been shown that the presence of lipohypertrophy is associated with high HbA1c levels, enhanced glycemic variability, unexplained hypoglycemia, and increased insulin doses. Thereby, lipohypertrophy aggravates the diabetes-related costs.&#x0D; The main risk factor for lipohypertrophy is inappropriate injection technique, including the lack of the site rotation, injections into lipodystrophic lesions, small injection area, reuse or excessive length of the needles. Accordingly, training patients in the injection technique is the basis for prevention of complication. The cessation of injections in lipohypertrophy areas and regular site rotation is essential for adequate titration of insulin dose and achievement of glycemic targets.