Perception of university students about doctors and quality of health care provision at clinics: a multi-national study in India, Pakistan, Spain and United States of America

Background: Patient satisfaction is considered as an indicator of the healthcare quality. Information on patient satisfaction based on medical expertise of the physician, interpersonal skills, physician-patient interaction time, perception and needs of the patient allow policymakers to identify areas for improvement. Primary care services and healthcare structure differ between the countries. The present study was done to determine and analyze the determinants associated with patient satisfaction in India, Pakistan, Spain and USA.Methods: This descriptive study was performed in January to August 2019 among students from Mumbai University, India, Dow University of Health Sciences, Karachi, Pakistan, University CEU Cardenal Herrera, Valencia, Spain, Texas State University, Texas, USA. On the basis of the eligibility criterion (those who gave a written informed consent and were registered students of respective university) 890 (India: 369, Pakistan: 128, Spain: 195, USA: 99) students were selected for the present study.Results: India had almost similar male (49%) to female (51%) ratio of participants. For other 3 countries (PK, ES, US), female participant percentage was nearly 20% or even more as compared to male participants. Overall participant’s satisfaction score about medial expertise of the doctor were highest in India (71%) and were lowest in Spain (43%). Overall satisfaction score about time spent with doctor were highest for India (64%) and were lowest for Spain (41%). Overall satisfaction score about communication with doctor were highest for US (60%) and were lowest for PK (53%). Overall satisfaction score for medical care given by the doctor was lowest in PK (43%) and was highest in US (64%). Overall satisfaction about doctor, highest number of US (83%) and lowest number of PK (32%) participants were satisfied about medical interaction with doctors.Conclusions: These multi-country findings can provide information for health policy making in India, Pakistan, Spain and USA. Although the average satisfaction per country, except Pakistan is more than 60%, the results suggest that there is ample room for improvement.

O que a pesquisa sobre raciocínio clínico tem a dizer a preceptores e professores de áreas clínicas? / What does research on clinical reasoning have to say to clinical teachers?

O raciocínio clínico é um fator determinante da performance do médico, crucial para chegar a um diagnóstico correto e possibilitar decisões terapêuticas adequadas. Ajudar seus estudantes a desenvolver o raciocínio clínico é um desafio diário de muitos professores e, para selecionar estratégias de ensino adequadas, pode ser útil conhecer um pouco dos resultados da pesquisa sobre raciocínio clínico que vem se desenvolvendo já há algumas décadas. Este artigo traz uma síntese de achados desta pesquisa que ajudam a compreender os processos cognitivos envolvidos no raciocínio clínico, a trajetória que leva o estudante de uma condição de "iniciante" `a de "expert" e abordagens instrucionais que têm se mostrado úteis para facilitar esta trajetória. O foco do artigo é o processo diagnóstico, porque é ele que tem sido o objeto central de pesquisa. Esta pesquisa indica que não há estratégias de raciocínio específicas, próprias do médico expert, que possam ser ensinadas ao estudante. É a existência de uma larga base de conhecimentos organizados na memória em scripts de doenças de diversos formatos que explica o melhor desempenho do expert. Quanto mais numerosos, mais ricos e melhor organizados são os scripts que um médico tem na memória, mais apto ele está para fazer diagnósticos acurados. Estes scripts são formados gradualmente ao longo dos anos de formação e para desenvolvê-los o estudante deve ser exposto a uma grande diversidade de problemas clínicos, com os quais ele deve interagir de forma ativa. Abordagens instrucionais que requerem que o estudante reflita de forma sistemática sobre os problemas, analisando diferenças e similaridades entre eles, explicando mecanismos subjacentes, comparando e contrastando diagnósticos alternativos têm se mostrado úteis para ajudar a refinar scripts de doenças e são ferramentas valiosas para os professores interessados no desenvolvimento do raciocínio clínico de seus estudantes.

Clinical reasoning is a crucial determinant of physicians' performance. It is key to arrive at a correct diagnosis, which substantially increases the chance of appropriate therapeutic decisions. Clinical teachers face the daily challenge of helping their students to develop clinical reasoning. To select appropriate teaching strategies, it may be useful to become acquainted with the results of the research on clinical reasoning that has been conducted over the last decades. This article synthesizes the findings of this research that help in particular to understand the cognitive processes involved in clinical reasoning, the trajectory that leads the student from novice to expert, and instructional approaches that have been shown to be useful to facilitating this trajectory. The focus of the article is the diagnostic process, because it is about it that most research has been conducted. This research indicates that there is not a particular reasoning strategy that is specific to expert physicians and could be taught to students. It is the availability of a large knowledge base organized in memory in illness scripts of different formats that explains the expert's better performance. The more, the richer, and the more well-structured are the illness scripts a physician has stored in memory, the more he/she would be able to make accurate diagnoses. These scripts are formed gradually over the years of education. To help develop them, students should be exposed to a wide variety of clinical problems, with which they must interact actively. Instructional approaches that require students to systematically reflect on problems, analyzing differences and similarities between them, explaining underlying mechanisms, comparing and contrasting alternative diagnoses, have proved useful to help refine disease scripts. These approaches are valuable tools for teachers concerned with the development of their students clinical reasoning.

The Construction of the Faculty of Hamheung Medical College in North Korea, 1946-48: An Unrest Coexistence of Political Ideology and Medical Expertise / 의사학

This paper aims to reveal how Hamheung Medical College in North Korea kept up its faculty with the trend of a new political system. The time period consists of three series of evaluations that occurred between the start of a reformation action in 1946 and the establishment of the regime in 1948. At the time, it was difficult to secure college faculty in the medical field, because of a serious shortage of medical personnel. Moreover, the problem in the recruitment of faculty at the medical college grew bigger since the members were required to have a high level of political consciousness. Then how did Hamheung Medical College accomplish this ideal securing of faculty that possessed political ideology and medical expertise? For the first time, a faculty evaluation at the local level was carried out and got rid of a few pro-Japanese or reactionary factions but maintained most of the faculty. Although academic background and research career of the faculty were considered, securing of the manpower in terms of number was crucial for the reconstruction of a professional school level. At the second time, as the central education bureau's intervention tightened the censorship, most of the faculty were evaluated as unqualified. Indeed, it was difficult to satisfy the standard of professionalism which emphasized a high level of academic career and political thought that included affiliation of Workers' Party of North Korea. The Medical College could not find faculty that could replace those professors and therefore, most of them maintained their faculty positions. Since then, the faculty who received excellent evaluations led the school at the very front. At the third time, the Medical College itself led the evaluations and implemented more relaxed standards of political ideology and medical expertise. Faculty who were cooperative to the reformation actions that North Korea carried forward or had working experience at the hospital and health service received a high level of recognition. Accordingly, the Medical College expanded itself by securing many professors, but also embodied a large gap of academic and ideological levels between them. Hence, the political ideology and medical expertise, which were set forth as the requirements for faculty, were constructed in the space of political ideal and social reality. Despite the high criteria the North Korean Government made, Hamheung Medical College's faculty fell below the average in terms of ideological and academic standards. As a way to compensate this, professors who greatly satisfied the both virtues were placed as leaders and, for supporting them, professors who taught the general education curriculum were recruited largely. And also, it appointed a large number of medical doctors who accumulated experiences in the field as new professors. Nevertheless, the Medical College struggled to raise the quality of medical education and was unable to prevent a part of its faculty from leaving to South Korea in the time of the Korean War. Thus, the political and academic virtues of the faculty at that time were not just simply about the professor individuals but were interrelated with the medical education and health care system in North Korea.

Trabalho docente, readaptação e saúde: a experiência dos professores de uma universidade pública / Teaching, readjustment and health: the experience of teachers at a public university in Brazil

O objetivo principal deste artigo é analisar, pelo ângulo dos próprios trabalhadores, os sentidos da readaptação na vida dos professores de uma universidade pública, sob o enfoque metodológico da pesquisa qualitativa. Participaram do estudo oito professores readaptados com vínculo estável na universidade, sendo que dois pertenciam ao colégio de aplicação. Quanto à discussão do material, optou-se pelo método de análise do discurso, objetivando interpretar, a partir de sua própria fala e vivência, como os docentes lidam com o fato de serem readaptados. As principais categorias empíricas advindas das análises das falas foram: "Você tem que correr atrás para que seu trabalho seja publicado e ainda ministrar e preparar as aulas"; "A readaptação foi favorável para minha saúde porque saí da sala de aula"; "Aqui há falta crônica de professores"; "O pior do processo de readaptação é o tratamento dado pelos colegas"; "Na perícia central você é muito maltratado". Concluiu-se que a readaptação funcional é um processo gerado por condições coletivas de trabalho como, por exemplo, a sobrecarga de aulas, o que exige a necessidade de intervenções institucionais de caráter coletivo para a promoção de ambientes laborais mais saudáveis.

In this paper we aimed at analyzing, from the perspective of workers themselves and under the methodological approach of qualitative research, the meanings of readjustment in the lives of professors at a public university. Eight readapted professors with stable relationship with the university and two others from Application School have participated in this study. As for the discussion of the material, we have chosen the method of discourse analysis, aiming to interpret from their own speech and experience, how the professors deal with the fact that they are readjusted. The main categories of empirical results from the speech analyzes were: "You have to catch up with your papers to be published and teach and prepare lessons, as well" "The readjustment was favorable to my health condition just because I've quit classes", "There is chronic lack of professors here", "The worst in the process of readjustment is the treatment you receive from colleagues", "In central expertise you are very badly treated". It was concluded that the functional readjustment is a process generated by collective work conditions, for example, the overhead of classes, which requires the need for collective character of institutional interventions to promote healthier working environments.

Medicina legal, peritos y peritaciones / Legal Medicine, experts and surveys

En el presente trabajo se expone la evolución histórica de Medicina Legal y cómo ha sido aplicada en diversos contextos. Se resalta la labor del perito como un experto, separándolo de lo que habitualmente es considerado cuando declara en un juicio: un simple testigo. Precisamente existen marcadas diferencias entre éste y un perito, el cual debe poseer una gran cantidad de valores éticos, morales y sociales para no deformar la verdad de los hechos. Asimismo, se sugiere cuáles deben ser las partes que deben poseer una peritación médico legal para que tenga un adecuado valor como instrumento probatorio durante un proceso judicial. Todo lo anterior siempre con el fin de mejorar la Administración de Justicia...