Practice-oriented training improves knowledge levels of chronic obstructive pulmonary disease among primary care physicians / 中华全科医师杂志

A 3-week practice-oriented training course on chronic obstructive pulmonary disease (COPD) management was conducted in December 2020, 34 primary care physicians from township or community health service centers attended the course. The impact of the training course on the knowledge levels of COPD management was evaluated with a questionnaire survey, the questionnaire contained the knowledge of COPD and its management. The survey showed that before the training, the participants had low knowledge levels on the definition of COPD and its risk factors; 67.6% (23/34) were not aware of COPD-related guidelines and new developments, and 17.6%(6/34) had conducted COPD follow-up assessments, pulmonary rehabilitation, and health education; only 8.8% (3/34) had used the improved British Medical Research Council Dyspnea Index (mMRC) and the chronic obstructive pulmonary disease assessment test (CAT) for patient self-assessment; there was no pulmonary function instrument in their units, and only 3 doctors (8.8%) had previously participated in pulmonary function training and knew indications and contraindications of the pulmonary function test, and complete report interpretation; all participants were unable to use common inhalation devices and master inhalation techniques completely and correctly; 11.8% (4/34) had assessed patients′ handling inhalation devices and performing inhalation. After the training, the knowledge levels of COPD clinical features, lung function and inhalation technique were significantly improved, and the scores were significantly increased compared with those before the training ( P<0.001). The study shows that primary care physicians have insufficient knowledge and management skill of COPD. The practice-oriented training can significantly improve the knowledge and skills of primary care physician for COPD management in the community.

Investigation on Recognition and Behavior of Primary Physicians to National Essential Medicine System in Luzhou / 中国药房

OBJECTIVE:To provide reference for further implementation and perfection of National Essential Medicine Sys-tem. METHODS:Stratified random sampling method was used to select 252 doctors from Sichuan Luzhou. Questionnaire survey was performed among them about recognition and behavior of them to National Essential Medicine System. Related investigation da-ta was analyzed statistically. RESULTS:A total of 252 questionnaires were issued and 243 valid questionnaires were collected with effective recovery rate of 96.4%. Of 242 respondents who had heard of National Essential Medicine System,the respondents who had heard but not clear occupied the highest percentage (52.1%). Of 149 participants who had participated in national essential medicine knowledge training or study,the proportion ofonly one knowledge training or studywas the highest(57.0%). The sur-vey respondents had a maximum of 45.0% and a minimum of 16.5% of common sense about National Essential Medicine System. After the implementation of National Essential Medicine System,respondents often propagandized National Essential Medicine Sys-tem to diagnosis and treatment objects accounted for only 23.1%. The proportion ofno changechosen for items of work motiva-tion,work efficiency and workload was the highest (all occupied 58.3%);the proportion oflittle influencechosen for item of clinical medication habit was the highest(38.8%). 86.4% of respondents were willing to give priority to the use of national essen-tial medicines;the top 4 reasons wereto obtain training and guidance on the use of essential medicinesto set utilization rate of essential medicines in primary health care institutionsto strengthen the propaganda of National Essential Medicine Systemto evaluate physician's prescriptions regularly. 13.6% were not willing to give priority to the use of national essential medicines;the top 4 reasons werelack of the confidence of the use of national essential medicinespoor accessibility of essential medicinesfear of medical accidents due to prescription essential medicines,lead to medical disputesdon't know what is essential medi-cine. CONCLUSIONS:The primary physicians'perceptions of National Essential Medicine System and the implementation of the System in Luzhou need to be strengthened. The main reason is that few national essential medicine knowledge training or study and poor effects. That the government's supporting poli-cy is not perfect may be one of reasons.

Reformation of post-graduate medical education system in Korea

Revision of the post-graduate medical education (PGME) system, which has been almost fixed since the introduction of the intern-resident training system in Korea more than 50 years ago, is particularly demanding because of changes in the contents of basic medical education and the patient-doctor relationship, division into sub-specialties, the introduction of fellowship training, changing patterns in doctors' work as information technology advanced, and the modifications to the PGME system in the advanced countries. The internship is not an effective course for PGME. The graduates of medical colleges or medical schools can practice by himself or herself without a PGME course. The durations of PGME for various subspecialties are almost the same: one year of internship and four years of residency. The working conditions of trainees are not adequate for proper education and patient safety. Current internships should be merged into residency by a straight internship. PGME should be mandatory for those who want to practice after graduation from medical colleges or medical school without resident training. The duration of PGME for each subspecialty should be newly adjusted. The working conditions of trainees must be improved. Even though this report suggests future directions for PGME on a broad scale, fine adjustment and design of further details should follow. This report has taken comments and opinions from the medical societies into consideration. Nonetheless, it may need further discussion among the stakeholders of PGME including trainees in order to minimize misunderstanding and 'trial and error' during the revision process.

Evaluation of Primary Doctor's Knowledge on Target Level of Blood Pressure in Hypertensive Patients

BACKGROUND: The purpose of this study was to find out whether primary physicians know the new guidelines (JNC VII) of target BP (blood pressure) and whether they educate their patients properly or not. METHODS: We made calls to local clinicians (family medicine (FM), internal medicine (IM), oriental medicine (OM)) under the disguise of the patient's caretaker and asked them the target BP for patients with hypertension without any cardiovascular disease and those with hypertension and DM (diabetes mellitus). We categorized the participants according to sex, age and departments. RESULTS: Out of the 145 clinics, 88 clinics responded (28 clinicians of FM, 30 clinicians of IM, 30 clinicians of OM). Questions on systolic target BP for patients with hypertension without cardiovascular disease, 87 clinicians answered. Among them, 64 clinicians (73.6%) answered correctly to the target BP (< or =140 mmHg), in the order of FM, IM, and OM. Questions on the diastolic pressure (< or =90 mmHg), 78 clinicians answered and all of them answered correctly. On the question of the target BP for the patients and hypertension and DM, 55 clinicians (63.2%) answered correctly to the systolic target BP (< or =130 mmHg) in the order of IM, FM, and OM. Only 19 clinicians (32.4%) answered correctly to the diastolic target BP (< or =90 mmHg) in the order of FM, IM, and OM. CONCLUSION: The clinicians have given less correct answers on the target BP in the patients and hypertension and DM than those with only essential hypertension. In conclusion, local clinicians should be fully aware of the target BP in patients with hypertension associated with cardiovascular disease or other complications. Also they should educate their patients properly.

Comparision of doctors' experience with and attitudes toward complementary and alternative medicine between western medicine and korean traditional medicine in office-based settings

BACKGROUD: Primary care physicians (PCPs) and ariental medical dactors (OMDs), as primary healthcare providers, could directly affect patients use of complementary and alternative medidne(CAM). This study was carried out to compare the practice experience with, the knowledge about, and the attitudes taward CAM between PCPs and OMDs in Korea. METHODS: A total of 502 PCPs and 500 OMDs in urban area of Karea were selected by the proportionate quota and systematic sampling methood. Face-to-face interviews were done with structured questionnaire. RESULTS: The rate af practice experience with and referral rate af CAM were reported 13.7% and 38.6% in PCPs, 76.8% and 85.4%. in OMDs respectively. OMDs evaluated the efficacy of each CAM higher than PCPs. Both doctors had wide variatians of knowledge in how to practice each CAM. However more than half OMDs knew how to practice chiropracic, taping therapy, aromatherapy, and iridology respectively, about 30% of PCPs high colic/enema and chiropractic. PCPs had mcire negative attitudes toward CAM and the advertisement of the other professional medidne (korean traditional medicine) than OMDs. OMDs more strongly supported the natural healing process, health-disease continuum, and psychological effect on health, and opposed Descares view on human body than PCPs. CONCLUSIONS: This study showed OMDs had more experience with, knowledge about, positive attitudes toward and supportive health concepts to CAM than PCPs. CAM practice would be diffused with chiropractic, taping therapy, aromatherapy, and iridolagy in OMDs; high colic/enema and chiropractic in PCPs.

The attitude and behavior if primary physicians in seoul toward alternative medicine

BACKGROUND: Alternative medicine is defined as a non-orthodox therapeutic practices including chiropractic, acupunture, herbal medicine, faith, spiritual therapy or as all sorts of medical care that do not follow the medical community standards. Patients do not think of modern medicine as the absolute solution to their health problems and they will sometimes ask for complementary therapy and in want of referral to alternative practitioner. We have investigated the primary physicians' attitude and behavior towards alternative medicine. METHODS: Randomly selected 770 practitioners, in primary care practice in Seoul, were questioned from July to September in 1996 about the attitude to wards alternative medicine, the reasons and symptoms when referring, and experience in alternative medicine practice. RESULTS: 150 questionnaires were returned and among them 139 completed ones (18.1%) were analyzed. Among 770 doctors, 35 (25.2%) have referred patients to alternative practitioner before and more referrals were made when they worked together closely or had some prior training. The belief of special effect of alternative medicine on certain disease was the first reason to refer. Other reasons were for herbal medicine, acupunture, and chiropractice in the order of seguence. The standard way to learn alternative medicine was to attend seminars available through certain institutions. On referral either chronic pain or musculoskeletal disease were the most chief complaints or main diseases of patients. 15 doctors (10.8% ) had some experience in practicing an alternative approach and the patient subjeccts were more likely to be women, and there was increased tendency to be working with another doctor, and to have been trained for such practice. The items used by alternative practitioners were acupunture, herbs in the order of seguence. CONCLUSIONS: Alternative medicine is accepted somewhat by primary physicians in Seoul although the rate of referral and practice is lower than 54% compared to 16% in Canada.

Technological Aspect of Basic Clinical Training in Primary Care Medicine / 医学教育

The main purpose of basic clinical training for housestaff is to acquire the ability to be a primary physician who can properly manage acute medical problems, develop intimate bonds with patients, and provide them with continuous care. We emphasize the importance of training in the office, clinic, or patients' homes. Although residents have so far spent most of their clinical rotations in an inpatient setting, a training program that devotes substantial time to ambulatory care is indispensable to improve basic clinical training in primary care medicine.

Analysis of Educational Goals and Objectives of Korean Medical Schools / 한국의학교육

The contents of educational goals and objectives of 32 Korean medical schools, that were listed in the Korean Medical Education Directory for 1994-1995, were analysed to help developing new educationa l goals and objectives. Regarding the professions in which the graduates of medical schools can be engaged, all of the 32 school were aiming at the medical doctor. 34.4% at the medical scientist, 28.1% at the medical educator, and 15.6% at the health administrator. Only 37.5% of the medical schools stated that their educational objective is training the primary physician and 50% of the schools did not specify the level of their graduates as a physician. The proportion of schools which stated that the medical student should learn in three domains of educational objectives, i.e. medical knowledge,clinical skills and attitude were 18.8% and 56.3% of the schools descirbed learning just in two domains of medical knowledge and skills which may reflect underating the importance of attitude. The proportions of knowledge and skills which may reflect underating the importance of attitude. The proportions of schools that stated aquiring the ability of holistic management of patients and self-learning/life long study in their educational objectives were 28.1% and 62.5%, respectively. The proportion of schools that emphasized on the medical ethics and morality was 93.8% and on cultivating human nature was 71.9%. These reflect that a high quality of ethics and morality was 93.8% and on cultivating human nature was 71.9%. These reflect that a high quality of ethics and human nature is required to the medical doctor. The universal and ultimate goal of human society and universities, such as democratic educational ideology, Korean educational ideology, prosperity of human society, promotion of human welfare, and improvement of public health, were included in the educational goals in 43.8% of the schools. As the primary goal of medical schools is the producing primary physicians, it is suggested to include the affective domain(attitude), cultivation of the capacity of self-learning and ability of holistic management of patients in the educational objectives of medical shools.