[RESIDENCY EXAMINATIONS IN THE COURSE OF THE COVID-19 CRISIS: THE EFFORTS OF THE ISRAELI SCIENTIFIC COUNCIL TO EXECUTE THE FINAL BOARD ORAL EXAMINATIONS DURING A LOCAL AND A WORLDWIDE PANDEMIC].

INTRODUCTION: The Israeli Scientific Council is responsible for the physician's training process and the residency exams. These are performed in two phases: Stage A (written examination) and Stage B (the final Board oral examination). The COVID-19 pandemic started in Israel a few weeks before the scheduled spring 2020 Stage B exams and had a major impact, not only on the health and economic systems in Israel, but also on the residency exams. AIMS: To describe the efforts of the Israeli Scientific Council to execute the spring 2020 Stage B exams during the COVID-19 pandemic in comparison to the worldwide data, and to deduce the appropriate management during potential future crises. METHODS: We present a description of the activity of the Israeli Scientific Council since the start of the COVID-19 pandemic according to documents and other sources, An internet search was conducted on the destiny of residency examinations throughout the world, and a comparison between them. RESULTS: Due to rapid worsening in the restrictions enforced in Israel, the spring 2020 oral board exams were cancelled. However, a decision was made to execute them in the summer. This new schedule dictated a delay in the schedule of other residency examinations and forced condensation of 5 periods into 10 months instead of 14. The examination team prepared the new summer exams period under the assumption that heavy restrictions will still be implemented. Indeed, COVID-19 was still around and the restrictions were still enforced. Despite that, all oral Board examinations were perfectly executed. This contrasts with the rest of the world, in which most residency exams were cancelled, even without a solution or an alternative date. CONCLUSIONS: Recruitment of all involved and preparation for the worst-case scenario enabled the perfect execution of the previously cancelled exams, and will enable the execution of future residency exams under conditions of potential health or war crises. DISCUSSION: To the best of our knowledge, the Israeli Scientific Council is the only communal body in the world which organized an alternative period for the cancelled oral exams, only 4 months after the cancelled dates. Due to an enormous effort and rigorous preparations, Israel is also the only place in which oral exams were successfully executed, physically, under an active disease and very heavy restrictions.

[POSTGRADUATE MEDICAL EDUCATION DURING COVID-19 PANDEMIC IN ISRAEL].

BACKGROUND: The Covid-19 pandemic has posed significant challenges to many aspects of life, including work processes to which we have become accustomed. Health systems world-wide have been affected in numerous ways and face epic and unprecedented challenges. Medical education, both in Israel and around the world, has been deeply impacted. It is no surprise that the institutions responsible for medical education, as well as many other institutions, have had to deal with uncertainty and unrest. In this article, we review the processes adopted by the Scientific Council of the Israel Medical Association, the body responsible for postgraduate medical training in the various medical specialties. The article reviews the actions taken by the Council during the first few months of the pandemic, March-July 2020, in order to maintain the quality of training.

[POSTGRADUATE TRAINING IS OUR SPECIALTY].

BACKGROUND: In recent years, following public expectations for high quality medical care and a teaching system that can adapt to public needs, changes are being implemented in medical education. The Scientific Council of the Israeli Medical Association (IMA) is responsible, under the Physicians Ordinance, for the planning and supervision of the physicians' specialization system in Israel and promotes post graduate medical education of the highest quality for the advancement of medicine in Israel. In this issue, we highlight the key goals of medical education: knowledge acquisition, skills imparting and application of professional values, as well as the different tasks the Scientific Council has undertaken in order to advance them. This issue includes reports discussing amendments to specialization programs, creation of new specialties, changes to board certification examinations and accrediting and overseeing professional training. In addition, the issue will emphasize the significant changes being made in medical education in Israel while implementing Competency Based Medical Education (CBME).

[HOW DOES A NEW MEDICAL PROFESSION COME TO LIFE?]

AIMS: In our article we seek to describe the initiation of new medical specialty fields in Israel, including the different considerations in the decision-making process and recent trends. BACKGROUND: Physicians' specialization by postgraduate training and specialty certification satisfies the publics' need for high quality medical treatment, supports medical institutions confidence in their medical staff qualifications, guarantees physicians' social accountability and is also linked with positive medical results. Nevertheless, fragmentation of medicine enfolds a hazard to continuity of medical care and loss of holistic perspectives, as well as hazards of systematic malfunction such as brain drain in vital basic specialties and high costs. METHODS: Information was gathered from the protocols of relevant deliberations conducted at the Scientific Council of the Israeli Medical Association, dealing with the initiation of new medical specialty fields and from relevant regulations. Numerical data was extracted from the IMA database. The information gathered was qualitatively analyzed by Template Analysis. RESULTS: Over two decades ranging between 1999 and 2019, three new medical specialties were initiated, including Emergency Medicine (1999), Pain Relief Medicine (2008) and Palliative Medicine (2012). The initiation of two other specialties, Invasive Neuro-Radiology and Metabolic Diseases, is still under process. The field of Child Development has joined an existing specialty in Pediatric Neurology, becoming a new specialty in Pediatric Neurology and Child Development in 2008, a new route for Pediatric Emergency Medicine branched out of Emergency Medicine (2008) and a new route for Pediatric Rheumatology branched out of Rheumatology (2013). We describe the different considerations taken into account, the prerequisites to initiation and milestones of the process, including grandfathering and accreditation. CONCLUSIONS: The trend of specialization in more medical fields will probably continue in the foreseen future. It will therefore continue to challenge the Scientific Council of the Israeli Medical Association with complex decision-making regarding the initiation of new medical professions or new routes within exciting professions.

[POSTGRADUATE MEDICAL EDUCATION ACCREDITATION IN ISRAEL].

INTRODUCTION: Accreditation of Post-Graduate Medical Education permits medical institutions to train residents, allowing them to achieve specialist certification. An accreditation system usually employs several tools such as site-visits, information gathering and occasionally self-evaluation, to determine adherence to pre-defined standards. The Scientific Council of the Israeli Medical Association is entrusted by law on this accreditation system in Israel. In our article, we briefly review the Post-Graduate Medical Education accreditation system in Israel and a number of pivotal challenges faced by the Scientific Council in this field in the 21st century. These challenges include the adaptation to different medical settings such as community based clinics and medical arrays, the adaptation of tools used for accreditation, new methods for up to date information gathering and updated structure of site-visit teams. A significant future challenge will be adapting the accreditation system to the new Competency Based Medical Education model of residency promoted in Israel by the Scientific Council.

Accreditation systems for Postgraduate Medical Education: a comparison of five countries.

There is a widespread consensus about the need for accreditation systems for evaluating post-graduate medical education programs, but accreditation systems differ substantially across countries. A cross-country comparison of accreditation systems could provide valuable input into policy development processes. We reviewed the accreditation systems of five countries: The United States, Canada, The United Kingdom, Germany and Israel. We used three information sources: a literature review, an online search for published information and applications to some accreditation authorities. We used template analysis for coding and identification of major themes. All five systems accredit according to standards, and basically apply the same accreditation tools: site-visits, annual data collection and self-evaluations. Differences were found in format of standards and specifications, the application of tools and accreditation consequences. Over a 20-year period, the review identified a three-phased process of evolution-from a process-based accreditation system, through an adaptation phase, until the employment of an outcome-based accreditation system. Based on the five-system comparison, we recommend that accrediting authorities: broaden the consequences scale; reconsider the site-visit policy; use multiple data sources; learn from other countries' experiences with the move to an outcome-based system and take the division of roles into account.

[Mentoring newly appointed department heads--a new project review and initial findings].

BACKGROUND: In Israel, the training of a department head is based mostly on clinical and professional aspects and often does not include any training in other facets of management he or she will encounter. The newly appointed department head is expected from the start to deal with many diverse tasks, and is exposed to great physical and emotional stress. The Israeli Medical Association, taking note of this situation, initiated a mentoring program for newly appointed heads of medical departments, clinics and units. This article seeks to present a preliminary description of our experience with this mentoring project, in which senior managers mentor novices in the position. METHOD: An announcement of the new project was sent to both senior and beginning managers, detailing the project's goal. The project's content and structure were determined together with the participants, mentors and mentees. The values attending the project were delineated as full and genuine partnership, attention to needs, and personal choice of the mentee. Basic guidelines, adaptive to modification according to personal preferences, were developed based on these values. Though not readily assumed, our decision to allow mentees to choose their mentors was found to be suitable for this project. All participants, mentors and mentees, were asked to complete feedback forms in preparation for the final gathering of the group. RESULTS: The first session of the project included 8 mentor and mentee couples. Feedback indicated a high suitability rate between mentor and mentee, which resulted in high levels of satisfaction among the mentees. Responses to feedback questionnaires depicted that the relationships between the mentors and mentees included trust, openness and a non-judgmental approach, which allowed mentees to share personal difficulties and develop plans to overcome them. Most mentees described the mentorship as providing leverage to personal growth. Mentors expressed satisfaction for the opportunity to contribute of their experience. CONCLUSIONS: The success of the first session and the satisfaction expressed by its participants serve as an indication that the project met an existing need of beginning managers. The successful cooperation between mentors and mentees, closely accompanied by the professional staff, proved that beginning managers are more than willing to work alongside senior managers and learn from their vast experience. The writers believe there is a true need for mentorship for managers in our health system. The method depicted in this project was found to be efficient at this point. The next sessions of the project will allow us to identify more ways to match and oversee the mentor-mentee couples.

[Basic research during residency in Israel: is change needed?].

A six-month research period is a mandatory part of the residency training program in most basic specialties in Israel and is named: the "basic science period". This is the only period in an Israeli physician's medical career which is dedicated strictly to research, accentuating the importance of medical research to the quality of training and level of medicine in Israel. From another point of view, one may argue that in an era of shortage of physicians on the one hand and the dizzying rate of growth in medical knowledge on the other hand, every moment spent training in residency is precious, therefore, making the decision of whether to dedicate six months for research becomes ever more relevant. This question is currently raised for discussion once again by the Scientific Council of the Israeli Medical Association. The Scientific Council lately issued a call for comments sent to all Israeli physicians, asking their opinion on several key questions regarding basic science research. Learning the public's opinion will serve as a background for discussion. A total of 380 physicians responded to the call and specified their standpoint on the subject, among them heads of departments, units and clinics, senior physicians and residents. The findings pointed to strong support in maintaining the research period as part of residency training due to its importance to medical training and medicine, although half the respondents supported the use of various alternative formats for research together with the existing format. Those alternative format suggestions will be thoroughly reviewed. A smaller group of respondents supported allowing residents a choice between two tracks--with or without a research period, and only a few were in favor of canceling the research requirement altogether. The writers maintain that the "basic science period" of research during residency training is vital and its contribution to the high level of specialists and high level of medicine requires its conservation. Nevertheless, alternative formats which might be suitable for some residents should be considered, and auxiliary tools to help residents fulfill their potential in research and raise the quality of written research papers should be constructed.

[Part-time residency training in Israel].

Full-time work has long been perceived as a cornerstone of medical residency, the consensus being that a resident must apply the bulk of his time and attention to his professional training. Demographic and cultural changes that have taken place over the last several years, specifically the rise in the number of female doctors and the importance of leisure time to the younger generation, have intensified the need to find new and innovative ways to deal with the plight of the resident population. One idea, already in effect in many Western countries, is the institution of part-time residency programs. The possibility of fulfilling residency requirements on a part-time basis is intended to assist medical residents in integrating their professional development with their personal and family life, without compromising the quality of their training. A number of research studies conducted over the last several years in countries that allow part-time residency, among them the United States, England and Switzerland, aimed to examine the quality of part-time training. The various studies evinced a high level of satisfaction from the program both by the residents themselves and their supervisors, and in many aspects those doing residency part-time received higher appraisals than their full-time colleagues. Some of the residents polled noted that they would have totally foregone the practice of medicine had there not been an option to complete residency part-time. In light of the experience throughout the world and the changing landscape in Israel, the Scientific Council of the Israeli Medical Association decided to examine the issue and its various aspects, and weighed all the considerations in favor and against part-time residency. Recently, the Scientific Council approved the launch of a pilot program to allow part-time residency in several fields that were carefully selected according to specific criteria. Once the Ministry of Health completes the LegisLation process, part-time residency will officially begin in Israel.

Genetic testing for enzymes of drug metabolism: does it have clinical utility for pain medicine at the present time? A structured review.

STUDY DESIGN: This is a structured review of genomic (genetic) testing for enzymes of drug metabolism. OBJECTIVES: Recently, industry began offering genomic testing for enzymes of drug metabolism. As such, the objective of this review was to determine if genomic testing for enzymes of drug metabolism has any imminent clinical relevance for the practice of pain medicine. METHODS: Relevant references relating to pharmacogenetics, pharmacogenomics, and the metabolizing of drugs used in pain medicine by cytochrome P-450 enzymes were located and reviewed in detail. The P-450 enzymes that metabolize each drug and whether that drug had been identified as being subject to a clinical consequence of a genetic polymorphism of the P-450 enzyme involved in its metabolism were placed into tabular form. RESULTS OF DATA SYNTHESIS: 1) For a large number of drugs, we do not yet know which cytochrome P-450 enzymes are involved in their metabolism; 2) For a large number of drugs, the consequences of a P-450 genetic polymorphism have yet to be determined; 3) Genetic polymorphism can lead to important potential clinical consequences for some opioids, anticonvulsants (phenytoin), benzodiazepines (diazepam), muscle relaxants (succinylcholine), antidepressants (imipramine, nortriptyline, venlafaxine), typical neuroleptics, alcohol, antihypertensives (propranolol, timolol), local anesthetics (procainamide), L-dopa, nicotine, and warfarin. Based on these results, factors for and against using genomic testing were reviewed. CONCLUSIONS/RECOMMENDATIONS: It was concluded that genomic testing for enzymes of drug metabolism has significant potential for improving the efficacy of drug treatment and reducing adverse drug reactions. Recommendations for when such testing would be useful are outlined.