Survey of faculty development in four Israeli medical schools: clinical faculty development is inadequate and clinical teaching is undervalued in Israeli faculties of medicine.

BACKGROUND: Teaching medical students is a central part of being a doctor, and is essential for the training of the next generation of physicians and for maintaining the quality of medicine. Our research reviews the training that physicians in Israel receive as teachers of clinical clerkships, and their thoughts regarding teaching students. The importance of faculty development cannot be overstated, for securing quality medicine and physician empowerment. METHODS: This study was based on a survey conducted among physicians teaching at Israeli medical schools. The survey was conducted using an online questionnaire sent to clinical teachers according to lists received from the teaching units of the faculties, department heads, and other clinical teachers. Participation in the study was anonymous. FINDINGS: Of 433 invited physicians, 245 (56%) from three departments (internal medicine, paediatrics, obstetrics and gynaecology) of four faculties of medicine in Israel, out of five total, completed the questionnaire. Only 35% of the physicians reported having received training for their role as teachers, most of these participated in a short course of up to 2 days. There were significant differences between the Technion and the other schools. Technion teachers without academic appointment had higher rates of pedagogic training. The same was true in regard to Technion teachers, either residents or young specialist. Significant gaps were reported between the content covered in the training and the topics the doctors felt they would want to learn. The clinicians who participated in the survey expressed that clinical teaching was less valued and more poorly remunerated than research, and that improved compensation and perceived appreciation would likely improve the quality of clinical teaching. CONCLUSIONS: Of the one-third of the physicians surveyed who had received some training in clinical teaching, the training was perceived as inadequate and not aligned with their needs. There was a significant difference in rates of pedagogic training between the Technion and other medical schools. In addition, most clinical teachers surveyed felt that teaching students is inadequately valued. Due to its focus on just three disciplines, and higher relative number participants from the Technion faculty of medicine, our survey may not fully represent the activities of the faculties of medicine in Israel. Nevertheless, given the importance of clinical teaching of medical students, our findings argue for increasing faculty development and educational training of physicians in clinical settings, for recognizing the importance of teaching in academic and professional promotion processes.

'Becoming a Physician'-medical students get acquainted with disadvantaged populations, and practise sensitive and effective communication.

BACKGROUND: The three-year pre-medical programme 'Becoming a Physician' focuses on different aspects of medical professionalism. Objectives are to increase awareness and sensitivity to disadvantaged populations, and practise sensitive effective communication skills. METHODS: The curriculum includes: (1) Visits to treatment centres for people with special needs, mental illnesses, substance abuse issues, physically or sexually abused, and prisoners. Students tour the facility, hold discussions with residents, and discuss ethical professional interrelations to the medical world. Students then write 'reflective diaries' summarizing their thoughts and emotions. (2) Participation in a communication course that focuses on learning by practising patient-oriented communication. Qualitative data were collected from three sources: reflective diaries, students' course evaluations, and interviews with the students' tutors. RESULTS: Data indicated that the students were very satisfied with the programme. They indicated an increase in awareness of the special needs of diverse populations, and in the sense of efficacy for conducting interviews tailored to patients' needs. Tutors reported a sense of 'personal growth' following their role as mentors. REFLECTIONS: Interactions of medical students with diverse populations, when accompanied by appropriate feedback mechanisms and strengthening of communication skills, can improve awareness and sensitivity to patients' special needs. This could help students become more sensitive and thoughtful physicians.

Hospital-community interface: a qualitative study on patients with cancer and health care providers' experiences.

BACKGROUND: Patients with cancer must deal with complex and fragmented healthcare systems in addition to coping with the burden of their illness. To improve oncology treatment along the care continuum, the barriers and facilitators for streamlined oncologic care need to be better understood. PURPOSE: This study sought to gain insight into the hospital-community interface from the point of view of patients with cancer, their families, and health care providers on both sides of the interface i.e., the community and hospital settings. METHODS AND SAMPLE: The sample comprised 37 cancer patients, their family members, and 40 multidisciplinary health care providers. Twelve participants were interviewed individually and 65 took part in 10 focus groups. Based on the grounded theory approach, theoretical sampling and constant comparative analyses were used. RESULTS: Two major concepts emerged: "ambivalence and confusion" and "overcoming healthcare system barriers." Ambiguity was expressed regarding the roles of health care providers in the community and in the hospital. We identified three main strategies by which these patients and their families overcame barriers within the system: patients and families became their own case managers; patients and health care providers used informal routes of communication; and nurse specialists played a significant role in managing care. CONCLUSIONS: The heavy reliance on informal routes of communication and integration by patients and providers emphasizes the urgent need for change in order to improve coordinating mechanisms for hospital-community oncologic care.

Cancer care at the hospital-community interface: perspectives of patients from different cultural and ethnic groups.

OBJECTIVE: To examine perceptions of cancer patients from different cultural and ethnic groups regarding the quality of their care at the hospital-community interface. METHODS: Cross-sectional study of cancer patients from a large tertiary center in Israel. Patients were surveyed on the quality of their primary-care and on their transition from the hospital. Regression analyses were used to examine differences among Hebrew-, Russian-, and Arabic-speaking patients in their assessment of six primary-care domains and of their care transition process. RESULTS: 422 patients completed the survey. Russian speakers gave the lowest and Arabic speakers the highest ratings for all primary care domains. Arabic speakers also gave higher ratings for their care transition process than the other two groups. Minority patients' primary-care physicians were significantly more likely than Hebrew speakers' physicians to facilitate the hospital transition process by reviewing the discharge recommendations. CONCLUSIONS: Cancer patients from different ethnic groups differ in their primary-care experience and their perceptions of their hospital to community transition. Primary-care physicians serve as facilitators of care transitions by discussing discharge recommendations with their minority patients. PRACTICE IMPLICATIONS: Reviewing the discharge recommendations with the patient at the post-discharge primary-care visit is an important contributor to high quality transitional care.

[The encounter between literature and medicine--from theory to practice].

The relationship between literature and medicine has existed from Ancient Greece to the 19th century. However, in the last two centuries, the scientific achievements in medicine, along with the dominance of the biological model in medical education, have weakened this relationship. In the last quarter of the 20th century "Literature and Medicine" has made a comeback in an effort to restore the humanistic component to medical education. "Literature and Medicine" is a subdiscipline of literary studies and a part of "medical humanities". It focuses on issues such as; the physician, the patient, doctor-patient communication, empathy, ethics and life perspective. The growing interest in "Literature and Medicine" is evident not only in undergraduate medical education, but also in many publications in medical journals, and in the increasing number of literature and medicine groups for health care professionals. A "Literature and Medicine" group for physicians and other health care providers has been active for 4 years in the Faculty of Medicine at the Technion in Haifa. So far, the group has read and discussed about thirty literary works. The participants stress how this activity enhances exposure to literature, generates a commitment to reading and leads to a better understanding of literary texts.