Influence of E-consultation on the Intention of First-Visit Patients to Select Medical Services: Results of a Scenario Survey.

BACKGROUND: E-consultation is expected to improve the information level of patients, affect patients' subsequent judgments of medical services, and guide patients to make a reasonable medical selection in the future. Thus, it is important to understand the influence mechanism of e-consultation on patients' medical selection. OBJECTIVE: This study aims to explore the changes in first-visit patients' understanding of disease and medical resources after e-consultation as well as the choice of follow-up medical services. METHODS: Patients' medical selection before and after e-consultation was compared using a scenario survey. Based on the service characteristics of the e-consultation platform, representative simulation scenarios were determined, and parallel control groups were set up considering the order effect in comparison. Finally, a total of 4 scenario simulation questionnaires were designed. A total of 4164 valid questionnaires were collected through the online questionnaire collection platform. Patients' perception of disease severity, evaluation of treatment capacity of medical institutions, selection of hospitals and doctors, and other outcome indicators were tested to analyze the differences in patients' evaluation and choice of medical services before and after e-consultation. Additionally, the results' stability was tested by regression analysis. RESULTS: In scenario 1 (mild case), before e-consultation, 14.1% (104/740) of participants considered their conditions as not serious. After e-consultation, 69.5% (539/775) of them considered their diseases as not serious. Furthermore, participants' evaluation of the disease treatment capacity of medical institutions at all levels had improved after using e-consultation. In scenario 3 (severe case), before e-consultation, 54.1% (494/913) of the participants believed their diseases were very serious. After e-consultation, 16.6% (157/945) considered their diseases were very serious. The evaluation of disease treatment capacity of medical institutions in nontertiary hospitals decreased, whereas that of tertiary hospitals improved. In both mild and severe cases, before e-consultation, all of the participants were inclined to directly visit the hospital. After e-consultation, more than 71.4% (553/775) of the patients with mild diseases chose self-treatment, whereas those with severe diseases still opted for a face-to-face consultation. After e-consultation, patients who were set on being treated in a hospital, regardless of the disease severity, preferred to select the tertiary hospitals. Of the patients with mild diseases who chose to go to a hospital, 25.7% (57/222) wanted to consult online doctors face-to-face. By contrast, 56.4% (506/897) of the severe cases wanted to consult online doctors face-to-face. CONCLUSIONS: E-consultation can help patients accurately enhance their awareness of the disease and guide them to make a more reasonable medical selection. However, it is likely that e-consultation makes online medical services centralized. Additionally, the guiding effect of e-consultation is limited, and e-consultation needs to be combined with other supporting systems conducive to medical selection to play an improved role.

UK nationals who received their medical degrees abroad: selection into, and subsequent performance in postgraduate training: a national data linkage study.

OBJECTIVES: To compare the likelihood of success at selection into specialty training for doctors who were UK nationals but obtained their primary medical qualification (PMQ) from outside the UK ('UK overseas graduates') with other graduate groups based on their nationality and where they gained their PMQ. We also compared subsequent educational performance during postgraduate training between the graduate groups. DESIGN: Observational study linking UK medical specialty recruitment data with postgraduate educational performance (Annual Review of Competence Progression (ARCP) ratings). SETTING: Doctors recruited into national programmes of postgraduate specialist training in the UK from 2012 to 2016. PARTICIPANTS: 34 755 UK-based trainee doctors recruited into national specialty training programmes with at least one subsequent ARCP outcome reported during the study period, including 1108 UK overseas graduates. MAIN OUTCOME MEASURES: Odds of being deemed appointable at specialty selection and subsequent odds of obtaining a less versus more satisfactory category of ARCP outcome. RESULTS: UK overseas graduates were more likely to be deemed appointable compared with non-EU medical graduates who were not UK citizens (OR 1.29, 95% CI 1.16 to 1.42), although less so than UK (OR 0.25, 95% CI 0.23 to 0.27) or European graduates (OR 0.66, 95% CI 0.58 to 0.75). However, UK overseas graduates were subsequently more likely to receive a less satisfactory outcome at ARCP than other graduate groups. Adjusting for age, sex, experience and the economic disparity between country of nationality and place of qualification reduced intergroup differences. CONCLUSIONS: The failure of recruitment patterns to mirror the ARCP data raises issues regarding consistency in selection and the deaneries' subsequent annual reviews. Excessive weight is possibly given to interview performance at specialty recruitment. Regulators and selectors should continue to develop robust processes for selection and assessment of doctors in training. Further support could be considered for UK overseas graduates returning to practice in the UK.

Artificial or intelligent? Machine learning and medical selection: possibilities and risks.

This article was migrated. The article was marked as recommended. Machine learning approaches form the basis of "artificial intelligence" and have been increasingly applied in health services settings. It has been shown that such approaches may produce more accurate predictions in some contexts, compared to conventional statistical approaches, and may also reduce the costs of decision-making through automation.  Nevertheless, there are both general limitations to developing and implementing machine learning approaches that must be borne in mind. To date, relatively little research has been published on the potential for machine learning to support personnel selection. Moreover, there are particular challenges and issues that need to be considered if such methods are to be used to support decision-making in medical selection scenarios. This article describes some of these potential advantages and challenges and presents an illustrative example, based on real-world data, related to the selection of medical undergraduates.

A comparative study on the influencing factors of medical behaviors for both urban and rural residents in Hubei province / 中华医院管理杂志

Objective To study the influencing factors of the medical behaviors between urban and rural residents in Hubei province .Methods The survey selected 454 families in Wuhan and Macheng ;investigated their family income ,health condition and medical behaviors ,multiple correspondence and logistic regression were applied to study the influence factors of medical behaviors . Results 845 people(85.05％ )selected primary medical institutions ,and 126 people(12.83％ )selected secondary medical institution in Macheng ;321 people(47.53％ )selected primary medical institutions , and 283 people (42.30％ )selected tertiary medical institutions in Wuhan ;Macheng and Wuhan′s Cronbach′s alpha reliability coefficients for multiple correspondence model are 0.57 and 0.72 respectively ,and nagelkerke R2 for logistic regression model are 0.56 and 0.59 respectively ;Both urban and rural residents selected medical institutions depending on types of diseases ;family income influences the selection of medical institution of Macheng residents ;age and economic contribution have a great effect on medical behaviors of Wuhan resident .Conclusions Family economic income constitutes a major factor for senior people ,while such factor poses different influences over different medical insurance and economic level of these people .

Future directions in personality, occupational and medical selection: myths, misunderstandings, measurement, and suggestions.

This paper has two objectives: (1) presenting recent advances in personality theory whereby personality traits are conceptualized within a framework that focuses on the dynamic interactions of behaviour, biology, context, and states, and (2) discussing the implications of these developments for measurement and medical selection. We start by presenting evidence that traits are no longer regarded as stable deterministic predictors of behaviour. Instead, traits are found to change across generations, the life span, and in response to environmental contingencies. Thus, there is an urgent need to explore how traits change as function of medical education. Second, drawing on recent theory and research (behavioural reaction norms and the density distribution model) we highlight evidence to show how the expression of trait relevant behaviour is dependent on context, and is distributed with an average (typical behaviour or personality) and a variance (plasticity or adaptability), with traditional personality measure associated with typical responding. Third, we demystify that some traits are better than others showing that so-called "good" traits have a dark-side. Fourth, we show how these developments impact on how personality might be assessed, thereby presenting recent evidence on the use of contextualized personality measures, situational judgment tests, other reports, and implicit measures. Throughout the paper, we outline the key implications of these developments for medical selection practices.

Analysis of medical disqualification of 1281 students recruited into Air Force youth aviation school / 军事医学

Objective To analyze the results of the final aviation medical examination of 1281 students recruited into Air Force youth aviation schools in Hunan and Hubei provinces in order to provide reference for establishing the items and standards of medical selection .Methods The data of 1281 students who participated in final aviation medical examination of Air Force youth aviation schools in 2016 were collected , who came from 28 cities in the above two provinces .The disqualification rate and related unqualified medical items were calculated , and the differences of the disqualification rate and medical geographical areas in the 28 cities were analyzed .Results According to the disqualification rate , the top five departments were ophthalmology , otolaryngology, surgery, radiology and ultrasonic departments .The top 10 unqualified items were the lack of distant vision , fundus diseases , nasal anomaly , ametropia and strabismus , spine abnormality , audition abnormality, vestibular function badness , vitreous opacity, and lens abnormalities.There was no significant difference between the 28 cities in the disqualification rate (P >0.05) or between the two provinces (P >0.05). Conclusion The results of the final aviation medical examination reflect the quality and efficiency of the initial aviation medical examination .To improve the quality of medical selection , further research is needed to set a scientific standard for the initial aviation medical examination while strengthening the scientific protection and intervention of distant vision .The efficiency of selection depends on improving the accuracy of initial aviation medical examination in nasal cavity structure, body shape ,and lens opacity .With a better understanding of the disqualification rate and abnormal items in different cities , a scientific arrangement of professional staff and technical force can make the initial aviation medical examination better, thus effectively reducing the rate of false elimination rate and misdiagnosis .

Sampling follow-up study of anthropometry in medical selection for a teenager aviation school / 军事医学

Objective To observe the physical development indexes of students from a teenager aviation school and to find out about the trainees′characteristics of physical development in order to advise on medical selection of teenager flying cadets and improve the present training programs .Methods Four hundred and thirty six students Grade 2015 were selected as subjects .The data of their physical examinations between school selection examination and annual examination were compared via matched-pair design.Physical growth and development of students in the aviation school were analyzed . Results The height, relative body mass and body mass index (IBM) of the students changed significantly (P<0.05) after one-year training in the youth aviation school .The proportion of students whose body mass accounted for 85% to 120%of standard weight was increased from 84.40%to 93.12%.94.74%of the increase came from students who used to be underweight .The qualified rate of students who reached the 70%-79% of the standard relative body mass in school selection examination was 57.14%.The reached qualified rate of students who reached the 80%-84% of the standard relative body mass in school selection examination was as high as 95.65%.The average height growth of the students was about 2.0 cm in the previous year .Conclusion The relative body mass of students who reached the 70%-85% of the standard relative body mass in school selection examination improved obviously ,suggesting that we should revise the weight standard to less than 30% of the standard weight , which conforms to the objective law of growth and development of adolescents .The rate of development of adolescent height requires further follow-up observation .All the students of a teenager aviation school should pay attention to a reasonable diet , take more physical exercise and monitor body mass .

A comparative study of nephroptosis in the second and final stage of medical selection of flying cadets / 军事医学

Objective To compare the physical examination results of nephroptosis in the second stage and the final stage, to find the underlying reasons, and to explore better ways to detect nephroptosis.Methods A total of 1334 subjects participated in both the second stage and final stage of PLA air force medical selection of flying cadets, and physical examination results of both stages were compared.Results All the subjects recruited denied a history of abdominal pain or recurrent urinary tract infection, and urine tests were normal.The positive rate of nephroptosis in the second stage was 10.2%, compared to 5.5% in the final stage.The difference of physical examination results in the two stages was significant, and so was that of disqualification rates.Conclusion Results of physical examination of nephroptosis in the second stage are different from those in the final stage.It′s necessary to find better ways of detection of nephroptosis.

Predictive validity of the UKCAT for medical school undergraduate performance: a national prospective cohort study.

BACKGROUND: The UK Clinical Aptitude Test (UKCAT) has been shown to have a modest but statistically significant ability to predict aspects of academic performance throughout medical school. Previously, this ability has been shown to be incremental to conventional measures of educational performance for the first year of medical school. This study evaluates whether this predictive ability extends throughout the whole of undergraduate medical study and explores the potential impact of using the test as a selection screening tool. METHODS: This was an observational prospective study, linking UKCAT scores, prior educational attainment and sociodemographic variables with subsequent academic outcomes during the 5 years of UK medical undergraduate training. The participants were 6812 entrants to UK medical schools in 2007-8 using the UKCAT. The main outcome was academic performance at each year of medical school. A receiver operating characteristic (ROC) curve analysis was also conducted, treating the UKCAT as a screening test for a negative academic outcome (failing at least 1 year at first attempt). RESULTS: All four of the UKCAT scale scores significantly predicted performance in theory- and skills-based exams. After adjustment for prior educational achievement, the UKCAT scale scores remained significantly predictive for most years. Findings from the ROC analysis suggested that, if used as a sole screening test, with the mean applicant UKCAT score as the cut-off, the test could be used to reject candidates at high risk of failing at least 1 year at first attempt. However, the 'number needed to reject' value would be high (at 1.18), with roughly one candidate who would have been likely to pass all years at first sitting being rejected for every higher risk candidate potentially declined entry on this basis. CONCLUSIONS: The UKCAT scores demonstrate a statistically significant but modest degree of incremental predictive validity throughout undergraduate training. Whilst the UKCAT could be considered a fairly crude screening tool for future academic performance, it may offer added value when used in conjunction with other selection measures. Future work should focus on the optimum role of such tests within the selection process and the prediction of post-graduate performance.

An empirical study on medical selection of flying cadets with hernia disease between PLAAF and USAF / 军事医学

Objective To analyze the disease spectrum of abdominal external hernia during medical selection of flying cadets and compare the medical standards between US Air Force and Chinese PLA Air Force in order to improve the system of medical selection.Methods The data about abdominal external hernia among flying cadets during Chinese PLAAF medical selection between 2012 and 2015 were retrospectively analyzed and compared with the medical standards of the USAF flying cadets.Results Twenty-nine candidates were eliminated because of hernia,including 4 cases of hiatal hernia,3 cases of umbilical hernia and 22 cases of inguinal hernia.4.70% of the candidates were eliminated because of hernia disease.Empirical research showed difference in hernia standards between China and the USA.Conclusion Compared with Chinese medical selection standards,the USAF standards give more weight to whether the symptoms of disease impact air safety and efficiency.Our medical selection standards need to be improved by learning from foreign practices.

An empirical study on medical selection of flying cadets with anal diseases between PLAAF and USAF / 军事医学

Objective To analyze the spectrum of anus disease during the medical selection of flying cadets and com-pare the medical standard between US Air Force and Chinese Air Force in order to improve the system of medical selection. Methods The data on flying cadets of Chinese Air Force medical selection from 2012 to 2015 were retrospectively analyzed and these data were re-analyzed by medical standards for US Air Force flying cadets.Results Ninety students were elimi-nated because of anal disease,including 65 hemorrhoids,14 fistula and 11 fissure.The rate of disqualification from 2012 to 2015 was 48.28%, 33.33%, 31.37%, 39.69%and there was no significant statistical difference between each two years (x2 =2.6154,P=0.4548).There was statistically significant difference(P=0<0.05)in hemorrhoids standards between CAF and USAF,and significant difference in fistula and fissure standards.Conclusion Compared with Chinese medical se-lection standards,the US Air Force standards focus on whether the symptoms of disease have effect on air safety and effi-ciency.To improve our medical selection standards,we need to learn from foreign air forces and take our own conditions into account.

Analysis of regional difference in medical selection for teenager aviation school / 军事医学

Objective To discuss the reasons for the difference in the results of medical checkups for cardidates enlisted in teenager aviation classes, in order to offer tips for the establishment of regional training programs and improve the qualification rate and acceptability.Methods A total of 2894 junior high school graduates as candidates for selection to teenager aviation classes in 2015 were given a double-blind medical examination.Cross-sectional survey methodology was used to compare the differences in the results of physical examinations, for candidates from seven areas.Results The qualification rate of physical checkups in the above regions were significantly different.The regional differences in the rejection rate related to ophthalmology, surgery, neurology and ultrasound were significant(P 0.05).The vision, height and relative body mass in different regions were significantly different (P0.05).Conclusion The physical differences are the results of various factors.In order to improve the passing rate of candidats, the aviation training plan for teenager aviation classes should consider the geography, climate, socio-economic environment and the physical health of local students.We should implement training programs in line with local conditions reather than use a unified national standard.

Comparison of recruitment standards for cadet pilots between PLAAF and USAF / 军事医学

Objective To compare the standards for recruitment of cadet pilots between PLA Air Force and the US Air Force,so as to offer reference for revising PLAAF medical standards for recruiting cadet pilots.Methods Literature from medical bibliographic databases and foreign military official websites was retrieved, four published reports and network information were cited and PLAAF medical standards were compared with those in China.Results The American medical standards include Department of Defense Instruction, Air Force Medical Examination and Standards, Air Force Medical Standards Directory, and Air Force Waiver Guide,which are independent and aimed directly at different examinations so that medical requirements have been gradually broadened.Compared to our standards, the American medical selection is more dependent on clinic consultations, and more detailed in specifications of diseases, more focused on body functions than on body shape, and the psychological screening is more subtle.Conclusion The standards adopted by US Air Force are more evidence-based.We are to rectify our medical standards accordingly, which should be efficacious, safe and effective for improving the overall quality of our military pilots.

An empirical study on medical selection of flying cadets with arrhythmia between PLAAF and USAF / 军事医学

Objective To determine whether the candidates who are disqualified because of arrhythmia during medical selection of flying cadets in China are qualified or not according to United States Air Force ( USAF ) Medical Standards Directory( MSD) , in order to raise suggestions on revising PLAAF medical selection of flying cadets.Methods ECG was performed on all candidates who participated in the final stage of medical selection of flying cadets, and they were considered qualified or not according to USAF MSD.Results Arrhythmia accounted for the largest proportion of cardiovascular diseases( CVDs) in PLAAF medical selection of flying cadets,the constituent ratios of CVDs from 2012 to 2015 were significant different (P<0.01).There were differences between the two countries and the outcome of 81.48%of the candidates disqualified for premature systole in PLAAF was unknown according to USAF MSD.Conclusion There are some differences in medical selection standards of flying cadets between PLAAF and USAF, and we could revise PLAAF standards with reference to USAF standards.

An empirical study on medical selection of flying cadets with ear diseases between PLAAF and USAF / 军事医学

Objective To determine whether the candidates who are disqualified because of ear diseases during medical selection of flying cadets in China are qualified or not according to United States Air Force ( USAF ) Medical Standards Directory in order to raise suggestions for revising PLAAF medical standards for flying cadets.Methods Data of final selections from 2013 to 2015 and the conclusions were compared by different standards.Results and Conclusion There was a marked difference (x2 =7.99,P0.05) in the disqualification rate related to ear diseases.Vestibular dysfunction and dysacousis were the leading causes of disqualification among ear diseases, making up 45.54% and 38.84% respectively, with other diseases less than 5%.Medical standards for ear diseases in China are more strict than in the USAF, so we should revise some PLAAF standards according to the USAF standards for reference, such as those for vestibular neuritis, dysacousis and tympanic disease in order to enlarge the source of cadets.

An empirical study on medical selection of flying cadets regarding lumbar spondylol-ysis and scoliosis between PLAAF and USAF / 军事医学

Objective To improve and determine the Medical Standards Directory of the Air Force of People′s Libera-tion Army of China( PLAAF) by analyzing the differences in lumbar spondylolysis and scoliosis between PLAAF and the US Air Force( USAF) .Methods All candidates of flying cadets participating in the final radiographic selection between 2013 and 2015 were chosen.They were judged to be qualified or not according to PLAAF and USAF Medical Standards Directory. Results The average morbility of lumbar spondylolysis and scoliosis in PLAAF was 47%and 30.3%respectively.Arnong those who were eliminated in China,86.0%and 92.5%could be regarded as qualified according to the standard of USAF in 2015.The difference was statistically significant (P<0.01).Conclusion Our selection standards for lumbar spondylol-ysis and scoliosis should be improved based on this study.

An empirical study on medical selection of flying cadets regarding genu varum and genu valgum between PLAAF and USAF / 军事医学

Objective To reveal the difference between the standards for genu varum and genu valgum in the medical standard directory PLA Air Force( PLAAF) for recruitment of flying cadets and those adopted in the United States Air Force ( USAF) , and suggest a method for the reform of our flying cadets recruitment.Methods The rejection rate and comprehe nsive assessment qualification rate of genu varum and genu valgum during physical examinations for recruitment of flying cadets between 2012 and 2015 were analyzed.The different standards for genu varum and genu valgum in PLAAF and USAF flying cadets recruitment were compared and subjected to an empirical study.Results During the final physical examination for selection of flying cadets between 2012 and 2015, only 18 candidates were eliminated because of genu varum and genu valgum, accounting 9.1% of the total eliminated candidates because of orthopadics diseases.Four candidates with genu varum and genu valgum passed the comprehensive assessment in 2014 and 31 in 2015, which accounted for 15%of the candidates with orthopaedics diseases approved by comprehensive assessment.The standards for genu varum and genu valgum in PLAAF were based on morphology while those in the USAF based on the function of knees.According to the USAF medical standard directory, 9 of the candidates rejected because of genu varum and genu valgum were qualified and 9 disqualified.Among the candidates with genu varum and genu valgum approved by comprehensive assessment, 32 were qualified and 3 disqualified.Conclusion The standards for genu varum and genu valgum in PLAAF medical standard directory are of lower accuracy.The standards of USAF should be referred to and the function of knees should be considered in selection of flying cadets.Femur-tibia angle should be measured to improve the morphological standards.

An empirical study on medical selection of flying cadets with urinary system diseases between PLAAF and USAF / 军事医学

Objective To investigate the effect of different medical standards for the urinary system on the enlistment of pilots between PLAAF and USAF , and offer support to amendment .Methods Data on pilots′final enlistment between 2012 and 2015 were analyzed , and results of physical examinations of the urinary system were compared according to differ -ent medical standards .Results One hundred and twenty teenagers enrolled in this examination were disqualifiied due to defects of the urinary system while 97 applicants were qualified after comprehensive assessment of the urinary system .The main problems with the urinary system that affected results of pilots′enlistment were nephroptosia , renal cyst , microscopic hematuria , renal calcified foci and calculus .Conclusion Medical standards for the urinary system are different between PLAAF and USAF, especially those for nephroptosia , renal cyst and microscopic hematuria .The medical standards directo-ry about the urinary system approved by USAF can serve as a reference during our revision of current medical enlistment standards.

An empirical study on medical selection of flying cadets with nervous and mental system diseases between PLAAF and USAF / 军事医学

Objective To compare the medical selection standards of flying cadets in the nervous and mental system between Air Force of PLA(PLAAF) and the US Air Force(USAF), and to offer suggestions on revising PLAAF medical standards for flying cadets .Methods All our candidates who had participated in the final medical selection of flying cadets were subjected to neurological examinations , and determined as qualified or not according to USAF Medical Standards Directory.Results 123 people were disqualified during the neurological examination , accounting for 1.1% of the total. According to USAF Medical Standards Directory , 13 of them were disqualified , 24 of them were qualified , and 86 of them needed a second examination .There was marked difference between disqualification rates of PLAAF and USAF .Conclusion There are some differences in medical selection standards for flying cadets in the nervous and mental system between PLAAF and USAF, and we could revise PLAAF standards using USAF standards for reference .

An empirical study on medical selection of flying cadets with skin diseases between PLAAF and USAF / 军事医学

Objective To determine whether the candidates who were disqualified due to skin diseases in PLAAF medical selection of flying cadets are qualified or not according to USAF Medical Standards Directory , and to raise suggestions about revising PLAAF medical standards for flying cadets .Methods All the candidates who participated in the final medical selection of flying cadets received skin examination , and were judged to be qualified or not according to USAF Medical Standards Directory.Results Scar,bromhidrosis, chronic eczema, and vitiligo accounted for the largest proportion of skin diseases in PLAAF medical selection of flying cadets .There was a marked difference between disqualification rates of PLAAF and USAF, and the selection outcome of 34.48% of the candidates disqualified for skin disease were unknown according to USAF Medical Standards Directory .Conclusion There are some differences in medical selection standards of flying cadets between PLAAF and USAF , and we can revise PLAAF standards using USAF standards for reference , such as replacing bromhidrosis with ephidrosis , observing the therapeutic effect of chronic eczema , and adding impact evaluation of scar on military equipment .