Addressing the GP vocational training crisis in remote Australia: Lessons from the Northern Territory.

OBJECTIVE: GP vocational training enrolments are declining Australia-wide and, in the Northern Territory (NT), considered by some as '…the litmus test for the national scene' the decline is precipitous. This research investigates the drivers of declining GP training uptake in the NT and identifies and ranks potential solutions. SETTING: NT, Australia. PARTICIPANTS: Ten senior medical students, 6 junior doctors, 11 GP registrars, 11 GP supervisors and 31 stakeholders. DESIGN: Mixed methods: scoping review of Australian literature mapping key concepts to GP training pathway stages and marketing/communications; secondary data analyses; key informant interviews; and a stakeholder validation/prioritisation workshop. Interview data were thematically analysed. Workshop participants received summarised study findings and participated in structured discussions of potential solutions prior to nominating top five strategies in each of five categories. RESULTS: Highly prioritised strategies included increasing prevocational training opportunities in primary care and selecting junior doctors interested in rural generalism and long-term NT practice. Also ranked highly were: [Medical School] ensuring adequate infrastructure; [Vocational Training] offering high quality, culturally sensitive, flexible professional and personal support; [General Practice] better remunerating GPs; and [Marketing] ensuring positive aspects such as diversity of experiences and expedited GP career opportunities were promoted. CONCLUSION: Multifaceted strategies to increase GP training uptake are needed, which target different stages of GP training. Effective action is likely to require multiple strategies with coordinated action by different jurisdictional and national key stakeholder agencies. Foremost amongst the interventions required is the urgent need to expand primary care training opportunities in NT for prevocational doctors.

Knowledge, attitudes, and practices toward research among Oman medical specialty board residents.

OBJECTIVES: The Accreditation Council for Graduate Medical Education has mandated residency programs to teach the basic principles of research in residency programs. This study aimed to assess the research knowledge, attitude, and practice among the Oman Medical Specialty Board (OMSB) residents. Secondarily, it aimed to asses associations between different factors and research-related knowledge, attitude, and practice. MATERIALS AND METHODS: This cross-sectional study was conducted among all residents who were involved in OMSB various training programs in the academic year 2018/2019. A validated self-administered questionnaire was used. Hard copies of the questionnaire were delivered to residents in addition to the online forms. Data were entered using EpiData entry software and analyzed using SPSS version 24. RESULTS: A total of 256 residents participated in the study with a response rate of 46.5%. Around 55% of included residents have poor knowledge level, and 44% have moderate knowledge level. The study showed that the majority (93%) of the residents have positive research attitude. However, the practice domain showed that only 27.8% of residents have published articles as first or coauthor. Lack of time was reported as a major hindrance in nearly two-thirds of the residents. Lack of training (56%), lack of research-focused curriculum (47%), and lack of effective supervision (46%) were among major reported obstacles beside others. CONCLUSIONS: This study showed that OMSB residents have inadequate knowledge and lagging research practices, but a positive attitude toward research. This emphasizes the need for research-focused curricula and further training. In addition, applying new regulations, including mandatory manuscript submission, may improve the practice status.

Relación de la industria farmacéutica con los médicos residentes de la República Dominicana / Relationship of the Pharmaceutical Industry with the Medical Residences of the Dominican Republic

Introducción: las relaciones médicas con la industria farmacéutica son cada vez más complejas y los desafíos éticos que plantea son reales. Objetivo: conocer la relación que existe entre la industria farmacéutica con los médicos residentes del país y el impacto que pudiera tener esta relación. Material y Métodos: estudio descriptivo transversal mediante encuesta electrónica anónima. Se consideró la participación si confirmaban el llenado de la encuesta, que estuvo disponible durante abril y mayo de 2019. Se realizó un análisis descriptivo y se aseguró la confidencialidad y el anonimato de los datos. Resultados: se encuestaron 77 médicos residentes del país; 55.8 % recibe semanalmente visita del representante farmacéutico. Al menos cinco veces al año recibieron obsequio (49.4 %), participaron en comida, cena u otro eventosocial (48.1 %), participó en charla financiada por empresa farmacéutica (57.1 %). 40.3 % recibieron una vez al año el pago por parte de la industria farmacéutica, de inscripción/ viaje a algún evento (congreso, jornada, etc.). Están de acuerdo en que los regalos/propuestas de la industria farmacéutica influyen en la prescripción de los medicamentos (20.8 %), considera bien aceptar pago de eventos (45.4 %), refirieron que en su residencia se suelen aceptar regalos y ofertas y no ha tenido un espacio formativo sobre relaciones con la industria farmacéutica (89.6 %). Conclusión: existe un alto nivel de contacto de los médicos residentes con la industria farmacéutica, es necesario más y mejor formación en manejo de conflictos de intereses en la práctica profesional.

Introduction: Medical relationships with the pharmaceutical industry are increasingly complex and the ethical challenges it poses are real. Objective: To know the relationship that exists between the pharmaceutical industry and the resident doctors of the country and the impact that this relationship could have. Material and Methods: Cross-sectional descriptive study, through anonymous electronic survey participation was considered if they confirmed the completion of the survey that was available during April and May 2019. A descriptive analysis was conducted and the confidentiality and anonymity of the data was ensured. Results: 77 resident physicians of the country were surveyed; 55.8% receive a weekly visit from the pharmaceutical representative. At least 5 times a year they received a gift (49.4%), participated in a meal, dinner or other social event (48.1%), participated in a talk funded by a pharmaceutical company (57.1%). 40.3% received once a year the payment by the FI, of registration / trip to an event (congress, day, etc.). They agree that the gifts / proposals of the pharmaceutical industry influence the prescription of the medicines (20.8%), consider accepting payment of events (45.4%), they said that in their residence they usually accept gifts and offers of the pharmaceutical industry and has not had a training space on relations with the pharmaceutical industry (89.6%). Conclusion: There is a high level of contact of resident physicians with the Pharmaceutical Industry, it is necessary more and better training in handling conflicts of interest in professional practice

Mexican ENARM: performance comparison of public vs. private medical schools, geographic and socioeconomic regions.

OBJECTIVE: This study aimed to compare the performance in the National Assessment for Applicants for Medical Resi- dency (ENARM in spanish) of private versus public medical schools, geographic regions and socioeconomic levels by using three different statistical methods (summary measurements, the rate of change and the area under the receiver operator characteristics [AUROC]). These methods have not been previously used for the ENARM; however, some variations of the summary measurements have been reported in some USA assessments of medical school graduates. MATERIALS AND METHODS: Cross-sectional study based on historical data (2001-2017). We use summary measures and colourfilled map. The statistical analysis included Mann-Whitney U, Kruskal-Wallis, Spearman correlation coefficient (Rs), and linear regression. RESULTS: A total of 113 medical schools were included in our analysis; 60 were public and 53 private. We found difference in the median of total scores for type of schools, MD= 54.07 vs. MD= 57.36, p= 0.011. There were also significant differences among geographic and socioeconomic regions (p<0.05). CONCLUSIONS: Differences exist in the total scores and percentage of selected test-takers between type of schools, geographic and socioeconomic regions. Higher scores are prevalent in the Northeast and Norwest regions. Additional research is required to identify factors that contribute to these differences. Unsuspected differences in examination scores can be unveiled using summary measures.

OBJETIVO: Comparar el desempeño en el Examen Nacional de Aspirantes a Residencias Médicas (ENARM) de escuelas de medicina privadas y públicas, regiones geográficas y niveles socioeconómicos mediante el uso de tres métodos estadísti- cos diferentes (medidas de resumen, tasa de cambio y el área bajo las características del operador receptor [AUROC en inglés]). Estos métodos no han sido utilizados previamente para el ENARM; sin embargo, se han informado algunas variaciones de las mediciones de resumen en algunas evaluaciones de graduados de medicina de Estados Unidos. MATERIAL Y MÉTODOS: Estudio transversal basado en datos históricos (2001-2017). Se usaron medidas de resumen y un mapa lleno de color. El análisis estadístico incluyó Mann Whitney U, Kruskal-Wallis y coeficiente de correlación de Spearman (Rs). RESULTADOS: Se incluyeron 113 escuelas de medicina en el análisis; 60 eran públicas y 53 privadas. Se encontraron diferencias en la mediana de las puntuaciones totales para el tipo de escuelas, MD= 54.07 vs. MD= 57.36, p= 0.011. También hubo diferencias significativas entre las regiones geográficas y socioeconómicas (p<0.05). CONCLUSIONES: Existen diferencias en los puntajes totales y el porcentaje de examinados seleccionados entre el tipo de escuelas, regiones geográficas y socioeconómicas. Las puntuaciones más altas prevalecen en las regiones noreste y noroeste. Se requieren investigaciones adicionales para identificar los factores que contribuyen a estas diferencias. Las diferencias insospechadas en los puntajes de los exámenes se pueden revelar usando medidas de resumen.

Mexican ENARM: performance comparison of public vs. private medical schools, geographic and socioeconomic regions / ENARM: comparación del desempeño de escuelas de medicina públicas y privadas, regiones geográficas y socioeconómicas

Abstract: Objectives: This study aimed to compare the performance in the National Assessment for Applicants for Medical Residency (ENARM in spanish) of private versus public medical schools, geographic regions and socioeconomic levels by using three different statistical methods (summary measurements, the rate of change and the area under the receiver operator characteristics [AUROC]). These methods have not been previously used for the ENARM; however, some variations of the summary measurements have been reported in some USA assessments of medical school graduates. Materials and methods: Cross-sectional study based on historical data (2001-2017). We use summary measures and colour-filled map. The statistical analysis included Mann-Whitney U, Kruskal-Wallis, Spearman correlation coefficient (Rs), and linear regression. Results: A total of 113 medical schools were included in our analysis; 60 were public and 53 private. We found difference in the median of total scores for type of schools, MD= 54.07 vs. MD= 57.36,p= 0.011. There were also significant differences among geographic and socioeconomic regions (p<0.05). Conclusions: Differences exist in the total scores and percentage of selected test-takers between type of schools, geographic and socioeconomic regions. Higher scores are prevalent in the Northeast and Norwest regions. Additional research is required to identify factors that contribute to these differences. Unsuspected differences in examination scores can be unveiled using summary measures.

Resumen: Objetivo: Comparar el desempeño en el Examen Nacional de Aspirantes a Residencias Médicas (ENARM) de escuelas de medicina privadas y públicas, regiones geográficas y niveles socioeconómicos mediante el uso de tres métodos estadísticos diferentes (medidas de resumen, tasa de cambio y el área bajo las características del operador receptor [AUROC en inglés]). Estos métodos no han sido utilizados previamente para el ENARM; sin embargo, se han informado algunas variaciones de las mediciones de resumen en algunas evaluaciones de graduados de medicina de Estados Unidos. Material y métodos: Estudio transversal basado en datos históricos (2001-2017). Se usaron medidas de resumen y un mapa lleno de color. El análisis estadístico incluyó Mann Whitney U, Kruskal-Wallis y coeficiente de correlación de Spearman (Rs). Resultados: Se incluyeron 113 escuelas de medicina en el análisis; 60 eran públicas y 53 privadas. Se encontraron diferencias en la mediana de las puntuaciones totales para el tipo de escuelas, MD= 54.07 vs. MD= 57.36,p= 0.011. También hubo diferencias significativas entre las regiones geográficas y socioeconómicas (p<0.05). Conclusiones: Existen diferencias en los puntajes totales y el porcentaje de examinados seleccionados entre el tipo de escuelas, regiones geográficas y socioeconómicas. Las puntuaciones más altas prevalecen en las regiones noreste y noroeste. Se requieren investigaciones adicionales para identificar los factores que contribuyen a estas diferencias. Las diferencias insospechadas en los puntajes de los exámenes se pueden revelar usando medidas de resumen.

Speciality preference with respect to gender among medical students of Pakistan.

This research was conducted to determine the impact of gender and other factors in choosing a medical speciality. This cross-sectional study was conducted from 5th February 2017 to 5th July 2017 at different Medical Colleges and Teaching Hospitals. Students from fourth, final year and House Officers were enrolled using a self made questionnaire. Data was analyzed using SPSS 22. Of the 314 participants, 171(54.5%) were males and 143(45.5%) were females. Majority chose Surgery 90(28.7%), and Internal Medicine 58(18.5%). Only 1(0.3%) participant chose Public Health as a career speciality. The main reason for choice for both genders was "Interest in Content" and "Good Salary". Research shows a shift in trend of women towards Surgery and Internal Medicine rather than Gynaecology and Paediatrics, which indicates more competition in Surgery in near future. Main influencing factors for choice were personal interest and good salary. Students should be counselled regarding career in Public Health and Psychiatry.

The compelling arguments for the need of medical vascular physicians in Europe.

The burden of vascular diseases is growing worldwide, as the population ages, prompting a call to action not only in terms of awareness but also and most urgently in recognizing the need for vascular physicians, also called angiologists. Vascular medicine views the vascular system (arteries, veins, and lymphatics) as a whole, unique, and independent entity requiring specialized competencies. Vascular physicians offer a holistic and comprehensive approach to vascular patients including provision of interventional procedures, management of a heterogeneous group of multi-morbid and frail patients affected by multi-vessel diseases, and connecting different specialists in a multidisciplinary effort. Vascular medicine practise varies across European countries. While it is a firmly accepted medical speciality in many European countries it is not formally recognized by the European Union limiting adoption in the other countries. The lack of vascular physicians likely accounts for inequality of care of vascular patients as compared for example to patients with heart disease and might contribute to adverse outcomes and healthcare costs associated with vascular diseases. To move forward in the struggle to provide efficient care for multimorbid poly-vascular patients, it is essential to establish vascular medicine programs in Europe and worldwide. Important steps to achieve this goal include improving public awareness of vascular diseases, attain formal recognition by the EU of angiology/vascular medicine as a medical specialty, creating specialized treatment guidelines, and to harmonize vascular care in Europe.

Motives influencing students' preferences for obstetrics and gynaecology speciality: A cross-sectional multi-site Swiss study.

OBJECTIVES: Knowing and understanding the reasons why medical students choose postgraduate medical specialities are essential to help influence the workforce for a balanced national healthcare system. The objective of this study was to determine motivating factors for choosing a speciality career in general and, more specifically, for the choice of obstetrics and gynaecology (OBGYN) over surgery or general practice. STUDY DESIGN: This study was based on prospectively collected data from a large research multi-site cross-sectional study. We sent a survey to medical students in the sixth year, which contained questions about demographics, choice of speciality and motives for choosing. We grouped the specialities into families of specialities and motives into motivating factors clustered by principal component analysis. We used a multivariate analysis of variance (MANOVA) test to identify differences between motivating factors in speciality categories and gender. We performed logistic regression analyse to compare the choice of OBGYN to choices of surgery and general practice as well as undecided. RESULTS: A total of 1749 students responded with an average return rate of 56%. Our study revealed four motivating factors: "experiential", "relational", "occupational" and "scientific". Logistic regression analysis showed that the choice of OBGYN was particularly influenced by "experiential factor" (OR 1.5; 95%CI [1.2; 1.9]) and by gender (OR 4.5; 95%CI [2.2; 9.2]). When we compared the motivational profile of OBGYN to other speciality categories, OBGYN appeared to stand between surgery and general practice for the "experiential" and "relational" factors, more like surgery for the "occupational factor" and more like general practice for the "scientific factor". CONCLUSION: This study highlighted the importance of "experiential factor" and gender for choosing OBGYN as a career. OBGYN seemed to stand between surgery and general practice from a Swiss students' point of view. These findings provide useful information for targeted interventions to promote OBGYN at the undergraduate level. Such interventions could include providing more hands-on experiences, improving integration of male students and encouraging student involvement in patient care.

Fatores associados à aprovação na prova de título de Especialista em Ortopedia, Brasil 2017 / Factors associated with the approval in the Orthopedics specialist test, Brazil 2017

Objetivos: avaliar os fatores associados à aprovação na prova de TEOT. Materiais e métodos: estudo observacional comparativo, através de questionário autorrespondido, contendo questões sociodemográficas, comportamentais e associadas à residência médica, aplicado a residentes de Ortopedia e Traumatologia no Congresso Brasileiro da respectiva Sociedade, no ano de 2016, na cidade de Belo Horizonte, e realizaram a prova de título de especialista em Ortopedia e Traumatologia (TEOT). Resultados: 190 residentes presentes ao Congresso Brasileiro realizaram o TEOT, sendo 169 aprovados e 21 reprovados. Foram selecionados, aleatoriamente, três controles (reprovados) para cada um dos 21 residentes, num total de 94 voluntários. Fatores associados à aprovação foram: ser disciplinado para o estudo (p=0,001) e ter domínio de língua estrangeira (p=0,006). Conclusões: residentes com uma maior disciplina e conhecimento de língua estrangeira apresentaram maior chance de sucesso na prova do TEOT. Nenhum fator sociodemográfico avaliado estava associado à aprovação

Objectives: evaluate factors associated to approval on the TEOT test. Method: observational, comparative study made through self-administered questionnaire containing sociodemographic, behavioral and associated to the medical residency questions applied to Orthopedics and Traumatology residentes at the Brazilian Congress from this Society in 2016, at Belo Horizonte and who took the test to get the Tittle of Specialist in Orthopedics and Traumatology (in Portuguese, TEOT). Results: 190 residents who were attending the Brazilian Congress took the TEOT: 169 were approved and 21 failed. For each one of the 21 residents, three control residents (who failed the test) were randomly selected, resulting in 94 volunteers. The factors which were associated to succeeding the test were: being disciplined when it concerns to studying (p=0,001) and mastering English (p=0,006). Conclusions: those residents who were more disciplined and who mastered English had better chances of succeeding at TEOT test. None of the evaluated sociodemographic factors were associated to being approved on the test

Strategies in overcoming racial and socio-cultural differences in the learning environment of post-graduate medical specialty training in South Africa.

This article was migrated. The article was marked as recommended. Study problem The training of postgraduate medical students in the multi-racial landscape of South Africa has faced challenges given the need for relationships in personal mentoring and learning through legitimate participation in the community of practice (CoP), as part of cognitive apprenticeship training. A high failure rate in the exit examination had stimulated interest into understanding the nature of the learning environment. Aim and objectives The study explored conceptions of former students in a medical specialty program regarding the nature of racial and socio-cultural diversities in their learning environment, influences on learning, and how they responded to them. Methodology A qualitative enquiry using in-depth interviews with semi-structured open-ended questions and thematic analysis with a social constructionist approach of epistemology used for data analysis and interpretation. Findings Students conceived race, language, departmental culture and social identity as barriers in their learning. The lack of structured formative training with feedback, evaluation, personal mentoring, and supervision also emerged. Through resilience, adaptability, and maturity qualified students overcame these difficulties. Conclusion Current and future students may benefit by developing resilience when dealing with racial and socio-cultural differences, and findings support the inclusion of cultural competence and a multi-lens approach in medical specialty curricula.

Barriers to Medical Compassion as a Function of Experience and Specialization: Psychiatry, Pediatrics, Internal Medicine, Surgery, and General Practice.

CONTEXT: Compassion is an expectation of patients, regulatory bodies, and physicians themselves. Most research has, however, studied compassion fatigue rather than compassion itself and has concentrated on the role of the physician. The Transactional Model of Physician Compassion suggests that physician, patient, external environment, and clinical factors are all relevant. Because these factors vary both across different specialities and among physicians with differing degrees of experience, barriers to compassion are also likely to vary. OBJECTIVES: We describe barriers to physician compassion as a function of specialization (psychiatry, general practice, surgery, internal medicine, and pediatrics) and physician experience. METHODS: We used a cross-sectional study using demographic data, specialization, practice parameters, and the Barriers to Physician Compassion Questionnaire. Nonrandom convenience sampling was used to recruit 580 doctors, of whom 444 belonged to the targeted speciality groups. The sample was characterized before conducting a factorial Multivariate Analysis of Covariance and further post hoc analyses. RESULTS: A 5 (speciality grouping) × 2 (more vs. less physician experience) Multivariate Analysis of Covariance showed that the barriers varied as a function of both speciality and experience. In general, psychiatrists reported lower barriers, whereas general practitioners and internal medicine specialists generally reported greater barriers. Barriers were generally greater among less experienced doctors. CONCLUSION: Documenting and investigating barriers to compassion in different speciality groups have the potential to broaden current foci beyond the physician and inform interventions aimed at enhancing medical compassion. In addition, certain aspects of the training or practice of psychiatry that enhance compassion may mitigate barriers to compassion in other specialities.

Innovating the practice of medical speciality training.

Educational innovations are being introduced into medical speciality training. But how do people who participate in medical speciality training (residents, consultants, programme directors) deal with these innovations? And what effects do educational innovations have according to these people?By addressing these questions, this thesis contributes to the knowledge about the challenging process of innovating medical speciality training.

Research on the ideas and modes of continuous medical education / 中国医学装备

In this article the present situation is analyzed by retrieving the training pattern and the curriculum of the continuing medical education in China, and new thoughts and training patterns which are more suitable for China's national conditions are put forward. It can be strengthened by course offered that the knowledge and skill of basic medical knowledge, new medical technology, medicopsychology, medical dietetics, professional medicine and communication skills. So the medical technologists can get comprehensive continuing education and skill development. Finally, the high level of teaching quality of the continuing education organization and the effective monitoring and feedback system which will lay the foundation for further improving the quality of the continuing medical education.