Quantitative assessment of the impact of a triage physician on the Accreditation Council for Graduate Medical Education resident milestones in the emergency department

The “door-to-doctor” time for patients to be seen by a physician is an increasingly studied metric.Hospitals may shorten this time by implementing a triage physician (TP).The exact role of a TP may vary across departments.TPs put in preliminary orders for lab work,imaging,and treatment,and decide treatment location for further evaluation.As the prevalence of TPs grows,its effect on resident education in academic emergency departments (EDs) remains unclear.We implemented a TP in the spring of 2016 and assessed resident physicians before and after implementation.

Emergency physicians’ occupational risks in China

With the rapid development of emergency medicine,emergency physicians are working around the clock,[1]including additional workloads due to sudden public health emergencies and disasters.Occupational risks for emergency physicians are significantly high due to an increasing number of patients with acute and severe diseases,an increased workload.

Comparison of posttraumatic growth and posttraumatic stress of nurses with physicians and medical students after caring of COVID‑19 patients

Objectives:The present study compared the prevalence and psychosocial factors affecting posttraumatic growth(PTG),posttraumatic stress disorder(PTSD),and psychological distress in nurses,physicians,and medical students.Materials and Methods:In a cross‑sectional study,three groups of medical staff including nurses(n=57),physicians(n=40),and medical students(n=34)who were responsible for the care/treatment of COVID‑19 patients admitted to a general hospital for 4 months responded to Posttraumatic Growth Inventory,Brief Symptom Inventory‑18,Resilience Questionnaire,PTSD Screen,and Social Capital‑Integrated Questionnaire.Results:After the exposure of medical staff to at least 4 months of treatment/care of COVID‑19 patients,PTG prevalence was higher than PTSD(38.2%vs.14.6%),but they experienced some degrees of psychological distress(65.5%).The nurses had 8.33(confidence interval[CI]:2.5–26.7)times higher PTG rate than medical students(P<0.001).Physicists also experienced 5.00(CI:1.4–26.7)times higher PTG than medical students(P<0.001).PTG was aided by age,married status,strong resilience,and high social capital,but gender had no influence.Resilience played an important protective role to prevent the incidence of psychological distress in nurses,medical students,and physicians.Conclusion:Despite the fact that the PTSD and psychological distress were same in the three groups of medical staff,the nurses had a greater rate of PTG than physicians and medical students.

Compliance of Physicians with Standard Precautions of Handling Patients with Infectious Respiratory Disease

Background: Standard precautions (SPs) are the minimum infection prevention practices that aim to protect Health care workers (HCWs) including physicians and prevent them from transmitting the infections to their patients. Purpose: To assess the level of compliance of physicians with standard precautions of handling patients with infectious respiratory disease. Method: A cross sectional questionnaire-based study was conducted in two tertiary level hospitals named M Abdur Rahim Medical College and Hospital, Dinajpur, Bangladesh and Rajshahi Medical College and Hospital, Rajshahi, Bangladesh to assess the level of compliance of physicians with standard precautions. Purposive sampling technique was applied as per inclusion criteria and data was collected by face to face interview from 285 physicians. Statistical analysis of the results was done by SPSS and a p value less than 0.05 was considered as significant. Result: The study revealed that maximum physicians (76.5%) handling patients with infectious respiratory disease had a moderate level of compliance with standard precautions. 78.6% of the physicians had moderate level of awareness about standard precautions. Only 20.35% of the physicians had training on infection control. 94.4% of the respondents didn’t know the component of standard precaution and most of the physicians were not aware of the sequence of wearing and removing the different components of PPEs. Conclusion: The study result implies that with increased awareness, the compliance of the physicians with standard precautions increased. The main reasons of non-compliance with standard precautions were found to be lack of resources, lack of regular training and excess workload.

Occurrence of Boerhaave's syndrome after diagnostic colonoscopy:what else can emergency physicians do?

Dear editor,Boerhaave’s syndrome is a barogenic tear of the esophagus,typically at the gastroesophageal junction,caused by a sudden increase in intraluminal pressure in the distal esophagus.[1]In recent years,the number of Boerhaave’s syndrome cases has increased,and a growing proportion of clinicians have recognized this rare but life-threatening disease.

Adjuvant therapy for hormone receptor-positive breast cancer: Perspective from a survey on breast cancer physicians' acceptance of practice-changing data

A cross-sectional online survey was conducted.A high proportion of the Chinese breast cancer(BC)physician respondents(n=77)would prescribe extended adjuvant endocrine therapy(AET)with aromatase inhibitors(AI)beyond 5 years for postmenopausal females with BC,especially those with higher risk.Respondents with≥15 years of clinical experience were more likely to prescribe a longer duration of AET for low-risk patients.Half of the respondents considered intermittent letrozole as an acceptable option.Most respondents would prescribe adjuvant chemotherapy to genomic high-intermediate risk[Oncotype DX recurrence score(RS)21-25]females aged≤50 years regardless of the clinical risk classification.

Views of South Asian Physicians on Climate Related Health Effects: A Multinational Cross-Sectional Pilot Study

Background: South Asian populations are vulnerable to poor health outcomes associated with climate due to the region’s complex topography, poverty, lack of education, and population density. Physicians, being highly trusted members of society, can help mitigate climate change effects in their countries. Objectives: The present study assessed perceptions of physicians from four South Asian countries (Bangladesh, Bhutan, India, and Pakistan). We hypothesized that physicians from these countries will be aware and knowledgeable about health effects of climate change. Methods: We conducted a cross-sectional online survey of physicians between March and July 2022. Data of 201 physicians was analyzed using the Kruskal-Wallis test and Dunn’s post hoc method. Results: Physicians from four South Asian countries were attuned to the health risks associated with climate change. A majority of physicians (86.6%) believed that climate change would make health conditions in their countries more severe or frequent (Bangladesh 83.3%;Bhutan 70%;India 91% and Pakistan 90.8%). The most common health effect related to climate change was illnesses related to reduced outdoor air quality (54.3%). Common barriers to discuss climate change with patients from all four countries were physicians’ lack of knowledge (strongly agree, 13.8%;agree 47.7%) in how to approach the issue with patients, lack of time (strongly agree, 12%;agree, 48%) and their perception that patients were not interested in knowing about climate change (strongly agree, 8.6%;agree, 42.6%). More than half (56.2%) of the physicians reported no training (Bangladesh, 51.7%;Bhutan, 80%;India, 44.6%;Pakistan, 63.1%) and approximately 30% reported less than 20 hours of training (Bangladesh, 28.3%;Bhutan, 15.0%;India, 39.3%;Pakistan, 27.7%) in climate-change-related health effects. Conclusion: While additional large-scale research is needed to understand the trends observed in our pilot study, our findings identify the need to introduce interventions to improve physicians’ knowledge of the health impacts of climate crisis.

Underrecognition and un-dertreatment of stress-related psychiatric disorders in physicians:Determinants,challenges,and the impact of the COVID-19 pandemic

Medical practitioners’duties are highly stressful and performed in a particularly challenging and competitive work environment.Stress and burnout among physicians have emerged as a worldwide public health problem in recent years.A high level of distress and burnout can lead to clinically significant behavioral health problems,such as stress-related psychiatric disorders.Mounting evidence shows that physicians have higher risks of insomnia,anxiety,and depression than the general population,especially during the coronavirus disease 2019 pandemic.However,the behavioral health problems of these vulnerable healthcare professionals are noteworthy for being underrecognized and undertreated.In this minireview,we summarize the current progress of studies on the prevalence and determinants of distress and stress-related psychiatric disorders among physicians and their healthcare-seeking behaviors.We discuss future research directions and the clinical approach that may maximize self-awareness and promote prompt and adequate treatment for clinically significant behavioral health problems of physicians.

我国医患关系研究的进路与省思

基于CiteSpace可视化分析工具,以“医患关系”为关键词,分析近年来传播学视域的医患关系研究议题与进程,发现医患关系研究出现从“媒介”到“人”的研究转向。其中以“媒介”为中心的医患关系视角注重医患关系的媒介呈现和媒介宣传,以“人”为中心的医患关系视角注重媒介使用与医患信任建构、媒介与患者健康意向行为关系及新型医患沟通模式分析。同时,探讨提升中国社会的医患关系研究路径,提出未来研究更应注重制度和文化等语境,跳出实证主义范式以及单一的“医−患”二元视角,以推动医患关系研究的均衡与系统化发展。

Physician-scientists or celebrities?Kardashian-index of gastroenterologists

BACKGROUND The coronavirus disease 2019 pandemic unleashed a flood of untrustworthy information on social media platforms,resulting in the unfortunate consequence of expert scientists'opinions getting lost amidst the chaotic sea of misinformation.The question of how much influence these esteemed scientists hold on social media platforms remains elusive.To address this scientific quandary,we sought to explore the concept of the Kardashian index(K-index),a term introduced by Hall in 2014.This metric provides a rudimentary means of evaluating whether a physician scientist's popularity on social media aligns with their significant scientific contributions.AIM To evaluate if a Gastroenterologist physician's popularity on social media is at par with their scientific contributions(research articles and publications).METHODS We conducted an extensive search to identify all gastroenterologists actively practicing and associated with the top 100 hospitals as reported by the United States News.We collected specific data on a sub-group including their names,affiliations,degrees,and sub-specializations.To gauge their social media popularity,we utilized the K-index calculation which is determined by dividing the actual number of Twitter followers by the number of researcher’s citations.The expected number of followers(F)is calculated using the formula F=43.3 C^0.32,where C represents the number of citations.RESULTS Physicians affiliated with the Mayo Clinic emerged as the most prominent presence on Twitter,constituting 16%of the total.They were followed closely by physicians from Mount Sinai Hospital(9%)and the University of Michigan Hospital(9%).Surprisingly,76%of the physicians evaluated exhibited a low K-index,falling within the range of 0 to less than 2.This suggests that a significant number of highly influential physician-scientists are not receiving due recognition,as indicated by their relatively low number of followers.On the other hand,24%of the physicians had an inflated K-index,exceeding 5,which positioned them as the"Kardashians".These individuals enjoyed greater social media popularity than their actual scientific contributions.Interestingly,our analysis revealed no discernible association between sex and K-index(P value of 0.92).CONCLUSION In the gastroenterology field,our study estimated that a majority(76%)of highly researched physicians are undervalued despite their significant scientific contributions.

PBL联合CBL教学法在实验诊断学住培教学中的应用

目的研究以问题为基础的教学法(problem-based learning,PBL)联合案例教学法(case-based learning,CBL)在住院医师规范化培训(简称住培)医师实验诊断学以系统-器官疾病为中心的教学改革中的应用效果。方法选取2017年6月—2020年6月哈尔滨医科大学附属第四医院检验科内设置的医学检验专业住培基地的住培医师60名为研究对象,随机选取2017~2018年度住培医师30名纳入对照组,采用普通五年制教材传统教学法。将2019~2020年度住培医师30名纳入观察组,采用PBL联合CBL教学法。比较2组住培医师考试成绩、学习效果及教学满意度。结果观察组的优良率为100%,高于对照组的80.00%,差异有统计学意义(P<0.05)。观察组住培医师学习主动性、思辨力、团队协作、有效沟通4个维度的得分均高于对照组,差异有统计学意义(P<0.05)。观察组住培医师的总满意度为100%,高于对照组的73.33%,差异有统计学意义(P<0.05)。结论PBL联合CBL教学法在住培医师实验诊断学以系统-器官疾病为中心的教学改革中的应用效果较好,提高了住培医师成绩,锻炼了住培医师解决临床问题的综合能力。

An approach to the development of the humanistic capacities of physicians

Introduction There is growing interest in the need for a deeper integration of the human aspects of health care in the curriculum of physicians.The student during his training starts from the basic sciences(physics,chemistry,physiology,pathophysiology,etc.)and later goes to the clinical symptoms and the patient;that is,for example,they first learn about the glucose molecule,then the clinical entity of diabetes and finally the diabetic patient.

眼科研究生分层递进式教学改革的实践探索

眼科是一门实践性很强的学科,内容庞杂,随着疾病谱的变化,新技术的应用,原有研究生课程体系与教学内容已不再适用,传统的研究生医师培训中存在培训方案和考核机制不完善、教师和学生积极性不高、教学方法单一枯燥等问题,无法满足目前国家对眼科研究生医师规范化培训的要求,新的课程体系构建与教学内容改革已成为急需。我国医师协会联合8家国内精英教学医院作为试点单位,形成研究生医师核心胜任力框架共识,大力推广以岗位胜任力为导向的医学教育,开展跨学科、多种多样、体现年度渐进理念的教学活动。构建眼科研究生医师规范化培训课程体系和开展跨学科、形式多样、分层递进的教学活动,培养具有临床岗位胜任力的眼科研究生医师对推广教育改革新理念、促进教育教学高质量发展具有更积极的意义。

MDT教学在进修医师脊柱肿瘤培训中的应用研究

目的:探讨多学科协作(multi-disciplinary team, MDT)教学在脊柱肿瘤教学中的效果。方法:选择2020年9月至2022年9月在北京大学第三医院骨科进修的脊柱外科专业的32名进修医师为研究对象,采用试验对照方法,在脊柱原发性肿瘤教学时采取MDT教学,在脊柱转移瘤教学时采取传统查房方法教学。通过客观的考核、课堂体验调查,对比两种不同教学方法的教学效果。结果:考核结果表明,在判断肿瘤良恶性、制定手术方案以及术后是否需要放化疗或靶向治疗这3个问题上,两种教学方法下医师得分分别为(9.0±1.1)分、(9.2±0.7)分、(9.1±0.8)分以及(7.4±1.4)分、(7.2±1.1)分、(6.8±0.9)分,其差异具有统计学意义(P<0.05)。调查结果表明,65.6%的医师认为MDT教学使其对脊柱肿瘤更感兴趣,71.9%的医师认为MDT教学提高了其自主学习能力,75.0%的医师认为MDT教学提高了其学习效率,87.5%的医师认为MDT教学增长了其脊柱肿瘤的相关知识。结论:采用MDT教学可以激发进修医师的学习兴趣,提高自主学习能力及学习效率,更好地掌握脊柱肿瘤相关知识。

OBE理念融入课程思政构建基础医学总论的效果初探

基于社会需求以培养德才兼备的医学生为成果导向教育(outcome-based education,OBE)融入课程思政构建基础医学总论提供了基础。基础医学总论是内蒙古医科大学五年制临床医学专业卓越医师教改班开设的第一门基础医学课程,具有学时多,教学内容多且不系统,课程难度大的特性。以线上和线下教学平台为载体,基于OBE理念融入课程思政以调整教学方法和手段,为国家培养能肩负“健康所系、性命相托”职责的医学人才,使医学生既具有精湛的医技,还具有“敬畏生命、仁爱至善、坚韧尚行”的医者精神。基于OBE理念融入课程思政构建基础医学总论,克服了学生的学习畏难情绪,增强了教学效果,利于培养德才兼备的医学生。本研究可为今后医学课程教学改革提供参考。

住培医师作为标准化病人的PBL教学法在神经内科教学中的应用

目的探讨住培医师作为标准化病人的以问题为导向的教学法(problem-based learning,PBL)在神经内科临床教学中的应用效果。方法采用随机数字表法,将2020年6月—2021年10月苏州大学附属第二医院62名正在培训的神经内科住培医师随机分成对照组(31名,传统教学法)和观察组(31名,住培医师作为标准化病人的PBL教学法)进行临床住培。从神经内科轮转期6个月以上住培学员中选取标准化病人培训对象。比较2组住培医师培训之后的理论知识、实践能力及综合素质评分。结果观察组住培医师的理论知识及实践操作成绩均高于对照组,差异有统计学意义(P<0.05);观察组住培医师的综合素质评分均高于对照组,差异有统计学意义(P<0.05)。结论住培医师作为标准化病人的PBL教学法在神经科临床培训教学中的应用效果显著。

基于模糊综合评判的住院医师规范化培训带教质量评价

带教质量直接影响住院医师规范化培训工作中最终输出人才的质量,对带教质量进行合理、有效的评价,是提升住院医师规范化培训质量、完善住院医师规范化培训制度的重要保证。针对住院医师规范化培训工作中带教质量评价因素的复杂性、模糊性以及定性指标难以量化的问题,提出一种基于模糊综合评判的带教质量评价方法。首先,进行一级评判,通过确定因素集、评价集,进行单因素评价,再确定各因素的权重,进行综合评价;其次,进行二级或多级综合评判,构建基于模糊综合评判的带教质量评价模型;最后,通过带教质量的模糊综合评价实例,对带教质量的评价方法进行研究。

应用临床教学五步法进行形成性评价提升住院医师医患沟通能力

目的研究应用临床教学五步法进行形成性评价提升住院医师医患沟通能力。方法采用自身对照的队列研究方法,由参与研究的指导医师对自愿纳入研究的住院医师进行5次关于医患沟通技能的形成性评价,每次均应用临床教学五步法进行反馈指导。对形成性评价前后住院医师的自评和他评结果进行对比分析。结果21名住院医师纳入研究。第5次形成性评价得分(90.00±2.47)分与第1次得分(61.24±9.86)分相比,差异有统计学意义(P<0.01)。18名住院医师完成自评问卷,结果提示,应用临床教学五步法进行形成性评价后,住院医师更注意在沟通前了解患方的社会文化背景,并据此拟定不同沟通策略。在沟通中,住院医师更注意观察患者的表情和语气的变化,主动询问患者的理解程度、治疗期望和意愿(P<0.05)。结论应用教学五步法进行形成性评价可有效提升住院医师医患沟通能力。

Adherence in Patients with Type 2 Diabetes and Depression and the Role of Physician-Patient Relationship: A Cross-Sectional Study

Background: Diabetes mellitus (DM) challenges health and quality of life of patients, families, and communities. Patients with comorbid depression are more likely to develop macrovascular and microvascular complications. The aim was to assess glycemic control and adherence in diabetic patients with comorbid depression. Further, the study evaluated the relationship between adherence and the physician-patient relationship. Methods: The study was conducted at Al-Agouza Family Medicine Center (AFMC) between February 2018 and March 2020. The included patients were between 35 - 80 years of age;had type 2 diabetes with hemoglobin A1c (HbA1c) ≥ 6.5%, fasting plasma glucose ≥ 126 mg/dl, and scored between 11 - 30 on the Beck Depression Inventory (BDI). Logistic regression, chi-square, and analysis of variance (ANOVA) were used to assess the relationship between depression, adherence, physician-patient relationship, and other variables. Results: The study included 100 eligible patients with a median BDI score of 20 (10 - 30). The median diabetic panel for patients was FBS 188 (126 - 348) mg/dl, PPS 282.50 (162 - 448) mg/dl, and HbA1c 9.5 (6.6 - 14.0)%. Depression and regular follow-up visits were statistically associated with improvement of diabetes symptoms (p = 0.019). There was a significant relationship (p 0.001) between adherence, regular follow-up visits, and knowledge of DM. Further, there was a significant relationship between the physician-patient relationship and DM improvement (p = 0.047). Conclusion: Physician-patient relationship was paramount to improving adherence and positive diabetes care. Our findings suggest a shift to a physician-patient relationship model with mutual agreement on medical decisions is highly recommended.

教师模拟标准化病人联合临床医师技能培训考试系统教学模式应用于住院医师规范化培训中的效果

目的探讨教师模拟标准化病人(TSP)联合临床医师技能培训考试系统(OSCE)教学模式应用于住院医师规范化培训(以下简称“规培”)中的效果。方法选取2022年8月至2023年8月在潍坊医学院附属医院接受规培的住院医师60名,按随机抽签法分为两组,对照组30名培训过程中应用传统教学模式,研究组30名培训中应用TSP联合OSCE教学模式。比较两组规培医师培训前后的培训效果、综合能力及对规培医师对教学模式认同度。结果研究组培训后的理论、实践操作成绩均高于对照组,差异有统计学意义(P<0.05)。研究组培训后的迷你临床演练评估(Mini-CEX)、批判性思维能力测量表(CTDI-CV)评分均高于对照组,差异有统计学意义(P<0.05)。研究组规培医师对教学模式的认同度高于对照组,差异有统计学意义(P<0.05)。结论TSP联合OSCE教学模式应用于住院医师规培中可有效提升其成绩及综合能力,且规培医师对此教学模式的认同度较高。