Core undergraduate psychiatry: what do non-specialists need to know?

OBJECTIVE: The purpose of this study is to define the most relevant topics for inclusion in an undergraduate psychiatric curriculum by asking non-psychiatrists what knowledge, skills and attitudes related to psychiatry they need in their day-to-day practice. METHODS: A questionnaire study involving non-psychiatric doctors (based both in hospitals and general practice) was carried out using Delphi methodology in 2 waves. In the first wave, 408 doctors described the psychiatric competencies they required in their current posts. From this, a list of 101 psychiatric topics was generated. In the second wave, 867 doctors rated these topics according to the relevance of each topic to their practice. RESULTS: Depression, alcohol misuse and drug misuse were rated as most relevant. General practitioners found more topics relevant to their practice than did hospital doctors, and there were disparities in the relative importance that the 2 groups gave to topics. CONCLUSIONS: This study demonstrates a systematic method for developing core curricular undergraduate learning objectives in a specialty area by asking doctors outside that specialty to identify topics that are relevant to their practice. Similar methods could be used for a range of specialties other than psychiatry and could provide a rational and transparent means of developing a core curriculum for medical students, when combined with perspectives from other sources.     

Continuing medical education and career choice among graduates of problem-based and traditional curricula

A survey was conducted among graduates of two Canadian medical schools who have been in practice for more than 9 years. The purpose of the study was to test the hypothesis that graduates of a problem-based curriculum differ from graduates of a traditional curriculum in their attitude to and participation in continuing medical education (CME) activities. Differences were noted in the rate of participation in certain CME activities (attendance at national and international conferences and meetings) between specialists and family doctors in both groups of alumni. However, the data indicate that the differences in learning-teaching methods employed in the course of the undergraduate medical curriculum do not exert a decisive influence upon the learning habits of the graduates.     

Profile of doctors who participate in continuing medical education in Malaysia

A random survey of 400 doctors was carried out over a period of 3 months to determine the factors that would facilitate or inhibit the participation of doctors in continuing medical education (CME) in Malaysia. Regular participation in CME was defined as participation in any activity (self-directed reading or attending organized activities) at least once a month during the past year. It was found that 78% of doctors regularly participated in CME. Working in a hospital environment and being members of the Malaysian Medical Association and at least one specialty organization appeared to be important facilitatory factors in CME participation. These doctors also read the local medical journals regularly and subscribed to other journals. In addition, they were more likely to possess postgraduate qualifications and would have teaching, research, diagnostic or clinical responsibilities as major components of their work. They were more likely to practise in the big cities and would tend to be active in at least one voluntary or social organization. If they were in the Government sector, they were more likely to work in the Universities or in the Hospital Division of the Ministry of Health. The 22% who were less likely to participate in CME were general practitioners in the private sector. They worked long hours with day, evening and/or night shifts every day. If the doctors were in the Government sector, they were more likely to be in the Health Division, working in administration and public health, or they were in the armed forces and other organizations such as local councils. They worked in the smaller towns or in the districts.(ABSTRACT TRUNCATED AT 250 WORDS)     

浙江省家庭医生服务供需匹配现状及其对接策略研究* ——以平湖市为个案

目的通过对平湖市钟埭街道社区居民、家庭医生团队成员和队长进行调查,了解家庭医生服务供需匹配状况,发现存在的问题,提出促进家庭医生服务供需对接的策略和建议。方法 2018年4—5月对钟埭街道社区居民进行实证调查,采取多阶段随机抽样的方法抽取305名居民为调查对象,了解需方现况;对45名家庭医生和5名家庭医生团队队长进行调查,了解供方现况。结果结合问卷调查和访谈结果发现,目前社区卫生卫生服务中心提供的家庭医生服务存在供需不匹配的问题。究其原因,主要有家庭医生数量不足和质量不高、社区卫生服务机构硬件基础不够完备以及供需双方积极性均有待提高等。结论家庭医生制度的纵深发展离不开对供需对接策略的思考,可以从家庭医生队伍培养、社区优质卫生资源整合、公众参与表达机制建构、精准化签约服务供给以及供需双方签约积极性双提升等方面着手构思。     

Teaching on gender-related issues; a survey of psychiatry faculty and residents

A survey was distributed to 299 members of the McGill Department of Psychiatry regarding the teaching of gender-related issues. The response rate was 62.5%. The majority of respondents indicated that they were moderately or very knowledgeable about, and moderately or very interested in gender issues. Current teaching was rated as less than adequate, while future teaching was rated as very important. Women rated personal interest and importance of future teaching higher than men, but rated adequacy of current teaching lower. Residents rated personal interest higher than certified psychiatrists, but rated self-assessed knowledge lower, and tended to rate adequacy of current teaching lower.     

Continuing medical education and primary physicians' job stress, burnout and dissatisfaction

OBJECTIVES: The association between opportunities for continuing medical education (CME) and primary physicians' job stress, burnout and job dissatisfaction has not been investigated. It was hypothesized that participation in CME activities and perceived opportunities at work for keeping up-to-date with medical and professional developments would be correlated negatively with job stress and burnout, and positively with job satisfaction. METHOD: 309 primary care physicians (183 family physicians and 126 paediatricians) employed in health maintenance organizations in Israel responded to a mailed questionnaire. The independent variables were the extent of engagement in CME activities and perceived opportunities at work for professional updating. The dependent variables were job stress, burnout and job satisfaction. Multiple regression analyses were employed. RESULTS: After controlling for age, sex and professional status, participation in CME activities was associated negatively with job stress and positively with job satisfaction, among family physicians. Among paediatricians, CME was associated negatively with burnout. Perceived opportunities for professional updating were associated negatively with burnout and (marginally) with stress among family physicians, and negatively with stress and positively with satisfaction among paediatricians. A third of the paediatricians and a quarter of the family physicians wanted to increase their involvement in CME. DISCUSSION: In this cross-sectional study, causality cannot be established and the CME measures should be refined. However, the results are consistent with the study's hypotheses and suggest that opportunities for CME and professional updating may reduce physicians' job distress and dissatisfaction.     

Parent Preparation for the NICU-to-Home Transition: Staff and Parent Perceptions

Thirty-four nurses who were employed more than 20 hr per week in a neonatal intensive care unit (NICU) at a midwestern teaching hospital participated in a survey on discharge teaching. The survey consisted of 43 topics on which parents may or may not receive instruction prior to their baby's discharge from the NICU. For each topic, nurses were asked how important the topic is for parents to learn about prior to discharge, whether parents in the NICU are currently receiving instruction on the topic, and who among the NICU staff is responsible for instruction on the topic. Data obtained from this survey were compared to data obtained from a similar survey conducted 18 months previously with parents in the same NICU. Nurses rated the majority of topics in the survey as being very important for parents to learn about prior to their baby's discharge. For many of the items, a significant discrepancy existed between the percentage of nurses reporting the topics that were routinely taught and the percentage of parents who actually recalled learning about the topics. Suggestions on ways to improve the effectiveness of discharge teaching are provided.     

Small-group format for continuing medical education: a report from the field

BACKGROUND: For continuing medical education (CME) to be effective, several key features must be realized. These include a learner-directed agenda of topics, presentation of information by trusted peers or local experts, and opportunity for practice and feedback. If the information comes from several sources--printed materials, peer discussion, patient questions, and presentation from the specialist community--the perception of need for and the durability of change are enhanced. Finally, motivation for change must be high enough for change to occur, yet not overwhelming. METHOD: Facilitated small-group discussion among general practitioner colleagues with an expert specialist around clinic-based problems meets many of these requirements. When followed up by relevant literature, key concepts and practice changes are reinforced. RESULTS: We discuss our 3-year experience with the small-group format, comprising more than 25 sessions as either learners or facilitators. We describe the maturation of our group. We highlight the benefits to learners, including the relevance to clinical practice and the opportunity to ascertain the standard of care of peers. The benefits to the specialist are also discussed, including opportunities to learn which suggestions are difficult to implement. IMPLICATIONS: Our experience demonstrates that this format is sustainable over the long term. The success of the small-group format at improving CME and patient outcomes deserves further evaluation.     

Ethnic and gender differences in Southwestern students' sources of information about health

Students from several rural, Southwestern schools rated family, television, teachers and doctors as the most important of 11 sources of information about various health topics. However, doctors were only the fifth-ranked source of information about sex and reproduction and the seventh-ranked source of information about drugs, with friends being the fourth- and third-ranked sources of information about these two more personal and sensitive topics. American Indians reported even stronger reliance on doctors than did Hispanic and Anglo students, and rated clinic nurses as much more important sources of health information than did the other two ethnic groups. Females showed greater reliance on social sources and less on electronic media than did male students, and high school students relied more on print media and less on television, nurses and family than did younger children. Students felt more knowledgeable about smoking, alcohol and exercise than about diet, the heart-blood system and cancer; however, American Indians felt less informed about smoking and alcohol than did Anglos or Hispanics. These findings (especially when compared to previous results) suggest that effective health education programs must be tailored to particular populations and based on specific knowledge of their attitudes, behavior and environment.     

Training needs in adolescent medicine of practising doctors: a Swiss national survey of six disciplines

OBJECTIVE: To assess and compare the training needs in adolescent medicine of doctors within 6 specialties as a basis for the development of pre/postgraduate and continuing medical education (CME) training curricula. DESIGN: Cross-sectional postal survey. SETTING: Switzerland. PARTICIPANTS: National, representative, random sample of 1857 practising doctors in 6 disciplines (general practitioners, paediatricians, gynaecologists, internists, psychiatrists, child psychiatrists) registered with the Swiss Medical Association. MAIN OUTCOME MEASURES: Perceived importance of and training interest in 35 topics related to adolescent medicine listed in a self-administered, anonymous questionnaire. RESULTS: A total of 1367 questionnaires were returned, representing a response rate of 73.9%. Clear interest in adolescent medicine was reported by 62.1% of respondents. Topics perceived to be the most important in everyday practice were functional symptoms (71.4%), acne (67.1%), obesity (64.6%), depression-anxiety (68.1%) and communication with adolescents (61.7%). Differences between disciplines were especially marked for gynaecologists, who expressed interest almost exclusively in medical topics specific to their field. In contrast, other disciplines commonly reported a keen interest in psychosocial problems. Accordingly, interest in further training was expressed mostly for functional symptoms (62.4%), eating disorders (56.3%), depression-anxiety (53.7%) and obesity (52.6%). Issues related to injury prevention, chronic disease and confidentiality were rated as low priorities. CONCLUSIONS: Regardless of discipline, Swiss primary care doctors expressed a strong interest in adolescent medicine. Continuing medical education courses should include both interdisciplinary courses and discipline-specific sessions. Further training should address epidemiological and legal/ethical issues (e.g. injury prevention, confidentiality, impact of chronic conditions).     

Need for comprehensive women's health continuing medical education among primary care physicians

BACKGROUND: The Council on Graduate Medical Education's (COGME) Fifth Report on Women and Medicine states that "changes in undergraduate and graduate medical education, in addition to continuing medical education, are needed to address adequately the comprehensive health needs of women." Primary care physicians (PCPs) who completed residency training prior to the establishment of new guidelines for women's health education are dependent on continuing medical education (CME) to update their knowledge and skills. METHODS: Primary care physicians attending a university-based CME program in family medicine were surveyed (n = 300) about their need for CME in women's health topics. Responses were analyzed using chi-square analysis and Pearson correlations. Topics of interest were compared with women's health competencies published in 1997 by the American Board of Internal Medicine (ABIM) and in 1997 by the American Academy of Family Physicians (AAFP). RESULTS: Of 30 women's health topics listed, 22 were of interest to 50% or more of respondents and 11 were of very high interest (p < .05). Respondents most interested in women's health CME were most likely to believe CME would reduce the number of referrals currently required to evaluate women's breast problems. Topics of interest also align well with ABIM and AAFP competencies in women's health. CME in comprehensive women's health care is therefore of high interest to our respondents and topics of greatest interest are identified. IMPLICATIONS: Areas of interest correlate well with new requirements by ABIM and AAFP and should be targeted by CME programs.     

Parent Preparation for the NICU-to-Home Transition: Staff and Parent Perceptions

Thirty-four nurses who were employed more than 20 hr per week in a neonatal intensive care unit (NICU) at a midwestern teaching hospital participated in a survey on discharge teaching. The survey consisted of 43 topics on which parents may or may not receive instruction prior to their baby's discharge from the NICU. For each topic, nurses were asked how important the topic is for parents to learn about prior to discharge, whether parents in the NICU are currently receiving instruction on the topic, and who among the NICU staff is responsible for instruction on the topic. Data obtained from this survey were compared to data obtained from a similar survey conducted 18 months previously with parents in the same NICU. Nurses rated the majority of topics in the survey as being very important for parents to learn about prior to their baby's discharge. For many of the items, a significant discrepancy existed between the percentage of nurses reporting the topics that were routinely taught and the percentage of parents who actually recalled learning about the topics. Suggestions on ways to improve the effectiveness of discharge teaching are provided.     

Skills and topics in continuing medical education for rural doctors

BACKGROUND: Organizations that fund and produce continuing medical education (CME) activities must have up-to-date information on the needs of their participants. The paper describes a method for assessing priorities for the provision of facilities to rural doctors in Australia for educational topics and skills upgrades. It uses an instrument designed to establish a measure of knowledge and skills that records the difference between the "current felt need" and "desired level of competence." METHODS: A questionnaire was sent to all identifiable rural doctors throughout Australia, including participants in various types of practice. The resulting dataset is designed for future dissection and comparison of subsets by gender, practice size, rurality, and style of practice (whether procedural). It seeks to deliver a prioritized list of educational topics based on subjective gap analysis with weighting on the degree to which the need is unmet. RESULTS: There was considerable consonance between the major "felt needs" and other measures of need. IMPLICATIONS: In spite of statistical deficiencies, which would be corrected in future work, the method offers a new instrument to prioritize the use of resources for CME delivery.     

Epitaph for the Lone Ranger, MD: adapting continuing medical education to the twenty-first century

Continuing medical education (CME) is plagued by outdated ideas about how physicians should use information in treating their patients. To maintain relevance, CME programs must develop a new approach to teaching that acknowledges the realities of twenty-first century health care and offers physicians a better way to learn.     

A standardized approach to assessing physician expectations and perceptions of continuing medical education

INTRODUCTION: Rapidly expanding science and mandates for maintaining credentials place increasing demands on continuing medical education (CME) activities to provide information that is current and relevant to patient care. Quality may be seen as the perceived level of service measured against consumer expectations. Standard tools have not been developed to determine how well CME activities meet consumer expectations. METHODS: A widely used approach for evaluating perceptions of service quality in other fields, SERVQUAL, was adapted for CME by eliciting perspectives from physician consumers of CME and CME providers through nominal group techniques. These perspectives were used to develop a CMEQUAL evaluation survey instrument. Feasibility testing was conducted. Data were analyzed and items were tested for internal consistency. RESULTS: CME participants were individuals willing to complete items related to expectations before participation and perceptions after participation in a CME activity. Of the CME activity participants who provided CMEQUAL rating data for the study, 43% rated their overall perceptions of the CME activity below their overall expectations. CME activities most clearly met participant expectations in providing fair and balanced evidence-based content. Areas of lower priority for participants included opportunities for self-assessment, solving cases, and interactive learning. Two areas highly valued by participants but not adequately addressed by CME activities were (1) translating trial data to patient seen in practice and (2) addressing barriers to optimal patient management. DISCUSSION: Developing standards for evaluating physician perceptions of the quality of CME activities may assist CME providers in improving the effectiveness of CME activities in meeting physician learning needs.     

The value of clinical judgement analysis for improving the quality of doctors' prescribing decisions

BACKGROUND: Many initiatives are taken to improve prescribing decisions. Educational strategies for doctors have been effective in at least 50% of cases. Some reflection on one's own performance seems to be a common feature of the most effective strategies. So far, such reflections have mainly focused on the observed outcomes of the doctors' decisions, i.e. on what doctors do in practice. Studies in other fields have shown that another form of feedback based on the analysis of judgements may be useful as well. OBJECTIVES: The objectives of the study were to discuss the principles underlying clinical judgement analysis, give examples of its use in the medical context, and discuss its potential for improving prescribing decisions. RESULTS: Clinical judgement analysis can look behind the outcome of a decision to the underlying decision process. Carefully constructed or selected case material is required for this analysis. Combining feedback on outcomes with feedback based on clinical judgement analysis offers doctors insight both in what they do, and why or when they do it. It may reveal determinants of decision making which are not available through unaided introspection. Interventions using this combination of feedback for improving doctors' prescribing behaviour have been (partly) successful in 4 cases and unsuccessful in one case. CONCLUSIONS: Clinical judgement analysis gives doctors a structured reflection on the decision-making policy, and can help them to improve their future decisions. It may be especially useful for groups of doctors who try to work towards a consensus policy. The approach is not very helpful when simple decision rules are appropriate.     

Involving doctors in management. A survey of the management development career needs of selected doctors in NHS Wales

Reports the results of a survey of 209 senior registrars and 269 consultants throughout Wales to identify the management development needs of doctors and ascertain their views of the value and utility of current management development course offerings in Wales. Finds that, currently, management development for doctors in Wales is unstructured and uncoordinated but, despite this, many doctors, especially senior registrars, appeared keen to increase their future involvement in management and held positive views regarding management and management development. The questionnaire also required doctors to rank order six managerial topics and their elements: financial, human resource, strategic, operational, service quality and self-management. Of these, self-management issues were rated highest and there was some congruity in the rankings of the six topics by senior registrars and the other three consultant categories. Overall, managing a budget, medical and clinical audit, negotiating skills and leadership skills were ranked highest for inclusion in management development while project management, quality circles and equal opportunities received the lowest ratings.     

Survey of hospital doctors'training goals in diagnosis and management of pulmonary diseases

Although subspecialty training goals for junior hospital doctors have not been evaluated, they are potentially useful for assessing clinical competence. A questionnaire was sent to medical residents, full-time pulmonary teaching staff, and community-based physicians who were asked to rate the importance of diagnosing and managing selected pulmonary diseases for the future practices of young hospital doctors. The latter also rated their perceived preparedness for the same training goals. Generally good intra- and intergroup agreement about the relevance of most of the training goals was observed, although the hospital doctors rated a greater number of items to be more important than did the two other groups. This finding may be attributed to institutional influences and to many clinical abilities expected of all physicians. Immunological or fibrotic and paediatric respiratory disorders were rated least important by most respondents. The hospital doctors disagreed on the basis of the distribution of their ratings about their preparedness for the same goals, which probably reflects varying training experiences and background. The process of developing general professional training goals in a subspecialty requires discussion, identification, and consensus to identify and potentially correct areas of weakness, with allowance for institutional training patterns. A survey such as described in this study can provide data that can help measure clinical competence and support or define curricular changes.     

中外医学期刊继续医学教育模式调查分析

【目的】 探索医学期刊开展继续医学教育(Continuing Medical Education, CME)的模式,以提升医学期刊服务行业发展的能力。【方法】 通过期刊网站调查分析国外3种(Annals of Internal Medicine、JAMA、BMJ)和国内9种医学期刊(包括《中华医学杂志》《中华外科杂志》《中华儿科杂志》等)的CME模式,调查内容包括CME课程素材、主题、内容、结构及形式等。【结果】 3种国外期刊均在网站上创建了完善的CME平台/版块,包括多种主题和形式的CME课程,课程素材不仅局限于期刊文章;课程主题多样,包括医学专业知识和技能、医学伦理规范和医患沟通技巧等;均采用图文、音频和视频等多种媒体形式;测试内容兼顾实践能力评估,学分申领过程简便。相比之下,国内医学期刊网站缺乏完善的CME平台/版块,课程主题相对局限;素材仅来自期刊少数栏目的文章;形式相对单一,以纯文本为主;测试内容仅重视专业知识,且学分申领过程相对繁琐。【结论】 国内医学期刊应从课程素材、内容、形式及测试环节等方面改进以提高CME质量,从而推动医学知识向临床实践转化。