Genetic testing for a variety of diseases is becoming more available to primary care physicians, but it is unclear how useful physicians perceive these tests to be. We examined academic family physicians' perception of and experiences with clinical genetic testing and direct-to-consumer genetic testing.
This study is an analysis of a survey conducted as part of the Council of Academic Family Medicine Educational Research Alliance (CERA). Academic family physicians in the United States and Canada were queried about their perception of genetic testing's utility, how frequently patients ask about genetic testing, and the importance of genetic testing in future practice and education of students and residents.
The overall survey had a response rate of 45.1% (1,404/3,112). A majority (54.4%) of respondents felt that they were not knowledgeable about available genetic tests. Respondents perceived greater utility of genetic tests for breast cancer (94.9%) and hemochromatosis (74.9%) than for Alzheimer's disease (30.3%), heart disease (25.4%), or diabetes (25.2%). Individuals with greater self-perceived knowledge of genetic tests were more likely to feel that genetic testing would have a significant impact on their future practice (23.1%) than those with less knowledge (13.4%). Respondents had little exposure to direct-to-consumer genetic tests, but a majority felt that they were more likely to cause harm than benefit.
Academic family physicians acknowledge their lack of knowledge about genetic tests. Educational initiatives may be useful in helping them incorporate genetic testing into practice and in teaching these skills to medical students and residents.
A profile of the activities and responsibilities of vice chairs for education is notably absent from the medical education literature. The authors sought to determine the demographics, roles and responsibilities, and major priorities and challenges faced by vice chairs for education.
In 2010, the authors sent a confidential, Web-based survey to all 82 identified department of medicine vice chairs for education in the United States and Canada. The authors inquired about demographics, roles, expectations of and for their position, opinions on the responsibilities outlined for their position, metrics used to evaluate their success, top priorities, and job descriptions. Analysis included creating descriptive statistics and categorizing the qualitative comments.
Fifty-nine vice chairs for education (72%) responded. At the time of appointment, only 6 (10%) were given a job description, and only 17 (28%) had a defined job description and metrics used to evaluate their success. Only 20 (33%) had any formal budget management training, and 23 (38%) controlled an education budget. Five themes emerged regarding the responsibilities and goals of the vice chair for education: oversee educational programs; possess educational expertise; promote educational scholarship; serve in leadership activities; and, disturbingly, respondents found expectations to be vague and ill defined.
Vice chairs for education are departmental leaders. The authors' findings and recommendations can serve as a beginning for defining educational directions and resources, building consensus, and designing an appropriate educational infrastructure for departments of medicine.
The adoption of new medical technologies often generates losses in efficiency associated with the excess or insufficient acquisition of new equipment, an inappropriate choice (in terms of economic and clinical parameters) of medical equipment, and its poor use. Russia is a good example for exploring the problem of the ineffective adoption of new medical technologies due to the massive public investment in new equipment for medical institutions in 2006-2013. This study examines the procurement of new technologies in Russian hospitals to find the main causes of inefficiency. The research strategy was based on in-depth semistructured interviews with representatives of prominent actors (regional health care authorities, hospital executives, senior physicians). The main result is that inefficiencies arise from the contradiction between hospitals' and authorities' motivation for acquiring new technologies: hospitals tend to adopt technologies which bring benefits to their department heads and physicians and minimize maintenance and servicing costs, while the authorities' main concern is the initial cost of the technology.
The purpose of this study was to determine the factors that help or hinder the adoption of new procedures and practices by Canadian radiologists. Canadian radiologists were asked, by means of a mail survey, for information about innovations in practice adopted during the previous 2 years or planned for the next 2 years. Surveys were sent to the 1077 practising radiologists registered in the Canadian Association of Radiologists as of Sept. 30, 1991; 325 responded (30.2%). The responses were correlated with demographic information obtained in the same survey and through the Maintenance of Competence Program of the Royal College of Physicians and Surgeons of Canada. Magnetic resonance imaging (MRI) was more likely to be adopted in larger communities (those with a population of more than 500,000), computed tomography in medium-sized and larger communities (more than 100,000), mammography in medium-sized and smaller communities (500,000 or less) and ultrasonography (US) in smaller communities (100,000 or less). Radiologists with a faculty appointment at a university were more likely to adopt MRI and digital imaging, whereas those with no faculty status were more likely to adopt US and structural changes to a practice. The authors conclude that the size of the community in which a practice is located and the practitioner's faculty status both play a role in the adoption of innovations.
Facing a projected $1.4M deficit on a $35M operating budget for fiscal year 2011/2012, members of the Dalhousie University Faculty of Medicine developed and implemented an explicit, transparent, criteria-based priority setting process for resource reallocation. A task group that included representatives from across the Faculty of Medicine used a program budgeting and marginal analysis (PBMA) framework, which provided an alternative to the typical public-sector approaches to addressing a budget deficit of across-the-board spending cuts and political negotiation. Key steps to the PBMA process included training staff members and department heads on priority setting and resource reallocation, establishing process guidelines to meet immediate and longer-term fiscal needs, developing a reporting structure and forming key working groups, creating assessment criteria to guide resource reallocation decisions, assessing disinvestment proposals from all departments, and providing proposal implementation recommendations to the dean. All departments were required to submit proposals for consideration. The task group approved 27 service reduction proposals and 28 efficiency gains proposals, totaling approximately $2.7M in savings across two years. During this process, the task group faced a number of challenges, including a tight timeline for development and implementation (January to April 2011), a culture that historically supported decentralized planning, at times competing interests (e.g., research versus teaching objectives), and reductions in overall health care and postsecondary education government funding. Overall, faculty and staff preferred the PBMA approach to previous practices. Other institutions should use this example to set priorities in times of fiscal constraints.
Because of shrinking resources and the resulting threat to its academic vitality the Department of Paediatrics, Hospital for Sick Children, University of Toronto, entered into an agreement on alternative funding with the Ontario Ministry of Health in 1990. The department developed a set of principles that guided the negotiations, which ultimately led to a budget that formed the basis of the agreement. The contract with the ministry provides a global budget to the department; this budget funds faculty members, administrative staff and the educational and research programs formerly supported by fee-for-service billing to the Ontario Health Insurance Plan. The alternative funding plan has provided financial stability to the department and affords an opportunity to develop innovative and cost-effective models of pediatric care.