INTRODUCTION: In Aarhus, Denmark, advanced prehospital care was carried out by anaesthetists working in a rendezvous model with ordinary ambulances. The effect on the patient was evaluated by the physician on scene. The purpose of the study was to evaluate survival rate, health status and functional level in patients after lifesaving prehospital care. MATERIALS AND METHODS: Consecutive data were reported to a prehospital database and the National Patient Registry. Data on survival from 1998 to 2000 were retrieved. Functional level was studied in lifesaving cases in the year 2000. We interviewed the general practitioners (GPs) involved according to EuroQol. The EuroQol interview concerned health status and function level. RESULTS: In 1998-2000, prehospital anaesthetists attended a total of 11,684 patients. Treatment was described as lifesaving in 238 (2%) of the cases, and 63% of the patients (151/238) were alive one year later. In the year 2000, 79 patients were identified as having had lifesaving treatment, and 48 were alive one year later; 67% (32/48) were without functional impairment according to EuroQol. The most frequent diagnoses were self-intoxication and cardiovascular and respiratory diseases. CONCLUSION: Lifesaving prehospital care, as evaluated by the prehospital physician on scene, was performed in 2 percent of all cases attended by a prehospital anaesthetist. Of these patients, the majority were alive after one year and without functional impairment, according to their GP. The diagnoses were varied.
Comment In: Ugeskr Laeger. 2006 Jan 16;168(3):297-8; author reply 29816430828
The Clinician Assessment for Practice Program (CAPP), a program of the College of Physicians and Surgeons of Nova Scotia (CPSNS), assesses the readiness for family practice of international medical graduates (IMGs) who have trained and practiced abroad with no formal Canadian residency training.CAPP has three parts. Part A, a therapeutics exam and an objective structured clinical examination, assesses practice readiness. Part B is a 12-month mentorship in which the CAPP physician is in active practice under a defined license and is mentored by an established family physician. The mentor provides teaching, supervision, guidance, and regular performance assessment. Each CAPP physician negotiates an individualized continuing medical education plan. An on-site assessment of each CAPP physician's practice is conducted by an external assessor who provides feedback to the CAPP physician and his or her mentor. Multisource feedback is administered at 10 months, using questionnaires from patients and colleagues. After 12 months, all assessment data are reviewed by the CPSNS to determine whether to continue the defined license. Part C, run by the registration department (not CAPP), may last three additional years until full licensure is obtained. To date, 148 IMGs have been assessed, 35 have been deemed eligible for a defined license, and 27 have entered family practice, virtually all in small or medium-sized communities in Nova Scotia. The program has been well received by participants and their communities. The mentorship, particularly valuable in assisting IMGs to integrate into their communities, has proven to be the defining feature of CAPP.
INTRODUCTION: Due to shortage of general practitioners, it may be necessary to improve productivity. We assess the association between productivity, list size and patient- and practice characteristics. MATERIAL AND METHODS: A regression approach is used to perform productivity analysis based on national register data and survey data for 1,758 practices. Practices are divided into four groups according to list size and productivity. Statistical tests are used to assess differences in patient- and practice characteristics. RESULTS: There is a significant, positive correlation between list size and productivity (p
The aim of this study is to describe the role of the GP in the care of one specified cancer patient per GP and to explore the GP's knowledge about that patient's disease and treatments. A further aim was to evaluate the effects of an extended information routine, including increased information from the specialist clinic to the GP. Twenty GPs were selected for a semi-structured interview about a patient randomised either to an extended GP information routine or to standard information. The results suggest that GPs are commonly involved in the care of cancer patients, particularly in the diagnosis of the disease but also during the period of treatments and follow-up. The information from the specialist clinic to the GP is insufficient in standard care. The extended information routine increased the GPs' knowledge about the disease and treatments and facilitated their possibilities to determine patients' need for support. However, this did not affect the extent of contacts with the patient.
Reported here are the results of a study of the degree to which medical careers in general practice versus specialization are pursued by graduates of the University of Toronto Faculty of Medicine in the first six years after the completion of their internships. The retention rates in general practice and residency are documented on an annual basis using the life table method. The annual rate of attrition from general practice dropped substantially after the first three years. Fifteen percent of the initial general practice group dropped out during the first year, 10 percent of the remainder in the second year, and 8 percent of the rest in the third year. In each of the subsequent three years, the attrition rate was 4 percent, 4 percent, and 2 percent, respectively.
To explore the dimensions of family physician resilience.
Qualitative study using in-depth interviews with family physician peers.
Purposive sample of 17 family physicians.
An iterative process of face-to-face, in-depth interviews that were audiotaped and transcribed. The research team independently reviewed each interview for emergent themes with consensus reached through discussion and comparison. Themes were grouped into conceptual categories.
Four main aspects of physician resilience were identified: 1) attitudes and perspectives, which include valuing the physician role, maintaining interest, developing self-awareness, and accepting personal limitations; 2) balance and prioritization, which include setting limits, taking effective approaches to continuing professional development, and honouring the self;3) practice management style, which includes sound business management, having good staff, and using effective practice arrangements; and 4) supportive relations, which include positive personal relationships, effective professional relationships, and good communication.
Resilience is a dynamic, evolving process of positive attitudes and effective strategies.
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Over the last 10 years the number of medical students choosing family medicine as a career has steadily declined. Studies have demonstrated that career preference at the time that students begin medical school may be significantly associated with their ultimate career choice. We sought to identify the career preferences students have at entry to medical school and the factors related to family medicine as a first-choice career option.
A questionnaire was administered to students entering medical school programs at the time of entry at the University of Calgary (programs beginning in 2001 and 2002), University of British Columbia (2001 and 2002) and University of Alberta (2002). Students were asked to indicate their top 3 career choices and to rank the importance of 25 variables with respect to their career choice. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choice were also calculated. A logistic regression was performed using career choice (family v. other) as the criterion variable and the factors plus demographic characteristics as predictor variables.
Of 583 students, 519 (89%) completed the questionnaire. Only 20% of the respondents identified family medicine as their first career option, and about half ranked family medicine in their top 3 choices. Factor analysis produced 5 factors (medical lifestyle, societal orientation, prestige, hospital orientation and varied scope of practice) that explained 52% of the variance in responses. The 5 factors demonstrated acceptable internal consistency and correlated in the expected direction with the choice of family medicine. Logistic regression revealed that students who identified family medicine as their first choice tended to be older, to be concerned about medical lifestyle and to have lived in smaller communities at the time of completing high school; they were also less likely to be hospital oriented. Moreover, students who chose family medicine were much more likely to demonstrate a societal orientation and to desire a varied scope of practice.
Several factors appear to drive students toward family medicine, most notably having a societal orientation and a desire for a varied scope of practice. If the factors that influence medical students to choose family medicine can be identified accurately, then it may be possible to use such a model to change medical school admission policies so that the number of students choosing to enter family medicine can be increased.
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