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[Adaptability of physicians offering primary care to the poor: social competency revisited].

https://arctichealth.org/en/permalink/ahliterature105305
Source
Healthc Policy. 2013 Oct;9(Spec Issue):59-70
Publication Type
Article
Date
Oct-2013
Author
Christine Loignon
Alexandrine Boudreault-Fournier
Author Affiliation
Département de médecine familiale, Université de Sherbrooke, Sherbrooke, QC.
Source
Healthc Policy. 2013 Oct;9(Spec Issue):59-70
Date
Oct-2013
Language
French
Publication Type
Article
Keywords
Clinical Competence
Health services needs and demand
Humans
Interviews as Topic
Paternalism
Physician-Patient Relations
Physicians - psychology - standards
Poverty - psychology
Primary Health Care - methods
Quebec
Social Behavior
Abstract
This paper attempts to go deeper into the topic of social competency of physicians who provide primary care to populations living in poverty in Montreal. Adaptability as well as the ability to tailor practices according to patient expectations, needs and capabilities were found to be important in the development of the concept of social competency. The case of paternalism is used to demonstrate how a historically and socially contested medical approach is readapted by players in certain contexts in order to better meet patient expectations. This paper presents data collected in a qualitative study comprising 25 semi-supervised interviews with physicians recognized by their peers as having developed exemplary practices in Montreal's impoverished neighbourhoods.
PubMed ID
24289940 View in PubMed
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A comparison of pain assessment by physicians, parents and children in an outpatient setting.

https://arctichealth.org/en/permalink/ahliterature286905
Source
Emerg Med J. 2017 Mar;34(3):138-144
Publication Type
Article
Date
Mar-2017
Author
Christina Brudvik
Svein-Denis Moutte
Valborg Baste
Tone Morken
Source
Emerg Med J. 2017 Mar;34(3):138-144
Date
Mar-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Analgesics - therapeutic use
Child
Child, Preschool
Cross-Sectional Studies
Emergency Service, Hospital - manpower - organization & administration
Female
Humans
Male
Norway
Outpatients - psychology
Pain Management - methods - standards
Pain Measurement - standards
Parents - psychology
Perception
Physicians - psychology - standards
Self Report - standards
Surveys and Questionnaires
Abstract
Our objective was to compare pain assessments by patients, parents and physicians in children with different medical conditions, and analyse how this affected the physicians' administration of pain relief.
This cross-sectional study involved 243 children aged 3-15 years treated at Bergen Accident and Emergency Department (ED) in 2011. The child patient's pain intensity was measured using age-adapted scales while parents and physicians did independent numeric rating scale (NRS) assessments.
Physicians assessed the child's mean pain to be NRS=3.2 (SD 2.0), parents: NRS=4.8 (SD 2.2) and children: NRS=5.5 (SD 2.4). The overall child-parent agreement was moderate (Cohen's weighted ?=0.55), but low between child-physician (?=0.12) and parent-physician (?=0.17). Physicians significantly underestimated pain in all paediatric patients =3 years old and in all categories of medical conditions. However, the difference in pain assessment between child and physician was significantly lower for fractures (NRS=1.2; 95% CI 0.5 to 2.0) compared to wounds (NRS=3.4; CI 2.2 to 4.5; p=0.001), infections (NRS=3.1; CI 2.2 to 4.0; p=0.002) and soft tissue injuries (NRS=2.4; CI 1.9 to 2.9; p=0.007). The physicians' pain assessment improved with increasing levels of pain, but only 42.1% of children with severe pain (NRS=7) received pain relief.
Paediatric pain was significantly underestimated by ED physicians. In the absence of a self-report from the child, parents' evaluation should be listened to. Despite improved pain assessments in children with fractures and when pain was perceived to be severe, it is worrying that barely half of the children with severe pain received analgesics in the ED.
Notes
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PubMed ID
27797872 View in PubMed
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Customisation of an instrument to assess anaesthesiologists' non-technical skills.

https://arctichealth.org/en/permalink/ahliterature266260
Source
Int J Med Educ. 2015;6:17-25
Publication Type
Article
Date
2015
Author
Rikke M H G Jepsen
Lene Spanager
Helle T Lyk-Jensen
Peter Dieckmann
Doris Østergaard
Source
Int J Med Educ. 2015;6:17-25
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Anesthesiology - manpower
Awareness
Calibration
Clinical Competence
Denmark
Female
Humans
Interprofessional Relations
Interviews as Topic
Male
Middle Aged
Nurse Anesthetists - psychology - standards
Nurses
Operating Rooms - manpower
Physicians - psychology - standards
Questionnaires - standards
Social Skills
Young Adult
Abstract
The objectives of the study were to identify Danish anaesthesiologists' non-technical skills and to customise the Scottish-developed Anaesthetists' Non-Technical Skills instrument for Danish anaesthesiologists.
Six semi-structured group interviews were conducted with 31 operating room team members: anaes-thesiologists, nurse anaesthetists, surgeons, and scrub nurses. Interviews were transcribed verbatim and analysed using directed content analysis. Anaesthesiologists' non-technical skills were identified, coded, and sorted using the original instrument as a basis. The resulting prototype instrument was discussed with anaesthesiologists from 17 centres to ensure face validity.
Interviews lasted 46-67 minutes. Identified examples of anaesthesiologists' good or poor non-technical skills fit the four categories in the original instrument: situation awareness; decision making; team working; and task management. Anaesthesiologists' leadership role in the operating room was emphasised: the original 'Task Management' category was named 'Leadership'. One new element, 'Demonstrating self-awareness' was added under the category 'Situation Awareness'. Compared with the original instrument, half of the behavioural markers were new, which reflected that being aware of and communicating one's own abilities to the team; working systematically; and speaking up to avoid adverse events were important skills.
The Anaesthetists' Non-Technical Skills instrument was customised to a Danish setting using the identified non-technical skills for anaesthesiologists and the original instrument as basis. The customised instrument comprises four categories and 16 underpinning elements supported by multiple behavioural markers. Identifying non-technical skills through semi-structured group interviews and analysing them using direct content analysis proved a useful method for customising an assessment instrument to another setting.
Notes
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PubMed ID
25702157 View in PubMed
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Determining the weighting and relative importance of CanMEDS roles and competencies.

https://arctichealth.org/en/permalink/ahliterature122595
Source
BMC Res Notes. 2012;5:354
Publication Type
Article
Date
2012
Author
Brenda J Stutsky
Marilyn Singer
Robert Renaud
Author Affiliation
Division of Continuing Professional Development, University of Manitoba, Winnipeg, MB, Canada. brenda.stutsky@med.umanitoba.ca
Source
BMC Res Notes. 2012;5:354
Date
2012
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Clinical Competence - standards
Health Knowledge, Attitudes, Practice
Humans
Internet
Licensure, Medical - standards
Manitoba
Perception
Physician's Role
Physicians - psychology - standards
Physicians, Family - standards
Practice Guidelines as Topic
Program Development
Questionnaires
Specialization - standards
Abstract
The CanMEDS roles and competencies are being used as the framework to support the development of the Manitoba Practice Assessment Program (MPAP) designed to assess the competence of physicians practicing with a conditional license. Establishing the link between clinical practice and assessment of performance is critical in the development of the MPAP. A first step in establishing this link is to identify activities performed in actual clinical practice as well as the importance of those activities.
A descriptive survey design was used to answer the research questions: (1) How do physicians rate the complexity, frequency, and criticality of CanMEDS roles? (2) What is the distribution of perceived importance scores for the CanMEDS roles? Two online surveys, one specific to family practice physicians, and one specific to specialists, were emailed to a sample of Canadian physicians.
Overall perceived importance scores were calculated for each of the CanMEDS roles. It appears that each role is considered to be at least moderately important. The Medical Expert role was ranked as the most important, followed by the roles of Communicator, Professional, Collaborator, Scholar, Manager, and Health Advocate. There were no significant differences in overall CanMEDS perceived importance scores between family practice physicians and specialists (N?=?88).
Given that each of the CanMEDS roles is considered at least moderately important, a variety of assessment tools are needed to evaluate competencies across the entire spectrum of roles. The results underscore the importance of incorporating a multifaceted approach when developing a practice assessment program.
Notes
Cites: Eval Health Prof. 2012 Dec;35(4):383-9522158690
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Cites: World J Surg. 2003 Aug;27(8):972-8; discussion 97812879288
Cites: Med Educ. 2006 Aug;40(8):807-1516869928
Cites: Can J Ophthalmol. 2007 Apr;42(2):299-30417392856
Cites: Adv Health Sci Educ Theory Pract. 2011 Dec;16(5):681-9421286808
Cites: Med Teach. 2007 Sep;29(7):642-718236250
Cites: Med Educ. 2008 Sep;42(9):879-8618715485
Cites: Med Educ. 2011 Jan;45(1):36-4321155866
Cites: CJEM. 2011 Jan;13(1):34-921324295
Cites: Med Educ. 2007 Oct;41(10):990-417822413
PubMed ID
22800295 View in PubMed
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Duchenne muscular dystrophy: Canadian paediatric neuromuscular physicians survey.

https://arctichealth.org/en/permalink/ahliterature143823
Source
Can J Neurol Sci. 2010 Mar;37(2):195-205
Publication Type
Article
Date
Mar-2010
Author
Hugh J McMillan
Craig Campbell
Jean K Mah
Author Affiliation
Division of Neurology, Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa.
Source
Can J Neurol Sci. 2010 Mar;37(2):195-205
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada - epidemiology
Female
Health Surveys
Humans
Male
Muscular Dystrophy, Duchenne - complications - epidemiology
Pediatrics
Physician's Practice Patterns - standards
Physicians - psychology - standards - statistics & numerical data
Questionnaires
Abstract
Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in childhood.
To assess the current care of paediatric DMD patients in Canada, a questionnaire was mailed to 17 physicians who were members of the Canadian paediatric neuromuscular group. Areas of enquiry included; 1) multidisciplinary team composition; 2) means of DMD diagnosis; 3) corticosteroid use; surveillance and management for: 4) orthopaedic, 5) respiratory and 6) cardiac complications and 7) health maintenance (nutrition & immunizations).
Completed surveys were returned by 14/17 (82%) of physicians. Twelve respondents followed DMD patients. All centres had multidisciplinary teams, including respirology (11/12), child neurology or physiatry (11), physiotherapy (9), occupational therapy (9) and orthopaedic surgery (7). Deflazacort 0.9 mg/kg/d was used at all centres, which was continued after loss of independent ambulation (11), along with routine calcium and vitamin D supplementation (10). Night splints were prescribed at all centres. Routine surveillance studies included pulmonary function testing (11), sleep studies (10), EKG/echocardiogram (10), bone density (DEXA) scans (10), spine radiography (9), and dietician referral (4).
Paediatric DMD patients are receiving relatively consistent care in multidisciplinary clinics across Canada, in accordance with recommended guidelines for DMD.
PubMed ID
20437929 View in PubMed
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[Future physicians--"what is in it for me?" younger physicians' question--what do future workplaces demand?].

https://arctichealth.org/en/permalink/ahliterature176481
Source
Ugeskr Laeger. 2004 Dec 13;166(51):4708-9
Publication Type
Article
Date
Dec-13-2004

Physicians' attitudes and practice toward treating injection drug users with hepatitis C: results from a national specialist survey in Canada.

https://arctichealth.org/en/permalink/ahliterature135221
Source
Can J Gastroenterol. 2011 Mar;25(3):135-9
Publication Type
Article
Date
Mar-2011
Author
Angelique Myles
Gerry J Mugford
Jing Zhao
Murray Krahn
Peizhong P Wang
Author Affiliation
Division of Community Health and Humanities, Memorial University of Newfoundland.
Source
Can J Gastroenterol. 2011 Mar;25(3):135-9
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Canada - epidemiology
Clinical Competence - standards
Communication Barriers
Comprehensive Health Care - organization & administration
Cross-Sectional Studies
Eligibility Determination - standards
Female
Health Services Accessibility
Hepatitis C - etiology - therapy
Humans
Interdisciplinary Communication
Male
Middle Aged
Physicians - psychology - standards
Questionnaires
Safety Management - organization & administration
Substance Abuse, Intravenous - complications - epidemiology
Abstract
In Canada, more than 70% of new cases of hepatitis C virus (HCV) infection per year involve injection drug users (IDUs) and, currently, there is no consensus on how to offer them medical care.
To examine the characteristics of Canadian specialist physicians and their likelihood to provide treatment to HCV patients who are IDUs.
A nationwide, cross-sectional study was conducted in the specialty areas of hepatology, gastroenterology and infectious diseases to examine HCV services. The questionnaire requested information regarding basic demographics, referral pathways and opinions (yes/no), and examined how a physician's treatment regimen is influenced by factors such as treatment eligibility, HCV care management and barriers to providing quality service.
Despite the fact that the majority of prevalent and incident cases of HCV are associated with injection drug use, very few specialist physicians actually provide the necessary therapy to this population. Only 19 (19.79%) comprehensive service providers were likely to provide treatment to a current IDU who uses a needle exchange on a regular basis. The majority of comprehensive service providers (n=86 [89.58%]) were likely to provide treatment to a former IDU who was stable on substitution therapy. On bivariate analysis, factors associated with the likelihood to provide treatment to current IDUs included physicians' type, ie, infectious disease specialists compared with noninfectious specialists (OR 3.27 [95% CI 1.11 to 9.63]), and the size of the community where they practice (OR 4.16 [95% CI 1.36 to 12.71] [population 500,000 or greater versus less than 500,000]). Results of the multivariate logistic regression analysis were largely consistent with the results observed in the bivariate analyses. After controlling for other confounding variables, only community size was significantly associated with providing treatment to current IDUs (OR 3.89 [95% CI 1.06 to 14.26] [population 500,000 or greater versus less than 500,000]).
The present study highlighted the reluctance of specialists to provide treatment to current IDUs infected with HCV. Providing treatment services for HCV-infected substance abusers is challenging and there are many treatment barriers. However, effective delivery of treatment to this population will help to limit the spread of HCV. The present study clearly identified a need for improved HCV treatment accessibility for IDUs.
Notes
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PubMed ID
21499577 View in PubMed
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The professional culture among physicians in Sweden: potential implications for patient safety.

https://arctichealth.org/en/permalink/ahliterature296971
Source
BMC Health Serv Res. 2018 07 11; 18(1):543
Publication Type
Journal Article
Date
07-11-2018
Author
Marita Danielsson
Per Nilsen
Hans Rutberg
Siw Carlfjord
Author Affiliation
Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, SE-581 83, Linköping, Sweden. marita.danielsson@regionostergotland.se.
Source
BMC Health Serv Res. 2018 07 11; 18(1):543
Date
07-11-2018
Language
English
Publication Type
Journal Article
Keywords
Attitude of Health Personnel
Decision Making
Female
Health Services Research
Humans
Male
Organizational Culture
Patient Safety - standards
Physician's Role
Physicians - psychology - standards
Professional Competence - standards
Qualitative Research
Safety Management - standards
Sweden
Abstract
Patient safety culture, i.e. a subset of an organization's culture, has become an important focus of patient safety research. An organization's culture consists of many cultures, underscoring the importance of studying subcultures. Professional subcultures in health care are potentially important from a patient safety point of view. Physicians have an important role to play in the effort to improve patient safety. The aim was to explore physicians' shared values and norms of potential relevance for patient safety in Swedish health care.
Data were collected through group and individual interviews with 28 physicians in 16 semi-structured interviews, which were recorded and transcribed verbatim before being analysed with an inductive approach.
Two overarching themes, "the competent physician" and "the integrated yet independent physician", emerged from the interview data. The former theme consists of the categories Infallible and Responsible, while the latter theme consists of the categories Autonomous and Team player. The two themes and four categories express physicians' values and norms that create expectations for the physicians' behaviours that might have relevance for patient safety.
Physicians represent a distinct professional subculture in Swedish health care. Several aspects of physicians' professional culture may have relevance for patient safety. Expectations of being infallible reduce their willingness to talk about errors they make, thus limiting opportunities for learning from errors. The autonomy of physicians is associated with expectations to act independently, and they use their decisional latitude to determine the extent to which they engage in patient safety. The physicians perceived that organizational barriers make it difficult to live up to expectations to assume responsibility for patient safety. Similarly, expectations to be part of multi-professional teams were deemed difficult to fulfil. It is important to recognize the implications of a multi-faceted perspective on the culture of health care organizations, including physicians' professional culture, in efforts to improve patient safety.
PubMed ID
29996832 View in PubMed
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Renowned physicians' perceptions of expert diagnostic practice.

https://arctichealth.org/en/permalink/ahliterature121365
Source
Acad Med. 2012 Oct;87(10):1413-7
Publication Type
Article
Date
Oct-2012
Author
Maria Mylopoulos
Lynne Lohfeld
Geoffrey R Norman
Gurpreet Dhaliwal
Kevin W Eva
Author Affiliation
University of Toronto Faculty of Medicine, Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada. maria.mylopoulos@utoronto.ca
Source
Acad Med. 2012 Oct;87(10):1413-7
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Clinical Competence - standards
Clinical Medicine - standards
Diagnosis
Faculty, Medical
Female
Humans
Interviews as Topic
Learning
Male
Middle Aged
Models, Theoretical
Physician-Patient Relations
Physicians - psychology - standards
Professional Practice
United States
Abstract
To further the development of a substantive theory of expert diagnostic practice, the authors explored the ways in which exceptional physicians, nominated by their peers, conceptualized their own diagnostic expertise specifically and diagnostic excellence generally.
In this grounded theory, interview-based study, physicians at six North American research sites were nominated by their peers as exceptional diagnosticians and exceptional professionals and invited to participate in the study. A saturation sample included 34 participants, 20 exceptional diagnosticians, and 14 exceptional professionals. Using a constant comparative approach, the authors conducted one-on-one interviews with participants, transcribed the audiotapes of those interviews, and analyzed them for emergent themes. They developed a stable thematic structure and applied it to the entire data set.
Four interconnected themes emerged that inform the community's understanding of how physicians conceptualize expert diagnostic practice: (1) possession of extensive knowledge built through purposeful, continuous engagement in clinical practice, (2) possession of the skills to effectively gather patient stories, (3) reflective integration of that knowledge and those patient stories during diagnosis, and (4) continuous learning through clinical practice.
Exploring these results within the context of current discourses in medical education brings to the forefront two key features of physicians' construction of diagnostic excellence: (1) the integrated nature of the medical competencies that underpin the diagnostic process and (2) the optimally adaptive nature of the diagnostic process. These findings can inform the development of practical and effective pedagogical strategies to guide trainees, clinicians, and medical educators who strive for excellence.
PubMed ID
22914510 View in PubMed
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The uncertain consultation and patient satisfaction: the impact of patients' illness perceptions and a randomized controlled trial on the training of physicians' communication skills.

https://arctichealth.org/en/permalink/ahliterature70486
Source
Psychosom Med. 2005 Nov-Dec;67(6):897-905
Publication Type
Article
Author
Lisbeth Frostholm
Per Fink
Eva Oernboel
Kaj S Christensen
Tomas Toft
Frede Olesen
John Weinman
Author Affiliation
Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark.
Source
Psychosom Med. 2005 Nov-Dec;67(6):897-905
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Attitude to Health
Communication
Comparative Study
Family Practice - education - methods - standards
Female
Follow-Up Studies
Health Services Research
Health status
Humans
Male
Middle Aged
Multivariate Analysis
Patient satisfaction
Personality Inventory
Physicians - psychology - standards
Prognosis
Psychiatric Status Rating Scales
Questionnaires
Referral and Consultation - standards
Regression Analysis
Research Support, Non-U.S. Gov't
Somatoform Disorders - diagnosis - psychology - therapy
Teaching
Abstract
OBJECTIVE: To identify predictors of patient satisfaction among a range of patient and practitioner variables. In particular, to focus on patients' illness perceptions and the impact of a randomized controlled trial on the training of physicians in general communication skills and how to treat patients presenting with poorly defined illness. METHODS: A randomized controlled follow-up study conducted in 28 general practices in Aarhus County, Denmark. Half of the physicians were randomized into an educational program on treatment of patients presenting with medically unexplained symptoms (somatization). One thousand seven hundred eighty-five general practice attenders presenting a new health problem completed questionnaires on illness perceptions, physical functioning, and mental distress before the consultation. After the consultation, a questionnaire including relational and communicative domains of patient satisfaction with the current consultation was completed. The physicians completed a questionnaire for each patient on diagnostics and prognostics. Predictors of patient satisfaction were determined by logistic regression. RESULTS: A large number of patient and practitioner variables predicted satisfaction in univariate logistic regression models. Results from a multivariate logistic model showed that the illness perceptions "uncertainty" (patient not knowing what is wrong) and "emotional representations" (the complaint making the patient feel worried, depressed, helpless, afraid, hopeless) predicted dissatisfaction at OR (CI) = 1.8 (1.3-2.4), p
PubMed ID
16314594 View in PubMed
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12 records – page 1 of 2.