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Author: Brian S McGowan, PhD

ABSTRACT: From Time-Based to Competency-Based Standards: Core Transitional Competencies in Plastic Surgery.

PURPOSE:
Competency-based medical education is becoming increasingly prevalent and is likely to be mandated by the Royal College in the near future. The objective of this study was to define the core technical competencies that should be possessed by plastic surgery residents as they transition into their senior (presently postgraduate year 3) years of training.
METHODS:
A list of potential core competencies was generated using a modified Delphi method that included the investigators and 6 experienced, academic plastic surgeons from across Canada and the United States. Generated items were divided into 7 domains: basic surgical skills, anesthesia, hand surgery, cutaneous surgery, esthetic surgery, breast surgery, and craniofacial surgery. Members of the Delphi group were asked to rank particular skills on a 4-point scale with anchored descriptors. Item reduction resulted in a survey consisting of 48 skills grouped into the aforementioned domains. This self-administered survey was distributed to all Canadian program directors (n = 11) via e-mail for validation and further item reduction.
RESULTS:
The response rate was 100% (11/11). Using the average rankings of program directors, 26 “core” skills were identified. There was agreement of core skills across all domains except for breast surgery and esthetic surgery. Of them, 7 skills were determined to be above the level of a trainee at this stage; a further 15 skills were agreed to be important, but not core, competencies.
CONCLUSIONS:
Overall, 26 competencies have been identified as “core” for plastic surgery residents to possess as they begin their senior, on-service years. The nature of these skills makes them suitable for teaching in a formal, simulated environment, which would ensure that all plastic surgery trainees are competent in these tasks as they transition to their senior years of residency

via From Time-Based to Competency-Based Standards: Core Transitional Co… – PubMed – NCBI.

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MANUSCRIPT: A modified evidence-based practice- knowledge, attitudes, behaviour and decisions/outcomes questionnaire is valid across multiple professions involved in pain management

A validated and reliable instrument was developed to knowledge, attitudes and behaviours with respect to evidence-based practice EBB-KABQ in medical trainees but requires further adaptation and validation to be applied across different health professionals.MethodsA modified 33-item evidence-based practice scale EBP-KABQ was developed to evaluate EBP perceptions and behaviors in clinicians. An international sample of 673 clinicians interested in treatment of pain mean age?=?45?years, 48% occupational therapists/physical therapists, 25% had more than 5?years of clinical training completed an online English version of the questionnaire and demographics. Scaling properties internal consistency, floor/ceiling effects and construct validity association with EBP activities, comparator constructs were examined. A confirmatory factor analysis was used to assess the 4-domain structure EBP knowledge, attitudes, behavior, outcomes/decisions.ResultsThe EBP-KABQ scale demonstrated high internal consistency Cronbach?s alpha?=?0.85, no evident floor/ceiling effects, and support for a priori construct validation hypotheses. A 4-factor structure provided the best fit statistics CFI =0.89, TLI =0.86, and RMSEA?=?0.06.ConclusionsThe EBP-KABQ scale demonstrates promising psychometric properties in this sample. Areas for improvement are described.

via BMC Medical Education | Abstract | A modified evidence-based practice- knowledge, attitudes, behaviour and decisions/outcomes questionnaire is valid across multiple professions involved in pain management.

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RESOURCE: Which academic research caught the public imagination in 2014?

At Altmetric, we track who’s saying what about academic papers. Here, we take a look back at 2014, with a review of the 100 papers that received the most attention online – and the conversations that happened around them.
You can find out more about how we collect data and put this list together on our blog.

via Altmetric Top 100 – 2014.

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ABSTRACT: How do medical doctors in the European Union demonstrate that they continue to meet criteria for registration and licencing?

This paper reviews procedures for ensuring that physicians in the European Union (EU) continue to meet criteria for registration and the implications of these procedures for cross-border movement of health professionals following implementation of the 2005/36/EC Directive on professional qualifications. A questionnaire was completed by key informants in 10 EU member states, supplemented by a review of peer-reviewed and grey literature and a review conducted by key experts in each country. The questionnaire covered three aspects: actors involved in processes for ensuring continued adherence to standards for registration and/or licencing (such as revalidation), including their roles and functions; the processes involved, including continuing professional development (CPD) and/or continuing medical education (CME); and contextual factors, particularly those impacting professional mobility. All countries included in the study view CPD/CME as one mechanism to demonstrate that doctors continue to meet key standards. Although regulatory bodies in a few countries have established explicit systems of ensuring continued competence, at least for some doctors (in Belgium, Germany, Hungary, the Netherlands, Slovenia and the UK), self-regulation is considered sufficient to ensure that physicians are up to date and fit to practice in others (Austria, Finland, Estonia and Spain). Formal systems vary greatly in their rationale, structure, and coverage. Whereas in Germany, Hungary and Slovenia, systems are exclusively focused on CPD/CME, the Netherlands also includes peer review and minimum activity thresholds. Belgium and the UK have developed more complex mechanisms, comprising a review of complaints or compliments on performance and (in the UK) colleague and patient questionnaires. Systems for ensuring that doctors continue to meet criteria for registration and licencing across the EU are complex and inconsistent. Participation in CPD/CME is only one aspect of maintaining professional competence but it is the only one common to all countries. Thus, there is a need to bring clarity to this confused landscape.

via How do medical doctors in the European Union demonstrate that they … – PubMed – NCBI.

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ABSTRACT: If Exercise is Medicine®, Where is Exercise in Medicine? Review of U.S. Medical Education Curricula for Physical Activity-Related Content.

BACKGROUND:
This study provides an update on the amount and type of physical activity education occurring in medical education in the United States in 2013. It is the first study to do so since 2002.
METHODS:
Applying content analysis methodology, we reviewed all accessible accredited doctor of medicine and doctor of osteopathic medicine institutions’ websites for physical activity education related coursework (N = 118 fully accessible; 69.41%).
RESULTS:
The majority of institutions did not offer any physical activity education-related courses. When offered, they were rarely required. Courses addressing sports medicine and exercise physiology were offered more than courses in other content domains. Most courses were taught using a clinical approach. No differences were observed between MD and DO institutions, or between private and public institutions.
CONCLUSIONS:
Over half of the physicians trained in the United States in 2013 received no formal education in physical activity and may, therefore, be ill-prepared to assist their patients in a manner consistent with Healthy People 2020, the National Physical Activity Plan, or the Exercise is Medicine® initiative. The Bipartisan Policy Center, American College of Sports Medicine, and the Alliance for a Healthier Generation called for a reversal of this situation on June 23, 2014.

via If Exercise is Medicine®, Where is Exercise in Medicine? Review of … – PubMed – NCBI.

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ABSTRACT: Systems-based practice: learning the concepts using a teamwork competition model.

BACKGROUND:
Systems-based practice (SBP) is a core competency of the Accreditation Council for Graduate Medical Education (ACGME) that must be integrated into residency training. We sought to develop a method to improve resident understanding using a teamwork competition model.
METHODS:
The residents were given a pretest to assess their understanding of SBP followed by a didactic lecture. They were then divided into teams to solve a programmatic “problem” in the residency. Each team had to prove that their solution best fulfilled the expectations of SBP. Their solutions were then presented at a departmental conference followed by a post-test to evaluate knowledge.
RESULTS:
In the pretest, 33% of the residents understood what SBP meant and only 15% knew the components of SBP. In the post-test, this increased to 85% and 89%, respectively.
CONCLUSIONS:
SBP is a competency mandated by the Accreditation Council for Graduate Medical Education in residency training. Using a novel approach, we were able to improve the residents’ understanding of SBP.

via Systems-based practice: learning the concepts using a teamwork comp… – PubMed – NCBI.

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ABSTRACT: [Exponential use of social media in medicine: Example of the interest of Twitter© in urology.]

AIM:
Social media (#SoMe) has changed the face of modern medicine. Our purpose was to asses the potential interest of Twitter in the field of urology.
MATERIAL AND METHODS:
A systematic review of the literature has been performed using PubMed without timeline restriction with the following keywords (MeSH): social media; Web 2.0; Twitter; Internet; network; urology; journal club; education.
RESULTS:
There were 3 categories of interest of Twitter in the field of urology: spread of scientific knowledge, scientific interaction during medical conferences and medical education and international medical debates. The unique spread of evidence-based-medecine through traditional scientific journals in paper version is over. Main scientific journals in urology and scientific societies are now using a Twitter account and became virtual. They use new bibliometrics available on #SoMe to estimate the social impact. Twitter allows for a better interactivity of doctors attending scientific conferences. Exponential use of Twitter is in the interest of speakers and leaders, audience and scientific societies. Lastly, medical academic education and continuing medical education can be achieved through #SoMe. Twitter became a lively virtual platform for scientific debates for complex oncological cases (dematerialized tumor board). Twitter is also a place for intense scientific discussion during virtual journal club without geographic or timeline restriction.
CONCLUSION:
Physicians need to respect the rules for a wise use of #SoMe in order not to break the Hippocratic Oath. There is a revolution around #SoMe and Twitter in the spread of scientific knowledge and academic teaching. International urologists are already committed in this evolution and France should also get involved.

via [Exponential use of social media in medicine: Example of the intere… – PubMed – NCBI.

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ABSTRACT: A Patient-centered Approach to Managing Patients with Type 2 Diabetes

Despite the availability of a number of therapeutic options, management of type 2 diabetes (T2DM) and hyperglycemia remains suboptimal. Evidence shows that physicians are not adequately individualizing incretin-based therapies as there is lack of clear understanding of the similarities and differences between various incretin-based therapies. Additionally, sodium-dependent glucose co-transporter 2 (SGLT2) inhibitors, a very recent addition to the therapeutic armamentarium, are not adequately utilized in managing patients with T2DM due to a lack of awareness or an increased concern regarding their safety, efficacy, and the mechanism of action. Insulin therapy is also not initiated or intensified appropriately due to a lack of clear understanding on when to add and how to intensify them and, more importantly, due to fear of increasing the risk of hypoglycemia in patients. To address these gaps, in the first section of this educational activity, the expert faculty will review the current understanding of the risks associated with hypoglycemia-one of the main factors that limit the successful use of insulin therapy-and when to initiate insulin therapy, as well as the available data on the risk of hypoglycemia with emerging agents. The expert faculty will also provide practical strategies on how to minimize the risk of hypoglycemia in patients. In the second section, the expert faculty will highlight the differences between the various incretin-based therapies in addition to providing strategies for physicians to individualize their choice of incretin-based therapy. The expert faculty will also review the mechanism of action, safety, efficacy, and the appropriate place for this class of therapies in the treatment continuum. In the third section, the expert faculty will discuss the mechanism of action, safety, and efficacy of the currently available SGLT2 inhibitors as well as the appropriate use of these newer agents in T2DM management.

via A Patient-centered Approach to Managing Patients with Type 2 Diabetes. – PubMed – NCBI.

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ABSTRACT: Polycystic ovary syndrome: A review for dermatologists: Part II. Treatment

Dermatologists are in a key position to treat the manifestations of polycystic ovary syndrome (PCOS). The management of PCOS should be tailored to each woman’s specific goals, reproductive interests, and particular constellation of symptoms. Therefore, a multidisciplinary approach is recommended. In part II of this continuing medical education article, we present the available safety and efficacy data regarding treatments for women with acne, hirsutism, and androgenetic alopecia. Therapies discussed include lifestyle modification, topical therapies, combined oral contraceptives, antiandrogen agents, and insulin-sensitizing drugs. Treatment recommendations are made based on the current available evidence.

via Polycystic ovary syndrome: A review for dermatologists: Part II. Tr… – PubMed – NCBI.

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ABSTRACT: Polycystic ovary syndrome: A review for dermatologists: Part I. Diagnosis and manifestations.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women who are of reproductive age. The pathogenesis involves several associated hormonal pathways that culminate in metabolic, reproductive, and cardiovascular effects. The hallmark features of hyperandrogenism and hyperinsulinemia have systemic long-term implications. Dermatologists frequently evaluate and manage the cutaneous manifestations of PCOS (ie, acanthosis nigricans, hirsutism, acne, and alopecia), and therefore play a key role in its diagnosis and management. In part I of this continuing medical education article, we review the definition, etiology, pathogenesis, and clinical features of PCOS.

via Polycystic ovary syndrome: A review for dermatologists: Part I. Dia… – PubMed – NCBI.

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