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Review of UKFPO required: unrepresentative, uncommunicative, and uncompassionate. BMJ 2021; 374:n1336. [PMID: 34341003 DOI: 10.1136/bmj.n1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Accelerated Graduation and the Deployment of New Physicians During the COVID-19 Pandemic. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1492-1494. [PMID: 32520751 PMCID: PMC7302071 DOI: 10.1097/acm.0000000000003540] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The COVID-19 pandemic has presented unprecedented challenges and opportunities for medical schools in the United States. In this Invited Commentary, the authors describe a unique collaboration between the University of Massachusetts Medical School (UMMS), the only public medical school in the state; the University of Massachusetts Memorial Medical Center (UMMMC); and the Commonwealth of Massachusetts. Through this partnership, UMMS was able to graduate fourth-year medical students 2 months early and deploy them to UMMMC to care for patients and alleviate workforce shortages during the COVID-19 surge, which peaked in Massachusetts in April 2020. The authors describe how they determined if students had fulfilled graduation requirements to graduate early, what commencement and the accompanying awards ceremony looked like this year as virtual events, the special emergency 90-day limited license these new graduates were given to practice at UMMMC during this time, and the impact these new physicians had in the hospital allowing residents and attendings to be redeployed to care for COVID-19 patients.
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Exploring the evolving concept of 'patient ownership' in the era of resident duty hour regulations-experience of residents and faculty in an internal medicine night float system. PERSPECTIVES ON MEDICAL EDUCATION 2019; 8:353-359. [PMID: 31642049 PMCID: PMC6904378 DOI: 10.1007/s40037-019-00540-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Despite the use of 'patient ownership' as an embodiment of professionalism and increasing concerns over its loss among trainees, how its development in residents has been affected by duty hour regulations has not been well described. In this qualitative study, we aim to outline the key features of patient ownership in internal medicine, factors enabling its development, and how these have been affected by the adoption of a night float system to comply with duty hour regulations. METHODS In this qualitative descriptive study, we interviewed 18 residents and 12 faculty internists at one university centre and conducted a thematic analysis of the data focused on the concept of patient ownership. RESULTS We identified three key features of patient ownership: personal concern for patients, professional capacity for autonomous decision-making, and knowledge of patients' issues. Within the context of a night float system, factors that facilitate development of patient ownership include improved fitness for duty and more consistent interactions with patients/families resulting from working the same shift over consecutive days (or nights). Conversely, the increase in patient handovers, if done poorly, is a potential threat to patient ownership development. Trainees often struggle to develop ownership when autonomy is not supported with supervision and when role-modelling by faculty is lacking. DISCUSSION These features of patient ownership can be used to frame discussions when coaching trainees. Residency programs should be mindful of the downstream effects of shift-based scheduling. We propose strategies to optimize factors that enable trainee development of patient ownership.
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Institutional differences in USMLE Step 1 and 2 CK performance: Cross-sectional study of 89 US allopathic medical schools. PLoS One 2019; 14:e0224675. [PMID: 31682639 PMCID: PMC6827894 DOI: 10.1371/journal.pone.0224675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/19/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction The United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) are important for trainee medical knowledge assessment and licensure, medical school program assessment, and residency program applicant screening. Little is known about how USMLE performance varies between institutions. This observational study attempts to identify institutions with above-predicted USMLE performance, which may indicate educational programs successful at promoting students’ medical knowledge. Methods Self-reported institution-level data was tabulated from publicly available US News and World Report and Association of American Medical Colleges publications for 131 US allopathic medical schools from 2012–2014. Bivariate and multiple linear regression were performed. The primary outcome was institutional mean USMLE Step 1 and Step 2 CK scores outside a 95% prediction interval (≥2 standard deviations above or below predicted) based on multiple regression accounting for students’ prior academic performance. Results Eighty-nine US medical schools (54 public, 35 private) reported complete USMLE scores over the three-year study period, representing over 39,000 examinees. Institutional mean grade point average (GPA) and Medical College Admission Test score (MCAT) achieved an adjusted R2 of 72% for Step 1 (standardized βMCAT 0.7, βGPA 0.2) and 41% for Step 2 CK (standardized βMCAT 0.5, βGPA 0.3) in multiple regression. Using this regression model, 5 institutions were identified with above-predicted institutional USMLE performance, while 3 institutions had below-predicted performance. Conclusions This exploratory study identified several US allopathic medical schools with significant above- or below-predicted USMLE performance. Although limited by self-reported data, the findings raise questions about inter-institutional USMLE performance parity, and thus, educational parity. Additional work is needed to determine the etiology and robustness of the observed performance differences.
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[Medical Student Secrecy, its Link to the Duty of Confidentiality and the Right to Access and Reuse Health Information]. ACTA MEDICA PORT 2019; 32:11-13. [PMID: 30753797 DOI: 10.20344/amp.10958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/30/2018] [Indexed: 11/20/2022]
Abstract
The authors address the legal void that exists regarding medical student access to clinical records and health information that local healthcare organizations hold under legal and institutional custody. They develop a legal thesis that configures the creation of medical student professional secrecy and its connection with the duty of confidentiality as assumptions that underlie the medical student's right to access and reuse health information. Medical students have the legitimacy to access health information and clinical records, as they bear an unequivocal informational, legitimate, constitutionally protected and sufficiently relevant need. They conclude that the legislature must work together with universities and hospital institutions to legally establish the concept of Medical Student Professional Secrecy, its link to the duty of confidentiality and the right of the medical student to access and reuse health information. Furthermore, it must do so in a specific legal act and in the precise terms of the text approved unanimously by the Council of Portuguese Medical Schools, by the National Council of Medical Ethics and Deontology, by the National Council of the Portuguese Medical Association and by its President.
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The right to exit and skilled labour emigration: Ethical considerations for compulsory health service programmes. Dev World Bioeth 2018; 19:169-179. [PMID: 30548442 DOI: 10.1111/dewb.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/09/2018] [Accepted: 09/20/2018] [Indexed: 12/01/2022]
Abstract
Compulsory (health) service contracts have recently received considerable attention in the normative literature. The service contracts are considered and offered as a permissible and liberal alternative to emigration restrictions if individuals relinquish their right to exit via contract in exchange for the state-funded tertiary education. To that end, the recent normative literature on the service programmes has particularly focused on discussing the circumstances or conditions in which the contracts should be signed, so that they are morally binding on the part of the skilled workers. However, little attention is devoted to the relevance of the right to exit for the debate on compulsory service programmes. In this paper, I argue that even if the service contracts are voluntary, and thus the would-be medical students voluntarily relinquish their right to exit, the reasons behind the right should be taken into account for the contracts to be morally valid. A clear understanding of the right to exit is a must in order not to breach its basic components and for the service contracts to be morally binding. To that end, I provide two accounts of the reasons to value the right to exit by presenting Patti Lenard's discussion of the right to exit and by reconstructing James Griffin's account of human rights. I conclude by offering brief ethical considerations for compulsory health service programmes grounded in the reasons to value the right to exit.
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Sexual Harassment in Medical Schools: The Challenge of Covert Retaliation as a Barrier to Reporting. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1770-1773. [PMID: 29794528 DOI: 10.1097/acm.0000000000002302] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Although Title IX, the federal law prohibiting sexual harassment in educational institutions, was enacted in 1972, sexual harassment continues to be distressingly common in medical training. In addition, many women who experience sexual harassment do not report their experiences to authorities within the medical school.In this article, the authors review the literature on the prevalence of sexual harassment in medical schools since Title IX was enacted and on the cultural and legal changes that have occurred during that period that have affected behaviors. These changes include decreased tolerance for harassing behavior; increased legal responsibility assigned to institutions; and a significant increase in the number of female medical students, residents, and faculty. The authors then discuss persisting barriers to reporting sexual harassment, including fears of reprisals and retaliation, especially covert retaliation. They define covert retaliation as vindictive comments made by a person accused of sexual harassment about his or her accuser in a confidential setting, such as a grant review, award selection, or search committee.The authors conclude by highlighting institutional and organizational approaches to decreasing sexual harassment and overt retaliation, and they propose other approaches to decreasing covert retaliation. These initiatives include encouraging senior faculty members to intervene and file bystander complaints when they witness inappropriate comments or behaviors as well as group reporting when multiple women are harassed by the same person.
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'Reasonable accommodation' for medical professionals with congenital colour vision deficiency. THE NATIONAL MEDICAL JOURNAL OF INDIA 2018; 31:65-66. [PMID: 30829218 DOI: 10.4103/0970-258x.253161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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What you should know about the 1500 increase in medical school places. BMJ 2017; 359:j5166. [PMID: 31055467 DOI: 10.1136/sbmj.j5166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Visions and reality: the idea of competence-oriented assessment for German medical students is not yet realised in licensing examinations. GMS JOURNAL FOR MEDICAL EDUCATION 2017; 34:Doc25. [PMID: 28584873 PMCID: PMC5450428 DOI: 10.3205/zma001102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 02/21/2017] [Accepted: 03/07/2017] [Indexed: 05/24/2023]
Abstract
Objective: Competence orientation, often based on the CanMEDS model, has become an important goal for modern curricula in medical education. The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) has been adopted in Germany. However, it is currently unknown whether the vision of competence orientation has also reached the licensing examination procedures. Methods: Therefore, a prospective, descriptive, single-centre, exemplary study design was applied to evaluate 4051 questions/tasks (from 28 examiners at 7 two-day licensing oral-practical exams) for undergraduate medical students at the University of Ulm. The oral and practical questions/tasks as well as the real bedside assessment were assigned to specific competence roles (NKLM section I), categories (NKLM section II) and taxonomy levels of learning domains. Results: Numerous questions/tasks were set per candidate (day 1/2: 70±24/86±19 questions) in the licensing oral-practical exam. Competence roles beyond the "medical expert" were scarcely considered. Furthermore, practical and communication skills at the bedside were hardly addressed (less than 3/15 min). Strikingly, there was a significant predominance of questions with a low-level taxonomy. Conclusions: The data indicate a misalignment of competence-oriented frameworks and the "real world" licensing practical-oral medical exam, which needs improvement in both evaluation and education processes.
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U.S. Medical Schools' Compliance With the Americans With Disabilities Act: Findings From a National Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:979-986. [PMID: 26796093 DOI: 10.1097/acm.0000000000001087] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Physician diversity improves care for underserved populations, yet there are few physicians with disabilities. The authors examined the availability of technical standards (TSs) from U.S. medical schools (MD- and DO-granting) and evaluated these relative to intent to comply with the Americans with Disabilities Act (ADA). METHOD Document analysis was conducted (2012-2014) on U.S. medical schools' TSs for hearing, visual, and mobility disabilities. Primary outcome measures were ease of obtaining TSs, willingness to provide reasonable accommodations, responsibility for accommodations, and acceptability of intermediaries or auxiliary aids. RESULTS TSs were available for 161/173 (93%) schools. While 146 (84%) posted these on their Web sites, 100 (58%) were located easily. Few schools, 53 (33%), had TSs specifically supporting accommodating disabilities; 79 (49%) did not clearly state policies, 6 (4%) were unsupportive, and 23 (14%) provided no information. Most schools, 98 (61%), lacked information on responsibility for providing accommodations, 33 (27%) provided accommodations, and 10 (6%) had students assume some responsibility. Approximately 40% allowed auxiliary aids (e.g., motorized scooter), but < 10% allowed intermediaries (e.g., sign language interpreter). Supportive schools were more likely to allow accommodations (P < .001), assume responsibility for accommodations (P < .001), and accept intermediaries (P < .002). DO-granting schools were more supportive for students with mobility disabilities. CONCLUSIONS Most medical school TSs do not support provision of reasonable accommodations for students with disabilities as intended by the ADA. Further study is needed to understand how schools operationalize TSs and barriers to achieving ADA standards.
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Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students. GMS JOURNAL FOR MEDICAL EDUCATION 2016; 33:Doc11. [PMID: 26958648 PMCID: PMC4766939 DOI: 10.3205/zma001010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any "regular, repetitive offer" (even on a non-profit basis) of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year medical students at the Technical University Munich on "physician-assisted suicide," "euthanasia" and "palliative sedation," based on a fictitious case vignette study. METHOD The vignette study described two versions of a case in which a patient suffered from a nasopharyngeal carcinoma (physical suffering subjectively perceived as being unbearable vs. emotional suffering). The students were asked about the current legal norms for each respective course of action as well as their attitudes towards the ethical acceptability of these measures. RESULTS Out of 301 students in total, 241 (80%) participated in the survey; 109 answered the version 1 questionnaire (physical suffering) and 132 answered the version 2 questionnaire (emotional suffering). The majority of students were able to assess the currently prevailing legal norms on palliative sedation (legal) and euthanasia (illegal) correctly (81.2% and 93.7%, respectively), while only a few students knew that physician-assisted suicide, at that point in time, did not constitute a criminal offense. In the case study that was presented, 83.3% of the participants considered palliative sedation and the simultaneous withholding of artificial nutrition and hydration as ethically acceptable, 51.2% considered physician-assisted suicide ethically legitimate, and 19.2% considered euthanasia ethically permissible. When comparing the results of versions 1 and 2, a significant difference could only be seen in the assessment of the legality of palliative sedation: it was considered legal more frequently in the physical suffering version (88.1% vs. 75.8%). CONCLUSION The majority of the students surveyed wrongly assumed that physician-assisted suicide is a punishable offense in Germany. However, a narrow majority considered physician-assisted suicide ethically acceptable in the case study presented. Compared to euthanasia, more than twice as many participants considered physician-assisted suicide acceptable. There was no significant difference between personal attitudes towards palliative sedation, physician-assisted suicide or euthanasia in light of physical or emotional suffering. Educational programs in this field should be expanded both qualitatively and quantitatively, especially considering the relevance of the subject matter, the deficits within the knowledge of legal norms and the now even higher complexity of the legal situation due to the new law from December 2015.
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[Introduction of "Student Doctors"]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2015; 104:2517-2522. [PMID: 28530365 DOI: 10.2169/naika.104.2517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Impact of policies regulating foreign physician migration to Switzerland: a modelling case study in anaesthesia. BMC Health Serv Res 2015; 15:204. [PMID: 25994360 PMCID: PMC4440310 DOI: 10.1186/s12913-015-0867-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 05/12/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Several countries have developed policies that restrict or limit duration of stay, clinical privileges or the number of residency permits allocated to migrating physicians. Switzerland is currently preparing a new law limiting overall foreign immigration. The impact of such restrictive policies is currently unknown. In a case study of anaesthesia care in Switzerland we modelled, trends in the size of physicians' workforce until 2024, following the implementation of a strict quota policy for foreign medical trainees. METHODS We developed a computer-based Markov model with Monte-Carlo simulations to project, in the context of a strict quota policy for foreign trainees, supply and demand for anaesthesia positions until 2024. We used data from a cross-sectional study performed in the French- and Italian-speaking cantons of Switzerland and the Health dataset from the OECD. RESULTS With 8 to 12 (95% CI 4-20) anaesthetists retiring per year, the implementation of strict quotas of foreign graduates would result in a 38% decrease in the number of anaesthetists in intermediary (senior registrars) positions by 2024. This decrease would be particularly important in district hospitals where nearly half (49%) of the non-Swiss anaesthetists are practising. Swiss graduates are unlikely to balance the shortage. Despite efforts by Swiss universities to increase the number of medical graduates, their number has dropped from 10.5 to 9.7/100 000 inhabitants between 2000 and 2012, due to the growth of the population. CONCLUSIONS This case study in Latin Switzerland shows that a restrictive policy limiting foreign immigration of trainees would result in a major deficit in the number of anaesthetists available to meet population needs. These aspects should be carefully considered when countries develop restrictions and limitations of foreign immigration.
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Not enough primary-care doctors? Try Missouri's prescription. MISSOURI MEDICINE 2014; 111:474-475. [PMID: 25665229 PMCID: PMC6173541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Better legal protection of doctoral research fellows. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:693-4. [PMID: 24721853 DOI: 10.4045/tidsskr.14.0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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FY1 doctors' ethicolegal challenges in their first year of clinical practice: an interview study. JOURNAL OF MEDICAL ETHICS 2014; 40:277-281. [PMID: 23538330 DOI: 10.1136/medethics-2011-100391] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND There is little evidence of junior trainee perspectives in the design and implementation of medical ethics and law (MEL) curriculum in UK medical schools. AIM To determine the ethical issues the foundation year 1 (FY1) doctors (first year after graduation) encountered during clinical practice and the skills and knowledge of MEL, which were useful in informing MEL curriculum development. METHOD The National Research Ethics Service gave ethical approval. Eighteen one-to-one interviews were conducted in each school with FY1 doctors. ANALYSIS Interviews were recorded and transcribed verbatim; a thematic analysis was undertaken with the transcriptions and saturation of themes was achieved. KEY FINDINGS Themes closely overlapped between the two study sites. (1) Knowing my place as an FY1 (this theme consisted of four subthemes: challenging the hierarchy, being honest when the team is titrating the truth, taking consent for unfamiliar procedures and personal safety vs competing considerations); (2) Do not attempt resuscitation)/end-of-life pathway and its implications; (3) 'You have to be there' (contextualising ethics and law teaching through cases or role plays to allow students to explore future work situations); and (4) advanced interpersonal skills competency for ethical clinical practice. CONCLUSIONS The data provide a snapshot of the real challenges faced by MEL FY1 doctors in early clinical practice: they may feel ill-prepared and sometimes unsupported by senior members of the team. The key themes suggest areas for development of undergraduate and postgraduate MEL curricula. We will work to develop our own curriculum accordingly. We intend to further investigate the applicability of our findings to UK medical ethics and law curriculum.
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[Information in health care: Students' rights to access medical records should be regulated]. LAKARTIDNINGEN 2014; 111:529. [PMID: 24734374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Doctors should be protected by the Human Rights Act too. BMJ 2014; 348:g1549. [PMID: 24554173 DOI: 10.1136/bmj.g1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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[Right maintenance and self-discipline of practicing dentist on the liability in medical damage of the tortuous liability (IX): a medical lawsuit case induced by supragingival oral prophylaxis performed by a medical student]. ZHONGHUA KOU QIANG YI XUE ZA ZHI = ZHONGHUA KOUQIANG YIXUE ZAZHI = CHINESE JOURNAL OF STOMATOLOGY 2013; 48:434-436. [PMID: 24262051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Abstract
Recent survey data gathered from British medical students reveal widespread acceptance of conscientious objection in medicine, despite the existence of strict policies in the UK that discourage conscientious refusals by students to aspects of their medical training. This disconnect demonstrates a pressing need to thoughtfully examine policies that allow conscience objections by medical students; as it so happens, the USA is one country that has examples of such policies. After presenting some background on promulgated US conscience protections and reflecting on their significance for conscience objections by medical students, this paper observes that the dominant approach (following the American Medical Association's conscience clause) is to allow exempted students to instead be evaluated on the basis of alternative curricular activities to learn the associated underlying content. This paper then introduces and discusses an example in which male Muslim students who believe it is wrong to touch members of the opposite sex object to performing physical examinations on female subjects in their medical training. This sort of case, it is argued, causes difficulty for a conscience clause that resolves the dilemma by granting reasonable exemptions in the form of participation in alternative curricular activities: there are cases where one must perform the 'objectionable' activity itself in order to learn the necessary content and underlying principles.
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Canadian trainees could be accused of "battery" for performing pelvic examinations under anaesthesia, say legal analysts. BMJ 2012; 344:e2426. [PMID: 22461503 DOI: 10.1136/bmj.e2426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
At an understaffed and underresourced urban African training hospital, Malawian medical students learn to be doctors while foreign medical students, visiting Malawi as clinical tourists on short-term electives, learn about “global health.” Scientific ideas circulate fast there; clinical tourists circulate readily from outside to Malawi but not the reverse; medical technologies circulate slowly, erratically, and sometimes not at all. Medicine's uneven globalization is on full display. I extend scholarship on moral imaginations and medical imaginaries to propose that students map these wards variously as places in which—or from which—they seek a better medicine. Clinical tourists, enacting their own moral maps, also become representatives of medicine “out there”: points on the maps of others. Ethnographic data show that for Malawians, clinical tourists are colleagues, foils against whom they construct ideas about a superior and distinctly Malawian medicine and visions of possible alternative futures for themselves.
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MESH Headings
- History, 20th Century
- History, 21st Century
- Hospitals, Teaching/economics
- Hospitals, Teaching/history
- Hospitals, Teaching/legislation & jurisprudence
- Malawi/ethnology
- Medical Tourism/economics
- Medical Tourism/history
- Medical Tourism/legislation & jurisprudence
- Medical Tourism/psychology
- Schools, Medical/economics
- Schools, Medical/history
- Students, Medical/history
- Students, Medical/legislation & jurisprudence
- Students, Medical/psychology
- Students, Public Health/history
- Students, Public Health/legislation & jurisprudence
- Students, Public Health/psychology
- Technology/economics
- Technology/education
- Technology/history
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High-fidelity birth simulators in American culture: an ecofeminist analysis. JOURNAL OF AMERICAN CULTURE (MALDEN, MASS. : 2003) 2012; 35:52-64. [PMID: 22662368 DOI: 10.1111/j.1542-734x.2011.00797.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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[Numerus clausus: what else!]. LA REVUE DU PRATICIEN 2012; 62:97-98. [PMID: 22335078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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What does a good lifestyle mean to you? Perspectives of 4th-year U.S. medical students with military service obligations in 2009. TEACHING AND LEARNING IN MEDICINE 2012; 24:292-297. [PMID: 23035994 DOI: 10.1080/10401334.2012.715264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND A specialties' lifestyle is known to be important for specialty selection, but how medical students define this concept is unknown. PURPOSE The aim of this article is to determine how 4th-year medical students perceive lifestyle of specialties. METHODS All 4th-year U.S. medical students graduating in 2009 with a military service obligation were invited to participate in an electronic survey. Responses to an open-ended question, "When someone says 'That specialty has a good lifestyle,' what does that mean to you?" were classified into themes by a consensus of the authors and then compared to the students' selected specialty. RESULTS Response rate for the questionnaire was 46% (369 of 797). Four themes describing lifestyle emerged: "schedule control" (67% of students), "off time" (53%), "financial aspects" (48%), and "work life" (26%). CONCLUSIONS Medical students' definition of a "good lifestyle" includes four themes, which should be used in future research of the lifestyle factor of specialty selection.
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[Medical training reform: what's the situation?]. LA TUNISIE MEDICALE 2011; 89:881-883. [PMID: 22198874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Going forth with PRIDE: the Graduating Oath Ceremony Address to the MUSC Class of 2009. JOURNAL OF THE SOUTH CAROLINA MEDICAL ASSOCIATION (1975) 2011; 107:192-193. [PMID: 22057806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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What awaits tomorrow's medical graduates: perfect bliss or perfect storm? JOURNAL OF THE SOUTH CAROLINA MEDICAL ASSOCIATION (1975) 2011; 107:185-186. [PMID: 22057802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Criminal background checks upon acceptance to medical school: the right policy at the right time. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:807. [PMID: 21715994 DOI: 10.1097/acm.0b013e31821e40b5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Commentary: criminal background checks for entering medical students: history, current issues, and future considerations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:795-798. [PMID: 21715989 DOI: 10.1097/acm.0b013e31821db0ab] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this commentary, the authors aim to contextualize the history and rationale for what has become the Association of American Medical Colleges-facilitated criminal background check process for entering medical students. As the process was being considered, many issues with a standardized process were identified. There were concerns that demographic or socioeconomic factors might unfairly burden certain applicants or discourage them from applying to medical school. On the other hand, a unified, national program would minimize cost and enhance quality assurance. The authors discuss these issues. Lessons learned in the first three years of the program are also addressed, including some unexpected and favorable consequences such as the identification of accepted applicants with at-risk behaviors (e.g., substance abuse), who would have otherwise gone undetected. Several challenges remain, including the fact that the criminal background check process creates an enhanced role for prehealth advisors and encourages undergraduate institutions to establish standards and processes relating to professionalism. While this is, no doubt, an evolving program which needs continued oversight and ongoing reevaluation, the authors support the continued advancement of the criminal background check process for entering medical students.
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Why did you order that CBC? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:791-792. [PMID: 21715985 DOI: 10.1097/acm.0b013e31821e4250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Criminal background checks upon acceptance to medical school: the wrong policy at the wrong time. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:808. [PMID: 21715995 DOI: 10.1097/acm.0b013e31821e4176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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European Court of Justice. ECJ 2010/5 - Nicolas Bressol and others and Céline Chaverot and others v Gouvernement de la Communauté française, 13 April 2010 (case C-73/08). EUROPEAN JOURNAL OF HEALTH LAW 2010; 17:315-320. [PMID: 20666294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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The social transformation of American medical education: class, status, and party influences on occupational closure, 1902–1919. THE SOCIOLOGICAL QUARTERLY 2010; 51:550-575. [PMID: 20939126 DOI: 10.1111/j.1533-8525.2010.01183.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Applying Weber's theorizing on action and stratification, this study examines whether the early 20th-century extinction of half of the medical schools in the United States resulted from actions intended to serve class, status, and party interests by achieving social closure. Analyses reveal closure intentions in the school ratings assigned by the American Medical Association, although not in the recommendations in the 1910 Carnegie-sponsored Flexner report. In contrast to claims that schools failed largely because of economic exigencies, analyses indicate that failures were influenced by the AMA's and Flexner's assessments, as well as by state regulatory regimes and school characteristics.
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[What are we going to do with our trainees?]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2009; 38:448-449. [PMID: 19643552 DOI: 10.1016/j.jgyn.2009.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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[Health services must be free from criminal physicians and medical students]. LAKARTIDNINGEN 2009; 106:295. [PMID: 19271460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Maude Abbott's postgraduate studies in Europe, 1894-1897. OSLER LIBRARY NEWSLETTER 2009:1-4. [PMID: 20509235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Theses in the Osler Library including that of Pierre de Sales Laterrière. OSLER LIBRARY NEWSLETTER 2009; 111:1-11. [PMID: 19582947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
MESH Headings
- Academic Dissertations as Topic/history
- Education, Medical/economics
- Education, Medical/history
- Education, Medical/legislation & jurisprudence
- Faculty, Medical/history
- History, 19th Century
- History, 20th Century
- Libraries, Medical/economics
- Libraries, Medical/history
- Libraries, Medical/legislation & jurisprudence
- Physicians/economics
- Physicians/history
- Physicians/legislation & jurisprudence
- Physicians/psychology
- Quebec/ethnology
- Schools, Medical/economics
- Schools, Medical/history
- Schools, Medical/legislation & jurisprudence
- Students, Medical/history
- Students, Medical/legislation & jurisprudence
- Students, Medical/psychology
- Universities/economics
- Universities/history
- Universities/legislation & jurisprudence
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Students whose behaviour causes concern: Am I my brother's keeper? BMJ 2008; 337:a2875. [PMID: 19114451 DOI: 10.1136/bmj.a2875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Students whose behaviour causes concern: Case history. BMJ 2008; 337:a2874. [PMID: 19114450 DOI: 10.1136/bmj.a2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Life at seventeen: coming of age. THE NATIONAL MEDICAL JOURNAL OF INDIA 2008; 21:193-199. [PMID: 19267043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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[One-eyedness on who are suitable as physician]. LAKARTIDNINGEN 2008; 105:384-385. [PMID: 18380361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Montreal, medicine and William Leslie Logie: McGill's first graduate and Canada's first medical graduate. 175th anniversary, 1833-2008. OSLER LIBRARY NEWSLETTER 2008; 109:1-7. [PMID: 19582946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
MESH Headings
- Anniversaries and Special Events
- Education, Medical/economics
- Education, Medical/history
- Education, Medical/legislation & jurisprudence
- Faculty, Medical/history
- History, 19th Century
- History, 20th Century
- History, 21st Century
- Legislation as Topic/economics
- Legislation as Topic/history
- Licensure, Medical/economics
- Licensure, Medical/history
- Licensure, Medical/legislation & jurisprudence
- Physicians/economics
- Physicians/history
- Physicians/legislation & jurisprudence
- Physicians/psychology
- Quebec/ethnology
- Schools, Medical/economics
- Schools, Medical/history
- Schools, Medical/legislation & jurisprudence
- Students, Medical/history
- Students, Medical/legislation & jurisprudence
- Students, Medical/psychology
- Universities/economics
- Universities/history
- Universities/legislation & jurisprudence
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[In the end it's the patient who decides]. LAKARTIDNINGEN 2007; 104:3898. [PMID: 18236614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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[I disagree!]. LAKARTIDNINGEN 2007; 104:3896. [PMID: 18232534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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