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Practicing Physicians (practicing + physician)

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Medical Sciences	100%

Selected Abstracts

Continuing Medical Education, Continuing Professional Development, and Knowledge Translation: Improving Care of Older Patients by Practicing Physicians

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2006
David C. Thomas MD
Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners. [source]

Implementation of the Suggested Guidelines for Breast Cancer Risk, Genetics, and Risk Assessment: The Critical Need for Educating Practicing Physicians

THE BREAST JOURNAL, Issue 1 2009
Shahla Masood MD Editor-in-Chief
No abstract is available for this article. [source]

Assessment of the practicing physician: Challenges and opportunities

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue S1 2008
Eric S. Holmboe MDArticle first published online: 4 DEC 200
Abstract Despite spending a substantial amount of time in structured educational settings during early medical training, most physicians will spend the majority of their career in clinical practice. In the clinical practice setting, physicians become responsible for determining and implementing their own educational program in order to maintain, at a minimum, competence. Pressure to change the nature of continuing medical education (CME) parallels pressure from patients, payers, and policymakers to hold individual physicians more accountable for the care they provide. How can these two forces be brought together more deliberately and effectively? Comprehensive physician assessment provides such an opportunity with the potential to benefit all parties involved in health care, especially patients and physicians. Many assessment methods and tools exist today that can facilitate the integration of CME and quality. Using a multifaceted physician-level performance assessment system has substantial potential to align the public's need and desire to ensure their physician is competent, at a minimum, with providing the physician with meaningful, actionable information and data to improve performance and engage in transformative learning. CME programs need to incorporate more robust assessment as part of the learning activity to facilitate improvements in health care more directly. [source]

Council of medical specialty societies: Committed to continuing medical education Reform

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 3 2005
MACP Executive Vice President, Walter J. McDonald MD
Abstract The Council of Medical Specialty Societies (CMSS) recognizes the need for continuing medical education (CME) reform and intends to be actively engaged in that process. While recognizing that CME reform must involve many organizations, the CMSS and particularly the 23 societies that make up the CMSS are in a position to affect many of the needed changes. Of these, perhaps the most important is the need to link CME to a change in physician behavior and patient outcomes. Other important tasks involve the expansion and improvement of available needs assessment modalities, the development and updating of curricula, the official recognition of multiple modalities available for physician learning, the broadening of the CME research agenda, and the need to explore alternate ways of financing lifelong learning. With the accomplishment of these reforms, medical education may finally be viewed as a continuum from undergraduate education through education of the practicing physician, and patient safety will be favorably impacted. Education will change from an episodic experience to a continuous process and one that is based on the realities of practice. These reforms will take time to accomplish and to be accepted by a profession that currently views itself as besieged by regulatory agencies and without the time and resources needed to comply with the changes. [source]

The management of heparin-induced thrombocytopenia

BRITISH JOURNAL OF HAEMATOLOGY, Issue 3 2006
David Keeling
Abstract The Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology has produced a concise practical guideline to highlight the key issues in the management of heparin-induced thrombocytopenia (HIT) for the practicing physician in the UK. The guideline is evidence-based and levels of evidence are included in the body of the article. All patients who are to receive heparin of any sort should have a platelet count on the day of starting treatment. For patients who have been exposed to heparin in the last 100 d, a baseline platelet count and a platelet count 24 h after starting heparin should be obtained. For all patients receiving unfractionated heparin (UFH), alternate day platelet counts should be performed from days 4 to 14. For surgical and medical patients receiving low-molecular-weight heparin (LMWH) platelet counts should be performed every 2,4 d from days 4 to 14. Obstetric patients receiving treatment doses of LMWH should have platelet counts performed every 2,4 d from days 4 to 14. Obstetric patients receiving prophylactic LMWH are at low risk and do not need routine platelet monitoring. If the platelet count falls by 50% or more, or falls below the laboratory normal range and/or the patient develops new thrombosis or skin allergy between days 4 and 14 of heparin administration HIT should be considered and a clinical assessment made. If the pretest probability of HIT is high, heparin should be stopped and an alternative anticoagulant started at full dosage unless there are significant contraindications while laboratory tests are performed. Platelet activation assays using washed platelets have a higher sensitivity than platelet aggregation assays but are technically demanding and their use should be restricted to laboratories experienced in the technique. Non-expert laboratories should use an antigen-based assay of high sensitivity. Only IgG class antibodies need to be measured. Useful information is gained by reporting the actual optical density, inhibition by high concentrations of heparin, and the cut-off value for a positive test rather than simply reporting the test as positive or negative. In making a diagnosis of HIT the clinician's estimate of the pretest probability of HIT together with the type of assay used and its quantitative result (enzyme-linked immunosorbent assay, ELISA, only) should be used to determine the overall probability of HIT. Clinical decisions should be made following consideration of the risks and benefits of treatment with an alternative anticoagulant. For patients with strongly suspected or confirmed HIT, heparin should be stopped and full-dose anticoagulation with an alternative, such as lepirudin or danaparoid, commenced (in the absence of a significant contraindication). Warfarin should not be used until the platelet count has recovered. When introduced in combination with warfarin, an alternative anticoagulant must be continued until the International Normalised Ratio (INR) is therapeutic for two consecutive days. Platelets should not be given for prophylaxis. Lepirudin, at doses adjusted to achieve an activated partial thromboplastin time (APTT) ratio of 1·5,2·5, reduces the risk of reaching the composite endpoint of limb amputation, death or new thrombosis in patients with HIT and HIT with thrombosis (HITT). The risk of major haemorrhage is directly related to the APTT ratio, lepirudin levels and serum creatinine levels. The patient's renal function needs to be taken into careful consideration before treatment with lepirudin is commenced. Severe anaphylaxis occurs rarely in recipients of lepirudin and is more common in previously exposed patients. Danaparoid in a high-dose regimen is equivalent to lepirudin in the treatment of HIT and HITT. Danaparoid at prophylactic doses is not recommended for the treatment of HIT or HITT. Patients with previous HIT who are antibody negative (usually so after >100 d) who require cardiac surgery should receive intraoperative UFH in preference to other anticoagulants that are less validated for this purpose. Pre- and postoperative anticoagulation should be with an anticoagulant other than UFH or LMWH. Patients with recent or active HIT should have the need for surgery reviewed and delayed until the patient is antibody negative if possible. They should then proceed as above. If deemed appropriate early surgery should be carried out with an alternative anticoagulant. We recommend discussion of these complex cases requiring surgery with an experienced centre. The diagnosis must be clearly recorded in the patient's medical record. [source]

Are Internal Medicine Residency Programs Adequately Preparing Physicians to Care for the Baby Boomers?

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2006
A National Survey from the Association of Directors of Geriatric Academic Programs Status of Geriatrics Workforce Study
Patients aged 65 and older account for 39% of ambulatory visits to internal medicine physicians. This article describes the progress made in training internal medicine residents to care for older Americans. Program directors in internal medicine residency programs accredited by the Accreditation Council for Graduate Medical Education were surveyed in the spring of 2005. Findings from this survey were compared with those from a similar 2002 survey to determine whether any changes had occurred. A 60% response rate was achieved (n=235). In these 3-year residency training programs, 20 programs (9%) required less than 2 weeks of clinical instruction that was specifically structured to teach geriatric care principles, 48 (21%) at least 2 weeks but less than 4 weeks, 144 (62%) at least 4 weeks but less than 6 weeks, and 21 (9%) required 6 or more weeks. As in 2002, internal medicine residency programs continue to depend on nursing home facilities, geriatric preceptors in nongeriatric clinical ambulatory settings, and outpatient geriatric assessment centers for their geriatrics training. Training was most often offered in a block format. The mean number of physician faculty per residency program dedicated to teaching geriatric medicine was 3.5 full-time equivalents (FTEs) (range 0,50), compared with a mean of 2.2 FTE faculty in 2002 (P,.001). Internal medicine educators are continuing to improve the training of residents so that, as they become practicing physicians, they will have the knowledge and skills in geriatric medicine to care for older adults. [source]

Continuing Medical Education, Continuing Professional Development, and Knowledge Translation: Improving Care of Older Patients by Practicing Physicians

Promoting free online CME for intimate partner violence: What works at what cost?

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 3 2009
John M. Harris Jr. MD, MBA President
Abstract Introduction: There is a need to provide practicing physicians with training on the recognition and management of intimate partner violence (IPV). Online continuing medical education (CME) could help meet this need, but there is little information on the costs and effectiveness of promoting online CME to physicians. This lack of information may discourage IPV training efforts and the use of online CME in general. Methods: We promoted an interactive, multimedia, online IPV CME program, which offered free CME credit, to 92 000 California physicians for 24 months. We collected data on user satisfaction, the costs of different promotional strategies, and self-reported user referral source. We evaluated California physician awareness of the promotion via telephone surveys. Results: Over 2 years, the CME program was used by 1869 California physicians (2% of market), who rated the program's overall quality highly (4.52 on a 1,5 scale; 5 = excellent). The average promotional cost per physician user was $75. Direct mail was the most effective strategy, costing $143 each for 821 users. E-promotion via search engine advertising and e-mail solicitation had less reach, but was more cost efficient ($30,$80 per user). Strategies with no direct cost, such as notices in professional newsletters, accounted for 31% (578) of physician users. Phone surveys found that 24% of California physicians were aware of the online IPV CME program after 18 months of promotion. Discussion: Promoting online CME, even well-received free CME, to busy community physicians requires resources, in this case at least $75 per physician reached. The effective use of promotional resources needs to be considered when developing social marketing strategies to improve community physician practices. Organizations with an interest in promoting online training might consider the use of e-promotion techniques along with conventional promotion strategies. [source]

Using the Theory of Reasoned Action to Model Retention in Rural Primary Care Physicians

THE JOURNAL OF RURAL HEALTH, Issue 3 2003
Thomas Hugh Feeley PhD
Purpose: The current review uses Fishbein and Ajzen's Theory of Reasoned Action (TRA) to organize the literature on the predictors and correlates of retention of rural practicing physicians. TRA suggests turnover behavior is directly predicted by one's turnover intentions, which are, in turn, predicted by one's attitudes about rural practice and perceptions of salient others' (eg, spouse's) attitudes about rural practice and rural living. Methods:Narrative literature review of scholarship in predicting and understanding predictors and correlates of rural physician retention. Findings: The TRA model provides a useful conceptual model to organize the literature on rural physician retention. Physicians' subjective norms regarding rural practice are an important source of influence in the decision to remain or leave one's position, and this relation should be more fully examined in future research [source]