continuing medical education

继续医学教育
  • 文章类型: Journal Article
    在医疗保健认证组织中,一个持续的挑战是确定一种有效的方式来评估医生的能力。医学领域在不断变化,有了新技术,研究和药理学可用,和医生必须保持最新,以适当地照顾他们的病人。维护认证,特别是,重新认证考试,用于验证在所有医疗专业中始终满足高标准的护理。然而,不同的国家有不同的结构,以确保医生了解最新的医学知识。例如,美国医生必须每十年通过标准化考试来重新认证自己,以保持自己的证书。相比之下,加拿大医生不需要通过正式考试。这种对比使人们质疑重新认证考试在医学专业发展计划中的价值。我们概述了加拿大和美国的整改情况,并推荐类似于加拿大的MOC计划,这不需要重新认证考试。
    An ongoing challenge among healthcare certifying organizations is identifying an effective manner of evaluating a physician\'s competency. The medical field is constantly changing, with new technology, research and pharmacology available, and physicians must be kept up to date in order to properly care for their patients. Maintenance of certification and specifically, recertification exams, are used to verify that a high standard of care is consistently met across all medical specialties. However, different countries have different structures in place to ensure physicians are kept abreast of the latest medical knowledge. For instance, American physicians must recertify themselves every ten years by passing a standardized exam to maintain their credentials. In comparison, Canadian physicians are not required to pass a formal examination. This contrast puts into question the value of the recertification exam in medical professional development programs. We outline the rectification situation in both Canada and the US and recommend MOC programs similar to Canada\'s, which does not require a recertification examination.
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  • 文章类型: Journal Article
    COVID-19加速了在线交付的持续专业发展(CPD)。我们旨在比较面对面与在线CPD课程对医学专家行为意图和后续行为的影响。在这项前后比较研究中,医学专家参加了九个临床主题的面对面课程。第二组参加了这些课程的改编在线版本。在课程之前和之后立即测量了行为意图及其心理社会决定因素。六个月后测量行为变化。使用广义估计方程(GEE)模型来比较课程格式的影响。共有82/206名现场注册人(平均年龄:52±10岁;50%的男性)和318/506名在线注册人(平均年龄:49±12岁;男性:63%)参加了。面对面课程前的平均意向为5.99±1.31,之后为6.43±0.80(平均意向增加0.44,CI:0.16-0.74;p=0.003);在线课程前的平均意向为5.53±1.62,之后为5.98±1.40(平均意向增加0.45,CI:0.30-0.58;p<0.0001)。两组之间的意图获得差异无统计学意义。6个月后报告的行为与两组的术后意向均无显著相关。然而,在表示采用了目标行为的人群中,意向差异显著增加(配对wilcoxon检验:n=40,p值=0.002),而在未采用目标行为的人群中,意向差异没有显著增加(配对wilcoxon检验:n=16,p值=0.223).总之,CPD课程结束后,专家的意向增加是相似的,无论是亲自课程还是在线课程。此外,这两个群体的意图都增加了被采纳的可能性。
    COVID-19 accelerated continuing professional development (CPD) delivered online. We aimed to compare the impact of in-person versus online CPD courses on medical specialists\' behavioural intentions and subsequent behaviour. In this comparative before-and-after study, medical specialists attended in-person courses on nine clinical topics. A second group attended an adapted online version of these courses. Behavioural intention and its psychosocial determinants were measured before and immediately after the courses. Behaviour change was measured six months later. Generalised estimating equation (GEE) models were used to compare the impact of course formats. A total of 82/206 in-person registrants (mean age: 52±10 years; 50% men) and 318/506 on-line registrants (mean age: 49±12 years; men: 63%) participated. Mean intention before in-person courses was 5.99±1.31 and 6.43±0.80 afterwards (average intention gain 0.44, CI: 0.16-0.74; p=0.003); mean intention before online courses was 5.53±1.62 and 5.98±1.40 afterwards (average intention gain of 0.45, CI: 0.30-0.58; p<0.0001). Difference in intention gain between groups was not statistically significant. Behaviour reported six months later was not significantly associated with post-course intention in either group. However, the intention difference increased significantly among those who said they had adopted the targeted behaviour (paired wilcoxon test: n = 40 and p-value=0.002) while it did not increase significantly in the group of those who had not adopted a targeted behaviour (paired wilcoxon test: n = 16 and p-value=0.223). In conclusion, the increase in intention of specialists after CPD courses was similar whether the course was in-person or online. Also, an increase in intention in both groups signalled more likelihood of adoption.
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  • 文章类型: Journal Article
    该评估的目的是描述医生参与CME/CPD的要求;探索国内中小企业对其CME/CPD系统的看法;描述国内医生对跨专业继续教育(IPCE)和独立CME/CPD的看法;并提供可能采用的建议以提高质量和有效性。此评估使用了混合方法方法,其中包括对国内主题专家的1:1访谈以及从国内执业医生那里获取定性和定量数据的电子调查。该评估反映了一个国家对其医师队伍的教育进行了投资。CME/CPD系统具有嵌入式治理结构,被授权提供教育的组织,和公认的信用体系。理事机构已实施法规,以限制商业利益组织对CME/CPD的影响,并且有机会扩展交付系统,以覆盖不同地理区域的医生,更好地将内容与个别医生的差距和学习需求保持一致,并降低成本。有机会在一个拥有强大专业等级制度的国家内投资IPCE。该评估反映了相对成熟的CME/CPD系统,并确定了扩展和增强系统以更好地满足医生的教育需求并对实践和患者结果产生积极影响的几个机会。
    Aims of this assessment were to describe requirements for physicians to engage in CME/CPD; explore perceptions of In-Country SMEs of their CME/CPD systems; describe perceptions of In-Country physicians about interprofessional continuing education (IPCE) and independent CME/CPD; and provide recommendations that may be adopted to improve quality and effectiveness. This assessment used a mixed-methods approach that included 1:1 interviews with in-country subject matter experts and an electronic survey capturing qualitative and quantitative data from practicing in-country physicians. This assessment reflects a country invested in the education of its physician workforce. CME/CPD systems have embedded governance structures, organizations authorized to provide education, and a recognized credit system. Governing bodies have implemented regulations to limit influence from commercial interest organizations on CME/CPD, and there is opportunity to expand delivery systems to reach physicians across diverse geographic regions, better align content to individual physicians\' gaps and learning needs, and reduce cost. There is opportunity to invest in IPCE within a country with a strong professional hierarchy system. This assessment reflects CME/CPD systems that are relatively mature and identifies several opportunities to expand and enhance systems to better meet educational needs of physicians and to positively impact practice and patient outcomes.
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  • 文章类型: Journal Article
    认为科学必须在与宗教甚至神学的存在矛盾中被理解的想法更多的是一种信念,而不是哲学或经验上的必要性。的确,我们现在可以提出“神学医学”作为一个长期现实的新术语:大多数医生,卫生保健提供者,病人,他们的看护人在神学框架内体验疾病的现实,至少对于那些有一定程度的精神或宗教信仰的人来说。制定神学医学课程可以开发一种机制,为医疗保健提供者提供适当的培训。这样的课程必须由经验丰富的医生和护理人员创建和交付,精神顾问,神职人员代表,如牧师或牧师来自不同的教会或信仰社区,生物伦理学家,心理学家,社会工作者,心理治疗师,患者支持小组成员,机构审查委员会成员,研究人员,甚至还有法律顾问,如果有的话。继续专业教育的要求也创造了一个机会,介绍和评估神学医学的能力,一门新兴学科,可以为医学实践的生活经验增加重要价值,而医学实践仍然基于医患之间独特的丰富关系。
    The idea that science must be understood in existential contradiction to religion and even theology is more of a conviction than a philosophical or experiential necessity. Indeed, we may now propose \"Theological Medicine\" as a new terminology for a perennial reality: that most physicians, health care providers, patients, and their caretakers experience the reality of illness within a theological framework, at least for those who have some degree of spiritual or religious belief. Developing a curriculum in Theological Medicine could develop a mechanism to offer appropriate training to healthcare providers. Such a course would have to be created and delivered by experienced physicians and nursing staff, spiritual advisors, clergy representatives such as pastors or priests from different churches or faith communities, bioethicists, psychologists, social workers, psychotherapists, patient support group members, members of institutional review boards, researchers, and even legal advisors, if available. Continuing professional education requirements also create an opportunity to introduce and evaluate competency in theological medicine, an emerging discipline that could add significant value to the lived experience of medical practice which remains based on the uniquely rich relationship between physician and patient.
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  • 文章类型: Journal Article
    阿尔茨海默病和相关疾病(ADRD)的患病率正在上升。初级保健提供者(PCP)将越来越需要在其检测中发挥作用,但缺乏培训。
    开发一种在初级保健中可行的认知评估模型,并评估其在大型卫生系统中的实施情况。
    初级保健认知计划包括基于网络的培训以及内置到电子记录中的集成工具。我们在大型卫生系统的14个诊所的PCP中实施了该计划。我们(1)调查了PCP,以评估训练对他们评估认知的信心的影响,(2)测量他们进行的认知评估的数量,和(3)追踪诊断为轻度认知障碍(MCI)的患者数量。
    39个PCP完成了包括如何评估认知的培训。这些PCP的调查应答率为74%。培训结束六个月后,他们报告了评估认知的信心(5分制平均4.6).健康记录中记录的认知评估从训练前的每月0.8增加到训练后六个月的2.5。新诊断为MCI的患者从训练前的每月4.2增加到训练后六个月的每月6.0。
    这种用于大型卫生系统中的认知评估的模型被证明可以增加认知测试并增加MCI的诊断。这种改进对于及时发现ADRD至关重要。
    UNASSIGNED: The prevalence of Alzheimer\'s disease and related disorders (ADRD) is rising. Primary care providers (PCPs) will increasingly be required to play a role in its detection but lack the training to do so.
    UNASSIGNED: To develop a model for cognitive evaluation which is feasible in primary care and evaluate its implementation in a large health system.
    UNASSIGNED: The Cognition in Primary Care Program consists of web-based training together with integrated tools built into the electronic record. We implemented the program among PCPs at 14 clinics in a large health system. We (1) surveyed PCPs to assess the impact of training on their confidence to evaluate cognition, (2) measured the number of cognitive assessments they performed, and (3) tracked the number of patients diagnosed with mild cognitive impairment (MCI).
    UNASSIGNED: Thirty-nine PCPs completed the training which covered how to evaluate cognition. Survey response rate from those PCPs was 74%. Six months after the end of the training, they reported confidence in assessing cognition (mean 4.6 on 5-point scale). Cognitive assessments documented in the health record increased from 0.8 per month before the training to 2.5 in the six months after the training. Patients who were newly diagnosed with MCI increased from 4.2 per month before the training to 6.0 per month in the six months after the training.
    UNASSIGNED: This model for cognitive evaluation in a large health system was shown to increase cognitive testing and increase diagnoses of MCI. Such improvements are essential for the timely detection of ADRD.
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  • 文章类型: Journal Article
    这项队列研究旨在探讨为期一天的在线继续医学教育(CME)对提高医师对功能性消化不良(FD)的知识和临床实践的影响。
    医生被邀请通过医学教育应用参与本次CME。预先制作的FD培训视频通过网络链接发送给参与者。训练前后,参与者被要求完成FD知识测试并提供FD患者的病例信息.McNemar测试,Wilcoxon秩和检验,弗里德曼测试,卡方检验,分位数回归,采用广义估计方程(GEE)进行统计分析。
    430名医生中有397名(92.33%)完成了这个CME计划。训练后FD知识测验总分明显高于训练前[488.3(468.3-510.0)vs.391.7(341.7-450.0),p<0.001]。特别是,与二级和三级医院的医生相比,基层医院的医生的总分增加更多。根据GEE模型,接受这种在线培训是医生选择FD患者上消化道内镜检查的独立预测因素[OR1.73,95CI(1.09-2.73),p=0.020],尤其是在PDS中。此外,它是FD患者医生选择抑酸药的独立预测因子[OR1.30,95CI(1.03-1.63),p=0.026],特别是在EPS和PDS重叠的EPS中。
    这项为期一天的在线CME计划有效,方便地提高了医师的知识和临床实践,为未来CME提供新思路,促进不同亚型FD患者的精确临床管理,尤其是在基层医院。
    UNASSIGNED: This cohort study aimed to explore the effect of a one-day online continuing medical education (CME) on the improvement of physicians\' knowledge and clinical practice on functional dyspepsia (FD).
    UNASSIGNED: Physicians were invited to participate in this CME via medical education applications. FD training videos made in advance were sent to participants via a weblink. Before and after training, participants were required to finish the FD knowledge test and provide case information of FD patients. McNemar test, Wilcoxon rank-sum test, Freidman test, Chi-square test, quantile regression, and generalized estimating equations (GEE) were used to perform statistical analysis.
    UNASSIGNED: There were 397 of 430 (92.33%) physicians finished this CME program. The total score of the FD knowledge test after training was significantly higher compared with before training [488.3 (468.3-510.0) vs. 391.7 (341.7-450.0), p < 0.001]. Particularly, physicians from primary hospitals show more increase in total scores than physicians from secondary and tertiary hospitals. According to the GEE model, receiving this online training was an independent predictor of physicians\' choice of upper gastrointestinal endoscopy in patients with FD [OR 1.73, 95%CI (1.09-2.73), p = 0.020], especially in PDS. Also, it was an independent predictor of physicians\' choice of acid-suppressive drugs in patients with FD [OR 1.30, 95%CI (1.03-1.63), p = 0.026], especially in EPS and PDS overlapping EPS.
    UNASSIGNED: This one-day online CME program effectively and conveniently improved physicians\' knowledge and clinical practice, providing new ideas for future CME and facilitating precise clinical management of FD patients with different subtypes especially in primary hospitals.
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  • 文章类型: English Abstract
    西班牙医学教育带来的问题多种多样。本文分析了目前用于选择将被西班牙公立医学院录取的候选人的系统,以及由于我国公立和私立医学院空前增加而引起的一些问题。通用能力在当今医学中的重要性以及在专业培训中回归核心设计的必要性是讨论的其他方面。高级认证文凭和特定能力领域的发展程度也需要分析。最后,作者强调了持续专业发展的重要性,以及专业再认证的理念,这是一个保证患者接受护理质量的系统。
    The problems posed by medical education in Spain are diverse. This paper analyzes the system currently used to select candidates who will be admitted to a public faculty of medicine in Spain and some issues arising from the unprecedented increase in both public and private medical schools in our country. The importance of generic competencies in today\'s medicine and the need to return to a core design in specialist training are other aspects that are discussed. The degree of development of advanced accreditation diplomas and areas of specific competence is also subject to analysis. Finally, the authors emphasize the importance of continuous professional development and the idea of professional recertification as a system that guarantees patients the quality of the care they receive.
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  • 文章类型: Journal Article
    目标:为了解决低收入和中等收入国家(LMICs)在放射肿瘤学教育方面的差距,我们试图评估免费向非洲和拉丁美洲(LATAM)现有放射治疗(RT)诊所提供的关于调强放疗(IMRT)的细化课程的有效性和普遍性.
    方法:根据先前的需求评估创建了课程,并针对参与的医学物理学家进行了调整。放射肿瘤学家,放射治疗师,和中低收入国家的受训者。讲英语和讲西班牙语的志愿者教育工作者团队每周1-2次,为期4个月,使用视频会议向非洲和拉丁美洲同伙提供27小时的课程,分别。对LATAM参与者进行了课程前和课程后的多项选择考试,收集所有参与者的课程前和课程后自信心(1-5李克特量表)和开放式反馈。
    结果:非洲(13)和拉丁美洲(12)的25个中心参加了会议,总共产生了332名注册参与者(128名非洲人,204LATAM).会议在非洲和拉丁美洲方案中平均有44名(22.5名)和85名(25.4名)参与者,分别。结对的课程前和课程后数据显示,知识从47.9%提高到89.6%,并且在四个领域(包括基础(+1.1))的自信心方面显着提高(p<0.001),调试(+1.3),轮廓(+1.7),和治疗计划(+1.0)。仅在“高出勤率”参与者中,出勤率是自信心变化的重要预测因子,暗示了阈值效应。定性数据表明,参与者期待在临床环境中应用他们的知识。
    结论:适合LMIC受众的专业放射肿瘤学课程对非洲和LATAM参与者都是有效的。参与者的反馈表明,完善的IMRT课程赋予诊所以知识和信心来帮助培训他人。这种可行的“集线器和辐条”方法,其中远程学习课程建立了一个由辐条(学习者)利用的集线器,可以推广到其他人,旨在通过培训努力减少全球医疗保健差距。
    OBJECTIVE: To address a gap in radiation oncology education in low- and middle-income countries (LMICs), we sought to evaluate the effectiveness and generalizability of a refined curriculum on intensity modulated radiotherapy (IMRT) offered to existing radiation therapy (RT) clinics across Africa and Latin America (LATAM) at no cost.
    METHODS: A curriculum was created based on prior needs assessments and adapted for participating medical physicists, radiation oncologists, radiation therapists, and trainees in LMICs. English-speaking and Spanish-speaking teams of volunteer educators delivered 27 hour-long sessions 1-2 times weekly for 4 months using video conferencing to African and LATAM cohorts, respectively. Pre- and post-course multiple-choice examinations were administered to LATAM participants, and pre- and post-course self-confidence (1-5 Likert-scale) and open-ended feedback were collected from all participants.
    RESULTS: Twenty-five centers across Africa (13) and LATAM (12) participated, yielding a total of 332 enrolled participants (128 African, 204 LATAM). Sessions were delivered with a mean of 44 (22.5) and 85 (25.4) participants in the African and LATAM programs, respectively. Paired pre and post-course data demonstrated significant (p < 0.001) improvement in knowledge from 47.9 to 89.6% and self-confidence across four domains including foundations (+ 1.1), commissioning (+ 1.3), contouring (+ 1.7), and treatment planning (+ 1.0). Attendance was a significant predictor of change in self-confidence in \"high attendance\" participants only, suggesting a threshold effect. Qualitative data demonstrates that participants look forward to applying their knowledge in the clinical setting.
    CONCLUSIONS: A specialized radiation oncology curriculum adapted for LMIC audiences was effective for both African and LATAM participants. Participant feedback suggests that the refined IMRT course empowered clinics with knowledge and confidence to help train others. This feasible \"Hub and Spokes\" approach in which a distance-learning course establishes a hub to be leveraged by spokes (learners) may be generalizable to others aiming to reduce global health care disparities through training efforts.
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  • 文章类型: Journal Article
    2016年,Nuplazid(pimavanserin)成为FDA批准的第一个治疗帕金森病精神病(PDP)的药物。我们探讨了PDP是为销售Nuplazid而创建的术语的可能性。我们通过MEDLINE搜索词频率研究了1990年代至2020年帕金森病患者对精神病的看法趋势,神经病学教科书,来自专业协会的指导,阿卡迪亚年度报告,赞助网站,以及由美国国立卫生研究院(NIH)主办的会议。我们分析了PDP上的继续医学教育(CME)活动,并分析了pimavanserin制造商的付款与处方之间的联系。我们对九项赞助的CME活动的分析揭示了误导性的主题,包括:PDP是常见的,进步,并不总是药物诱导的;没有良性幻觉,和精神病症状总是恶化;PDP增加死亡率;竞争治疗是无效或危险的,而匹马色林治疗PDP是安全有效的。行业赞助的CME被用来传播与帕金森病相关的精神病的不准确和误导性的营销信息。一些专业学会和一些教科书也抵制PDP标签。将PDP重新构建为唯一条件是条件标记的典型示例。PDP的建立扩大了匹马色林的使用,并可能导致许多可避免的死亡。
    In 2016, Nuplazid (pimavanserin) became the first FDA-approved treatment for Parkinson\'s Disease Psychosis (PDP). We explored the possibility that PDP was a term created to market Nuplazid. We examined trends in perceptions of psychosis in Parkinson\'s disease from the 1990s to 2020 through MEDLINE search term frequency, neurology textbooks, guidance from professional societies, Acadia annual reports, sponsored websites, and a sponsored meeting held by the National Institutes of Health (NIH). We analyzed continuing medical education (CME) activities on PDP and analyzed the connection between payments by the manufacturer of pimavanserin and prescriptions. Our analysis of nine sponsored CME activities reveals misleading themes, including: PDP is common, progressive, and not always drug-induced; there is no such thing as a benign hallucination, and psychotic symptoms always worsen; PDP increases mortality; and competing treatments are ineffective or dangerous while pimavanserin is safe and effective for treating PDP. Industry-sponsored CME was used to disseminate inaccurate and misleading marketing messages on psychosis related to Parkinson\'s disease. Some professional societies and some textbooks also resisted the PDP label. Reframing PDP as a unique condition is a typical example of condition branding. The establishment of PDP expanded the use of pimavanserin and is likely to have resulted in many avoidable deaths.
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  • 文章类型: English Abstract
    The objective of the study is to determine the possibility and the right to choose the directions of self-education and self-development by forensic medical experts within the framework of personal and professional development program in the educational trajectory formation. The materials of special and encyclopaedic literature including pedagogical and sociological sciences, as well as legal framework regulating the processes of continuing medical education have been studied. The choice of educational trajectory of forensic physician depending on personal benchmarks, self-education building and participation in educational activities has been defined.
    UNASSIGNED: Определить возможность и право выбора судебно-медицинскими экспертами направлений самообразования и саморазвития в рамках программы личностно-профессионального роста при формировании образовательной траектории. Изучены материалы специальной и энциклопедической литературы, в том числе по педагогическим, социологическим наукам, нормативной базы, регулирующей процессы непрерывного медицинского образования. Определен выбор образовательной траектории судебно-медицинского эксперта в зависимости от личностных ориентиров, построения самообразования и участия в образовательных мероприятиях.
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