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Accurate prediction of SARS-CoV-2 infection based on symptoms can be a cost-efficient tool for remote screening in healthcare settings with limited SARS-CoV-2 testing capacity. We used a machine learning approach to determine self-reported symptoms that best predict a positive SARS-CoV-2 test result in physician trainees from a large healthcare system in New York. We used survey data on symptoms history and SARS-CoV-2 testing results collected retrospectively from 328 physician trainees in the Mount Sinai Health System, over the period 1 February 2020 to 31 July 2020. Prospective data on symptoms reported prior to SARS-CoV-2 test results were available from the employee health service COVID-19 registry for 186 trainees and analyzed to confirm absence of recall bias. We estimated the associations between symptoms and IgG antibody and/or reverse transcriptase polymerase chain reaction test results using Bayesian generalized linear mixed effect regression models adjusted for confounders. We identified symptoms predicting a positive SARS-CoV-2 test result using extreme gradient boosting (XGBoost). Cough, chills, fever, fatigue, myalgia, headache, shortness of breath, diarrhea, nausea/vomiting, loss of smell, loss of taste, malaise and runny nose were associated with a positive SARS-CoV-2 test result. Loss of taste, myalgia, loss of smell, cough and fever were identified as key predictors for a positive SARS-CoV-2 test result in the XGBoost model. Inclusion of sociodemographic and occupational risk factors in the model improved prediction only slightly (from AUC = 0.822 to AUC = 0.838). Loss of taste, myalgia, loss of smell, cough and fever are key predictors for symptom-based screening of SARS-CoV-2 infection in healthcare settings with remote screening and/or limited testing capacity.

BACKGROUND: New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE: To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING: Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS: All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS: The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS: The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.

Objective: Residency has become a vulnerable period for burnout among physicians because many common and specific stress factors in healthcare. Our study aims to evaluate the burnout level among medical residents in three tertiary care hospitals and to identify the relationship between socio-demographic and occupational factors with the burnout level. Methods: We conducted a cross-sectional study in December 2019. Data was collected using self-administered questionnaires from 490 residents (64.2% of 763 eligible) who work at hospitals of three medical oriented universities in Istanbul, Turkey. Results: Mean scores for subscales of Maslach Burnout Inventory (Turkish adaptation) are 19.1±7.7 for Emotional Exhaustion, 7.3±4.3 for Depersonalization, and 20.7±5.1 for Personal Achievement. Female residents or residents who pursue surgical specialties or have more night shifts, experience more Emotional Exhaustion than their counterparts. Depersonalization increases accordingly with the increase of years in residency and the number of night shifts. Residents working at the hospital of foundation universities feel higher Personal Achievement than those of the state university. Conclusion: The burnout level of the participants is concerning and appears to be influenced by several modifiable occupational factors. Particularly, the impact of each year of residency training and the number of shifts should be considered carefully.

Objective: Occupational burnout occurs more often among doctors than among those working in other sectors. It is an indisputable fact that medics whose work requires almost continuous contact with people are more prone to burnout. It is noticed that the burnout syndrome affects doctors at all stages of their careers - from residents to experienced practitioners. Methods:. This paper performs a literature review on the frequency and causes of professional burnout among resident doctors. Results: The results of numerous large-scale studies are conclusive that the intensive workload of doctors, including night shifts and overtime, and the lack of work-life balance, due to the numerous resident duties, are the most common predisposing factors for the development of burnout syndrome in resident doctors. Another important conclusion from these studies is that a high level of BOS is mainly associated with depression and inadequate patient care. Conclusions: Professional burnout syndrome among resident doctors is an ongoing issue. It is then required that additional subjects, such as building skills to recognize and combat stress and implement strategies to overcome it, should be included in resident doctors training programmers.

International audience; Background: Dyspnea is a frightening and debilitating experience. It attracts less attention than pain ('dyspnea invisibility'), possibly because of its non-universal nature. We tested the impact of self-induced experimental dyspnea on medical residents.Materials and methods: During a teaching session following the principles of experiential learning, emergency medicine residents were taught about dyspnea theoretically, observed experimental dyspnea in their teacher, and personally experienced self-induced dyspnea. The corresponding psychophysiological reactions were described. Immediate and 1-year evaluations were conducted to assess course satisfaction (overall 0-20 grade) and the effect on the understanding of what dyspnea represents for patients.Results: Overall, 55 emergency medicine residents participated in the study (26 men, median age 26 years). They were moderately satisfied with previous dyspnea teaching (6 [5-7] on a 0-10 numerical rating scale [NRS]) and expressed a desire for an improvement in the teaching (8 [7-9]). Immediately after the course they reported improved understanding of patients' experience (7 [6-8]), which persisted at 1 year (8 [7-9], 28 respondents). Overall course grade was 17/20 [15-18], and there were significant correlations with experimental dyspnea ratings (intensity: r = 0.318 [0.001-0.576], p = 0.043; unpleasantness: r = 0.492 [0.208-0.699], p = 0.001). In multivariate analysis, the only factor independently associated with the overall course grade was 'experiential understanding' (the experimental dyspnea-related improvement in the understanding of dyspneic patients' experience). A separate similar experiment conducted in 50 respiratory medicine residents yielded identical results.Conclusions: This study suggests that, in advanced medical residents, the personal discovery of dyspnea can have a positive impact on the understanding of what dyspnea represents for patients. This could help fight dyspnea invisibility.

Purpose The aim was to determine sleep quality and related factors including restless leg syndrome in the 6th year medical students and medical residents in Pamukkale University, Faculty of Medicine, Denizli, Turkey. Methods The data collection phase of this cross-sectional study was completed between November 1st and December 31st, 2019, with a questionnaire including 59 items. Three hundred forty-one medical students and residents participated in the study. The Pittsburgh Sleep Quality Index was used to determine the participants' sleep quality. The International Restless Legs Syndrome Study Group Diagnostic Criteria and the Restless Leg Syndrome Rating Scale were used for the diagnosis and for determining the seriousness of restless leg syndrome, respectively. Results The mean age (SD +/-) was 26.6 +/- 3.2. Men (50%) and medical residents (59%) constituted the majority. Most of the participants (70%) had poor sleep quality, and 9% had restless leg syndrome. Despite losing their significance in multivariable analysis, a relationship existed between restless leg syndrome and sleep quality in bivariate comparisons (p = 0.04). According to the multiple variable analysis, age (p = 0.008), female gender (p = 0.04), insufficient income (p = 0.009), being on-medication (p = 0.007), being a current smoker (p = 0.01), not sleeping at the usual time (p = 0.04), and listening to music before sleeping (p = 0.03) were identified as independent risk factors for poor sleep quality. Conclusions The prevalence of poor sleep quality and restless leg syndrome are high in the 6th year medical students and residents. Necessary measures should be taken to reduce the effect of negative conditions on these vulnerable groups.

Resumen: Introducción: La depresión y el burnout entre los médicos residentes es una entidad grave y común. El objetivo de este trabajo fue evaluar la influencia del síndrome de burnout y las características sociodemográficas en los niveles de depresión de médicos residentes de un hospital general del Perú. Métodos: Estudio transversal realizado en médicos residentes de un hospital general del Perú. Se utilizó el Patient Health Questionnaire-9 (PHQ-9) y el Maslach Burnout Inventory (MBI) en 145 médicos residentes. Resultados: El 27,6% tuvieron síntomas depresivos leves, el 13,8% moderados y el 5,5% moderadamente severos. La prevalencia de síndrome de burnout fue del 9,65%. El total del PHQ-9 se correlacionó de manera positiva con el puntaje total del MBI (ρ = 0,707; p

From 1940 to 1980, studies of medical education were foundational to sociology, but attention shifted away from medical training in the late 1980s. Recently, there has been a marked return to this once pivotal topic, reflecting new questions and stakes. This article traces this resurgence by reviewing recent substantive research trends and setting the agenda for future research. We summarize four current research foci that reflect and critically map onto earlier projects in this subfield while driving theoretical development elsewhere in the larger discipline: (1) professional socialization, (2) knowledge regimes, (3) stratification within the profession, and (4) sociology of the field of medical education. We then offer six potential future directions where more research is needed: (1) inequalities in medical education, (2) socialization across the life course and new institutional forms of gatekeeping, (3) provider well-being, (4) globalization, (5) medical education as knowledge-based work, and (6) effects of the COVID-19 pandemic.

Participants in specialist medical education programs are one aspect that plays an important role in national development in the health sector. This is inseparable from one aspect of the specialist medical education program, which is service. Other countries such as the United States and Canada have realized the importance of participants in this specialist medical education program both as students as well as workers. But in Indonesia, it is only the status of a student. The purpose of this study is to further examine the equality of rights between workers and participants in the doctor's education program. This study is a normative juridical research using the conceptual approach to legislation, and comparative approach. The results indicate that there are similarities in the elements contained in the employment agreement between the workers and participants of the specialist medical education program so that the specialist education program participants should also obtain status as workers other than students. Based on this, then in this study there are several suggestions by the author including the need for revisions in the status of students towards specialist medical education participants. Abstrak Peserta program pendidikan dokter spesialis merupakan salah satu aspek yang berperan penting dalam pembangunan nasional di bidang kesehatan. Hal ini tidak terlepas dari salah satu aspek dalam program pendidikan dokter spesialis yaitu pelayanan. Negara-negara lain seperti Amerika Serikat dan Kanada telah menyadari akan pentingnya peserta program pendidikan dokter spesialis ini sehingga status peserta program pendidikan dokter spesialis di kedua negara tersebut adalah sebagai mahasiswa sekaligus sebagai pekerja. Namun di Indonesia, hanya berstatus sebagai mahasiswa. Tujuan dalam penelitian ini adalah untuk meneliti lebih jauh persamaan hak-hak antara pekerja dengan peserta program pendidikan dokter. Penelitian ini merupakan penelitian yuridis normatif dengan pendekatan perundang-undangan pendekatan konseptual, dan pendekatan perbandingan. Hasil penelitian menunjukkan bahwa terdapat persamaan unsur-unsur yang terkandung dalam perjanjian kerja antara pekerja dan peserta program pendidikan dokter spesialis sehingga peserta program pendidikan dokter spesialis seharusnya juga memperoleh status sebagai pekerja selain mahasiswa. Berdasarkan hal ini, maka dalam penelitian ini terdapat beberapa saran oleh penulis diantaranya adalah perlu adanya revisi dalam status mahasiswa terhadap peserta pendidikan dokter spesialis.

Summary Team-based learning (TBL) is a well-established instructional strategy that provides students with the chance to apply conceptual knowledge through a series of actions, including pre-class, individual, team class activity, and immediate feedback. The purpose of the present study was to introduce a course of teaching the evidence-based medicine (EBM) to all first-year medical residents in different disciplines at Shiraz Medical School in Iran country using the TBL instructional strategy. The sample included 86 medical residents at Shiraz Medical School. This study had a quasi-experimental design and was conducted in 12 sessions of evidence-based medicine (EBM) based on team-based learning (TBL) strategy. The obtained data were analyzed using SPSS software. In all sections, the results of Individual Readiness Assurance Tests (IRATs) and Group Readiness Assurance Tests (GRATs) were added and calculated. Cronbach’s alpha test was implemented to evaluate the reliability of the questionnaires. For the descriptive analysis of data, descriptive statistics were used. ANOVA and T-test were used for analytic analysis. There was a significant difference in answering the questions between individual (3.73 ± 2.33) and group (4.71 ± 2.29) stages. Residents gained higher average grades on working in the team (P-value < 0.02). Results of residents’ response about satisfaction questionnaire are shown that the best scores belong to group activities in TBL. The results of this study showed that TBL could be used as an effective method for residents’ education in different disciplines.

We analysed the impact of several strategies aimed at increasing influenza immunisation rates among Medical Residents (MRs) of an Italian teaching Hospital. During the 2015–16 and 2016–17 influenza seasons we carried out several interventions: ambulatory doubling where vaccination was offered, ambulatory opening hour extension, email invitations, informative materials, forum theatre and vaccination campaign conference. In addition, during the 2016–17 the OSV was carried out: MRs who go to specific wards where they perform influenza immunisation counselling and eventually vaccinate the personnel. 99/1041 (9.5%) and 184/1013 (18.2%) MRs received the vaccine in 2015–16 and in 2016–17 respectively (p

Background The COVID-19 outbreak has caused challenges for healthcare systems worldwide. Recent data indicates that the psychological impact has differed with respect to occupation. In many countries, medical residents have been on the front line of this pandemic. However, data on the psychological impact of infectious disease outbreaks, and COVID-19 in particular, on medical residents are relatively lacking. Aims The aim of our study was to assess the psychological impact of the COVID-19 pandemic on medical residents working on the front and second line. Method An electronic survey was sent to all medical residents in Qatar. Depression, anxiety and stress were assessed by the Depression, Anxiety and Stress Scale – 21 Items. Professional quality of life was measured by the Professional Quality of Life measure. Results Of the 640 medical residents contacted, 127 (20%) responded. A considerable proportion of residents reported symptoms of depression (42.5%), anxiety (41.7%) and stress (30.7%). Multivariate analysis of variance showed significant effects of seniority in residency, with junior residents having poorer outcomes. In addition, there was a statistically significant interaction effect with moderate effect sizes between gender and working on the front line, as well as gender, working on the front line and seniority, on mental health outcomes. Conclusions The COVID-19 pandemic may have a negative impact on junior residents’ mental health. Preventive measures to reduce stress levels and easy access to professional mental health services are crucial.

Fatigue in resident physicians has been identified as a factor that contributes to burnout and a decline in overall wellbeing. Fatigue risk exists because of poor sleep habits and demanding work schedules that have only increased due to the COVID‐19 pandemic. At this time, it is important not to lose sight of how fatigue can impact residents and how fatigue risk can be mitigated. While fatigue mitigation is currently addressed by duty hour restrictions and education about fatigue, Fatigue Risk Management Systems (FRMSs) offer a more comprehensive strategy for addressing these issues. An important component of FRMS in other shiftwork industries, such as aviation and trucking, is the use of biomathematical models to prospectively identify fatigue risk in work schedules. Such an approach incorporates decades of knowledge of sleep and circadian rhythm research into shift schedules, taking into account not just duty hour restrictions but the temporal placement of work schedules. Recent research has shown that biomathematical models of fatigue can be adapted to a resident physician population and can help address fatigue risk. Such models do not require subject matter experts and can be applied in graduate medical education program shift scheduling. It is important for graduate medical education program providers to consider these alternative methods of fatigue mitigation. These tools can help reduce fatigue risk and may improve wellness as they allow for a more precise fatigue management strategy without reducing overall work hours.

Introduction Direct-acting oral anticoagulant (DOAC) prescriptions have increased steadily since the first, dabigatran, was Food and Drug Administration-approved in 2010. They have multiple advantages over vitamin K antagonists including fixed dosing without coagulation lab monitoring, rapid onset and offset of action, and fewer drug and food interactions. Patient-specific dosing, administration education, adherence, and monitoring are critically important. Many providers are unfamiliar with these concepts and too often use DOACs for off-label indications or at off-label dosing. A DOAC workshop was created to address knowledge gaps and improve internal medicine resident prescribing confidence. Methods One author (Irsk Anderson) conducted four 1-hour DOAC workshops with 49 total internal medicine residents rotating on their outpatient clinical rotation between October 2018 and November 2019. Residents performed small-group learning around four DOAC-specific cases, followed by a large-group report-out session. The residents completed pre- and postworkshop multiple-choice questions (MCQs) to assess knowledge as well as a postworkshop DOAC confidence self-assessment. Results Resident knowledge, assessed by percentage of residents answering correctly, improved significantly for all four MCQs after completing the workshop (all p

Background Clinical trials are an important tool to test the efficacy of new treatment modalities for cancer patients. Physicians, including medical residents, should play a major role in carrying out clinical trials to generate a strong body of evidence to determine the best available treatment for their patients. Carrying out clinical trials demands adequate understanding of the research phases and requirements including ethical standards as well as presenting positive attitudes toward the clinical research. Hence, evaluating the knowledge and attitudes of medical residents toward running clinical trials is essential to assess their preparedness and willingness to participate in future studies. Methods This study was a questionnaire-based observational study. It involved medical residents from various specialties who served cancer patients admitted at King Abdullah University Hospital during the period from June 1 to August 15, 2017. Results A total number of 83 respondents completed the questionnaire. Of them, 56.7% and 53.0% of the respondents reported either current or previous participation in clinical trials research, respectively. Only 10 residents (12.0%) had previous participation in clinical research where a new investigational cancer treatment was tested. While, 91.6% of respondents believed that physicians should be involved in running clinical cancer research, only 25.3% had previous experience in writing a cancer clinical trial protocol and 28.9% wrote a scientific manuscript on cancer clinical trials for publication. Moreover, 67.5% of residents knew when informed consent should be obtained and 62.7% were aware of the clinical equipoise concept in clinical trials. Conclusion Much remains to be done to improve knowledge and attitudes of medical residents toward cancer clinical trials and the main ethical principles that should be followed to assure having an ideal research environment, which will pave the way for the generation of high quality clinical cancer research and reliable evidence-based clinical practice for cancer management.

BackgroundShared Decision Making (SDM) is as ideal model for resident-patient relationship which may improve medical outcomes. Nevertheless, predictive psychological factors influencing residents’ perspective regarding SDM are unclear. The current study investigated the relationship between two psychological factors, mental health and personality traits, and residents’ views toward SDM.MethodIn a cross-sectional study, 168 medical residents of the Babol University of Medical Sciences studying in 13 field specialties were recruited. The residents completed three questionnaires including Shared Decision-Making Questionnaire (SDM-Q-Doc, physician version), General Health Questionnaire (GHQ-12), and Big Five Personality (NEO-FFI).ResultsResidents had an overall agreement of about 88% regarding SDM with patients. There was no significant difference between male and female residents in terms of the degree of agreement for SDM. Concerning SDM, there was no significant relationship either between residents’ views and neuroticism, extraversion, agreeableness, and conscientiousness. In multivariate regression, mental health did not predict the SDM, but openness to experience negatively predicted residents’ views concerning SDM (β = − 0.388,p ConclusionThe residents’ personality trait of openness to experience was a significant negative predictor of SDM with patients. A better understanding of how psychological factors relate to residents’ perspectives may help clinicians properly discuss the treatment options with the patient thereby encouraging them for SDM or to consider their own preferences.

The COVID-19 pandemic has affected almost all areas of human endeavors. The impact of the pandemic on medical students’ education in the USA (US) has been well established in the literature [1–3]. ...

BACKGROUND Headache is quite prevalent in general population. Few studies have been done on medical residents and comparison between headache prevalence and types in medical and non-medical student groups is quite lacking. This institute having medical residents as well as non-medical students, provides an opportunity to study and compare frequency and pattern of headache in these student groups. The study was aimed at finding out the type and frequency of headache, disability due to headache and treatment practices followed by these two student groups and the effect on the quality of life of our work force resulting from headache. MATERIALS AND METHODS Headache characteristics were studied in 200 medical residents and non-medical students who had at least one episode of headache of at least moderate intensity in the last 1 year using structured questionnaire. RESULTS Headache occurred in 81% students (79.9% of males and 83.9% of females), of whom, 81.82% were medical, 77.14% were non-medical, 79.65% were married and 82.76% were unmarried. Episodic tension-type headache (TTH) was most frequent headache type and migraine without aura was uncommon. More males had TTH than females (55.6% versus 39.3%) and migraine was more common in females (39.3% versus 20.1%). Common triggers for headache in medical students were stress, lack of sleep and in non-medical students were stress, sunshine and loud noise. Only 10.5% students were on prescription drugs while 69.8% were self-medicating. CONCLUSION Headache is almost as frequent in medical as in non-medical students and it affects the quality of life of our work force

Residents-as-teachers (RaT) is a theoretical framework emphasizing the significance of the similar learning background of teachers and learners. In Japan, community-based medical education (CBME) is a practical approach to teaching family medicine. This study aimed to investigate the impact and challenges of RaT on the learning of medical students and residents in CBME at a rural community hospital in Japan. Over the course of a year, the researchers conducted one-on-one interviews with three residents and ten medical students participating in family medicine training at the hospital. The interviews were recorded and transcribed verbatim. Grounded theory was used in the data analysis to clarify the findings. Three key themes emerged from the research: lack of educational experience with RaT, effectiveness of RaT, and challenges of RaT. Although participants were prejudiced against RaT, they felt its implementation could facilitate the establishment of beneficial relationships between learners and teachers. They were also able to participate in medical teams effectively. The findings suggest that the increased participation of senior doctors in RaT could strengthen its learning effects. RaT in rural CBME should be applied in various contexts, and its effectiveness should be further investigated both qualitatively and quantitatively.

ResumenIntroducciónLa estadística médica es considerada un elemento importante de la medicina basada en la evidencia. El objetivo de este estudio fue evaluar el conocimiento de métodos básicos de estadística, epidemiología e investigación en médicos residentes de la Universidad Nacional de Asunción, y evaluar el efecto de las características individuales sobre el nivel de conocimientos.Materiales y métodosEstudio observacional, analítico de corte transverso y muestreo no probabilístico, en el que se incluyeron 50 médicos residentes. Se utilizó una versión adaptada del cuestionario de Novack et al. sobre conocimientos de epidemiología y estadística. Para establecer asociaciones se usaron las pruebas de correlación de Pearson, «t» de Student y ANOVA, estableciendo una significación de p

Contains fulltext : 175323.pdf (Publisher’s version ) (Open Access) Introduction: Work engagement is important for medical residents and the healthcare organizations they work for. However, relatively little is known about the specific predictors of work engagement in medical residents. Therefore, we examined the associations of work and home characteristics, and work-home interference with work engagement in male and female residents. Methods: This study was conducted on a nationwide sample of medical residents. In 2005, all Dutch medical residents (n = 5245) received a self-report questionnaire. Path analysis was used to examine the associations between the potential predictors and work engagement. Results: In total, 2115 (41.1%) residents completed the questionnaire. Job characteristics, home characteristics and work-home interference were associated with work engagement. Important positive contributing factors of work engagement were opportunities for job development, mental demands at work, positive work-home interference and positive home-work interference. Important negative contributing factors were emotional demands at work and negative home-work interference. The influence of these factors on work engagement was similar in male and female residents. Discussion: Opportunities for job development and having challenging work are of high relevance in enhancing work engagement. Furthermore, interventions that teach how to deal skilfully with emotional demands at work and home-work interference are expected to be the most effective interventions to enhance work engagement in medical residents. 10 p.

RESUMEN El insomnio es un trastorno que puede presentarse en cualquier edad y hasta un 30% de la población mundial lo padece en algún momento; puede ser síntoma de un sinnúmero de patologías médicas que incluye muchos trastornos psiquiátricos. El objetivo de este estudio observacional analítico de corte transversal fue determinar el grado de conocimiento sobre insomnio en médicos residentes de Asunción-Paraguay; se incluyeron 54 médicos residentes entre 26-39 años de edad de las Cátedras de Medicina Interna (26), Medicina Familiar (11) y Psiquiatría (17). Significativamente mayor proporción de residentes de Psiquiatría (47,1%) y de Medicina Familiar (45,5%) tuvieron buen conocimiento comparado a los de Medicina Interna (7,7%). El 59,3% de los residentes (Psiquiatría: 58,8%, Medicina Familiar: 75,0% y Medicina Interna: 53,8%) había diagnosticado alguna vez insomnio primario y la mayoría de ellos registra ≤20% de los pacientes con insomnio en las historias clínicas. Sobre el tratamiento instaurado, el 57,4% utiliza medidas farmacológicas, el 55,5% medidas de higiene del sueño, mientras que 18,5% recomienda actividad física. Entre los grupos farmacológicos que conocen para el tratamiento del insomnio, el 72,2% de los residentes citó a las benzodiacepinas; hipnóticos no benzodiacepínicos (16,7%); antipsicóticos (35,2%); antihistamínicos (9,3%) y otras medicaciones (27,8%). Los conocimientos de los residentes respecto a la terapéutica del insomnio son suficientes, pero no del nivel deseable. Esto resalta la necesidad de establecer oportunidades educativas sobre el manejo y tratamiento del insomnio y mayor profundización de la teoría y la práctica de la medicina del sueño en estudiantes de grado y posgrado. ABSTRACT Insomnia is a global distribution disorder that may occur at any age and up to 30% of the world’s population suffers from insomnia at some point in their lives. Insomnia presents the peculiarity of being a symptom of a number of medical pathologies among which are many psychiatric disorders. The objective of this cross-sectional, observational study was to determine the knowledge on insomnia in medical residents in Asunción, Paraguay. The study includes 54 medical residents between 26 and 39 years of age, from the Departments of Internal Medicine (26), Family Medicine (11) and Psychiatry (17). A higher proportion of residents of Psychiatry (47.1%) and Family Medicine (45.5%) had a good knowledge of insomnia compared to Internal Medicine residents (7.7%); 59.3% of residents (Psychiatry: 58.8%, Family Medicine: 75.0% and Internal Medicine: 53,8%) had ever diagnosed primary insomnia and the majority of them recorded ≤20% of the patients with an insomnia diagnosis in the medical records. About the treatment established, 57.4% used pharmacological measures, 55.5% sleep hygiene measures, while 18.5% recommended physical activity. Among the pharmacological groups known for the treatment of insomnia, 72.2% of residents cited benzodiazepines; non-benzodiazepine hypnotics (16.7%); antipsychotics (35.2%); antihistamines (9.3%) and, other medications (27.8%). Residents' knowledge of insomnia therapy is sufficient, but not at the desirable level. This highlights the need to establish educational opportunities on the management and treatment of insomnia and further deepening the theory and practice of sleep medicine in undergraduate and postgraduate students.

Background: Residents frequently encounter situations in their workplace that may induce moral distress or burnout. The objective of this study was to measure overall and rotation-specific moral distress and burnout in medical residents, and the relationship between demographics and moral distress and burnout.Methods: The revised Moral Distress Scale and the Maslach Burnout Inventory (Human Service version) were administered to Internal Medicine residents in the 2013-2014 academic year at the University of British Columbia.Results: Of the 88 residents, 45 completed the surveys. Participants (mean age 30+/-3; 46% male) reported a median moral distress score (interquartile range) of 77 (50-96). Twenty-six percent of residents had considered quitting because of moral distress, 21% had a high level of burnout, and only 5% had a low level of burnout. Moral distress scores were highest during Intensive Care Unit (ICU) and Clinical Teaching Unit (CTU) rotations, and lowest during elective rotations (p

Background Several studies correlate medical residency with the occurrence of mental health disorders, Burnout Syndrome and quality of life impairment. It has been demonstrated that mental health disorders increase medical errors and lead to less effective patient care. Considering such context, this study aimed to evaluate the prevalence of anxiety, depression, stress and to identify its correlates with Burnout Syndrome and quality of life in a sample of medical residents and fellow physicians of the largest Brazilian academic health system. Methods In 2017, 1648 participants were voluntarily and anonymously surveyed online about demographic characteristics, Burnout Syndrome, mental symptoms, and quality of life measured by validated questionnaires. Responses were captured through REDCap platform and multivariate statistical analyses were performed with STATA 15. Results A total of 606 (36.8%) residents/fellows physicians completed the survey. Depression symptoms were present in 19%, anxiety symptoms in 16% and stress symptoms in 17.7% of the sample. Burnout Syndrome was present in 63% of the sample. Multivariate analysis showed a statistical significant positive correlation between Burnout Syndrome and depression, anxiety and stress symptoms and a negative correlation between mental symptoms and quality of life scores. Conclusions Mental health symptoms prevalence in this study is similar to other studies and their occurrence is positively correlated with Burnout Syndrome among medical residents/fellow physicians of the largest Brazilian academic health system. These results are relevant and must be confirmed by multicentric longitudinal studies. This study reinforces the importance of debating interventions to improve mental health among doctors in training.

Objectives: The Dubai Residency Training Program (DRTP) commenced in the year 1993; then, a “Residency Research Program (RRP)” has implemented from 2011 to promote research among young physicians. This study was conducted by the Dubai Health Authority to review the RRP to assess its effectiveness in meeting original objectives and generating desired outcomes. Methods: Source documents such as the chronicles of the DRTP, communication between the stakeholders, resident feedback, research director, and program director reports were accessed and retrospectively reviewed. Results: Seven research workshops and ten advanced statistics courses were held. Ten scholarships were provided to the residents for “Introduction to Clinical Research Training” held by Harvard Medical School. Of 370 residents, a total of 156 residents submitted their research proposal, of which 128 residents presented their thesis. Nineteen residents presented their research on international conferences, 12 published their study, and 9 got award locally. Conclusions: Efforts are focused on improving the quality of the research projects, as well as getting residents involved in research that leads eventually to publication. Research is a major component of DRTP; nevertheless, it is challenging for residents to conduct research successfully because of some barriers inherent in residency training. This experience was the first in the United Arab Emirates, and we believe that this paper will contribute to the integrating research in residency programs by the educators and academics in across countries within the region.

Background: Previous studies have highlighted risks for depression and suicide in medical cohorts, but evidence regarding psychiatric residents is missing. This study aimed to determine rates of depression, suicide ideation and suicide attempt among psychiatric residents and to identify associated individual, educational and work-related risk factors.Methods: A total of 1980 residents from 22 countries completed the online survey which collected data on depression (PHQ-9), suicidality (SIBQ), socio-demographic profiles, training, and education. Generalized linear modeling and logistic regression analysis were used to predict depression and suicide ideation, respectively.Results: The vast majority of residents did not report depression, suicide ideation or attempting suicide during psychiatric training. Approximately 15% (n = 280) of residents met criteria for depression, 12.3% (n = 225) reported active suicide ideation, and 0.7% (n = 12) attempted suicide during the training. Long working hours and no clinical supervision were associated with depression, while more completed years of training and lack of other postgraduate education (e.g. PhD or psychotherapy training) were associated with increased risk for suicide ideation during psychiatric training. Being single and female was associated with worse mental health during training.Limitations: Due to the cross-sectional nature of the study, results should be confirmed by longitudinal studies. Response rate was variable but the outcome variables did not statistically significantly differ between countries with response rates of more or less than 50%.Conclusion: Depression rates among psychiatric residents in this study were lower than previously reported data, while suicide ideation rates were similar to previous reports. Poor working and training conditions were associated with worse outcomes. Training programmes should include effective help for residents experiencing mental health problems so that they could progress through their career to the benefit of their patients and wider society.

One issue that has received less attention in present health care protocols is pediatric palliative care (PPC), which is an approach to care starting with the diagnosis of life-threatening diseases in children. It embraces physical, emotional and spiritual elements. Ethical issues are major concerns in today’s pediatric health care guidelines and must be considered by residents and attending physicians in this field. The present study was conducted in Namazi Teaching Hospital, Shiraz, Iran. Forty-eight out of 92 pediatricians were enrolled in this research, including 8 attendings, 6 fellows, and 34 residents. The study questionnaire consisted of 66 items. It was built based on previous reliable and validated questionnaire; also the calculated Cranach’s alpha was 0.815. Data were analyzed and presented by mean ± SD and percentage. While seventy-five percent of the participants reported involvement in pediatric palliative care, fifty-six percent did not acknowledge any information about the subject. More than half of the participants perceived the pediatric palliative care services in Namazi Hospital as somewhat or completely satisfactory. Furthermore, thirty-five percent of the applicants stated that they encounter an ethical problem with regard to PPC once a week. There are many challenges to providing decent palliative care for children, including symptom controlling, shifting to end of life care, background dissimilarities of patients, financial restrictions, and acceptance of death. Our applicants believed that offering psycho-spiritual support was the most important challenge in PPC. However, further investigations are needed to determine other requirements for providing a comprehensive guideline on PPC.

Background: Health care providers (HCPs) may ask patients if they understand their diagnosis or instructions during clinic visits; patients often simply say yes. However, many patients leave with little idea of their medication and discharge instructions. Teach Back (TB) is a patient-centered health-literate technique that allows HCPs to confirm patient understanding during clinic visits. Objective: The purpose of this pilot study was to determine a relationship between perception and actual use of TB by medical residents in primary care outpatient clinics (providers, N = 16; clinic visits, N = 80) and, if the observed rate of TB was discordant with perception, did a TB skills training intervention have any impact on use of TB (clinic visit, N = 78). We were also interested in language used during TB and if use of TB was related to patient demographics or health literacy level. Methods: Medical residents' perception was measured using the “Always Use Teach-Back Confidence and Conviction Scale” ( N = 16). Clinic visits were audiotaped and scored for use of TB (pre-intervention, N = 80; post-intervention, N =78). The intervention was a 1-hour TB skills training course. Content analysis was performed to understand the use of TB language. Key Results: Despite the high level of confidence/conviction about TB ( r [16] = .669, p N = 16] = 6.533, p Conclusion: Results from our pilot study identified three important observations that may be critical to improving health-literate physician communication: residents believe they are using TB in the clinic for many patients; use of TB was discordantly low at 2.5%; and a single 1-hour skills training intervention dramatically increased TB use to 53%. Residents used patient-centered TB language after the training intervention. [ HLRP: Health Literacy Research and Practice . 2019;3(2):e117–e126.] Plain Language Summary: Medical residents believe they are using Teach Back to confirm patient understanding in the clinic 60% of the time when they actually used Teach Back only 2.5% of the time. After an educational intervention, they used Teach Back 53% of the time; Teach-Back language was collaborative and patient-centered, and all but two patients confirmed their medication and discharge plan.

Jamiu O Busari,1,2 Huriye Yaldiz,3 Daniëlle Verstegen4 1Pediatric Residency Program, Department of Pediatrics, Zuyderland Medical Center, Heerlen, the Netherlands; 2Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands; 3Faculty of Medicine, Radboud University, Nijmegen, the Netherlands; 4Health Professions Education Program, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands Background: Previous research has shown that medical residents are in need of additional training in management and leadership skills. One of the possible ways of teaching this competency is the use of a serious game. This study explores residents’ views of the potential use of a serious game to teach a module on negotiation in practice management and leadership curriculum. Method: The aim of this study was to identify the features required to design a serious game for management and leadership education, including potential scenarios for such a game. Qualitative interviews were conducted with six medical residents. After transcription and coding of data, thematic analysis was used to group the data into four themes, namely: 1) CanMEDS leader competency, 2) personal views about negotiation, 3) views about serious games, and 4) educational needs in a serious game. Results: Our findings revealed that leadership and negotiation were two domains where residents felt they needed additional training. Those who were already familiar with medical applications and had them installed on their smartphones or tablets had a more positive attitude toward gaming than those who did not. The residents were mostly interested in how realistic the content of a serious game was and its ability to combine management and leadership skills with medical knowledge and clinical expertise. Conclusions: The findings in this study demonstrate that serious games have the potential to teach certain aspects of management and leadership. The study shows that residents are receptive to the use of serious games and, if well designed, believe that it can be used to improve their management and leadership competencies. Keywords: serious games, postgraduate medical education, medical residents, management, leadership

Objectives: To determine medical residents’ emotions, attitudes, and knowledge related to Middle East respiratory syndrome (MERS) outbreaks. Methods: In this is a cross sectional study, self-administered questionnaires were distributed and collected before resident education activities in 4 tertiary hospitals in Riyadh, Kingdom of Saudi Arabia, between November 2015 and January 2016. The questionnaire included questions related to residents’ demographic data and their emotions, attitudes, and knowledge related to an MERS outbreak. Results: Of the 228 participants analyzed, 85.5% believed their work put them at risk of infection, and two-thirds believed their family was exposed to a greater risk of infection. However, only 2.6% would change their job. Nearly half of the residents indicated that their hospital had a clear plan, and only 28% considered themselves not well prepared for an MERS outbreak. Conclusions: Our study highlights medical residents’ attitude and emotions related to MERS outbreaks. Residents’ concerns and emotions in relation to MERS should be considered in greater detail by hospital policymakers. Saudi Med J 2017; Vol. 38 (9): 942-947 doi: 10.15537/smj.2017.9.20626 How to cite this article: Aldrees T, Al Ghobain M, Alenezi A, Alqaryan S, Aldadeeb D, Alotaibi N, et al. Medical residents' attitudes and emotions related to Middle East respiratory syndrome in Saudi Arabia. A cross-sectional study. Saudi Med J . 2017 Sep;38(9):942-947. doi: 10.15537/smj.2017.9.20626.

Contains fulltext : 175906.pdf (Publisher’s version ) (Open Access) Burnout is highly prevalent in medical residents. In order to prevent or reduce burnout in medical residents, we should gain a better understanding of contributing and protective factors of burnout. Therefore we examined the associations of job demands and resources, home demands and resources, and work-home interferences with burnout in male and female medical residents. This study was conducted on a nation-wide sample of medical residents. In 2005, all Dutch medical residents (n = 5245) received a self-report questionnaire on burnout, job and home demands and resources and work-home interference. Path analysis was used to examine the associations between job and home characteristics and work-home interference and burnout in both males and females. In total, 2115 (41.1 %) residents completed the questionnaire. In both sexes emotional demands at work and the interference between work and home were important contributors to burnout, especially when work interferes with home life. Opportunities for job development appeared to be an important protective factor. Other contributing and protective factors were different for male and female residents. In females, social support from family or partner seemed protective against burnout. In males, social support from colleagues and participation in decision-making at work seemed important. Effectively handling emotional demands at work, dealing with the interference between work and home, and having opportunities for job development are the most essential factors which should be addressed. However it is important to take gender differences into consideration when implementing preventive or therapeutic interventions for burnout in medical residents. 16 p.

Background: Medical residents are at a high risk of depression. The National Institute for Occupational Safety and Health (NIOSH) job stress model explains that job stressors, buffer factors, and individual factors are related to worker health, including depression. This study investigated which job stressors and buffer factors influence depression in residents, independent of individual factors.Methods: A self-administered questionnaire was distributed to second-year residents at 251 teaching hospitals. The questionnaire contained the Brief Scales for Job Stress (BSJS), the Sense of Coherence (SOC) Scale, the Center for Epidemiologic Studies Depression (CES-D) Scale, and questions on working hours and demographic characteristics. The BSJS is composed of six subscales including workload, mental workload, problems in personal relationships, job control, reward from work, and support from colleagues and superiors. The SOC includes individual factors about life stressors and health. We analyzed the relationship between depressive symptoms and these factors.Results: Among 1,121 second-year residents who responded (64.5% response rate), 274 (24.4%) had depressive symptoms. In the multivariable analysis, depressive symptoms were significantly associated with SOC-13 score (p < 0.001), mental workload (p < 0.01), problems in personal relationships (p < 0.001), and reward from work (p < 0.01). Depressive symptoms were not significantly associated with mean number of hours worked per week.Conclusion: Mental workload and problems in personal relationships are job stressors and reward from work is a buffer factor associated with depressive symptoms in medical residents. These findings can help residency programs support mental health of residents more effectively.

BACKGROUND Each July thousands begin medical residencies and acquire increased responsibility for patient care. Many have suggested that these new medical residents may produce errors and worsen patient outcomes—the so-called “July Effect;” however, we have found no U.S. evidence documenting this effect. OBJECTIVE Determine whether fatal medication errors spike in July. DESIGN We examined all U.S. death certificates, 1979–2006 (n = 62,338,584), focusing on medication errors (n = 244,388). We compared the observed number of deaths in July with the number expected, determined by least-squares regression techniques. We compared the July Effect inside versus outside medical institutions. We also compared the July Effect in counties with versus without teaching hospitals. OUTCOME MEASURE JR = Observed number of July deaths / Expected number of July deaths. RESULTS Inside medical institutions, in counties containing teaching hospitals, fatal medication errors spiked by 10% in July and in no other month [JR = 1.10 (1.06–1.14)]. In contrast, there was no July spike in counties without teaching hospitals. The greater the concentration of teaching hospitals in a region, the greater the July spike (r = .80; P = .005). These findings held only for medication errors, not for other causes of death. CONCLUSIONS We found a significant July spike in fatal medication errors inside medical institutions. After assessing competing explanations, we concluded that the July mortality spike results at least partly from changes associated with the arrival of new medical residents.

Background The purpose of this study was to analyze the perceptions and practices of internal medicine residents in the western region of Saudi Arabia regarding the implementation of do not resuscitate (DNR) orders to improve future training practices among physicians. Methods Medical residents involved in training programs in the western region of Saudi Arabia, including Jeddah, Makah, Medinah, and Taif, were invited to participate in a cross-sectional, anonymous, online survey regarding DNR orders. The 16-question survey was distributed to residents in all training programs in the region using surveymonkey.com, and the results were collected and tabulated. Results Of 364 residents, 157 completed the questionnaire, resulting in a 43% response rate. The study showed that most (66%) internal medicine residents in the western region of Saudi Arabia participate in DNR discussions with patients and family or surrogate decision-makers. In addition, 43% were observed by faculty members, and half of them (51.9%) reported feeling comfortable during these discussions. Furthermore, most residents believed that additional educational programs would enhance their competence in addressing issues related to DNR discussions. Conclusion This study highlights the need for a structured curriculum to teach skills relating to end-of-life issues such as DNR orders to residents in the Saudi Arabian medical system. The majority of residents surveyed believe they would benefit from additional training in DNR discussions. Therefore, an evidence-based curriculum providing instruction for improving discussions regarding DNR orders would improve physician confidence and effectiveness in caring for critically ill patients.

ObjetivoConocer la opinión de los usuarios acerca de la presencia de médicos internos residentes (MIR) en las consultas de atención primaria.DiseñoEstudio descriptivo, observacional y transversal.EmplazamientoCentro de salud urbano.ParticipantesSe seleccionó por muestreo sistemático a 421 pacientes de las consultas de los tutores de los MIR.MediciónSe elaboró un cuestionario estructurado de preguntas cerradas de respuestas alternativas de múltiples opciones con escala de Likert, y otras de respuesta dicotómica a la que se añadió la respuesta:«es indiferente». Las encuestas se realizaron en las salas de espera.ResultadosTodos los pacientes respondieron al cuestionario (un 63% mujeres y un 37% varones). El 71% prefiere que le atienda el mismo médico; el 68% considera estar major tratado si le atiende siempre el mismo. El 89% cree que la presencia del MIR es necesaria para su formación, al 90% no le molesta su presencia en la consulta, el 82% cree que el MIR nunca entorpece la relación con el médico y el 94% declara que nunca ha dejado de expresar algo importante ante la presencia del MIR en la consulta. El 55% piensa que el paciente tiene derecho a opinar sobre la presencia del residente en la consulta.ConclusionesLa mayoría de los pacientes considera positiva la presencia de los MIR en las consultas de atención primaria y la cree necesaria para la formación de éstos.SummaryObjectiveTo find what users think of the presence of medical residents (MIR) at primary care consultations.DesignObservational and cross-sectional descriptive study.SettingUrban health centre.Patients421 patients, selected by systematic sampling, attending consultations of MIR tutors.MethodA structured questionnaire was drawn up, with some closed questions with multipleoption replies on the Likert scale; and others with a yes/no or “indifferent” reply. The questionnaires were filled out in the waitingrooms.Results100% (63% women, 37% men) answered the questionnaire. 71% preferred to be seen by the same doctor; and 68% thought they were better treated if they were always seen by the same doctor. 89% thought that the presence of the resident was a necessary part of his/her training; 90% were not bothered by his/her presence during the consultation; 82% thought the resident did not obstruct in any way their relationship with the doctor; 94% thought that the presence of the resident had never stopped them mentioning something important; 55% thought that patients had the right to an opinion on the presence of the resident.ConclusionsMost patients valued the presence of residents at consultations positively and thought it a necessary part of their training.

Los programas de especialización médica consideran a la comunicación y profesionalismo como competencias que debe tener un médico especialista. El objetivo de esta revisión fue evaluar la utilización de la simulación clínica como instrumento de entrenamiento y evaluación de las competencias profesionalismo y comunicación en los programas de especialización médica. La Evaluación Clínica Objetiva y Estructurada (ECOE) evalúa el aprendizaje y es recomendada por sistemas de acreditación internacional como el Royal College of Physicians of Canada que elaboró los estándares Canadian Medical Education Directives for Specialist (CanMEDS) y el Comité de acreditación de los programas de postgrado de los Estados Unidos de América, Accreditation Council for Graduate Medical Education (ACGME). Para la evaluación de competencias de comunicación y profesionalismo, el ECOE aplica escenarios de simulación clínica validados que permiten una evaluación formativa y sumativa en los programas de especialización. El ECOE puede ser implementado como instrumento de evaluación de competencias en los programas de especialización de Perú. Communication and professionalism are two competences that training subspecialties programs in medicine do consider essential among trainees. This review has the objective to evaluate the use of clinical simulation as an instrument to train residents of medicine subspecialties in getting competences in communication and professionalism. The OSCE is recommended by international accredited systems such as the Royal College of Physicians of Canada and the Accreditation Council for Graduate Medical Education of the USA. To asses competences in communication and professionalism, the OSCE uses validated scenarios of clinical simulation allowing formative and summative evaluations. OSCE can be implemented as a tool to asses competences in medicine subspecialties training programs.

Analisi comparativa dei percorsi formativi offerti dalle Scuole di specializzazione di Igiene e Medicina Preventiva in Italia Background: Il percorso formativo dello specialista in Igiene e Medicina Preventiva dovrebbe garantire adeguate conoscenze tecnico-scientifiche e professionali nei campi della medicina preventiva, della promozione della salute e della programmazione dei servizi sanitari secondo quanto indicato anche dal DM 285/2005. La Consulta degli Specializzandi, da sempre coinvolta in attività di monitoraggio della formazione a livello nazionale, si prefigge l’obiettivo di valutare l’omogeneità delle proposte formative tra le diverse sedi italiane, non solo per segnalare le criticità, ma anche per evidenziarne le opportunità. Metodi: Lo studio, di tipo cross-sectional, è stato condotto mediante la somministrazione di un questionario semi-strutturato inviato per la compilazione ai rappresentanti delle 32 le Scuole di Igiene e Medicina Preventiva italiane. Lo strumento di valutazione è costituito da quattro sezioni: informazioni generali, attività formativa universitaria, attività formativa extra-universitaria, attività formativa intersettoriale. L’indagine è stata svolta nel periodo tra marzo e maggio 2013 ed è stata prodotta un’analisi descrittiva dei dati ottenuti. Risultati: Il questionario è stato compilato da 28 Scuole su 32 (tasso di risposta 88%), distribuite su tutto il territorio nazionale. Il numero di medici in formazione varia tra 7 e 31 e il rapporto tra docenti del settore scientifico-disciplinare di interesse e i discenti è compreso tra 0,2 e 2. Per quanto riguarda la didattica, solo in 4 Scuole si effettuano tutti i corsi previsti dal DM. La maggior parte delle sedi svolge almeno il 75% dei corsi previsti, ma esistono sedi in cui il numero di corsi è inferiore al 50%. La maggior parte delle Scuole svolge più del 60% delle attività professionalizzanti essenziali secondo il decreto, ma 2 Scuole non arrivano al 50%. Tutte le Scuole prevedono un tirocinio di 6-12 mesi in ASL, affiancando principalmente attività del Dipartimento di Prevenzione. Ovunque è previsto un periodo in Direzione Medica Ospedaliera, mentre le Strutture Riabilitative rientrano raramente nella rete formativa. Nella maggioranza delle Scuole è possibile frequentare aziende con rischio biologico oppure seguire simili attività nei Servizi dedicati della ASL. Molte Scuole, infine, consentono di frequentare diverse strutture territoriali (Agenzia di Controllo delle Acque), regionali (Assessorati) o nazionali (Ministero, Istituto Superiore di Sanità); in alcuni casi si tratta di Università gemellate e Istituti di Ricerca. Conclusioni: Nonostante il DM 285/2005 indichi quali siano le fondamenta della sanità pubblica, la flessibilità nella scelta formativa è vista come requisito essenziale per ottimizzare le risorse e contestualizzare l’adeguata formazione del medico in formazione specialistica in Igiene e Medicina Preventiva. La maggior parte delle Scuole di Specializzazione italiane dovrebbe però prevedere lo svolgimento della quasi totalità delle attività formative previste, al fine di non creare disuguaglianze formative tra gli specializzandi. Infine, considerato che la sanità pubblica è una disciplina in continuo divenire, il DM del 2005 andrebbe rivisitato tenendo in considerazione la flessibilità della formazione ed i continui cambiamenti dei bisogni di salute essenziali della popolazione. Inoltre, nel processo di rivisitazione dei bisogni formativi dei medici in formazione specialistica, dovrebbero essere coinvolti anche i discenti al fine di rafforzare il potere e l’efficacia dell’insegnamento. Background The postgraduate medical Schools in Public Health (locally known as School of Hygiene and Preventive Medicine) should ensure adequate scientific and technical knowledge and professional skills in preventive medicine, health promotion and healthcare planning as provided by Ministerial Decree 285/2005. The Italian Committee of Medical Residents in Hygiene, Preventive Medicine and Public Health of the Italian Society of Hygiene, Public Health and Preventive Medicine - S.It.I. (Consulta Nazionale dei medici in formazione specialistica S.It.I.) has always been engaged in monitoring activities on public health teaching, guaranteeing the homogeneity of educational proposals among all national Schools in Public Health. The purpose of this study is to provide a 'snapshot' of public health education and training in Italy and to identify the improvement actions needed for implementing an innovative and homogeneous public health training. Methods: A cross-sectional study was carried out over a period of three months (March to May 2013). A self-administered questionnaire was e-mailed to local Committee’s delegates of all 32 postgraduate medical Schools in Public Health in Italy. The questionnaire was structured in four sections: general information, University education and training, extra-University training, interdisciplinary activities. The majority of local Committee’s delegates have agreed to be enrolled in the survey. Results: A total of 28 questionnaires were returned (88% response rate). The number of residents in each Italian School in Public Health ranged from 7 to 31. The distribution of professors in relation to residents is not similar for each University Schools. The ratio professors/residents spanning from 0.2 to 2. About teaching, only 4 University Schools offered all courses requested by Ministerial Decree 285/2005. Most of them offered at least 75% of the requested courses, but there were Schools in which the courses were less than 50%. The vast majority of schools held more than 60% of the qualifying activities considered essential according to the Decree, while 2 Schools were below 50%. All Schools required an internship of 6-12 months in local health authority offices (ASL), mainly concerning the Department of Prevention activities. In all Schools a period of stay in a Hospital Medical Direction was scheduled, while professional activities at Residential care homes were very rarely included in training programmes. Many Schools allowed residents to attend companies with biological hazard or to follow similar activities in dedicated services of ASL. Finally, in the majority of Schools, a training period in various local (Service for Water Control), regional (Departments) or national (Ministry, National Institute of Health) health facilities was contemplated and, in some cases, also in other Universities or Research Institutes. Conclusions: Although the Ministerial Decree indicates the essential milestones of the public health education, flexibility is seen as an important element in order to optimize resources and contextualize the adequate education of residents. In any case, at least regarding public health courses, the majority of University education and extra-University training activities should be carried out by all Schools. In order to obtain shared knowledge and skills, the Ministerial Decree should be revised taking into account flexibility and changing as intrinsic characteristics of public health profession and learners should be involved in the reform to strengthening the role of public health teaching

Background: Hand hygiene is considered one of the most important infection control measures for preventing health care-associated infections. Although the techniques involved in hand hygiene are simple, compliance with hand hygiene recommendations is poor worldwide. Objectives: We sought to perform a knowledge, attitudes, and practices (KAP) study on hand hygiene among medical residents at Imam Hossein hospital, Tehran, Iran. Patients and Methods: This cross-sectional KAP study was conducted among medical residents in Imam Hossein hospital, Iran, 2013. All medical residents from different wards were invited to participate in this study (270 in total). The world health organization questionnaires and an observational checklist were used to collect data. The χ2 test and the Fisher exact test were utilized to analyze the qualitative variables. Since the quantitative variables had no normal distribution, the Mann-Whitney test and the Kruskal-Wallis method were employed. A P value < 0.05 was considered statistically significant. The data were analyzed using SPSS, version 17. Results: The mean overall score of the residents’ knowledge was 14.2 ± 2.6 (mean ± SD). The residents received weak scores in attitudes and practices. Forty-nine percent (n = 124) of the residents responded to the questions on attitudes toward hand hygiene, and only 20.16% (n = 25) managed to identify the correct answer. Moreover, 3.1% (n = 8) of the residents adhered to the 8 standard steps, 12.1% (n = 31) washed their hands for 20 - 30 seconds, and only 2 residents observed the sequences of hand hygiene. Additionally, none of the residents performed hand washing with available means (water and hand-washing liquid) in the morning visit hours. Conclusions: Concerning hand hygiene, the residents had moderate knowledge but overall poor attitudes and practices. The present study underscores the need for further improvement in the existing training programs to address the gaps in KAP regarding hand hygiene.

Context: The practice of medicine requires good communication skills to foster excellent rapport in doctor patient relationship. Reports on communication skills learning attitude among medical professionals are key essentials toward improving patient safety and quality of care. Aims: We aimed to determine factors affecting communication skills learning attitudes among medical residents in Malaysia. Settings and Design: Cross-sectional survey, in a Malaysian public health hospital. Materials and Methods: A total of 191 medical residents across medical and surgical based rotations were included. We assessed the validated communication skills attitude scale among medical residents from different rotations. Statistical Analysis: Statistical Package of Social Sciences (SPSS®) (version 16.0, IBM, Armonk, NY) was used. Cronbach's alpha was used to test the internal consistency of the scale. Descriptive analysis was conducted for all variables. Bivariate analysis was employed across the socio-demographic variables. Results: Majority of the residents believed that communication skills training should be made compulsory in Malaysia (78.5%). Medical residents agreed that acquiring good communication skills is essential to be a good doctor. However, the majority cited time pressures for not being able to learn communication skills. Significant differences in communication skills learning attitude scores were found between Malays and Chinese. Conclusion: The majority of medical residents had a positive attitude toward communication skills learning. Socio-demographic factors influenced communication skills learning attitude among medical residents. Incorporating communicative skills modules during hospital Continuous Medical Education for medical residents is essential to cultivate communicative skills attitudes for effective doctor-patient relationship during the routine medical encounters.

Objectives: Recent research showed that medical residents have a high risk for developing burnout. The present study investigates the prevalence of burnout and its relationship with suicidal thoughts among medical residents.Methods: All Dutch medical residents (n = 5126) received a self-report questionnaire. Burnout was measured with the Maslach Burnout Inventory. Residents were asked about the frequency of suicidal thoughts.Results: Response rate was 41.3% (n = 2115). 432 Residents (20.6%) were classified as burnout. 12% reported having suicidal thoughts at least 1 time during their residency, and 1% many times. Suicidal thoughts were substantially more prevalent in the group with burnout in comparison to non-burnout (20.5% vs. 7.6%; chi(2) = 182.9, p Conclusion: Knowledge about the relationship between burnout and suicidal thoughts among these young medical professionals could be important for suicide prevention.

Purpose : The aim of this study is to determine the perceived familiarity of medical residents with statistical concepts, assess their ability to integrate these concepts in clinical scenarios, and investigate their susceptibility to the gambler's fallacy and the conjunction fallacy. Methods : A multi-institutional, cross-sectional survey of Greek medical residents was performed. Participants were asked to indicate their familiarity with basic statistical concepts and answer clinically oriented questions designed to assess their biostatistics knowledge and cognitive biases. Univariate, bivariate, and multivariate statistical models were used for the evaluation of data. Results : Out of 153 respondents (76.5% response rate), only two participants (1.3%) were able to answer all seven biostatistics knowledge questions correctly while 29 residents (19%) gave incorrect answers to all questions. The proportion of correct answers to each biostatistics knowledge question ranged from 15 to 51.6%. Residents with greater self-reported familiarity were more likely to perform better on the respective knowledge question (all p

Nowadays, educators pay attention to emotional intelligence which is defined as the ability to monitor and explain one’s own and other’s emotional experience and feelings to differentiate between them as well as applying necessary information for determining thoughts and actions. The goal of this study was to determine emotional intelligence of medical residents of Tehran University of Medical Sciences. By means of two stage cluster sampling, 98 medical residents of Tehran University of Medical Sciences were selected. Participants were asked to fill valid and reliable Persian version of Emotional Quotient inventory (EQ-i) questionnaire which had been developed due to Bar-On model. Seventy two filled-up questionnaires were returned (RR=73%). Mean EI score of all participants was 319.94 ± 32.4. Mean EI score was not significantly different between male and female also, single and married participants. EI did not differ significantly in residents in respect to their discipline. Mean responsibility subscale differ significantly between male and female participants (P=0.008). Multiple regression analysis showed that happiness subscale is a predictive factor for total EI score (B=-0.32, P=0.009). Responsibility subscale differed significantly between men and women participants and happiness subscale was a good predictor for emotional intelligence score. These factors should be considered in education of medical residents.

Background Previous research has shown that Dutch medical residents feel inadequate in certain management areas: 85% had a need for management training and reported preferences on the format of such training. Our objective was to explore if the perceived deficiencies and needs among Dutch residents were similar to those of their peers in other countries, and if a longer duration of the incorporation of the CanMEDS competency framework into curricula as well as management training had an influence on these perceptions. Methods Medical residents from Denmark, Canada and Australia were approached for participation. The questionnaire used to survey the perceptions of Dutch residents was slightly modified, translated into English and sent by email to all international participants. Results Response rates were; Denmark 719/2105 (34%), Canada 177/500 (35%) and Australia 194/1213 (16%) respectively. The Danish as well as the Canadian residents rated their negotiating skills poorly. In Australia the residents found their knowledge on how their specialist department was organized to be insufficient, while residents in the Netherlands rated their knowledge on how the healthcare system was organized as inadequate. In all of the countries, more than 70% of the residents reported a perceived need for management training. Conclusions A majority of the residents in all countries felt the need for specific training in developing their management competencies. The adoption of the CanMEDS framework alone seems to be insufficient in meeting residents’ perceived educational needs in this area.

This paper uses a two-year panel dataset on hospitals from the American Hospital Association (AHA) to evaluate the effect a policy change has on the marginal product of medical residents. A weighted 2SLS approach is used to estimate a semi-parametric production function. A policy restricting medical residents to work no more than 80 hours a week is found to result in a net loss of 14 inpatient days per resident annually, which is not statistically different from zero. In addition, the model presented in this paper performs better than past models when estimating first-order effects of inputs in the hospital production function.