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Background: Retraction is an essential procedure for correcting scientific literature and informing readers about articles containing significant errors or omissions. Ethical violations are one of the significant triggers of the retraction process. The objective of this study was to evaluate the characteristics of retracted articles in the medical literature due to ethical violations., Methods: The Retraction Watch Database was utilized for this descriptive study. The 'ethical violations' and 'medicine' options were chosen. The date range was 2010 to 2023. The collected data included the number of authors, the date of publication and retraction, the journal of publication, the indexing status of the journal, the country of the corresponding author, the subject area of the article, and the particular retraction reasons., Results: A total of 177 articles were analyzed. The most retractions were detected in 2019 (n = 29) and 2012 (n = 28). The median time period between the articles' first publication date and the date of retraction was 647 (0-4,295) days. The leading countries were China (n = 47), USA (n = 25), South Korea (n = 23), Iran (n = 14), and India (n = 12). The main causes of retraction were ethical approval issues (n = 65), data-related concerns (n = 51), informed consent issues (n = 45), and fake-biased peer review (n = 30)., Conclusion: Unethical behavior is one of the most significant obstacles to scientific advancement. Obtaining appropriate ethics committee approvals and informed consent forms is crucial in ensuring the ethical conduct of medical research. It is the responsibility of journal editors to ensure that raw data is controlled and peer review processes are conducted effectively. It is essential to educate young researchers on unethical practices and the negative outcomes that may result from them., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2023 The Korean Academy of Medical Sciences.)

Background: Marine medicine is one of the medical fields that deals with the health and safety of people related to the sea but the marine medicine syllabus for education to the students is not specified yet. The present study aimed to develop the marine medicine syllabus to medical sciences students education., Methods: This study was conducted in three phases. First, a literature review was conducted to find the concepts and topics related to marine medicine. Second, a content analysis research method was conducted. Data collection was done first by using semi-structured interviews with the 12 experts in marine medicine. Sampling was purposeful and continued until data saturation was reached. The information obtained from the interviews was analyzed by conventional content analysis with Geranheim's method. The found topics in the literature review and content analysis of interviews were combined and formed the initial draft of the marine medicine syllabus, which was validated with the Delphi method in the third phase. The Delphi was conducted in two rounds and the panel consisted of 18 experts in the field of marine medicine. After the completion of each round, the items that had less than 80% consensus among the participants were removed and the remaining topics after round two formed the final syllabus of the marine medicine., Results: The findings showed that the marine medicine syllabus should include an overview of marine medicine, health at sea, common physical diseases and injuries at sea, subsurface medicine and hyperbaric, safety action in marine incidents, medical care at sea, psychology at sea and medical examinations of people working at sea main topics and their sub topics., Conclusions: Marine medicine is an extent and specialized medical field which has been neglected and it is necessary to teach this lesson to medical sciences students with the syllabus found in the present study., (© 2023. The Author(s).)

As a scientific community we assumed that exome sequencing will elucidate the basis of most heritable diseases. However, it turned out it was not the case; therefore, attention has been increasingly focused on the non-coding sequences that encompass 98% of the genome and may play an important regulatory function. The first WGS-based datasets have already been released including underrepresented populations. Although many databases contain pooled data from several cohorts, recently the importance of local databases has been highlighted. Genomic databases are not only collecting data but may also contribute to better diagnostics and therapies. They may find applications in population studies, rare diseases, oncology, pharmacogenetics, and infectious and inflammatory diseases. Further data may be analysed with Al technologies and in the context of other omics data. To exemplify their utility, we put a highlight on the Polish genome database and its practical application.

Background: Due to the further decrease in the number of habilitations in medicine since 2010, the general requirements for habilitation could have increased during the same period., Objective: The requirements for a medical habilitation at German universities in a comparison of 23 years are re-evaluated., Material and Methods: An analysis of habilitation regulations for 12 target parameters and evaluation of these by a scoring system (range 0-34 points)., Results: Only the criterion of the requirement for a doctorate has remained the same in the 23-year comparison in the evaluation (1998-2021). All results of the other 11 criteria have changed compared to the previous study from 2010. The rating of habilitation achievements has increased from a total score in 1998 of 15.2 ± 5.1 points (95% confidence interval 13.6-16.9 points) to 25.1 ± 3.6 points in 2021 (95% confidence interval 23.9-26.2 points; p < 0.001). The range of assigned scoring values is again more broadly spread in the 11-year comparison with values from 12 to 31 points. A striking new criterion was that 98% of the assessed habilitation regulations now require a didactic continuing education in, however, significantly different requirements from the faculties., Conclusion: The requirements for a medical habilitation continued to significantly increase over the 23-year period with, however, a wider dispersion of scores. The more detailed description can be seen as a direct indication of an improvement in transparency. In contrast, the broader dispersion shows that a uniform assessment standard for Germany has again receded into the distance., (© 2021. The Author(s).)

Context: The accuracy of provider directories and whether consumers can schedule timely appointments are crucial determinants of health access and outcomes., Methods: We evaluated accuracy and timely access data obtained from the California Department of Managed Health Care, consisting of responses to large, random, representative surveys of primary care providers, cardiologists, endocrinologists, and gastroenterologists for 2018 and 2019 for all managed care plans in California., Findings: Surveys were able to verify provider directory entries for the four specialties for 59% to 76% of listings or 78% to 88% of providers reached. We found that consumers were able to schedule urgent care appointments for 28% to 54% of listings or 44% to 72% of accurately listed providers. For general care appointments, the percentages ranged from 35% to 64% of listed providers or 51% to 87% of accurately listed providers. Differences across markets related to accuracy were generally small. Medi-Cal plans outperformed other markets with regard to timely access. Primary care consistently outperformed all other specialties. Timely access rates were higher for general appointments than for urgent care appointments., Conclusions: Our finding raise questions about the regulatory regime as well as consumer access and health outcomes., (Copyright © 2022 by Duke University Press.)

Introduction: We reviewed and compared current drug shortages and shortage management practices in six selected countries (Hungary, Belgium, Spain, Switzerland, Australia, United States) based on the most comprehensive national shortage databases for each country, for four Anatomical Therapeutic Chemical (ATC) groups, to analyze the criticality of drug shortages across countries and identify best practices in shortage management strategies., Materials and Methods: Countries were selected to cover a wide geographical range of high-income nations where a lack of economic power as a potential source of drug shortages is not observable. ATC groups were selected based on a pre-examination of the databases to analyze groups most often in shortage, and groups where the absence of which could have a severe negative impact on treatment outcomes. The bias originating from the different reporting systems had to be reduced to gain comprehensive and comparable information. The first bias-reducing mechanism was transforming the raw number of shortages into proportion per million people. Secondly, critical cases were classified, and thirdly, critical cases were compared with the Word Health Organization (WHO) Essential Medicine Lists., Results: The results indicate that every European country studied reports significantly higher total and critical shortages per population compared to the US and Australia. Within Europe, Hungary reports the highest number of cases both for total and critical shortages, while Spain has the lowest results in both aspects. While in the US and Australia critical shortages were observable in similar proportions across all ATC groups, in European countries ATC groups of anti-infectives for systemic use (J) and the nervous system (N) were found to account for a notably higher proportion of critical shortages. Current shortage management practices were examined in each country and classified into five groups to identify common best practices., Conclusions: Due to the different characterization of reporting systems, several bias-reducing mechanisms should be applied to compare and evaluate shortages. In addition, European harmonization should be initiated to create mutually acknowledged definitions and reporting systems, which could be the basis of good drug shortage handling practices in Europe.

Uiyeokju Palsebo is a genealogy record that contains the eighth generation of patrilineal ancestors, maternal grandfathers, and fathers-in-law of technical officials who worked in three fields: medicine, linguistics, and mathematics. This book covers members of influential families who monopolized the positions of technical officers. In that respect, it seems to have had an effect like a kind of 'white list'. This paper identifies the range of families based on common ancestors above eight generations according to the editing method of this book, attempting various statistical analysis. The results of the analysis shows that it is possible to determine the size of the medical families, which varied according to the number of medical bureaucrats and the distance of kinship between them. Most of the families had workers in the three fields of medicine, linguistics, and mathematics, but there were also 'families more specialized in medicine' that produced a large number of medical figures. The ancestors of medical figures were mainly engaged in the three fields of medicine, linguistics, and mathematics, but there were also a small number of officials in charge of "unhak(including astronomy, geography, and fortune-telling)," law, art, and transcription. For distant ancestors from common ancestors to the fifth generation, the proportion of technical officers was small, but for relatively close ancestors, the proportion of technical officers, especially medical officers, increased. It can be seen that the status as a medical officer tends to be hereditary further down the generations. The fields of activity of the maternal grandfathers and fathers-in-law of medical figures were more concentrated in the medical field. This can be the result of confirming the influence of the marital relationship network that was formed in the close period with the medical persons being investigated. In this paper, only medical figures were considered as primary research subjects, but their macroscopic networks were relatively evenly spread out in the three fields of medicine, linguistics, and mathematics. In this network, Uiyeokju Palsebo contained homogeneous hierarchies that could continuously dominate a specific field of government office.

In 2009, the Herbert Wertheim College of Medicine at Florida International University opened its doors. From the start, its medical library sought student feedback by administering a survey to each class. The responses found that students use online resources far more than the facility, that the hours are mostly adequate, and that most students prefer a combination of print and electronic textbooks. By analyzing the data, the library determined students' preferences for space, services, and resources and how those preferences have changed over time. This data will inform future decisions about the library's collection, services, and facility.

Abstract: Measuring patient satisfaction scores and interpreting factors that impact their variation is of importance as scores influence various aspects of health care administration. Our objective was to evaluate if Press Ganey scores differ between medical specialties.New patient visits between January 2014 and December 2016 at a single tertiary academic center were included in this study. Press Ganey scores were compared between specialties using a multivariable logistic mixed effects model. Secondary outcomes included a comparison between surgical versus non-surgical specialties, and pediatric versus adult specialties. Due to the survey's high ceiling effect, satisfaction was defined as a perfect total score.Forty four thousand four hundred ninety six patients met inclusion criteria. Compared to internal medicine, plastic surgery, general surgery, dermatology, and family medicine were more likely to achieve a perfect overall score, as, with odds ratios of 1.46 (P = .02), 1.29 (P = .002), 1.22 (P = .004), and 1.16 (P = .02) respectively. Orthopaedics, pediatric medicine, pediatric neurology, neurology, and pain management were less likely to achieve satisfaction with odds ratios of 0.85 (P = .047), 0.71 (P < .001), 0.63 (P = .005), 0.57 (P < .001), and 0.51 (P = .006), respectively. Compared to pediatric specialties, adult specialties were more likely to achieve satisfaction (OR 1.73; P < .001). There were no significant differences between surgical versus non-surgical specialties.Press Ganey scores systematically differ between specialties within the studied institution. These differences should be considered by healthcare systems that use patient satisfaction data to modify provider reimbursement., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Common data elements are a combination of a precisely defined question paired with a specified set of responses. Common data elements contribute to the National Institutes of Health-supported principle of Findable, Accessible, Interoperable, and Reusableness of research data. Routine use of Common data elements and standardized definitions within pediatric critical care research are likely to promote collaboration, improve quality, and consistency of data collection, improve overall efficiency of study or trial setup, and facilitate cross-study comparisons, meta-analysis, and merging of study cohorts. The purpose of this Pediatric Critical Care Medicine Perspective is to establish a road map for the development of multinational, multidisciplinary consensus-based common data elements that could be adapted for use within any pediatric critical care subject area., Methods: We describe a multistep process for the creation of "core domains" of research (e.g. patient outcomes, health-related conditions, or aspects of health) and the development of common data elements within each core domain. We define a tiered approach to data collection based on relevance of each common data element to future studies and clinical practice within the field of interest. Additionally, we describe the use of the Delphi methods to achieve consensus of these common data element documents using an international, multidisciplinary panel of experts.

Estimating prescription medicine use is challenging due to recall bias associated with surveys and coverage bias in administrative data. This study assesses how making operational improvements and combining both survey and administrative data sources can increase data quality on filled prescriptions. We use data from the Medicare Current Beneficiary Survey (MCBS) and administrative data from the Centers for Medicare and Medicaid Services (CMS). First, we investigate improvements from a prescription medicine lookup (PMLU) tool integrating a commercial medicine database into the MCBS. We then examine impacts of matching survey-reported medicines to Part D claims. We find that the PMLU improves accuracy and reduces measurement bias. Claims matching identifies additional medicines, especially for beneficiaries with more chronic conditions and medicines. This study shows that integrating a commercial database and supplementing with administrative data improves data quality and reduces sources of error.

We live in an age of plentiful information, collected continuously by pervasive gadgetry, distributed through digital and social networks, and mined deeply by ever-more-powerful analytics systems. And yet, one of the things we know the least about is our bodies. When it comes to our own health, we are driving blindly. Modern medicine has clearly been remarkably successful, as evidenced by continually growing life expectancies. For example, the number of people 65 and older in the United States has seen a steady increase over the last century, rising from 3.1 million in 1900 to 41.4 million as of 2011-and is expected to grow to 80 million by 2040. Concurrently, the number (and fraction) of people suffering from chronic conditions is also growing, from 44.7% in 1995 to 47.7% in 2015-and expected to rise to over 49% by 2030 [1]. According to the U.S. Centers for Disease Control and Prevention, the vast majority of healthcare costs (86%) are spent on treating and managing chronic disease. Indeed, the medical field today focuses almost entirely on care after illness: modern medicine is largely reactive, waiting until the system fails before taking action. While the field of dentistry has fully embraced regular preventive evaluation and treatment with great success, most other medical fields have yet to do so. Yearly physical evaluations are recommended, but they rely on very limited data collection. As long as there are no symptoms, current standard medical practice largely foregoes testing (laboratory, imaging, etc.) as a screening method to detect disease before it manifests itself.

The "first digit law" or "Benford's law" is a mathematical distribution discovered by Simon Newcomb and Frank Benford. It states, that the probability of the leading number d (d∈{1,…,9}) in many natural datasets follows: P (d)=log 10 (d+1)-log 10 (d)=log 10 (1+1/d). It was successfully used through tax authorities and "forensic accounting" in order to detect fraud and other irregularities. Benfords law was almost neglected for its use outside financial accounting. The planning for health care systems in developing countries is extremely dependant on good, valid data. Whether you plan the catchment area for the future district hospitals, the number of health posts, the staff establishment for the central hospital or the drug budget in the Ministry. The "first digit law" can be used in medicine, public health, physiology and development aid to unmask questionable data, to discover unexpected challenges, difficulties in the data collection process, loss through corruption and criminal fraud. Our hypothesis suggests, that the "first digit law" is a cost effective tool, which is easy to use for most people in the medical profession, which does not really needs complicated statistical software and can be used on the spot, even in the resource restricted conditions of developing countries. Several preconditions (like the size of the data set and its reach over more than two dimensions) have to be fulfilled, but then Benfords law can be used by any clinician, physiologist, public health specialist or aid consultant without difficulties and without deeper statistical knowledge in the four steps, we suggest in this article. The consequences will be different depending on the level (local regional, national, continental, international) on which you will use the law. All levels will be enabled to get insight into the validity of the data-challenges for the other levels without the help of trained statisticians or accountants. We believe that the "first digit law" is a vastly underestimated and neglected, but extremely useful tool for the identification of unexpected challenges, supervision and control in various parts of medicine and public health for almost all aspects of development aid., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: In the context of the iCept-Study several medical specialties have been examined for their stress related working conditions. This study contrasts the different medical specialties., Methods: The iCept-Study was designed as a web based survey in which altogether 7.090 respondents took part. The published data concerning the iCept-Study was systematically analyzed focusing on distress and job satisfaction., Results: 53,9% of respondents showed unfavorable working conditions with an ER/JDC-Ratio > 1 (distress). Especially surgical specialties showed a higher prevalence: The odds ratio of surgery to anesthesiology was at 1,59 (95%-CI: 1,35|1,86; p < 0,001). On the other hand specialties like occupational medicine showed a lower prevalence in comparison with the average: The odds ratio was here at 0,37 (95%CI: 0,19|0,71; p < 0,01). Furthermore 55,8% of respondents stated that they were very satisfied with their job., Consequences: Surgical specialties encountered distress the most. Moreover there was a positive correlation between high job satisfaction and lack of distress evident. Therefore it seems that distress and job satisfaction are two dependent characteristics of a changing work environment. Especially surgical specialties need to catch up with today's demand of improved working conditions and thus reducing distress and increasing satisfaction., (© Georg Thieme Verlag KG Stuttgart · New York.)

This study explores the origins and evolution of the specialty name for what is now primarily known in the English-speaking world as otolaryngology-head and neck surgery. This appellation is the longest and least pronounceable of all medical specialties. While it is reasonably well understood among medical professionals, surveys show that only a small fraction of health consumers understand its meaning. The ideal medical specialty name should have a meaning recognizable to a large segment of the public, be easily pronounceable, be reasonably short, and serve to communicate the type of illnesses treated. The cumbersomeness of the specialty name has led to nearly universal use of informal substitutes, which do not covey the scope of contemporary practice (e.g., ear, nose, and throat) and to abbreviations (e.g., ENT, ORL, OHNS). Based on the commercial experience, it is clear that shorter is better. The authors advocate that dialog be opened, guided by the experience from instances of successful corporate rebranding, to consider possible alternatives.

Background: Globalization has facilitated the employability of doctors almost anywhere in the world. In recent years, the migration of doctors seems to have increased. However, we lack studies on doctors' migration from developed countries. Because the economic recession experienced by many countries might have affected the migration of doctors, research on this topic is important for the retention of doctors. Iceland was hit hard by the economic recession in 2008. Therefore, we want to explore how many specialist doctors in Iceland have considered migrating and whether economic factors at work and in private life, such as extensive cost-containment initiatives at work and worries about personal finances, are related to doctors' migration considerations., Methods: In 2010, all doctors in Iceland registered with the Icelandic Medical Association were sent an electronic cross-sectional survey by email. The 467 specialists who participated in this study represent 55% of all specialist doctors working in Iceland. Information on doctors' contemplation of migration was available from responses to the question: "Have you considered moving and working abroad?" The predictor variables in our logistic regression model are perceived cost-containment initiatives at work, stress related to personal finances, experience of working abroad during vacations, job dissatisfaction, job position, age, and gender., Results: Sixty-three per cent of Iceland's specialist doctors had considered relocation abroad, 4% were moving in the next year or two, and 33% had not considered relocating. Logistic regression analysis shows that, controlling for age, gender, job position, job satisfaction, and experience of working abroad during vacations, doctors' migration considerations were significantly affected by their experiences of cost-containment initiatives at work (odds ratio (OR) = 2.0, p < 0.01) and being stressed about personal finances (OR = 1.6, p < 0.001). Age, job satisfaction, and working abroad during vacations also had an effect, whereas job position did not., Conclusions: Economic factors affect whether specialist doctors in Iceland consider migration. More studies on the effect of economic recession on migration by doctors are needed.

Background: Factors influencing specialty choice have been studied in an attempt to find incentives to enhance the workforce in certain specialties. The notion of "controllable lifestyle (CL) specialties," defined by work hours and income, is gaining in popularity. As a result, many reports advocate providing a 'lifestyle-friendly' work environment to attract medical graduates. However, little has been documented about the priority in choosing specialties across the diverse career opportunities.This nationwide study was conducted in Japan with the aim of identifying factors that influence specialty choice. It looked for characteristic profiles among senior students and junior doctors who were choosing between different specialties., Methods: We conducted a survey of 4th and 6th (final)-year medical students and foundation year doctors, using a questionnaire enquiring about their specialty preference and to what extent their decision was influenced by a set of given criteria. The results were subjected to a factor analysis. After identifying factors, we analysed a subset of responses from 6th year students and junior doctors who identified a single specialty as their future career, to calculate a z-score (standard score) of each factor and then we plotted the scores on a cobweb chart to visualise characteristic profiles., Results: Factor analysis yielded 5 factors that influence career preference. Fifteen specialties were sorted into 4 groups based on the factor with the highest z-score: "fulfilling life with job security" (radiology, ophthalmology, anaesthesiology, dermatology and psychiatry), "bioscientific orientation" (internal medicine subspecialties, surgery, obstetrics and gynaecology, emergency medicine, urology, and neurosurgery), and "personal reasons" (paediatrics and orthopaedics). Two other factors were "advice from others" and "educational experience". General medicine / family medicine and otolaryngology were categorized as "intermediate" group because of similar degree of influence from 5 factors., Conclusion: What is valued in deciding a career varies between specialties. Emphasis on lifestyle issues, albeit important, might dissuade students and junior doctors who are more interested in bioscientific aspects of the specialty or have strong personal reasons to pursue the career choice. In order to secure balanced workforce across the specialties, enrolling students with varied background and beliefs should be considered in the student selection process.

Purpose: To describe diverse medical students' perceptions of and interest in careers in academic medicine., Method: In 2010, the authors invited students attending three national medical student conferences to respond to a survey and participate in six focus groups. The authors identified trends in data through bivariate analyses of the quantitative dataset and using a grounded theory approach in their analysis of focus group transcripts., Results: The 601 survey respondents represented 103 U.S. medical schools. The majority (72%) were in their first or second year; 34% were black and 17% were Hispanic. Many respondents (64%) expressed interest in careers in academic medicine; teaching and research were viewed as positive influences on that interest. However, black and Hispanic respondents felt they would have a harder time succeeding in academia. The 73 focus group participants (25% black, 29% Hispanic) described individual- and institutional-level challenges to academic medicine careers and offered recommendations. They desired deliberate and coordinated exposure to academic career paths, research training, clarification of the promotion process, mentorship, protected time for faculty to provide teaching and research training, and an enhanced infrastructure to support diversity and inclusion., Conclusions: Medical students expressed an early interest in academic medicine but lacked clarity about the career path. Black and Hispanic students' perceptions of having greater difficulty succeeding in academia may be an obstacle to engaging them in the prospective pool of academicians. Strategic and dedicated institutional resources are needed to encourage racial and ethnic minority medical students to explore careers in academic medicine.

Background: Determinants of career choice are numerous. The impact of teaching has not yet been reported., Objectives: The objectives were to assess determinants of career choice among DCEM 4 (sixth year) medical students at Paris Descartes University and Pierre-et-Marie-Curie University; and to determine the impact of teaching on career choice., Materials and Methods: Prospective study based on an online survey, after the 2011 National Grading Examination, among 865 DCEM 4 students. Collection of socio-demographic data, commonly reported determinants of medical specialty choice, and the impact of the teaching on this choice., Results: Two hundred and seven (24%) students (67% female) answered the survey. During their medical studies, students changed their mind on their career choice an average of 3 times (range 0-10). Nearly 60% of them made their final choice during the fifth year. Choices varied significantly between the beginning and end of the studies (P<0.0001), with interest in surgical and pediatric careers falling significantly (P<0.0001 and p=0.0003 respectively). At the time of expressing the final choice, surgical careers were mainly chosen by male students (19.8% of males vs. 9.9% of females, P=0.04), whereas medical careers were chosen equally by males and females (37.7% vs. 35.5%, P=0.75). The main determinant was interest in the specialty (96% of students), followed by perceived quality of life (56% of students). Teaching was a determinant for 74% of students, of whom 88% were influenced by the teaching they received during their clinical training. In 42% of cases, the teacher did not belong to the university corpus. In 10% of cases, students were discouraged from their choice by a teacher (a university professor in 50%)., Discussion and Conclusion: Our results highlight the impact of both teaching and the teacher on medical students' career choice. If career choice is now compelled in France by the "careers law", teaching is more than ever an effective way of interesting students in specialties which might appear less attractive. At a time when the selection of candidates for hospital-university careers is mainly based on publications, this study calls for reflection on the evaluation of these candidates' teaching qualities., (Copyright © 2012. Published by Elsevier Masson SAS.)

This study investigated the career preferences of medical graduates in Germany with regard to discipline, place and position after the completion of postgraduate training. We also investigated differences in career options according to gender and region of study (former German Federal Republic vs. former German Democratic Republic).The study is based on a standardised postal survey among all last year medical students in the medical faculties of Erlangen, Giessen, Hamburg, Heidelberg, Cologne, Leipzig and Magdeburg in 2009. 2 107 persons were contacted and 1 012 (48%) participated in the survey.96% of participants stated their intention to pursue a postgraduate training in a medical discipline, and only 0.4% denied such an objective. 7% of the graduates preferred a career towards general practice, and a similar percentage preferred general internal medicine which usually also leads to a primary care activity. 84% aimed at becoming a medical specialist. In total, 28% intended to work in a specialist practice, and 10% in a general practice. Only one-fifth of the latter aimed at working in a countryside setting. 7% aimed at starting postgraduate training outside of Germany, and 8% preferred to work outside Germany after completion of the postgraduate training. In both cases, Switzerland was by far the most preferred country.The results contradict the thesis that young graduates are reluctant to enter clinical medicine. Working abroad is within the scope of less than 10% of the graduates. A dramatic difference between the demand for general practitioners and the career intentions of medical graduates is observed. Measures to increase the attractiveness of primary care, especially in the countryside, are urgently needed., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: The expansion of pediatric-based fetal care raises questions regarding pediatric specialists' involvement in pregnancies when maternal conditions may affect pediatric outcomes. For several such conditions, we compared pediatric and obstetric specialists' attitudes regarding whether and when pediatrics consultation should be offered and their views about seeking court authorization to override maternal refusal of physician recommendations., Methods: We used a mail survey of 434 maternal-fetal medicine specialists (MFMs) and fetal care pediatric specialists (FCPs) (response rate: MFM, 60.9%; FCP, 54.2%)., Results: FCPs were more likely than MFMs to indicate that pediatric counseling should occur before decisions regarding continuing or interrupting pregnancies complicated by maternal alcohol abuse (FCP versus MFM: 63% vs 36%), cocaine abuse (FCP versus MFM: 60% vs 32%), use of seizure medications (FCP versus MFM: 62% vs 33%), and diabetes (FCP versus MFM: 56% vs 27%) (all P < .001). For all conditions, MFMs were more than twice as likely as FCPs to think that no pediatric specialist consultation was ever necessary. FCPs were more likely to agree that seeking court interventions was appropriate for maternal refusal to enter a program to discontinue cocaine use (FCP versus MFM: 72% vs 33%), refusal of azidothymidine to prevent perinatal HIV transmission (80% vs 41%), and refusal of percutaneous transfusion for fetal anemia (62% vs 28%) (all P < .001)., Conclusions: Pediatric and obstetric specialists differ considerably regarding pediatric specialists' role in prenatal care for maternal conditions, and regarding whether to seek judicial intervention for maternal refusal of recommended treatment.

Background: The percentage of females in the physician workforce is increasing in Japan, as in other countries; however, the working status of female physicians has not been sufficiently investigated., Methods: Original data were obtained from the National Survey of Physicians (NSP) conducted by the Ministry of Health, Labour and Welfare, Japan, from 1984 to 2004. We examined the trend of female physicians' areas of practice and analyzed their leave, return to work, and change in areas of practice using cohort data., Results: The percentage of female physicians has increased significantly in recent generations, especially in surgery, surgical subareas of practice, and obstetrics and gynecology. A remarkable increase was found in obstetrics and gynecology among women under 29 years old from 15.4 to 66.2%. The total number of female physicians on leave has been higher than the number of female physicians returning since 1998. The average percentage of those who changed their area of practice was high in surgery (20.7%) and low in pediatrics (5.0%) and obstetrics and gynecology (1.7%)., Conclusions: A strategic plan is needed for future health policy to plan for the physician workforce, especially for the areas of practice with increasing proportions of young female physicians., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: A knowledge and understanding of specialist anatomy, which includes radiological, laparoscopic, endoscopic and endovascular anatomy is essential for interpretation of imaging and development of procedural skills., Methods and Materials: Medical students, specialist trainees and specialists from the London (England, UK) area were surveyed to investigate individual experiences and recommendations for: (1) timing of the introduction of specialist anatomy teaching, and (2) pedagogical methods used. Opinions relating to radiological, laparoscopic, endoscopic and endovascular anatomy were collected. Non-parametric tests were used to investigate differences in recommendations between specialist trainees and specialists., Results: Two hundred and twenty-eight (53%) individuals responded to the survey. Imaging was most commonly used to learn radiological anatomy (94.5%). Procedural observation was most commonly used to learn laparoscopic (89.0%), endoscopic (87.3%) and endovascular anatomy (66.2%). Imaging was the most recommended method to learn radiological anatomy (92.1%). Procedural observation was the most recommended method for learning laparoscopic (80.0%), endoscopic (81.2%) and endovascular anatomy (42.5%). Specialist trainees and specialists recommended introduction of specialist anatomy during undergraduate training., Conclusion: Although the methods for specialist anatomy learning are in practice, there is no consensus on timing and structure within the anatomy curriculum. Recommendations from trainees and specialists should be considered so that the existing curriculum can be refined to maximise learning outcomes., (Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Background: The aim was to explore the expectations of general practitioners (GPs) towards specialized outpatient palliative care (SAPV) focused on older patients in the last phase of life., Methods: A standardized postal survey was carried out with 1,962 GPs in Lower Saxony with an analysis of physician and practice-related factors., Results: The response rate was 46% (n=897) and SAPV was known to 68% of the participants (n=599) of whom 48% (n=288) assumed that SAPV will improve the healthcare for older patients in the last phase of life. The GPs favored advice by and collaborative patient care with SAPV teams. Younger and female GPs, and GPs who had been practicing for a shorter period or working in a group practice showed greater interest in collaboration than other colleagues., Conclusions: The perception of patients in specialized palliative care with its current focus on cancer patients is different from the perception in general practice with its focus on geriatric and multimorbid patients. This may be a reason for the skepticism showed in this study whether SAPV will actually improve healthcare in the community. However, with respect to the concept and framework SAPV has the potential to fulfill GPs expectations and should be focused on counseling and collaborative services. The knowledge about physician and practice-related factors shaping GPs attitudes towards SAPV can be helpful to further implement SAPV into practice., (© Deutsche Gesellschaft zum Studium des Schmerzes)

Objective: To assess the workforce and workplace in rheumatology, and the research work of early-career rheumatologists., Methods: Early-career rheumatologists were defined as practicing physicians who joined the American College of Rheumatology (ACR) in 1991-2005, were 49 years of age or younger when they joined, and reside in North America. This cohort participated in a Web-based survey distributed by the ACR. A total of 247 surveys (21.2% response) were used for this analysis. Survey questions were designed to obtain core insights about the workforce, workplace, research activities, funding, and the demographic profile of respondents., Results: Respondents from all workplaces-clinical, academic, federal, and industry-engaged in clinical care, teaching, administration, and research. The time devoted to these tasks was employer dependent, and workplaces shaped the scale and scope of research. Patient-oriented research was predominant across all workplaces. Disease, population, and translational research were intermediate, and few respondents pursued basic or prevention-oriented research in any type of workplace. Rheumatologists obtained extramural funds (21.3%) and intramural funds (78.7%) to pay portions of their salaries for time spent on research. Receiving a National Institutes of Health K08/K23 award was associated with receipt of a federal research project grant (P < 0.001). Respondents associated investigative work with reduced earnings, a perception validated by an estimated drop in pre-tax annual earnings of 2.3% for each half-day/week dedicated to research (P < 0.01)., Conclusion: The results of this study justify interventions for closing gaps embedded in investigational rheumatology. These include improved funding for clinical research, increasing the number of K08/K23 awards, and recruiting rheumatologists from underrepresented demographic groups., (Copyright © 2010 by the American College of Rheumatology.)

Objectives: To investigate trends of specialty distribution and physicians' career paths in Japan, and to discuss potential policy implications., Methods: Distribution of main area of practice, relation between board-certified specialists and reported main area of practice, and migration of main area of practice by career stage were analyzed in data from the National Physician Survey, collected between 1996 and 2006., Results: The percentages of physicians involved in internal medicine, surgery, neurosurgery, pediatrics, ophthalmology, obstetrics and gynecology and otorhinolaryngology decreased from 1996 to 2006. Overall, the numbers reported for the main area of practice matched the number of board-certified specialists. Among physicians who began their careers as internal medicine physicians in the 1996 registration cohort, the proportion of those engaged in internal medicine fell from 82.5% in 1996, to 43.6% in 2000, to 37.0% by their 10th year. Among five registration cohorts analyzed, 9.1-16.8% of the surgical specialties group switched their main area of practice to internal medicine within 10 years., Conclusions: While there is a general trend toward specialization, it is important to balance between general practice and specialization to strengthen health care systems. Developing a certification system and maintaining the quality of specialist physicians are also crucial., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

In the context of doctor shortages and mal-distributions in many Western countries, prestige and lifestyle friendliness have emerged as significant factors for medical students when they choose a medical specialty. In this study, we surveyed two samples of Australian medical students and had them rank 19 medical specialties for prestige (N = 530) and lifestyle friendliness (N = 644). The prestige rankings were generally consistent with previous ratings by physicians, lay people and advanced medical students, with surgery, internal, and intensive care medicine ranking the highest, and public health, occupational, and non-specialist hospital medicine ranking lowest. This suggests that medical students have incorporated prevailing prestige perceptions of practicing doctors and the community. Lifestyle rankings were markedly different from prestige rankings, where dermatology, general practice, and public health medicine were ranked the most lifestyle friendly, and surgery, obstetrics/gynaecology and intensive care were ranked least friendly. Student lifestyle rankings differed from physician and author-generated rankings, indicating that student preferences should be considered rather than relying on ratings created by others. Few differences were found for gender or year of study, signifying perceptions of prestige and lifestyle friendliness were consistent across the students sampled. Having access to and understanding these rankings will assist career counsellors to aid student and junior doctor decision-making and aid workforce planners to address gaps in medical specialty health services., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Equal access to health care is a central goal of all European health-care systems. International studies, however, show that this goal has not been accomplished yet. The aim of this study is to investigate if there are inequalities across patients with different levels of education and if these differences vary with the institutional set-up of health-care systems. The test of this hypothesis is based on a comparison of eleven European countries using data from the SHARE survey (Survey of Health, Ageing and Retirement in Europe). Our results show that in countries with institutionalised gatekeeping systems differences of utilisation between educational groups are rather low. In countries with free access to specialists, patients with higher levels of education show a higher probability of specialist visits than their counterparts with lower levels of education., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Transfusion-related acute lung injury (TRALI) is hypothesized to be a "two-hit" entity, in which an inflammatory condition (e.g., sepsis) predisposes to TRALI. TRALI is a clinical diagnosis. Disciplines involved in managing TRALI may differ in decision-making on the reporting of TRALI., Study Design and Methods: A survey was conducted among critical care physicians, hematologists, hemovigilance workers, and transfusion medicine physicians, using case vignettes and a questionnaire. The vignettes varied in patient- and blood product-related factors that may influence the decision to report a TRALI case. Multiple linear regression analysis was performed. A positive beta-coefficient is in favor of reporting., Results: Ninety-two questionnaires were returned (response rate, 68%). For all disciplines, preferences in favor of reporting TRALI were onset of symptoms within 1 hour (beta = 0.4), after transfusion of a single unit of FFP (beta = 0.5), and in the absence of acute lung injury before transfusion (beta = 1.3). An admission diagnosis of sepsis was a negative preference (beta = -0.3). Massive transfusion (6 RBC plus 4 FFP units) was a negative preference for transfusion medicine physicians (beta = -0.3), but a positive preference for the other disciplines. The questionnaire revealed that massive transfusion and the age of blood products were considered relatively more important reasons to report TRALI by critical care physicians compared to the other disciplines (p < 0.05)., Conclusion: A pretransfusion inflammatory condition is a reason to withhold from reporting of a suspected TRALI case. Disciplines involved in managing TRALI differ in decision-making of reporting TRALI, which may contribute to variance in incidence.

Background: Nationally health systems are making increasing investments in the use of clinical information systems. Little is known about current computer use by specialist physicians, particularly outside the hospital setting., Aims: To identify the extent and reasons physician Fellows of the Royal Australasian College of Physicians (RACP) use computers in their work., Methods: A self-administered survey was emailed from the RACP to all practising physicians in 2007 that were living in Australia and New Zealand who had consented to email contact with the College., Results: The survey was sent to a total of 7445 eligible physicians, 2328 physicians responded (31.3% response rate), but only 1266 responses (21.0%) were able to be analysed. Most 97.5% had access to computers at work and 96.5% used home computers for work purposes. Physicians in public hospitals (72.6%) were more likely to use computers for work (65.6%) than those in private hospitals (12.6%) or consulting rooms (27.3%). Overall physicians working in public hospitals used a wider range of applications with 70.5% using their computers for searching the internet, 53.7% for receiving results and 52.7% used their computers to engage in specific educational activities. Physicians working from their consulting rooms (33.6%) were more likely to use electronic prescribing (11%) compared with physicians working in public hospitals (5.7%)., Conclusions: Fellows have not incorporated computers into their consulting rooms over which they have control. This is in contrast to general practitioners who have embraced computers after the provision of various incentives. The rate of use of computers by physicians for electronic prescribing in consulting rooms (11%) is very low in comparison with general practitioners (98%). One reason may be that physicians work in multiple locations whereas general practitioners are more likely to work from one location.

Background: Specialty-specific data on career satisfaction may be useful for understanding physician workforce trends and for counseling medical students about career options., Methods: We analyzed cross-sectional data from 6,590 physicians (response rate, 53%) in Round 4 (2004-2005) of the Community Tracking Study Physician Survey. The dependent variable ranged from +1 to -1 and measured satisfaction and dissatisfaction with career. Forty-two specialties were analyzed with survey-adjusted linear regressions, Results: After adjusting for physician, practice, and community characteristics, the following specialties had significantly higher satisfaction levels than family medicine: pediatric emergency medicine (regression coefficient = 0.349); geriatric medicine (0.323); other pediatric subspecialties (0.270); neonatal/prenatal medicine (0.266); internal medicine and pediatrics (combined practice) (0.250); pediatrics (0.250); dermatology (0.249);and child and adolescent psychiatry (0.203). The following specialties had significantly lower satisfaction levels than family medicine: neurological surgery (-0.707); pulmonary critical care medicine (-0.273); nephrology (-0.206); and obstetrics and gynecology (-0.188). We also found satisfaction was significantly and positively related to income and employment in a medical school but negatively associated with more than 50 work-hours per-week, being a full-owner of the practice, greater reliance on managed care revenue, and uncontrollable lifestyle. We observed no statistically significant gender differences and no differences between African-Americans and whites., Conclusion: Career satisfaction varied across specialties. A number of stakeholders will likely be interested in these findings including physicians in specialties that rank high and low and students contemplating specialty. Our findings regarding "less satisfied" specialties should elicit concern from residency directors and policy makers since they appear to be in critical areas of medicine.

Background: Given the looming shortage of physicians in Canada, we wished to determine how closely the career preference of students entering Canadian medical schools was aligned with the current physician mix in Canada., Methods: Career choice information was collected from a survey of 2,896 Canadian medical students upon their entry to medical school. The distribution of career choices of survey respondents was compared to the current physician specialty mix in Canada., Results: We show that there is a clear mismatch between student career choice at medical school entry and the current specialty mix of physicians in Canada. This mismatch is greatest in Urban Family Medicine with far fewer students interested in this career at medical school entry compared to the current proportion of practicing physicians. There are also fewer students interested in Psychiatry than the current proportion of practicing physicians., Conclusion: This mismatch between the student interest and the current proportion of practicing physicians in the various specialties in Canada is particularly disturbing in the face of the current sub-optimal distribution of physicians. If nothing is done to correct this mismatch of student interest in certain specialties, shortages and misdistributions of physicians will be further amplified. Studies such as this can give a window into the future health human resources challenges for a nation.

Objectives: To better understand the relationship between board certification and credentialing policies for surgeons and nonsurgical subspecialists and to examine possible variation in use of board certification among different types of hospitals., Design, Setting, and Participants: Telephone survey conducted from November 14, 2006, through March 16, 2007, of the privileging personnel among a random sample of 235 nonchildren's hospitals stratified by teaching status, bed size, metropolitan statistical area, system affiliation, and tax status., Main Outcome Measures: Proportion of hospitals that require specialty board certification to gain privileges and hospital requirements for recertification., Results: Of 235 hospitals, 11 were ineligible and 183 completed the telephone interview, resulting in an overall response rate of 82%. Approximately one-third of hospitals did not require surgeons and nonsurgical subspecialists ever to be board certified to receive hospital privileges. Among the 109 hospitals that required certification at some point, only 5 (5%) required surgeons and 3 (3%) required nonsurgical subspecialists to be board certified at the point of initial privileging. More than three-fourths of hospitals had exceptions to their certification policies for surgeons and 84 (77%) had them for nonsurgical subspecialists. Eighty-two percent of all hospitals and two-thirds of hospitals whose policies required recertification allowed surgeons and nonsurgical subspecialists to retain privileges when their board certification expired., Conclusion: Most hospitals do not consistently use board certification to ensure physician competence at their institutions.

Background: Discrepancies in medication documentation most often occur at handoffs or transition points in care. A process improvement team at the Portland Department of Veterans Affairs developed a standardized medication reconciliation process for the Portland chemotherapy administration unit, a physically self-contained clinic with a standard intake process and a uniform patient traffic pattern., Methods: The team developed the automated patient history intake device (APHID), a reconciliation software program accessed by the patient using a computer terminal kiosk in the clinic lobby. The program simultaneously checks in patients for an appointment and gathers a medication-adherence history by retrieving medication lists from all Veterans Affairs facilities and pairing each medication with a pill picture. Installation of the APHID kiosk included an initial two-week roll-in period beginning in February 2008., Results: During the roll-in period, 91 (82.0%) of 111 patients completed check-in and performed medication reconciliation using the kiosk. Medication lists gathered at the kiosk were compared with existing health record documentation and clinician interviews. For each patient encounter, the process demonstrated an average of 4.59 discrepancies and an average of 1.61 clinically significant or potentially lethal discrepancies. The new process saved approximately 0.24 full-time equivalents of nursing time in the chemotherapy clinic-a nearly 50% reduction in nursing time dedicated to reconciliation activities without an apparent loss in data accuracy., Discussion: A patient-centered reconciliation model using consumer-based kiosk technology helped providers efficiently retrieve a comprehensive list of medications across a geographically diverse area and improve patient medication recall using visual cues including medication pictures.

An electronic survey on substance-induced epileptic crisis was conducted in order to investigate whether doctors, who recognise their own prescription errors, increase their therapeutic aggressiveness, resulting in a so-called "iatrogenicity cascade". Two pairs of clinical vignettes were constructed, in which a patient suffers from iatrogenic (original version) or non-iatrogenic (control version) epileptic crisis. Vignettes were randomised and sent to doctors at the University Hospital of Lausanne, Switzerland, at an interval of 3 weeks. The results of the present survey in the surveyed population of doctors suggest that inappropriate prescription does not increase therapeutic aggressiveness.

Periodically debates on the legalization of active euthanasia are conducted in the Austrian media. In contrast to most European and North American countries, these debates are not based on local empirical data, because until now no studies on respective attitudes and values exist. In this study notion towards active euthanasia of (1) medical lays, (2) medical students and medical specialists in psychiatry, surgery and internal medicine are explored by means of a semistructured questionnaire. We found that increasing closeness to the medical profession is associated with an increasing refusal of active euthanasia. Among the medical specialists, specialists in internal medicine, who, after the legalization, would be most involved in decision-making processes as well as in the execution of active euthanasia, showed the greatest reservation concerning this question.

Introduction: COPD is one of the most important lung diseases. It is responsible for significant proportion of outpatients pulmonary clinics visits. Data on outpatients care of COPD patients in Poland are limited. This article presents design of the KOMPAS study and basic results relating to COPD patients., Material and Methods: The aim of this prospective study was to describe population of patients with COPD treated by specialists, and to characterize methods of care used in various COPD stages. Participating physicians used pocket PCs equipped with specially developed software to collect COPD patients' data., Results: Data on 2958 COPD patients were analyzed. 2/3 of patients were males. Mean patients age was 63 years and mean FEV(1) - 57% of predicted value. 86% of all subjects underwent spirometry during the first visit or the previous 6 months. Cough and exertional dyspnoea were the most frequently reported COPD symptoms (about 80% of patients). At the first visit 32% of subjects were current smokers and 51% were ex-smokers. 17% of all study patients have never smoked. Before inclusion 2/3 of patients were treated with bronchodilatator, and about 1/3 with inhaled steroid. After entering the study, over 90% received bronchodilatator and more than 2/3 received inhaled steroid. Differences in treatment between stages of COPD based on its severity were relatively small., Conclusions: Results of the KOMPAS study provide basic information about COPD outpatients care in Poland. These data, especially concerning physicians' compliance with current COPD guidelines, may be useful in planning undergraduate/postgraduate training for physicians and for those who are responsible for health resource allocation.