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[PMID]:28811123
[Au] Autor:Ali NJ; McWilliams JM; Epstein SK; Smulowitz PB
[Ad] Endereço:Department of Emergency Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, and Tufts Medical Center, Boston, MA. Electronic address: njali@mah.harvard.edu.
[Ti] Título:Emergency Department Involvement in Accountable Care Organizations in Massachusetts: A Survey Study.
[So] Source:Ann Emerg Med;70(5):615-620.e2, 2017 Nov.
[Is] ISSN:1097-6760
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:STUDY OBJECTIVE: We assess Massachusetts emergency department (ED) involvement and internal ED constructs within accountable care organization contracts. METHODS: An online survey was distributed to 70 Massachusetts ED directors. Questions attempted to assess involvement of EDs in accountable care organizations and the structures in place in EDs-from departmental resources to physician incentives-to help achieve accountable care organization goals of decreasing spending and improving quality. RESULTS: Of responding ED directors, 79% reported alignment between the ED and an accountable care organization. Almost all ED groups (88%) reported bearing no financial risk as a result of the accountable care organization contracts in which their organizations participated. Major obstacles to meeting accountable care organization objectives included care coordination challenges (62%) and lack of familiarity with accountable care organization goals (58%). The most common cost-reduction strategies included ED case management (85%) and information technology (61%). Limitations of this study include that information was self-reported by ED directors, a focus limited to Massachusetts, and a survey response rate of 47%. CONCLUSION: The ED directors perceived that the majority of physicians were not familiar with accountable care organization goals, many challenges remain in coordinating care for patients in the ED, and most EDs have no financial incentives tied to accountable care organizations. EDs in Massachusetts have begun to implement strategies aimed at reducing admissions, utilization, and overall cost, but these strategies are not widespread apart from case management, even in a state with heavy accountable care organization penetration. Our results suggest that Massachusetts EDs still lack clear directives and direct involvement in meeting accountable care organization goals.
[Mh] Termos MeSH primário: Organizações de Assistência Responsáveis/economia
Serviço Hospitalar de Emergência/economia
Serviço Hospitalar de Emergência/estatística & dados numéricos
[Mh] Termos MeSH secundário: Administração de Caso/economia
Administração de Caso/estatística & dados numéricos
Serviço Hospitalar de Emergência/organização & administração
Seres Humanos
Massachusetts/epidemiologia
Informática Médica/economia
Informática Médica/estatística & dados numéricos
Admissão do Paciente/estatística & dados numéricos
Diretores Médicos/organização & administração
Diretores Médicos/estatística & dados numéricos
Planos de Incentivos Médicos/organização & administração
Médicos/organização & administração
Médicos/estatística & dados numéricos
Melhoria de Qualidade/legislação & jurisprudência
Qualidade da Assistência à Saúde
Autorrelato
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170817
[St] Status:MEDLINE


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[PMID]:28557930
[Au] Autor:Bing-You RG; Holmboe E; Varaklis K; Linder J
[Ad] Endereço:R.G. Bing-You is vice president for medical education and designated institutional official, Maine Medical Center, Portland, Maine. E. Holmboe is senior vice president, Milestone Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. K. Varaklis is obstetrics/gynecology residency program director and assistant to the designated institutional official, Maine Medical Center, Portland, Maine. J. Linder is director of student affairs, Tufts University School of Medicine-Maine Medical Center Program, Portland, Maine.
[Ti] Título:Is It Time for Entrustable Professional Activities for Residency Program Directors?
[So] Source:Acad Med;92(6):739-742, 2017 Jun.
[Is] ISSN:1938-808X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Residency program directors (PDs) play an important role in establishing and leading high-quality graduate medical education programs. However, medical educators have failed to codify the position on a national level, and PDs are often not recognized for the significant role they play. The authors of this Commentary argue that the core entrustable professional activities (EPAs) framework may be a mechanism to further this work and define the roles and responsibilities of the PD position. Based on personal observations as PDs and communications with others in the academic medicine community, the authors used work in competency-based medical education to define a list of potential EPAs for PDs. The benefits of developing these EPAs include being able to define competencies for PDs using a deconstructive process, highlighting the increasingly important role PDs play in leading high-quality graduate medical education programs, using EPAs as a framework to assess PD performance and provide feedback, allowing PDs to focus their professional development efforts on the most important areas for their work, and helping guide the PD recruitment and selection processes.
[Mh] Termos MeSH primário: Educação de Pós-Graduação em Medicina/normas
Avaliação Educacional/métodos
Docentes de Medicina/normas
Internato e Residência/normas
Diretores Médicos/normas
Competência Profissional/normas
Papel Profissional
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170808
[Lr] Data última revisão:
170808
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170531
[St] Status:MEDLINE
[do] DOI:10.1097/ACM.0000000000001503


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[PMID]:28431871
[Au] Autor:Rostykus P; Jarrard H; Heigel G; Gonzalez C; Pattee B; Tomcyzk S; Daya M
[Ad] Endereço:Department of Emergency Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, United States. Electronic address: rostykusmd@mind.net.
[Ti] Título:How do EMS medical directors think?
[So] Source:Am J Emerg Med;35(9):1376-1378, 2017 09.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Serviços Médicos de Emergência/normas
Tratamento de Emergência/normas
Diretores Médicos
[Mh] Termos MeSH secundário: Benchmarking
Fidelidade a Diretrizes
Pesquisas sobre Serviços de Saúde
Seres Humanos
[Pt] Tipo de publicação:LETTER
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170423
[St] Status:MEDLINE


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[PMID]:28365621
[Au] Autor:Halter M; Wheeler C; Drennan VM; de Lusignan S; Grant R; Gabe J; Gage H; Ennis J; Parle J
[Ad] Endereço:Kingston University and St George's, University of London, London, UK maryhalter@sgul.kingston.ac.uk.
[Ti] Título:Physician associates in England's hospitals: a survey of medical directors exploring current usage and factors affecting recruitment.
[So] Source:Clin Med (Lond);17(2):126-131, 2017 Apr.
[Is] ISSN:1473-4893
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:In the UK secondary care setting, the case for physician associates is based on the cover and stability they might offer to medical teams. We assessed the extent of their adoption and deployment - that is, their current usage and the factors supporting or inhibiting their inclusion in medical teams - using an electronic, self-report survey of medical directors of acute and mental health NHS trusts in England. Physician associates - employed in small numbers, in a range of specialties, in 20 of the responding trusts - were reported to have been employed to fill gaps in medical staffing and support medical specialty trainees. Inhibiting factors were commonly a shortage of physician associates to recruit and lack of authority to prescribe, as well as a lack of evidence and colleague resistance. Our data suggest there is an appetite for employment of physician associates while practical and attitudinal barriers are yet to be fully overcome.
[Mh] Termos MeSH primário: Seleção de Pessoal/estatística & dados numéricos
Assistentes Médicos
[Mh] Termos MeSH secundário: Estudos Transversais
Inglaterra
Seres Humanos
Assistentes Médicos/organização & administração
Assistentes Médicos/estatística & dados numéricos
Assistentes Médicos/provisão & distribuição
Diretores Médicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170629
[Lr] Data última revisão:
170629
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170403
[St] Status:MEDLINE
[do] DOI:10.7861/clinmedicine.17-2-126


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[PMID]:28348198
[Au] Autor:McKee M
[Ad] Endereço:London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK Martin.McKee@lshtm.ac.uk.
[Ti] Título:The changing role of the chief medical officer for England.
[So] Source:BMJ;356:j1545, 2017 03 27.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Diretores Médicos/tendências
Papel Profissional
[Mh] Termos MeSH secundário: União Europeia
Política de Saúde
Seres Humanos
Relações Interprofissionais
Saúde Pública/tendências
Reino Unido
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170329
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j1545


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[PMID]:28272955
[Au] Autor:Sledge D
[Ad] Endereço:Daniel Sledge is with the Department of Political Science, University of Texas, Arlington.
[Ti] Título:Linking Public Health and Individual Medicine: The Health Policy Approach of Surgeon General Thomas Parran.
[So] Source:Am J Public Health;107(4):509-516, 2017 Apr.
[Is] ISSN:1541-0048
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Surgeon General Thomas Parran Jr was once viewed as a path-breaking leader, but his legacy is now highly contested. Scholars of national health insurance have viewed Parran as an impediment to government-backed insurance, and revelations about his role in the Tuskegee Study and in the Public Health Service's experiments in Guatemala have cast a shadow over his career. Surgeon General from 1936 to 1948, Parran led the Public Health Service during the development of key features of the modern American health system and was involved in critical debates over the role of the national government in health. I argue that Parran is best understood not as an opponent of insurance but as the proponent of an approach to health policy that sought to link public health and individual medicine. A pragmatic bureaucrat, Parran believed that effective policymaking required compromise with the American Medical Association.
[Mh] Termos MeSH primário: Política de Saúde/história
Experimentação Humana/história
United States Public Health Service/história
[Mh] Termos MeSH secundário: História do Século XX
Seres Humanos
Diretores Médicos/história
Doenças Sexualmente Transmissíveis/história
Estados Unidos
[Pt] Tipo de publicação:BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE
[Ps] Nome de pessoa como assunto:Parran TJ
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170309
[St] Status:MEDLINE
[do] DOI:10.2105/AJPH.2016.303639


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[PMID]:28248694
[Au] Autor:Myers CG; Pronovost PJ
[Ad] Endereço:C.G. Myers is assistant professor, Carey Business School, Johns Hopkins University, and core faculty, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. P.J. Pronovost is senior vice president for patient safety and quality, Johns Hopkins Medicine, director, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
[Ti] Título:Making Management Skills a Core Component of Medical Education.
[So] Source:Acad Med;92(5):582-584, 2017 May.
[Is] ISSN:1938-808X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Physicians are being called upon to engage in greater leadership and management in increasingly complex and dynamic health care organizations. Yet, management skills are largely undeveloped in medical education. Without formal management training in the medical curriculum, physicians are left to cultivate their leadership and management abilities through a haphazard array of training programs or simply through trial and error, with consequences that may range from frustration among staff to reduced quality of care and increased risk of patient harm. To address this issue, the authors posit that medical education needs a more systematic focus on topics related to management and organization, such as individual decision making, interpersonal communication, team knowledge sharing, and organizational culture. They encourage medical schools to partner with business school faculty or other organizational scholars to offer a "Management 101" course in the medical curriculum to provide physicians-in-training with an understanding of these topics and raise the quality of physician leadership and management in modern health care organizations.
[Mh] Termos MeSH primário: Educação Médica/métodos
Administração de Serviços de Saúde
Liderança
Diretores Médicos/educação
Competência Profissional
[Mh] Termos MeSH secundário: Comunicação
Currículo
Tomada de Decisões
Seres Humanos
Cultura Organizacional
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170302
[St] Status:MEDLINE
[do] DOI:10.1097/ACM.0000000000001627


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[PMID]:28212364
[Au] Autor:Kahl BS
[Ad] Endereço:Washington University School of Medicine, St. Louis, Missouri.
[Ti] Título:Letter From the Editor: The ASH rehash.
[So] Source:Clin Adv Hematol Oncol;15(1):7, 2017 Jan.
[Is] ISSN:1543-0790
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hematologia
Publicações Periódicas como Assunto
[Mh] Termos MeSH secundário: Seres Humanos
Diretores Médicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170228
[Lr] Data última revisão:
170228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170218
[St] Status:MEDLINE


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[PMID]:28116024
[Au] Autor:Greenstein J; Hardy R; Chacko J; Husain A
[Ad] Endereço:Staten Island University Hospital, Northwell Health, Department of Emergency Medicine, Staten Island, New York.
[Ti] Título:Demographics and Fellowship Training of Residency Leadership in EM: A Descriptive Analysis.
[So] Source:West J Emerg Med;18(1):129-132, 2017 Jan.
[Is] ISSN:1936-9018
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Emergency medicine (EM) fellowships are becoming increasingly numerous, and there is a growing trend among EM residents to pursue postgraduate fellowship training. Scant data have been published on the prevalence of postgraduate training among emergency physicians. We aimed to describe the prevalence and regional variation of fellowships among EM residency leadership. METHODS: We conducted an online anonymous survey that was sent to the Council of EM Residency Directors (CORD) membership in October 2014. The survey was a brief questionnaire, which inquired about fellowship, secondary board certification, gender, and length in a leadership position of each member of its residency leadership. We separated the responses to the survey into four different geographic regions. The geographic regions were defined by the same classification used by the National Resident Matching Program (NRMP). We defined residency leadership as program director (PD), associate PD and assistant PD. Residencies that did not complete the survey were then individually contacted to encourage completion. The survey was initially piloted for ease of use and understanding of the questions with a select few EM PDs. RESULTS: We obtained responses from 145 of the 164 Accrediting Council for Graduate Medical Education-accredited EM residencies (88%). The fellowship prevalence among PDs, associate PDs, and assistant PDs was 21.4%, 20.3%, and 24.9% respectively. The most common fellowship completed was a fellowship in toxicology. Secondary board certification among PDs, associate PDs, and assistant PDs was 9.7%, 4.8%, and 2.9% respectively. Eighty-two percent of PDs have at least five years in residency leadership. Seventy-six percent of PDs were male, and there was a near-even split of gender among associate PDs and assistant PDs. The Western region had the highest percentage of fellowship and or secondary board certification among all levels of residency leadership. CONCLUSION: There is a low prevalence of fellowship training and secondary board certification among EM residency leadership, with the most common being toxicology. Assistant PDs, the majority of whom had less than five years residency leadership experience, had the highest percentage of fellowship training. There may be a regional variation in the percentage of residency leadership completing postgraduate training.
[Mh] Termos MeSH primário: Certificação/estatística & dados numéricos
Educação de Pós-Graduação em Medicina/normas
Medicina de Emergência/educação
Bolsas de Estudo/estatística & dados numéricos
Internato e Residência/estatística & dados numéricos
Liderança
[Mh] Termos MeSH secundário: Demografia
Seres Humanos
Diretores Médicos
Inquéritos e Questionários
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170525
[Lr] Data última revisão:
170525
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170125
[St] Status:MEDLINE
[do] DOI:10.5811/westjem.2016.10.31452


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[PMID]:28116023
[Au] Autor:King K; Kass D
[Ad] Endereço:The University of Texas Health Science Center at San Antonio, Department of Emergency Medicine, San Antonio, Texas.
[Ti] Título:What Do They Want from Us? A Survey of EM Program Directors on EM Application Criteria.
[So] Source:West J Emerg Med;18(1):126-128, 2017 Jan.
[Is] ISSN:1936-9018
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Although a relatively young specialty, emergency medicine (EM) is popular among medical students and is one of the most competitive large specialties. Consequently, students increasingly seek more opportunity to differentiate themselves from their colleagues by pursuing more clerkships at the cost of taking out additional loans: this despite the fact that those who match in EM typically do so in their top three choices. We sought to ascertain what factors EM program directors seek in their typical candidate. METHODS: We recruited EM program directors via the Council of Emergency Medicine Residency Directors email listserv to participate in an anonymous survey regarding the United States Medical Licensing Examination (USMLE), the number of standardized letters of evaluation (SLOE), and the number of EM rotations during the fourth year. RESULTS: 135 respondents completed the anonymous survey: 59% of respondents stated their program did not have a minimum USMLE Step 1 score, but 39% reported a minimum score of 210 or higher; 95% of programs do not require Step 2 to grant an interview, but 46% require it to place the student on the rank list; 80% require only one EM rotation to grant an interview and none require more than two; 95% of programs will accept two SLOEs for both application and rank list placement. CONCLUSION: For the typical EM applicant, there is likely little benefit to performing more than two rotations and obtaining more than two SLOEs. Students can defer USMLE Step 2 but must complete it by the time rank lists are due. Our study was limited by the anonymity of the survey, and comments by the respondents revealed the questions did not account for some nuances programs apply to their application review process.
[Mh] Termos MeSH primário: Avaliação Educacional/normas
Medicina de Emergência/educação
Internato e Residência/economia
Internato e Residência/normas
[Mh] Termos MeSH secundário: Seres Humanos
Diretores Médicos
Inquéritos e Questionários
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170525
[Lr] Data última revisão:
170525
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170125
[St] Status:MEDLINE
[do] DOI:10.5811/westjem.2016.10.31496



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