The contribution of family medicine to community-orientated health services in Mali: A short report

Family medicine has not received appropriate attention in the sub-Saharan African context. In particular, family medicine is rarely recognised as a medical speciality and most African countries are silent on the role of family medicine in their health systems. There is, however, an emerging interest in developing family medicine as a key component of primary healthcare. Postgraduate training in family medicine is progressing and many countries have already established specific training programmes. In addition, there have been attempts to define the importance of family medicine, which, we expect, this short report contributes to. Interviews were conducted with physicians, partners and beneficiaries of two international development projects funded by the Canadian government. The one project supports training of health professionals and the other education of healthy women and girls in the community. The objective was to document the strengthening of primary healthcare through the creation and adaptation of a new family and community medicine postgraduate medical programme (which includes both family and community medicine) emphasising field training, immersion in local communities and interdisciplinary collaboration. This article underlines the importance of family medicine in Mali by documenting how what is now termed family and community medicine can promote community-orientated health services. To do so, we use the examples of initiatives and actions done through two international health development projects.

On the issue of ensuring the safety of the hospital environment

Objective: We identified the main occupational hazards in the hospital environment and determined their role in the formation of the safety of medical personnel at healthcare institutions. Materials and methods: We applied the bibliosemantic, questionnaire, hygienic and statistical research methods. Results: In the course of the labour activity at the health care institutions (HCI), the medical workers are exposed to the risk of negative effects of biological, psychophysiological, chemical, physical and social harmful and dangerous factors. The biological and psychophysiological factors are the most harmful factors. The adverse occupational factors of the hospital environment do not have an isolated effect, but have a complex, combined and joint effect, and their priority varies depending on the specificity of medical speciality. Under conditions of COVID-19 pandemic, the risk of the negative impact of production environment factors on the medical personnel at the HCI has been increased. In particular, the risk of infection with pathogens of infectious diseases increases, the work load, psycho-emotional tension, the duration of the use of personal protective equipment and the frequency of contact with the disinfectant solutions increase, the probability of violence, harassment, stigmatization, and discrimination related to the professional affiliation of health care personnel increases. The lack of a safety culture is one of the most important mechanisms for launching and realizing the dangers of a hospital environment, and just a creation of positive practice of a safety culture at work can significantly reduce the risks of realizing potential hazards that exist at health care institutions. Conclusion: The identification of the dangers of the hospital environment with the formation of a comprehensive understanding of their importance for the ensurance of the safety for medical personnel is an urgent task for modern medical science and will make it possible to develop reasonably the measures aimed at the ensurance of the safety of the hospital environment in terms of the safety of medical personnel.

985 Improving the Accessibility and Quality of Junior Doctor's Rotas During the Covid19 Pandemic

Introduction Rotas are an important part of a Junior Doctors working life. Having an up to date and accessible rota is important in enhancing Junior Doctor’s working lives in addition to being vital for work force planning and patient safety. During the Covid19 pandemic, rotas have changed several times making it difficult to track changes. Prior to our project, Junior Doctors found it neither difficult nor easy to access rotas at work (2.84 out of 5), found it fairly difficult to access rotas at home (2.38 out of 5) and the rotas they had access to were only average in being up to date (2.69 out of 5). Our project looked to improve this. Method Data was collected by surveys sent to Junior Doctors in the surgical department. PDSA Cycle 1 involved implementing surgical rotas on Microsoft Teams. PDSA Cycle 2 involved having other speciality rotas on Microsoft Teams. Our aims were to improve accessibility of rotas both at home and in the workplace whilst improving how up to date the available rota is. Results After the surgical rotas were on Microsoft Teams, rotas were easy to access at work (4.64 out of 5), fairly easy to access at home (4.24 out of 5) and were mostly up to date (4.41 out of 5). This has led to an improved satisfaction amongst Junior Doctors. Conclusions Currently the surgical department in Derby is using our solution for rotas. Medical staffing is in the midst of implementing this in the Medical speciality.

Palliative care delivery models

Palliative care has grown rapidly across the globe, with a network of services. It is variably a medical speciality or subspeciality, often with academic departments and with different levels of integration. As the population ages and as treatments extend life for children, younger and older people with chronic diseases, and in particular as multimorbidity is growing, so palliative care is more important. Specialist palliative care service are dedicated to palliative care, have staff trained in palliative care, and in addition to providing clinical care, engage in education, research, and the measurement of outcomes. As palliative care extends to support patients with organ failure, dementia, and earlier in the course of illness, new models are emerging. These include short-term palliative care services, working in an integrated way with other services. Principles common to all services include a holistic approach (physical, emotional, social, and spiritual), considering the patient and those important to them as the unit of care, and with impeccable attention to listening, communication, individualized care, and support in decision-making. People with advanced and progressive illness are found in almost all healthcare settings. Therefore, all doctors, nurses, and other health and social care professionals have to offer and know general palliative care and symptom control. Specialist palliative care teams often support those working in general settings with specific tools and/or training.

Organizational perspectives on implementing complex health interventions: clinical genomics in Australia

PurposeClinical genomics is a complex, innovative medical speciality requiring clinical and organizational engagement to fulfil the clinical reward promised to date. Focus thus far has been on gene discovery and clinicians’ perspectives. The purpose of this study was to use implementation science theory to identify organizational barriers and enablers to implementation of clinical genomics along an organizations’ implementation journey from Preadoption through to Adoption and Implementation.Design/methodology/approachWe used a deductive qualitative approach study design drawing on implementation science theory - (1) Translation Science to Population Impact Framework, to inform semi structured interviews with organizational decision-makers collaborating with Australian and Melbourne Genomics, alongside and (2) Theoretical Domains Framework (TDF), to guide data analysis.FindingsWe identified evolving organizational barriers across the implementation journey from Preadoption to Implementation. Initially the organizational focus is on understanding the value of clinical genomics (TDF code: belief about consequences) and setting the scene (TDF code: goals) before organizational (TDF codes: knowledge and belief about consequences) and clinician (TDF codes: belief about capability and intentions) willingness to adopt is apparent. Once at the stage of Implementation, leadership and clarity in organizational priorities (TDF codes: intentions, professional identity and emotion) that include clinical genomics are essential prerequisites to implementing clinical genomics in practice. Intuitive enablers were identified (e.g. ‘providing multiple opportunities for people to come on board) and mapped hypothetically to barriers.Originality/valueAttention to date has centred on the barriers facing clinicians when introducing clinical genomics into practice. This paper uses a combination of implementation science theories to begin to unravel the organizational perspectives of implementing this complex health intervention.

Core procedural skills competencies and the maintenance of procedural skills for medical students: a Delphi study

Background: It is well recognised that medical students need to acquire certain procedural skills during their medical training, however, agreement on the level and acquisition of competency to be achieved in these skills is under debate. Further, the maintenance of competency of procedural skills across medical curricula is often not considered. The purpose of this study was to identify core procedural skills competencies for Australian medical students and to establish the importance of the maintenance of such skills.Methods: A three-round, online Delphi method was used to identify consensus on competencies of procedural skills for graduating medical students in Australia. In Round 1, an initial structured questionnaire was developed using content identified from the literature. Respondents were invited experts that rated their agreement on the inclusion of teaching 74 procedural skills and 11 suggested additional procedures. In Round 2, experts re-appraised the importance of 85 skills and rated the importance of maintenance of competency (i.e., Not at all important to Extremely important). In Round 3, experts rated the level of maintenance of competence (i.e., Observer, Novice, Competent, Proficient) in 46 procedures achieving consensus. Subjects: Thirty-six experts representing medical education and multidisciplinary clinicians involved with medical students undertaking procedural skills.Results: Consensus, defined as >80% agreement, was established with 46 procedural skills across ten categories: cardiovascular, diagnostic/measurement, gastrointestinal, injections/intravenous, ophthalmic/ENT, respiratory, surgical, trauma, women’s health and urogenital procedures. The procedural skills that established consensus with the highest level of agreement included cardiopulmonary resuscitation, airway management, asepsis and surgical scrub, gown and gloving. The importance for medical students to demonstrate maintenance of competency in procedural skills was assessed on the 6-point Likert scale with a mean of 5.03. Conclusions: The findings from the Delphi study provided critical information about procedural skills for the Clinical Practice domain of Australian medical curricula. The inclusion of experts from medical faculty and clinicians provided opportunities to capture a range of experience independent of medical speciality. These findings demonstrate the importance of maintenance of competency of procedural skills and provides the groundwork for further investigations into monitoring medical students’ skills prior to graduation.

Prescribing stigma in mental disorders: A comparative study of Portuguese psychiatrists and general practitioners

Background: Physicians, including psychiatrists and general practitioners (GPs), have been reported as essential sources of stigma towards people diagnosed with a mental disorder (PDMDs), which constitutes an important barrier to recovery and is associated with poorer clinical outcomes. Therefore, psychiatrists and GPs are key populations where it is crucial to examine stigma, improve attitudes and reduce discrimination towards psychiatric patients. Aims: This study is the first to explore mental health-related stigma among Portuguese psychiatrists and GPs, examining the differences between these two specialities and assessing whether sociodemographic and professional variables are associated with stigma. Method: A cross-sectional study was performed between June 2018 and August 2019. A consecutive sample of 55 Psychiatrists and 67 GPs working in Porto (Portugal) filled a 25-item self-report questionnaire to assess their attitudes towards PDMDs in clinical practice. The instrument was designed by the authors, based on previous mental health-related stigma studies and validated scales. The questionnaire includes 12 stigma dimensions ( Autonomy, Coercion, Incompetence, Dangerousness, Permanence, Pity, Responsibility, Segregation, Labelling, Diagnostic Overshadowing, Shame and Parental Incompetence), and its total score was used to measure Overall Stigma (OS). Sample characteristics were examined using descriptive statistics, and the factors affecting stigma were assessed through regression analysis. Results: GPs exhibit significantly higher OS levels than psychiatrists, and present higher scores in the dimensions of dangerousness, parental incompetence, diagnostic overshadowing and responsibility. Besides medical speciality, several other sociodemographic variables were associated with sigma, including age, gender, having a friend with a mental disorder, professional category, agreement that Psychiatry diverges from core medicine and physician’s interest in mental health topics. Conclusions: Our data suggest that both psychiatrists and GPs hold some degree of stigmatizing attitudes towards PDMDs. Overall, these results bring new light to stigma research, and provide information to tailor anti-stigma interventions to Portuguese psychiatrists and GPs.

Gender Disparity in the Medical Speciality of Obstetrics and Gynecology

Background:: The actual question on the health care system all over the world is gender inequity in some specialties. In spite of different influencing factors for choosing their specialty by medical students and residents, the recent research studies show that gender is significantly influencing on their specialty. Especially gender disparity or inequity is mostly seen in the field of Obstetrics and gynecology. Aim of the Research:: The purpose of our study is to understand the actual problems for male specialists in the field of obstetrics and gynecology in health care system and to understand how it affects the nation’s health care system and to analyze the possible solutions. Materials and Methods:: The research consists of 815 respondents, which includes medical students, obstetricians and gynecologists and ObsGyn patients. Average age of the respondents were 20 - 50 years. They were divided into three groups. Questionnaire consists of 15 different questions for each group of people in different languages. Results:: The significant difference about the future plan towards choosing of specialty of ObsGyn were less among male respondents with 4%, whereas female respondents accounts for 69% (P<0.001). The main reason for women to choose ObsGyn specialty were comfortability on field with 43%. On the other hand, male respondents didn’t choose ObsGyn specialty because of its less scope for male specialists in this field with 37% and they weren’t sure about the availability of patients with 51%. There is a direct proportion between patients age and wish to visit the male consultants. And indirect proportion between patients age and wish to visit the female consultants. Conclusion:: Less number of male specialists in the obstetrics and gynecology field, doesn’t mean that the male students and residents have no interests on obstetrics and gynecology, but they are thinking and doubting on employment, patient’s availability and scope in the field. By including male and female specialists equally in this field we can improve the quality in preservation of reproductive health, women’s health and significant changes in crude and specific demographic indices. Making proper awareness and explaining about the current reality could be the best possible solution for this issue. The interpersonal style and communication skills should be the most important traits in physicians rather than gender.

The Identity of Psychiatry and the Challenge of Mad Activism: Rethinking the Clinical Encounter

Central to the identity of modern medical specialities, including psychiatry, is the notion of hypostatic abstraction: doctors treat conditions or disorders, which are conceived of as “things” that people “have.” Mad activism rejects this notion and hence challenges psychiatry’s identity as a medical specialty. This article elaborates the challenge of Mad activism and develops the hypostatic abstraction as applied to medicine. For psychiatry to maintain its identity as a medical speciality while accommodating the challenge of Mad activism, it must develop an additional conception of the clinical encounter. Toward elaborating this conception, this article raises two basic framing questions: For what kind of understanding of the situation should the clinical encounter aim? What is the therapeutic aim of the encounter as a whole? It proposes that the concepts of “secondary insight” (as the aim of understanding) and of “identity-making” (as a therapeutic aim) can allow the clinical encounter to proceed in a way that accommodates the challenge of Mad activism.