Is Mindfulness and Compassion Training Advisable in Alleviating Professional Burnout Among Physicians? Dilemmas and Possibilities in Healthcare System

The profession of a physician is a profession of social responsibility, in which medical competence should go hand in hand with non-medical competences. Mental strain, physical fatigue and entanglement in the administrative system can result in chronic stress and contribute to professional burnout, affecting both the well-being of medical staff and the quality of medical care provided. The Author’s intention is to promote mindfulness and compassion training that are considered to be protective and promoting the well-being of physicians resources in conditions of exposure to occupational stress. The analysis was based on 197 documents retrieved from the PubMed/Medline, Science Direct/Scopus databases in years 2008–2017, referring to the impact of mindfulness and compassion training on professional burnout among physicians. Only 21 papers retrieved from the scientific bases met inclusion criteria, referring to the impact of mindfulness and compassion training on professional burnout among physicians. Increasing concentration, improving memory, reducing the level of stress, anxiety and depression and strengthening kindness attitude are the basis for mindfulness and compassion training, which also supports the ability of unreactive responses to difficult situations, develops communication between the physician and the patient.

Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies

ObjectiveOverview on risks of acupuncture-related adverse events (AEs).DesignSystematic review and meta-analyses of prospective studies.Data sourcesPubMed, Scopus and Embase from inception date to 15 September 2019.Eligibility criteria for selecting studiesProspective studies assessing AEs caused by needle acupuncture in humans as primary outcome published in English or German.Data extraction and synthesisTwo independent researchers selected articles, extracted the data and assessed study quality. Overall risks and risks for different AE categories were obtained from random effects meta-analyses.Main outcomesOverall risk of minor AEs and serious adverse events (SAEs) per patients and per treatments.ResultsA total of 7679 publications were identified. Twenty-two articles reporting on 21 studies were included. Meta-analyses suggest at least one AE occurring in 9.31% (95% CI 5.10% to 14.62%, 11 studies) of patients undergoing an acupuncture series and in 7.57% (95% CI 1.43% to 17.95%, 5 studies) of treatments. Summary risk estimates for SAEs were 1.01 (95% CI 0.23 to 2.33, 11 studies) per 10 000 patients and 7.98 (95% CI 1.39 to 20.00, 14 studies) per one million treatments, for AEs requiring treatment 1.14 (95% CI 0.00 to 7.37, 8 studies) per 1000 patients. Heterogeneity was substantial (I2 >80%). On average, 9.4 AEs occurred in 100 treatments. Half of the AEs were bleeding, pain or flare at the needle site that are argued to represent intended acupuncture reaction. AE definitions and assessments varied largely.ConclusionAcupuncture can be considered among the safer treatments in medicine. SAEs are rare, and the most common minor AEs are very mild. AEs requiring medical management are uncommon but necessitate medical competence to assure patient safety. Clinical and methodological heterogeneity call for standardised AE assessments tools, clear criteria for differentiating acupuncture-related AEs from therapeutically desired reactions, and identification of patient-related risk factors for AEs.PROSPERO registration numberCRD42020151930.

The Model for Thai Physician Competency Development

Objective: The purpose of the present research was to study the model of competency development of Thai physicians. And find the desired performance, including a model that will be a guideline for Thai doctors to be consistent and suitable for Thai society both in the present and in the future. Materials and Methods: The present study used qualitative and quantitative technique combinations. Data were acquired using the Delphi technique; three experts selected 21 experts from different domains with in-depth knowledge of Thai medical competence. Several basic elements were built through in-depth interviews with five-level Likert items for 21 experts’ content analysis and three-level Likert items for three experts’ content validity. The analysis was based on the items of objectives congruence (IOC), the median (MD) and the quartile deviation (QD). A focus group discussion was then held with other qualified medical professionals on the competence development model for Thai physicians, which is widely acknowledged in the medical community. Results: Five current problems affecting the work performance of Thai physicians were identified. Medical knowledge, patient care, professionalism, compliance with system-based learning, practice-based learning, and interpersonal relationships and communication skills are desirable competencies of Thai physicians. Final Thai doctors’ competency development model was designed, combining individual, organizational, network, and enable environmental development. Conclusion: The present study has demonstrated validity and reliability in measuring medical competence in Thailand and can be utilized in government health policies to improve the quality of public health services and encourage and cultivate doctors with higher competency and strong expertise. Keywords: Competency Development; Thai Physicians; Model; Competency; Delphi

Penolakan Peran Dokter Sebagai Eksekutor Sanksi Hukum Kebiri di Indonesia: Perspektif Filsafat Hukum Islam

Behind the pro-contra polemic of imposing castration legal sanctions for criminals of pedophilia in Indonesia, doctors have a dilemma as a profession that is considered to have medical competence and is worthy of being executors. It is due to the principle of maintaining the safety of human souls and the prohibition of taking action that endangers the lives of others in the code of ethics for the medical profession. The research seeks to present the perspective of Islamic legal philosophy in analyzing the arguments in the Indonesian Doctors Association (IDI) rejection as the executor of the punishment for castration. This research is qualitative in the form of a literature review. This type of legal research is included in the category of philosophical normative Islamic law research using Islamic law principles (qawaid fiqhiyah). This research concludes that the principle of not endangering the safety of others in the medical profession is parallel to the rules of Islamic law (fiqh) which reads al-ḍararu yuzālu (fade must be eliminated). However, the provisions of the fiqh rule are not absolute. It means that under certain conditions, the act of harming someone is allowed in order to create public benefit (al-maslahat al-ammah). Therefore, a doctor who serves as executor in applying the caste penalty for pedophile offenders does not contradict the philosophy of Islamic law.

Key Assumptions Underlying a Competency-Based Approach to Medical Sciences Education, and Their Applicability to Veterinary Medical Education

This perspective explores six key assumptions of a competency-based approach to medical-sciences education, as they relate to veterinary medical education. Those assumptions, derived from characteristics of competency based medical education (CBME) identified by CBME proponents are: (1) There are sufficient shortcomings in the medical competence of graduate veterinarians that solutions are necessary, and changes in the way we teach veterinarians will address those problems. (2) It is feasible to identify generally accepted core competencies in veterinary medical practice. (3) Teaching to defined learning outcomes will produce greater achievement for learners than approaches that do not emphasize clearly defined outcomes. (4) In veterinary medical education, it is possible to articulate the development of competence sequentially in a manner that is relatively consistent across learners, and carefully planning and sequencing learning activities will produce better learning outcomes. (5) Competency-focused instruction, which tailors the pace and progression of instruction to learners, is feasible in veterinary medical education, and will produce better outcomes than instruction that moves all students through an equivalent process in a set time frame. (6) Programmatic Assessment, including numerous direct observations with feedback, will improve learning outcomes, and is feasible in veterinary medical education. While available research does not unequivocally support all six assumptions, overall the potential benefits of adopting a competency-based approach seem promising for veterinary medical education.

What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance

Background Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians’ (PCPs’) perspectives on admission to a MAW as an alternative to hospitalisation. Methods The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. Results The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients’ condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients’ and relatives’ participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients’ wishes conflicted with what PCPs considered professionally sound. Conclusions The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services.

Using Case Study Method for Forming Clinical Thinking Ability in Nursing and Midwifery Education

This paper aims to examine the formation of clinical thinking within the case study method in teaching midwifery and nursing students. Statistical methods include the Kolmogorov-Smirnov test and the Mann-Whitney U test. After the analysis of the data, it was concluded that the use of the method develops the necessary medical competence for quality realization in the chosen profession.

Shedding light on autistic traits in struggling learners: A blind spot in medical education

Some highly challenging, seemingly “unsolvable” situations that arise in medical education could be the result of autistic traits (AT) in learners. AT exist in physicians and learners, ranging from profiles compatible with DSM-5’s criteria for autism spectrum disorder (ASD) to more subtle manifestations of ASD’s “broader phenotype.” Often associated with strengths and talents, AT may nonetheless pose significant challenges for learning, teaching, and practising medicine. Since AT remain widely under-recognized and misunderstood by educators, clinicians, and affected individuals alike, they represent a blind spot in medical education. The use of a “neurodiversity lens” to examine challenging situations may help educators consider different pedagogical approaches to address those potentially stemming from AT.This paper aims to raise awareness and understanding of AT-related difficulties in struggling medical learners. To overcome the blind spot challenge and help develop this “neurodiversity lens,” we explore different angles. Beyond any diagnostic consideration, we offer a series of contextual examples, paralleled with explanatory concepts from the field of ASD. We also underline the role of context on functional impact and describe the often ill-defined pattern of challenges encountered, as well as the fertile grounds for interpersonal misunderstandings and disrespect. We propose historical, cultural, and clinical reasons likely contributing to the blind spot. Mindful of the potential risks of prejudice associated with identifying AT-related difficulties, we underline the necessity and feasibility of conciliating diversity and dignity with accountability standards for medical competence.