- MeSH
- nemocniční lékárny * MeSH
- průzkumy a dotazníky MeSH
- specializace MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Previous studies in multiple sclerosis (MS) showed that therapeutic inertia (TI) affects 60-90% of neurologists and up to 25% of daily treatment decisions. The objective of this study was to determine the most common factors and attribute levels associated with decisions to treatment escalation in an international study in MS care. METHODS: 300 neurologists with MS expertise from 20 countries were invited to participate. Participants were presented with 12 pairs of simulated MS patient profiles described by 13 clinically relevant factors. We used disaggregated discrete choice experiments to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies. RESULTS: Overall, 229 neurologists completed the study (completion rate: 76.3%). The top 3 weighted factors associated with treatment escalation were: previous relapses (20%), baseline expanded disability status scale [EDSS] (18%), and MRI activity (13%). Patient demographics and desire for pregnancy had a modest influence (≤ 3%). We observed differences in the weight of factors associated with treatment escalation between MS specialists and non-MS specialists. CONCLUSIONS: Our results provide critical information on factors influencing neurologists' treatment decisions and should be applied to continuing medical education strategies.
- MeSH
- lidé MeSH
- neurologové * MeSH
- recidiva MeSH
- roztroušená skleróza * farmakoterapie terapie MeSH
- specializace MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Therapeutic inertia (TI) is a worldwide phenomenon that affects 60 to 90% of neurologists and up to 25% of daily treatment decisions during management of multiple sclerosis (MS) patients. A large volume of MS patients are women of childbearing age, and desire for pregnancy is a complex variable often affecting MS care. The objective of this study was to determine the effect of desire for pregnancy on decisions to escalate treatment during management of MS patients. METHODS: 300 neurologists with expertise in MS from 20 countries were invited to participate in the study. Participants were presented with 12 pairs of simulated MS patient profiles reflective of case scenarios encountered in clinical practice. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies. Disaggregated discrete choice experiments were used to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. An excel calculator that provides estimates as the percentage of participants that would escalate treatment for a simulated case-scenario was constructed. RESULTS: 229 (76.3%) completed the study. The mean age (SD) of study participants was 44 (±10) years. The mean (SD) number of MS patients seen per month by each neurologist was 18 (±16). Non-MS specialists were significantly less likely to escalate treatment than MS specialists across mild, moderate, and severe patient cases. These differences were accentuated when case scenarios introduced a desire for pregnancy. The findings were consistent when MRI-lesions, severity of symptoms, and number of relapses were included. CONCLUSIONS: Desire for pregnancy differentially influences decisions to escalate treatment, suggesting knowledge-to-action gaps between MS and non-MS specialists. Our findings indicate the need for educational strategies to overcome these gaps and improve clinical outcomes for MS patients who desire pregnancy.
- MeSH
- kardiologie * MeSH
- kurikulum MeSH
- lidé MeSH
- specializace MeSH
- studium lékařství specializační postgraduální MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
European Union (EU) Directive 2013/55/EC (The Recognition of Professional Qualifications) allows Member States to decide on a common set of minimum knowledge, skills and competences that are needed to pursue a given profession through a Common Training Framework. To be adopted the framework must combine the knowledge, skills and competences of at least one third of the Member States. Professionals who have gained their qualifications under a Common Training Framework will be able to have these recognised automatically within the Union. The backbone of the European Federation of Clinical Chemistry and Laboratory Medicine's (EFLM) proposed Common Training Framework for non-medical Specialists in Laboratory Medicine is outlined here. It is based on an Equivalence of Standards in education, training, qualifications, knowledge, skills, competences and the professional conduct associated with specialist practice. In proposing the recognition of specialist practice EFLM has identified 15 EU Member States able to meet Equivalence and in whom the profession and/or its training is regulated (an additional EU Commission requirement). The framework supports and contributes to the Directive's enabling goals for increasing professional mobility, safeguarding consumers and ensuring a more equitable distribution of skills and expertise across the Member States. It represents EFLM's position statement and provides a template for professional societies and/or competent authorities to engage with the EU Commission.
- MeSH
- Evropská unie MeSH
- klinická chemie MeSH
- kurikulum MeSH
- laboratoře * MeSH
- lidé MeSH
- specializace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
The 4th version of the guide to the Register for European Specialists in Laboratory Medicine (EuSpLM) established by the European Communities Confederation of Clinical Chemistry and Laboratory Medicine describes the transfer of the register to the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) in 2016, the extension in 2018 of the Register beyond the European Union to Europe and the benefits of membership of the EFLM Academy to which the Register transferred on the Academy's launch in 2019. The Academy offers EuSpLM registrants access to benefits that include reduced registration rates at selected conferences and free subscription to Clinical Chemistry and Laboratory Medicine. With effect from 2020 eligibility was extended to anyone with an interest in laboratory medicine. The updated guide describes the electronically driven processes for individual membership and block enrolment from national societies/organisations, and the stepping stones to recognition as an EuSpLM within the Academy. Whilst eligibility for recognition as an EuSpLM remains largely unchanged new expectations across Europe in education, training, professional regulation and qualifications are reflected in updated criteria. The continuing driver for establishing the Academy and growing the EFLM Register reflects the federation's leadership role in the harmonisation of high quality education and training for those with an interest in laboratory medicine as well as ongoing initiatives to establish a Common Training Framework for Specialists in Laboratory Medicine under EU Directive 2013/55/EC (The Recognition of Professional Qualifications).
- MeSH
- Evropská unie MeSH
- klinická chemie * MeSH
- laboratoře * MeSH
- lidé MeSH
- specializace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
Cíl: O psychiatrii a dětskou a dorostovou psychiatrii je mezi absolventy lékařských fakult malý zájem. Cílem naší studie bylo porozumět faktorům, které ovlivnily rozhodování lékařů stát se psychiatry či dětskými a dorostovými psychiatry. Materiál a metoda: V tomto kvalitativním výzkumu jsme realizovali polostrukturované rozhovory s lékaři v předatestační přípravě oborů Psychiatrie a Dětská a dorostová psychiatrie v ČR. Výběr účastníků studie byl záměrný. Analytický rámec vycházel z konceptu dynamiky kariérní volby u studentů medicíny. Výsledky: Výzkumný soubor zahrnoval 21 lékařů: 14 v oboru Psychiatrie (8 žen a 6 mužů) a 7 v oboru Dětská a dorostová psychiatrie (4 ženy a 3 muži). Délka předatestační přípravy se pohybovala mezi 4 měsíci a 5 lety. Identifikovali jsme 15 faktorů, které jsme kategorizovali do 4 základních okruhů: charakteristiky a hodnoty lékařů, kariérní potřeby během rozhodování o výběru specializace, vnímání oboru psychiatrie / dětské a dorostové psychiatrie a faktory setrvání v profesi. Závěr: K základním motivačním faktorům patří práce s pacientem založená na komunikaci a navázání vztahu, dále komplexní povaha oboru, který propojuje somatickou, farmakologickou a psychoterapeutickou péči, a zahrnuje i sociální a soudní problematiku. Z praktického hlediska se psychiatrie během rozhodování zdála být oborem, kde je méně stresu, víc času na pacienta, diagnostiku a terapii, ale i na osobní život. Specifickým motivačním faktorem pro obor dětská a dorostová psychiatrie je vztah k dětem; s motivací pracovat s dětmi nastupují studenti často již na lékařskou fakultu. Dětští a dorostoví psychiatři oceňují zejména bezprostřednost a hravost dětí a to, že jsou na začátku vývoje a lze u nich dosáhnout velkých změn. Volbu dětské a dorostové psychiatrie ovlivnily i pragmatické důvody, a to pracovní uplatnění v situaci nedostatku dětských a dorostových psychiatrů. Dotazovaní oceňovali možnost intelektuálního rozvoje, jelikož dětská psychiatrie nabízí málo probádaná témata. Odrazujícími faktory jsou společenské předsudky, které jako reakci svých rodičů přiznala polovina dotazovaných bez ohledu na jejich profesi. Se stigmatizací ze strany pedagogů se lékaři setkávali již během studia medicíny. Zásadním problémem je nedostatečná informovanost o existenci samostatného atestačního oboru Dětská a dorostová psychiatrie, včetně prakticky nulové expozice tomuto oboru během studia na lékařské fakultě.
Introduction: There has been a low interest in pursuing career in Psychiatry and Child and adolescent psychiatry among medical school graduates. The aim of our study was to identify factors that influenced choice of these medical disciplines among psychiatric trainees. Method: In this qualitative study we conducted semi-structured interviews with purposively sampled trainees in Psychiatry and Child adolescent psychiatry programs in the Czech Republic. An analytical framework for this study is based on the concept of dynamics ofcareer choice among medical students. Results: Out of 21 respondents there were 14 trainees in Psychiatry program (8 women, 6 men) and 7 in Child and adolescent psychiatry program (4 women, 3 men). The length of their training was between 4 months and 5 years. We identified 15 factors, that were cathegorized into 4 groups: characteristics and values, career needs during decision making proces of specialty choice, psychiatry and child and adolescent psychiatry perception and factors of remaining in profession. Conclusion: Motivating factors were oportunity for working with patients based on communication and therapeutic relationship; complexity of psychiatry that includes somatic, pharmacological and psychological care as well as social and forencis aspects. From a practical point of view psychiatry seemed to allow better worklife balance and was viewed as less stresfull with more time available for doctor-patient interaction, including diagnostics and treatment. Specific factor for child psychiatry was relationship to children, which motivated respondents for entering medical school. Trainees in Child and adolescent psychiatry appreciated spontaneity and playfulness of children and early developmental phase of life with a chance for behavioral change. There were also pragmatic reasons, namely chance for finding a job. Another reason was opportunity for intelectual development as there are many possible topics for research. De-motivating factors included societal prejudice, which was indentified in parents of half of respondents, regardless of their profession. Students were exposed to stigmatizing comments by academic staff after declaring their interest in psychiatry during medical school. Fundamental problem was lack of information about the existence of Child and adolescent psychiatry as a unique speciality with training available right after graduation and practically no exposure to this medical speciality during medical school.
- MeSH
- dětská psychiatrie výchova MeSH
- lékaři psychologie MeSH
- lidé MeSH
- motivace MeSH
- odborná způsobilost MeSH
- psychiatrie adolescentů výchova MeSH
- psychiatrie * výchova MeSH
- rozhovory jako téma MeSH
- specializace MeSH
- studium lékařství MeSH
- studium vysokoškolské MeSH
- volba povolání * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- dermatologie * výchova MeSH
- lidé MeSH
- nezletilí MeSH
- specializace * MeSH
- výchova a vzdělávání organizace a řízení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- směrnice MeSH
