Suchergebnisse

The training of physicians in the past century was based primarily on responsibility and the chain-of-command. Those with the bulk of that responsibility in the fields of pediatrics and internal medicine were residents. Residents trained the medical students and supervised them carefully in caring for patients. Most attending physicians supervised their teams at arm's length, primarily serving as teachers of the finer points of diagnosis and treatment during set periods of the day or week with a perfunctory signature on write-ups or progress notes. Residents endeavored to protect the attending physician from being heavily involved unless they were unsure about a clinical problem. Before contacting the attending physician, a more senior resident would be called. Responsibility was the ultimate teacher. The introduction of diagnosis-related groups by the federal government dramatically changed the health care delivery system, placing greater emphasis on attending physician visibility in the medical record, ultimately resulting in more attending physician involvement in day-to-day care of patients in academic institutions. Without specified content in attending notes, hospital revenues would decline. Although always in charge technically, attending physicians increasingly have assumed the role once dominated by the resident. Using biographical experiences of more than 40 years, the author acknowledges and praises the educational role of responsibility in his own training and laments its declining role in today's students and house staff.

Part 4: eParticipation Initiatives and Country Studies ; International audience ; In the context of local civic governance, much of the interest in e-Participation concerns the extent to which online media might overcome the limitations of geography and scale, and so allow local interests to be better represented in institutionally driven participatory processes at national or regional level. In contrast, this study investigates the online deliberations of a local, geographically bounded community in a series of mailing lists that had originated from their own initiative and self-organisation. The interactions we observe challenges assumptions of democratic deliberation as mainly policy debate between citizens and government, or of lobbying administrative government. It also proposes a broader conception of the role of online deliberation in local governance, where instrumental decision-making and developing consensus is frequently over privileged in research.

Cover -- Praise for Ibtihal Samarayi's -- Title -- Copyright -- Table of Contents -- Acknowledgments -- Foreword -- Author's note -- Prologue -- One -- Two -- Three -- Four -- Five -- Six -- Seven -- Eight -- Nine -- Ten -- Eleven -- Twelve -- Thirteen -- Fourteen -- Epilogue - Australia: "for we are young and free …".

Bournemouth Churches Housing Association has developed a continuum of accommodation and support services through consultation with residents and local authorities. This is a holistic continuum of services that is designed to be flexible enough to enable residents to move between different services offered as their support needs change. Ultimately, the continuum of support services is intended to empower residents in achieving independent living after moving from fully supported services, to semi‐supported services, to independent accommodation with floating support. It has been possible to develop this range of services by mapping accurately support needs and developing effective professional working relationships with partnership agencies, such as Supporting People Administering Authorities.

Introduction Efficient neurosurgical training is of paramount importance to provide continuing high-quality medical care to patients. In this era of law-enforced working hour restrictions, however, maintaining high-quality training can be a challenge and requires some restructuring. We evaluated the current status of resident training in Germany.
Methods An electronic survey was sent to European neurosurgical trainees between June 2014 and March 2015. The responses of German trainees were compared with those of trainees from other European countries. Logistic regression analysis was performed to assess the effect size of the relationship between a trainee being from Germany and the outcome (e.g., satisfaction, working time).
Results Of 532 responses, 95 were from German trainees (17.8%). In a multivariate analysis corrected for baseline group differences, German trainees were 29% as likely as non-German trainees to be satisfied with clinical lectures given at their teaching facility (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.18–0.49; p < 0.0001). The satisfaction rate with hands-on operating room exposure was 73.9% and equal to the rate in Europe (OR: 0.94; 95% CI, 0.56–1.59; p = 0.834). German trainees were 2.3 times as likely to perform a lumbar spine intervention as the primary surgeon within the first year of training (OR: 2.27; 95% CI, 1.42–3.64; p = 0.001). However, they were less likely to perform a cervical spine procedure within 24 months of training (OR: 0.38; 95% CI, 0.17–0.82; p = 0.014) and less likely to perform a craniotomy within 36 months of training (OR: 0.49; 95% CI, 0.31–0.79; p = 0.003). Only 25.6% of German trainees currently adhere to the weekly limit of 48 hours as requested from the European Working Time Directive 2003/88/EC, and in an international comparison, German trainees were twice as likely to work > 50 hours per week (OR: 2.13; 95% CI, 1.25–3.61; p = 0.005). This working time, however, is less spent in the operating suite (OR: 0.26; 95% CI, 0.11–0.59; p = 0.001) and more doing administrative work (OR: 1.83; 95% CI, 1.13–2.96; p = 0.015).
Conclusion Some theoretical and practical aspects of neurosurgical training are superior, but a considerable proportion of relevant aspects are inferior in Germany compared with other European countries. The present analyses provide the opportunity for a critical review of the local conditions in German training facilities.