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1.  The Academic Backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors 
BMC Medicine  2013;11:242.
Background
Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades.
Methods
Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register.
Results
Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on measures of educational attainment, undergraduate, and post-graduate performance. Women performed better in assessments but were less likely to be on the Specialist Register. Non-white participants generally underperformed in undergraduate and post-graduate assessments, but were equally likely to be on the Specialist Register. There was a suggestion of smaller ethnicity effects in earlier studies.
Conclusions
The existence of the Academic Backbone concept is strongly supported, with attainment at secondary school predicting performance in undergraduate and post-graduate medical assessments, and the effects spanning many years. The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge ('cognitive capital’ and 'medical capital’). The Academic Backbone provides strong support for using measures of educational attainment, particularly A-levels, in student selection.
doi:10.1186/1741-7015-11-242
PMCID: PMC3827330  PMID: 24229333
Academic Backbone; Secondary school attainment; Undergraduate medical education; Post-graduate medical education; Longitudinal analyses; Continuities; Medical student selection; Cognitive capital; Medical capital; Aptitude tests
2.  Graduates from a reformed undergraduate medical curriculum based on Tomorrow's Doctors evaluate the effectiveness of their curriculum 6 years after graduation through interviews 
BMC Medical Education  2010;10:65.
Background
In 1996 Liverpool reformed its medical curriculum from a traditional lecture based course to a curriculum based on the recommendations in Tomorrow's Doctors. A project has been underway since 2000 to evaluate this change. This paper focuses on the views of graduates from that reformed curriculum 6 years after they had graduated.
Methods
Between 2007 and 2009 45 interviews took place with doctors from the first two cohorts to graduate from the reformed curriculum.
Results
The interviewees felt like they had been clinically well prepared to work as doctors and in particular had graduated with good clinical and communication skills and had a good knowledge of what the role of doctor entailed. They also felt they had good self directed learning and research skills. They did feel their basic science knowledge level was weaker than traditional graduates and perceived they had to work harder to pass postgraduate exams. Whilst many had enjoyed the curriculum and in particular the clinical skills resource centre and the clinical exposure of the final year including the "shadowing" and A & E attachment they would have liked more "structure" alongside the PBL when learning the basic sciences.
Conclusion
According to the graduates themselves many of the aims of curriculum reform have been met by the reformed curriculum and they were well prepared clinically to work as doctors. However, further reforms may be needed to give confidence to science knowledge acquisition.
doi:10.1186/1472-6920-10-65
PMCID: PMC2956712  PMID: 20920263
3.  Doctoral Programs to Train Future Leaders in Clinical and Translational Science 
Purpose
Although the National Institutes of Health (NIH) has made extensive investments in educational programs related to clinical and translational science (CTS), there has been no systematic investigation of the number and characteristics of PhD programs providing training to future leaders in CTS. The authors undertook to determine the number of institutions that, having had received NIH-funded Clinical and Translational Science Awards (CTSAs), currently had or were developing PhD programs in CTS; to examine differences between programs developed before and after CTSA funding; and to provide detailed characteristics of new programs.
Method
In 2012, CTS program leaders at the 60 CTSA-funded institutions completed a cross-sectional survey focusing on four key domains related to PhD programs in CTS: program development and oversight; students; curriculum and research; and milestones.
Results
Twenty-two institutions had fully developed PhD programs in CTS, and 268 students were earning a PhD in this new field; 13 institutions were planning a PhD program. New programs were more likely to have fully developed PhD competencies and more likely to include students in medical school, students working only on their PhD, students working on a first doctoral degree, and students working in T1 translational research. They were less likely to include physicians and students working in clinical or T2 research.
Conclusions
Although CTS PhD programs have similarities, they also vary in their characteristics and management of students. This may be due to diversity in translational science itself or to the relative infancy of CTS as a discipline.
doi:10.1097/ACM.0b013e31829e7bce
PMCID: PMC3845359  PMID: 23899901
4.  Neurophobia among medical students and non-specialist doctors in Sri Lanka 
BMC Medical Education  2013;13:164.
Background
Neurophobia is the fear of neurosciences held by medical students and doctors. The present study aims to identify whether Neurology is considered a difficult subject by medical students and non-specialist doctors from Sri Lanka and evaluate reasons for such perceived difficulties.
Methods
The study was conducted from May-June 2008. One hundred non-specialist doctors from the Colombo South Teaching Hospital and 150 medical students from the University of Sri Jayewardenepura were invited for the study. Data were collected by a pre-tested expert-validated self-administered questionnaire, designed to assess the degree of perceived difficulty, confidence, interest and knowledge of Neurology as compared to other subjects. It also evaluated reasons and probable strategies to overcome the perceived difficulties and/or lack of interests.
Results
All non-specialist doctors and 148 medical students responded to the questionnaire (response rate–99.2%). The most favourite subject among medical students and non-specialist doctors were Cardiology and Endocrinology respectively, while Neurology was ranked third. In all participants the current level of interest was most for Cardiology (3.52±1.36), while Neurology was the least interesting specialty for majority of medical students (18.5%) and non-specialist doctors (25.0%). The current level of knowledge among medical students was most for Cardiology (3.12±0.86), while Neurology (2.53±0.96) was ranked fifth. The most difficult specialty for majority of medical students (50.0%) and non-specialist doctors (41.7%) was Neurology. All the participants were least confident when dealing with patients with headache (2.20±0.81), numbness of feet (2.07±0.79) and dizziness (2.07±0.78) when compared to dealing with other non-neurological complaints. The commonest reasons ‘why Neurology was felt to be a difficult subject’ were; the need to know basic neuro-anatomy and having a complex clinical examination. Participants’ felt that clinical/hospital based teaching (3.49±0.65), case discussions (3.45±0.68) and teaching aids (3.10±0.89) would be the most important teaching strategies to improve their competency in Neurology.
Conclusion
Neurology is considered a difficult subject by undergraduates and non-specialist doctors of Sri Lanka. The main reason for the perceived difficulty was the lack of understanding of basic sciences and deficiencies in clinical teaching. This lack of confidence could have a significant impact on patient care.
doi:10.1186/1472-6920-13-164
PMCID: PMC3909313  PMID: 24321477
Neurophobia; Non-specialist doctors; Medical students; Sri Lanka
5.  Hippocratic oath and conversion of ethico-regulatory aspects onto doctors as a physician, private individual and a clinical investigator 
Journal of Mid-Life Health  2013;4(4):203-209.
Hippocratic Oath is a living document for ethical conduct of the physicians around the world. World Medical Association has been amending the oath as per the contemporary times. Although physicians maintain their ethical standards while treating a patient yet many a times social, administrative and ruling powers either use physicians as their tool of oppression or victimize them for conducting duties as per their oath. The Tuskegee Syphilis Study and Human Radiation Experiments in America, Nazi Experiments in Germany and compulsory sterilization program in India were the studies where States used physicians for the advancement of their rationality or belief. Conversely victimization of physicians in Kosovo, Sri Lanka and incarcerating physicians for treating human immunodeficiency virus/acquired immunodeficiency syndrome patients in some countries is concerning. The Nuremberg code, the Declaration of Geneva, Belmont Report and Declaration of Helsinki are ethical documents while active involvement of Food and Drug Administration through “common rule” resulted in guidelines like International Conference on Harmonization and Good Clinical Practices. Still unethical studies are found in developing countries. Studies such as experimental anticancer drugs in 24 cancer patients without adequate prior animal testing and informed consent in Kerala, studies at All India Institute of Medical Sciences in New Delhi resulted in 49 deaths of children and many more suspicious studies are rampant. Reverting back to the fundamentals of the medical profession; teaching medical ethics and enforcement of “medical neutrality” by embarking some grade of “medical immunity” on the basis of the oath is necessary for ethical conduct of physicians.
doi:10.4103/0976-7800.122232
PMCID: PMC3872665  PMID: 24381460
Ethical documents; hippocratic oath; medical ethics; medical immunity; medical neutrality
6.  Prevalence of stress in junior doctors during their internship training: a cross-sectional study of three Saudi medical colleges’ hospitals 
Background
Medical science is perceived as a stressful educational career, and medical students experience monstrous stress during their undergraduate studies, internship, and residency training, which affects their cognitive function, practical life, and patient care. In the present study, an assessment of the prevalence of self-perceived stress among new medical graduates during their internship training has been performed, and correlations of self-perceived stress with sex, marital status, and clinical rotations have been evaluated.
Patients and methods
Interns of the King Khalid, King Abdulaziz, and King Fahd University hospitals in Saudi Arabia were invited to complete a stress inventory known as the Kessler 10, which is used for stress measurement. Apart from stress evaluation, the questionnaire collected personal data, such as age, sex, and marital status, in addition to information relevant to hospital training, assigned duties, and clinical training rotations.
Results
Our results showed that nearly 73.0% of interns were under stressed conditions. Most of the interns were affected by a severe level of stress (34.9%), followed by mild (19.3%) and moderate (18.8%) levels of stress. The stress level was significantly higher (84.0%) among female interns in comparison with male interns (66.5%) (odds ratio =2.64; confidence interval =1.59–4.39; P<0.0002). There were statistically significant differences between the percentages of male and female interns (P≤0.047) at mild, moderate, and severe stress levels. Marital status had no role in causing stress. The highest stress level was reported by interns during the clinical rotations of medicine (78.8%), followed by surgery (74.7%), pediatrics (72.4%), obstetrics and gynecology (70.1%), and emergency (58.3%). The prevalence of stress among the interns and their corresponding clinical rotations in all three hospitals had significant linear correlations (r≥0.829, P≤0.041).
Conclusion
We found a significantly high level of stress among the medical interns. High stress may have negative effects on cognitive functioning, learning, and patient care. Hence, medical interns need support and subsequent interventions to cope with stress.
Video abstract
doi:10.2147/NDT.S68039
PMCID: PMC4196886  PMID: 25328389
medical education; clinical rotation; medicine; surgery; pediatrics
7.  Physical activity education in the undergraduate curricula of all UK medical schools. Are tomorrow's doctors equipped to follow clinical guidelines? 
British Journal of Sports Medicine  2012;46(14):1024-1026.
Physical activity (PA) is a cornerstone of disease prevention and treatment. There is, however, a considerable disparity between public health policy, clinical guidelines and the delivery of physical activity promotion within the National Health Service in the UK. If this is to be addressed in the battle against non-communicable diseases, it is vital that tomorrow's doctors understand the basic science and health benefits of physical activity. The aim of this study was to assess the provision of physical activity teaching content in the curricula of all medical schools in the UK. Our results, with responses from all UK medical schools, uncovered some alarming findings, showing that there is widespread omission of basic teaching elements, such as the Chief Medical Officer recommendations and guidance on physical activity. There is an urgent need for physical activity teaching to have dedicated time at medical schools, to equip tomorrow's doctors with the basic knowledge, confidence and skills to promote physical activity and follow numerous clinical guidelines that support physical activity promotion.
doi:10.1136/bjsports-2012-091380
PMCID: PMC3856633  PMID: 22846233
8.  How well do doctors think they perform on the General Medical Council's Tests of Competence pilot examinations? A cross-sectional study 
BMJ Open  2014;4(2):e004131.
Objective
To investigate how accurately doctors estimated their performance on the General Medical Council's Tests of Competence pilot examinations.
Design
A cross-sectional survey design using a questionnaire method.
Setting
University College London Medical School.
Participants
524 medical doctors working in a range of clinical specialties between foundation year two and consultant level.
Main outcome measures
Estimated and actual total scores on a knowledge test and Observed Structured Clinical Examination (OSCE).
Results
The pattern of results for OSCE performance differed from the results for knowledge test performance. The majority of doctors significantly underestimated their OSCE performance. Whereas estimated knowledge test performance differed between high and low performers. Those who did particularly well significantly underestimated their knowledge test performance (t (196)=−7.70, p<0.01) and those who did less well significantly overestimated (t (172)=6.09, p<0.01). There were also significant differences between estimated and/or actual performance by gender, ethnicity and region of Primary Medical Qualification.
Conclusions
Doctors were more accurate in predicating their knowledge test performance than their OSCE performance. The association between estimated and actual knowledge test performance supports the established differences between high and low performers described in the behavioural sciences literature. This was not the case for the OSCE. The implications of the results to the revalidation process are discussed.
doi:10.1136/bmjopen-2013-004131
PMCID: PMC3918998  PMID: 24503300
Education & Training (see Medical Education & Training); Medical Education & Training; Statistics & Research Methods
9.  An audit of the knowledge and attitudes of doctors towards Surgical Informed Consent (SIC) 
Background: The Surgical Informed Consent (SIC) is a comprehensive process that establishes an information-based agreement between the patient and his doctor to undertake a clearly outlined medical or surgical intervention. It is neither a casual formality nor a casually signed piece of paper. The present study was designed to audit the current knowledge and attitudes of doctors towards SIC at a tertiary care teaching hospital in Pakistan.
Methods: This cross-sectional qualitative investigation was conducted under the auspices of the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over three months period. A 19-item questionnaire was employed for data collection. The participants were selected at random from the list of the surgeons maintained in the hospital and approached face-to-face with the help of a team of junior doctors detailed for questionnaire distribution among them. The target was to cover over 50% of these doctors by convenience sampling.
Results: Out of 231 respondents, there were 32 seniors while 199 junior doctors, constituting a ratio of 1:6.22. The respondents variably responded to the questions regarding various attributes of the process of SIC. Overall, the junior doctors performed poorer compared to the seniors.
Conclusion: The knowledge and attitudes of our doctors particularly the junior ones, towards the SIC are less than ideal. This results in their failure to avail this golden opportunity of doctor-patient communication to guide their patients through a solidly informative and legally valid SIC. They are often unaware of the essential preconditions of the SIC; provide incomplete information to their patients; and quite often do not ensure direct involvement of their patients in the process. Additionally they lack an understanding of using interactive computer-based programs as well as the concept of nocebo effect of informed consent.
doi:10.15171/ijhpm.2014.109
PMCID: PMC4226621  PMID: 25396207
Surgical Informed Consent (SIC); Consent; Nocebo Effect of Informed Consent; Surgery
10.  Practice of Physical Activity among Future Doctors: A Cross Sectional Analysis 
Background:
Non communicable diseases (NCD) will account for 73% of deaths and 60% of the global disease burden by 2020. Physical activity plays a major role in the prevention of these non-communicable diseases. The stress involved in meeting responsibilities of becoming a physician may adversely affect the exercise habits of students. So, the current study aimed to study the practice of physical activity among undergraduate medical students.
Methods:
A cross sectional study was conducted among 240 undergraduate medical students. Quota sampling method was used to identify 60 students from each of the four even semesters. A pre-tested, semi-structured questionnaire was used to collect the data. Statistical Package for Social Sciences (SPSS) version 16 was used for data entry and analysis and results are expressed as percentages and proportions.
Results:
In our study, 55% were 20 to 22 years old. Over half of the students were utilizing the sports facilities provided by the university in the campus. Majority of students 165 (69%) had normal body mass index (BMI), (51) 21% were overweight, while 7 (3%) were obese. Of the 62% who were currently exercising, the practice of physical activity was more among boys as compared to girls (62% v/s 38%). Lack of time 46 (60.5%), laziness (61.8%), and exhaustion from academic activities (42%) were identified as important hindering factors among medical students who did not exercise.
Conclusion:
A longitudinal study to follow-up student behavior throughout their academic life is needed to identify the factors promoting the practice of physical activity among students.
PMCID: PMC3372079  PMID: 22708033
Body mass index; lack of time; medical students; physical activity; stamina
11.  Providing Guidance to Patients: Physicians’ Views About the Relative Responsibilities of Doctors and Religious Communities 
Southern medical journal  2013;106(7):399-406.
Objectives
Patients’ religious communities often influence their medical decisions. To date, no study has examined what physicians think about the responsibilities borne by religious communities to provide guidance to patients in different clinical contexts.
Methods
We mailed a confidential, self-administered survey to a stratified random sample of 1504 US primary care physicians (PCPs). Criterion variables were PCPs’ assessment of the responsibility that physicians and religious communities bear in providing guidance to patients in four different clinical scenarios. Predictors were physicians’ demographic and religious characteristics.
Results
The overall response rate was 63%. PCPs indicated that once all medical options have been presented, physicians and religious communities both are responsible for providing guidance to patients about which option to choose (mean responsibility between “some” and “a lot” in all scenarios). Religious communities were believed to have the most responsibility in scenarios in which the patient will die within a few weeks or in which the patient faces a morally complex medical decision. PCPs who were older, Hispanic, or more religious tended to rate religious community responsibility more highly. Compared with physicians of other affiliations, evangelical Protestants tended to rate religious community responsibility highest relative to the responsibility of physicians.
Conclusions
PCPs ascribe more responsibility to religious communities when medicine has less to offer (death is imminent) or the patient faces a decision that science cannot settle (a morally complex decision). Physicians’ ideas about the clinical role of religious communities are associated with the religious characteristics of physicians themselves.
doi:10.1097/SMJ.0b013e31829ba64f
PMCID: PMC3731943  PMID: 23820319
religious community; doctor–patient relationship; religion/spirituality; patient guidance; complementary and alternative medicine
12.  Qualitative study of Nocebo Phenomenon (NP) involved in doctor-patient communication 
Background: Doctor-patient communication has far reaching influences on the overall well-being of the patients. Words are powerful tools in the doctor’s armamentarium, having both healing as well as harming effects. Doctors need to be conscious about the choice of their words. This study aimed to determine the frequency and pattern of Nocebo Phenomenon (NP) un-intentionally induced by the communication of surgeons and anesthetists through the course of various interventional procedures such as surgery, anesthesia, and crucial communication encounters with their patients.
Methods: The study was carried out by the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over six months period. All residents and faculty members serving at our institute in various surgical and anesthesia departments constituted the study population. A questionnaire was employed as the data collection tool.
Results: Significant proportions of the doctor-patient communications under scrutiny entailed NP. It was more frequently observed in association with female gender of the involved professionals, residency status versus faculty position, and shorter professional experience (i.e. <5 years). Although the participants endorsed the fact that the choice of their words influenced the well-being of their patients, none of them were actually aware of the concept of NP.
Conclusion: NP existed in the clinical practice of the surgeons and anesthetists during their communication with patients. It was more frequently found among females, residents and professionals with less than five years of working experience. There is need to create awareness among these professionals about the subtle negative messages conveyed by such communication and alert them that the nocebo effects have negative repercussions on the clinical outcomes of their patients. The professionals should be formally educated to avoid nocebo words and phrases.
doi:10.15171/ijhpm.2014.54
PMCID: PMC4075099  PMID: 24987718
Nocebo Phenomenon (NP); Nocebo Words; Nocebo Effects; Nocebo Response; Placebo Phenomenon ; Doctor-Patient Communication
13.  Who are the doctor bloggers and what do they want? 
BMJ : British Medical Journal  2007;335(7621):644-645.
Medical blogs are sometimes seen as just rants about the state of health care, but they have also been credited with spreading public understanding of science and rooting out modern day quacks. Rebecca Coombes checks out the medical blogosphere
doi:10.1136/bmj.39349.478148.59
PMCID: PMC1995481  PMID: 17901512
14.  Frequency of Smoking and Specialized Awareness among Doctors and Nurses of Hospitals in Kerman, Iran 
Addiction & Health  2013;5(1-2):51-56.
Background
Nicotine is one of the strongest poisons. Every year about 75 thousand of Iranians die due to smoking. Since doctors and nurses have a major role in controlling smoking, this study tried to investigate the prevalence of cigarette smoking among doctors and nurses and their awareness about the effects of smoking.
Methods
This descriptive study was conducted on all doctors (n = 150) and nurses (n = 400) of hospitals affiliated with Kerman University of Medical Sciences (Kerman, Iran). Data was collected through a questionnaire with reliability of 0.8 and validity of 0.79. It consisted of two parts to assess demographic characteristics of the participants and their awareness about the side effects of smoking. Their awareness was ranked from poor to excellent based on the number of correct answers. Chi-square and Mann-Whitney tests were then used to analyze the collected data.
Findings
Of 550 questionnaires, 524 were completed (51.3% by the nurses and 48.7% by the doctors. While 21.2% of all participants smoked cigarettes, 71.8% of doctors and 95.3% of nurses did not smoke. The levels of awareness among nurses and doctors were determined as poor and moderate, respectively.
Conclusion
The higher prevalence of smoking among nurses confirms the significance of education. The level of awareness among the studied doctors and nurses was not desirable. Enhancing the awareness and attitude of medical staff will improve not only their own performance but also the behavioral pattern of the society.
PMCID: PMC3905567  PMID: 24494158
Cigarette; Smoking; Doctors; Nurses; Knowledge
15.  Trauma Training for Nonorthopaedic Doctors in Low- and Middle-income Countries 
Increasingly, nonspecialist Ghanaian doctors in district hospitals are called upon to perform a variety of surgical procedures for which they have little or no training. They are also required to provide initial stabilization for the injured and, in some cases, provide definitive management where referral is not possible. Elsewhere continuing medical education courses in trauma have improved the delivery of trauma care. Development of such courses must meet the realities of a low-income country. The Department of Surgery, Kwame Nkrumah University of Science and Technology developed a week-long trauma continuing medical education course for doctors in rural districts. The course was introduced in 1997, and has been run annually since. The trauma course specifically addresses the critical issues of trauma care in Ghana. It has improved the knowledge base of doctors, as well as their self-reported process of trauma care. Through the process we have learned lessons that could help in the efforts to improve trauma training and trauma care in other low-income countries.
doi:10.1007/s11999-008-0401-6
PMCID: PMC2584316  PMID: 18688692
16.  Disciplined doctors: Does the sex of a doctor matter? A cross-sectional study examining the association between a doctor's sex and receiving sanctions against their medical registration 
BMJ Open  2014;4(8):e005405.
Objectives
To examine the association between doctors’ sex and receiving sanctions on their medical registration, while controlling for other potentially confounding variables.
Design
Cross-sectional study.
Setting
The General Medical Council (GMC)'s List of Registered Medical Practitioners (LRMP) database of doctors practising in the UK.
Population
All doctors on the GMC's LRMP on 29 May 2013. The database included all doctors who are or have been registered to practise medicine in the UK since October 2005. The exposure of interest was doctor's sex. Confounding variables included years since primary medical qualification, world region of primary medical qualification and specialty.
Outcome measures
Sanctions on a doctor's medical registration. Sanction types included warnings, undertakings, conditions, suspension or erasure from the register. Binary logistic regression modelling, controlling for confounders, described the association between the doctor's sex and sanctions on a doctor's medical registration.
Results
Of the 329 542 doctors on the LRMP, 2697 (0.8%) had sanctions against their registration, 516 (19.1%) of whom were female. In the fully adjusted model, female doctors had nearly a third of the odds (OR: 0.37, 95% CI: 0.33 to 0.41) of having sanctions compared to male doctors. There was evidence that the association varies with specialty, with female doctors who had specialised as general practitioners being the least likely to receive sanctions compared with their male colleagues (OR: 0.26, 95% CI: 0.22 to 0.31).
Conclusions
Female doctors have reduced odds of receiving sanctions on their medical registration when compared with their male colleagues. This association remained after adjustment for the confounding factors. These results are representative of all doctors registered to practise in the UK. Further exploration of why doctors’ sex may impact their professional performance is underway.
doi:10.1136/bmjopen-2014-005405
PMCID: PMC4127941  PMID: 25104057
LAW (see Medical Law); MEDICAL EDUCATION & TRAINING; EPIDEMIOLOGY; GMC; Gender
17.  Alternative medicine: methinks the doctor protests too much and incidentally befuddles the debate. 
Journal of Medical Ethics  1992;18(1):23-25.
Dr Kottow in his paper Classical medicine v alternative medical practices (1) places the alternative/orthodox medicine debate within an historical context of anti-quackery literature. My paper explores the nature of science as it is applied to clinical practice and challenges the narrow view of the diagnostic process as outlined by Dr Kottow. Research methodologies more appropriate to 'whole person' medicine are suggested as having more ethical value than those based on the clinical trial.
PMCID: PMC1376080  PMID: 1573645
18.  Doctors on display: the evolution of television's doctors 
Doctors have been portrayed on television for over 50 years. In that time, their character has undergone significant changes, evolving from caring but infallible supermen with smoldering good looks and impeccable bedside manners to drug-addicted, sex-obsessed antiheroes. This article summarizes the major programs of the genre and explains the pattern of the TV doctors' character changes. Articulated over time in the many permutations of the doctor character is a complex, constant conversation between viewer and viewed representing public attitudes towards doctors, medicine, and science.
PMCID: PMC2943455  PMID: 20944763
19.  Moral Controversy, Directive Counsel, and the Doctor’s Role: Findings From a National Survey of Obstetrician–Gynecologists 
Purpose
To explore physicians’ attitudes toward providing directive counsel when dealing with morally controversial medical decisions, and to examine associations between physicians’ opinions and their demographic and religious characteristics.
Method
In 2008–2009, the authors mailed a survey to a stratified, random sample of 1,800 U.S. obstetrician–gynecologists. They asked participants whether, when dealing with either typical or morally controversial medical decisions, “a physician should encourage patients to make the decision that the physician believes is best.”
Results
Among eligible physicians, the response rate was 66%. Fifty-four percent of respondents rejected the use of directive counsel for typical medical decisions; 78% did so for morally controversial medical decisions. Physicians were less likely to refrain from directive counsel for typical medical decisions if they were older and foreign-born but more likely to refrain from directive counsel if they were more theologically pluralistic. Theological pluralism was the only characteristic significantly associated with refraining from directive counsel for morally controversial medical decisions.
Conclusions
Providing nondirective counsel to their patients appears to have become the norm among certain obstetrician–gynecologists in the United States, particularly when dealing with morally controversial medical decisions. These physicians tend to be female, younger, U.S.-born, and more theologically pluralistic. Shifts toward refraining from directive counsel seem to relate to shifts in physicians’ demographic, cultural, and religious characteristics.
doi:10.1097/ACM.0b013e3181eabacc
PMCID: PMC3634119  PMID: 20736675
20.  How do medical doctors use a web-based oncology protocol system? A comparison of Australian doctors at different levels of medical training using logfile analysis and an online survey 
Background
Electronic decision support is commonplace in medical practice. However, its adoption at the point-of-care is dependent on a range of organisational, patient and clinician-related factors. In particular, level of clinical experience is an important driver of electronic decision support uptake. Our objective was to examine the way in which Australian doctors at different stages of medical training use a web-based oncology system (http://www.eviq.org.au).
Methods
We used logfiles to examine the characteristics of eviQ registrants (2009–2012) and patterns of eviQ use in 2012, according to level of medical training. We also used a web-based survey to evaluate the way doctors at different levels of medical training use the online system and to elicit perceptions of the system’s utility in oncology care.
Results
Our study cohort comprised 2,549 eviQ registrants who were hospital-based medical doctors across all levels of training. 65% of the cohort used eviQ in 2012, with 25% of interns/residents, 61% of advanced oncology trainees and 47% of speciality-qualified oncologists accessing eviQ in the last 3 months of 2012. The cohort accounted for 445,492 webhits in 2012. On average, advanced trainees used eviQ up to five-times more than other doctors (42.6 webhits/month compared to 22.8 for specialty-qualified doctors and 7.4 webhits/month for interns/residents). Of the 52 survey respondents, 89% accessed eviQ’s chemotherapy protocols on a daily or weekly basis in the month prior to the survey. 79% of respondents used eviQ at least weekly to initiate therapy and to support monitoring (29%), altering (35%) or ceasing therapy (19%). Consistent with the logfile analysis, advanced oncology trainees report more frequent eviQ use than doctors at other stages of medical training.
Conclusions
The majority of the Australian oncology workforce are registered on eviQ. The frequency of use directly mirrors the clinical role of doctors and attitudes about the utility of eviQ in decision-making. Evaluations of this kind generate important data for system developers and medical educators to drive improvements in electronic decision support to better meet the needs of clinicians. This end-user focus will optimise the uptake of systems which will translate into improvements in processes of care and patient outcomes.
doi:10.1186/1472-6947-13-82
PMCID: PMC3750334  PMID: 23915178
Clinical decision support systems; Evidence-based practice; Medical education; Cancer chemotherapy protocols; Health personnel; ‘Medical staff; Hospital’
21.  Duties of a doctor: UK doctors and Good Medical Practice 
Quality in Health Care : QHC  2000;9(1):14-22.
Objective—To assess the responses of UK doctors to the General Medical Council's (GMC) Good Medical Practice and the Duties of a Doctor, and to the GMC's performance procedures for which they provide the professional underpinning.
Design—Questionnaire study of a representative sample of UK doctors.
Subjects—794 UK doctors, stratified by year of qualification, sex, place of qualification (UK v non-UK), and type of practice (hospital v general practice) of whom 591/759 (78%) replied to the questionnaire (35 undelivered).
Main outcome measures—A specially written questionnaire asking about awareness of Good Medical Practice, agreement with Duties of a Doctor, amount heard about the performance procedures, changes in own practice, awareness of cases perhaps requiring performance procedures, and attitudes to the performance procedures. Background measures of stress (General Health Questionnaire, GHQ-12), burnout, responses to uncertainty, and social desirability.
Results—Most doctors were aware of Good Medical Practice, had heard the performance procedures being discussed or had received information about them, and agreed with the stated duties of a doctor, although some items to do with doctor-patient communication and attitudes were more controversial. Nearly half of the doctors had made or were contemplating some change in their practice because of the performance procedures; a third of doctors had come across a case in the previous two years in their own professional practice that they thought might merit the performance procedures. Attitudes towards the performance procedures were variable. On the positive side, 60% or more of doctors saw them as reassuring the general public, making it necessary for doctors to report deficient performance in their colleagues, did not think they would impair morale, were not principally window dressing, and were not only appropriate for problems of technical competence. On the negative side, 60% or more of doctors thought the performance procedures were not well understood by most doctors, were a reason for more defensive practice, and could not be used for problems of attitude. Few differences were found among older and younger doctors, hospital doctors, or general practitioners, or UK and non-UK graduates, although some differences were present.
Conclusions—Most doctors working in the UK are aware of Good Medical Practice and the performance procedures, and are in broad sympathy with Duties of a Doctor. Many attitudes expressed by doctors are not positive, however, and provide areas where the GMC in particular may wish to encourage further discussion and awareness. The present results provide a good baseline for assessing change as the performance procedures become active and cases come before the GMC over the next few years.
(Quality in Health Care 2000;9:14–22)
Key Words: performance procedures; good medical practice; duties; attitudes; knowledge
doi:10.1136/qhc.9.1.14
PMCID: PMC1743494  PMID: 10848365
22.  Depersonalised doctors: a cross-sectional study of 564 doctors, 760 consultations and 1876 patient reports in UK general practice 
BMJ Open  2012;2(1):e000274.
Objectives
The objectives of this study were to assess burnout in a sample of general practitioners (GPs), to determine factors associated with depersonalisation and to investigate its impact on doctors' consultations with patients.
Design
Cross-sectional, postal survey of GPs using the Maslach Burnout Inventory (MBI). Patient survey and tape-recording of consultations for a subsample of respondents stratified by their MBI scores, gender and duration of General Medical Council registration.
Setting
UK general practice.
Participants
GPs within NHS Essex.
Primary and secondary outcome measures
Scores on MBI subscales (depersonalisation, emotional exhaustion, personal accomplishment); scores on Doctors' Interpersonal Skills Questionnaire and patient-centredness scores attributed to tape-recorded consultations by independent observers.
Results
In the postal survey, 564/789 (71%) GPs completed the MBI. High levels of emotional exhaustion (261/564 doctors, 46%) and depersonalisation (237 doctors, 42%) and low levels of personal accomplishment (190 doctors, 34%) were reported. Depersonalisation scores were related to characteristics of the doctor and the practice. Male doctors reported significantly higher (p<0.001) depersonalisation than female doctors. Doctors registered with the General Medical Council under 20 years had significantly higher (p=0.005) depersonalisation scores than those registered for longer. Doctors in group practices had significantly higher (p=0.001) depersonalisation scores than single-handed practitioners. Thirty-eight doctors agreed to complete the patient survey (n=1876 patients) and audio-record consultations (n=760 consultations). Depersonalised doctors were significantly more likely (p=0.03) to consult with patients who reported seeing their ‘usual doctor’. There were no significant associations between doctors' depersonalisation and their patient-rated interpersonal skills or observed patient-centredness.
Conclusions
This is the largest number of doctors completing the MBI with the highest levels of depersonalisation reported. Despite experiencing substantial depersonalisation, doctors' feelings of burnout were not detected by patients or independent observers. Such levels of burnout are, however, worrying and imply a need for action by doctors themselves, their medical colleagues, professional bodies, healthcare organisations and the Department of Health.
Article summary
Article focus
A cross-sectional survey was designed to assess levels of burnout in a census sample of GPs in Essex, UK, and to determine which doctor- or practice-related variables predicted higher levels of burnout.
In the substudy, patients rated the interpersonal skills of their doctor and independent observers assessed the degree of patient-centredness in a sample of the doctors' audio-taped consultations.
Key messages
High levels of burnout were reported in the census survey—46% doctors reported emotional exhaustion, 42% reported depersonalisation and 34% reported low levels of personal accomplishment.
Doctors' depersonalisation scores could be predicted by a range of variables relating to the individual doctor and their practice, but higher depersonalisation scores were not associated with poorer patient ratings of the doctors' interpersonal skills or a reduction in the patient-centredness of their consultations.
While the professional practice and patient-centredness of consultations of the GPs in this study were not affected by feelings of burnout, there is a need to offer help and support for doctors who are experiencing this.
Strengths and limitations of this study
A high response rate (71%) was achieved in the census sample of GPs completing the MBI and a subsample of 38 doctors who satisfied the predetermined sample stratification consented to further assessment (patient survey and audio-taping of consultations).
The study was, however, limited to one county in the UK and thus cannot be extrapolated to other parts of the UK.
There was a differential response rate by the gender of the participant. Male doctors who were registered with the General Medical Council for >20 years were less likely to respond to the survey than their female counterparts.
doi:10.1136/bmjopen-2011-000274
PMCID: PMC3274717  PMID: 22300669
23.  Doctors’ views about training and future careers expressed one year after graduation by UK-trained doctors: questionnaire surveys undertaken in 2009 and 2010 
BMC Medical Education  2014;14(1):270.
Background
The UK medical graduates of 2008 and 2009 were among the first to experience a fully implemented, new, UK training programme, called the Foundation Training Programme, for junior doctors. We report doctors’ views of the first Foundation year, based on comments made as part of a questionnaire survey covering career choices, plans, and experiences.
Methods
Postal and email based questionnaires about career intentions, destinations and views were sent in 2009 and 2010 to all UK medical graduates of 2008 and 2009. This paper is a qualitative study of ‘free-text’ comments made by first-year doctors when invited to comment, if they wished, on any aspect of their work, education, training, and future.
Results
The response rate to the surveys was 48% (6220/12952); and 1616 doctors volunteered comments. Of these, 61% wrote about their first year of training, 35% about the working conditions they had experienced, 33% about how well their medical school had prepared them for work, 29% about their future career, 25% about support from peers and colleagues, 22% about working in medicine, and 15% about lifestyle issues. When concerns were expressed, they were commonly about the balance between service provision, administrative work, and training and education, with the latter often suffering when it conflicted with the needs of medical service provision. They also wrote that the quality of a training post often depended on the commitment of an individual senior doctor. Service support from seniors was variable and some respondents complained of a lack of team work and team ethic. Excessive hours and the lack of time for reflection and career planning before choices about the future had to be made were also mentioned. Some doctors wrote that their views were not sought by their hospital and that NHS management structures did not lend themselves to efficiency. UK graduates from non-UK homes felt insecure about their future career prospects in the UK. There were positive comments about opportunities to train flexibly.
Conclusions
Although reported problems should be considered in the wider context, in which the majority held favourable overall views, many who commented had been disappointed by aspects of their first year of work. We hope that the concerns raised by our respondents will prompt trainers, locally, to determine, by interaction with junior staff, whether or not these are concerns in their own training programme.
Electronic supplementary material
The online version of this article (doi:10.1186/s12909-014-0270-5) contains supplementary material, which is available to authorized users.
doi:10.1186/s12909-014-0270-5
PMCID: PMC4302441  PMID: 25528260
Medical careers; Junior doctors; Medical education; Foundation training
24.  Doctor's perception of doctor-patient relationships in emergency departments: What roles do gender and ethnicity play? 
Background
Emergency departments continuously provide medical treatment on a walk-in basis. Several studies investigated the patient's perception of the doctor-patient relationship, but few have asked doctors about their views. Furthermore, the influence of the patient's ethnicity and gender on the doctor's perception remains largely unanswered.
Methods
Based on data collated in three gynaecology (GYN)/internal medicine (INT) emergency departments in Berlin, Germany, we evaluated the impact of the patient's gender and ethnicity on the doctors' satisfaction with the course of the treatment they provided. Information was gathered from 2.429 short questionnaires completed by doctors and the medical records of the corresponding patients.
Results
The patient's ethnicity had a significant impact on the doctors' satisfaction with the doctor-patient relationship. Logistic regression analysis showed that the odds ratio (OR) for physician satisfaction was significantly lower for patients of Turkish origin (OR = 2.6 INT and 5.5 GYN) than for those of German origin. The main reasons stated were problems with communication and a perceived lack of urgency for emergency treatment. The odds ratios for dissatisfaction due to a lack of language skills were 4.48 (INT) and 6.22 (GYN), and those due to perceived lack of urgency for emergency treatment were 0.75 (INT) and 0.63 (GYN). Sex differences caused minor variation.
Conclusion
The results show that good communication despite language barriers is crucial in providing medical care that is satisfactory to both patient and doctors, especially in emergency situations. Therefore the use of professional interpreters for improved communication and the training of medical staff for improved intercultural competence are essential for the provision of adequate health care in a multicultural setting.
doi:10.1186/1472-6963-8-82
PMCID: PMC2329628  PMID: 18405351
25.  Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980, and 1983. 
BMJ : British Medical Journal  1996;313(7048):19-24.
OBJECTIVE--To report the career preferences of doctors who qualified in the United Kingdom in 1993 and to compare their choices with those of earlier cohorts of qualifiers. DESIGN--Postal questionnaires with structured questions, including questions about choice of future long term career, were sent to doctors a year after qualification. SETTING--United Kingdom. SUBJECTS--All medical qualifiers of 1993, comparing their replies with those from earlier studies of the qualifiers of 1974, 1977, 1980, and 1983. MAIN OUTCOME MEASURES--Choice of future long term career and certainty of choice expressed at the end of the first year after qualification. RESULTS--Questionnaires were sent to 3657 doctors. 2621 (71.7%) replied. Of the 2621 respondents, 70.5% (1849) stated that their first preference was for a career in hospital practice, 25.8% (677) specified general practice, 1.0% (25) specified public health medicine or community health, 1.4% (36) specified careers outside medicine, and 1.3% (34) did not state a choice. By contrast, 44.7% (1416/3168) of the doctors in the 1983 cohort had specified that their first preference was general practice. Among the 1993 qualifiers, general practice was the first career choice of 17.5% of men (227/1297) and 34.0% of women (450/1324). Only 7.4% of men (96/1297) stated that they definitely wanted to enter general practice. Only 7.8% (103/1324) of women qualifiers in 1993 expressed a career preference for surgical specialties. Within hospital practice, comparing 1993 with 1983, choices for the medical specialties and for accident and emergency medicine rose and those for pathology fell. Women were less definite than men about their choice of future long term career. CONCLUSIONS--If the 1993 cohort is typical of the current generation of young doctors, there has been a substantial shift away from general practice as a career choice expressed at the end of the preregistration year. General practice was much more popular among women than men. Few women opted for surgery. The sex imbalance in the percentage of doctors who choose different mainstreams of medical practice seems set to continue.
PMCID: PMC2351449  PMID: 8664763

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