Can we finally change the system?
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Biomedical subjects
Publications and source records attributed to R F Maudsley.
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Initiated by Associated Medical Services (AMS), Educating Future Physicians for Ontario is a 5-year collaborative project whose overall goal is to make medical education in Ontario more responsive to that province's evolving health needs. It is supported by AMS, the five universities with medical schools or academic health sciences centres and the Ontario Ministry of Health. The project's five objectives are to (a) define the health needs and expectations of the public as they relate to the training of physicians, (b) prepare the educators of future physicians, (c) assess medical students' competencies, (d) support related curricular innovations and (e) develop ongoing leadership in medical education. There are several distinctive features: a focus on "demand-side" considerations in the design of curricula, collaboration within a geopolitical jurisdiction (Ontario), implementation rather than recommendation, a systematic project-evaluation plan and agreement as to defined project outcomes, in particular the development of institutional mechanisms of curriculum renewal as health needs and expectations evolve.
The clinical teaching unit (CTU), a distinctively Canadian concept, has served Canadian academic medicine well over the past 30 years. Times have changed considerably since the concept was first defined by the Association of Canadian Medical Colleges in 1962. Many proposals and ideas of Evans, Chute and Morley in their description of the CTU, clinical education and the practice of medicine remain relevant today. The concept of learning by doing, under supervision, in a relatively controlled academic environment is still valid. However, we must either expand our concept of the traditional CTU to make it consistent with the contemporary broad practice of medicine or maintain the current model as complementary, but not necessarily central, to an expanded paradigm of clinical education.
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The accreditation process gives assurance to a number of individuals and groups about the quality of approved programmes. It is based on principles that have evolved over time. The process of the Royal College of Physicians and Surgeons of Canada is based upon a set of nine explicitly stated standards, each amplified by a detailed interpretation. On-site surveys conducted at regular intervals by peers, with active involvement of the teachers and students being surveyed and using checks and balances with respect to information obtained and decisions made are major characteristics of the Canadian accreditation process.
Effective in-training evaluation can significantly enhance learning for both undergraduate and postgraduate medical students. The importance of ongoing assessment must be understood and supported by clinical teachers, and their involvement in effective evaluation requires time and effort. In-training evaluation can be both informal and formal and embrace a wide variety of methods. Self-evaluation by students should be emphasized as an important part of the in-training evaluation process. Clearly stated educational objectives, understood by both teachers and students, are essential. The use of constructive and supportive feedback adds considerably to clinical learning. Fair and forthright evaluation is of special importance when dealing with poor student performance.
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A group of 1370 specialists in obstetrics and gynecology were surveyed for information about practice patterns, continuing medical education preferences, and their perception of the adequacy of their own residency training. The overall response rate was 65.7%. More than half were in solo practice, practiced in communities of over 250,000, had been in practice for more than 10 years, or had a full or part-time appointment with a Canadian medical school. A wide range of continuing medical education methods were used. Journals were ranked highest by 41%. It is disturbing that very few physicians (15%) indicated any involvement in practice audit. The quality of residency training was ranked low in a number of areas including genetic counseling, ultrasound, neonatology, intensive care, colposcopy, sexual dysfunction, marital counseling, and hysteroscopy. The survey highlights a number of areas that merit the attention of Canadian programs in postgraduate and continuing medical education in obstetrics and gynecology.
Thermal injury to the small bowel occurred four times in a series of 7466 consecutive laparoscopies and tubal cauterization performed for sterilization. The four patients presented with signs and symptoms of delayed bowel perforation 4 to 11 days after the procedure. The perforations were small and involved the antimesenteric border of the terminal ileum. Histologic study of the excised specimen in one case showed full thickness coagulative necrosis of the bowel wall. Potential causes for bowel burn associated with tubal cauterization are discussed. Steps to minimize the occurrence of this complication include proper use of the laparoscope and cautery equipment, good anesthesia and gas distension of the abdomen, correct positioning of the patient and clear visualization of the operative field.
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