In 1993, the UK General Medical Council published Tomorrow's Doctors leading to a nationwide restructuring of undergraduate medical courses. Traditional courses with distinct pre-clinical and clinical phases gave way to a more integrated approach to undergraduate medical education, with an emphasis on the quality and variety of teaching provided. More than a decade after Tomorrow's Doctors, postgraduate medical training is being transformed. Modernising Medical Careers is leading to the introduction of a two-year Foundation Programme, with subsequent streamlined specialist training. In the context of these changes, we consider how the creation of posts for medically-qualified anatomy demonstrators would present an opportunity to fulfil needs in both undergraduate education and postgraduate training. We outline the threats facing established posts, and how these problems may be resolved. We hope that this overview of the challenges facing undergraduate and postgraduate education in the UK, with particular reference to anatomy, may offer some useful insight to teachers and learners in other countries. We conclude that the role of the medically-qualified anatomy demonstrator has proved valuable in the context of Tomorrow's Doctors, and that this role can evolve and expand as part of the 21st century "modern medical career."
Near-peer, cross-cultural academic exchange is an effective method of medical student-centered emergency training in Haiti. Limitations such as successfully implementing sustainability measures, addressing cultural differences, and coordinating between groups persist. This scalable, reproducible, and mutually beneficial collaboration between North American and Haitian medical trainees is a valid conduit for building Haiti's emergency response infrastructure and promoting global health.
Background:
In low resource settings, maximizing effective use of emergency room (ER) services is imperative. This problem is anecdotally observed in the public hospital setting in Santiago, Dominican Republic (DR). There are no studies presently published examining ER use in this pediatric population or reasons caregivers choose to utilize the pediatric ER. Financial and systemic limitations have been previously cited as important contributors to the high pediatric mortality rate in the DR.
Methods:
In this cross-sectional, descriptive study, a survey was administered to 117 caregivers (e.g. mother, father) of children in the ER at Hospital Especializado Juan XXIII over an eight-week period. Survey questions included perceived urgency of illness, education level, monthly income, and frequency of ER visits in the last six months. We defined frequent ER visits as greater than four visits within the last six months, low income as below 10,000 pesos/month, and low education as having no high school education. Logistic regression was used to assess significant associations between variables.
Results:
Caregivers in the pediatric ER were predominantly female (94%) with a mean age of 30 ± 11 years. 72% of respondents reported the child’s problem as “extremely urgent,” while 82% of the children were triaged as non-urgent. Children of caregivers with any high school education had 69% lower odds of having 4 or more ED visits in the last 6 months (OR, 0.31; 95% CI, 0.13–0.75; p = 0.009), compared to children of caregivers with no high school education, after adjusting for the income category of the caregiver.
Conclusions:
Perceived urgency of pediatric medical problems may contribute to increased use of the ER for non-urgent medical problems. Low education level is associated with increased pediatric ER use over a six-month period. Assessing utilization of pediatric ERs in the public health care system in Santiago could provide a framework for the design of targeted educational and systemic changes, supporting the ultimate goal of providing the best possible care for pediatric patients in low-resource settings.
Findings: Data on the presence of nurse anesthetists was obtained for 142 countries. Of these, 113 countries were found to practice task shifting to nurse anesthetists. Nurse anesthesia was documented in all major regions of the world. Training duration ranged from 0 to 3.5 years of post-nursing school training in anesthesia. For countries where data on supervision was available, unsupervised nurse anesthetist practice was identified in 17% (3/18) of high-income countries, 47% of upper-middle-income countries (7/15), 60% of lower-middle-income countries (9/15), and 100% of low-income countries (15/15).Interpretation: Nurse anesthetists are widely utilized providers of anesthetic care across all income categories and all major geographic regions. Their training duration varies significantly. High-income settings provide increased supervision compared to low-and middle-income settings. Future studies focused on health outcomes may provide the basis for consolidated models of anesthetic task shifting to address the surgical workforce crisis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.