Retraining and relicensing immigrant physicians: the Israeli approach.
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Journal Article↗
Biomedical subjects
N Notzer
Publications and source records attributed to N Notzer.
A model for educating humanistic physicians in the 21st century: the new medicine, patient, and society course at Tel Aviv University.
BACKGROUND: The impact of the social and behavioral sciences on medical education has often been limited due to a variety of organizational, curricular and professional barriers. The new "Medicine, Patient, and Society (MPS)" program in Tel Aviv attempts to rectify this educational shortcoming by exploring new ways to help students acquire the knowledge, attitudes and skills needed for becoming humanistic physicians and for helping patients (and themselves) adopt healthy behaviors. To work toward this goal, this program integrates the biomedical and psychosocial aspects of health care, providing developmentally appropriate learning experiences according to levels of training, together with a variety of educational methods, including learner-centered approaches. OBJECTIVES: To implement and evaluate the MPS pilot program. METHODS: The MPS program uses a "seamless" model of behavioral science education. This integrated curriculum interweaves several elements: behavioral science topics (presented through multiple approaches), clinical experiences, practical medical skills, and an independent project. During the program's first year there is a strong focus on "health" rather than "disease," with activities designed to encourage healthy behaviors, including smoking cessation, stress management, birth control, AIDS education, life cycle and preventive health services. Assessment of the pilot for first-year students included standardized questionnaires, student focus groups, participant observation of educational activities, and committee feedback. RESULTS: Students' quantitative evaluations indicated high levels of satisfaction with the MPS program, but their qualitative evaluations revealed some concerns. Participant observations and focus groups added unexpected insights. Student concerns included performance fears, difficulties with "learner-centered" education, and incompatibilities between more traditional first-year courses and the MPS program. Long-term follow-up will be needed to determine the impact of this emphasis on health during the first year. We assume it serves as a helpful foundation for students before they focus on disease and its sequelae in their later years.
Journal Article↗
[Determining power factors of clinical departments in a medical center].
The intradepartmental power factors in a medical center were studied. 3 strategic contingency factors were examined, based on the model of Hickson et al. (1971): centrality, substitutability, and coping-with uncertainty. Only coping-with-uncertainty contributed directly to departmental power, and not the summation of the 3. Power derives from department resources, connections and influence outside the medical center. Aspects related to inpatient treatment or teaching of residents did not contribute directly to departmental power status. Power is gained in stages: in the first the department contributes to the factor of centrality (mainly patient treatment, teaching and research). In the middle stage, power is gained due to the factor of substitutability--the unique services and research which the department has developed. The third stage contributes directly to power-coping with uncertainty. This implies the ability of a department to solve crucial problems of the medical center. Surprisingly, the clinical field (i.e. surgery) did not contribute significantly to power. The current trend is toward empowering ambulatory units in the medical center.
Hospital Departments↗
A three-year programme in oral diagnosis and treatment planning. A model using an interdisciplinary teaching team.
Diagnosis and treatment planning are considered to be the basis for successful clinical dentistry, however, these skills are difficult to teach and evaluate. At the Department of Diagnosis and Treatment Planning, Tel Aviv University Dental School, a 3-year teaching programme has been developed. The goals of the programme are to teach a systematic pattern of data collection from history, clinical examination, imaging modalities and models, and to use this data to identify the patient's problems and to arrive at a final diagnosis, to develop a treatment plan, taking into account all relevant information, and to consult experts when needed, to train in case presentation, and to deal with peer response. The program includes 20 h of lectures and 30 h of exercises in the 4th year, developing at least 8 full treatment plans per student in the fifth year, a 1 30-min weekly panel seminar during the final year, and a final integrative examination at the end of the 6th year.
Curriculum↗
[Correlation between success in specialty examinations and learning methods of family medicine residents].
Learning methods chosen by residents in family medicine during their residency and the correlation between them and achievement in the written specialty exams (Stage 1) were investigated. The learning patterns studied were: structured learning (certification course, study with a tutor, staff meetings, conferences) and self-learning (textbooks, journals, the Hebrew publication "Update," and audio tapes). Of 184 residents who took the examination in 1994-5. 104 responded to a questionnaire as to preferences for the various learning aids and satisfaction with their use. There was no correlation between use of a given learning method and success in the examination. Significantly more candidates preferred self-learning, especially among those who were successful, but also among some who failed the examination. There was no direct connection between the examination and the high level requirements of the residency program, for which up-to-date, integrated knowledge based on self-learning is needed.
Education, Medical, Continuing↗
Old thoughts, new ideas: comparing traditional Talmudic education with today's medical education.
The authors compare innovative learning strategies in medical education today with the traditional educational methods of Jewish Talmudic study. These methods began to be developed in yeshivas (the highest Jewish educational institutions) in the third century BC and continue to be used in yeshivas today. The teaching in thousands of yeshivas of Talmudic study worldwide emphasizes student-centered, problem-based, small-group, and lifelong learning. Further, in the yeshivas rote memorization is discouraged; students are selected on the basis of merit rather than social status; and the teachers (particularly master teachers) are expected to act as role models for all aspects of living. Over the centuries, the yeshiva has been slightly modified and specialized, and the number of students has increased, but the institution has retained its basic instructional format. The authors briefly describe each aspect of Talmudic study and how it relates to current educational practices in medical schools. They argue that comparing these two educational institutions--the yeshiva and medical school--is valuable, in that the history of the yeshiva educational system, which has successfully produced generations of creative scholars, educators, and leaders, as well as an enormous body of literature, validates the innovative teaching approaches being used in medical schools today.
Education, Medical↗
[Professional assessment of senior physicians who immigrated to Israel up to 1996].
Israel has absorbed many immigrant physicians and has utilized their skills without compromising local professional standards. In accordance with this policy a special law for the assessment of the licensing of senior immigrant physicians, mainly from the former Soviet Union, who had practiced medicine for at least 14 years was implemented in 1994. Considering their considerable medical experience on the one hand and their lack of experience in speaking Hebrew or undergoing testing techniques, they were exempted from the written national licensing examination. Instead they were obliged to undergo a 6-month clinical observation period in a local hospital or clinic. At the end of this period a letter of confirmation was issued which was followed by an oral assessment of their clinical ability. In the assessment session, each candidate was presented with written presentations of 4 typical clinical cases which practitioners encounter on a daily basis, in family medicine, emergency medicine, surgery, and pediatrics or gerontology. Of 114 cases prepared, 4 were selected for each candidate by the committee of 13 trained, experienced Israeli physicians. 3 members of the committee assessed each candidate using specified criteria. The assessment, which lasted about an hour, focused on the candidates' professional knowledge involved in differential diagnosis and case management. Of 497 candidates examined between 1994 and 1996, approximately 80% passed in their first attempt. However, about 30% of the invited candidates did not appear for the exam. Characteristics of successful candidates were being young and being among the seniors with the least clinical experience. Most had specialized in internal medicine and had completed their observation period in a non-academic hospital. There they had received somewhat more attention than those who had been in academic hospitals. Significantly, the successful candidates were more proficient in Hebrew than the unsuccessful candidates, and reported no special problems during the observation period.
Adult↗
[Use of student feedback by preclinical and clinical course directors].
We examined the conceptual and instrumental uses of student feedback on teaching by 2 preclinical and clinical course directors with authority to change structure and content of the courses, assess suitability of instructors and to change methods of teaching. Student feedback questionnaires have been collected systematically for over 2 decades. A report based on this feedback is sent to course directors, the dean, his assistants and the head of the curriculum committee. Course directors from both groups made broad use of the feedback but made greater use of the report than preclinical course directors. Students had greater regard for individual teaching by clinical course directors than by preclinical course coordinators. No relationship was found between the degree of use of feedback by members of either group and their level of teaching. We conclude that senior faculty use student feedback in their decisions regarding the structure and teaching methods of their courses and are not influenced by individual assessments, positive or negative, by their students.
Curriculum↗
A medical technology assessment course.
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Curriculum↗
Israel's unique approach to licensing immigrant physicians.
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Foreign Medical Graduates↗
[Women in the medical profession in Israel].
This paper describes the current status of women physicians in Israel at various stages in their professional careers: in medical school, in the medical specialties and in academia. In the past, as in most western countries, medicine in Israel was regarded as a man's profession. The last decade has seen major demographic changes: the proportion of women entering medical school is now similar to that of men, and as a result of immigration from the former Soviet Union, the percentage of women physicians is approaching the level in eastern European countries. Recent findings show an increase in women in all specialty areas. However, they are concentrated in the lower status strata and in primary care, occupying the base of the academic pyramid. It appears that when objective criteria are employed, such as for admission to medical school and licensing examinations, women and men have similar levels of achievement. However, when subjective criteria are used, such as in admission to residency training, gender-based differences in distribution in the medical specialties are apparent. We suggest implementing objective standards for acceptance for residency training which should help equalize the status of women in the Israeli medical establishment.
Emigration and Immigration↗
[Hebrew knowledge of new immigrant physicians].
Since 1989, 10,000 physicians have immigrated to Israel, mostly from the former Soviet Union. Lack of a reasonable command of Hebrew, the language of the Israeli medical system, is likely to adversely affect doctor-patient communication and cause critical errors. We report the development of a structured, written examination to assess knowledge of medical Hebrew. It was administered to 67 Russian immigrant physicians and the results indicated low proficiency in Hebrew in general, and in medical Hebrew in particular. There was a significant correlation with extent of general medical knowledge.
Communication Barriers↗
Assessment of physician competence in prehospital trauma care.
In an attempt to develop a model to measure the competence of physicians providing emergency care under difficult field conditions, 75 Israeli army medical corps physicians were evaluated through the use of four instruments: a debriefing interview, peer assessment, self-assessment and written examination. The special on-site assessment model was designed to examine actual events, enabling an assessment of performance in real situations rather than simulated cases. Significant positive correlations were found between the results of the written examination and the peer evaluation on two of four measures (r = 0.36, P = 0.001; r = 0.23, P = 0.05) as well as on the two measures regarding self-evaluation and peer evaluation (r = 0.54, P = 0.001; r = 0.38, P = 0.05). It was found that those physicians who were trained in the army's medical officer course scored significantly higher on the written examination (P = 0.001) and were rated more highly by their senior peers (P = 0.048) than those who did not receive such training. It was concluded that it is advantageous to use a combination of knowledge (written examination) and performance (peer assessment or self-assessment) measures in order to arrive at a more comprehensive assessment of competence. In addition, the written examination format should be expanded and developed to include more clinical vignettes requiring treatment decisions, making this instrument a more clinically oriented measure of physician competence in trauma care.
Clinical Competence↗
The feminization of the medical profession in Israel.
Two factors have caused major changes in the gender composition of the Israeli medical profession in recent years: (i) a wave of immigration from the former USSR, which increased the doctor population by approximately 70% and which included a majority of women physicians, and (ii) the entry of more Israeli women into medical school. This report presents the current gender status of the Israeli medical profession, regarding students and physicians, and the choice of medical specialty and academic seniority, and compares gender differences in Israel with those in other countries. Traditional patterns of specialization persist in Israel, with women still concentrated in primary care (family medicine, paediatrics and psychiatry). In addition, women still face obstacles in entering the more prestigious (mainly surgical) specialties. Whilst the number of women in academic medicine has increased over the last decade, women are still concentrated in the lowest echelons of academic medicine. However, the steady trend towards the feminization of medicine will inevitably lead to an increase of women in all areas of the medical profession. Because cross-cultural studies have repeatedly revealed that women doctors have a more humanistic and personalized approach to patient care, a higher ratio of women in the profession should have a qualitative effect in this direction, despite the bureaucratic and fiscal constraints incumbent upon practising doctors. As more women become role models for medical students, their approach will influence the education of the doctors of the future.
Career Choice↗
Use of student feedback by curriculum decision makers and its relation to the quality of their teaching.
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Curriculum↗
[A national qualifying internal medicine examination for Israeli medical students].
In 1991 the deans of the 4 medical schools in Israel decided to institute a national qualifying examination in internal medicine. This marked the beginning of the process of unifying the qualifying examinations in all major medical fields. We describe the development of the examination, experience with its administration to 720 students in 1992-1994, and the outcome of this initial effort. The examinations were prepared by a committee of senior faculty from the 4 schools, representing all the relevant clinical areas. Professional consultation was provided by the Unit for Medical Education of Tel Aviv University. Each examination consisted of 180 multiple choice items, reflecting an agreed representation of the various medical specialties, and was designed to test both comprehension and problem-solving ability. A syllabus was published by the committee and distributed to students and faculty in preparation for the examination. In composing the examination, the committee took into consideration differences in general policy and varying emphases in the curricula of the 4 schools. Analysis of the results of the 3 annual examinations showed both a high level of reliability and high quality of the majority of the individual test items. There was a trend with time to slightly lower average scores, and fewer passed the exam last year. There was improvement in the results after the first 2 years in the area of problem-solving related to interpretation of imaging, blood smears and clinical photographs, but this trend did not continue into 1994. The introduction of a high level examination based on a common syllabus provided important feedback, improving both student motivation and clinical teaching. For all schools, the outcome of the examination served as an important external indicator of teaching standards. Following this positive experience, uniform examinations in surgical subjects and pediatrics were introduced for the first time in 1993. The committee recommends that Israeli medical schools gradually introduce a comprehensive qualifying examination based on a mutually agreed list of objectives and syllabus.
Educational Measurement↗
[Assessment of IDF physicians in in-field trauma].
The system of care delivery of in-field trauma was assessed, leading to suggestions for improving the system and military medical training. This study reports the feasibility and validity of various methods of assessing the performance of Israel Defense Force physicians in administering trauma care. The methods included a standardized medical debriefing with filling in of a report form by a senior traumatologist, his review of the physician's performance, self-assessment by the physician, and a written test. 5 senior traumatologists with extensive experience in military trauma care were trained to assess the physicians' performance within 24-48 hours of incidents involving moderate to severe trauma injuries. 75 physicians who had been involved in the care of the in-field trauma patients during a 1-year period, November 1988 to October 1989, were assessed. Analysis of the results clearly indicated 2 areas for assessment: a) knowledge, mainly levels of comprehension and application in relevant areas of trauma and b) performance, including immediate diagnosis, treatment skills, and triage. The best method for evaluating knowledge was the written test, not peer review nor self-evaluation. However, the traumatologist's evaluation of care performance was highly correlated with the physician's self-assessment. For comprehensive assessment of in-field care it is advisable to integrate the 2 methods: performance review by a traumatologist and a comprehensive written test. Information gained from such assessment could improve the planning of in-service trauma training and the posting of physicians within the military framework.
Clinical Competence↗
[Women entering medicine: implications for health care in Israel].
An increasing number of women have been entering the medical profession during the past 2 decades. In all 4 medical schools in Israel, 46% of the students in 1989 were women, as were 30% of hospital residents. However, only a few women have reached top academic posts. With the increasing growth of immigration from the Soviet Union, a further increase in the number of women physicians is expected. However, half of the hospital-based residents of both sexes have similar specialty paths in pediatrics and medicine, but there are significant differences with regard to the other specialties: more men choose hospital-based surgical specialties, while women usually enter family medicine and psychiatry, mostly in an out-patient setting. These findings are compatible with other studies in Israel and abroad which reflect women's greater compassion and ability to communicate with patients and their families, as compared to men. Male physicians are more competitive and tend to seek professional status, power and practical rewards. It is anticipated that these trends will influence the nature and the education of the medical profession in the direction of a more humane type of medicine.
Career Choice↗