PubMed · 15357550
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Jennifer Percival. Lend a friendly ear.. https://pubmed.ncbi.nlm.nih.gov/15357550/
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MATERIAL AND METHODS: All surgical departments in Saxony-Anhalt, Saxony and Thuringia were included in the study. Two questionnaires were administered. One was directed at the chairmen of departments and the other at residents. An additional questionnaire was administered to foreign residents. RESULTS: A total of 58 chairmen of surgical departments, who maintain 270 training positions and 100 residents with 22 (22%) being foreigners, participated in the study. Twenty resident positions (7.4%) were unfilled, 27 (27%) residents saw their professional future abroad and 46 (46%) were generally satisfied with their surgical records while three (3%) were satisfied with the documentation procedures. A total of 28 (28%) were content with the amount of free time but 7 (31.8%) foreign residents regretted their decision to come to Germany. CONCLUSION: The decline in the number of physicians in central Germany is serious. The situation is caused by insufficient salary, unrecorded and unpaid overtime, an unacceptable amount of leisure time and an insufficient guarantee for the amount surgical procedures provided.
Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a "take-home" dose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored.
BACKGROUND: While much research has addressed physician competency, the development of confidence has not been studied. We sought to identify which elements of internship residents feel most contributed to building their confidence. METHODS: By anonymous survey, University of Pennsylvania residents rated 104 internship elements for contribution to building physician confidence and reported their subjective confidence during and since internship. RESULTS: Two hundred ten residents in 18 specialties participated. Detailed ratings for all 104 elements are provided. Generally, independent decision-making items and good back-up support were equally highly valued, as was developing work efficiency. Poorly valued items included high patient loads, long hours, and abusive interactions. Surgical and medical residents agreed. Mean confidence increased during internship from 12 to 32 (1-100 scale) but remained in the 50s during residency for most specialties. CONCLUSIONS: Faculty should make informed, deliberate attempts to provide those elements identified as most fostering the development of physician confidence.