51 research outputs found
Evaluating 10 years of state-funded GP training in GP offices in Switzerland.
No full textBACKGROUND
Switzerland lacks future general practitioners (GPs). Residents who wished to specialize as general practitioners were formerly trained solely in hospital settings. To better prepare and also attract more young doctors to become GPs, the canton of Bern (equivalent to a state) has implemented a partly state-funded vocational training program in GP practices. Our study examines the efficacy of this 10-year program, identifies factors that positively influence residents in their decision to become a GP and the distribution of new GPs in the canton of Bern, who had taken part in the traineeship.
METHODS
This cross-sectional survey among all residents, who participated in a traineeship in general practice from 2008 to 2017 in the canton of Bern asked if residents had taken a subsequent career choice as a GP and if so in which region. Residents scored the importance of their traineeship and their mentor's influence on becoming a GP. By using zip codes of work area of respondents already working as GPs and matching it with population census data, we could obtain the distribution of GPs on a per capita basis.
RESULTS
Out of 165 residents who participated in a traineeship, 151 (92%) completed our survey. 81% had chosen a career as a GP or were on track to become a GP. Almost half of the participants became GPs in the offices of their mentors or in the area. Our respondents emphasized the importance of their mentors' influence as well as the training program in their decision-making to become a GP. Most mentioned benefits of being a GP were broad field of medical care (37%) and a fulfilling doctor-patient relationship (34%). We could show an increase in GP practices in the canton of Bern, not only in urban but also accordingly in rural areas.
CONCLUSIONS
Most residents continued subsequent careers as general practitioners after having completed a GP traineeship, with almost half of them in the region of their training. A vocational training program helped motivating young doctors to become GPs and underserved regions of the canton of Bern to gain new GPs
Assessing the mental wellbeing of next generation general practitioners: a cross-sectional survey.
No full textBACKGROUND
Future and practising GPs encounter various stressors, which can potentially impair mental wellbeing and develop into mental illnesses.
AIM
To assess mental wellbeing of young and future GPs by their level of training.
DESIGN & SETTING
A cross-sectional anonymous survey of members of the Swiss Young General Practitioners Association (JHaS) was undertaken.
METHOD
Basic characteristics and the current mental wellbeing were assessed using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Specific stressors that can influence wellbeing were focused on. Participants were asked for ideas on how to improve wellbeing via open questions.
RESULTS
Response rate was 57% (n = 503). Mean value for mental wellbeing (WEMWBS) was 52.4 (maximum 70, standard deviation [SD] 7.2). Residents had a significantly lower level of mental health (51.0, SD 7.6) compared with GPs (54.2, SD 6.2). Overall, stress level was reported as high or very high by almost half of participants (49%). Forty-five per cent indicated a lack of private time; the highest proportion was among residents. Fifteen per cent (20% among residents) were at risk of burnout. Most frequent stressors were administrative tasks, high workload, and work demands. Support requests included improvement of work-life balance and reduction of administrative workload.
CONCLUSION
Residents had the lowest mental wellbeing, at a stress level similarly high to that of GPs. They most often indicated not having enough time for a private life and were most at risk of burnout. Improvement suggestions should be implemented to maintain mental health of young and future GPs. Particular attention should be paid to GPs in training, as owing to their reduced mental health, they may benefit most
a case vignette study in 31 countries
No full textFunding: The work of Katharina Tabea Jungo was supported by the Swiss National Science Foundation (SNSF) (NFP 407440_167465, PI Prof. Streit) and the work of Zsofia Rozsnyai by the Swiss Society of General Internal Medicine (SGAIM) Foundation (PI Prof. Streit). The SGAIM Foundation reviewed the study protocol but did not give us feedback or help usplan, conduct, interpret results, or write this manuscript. The SNSF had the same role but did not review the study protocol. CM is funded by the National Institute for Health Research (NIHR) Applied Research Collaborations (West Midlands), the NIHR School for Primary Caren Research and an NIHR Research Professorship in General Practice (RP 2014–04-026). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. ER is supported by an NHMRC-ARC Dementia Research Development Fellowship.Background: General practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients’ health. However, deprescribing can be challenging for physicians. This study investigates GPs’ deprescribing decisions in 31 countries. Methods: In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs’ deprescribing decisions. Results: Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). Interpretation: The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.publishersversionpublishe
What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey.
No full textBACKGROUND
Multimorbidity and polypharmacy are very common in older adults in primary care. Ideally, general practitioners (GPs), should regularly review medication lists to identify inappropriate medication(s) and, where appropriate, deprescribe. However, it remains challenging to deprescribe given time constraints and few recommendations from guidelines. Further, patient related barriers and enablers to deprescribing have to be accounted for. The aim of this study was to identify barriers and enablers to deprescribing as reported by older adults with polypharmacy and multimorbidity.
METHODS
We conducted a survey among participants aged ≥70 years, with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 chronic medications). We invited Swiss GPs, to recruit eligible patients who then completed a paper-based survey on demographics, medications and chronic conditions. We used the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire and added twelve additional Likert scale questions and two open-ended questions to assess barriers and enablers towards deprescribing, which we coded and categorized into meaningful themes.
RESULT
Sixty four Swiss GPs consented to recruit 5-6 patients each and returned 300 participant responses. Participants were 79.1 years (SD 5.7), 47% female, 34% lived alone, and 86% managed their medications themselves. Sixty-seven percent of participants took 5-9 regular medicines and 24% took ≥10 medicines. The majority of participants (77%) were willing to deprescribe one or more of their medicines if their doctor said it was possible. There was no association with sex, age or the number of medicines and willingness to deprescribe. After adjustment for baseline characteristics, there was a strong positive association between willingness to deprescribe and saying that because they have a good relationship with their GP, they would feel that deprescribing was safe OR 11.3 (95% CI: 4.64-27.3) and agreeing that they would be willing to deprescribe if new studies showed an avoidable risk OR 8.0 (95% CI 3.79-16.9). From the open questions, the most mentioned barriers towards deprescribing were patients feeling well on their current medicines and being convinced that they need all their medicines.
CONCLUSIONS
Most older adults with polypharmacy are willing to deprescribe. GPs may be able to increase deprescribing by building trust with their patients and communicating evidence about the risks of medication use
Primary Care Physician Workforce 2020 to 2025 - a cross-sectional study for the Canton of Bern.
No full textAIM OF THIS STUDY
The Swiss primary care sector faces a lack in its workforce and the Canton of Bern - the second largest canton (i.e. federal state) - is believed to be more affected than others. To be able to predict a shortage in the overall workforce, reliable numbers for the workforce of all general practitioners (GPs) and paediatricians (primary care physicians, PCPs) actively working in the Canton of Bern are needed. Switzerland has no registry of active PCPs; therefore, our goal was to (1) define the number and characteristics of all PCPs in the Canton of Bern, (2) to establish the workforce density for the whole canton and its administrative districts, and (3) to forecast the next five years with respect to the PCP workforce development.
METHODS
In this cross-sectional study, we contacted all potential PCPs of the Canton of Bern. We included all board-certified physicians in general internal medicine, paediatrics and physicians with the title "Praktischer Arzt (practical doctor)" with a professional license from the available registers (MedReg and the FMH register). All potential PCPs received a questionnaire to assess their involvement in the primary care setting, their personal characteristics including workload (current and in 5 years to allow us to estimate the projected workforce per projected population size in 2025), type of practice, administrative district, and additional questions on their acceptance of new patients and their perception of a shortage in their region. The data from non-responders were collected via follow-up letters, emails and phone calls. The density was calculated as full-time equivalent PCPs per 1000 inhabitants in total and per district.
RESULTS
From all potential PCPs (n = 2217), we identified 972 working in the Canton of Bern, 851 as GPs (88%) and 121 as paediatricians (12%). From these physicians, we had a response rate of 95%. The mean age was 53 years for GPs and 50 years for paediatricians. Thirteen percent of all PCPs were aged 65 or older. The average workload was 7.6 half-days (GPs) and 6.9 half-days (paediatricians). We found a density of 0.75 (95% confidence interval [CI] 0.69-0.81) full-time equivalents per 1000 inhabitants for the total of the Canton of Bern, and a regional variability with densities between 0.59 to 0.93. Without new PCPs, the workforce density of PCPs will drop to 0.56 (95% CI 0.49-0.62) within the next 5years.
CONCLUSION
This is the first study in which 95% of active PCPs participated and it demonstrated that within the next 5 years there will be a shortage in the workforce of PCPs that can only be improved by higher numbers of new domestic PCPs - even after accounting for the current inflow of foreign PCPs
Swiss students and young physicians want a flexible goal-oriented GP training curriculum
No full textBackground: A growing shortage of general practitioners (GPs), in Switzerland and around the world, has forced countries to find new ways to attract young physicians to the specialty. In 2017, Switzerland began to fund hundreds of new study places for medical students. This wave of young physicians will soon finish University and be ready for postgraduate training. We hypothesized that an attractive postgraduate training program would encourage interested young physicians to pursue a GP career. Methods: This is a cross-sectional survey of young physicians from the Swiss Young General Practitioners Association (JHaS), members of Cursus Romand de médecine de famille (CRMF), and all current medical students (5th or 6th years) (n = 554) in Switzerland, excluding students indicating definitely not to become GPs. We asked all if they were likely to become a GP (Likert: 1-10), and then asked them to score general features of a GP training curriculum, and likely effects of the curriculum on their career choice (Likert scale). They then rated our model curriculum (GO-GP) for attractiveness and effect (Likert Scales, open questions). Results: Most participants thought they would become GPs (Likert: 8 of 10). Over 90% identified the same features as an important part of a curriculum (“yes” or “likely yes”): Our respondents thought the GO-GP curriculum was attractive (7.3 of 10). It was most attractive to those highly motivated to become GPs. After reviewing the curriculum, most respondents (58%) felt GO-GP would make them more likely to become a GP. Almost 80% of respondents thought an attractive postgraduate training program like GO-GP could motivate more young physicians to become GPs. Conclusions: Overall, medical students and young physicians found similar features attractive in the general and GO-GP curriculum, regardless of region or gender, and thought an attractive curriculum would attract more young doctors to the GP specialty.Key points An attractive postgraduate training program in general practice can attract more young physicians to become GPs. In this study cross-sectional survey including medical students (n = 242) and young physicians (n = 312) we presented general features for a curriculum and a model curriculum for general practice training, for evaluation of attractiveness to our study population. General practice training curriculum provides flexibility in choice of rotations, access to short rotations in a wide variety of medical specialties, training in specialty practices as well, mentoring and career guidance by GPs and guidance in choosing courses/certificate programs necessary for general practice. These findings help building attractive postgraduate training programs in general practice and fight GP shortage
Chancenreiche Zukunft in der Allgemeinen Inneren Medizin für die nächste Ärztegeneration
No full text Zusammenfassung. Wir stehen vor einem Mangel an Fachärztinnen und -ärzten in Allgemeiner Innerer Medizin in den Hausarztpraxen sowie im Spital bei gleichzeitig einer immer älter werdenden Bevölkerung mit meist mehreren chronischen Krankheiten (Multimorbidität). Dank mehr Studienplätzen, einem verbesserten Berufsbild der Allgemeinen Inneren Medizin und neuen Weiterbildungsangeboten ist das Interesse an der Allgemeinen Inneren Medizin angestiegen, wie Befragungen bei Studierenden andeuten. Die junge Generation von Hausärzten und Generalisten im Spital wünscht sich flexible Arbeitsbedingungen, um Beruf, Familie und Freizeit bestmöglich unter einen Hut zu bringen. Das Arbeitsklima und die Arbeitskollegen haben dabei eine hohe Priorität. Diese Wünsche müssen jetzt in eine attraktive Weiterbildung mit flexiblen Curricula und Mentoringangeboten einfliessen, damit die Nachwuchsförderung gelingt. </jats:p
Identification of nine new susceptibility loci for testicular cancer, including variants near DAZL and PRDM14.
No full textTesticular germ cell tumor (TGCT) is the most common cancer in young men and is notable for its high familial risks. So far, six loci associated with TGCT have been reported. From genome-wide association study (GWAS) analysis of 307,291 SNPs in 986 TGCT cases and 4,946 controls, we selected for follow-up 694 SNPs, which we genotyped in a further 1,064 TGCT cases and 10,082 controls from the UK. We identified SNPs at nine new loci (1q22, 1q24.1, 3p24.3, 4q24, 5q31.1, 8q13.3, 16q12.1, 17q22 and 21q22.3) showing association with TGCT (P < 5 × 10(-8)), which together account for an additional 4-6% of the familial risk of TGCT. The loci include genes plausibly related to TGCT development. PRDM14, at 8q13.3, is essential for early germ cell specification, and DAZL, at 3p24.3, is required for the regulation of germ cell development. Furthermore, PITX1, at 5q31.1, regulates TERT expression and is the third TGCT-associated locus implicated in telomerase regulation
Potentially inappropriate medication and attitudes of older adults towards deprescribing.
No full textINTRODUCTION
Multimorbidity and polypharmacy are current challenges when caring for the older population. Both have led to an increase of potentially inappropriate medication (PIM), illustrating the need to assess patients' attitudes towards deprescribing. We aimed to assess the prevalence of PIM use and whether this was associated with patient factors and willingness to deprescribe.
METHOD
We analysed data from the LESS Study, a cross-sectional study on self-reported medication and on barriers and enablers towards the willingness to deprescribe (rPATD questionnaire). The survey was conducted among multimorbid (≥3 chronic conditions) participants ≥70 years with polypharmacy (≥5 long-term medications). A subset of the Beers 2019 criteria was applied for the assessment of medication appropriateness.
RESULTS
Data from 300 patients were analysed. The mean age was 79.1 years (SD 5.7). 53% had at least one PIM (men: 47.8%%, women: 60.4%%; p = 0.007). A higher number of medications was associated with PIM use (p = 0.002). We found high willingness to deprescribe in both participants with and without PIM. Willingness to deprescribe was not associated with PIM use (p = 0.25), nor number of PIMs (p = 0.81).
CONCLUSION
The willingness of older adults with polypharmacy towards deprescribing was not associated with PIM use in this study. These results suggest that patients may not be aware if they are taking PIMs. This implies the need for raising patients' awareness about PIMs through education, especially in females, in order to implement deprescribing in daily practice
Men er vi ikke egentlig sånn? En lesning av Jeg er egentlig ikke sånn (2022) av Marie Aubert som crossoverlitteratur.
No full textDenne masteroppgaven tar utgangspunkt i begrepet crossover literature, som er hentet fra det engelske-amerikanske forskningsfeltet for ungdomslitteratur, Young Adult literature. Crossover-termen viser til litteratur som befinner seg i en grenseoppgang, enten mellom barnelitteratur og ungdomslitteratur, eller ungdomslitteratur og voksenlitteratur. Sistnevnte har blitt relevant for denne masteroppgaven. Basert på en lesning av Marie Auberts roman Jeg er egentlig ikke sånn (2022), forsøker jeg i denne oppgaven å argumentere for at det er mulig å lese romaner som dette med en dobbel inngang; En crossover-lesning. Crossover-lesningen grunner i en tanke om at det er mulig å ha både en ung, direkte og umiddelbar tilnærming til romanen, og en voksen, distansert og ironisk tilnærming til den. Jeg er egentlig ikke sånn handler om fire familiemedlemmer som møtes til konfirmasjon, og viser frem hvordan møtet mellom dem utarter seg. Den portretterer gjenkjennelige mennesker og situasjoner, og er skrevet kronologisk, med et kortfattet og tilgjengelig språk. Dette gjør at man kan antyde at den faktisk er crossoverlitteratur. Konsekvensene av crossover-lesningen, er at ulike litterære og fortellertekniske grep blir synlige i lesningen, og at det åpnes opp for flere forståelser av romanens karakterer, fortelling og mulige formål.This master’s thesis is based on the concept of crossover literature, which is a term taken from the English research field of Yong Adult literature. The term crossover refers to literature that finds itself at a borderline, either between children’s literature and youth literature, or between youth literature and adult literature. The latter is relevant for this master’s thesis. Based on a reading of the novel Jeg er egentlig ikke sånn (2022) by the author Marie Aubert, I try to argue that it is possible to read novels like this with a double entrance; A crossover reading. The crossover reading is based on the idea that it is possible to have both a young, direct and immediate approach to the novel, as well as an adult, distanced and ironic approach to it. Jeg er egentlig ikke sånn is about four family members who meet up for a weekend, to participate in a confirmation, and shows further how the meeting between them turns out. The novel is written chronologically, with a concise and accessible language, and portrays recognizable people and situations. This allows one to suggest that the novel actually is crossover literature. The consequences of the crossover reading are that various literary and storytelling techniques become visible in the reading, as well as that is opens up for several understandings of the narrative, the characters and the possible purpose or message of the novel
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