Search

Clinician-scientists, physicians who conduct research, may fulfil a bridging role in networks of health care researchers and practitioners. Within clinician-scientists' networks, knowledge sharing is thought to play a vital role in the continuing professional development of themselves and their colleagues. However, little is known about networks of clinician-scientists and how this impacts continuing professional development. Rooted in social capital theory, this study provides a mixed methods exploration of clinician-scientists' networks. Ego-level social network data were collected via semi-structured interviews on professional interactions about evidence-based practice with 15 clinician-scientists in the area of general practice and elderly care. Quantitative analysis revealed that professional networks of clinician-scientists varied in size, composition, and frequency of interactions depending on appointed research time and experience. Less experienced clinician-scientists interacted most frequently with other clinician-scientists while experienced clinician-scientist experienced more sporadically with clinicians. Clinician-scientists with more research time interacted more frequently with scientists and had a slightly larger professional network than those with less research time. The thematic qualitative analysis revealed different decision-making processes of clinician-scientists on mobilising their social capital and connecting to others in the network: (1) deliberate decision about initiating connections; (2) reactive behaviour without a decision; (3) ad-hoc decision. Clinician-scientists exchange knowledge to enhance their own continuing professional development mainly but also contribute to the professional development of clinicians, scientists, and other clinician-scientists. [ABSTRACT FROM AUTHOR]

Background Current guidance suggests oral antibiotics can be considered for children with acute otitis media (AOM) and ear discharge, but there is an absence of evidence regarding the relative effectiveness of antibiotic-corticosteroid eardrops. Aim To establish whether antibiotic-corticosteroid eardrops are non-inferior to oral antibiotics in children with AOM and ear discharge. Design and setting Open randomized controlled non-inferiority trial set in Dutch primary care. Methods Children were randomized to hydrocortisone-bacitracin-colistin eardrops (five drops, three times per day in the discharging ear(s)) or amoxicillin suspension (50 mg per kilogram of body weight per day, divided over three doses administered orally) for 7 days. The primary outcome was the proportion of children with resolution of ear pain and fever at day 3. Results Between December 2017 and March 2023, 58 of the planned 350 children were recruited due to slow accrual for various reasons. Children assigned to eardrops (n  = 26) had lower resolution rates of ear pain and fever at 3 days compared to those receiving oral antibiotics (n  = 31): 42% vs 65%; adjusted risk difference 20.3%, 95% confidence interval −5.3% to 41.9%), longer parent-reported ear discharge (6 vs 3 days; P  = .04), and slightly higher mean ear pain scores (Likert scale 0–6) over days 1–3 (2.1 vs 1.4, P  = .02), but received fewer oral antibiotic courses in 3months (11 for 25 children vs 33 for 30 children), and had less GI upset and rash (12% vs 32% and 8% vs 16%, respectively). Conclusion Early termination stopped us from determining non-inferiority of antibiotic-corticosteroid eardrops. Our limited data, requiring confirmation, suggest that oral antibiotics may be more effective than antibiotic-corticosteroid eardrops in resolving symptoms and shortening the duration of ear discharge. [ABSTRACT FROM AUTHOR]

Given the positive outcomes of patient-centred care on health outcomes, future doctors should learn how to deliver patient-centred care. The literature describes a wide variety of educational interventions with standardized patients (SPs) that focus on learning patient-centredness. However, it is unclear which mechanisms are responsible for learning patient-centredness when applying educational interventions with SPs. This study aims to clarify how healthcare learners and professionals learn patient-centredness through interventions involving SPs in different healthcare educational contexts. A realist approach was used to focus on what works, for whom, in what circumstances, in what respect and why. Databases were searched through 2019. Nineteen papers were included for analysis. Through inductive and deductive coding, CIC'MO configurations were identified to build partial program theories. These CIC'MOs describe how Interventions with SPs change the Context (C→C') such that Mechanisms (M) are triggered that are expected to foster patient-centredness as Outcome. Interventions with SPs create three contexts which are 'a safe learning environment,' 'reflective practice,' and 'enabling people to learn together.' These contexts trigger the following seven mechanisms: feeling confident, feeling a sense of comfort, feeling safe, self-reflection, awareness, comparing & contrasting perspectives, combining and broadening perspectives. A tentative final program theory with mechanisms belonging to three main learning components (cognitive, regulative metacognitive and affective) is proposed: Interventions with SPs create a safe learning environment (C') in which learners gain feelings of confidence, comfort and safety (affective M). This safe learning environment enables two other mutual related contexts in which learners learn together (C'), through comparing & contrasting, combining and broadening their perspectives (cognitive M) and in which reflective practice (C') facilitates self-reflection and awareness (metacognitive M) in order to learn patient-centeredness. These insights offer educators ways to deliberately use interventions with SPs that trigger the described mechanisms for learning patient-centredness. [ABSTRACT FROM AUTHOR]

Background Objectives Scope Methods Results Conclusion Clinician‐teachers, physicians with educational responsibilities in either classroom or clinical setting, are assumed to add value by virtue of their dual role. The clinical responsibilities are often prioritised over the educational tasks. How and under which circumstances clinician‐teachers are able to perform their educational role and create added value for different stakeholders is currently unclear.To identify for whom, how and under which circumstances educational activities executed by CTs by virtue of their dual role add value to others.CTs activities linking the system of education and clinical practice beyond direct patient interactions and purposefully executed.A realist review was conducted. Databases were searched in two stages: a narrow conventional search, followed by a comprehensive artificial intelligence‐aided search. Studies concerning clinician‐teachers' dual role were included. Realist analysis was applied to identify in which contexts resource mechanisms triggered reasoning mechanisms, which led to specific outcomes for different stakeholders.Sixty‐six studies were included. In contexts where clinician‐teachers' dual role was formally recognised and valued, clinician‐teachers benefitted from the credibility and legitimacy bestowed on them, making the transfer of domain‐specific knowledge more impactful. In contexts where sociocultural differences between both systems existed, CTs were able to mediate and adjust recommendations aligned with stakeholders' perceived relevance. Also, contexts organised to support both roles made resource mechanisms more impactful. Clinician‐teachers added value to students' clinical competency and learning environment, and to educational organisations' curricular innovation. In their clinical workspace, clinician‐teachers added value by enhancing colleague physicians' teaching expertise, implementing educational innovations and recruiting students for scarce specialisms.Clinician‐teachers add value to students, colleague physicians and the clinical and educational contexts at large. Domain‐specific knowledge of both systems was important to gain credibility and achieve added value. Openness, formal recognition and allocated time for both roles in educational and clinical contexts towards the dual role are important to strengthen the impact of the dual role. [ABSTRACT FROM AUTHOR]

The Medical Specialties council of the Royal Dutch medical association (CGS) has published an innovative perspective on the future landscape of specialisms in medicine. The proposal introduces generalism as the standard of training and professional practice, which represents a fundamental change from the current system. The envisioned new structure would consist of a number of broad core specialisms, emphasizing generalist knowledge and skills, and additional subspecialties for highly complex care. This is expected to enhance healthcare efficiency and improve patient treatment. The plan meets changing healthcare needs and accommodates the preference of young doctors regarding their residency training and careers.The CGS wants to further explore the new perspective with all parties involved.

It is often thought that acute ear discharge as a presenting symptom of acute otitis media (AOM) means that the infection is petering out. However, children with AOM presenting with ear discharge due to a spontaneous perforation of the eardrum (AOMd) have a poorer prognosis (i.e. higher rates of ear pain and/or fever at 3-7 days) than those without ear discharge. In this article we emphasize the importance of physical examination and early treatment of children and adults who present with acute ear discharge.