Working and Training Conditions of Gynecology Residents in North Rhine-Westfalia, Germany.
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SUBMITTER: Fehr D
PROVIDER: S-EPMC3973940 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background: The course "Psychosomatic Primary Care" has been part of the training curriculum of obstetrics and gynecology in Germany since 2003. The aim of the course is to train up physicians, whose prior training primarily focussed on somatic care, to enable them to offer care also taking into account biopsychosocial aspects. Taking the guidelines for psychotherapy as a template, the aim of psychosomatic primary care is to recognize the etiological links between psychological and somatic factors which contribute to diseases. The necessity for a compulsory course as part of training in gynecology was recently critically discussed. Major points discussed included the question whether the current forms of teaching, consisting of courses, are outdated and whether the required skills should be part of regular daily training. Method: A 3-part online questionnaire consisting of 30 items was developed and sent to 2431 residents in the period from September to December 2012 through the online mailing list of the DGGG. Results: The 540 residents who responded to the questionnaire were predominantly female (83.3?%) with an average age of 30 years; 50.3?% were in their 1st to their 4th year of training. Over the longer term, the majority of respondents (56.1?%) hoped to continue working in a hospital and regularly (84.6?%) attended teaching courses voluntarily. 70.9?% of them had already attended the course "Psychosomatic Primary Care". Of the group who had completed the course, 29.4?% were satisfied with the offer. The main criticism directed against the course was its scope which 24.1?% considered completely inadequate. 24.5?% considered the course to be an important part of training, while 16.5?% would have preferred that the course be abolished. 18?% of respondents reported that psychosomatic medicine did not feature regularly in their daily clinical routine. Perspective: Because of the huge gap between what is currently offered and the experiences reported by the respondents, the Young Forum of the DGGG and the DGPFG have expanded the program of courses offered by the DGPFG, which will offer practice-oriented courses to future gynecologists across Germany in cooperation with the DAGG. The first courses are held in Heidelberg and Erlangen in 2014.
| S-EPMC4069216 | biostudies-literature
Project description:Wastewater-based epidemiology (WBE) has demonstrated its importance to support SARS-CoV-2 epidemiology complementing individual testing strategies. Due to their immune-evasive potential and the resulting significance for public health, close monitoring of SARS-CoV-2 variants of concern (VoC) is required to evaluate the regulation of early local countermeasures. In this study, we demonstrate a rapid workflow for wastewater-based early detection and monitoring of the newly emerging SARS-CoV-2 VoCs Omicron in the end of 2021 at the municipal wastewater treatment plant (WWTP) Emschermuendung (KLEM) in the Federal State of North-Rhine-Westphalia (NRW, Germany). Initially, available primers detecting Omicron-related mutations were rapidly validated in a central laboratory. Subsequently, RT-qPCR analysis of purified SARS-CoV-2 RNA was performed in a decentral PCR laboratory in close proximity to KLEM. This decentralized approach enabled the early detection of K417N present in Omicron in samples collected on 8th December 2021 and the detection of further mutations (N501Y, Δ69/70) in subsequent biweekly sampling campaigns. The presence of Omicron in wastewater was confirmed by next generation sequencing (NGS) in a central laboratory with samples obtained on 14th December 2021. Moreover, the relative increase of the mutant fraction of Omicron was quantitatively monitored over time by dPCR in a central PCR laboratory starting on 12th December 2021 confirming Omicron as the dominant variant by the end of 2021. In conclusions, WBE plays a crucial role in surveillance of SARS-CoV-2 variants and is suitable as an early warning system to identify variant emergence. In particular, the successive workflow using RT-qPCR, RT-dPCR and NGS demonstrates the strength of WBE as a versatile tool to monitor variant spreading.
| S-EPMC9287496 | biostudies-literature
Project description:Knowledge on the mechanisms of viral spread, of time-related changes, and age-specific factors of severe acute respiratory syndrome coronavirus 2 infections is important to develop recommendations aimed at controlling the pandemic. In this context, longitudinal data on proportions of positive results in different age groups are rare. Data on total positive counts and on shares of positive counts deriving from a private (MVZ) and a University (RWTH) laboratory were analyzed retrospectively and compared with public data on total positive counts of the Robert Koch Institute (RKI). Data were covered for Weeks 9-24 of the year 2020 and all patient ages. Total positive counts were lower in children compared to adults. Proportions of children and adults tested positive were 3%-5% and 5%-7%, respectively. RKI and MVZ data showed similar time-related patterns. Patients of 20-60 years of age did account for the initial virus spread (maximum infection rates at Weeks 9-11). Thereafter, infection rates decreased in older patients whereas children did not show a comparable time-related decrease. Pediatric data generated in outpatient settings and hospitals differed markedly which should be considered in further studies. In summary, compared with adults children are less affected by severe acute respiratory syndrome coronavirus 2 infections and are unlikely to account for the initial viral spread. However, children show sustained viral activity and may serve as a viral reservoir.
| S-EPMC7537067 | biostudies-literature
Project description:BackgroundDue to the risk of spreading epizootic diseases through rodents, pest control is mandatory in pig farming in European countries. However, there is limited research focused on rodent control practices, usage of anticoagulant rodenticides, and the acceptance of Pest Control Operators (PCOs) in pig farming in Germany. Therefore, the present study aims to investigate current control practices in pig holdings and to analyze the potential of a financial support on the implementation of professional pest control.ResultsData were collected from monitoring records of PCOs and personal interviews with farmers and PCOs. 33 of 47 farmers, who were offered the possibility to outsource rodent control to PCOs supported by financial contribution of the North Rhine-Westphalian Animal Disease Fund (TSK) for a period of 2 years, joined the project.Despite the widespread opinion that the professional would not be beneficial - the authors figured out that farmers could financially benefit in time saved and by improved rodent control measures from the work of the PCOs. Costs of pest control measures per operation on average did not differ significantly between costs incurred by employment of PCOs (1.310 € per year) and calculated costs that arise by farmers themselves (1.217 € per year).All PCOs used Difenacoum and Brodifacoum against pest infestations. In doing so, the infestation with rodents was reduced and most of the participating farmers assessed the project as successful and employ the PCOs permanently. However, mapping the farm locations to resistance areas of the Rodenticide Resistance Action Committee (RRAC) shows that Brodifacoum was frequently used in areas which are marked as areas that are at low risk or rather have no risk for resistance. The environmental risks, however, are increased in these areas.ConclusionThe instrument of temporal start-up financing professional pest control allows ensuring the continuous engagement of PCOs after the project period. This could possibly lead to long-term effects on the individual farm hygiene and on disease prevention. Nevertheless, important research questions with regard to the application of anticoagulant rodenticides of farmers and PCOs in livestock farming and with regard to risk mitigation measures were generated, meriting further investigation.
| S-EPMC6166279 | biostudies-literature
Project description:BackgroundIn 2016, the WHO introduced an updated classification for testicular tumors. The application of this updated classification to cancer registry data requires some recoding of tumors.ObjectivesThe aim of this study was to provide up-to-date population-based incidence estimates of subtypes of testicular germ cell tumors (TGCT) according to the updated classification.Material and methodsWe reviewed 2251 pathology reports (42.9%) out of 5252 testicular tumors at the cancer registry of North Rhine-Westphalia for the years 2008-2013. We used population counts to estimate age-standardized incidence rates per million person-years (EUROSTAT revised European Standard Population).ResultsThe application of the updated WHO classification resulted in a recoding of 8.9% of all testicular tumors. While the recodings have no influence on the incidence of seminomatous and non-seminomatous TGCTs that include mixed TGCTs, they influence the incidence of individual histological types of seminomatous and non-seminomatous TGCTs. Among the 4935 testicular germ cell tumors (TGCT), 23.7% were mixed TGCTs. Overall, 46.9% of all mixed TGCTs included seminoma and age-standardized incidence rates were highest for the combination seminoma plus embryonal carcinoma (5.9 per million person-years) and embryonal carcinoma plus teratoma (4.9 per million person-years). The median age at diagnosis was higher for mixed TGCTs including seminoma (31 years) than those that did not include seminoma (28 years).Discussion and conclusionsPopulation-based incidence time trends for seminomatous and non-seminomatous TGCTs that include mixed TGCTs are not distorted by the introduction of the WHO update. Trend distortions can only be expected if time trends of individual histological subtypes of the seminomatous and non-seminomatous TGCTs are examined.
| S-EPMC8779128 | biostudies-literature
Project description:IntroductionAn overview of the requirements for the head of a surgical department in Germany should be given.Materials and methodsA retrospective literature research on surgical professional policy publications of the last 10 years in Germany was conducted.ResultsSurveys show that commercial influences on medical decisions in German hospitals have today become an everyday, predominantly negative, actuality. Nevertheless, in one survey, 82.9% of surgical chief physicians reported being very satisfied with their profession, compared with 61.5% of senior physicians and only 43.4% of hospital specialists. Here, the chief physician is challenged. Only 70% of those surveyed stated that they could rely on their direct superiors when difficulties arose at work, and only 34.1% regarded feedback on the quality of their work as sufficient. The high distress rate in surgery (58.2% for all respondents) has led to a lack in desirability and is reflected in a shortage of qualified applicants for resident positions. In various position papers, surgical residents (only 35% describe their working conditions as good) demand improved working conditions. Chief physicians are being asked to facilitate a suitable work-life balance with regular working hours and a corporate culture with participative management and collegial cooperation. Appreciation of employee performance must also be expressed. An essential factor contributing to dissatisfaction is that residents fill a large part of their daily working hours with non-physician tasks. In surveys, 70% of respondents stated that they spend up to ≥3 h a day on documentation and secretarial work.DiscussionThe chief physician is expected to relieve his medical staff by employing non-physician assistants to take care of non-physician tasks. Transparent and clearly structured training to achieve specialist status is essential. It has been shown that a balanced work-life balance can be achieved for surgeons. Family and career can be reconciled in appropriately organized departments by making use of part-time and shift models that exclude 24-h shifts and making working hours more flexible.
| S-EPMC6754057 | biostudies-literature
Project description:ObjectiveCompetency based medical education (CBME) requires novel approaches to surgical education. Significant investment has been made in laparoscopic simulation, which has been shown to foster skill development prior to patient encounters. However, research suggests variable voluntary use of these resources by residents, and little is known about the motivational factors that influence their utilization. The purpose of this study was to characterize factors that motivate residents to seek laparoscopic simulation experience outside of the formal curriculum.DesignWe developed a questionnaire grounded in Expectancy Value Theory, an established psychological theory of motivation, by adapting validated measures to fit the study context. We conducted a cross sectional survey of Canadian obstetrics and gynecology residents.SettingWe invited residents enrolled in English-language obstetrics and gynecology training programs in Canada to participate.ParticipantsAll residents engaged in clinical duties during Winter 2018 were invited to complete the questionnaire. Forty-four Obstetrics and Gynecology (Ob/Gyn) residents participated in the study.ResultsResidents reported limited use of simulation resources and identified multiple barriers including lack of time, access, and supervision. They expressed concern about development of bad habits during independent practice, and simulation use was positively correlated with perceived utility. Compared to junior residents, senior residents reported greater enjoyment of laparoscopic surgery, less emotional costs, and higher self-efficacy for learning laparoscopy.ConclusionsResidents' perception of utility and barriers impede voluntary simulation use and overall use was limited. As programs undertake curricula redevelopment for CBME, mitigating barriers and improving perceived utility of laparoscopic simulation is vital to increase use and enhance skill development.
| S-EPMC7117757 | biostudies-literature
Project description:Medical decision-making is critical and the decisions are made under uncertain, complex, and dynamic conditions. In this regard, practitioners' experiences and perceptions may provide a bottom-up knowledge of the issues, as well as a corresponding support system that assists them in learning to make decisions in critical situations. The current study aimed to examine these experiences in the Pakistani context. We interviewed 14 trainee residents (aged 26 to 34 years) from tertiary care hospitals. Using inductive thematic analysis, we explored a participant-centered perspective on the support system and decision-making process. Findings reveal that the major challenges to decision-making include uncertain and complex situations, hospital-related constraints, and sociocultural context. Both non-critical and critical case management are used in individual and group decision-making processes. The residents use knowledge-based, emotional, and instrumental support to make decisions. The study gave practitioners and academics a transdisciplinary platform to explore the cognitive, social, and behavioral aspects of decision-making in the healthcare industry.
| S-EPMC10621809 | biostudies-literature
Project description:BackgroundResidency is the fundation for high-quality medical care and also for career development of young urologists. In 2015 the GeSRU (German Society of Residents in Urology) carried out the first nationwide survey among young physicians in urology and described the status quo of their residency. This revised follow-up examination draws an updated picture of the training and working conditions of residents in urology and assesses the development.MethodsIn 2020 the GeSRU conducted an online-based survey of all residents in urology; therefore, the 2015 questionnaire was expanded. The model of the professional gratification crisis was used again.ResultsA total of 332 questionnaires were analyzed. Major findings have not changed since 2015. The daily working routine is characterized by high pace and workload and economic considerations. Family- and research-friendly working conditions are largely lacking. 35% of the respondents draw professional consequences. The psychosocial strain remains very high and conveys a risk for physicians' health and patients' quality of care.ConclusionThese results demonstrate that there are still systemically immanent burdens for residents in urology, which require adjustments to the working and training conditions. A structured, transparent curriculum for urological residency, remuneration and time for training and models which enable work-life balance should be established.
| S-EPMC8278189 | biostudies-literature
Project description:Background:Physician empathy is associated with improved patient outcomes. No studies have examined the outcomes of medical improvisational (improv) training on empathy. Objective:Our aims were to determine whether an improv workshop is an effective tool to deliver empathy training for obstetrics and gynecology (OB-GYN) residents, and whether that effect is sustained over time. Methods:We conducted a prospective cohort study of OB-GYN residents undergoing empathy training through 4 improv games in a 1-hour session. Empathy surveys (score range 20-140) with validity evidence were administered 2 weeks prior to empathy training, immediately after, and 1, 3, and 6 months later. Fisher's exact test, Student's t test, and Wilcoxon rank sum test were used to compare statistical differences at each post-intervention assessment. Results:All 22 invited residents participated in empathy training. Empathy scores improved immediately after (120.0 ± 9.8 versus 113.1 ± 10.6, P = .026), though they regressed toward baseline through 6 months (116.3 ± 11.0 versus 113.1 ± 10.6, P = .43). When asked on a scale of 1-5 how much the workshop would impact their work, there was an increase in scores both immediately after (mean 3.5 versus 4.6, P < .001) and 1 month later (mean 3.5 versus 4.1, P = .039), but this difference disappeared at 6 months. Conclusions:Using improv comedy to deliver empathy training is associated with a minor improvement in empathy scores in OB-GYN residents, which decreased at 6 months. Residents found the activity to be acceptable and reported the training would impact their clinical practice.
| S-EPMC6795330 | biostudies-literature