A simulated teaching package that focuses on helping undergraduate medical students to improve their ability to conduct arterial blood gas (ABG) testing has been developed by a team at the Bath Academy in the U.K. This simulated teaching package is expected to advance the competence and confidence levels of Bristol university medical school undergrads to perform these important blood tests.

Arterial blood gases (ABGs) testing is often required in testing sick patients to help diagnose the severity of a condition and assist in assessing treatment. We've learned in highschool that as blood passes through our lungs, oxygen moves into the blood and carbon dioxide moves out of the blood and into the lungs. What an ABG test does is check how well the lungs are able to carry oxygen into the blood and remove carbon dioxide from the blood. The test uses blood drawn from an artery to measure its oxygen and carbon dioxide levels before they enter body tissue.

The Bath Academy, which trains the medical students at the Royal United Hospital, hopes the simulated teaching package will help to improve positive patient outcomes and gain valuable experience for the medical students. For more information, click here>>

With a tradition more than 100 years old, osteopathic physicians are hardly the new doctors in town. But the profession’s recent growth — in both training facilities and number of graduates — could help reverse a looming shortage of primary-care providers that experts say will hit rural communities especially hard.

The national shortfall of family doctors, pediatricians and other generalists is expected to reach 52,000 by 2025, according to a study published last year in Annals of Family Medicine. (This study estimated that there were about 209,000 physicians delivering office-based primary care in 2010.) And only 9 percent of physicians practice in rural areas, where 20 percent of the U.S. population lives, according to a 2011 report from the Department of Health and Human Services.

“That’s where osteopaths have been largely helpful — in primary care and especially for those in need,” said Brock Slabach, senior vice president for member services at the National Rural Health Association.

And their footprint appears to be growing.

Since 2000, the number of osteopathic medical schools in the United States has increased from 19 to 34, offering about 1,900 new training slots, compared with about 1,600 new positions in MD programs. In 2011, there were about 74,000 osteopathic physicians, compared with about 29,500 in 1990.

Some of that increase is a result of greater acceptance of doctors with osteopathic backgrounds. Although their four-year training includes much of the conventional instruction that medical doctors, or MDs, receive, it also has a heavy focus on the musculoskeletal system and includes a technique called osteopathic manipulative treatment, similar to chiropractic and massage therapy. DOs spend the same amount of time in residency programs and also are required to take board exams for certification.

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The resourceful F. Marie Hall SimLife Center at the Texas Tech University Health Sciences Center (TTUHSC) in Lubbock, Texas opened in September 2010. This clinical simulation center allows students in the nursing, medicine, and allied health professions to acquire and practice a full range of skills on manikins, from drawing blood and inserting urinary catheters to delivering babies.

Sharon Decker, Center Director, observes, “Learning in a simulated environment allows students to make mistakes without the need for intervention by faculty to prevent patient harm. Research has demonstrated that simulation provides an effective method of teaching while promoting learner satisfaction and self-competence.” Learners at TTUHSC can walk away from this simulated experience confident in their abilities and skills when dealing with live patients and unanticipated medical events. 

TTUHSC doesn’t plan on using the clinical simulation facility for students alone. According to Ted Mitchell, president, TTUHSC plans to use this technology for continued education for community nurses and physicians as well as faculty. “Part of our educational mission is to make sure we have as much interdisciplinary teamwork as we can,” remarks Mitchell, “and this is a great tool for doing that.”

One of the major influences that drove TTUHSC to choose Education Management Solutions (EMS) as their vendor was the ability to pull scenarios together and create a video clip of learners performing skills. This, they said, was not offered by other vendors. These clips will be important when recent graduates are searching for employment and they have visual proof of their demonstrated clinical capabilities.

Clinical simulation is the future. With many options on the horizon, TTUHSC has a plan to improve the SimLife Center by expanding the services currently offered to its customers; developing a program of educational and certification courses; and expanding the current program of research related to clinical simulation to explore transfer and sustainability of skills attainment. In this ever progressing era of technology, faculty has high hopes for goals they deem achievable. 

Demand is growing for patient engagement, as the health care landscape shifts toward more shared decision-making. As more health care organizations adopt technology such as electronic health records and patient portals, meeting those expectations has become easier.

Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle set out to see whether opening clinical notes to patients would enhance patient engagement. Sometimes the concept is called “open notes” — making notes readily available to patients, generally through an EHR or portal.

The results were encouraging, and researchers said the message to physicians was loud and clear: “There’s little to worry about,” said Jan Walker, RN, MBA, a health services researcher at Beth Israel Deaconess Medical Center, Harvard Medical School in Boston. Walker was a co-author of a study in the Oct. 2 Annals of Internal Medicine.

Physicians and patients in the pilot program at Beth Israel received no training or preparation before going live, Walker said, but that will change.

“When we started, we were thinking we’ll teach the patients about the notes and we’ll teach the doctors about what not to write, and we’ll do all this educating. Then we decided not to do all that, simply because if it worked, we wanted anybody to be able to do it,” she said.

Information from the pilot will help shape educational materials and programs for physicians and patients, but the materials may look different for each organization that adopts this approach.

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In the United States, we are now short approximately 9,000 primary care doctors. These are the general internists, family doctors, geriatricians and general pediatricians, the doctors responsible for diagnosing new illnesses, managing chronic ones, advocating preventive care and protecting wellness. And health care leaders predict that that deficit will worsen dramatically in the next 15 years. Specialties like general surgery, neurosurgery and emergency medicine will also become critically understaffed; but primary care will be hardest hit, with a shortfall of more than 65,000 doctors.

While the demands from a growing and aging population and an influx of 40 million patients newly covered by insurance are considered the main drivers of this crisis, there is no shortage of issues on the physician supply side.

For starters, only 2 percent of all medical students in a recent study expressed interest in practicing primary care as a general internist. Most continue to flock to subspecialty fields like dermatology, anesthesiology, radiology and ophthalmology.

And once trained, primary care practitioners are particularly vulnerable to burnout and more likely to leave clinical practice than doctors in subspecialties like cardiology or gastroenterology.

It’s like the patient is bleeding faster than we can transfuse.

Experts have proposed several solutions to the doctor shortage. But for many worried patients and doctors, the best answer is seemingly the most obvious one: churn out more young doctors and funnel them into residency programs that train for primary care.

Unfortunately, according to a new study published in The Journal of the American Medical Association, it’s not that obvious.

Researchers asked more than 50,000 doctors training in internal medicine about their career plans. As expected, the majority of these young doctors planned on becoming subspecialists.

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Medical practices are increasingly putting up Facebook pages to promote business and solder their community of patients. By adding social media, pediatricians and clinics are now capturing teenagers, some of their most elusive patients. Unlike younger children, who may see pediatricians several times a year, teenagers visit doctors infrequently. Generally healthy, they may stop by only for health forms for work permits, driver’s licenses and sports teams.

But even as they insist on their growing independence, conflating privacy with secrecy, teenagers can be vulnerable to high-stakes, impulsive behavior. Monitoring them carefully but respectfully is tricky for doctors as well as parents. So while a decade ago practitioners saw the Internet as the enemy, a tool for demanding patients who brandished printouts during visits and called at all hours with obscure questions, adolescent-medicine specialists and pediatricians are now turning technology to their advantage.

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Dr. Vanessa Kerry, the 35-year-old Massachusetts General Hospital physician and daughter of Senator John Kerry, aims to improve health care, both in developing nations and in the U.S. Her new nonprofit, tentatively called the Global Health Service Partnership, will send doctors and nurses to work in developing countries and in return help pay off their hefty student loans.

The goal of the program, which is partnered with the Peace Corps, is to aid countries with severe shortages of health professionals. But, as NPR reported, Kerry thinks the program will also help bolster health care in America by broadening doctors’ worldviews and teaching them to make the most of the resources they have available. “There’s evidence people come back with better clinical skills, better appreciation of needs, more likely to work in underserved specialties,” Kerry told NPR’s Shots blog.

Kerry partnered with the Peace Corps both for its name recognition and its institutional knowledge — it’s been sending workers abroad “in a sensitive, integrated way,” Kerry said, for 50 years. The Global Health Service Partnership will serve to fill a hole left by the Peace Corps, which doesn’t deploy doctors or nurses: volunteers in Kerry’s program will not only offer medical care but also teach and mentor local health care workers.

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During a minimally invasive surgery, a surgeon operates on a patient via a small hole or incision in a body cavity or the skin and, unlike open surgery, minimally invasive surgery causes less damage to tissue structures. A surgeon will make one or more small cuts in the patient. A tube containing a camera and fiber optic flashlight, as well as specially designed surgical instruments, is then inserted. The organs and instruments are magnified and displayed on television monitors. A minimally invasive surgery often takes place in the pelvic, abdominal, or chest cavity, but can also take place in the limbs, throat, or head.

Some advantaged of minimally invasive surgery include less blood loss, less severe trauma, fewer scars, and a faster recovery time. These positive outcomes have been noted by physicians since the beginning of the 20th century. However, it wasn't until the invention of the computer chip television camera that minimally invasive surgery became a widely successful and common practice.

Orthopedic or musculoskeletal procedures are ideal for minimally invasive surgery, as well as chest surgery, urology, brain surgery, ear, nose, and throat surgery, and more. Many patients prefer minimally invasive surgery to open surgery because they expect to experience less pain and spend less time in the hospital.

To many surgeons, minimally invasive surgery adds new technical complexity to the surgical practice. Minimally invasive surgery requires practitioners to develop advanced hand-eye coordination skills specific to using laparoscopic instruments in an altered frame of vision, and surgeons must undergo additional training and cultivate the practice as a sub-specialty.

New technology and more specialized instruments enhance the practice of minimally invasive surgery. Electromechanical tools help dampen vibrations from surgeons' hands and shaky machinery, and HD cameras increase the viewing area and overall visibility, making it easier for surgeons to navigate. Better technology also makes it possible for surgeons to create the fewest possible incisions.

As advanced tool availability and refined skill development becomes the norm, minimally invasive surgery will be even more common. This is good news for patients. Minimally invasive surgery leads to shortened hospital stays and expedited recovery times, so patients can enjoy a quicker return to everyday living.

Three times in the last two months, researchers from St. Luke’s-Roosevelt Hospital Center in Manhattan headed across town to the Animal Medical Center to look at dogs.

Doctors at the hospital’s Vascular Birthmark Institute were enticed by the chance to study anomalies of the arteries and veins that are rare in humans but common in dogs. And the traffic between human and animal hospitals flows in the other direction, too: Late last month, veterinarians from the Animal Medical Center began meeting with their counterparts at Memorial Sloan-Kettering Cancer Center to set up trials of a noninvasive device for removing tumors of the urinary tract with electrical impulses.

Exchanges of this sort are becoming increasingly common. Once a narrow trail traveled by a few hardy pioneers, the road connecting veterinary colleges and human medical institutions has become a busy thoroughfare over the last five years or so, with a steady flow of researchers representing a wide variety of medical disciplines on both sides.

One reason is a growing frustration with the inefficiency of using the rodent model in lab research, which often fails to translate to human subjects. So researchers are turning their attention to the naturally occurring diseases in dogs, horses, sheep and pigs, whose physiology and anatomy more closely resemble those of humans.

“The drugs cure the mice and keep failing when we try them on humans,” said Dr. John Ohlfest, an immunotherapist at the University of Minnesota Masonic Cancer Center, who began working with the university’s veterinary school in 2005 to study canine brain cancers. “The whole system is broken.”

Dr. Laurence J. N. Cooper, who develops immune-based therapies at the M. D. Anderson Cancer Center in Houston and recently started making canine T cells for lymphoma research at Texas A&M’s veterinary school, said: “There’s got to be a better way. Canine biologies look like ours, and the treatments look like ours.”

The growing realization that vets and medical doctors may have very good reasons to talk to one another has led to a host of collaborative research projects aimed at speeding the journey from lab to human clinical trials and, in the end, producing a result that can be applied to human and animal patients alike.

These projects often emanate from partnerships like the National Cancer Center’s comparative oncology program, created in 2006 to coordinate canine cancer trials among 20 oncology centers across the United States, or the Center for Comparative Medicine and Translational Research at North Carolina State University’s veterinary college, which recently signed a partnership agreement with the Institute for Regenerative Medicine at Wake Forest Baptist Medical Center to do research on regenerating organs in humans and pets.

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Researchers analyzed the professional trajectories of almost 2,000 midcareer physician-researchers. Chosen because of their similarity to one another in professional interests, aptitude and ambition, the doctors in the study each had received a highly prestigious research grant early in their careers and worked not in private practice but in academic medical centers. The researchers examined a wide range of career factors, including the number of hours worked, professional achievements, leadership positions, marital status, parental status and salary.

As in some earlier studies, the researchers found a difference in income, with a male doctor’s annual salary averaging just over $200,000 and a female’s averaging about $168,000. And like previous researchers, they found that the female doctors tended to be in lower-paying specialties, have fewer publications, work fewer hours and hold fewer administrative leadership positions.

But when these researchers ran the numbers again, this time adjusting for differences in specialty, publications, academic rank, hours worked and leadership positions, they found that the expected average salary for women still fell behind that of their male colleagues. The male doctors made over $12,000 per year more than the women.

Calculated over the course of a 30-year career, the income gap based on sex alone amounted to over $350,000.

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