Revalidation in the Australian context
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The document discusses revalidation in the Australian context, noting that mandatory continuing professional development (CPD) has been in place since 2010 but varies by field of practice. It outlines the Medical Board of Australia's progress, including commissioning research on options and community expectations and establishing expert advisory groups. Pilot models of revalidation will be tested from 2016-2017 before potential adoption and implementation in 2017-2018. Key challenges for Australia include that legislation currently mandates CPD not revalidation, determining the purpose of revalidation, and deciding on universal or risk-based approaches while considering feasibility, acceptability and cost.
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This document discusses public expectations of regulatory revalidation of clinicians and whether revalidation can deliver on those expectations. It notes that public expectations are modest, focusing more on access to care than quality or outcomes. It also discusses different definitions of competency and the complexity of problems in healthcare. While revalidation aims to maintain competency, it has limitations as practice is continuous but revalidation is periodic. The document suggests that for revalidation to meet public expectations, it would need to take a systems approach and include organizational assessments in addition to individual assessments. It also raises the possibility of alternative approaches to evaluation that focus more on intrinsic motivation and attitudes rather than just knowledge and skills.
Evaluating Revalidation: Lessons from the Evaluation of Complex Interventions
This document discusses key considerations for evaluating complex interventions like revalidation of physicians. It makes three main points:
1. Revalidation involves complex interactions that are nonlinear and context-dependent, so evaluations must account for these complexities. Randomized trials may not be possible.
2. Evaluations should have both formative and summative components to support learning and improvement, as well as assess merit and worth. Longitudinal, multilevel designs can help link processes to outcomes over time.
3. Evaluations must develop a clear theory of change and understand how different elements of revalidation interact and impact outcomes like quality of care. Stakeholder engagement and mixed methods can provide a more comprehensive understanding.
Top 3 challenges in planning and implementing revalidation in Ireland
The top 3 challenges in planning and implementing revalidation in Ireland according to Prof Freddie Wood are:
1) The diversity in medical practice between the general and specialist divisions and determining whether to have one size fits all or different models for each.
2) Striking the right balance as a regulatory body between proportionality in responses like withholding registration versus raising a complaint, and relying on hard regulatory force versus professional leadership.
3) Shifting the focus from inputs like engagement in training programs to meaningful outcomes like quality of performance and in-practice assessments of competence.
MOL challenges - Dr. Gifford
This document discusses challenges faced in implementing revalidation requirements across multiple US licensing jurisdictions with varied rules. It notes resource and administrative constraints like costs, staff turnover, and legislative concerns. It also describes competing priorities for medical boards like physician mobility, opioid prescribing, and end of life care. There is opposition from some physicians who feel overburdened by existing requirements from entities like CMS, hospitals, and quality reporting. The document provides contacts for more information on the medical licensing organization.
Revalidation challenges - Dr. Trevor Theman
This document discusses the challenges of implementing physician revalidation in Canada. It identifies key challenges such as cost, defining responsibilities, and ensuring access to tools and education. The largest challenge is defining the goals of revalidation - whether it should be summative or formative, high stakes or not, generalist or practice-specific. The goal of the current strategy is to help all physicians improve, identify doctors who need focused assessment, and clarify roles in enhancing physician performance.
How can ePortfolios contribute to the revalidation efforts and support the co...
This document discusses how ePortfolios can contribute to physician revalidation and support the continuing competence of the medical profession. It defines ePortfolios and different types, and explores how they can support learning, assessment, and the demonstration of continuing competence for revalidation purposes. Specifically, ePortfolios allow physicians to document professional learning and its impact on practice, align activities with competencies and scope of practice, and demonstrate the achievement of important education and clinical outcomes over time.
Value and Impact of CME Accreditation in the ACCME System
This document discusses the value and impact of continuing medical education (CME) accreditation through the Accreditation Council for Continuing Medical Education (ACCME) system. It provides an overview of the ACCME's mission to ensure CME is linked to quality/safety, improves practice, is independent of commercial bias, and is evidence-based. Statistics on accredited providers and CME activities are presented. The document also outlines accreditation requirements and challenges/opportunities in CME to engage health leaders, clinicians, learners, and demonstrate value to health systems.
Tests of Knowledge: How Can They Contribute to Maintenance of Certification ...
Tests of knowledge can contribute to maintenance of certification (MoC) and revalidation in two ways: assessment of learning and assessment for learning. Assessment of learning uses high-stakes knowledge tests summatively to identify doctors with performance problems, while assessment for learning takes a longitudinal approach through frequent, low-stakes tests to provide feedback and assist doctors in keeping knowledge up to date. There are challenges to the use of knowledge tests, such as determining relevant content and preventing tests from being seen as irrelevant facts, that different assessment approaches aim to address.
Multisource feedback & its utility
This document discusses multisource feedback (MSF) and its use in physician assessment and revalidation. It provides evidence from various studies that MSF can reliably and validly assess physician competencies. However, it also notes limitations in terms of its ability to consistently change physician behavior and the high costs associated with MSF programs. Overall, the document presents both sides of the debate around using MSF as an essential component of physician revalidation.
The outcomes & effectiveness of revalidation in New Zealand for non-certified...
This document discusses revalidation in New Zealand for non-certified general practitioners. It defines key terms and explains why revalidation was implemented, including ensuring doctor competence and standardizing continuing professional development. The revalidation program includes requirements like an e-portfolio, annual and triennial activities, and a Regular Practice Review involving practice visits. Early results found most doctors viewed the review positively and many reported immediate practice changes. Follow-up surveys found later participants saw greater benefits including improved patient care. As the program continues, results are expected to provide firmer conclusions about its effectiveness and value.
The outcomes/effectiveness of revalidation in the United Kingdom: evaluating ...
This document outlines the purpose and work packages of an evaluation of medical revalidation in the United Kingdom. The evaluation aims to address 30 research questions across 6 core regulatory aims, including whether revalidation is consistently bringing all doctors under governance and evaluation of fitness to practice. The work is organized into 7 packages, including literature reviews, analysis of existing data, surveys, analysis of appraisal captures, stakeholder interviews, documentary analysis, and root cause analysis of appraisal documents related to fitness to practice referrals. The growing evidence base may help inform regulatory approaches in other countries like Australia.
Outcomes/Effectiveness of revalidation in the UK
Revalidation is a five-year process in the UK that aims to bring all doctors into a clinical governance system, help identify problems earlier, encourage self-reflection, and contribute to safer, higher quality patient care. So far, over 118,000 doctors have been revalidated. Early evidence suggests revalidation is increasing appraisal rates and identification of concerns, while 24,795 doctors have given up their licenses. Responsible Officers report revalidation is central to quality improvement and allows better understanding of doctors' practices. The future of revalidation may see it more integrated with team performance and use more objective data linked to specialist expectations.
More from IAMRAreval2015 (12)
Evaluating Revalidation: Lessons from the Evaluation of Complex Interventions
Evaluating Revalidation: Lessons from the Evaluation of Complex Interventions
Top 3 challenges in planning and implementing revalidation in Ireland
Top 3 challenges in planning and implementing revalidation in Ireland
How can ePortfolios contribute to the revalidation efforts and support the co...
How can ePortfolios contribute to the revalidation efforts and support the co...
Value and Impact of CME Accreditation in the ACCME System
Value and Impact of CME Accreditation in the ACCME System
Tests of Knowledge: How Can They Contribute to Maintenance of Certification ...
Tests of Knowledge: How Can They Contribute to Maintenance of Certification ...
The outcomes & effectiveness of revalidation in New Zealand for non-certified...
The outcomes & effectiveness of revalidation in New Zealand for non-certified...
The outcomes/effectiveness of revalidation in the United Kingdom: evaluating ...
The outcomes/effectiveness of revalidation in the United Kingdom: evaluating ...
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Physiology of Special Chemical Sensation of Taste
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
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Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Revalidation in the Australian context
- 1. Revalidation in the Australian context Dr Joanna Flynn Chair, Medical Board of Australia IAMRA 2015 Revalidation Symposium Montreal
- 2. Progress to date • Mandatory CPD since 2010 – varies by field of practice • Commenced discussion about revalidation with profession and key stakeholders late 2012 • Commissioned CAMERA, Plymouth University UK to provide options and evidence – report mid 2015 • Commissioning research re community expectations • Established expert advisory group to: – provide technical expert advice and recommend models that can be evaluated for effectiveness, feasibility and acceptability • Established consultative committee of key stakeholders 2
- 3. Published timelines • Expert Advisory Group report by June 2016 • Pilot models and evaluate for effectiveness, feasibility and acceptability in 2016-17 • Review outcomes and move to adoption and implementation 2017-18 • Revalidation report and other information is published on the Board's website www.medicalboard.gov.au/registration/revalidation 3
- 4. Challenges in the Australian context • Our legislation mandates CPD, not revalidation • Need to be clear about our purpose – one or both – improving everyone – identifying poor performers • Need to decide if we have universal or risk based approach • Feasibility, acceptability and cost 4