醫師過勞仍普遍 醫學生籲評鑑比照國際規範

[chienchun]

醫師過勞仍普遍 醫學生籲評鑑比照國際規範

作者： 康紀漢 | 國立教育廣播電台 – 2013年4月29日 上午11:56
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醫師過勞仍普遍 醫學生籲評鑑比照國際規範
國內醫師的過勞問題，仍然需要有關單位來重視！醫師勞動條件改革小組針對實習與住院醫師進行調查，結果發現實習與住院醫師的過勞情形仍然相當嚴重，呼籲衛生署在評鑑制度應該要比照美國ACGME的規範，才可以減少醫師過勞帶來的負面影響。
醫師勞動條件改革小組在去年5到8月，針對國內214位實習與住院醫師進行問卷調查，結果發現醫師的過勞問題仍然需要政府有關單位來重視。
醫師勞動條件改革小組執行委員張漢任表示，調查發現，除了有71%的實習和住院醫師每週工作時間超過80個小時，當中還有86%醫師的連續工時超過32個小時以上，並且醫師平均每天的睡眠時間也不到6個小時，甚至更有32%實習醫師的照顧床數超過10床，以及20%住院醫師的照顧床數超過15床，顯示出實習和住院醫師的過勞情形仍然相當嚴重。
醫師勞動條件改革小組執行委員許睿琪也指出，實習和住院醫師過勞，會對他們的身心健康、醫療品質、臨床和自主學習造成負面影響，可是在衛生署規劃的評鑑制度中，卻把醫師的每週工作時間訂為88小時，超過美國ACGME規範的80小時工時，同時，國內規範的連續工時更長達36個小時，也比ACGME規範的28小時上限還要不合理。
立委李應元則呼籲衛生署在評鑑制度的規範，應該要將醫師的每週工作時間訂為80個小時，並把醫師的連續工時縮減為28小時，才能夠減少醫師過勞帶來的負面影響。
http://tw.news.yahoo.com/%E9%86%AB%E5%B ... 04987.html

[newshine]

[auricle]

衛生署 : 不凹你們怎麼圖利財團呢 ? 笨啊~

[李誠民]

那請問減少住院醫師的工時(WORKING HOURS),所帶來的照護病患工作要由誰替補,如何彌補?!
這是現實問題,ACGME做出了80hrs./wk.(?)還有許多其他規定,對"patient Safety"---2009年的 IOM初步報告也未有定論,final report(?)要在2014年出來!!!......
但ACGME的縮短working hrs.(80hrs/wk 0r65hrs/wk),並未增加GPY-1(Intern)的睡眠時間.........天下沒有白吃的午餐?! ----只有台灣有,而且就是台灣醫師有,所以台灣健保制度有世界獨有的點值支付制度

[李誠民]

美國對Libby Zion Act為甚麼OSHA推掉應負的責任,推給ACGME,請醫師, 醫院,診所,........深思!可能傷害到病人的權益&安全!!!
政治人物是不會考慮的,因為它可能根本沒什麼基本信仰;尤其是Bumbler,雖然是哈佛法學博士!---有興趣談談美牛進口案(2008年)

[李誠民]

醫學生(?包括Clerk-見習生, Intern-實習生???),對ACGME的規定了解有多少?......

ACGME規定的是住院醫師(Trainee,包括Intern-PGY-1), 醫學生(graduate medical school student?)有何關聯?---只是被利用的一群可憐人(?!)

這些人有沒有上ACGME官方網站,閱讀過它的規定?.........可是好幾(十)頁的規定!!!....甚麼80 hrs/wk,什麼輪班制度(36hrs. on call or/&on duty)有甚麼人看過了!!!,IOM的報告是什麼"碗糕"??? 要在2014年初來,又要改了(?!),;台灣怎麼跟著做----國情, 問題都不同.........

GMC launches new whistleblowing helpline
Authors: Helen Jaques
Publication date: 12 十二月 2012

Whistleblowing helpline takes more than 350 calls in first four months
BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2774 (Published 29 April 2013)
Cite this as: BMJ 2013;346:f2774

台灣醫師的陳坷,或許學學英國設立告密電話( Whistleblowing helpline ),但前提是正常 長官(上級醫師,指導醫師,....都是不通的!!!---長庚不就是如此,台大更是如此!!!......如何解決?!只好借助外力---全聯會,更是官衙門一個!!...怎麼辦?!......茉莉花革命?--笑死人!! 施理事的叔叔---施明德的革命???)

[dtemer92]

呼籲衛生署在評鑑制度要比照美國ACGME的規範，才可以減少醫師過勞帶來的負面影響。

這也是請鬼開藥單 @@"

不至少對於醫學生勇於爭取權益拍拍手.

醫學生不是醫師, 看事情的高不也不一樣;
如果他們成功爭取減少的workload, 將來發現會被加到residents身上,
導致自身不斷於悲慘循環中遭遇一樣的事情
她們會做何感想.

同理, 萬一residents爭取到的減少工作量, 最後發現自己當了VS還在承擔, 不知道會不會後悔. (不過residents通常已經很認命了, 而且看事情觀點不同)

反正問題是一個個發掘, 一個個解決.
最終, 還是大環境問題. 健保才是萬惡淵藪.

[李誠民]

Holistic全人教育 Review — Shaping the Medical Profession One Applicant at a Time
Robert A. Witzburg, M.D., and Henry M. Sondheimer, M.D.
April 10, 2013DOI: 10.1056/NEJMp1300411
Modern medicine has been characterized by rapid and accelerating progress in biomedical sciences as the foundation for clinical practice. In 1910, the Flexner Report established these sciences as the core of medical education.1 Admissions committees at U.S. medical schools have, for the past century, focused their attention largely on predictors of success in the foundational science curriculum, relying heavily on academic performance in the biologic and physical sciences and scores on the Medical College Admission Test (MCAT) in selecting applicants for medical school.

Abundant data support the contention that performance in the medical school science curriculum and on the U.S. Medical Licensing Examination (USMLE) Step 1 are predicted by performance on the MCAT and in the undergraduate science coursework required of medical school applicants.2 Key aspects of behavior, character, and performance that are essential for the practice of medicine, however, cannot be predicted from these measures. In addition, performance on standardized tests and in undergraduate sciences is influenced by myriad social, demographic, and economic factors that limit the utility of these measures in large segments of the potential applicant pool for medical school.

Over the past decade, individual medical schools, supported by the Association of American Medical Colleges (AAMC), have been working to expand the frame of reference for evaluating applicants for medical school. These efforts have come together under the “holistic review” rubric endorsed by the U.S. Supreme Court in 2003: “..........
In 2003, the Boston University School of Medicine (BUSM) became one of a number of U.S. medical schools to launch a systematic transition from a traditional admissions model based largely on the review of academic metrics to a comprehensive, holistic review process.......
.....
......

Reforming Premedical Education — Out with the Old, in with the New
David Muller, M.D.
April 10, 2013DOI: 10.1056/NEJMp1302259
Comments open through April 17, 2013
The most consistent and strident刺耳的 calls for medical education reform over the past century have focused on premedical preparation. The first attempt at standardizing requirements for medical school admission came in 1904 from the American Medical Association's Council on Medical Education. In 1910, Abraham Flexner recommended requiring biology, chemistry, botany, and physics, and by 1930, today's premedical science preparation — biology, chemistry, organic chemistry, and physics — was firmly established. But criticism began as early as 1929, and in 1939 the Association of American Medical Colleges weighed in.......
......
.......

The Step 2 Clinical Skills Exam — A Poor Value Proposition
Elmer Philip Lehman, IV, M.D., M.P.P., and Jason Ross Guercio, M.D., M.B.A.
N Engl J Med 2013; 368:889-891March 7, 2013DOI: 10.1056/NEJMp1213760
Efforts to minimize the regulatory and administrative burden in U.S. health care have never been greater. Stakeholders, including physicians, increasingly focus on eliminating waste and reducing costs in these areas to maximize the value and efficiency of care. One regulatory domain that deserves greater scrutiny in this context is medical licensure.

For example, the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB) mandate the purchase of four licensing products by medical students and resident physicians over the course of their training......
Step 2 Clinical Skills (CS), is a day-long evaluation of clinical skills that takes place at one of five standardized-testing centers in the United States. Given the pass rates among examinees and the exam's cost, we believe that Step 2 CS provides a poor return on investment and little appreciable value to the U.S. health care system — and should therefore be eliminated........

Step 2 CS. Using the most recent data available, we calculate that the cost of this test to U.S. and Canadian examinees is at least $20.4 million per year, given that 17,852 first-time examinees took the test in 2011 at a per-examinee cost of $1,140 (see tableFinancial Analysis of the USMLE Step 2 Clinical Skills Exam....
Under the assumption that the average physician takes 15 years to pay off medical student debt, compounded interest would increase the aggregate annual cost of the Step 2 CS to $56.4 million. If that were the case, given a standard inflation discount rate of 3%, the 15-year cost of the exam would be $36.2 million annually in 2012 dollars.....
.........
.........自行參考!!
呈dtemer92先生參考!台灣醫學生(?)-----井底之哇!!!.....同意嗎?!

[李誠民]

Holistic全人教育 Review — Shaping the Medical Profession One Applicant at a Time
Robert A. Witzburg, M.D., and Henry M. Sondheimer, M.D.
April 10, 2013DOI: 10.1056/NEJMp1300411
Modern medicine has been characterized by rapid and accelerating progress in biomedical sciences as the foundation for clinical practice. In 1910, the Flexner Report established these sciences as the core of medical education.1 Admissions committees at U.S. medical schools have, for the past century, focused their attention largely on predictors of success in the foundational science curriculum, relying heavily on academic performance in the biologic and physical sciences and scores on the Medical College Admission Test (MCAT) in selecting applicants for medical school.
Abundant data support the contention that performance in the medical school science curriculum and on the U.S. Medical Licensing Examination (USMLE) Step 1 are predicted by performance on the MCAT and in the undergraduate science coursework required of medical school applicants.2 Key aspects of behavior, character, and performance that are essential for the practice of medicine, however, cannot be predicted from these measures. In addition, performance on standardized tests and in undergraduate sciences is influenced by myriad social, demographic, and economic factors that limit the utility of these measures in large segments of the potential applicant pool for medical school.

Over the past decade, individual medical schools, supported by the Association of American Medical Colleges (AAMC), have been working to expand the frame of reference for evaluating applicants for medical school. These efforts have come together under the “holistic review” rubric endorsed by the U.S. Supreme Court in 2003: “..........
In 2003, the Boston University School of Medicine (BUSM) became one of a number of U.S. medical schools to launch a systematic transition from a traditional admissions model based largely on the review of academic metrics to a comprehensive, holistic review process.......
.....
......

Reforming Premedical Education — Out with the Old, in with the New
David Muller, M.D.
April 10, 2013DOI: 10.1056/NEJMp1302259
Comments open through April 17, 2013
The most consistent and strident刺耳的 calls for medical education reform over the past century have focused on premedical preparation. The first attempt at standardizing requirements for medical school admission came in 1904 from the American Medical Association's Council on Medical Education. In 1910, Abraham Flexner recommended requiring biology, chemistry, botany, and physics, and by 1930, today's premedical science preparation — biology, chemistry, organic chemistry, and physics — was firmly established. But criticism began as early as 1929, and in 1939 the Association of American Medical Colleges weighed in.......
......
.......

The Step 2 Clinical Skills Exam — A Poor Value Proposition
Elmer Philip Lehman, IV, M.D., M.P.P., and Jason Ross Guercio, M.D., M.B.A.
N Engl J Med 2013; 368:889-891March 7, 2013DOI: 10.1056/NEJMp1213760
Efforts to minimize the regulatory and administrative burden in U.S. health care have never been greater. Stakeholders, including physicians, increasingly focus on eliminating waste and reducing costs in these areas to maximize the value and efficiency of care. One regulatory domain that deserves greater scrutiny in this context is medical licensure.

For example, the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB) mandate the purchase of four licensing products by medical students and resident physicians over the course of their training......
Step 2 Clinical Skills (CS), is a day-long evaluation of clinical skills that takes place at one of five standardized-testing centers in the United States. Given the pass rates among examinees and the exam's cost, we believe that Step 2 CS provides a poor return on investment and little appreciable value to the U.S. health care system — and should therefore be eliminated........

Step 2 CS. Using the most recent data available, we calculate that the cost of this test to U.S. and Canadian examinees is at least $20.4 million per year, given that 17,852 first-time examinees took the test in 2011 at a per-examinee cost of $1,140 (see tableFinancial Analysis of the USMLE Step 2 Clinical Skills Exam....
Under the assumption that the average physician takes 15 years to pay off medical student debt, compounded interest would increase the aggregate annual cost of the Step 2 CS to $56.4 million. If that were the case, given a standard inflation discount rate of 3%, the 15-year cost of the exam would be $36.2 million annually in 2012 dollars.....
.........
.........自行參考!!
呈dtemer92先生參考!台灣醫學生(?)-----井底之哇!!!.....同意嗎?!
還好!!現在台大醫學院的建議(教育部規定),還沒有提到要繳多少費用?!還是不用費用???---醫學生等著被剝削吧?!.........