Autor : Ibarrola, Manuel1, Falco, Jimena1, Heres, Marcela1, Quadrelli, Silvia1
1Sanatorio Güemes, Autonomous City of Buenos Aires
https://doi.org/10.56538/ramr.XRCW5287
Correspondencia : Manuel Ibarrola. E-mail: cm.ibarrola@gmail.com
ABSTRACT
Continuing
Medical Education (CME) is essential to ensure that healthcare professionals
stay updated on advances and changes in their field. However, CME faces a
series of challenges that limit its effectiveness and scope, including lack of
time and resources, limited accessibility, and the need for greater
collaboration and coordination among continuing medical education
organizations.
This
work provides valuable information about the working conditions of doctors, continuing
medical education, and participation in research projects, as well as the
impact of the COVID pandemic on them.
Key
words: Education,
Medical, Continuing, Working Conditions, COVID 19
RESUMEN
La
educación médica continua (EMC) es fundamental para asegurar que
los profesionales de la salud estén actualizados en cuanto a los
avances y cambios en su campo. Sin embargo, la EMC se enfrenta a una serie de
desafíos que limitan su efectividad y alcance, entre los que se incluye
la falta de tiempo y recursos, la accesibilidad limitada, y la necesidad de una
mayor colaboración y coordinación entre las organizaciones de
formación médica continua.
El
presente trabajo proporciona información valiosa sobre las condiciones
de trabajo de los médicos, la educación médica continua y
la participación en proyectos de investigación, así como
el impacto de la pandemia COVID en ellos
Palabras
clave: Educación
Médica Continua, Condiciones laborales, COVID 19
Recibido: 05/23/2024
Aceptado: 10/26/2024
INTRODUCTION
Continuing
Medical Education (CME) is essential to ensure that healthcare professionals
stay updated on advances and changes in their field. However, CME faces a
series of challenges that limit its effectiveness and scope, including lack of
time and resources, limited accessibility, and the need for greater
collaboration and coordination among continuing medical education
organizations.
The
COVID-19 pandemic has significantly impacted CME and has brought about changes
in the attitudes and motivations of physicians. The need to quickly incorporate
knowledge about various aspects of an entirely new topic, the demand for new
education formats compatible with isolation, and the influx of information with
lower levels of processing and evidence have generated enormous pressure and
some uncertainty. On the other hand, the pandemic has also affected the
availability of resources and time for continuing education. During the
pandemic, physicians and other healthcare professionals have faced significant
demands and pressures due to the workload and the challenges of providing
healthcare in a context of crisis.
After
the pandemic, there was a decreased demand for traditional CME formats
(face-to-face courses, workshops, conferences) as well as certain disinterest
in both intensive and low-intensity educational proposals. We can’t ignore the
fact that the lack of recognition and support for physicians has generated
discontent and frustration in some cases, which lead to some of them seeking
new job opportunities or even considering leaving the profession. Regarding
this reality observed in daily professional practice, Drs. Silvia Quadrelli,
Rosa Estevan, and Lilian Capone conducted a survey in 2021 to evaluate the
impact of the pandemic on the work and economic aspects of pulmonologists and
kinesiologists in the Autonomous City of Buenos Aires (CABA). The survey wasn’t
published, but it was presented at the 49th Argentine Congress of Respiratory Medicine.
It revealed several important findings:
•
the number of professionals considering leaving their medical social work
tripled (from 14.9% to 49.4%)
•
58.6% of respondents increased the number of in-person working hours, while
approximately the same amount (57.5%) reported earning less during the pandemic
•
50.6% stated that they had not regained their pre-pandemic income levels
•
51.7% of respondents felt that society did not value their work during the
pandemic, while 37.9% felt it was only partially valued
•
48.2% reported having less satisfaction with being a healthcare professional
during and after the pandemic
These
data support the general observation that job satisfaction among physicians is
lower after the pandemic, but it is unclear how much this depends on the
different factors (including their work environment, the quality of care they
can provide, the support they receive from their employers and society, and
their ability to maintain a work-life balance) or what their expectations are
regarding different educational formats. This study aims to contribute to a
better understanding of the educational landscape in order to be able to
promote policies and practices that address these factors, which in turn may
help improve satisfaction with educational proposals after the pandemic.
MATERIALS AND METHODS
A
total of 310 surveys were distributed among pulmonologists currently
practicing in Argentina. These surveys were created
using Google Forms and
were distributed digitally via the WhatsApp application to private mobile phones, sent
individually. The spectrum of respondents included all levels of training (from
physicians completing their training as pulmonologists to senior pulmonologists
with many years of practice). There were no restrictions to be included in the
sample as long as all the responses were completed. The responses were received
online and were anonymous. The survey included 23 questions related to
demographic data, type of professional practice, educational topics and formats
of interest, desired and actual time allocated for continuing medical
education, and obstacles to achieving the necessary goals.
Descriptive
statistics methods were used. For group comparisons, Student’s t-test or
chi-square tests were used.
RESULTS
230
responses were obtained from the 310 distributed surveys (74.1%). Table 1
details the characteristics of the surveyed population (age and type of medical
practice). The average time dedicated to outpatient care was 71.3% (range 0 to
100%, SD 27.2%). Additionally, 73% of the doctors devoted more than 60% of
their practice to outpatient care.
When
asked if institutional consultation spaces were available to discuss their
patients, 56.1% responded that they were always available when needed, while
only 8.3% said they were never available.
81.7%
considered that they weren’t dedicating enough time to their Continuing Medical
Education (CME). The dedicated average time was 6.2 hours per week with a wide
dispersion (range 0 to 14; SD 3.8). The most common cause was work obligations
(73%), and the influence of the quality of educational formats was only 11%
(Table 2).
Regarding
face-to-face educational events, only 33% (n = 76) reported having attended 40%
or more of the face-to-face events they were aware of, while attendance at
online events was higher, at 44.3% (n = 102, p < 0.001).
The
activities considered the most useful as educational formats were the Thematic
Conferences of the Argentinian Association of Respiratory Medicine (AAMR, for
its acronym in Spanish), and the least favored were the activities organized by
the industry itself. (Figure 1). Most educational formats were considered quite
useful or very useful (Table 3).
Regarding
the completion of intensive activities, 69.5% (n = 160) considered rotations of
one or two weeks in high-complexity Argentinian institutions to be quite or
very useful, and 53.4% considered them useful as long as they lasted one month.
In the analysis of the usefulness and feasibility of rotations of at least one
month in foreign institutions, 52.1% found them useful or very useful.
When
asked about their interest in participating in research projects (even
considering that they require time and effort), 53% would be very interested
and only 9.6% would not be interested in participating in multi-institutional
projects. In the case of projects that would only involve their institution,
44% were very interested and 11.7% were not interested. The higher interest in
participating in multi-institutional projects was statistically significant (p
= 0.046).
Populations older and younger than 40 years were compared. There
weren’t differences in the frequency of attendance at face-to-face events (p =
0.18) and virtual events (p = 0.20). There was a statistically significant
higher prevalence of financial concerns as the cause of a decreased dedication
to CME in the population under 40 years old (37.5% vs 20.7%; p = 0.02).
The respondents were asked to rate the different components of an
educational event (where 0 meant “I don’t value it” and 10 meant “I value it
very much”). The average ratings for a Congress or Thematic Conference were as
follows: expert talks 7.83 ± 2.0, case presentations 7.51 ± 2,36, practical
workshops 8.17 ± 2.16 and interactive questions 7.69 ± 2.1.
The presence of international experts, and to a lesser extent, of
national experts, along with the possibility of active participation
(presenting cases, asking questions, interacting with the experts), were the
factors considered as the most influential when deciding whether to attend an
event or not (Figure 2).
In response to the question, “How
comfortable and satisfied with your profession do you feel compared to what
you felt pre-pandemic?”, 40% said that they felt worse, while 19.1%
said that they felt better. 28.2% (n = 65) identified the phrase “I am
overwhelmed by my economic situation” as best defining their current situation;
35.2% (n = 81) declared that they felt the impact of society and/ or
institutions not recognizing the value of their work, and 25.6% (n = 59)
acknowledged being overwhelmed by the bureaucratic burden.
DISCUSSION
Regarding the objective of the present work, the survey demonstrated
that:
-The majority of the surveyed physicians spend most of their time
treating outpatients, and more than a third of them treat patients from trade
union-related health insurance and those with prepaid medical care.
-Most of the surveyed physicians reported that they do not
dedicate enough time to their continuing education. The main obstacles to
dedicating the necessary time to CME are the lack of time, workload, and
economic concerns, while the quality of educational formats does not seem to
be a determining factor in the physicians’ perception of the attractiveness and
adherence to educational offerings. Both face-to-face and the well-established
virtual formats seem to maintain the interest of the majority of the
postgraduate educational community.
-The respondents highlighted the importance of rotations in
high-complexity institutions, both in Argentina and
abroad, to improve their training. It has long been accepted that medicine is
not just an accumulation of knowledge but requires the development of
technical, cognitive, and emotional abilities, for which training oriented
towards skill acquisition is definitely necessary.
-The majority of the surveyed physicians expressed interest in
participating in research projects, especially if they are multi-institutional.
-According to the survey results, physicians value the possibility
of interacting with colleagues and experts in the field of pulmonology.
EURACT (European Academy of Teachers in General Practice) and
other medical organizations recommend interactive teaching techniques, which
are a mandatory part of the combination of different teaching models for
general practitioners in most European countries.1 The optimal combination of
teaching methods in the training of medical professionals—such as learning in
specific spaces (classes, workshops), in practice, or at home, as well as the
appropriate use of information and communications technology (ICT)—has been
found to be a blended learning system that can yield the best results.2
The data presented in this work cannot be analyzed outside the
context described by the respondents themselves. Under normal conditions,
adults want to learn, are self-directed, and need learning to be relevant and
applicable in their environment; when these conditions are met, they are highly
motivated.3 However, it is alarming to
highlight such a high proportion of physicians under 40 years old with
financial concerns that affect their dedication to continuing medical
education.
Research on the negative implications of medical burnout is
abundant, with key insights established long before the onset and ongoing
burden of the COVID-19 pandemic. Hodkinson et al analyzed 170 observational
studies involving 239,246 physicians in a large systematic review and
meta-analysis examining the association between medical burnout, career
commitment, and the quality of patient care. They demonstrated that burnout was
associated with a three to nearly fourfold increase in the likelihood of job
dissatisfaction and regrets about career choice, and that physicians who had
suffered burnout were three times more likely to consider leaving the
profession.4
A 2018 report by the Merritt Hawkins Medical Foundation found
that 46% of the surveyed physicians were planning to leave their current
position within the following three years.5 In 2020, the turnover rate for
registered nurses in the U.S. increased by 2.8%, reaching 18.7% currently, and
for physicians specifically, the turnover rate is estimated to be around 28%
for those in hospitals.6 According to global projections,
by 2030, 80 million qualified healthcare professionals will be needed, but
probably they won’t be available.7
This study has obvious limitations, and its main purpose is to
serve as a starting point for the formation of multidisciplinary working groups
from different areas of the healthcare system in Argentina.
It should be noted that the sample size is relatively small and almost
exclusively includes physicians from the Argentinian Association of
Respiratory Medicine. Therefore, the results may not be representative of the
general medical population in Argentina. The survey is
self-reported, which may affect the accuracy of the results. Despite these
limitations, this study provides evidence showing that physicians seek certain
characteristics in educational experiences: they look for educational
experiences that are relevant to their clinical practice and help them improve
their performance. Courses and workshops should be oriented towards practical
problems encountered in daily medical practice. Interactivity is essential;
experiences that allow interaction among participants are highly valued.
Physicians prefer those courses where they can discuss real cases, ask
questions, and receive feedback from colleagues and experts. They require
innovation and value experiences that offer new perspectives and strategies to
improve their clinical practice It will be necessary to incorporate innovative
technologies, such as virtual reality or machine learning, to adapt to the
needs of the highly digitalized new generations.
Conflict of interests:
Authors have no conflict of interest to declare.
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https://mphdegree.usc.edu/blog/a-closer-look-at-the-public-health-workforce-crisis/
| Galería de imágenes | ||
| Mujer joven con afectación pulmonar bilateral y alteración de la conciencia | ||
Autores: Churin Lisandro |
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