תוצאת חיפוש

Professional Assessment of Senior Immigrant Physicians

N. Notzer, M.I. Zibziner, J. Shemer, M. Ravid

Sackler Faculty of Medicine, Tel Aviv University

Israel has absorbed many immigrant physicians and has utilized their skills without compromising local professional standards. In accordance with this policy a special law for the assessment of the licensing of senior immigrant physicians, mainly from the former Soviet Union, who had practiced medicine for at least 14 years was implemented in 1994.

Considering their considerable medical experience on the one hand and their lack of experience in speaking Hebrew or undergoing testing techniques, they were exempted from the written national licensing examination. Instead they were obliged to undergo a 6-month clinical observation period in a local hospital or clinic.

At the end of this period a letter of confirmation was issued which was followed by an oral assessment of their clinical ability. In the assessment session, each candidate was presented with written presentations of 4 typical clinical cases which practitioners encounter on a daily basis, in family medicine, emergency medicine, surgery, and pediatrics or gerontology. Of 114 cases prepared, 4 were selected for each candidate by the committee of 13 trained, experienced Israeli physicians.

3 members of the committee assessed each candidate using specified criteria. The assessment, which lasted about an hour, focused on the candidates' professional knowledge involved in differential diagnosis and case management.

Of 497 candidates examined between 1994 and 1996, approximately 80% passed in their first attempt. However, about 30% of the invited candidates did not appear for the exam. Characteristics of successful candidates were being young and being among the seniors with the least clinical experience. Most had specialized in internal medicine and had completed their observation period in a non-academic hospital. There they had received somewhat more attention than those who had been in academic hospitals. Significantly, the successful candidates were more proficient in Hebrew than the unsuccessful candidates, and reported no special problems during the observation period.

Changes in Structure and Process Components of Trauma Care in Emergedepartments

Rephael Joseph Heruti, Ron Ben-Abraham, Yanir Abramovitch, Michael Stein, Joshua Shemer, Baruch Marganit

Trauma Control, Israeli Center for Disease Control (ICDC), Israel Ministry of Health and Sackler School of Medicine, Tel Aviv University

In recent years there have been tremendous efforts to improve primary trauma care. The Ministry of Health and other authorities have invested in new trauma facilities in various hospitals. A nationwide survey with regard to structure and function of emergency departments was carried out. Compared to a similar survey conducted in 1992, significant progress in quality and quantity of equipment at various emergency departments was demonstrated. However, there are still differences between various hospitals. A drive to standardize trauma care will undoubtedly contribute to improvement in care of the injured.

Israel's ATLS Program: Summary and Outlook

Ron Ben Abraham, Michael Stein, Yoram Kluger, Gideon Paret, Avraham Rivkind, Joshua Shemer

Medical Dept., Israel Defense Forces and Israel Trauma Society

In recent years a vigorous effort has been made to improve quality of primary trauma care in Israel. Advanced trauma life support courses (ATLS) were given to physicians throughout the country, regardless of their specialties. In 7 years 4229 physicians participated in 202 courses with an average success rate of 76%. In the future, issues such as mandatory vs. voluntary training, language barriers, and continuous decline of knowledge should be addressed if momentum is to be maintained.

ATLS Course for Surgery Residents - Should it be Mandatory?

Ron Ben-Abraham, Michael Stein, Yoram Kluger, Gideon Paret, Avraham Rivkind, Joshua Shemer

Medical Corps, Israel Defense Forces; Sourasky Medical Center and Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University; and Hadassah Medical Center, Jerusalem

Senior surgeons were asked about mandatory participation of general surgery residents in the advanced trauma life support (ATLS) course. Although trauma care in Israel is given by surgical residents, in the opinion of their senior mentors the course should continue to be mandatory for them.

Orthopedic Ward Policy in Introduction of New Types of Total Hip Implants

U. Givon, M.I. Siebzhener, M. Salai, A. Chechick, H. Horoszowski, J. Shemer

Orthopedic Staff, Medical Technology Unit, Medical Dept. F, and Gertner Institute for Study of Health Services, Chaim Sheba Medical Center, Tel Hashomer

The use of different types of total hip implants in medical centers in Israel was surveyed. Questionnaires were sent to all orthopedic ward directors in Israel requesting information on the number of total hip arthroplasties performed between the years 1984-1993, the types of implants used, and whether attending physicians or residents perform the operations. 22 of 24 orthopedic wards responded but 1 ward was excluded because only the results for 1993 were reported. 5 wards reported more and 16 fewer than 50 operations a year. 15 different types of implants were in use in Israel in that period, and in 5 wards 5 or more types of implants were used. Only 1 of the wards performed more than 50 operations a year. We conclude that the indiscriminate use of multiple technologies in wards performing few operations can lead to the long "learning curves" previously associated with poor results. Orthopedic surgeons should resist the impulse to introduce new implants, thus improving results and lowering expenditure. The need for regulating the introduction of new implants is emphasized.

Epidemiological Characteristics of Outbreaks of Diarrhea and Food Poisoning in the Israel Defense Forces

I. Grotto, Y. Mandel, I. Ashkenazi, J. Shemer

Army Health Branch, IDF Medical Corps and Sackler Faculty of Medicine, Tel Aviv University

Acute infectious diseases of the gastrointestinal tract and food poisoning are problems of great importance in the Israel Defense Force (IDF). They involve individual and epidemic morbidity, with impairment of health of individual soldiers and in the activities of units. Outbreaks of gastrointestinal infectious diseases must be reported to the IDF army health branch, which conducts epidemiological investigation. This study is based on data from yearly epidemiological reports for 1978-1989, and from a computerized database for the years 1990-1995. The incidence of outbreaks is characterized by an unstable trend, It was highest at the end of the 80's (68.3 per 100,000 soldiers on active duty) and lowest for the last 2 years (1994-1995, 36.3 per 100,000). The incidence of soldiers involved in food-borne outbreaks has been more stable, constantly declining during the course of the years. There was marked seasonality with a peak in the summer months. Sporadic morbidity was constant in 1990-1995, with a yearly attack rate of 60% in soldiers on active duty. Shigella strains were the leading cause of outbreaks until 1993, while in 1994-1995 their proportion decreased, with an increase in the proportion of Salmonella strains. As to Staphylococcus aureus, its role in causing food poisoning has been characterized by marked changes. Shigella sonnei replaced Shigella flexneri as the leading strain. 73.3% of outbreaks were small, with fewer than 40 soldiers involved, while 5.4% of outbreaks affected more than 100 soldiers. Outbreaks in which a bacterial agent was identified or which occurred in new-recruit bases were larger than those in which a bacterial agent was not identified, or which occurred in active field unit bases. In conclusion, the rates of infectious disease of the gastrointestinal tract are still high, although there has been a marked decrease since 1994. The incidence of outbreaks has also decreased, as well as the role of Shigella as a leading causative agent.

ATLS Course in Emergency Medicine for Physicians?

Ron Ben-Abraham, Michael Stein, Yoram Kluger, Amir Blumenfeld, Avraham Rivkind, Joshua Shemer

Medical Corps, Israel Defense Forces; and Trauma Units of Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, and of Hadassah Hospital, Jerusalem

Implementation of Advanced Trauma Life Support (ATLS) skills among practicing physicians and its perceived utility in their civilian practices, as well as in their potential army combat assignments, was evaluated. 177 physicians in various subspecialties, who were graduates of ATLS training courses, answered a specially designed telephone questionnaire. An unexpectedly high percentage of physicians (47%) had used their ATLS training when called to treat trauma victims. 67% of physicians stressed the contribution of the ATLS course to enhancing their skills. We believe that a properly designed ATLS course for general practitioners would be very beneficial for trauma victims.

Smoking Habits of Young Israeli Soldiers

I. Askenazi, J. Shemer

Medical Corps, Israel Defense Forces, and Sackler Faculty of Medicine, Tel Aviv University

A random sample of 32,166 soldiers were interviewed (on their day of discharge from the Israeli Defence Forces, between 1980-1995) with regard to smoking habits. Among men, prevalence of current smoking was 46.8%, and among women 32.9%. Over the study period, prevalence in men decreased 27%. Among women, prevalence decreased from 1981 to 1991, but since then it has steadily increased. Among men, mean number of cigarettes smoked decreased from 21.6 in 1989 to 16.6 in 1995. Among women cigarettes smoked decreased from a mean of 14.3 in 1989 to 13.1 in 1995. 65.9% of the men and 49.3% of the women had started smoking by the age of 18. Among men the age distribution of smoking changed hardly at all over the years of the study. However, the proportion of women who began to smoke in the youngest age bracket (15 years of younger) doubled over the course of the study.