Family physicians practicing in the most obese population in the United States tend to be high-frequency obesity nutrition counselors who frequently use specific tools, consider their education lacking and face oft-cited barriers. Studies in other highly endemic areas are needed to confirm these findings.
Though inter-facility acute care patient transfers from resource-limited rural hospitals are necessary, it is desirable to minimize them for several reasons. Some transfers might be potentially avoidable with appropriate pre-transfer teleconsultation. We conducted a retrospective record review of adult patient transfers to our rural academic medical center for medical-surgical services or critical care to estimate the frequency of potentially avoidable patient transfers and to identify any re-quested specialty that was more often associated withpotentially avoidable patient transfers. Excluded were patients transferred via trauma network or for obstetrics care. Transfers were judged potentially avoidable if resulting in live discharge within 48 hours without procedures or intensive care. We studied patient demographics and transferring facility characteristics.We examined 1,180 transfers between June 2016 and January 2017 and judged 21.6% (N=255) potentially avoidable. Transfers for Neurology consultation were 2.5 times (95% CI 1.2 -5.0) more likely to be avoidable relative to transfers for General Surgery. Neurology was the only specialty associated with a greater likelihood of potentially avoidable transfers than the comparator specialty.A significant proportion of inter-facility patient transfers to our facility are potentially avoidable. Neurology-related transfers might warrant pre-transfer teleconsultation.
North American medical students are increasingly seeking global health clinical field experiences very early in their training. These experiences can be greatly improved by appropriate preparatory didactic courses. The challenges of designing a course like this for early-stage medical students are considerable. No medical school appears to offer a brief, intensive didactic course encompassing both biological and psycho-social determinants of health designed for application to real-life scenarios in resource-poor global contexts by medical students with limited basic science and clinical background. This paper describes a course, "Human Behavior and Disease in Tropical Developing Countries" (FCH 735) offered at Joan C. Edwards School of Medicine (JCESOM) at Marshall University that fits these criteria. The course, taught by a family physician, is offered to medical students as a forty-hour, one-week summer elective after the first year. It employs a distinctive pedagogical strategy and organizes material according to relevant human behaviors. Students have performed well on written and oral evaluative exercises. Nine students' reactions to the course were further explored confidentially, using qualitative research techniques, by a peer not enrolled in the class. The students' comments affirmed that the course's goals had been achieved. FCH 735 is a unique global health course offering that appears to meet the challenges faced in designing a robust preparatory didactic global health course for early-stage medical students. Replication and application of the course's methodology in other settings and to other aspects of pre-clinical medical school curriculum might be beneficial.
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