Kevser Vatansever

Exposure of medical students to pharmaceutical marketing in primary care settings: frequent and influential

It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient–physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts. Considering the move toward early clinical encounters and community-based education, which expose students early to pharmaceutical representatives, the influence of those gifts is becoming a matter of concern. This study examines the frequency and influence of student exposure to drug marketing in primary care settings, as well as student perceptions of physician–pharmaceutical company relationships. This was a two-phase study consisting of qualitative research followed by a cross-sectional survey. Clinical experience logbooks of 280 second-year students in one school were analysed, and the themes that emerged were used to develop a survey that was administered to 308 third-year students from two medical schools. Survey results showed a 91.2% exposure to any type of marketing, and 56.8% of students were exposed to all classes of marketing methods studied. Deliberate targeting of students by pharmaceutical representatives, in particular, was correlated with being less sensitive to the negative effects of and having positive opinions about interactions with pharmaceutical companies. The vast majority of students are exposed to drug marketing in primary care settings, and may become more vulnerable to that strategy. Considering that medical students are vulnerable and are targeted deliberately by pharmaceutical companies, interventions aimed at developing skills in the rational use of medicines and in strategies for coping with drug marketing should be devised.

Validity and reliability of the Turkish version of the Hill–Bone compliance to high blood pressure therapy scale for use in primary health care settings

Abstract Objectives: To assess the validity and reliability of the Turkish version of the Hill–Bone compliance to high blood pressure therapy scale for use in primary care in Turkey. Methods: To develop a Turkish version of the scale, it was translated into Turkish then back-translated into English. The final version was used in a survey in two urban primary health care centers in Izmir, Turkey. For assessing the validity of Turkish scale, we performed factor analysis to test construct validity. Reliability was assessed by calculating the Cronbachs alpha as a measure of internal consistency. Results: Factor analysis revealed a three–factor structure representing unintentional medication non-adherence; intentional medication non-adherence; and salt intake adherence. Percentages of explained variance were 33.3%, 14.6% and 11.2% respectively. When forcing a two-factor structure we found salt intake and medication adherence clusters. Cronbachs alpha was 0.72 and 0.83 for medication adherence and whole scale, respectively. Conclusion: The Turkish Hill–Bone scale presented a factor structure consistent with the original scale, had a high level of internal consistency. It can be used for assessing hypertension patients’ compliance in Turkish primary care settings.

An early patient contact programme combining simulation and real settings.

Context and setting We present the format and the first year’s evaluation results of our Early Patient Contact Programme (EPCP) in the Year 2 curriculum. We implemented the EPCP during the 13-week Introduction to Clinical and Pathological Sciences block. We used a portfolio-driven, multisetting-based, experiential learning approach to teach patient interviewing skills to students. Why the idea was necessary Although early student)patient contact is generally seen as an educationally sound approach, the hospital setting seems not to be optimal. Previously, there was no structured patient contact programme in our curriculum. Teaching took place on an ad hoc basis during the clinical years and there was neither content nor method consensus among teachers. What was done In the preparation phase, an educational collaboration contract was signed with 20 primary health care centres (PHCCs). A computerised standardised patient laboratory was established. Using guidelines drawn from the Calgary-Cambridge Observation Guide to the Consultation and MAASGlobal (an instrument designed to rate the communication and clinical skills of doctors in consultations), a conceptual framework and a set of patient interview guidelines were developed. A total of 284 Year 2 students were divided into 3 main rotating groups and then into 32 subgroups, each consisting of 3 students. Teaching teams were formed, each composed of 1 clinical teacher and 1 general practitioner (GP) teacher and each in charge of 3–6 subgroups. Nine teacher training and programme development workshops were organised for GPs and faculty members. A student learning and assessment portfolio was developed. In the implementation phase, the programme included 8 hours of preparatory lectures, 3 half-day work sessions at PHCCs and hospital clinics, 9 SP encounters (in 3 doctor and 6 observational roles) and 3 group feedback sessions. In each session, teachers worked with 3–6 students and used the experiential learning cycle. Students were given feedback on the SP contacts by their peers and the SPs following the SP contact and from their GP teachers through the records. Evaluation of results and impact The EPCP was evaluated by: • student achievement: assessed with a portfolio (40%) and an SP-based performance examination (60%); • a student feedback questionnaire; • a student programme evaluation meeting, and • teachers’ SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis.

Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey

Background Natural disasters, armed conflict, migration, and epidemics today occur more frequently, causing more death, displacement of people and economic loss. Their burden on health systems and healthcare workers (HCWs) is getting heavier accordingly. The ethical problems that arise in disaster settings may be different than the ones in daily practice, and can cause preventable harm or the violation of basic human rights. Understanding the types and the determinants of ethical challenges is crucial in order to find the most benevolent action while respecting the dignity of those affected people. Considering the limited scope of studies on ethical challenges within disaster settings, we set upon conducting a qualitative study among local HCWs. Methods Our study was conducted in six cities of Turkey, a country where disasters are frequent, including armed conflict, terrorist attacks and a massive influx of refugees. In-depth interviews were carried out with a total of 31 HCWs working with various backgrounds and experience. Data analysis was done concurrently with ongoing interviews. Results Several fundamental elements currently hinder ethics in relief work. Attitudes of public authorities, politicians and relief organizations, the mismanagement of impromptu humanitarian action and relief and the medias mindset create ethical problems on the macro-level such as discrimination, unjust resource allocation and violation of personal rights, and can also directly cause or facilitate the emergence of problems on the micro-level. An important component which prevents humanitarian action towards victims is insufficient competence. The duty to care during epidemics and armed conflicts becomes controversial. Many participants defend a paternalistic approach related to autonomy. Confidentiality and privacy are either neglected or cannot be secured. Conclusion Intervention in factors on the macro-level could have a significant effect in problem prevention. Improving guidelines and professional codes as well as educating HCWs are also areas for improvement. Also, ethical questions exposed within this study should be deliberated and actualized with universal consensus in order to guide HCWs and increase humane attitudes.

Hastane Öncesi̇ Sağlık Profesyonelleri̇ne Yöneli̇k Travma İleri̇ Yaşam Desteği̇ Eği̇ti̇m Programı

Amac Calismanin amaci, hastane oncesinde karsilasilma ve olum orani yuksek vakalar arasinda yer alan travmaya, daha etkili, dogru ve acil mudahale edebilmek icin, ogrenen merkezli, kucuk grup calismasi iceren, uygulama ve simulasyon agirlikli, gercek yasam ortamlariyla uyumlu, ogrenenlerin uzak transferini kolaylastirmayi, yasam boyu ogrenmeyi icsellestirmeyi amaclayan bir egitim programi olarak hayata gecirilen “Travma Ileri Yasam Destegi Egitimi (TIYDE) ”nin tanitilmasidir. Gerec ve Yontem Arastirmada inceleme materyali olarak Haziran-Ekim 2015 zaman araliginda 89 katilimci ile 4 kez uygulanan TIYDE ele alinmistir. Istatistiksel analizler icin IBM Statistical Package for the Social Sciences (SPSS) 21.0 kullanilmistir. On-test, son-test ve uygulama sinavlari icin frekans dagilimlari hesaplanmis, karsilastirmali analizler icin ki-kare testi uygulanmistir. Bulgular Istatistiksel bulgularda; her kurs icin uygulama sinavlarindaki task gruplarina yonelik basari oranlari, on-test ve son-test ortalamalari, kurslar arasi uygulama sinav sonuclari ve cinsiyete gore on-test, son-test ve uygulama sinavlari karsilastirilmistir. Sonuc TIYDE programi, ulkemizde 4C-ID yontemi kullanilarak tasarlanmis ilk egitim programidir. Karmasik beceri ogretiminin hedeflendigi 4C-ID ogretim tasarimi modelinin sablonu travma egitiminin icerigi ve amaciyla bire bir ortustugu icin basarili ve etkin bir egitim programi ortaya cikmistir. Travma egitiminde ve diger karmasik ogrenme gerektiren beceri egitimlerinde 4C-ID yonteminin kullanildigi baska calismalara da gereksinim vardir.

Medical Students' Opinions About the Commercialization of Healthcare: A Cross-Sectional Survey.

There are serious concerns about the commercialization of healthcare and adoption of the business approach in medicine. As market dynamics endanger established professional values, healthcare workers face more complicated ethical dilemmas in their daily practice. The aim of this study was to investigate the willingness of medical students to accept the assertions of commercialized healthcare and the factors affecting their level of agreement, factors which could influence their moral stance when market demands conflict with professional values. A cross-sectional study was conducted in three medical schools in Turkey. The study population consisted of first-, third-, and sixth-year students, and 1,781 students participated in total. Students were asked to state if they agreed with the assertions of commercialized healthcare. Of all students, 87.2 per cent agreed with at least one of the assertions, and one-fifth (20.8 per cent) of them agreed with more than half of the assertions. First-year students significantly agreed more with some assertions than third- and sixth-year students. Being female, having mid-level family income, choosing medicine due to idealistic reasons, and being in the third or sixth years of medical study increased the probability of disagreement. Also, studying in a medical school that included integrated lectures on health policies, rights related to health, and health inequities, along with early field visits, increased the probability of disagreement. This study suggests that agreement with the assertions of commercialized healthcare might be prevalent among students at a considerable level. We argue that this level of agreement is not compatible with best practice in professional ethics and indicates the need for an educational intervention in order to have physicians who give priority to patients’ best interests in the face of market demands.

Education For Healthcare In Disasters: An Imperative For Undergraduate Medical Education

Obsesif kompulsif bozukluk genellikle 2.3. on yilda ortaya cikan tekrarlayici, istenmeyen, sikinti yaratici dusunce, imaj ya da durtuler ve eslik eden davranislardir. Gec yasta baslayan olgular nadirdir. 71 yasindaki hasta sol tarafinda gucsuzluk nedeniyle klinigimize basvurdu. Norolojik muayene ile sol hemiparezi, minimal disfazi ve anozognozi saptandi. Kranyal manyetik rezonans goruntulemede, sagda orta serebral arter kortikal dali sulama alaninda orta temporal girus posterior kismi ile inferior parietal lobulde, lentikulostriat arter sulama alaninda internal kapsul, sag globus pallidus ve putamende infarkt alani ve sag internal karotid arterde (ICA) okluzyon saptandi. 15 gun sonra idrar bulasma korkusu, surekli banyo yapma, el yikama, uykusuzluk ve yogun sikinti hissi yakinmalari gelisti. Davranislarinin sacma oldugunun bilincindeydi, fakat engelleyemiyordu. Noropsikolojik testlerde basit dikkati hafif bozuktu. Vizuospasyal islev ve kontruksiyon yetileri de bozuk olarak degerlendirildi. Obsesif kompulsif bozukluk genelde erken yaslarda baslamaktadir. Biz bu olgu ile serebrovaskuler nedenlere sekonder gelisen ileri yas olgulara dikkat cekmek istedik.“Gereksinimlerin yerel kaynaklarin kapasitesini astigi durumlar” biciminde tanimlanan olagandisi durumlarin sikligi, cesitliligi ve yikiciligi, dunyada ve ulkemizde artis gostermektedir. Saglik sistemlerinin dogrudan yasadigi altyapi ve insan gucu kayiplarinin yani sira toplumun saglik hizmeti gereksiniminin artmasi, cok-disiplinli ve gonullu ekiplerle calisma zorunlulugu, yerine getirilmesi gereken gorevlerin coklugu ve cesitliligi gibi sorunlar, durumu daha da karmasiklastirmaktadir. Bu sorunlarla bas etmek icin en temel araclardan birisi, saglik calisanlarinin olagandisi durumlara yonelik olarak egitilmesidir. Ancak dunyada ve Turkiye’de olagandisi durumlara hazirlikli olma ve etkili yanit verme egitimi acisindan cok umutlu bir tablo oldugunu ileri surmek guctur. Cok sayida program uygulaniyor olsa da, programlar cogunlukla kurumlarin birbiriyle isbirligi yapmadan duzenledigi, icerik acisindan onemli eksikler tasiyan, hedef grup kapsayiciligi yetersiz ve farkli sektorlerden olagandisi durum calisanlarinin esgudumunu desteklemeyen niteliktedir. Bu calismada dunyada ve Turkiye’de saglik alaninda olagandisi durum egitimiyle ilgili durum gozden gecirilmekte ve gereksinimlerin tanimlanmasi amaclanmaktadir. Ayrica bir ornek olarak, mezuniyet oncesi tip egitimi icin cekirdek yeterlik hedefleri belirlenmekte ve bir program onerisi sunulmaktadir. Program onerisi hazirlanirken, egitim programlarinin etkililigini guvenceye almak amaciyla onerilen egitim programi gelistirme basamaklari izlenmistir. Bu amacla, cesitli yontemlerle egitsel gereksinimler belirlenmis; olagandisi durum tibbiyla ilgili temel kaynaklar incelenerek ogrenme hedefleri secilmis ve ogrenme hedeflerine uygun ogretme yontem ve teknikleri kararlastirilmistir.