Journal of general internal medicine
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Inpatients with impaired decision-making capacity may attempt to leave the hospital prematurely. When no surrogate decision-maker is available, clinical teams often lack a legal basis to keep these patients. ⋯ Clinicians need explicit legal authority to temporarily detain and treat incapacitated and unrepresented patients. Physician and hospital associations should lobby state legislatures to create new statutes for medical incapacity modeled after mental health laws.
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Nonverbal communication plays a pivotal role in the provision of effective patient care and has been associated with important patient health outcomes. Clinician posture, a nonverbal form of communication, may influence the patient experience and satisfaction. The relationship between clinician posture (i.e., standing or at the patient's eye level) and patient perceptions of clinician communication in the hospital-a setting with heightened power dynamics between patient and clinician-is currently unknown. ⋯ PROSPERO, CRD42020199817.
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Misinformation about reproductive health threatens to harm health outcomes, compromise medical trust, and enable misinformed policy restrictions. In recent years, reproductive health misinformation has proliferated online due to ideological campaigns and limited content moderation for reproductive health topics. Developing evidence-based practices to counter reproductive health misinformation requires an understanding of the content that women are exposed to online, which is currently lacking. ⋯ Fourteen percent promoted alternative medicine. Smaller numbers of claims and narratives exaggerated risks of medical interventions, discouraged evidence-based interventions, directly undermined medical trust, and proposed inaccurate biological mechanisms. Healthcare professionals can proactively promote evidence-based medical decision-making by increasing their awareness of prominent misleading claims and narratives.
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In medical education, learner self-assessments are standard methods used to evaluate the impact of curricula and workshops. Due to the subjective nature of self-assessment, these measures are prone to known biases including framing, recall, social desirability, and response-shift bias. These biases can contribute to floor and ceiling effects of measurement, which can lead to false conclusions about whether the intended learning objectives were achieved. ⋯ For each design, we review strengths, weaknesses, and known biases and discuss examples to highlight trade-offs between options. We also discuss the use of control groups and follow-up surveys to measure retention over time as additional methods to address bias and related confounding. The guidance presented here is intended to raise educators' awareness of common pitfalls in self-assessment; minimize the impact of known biases when possible; provide evidence, examples, and rationales for optimal design choices; and increase the rigor of self-assessment evaluations.
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Editorial Review
Complexities of Physician Workforce Projection: Call for a Unified National Healthcare Workforce Policy.
Ensuring an adequate supply of physicians is paramount in securing the future of healthcare. To do so, accurate physician workforce predictions are needed to inform policymakers. ⋯ Moreover, while federal and state entities invest approximately $15 billion annually in graduate medical education (GME) payments, they have very little control over how the funding is used to shape the future physician workforce. In this article, we review physician workforce predictions from both an international and a domestic perspective and finally discuss how the creation of an apolitical, data-driven, expert-led panel at the federal level with sufficient authority to influence broader workforce policy is the optimal solution for ensuring an adequate supply of physicians for generations to come.