GP-MCQS teaching - Prometric MCQS for general practitioner (GP) Doctor Updated: 2023

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Hospital medicine is often synonymous with internal medicine, but as Bob Dylan famously said, the times they are a-changin’.

Family-medicine-trained hospital medicine practitioners may only represent 10 to 15% of practicing hospitalists, but they are a growing subgroup in the specialty, and the leaders of SHM’s Family Medicine Special Interest Group (SIG) aim to make that known as often and as loudly as they can.

Dr. Odeti

“Family medicine historically has been looked at as traditional outpatient practice,” said the SIG’s immediate past president Shyam Odeti, MD, MS, FAAFP, MBA, SFHM, section chief of Carilion Clinic in Roanoke, Va.

In the early days of hospital medicine, “there were not many organizations that were too familiar with family medicine physicians taking care of hospitalists’ roles,” he said. This perception has improved but isn’t completely gone. “So, one of the biggest advocacy initiatives is, ‘How do we make sure all the organizations across the nation know that family-medicine-trained physicians’ training during their residency programs adequately prepares them for the inpatient medicine practice?’”

Advocacy began with statements of support from SHM and the American Academy of Family Physicians. But to keep the progress rolling, the SIG acts as a real-time advocacy platform for its 1,129 members.

Dr. Chaudhry

For SIG chair Usman Chaudhry, MD, FHM, advocacy often starts with recruiters and medical directors hiring physicians in the first place. “They should be comfortable hiring them in their programs,” said Dr. Chaudhry, a family-medicine hospitalist medical director with Texas Health Physicians Group in Flower Mound, Texas.

Dr. Syamala

SIG vice-chair Krishna Syamala, MD, FAAFP, says a basic step for health care is for many institutions to change hospital bylaws, some created 25 or 50 years ago, long before hospital medicine became a specialty. Protocols that don’t account for family-medicine-trained hospitalists may not seem important, but some of the SIG leaders’ experiences suggest otherwise. They’ve secured positions in hospital leadership roles that were advertised for internal-medicine-trained hospitalists exclusively. 

“They ended up in their roles because of their exemplary track records, experience, and their ability to make a case for their roles,” said Dr. Syamala, who practices with SSM Health in suburban St. Louis. “So, likewise, I think educating more hospital medicine department chiefs, and engaging with them and advocating for taking family-medicine-trained hospitalists into their programs, I think that’s where SHM is really important for us.”

Another area of education is, well, education.

“When people are training in family medicine, they may not be aware of all the opportunities they would have in hospital medicine,” Dr. Odeti said. “So, we want to educate the group on what opportunities we have after the training.”

The SIG “reaches out to the residency programs and is also looking into reaching out to the medical students and having them be a part of the special interest group,” Dr. Chaudhry said. “That will help future residents, and it will help their careers improve.”

As is often the case in health care, continuing education is just as important. So family-medicine-minded hospital medicine leaders worked with the American Board of Family Medicine (ABFM) and the American Board of Internal Medicine (ABIM) to create a pathway for practitioners with different training backgrounds to work better together.

“We had to work with ABFM and ABIM to come up with the specialized certification called designated focus in hospital medicine,” Dr. Odeti said. “Once the hospitalists trained in family medicine were able to get certified after taking a test, per the Accreditation Council for Graduate Medical Education, they could be faculty in the internal-medicine training programs.

“What would that do? That would help family-medicine-trained hospitalists progress farther in their careers and be able to seek opportunities where there are internal-medicine residents in a program, and that would not become an exclusion factor for them for being hired.”

The SIG’s leadership board is focusing on advocacy not just with SHM and hospitalist leaders nationwide, but with stakeholders from the American Academy of Family Physicians, ABFM, ABIM, and other physician associations that have a role in spreading the word. Steps as seemingly simple as creating training modules within each specialty that recognize the roles played by family-medicine-trained hospitalists would be a step in the right direction.

“This is a cross-organization collaboration,” Dr. Odeti said, “so that we are not doing the work in silos.”

One initiative gaining steam is a critical-care fellowship that the SIG is pursuing via the ABIM.

“If family-medicine-trained hospitalists are accepted by ABIM, and they are allowed to participate in academic programs as full faculty members, it will be a big change in practice,” Dr. Syamala said. “The critical care pathway is one option that will be open. Also, other fellowship options will be open for us, like endocrinology, rheumatology, and so on and so forth.” 

Richard Quinn is a freelance writer in New Jersey.

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Annual wellness visits have long been considered a vital component of preventive health care. That hasn’t changed, though the dynamic between patient and health care professional during those visits has changed considerably for many people.

Once a realm exclusive to patients and their physicians, annual wellness exams now often involve patients and nurse practitioners. In fact, the American Association of Nurse Practitioners notes that NPs have become the preferred health partner of choice for millions of people, which makes it worthwhile to explore just what NPs do.

What is a nurse practitioner?

The AANP notes that NPs are highly educated clinicians who blend clinical experience in diagnosing and treating health conditions with an added emphasis on disease prevention and health management. All NPs must complete a master’s or doctoral degree program and have advanced clinical training beyond their initial professional registered nurse preparation. The education and training required of NPs prepares them to practice in various health care settings, including primary care, acute care and long-term care.

Which services can NPs provide?

Some people may not even realize that the NP they speak with during an annual wellness exam isn’t a physician. That’s because NPs can perform a host of services people often associate with physicians. The U.S. National Library of Medicine notes that NPs are allowed to provide a broad range of services, including:

• Perform a physical exam

• Order laboratory tests and procedures

• Diagnose, treat and manage diseases

• Prescribe medications and write prescriptions

• Coordinate referrals

• Provide information regarding preventive care and healthy lifestyles

• Perform certain medical procedures

What are the qualifications to be an NP?

The AANP notes that NPs undergo rigorous certification, periodic peer review and clinical outcome evaluations. NPs also must adhere to ethical codes. In addition, due to the fluid nature of health care, NPs must self-direct their continued learning and development to ensure they maintain their clinical competency.

Why do I see an NP and not a physician?

The AANP notes that NPs help to address a shortage of primary care physicians. With their expertise and accepted range of responsibilities, NPs are helping to ensure patients receive timely and accurate medical advice. Without NPs, patients may have to wait especially long periods of time to see their physicians, which could have dramatic and adverse long-term effects on their overall health.

Nurse practitioners play a vital role in modern health care settings. These versatile, talented professionals routinely apply their rigorous training and extensive education in ways that benefit their patients every day.

AMONG the myriad problems that President Bola Tinubu inherits are the terribly dysfunctional health and education sectors. To describe them as a mess is an understatement. Although his inaugural speech was silent on these two critical sectors, his manifesto sets out an ambitious desire to transform the education sector, reform the health care delivery system and ensure access to health services to all citizens. He will need to bring considerable skills, doggedness and effective policies to bear to fulfil these promises.

Tinubu advertises Nigeria’s broken health system. Like his predecessor, Muhammadu Buhari, he relies on foreign medical facilities for his own health care needs. Shamelessly, Nigeria’s leaders at every level jet abroad for theirs and their families’ health care. Buhari spent a cumulative 225 days on medical tourism in his eight years in office, according to Saturday PUNCH. Umaru Yar’Adua spent the greater part of the three years as president in German and Saudi Arabian hospitals before dying in office in 2010.

Tinubu had also been flitting in and out of the country for medical care ahead of his inauguration. Worse, also like his predecessors, he and his aides refuse to come clean with Nigerians on his health status. He should break sharply with such embarrassing behaviour by resolving to build first-rate hospitals and a national health care system that will obviate the need to seek care abroad. Findings by The PUNCH revealed that Nigerians spent $3 billion on medical tourism between 2020 and 2022.

The same applies to the education sector. Nigeria’s leaders at federal, state and local government levels have demonstrated their loss of faith in the country’s public educational system. Having ruined the public education system, they send their own children to exclusive preparatory, primary and secondary schools in the country. They thereafter send them abroad for higher education. Again, without shame, they regale Nigerians with photographs of their children matriculating or graduating in foreign institutions. Tinubu must reverse this trend. Development is accelerated by leaders determined to replicate the modernity they observed in other countries at home. But Nigeria’s public office holders simply do not care.

The disrepair in public hospitals, ill-motivated health workers and decrepit equipment have increased the appeal of overseas medical trips. Governments at all levels have refused to fix the problems.

Medical personnel are leaving in droves. The UK General Medical Council licensed at least 200 Nigerian-trained doctors between August 31 and September 30, 2022. Its data further indicated that 10,096 Nigerian-trained doctors moved to the UK 2015-2023. Nurses are not left out: 7,256 Nigerian-trained nurses relocated to the UK between March 2021 and March 2022, according to the UK Nursing and Midwifery Council.

Rather than confront the mess through adequate funding, equipping and motivation of personnel, and engagement with critical stakeholders, the government and the National Assembly chase shadows. The House of Representatives hurriedly proposed a draconian bill to amend the Medical and Dental Council of Nigeria Act to deny Nigerian-trained medical and dental medicine practitioners being fully licensed until they have worked for a minimum of five years in the country. The bill, which stakeholders say amounts to an exercise in futility, is a distraction; the sector needs radical reform to serve Nigerians and retain manpower.

Tinubu should tackle the rot headlong. His manifesto rightly acknowledges access to healthcare as a fundamental human right “and a matter of long-term national security.” It declares an intention to pursue reforms and policies “defined by the concept of Universal Health Coverage,” and through this, provide universal coverage, create jobs and reinvigorate the economy. That is the way to go.

Cuba has proved to the world that a country does not have to be rich to build an efficient healthcare delivery system. Its three-tiered structure of primary, secondary, and tertiary care is regarded as the world’s best and is recommended for developing economies by the World Health Organisation.

He should end public funding of medical tourism for public office holders. This requires building a sustainable and strong health care system through the provision of facilities and substantial funding. The administration’s mandate should focus on a patient-centred and motivated workforce. He should ensure accessible, quality and efficient health services with buy-in from state governments. Many Nigerians are dying from common diseases because they cannot afford the cost of treatment.

The state of primary health centres across states compounds the challenges with their lack of manpower, facilities, drugs, and rundown structures. They should be fully equipped in communities to reduce mortality rates and Excellerate Nigeria’s health indices. The WHO states, “Primary health care enables health systems to support a person’s health needs–from health promotion to disease prevention, treatment, rehabilitation, palliative and more.”

Tinubu needs to end perennial strikes by health workers by engaging honestly with them. A Saturday PUNCH report found that the numerous strikes by the National Association of Resident Doctors cost about 128 working days lost between 2016 and 2023. The doctors are seeking better working conditions and improved funding of the health care system.

The brain drain in the sector is disconcerting and Tinubu must stem the tide. The Nigerian Medical Association said only 24,000 licensed physicians currently cater to the over 200 million population in the country. This negates the WHO minimum threshold that a country needs a mix of 23 doctors, nurses, and midwives per 10,000 population.

Nigeria depends heavily on foreign drug manufacturers for its medical needs. For instance, Foreign Trade Statistics by the National Bureau of Statistics revealed that the country imported anti-malarial drugs worth N65.98 billion in the third quarter of 2021, and N43.47 billion in Q4 of the same year. The Tinubu administration must implement measures to stimulate local drug manufacturing capacity.

The challenges in the education sector are also legion. From inadequate funding, brain drain, inadequate research, and infrastructure decay to incessant strikes by the Academic Staff Union of Universities and other unions, education wobbles.

A United Nations Children Emergency Fund report in 2022 said Nigeria accounts for approximately 20.2 million out-of-school children, the second highest number of unschooled children globally after India. The situation is blamed on insecurity, poverty, displacement, street hawking, and excessive childbearing, among others. These issues must be addressed with allied partners, including community and religious leaders in the North, where the problem is most commonplace.

The current administration should convene an education summit involving states since education is on the Concurrent List to engender quality and relevance in the country’s education space. States and local governments should be roused to entirely drive primary and secondary education as they have embarrassingly abdicated this responsibility. NEEDS assessments should be conducted to identify key needs and ways to address them.

The broad objectives set out in Tinubu’s manifesto promise reforms focused on quality access, funding management, effectiveness, and competitiveness. It highlights improvements across the board and investment in infrastructure in educational institutions, including improved access to ICT by learners and the reintroduction of student loans.

Hopefully, these should not be mere empty documents to be promptly dumped on assuming office as all political parties in the Fourth Republic have done.

The national curriculum should be reviewed to reflect global learning and real-world issues. Competent education ministers must be appointed. The era of putting square pegs in round holes as a political reward should cease. Garrulous, mediocre, and incompetent individuals have no place in education, the bedrock of serious nations desparate on growth and development stimulation.

Nigeria has higher institutions it cannot fund; yet federal lawmakers keep approving new ones. There are 49 federal, 59 state and 111 private universities in the country according to the NUC; 40 federal, 49 state and 76 private polytechnics; 17 private, 70 federal and state-owned colleges of health with 219 colleges of education. These are in addition to specialised institutions established with ridiculously low take-off grants. In 2021, four additional universities took off with a combined grant of N18 billion.

Past governments have been unable to meet the UNESCO benchmark for funding, which recommends governments spend between four per cent and six per cent of GDP on education, and an adequate percentage of national budgets. There should be a moratorium on new federal higher institutions as the government does not have the financial or personnel wherewithal to run the existing ones

Tinubu’s campaign and initial pronouncements have been uncomfortably silent on the decades-old FG/ASUU stand-off. Yet, the unresolved agreements and the ensuing endless ASUU strikes have been the main issues in Nigeria’s tertiary education system for two decades. He should resolve to end the crisis. Cumulatively, the university system has lost several semesters, the academic calendar has been disrupted, quality compromised, and many dons have left the system, some relocating abroad.

The issues of allowances, revitalisation of public universities, transparency and accountability, among many others, should be finally addressed within the government’s financial means and capacity. Agreements must be honoured.

Decay, crises and dysfunction reign in the education and health sectors. Successive administrations came, saw and all, without exception, left them in even worse shape than they met them.

Tinubu should break the mould and breathe life into these two important areas of national life.

For years, People Incorporated, a St. Paul-based community provider of behavioral and mental health services, has been offering classes and programs on a variety of mental health syllabus for their employees as well as workers from other social service agencies through the organization’s Training Institute. 

More recently, People Incorporated began hearing from employers in other industries who were curious if the nonprofit could provide specialized mental health training for their workers. These organizations offered a wide range of services but they had one thing in common: Their workers interacted with customers in public spaces. 

Russ Turner, director of People Incorporated’s Training Institute, said that one of the more latest — and largest — employers that his organization created a customized training program for is Metro Transit. The system’s bus operators were seeing increased numbers of riders struggling with mental health issues and wanted to learn safe and effective ways to respond. 

The growing number of requests for the training institute’s services is connected to a general increase in mental health issues across the community, Turner explained.  Workers who were never trained to assist people in mental health crises are now finding themselves in situations where these skills could be of use. 

“Most of these workers don’t have a social work degree,” Turner said of the workshop participants. “They are not mental health practitioners, and they probably don’t really want to be. But in a way that’s what they’re doing now.” 

Turner and I spoke recently about this change, where it came from and how his organization is rising to the challenge. This interview has been edited for length and clarity. 

MinnPost: What made you decide to offer these specialized trainings? 

Russ Turner: Around 10, 12 years ago I started noticing that people from other companies and agencies were drifting into our trainings,  which is unusual.  When we were providing continuing education for people in our industry, we were partnering across organizations, building bridges in our own bubble with other social service agencies. We were offering continuing education units for social workers, for instance. 

People from other industries are now very interested in mental health in the workplace.

MP: Why is that? 

RT: Whatever’s happening in society, in the community, out on the streets, it will eventually come into people’s workplaces. We’ve done trainings for schools, libraries, rec centers. You have staff whose primary job has typically been to book people into the gym, check out their library books. That’s their basic job, but increasingly what they have actually been tasked with is working with people who are homeless, people who are severely and persistently mentally ill, who are coming into the center. In a way, these are people who are lost. 

MP: How does that change impact workers?

RT: Now people have a whole new set of things that they are working with. In most workplaces, de-escalating a mental health crisis is not in your job description. A great example of this is libraires. They are public spaces, a community place that is warm during the winter. People are coming into libraries, some are borrowing books, a lot are not. The library staff have to work with all this and they also have to work with their “legacy” customers at the same time. People are coming into the library in all sorts of psychiatric states. 

MP: How do you design trainings that speak to specific workers or workplaces?

RT: We try to go into the space that exists between the mental health community and the workplace. We come into the middle and say, “We can bring you some pretty good ideas for mental health but we don’t know a lot about your workplace so if we can come together and workshop it first it could be helpful.” There is a lot of residual anxiety, stress and trauma in the community from the pandemic, from George Floyd, from January 6. All of that anxiety and tension is seeping into workplaces. We would like to help different types of workers understand a bit more about mental health crisis de-escalation, mental health awareness and critical-incident stress debriefing after a difficult day. 

MP: One organization that has hired you to train its employees is Metro Transit. You’ve been offering mental health awareness workshops and training for bus operators. Can you tell me more about that partnership? 

RT: Metro Transit is a very forward-thinking organization. Instead of being located in a physical building, their workers are located in a bus. But the same concepts apply. And there are issues their workers have to deal with that go way beyond driving the vehicle. Not only does the operator have to operate the vehicle, they also have to be able to manage the tension with people getting on and off.  They have to keep the environment calm and safe. They also have to manage their own mental health. This work is quite taxing over time. 

While Metro Transit is just one example of many organizations that we’ve worked with, it is a particularly exciting one. We trained 1,800 bus drivers right through the pandemic. We are also part of their apprentice program, where an employee’s first couple of years of them being an operator includes a little bit of monthly education. Mental health awareness is part of that. 

MinnPost: What kinds of skills did you teach during those trainings? 

RT: We provide the drivers one or two good tools, things they can say and should not say to people who are upset, to help keep the situation as calm and safe as possible. But that’s only one component of it. Part of our work with Metro Transit has been to provide training that essentially destigmatizes mental health so people understand it better. It is easy when someone is “acting out” to just to see those behaviors and be upset with them. If you understand more about how trauma manifests in people you begin to understand it a bit better. You are more likely to produce a more empathetic response that is safer and more effective.

MP:  What are some of the other organizations you’ve worked with? 

RT: We did a program with the St. Paul Fire Department. Their EMTs are good at their job: They can get you to Regions Hospital in 12 minutes. But what they are telling us is that a lot of what they are working with is beyond that. It looks like a mental health crisis. We worked with them on how they can address that. 

We’ve also worked with a range of retail workers. Mask mandates set a lot of that off. You have someone whose primary  job is to work on the cash register and now they are becoming some sort of bouncer or security officer. That’s not easy work. It is a whole different set of skills. We did some work with a grocery organization in Wisconsin about using de-escalation techniques  to help people to comply with mask mandates without them getting so upset.

One thing these organizations have in common is they are all about public spaces. They’re a representation in a way of what’s happening in society. 

MP: Have you been surprised by any of the organizations that have inquired about your trainings? 

RT: We did a couple of trainings with museums. The staff needed trainings so they could work with irate customers who didn’t want to follow safety protocol. When I step back and think about it, that’s a little jarring: I’m old enough to remember when going to a library or going to a museum would be one of the most boring things you could do, whereas now staff need awareness that they didn’t before. 

MP: Are there any workers out there that already have these skills and don’t need your workshops? 

RT: Hair stylists and bartenders are already experts. An experienced and skillful bartender has great people skills. If you had an opportunity to meet with a bunch of hair stylists and bartenders, and you framed it in a mental health paradigm, they’d probably sit through the class and say, “Yeah, yeah. I do that already.”  Those skills are golden but they are still somewhat rare and getting rarer, especially with less authentic face-to-face interaction generally. 

Music in secondary schools is at risk of extinction unless teachers embrace new technologies and incorporate contemporary genres in the classroom, a leading academic has warned.

Dr. Pete Dale, from the University of York's School of Arts and Creative Technologies and lead researcher at the Contemporary Urban Music for Inclusion Network (CUMIN), says his research has revealed that teachers are often reluctant to use new technology, despite evidence to show that integrating new genres that young adults enjoy the most could transform their educational experience.

New technologies

In his review of research papers conducted with teachers over a 15 year period, which included collating interviews, surveys and data, he identified a 'nervousness' by some music teachers to use new technologies in the classroom, such as DJ controller decks, MIDI controllers and Digital Audio Workstations (DAWs).

These studies have shown that music teaching tends to be technologically 'conservative' and does not integrate the advances in modern music production within the teaching of classical or traditional music.

Music education

A study in 2021, for example, suggested that this reticence with music technology derives from fears that the technology will diminish more traditional music education, as well as a lack of training among many music teachers.

Dr. Dale said, "These teachers are protective of their established methods and feel threatened by the potential influence of technology. However, CUMIN has shown that there is a significant appetite for music technology, particularly beyond the school gates."

Performance

One teacher, in a report authored by Dr. Dale, stated that they had never used technology for an assessed GCSE or A-level performance and "couldn't imagine doing that" due to being nervous of the assessment process. They said "I'd love to do it but I'm nervous... I have a genuine fear that people [who do moderation] don't understand the use of technology."

Dr. Dale, said, "My research work with teachers across the UK has shown that many teachers are hugely anxious about using music technology in general and nervous about using DJ decks in particular for GCSE assessments.

"This is unfortunate because my research has also shown that when teachers do include DJ decks and contemporary music in their classrooms, uptake at Key Stage 4 can be massively improved and greater engagement in the classroom can become possible."

Opportunity

"If music is 'under threat of extinction in schools', as some influential researchers have argued in latest years, there is a huge opportunity here to reverse this misfortune and bring music education up to date for the 21st Century in the UK."

"Although classical has always been a mainstay in music education, lessons in what students consider 'their music' will inevitably help them engage with something they already have deep interests in."

The findings will be presented at the Contemporary Urban Music for Inclusion Network conference on Friday 30th June at Trinity Laban Conservatoire of Music and Dance in London with input from a range of artists, educators (including exam boards such as AQA and Edexcel) and arts-for-health practitioners.