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OBJECTIVE: To evaluate the effect of 2 different systems of hospital care by means of a literature review. QUALITY OF EVIDENCE: Many areas remain unclear because several of the studies are opportunistic and report only isolated experiences or simple before-after observations. Few studies are really experimental, and all were conducted in academic settings, which limits their validity outside these settings. MAIN MESSAGE: The evidence supports the use of hospitalists who devote a minimum of 2 months each year to hospital work and practice full-time on the wards. More often than not, costs are reduced and better education for residents is provided with the hospitalist system. An important point regarding quality of care is that mortality rates are similar with both systems. CONCLUSION: Some questions remain unanswered. For example, what is the best type of training for preparing residents for hospital work and what is the best way for physicians to maintain their skills in this area?

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BACKGROUND AND OBJECTIVES: Professional boundaries help to establish and maintain the foundation of the doctor-patient relationship. Our objective was to measure physicians' level of awareness in recognizing a boundary limit, their intention to change their behavior regarding boundaries, and their self-reported changes in behavior after participation in an educational workshop, "The Right Distance." METHODS: This longitudinal study used questionnaires to measure the level of awareness of the participants in recognizing boundary limits before and after the workshop and to measure their intention to change their behavior and self-reported behavior changes immediately after the workshop and 6 months later. RESULTS: Before the workshop, the level of awareness in recognizing the boundary limits was 3.9 on a 5.0 point scale in which 5.0 represented the highest level of awareness, and immediately after the workshop it was 4.2/5.0. Female physicians were more aware of these issues. Following the workshop, 51% of participants indicated an intention to change their behavior. On the 6-month follow-up questionnaire, 138 physicians (60%) answered that they had not changed their behavior, and 92 physicians (40%) answered that they had modified their behavior by changing their attitude toward their personal and professional life and toward gifts and gratuities. When the post-workshop and the 6-month follow-up questionnaires were matched, 34 of 57 (60%) participants who stated their intention to change did in fact change their behavior regarding the "right distance." CONCLUSIONS: Boundary issues and level of awareness can be effectively taught in a continuing medical education workshop.

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OBJECTIVE: To identify the problems encountered by residents during training and the solutions they proposed. DESIGN: Qualitative study. SETTING: Family practice program at Sherbrooke University. PARTICIPANTS: Sixty-eight residents in the Family practice program between 1999 and 2000. METHOD: We used the nominal group technique with four groups of participants. Then we held five 3-hour discussion groups to explore difficulties and solutions in depth. Finally, data were validated with a written questionnaire. MAIN FINDINGS: At least 20% of respondents confirmed 65 difficulties and 61 solutions. Three major themes emerged: the many demands of the residence program, residents' personal experience of the program, and the lack of time for personal life. CONCLUSION: Publication of these results could help residents develop proactive adaptive strategies to deal with the stress of their training programs. Certain adjustments will be made by the program administration to make it easier for residents to manage their stress.

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OBJECTIVE: To evaluate the impact of an interactive continuing medical education workshop designed to help physicians in breaking bad news to their patients. METHODOLOGY: Analysis of post-workshop questionnaires from 539 physicians assessing the retention of the key concepts and the perception of the potential impact of the workshop on their practice immediately after the workshop and six months later. RESULTS: The most significant concepts retained by the respondents are: the need to take into consideration the whole patient (42.7% post-workshop and 45.6% of follow-up responses), the need to be prepared for the consultation (11.6% and 15%), the importance of better guiding the interview (18.8% and 13.6%), and the value of taking more time during the consultation (5.8% and 8.3%). Analysis of paired responses on the post-workshop and the follow-up questionnaires shows that 35% of the concepts retained are identical. CONCLUSION: The majority of physicians retained the key concepts, both immediately following the workshop and in the longer term.

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