Background: The COVID-19 is a significant stressor for the resident physicians. This public health issue augmented the already rigid and demanding residency training. Objective: To determine the coping strategies employed by the resident physicians at the Southern Philippines Medical Center during the COVID-19 pandemic. Methods: The study was a cross-sectional design using the descriptive-survey research method. A total of 200 resident physicians participated in this study. The instruments used were a self-made sociodemographic profile questionnaire and the 37-item Filipino Coping Strategies Scale, adopted with permission from the developer. The study used frequency and percentage for categorical variables and mean and standard deviations for continuous variables. Results: The respondents were primarily female resident doctors (56%), unmarried (83%), with an average age of 30, and with the majority living with their immediate family (54%) with mostly three to four family members at home (64%). Most resident doctors were assigned to COVID-19 wards (52.5%) and managed COVID-19 patients directly (73%). Twenty percent of these respondents working in COVID-19 wards have reported and claimed having pre-existing health conditions. The most prevalent coping strategies employed were religiosity (3.15 ± 0.66) and problem-solving (3.11 ± 0.50). On the other hand, resident doctors rarely turned to overactivity or substance use. Conclusion This study has shown that residents most frequently utilized problem-focused (problem-solving) and emotion-focused (spirituality, relaxation/recreation, and tolerance) strategies. Coping is necessary for resident physicians to confront threats of COVID-19 infection. Psychological-emotional support for the well-being of resident doctors must be in place in every residency training program.
Physicians

Introduction: The 'first generation' physician gathers a lot of strength to venture into a world unknown to him. Unlike a physician born to a family of physicians who has a family to guide him, the 'first generation' physician only has himself to survive this endeavor. Through the life worlds of a select group of 'first generation' physician-in-training, this study seeks to answer the following central question: How do 'first generation' Filipino physicians collectively characterize their liminal spaces in transition from medical school to clinical practice?

Methodology: Anchored on the Theory of the Rites of Passage, this phenomenological inquiry, intends to surface the lebenswelt or essence of the experience of being the only physician in the family. Respondents comprised a purposive sample of physicians-in-training (residents and fellows), who are the only physicians in the family. Data were gathered using semi-structured interviews. Triangulation and member checking procedures were done to ensure the data reliability. Data were then subjected to cool (categorization) and warm analysis (thematization) using the Colaizzi's method.

Findings and Discussion: With all the transcribed experiences summarized and those with the same meaning analyzed, the following categories and themes were generated: The Intending Facet / Purpose: From Uncertainty towards Redefinition; The Thinking Facet / Process: From Perplexity towards Self-efficacy; The Relating Facet / People: From Isolation towards Integration; and The Transforming Facet / Power: From Vulnerability towards Empowerment. It was shown that a 'first generation' physician in this liminal space undergoes challenges and struggles during his training in medicine. This served as his Rite of Passage to transition him to someone dreaming only to become a physician, to become redefined with conviction, supported and integrated into the health system, empowered and transformed to the physician he is meant to be.

Recommendations: Physicians undergo a lot of challenges and mental stress and it means a lot for trainers to enter into the trainees' life-world, especially that of a 'first generation' physician, so that they can build socio-emotional learning and mentoring programs and counselling services that address different facets of liminal space that the trainees go through.

Questionnaires were distributed and direct interviews were held. Some results were drawn and some recommendations were made to improve the effectiveness of the policy
Physicians ; Questionnaires

Background and Objective: Palliative care is a human right. In the local setting, only a few data have been published regarding its practice among healthcare workers. This study aimed to determine the gaps and potential barriers in palliative care services among resident physicians. Methodology: A cross-sectional study design using a 27-item interview-based questionnaire was conducted from July to September 2019 among resident trainees in seven departments of four hospitals in Manila, Philippines. The data gathered were tallied using Microsoft Excel and analyzed using STATA Statistical Software with p-value of 0.05 as statistically significant. Results: A total of 200 physicians participated in the study. Majority of the respondents referred patients to palliative care services, primarily for symptom control and home care upon the diagnosis of a terminal illness. Sixty percent of respondents correctly identified patients eligible for hospice care. The 3 services rated as most important in palliative care were pain control, symptom control and psychological support. Most of the respondents perceived that palliative care is underutilized, and yet they felt that attending doctors know when referral to such is appropriate. The discrepancy is due to their lack of knowledge on the nature of its scope of care and eligibility criteria. The common barriers for referral to palliative care were “no time to refer secondary to rapid demise of the patient”, “difficulty in accurately predicting death”, and “lack of time to discuss issues of dying and hospice care”. These presumed barriers contradicted the respondents’ perceived practices in advance care planning, particularly on confirming the goals of treatment with the patient and family. Conclusion The prevailing illiteracy on palliative care that poorly translates to actualization is alarming as it deprives many patients of their right to a dignified and quality of life given their limited days. The inexcusable lack of awareness must be the impetus to a massive knowledge drive to impact clinical practice.
Hospices ; Physicians

No abstract available.
Humans ; Physicians, Family*

No abstract available.
Acupuncture* ; Humans ; Physicians, Family*

Objective: The implementation of guidelines in clinical practice is still facing a lot of obstacles. Although clinical recommendations of dyslipidemia are extant, little is known about how community physicians view guidelines and their implementation. The objective of this study is to assess the acceptance of guideline content and perceived implementation of dyslipidemia guidelines among physicians in Malang, Indonesia. Methodology: Semi-structured validated questionnaires were given to 67 random physicians consisting of general practitioners (GP), internal medicine residents and internists. The questionnaire consisted of 19 questions evaluating four parts: information about access to dyslipidemia training, dyslipidemia guideline-perceived knowledge, level of understanding of dyslipidemia guidelines and application rate of guideline adopted. Evaluation results were scored ordinally and divided into 3 levels; less, enough and good for each part of the questionnaire. Results: 89.2% of samples in the GP group lacked information about dyslipidemia training. The resident group had participated and were involved in dyslipidemia management training (98.3%), followed by the internist group (95.2%). In the GP group, 89.2% never or had less participation in dyslipidemia management training. The GP group (76.2%) also had had poor knowledge in understanding lipid guidelines, in which the least knowledge is known about targets of treatment, non-drug treatment and risk factors. Also, 40.3% of the GP group is still not capable of adopting dyslipidemia guidelines in daily practice. A major barrier was lack of understanding of guidelines (76.3%), followed by failure of adherence to the therapy of patients (12.1%). In the resident group, a major obstacle in the application of the guidelines is education level of the patient (45.5%). In all groups, HMG-CoA Reductase inhibitors are the most commonly used lipid-lowering drugs for treatment of dyslipidemia (98.1% in GP group, 96.3% in resident group, and 97.3% in internist group). Conclusions GPs, as physicians in primary health care system, had poor information and participation in dyslipidemia training, and poor knowledge of dyslipidemia guidelines (AACE, AHA, CCS), as well as understanding and application of the dyslipidemia guidelines (ATP III, PERKENI) to the population, whereas residents and internists had better perception and application of dyslipidemia guidelines.
Dyslipidemias ; Guideline ; Physicians

The Southern Philippines Medical Center (SPMC) is the tertiary hospital in Davao City that is fast becoming a world-class, service-oriented medical center, leading in the provision of health care and training in Mindanao. For a century now, SPMC underwent several processes of reinvention in order to meet the changing needs of the public we serve. Between the years 1917 and 1920, Davao Hospital started operations in a temporary wooden pavilion originally built by the Bureau of Public Works for its sick laborers. The temporary hospital was equipped with basic equipment and had a small laboratory. The government of the Philippine Islands allocated budget for the salaries of one resident physician, one superintendent and property clerk, three nurses, four ward attendants, one cook, one assistant cook, and five laborers-a total of 16 personnel-to keep the hospital running. Over the succeeding decades, the Davao Hospital underwent several name changes, with corresponding increases in bed capacity from 50 in 1921 to 1200 in 2009. The hospital also slowly provided specialized health care services to cater to the growing needs of the populace. Starting in the 1950s, the hospital's services were divided into specialty areas, and the establishment of residency training programs in different medical disciplines soon followed. The services also became more specialized and sophisticated with the establishment of a burn unit, a heart center, a dialysis center, and a kidney transplant unit. We are an “accomplished” old institution. It is very tempting to go gentle into that good night and rest on our laurels. However, resting on previous achievements is definitely not an option. Prior success does not always guarantee continued results.
Physicians ; Internship and Residency

The Coronavirus-19 (Covid-19) pandemic disrupts our medical world. There are substantial demands on our overstretched, understaffed, and under-resourced health systems. Physicians continuously adjust to “crisis standard of care” and new skills for on-line or face to face restricted practice. Physician health and well-being suffer stress, burn-out and moral injury. Many get sick and some die. They ask :“How should I behave as a medical professional in a time of the Covid-19 Pandemic and Beyond?” This article explores medical professionalism: its meaning, its core values and challenges in the time of Covid-19. Its aim is to help doctors and medical students improve their professionalism, and mature into more dedicated physicians who derive joy and pride in what they do.
COVID-19 ; Physicians

Introduction: Dermatologic diseases are one of the common reasons for consult in primary care. Primary care physicians such as the doctors to the barrios (DTTBs) assigned in geographically isolated areas play a critical role in providing primary skin health services since they are the first, and sometimes, only doctors patients rely on for consult. In managing skin diseases, adequate knowledge and skills are needed to arrive at a correct diagnosis, and a physician’s proper initial treatment and timely referral to dermatologists will lead to less affectation on quality of life. Identifying what is lacking in skin health services and referral system would aid dermatologists in finding out how to bridge the gap in knowledge and access to our specialized skin health care. Objectives: The study aimed to determine the knowledge, attitudes, practices, and perceptions of primary care physicians in the Philippines regarding common dermatologic conditions. Methods: This is a cross-sectional study that utilized a self-administered questionnaire to collect data from rural government primary care phy- sicians (doctors to the barrios). At the end of the study, the proponents collated the data and data analysis was done using STATA 13.1 guided by a statistician. Results: A total of 118 DTTBs were included in the study. The mean age of the physicians is 28 years old. One-half of the physicians were assigned to low-income class municipalities; 26.85% and 25% are from 4th class and 5th class municipalities respectively. Factors such as age, sex and clinical experience were not associated with level of knowledge of the respondents. Majority or 55% of the primary care physicians were classified as hav- ing insufficient knowledge on common skin diseases. The respondents have an average of 250 consultations per week and 6% of these are derma- tologic diseases. The most common skin diseases they encountered were impetigo (46.61%), scabies (46.61%), contact dermatitis (43.22%), fungal infection (25.42%) and cellulitis (20.34%). The most prescribed and available medications for skin diseases are oral and systemic antibiotics. Only 42.37% of the physicians are able to refer to dermatologists through various online communication platforms while the rest refer through phone calls or advise their patients to seek dermatologic consult. 25% of the respondents have direct access to dermatologists. DTTBs also have recog- nized the importance of having adequate knowledge on skin diseases and majority are very interested in learning more about these conditions. The top 3 barriers to the proper management of skin diseases were lack of training, lack of experience, and lack of medications. Most of the re- spondents have rated themselves as average to bad in their perceived competency in diagnosing and managing different common skin diseases. Conclusion The study showed that majority of the respondents had insufficient knowledge on the diagnosis and management of common der- matological diseases but had a strong interest to learn more. A significant number of the respondents do not always refer to dermatologists and have poor access to specialty care. Overall, our findings suggest that there are indeed barriers to delivery of skin-related health services that should be addressed.
Physicians, Primary Care