components of medical problem solving

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Evidence-Based Practice: Overview

Asking a Clinical Question (PICO)
Levels of Evidence
Finding the Evidence
Practice Guidelines
Appraising the Evidence
Integrating the Evidence
Selected EBP Publications

This library guide is meant to provide an overview of Evidence Based Practice, including links, worksheets, and other relevant information related to each of the steps of the EBP process. This guide provides definition and scope of EBP, resources for finding the best available evidence, analyzing the evidence, and applying it to practice.

If you are working on you evidence based practice presentation for your N-CARE promotion or maintenance, please refer to the N-CARE specific information.

Your Librarian,

Lindsay Boyce Research Informationist III [email protected]

What is Evidence Based Practice (EBP)

Evidence-based practice (EBP) is the process of collecting, processing, and implementing research findings to improve clinical practice, the work environment, or patient outcomes. It is a problem solving approach to clinical practice that incorporates high-quality evidence from well-designed studies along with the patient's values and desires, and the clinician's knowledge and expertise to make decisions about a patient's care.

Image: Evidence Based Practice Resources Subject Guide, UC Davis Libraries, https://www.library.ucdavis.edu/guide/ebp-resources/

MSK achieved Magnet® recognition on February 17, 2016. A significant aspect of Magnet® is that nursing care must be rooted in evidence-based practice. MSK's N-CARE Program fulfills part of the evidence-based practice philosophy by requiring nurses to complete evidence-based clinical research questions based on the PICO(T) framework.

PICO(T) Search Form

Literature Search Need assistance with your literature search? Contact the library! Use our question form and select "Submit a literature search or PICO(T) search request" under "How can we help?"

The Seven Steps of Evidence-Based Practice

Image: Cultivating Curiousity Module, McGill University Libraries, https://www.youtube.com/watch?v=C8VCu-peFm4

Step 0 - Cultivate a spirit of inquiry within an EBP culture and environement

Step 1 - Ask the burning clinical question in PICOT format

Step 2 - Search for and collect the most relevant best evidence

Step 3 - Critically appraise the evidence (i.e. rapid critical appraisal, evaluation, synthesis, and recommendations)

Step 4 - Integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change

Step 5 - Evaluate outcomes of the practice decision or change based on evidence

Step 6 - Disseminate the outcomes of the EBP decision or change

Source: Melnyk BM. Implementing the Evidence-Based Practice (EBP) Competencies in Healthcare : A Practical Guide to Improving Quality, Safety, and Outcomes . ; 2016. (Table 1.2, p. 11)

Evidence Based Practice Textbooks

Evidence Based Practice Literature

Evidence Based Medicine Journal Evidence-Based Medicine systematically searches a wide range of international medical journals applying strict criteria for the validity of research. Content is critically appraised then the most clinically relevant articles are summarised into an expert commentary focusing on the papers clinical applicability. EBM also publishes articles relevant to the study and practice of evidence-based medicine; including Original Research and Reviews. more... less... Evidence-Based Medicine is owned by BMJ.
Evidence-Based Practice: Step by Step This collection of articles was authored by faculty from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved. The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles appeared every two months to allow time for staff to incorporate information as they worked toward implementing EBP at their institutions. more... less... American Journal of Nursing Collection

Evidence Based Practice Resources

Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare The Fuld Institute for EBP is a national hub for the formation, teaching and dissemination of best practices to improve healthcare quality, safety, costs and patient outcomes.Its cores include transdisciplinary clinical practice, academics, EBP implementation science and consumer education.
Evidence Based Medicine: An Oral History JAMA and the BMJ invited 6 individuals who have played a prominent part in the development of EBM to participate in an oral history event and filming. more... less... JAMA. 2014;311(4):365-367. doi:10.1001/jama.2013.286182.
Glossary of EBM Terms Glossary of EBM Terms from the Evidence Based Medicine Toolbox
Centre for Evidence Based Medicine This website contains details of learning resources available from the Centre and collaborative departments. CEBM aims to develop, teach and promote evidence-based health care through conferences, workshops and EBM tools so that all health care professionals can maintain the highest standards of medicine. CEBM trains Healthcare professionals from all over the world either in Oxford or through our growing Outreach Programme. more... less... CEBM is located at the Nuffield Department of Primary Care Health Sciences at the University of Oxford.
Evidence Based Medicine Toolbox The goal of this website is to help develop, disseminate, and evaluate resources that can be used to practice and teach EBM for undergraduate, postgraduate and continuing education for health care professionals from a variety of clinical disciplines. This site also serves as a support for the book entitled, Evidence-based Medicine: How to practice and teach EBM by David L. Sackett, Sharon E. Straus, W. Scott Richardson, William Rosenberg, and R. Brian Haynes. more... less... The KT Clearinghouse website is funded by the Canadian Institute of Health Research (CIHR) to serve as the repository of Knowledge Translation resources for individuals who want to learn about the science and practice of KT, and access tools that facilitate their own KT research and practices.
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Last Updated: Apr 2, 2024 2:01 PM
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Clinical problem...

Clinical problem solving and diagnostic decision making: selective review of the cognitive literature

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This article has a correction. Please see:

Clinical problem solving and diagnostic decision making: selective review of the cognitive literature - November 02, 2006
Arthur S Elstein , professor ([email protected]) ,
Alan Schwarz , assistant professor of clinical decision making.
Department of Medical Education, University of Illinois College of Medicine, Chicago, IL 60612-7309, USA
Correspondence to: A S Elstein

This is the fourth in a series of five articles

This article reviews our current understanding of the cognitive processes involved in diagnostic reasoning in clinical medicine. It describes and analyses the psychological processes employed in identifying and solving diagnostic problems and reviews errors and pitfalls in diagnostic reasoning in the light of two particularly influential approaches: problem solving 1 , 2 , 3 and decision making. 4 , 5 , 6 , 7 , 8 Problem solving research was initially aimed at describing reasoning by expert physicians, to improve instruction of medical students and house officers. Psychological decision research has been influenced from the start by statistical models of reasoning under uncertainty, and has concentrated on identifying departures from these standards.

Summary points

Problem solving and decision making are two paradigms for psychological research on clinical reasoning, each with its own assumptions and methods

The choice of strategy for diagnostic problem solving depends on the perceived difficulty of the case and on knowledge of content as well as strategy

Final conclusions should depend both on prior belief and strength of the evidence

Conclusions reached by Bayes's theorem and clinical intuition may conflict

Because of cognitive limitations, systematic biases and errors result from employing simpler rather than more complex cognitive strategies

Evidence based medicine applies decision theory to clinical diagnosis

Problem solving

Diagnosis as selecting a hypothesis.

The earliest psychological formulation viewed diagnostic reasoning as a process of testing hypotheses. Solutions to difficult diagnostic problems were found by generating a limited number of hypotheses early in the diagnostic process and using them to guide subsequent collection of data. 1 Each hypothesis can be used to predict what additional findings ought to be present if it were true, and the diagnostic process is a guided search for these findings. Experienced physicians form hypotheses and their diagnostic plan rapidly, and the …

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Clinical Problem Analysis (CPA)

A systematic approach to teaching complex medical problem solving.

Custers, Eugène J. F. M. PhD; Stuyt, Paul M. J. MD, PhD; De Vries Robbé, Pieter F. MD, PhD

Dr. Custers is assistant professor, Department of Medical Informatics; Dr. Stuyt is associate professor, Department of Internal Medicine; and Dr. De Vries Robbé is professor, Department of Medical Informatics; all at the Faculty of Medicine, Nijmegen University, Nijmegen, The Netherlands.

Correspondence and requests for reprints should be addressed to Dr. De Vries Robbé, Nijmegen University, Department of Medical Informatics, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; e-mail: 〈 [email protected] 〉.

The authors describe and discuss clinical problem analysis (CPA), an approach to solving complex clinical problems. They outline the five steps of the CPA model and the essential elements of each step. Next, they discuss the value of CPA's content-independent (methodical) approach and argue that teaching students to use CPA will enable them to avoid some common diagnostic reasoning errors and pitfalls. Finally, they compare CPA with two existing approaches to clinical problem solving.

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Diagnosis: Fundamental Principles and Methods

Affiliation.

1 Endodontics, Ivanhoe Specialist Endodontics, Melbourne, AUS.
PMID: 36204022
PMCID: PMC9528852
DOI: 10.7759/cureus.28730

Problem-solving is an essential human endeavor. It involves problem definition, followed by solution design, solution implementation, and, finally, review. Healthcare is a prime and often successful example of problem-solving. In medical terminology, the problem definition is termed the diagnosis, the solution design is called the treatment plan, and the solution itself is the provision of treatment. The case review is used to assess the efficacy of the solution. This process is sequential and consequential. Obviously, if a problem's definition is absent or incorrect, then an appropriate solution cannot be designed or implemented. Unfortunately, missed or incorrect diagnoses are not uncommon in healthcare and can cause considerable harm and economic cost. Minimizing these diagnostic errors would confer great benefits to patients, clinicians, and healthcare organizations. Understanding the nature of diagnosis and why it can be so difficult are some of the first steps in reducing these diagnostic errors. One issue is that diagnosis may seem to be more of an art than a science when the exact mechanisms of diagnosis are often not clearly described. Clinicians typically learn their diagnostic craft by mimicry of their mentors over years of hard experience. This absence of a clear method not only makes diagnosis difficult to do well it also makes diagnosis difficult to teach well. The purpose of this paper is to try to better articulate the fundamental principles and methods of diagnosis and to make diagnosis more intellectually understandable, and so more teachable, and more achievable by clinicians.

Keywords: clinical decision making; clinical decision rules; decision support techniques; diagnostic error; diagnostic systems; diagnostic technique.

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Conflict of interest statement

The authors have declared that no competing interests exist.

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Figure 3. System data and its analysis for clinical diagnosis.

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Medical problem-solving skills are essential to learning how to develop an effective differential diagnosis in an efficient manner, as well as how to engage in the reflective practice of medicine.   Students' experience in CBI complements the clinical reasoning skills they learn through the UA COM Doctor and Patient course and through their Societies mentors.

The UA COM medical problem-solving structure applies the B-D-A ( Before-During-After) framework as an educational strategy. Thus, CBI requires students to engage in reflection before, during and following facilitated sessions. Reflection contributes to improvement in problem-solving skills and helps medical students cultivate a habit of reflection that will serve them well as they become lifelong professional learners.

As with medical-problem solving, practice-based learning (learning through experience) requires students to engage in reflection before, during and following each learning experiences. Reflection contributes to improvement in problem-solving skills and cultivating a habit of reflection will serve medical students well as they become lifelong professional learners.

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B-D-A Framework Reflective Learning Guide Cognitive Error Quick Guide

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Medical problem solving: an analysis of clinical reasoning

... Medical problem solving: An analysis of clinical reasoning. Post a Comment. CONTRIBUTORS: ... VOLUME/EDITION: PAGES (INTRO/BODY): xvi, 330 p. SUBJECT(S): Medical logic; Medicine; Problem solving; Diagnosis; Decision making. DISCIPLINE: No discipline assigned. ...

Related Papers

Vimla Patel

Paul Feltovich

Cognitive Science

Vimla L. Patel

Journal of evaluation in clinical practice

Patrick Daly

What constitutes clinical reasoning is a disputed subject regarding the processes underlying accurate diagnosis, the importance of patient‐specific versus population‐based data, and the relation between virtue and expertise in clinical practice. In this paper, I present a model of clinical reasoning that identifies and integrates the processes of diagnosis, prognosis, and therapeutic decision making. The model is based on the generalized empirical method of Bernard Lonergan, which approaches inquiry with equal attention to the subject who investigates and the object under investigation. After identifying the structured operations of knowing and doing and relating these to a self‐correcting cycle of learning, I correlate levels of inquiry regarding what‐is‐going‐on and what‐to‐do to the practical and theoretical elements of clinical reasoning. I conclude that this model provides a methodical way to study questions regarding the operations of clinical reasoning as well as what constitute significant clinical data, clinical expertise, and virtuous health care practice. [Link to full text (read only): https://rdcu.be/TQW1]

Arthur S Elstein

Academic Medicine

Maryam hoseini

Background: Clinical reasoning plays an important role in the ability of physicians to make diagnoses and decisions. It is considered the physician’s most critical competence, but it is an ambiguous concept in medicine that needs a clear analysis and definition. Our aim was to clarify the concept of clinical reasoning in medicine by identifying its components and to differentiate it from other similar concepts. It is necessary to have an operational definition of clinical reasoning, and its components must be precisely defined in order to design successful interventions and use it easily in future research. Methods: McKenna’s nine-step model was applied to facilitate the clarification of the concept of clinical reasoning. The literature for this concept analysis was retrieved from several databases, including Scopus, Elsevier, PubMed, ISI, ISC, Medline, and Google Scholar, for the years 1995– 2016 (until September 2016). An extensive search of the literature was conducted using the ...

Nigerian journal of Paediatrics

Datonye Briggs

Introduction: Developing the skills of clinical reasoning is a tedious process, especially for the novice learner and requires practice. The clinical reasoning skill is a cognitive process of systematic clinical decision making needed to reduce diagnostic errors. A clinical reasoning tool for diagnosis using the Bloom's tax-onomy of critical thinking has been in use in the Paediatrics Department of the University of Port Harcourt. However, little is known about the difficulties encountered by trainees (medical students and early career doctors) while using the tool during daily clinical clerkship. We aimed to determine aspects of the clinical reasoning process trainees find difficult and ways to make this easier. Methods: A well-structured, pre-tested questionnaire was administered to 67 medical undergraduates and 99 early career medical doctors which assessed responses to the definition of clinical reasoning , matching Bloom's taxon-omy hierarchy with steps in clinical reasoning, functional and structural abnormalities and attitudes towards the use of the clinical reasoning tool. The Likert 5 point scale tool was used to assess attitudes and practice difficulties during the use of the tool. The differences in responses were tested for significance using Stu-dent's T test, and Chi squared test, with p values <0.05 as significant. Results: Of the 166 respondents analysed, 103 (62%) got the correct definition of clinical reasoning with early career doctors having a higher proportion of correct respondents , χ2 = 4.59, p = 0.032. Specific areas of difficulties identified were with making clinical diagnosis in 50 (30.1%) and patho-logic diagnosis (es) in 38 (22.9%). Ninety-nine (59.6%) responded that clinical reasoning was time consuming and 42 (25.3%) thought it was difficult to practice in a busy clinic. One hundred and six (64.1%) respondents suggested a view of basic clinical studies before starting clinical practice in order to improve clinical reasoning. Conclusion/Recommendation: Making clinical diagnosis is difficult for the clinical trainee while using the clinical reasoning tool, therefore the clinical teacher should help trainees move from one cognitive level to the next until the trainee can create logical conclusions from information gathered following clerking.

The Journal of Emergency Medicine

Edward Gallagher

Alan Schwartz

Korean Journal of Medical Education

Hyoung Seok Shin

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Identifying and solving scientific problems in the medicine: key to become a competent scientist

The scientific method can be described as a multistep and detailed process, in which finding the best question is the first and most crucial step. Thus, scientific problem should be examined thoroughly in different ways and perspectives. The amount and diversity of scientific data are enormously increasing and becoming more specific day by day, therefore traditional observational biology is not sufficient on an individual basis to understand and treat multifactorial diseases. Moreover, protocols, documentations, information, outcomes, precisions, and considerations of evidence should be improved to answer scientific questions correctly during the scientific research. Because of the diversity of the data and the methods, statisticians and methodologists should be involved and contribute to the all stages of research. Besides that, all scientific data should be certainly reproducible and repeatable. Scientific knowledge is in a state of flux and becomes more complex day by day. Thus, becoming a competent scientist needs, abilities and skills such as creativity, hardworking and self-discipline that all requires lifelong learning, searching, and widening scientific horizons consistently.

Bilimsel yöntem, en iyi soruyu bulmanın ilk ve en önemli adım olduğu çok aşamalı ve ayrıntılı bir süreç olarak tanımlanabilir. Bu nedenle, bilimsel problem farklı şekillerde ve bakış açılarıyla ayrıntılı olarak incelenmelidir. Bilimsel verilerin sayısı ve çeşitliliği gün geçtikçe son derece hızlı bir biçimde artmakta ve daha belirgin hale gelmektedir, bu nedenle gelenekseli, gözlemsel biyoloji, çok faktörlü hastalıkları anlamak ve tedavi etmek için tek başına yeterli değildir. Ayrıca, bilimsel araştırma sırasında bilimsel sorulara doğru cevap verebilmek için protokoller, belgeler, bilgiler, sonuçlar, kesinlikler ve kanıtlar iyileştirilmelidir. Verilerin çeşitliliği ve yöntemlerden dolayı, istatistikçiler ve metod geliştirenler araştırmaya katılmalı ve araştırmanın her aşamasına katkıda bulunmalıdır. Bunun yanı sıra, tüm bilimsel veriler kesinlikle tekrarlanabilir olmalıdır. Bilimsel bilgi bir akış halindedir ve gün geçtikçe daha karmaşık hale gelir. Böylece, yetkin bir bilim insanının yaratıcılık, çalışkanlık ve öz disiplin gibi ihtiyaçları, yetenekleri ve becerileri herkesin yaşam boyu öğrenmeyi, aramayı ve bilimsel ufukları tutarlı bir şekilde genişletmeyi gerektiren bir hale gelir.

Introduction

The scientific method in medicine is comprised of research design, conducting research, data analyzing and interpretation that all contribute to the solving specified problems. Research design types can be categorized as a case study, survey, observational study, semi-experimental, experimental, review, meta-analytic or comparative [ 1 ]. However, before choosing research design type in medicine, finding the best question of which either comprises huge populations such as patients with diabetes, cancer or affects small groups like people with rare diseases is the first and most crucial step. Although rare diseases impact fewer human beings, in total many people are affected from them in the worldwide since there are no cure [ 2 ], [ 3 ], [ 4 ].

Present problems in the medical and biological sciences should be examined thoroughly in different ways and perspectives to find the best scientific question. Therefore, researchers should widen their scientific horizons consistently and should develop deep insight in their specific fields [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ]. The amount and diversity of scientific data are enormously increasing and becoming more specific day by day. Therefore, traditional observational biology is not sufficient alone to understand and treat multifactorial diseases such as obesity, cancer or neurological disorders. Every data contributes to the scientific knowledge in the worldwide. Thus, access to the largest data by using omic technologies such as lipidomics, metabolics, proteomics, genomics, etc. has led to the revolution in the medical and biological sciences, that enable scientist to reveal complex mechanisms behind various diseases which affect either huge or small populations. Thus, not only determining the problem, but also knowing how to analyze and integrate the scientific data is crucial to become a competent scientist [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ].

Protocols, documentations, information, outcomes, precisions and considerations of evidence should be improved for data analysis and interpretation. However, in research design there are also other factors affecting the research quality, for instance originality, instruments used in the experiments that all parameters together contribute to the increasing validity and the reliability of a research [ 11 ]. Also, since methods using in each field are diversifying day by day, choosing the best and most effective methods play a vital role to obtain the most accurate and reliable data. Therefore, statisticians and methodologists should be involved and contribute to the all stages of medical and biological research. Besides that, all scientific data and procedure should be certainly reproducible and repeatable in every area of the discipline including medicine [ 11 ].

The scientific world is continuously in progress and improving itself day by day. New methods and data analyzing approaches, including various omic technologies revolutionize the medical research field. Thus, researchers encounter new concepts such as subtyping patients with diseases to reveal biomarker that enables us to discover personalized medicine techniques. Personalized treatments are promising therapeutic approaches which increasing efficacy of the treatment and reducing side effects. These factors enable us to predict disease susceptibility that all together contribute to the improving human health [ 10 ], [ 11 ], [ 12 ].

The researcher’s creativity, critical thinking skills, abilities and successes are directly correlated with the researchers’ deep knowledge on a specific topic, current technologies, data analysis and interpretation. Since science continues from past to present, every step we follow reflects an evolutionary step on the way. Scientific knowledge is in a state of flux and becomes more complex and competitive day by day. Therefore, being a competent scientist needs various skills such as creativity, hardworking and self-discipline, since this process is a lifelong journey requiring consistently learning, searching, and widening scientific horizons for a lifetime.

Currently the world has realized the importance and the need of describing reasons of various public health concerns, since this is the key to solving them. Therefore, finding the best question of which either comprises huge populations or affects small groups is the first and most crucial step in the medical and biological sciences. The amount and diversity of scientific data and novel methods are enormously increasing and becoming more specific day by day. Therefore, a researcher’s creative and critical thinking, abilities and successes are directly correlated with the researchers’ deep knowledge on a specific topic, current technologies, data analysis and interpretation.

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Book/Report

Medical Problem Solving: An Analysis of Clinical Reasoning.

Elstein AS, ed. Cambridge, MA: Harvard University Press; 1978. ISBN: 9780674561250.

Clinical reasoning lies at the heart of formulating diagnoses and selecting treatments. The results of these medical decisions determine a substantial portion of the dollars spent on health care. Considering the fundamental importance of clinical reasoning, the topic has received surprisingly little systematic study. Even with the widespread interest in medical error and patient safety in recent years, diagnostic errors and other errors in clinical reasoning have received little attention. This classic collection of empiric studies on clinical reasoning in action thus remains highly relevant more than 25 years after its original publication. One finding of particular relevance for those interested in patient safety and quality improvement is that competence may be problem specific; thus, there is no generic approach to clinical problem solving that, when followed, ensures excellent, or even competent, performance in a variety of domains within a field. The authors also provide an excellent overview of theoretic models relevant to the study of clinical reasoning.

Medical Harm: Historical, Conceptual, and Ethical Dimensions of Iatrogenic Illness. March 27, 2005

Human Error. March 27, 2005

Merry and McCall Smith's Errors, Medicine, and the Law. 2nd ed. March 6, 2005

Judgment under Uncertainty: Heuristics and Biases. March 6, 2005

Working Knowledge: How Organizations Manage What They Know. September 14, 2005

First, Do Less Harm: Confronting the Inconvenient Problems of Patient Safety. June 6, 2012

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Error and Uncertainty in Diagnostic Radiology. March 20, 2019

A Randomized Field Study of a Leadership WalkRounds-Based Intervention. September 5, 2012

Work Design Drivers of Organizational Learning about Operational Failures: A Laboratory Experiment on Medication Administration. January 9, 2013

Speaking Up Constructively: Managerial Practices that Elicit Solutions from Front-Line Employees. March 9, 2011

Improving Quality and Safety in Healthcare. April 16, 2024

2011 Annual Benchmarking Report: Malpractice Risks in Emergency Medicine. September 26, 2012

2014 Annual Benchmarking Report: Malpractice Risks in the Diagnostic Process. January 14, 2015

Sources of Power: How People Make Decisions. March 6, 2005

Out of the Crisis. March 27, 2005

Unity of Mistakes: A Phenomenological Interpretation of Medical Work. March 6, 2005

Oxford Professional Practice: Handbook of Patient Safety. July 27, 2022

The Cognitive Autopsy: A Root Cause Analysis of Medical Decision Making. January 27, 2021

Closing Death’s Door: Legal Innovations to End the Epidemic of Healthcare Harm. July 7, 2021

Still Not Safe: Patient Safety and the Middle-Managing of American Medicine. December 18, 2019

Improving Patient Safety Through Teamwork and Team Training. January 29, 2014

Are Workarounds Ethical? Managing Moral Problems in Health Care Systems. February 3, 2016

Listening for What Matters: Avoiding Contextual Errors in Health Care. March 9, 2016

Organizing for Reliability: A Guide for Research and Practice. January 30, 2019

Patient Safety Ethics: How Vigilance, Mindfulness, Compliance, and Humility can Make Healthcare Safer. July 24, 2019

Quality and Safety in Anesthesia and Perioperative Care. July 17, 2019

Talking with Patients and Families about Medical Error: A Guide for Education and Practice. February 16, 2011

After Harm: Medical Error and the Ethics of Forgiveness. September 14, 2005

Practical Patient Safety. October 14, 2009

The Challenger Launch Decision: Risky Technology, Culture, and Deviance at NASA. March 27, 2005

The Limits of Safety: Organizations, Accidents and Nuclear Weapons. March 6, 2005

Demanding Medical Excellence. Doctors and Accountability in the Information Age. March 6, 2005

Forgive and Remember: Managing Medical Failure. 2nd ed. March 6, 2005

Failure in Safety-Critical Systems: A Handbook of Accident and Incident Reporting. March 6, 2005

Engaging Patients as Safety Partners: a Guide for Reducing Errors and Improving Satisfaction. June 18, 2008

Handbook of Human Factors and Ergonomics in Health Care and Patient Safety. 2nd ed. February 13, 2017

Patient Safety: Achieving a New Standard for Care. March 6, 2005

Misadventures in Health Care: Inside Stories. August 24, 2005

Principles of Risk Management and Patient Safety. March 9, 2011

Patient Safety Handbook, Second Edition. August 17, 2013

When We Do Harm: A Doctor Confronts Medical Error. April 22, 2020

A Crisis in Health Care: A Call to Action on Physician Burnout. January 30, 2019

Learning in Action: A Guide to Putting the Learning Organization to Work. March 27, 2005

The Public's Views on Medical Error in Massachusetts. December 17, 2014

Safety Quality and Informatics Leadership Program. January 7, 2015

Maternal and Infant Health Inequality: New Evidence from Linked Administrative Data. February 22, 2023

Safer Together Survey: Advancing Patient and Workforce Safety January 18, 2023

Addressing the Opioid Crisis in the United States. November 2, 2016

A Framework for Safe, Reliable, and Effective Care. February 15, 2017

Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era. December 13, 2017

Addressing the Opioid Epidemic: Is There a Role for Physician Education? August 23, 2017

IHI Framework for Improving Joy in Work. August 9, 2017

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Optimizing a Business Case for Safe Health Care: An Integrated Approach to Safety and Finance. July 12, 2017

How-to Guides: Improving Transitions from the Hospital to Reduce Avoidable Rehospitalizations. August 8, 2012

How-to Guide: Prevent Obstetrical Adverse Events. October 24, 2012

IHI Skilled Nursing Facility Trigger Tool for Measuring Adverse Events. January 27, 2016

Malpractice Risks in Communication Failures: 2015 Annual Benchmarking Report. February 10, 2016

The Power to Predict: Leveraging Medical Malpractice Data to Reduce Patient Harm and Financial Loss. June 24, 2020

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Annual Benchmarking Report: Malpractice Risks in Surgery. June 9, 2010

IHI Global Trigger Tool for Measuring Adverse Events. 2nd Edition. May 9, 2009

Seven Leadership Leverage Points for Organization-Level Improvement in Health Care. Second edition. June 1, 2005

Leadership Guide to Patient Safety: Resources and Tools for Establishing and Maintaining Patient Safety. September 28, 2005

Respectful Management of Serious Clinical Adverse Events. Second Edition. October 27, 2010

How-to Guide: Multidisciplinary Rounds. March 10, 2010

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Error Reduction in Health Care: A Systems Approach to Improving Patient Safety, Second edition. June 1, 2011

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Annual Perspective

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Medical malpractice lawsuits involving trainees in obstetrics and gynecology in the USA. September 21, 2022

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NCICLE Pathways to Excellence: Expectations for an Optimal Clinical Learning Environment to Achieve Safe and High-Quality Patient Care, 2021. November 24, 2021

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Resident-faculty overnight discrepancy rates as a function of number of consecutive nights during a week of night float. January 13, 2021

ACGME Summary Report: The Pursuing Excellence Pathway Leaders Patient Safety Collaborative. November 18, 2020

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Assessing clinical reasoning: targeting the higher levels of the pyramid. September 18, 2019

Professionalism lapses and adverse childhood experiences: reflections from the island of last resort. August 14, 2019

Association of residency work hour reform with long term quality and costs of care of US physicians: observational study. July 24, 2019

Effects on resident work hours, sleep duration and work experience in a Randomized Order Safety Trial Evaluating Resident-physician Schedules (ROSTERS). June 26, 2019

Pediatric faculty knowledge and comfort discussing diagnostic errors: a pilot survey to understand barriers to an educational program. June 12, 2019

Health Professions Education. June 12, 2019

Associations between in-hospital mortality, health care utilization, and inpatient costs with the 2011 resident duty hour revision. May 15, 2019

Perception of the usability and implementation of a metacognitive mnemonic to check cognitive errors in clinical setting. April 10, 2019

Sleep and alertness in a duty-hour flexibility trial in internal medicine. March 13, 2019

Patient safety outcomes under flexible and standard resident duty-hour rules. March 13, 2019

"Does your knee make more of a click or a clack?"; teaching "Car Talk" to new docs. March 13, 2019

Teaching about diagnostic errors through virtual patient cases: a pilot exploration. February 27, 2019

Adjusting to duty hour reforms: residents' perception of the safety climate in interdisciplinary night-float rotations. February 20, 2019

Data omission by physician trainees on ICU rounds. February 6, 2019

Utilizing a Systems and Design Thinking Approach for Improving Well-Being Within Health Professional Education and Health Care. January 16, 2019

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What Is Problem-Solving Therapy?

Verywell / Madelyn Goodnight

Problem-Solving Therapy Techniques

How effective is problem-solving therapy, things to consider, how to get started.

Problem-solving therapy is a brief intervention that provides people with the tools they need to identify and solve problems that arise from big and small life stressors. It aims to improve your overall quality of life and reduce the negative impact of psychological and physical illness.

Problem-solving therapy can be used to treat depression , among other conditions. It can be administered by a doctor or mental health professional and may be combined with other treatment approaches.

At a Glance

Problem-solving therapy is a short-term treatment used to help people who are experiencing depression, stress, PTSD, self-harm, suicidal ideation, and other mental health problems develop the tools they need to deal with challenges. This approach teaches people to identify problems, generate solutions, and implement those solutions. Let's take a closer look at how problem-solving therapy can help people be more resilient and adaptive in the face of stress.

Problem-solving therapy is based on a model that takes into account the importance of real-life problem-solving. In other words, the key to managing the impact of stressful life events is to know how to address issues as they arise. Problem-solving therapy is very practical in its approach and is only concerned with the present, rather than delving into your past.

This form of therapy can take place one-on-one or in a group format and may be offered in person or online via telehealth . Sessions can be anywhere from 30 minutes to two hours long.

Key Components

There are two major components that make up the problem-solving therapy framework:

Applying a positive problem-solving orientation to your life
Using problem-solving skills

A positive problem-solving orientation means viewing things in an optimistic light, embracing self-efficacy , and accepting the idea that problems are a normal part of life. Problem-solving skills are behaviors that you can rely on to help you navigate conflict, even during times of stress. This includes skills like:

Knowing how to identify a problem
Defining the problem in a helpful way
Trying to understand the problem more deeply
Setting goals related to the problem
Generating alternative, creative solutions to the problem
Choosing the best course of action
Implementing the choice you have made
Evaluating the outcome to determine next steps

Problem-solving therapy is all about training you to become adaptive in your life so that you will start to see problems as challenges to be solved instead of insurmountable obstacles. It also means that you will recognize the action that is required to engage in effective problem-solving techniques.

Planful Problem-Solving

One problem-solving technique, called planful problem-solving, involves following a series of steps to fix issues in a healthy, constructive way:

Problem definition and formulation : This step involves identifying the real-life problem that needs to be solved and formulating it in a way that allows you to generate potential solutions.
Generation of alternative solutions : This stage involves coming up with various potential solutions to the problem at hand. The goal in this step is to brainstorm options to creatively address the life stressor in ways that you may not have previously considered.
Decision-making strategies : This stage involves discussing different strategies for making decisions as well as identifying obstacles that may get in the way of solving the problem at hand.
Solution implementation and verification : This stage involves implementing a chosen solution and then verifying whether it was effective in addressing the problem.

Other Techniques

Other techniques your therapist may go over include:

Problem-solving multitasking , which helps you learn to think clearly and solve problems effectively even during times of stress
Stop, slow down, think, and act (SSTA) , which is meant to encourage you to become more emotionally mindful when faced with conflict
Healthy thinking and imagery , which teaches you how to embrace more positive self-talk while problem-solving

What Problem-Solving Therapy Can Help With

Problem-solving therapy addresses life stress issues and focuses on helping you find solutions to concrete issues. This approach can be applied to problems associated with various psychological and physiological symptoms.

Mental Health Issues

Problem-solving therapy may help address mental health issues, like:

Chronic stress due to accumulating minor issues
Complications associated with traumatic brain injury (TBI)
Emotional distress
Post-traumatic stress disorder (PTSD)
Problems associated with a chronic disease like cancer, heart disease, or diabetes
Self-harm and feelings of hopelessness
Substance use
Suicidal ideation

Specific Life Challenges

This form of therapy is also helpful for dealing with specific life problems, such as:

Death of a loved one
Dissatisfaction at work
Everyday life stressors
Family problems
Financial difficulties
Relationship conflicts

Your doctor or mental healthcare professional will be able to advise whether problem-solving therapy could be helpful for your particular issue. In general, if you are struggling with specific, concrete problems that you are having trouble finding solutions for, problem-solving therapy could be helpful for you.

Benefits of Problem-Solving Therapy

The skills learned in problem-solving therapy can be helpful for managing all areas of your life. These can include:

Being able to identify which stressors trigger your negative emotions (e.g., sadness, anger)
Confidence that you can handle problems that you face
Having a systematic approach on how to deal with life's problems
Having a toolbox of strategies to solve the issues you face
Increased confidence to find creative solutions
Knowing how to identify which barriers will impede your progress
Knowing how to manage emotions when they arise
Reduced avoidance and increased action-taking
The ability to accept life problems that can't be solved
The ability to make effective decisions
The development of patience (realizing that not all problems have a "quick fix")

Problem-solving therapy can help people feel more empowered to deal with the problems they face in their lives. Rather than feeling overwhelmed when stressors begin to take a toll, this therapy introduces new coping skills that can boost self-efficacy and resilience .

Other Types of Therapy

Other similar types of therapy include cognitive-behavioral therapy (CBT) and solution-focused brief therapy (SFBT) . While these therapies work to change thinking and behaviors, they work a bit differently. Both CBT and SFBT are less structured than problem-solving therapy and may focus on broader issues. CBT focuses on identifying and changing maladaptive thoughts, and SFBT works to help people look for solutions and build self-efficacy based on strengths.

This form of therapy was initially developed to help people combat stress through effective problem-solving, and it was later adapted to address clinical depression specifically. Today, much of the research on problem-solving therapy deals with its effectiveness in treating depression.

Problem-solving therapy has been shown to help depression in:

Older adults
People coping with serious illnesses like cancer

Problem-solving therapy also appears to be effective as a brief treatment for depression, offering benefits in as little as six to eight sessions with a therapist or another healthcare professional. This may make it a good option for someone unable to commit to a lengthier treatment for depression.

Problem-solving therapy is not a good fit for everyone. It may not be effective at addressing issues that don't have clear solutions, like seeking meaning or purpose in life. Problem-solving therapy is also intended to treat specific problems, not general habits or thought patterns .

In general, it's also important to remember that problem-solving therapy is not a primary treatment for mental disorders. If you are living with the symptoms of a serious mental illness such as bipolar disorder or schizophrenia , you may need additional treatment with evidence-based approaches for your particular concern.

Problem-solving therapy is best aimed at someone who has a mental or physical issue that is being treated separately, but who also has life issues that go along with that problem that has yet to be addressed.

For example, it could help if you can't clean your house or pay your bills because of your depression, or if a cancer diagnosis is interfering with your quality of life.

Your doctor may be able to recommend therapists in your area who utilize this approach, or they may offer it themselves as part of their practice. You can also search for a problem-solving therapist with help from the American Psychological Association’s (APA) Society of Clinical Psychology .

If receiving problem-solving therapy from a doctor or mental healthcare professional is not an option for you, you could also consider implementing it as a self-help strategy using a workbook designed to help you learn problem-solving skills on your own.

During your first session, your therapist may spend some time explaining their process and approach. They may ask you to identify the problem you’re currently facing, and they’ll likely discuss your goals for therapy .

Keep In Mind

Problem-solving therapy may be a short-term intervention that's focused on solving a specific issue in your life. If you need further help with something more pervasive, it can also become a longer-term treatment option.

Get Help Now

We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you.

Shang P, Cao X, You S, Feng X, Li N, Jia Y. Problem-solving therapy for major depressive disorders in older adults: an updated systematic review and meta-analysis of randomized controlled trials . Aging Clin Exp Res . 2021;33(6):1465-1475. doi:10.1007/s40520-020-01672-3

Cuijpers P, Wit L de, Kleiboer A, Karyotaki E, Ebert DD. Problem-solving therapy for adult depression: An updated meta-analysis . Eur Psychiatry . 2018;48(1):27-37. doi:10.1016/j.eurpsy.2017.11.006

Nezu AM, Nezu CM, D'Zurilla TJ. Problem-Solving Therapy: A Treatment Manual . New York; 2013. doi:10.1891/9780826109415.0001

Owens D, Wright-Hughes A, Graham L, et al. Problem-solving therapy rather than treatment as usual for adults after self-harm: a pragmatic, feasibility, randomised controlled trial (the MIDSHIPS trial) . Pilot Feasibility Stud . 2020;6:119. doi:10.1186/s40814-020-00668-0

Sorsdahl K, Stein DJ, Corrigall J, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial . Subst Abuse Treat Prev Policy . 2015;10(1):46. doi:doi.org/10.1186/s13011-015-0042-1

Margolis SA, Osborne P, Gonzalez JS. Problem solving . In: Gellman MD, ed. Encyclopedia of Behavioral Medicine . Springer International Publishing; 2020:1745-1747. doi:10.1007/978-3-030-39903-0_208

Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults . Int J Geriatr Psychiatry . 2016;31(5):526-535. doi:10.1002/gps.4358

Garand L, Rinaldo DE, Alberth MM, et al. Effects of problem solving therapy on mental health outcomes in family caregivers of persons with a new diagnosis of mild cognitive impairment or early dementia: A randomized controlled trial . Am J Geriatr Psychiatry . 2014;22(8):771-781. doi:10.1016/j.jagp.2013.07.007

Noyes K, Zapf AL, Depner RM, et al. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study . Cancer Treat Res Commun . 2022;31:100552. doi:10.1016/j.ctarc.2022.100552

Albert SM, King J, Anderson S, et al. Depression agency-based collaborative: effect of problem-solving therapy on risk of common mental disorders in older adults with home care needs . The American Journal of Geriatric Psychiatry . 2019;27(6):619-624. doi:10.1016/j.jagp.2019.01.002

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

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What Are the 5 Health-Related Components of Physical Fitness?

5 Fitness Components

Cardiovascular Endurance

Muscular strength, muscular endurance, mobility/flexibility, body composition.

Balanced Training Program

Fitness can be divided into five health-related components, including cardiovascular endurance, muscular strength, muscular endurance, flexibility/mobility, and body composition.

Fitness is defined as the condition of being physically fit and healthy, improving your ability to execute daily activities. Being physically active is important for good health.

This article discusses components of fitness, including what they are and how they contribute to overall health.

Ekkasit Jokthong / Getty Images

The 5 Components of Fitness, Explained

Fitness is a general term that includes multiple health-related components. These include:

Cardiovascular endurance : Your heart's ability to pump blood to your muscles, allowing you to exercise for longer periods of time
Muscular strength : The maximum force your muscles can exert for one movement
Muscular endurance : Your muscles' ability to continue to exert force against repeated resistance
Flexibility/mobility : The ability of your joints to move freely and through a normal range of motion
Body composition : The makeup of your body, including your muscles, bones, fat, and other structures

A Word From Verywell

Before starting an exercise regimen, those with an underlying health concern or medical condition or those recovering from an acute injury or surgery should consult with a healthcare provider.

Why Are They Important?

Each component of fitness is important for overall health . Together offer have a wide range of benefits for the body and the mind, such as:

Decreased risk of heart disease , heart attack, and stroke
Healthy body weight
Healthy cholesterol levels
Helping to manage blood sugar levels, lowering risk of type 2 diabetes
Improved ability to perform daily tasks
Improved cognition (such as thinking and problem solving skills)
Improved mood
Lower depression risk
Lower blood pressure
Reduced risk of falls or injuries
Slowed biological aging and lowered risk of premature death
Stronger bones

Cardiovascular endurance activities strengthen your heart muscle and lungs. This type of exercise improves your ability to use oxygen brought in through the lungs and pump it more efficiently to muscles throughout your body.

Examples of cardiovascular endurance activities—also called aerobic exercise , include:

Aerobic exercise classes
Jogging/running
Sports Activities
Water aerobics

Daily activities that increase your heart rate also qualify as aerobic activity. Examples include:

Climbing stairs
Pushing a shopping card

Muscular strength can be measured by your ability to perform one repetition of a particular movement. Strengthening exercises involve using your muscles to resist an external force.

Strengthening exercises can be performed with or without equipment. For example, push-ups, sit-ups, and squats are strengthening exercises that use your body weight as resistance.

Other equipment that can be used for strength training includes:

Cable machines
Elastic bands
Gym equipment
Kettlebells

However, simple objects, such as water jugs and sandbags, can also be used in strengthening exercises.

Weight lifting, or strength training, is the most important component of an exercise regimen for aging adults as it helps mitigate the decline in muscular strength and power, which delays the transition to frailty.

Before engaging in strengthening exercises, it is crucial to learn proper form and biomechanics to avoid injury.

Muscular endurance is the ability of your muscles to perform lots of repetitions of a specific movement. Many of the exercises that improve cardiovascular endurance—cycling, running, and swimming—also improve muscle endurance.

Isometrics is another type of exercise that improves muscular endurance. These exercises involve holding a static position as long as possible—such as performing a plank or holding a squat position. Your muscles are contracting, but your body is not moving.

Isometrics are a great option for individuals with injuries, previous or current, as well as those with limited mobility due to pain or an underlying health condition.

Muscular endurance exercises help you maintain a stable posture during daily activities, which can decrease your risk of falls.

Mobility/flexibility is a component of fitness that is sometimes overlooked. However, this aspect plays an important role in maintaining your range of motion and improving your ability to move when performing daily tasks or participating in other types of exercise.

There are several types of stretching techniques and exercises that improve mobility and flexibility.

Static Stretching

Static stretching is the most familiar type of flexibility exercise that is typically performed. This type of exercise involves bringing a muscle into a position where it is under tension, then holding this position for at least 30 seconds.

Examples of muscles and body parts commonly targeted with static stretches include:

Dynamic (Active) Stretching

Dynamic stretching elongates muscles (stretches them out) while the body is moving. Typically, this type of stretching or mobility exercise is done before a specific aerobic activity , such as running or playing a sport.

For example, a person might perform walking lunges, taking very large steps prior to sprinting.

Dynamic Exercises

Dynamic exercises are activities that improve flexibility and mobility through movement. Examples include:

Body composition, or how your body is made up, includes fat, muscle, bone, and other structures. Learning about your body composition can give you an idea of your overall health.

Body composition can be measured in various ways, including the following, with some being more accessible to the public than others:

Bioimpedance (also called bioelectrical impedance) : Smart scales use this technology to send electrical impulses through the body to estimate the amount of body fat vs. lean tissue that is present.
Skin calipers : This technique measures skinfold thickness at specific areas of the body. The data collected is used to estimate body fat percentage.
Dual-energy X-ray absorptiometry (DEXA or DXA scan) : This type of testing uses X-rays to assess body composition. DEXA scan is most commonly used with athletes.
Hydro-densitometry (also called underwater weighing) : This technique measures the amount of water displaced when a person is submerged to assess body composition.
Air displacement plethysmography (ADP) : This method of assessing body composition utilizes a machine that measures the amount of air displaced when a person is in a sealed chamber.

Using the Health-Related Components of Physical Fitness to Design a Training Program

A well-rounded training program includes activities that address all components of fitness.

The Centers for Disease Control and Prevention (CDC) provides guidelines for adults who are looking to start an exercise program:

Aim to get at least 150 minutes of aerobic activity (exercises or activities that increase your heart rate) each week. Depending on your lifestyle, this can be broken up into smaller chunks of time throughout your day or performed during a formal exercise session.
Perform strength training exercises at least two days per week.
Include flexibility and mobility work at least two to three times per week. They can be done before or after exercise or independently of other exercise activities.

Physical fitness consists of five components: cardiovascular endurance, muscular strength, muscular endurance, mobility/flexibility, and body composition. Each contributes to improved function during daily tasks and an overall better quality of life by allowing you to be active for longer periods of time and move with ease.

A body composition assessment compares the amount of fat versus lean muscle tissue to help track your overall health. To get the most benefit from an exercise program, include activities that address all five components of fitness.

American Heart Association. Flexibility exercise (stretching) .

Hughes DC, Ellefsen S, Baar K. Adaptations to endurance and strength training . Cold Spring Harb Perspect Med . 2018;8(6):a029769. doi:10.1101/cshperspect.a029769

National Heart, Lung, and Blood Institute. Physical activity and your heart .

Ruegsegger GN, Booth FW. Health benefits of exercise . Cold Spring Harb Perspect Med . 2018;8(7):a029694. doi:10.1101/cshperspect.a029694

National Heart, Lung, and Blood Institute. Physical activity and your heart: types .

Harvard T.H. Chan School of Public Medicine. Examples of moderate and vigorous physical activity .

Centers for Disease Control and Prevention. What counts as physical activity for adults .

Phillips SM, Ma JK, Rawson ES. The coming of age of resistance exercise as a primary form of exercise for health . ACSM’s Health and Fitness Journal . 2023;27(6):19-25. doi:10.1249/FIT.0000000000000916

Better Health. Resistance training—preventing injury .

National Academy of Sports Medicine. Isometric exercises: examples, benefits, and applications .

The American Council on Exercise. Types of stretching .

Kasper AM, Langan-Evans C, Hudson JF, et al. Come back skinfolds, all is forgiven: a narrative review of the efficacy of common body composition methods in applied sports practice . Nutrients. 2021;13(4):1075. doi:10.3390/nu13041075

Lemos T, Gallagher D. Current body composition measurement techniques . Curr Opin Endocrinol Diabetes Obes . 2017 Oct;24(5):310-314. doi: 10.1097/MED.0000000000000360

Centers for Disease Control and Prevention. Physical activity for adults: an overview .

By Aubrey Bailey, PT, DPT, CHT Dr, Bailey is a Virginia-based physical therapist and professor of anatomy and physiology with over a decade of experience.

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What is Mechanical Engineering?

The essence of mechanical engineering is problem solving. MEs combine creativity, knowledge and analytical tools to complete the difficult task of shaping an idea into reality.

Mechanical engineering is one of the broadest engineering disciplines—offering opportunities to specialize in areas such as robotics, aerospace, automotive engineering, HVAC (heating, ventilation, and air conditioning), biomechanics, and more. Mechanical engineers design, develop, build, and test. They deal with anything that moves, from components to machines to the human body. The work of mechanical engineers plays a crucial role in shaping the technology and infrastructure that drive our modern world.

What Is Mechanical Engineering?

Technically, mechanical engineering is the application of the principles and problem-solving techniques of engineering from design to manufacturing to the marketplace for any object. Mechanical engineers analyze their work using the principles of motion, energy, and force—ensuring that designs function safely, efficiently, and reliably, all at a competitive cost.

Mechanical engineers make a difference. That's because mechanical engineering careers center on creating technologies to meet human needs. Virtually every product or service in modern life has probably been touched in some way by a mechanical engineer to help humankind.

This includes solving today's problems and creating future solutions in health care, energy, transportation, world hunger, space exploration, climate change, and more.

Being ingrained in many challenges and innovations across many fields means a mechanical engineering education is versatile. To meet this broad demand, mechanical engineers may design a component, a machine, a system, or a process. This ranges from the macro to the micro, from the largest systems like cars and satellites to the smallest components like sensors and switches. Anything that needs to be manufactured—indeed, anything with moving parts—needs the expertise of a mechanical engineer .

What do mechanical engineers do?

Mechanical engineering combines creativity, knowledge and analytical tools to complete the difficult task of shaping an idea into reality.

This transformation happens at the personal scale, affecting human lives on a level we can reach out and touch like robotic prostheses. It happens on the local scale, affecting people in community-level spaces, like with agile interconnected microgrids . And it happens on bigger scales, like with advanced power systems , through engineering that operates nationwide or across the globe.

Mechanical engineers have an enormous range of opportunity and their education mirrors this breadth of subjects. Students concentrate on one area while strengthening analytical and problem-solving skills applicable to any engineering situation. Mechanical engineers work on a wide range of projects, from designing engines, power plants, and robots to developing heating and cooling systems, manufacturing processes, and even nanotechnology.

Mechanical Engineering Disciplines

Disciplines within the mechanical engineering field include but are not limited to:

Autonomous Systems
Biotechnology
Computer Aided Design (CAD)
Control Systems
Cyber security
Human health
Manufacturing and additive manufacturing
materials science
Nanotechnology
Production planning
Structural analysis

Technology itself has also shaped how mechanical engineers work and the suite of tools has grown quite powerful in recent decades. Computer-aided engineering (CAE) is an umbrella term that covers everything from typical CAD techniques to computer-aided manufacturing to computer-aided engineering, involving finite element analysis (FEA) and computational fluid dynamics (CFD). These tools and others have further broadened the horizons of mechanical engineering.

What careers are there in mechanical engineering?

Society depends on mechanical engineering. The need for this expertise is great in so many fields, and as such, there is no real limit for the freshly minted mechanical engineer. Jobs are always in demand, particularly in the automotive, aerospace, electronics, biotechnology, and energy industries.

Mechanical Engineering Job Types

Here are a handful of mechanical engineering fields .

Mechanical engineers play vital roles in the aerospace industry, contributing to various aspects of aircraft and spacecraft design, development, and maintenance.

In statics , research focuses on how forces are transmitted to and throughout a structure. Once a system is in motion, mechanical engineers look at dynamics , or what velocities, accelerations and resulting forces come into play. Kinematics then examines how a mechanism behaves as it moves through its range of motion.

Materials science delves into determining the best materials for different applications. A part of that is materials strength —testing support loads, stiffness, brittleness and other properties—which is essential for many construction, automobile, and medical materials.

How energy gets converted into useful power is the heart of thermodynamics , as well as determining what energy is lost in the process. One specific kind of energy, heat transfer , is crucial in many applications and requires gathering and analyzing temperature data and distributions.

Fluid mechanics , which also has a variety of applications, looks at many properties including pressure drops from fluid flow and aerodynamic drag forces.

Manufacturing is an important step in mechanical engineering. Within the field, researchers investigate the best processes to make manufacturing more efficient. Laboratory methods focus on improving how to measure both thermal and mechanical engineering products and processes. Likewise, machine design develops equipment-scale processes while electrical engineering focuses on circuitry. All this equipment produces vibrations , another field of mechanical engineering, in which researchers study how to predict and control vibrations.

Engineering economics makes mechanical designs relevant and usable in the real world by estimating manufacturing and life cycle costs of materials, designs, and other engineered products.

What skills do mechanical engineers need?

The essence of engineering is problem solving. With this at its core, mechanical engineering also requires applied creativity—a hands on understanding of the work involved—along with strong interpersonal skills like networking, leadership, and conflict management. Creating a product is only part of the equation; knowing how to work with people, ideas, data, and economics fully makes a mechanical engineer.

Here are ten essential skills for mechanical engineers to possess:

Technical Knowledge: A strong foundation in physics, mathematics, and mechanics is crucial. Understanding principles like thermodynamics, fluid mechanics, materials science, and structural analysis forms the backbone of mechanical engineering.

Problem-Solving: Mechanical engineers often encounter complex problems that require analytical thinking and creative solutions. The ability to break down problems and develop innovative solutions is highly valuable.

Design and CAD: Proficiency in computer-aided design (CAD) software is essential for creating, analyzing, and optimizing designs. Knowledge of software like SolidWorks, AutoCAD, or similar programs is valuable.

Critical Thinking: Assessing risks, evaluating different design options, and making decisions based on data and analysis are critical skills for mechanical engineers.

Communication: Being able to communicate technical information clearly, whether in written reports, presentations, or discussions with team members or clients, is vital for success in this field.

Project Management: Managing projects, including budgeting, scheduling, and coordinating with teams, suppliers, and clients, is often part of a mechanical engineer's role.

Hands-on Application: Practical skills in building prototypes, conducting experiments, and testing designs are valuable. Having a good understanding of manufacturing processes and techniques is beneficial.

Continuous Learning/Improvement: Given the rapid advancements in technology and techniques, a willingness to learn and adapt to new tools, methodologies, and industry trends is crucial for staying competitive.

Teamwork: Mechanical engineers often work in multidisciplinary teams. The ability to collaborate effectively with professionals from various backgrounds is essential.

Ethical Standards: Upholding ethical standards and understanding the broader impact of engineering solutions on society and the environment is increasingly important for modern mechanical engineers.

Developing a balance of technical expertise, problem-solving capabilities, and soft skills is key to becoming a successful mechanical engineer.

What tasks do mechanical engineers do?

Careers in mechanical engineering call for a variety of tasks.

Conceptual design
Presentations and report writing
Multidisciplinary teamwork
Concurrent engineering
Benchmarking the competition
Project management
Prototyping
Measurements
Data Interpretation
Developmental design
Analysis (FEA and CFD)
Working with suppliers
Customer service

How much do mechanical engineers earn?

Like careers in many other engineering fields, mechanical engineers are well paid. Compared to other fields, mechanical engineers earn well above average throughout each stage of their careers. According to the U.S. Bureau of Labor Statistics, the mean salary for a mechanical engineer is $105,220 , with the top ten percent earning close to $157,470 .

Mechanical Engineering Salaries
Mean Entry-Level Salary (Payscale)	Mean Annual Salary (BLS)	Top 10 Percent (BLS)

See additional engineering salary information .

The future of mechanical engineering

Breakthroughs in materials and analytical tools have opened new frontiers for mechanical engineers. Nanotechnology, biotechnology, composites, computational fluid dynamics (CFD), and acoustical engineering have all expanded the mechanical engineering toolbox.

Nanotechnology allows for the engineering of materials on the smallest of scales. With the ability to design and manufacture down to the elemental level, the possibilities for objects grows immensely. Composites are another area where the manipulation of materials allows for new manufacturing opportunities. By combining materials with different characteristics in innovative ways, the best of each material can be employed and new solutions found. CFD gives mechanical engineers the opportunity to study complex fluid flows analyzed with algorithms. This allows for the modeling of situations that would previously have been impossible. Acoustical engineering examines vibration and sound, providing the opportunity to reduce noise in devices and increase efficiency in everything from biotechnology to architecture.

How do I become a mechanical engineer?

There are several paths you can take to a career in mechanical engineering . Tomorrow needs MEs who are prepared to make a difference in the world to solve challenges in healthcare, energy, transportation, space exploration, climate change, and more.

Most entry-level mechanical engineering positions require at least a bachelor's degree in mechanical engineering or mechanical engineering technology. Positions that are related to national defense may need a security clearance and a US citizenship may be required for certain types and levels of clearances.

In high school, focus on classes in math and physics. Other science courses can also be helpful. Research colleges and universities offering an accredited mechanical engineering degree program. Visit the schools you are interested in and apply early. Become a mechanical engineer.

Mechanical Engineering at Michigan Tech

We are committed to our mission of hands-on education of our mechanical engineering students, by world-class faculty, through innovative teaching, mentoring, and knowledge creation.

Mechanical Engineering Degrees

The bachelor's degree in mechanical engineering at Michigan Tech offers undergraduate students many unique, hands-on learning opportunities:

Undergraduate Research Opportunities

Undergraduate research opportunities are plentiful. Our department offers undergraduate students numerous opportunities in research, hands-on experience, and real-world client work. Research projects often require help from students for running simulations, taking data, analyzing results, etc. These opportunities may even be paid, depending on the availability of funds on the particular project. Take advantage of over 50,000 square feet of labs and computer centers, in the 13-story R. L. Smith Mechanical Engineering-Engineering Mechanics Building.

Real-World Experience

Get ready to contribute on the job from day one. Our students benefit from hands-on experiences ranging from our senior capstone design program to our enterprise teams to internships/co-ops . As a mechanical engineer, you can make a difference in the world by using the latest technologies to help solve today's grand challenges.

ABET Accreditation

Our undergraduate mechanical engineering program is ABET Accredited . ABET accreditation is a significant achievement. We have worked hard to ensure that our program meets the quality standards set by the profession. And, because it requires comprehensive, periodic evaluations, ABET accreditation demonstrates our continuing commitment to the quality of our program—both now and in the future.

Prepare for Graduate Study

Our undergraduate program in mechanical engineering prepares you for advanced study in the field. Earn an MS degree in mechanical engineering , an MS degree in engineering mechanics , or a PhD degree in mechanical Engineering–engineering mechanics .

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How One Bad CrowdStrike Update Crashed the World’s Computers

Only a handful of times in history has a single piece of code managed to instantly wreck computer systems worldwide. The Slammer worm of 2003 . Russia’s Ukraine-targeted NotPetya cyberattack . North Korea’s self-spreading ransomware WannaCry . But the ongoing digital catastrophe that rocked the internet and IT infrastructure around the globe over the past 12 hours appears to have been triggered not by malicious code released by hackers, but by the software designed to stop them.

Two internet infrastructure disasters collided on Friday to produce disruptions around the world in airports, train systems, banks, health care organizations, hotels, television stations, and more. On Thursday night, Microsoft’s cloud platform Azure experienced a widespread outage. By Friday morning, the situation turned into a perfect storm when the security firm CrowdStrike released a flawed software update that sent Windows computers into a catastrophic reboot spiral. A Microsoft spokesperson tells WIRED that the two IT failures are unrelated.

The cause of one of those two disasters, at least, has become clear: buggy code pushed out as an update to CrowdStrike’s Falcon monitoring product, essentially an antivirus platform that runs with deep system access on “endpoints” like laptops, servers, and routers to detect malware and suspicious activity that could indicate compromise. Falcon requires permission to update itself automatically and regularly, since CrowdStrike is constantly adding detections to the system to defend against new and evolving threats. The downside of this arrangement, though, is the risk that this system, which is meant to enhance security and stability, could end up undermining it instead.

“It's the biggest case in history. We’ve never had a worldwide workstation outage like this,” says Mikko Hyppönen, the chief research officer at cybersecurity company WithSecure. Around a decade ago, Hyppönen says, widespread outages were more common due to the spread of worms or trojans. More recently, global outages have happened on the “server side” of systems, meaning outages often stem from cloud providers such as Amazon’s Web Services , internet cable cuts , or authentication and DNS issues .

CrowdStrike CEO George Kurtz said on Friday that the issues were caused by a “defect” in code the company released for Windows. Mac and Linux systems were not affected. “The issue has been identified, isolated and a fix has been deployed,” Kurtz said in a statement, adding the problems were not the result of a cyberattack. In an interview with NBC, Kurtz apologized for the disruption and said it may take some time for things to be back to normal.

The widespread Windows outages have been linked to a software update from cybersecurity giant CrowdStrike. It is believed the issues are not linked to a malicious cyberattack, cybersecurity officials say, but rather stem from a misconfigured/corrupted update that CrowdStrike pushed out to its customers.

Why Paris 2024 Olympic Athletes Are Sleeping on Cardboard Beds

In a more detailed update Friday evening , CrowdStrike wrote in a blog post that the root cause of the crash had been a single configuration file pushed as an update to Falcon. The update was specifically aimed at changing how Falcon inspects “named pipes” in Windows, a feature that allows software to send data between processes on the same machine or with other computers on the local network. CrowdStrike says the configuration file update was aimed at allowing Falcon to catch a new method that hackers were using for communication between their malware on victim machines and command-and-control servers. “The configuration update triggered a logic error that resulted in an operating system crash,” the post reads.

Security and IT analysts searching for the root cause of the gargantuan outage had initially thought that it must be related to a “kernel driver” update to CrowdStrike’s Falcon software, due in part to the fact that the file that caused the crash ended in .sys, the file extension kernel drivers use. Kernel drivers are the software components that allow applications to interact with Windows at its deepest level, the core of the operating system known as its kernel. That highly sensitive level of access is necessary for security software, so that it can run prior to any malicious software installed on the system and access any part of the system where hackers might seek to plant their code. As malware has improved and evolved, it has pushed defense software to require constant connection and more extensive control.

That deeper access also introduces a far higher possibility that security software—and updates to that software—will crash the whole system, says Matthieu Suiche, head of detection engineering at the security firm Magnet Forensics. He compares running malicious code detection software at the kernel level of an operating system to “open-heart surgery.”

CrowdStrike noted in its blog post that despite the fact that the configuration file that caused the crash ended in the .sys file extension, it was not in fact a kernel driver. Yet it does appear that the configuration file was used by the driver and altered its functionality in a way that caused it to crash, says Costin Raiu, who worked at Russian security software firm Kaspersky for 23 years and led its threat intelligence team before leaving the company last year. During his years at Kaspersky, Raiu says, driver updates for Windows software were closely scrutinized and tested for weeks before they were pushed out. In this case, he suggests the configuration file may have been a far less scrutinized update that nonetheless able to change the way the kernel driver functioned and thus cause the crash. “It’s surprising that with the extreme attention paid to drivers, this still happened,” says Raiu. “One simple driver can bring down everything. Which is what we saw here.”

Microsoft requires developers to get its approval for kernel driver updates, which entails the company’s own careful inspection process. But Microsoft wouldn’t necessarily require any such approval for a configuration file. A Microsoft spokesperson told WIRED that the “CrowdStrike update was responsible for bringing down a number of IT systems globally,” and added that “Microsoft does not have oversight into updates that CrowdStrike makes in its systems.”

Raiu adds that, even so, CrowdStrike is far from the only security firm to trigger Windows crashes. Updates to Kaspersky and even Windows’ own built-in antivirus software Windows Defender have caused similar Blue Screen of Death crashes in years past, he notes. “Every security solution on the planet has had their CrowdStrike moments,” Raiu says. “This is nothing new but the scale of the event.”

Cybersecurity authorities around the world have issued alerts about the disruption, but have similarly been quick to rule out any nefarious activity by hackers. “The NCSC assesses that these have not been caused by malicious cyber attacks,” Felicity Oswald, CEO of the UK’s National Cyber Security Center, said. Officials in Australia have come to the same conclusion .

Nevertheless, the impact has been sweeping and dramatic. Around the world, the outages have been spiraling as companies, public bodies, and IT teams race to fix bricked machines, which involves manually taking machines through a series of corrective steps, including rebooting. In the UK, Israel, and Germany, health care services and hospitals saw systems that they use to communicate with patients disrupted, and canceled some appointments. Emergency services in the US using 911 have reportedly had problems with their lines too. In the earliest hours of the outages, some TV stations, including Sky News in the UK, stopped live news broadcasts.

Global air travel has been one of the most impacted sectors so far. Huge lines formed at airports around the world, with one airport in India using handwritten boarding passes. In the US, Delta, United, and American Airlines grounded all flights at least temporarily, with a dramatic graphic showing air traffic plummeting above the US .

The catastrophic situation reflects the fragility and deep interconnectedness of the internet. Numerous security practitioners told WIRED that they anticipated or even worked with clients to attempt to protect against a scenario where defense software itself caused cascading failures as a result of malicious exploitation or human error, as is the case with CrowdStrike. “This is an incredibly powerful illustration of our global digital vulnerabilities and the fragility of core internet infrastructure,” says Ciaran Martin, a professor at the University of Oxford and the former head of the UK’s National Cyber Security Center.

The ability of one update to trigger such massive disruption still puzzles Raiu. According to Gartner, a market research firm, CrowdStrike accounts for 14 percent of the security software market by revenue, meaning its software is on a wide array of systems. Raiu suggests that the Falcon update must have triggered crashes in other parts of web infrastructure, which could have multiplied the disaster. “CrowdStrike is big, but it can’t be this big,” Raiu says. “Airports, critical infrastructure, hospitals. It cannot be just CrowdStrike everywhere. I suspect we’re seeing a combination of factors, a cascading effect, a chain reaction.”

Hyppönen, from WithSecure, says his “guess” is that the issues may have happened due to “human error” in the update process. “An engineer at CrowdStrike is having a really bad day,” he says. Hyppönen suggests that CrowdStrike could have shipped software different to what they had been testing or mixed up files, or there could’ve been a combination of different factors. “Software like this has to go through extensive testing,” Hyppönen says. “That's what we do. That's what CrowdStrike, of course, does. You have to be really careful about what you ship, which is tough to do because security software is updated very frequently.”

While many of the impacts of the outage are ongoing and still unraveling, the nature of the problem means that individually impacted machines may need to be rebooted manually rather than through an automated process. “It could be some time for some systems that just automatically won’t recover,” CrowdStrike CEO Kurtz told NBC.

The company’s initial “ workaround ” guidance for dealing with the incident says Windows machines should be booted in a safe mode, a specific file should be deleted, and then rebooted. “The fixes we’ve seen so far mean that you have to physically go to every machine, which will take days, because it’s millions of machines around the world which are having the problem right now,” says Hyppönen from WithSecure.

As system administrators race to contain the fallout, the larger existential question of how to prevent another, similar crisis looms large.

“People may now demand changes in this operating model,” says Jake Williams, vice president of research and development at the cybersecurity consultancy Hunter Strategy. “For better or worse, CrowdStrike has just shown why pushing updates without IT intervention is unsustainable.”

Update 7/19/2024, 11am ET: Added comment from Microsoft saying that the Azure outage and the CrowdStrike issue are unrelated.

Update 7/19/2024, 12:30pm ET: Added further comment from Microsoft about its lack of oversight of CrowdStrike's updates.

Update 7/19/2024, 3:45pm ET: Updated to clarify that Amazon Web Services was not impacted by the CrowdStrike update, according to the company.

Update 7/20/2024, 9:30am ET: In an technical explanation released on Friday evening, CrowdStrike clarified that the issue causing the global IT crash was due to a problem with a configuration file that uses the .sys file extension also used by kernel drivers. However, the company clarified that it was not a kernel driver itself. We've updated the piece with the new technical details.

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National Academy of Engineering (US) and Institute of Medicine (US) Committee on Engineering and the Health Care System; Reid PP, Compton WD, Grossman JH, et al., editors. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington (DC): National Academies Press (US); 2005.

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Building a Better Delivery System: A New Engineering/Health Care Partnership.

Hardcopy Version at National Academies Press

2 A Framework for a Systems Approach to Health Care Delivery

To consider how information/communications technologies and systems-engineering tools can be used to help realize the IOM vision of a patient-centered health care system, we must first understand the challenges facing the U.S. health care system ( IOM, 2001 ). The committee has adapted a four-level model by Ferlie and Shortell (2001) to clarify the structure and dynamics of the health care system, the rough divisions of labor and interdependencies among major elements of the system, and the levers for change. A brief description of the model follows. The remainder of this chapter provides a “systems view” of health care and a brief description of the potential role of information/ communications systems.

A FOUR-LEVEL MODEL OF THE HEALTH CARE SYSTEM

In this model, adapted from Ferlie and Shortell (2001) , the health care system is divided into four “nested” levels: (1) the individual patient; (2) the care team, which includes professional care providers (e.g., clinicians, pharmacists, and others), the patient, and family members; (3) the organization (e.g., hospital, clinic, nursing home, etc.) that supports the development and work of care teams by providing infrastructure and complementary resources; and (4) the political and economic environment (e.g., regulatory, financial, payment regimes, and markets), the conditions under which organizations, care teams, individual patients, and individual care providers operate (see Figure 2-1 ).

Conceptual drawing of a four-level health care system.

The Individual Patient

We begin appropriately with the individual patient, whose needs and preferences should be the defining factors in a patient-centered health care system. Recent changes in health care policy reflect an emphasis on “consumer-driven” health care. The availability of information, the establishment of private health care spending accounts, and other measures reflect an increasing expectation that patients will drive changes in the system for improved quality, efficiency, and effectiveness. Overall, the role of the patient has changed from a passive recipient of care to a more active participant in care delivery.

At the same time, the fragmented delivery system, combined with the growing burden of chronic disease and the need for continuous care, have all but forced many patients to assume an active role in the design, coordination, “production,” and implementation of their care, whether they want to or not. Unfortunately, most people do not have access to the information, tools, and other resources they need to play this new role effectively. Considering the roles, needs, and objectives of first-level actors—individual patients—and their interdependencies with actors at other levels of the system, opportunities abound for using information/ communications technologies and systems-engineering tools to improve the overall performance of the health care system.

A starting point for increasing the “patient-centeredness” of health care delivery is changing the perspective of clinicians to consider patients and their families as “partners” and to incorporate their values and wishes into care processes. The level of responsibility patients and their families assume differs from patient to patient. Some prefer to delegate some, if not most, of the decision making to a trusted clinician/counselor in the care system; others want to be full partners in decision making. In either case, however, patients need a free exchange of information and communication with physician(s) and other members of the care team, as well as with the organizations that provide the supporting infrastructure for the care teams.

For patients to communicate “informed” needs and preferences, participate effectively in decision making, and coordinate, or at least monitor the coordination, of their care, they must have access to the same information streams—in “patient-accessible” form—as their physician(s) and care team. Information that supports evidence-based, effective, efficient care encompasses the patient's medical record, including real-time physiological data; the most up-to-date medical evidence base; and orders in process concerning the patient's care. The patient and/or his or her clinician/counselor or family member must also have access to educational, decision-support, information-management, and communication tools that can help them integrate critical information from different sources.

From the patient's perspective, improving the timeliness, convenience, effectiveness, and efficiency of care will require that the patient be interconnected to the health care system. Synchronous communication between patient and physician could improve the quality of care in a number of ways. For example, continuous, real-time communication of a patient's physiological data to care providers could accelerate the pace of diagnosis and treatment, thereby reducing complications and injuries that might result from delays. Remote (e.g., in-the-home, on-the-go) monitoring, diagnosis, and treatment would make care much more convenient for patients, save them time, and conceivably improve compliance with care regimes (see paper by Budinger in this volume). Communication technologies also have the potential to change the nature of the relationship between patient and provider, making it easier for patients to develop and maintain trusting relationships with their clinicians.

Asynchronous communication also has the potential to significantly improve quality of care. The easy accessibility of the Internet and the World Wide Web should enable all but continuous inquiries and feedback between patients and the rest of the health care system ( IOM, 2001 ). The World Wide Web has already changed patients' ability to interact with the system and to self-manage aspects of their care. One of the fastest growing uses of the these communication technologies is as a source of medical information from third parties, which has made the consumer (i.e., the patient) both more informed, and, unfortunately, sometimes misinformed.

Some of the improvements just described are available today, some are under study, and some are as much as a decade away from realization. Thus, research is still an essential component in transforming the current system.

The Care Team

The care team, the second level of the health care system, consists of the individual physician and a group of care providers, including health professionals, patients' family members, and others, whose collective efforts result in the delivery of care to a patient or population of patients. The care team is the basic building block of a “clinical microsystem,” defined as “the smallest replicable unit within an organization [or across multiple organizations] that is replicable in the sense that it contains within itself the necessary human, financial, and technological resources to do its work” ( Quinn, 1992 ).

In addition to the care team, a clinical microsystem includes a defined patient population; an information environment that supports the work of professional and family caregivers and patients; and support staff, equipment, and facilities ( Nelson et al., 1998 ). Ideally, the role of the microsystem is to “standardize care where possible, based on best current evidence; to stratify patients based on medical need and provide the best evidence-based care within each stratum; and to customize care to meet individual needs for patients with complex health problems” ( Ferlie and Shortell, 2001 ). Most health and medical services today, however, are not delivered by groups or teams.

The role and needs of individual physicians have undergone changes parallel to those of individual patients. The exponential increase in medical knowledge, the proliferation of medical specialties, and the rising burden of providing chronic care have radically undercut the autonomy of individual physicians and required that they learn to work as part of care teams, either in a single institution/organization or across institutional settings. The slow adaptation of individual clinicians to team-based health care has been influenced by several factors, including a lack of formal training in teamwork techniques, a persistent culture of professional autonomy in medicine, and the absence of tools, infrastructure, and incentives to facilitate the change.

To participate in, let alone lead and orchestrate, the work of a care team and maintain the trust of the patient, the physician must have on-demand access to critical clinical and administrative information, as well as information-management, communication, decision-support, and educational tools to synthesize, analyze, and make the best use of that information. Moreover, to deliver patient-centered care (i.e., care based on the patient's needs and preferences), the physician must be equipped and educated to serve as trusted advisor, educator, and counselor, as well as medical expert, and must know how to encourage the patient's participation in the design and delivery of care.

At the present time, precious few care teams or clinical microsystems are the primary agents of patient-centered clinical care. Unwarranted variations in medical practice are common, even for conditions and patient populations for which there are standard, evidence-based, patient-stratified “best practice” protocols ( McGlynn et al., 2003 ; Wennberg et al., 1989 ). Even though many clinicians now accept the value of “evidence-based medicine” and recognize that they cannot deliver evidence-based care on their own, they are many barriers to their changing accordingly: the guild structure of the health care professions; the absence of training in teamwork; the strong focus on the needs of individual patients as opposed to the needs of patient populations; and the lack of supporting information tools and infrastructure. All of these can, and do, prevent systems thinking by clinicians, the diffusion of evidence-based medicine, and the clinical microsystems approach to care delivery. Thus, tailoring evidence-based care to meet the needs and preferences of individual patients with complex health problems remains an elusive goal.

For care teams to become truly patient-centered, the rules of engagement between care teams and patients must be changed. Like individual care providers, the care team must become more responsive to the needs and preferences of patients and involve them and their families (to the extent they desire) in the design and implementation of care. Care teams must provide patients with continuous, convenient, timely access to quality care. One member of the care team must be responsible for ensuring effective communication and coordination between the patient and other members of the care team.

The Organization

The third level of the health care system is the organization (e.g., hospital, clinic, nursing home) that provides infrastructure and other complementary resources to support the work and development of care teams and microsystems. The organization is a critical lever of change in the health care system because it can “provide an overall climate and culture for change through its various decision-making systems, operating systems, and human resource practices” ( Ferlie and Shortell, 2001 ). The organization encompasses the decision-making systems, information systems, operating systems, and processes (financial, administrative, human-resource, and clinical) to coordinate the activities of multiple care teams and supporting units and manage the allocation and flow of human, material, and financial resources and information in support of care teams. The organization is the business level, the level at which most investments are made in information systems and infrastructure, process-management systems, and systems tools.

Health care organizations face many challenges. In response to the escalating cost of health care, government and industry—the third-party payers for most people—have shifted a growing share of the cost burden back to care providers and patients in recent years. As a result, hospitals and ambulatory care facilities are under great pressure to accomplish more work with fewer people to keep revenues ahead of rising costs.

In certain respects, management of health care organizations is not well positioned to respond to mounting cost and quality crises. Compared to other industries, health care has evolved with little shaping by the visible hands of management. Historically, most leaders of health care organizations were initially trained in medicine or public health. Moreover, except in the relatively few integrated, corporate provider organizations (e.g., Kaiser-Permanente, Mayo Clinic, et al.), the management of most hospitals faces the challenge of “managing” clinicians, the majority of whom function as “independent agents.”

Less than 40 percent of all hospital-based physicians are employed as full-time staff by the hospitals where they practice, a reflection of the deeply ingrained culture of professional autonomy in medicine and the deeply held belief of care professionals that their ultimate responsibility is to individual patients. These circumstances have posed significant challenges to the authority of health care management in many organizations, often creating discord and mistrust between health care professionals and health care management. Other challenges to management include the hierarchical nature of the health professions and inherent resistance to team-based care, significant regulatory and administrative requirements (e.g., controlled substances, biohazardous waste disposal, patient privacy, safety, etc.), and health care payment/reimbursement regimes that provide little, if any, incentives for health care organizations to invest in non-revenue-generating assets, such as information/ communications technologies and process-management tools.

To support patient-centered care delivery by well functioning clinical care teams or microsystems, health organizations must find ways to bridge the health care professional/ delivery system management divide and invest in information/ communications technologies, systems-engineering tools, and associated knowledge. Integrated, patient-centered, team-based care requires material, managerial, logistical, and technical support that can cross organizational/institutional boundaries—support that is very difficult to provide in a highly fragmented, distributed-care delivery system.

Financial investments in information/communications technologies and systems-engineering tools alone will not be enough, however. These investments must be accompanied by an organizational culture that encourages the development of care teams working with semiautonomous agents/ physicians (see paper by Bohmer in this volume). “Developing a culture that emphasizes learning, teamwork, and customer focus may be a ‘core property' that health care organizations …will need to adopt if significant progress in quality improvement is to be made” ( Ferlie and Shortell, 2001 ). Finally, health care institutions must become “learning organizations” that are “skilled at creating, acquiring, and transferring knowledge, and at modifying [their] behavior to reflect new knowledge and insights” ( Garvin, 1993 ).

The Political and Economic Environment

The fourth and final level of the health care system is the political, economic (or market) environment, which includes regulatory, financial, and payment regimes and entities that influence the structure and performance of health care organizations directly and, through them, all other levels of the system. Many actors influence the political and economic environment for health care. The federal government influences care through the reimbursement practices of Medicare/ Medicaid, through regulation of private-payer and provider organizations, and through its support for the development and use of selected diagnostic and therapeutic interventions (e.g., drugs, devices, equipment, and procedures). State governments, which play a major role in the administration of Medicaid, also influence care systems. Private-sector purchasers of health care, particularly large corporations that contract directly with health care provider organizations and third-party payers (e.g., health plans and insurance companies), are also important environment-level actors, in some cases reimbursing providers for services not covered by the federal government.

Federal regulations influence the structure, level, and nature of competition among providers and insurers. They can also affect the transparency of the health care system by setting requirements related to patient safety and other aspects of the quality of care. By exercising its responsibility to monitor, protect, and improve public health, the federal government shapes the market environment for health care. Federal agencies, the primary sources of funding for biomedical research, influence the research and technological trajectories of health care, and, with them, the education of health care professionals and professionals in other areas invested in the health care enterprise.

At present, many factors and forces at the environmental level, including reimbursement schemes for health care services and some regulatory policies, do not support the goals and objectives of patient-centered, high-performance health care organizations or the health care delivery system as a whole. Although the federal government, the single largest purchaser of health care services, principal regulator, and major research patron, is, in many ways, best positioned to drive changes in the health care delivery system, some private-sector payer organizations and state governments are better positioned to experiment with new mechanisms and incentives for improving the quality of care and making health care more affordable (see papers by De Parle and Milstein in this volume).

A SYSTEMS VIEW OF HEALTH CARE

In Chapter 1 , the health care delivery system was described as a “cottage industry.” The main characteristic of a cottage industry is that it comprises many units operating independently, each focused on its own performance. Each unit has considerable freedom to set standards of performance and measure itself against metrics of its own choosing. In addition, cottage industries do not generally attempt to standardize or coordinate the processes or performance of Unit A with those of Units B, C, and so on.

Indeed, this is an apt characterization of the current health care delivery system. Even in many hospitals, individual departments operate more or less autonomously, creating so-called “silos.” Many physicians practice independently or in small groups, and ambulatory clinics, pharmacies, laboratories, rehabilitation clinics, and other organizations—although part of the delivery system—often act as independent entities. We often call this arrangement a “health care system,” even though it was not created as a system and has never performed as a system.

Moving from the current conglomeration of independent entities toward a “system” will require that every participating unit recognize its dependence and influence on all other units. Each unit must not only achieve high performance but must also recognize the imperative of joining with other units to optimize the performance of the system as a whole. Moreover, each individual care provider must recognize his or her dependence and influence on other care team members (e.g., specialists in different fields, pharmacists, nurses, social workers, psychologists, physical therapists, etc.) ( IOM, 2003 ). These are the underlying attitudes that support a systems approach to solving problems.

Changing attitudes to embrace teamwork and systems “thinking” can be extremely difficult and may encounter resistance. Nevertheless, a concerted, visible commitment by management will be necessary to achieve this new way of thinking as a giant step toward the improvements identified in Crossing the Quality Chasm ( IOM, 2001 ).

Optimization

It is easy to show mathematically that the optimization of individual units rarely, and only under highly improbable circumstances, results in optimization of the whole. Optimization is determined by a variety of metrics, including the productivity of a unit, the quality of service, the use of physical resources, or a combination of all of these. Optimization of the whole requires a clear understanding of the goal of the overall system, as well of interactions among the subsystems. The whole must be recognized as being greater than the sum of its parts ( Box 2-1 ).

Optimizing System Performance. Optimization of the performance of a large system is often attempted through the optimization of each sub-element of the system. In industry, this is commonly accomplished by creating independent “profit/loss” (more...)

A handful of health care organizations have embraced the systems view (e.g., the Veterans Administration and Kaiser-Permanente Health Care). These significant exceptions to the general rule demonstrate that the systems view is applicable to health care and could be a model for other health care organizations. The goal of this report is to identify existing tools that can be used to address problems and to suggest areas for further exploration.

In any large system that has many subsystems, achieving high operating performance for each subsystem while taking into account the mutual influence of subsystems on each other and on the system as a whole can be a daunting task. A simple pictorial description of interacting elements in a system may be helpful for understanding how the system works. However, a deeper understanding invariably involves creating a mathematical description of subsystems, their performance, and their interactions. This, in turn, requires a model, that is, an abstract representation of how the system operates (a mathematical form that can be used to analyze the system) that includes parameters that determine the performance of each sub-element of the system, as well as descriptions of interactions. The model is a tool for simulating the performance of the actual system.

The principal objective of a simulation is to ask “what if” questions and assess the impact of alternative actions on the performance of the system to determine which ones might improve overall system performance. For example, if a change is planned in the layout of a facility, a model can be used to determine if it will improve the flow of people and equipment through the facility. A model might help determine how much inventory must be kept at Station A to ensure that it can respond to an emergency in less than five minutes. A model might also reveal if a different communication system might reduce the required inventory or the best way to assign a nursing staff when 10 percent of the nurses are not available. As Alan Pritsker, the author of many treatises on large-scale system modeling and simulation, writes, “The system approach is a methodology that seeks to ensure that changes in any part of the system will result in significant improvements in total system performance” ( Pritsker, 1990 ).

Because the health care system involves a myriad of interacting elements, it is difficult, or even impossible, for any individual to have a complete picture of the system without using special tools to perform a systems analysis. A model of the health care system must include a description of “processes,” including a wide variety of activities, from nurses administering medication on the hospital floor to examinations by a doctor to laboratory tests to the filling of prescriptions by a pharmacist to follow-on visits by a nurse. The model must include the role of each process in health care delivery and its interactions with other processes in the system. But clinical elements are not the only important elements in an analysis. The interaction between administrative elements (e.g., patient check-in and billing procedures) and other processes can also significantly influence the overall performance of the system from the patient and organization's point of view. All processes must be quantitatively described to be included in the model.

Any attempt to optimize the performance of a system must take into account objectives that are difficult to quantify and that may, in fact, conflict with each other. Quantifying the quality of care, for example, can be difficult, largely because the meaning of quality varies depending on whether the patient, the health care professional, or the clinic or hospital is assessing it. Improvements in productivity may mean an increase in the number of patients that can be accommodated or a decrease in waiting time for the average patient. IOM identified safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity as proper quality objectives for the health care delivery system. Systems analyses can be used to improve the overall performance of systems with multiple objectives because they include possible trade-offs and/or synergies among these objectives. In addition, potentially conflicting goals—for example, cost containment and patient-centeredness—can also be analyzed.

THE ROLE OF INFORMATION AND COMMUNICATIONS TECHNOLOGY

Many industries have attempted to use information/ communications systems in place of manual operations, such as record keeping. But information/communications systems can be used for much more than electronic record keeping. With incredible advances in computational speed and capacity and parallel advances in computer software, clinical information and communications systems can provide immediate access to information, including patient-based information (e.g., past laboratory values and current diagnoses and medications), institution-based information (e.g., drug-resistance patterns of various bacteria to different antibiotics), profession-based information (e.g., clinical-practice guidelines, including summaries of recommended best practices in various situations), real-time decision support (e.g., alerts about potential drug interactions or dosing patterns in a patient with a compromised drug-metabolism mechanism), practice-surveillance support (e.g., reminders about upcoming screening tests recommended for a patient), and population health data (e.g., for epidemiological research, disease and biohazard surveillance, notification of post-introduction adverse drug events).

Information/communications systems can also provide important information to the patient for self-treatment of diseases and enable ongoing asynchronous communication between patients and care providers. In the future, with the advent of remote monitoring devices and wireless communication systems, information/communications systems have the potential to support continuous monitoring of a patient's health status at home, rapid diagnosis by clinicians, and timely, effective therapeutic interventions in the home by the patient or a family member, with guidance by health professionals. Furthermore, by capturing process and system performance data for systems analysis, control and design, information/communications technologies can facilitate the use of systems-engineering tools by patient care teams, provider organizations, and environmental actors at all levels of the health care delivery system.

Chapter 3 provides descriptions of a large portfolio of systems-engineering tools and concepts with the potential to significantly improve the quality and cost performance of the health care system. These tools have been widely and effectively used to design, analyze, and control complex processes and systems in many major manufacturing and services industries. In Chapter 4 opportunities are described for accelerating the development and widespread diffusion of clinical information and communications systems for health care delivery that can support the use of systems tools and improve the connectivity, continuity of care, and responsiveness of the health care system as a whole .

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Cite this Page National Academy of Engineering (US) and Institute of Medicine (US) Committee on Engineering and the Health Care System; Reid PP, Compton WD, Grossman JH, et al., editors. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington (DC): National Academies Press (US); 2005. 2, A Framework for a Systems Approach to Health Care Delivery.
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National Professional Officer (Mental Health) - (2405237)

IMPORTANT NOTICE: Please note that the deadline for receipt of applications indicated above reflects your personal device's system settings.

OBJECTIVES OF THE PROGRAMME

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends. Related to mental health, WHO Sri Lanka office aims to improve quality of life people in Sri Lanka by supporting the government in prevention and control of priority mental health, substance use and neurological disorders, preventing suicides, and promoting mental health, advocating for integrated mental health and social care services in PHC and community-based settings, preparing and responding to mental health and psychosocial issues during health emergencies and promoting the rights of people with psychosocial, intellectual and cognitive disabilities.

DESCRIPTION OF DUTIES

Under the direct supervision of Medical Officer (NCD) and the overall guidance of the WHO Representative and in close collaboration and coordination with the Ministry of Health and partners, the incumbent will:

1. Facilitate policy support as needed for enabling planning, implementation, monitoring and evaluation of the essential components of the National Mental Health policy and plan;

2. Support scaling up services for mental, neurological and substance use (MNS) disorders via implementation of WHO Mental Health Gap Action Programme (mhGAP);

3. Provide technical tools, SOPs etc. to ensure provision of comprehensive, integrated mental health and social care services in primary care and community-based settings;

4. Support implementation of strategies for mental health promotion and prevention especially in schools and workplaces and promote programs targeted at vulnerable groups, including children, elderly and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters and during emergencies);

5. Provide technical assistance to strengthen information systems and research to improve data on burden of mental and neurological disorders;

6. Provide technical assistance to the country in developing mental health related tools and guidelines including LIVE LIFE: an implementation guide for suicide prevention;

7. Support the country to update the mental health law taking into consideration regional and international human rights instruments;

8. Provide support to improve mental health literacy, address stigma and discrimination and promote the rights, opportunities and care of individuals with mental disorders;

9. Encourage using WHO Quality Rights toolkit to evaluate quality of mental health services;

10. Increase awareness of disability issues, and promote the inclusion of disability as a component in national and sub-national health programmes;

11. Facilitate collection and dissemination of disability-related data and information;

12. Support the country to conduct the WHO/WB Model Disability Survey and/or WHO Disability Assessment Schedule (WHO DAS 2.0);

13. Represent WHO country office in the UN Disability Inclusion Inter-Agency Coordination mechanism at the country level, and contribute to reporting via the UNCT Accountability Scorecard on Disability Inclusion tool;

14. Support proposal writing and donor reporting for Mental Health, Psycho-Social Support and Disability programs;

15. Perform any other duties as assigned by the supervisor(s).

REQUIRED QUALIFICATIONS

Essential : Bachelor degree in Medicine or public health Desirable : Master's degree in public health or medical science

Essential : At least two (2) years of professional work experience in the field of mental health, and/or psychiatry Desirable : Experience of working with the MoH and/or province level; Experience in developing mental health guidelines, training modules and other tools; Experience in conducting of WHO disability assessment Schedule (WHODAS.2)

Essential: Sound understanding of principles of public health, to be able to provide quality technical inputs, and good problem-solving, analytical and negotiation skills

Desirable: Knowledge of WHO programmes and practices an asset

WHO Competencies

Respecting and promoting individual and cultural differences
Communication
Ensuring the effective use of resources
Building and promoting partnerships across the organization and beyond

Use of Language Skills

Essential : Expert knowledge of English. Expert knowledge of local language.

REMUNERATION

Remuneration comprises an annual base salary starting at LKR 6,980,640 (subject to mandatory deductions for pension contributions and health insurance, as applicable) and 30 days of annual leave.

ADDITIONAL INFORMATION

This vacancy notice may be used to fill other similar positions at the same grade level.
Only candidates under serious consideration will be contacted.
A written test and/or an asynchronous video assessment may be used as a form of screening.
In the event that your candidature is retained for an interview, you will be required to provide, in advance, a scanned copy of the degree(s)/diploma(s)/certificate(s) required for this position. WHO only considers higher educational qualifications obtained from an institution accredited/recognized in the World Higher Education Database (WHED), a list updated by the International Association of Universities (IAU)/United Nations Educational, Scientific and Cultural Organization (UNESCO). The list can be accessed through the link: http://www.whed.net/ . Some professional certificates may not appear in the WHED and will require individual review.
According to article 101, paragraph 3, of the Charter of the United Nations, the paramount consideration in the employment of the staff is the necessity of securing the highest standards of efficiency, competence, and integrity. Due regard will be paid to the importance of recruiting the staff on as wide a geographical basis as possible.
Any appointment/extension of appointment is subject to WHO Staff Regulations, Staff Rules and Manual.
The WHO is committed to creating a diverse and inclusive environment of mutual respect. The WHO recruits and employs staff regardless of disability status, sex, gender identity, sexual orientation, language, race, marital status, religious, cultural, ethnic and socio-economic backgrounds, or any other personal characteristics.
The WHO is committed to achieving gender parity and geographical diversity in its staff. Women, persons with disabilities, and nationals of unrepresented and underrepresented Member States ( https://www.who.int/careers/diversity-equity-and-inclusion ) are strongly encouraged to apply.
Persons with disabilities can request reasonable accommodations to enable participation in the recruitment process. Requests for reasonable accommodation should be sent through an email to [email protected]
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Link to apply:

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A Framework for a Systems Approach to Health Care Delivery
A FOUR-LEVEL MODEL OF THE HEALTH CARE SYSTEM. In this model, adapted from Ferlie and Shortell (2001), the health care system is divided into four "nested" levels: (1) the individual patient; (2) the care team, which includes professional care providers (e.g., clinicians, pharmacists, and others), the patient, and family members; (3) the organization (e.g., hospital, clinic, nursing home ...
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Facilitate policy support as needed for enabling planning, implementation, monitoring and evaluation of the essential components of the National Mental Health policy and plan;2. Support scaling up services for mental, neurological and substance use (MNS) disorders via implementation of WHO Mental Health Gap Action Programme (mhGAP);3.

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Clinical problem solving and diagnostic decision making: selective review of the cognitive literature

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Problem solving

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Clinical Problem Analysis (CPA)

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