Q.2 write reply to this article(Tracy) 

I work in radiation Oncology.  we have a very extensive residency program. We have 3 new residents each year and these residents work with us for 4 years.  Over the last 3 years we have hired 1-2 residents as attendings.   The process is very detailed.  First, the potential attending must complete residency at the highest of their class. Next, they must pass the Radiation Oncology Board exam which will test their knowledge of site specific diagnosis, treatments, necessary imaging and overall patient management.  Then, they will have several interviews of oral questions by current attending in the department.  They will be presented with scenarios  to test the knowledge, skills, and ability to make immediate decisions based on immediate information presented.   They will finally meet with senior Leadership who will decide if the prospects meet Hospitals values and mission to provide care to the community. 

Review of medical records, documentation, proper billing of E/M levels are done monthly.  At any time a physician is failing to meet the guidelines of the hospital and department, the Clinical Director and Department Director are notified and the attending has specific amount of time to correct documentation and behaviors or will be released of performing duties. 

American Board of Physician Specialties. (2020, May 6). Radiation Oncology Board Certification | Exam Blueprint | ABPShttps://www.abpsus.org/radiation-oncology-exam-blueprint/ 

Q.3 write reply for this article’s (Sylvia)

The process is pretty lengthy depending on the role that Is being applied for. There are multiple interview stages that would need to be fulfilled. My mom is an RN, she applied internally for a position within her company and her interview was a total of 6 hours, with a brief 30 min break after 3 hours. I think honestly that is done to see who will stick around long enough to see the finish line for the opening position. That shows the patience that will be needed when dealing with patients. That shows time dedicated to their position, and also shows dependability. All characteristics that they need to posses to be successful in their position. One thing you pointed out deja was the certification in their state. Here in NY, there are so many extra steps before a certificate is given, so the do allow NYS certification in other states. 

ETH

Q.4 write a report/ response for this article (Nicholas)

The impact of the ethics committee pertaining to euthanasia concentrates on a fundamental aspect of correct application and facilitation of the process, provide a legally safe outlook for professionals and persons that are willing to go on this journey. For the doctors that support the process it is a very important process pertaining to the states where it is legal, when facing these circumstances and honoring terminally ill patients wish. 

The legal aspect behind the ethics committees and the euthanasia process is to legally protect freedom of the person that is willing to committee to this process, overall the aspect of this process assuming you are ” pro ” is to ensure their pain and suffering does not continue unnecessary. Of course there is a ying yang effect who are against the euthanasia, where the doctors do no harm obligation is to heal people instead of just performing this task in a ” routine ” fashion. End of life depression and anxiety some may argue are treatable and the health aspect may be assessed first. 

This is a very tough topic but at the end we must understand what the patients wants and why and then determine if what the patients wants legal regardless if it is overall socially acceptable in 1 place where it is not in the other

Q. 5 Write a reply / response for this article (Tracy wil)

We have a one vault Proton Therapy Center that I work at.  When we were operating at compacity it was important to establish ethical guidelines to score patients based on a multiple of factors to determine who received treatment first.  Of course each physician believes their patient needs treatment first. In the beginning, more emergent cases bumped other patients from start times, while pediatric cases could wipe out an entire morning of patients due to longer more complex treatment courses. 

Through a collaboration with a  multidisciplinary panel of experts, a ethical scoring system was developed. 

*age of patient (life expectancy)

*previous radiation

*enrolled in clinical trails

*KPS – comorbidity

*anesthesia

*complexity of treatment

*time required

Each of these areas were given a score, the higher the score, the sooner the treatment needed to be.  In addition, once insurance was approved for treatment, the patient was tentatively scheduled for treatment.  Once that occurred they could not lose their position.  Over the course of two years, we were able to collect enough data and publish a research document outlining the importance of an ethical scoring system for other Proton Centers to utilize as well. 

Ethical Allocation of Proton Therapy and the Insurance Review Process. (2021, February 3). ScienceDirect. https://www.sciencedirect.com/science/article/abs/pii/S1879850021000424 

Q. 6 Write a reply / response for this article (Maria)

The Ethics Committee purpose is to help families, patients, and medical professional with any ethical questions they may have regarding treatment. Also. the committee upholds the policies, reviews cases, political advocacy, etc. The ethics committee involvement is determined on the healthcare organization’s needs. An example, a family cannot come to terms with the patient decision to have a Do Not Resuscitate (DNA). If the patient choosing not to have any lifesaving methods and a family tries to fight it the committee would have to step in at that point. Unfortunately, for the family legally the healthcare organization would have to abide by the DNR.

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