Are We Training Plastic Surgeons for the Future Needs of the Canadian Population?
Notice bibliographique
Résumé
Just over half a century ago when I was interviewed for medical school, one of the questions I was asked "In Canada, we have a problem with physicians practicing in the big cities and not in smaller communities where they are needed.What is your solution to this problem?"Without any hesitation, I responded "the solution is simple."I sensed they were surprised that a naive prospective medical student felt they knew the solution to something that was at the time a major challenge and remains one to this day."Do not give them a choice," I responded, "send them where they are needed for a prescribed period, then give them the opportunity to move elsewhere after their service if they wish.If we look to other government-funded services like the Canadian Military, where members are assigned to bases or regions where they are most needed, there is precedent-and the same could apply to physicians."Most of the cost of medical education is subsidized by the government I reasoned, so the government should be able to direct early career physician placement.Two of the three interviewers frowned at my answer.The third remained poker-faced so I was unsure what they thought of my answer.It was clear to me at the time that the panel did not care for my response, which I can understand.They raised the issues of freedom of movement and professional autonomy.Though my answer might have just ended my dream of medicine, I stood my ground.I explained that I believed it was the only fair, ethical, and democratic way to provide care for underserved areas.Half a century later, as I am entering retirement, I still find myself reflecting on this matter.From being a healthcare provider, I may soon become a healthcare consumer.Will there be a plastic surgeon available to provide me with the care I may need?Based on present trends, I am not so sure.Meaningful plastics coverage in emergencies is a serious challenge for our field.In 2007, the average waitlist time for urgent consultations was 11 days.1 I suspect it is regrettably even longer now.Where I am based (Hamilton ON), quite frequently, we do not have coverage for emergency cases in hospitals within a 20-to 50-mile radius of our university hospitals.When we confront our offending colleagues and ask why they are not seeing the patients in their catchment area, a typical
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,016 | 0,066 |
| Méta-épidémiologie (sens strict) | 0,005 | 0,002 |
| Méta-épidémiologie (sens large) | 0,005 | 0,004 |
| Bibliométrie | 0,006 | 0,005 |
| Études des sciences et des technologies | 0,010 | 0,005 |
| Communication savante | 0,013 | 0,005 |
| Science ouverte | 0,006 | 0,002 |
| Intégrité de la recherche | 0,037 | 0,033 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,014 | 0,006 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».