Creation and Administration of a Chiropractic Program Practical Classroom Preparticipation Screening Aimed to Prevent Student Injuries: A Descriptive Report

Objective

The purpose of this descriptive report is to describe the development of a preparticipation risk assessment screening process for incoming students prior to participation in practical labs.

Methods

A committee at the Palmer College of Chiropractic, Florida met to discuss a health history questionnaire, physical examination process, and course of action to have second-year students use their current knowledge to screen incoming students for possible clinical considerations of practice lab participation. The aim was to identify potential risk factors that may require application modification associated with performing and receiving adjustments and other hands-on lab activities within the curriculum. The preparticipation screening process, focused on general health and curriculum referenced chiropractic clinical considerations, and was created as an expansion of the existing informed consent procedures to screen incoming students prior to participating in palpation, technique, physical examination, and open adjusting labs in the chiropractic program. Any clinical considerations identified during the screening were referred to be fully evaluated by a third-year clinic intern and faculty-licensed chiropractor to maintain classroom safety standards for the students. Referred students were restricted from full classroom lab participation until recommendations from the clinic or outside licensed healthcare providers managing their concerns were received.

Results

The program was implemented in April 2022. Eight out of the 48 students evaluated in the first group and 12 of the 81 in the second group had possible clinical considerations to participation and were referred appropriately for a full evaluation. In the third group, 35 out of 146 students with suspected clinical considerations to participation were identified. Of the 55 students referred out, all students are now actively participating in classroom activities. Fifteen have been cleared to return to classroom participation with no restrictions and the remaining 40 students have been released for participation with patient-specific restrictions as directed by their managing health care providers.

Conclusion

The preparticipation screening process was implemented as all incoming students since the inception of the process have been screened, referred for evaluation when deemed appropriate, and cleared to participate in labs either with or without restrictions. This process has also demonstrated the possibility of identifying multiple clinical considerations for safe curricular participation while participating in doctor-patient simulated classroom activities. This process may be helpful for new students to recognize the patient history and examination procedures as an important aspect of a patient encounter prior to receiving treatment.

Diagnostic accuracy of artificial intelligence in detecting retinitis pigmentosa: A systematic review and meta-analysis

Retinitis pigmentosa (RP) is often undetected in its early stages. Artificial intelligence (AI) has emerged as a promising tool in medical diagnostics. Therefore, we conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of AI in detecting RP using various ophthalmic images. We conducted a systematic search on PubMed, Scopus, and Web of Science databases on December 31, 2022. We included studies in the English language that used any ophthalmic imaging modality, such as OCT or fundus photography, used any AI technologies, had at least an expert in ophthalmology as a reference standard, and proposed an AI algorithm able to distinguish between images with and without retinitis pigmentosa features. We considered the sensitivity, specificity, and area under the curve (AUC) as the main measures of accuracy. We had a total of 14 studies in the qualitative analysis and 10 studies in the quantitative analysis. In total, the studies included in the meta-analysis dealt with 920,162 images. Overall, AI showed an excellent performance in detecting RP with pooled sensitivity and specificity of 0.985 [95%CI: 0.948-0.996], 0.993 [95%CI: 0.982-0.997] respectively. The area under the receiver operating characteristic (AUROC), using a random-effect model, was calculated to be 0.999 [95%CI: 0.998-1.000; P < 0.001]. The Zhou and Dendukuri I² test revealed a low level of heterogeneity between the studies, with [I2 = 19.94%] for sensitivity and [I2 = 21.07%] for specificity. The bivariate I² [20.33%] also suggested a low degree of heterogeneity. We found evidence supporting the accuracy of AI in the detection of RP; however, the level of heterogeneity between the studies was low.

Seven Steps to Financial Health

Physicians and dentists have a very limited exposure to personal financial management and yet find themselves in the top 10% of earners in the United States of America. Education loans, practice expenses, and high standards of living obligate them to be good financial stewards to succeed financially. Anecdotal personal experience and review. The article establishes seven steps to implement as medical/dental students, interns, residents, or practicing doctors to move towards financial health and security. The steps include (1) saving enough; (2) good debt management; (3) being tax savvy; (4) obtaining the correct insurance; (5) making wise investments; (6) if choosing to marry, avoid divorce; and (7) keeping track with periodic progress assessment. Each of these steps contains several components that can aid and guide physicians and dentists in their financial arc of development over their professional career and into retirement, considering generational wealth transfer or charitable donation as ultimate goals. This brief guide is based on my own financial journey to achieve long-term financial independence: start early, use simple tax deferred investments without chasing trends while keeping fees down, live within your means, and adequately insure your income.

Advancements in Human Embryonic Stem Cell Research: Clinical Applications and Ethical Issues

BACKGROUND

The development and use of human embryonic stem cells (hESCs) in regenerative medicine have been revolutionary, offering significant advancements in treating various diseases. These pluripotent cells, derived from early human embryos, are central to modern biomedical research. However, their application is mired in ethical and regulatory complexities related to the use of human embryos.

METHOD

This review utilized key databases such as ClinicalTrials.gov, EU Clinical Trials Register, PubMed, and Google Scholar to gather recent clinical trials and studies involving hESCs. The focus was on their clinical application in regenerative medicine, emphasizing clinical trials and research directly involving hESCs.

RESULTS

Preclinical studies and clinical trials in various areas like ophthalmology, neurology, endocrinology, and reproductive medicine have demonstrated the versatility of hESCs in regenerative medicine. These studies underscore the potential of hESCs in treating a wide array of conditions. However, the field faces ethical and regulatory challenges, with significant variations in policies and perspectives across different countries.

CONCLUSION

The potential of hESCs in regenerative medicine is immense, offering new avenues for treating previously incurable diseases. However, navigating the ethical, legal, and regulatory landscapes is crucial for the continued advancement and responsible application of hESC research in the medical field. Considering both scientific potential and ethical implications, a balanced approach is essential for successfully integrating hESCs into clinical practice.

Validation of clinical simulation scenarios for the teaching of soft skills in child-centered care

Consultations with children and their families are complex and require soft skills. However, there is a gap in the medical curriculum concerning these skills, especially as encounter training is often adult-centered. We developed, validated, and applied simulation scenarios that prioritize active participation of children to train soft skills in child-centered care for undergraduate medical students. This is a methodological study to develop three scenarios and a checklist of what is expected. The content was validated by 18 experts. A pre-test was carried out for adjustments. Then, the simulations were applied and evaluated by 18 medical undergraduate students. They included the participation of 6 pediatric simulated patients aged 9-12 years trained by a drama teacher. According to the results, the scenarios and checklist proved to be valid instruments in content terms (ICV-I > 0.8). The scripts were followed by the simulated pediatric patients, but they had difficulty mimicking a hypoactive state. Some were anxious, but everyone enjoyed participating in the feedback. The simulated parents had difficulty participating and giving space to the child's speech. Participants assessed that the simulations performed as they were proposed and, after experimenting them, felt more prepared. The simulations provided an opportunity for students to practice soft skills by interacting with children in a safe environment. Using children as simulated patients is feasible but presents some challenges. Our study has expanded the ways in which children's health content can be taught. We are investigating whether this training leads to better patient outcomes in real clinical settings.

LEARNING CURVE IN PONSETI METHOD - EVOLUTION IN 5 YEAR-INTERVALS

Objective

Evaluate whether the experience of the surgeon could reduce Ponseti treatment time, and a number of cast changes, and the evolution of the Pirani Score.

Methods

2 reference centers were evaluated. At Institution 1, 254 patients with idiopathic clubfoot (403 feet) were included, and at Institution 2, 32 patients (51 feet). At institution 1 (mentor), 3 intervals of 5 years each were analyzed. At the Institution 2 (trainee), 1 interval of 5 years was analyzed.

Results

Patients treated by the mentor had fewer casts compared with the trainee (p < 0.001). At Institution 1, the three mentor intervals showed differences in the number of casts (p < 0.05). A statistically significant difference was observed only in the first mentor interval (2000 to 2005, average of 3.47 casts) compared with the 2 other intervals (2005 to 2010; average of 2.6 casts and 2011 to 2015; average of 2.79 casts; p < 0.0001). Pirani score decreases the most until the third clinic visit.

Conclusion

The mentor's greater expertise was associated with fewer casts and shorter time to obtain correction in isolated clubfoot, especially right after the first 5 years of practice. Progression of the Pirani score in both institutions occurs between the first and the third casts. Level of Evidence III; Therapeutic Study, Retrospective Comparative Study.

Digital twin: Data exploration, architecture, implementation and future

A Digital Twin (DT) is a digital copy or virtual representation of an object, process, service, or system in the real world. It was first introduced to the world by the National Aeronautics and Space Administration (NASA) through its Apollo Mission in the '60s. It can successfully design a virtual object from its physical counterpart. However, the main function of a digital twin system is to provide a bidirectional data flow between the physical and the virtual entity so that it can continuously upgrade the physical counterpart. It is a state-of-the-art iterative method for creating an autonomous system. Data is the brain or building block of any digital twin system. The articles that are found online cover an individual field or two at a time regarding data analysis technology. There are no overall studies found regarding this manner online. The purpose of this study is to provide an overview of the data level in the digital twin system, and it involves the data at various phases. This paper will provide a comparative study among all the fields in which digital twins have been applied in recent years. Digital twin works with a vast amount of data, which needs to be organized, stored, linked, and put together, which is also a motive of our study. Data is essential for building virtual models, making cyber-physical connections, and running intelligent operations. The current development status and the challenges present in the different phases of digital twin data analysis have been discussed. This paper also outlines how DT is used in different fields, like manufacturing, urban planning, agriculture, medicine, robotics, and the military/aviation industry, and shows a data structure based on every sector using recent review papers. Finally, we attempted to give a horizontal comparison based on the features of the data across various fields, to extract the commonalities and uniqueness of the data in different sectors, and to shed light on the challenges at the current level as well as the limitations and future of DT from a data standpoint.

Effectiveness of online interprofessional education-communication course during the COVID-19 pandemic

A developed IPE (Interprofessional Education)-communication course was first implemented at Universitas Pelita Harapan/UPH via online learning due to the COVID-19 pandemic. This study aimed to analyze the effectiveness of a newly developed IPE-online communication course offered to medical (MS) and nursing (NS) students. This study was a quantitative study using a pre-post design without control. The IPAS (Interprofessional Attitude Scale) assessed students' attitudes toward IPE. Satisfaction with the program was also measured following its completion. The questionnaire was administered via Survey Monkey to 535 respondents (MS = 250; NS = 285). Univariate and bivariate statistical analyses were employed. Before and after the IPE program, 161 MS and 146 NS completed the IPAS questionnaire (n = 307). The attitude of MS and NS were not improved significantly (p-value >0.05). Moreover, several subscales of attitudes decreased significantly, including "Diversity and Ethics" with a low-size effect for medical students and "Teamwork, Roles, and Responsibilities" and "Patient-Centeredness" with a low-size effect for nursing students. Both students (n = 307) were also satisfied with the IPE course (Mean MS: 4.28 and NS: 4.34). This study suggests that online IPE communication course may not be effective in fostering student attitudes. The IPE communication course should be accomplished through in-person class instead of online learning. Further IPE course evaluations are required to improve the acceptability, applicability, and effectiveness of IPE in health education.

Demanded interdisciplinary subjects for integration in medical education program from the point of view of graduated medical physicians and senior medical students: a nationwide mixed qualitative-quantitative study from Iran

INTRODUCTION

This study aimed to detect interdisciplinary subjects for integration into the medical education program of Iran.

METHODS

A qualitative-quantitative method was used. Firstly, interdisciplinary subjects demanded by medical graduates and senior medical students were defined by qualitative study. In the second stage, questionnaire was developed which based on the findings of qualitative stage, experts' opinion and reviewing of the national general guide of professional ethics for medical practitioners. Questionnaire consisted of demographic, occupational and thirteen interdisciplinary items. These items consisted of social determinants of health, social and economic consequences of disease, social prescribing, physicians' social responsibility, role of gender, racial, ethnic, social and economic issues in approach to patients, role of logic and mathematics in clinical decision-making, philosophy of medicine, maintaining work-life balance, self-anger management, national laws of medicine, religious law in medical practice, health system structure, and teamwork principles. Level and importance of knowledge and self-assessed educational needs were asked about each item. In the third stage, a national online survey was conducted. SPSS 25 was used for statistics.

RESULTS

By content analysis of data in qualitative stage, 36 sub-themes and 7 themes were extracted. In the quantitative part, 3580 subjects from 41 medical universities across Iran participated in this study. 2896 (80.9%) were medical graduates and 684 (19.1%) were senior medical students. Overall, knowledge about interdisciplinary items was low to intermediate, while high to very high knowledge ranged from maximally 38.7% about socioeconomic consequences of disease to minimally 17.2% about social prescribing. Participants gave the most importance to the having knowledge about self-anger management (88.3%), maintaining work-life balance (87.2%) and social determinants of health (85.8%), respectively. However, national laws of medicine (77.6%), maintaining work-life balance (75.4%) and self-anger management (74%) were the first top three educational demands by participants.

CONCLUSION

This study revealed a low to moderate level of knowledge about interdisciplinary topics among both graduated medical physicians and senior medical students. These groups showed a strong demand and tendency to know and to be educated about these topics. These findings underscore the urgency for educational reforms to meet the interdisciplinary needs of medical professionals in Iran.

Dataset of clinical cases, images, image labels and captions from open access case reports from PubMed Central (1990-2023)

This paper details the acquisition, structure and preprocessing of the MultiCaRe Dataset, a multimodal case report dataset which contains data from 75,382 open access PubMed Central articles spanning the period from 1990 to 2023. The dataset includes 96,428 clinical cases, 135,596 images, and their corresponding labels and captions. Data extraction was performed using different APIs and packages such as Biopython, requests, Beautifulsoup, BioC API for PMC and EuropePMC RESTful API. Image labels were created based on the contents of their corresponding captions, by using Spark NLP for Healthcare and manual annotations. Images were preprocessed with OpenCV in order to remove borders and split figures containing multiple images, data were analyzed and described, and a subset was randomly selected for quality assessment. The dataset's structure allows for seamless integration of different types of data, making it a valuable resource for training or fine-tuning medical language, computer vision or multi-modal models.

Observational Study About the Impact of Simulation Training of Non-Technical Skills on Teamwork: Towards a Paradigm Shift in Undergraduate Medical Training

INTRODUCTION

Recently, simulation as an educational method has gained increasing importance in Medicine. However, medical education has favored the acquisition of individual knowledge and skills, while overlooking the development of teamwork skills. Since most errors in clinical practice are due to human factors, i.e., non-technical skills, the aim of this study was to assess the impact that training in a simulation environment has on teamwork in an undergraduate setting.

MATERIAL AND METHODS

This study took place in a simulation center, with a study population of 23 participants, fifth year undergraduate students, randomly divided into teams of four elements. Twenty simulated scenarios of teamwork in the initial assessment and resuscitation of critically ill trauma patients were recorded. Video recordings were made at three distinct learning moments (before training, end of the semester, and six months after the last training), and a blinded evaluation was performed by two independent observers, who applied the Trauma Team Performance Observation Tool (TPOT). Additionally, the Team STEPPS Teamwork Attitudes Questionnaire (T-TAQ) was applied to the study population before and after the training to assess any change in individual attitudes towards non-technical skills. A 5% (or 0.05) significance level was considered for statistical analysis.

RESULTS

With a moderate level of inter-observer agreement (Kappa = 0.52, p = 0.002), there was a statistically significant improvement in the team's overall approach, evidenced by the TPOT scores (median of 4.23, 4.35 and 4.50, in the three time-points assessed, respectively, p = 0.003). In the T-TAQ, there was an improvement in non-technical skills, that was statistically significant for "Mutual Support" (median from 2.50 to 3.00, p = 0.010).

CONCLUSION

In this study, incorporating non-technical skills education and training in undergraduate medical education was associated with sustained improvement in team performance in the approach to the simulated trauma patient. Consideration should be given to introducing non-technical skills training and teamwork in the emergency setting during undergraduate training.

Evaluating the publication practices of medical students: A mixed-methods study

PURPOSE

Engagement in research and publication helps medical students develop the skills to improve healthcare through evidence-based medicine. The qualitative evidence-base for the medical student experience of publishing is limited. This study aims to explore medical students' publication practices and understand their experiences of research and publication.

METHODS

The study is based on a mixed-methods convergent design. A survey questionnaire was distributed to medical students in UK medical schools by social media and email communication. We recruited volunteer participants through the survey and interviewed a sample whilst the survey was open. We purposively selected the sample to ensure representation from research-intensive and other universities.

RESULTS

Survey results indicated that 21.3% (27/127) of respondents had a publication. The most common publication type was a conference abstract. The main motivation to publish was career progression and the main barriers were lack of opportunity or support to submit an article. There was no significant association between attending a research-intensive university and submitting an article. The interviews revealed that contributing to academic advancement was also a motivation to publish. Participants expressed receiving differing levels of support from supervisors and their institutions.

CONCLUSIONS

Data from the interviews suggested that the most commonly perceived barriers identified in the survey (lack of opportunity and support to conduct and publish research) may vary in prevalence between different medical schools. Further research is required to explore how different types of support offered by medical schools affect student engagement in publishing research.

Carbon quantum dots derived from polysaccharides: Chemistry and potential applications

Since the beginning of 21th century, nanoscience and nanotechnology become the most promising topics in various fields, attributing to the superior characters of nanoscaled structures. The conventional quantum dots are substituted with new family of luminescent nanostructures, owing to their interchanged optical properties, low-cost of fabrication, biocompatibility, non-toxicity, ecofriendly, hydrophilicity and superior chemical stability. Carbon quantum dots (CQDs) were recently investigated for their simple synthesis, bio-consonance, and different revelation applicability. Obeying the green chemistry aspects, this review demonstrates an overview about CQDs generated from polysaccharides in brief, with a background on CQDs discovery, chemical composition, green synthesis via exploitation of different polysaccharides (cellulose, starch, pectin, chitin, etc) as biocompatible/biodegradable abundant biopolymers. Additionally, applications of CQDs originated from polysaccharides in environmental purposes, textiles industry and medical activities were also presented.

Effectiveness of interprofessional education for medical and nursing professionals and students on interprofessional educational outcomes: A systematic review

AIM AND BACKGROUND

Patient safety is a global health priority as unsafe care is a principal cause of death and disability. Ineffective interprofessional communication and collaboration among nursing and medical professionals and students contribute to unsafe practices. Interprofessional education provides opportunities to strengthen nurse-physician collaboration and enhance patient care. However, there is inconclusive evidence regarding interprofessional education effectiveness. This review aims to systematically evaluate interprofessional education effectiveness for nursing and medical professionals and students on interprofessional educational outcomes (interprofessional attitudes, perceptions, skills, knowledge, behaviours, and organisational and patient outcomes).

DESIGN AND METHODS

PubMed, Cochrane Library, Embase, Scopus, CINAHL, ERIC, PsycInfo, Web of Science were last searched on 13 January 2022. This review included published and unpublished randomised controlled trials, quasi-experimental and mixed-method studies in English examining interprofessional education outcomes among nursing and medical professionals and students. Two reviewers independently appraised studies using the Joanna Briggs Institute Critical Appraisal Tools and extracted data using a modified Joanna Briggs Institute data extraction form. Narrative synthesis was conducted instead of meta-analysis since majority of the included studies had quasi-experimental design, and various interventions and outcomes. Certainty of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations tool.

RESULTS

This review included 15 studies involving 1185 participants. Improvements were reported in each interprofessional educational outcome after interprofessional education. High-fidelity simulation with multiple scenarios, standardised communication tools, didactic and active learning methods, theoretical frameworks, debriefing sessions and provider training enhanced interprofessional education effectiveness.

CONCLUSIONS

Effectiveness of interprofessional education for nursing and medical professionals and students was demonstrated since improvements were observed for each interprofessional educational outcome. This systematic review addressed literature gaps, demonstrated effectiveness of interprofessional education in clinical practice and academic curricula and provided evidence-based insights that future research can consider to enhance global patient safety standards for optimal patient outcomes and quality of healthcare. Caution is advised in interpreting findings due to 'very low' evidence certainty and limited studies. More high-quality randomised controlled trials with longitudinal designs are needed.

Clinical and pathological correlation of P53 expression in oral cancers

In our study, we aimed to evaluate the overexpression of P53 in 155 oral squamous cell carcinomas and to correlate with various clinicopathological features like depth of invasion, lymph nodal involvement, and margin status, which affect the local recurrence and prognosis. This cross-sectional study included 155 oral squamous cell carcinoma patients who underwent surgical resection of primary and nodal disease. The histopathological and clinical features were noted. Immunohistochemical expression was reported, and other clinicopathological features were correlated. Statistical analysis was performed using SPSS software. In the present study, out of 155 patients, 127(81.9%) are males, and the majority are more than 50 years (55%). The most common site of oral carcinoma is the tongue, followed by buccal mucosa. An aberrant or mutational type of P53 was seen in 90 cases (58%), while the wild type was observed in 65 patients (42%). Expression of P53 is not similar in different sites of the oral cavity but is more frequently seen in the Gingiva, followed by retromolar trigone, lip, buccal mucosa, and tongue. There is a significant association between P53 expression and degree of tumor differentiation, T staging, and depth of invasion, involved margin, node positivity, and extranodal extension.

Assessment of eating habits, lifestyle and physical activity among medical and dental students of Faisalabad Medical University

Objective

To assess the eating habits, lifestyle and physical activity and their impact on health of students of Faisalabad Medical University (FMU) Faisalabad Pakistan.

Methods

A descriptive cross-sectional study was prepared on 328 medical and dental students at Faisalabad Medical University from June, 2022 to October, 2022. Three Factor Eating Questionnaire Revised 21 (TFEQ-R21) was used to assess the eating habits among medical students and physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short version. A self-constructed questionnaire was used to assess lifestyle patterns.

Results

According to the study, 191(58.2%) students out of 328 practiced unrestricted eating. While 229(69.8%) students demonstrated cognitive restraint and 128(39%) students indulged in emotional eating. Less than half of the students, 52(15.9%) lead unhealthy lifestyles compared to 276(84.1%) who had healthy habits. Out of 328 students, 104 (31.7%) engaged in low, 137(41.8%) in moderate, and 87(26.5%) in high levels of physical activity. Whereas a higher proportion of female students engaged in low to moderate physical activity (61.5% and 52.6%, respectively), while a higher proportion of male students (63.2%) were involved in intense physical activity.

Conclusions

A large proportion of medical students exhibited poor dietary habits with low physical activity. Obesity and other metabolic diseases are more likely to strike medical students who engage in these unhealthy eating habits. As future health providers, health interventions must be implemented to avert future harm.

Improving patient care by virtual case discussion between plastic surgeons and residents of Uganda and the Netherlands

INTRODUCTION

Traditional on-site missions of plastic surgeons from "high-income countries" in "low- and middle-income countries" are often limited in time and lack proper follow-up. Regular digital collaboration could lead to a more impactful and durable exchange of knowledge for plastic surgeons and residents in both settings.

AIMS

The aim of this study was to evaluate the satisfaction of the first twelve months of weekly digital meetings, explore advantages/disadvantages, and to provide tools for similar initiatives.

METHODS

Weekly meetings started from August 2021. An encrypted digital connection allowed residents and plastic surgeons from Uganda and the Netherlands to discuss cases for educational purposes, where treatment options were considered. After twelve months, a survey was sent to participants from both countries to indicate the meetings' strengths, weaknesses, and possible improvements.

RESULTS

A total of 18 participants responded to the questionnaire (ten plastic surgeons, six residents, and two researchers). The strengths of the meetings were the accessibility of the meetings, knowledge exchange and practice for residents' final exams. Possible improvements included having a clear format for patient discussion, a session moderator and better internet connectivity. Moreover, a database to assess the impact of the given intervention on the patient cases by evaluating postoperatively (e.g. three months), could further improve clinical care.

CONCLUSIONS

Virtual patient discussions subjectively contributed to medical education at both locations. Improved digital infrastructure and a collaborative database could further maximize learning capacity. Furthermore, digital proctoring is a promising way to establish sustainable collaborations between high- and low-resource countries.

Goals of the Morbidity and Mortality meeting in acute care: A scoping review

OBJECTIVE

The objective of this study was to describe what is known about understandings of the goals of the Morbidity and Mortality meeting.

REVIEW METHODS USED

The study utilised scoping review methodology.

DATA SOURCES

Papers in English presenting empirical data published in academic journals with Morbidity and Mortality meetings as the central concept of study. Included papers presented data about the perception of stakeholders about goals of the Morbidity and Mortality meeting. Medline, Embase, and CINAHL databases were search conducted from earliest record - October 20th 2021. A manual search of the reference lists of all included papers identified further eligible papers.

REVIEW METHODS

Data about the location, participant type, and methods/ methodology were extracted and entered onto a database. Content analysis of the results and discussion sections of qualitative papers yielded broad categories of meeting goal. This provided a framework for the organisation of the quantitative findings, which were subsequently extracted and charted under these categories.

RESULTS

Twenty-five papers were included in the review, and six main categories were identified in the qualitative synthesis of findings. These included meeting goals related to quality and safety, education, legal and reputational risk management, professional culture, family/caregivers, and peer support.

CONCLUSIONS

There are heterogeneous understandings of key terminologies used to describe Morbidity and Mortality meeting goals, particularly evident within understandings of educational and quality and safety meeting goals. This paper defines and unravels this complexity in a way that researchers and clinicians can define, compare and evaluate their own department's meeting goals.

Curriculum implementation challenges: Development and validation of an integrated curriculum implementation challenges tool

Objective

To develop an instrument to identify the challenges faced by faculty while implementing an integrated curriculum in an undergraduate dentistry program.

Methods

The study was conducted between September 2020 and October 2021 at the University College of Medicine and Dentistry (UCMD), University of Lahore (UOL). A preliminary questionnaire, developed through literature review and faculty interviews was sent to 10 medical education experts for content validation via the Delphi technique. Content Validity Index (CVI) was calculated for individual items (I-CVI) as well as for the composite scale (S-CVI). A panel agreement of more than 75% was considered as the criterion for the inclusion of items in the questionnaire. Cognitive pretesting of five faculty members was conducted and pilot testing was subsequently done with 27 faculty members. The reliability of the tool was determined by Cronbach's alpha.

Results

After the Delphi process, the final Integrated Curriculum Implementation Challenges (ICIC) questionnaire had 42 items. S-CVI was 0.87 and the cut-off value for I-CVI was taken as 0.78 as the criterion for item deletion. Cognitive interviews and pretesting revealed good item interpretation. Cronbach's alpha for this tool was 0.87.

Conclusion

ICIC is a useful instrument with good reliability and content validity. It can be used to identify the presence and extent of challenges faced by the faculty while implementing an integrated curriculum.

Knowledge, attitude, and perception of Arab medical students towards artificial intelligence in medicine and radiology: A multi-national cross-sectional study

OBJECTIVES

We aimed to assess undergraduate medical students' knowledge, attitude, and perception regarding artificial intelligence (AI) in medicine.

METHODS

A multi-national, multi-center cross-sectional study was conducted from March to April 2022, targeting undergraduate medical students in nine Arab countries. The study utilized a web-based questionnaire, with data collection carried out with the help of national leaders and local collaborators. Logistic regression analysis was performed to identify predictors of knowledge, attitude, and perception among the participants. Additionally, cluster analysis was employed to identify shared patterns within their responses.

RESULTS

Of the 4492 students surveyed, 92.4% had not received formal AI training. Regarding AI and deep learning (DL), 87.1% exhibited a low level of knowledge. Most students (84.9%) believed AI would revolutionize medicine and radiology, with 48.9% agreeing that it could reduce the need for radiologists. Students with high/moderate AI knowledge and training had higher odds of agreeing to endorse AI replacing radiologists, reducing their numbers, and being less likely to consider radiology as a career compared to those with low knowledge/no AI training. Additionally, the majority agreed that AI would aid in the automated detection and diagnosis of pathologies.

CONCLUSIONS

Arab medical students exhibit a notable deficit in their knowledge and training pertaining to AI. Despite this, they hold a positive perception of AI implementation in medicine and radiology, demonstrating a clear understanding of its significance for the healthcare system and medical curriculum.

CLINICAL RELEVANCE STATEMENT

This study highlights the need for widespread education and training in artificial intelligence for Arab medical students, indicating its significance for healthcare systems and medical curricula.

KEY POINTS

• Arab medical students demonstrate a significant knowledge and training gap when it comes to using AI in the fields of medicine and radiology. • Arab medical students recognize the importance of integrating AI into the medical curriculum. Students with a deeper understanding of AI were more likely to agree that all medical students should receive AI education. However, those with previous AI training were less supportive of this idea. • Students with moderate/high AI knowledge and training displayed increased odds of agreeing that AI has the potential to replace radiologists, reduce the demand for their services, and were less inclined to pursue a career in radiology, when compared to students with low knowledge/no AI training.

Postgraduate medical trainees at a Ugandan university perceive their clinical learning environment positively but differentially despite challenging circumstances: a cross-sectional study

PURPOSE

The clinical learning environment is an essential component in health professions' education. Data are scant on how postgraduate trainees in sub-Saharan Africa perceive their medical school learning environments, and how those perceptions contribute to their engagement during training, their emotional wellbeing, and career aspirations. This study examined perceptions of postgraduate medical trainees (residents) in a resource-limited setting, regarding their learning environment and explored perceptual contributions to their career engagement during training. The data reported contribute to understanding how clinical learning environments can be improved in low-resource settings in Uganda and elsewhere.

METHODS

This study was done at the Faculty of Medicine of Mbarara University of Science and Technology in Uganda. We used a descriptive cross-sectional design involving sequential mixed methods. Quantitative data were collected using the Postgraduate Hospital Educational Environment Measure (PHEEM). Qualitative data were collected using focus group discussions.

RESULTS

Ninety of the 113 eligible residents responded (79.6%). Of these, 62 (68.9%) were males, 51 (56.7%) were third-year trainees, and the majority (40%) of the residents were aged between 30 and 34 years. Overall PHEEM scored 98.22 ± 38.09; Role Autonomy scored 34.25 ± 13.69, Teaching scored 39.7 ± 13.81, and Social Support scored 24.27 ± 10.59. Gender differences occurred in the perceptions of teaching and social support. Cronbach's alpha coefficient was 0.94 for the overall PHEEM. Five major themes were identified from the qualitative data (trainee support, supervision environment, engagement with overall learning environment, preparation for future practice, and challenges that impede training).

CONCLUSIONS

Overall, this study suggests that postgraduate trainees at the institution perceived the clinical learning environment positively amidst challenges of limited resources. Trainees' insights provided data that propose improvements on a number of domains in the learning environment.

The postgraduate medical educational climate assessed by the Danish Residency Educational Climate Test (DK-RECT): a validation and cross-sectional observational study

BACKGROUND

A good educational climate is essential for delivering high-quality training for medical trainees, professional development, and patient care. The aim of this study was to (1) validate the Dutch Residency Educational Climate Test (D-RECT) in a Danish setting and (2) describe and evaluate the educational climate among medical trainees.

METHODS

D-RECT was adopted in a three-step process: translation of D-RECT into Danish (DK-RECT), psychometric validation, and evaluation of educational climate. Trainees from 31 medical specialties at Copenhagen University Hospital - Rigshospitalet, Denmark were asked to complete an online survey in a cross-sectional study.

RESULTS

We performed a forward-backward translation from Dutch to Danish. Confirmatory factor analysis showed that DK-RECT was robust and valid. The reliability analysis showed that only seven trainees from one specialty were needed for a reliable result. With 304 trainees completing DK-RECT, the response rate was 68%. The subsequent analysis indicated a positive overall educational climate, with a median score of 4.0 (interquartile range (IQR): 3.0-5.0) on a five-point Likert scale. Analysis of the subscales showed that the subscale Feedback received the lowest ratings, while Supervision and Peer collaboration were evaluated highest.

CONCLUSIONS

Psychometric validation of D-RECT in a Danish context demonstrated valid results on the educational climate in specialist training. DK-RECT can be used to evaluate the effectiveness of interventions in the future and can facilitate the conversation on the educational climate.

Standard setting for orthopaedic trauma competencies in postgraduate specialty training- catching those falling behind the curve

BACKGROUND

The Curriculum for Trauma and Orthopaedics focuses on producing competent Day-One Consultants. However, the expected development trajectory is not clear. It is important, yet difficult to objectively identify trainees who are "falling behind". This project proposes practical, consensus-based thresholds of Operative Trauma Competence at each Waypoint stage of training.

METHODS

32 trainers and 73 trainees in one Deanery were identified. The trainers and trainees were asked their PBA level expectation of a trainee at ST4, ST6 and ST8 for nine trauma competencies. Lower quartile values were calculated providing thresholds.

RESULTS

53 (72%) trainees and 22 (69%) trainers responded. At ST8, the lower quartile threshold was level 4 for all procedures. At ST6, three operation groups became apparent: Group 1 (hip hemiarthroplasty, Dynamic hip screw; k-wire distal radius fracture and Weber C Ankle open reduction, internal fixation (ORIF)) Group 2 (Tibial Nail; Olecranon Tension band wire, ORIF radial shaft; distal radius plate fixation)- Group 3 (supracondylar fracture fixation)Threshold levels for procedures were: Group 1- 4a; Group 2-3b and Group 3- 3a.At ST4, there was more variation and spread in responses, however, expectations could still be similarly grouped: Group 1- 3a; Group 2- 2b and Group 3- 2a.

CONCLUSION

In an increasingly competency-based training environment we provide tangible thresholds for expectations of orthopaedic trainees' progression and development. We identified two groups: basic trauma (Group 1 where level 4 competencies should be attained by ST6) and intermediate trauma (Groups 2 and 3 where level 4 competencies should be attained by ST8.).

Innovations in online classes introduced during the COVID-19 pandemic and their educational outcomes in Japan

BACKGROUND

The novel coronavirus disease (COVID-19) pandemic emerged in Japan in February 2020, forcing the adoption of online education by university medical schools across Japan. The advantages and disadvantages of online education have been studied in Japan; however, the educational outcome of online classes conducted during the COVID-19 pandemic has not been completely evaluated. In this study, we examined the relationship between lecture format (e.g., face-to-face or online) and performance of third-year university students in their organ-specific cardiovascular course examination.

METHODS

This retrospective, nonclinical, and noninterventional comparative educational study included 550 third-year medical students who took a cardiovascular course between April 2018 and May 2022. Cardiovascular coursework was conducted in-person in 2018 and 2019, online in 2020 and 2021, and again in-person in 2022. The course comprised 62 lecture and 2 problem-based learning (PBL) sessions. A quiz was set up in advance on Moodle based on all lectures conducted in 2021 and 2022. A written examination was administered at the end of the course to evaluate the knowledge of students. The student online course evaluation questionnaires were administered in 2020 and 2021. Examination scores and proportion of failures in each year were compared.

RESULTS

The mean examination scores were significantly higher in 2021 and 2022 than in 2018, 2019, and 2020 (p < 0.05). Univariate and multivariate analyses adjusted for the class type, online quiz, and PBL revealed that only online quiz was significantly associated with better examination results (p < 0.05). A student course evaluation survey indicated that the online format did not interfere with the students' learning and was beneficial.

CONCLUSIONS

The introduction of online classes into medical education due to the COVID-19 pandemic was as effective as face-to-face classes owing to learning management system and other innovations, such as online quizzes. Online education may confer more benefits when provided in a combination with face-to-face learning after COVID-19 pandemic.

Evaluation of an online modular eating disorders training (PreparED) to prepare healthcare trainees: a survey study

BACKGROUND

Eating disorders (EDs) are serious, complex disorders for which broad-based clinical training is lacking. This study aimed to evaluate the efficacy of a free, brief, web-based curriculum, PreparED, in increasing comfort and confidence with, and knowledge about EDs in healthcare trainees, and to obtain program feedback from key stakeholders (i.e., learners).

METHODS

This programmatic evaluation study was designed as a quantitative, repeated measures (i.e., pre- and post-test intervention) investigation. A convenience sample of two groups of healthcare trainees across geographically diverse training sites completed an anonymous survey pre- and post- engagement with PreparED. The survey included items to assess prior exposure to EDs, as well as program feasibility. The main educational outcomes included (1) Confidence and Comfort with EDs and (2) Knowledge of EDs. User experience variables of interest were likeability, usability, and engagement with the training modules. Mixed effects linear regression was used to assess the association between PreparED and educational outcome variables.

RESULTS

Participants (N = 67) included 41 nutrition graduate students and 26 nurse practitioner students recruited from Teacher's College/Columbia University in New York, NY, USA, Columbia University School of Nursing in New York, NY, USA and North Dakota State University School of Nursing in Fargo, ND, USA. Confidence/Comfort scores and Knowledge scores significantly improved following engagement with PreparED (β = for effect of intervention = 1.23, p < 0.001, and 1.69, p < 0.001, respectively). Neither training group nor prior exposure to EDs moderated the effect on outcomes. All learners agreed the program was easy to follow; the overwhelming majority (89.4%) felt the length of the modules was "just right." All participants perceived that PreparED had increased their knowledge of EDs, and the majority (94.0%) reported greater confidence in and comfort with caring for people with these disorders, including assessment of symptoms, awareness of associated medical complications, and likelihood of future screening.

CONCLUSIONS

Findings suggest that brief, user-friendly, online courses can improve knowledge and attitudes about EDs, filling a critical gap in healthcare training.

Beyond the bedside: protocol for a scoping review exploring the experiences of non-practicing healthcare professionals within health professions education

BACKGROUND

The number of healthcare professionals leaving clinical practice and transitioning to alternative careers in health professions education is increasing. Among these non-practicing healthcare professionals, concerns have been reported regarding tensions in relation to identity, role, and credibility in their new field. There are suggestions that this is a particularly pressing issue for minoritised professionals who make this transition. Support is critical to attract and retain diverse talent within health professions education teaching and research. The purpose of this scoping review is to explore the career experiences of non-practicing healthcare professionals who work in health professions education internationally.

METHODS

Arksey and O'Malley's framework has been utilised to guide the design of this scoping review process and will be used throughout the course of the review. A comprehensive search of seven electronic databases and limited search of Google Scholar will be conducted, as well as a hand search of eligible article reference lists. Two reviewers will independently screen all articles based on inclusion criteria, with conflicts resolved by a third reviewer. Data from included articles will be charted, collated, and analysed thematically. Meta-data will be summarised quantitatively.

DISCUSSION

This scoping review aims to explore the role and experiences of non-practicing healthcare professionals working within health professions education. The review will follow established scoping review guidelines and will include studies from various regions and languages, provided an English translation is available. The study remit will be broad, including both quantitative and qualitative studies, as well as reviews and opinion papers. Limitations may include the exclusion of non-English articles and potential difficulty of identifying papers which discuss the experiences of non-practicing clinicians. However, the review will provide insight into the current knowledge on what it is like to be a non-practicing clinician working within health professions education and identify gaps for both future research, and future support for those making this career transition.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework Registration  https://doi.org/10.17605/OSF.IO/485Z3.

Letter to the Editor: ChatGPT's contribution to cancer study

The role of large language models (LLM) in medical and biomedical sciences is remarkable, and chat generative pre-trained transformer (ChatGPT) as an AI model has the potential to assist in research and clinical practice. While it is essential to recognize that AI models like ChatGPT are tools that should be used with human expertise and judgment, they should argue, rather than replace, the knowledge and experience of healthcare professionals and researchers in the medical and biomedical fields.

Recent advances and discoveries of microbial-based glycolipids: Prospective alternative for remediation activities

Surfactants have always been a prominent chemical that is useful in various sectors (e.g., cleaning agent production industry, textile industry and painting industry). This is due to the special ability of surfactants to reduce surface tension between two fluid surfaces (e.g., water and oil). However, the current society has long omitted the harmful effects of petroleum-based surfactants (e.g., health issues towards humans and reducing cleaning ability of water bodies) due to their usefulness in reducing surface tension. These harmful effects will significantly damage the environment and negatively affect human health. As such, there is an urgency to secure environmentally friendly alternatives such as glycolipids to reduce the effects of these synthetic surfactants. Glycolipids is a biomolecule that shares similar properties with surfactants that are naturally synthesized in the cell of living organisms, glycolipids are amphiphilic in nature and can form micelles when glycolipid molecules clump together, reducing surface tension between two surfaces as how a surfactant molecule is able to achieve. This review paper aims to provide a comprehensive study on the recent advances in bacteria cultivation for glycolipids production and current lab scale applications of glycolipids (e.g., medical and waste bioremediation). Studies have proven that glycolipids are effective anti-microbial agents, subsequently leading to an excellent anti-biofilm forming agent. Heavy metal and hydrocarbon contaminated soil can also be bioremediated via the use of glycolipids. The major hurdle in the commercialization of glycolipid production is that the cultivation stage and downstream extraction stage of the glycolipid production process induces a very high operating cost. This review provides several solutions to overcome this issue for glycolipid production for the commercialization of glycolipids (e.g., developing new cultivating and extraction techniques, using waste as cultivation medium for microbes and identifying new strains for glycolipid production). The contribution of this review aims to serve as a future guideline for researchers that are dealing with glycolipid biosurfactants by providing an in-depth review on the recent advances of glycolipid biosurfactants. By summarizing the points discussed as above, it is recommended that glycolipids can substitute synthetic surfactants as an environmentally friendly alternative.

Treatments for Dissecting Cellulitis of the Scalp: A Systematic Review and Treatment Algorithm

BACKGROUND

Dissecting cellulitis of the scalp (DCS) is a chronic inflammatory skin condition characterized by abscesses, nodules, fistulas, and scarring alopecia. Management of this oftentimes debilitating dermatosis can be challenging due to its recalcitrant nature. There is limited data regarding the efficacy of treatment options for DCS.

OBJECTIVE

The aim of this study was to conduct a systematic review of the literature to explore the efficacy and safety of reported DCS treatments.

METHODS

In October 2022, MEDLINE and EMBASE databases were searched for articles on treatments for DCS. Studies that contained outcome efficacy data for DCS treatments were included. Reviews, conference abstracts, meta-analyses, commentaries, non-relevant articles, and articles with no full-text available were excluded. Data extraction was performed by two independent reviewers.

RESULTS

A total of 110 relevant articles with 417 patients were identified. A majority of studies (86.4%) were case reports or series. Treatment options included systemic antibiotics, oral retinoids, biologics, procedural treatments, combination agents, and topical treatments. Oral retinoids and photodynamic therapy were the most extensively studied medical and procedural interventions, respectively.

CONCLUSION

Overall, randomized controlled trials are needed to evaluate various treatment regimens for DCS and provide patients with a robust, evidence-based approach to therapy.

Inclusion of person-centred care in UK postgraduate medical education curricula: Interviews and documentary analysis

BACKGROUND

Person-centred care (PCC) involves placing people at the centre of their healthcare decision making to ensure it meets their needs, values, and personal circumstances. Increasingly, PCC is promoted in healthcare policy and guidance, but little is known about how this is embedded in postgraduate medical training. The aim of this research was to understand how PCC is embedded in UK postgraduate medical training and explore factors influencing inclusion of PCC in curricula content.

METHODS

To explore this, we interviewed senior professionals with key roles in the curricula from four UK Royal Colleges (Psychiatrists; Physicians; Surgeons; and GPs) and used framework analysis on interviews and relevant curricula documents to identify themes.

RESULTS

Legislation and professional/educational guidance influenced inclusion. PCC definitions and terminology differed and placement within curricula was variable. Royal Colleges defined the curriculum and provided training to ensure competence, but local deaneries independently implemented the curriculum. Trainer engagement was greater than trainee buy in. Quality assurance focused on feedback from trainers and trainees rather than patients, and patient and public involvement in curriculum development, teaching, and assessment was limited.

CONCLUSIONS

There is a need for cross-organisation collaboration to develop a PCC competence framework that defines the skills and level of competence required at different points in training, with clarity around the differences between undergraduate and postgraduate requirements. Greater auditing and quality assurance of programme delivery would help identify successful practices to share within and across Royal Colleges, while still maintaining the flexibility of local provision. Engagement with patients and the public in this work can only strengthen provision.

The enlightening role of explainable artificial intelligence in medical & healthcare domains: A systematic literature review

In domains such as medical and healthcare, the interpretability and explainability of machine learning and artificial intelligence systems are crucial for building trust in their results. Errors caused by these systems, such as incorrect diagnoses or treatments, can have severe and even life-threatening consequences for patients. To address this issue, Explainable Artificial Intelligence (XAI) has emerged as a popular area of research, focused on understanding the black-box nature of complex and hard-to-interpret machine learning models. While humans can increase the accuracy of these models through technical expertise, understanding how these models actually function during training can be difficult or even impossible. XAI algorithms such as Local Interpretable Model-Agnostic Explanations (LIME) and SHapley Additive exPlanations (SHAP) can provide explanations for these models, improving trust in their predictions by providing feature importance and increasing confidence in the systems. Many articles have been published that propose solutions to medical problems by using machine learning models alongside XAI algorithms to provide interpretability and explainability. In our study, we identified 454 articles published from 2018-2022 and analyzed 93 of them to explore the use of these techniques in the medical domain.

Surgeon educator perspectives of implementing a national undergraduate curriculum in otolaryngology

OBJECTIVE

The General Medical Council will be implementing a national medical licensing assessment for all UK medical students by 2024-25. Surgeon educator perceptions on a national undergraduate curriculum in otolaryngology were reviewed accordingly.

METHOD

A mixed methods study was undertaken within a UK school of surgery assessing ENT surgeon educators. Perspectives on teaching content, quality and student experience were assessed with degree of agreement assessed (Likert scoring). Associated qualitative focus group sessions underwent detailed thematic analysis according to grounded theory.

RESULTS

A response rate of 50 per cent was achieved involving 21 participants working across 14 hospitals. These showed strong agreement that implementation of a national curriculum would improve the standard of teaching delivered at a personal, institutional and national level. Further themes were identified relating to the personal, institutional and specialty related factors influencing practical delivery.

CONCLUSION

A series of practical recommendations are made to potentially assist the implementation of a national ENT curriculum.

"We are not there yet": perceptions, beliefs and experiences of healthcare professionals caring for women with pregnancy-related pelvic girdle pain in Australia

BACKGROUND

Pregnancy-related pelvic girdle pain (PPGP) is a common condition worldwide. Women report being unprepared about PPGP, and state they receive little recognition and support from healthcare professionals. Situated within the Common-Sense Model and Convergent Care Theory, this study sought to gain a conceptual understanding of the perceptions, beliefs and experiences of healthcare professionals who provide routine care for women with PPGP in Australia.

METHODS

A qualitative research design, using individual, semi-structured interviews with purposive sampling of healthcare professionals (N=27) consisting of doctors (N=9), midwives (N=9) and physiotherapists (N=9). Most participants were female (22/27) with a range of professional experience. An interview guide consisting of open-ended questions was used with a flexible and responsive approach. Thematic analysis was performed where interview data were transcribed, coded, grouped into meaningful categories and then constructed into broad themes.

RESULTS

Four themes were identified: 1. Identity and impact of PPGP; 2. What works well?; 3. What gets in the way?; and 4. Quality care: What is needed? Healthcare professionals recognised PPGP as a common and disabling condition, which created a large impact on a woman's life during pregnancy. Stepped-level care, including education and physiotherapy intervention, was seen to be helpful and led to a positive prognosis. Barriers at patient, clinician and organisation levels were identified and led to consequences for women with PPGP not receiving the care they need.

CONCLUSION

This study elucidates important implications for health care delivery. Acknowledging that PPGP is a common condition causing difficulty for many women, healthcare professionals identified strong teamwork and greater clinical experience as important factors in being able to deliver appropriate healthcare. Whilst healthcare professionals reported being committed to caring for women during pregnancy, busy workloads, attitudes towards curability, and a lack of formal education were identified as barriers to care. The findings suggest timely access, clear referral pathways and an integrated approach are required for best care practice for women with PPGP. A greater emphasis on the need for multidisciplinary models of care during pregnancy is evident.

Undergraduate research in medical schools in Pakistan: Relevance, Needs, and Importance

Recent trends in medical education demand practicing physicians to be competent in playing multiple roles. Life-long learning skills underpinned by research & scholarly activity will enable them to play these roles adequately. Therefore, the introduction of structured training in research during early undergraduate years is pivotal. This would enable trainee physicians to develop essential skills; the institutions will grow in terms of visibility & ranking; the trainers and supervisors will be satisfied in terms of research productivity and, most importantly the patients will benefit in terms of improved clinical outcomes.

Prioritizing women's choices, consent, and bodily autonomy: From a continuum of violence to women-centric reproductive care

Obstetric violence is a product of medical institutions' failure to prioritize women-centric reproductive care. Through interviews with local activists and leaders in Oaxaca, Mexico, as well as analysis of primary and secondary sources, we find that women-centric reproductive care is hindered by three barriers that are a part of a continuum of violence. These barriers include the cultural and religious norms surrounding reproductive care, the medical community and medical profiteers' opposition to combatting obstetric violence, and the state's resistance to women's human rights policy changes. Shifting to a women-centric reproductive care model requires: the life of the woman to be prioritized in reproductive care, the criminalization of obstetric violence, improved training for the medical community, reduced monetary incentives for unnecessary cesarean sections, and the respectful inclusion of indigenous and midwife knowledge and practices. Our study's theoretical and empirical contributions add to the scholarly research regarding the systemic causes of obstetric violence and the care ethic required for transformative change. Our recommendations can be applied across contexts with locally developed and culturally inclusive models of women-centric reproductive care.

Creating and confirming observable professional activities (OPAs): A brief report on the practical approach for OPA design for resident education

CONTEXT

The transition of graduate medical education to competency-based education systems has resulted in exploration of the efficacy of Entrustable Professional Activities (EPAs) and related Observable Practice Activities (OPAs) as evaluation tools. EPAs were introduced to PM&R in 2017, but no OPAs have been reported for a non-procedurally based EPA. The primary aims of this study were to create and form consensus on OPAs for the Spinal Cord Injury EPA.

METHODS

A Modified Delphi panel of seven experts in the field was utilized to gain consensus on ten PM&R OPAs for the Spinal Cord Injury EPA.

RESULTS

After the first round of evaluations, most OPAs were evaluated by experts as requiring modifications (30/70 votes to keep, 34/70 votes to modify) with a majority of comments focusing on the specific content of the OPAs. Edits were made, and after the second round, the OPAs were evaluated and determined to be kept (62/70 votes to keep, 6/70 votes to modify) with most edits being about semantics of the OPAs. Ultimately, there was significant difference in all three categories between round 1 and round 2 (P < 0.0001) and 10 OPAs were finalized for use.

CONCLUSIONS

This study created 10 OPAs that can potentially help provide targeted feedback to residents on their competency in caring for patients with spinal cord injury. With regular usage, OPAs are designed to provide residents with insight into how they are progressing towards independent practice. In the future, studies should aim to assess the feasibility and utility of implementing the newly developed OPAs.

Can the "Five Challenges" Overcome the Problem of "Reform Without Change" in Medical Education? Reexamining the "Hidden Curriculum"

N/a.

Automating medical simulations

OBJECTIVE

This study aims to explore speech as an alternative modality for human activity recognition (HAR) in medical settings. While current HAR technologies rely on video and sensory modalities, they are often unsuitable for the medical environment due to interference from medical personnel, privacy concerns, and environmental limitations. Therefore, we propose an end-to-end, fully automatic objective checklist validation framework that utilizes medical personnel's uttered speech to recognize and document the executed actions in a checklist format.

METHODS

Our framework records, processes, and analyzes medical personnel's speech to extract valuable information about performed actions. This information is then used to fill the corresponding rubrics in the checklist automatically.

RESULTS

Our approach to activity recognition outperformed the online expert examiner, achieving an F1 score of 0.869 on verbal tasks and an ICC score of 0.822 with an offline examiner. Furthermore, the framework successfully identified communication failures and medical errors made by physicians and nurses.

CONCLUSION

Implementing a speech-based framework in medical settings, such as the emergency room and operation room, holds promise for improving care delivery and enabling the development of automated assistive technologies in various medical domains. By leveraging speech as a modality for HAR, we can overcome the limitations of existing technologies and enhance workflow efficiency and patient safety.

Website mission statements of dermatology residency programs: a cross-sectional study

Recent calls for increased transparency from dermatology residency programs have revealed important opportunities, particularly including information on program websites. One piece of information that may especially benefit applicants assessing potential training programs is the program's mission statement. From August 9, 2022, to August 21, 2022, the websites of all ACGME-accredited dermatology residencies were examined to investigate the use and content of mission statements. Statements were categorized based on inclusion of mission, vision, virtue/value, aims, and goals. A total of 133 out of 143 dermatology programs (93.0%) were included. Overall, 46.15% of programs used at least one of the five mission statement categories on their websites, while 53.85% used none. Programs used the category "mission" (39.85%) most, and "vision" (3.01%) least. There was overlap in word choice across categories. The word "care" was among the top four words used in every category. Other words to appear frequently across multiple categories included "dermatology" (4/5), "residents" (3/5), "knowledge" (2/5), and "provide" (2/5). Other top words included "clinical" in the mission category, "advanced" and "leaders" in the vision category, "excellence" and "diversity" in the value/virtue category, and "patient" and "professional" in the objective category. Explicitly stating residency program missions may not only help programs plan more effectively, but also help applicants who may be undecided about which programs best align with their career goals.

The first nationwide website survey of the availability and costs of medical and non-medical oocyte cryopreservation in Japan

Research question

How does the cost-related oocyte cryopreservation (OoC) vary by the facility in Japan, and what data is provided on the websites about OoC procedures?

Design

Website survey. The websites of all 621 facilities that provide assistive reproductive technology registered in Japan were surveyed in 2021. Data included the rates of explicit statements regarding the provision of OoC for only medical reasons (medical only group) or non-medical reasons (non-medical group). Based on whether or not facilities that perform OoC clearly stated the cost on their websites, we compared the costs of OoC and annual storage cost between medical only and non-medical groups. Furthermore, we examined the stated number of OoC procedures performed and their clinical outcomes.

Results

Of the 621 facilities, 146 (23.5%) clearly stated that they offer OoC on their websites. Of the 88 medical only groups and 58 non-medical groups, 24 (27.3%) and 42 (72.4%) clearly stated the OoC cost, and 27 (30.7%) and 44 (75.9%) clearly states the annual oocyte storage cost, respectively. The OoC costs were significantly higher for the non-medical group than in the medical group. In the medical only group, the annual storage cost remained almost the same regardless of the number of oocytes, while in the non-medical group, the annual storage cost was 2-3 times higher than in the medical only group. Only 16 facilities (16/146, 11.0%) had mentioned the number of OoC procedures, and five facilities (3.4%) provided information on the clinical outcomes after OoC.

Conclusion

Costs related to OoC are higher for the non-medical group in Japan. In addition, the websites contain scant information on the costs and clinical outcomes of OoC.

Encouraging outpatients in an acute hospital for the relief of cancer-related pain: a qualitative study

PURPOSE

To identify the processes of cancer-related pain relief and exacerbation faced by outpatients in an acute care hospital and to examine the support needed for outpatient pain control.

METHODS

We conducted semi-structured, in-depth interviews with patients from the outpatient department of Showa University Northern Yokohama Hospital in Kanagawa Prefecture, Japan. Participants were recruited by purposive sampling. From the recorded data, verbatim transcripts were made and used as textual data for analysis by consistent comparative method.

RESULTS

Between April 2018 and April 2022, interviews were conducted with 30 participants. Analysis of the verbatim transcripts generated 13 categories from 27 concepts. Category relationships were examined, and a conceptual framework was developed. Outpatients went from being in a state of hesitation towards consultation with medical professionals to receiving individual consistent follow-ups by medical professionals in the hospital and community pharmacies, which led to patient teleconsultations when their physical condition changed, leading to an improvement of pain.

CONCLUSION

The process of relief and exacerbation of cancer-related pain experienced by outpatients in the acute care hospital reveals that the provision of consistent follow-up through remote or in-person interviews has an important role to play in pain management, as it helps to build relationships between patients and medical professionals. Alternatively, when outpatients exhibited endurance, their pain worsened, and they fell into a negative cycle of poor pain control.

Implementation of a longitudinal, near-peer ECG didactic curriculum in an internal medicine residency program and impact on ECG interpretation skills

BACKGROUND

To determine the impact of a longitudinal, near-peer, dedicated ECG didactic curriculum on internal medicine resident ability to accurately interpret ECGs.

METHODS

This study employs a prospective cohort design. Internal medicine residents at University at Buffalo participated in monthly ECG didactic sessions over a 7-month period. Residents were invited to complete pre- and post-curriculum questionnaires. Responses were anonymous and participation voluntary. Data collected included basic demographics, career interest, exposure to clinical cardiology, and number of sessions attended. Residents were asked to interpret sixteen unique ECGs, divided evenly among eight common rhythms into both questionnaires. Pre- and post-curriculum cohorts were compared using t-tests and chi-square analyses. Associations between attendance, comfort level in interpretation, and number of correct interpretations were analyzed using Pearson correlations. Multivariate linear regression determined the strongest predictor of the number of correct ECG interpretations.

RESULTS

The post-curriculum cohort correctly interpreted a significantly greater percentage of ECGs compared to pre-curriculum cohort (74.5% vs. 60.9%, p < .001). Didactic attendance was significantly associated with comfort level in interpreting ECGs (r = .328, p = .018) and trended towards an increased number of correct interpretations (r = .248, p = .077). Residents who attended three or more sessions demonstrated increased ECG interpretation skills compared to those who attended two or fewer sessions (80.0% vs. 71.1%, p = .048). Number of clinical cardiology rotations attended was significantly associated with correct interpretations (r = .310, p < .001) and was the strongest predictor of accurately interpreting ECGs (β = 0.29, p = .037).

CONCLUSIONS

Participation in a longitudinal, near-peer ECG didactic curriculum improved resident ability to interpret ECGs. A curriculum which contains both didactic sessions and clinical exposure may offer the greatest benefit in improving ECG interpretation skills.

Medical Consultations Option and Influencing Factors for SARS-CoV-2 Infected Individuals - Beijing Municipality, China, December 2022

What is already known about this topic?

In December 2022, China revised its epidemic prevention and control strategy, leading to an increase in coronavirus disease 2019 (COVID-19) cases and a peak in medical consultations. Government departments implemented relevant policies to coordinate and allocate medical resources throughout China. However, there is a scarcity of research on the status of medical consultations and the factors influencing them.

What is added by this report?

In the study population, over 80% of individuals with COVID-19 chose not to pursue medical care, while more than 70% of patients who sought treatment opted for primary healthcare facilities. The decision to consult medical professionals was influenced by various factors, such as age, education level, employment status, urban-rural distribution, and the presence of symptoms following COVID-19 infection.

What are the implications for public health practice?

The implementation of tiered diagnostic and treatment approaches, aligned with guidelines issued by governing bodies, is essential for mitigating the strain on medical resources. Primary healthcare institutions serve as "gatekeepers" for public health and should be further expanded in the future.

Medical and obstetric comorbidities and delivery outcomes in overweight and obese parturients: a retrospective analysis

BACKGROUND

Research on obesity in women of reproductive age is heterogeneous in gestational age and body mass index (BMI) classification and focused mostly on pregnancy-related rather than medical comorbidities. We studied the prevalences of pre-pregnancy BMI, chronic maternal and obstetric comorbidities, and delivery outcomes.

METHODS

Retrospective analysis of real-time data collected during deliveries in a single tertiary medical center. Pre-pregnancy BMI was classified into seven groups (kg/m²): underweight (BMI < 18.5), normal weight 1 (18.5 ≤ BMI < 22.5), normal weight 2 (22.5 ≤ BMI < 25.0), overweight 1 (25.0 ≤ BMI < 27.5), overweight 2 (27.5 ≤ BMI < 30.0), obese (30.0 ≤ BMI < 35.0), and morbidly obese (BMI ≥ 35.0). Data were collected on maternal demographics, chronic medical and obstetric comorbidities, and delivery outcomes.

RESULTS

Included were 13,726 women aged 18-50 years, with a gestational age of 24^0/7-41^6/7 weeks. Pre-pregnancy weights were 61.4% normal, 19.8% overweight, 7.6% obese, and 3.3% morbidly obese. Smoking was more prevalent among morbidly obese than among normal weight women. Obese and morbidly obese women were older and had more diabetes mellitus, hypertension, preeclampsia/eclampsia, and prior cesarean deliveries than normal weight parturients. Obese and morbidly obese women were also less likely to have a non-spontaneous conception, enter labor spontaneously (observed in the full study population and in a subgroup of term parturients), and were more likely to undergo cesarean rather than vaginal delivery. Subgroup analysis of primiparous women yielded similar results.

CONCLUSIONS

We identified a potential association between pre-pregnancy obesity and morbid obesity and higher rates of obstetric comorbidities, less natural conception and spontaneous labor, and more cesarean deliveries and adverse delivery outcomes. It remains to be seen if these findings remain after adjustment and whether they are related to obesity, treatment, or both.

Developing the marine medicine syllabus for medical sciences students: a multiphase design study

BACKGROUND

Marine medicine is one of the medical fields that deals with the health and safety of people related to the sea but the marine medicine syllabus for education to the students is not specified yet. The present study aimed to develop the marine medicine syllabus to medical sciences students education.

METHODS

This study was conducted in three phases. First, a literature review was conducted to find the concepts and topics related to marine medicine. Second, a content analysis research method was conducted. Data collection was done first by using semi-structured interviews with the 12 experts in marine medicine. Sampling was purposeful and continued until data saturation was reached. The information obtained from the interviews was analyzed by conventional content analysis with Geranheim's method. The found topics in the literature review and content analysis of interviews were combined and formed the initial draft of the marine medicine syllabus, which was validated with the Delphi method in the third phase. The Delphi was conducted in two rounds and the panel consisted of 18 experts in the field of marine medicine. After the completion of each round, the items that had less than 80% consensus among the participants were removed and the remaining topics after round two formed the final syllabus of the marine medicine.

RESULTS

The findings showed that the marine medicine syllabus should include an overview of marine medicine, health at sea, common physical diseases and injuries at sea, subsurface medicine and hyperbaric, safety action in marine incidents, medical care at sea, psychology at sea and medical examinations of people working at sea main topics and their sub topics.

CONCLUSIONS

Marine medicine is an extent and specialized medical field which has been neglected and it is necessary to teach this lesson to medical sciences students with the syllabus found in the present study.

Staying proper with your personal protective equipment: How to don and doff

INTRODUCTION

The global COVID-19 pandemic highlighted the importance of protecting frontline healthcare workers from novel respiratory infections while also exposing the limited instruction that medical students receive on proper donning of personal protective equipment (PPE) and more importantly the safe doffing of contaminated PPE to minimize their risk of nosocomial infection. The best methods of providing this kind of instruction have not yet been determined.

METHODS

Anesthesiology interns and CA-1 residents were trained on proper PPE donning and doffing for AGPs using a methodology based on Miller's pyramid and following a "knows-knows how-shows-does" progression. Participants donned PPE without instruction and were sprayed with Glo Germ® to identify areas of contamination, after which they received both video and in-person instruction on best practices for donning and doffing PPE for AGPs. Following instruction, they again donned PPE and were sprayed with Glo Germ® to identify areas of contamination.

RESULTS

54 participants completed the study. Before training, overall donning compliance was 60% and overall doffing compliance was 48%. Overall, 70% were contaminated after PPE doffing, with 46% having multiple sites of contamination. After training, donning compliance increased by nearly 30% (P < 0.001), doffing compliance increased by over 20% (P < 0.001), and overall contamination decreased by nearly 30% (P = 0.029), with multiple-site contamination decreasing to only 6% (P = 0.013).

DISCUSSION

While best methods for providing instruction regarding topics such as PPE donning and doffing have not yet been determined, we have demonstrated that the underlying knowledge base from medical school regarding proper donning and doffing for respiratory isolation is insufficient for preventing self-contamination, and that Miller's pyramid-based training using both video and in-person instruction combined with task execution by learners can improve compliance with PPE donning and doffing protocols and more importantly decrease skin contamination among a group of early training anesthesiology residents.

Performance and satisfaction during the E-learning transition in the COVID-19 pandemic among psychiatry course medical students

Background

In the field of medical education, students faced significant challenges during the COVID-19 pandemic. Abrupt alterations were made in the form of preventative precautions. Virtual classes replaced onsite classes, clinical placements were canceled, and social distance interventions prevented face-to-face practical sessions. The present study aimed to assess students' performance and satisfaction before and after the transition of a psychiatry course from onsite to entirely online during the COVID-19 pandemic.

Methods

A retrospective, non-clinical, and non-interventional comparative educational research study included all students registered in the psychiatric course for the academic year 2020 (pre-pandemic/onsite) and 2021 (during the pandemic/online).To assess students' satisfaction, we utilized the National Commission for Academic Accreditation and Assessment (NCAAA) students' satisfaction survey used by the academic quality unit at KSU, College of Medicine.Satisfaction was assessed in six domains: course organization, learning resources, faculty experiences, clinical teaching, practical sessions, and overall satisfaction. The reliability of the questionnaire was measured using Cronbach's alpha test.To assess their performance, students' grades from both periods were obtained from the exam center.

Results

A total of 193 medical students enrolled in the study; 80 received onsite learning and assessment, while another 113 received full online learning and assessment. The students' mean indicators of course satisfaction for the online courses exceeded their corresponding indicators significantly compared to the onsite courses. These indicators included students' satisfaction in terms of course organization, p < 0.001; medical learning resources, p < 0.050; faculty experience, p < 0.050; and overall course, p < 0.050. There were no significant differences regarding satisfaction in both practical sessions, p > 0.050, and clinical teaching, p > 0.050. The students' performance mean was significantly higher in the online (M = 91.76) compared to the onsite courses (M = 88.58) (p < 0.001), and the Cohen's D statistic showed there was a medium level of enhancement in students' overall grades (Cohen's d = 0.41).

Conclusion

Students perceived the switch to online delivery methods very favorably. Students' satisfaction significantly improved regarding the themes of course organization, faculty experience, learning resources, and overall course satisfaction, while a similar level of adequate student satisfaction was maintained in terms of clinical teaching and practical sessions during the transition of the course to e-learning. In addition, the online course was associated with a trend toward higher students' grades. However, the assessment of the achievement of course learning outcomes and the maintenance of this positive impact warrants further investigation.