Advanced Health Research Articles (Page 1)

Corporate Practice/Dental Service Organization.

Consensus-based indicators of advanced practice nursing outcomes: Results of a Delphi study in France.

Purpose This paper aims to analyze how key stakeholders, including the Ministry of Health (MOH), hospitals, universities, health polytechnics, and health industries, influence the adoption of the Robotic Telesurgery Project in Indonesia. Design/methodology/approach A qualitative approach was used to explore stakeholder roles, utilizing stakeholder theory and the Technology-Organization-Environment (TOE) framework. Interviews were conducted with 18 participants from relevant institutions and were analyzed thematically using NVivo. Findings The study identified four types of stakeholders based on their power and interest: Key Players, Keep Informed, Keep Satisfied, and Minimal Effort. Stakeholders influenced the adoption of robotic telesurgery through three mechanisms: technological, organizational, and environmental. These mechanisms include the technology’s advantages, trust, communication, infrastructure readiness, regulatory support, and alignment of interests. Originality/value This study is pioneering in examining how different types of stakeholders contribute to the adoption of robotic telesurgery in a developing country. The findings provide practical insights into managing stakeholder collaboration for the effective implementation of advanced health technologies.

Nowadays, composite materials have been widely used in modern engineering applications such as automotive, aerospace, structure, buildings, and architecture. The larger usage was based on their good durability, remarkable strength-to-weight ratio, and lightweight nature. For selection appropriate material and design is needed to be analysis the mechanical and physical properties. Our research work will be focused on review of the relationships between these parameters resin content, density, and matrix–filler ratio and important mechanical properties particularly tensile strength and elastic modulus. Tensile strength and elastic modulus have been closely linked due to their relationship called stiffness–strength coupling. Additionally, to enhance tensile performance, the study identifies optimal parameter ranges like a matrix–filler ratio of about 1.8 and a resin content around 150 g/m². These insights are crucial for engineering, as they aid in material optimization, performance forecasting, and ensuring structural reliability. However, concerns linger regarding the long-term durability of composites when faced with environmental stresses like temperature fluctuations, moisture, and chemical exposure, which can lead to issues like fatigue and creep. Early damage detection in many materials remains a challenge, highlighting the need for advanced structural health monitoring tools. Furthermore, there are still gaps in optimization methods, standardization processes, and predictive modeling where all of them are essential for maintaining consistent performance and safety.

ABSTRACTCKM is a common systemic disorder characterized by pathological and physiological interactions between the cardiovascular system. In recent years, the intake of micronutrients has been considered to be associated with CVD, CKD, and other conditions. However, the association between serum micronutrients and advanced CKM syndrome is still unclear. This study utilized data from the NHANES to analyze 6 serum micronutrients and employed the Boruta algorithm for feature selection. Subsequently, the risk of advanced CKM syndrome was predicted using 7 ML models. Additionally, SHAP and PDPs were employed to analyze the effects of serum micronutrients on advanced CKM syndrome. Results indicate that lower levels of β‐carotene, α‐tocopherol, lycopene, vitamin C, and 25(OH)D are associated with an increased risk of advanced CKM syndrome (all p < 0.05). The LGBM model exhibited the best performance in predicting the risk of advanced CKM syndrome, while SHAP and PDPs analyses show that the low level of 25(OH)D is the main potential risk factor. The synergistic effects indicated that managing serum 25(OH)D, vitamin C, and lycopene levels may play a vital role in the control of advanced CKM syndrome. This study systematically evaluated the relationship between serum micronutrients and the risk of advanced CKM syndrome using multiple models and ML methods for the first time. It identified the decrease of 25(OH)D, lycopene, and vitamin C as the main potential risk factors. These findings provide new evidence for the etiology of advanced CKM syndrome and public health interventions.

Objective structured clinical examinations (OSCEs) are widely used in competency-based education (CBE) to assess clinical competencies in Doctor of Nursing Practice (DNP) students. However, OSCE-related anxiety can hinder performance and affect competency evaluation. This quality improvement (QI) project implemented a structured OSCE preparation workshop in an advanced health assessment (AHA) course to improve preparation, reduce anxiety, and enhance performance. The workshop incorporated three evidence-based activities: video case evaluation, a structured clinical reasoning exercise, and mock OSCEs. A pre-/postsurvey design assessed changes in preparedness and anxiety, and students rated the usefulness of each activity. Objective structured clinical examination performance and remediation rates before and after implementation were compared. Across three semesters, 181 DNP students participated. After the workshop, preparedness significantly increased (p < .001), anxiety significantly decreased (p < .001), and mean OSCE scores significantly improved (p = .002). Remediation rates declined from 7.6% to 3.3%. Student feedback was overwhelmingly positive, with mock OSCEs rated as the most beneficial component. This structured OSCE preparation workshop improved student preparation, reduced anxiety, and enhanced performance, supporting its potential as a sustainable, evidence-informed QI initiative in AHA and other clinical courses. Limitations include self-reported measures, unmatched pre- and postsurvey responses, and a single-institution setting. Building on the success of the workshop, this model is highly scalable for other DNP programs. The low-cost, evidence-based activities can be adapted to diverse curricula, resources, and learner needs, making it a sustainable strategy for supporting CBE.

Flexible piezoresistive sensors, which combine high sensitivity and a wide linear detection range, are ideal choices for human health monitoring and robotic perception. However, sensors often exhibit a trade-off between sensitivity and linearity, with challenges caused by the incompressibility of soft materials and the stiffening of microstructures. In this study, a flexible pressure sensor with a 3D ordered tri-scale graded microstructure, fabricated by laser processing, is proposed. The sensor achieves an ultra-high sensitivity of 138.6 kPa-1 and a linear range up to 400 kPa (R2 = 0.99). The compensation behavior derived from the tri-scale graded microstructure's compression deformation counteracts contact hardening and delays sensitivity saturation. Furthermore, the sensor demonstrates a minimum detectable limit as low as 3 Pa, with response and recovery times of 34/39 ms, showing excellent stability after over 24000 repeated loading cycles. Physiological monitoring confirms that the sensor can accurately capture a wide range of pressure-variations, including those from the carotid artery, jugular vein, respiration, throat vibrations, and foot pressure. Additionally, the sensor can be used for remote operation of robotic hands. This work provides a strategy for manufacturing flexible pressure sensors with a combination of high sensitivity, high linearity, and a wide pressure response range.

Aims: to review the contributions of biochemistry and its clinical applications in patients management. Discussion: Advanced health professionals and their healthcare delivery nowadays rely essentially on basic biochemistry and its clinical application for understanding the pathophysiology of disease. Those doctors can make a definite diagnosis with best therapeutic option, pharmacologically and non-pharmacologically, all made available with strong basic and applied knowledge and by doing so, giving significant clinical benefits for the patient and also the best practice of clinical management. Classic daily problem encounters including operational restrictions, e.g., the sum of clinical sample delivered is way too scanty, equipment incompatibility, technique’s precision hindrances, and unsupported financial difficulties. Recent advancements in established technologies and apply it on clinical setting mass service, such as advance spectrometry and the buildout of state of the art high-throughput screening and basically point-of-care technologies such as current biosensor technology and wearable monitors which facilitate continuous health tracking are the role of Biochemistry in clinical management advancement. The application of these sophisticated biochemistry approaches is actually transforming the face of clinical service on to a more modern, reliable and accountable clinical management. Machine learning (ML) and Artificial Intelligence (AI) applications enhance analytical capabilities based on wide array of clinical proven data and allowing more room for predictive insights for individualized treatment protocols. Concerns regarding achievements and its dynamic limitation, including ethical issues always pose significant challenges. It must be addressed for more responsible integration between basic science and clinical management conducted by doctors and hospitals. Interprofessional colaboration ensure fairness and responsible health service while at the same time identifying research priorities to enhance diagnostic precision and better accessibility for superior healthcare delivery, such can be seen in tropical diseases management, cancer treatment, genetic disorders and metabolic diseases.

BackgroundImproving adolescent access to primary care services in vulnerable areas remains a critical challenge in Brazil. The Chega Junto Project was implemented in Paraisópolis - the third largest slum in Brazil - with the goal of strengthening professional skills and promoting adolescent-centered care in four primary health care centers.ObjectivesTo present the experience of co-developing and implementing five educational board games as a strategy to both train primary care professionals and engage adolescents around key health topics, fostering stronger ties between youth and health services. Roundtable Focus: This session will showcase five original board games created through participatory processes involving multiprofessional teams and adolescents. Each game addresses a specific health theme relevant to the adolescent population in Paraisópolis. Attendees will explore the games firsthand, reflect on their potential to support training and engagement, and discuss the process of collaborative development.Game Descriptions: Paraizópolis (Cooperative Game) Focus: Vaccination and misinformation. Players work together to protect the community from the “Monster of Misinformation,” navigating a board that maps real features of Paraisópolis. The game emphasizes teamwork and prevention strategies. Insano (Cooperative Game) Focus: Mental health and common mental disorders. Players must strengthen protective factors-such as physical activity, spirituality, and social bonds-while navigating real-life stressors. The goal is to reduce the intensity of symptoms and support each other. Caminhos (Competitive Game) Focus: Access to health services. Players face day-to-day health needs and receive cards with different service options (e.g., UBS, UPA, CAPS). Strategic dilemmas and real-world challenges highlight gaps and promote dialogue about the health network. Sonhos (Competitive Game) Focus: Life goals and future planning. Each player adopts a character and strives to assemble a winning hand of life aspirations (e.g., family, study, fun, money). Players trade cards and face unexpected events, reflecting the tension between dreams and context. Infecção (Cooperative Game) Focus: Infectious diseases, including STIs. Players represent internal organs under attack and must cooperate to avoid system failure and septic shock. They earn “points” through vaccines, SUS support, and treatments to overcome infections and survive.ConclusionsThese games supported both continuing education and adolescent engagement. They allowed professionals to reflect on sensitive topics while providing a playful and culturally relevant entry point for young people. Co-creation fostered empathy, mutual understanding, and locally grounded solutions. By integrating gamification into PHC training and service delivery, the Chega Junto Project advanced health promotion, youth-centered communication, and the creation of safe spaces for care in territories of vulnerability.Key messages• Gamification supports training and helps address sensitive health topics with adolescents in a playful, accessible, and impactful way.• Co-creating games with youth and teams fosters engagement, empathy, and stronger connections between adolescents and health services.

ObjectiveWorkplace-based learning (WPBL) for postgraduate paediatricians is well-established in advanced health systems but less so in low-resource settings. We evaluate the first WPBL pilot undertaken in paediatrics in Myanmar.DesignThis cohort study assesses the implementation of WPBL among 85 postgraduate doctors from five medical universities in Myanmar.SettingIn 2018, Myanmar’s paediatric medical leaders had outlined an ambitious plan to modernise learning at the postgraduate level through a multi-skilled in-situ approach. Supported by the Royal College of Paediatrics and Child Health (RCPCH, UK), a co-designed pilot programme of WPBL was trialled in a structured way.InterventionsThis pilot was Myanmar-led, with UK experts providing support to Myanmar supervisors and to the 85 paediatric postgraduate doctors whom they mentored. Progress was documented through a co-designed, standardised ‘portfolio of learning’ that included well-established WPBL strategies.Main outcome measuresThe quality of supervisor feedback in the portfolio to postgraduates was scored by independent assessors, as was the degree of completion of the portfolio, to determine adherence to the WPBL pilot objectives. Insights into the broader changes in practice resulting from the pilot were ascertained through a narrative commentary of moderated focus groups of both supervisors and postgraduates.Results'Clinical' WPBL topics were more often chosen than ‘softer’ skill areas, for example, communication and leadership. Focus groups identified the benefits of a structured approach to learning, particularly in areas of weaker clinical performance. There were regional variations in how WPBL was delivered, with disparities between medical schools located in the north and those in the south, challenging WPBL standardisation.ConclusionsEvidence on the impact of formalising WPBL in low-resource settings is minimal. This pilot demonstrates that setting up a WPBL programme is feasible in a low-resource setting, but it also presents challenges.

Wealth status plays a crucial role in shaping contraceptive choices among women in India. This study aims to investigate the impact of wealth quintiles on current contraceptive use and identify the factors contributing to differentials in contraceptive choices. Using data from National Family Health Survey-5 (2019-2021), current contraceptive use was categorised into non-users, traditional method users, permanent method users, and reversible modern method users. Multinomial logistic regression analysis was applied to investigate the association between wealth status and contraceptive method use while controlling for potential socio-economic factors. In addition, Wagstaff's concentration index was used to assess wealth inequality in each contraceptive method. The results indicate that 37.8% of women from the poorest quintiles do not use contraceptives, compared to 30.6% in the richest quintile. The use of reversible modern methods increases from 15.9% among the poorest to 25.0% among the richest. Women in the richest wealth quintiles were significantly more likely to use reversible modern methods (RRR = 1.61; 95% CI: 1.55-1.68) than in the poorest quintiles. Permanent method uses peaks in the middle wealth quintile (42.6%) and decreases in the richest quintile (33.7%). Regional disparities also exist, with higher use of permanent methods in southern and western India, while reversible methods were more common in northeastern and northern regions. The concentration index revealed a pro-rich pattern for reversible methods (CI = 0.092), while traditional and non-use were concentrated among poorer women. The findings suggested that wealth status significantly influenced contraceptive method use among currently married women in India. Reversible modern methods were more commonly used by wealthier women, whereas poorer women were more likely to rely on permanent methods or remain non-users. These differentials indicated persistent inequities in access to a diverse contraceptive method mix. These findings highlighted the need for targeted policy measures to improve availability of reversible methods in underserved areas, strengthening provider training to support informed choice, and addressing demand-side barriers through community support were essential to advanced reproductive health equity and help to meet the SDG 3.7 target in India.

Indonesian Case Base Groups (INA-CBG) become a reference for the Social Security Administering Body (BPJS) in payment of claims at advanced health facilities. From the article search, 20 articles were found that compare the real rates with the INA CBGs rates. Five articles yield higher INA CBG rates than hospital rates and another 15 articles provide higher real rates than INA CBG rates. RS. X is one of the hospitals located outside Java. This study aims to obtain an overview of the comparison between real rates and INA CBGs rates in hospitals. X, diseases with catastrophic or non-catastrophic categories that are widely used in hospitals. X and the comparison of costs and the effect of length of stay on real costs. This study is a cross-sectional study using secondary data, namely BPJS claim data for inpatients at the hospital. X in Southeast Sulawesi in 2021. The distribution normality test uses the Kolmogorov Smirnov normality test. Data with normal distribution were tested for significance using an independent t-test. Data that were not normally distributed were tested for significance with Mann Whitney. There are 2,534 data claimed by RS. X to BPJS in 2021. Claims consist of 209 types of disease descriptions where claims for non-catastrophic diseases are more than claims for catastrophic diseases. The biggest claim was cesarean section (mild) which was 209 claims (8.2%) which was included in the non-catastrophic category. RS. X must spend IDR 1,411,298,920,- to cover the difference between the INA CBGs tariff and the real rate for the non-catastrophic category and IDR 6,878,400 for catastrophic diseases. A stronger correlation between length of stay and real rates indicates that length of stay is one of the factors that cause real rates to be higher than INA CBG rates. The results of the t-test on non-catastrophic diseases showed that nine out of 10 disease descriptions had significant differences for real rates and INA CBG rates, while for catastrophic diseases there were no significant differences. There is only one disease description that has no significant difference, namely a disease with a description of Antepartum Disorder (Mild). The non-catastrophic disease is the most common in hospitalized patients. X in Southeast Sulawesi. The cost of hospital claims is greater than the cost of claims for INA CBGs in non-catastrophic and catastrophic diseases. Length of hospitalization has a significant correlation in hospitalized patients with catastrophic and non-catastrophic diseases. The correlation between length of stay was greater in patients with the catastrophic disease.

BackgroundWhile protocol-based psychological treatments have significantly advanced mental health care, real-world accessibility remains a challenge. Primary care, the main provider of mental health services, faces barriers such as limited resources and a diverse patient population with varying needs, making it difficult to rely solely on time-intensive, protocolized treatments. The Primary Care Behavioral Health (PCBH) model promotes brief, flexible interventions that may better accommodate these needs. However, limited research on these interventions raises concerns about potential undertreatment. To align with Universal Health Coverage principles, it is essential to identify which patient groups benefit most from resource-efficient protocol-based versus brief, flexible, and individualized treatments. Our main aim is to evaluate whether a integrating guided self-help into PCBH improves outcomes compared to the core PCBH model, as well as to assess whether patients identified as suitable for protocol-based interventions benefit more from the combined model.MethodsPatients seeking help for mental or behavioral health problems at PCBH primary care centers will be randomized to one of two arms: core PCBH, where patients receive a contextual assessment and brief interventions tailored to their needs, or an extended PCBH model, where a diagnostic assessment determines whether patients receive brief interventions or guided self-help. The primary outcome is functional impairment, assessed at baseline and followed up at 4, 8, and 12 weeks (primary endpoint), as well as at 1 year. Secondary outcomes include symptom change, cost-effectiveness, and care process factors.DiscussionThe study design allows for comparisons of patient outcomes between the two care models, with a primary focus on evaluating superiority and a secondary focus on non-inferiority, cost-effectiveness, and care process factors. Overall, the project seeks to advance understanding of effective mental health interventions in primary care settings and inform decision-making regarding treatment approaches.Trial registrationClinicalTrials.gov: NCT04900064. Registered on May 25th, 2021. Registered with the Swedish Ethical Review Board (2020–04198) on October 12th, 2020. This protocol was submitted for publication on March 18th, 2025, prior to the inclusion of the final participant, and will shortly thereafter, without any changes, be made publicly available as a preprint in an open-access repository.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13232-4.

Objectives: The primary objective was to compare the usage of Hazardous Materials (HazMat) Protective Personal Equipment (PPE) and ordinary PPE when performing basic and advanced health care support maneuvers in a prehospital setting, evaluating the effectiveness of several procedures, defined as the mean success rate of each. The secondary objective was to evaluate the presence of a learning effect, with improvements in the success rate and/or procedure timing. Methods: This was a prospective within-subjects (repeated-measures) study conducted on Emergency Medical Services (EMS) responders within their Chemical-Biological-Radiological-Nuclear-Explosive (CBRNe) training institutional programme. Volunteers performed a trial sequence of eight lifesaving procedures four times. During the first trial sequence, they wore standard clothing; during the three successive trials, they wore full HazMat PPE equipment. The primary outcomes were changes in success rate and time interval across the four trials. Results: A total of 146 EMS responders volunteered for the experiment. Procedure success rates remained high overall, with the most notable initial drop observed for video-assisted intubation (≈−10%). The only statistically significant delay in the first HazMat trial compared with baseline was for intravenous access (median +30 s; p < 0.001). In the two successive HazMat trials, success rates and timings improved, with median values coming close to baseline. However, only 61% of participants completed the entire drill due to tolerance limits of the equipment. Conclusions: HazMat PPE, while physically and ergonomically demanding, has minimal impact on most lifesaving procedures, though it may reduce intubation success and delay intravenous access. Tolerance to prolonged use is a key limitation, but dexterity improves rapidly with brief practice. EMS responders can benefit from continuous training practice, while manufacturers could explore ergonomic and tolerance improvements in their PPE equipment.

Objectives To investigate the prevalence across age groups and age disparities in factors associated with pulmonary tuberculosis (PTB) in Indonesia through a large-scale sample study. Methods The data source was the National Basic Health Survey 2018. We recruited 715,394 individuals aged 16 years and older in this study. Rao-Scott Chi-square analyses and binary logistic regressions were employed to investigate the association of PTB with a significance threshold of 5%. Age-group disparities in factors significantly associated with PTB in all age groups were identified by interaction term analysis. Results In youth, middle-aged, and elderly groups, the prevalence of PTB was 3.5‰, 6.8‰, and 9.6‰, respectively. Logistic regressions with interaction term analysis found age differences in the association between PTB and former smokers (p for interaction = 0.022), diabetes (p for interaction = 0.0001), and heart disease (p for interaction = 0.005). Moreover, our findings showed age-related differences in the effect of sex, family size, and unemployment status on PTB. Males exhibited a greater PTB risk than females only among the middle-aged group (OR: 2.06; 95% CI: 1.48–2.86) and older adults (OR: 1.89; 95% CI: 1.38–2.62). Larger families (OR: 1.33; 95% CI: 1.12–1.59) and unemployed individuals (OR: 1.49; 95% CI: 1.21–1.83) were significantly associated with PTB only among middle-aged adults. Conclusion Comprehending age-specific factors for PTB is crucial for developing effective public health strategies. Early detection and advanced health education for PTB should be targeted at elderly men and middle-aged men who are jobless or have a large family.

Objectives:Anemia is a prevalent hematological disorder in children infected with human immunodeficiency virus who are receiving antiretroviral therapy. Anemia is increasingly prevalent among children undergoing antiretroviral treatment; however, studies on the incidence and predictors of anemia in this population within Ethiopia remain limited. Therefore, this study aimed to determine the incidence of anemia and its predictors among children who were enrolled in antiretroviral therapy at health facilities in the Wolaita Zone, South Ethiopia, 2022.Methods:A facility-based retrospective cohort study was conducted among 352 medical records at health facilities in the Wolaita Zone from February 2022 to January 2023. The medical records were selected using the stratified cluster sampling method. The data were entered into EpiData and analyzed using STATA version 14. The Cox proportional hazard regression model was used. Finally, predictors with p < 0.05 were stated as statistically significant factors. The results were presented using text, tables, and figures.Results:The overall incidence rate of anemia among children was 4.29 (95% confidence interval: 3.46–5.34) per 100 person-years. Being female sex (adjusted hazard ratio = 1.79, 95% confidence interval: 1.29–2.47), advanced disease stage (adjusted hazard ratio = 2.26, 95% confidence interval: 1.26–4.06), a zidovudine-based regimen (adjusted hazard ratio = 2.07, 95% confidence interval: 1.16–3.69), and being stunted (adjusted hazard ratio = 3.37, 95% confidence interval: 2.06–5.50) were the predictors of anemia.Conclusion:The incidence of anemia in the study setting was relatively low. Females, children at advanced World Health Organization clinical stages, those who were stunted, and those who initiated with a zidovudine-based regimen were the predictors of anemia. Healthcare providers should give special attention to children who are at an advanced disease stage, who were stunted, and who are taking a zidovudine-based regimen.

Health risk assessment of water resources within the lignite series of Obomkpa and environs, southern Nigeria.

CN157 Enhancing adherence to oral hormone therapy in breast cancer: Role of advanced practice nurses and digital health in a Moroccan oncology setting

Objectives: Skin aging, often accelerated by dietary advanced glycation end products (AGEs), poses both cosmetic and health challenges. This study explores the protective effects of hydroxytyrosol (HT), a potent antioxidant found in olives, against AGEs-induced skin aging in mice. Methods: A total of forty-eight 8-month-old specific pathogen-free (SPF) male C57BL/6J mice were randomly assigned to one of four groups: control, model, low-dose hydroxytyrosol (HT25), and high-dose hydroxytyrosol (HT50). An additional group of six 6-week-old SPF male C57BL/6J mice served as the youth group. The experimental period lasted 16 weeks. Following the intervention, skin, serum, and ileum samples were collected. Results: The results demonstrated that HT50 significantly increased skin moisture, epidermal thickness, and dermal thickness (p < 0.05). HT50 also significantly elevated hydroxyproline levels as well as superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities in the skin while reducing malondialdehyde (MDA) content (p < 0.05). Furthermore, HT50 significantly reduced the levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) (p < 0.05). Regarding intestinal integrity, hydroxytyrosol intervention (either HT25 or HT50) significantly increased the positive staining ratios of zonula occludens-1 (ZO-1) and occludin in the ileum (p < 0.05). Conclusions: HT improves skin hydration, thickness, and collagen levels while reducing oxidative stress and inflammation. Notably, HT also enhances intestinal barrier function, suggesting a role for the gut–skin axis. These findings highlight HT’s potential as a natural intervention for skin aging.

Importance:The U.S. medical education system attracts and trains the next generation of physicians to advance the health care needs of a growing and increasingly diverse nation. This system can be credited for supplying a physician workforce achieving remarkable growth and innovation, yielding one of the world’s most technologically advanced health care systems on the planet. This system, unfortunately, also contributes to educational, workforce, and health disparities.Observations:The successes and challenges of the medical education and health care system align with broader economic, health, and educational patterns in the United States. An ecological model can be employed to unite a network of partners spanning four developmental stages to support a greater diversity of students for and from underrepresented communities to enter the physician workforce, enjoy the rewards granted by a career in medicine, and enact needed changes to eliminate health, economic, and educational disparities.Conclusions and Relevance:Comprehensive and ecologically attuned pathways to the physician workforce could be especially beneficial to states and communities suffering from the looming high school enrollment cliff, outflows of residents to other states, challenges in recruiting and retaining physicians, and significant educational and health disparities. The ecosystem model spurs significant changes in how we think about the developmental pathways to the physician workforce and how we may mobilize resources to promote progress and ease transitions, especially for underrepresented students who face many fewer opportunities and many more challenges along their journey.