American Board Research Articles

Modified Delphi Study to Establish Consensus About Child Neurology Residency Education: Next-Gen Training.

Rapid advances in diagnostics and treatments are shifting child neurology practice, but child neurology training requirements have been much slower to change. Previous literature confirms strong support for modernization, but no formal consensus exists regarding maintaining or changing training. We aimed to develop a holistic consensus regarding the optimal training pathway and requirements using a modified Delphi process. The authors invited 48 child neurologists as panelists, intentionally selecting to represent the diverse geography, practice type, subspecialties, and other demographics of child neurologists practicing in the United States. Panelists participated in an anonymized modified Delphi study with 4 rounds evaluating statements regarding current training requirements, core rotation durations, and mandatory subspecialty rotations with the option to agree or disagree. Statements were derived from current Accreditation Council of Graduate Medical Education, American Board of Psychiatry and Neurology, and American Board of Pediatrics requirements for child neurology training and recent literature. Statements that did not reach a predefined level of consensus (≥75% agreement or disagreement on a 7-point Likert scale) were re-queried or modified for subsequent rounds. Panelists had access to all previous anonymized results and comments. The final modifications were presented in round 4 as a comprehensive training proposal. Twenty-seven panelists agreed to participate, with most completing all 4 rounds. In round 1, consensus was reached on 45 of 118 (38%) items; round 2, 28 of 87 (32%); round 3, 16 of 25 (64%); and round 4, 1 of 1 (100%). There was consensus regarding the age scope of practice and certain subspecialties that should be required, but no initial consensus regarding time-based requirements. By round 4, consensus emerged for the following rotations-months: neonatal and pediatric intensive care-4, adolescent medicine-0.5, emergency medicine-1.5, inpatient pediatrics-3, outpatient pediatrics-3.5, inpatient child neurology-9.5, outpatient child neurology-6, inpatient adult neurology-3, outpatient adult neurology-2, genetics-2, EEG/neurophysiology-2, neuroimaging-1, child psychiatry-1, and electives-7.5. The consensus schedule consists of 46.5 total months of requirements. This study suggests that, despite diverging views prevalent among child neurologists, a diverse panel can, through a multiround Delphi process, arrive at consensus regarding many core features of the child neurology training structure and certification requirements.

How Different Are Family Medicine Residents Who Desire Additional Training?

Background and Objectives: Limited knowledge is present regarding how fellowship training correlates with graduate outcomes and whether current residents desire an additional year of residency training. The aim of this study is to examine trends in fellowship training and compare residency and practice outcomes between those interested and those not interested in fellowship training as well as the proportion of residents desiring an additional year of residency training. Methods: We compared data from the American Board of Family Medicine Initial Certification Questionnaire (2017–2019) to the National Graduate Survey (NGS; 2020–2022). We used bivariate analysis and ꭓ2 tests to assess for changes over time and to determine whether an association exists between those likely to pursue a fellowship and those interested in an additional year of residency training. Results: The final sample included 4,930 residency graduates with NGS data (response rate 46.8%). Overall, most (71.0%) respondents were not interested in any type of additional training. We found no differences in interest in a fellowship based on in-training examination (ITE), certification scores, or milestones attainment. Respondents without interest in a fellowship were more likely to provide continuity of care in practice, while respondents with interest in a fellowship were more likely to be faculty and less likely to have symptoms of burnout. Conclusions: Intention for fellowship training is associated with future faculty members and lower rates of symptoms of burnout and continuity practice. A majority of responding family medicine residents (>70%) do not favor an additional year of residency training.

Pediatric Nephrology Workforce and Access of Children with Kidney Failure to Transplantation in the United States.

Nephrology is one of the pediatric subspecialties with the largest workforce shortage in the US. Waitlist registration is one of the first steps towards kidney transplantation and is facilitated by pediatric nephrologists. The objective of this study was to determine whether state-level density of pediatric nephrologists is associated with access to waitlisting (primary outcome) or kidney transplantation (secondary outcome) in children with kidney failure. Using Cox proportional hazards and logistic regression analyses, we studied children <18 years who developed kidney failure between 2016-2020 according to the US Renal Data System, the national kidney failure registry. The density of pediatric nephrologists (determined by the count of pediatric nephrologists per 100,000 children in each state) was estimated using workforce data from the American Board of Pediatrics and categorized into three groups: > 1, 0.5-1, and <0.5. We included 4,497 children, of whom 3,198 (71%) were waitlisted and 2,691 (60%) received transplantation. Children residing in states with pediatric nephrologist density >1 had 33% (HR 1.33; 95%CI 1.07-1.66) and 22% (HR 1.22; 95%CI 1.02-1.45) better access to waitlisting compared to those residing in states with <0.5 pediatric nephrologist density (reference group) in unadjusted and adjusted analysis, respectively. Pediatric nephrologist density was particularly important for the odds of preemptive waitlisting (adjusted OR 1.56; 95% CI 1.02-2.41). The adjusted HR was 1.25 (95% CI 1.00-1.55, p=0.046) for deceased donor transplantation and 1.24 (95% CI 0.85-1.82) for living donor transplantation for children residing in states with pediatric nephrologist density > 1 compared to the reference group. Children residing in states with higher pediatric nephrologist density had better access to waitlist registration, especially preemptively, and deceased donor transplantation.

Predicting Performance in the Physical Medicine and Rehabilitation Part II Certification Oral Examination Based On Milestone Ratings.

The Accreditation Council for Graduate Medical Education (ACGME) introduced the Milestones to document learner development within a competency-based framework. On the other hand, board certifying examinations serve as a summative evaluation of a learner's readiness for independent medical practice. Scores in Part I of the American Board of Physical Medicine and Rehabilitation (ABPMR) examination, which measures medical knowledge, has been shown to correlate only with Milestones ratings in medical knowledge. We hypothesized that combined ratings of various Milestone competencies can predict subsequent performance in related ABPMR Part II certifying examination domains. Milestones data and ABPMR Part II examination scores of trainees in 3-yr PM&R residency programs in the United States from academic years (AY) 2014-2016 who sat for the ABPMR Parts I and II Examinations, immediately after completion of training, were reviewed. Regression analysis showed that Milestone sub-competencies, alone or in combination, did not correlate with Part II domain scaled scores. Medical Knowledge was the only Milestone sub-competency that was correlated with performance in the ABPMR Part I certifying examination. This current study found that no similar association exists between any of the Milestones Competencies and the ABPMR Part II certifying examination, suggesting that the two assessment tools measure different attributes.

Recognizing and Advancing Leadership in Dermatology: Promoting the Health Care Administration, Leadership, and Management Subspecialty.

The recognition and development of leadership training within dermatology has taken on new importance in recent years. In Spring 2023, the American Board of Medical Specialties announced the launch of the Health Care Administration Leadership and Management (HALM) subspecialty, co-sponsored by multiple American Boards, including the American Board of Dermatology. The skills and credentials earned through HALM can enhance career opportunities for dermatologists seeking to achieve executive positions in large practice groups and industries while fostering interprofessional partnerships. Dermatologists are uniquely poised to integrate health care leadership and health systems approaches into clinical practice given broad exposure to diverse patient populations, care delivery settings, and payer contexts. Two pathways have been proposed for achieving HALM certification: a "practice-only" pathway and a fellowship pathway that provides a specialized post-residency curriculum. A HALM certification examination will be the final requirement for certification under both pathways. The HALM certification represents a valuable opportunity for dermatologists to enhance their ability to be physician leaders within the health care landscape. HALM also offers an institutionalized and structured avenue with protected time for physicians to develop leadership skills. Dermatologists taking on management roles within health care can both shape the current system from their unique vantage points and elevate the specialty's presence. Leadership training such as HALM can not only foster individual career prospects - including qualifying for executive roles in larger practices and industry - but also boost intersectoral collaborations between dermatologists and providers, payers, industry, and policymakers broadly. J Drugs Dermatol. 2024;23(12):e191-e194. doi:10.36849/JDD.8482e.

2024 William McAdams Outstanding Service Award: Presented to KYLE KLEINHANS by the American Board of Health Physics July 2024.

2024 William McAdams Outstanding Service Award: Presented to KYLE KLEINHANS by the American Board of Health Physics July 2024.

2024 Joyce P. Davis Memorial Award: Presented to ROBERT EMERY By the American Board of Health Physics July 2024.

2024 Joyce P. Davis Memorial Award: Presented to ROBERT EMERY By the American Board of Health Physics July 2024.

2024 Bill Fitzgerald Service Award: Presented to ANDREA GEYER By the American Board of Health Physics July 2024.

2024 Bill Fitzgerald Service Award: Presented to ANDREA GEYER By the American Board of Health Physics July 2024.

2024 Nancy K. Johnson National Service Award: Presented to BRANT ULSH by the American Board of Health Physics July 2024.

2024 Nancy K. Johnson National Service Award: Presented to BRANT ULSH by the American Board of Health Physics July 2024.

Supporting the Well-Being of Children and Youth With Special Health Care Needs: NASEM Proceedings.

Children and youth with special health care needs (CYSHCN) are living longer than ever. These advances come with a price: Patients, families, communities, and systems must absorb the challenges of chronic caregiving, including protracted stress and poor mental health. In 2023, the National Academies of Science, Engineering, and Medicine convened thought-leaders for conversations about supporting the emotional well-being of CYSHCN and their families. Invited panelists included 2 parents and 3 academic pediatricians. Parents suggested opportunities for clinicians and systems to better support CYSHCN. Clinicians described work focused on:Individual patient- and family-level resilience: Defined as a process of harnessing resources to sustain well-being in the face of stress, resilience is learnable. Programs that teach people to identify and bolster "resilience resources" show promise in improving child and caregiver mental health;Clinician- and practice-level provision of care: Individual-level interventions are only effective if clinicians know when and how to deliver them. Hence, the American Board of Pediatrics created and demonstrated the success of a "roadmap" to support routine screening for and discussion of social and emotional health needs; andSystems-level barriers: Even with patient-level programs and clinician-practice guidance, unmet social and mental health needs persist. Accessing and coordinating services is difficult, may not be covered by insurance, and historically marginalized populations are the least likely to benefit. Together, the panel underscored a critical fact: We cannot optimize child and family well-being without focusing on patients, caregivers, clinicians, and systems.

Why so slow? The advancement of females in neurosurgery: a 30-year analysis.

As gender parity in medicine improves, neurosurgery lags behind. In pediatric neurosurgery, considered the most "female-friendly" subspecialty, determining the extent to which gender disparity has evolved over time, and how it compares to other subspecialties, can serve as an important benchmark for neurosurgery altogether. This study analyzed gender parity across different neurosurgical and subspecialty training stages to understand how female representation varies with training level and leadership positions. Data spanning from 1990 to 2023 were extracted from Association of American Medical Colleges (AAMC), Accreditation Council for Graduate Medical Education (ACGME), Accreditation Council for Pediatric Neurosurgical Fellowships (ACPNF), American Board of Neurological Surgery (ABNS), and American Board of Pediatric Neurological Surgery (ABPNS) databases and American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) subspecialty websites to examine the proportions of female-identifying trainees and neurosurgeons. Information regarding females in leadership roles was gathered from publicly available sources. Over the last 30 years, the proportion of female medical school graduates increased from 34.0% in 1990 to 51.9% in 2023 (0.45 graduates/year, R2 = 0.813). Female neurosurgery residency applicants increased from 10.5% in 1990 to 27.9% in 2023 (0.48 applicants/year, R2 = 0.694). Female neurosurgical residents increased from 7.3% in 1990 to 23.7% in 2023 (0.46 residents/year, R2 = 0.909). Female neurosurgeons obtaining ABNS certification increased from 5.0% in 1990 to 17.0% in 2023 (0.23 surgeons/year, R2 = 0.476). Female pediatric neurosurgery fellows increased from 0.0% in 1990 to 25.0% in 2023 (0.74 applicants/year, R2 = 0.369). The number of females obtaining ABPNS certification increased at a rate of 0.42 surgeons/year (R2 = 0.067). In neurosurgical academic leadership, female representation remains low: Society of Neurological Surgeons presidents at 0.98%, AANS presidents at 3.3%, CNS presidents at 0.0%, and departmental chairs at 1.5%. In pediatric neurosurgery, only 10% of division chiefs at top US News & World Report children's hospitals are female. Only 13.3% of past presidents of the AANS/CNS Section on Pediatric Neurosurgery were female; all American Society of Pediatric Neurosurgeons presidents have been male. There are higher proportions of female directors within ABPNS (33%) and the ACPNF board (43%). Other subspecialties have comparable female leadership representation, with 5.3% in spine, 5.1% in cerebrovascular, 5.9% in tumor, and 14.3% in functional/stereotactic. Despite encouraging growth in the number of females entering neurosurgery over the past 3 decades, there continues to be significant gender disparity that is most pronounced at advanced career stages-in both academic organized neurosurgery and pediatric neurosurgery. Pediatric neurosurgery, due to a separate fellowship accreditation and board certification, provides the most accurate view within the subspecialties. Because pediatric neurosurgery exhibits the lowest gender disparity among subspecialties, these findings suggest more pronounced female underrepresentation across the stages of other neurosurgical subspecialty trainings.

Substantial Variation Exists in Clinical Exposure to Chief Complaints Among Residents Within an Emergency Medicine Training Program

Introduction: While many aspects of emergency medicine (EM) residency training are standardized among residents within a single residency program, there is no standard for the distribution of chief complaints (CC) that residents should see over the course of residency. This could result in substantial variability in each resident’s clinical exposure. Our objective in this study was to explore EM residents’ clinical exposure to CCs to determine whether substantial variation exists. If such variation exists, this could suggest the need for curricular reform to address gaps in resident clinical exposure during training. Methods: This was a retrospective observational study of EM residents who graduated in the years 2016–2021 at a single, university-affiliated emergency department (ED) in the midwestern United States. All patient encounters where a CC was logged were included and categorized into 1 of 20 clinical domains based on the 2016 American Board of Emergency Medicine Model of Clinical Practice. We calculated descriptive statistics for the top 10 most encountered domains for comparison among residents. Results: We included a total of 228,916 patient encounters from 69 residents in the analysis. Residents were involved in an average of 3,323 distinct patient encounters during the study period. The overall interquartile range for patient encounters was 523. The three CC domains with the broadest interquartile variation were abdominal and gastrointestinal disorders (116), musculoskeletal disorders (nontraumatic)(93), and traumatic disorders (86). Conclusion: Within a single, three-year academic EM program, substantial variation existed among residents with regard to the variety of patient CCs seen during their residency training.

Evaluation of the Efficacy of 3D-Printed Customized Orthodontic Brackets in Reducing Treatment Time and Improving Outcomes

ABSTRACT Background: The advent of 3D printing technology has revolutionized orthodontic treatment, enabling the production of customized orthodontic brackets tailored to individual patients. These customized brackets are hypothesized to reduce treatment time and improve clinical outcomes by providing better alignment precision and minimizing the need for adjustments. Materials and Methods: A randomized controlled trial was conducted with 60 patients aged 12–25 years requiring orthodontic treatment. The participants were randomly assigned to two groups: the experimental group (n = 30) received 3D-printed customized orthodontic brackets, while the control group (n = 30) received conventional brackets. Treatment duration, the number of adjustment visits, and the quality of alignment were recorded over an 18-month period. Quality of alignment was assessed using the American Board of Orthodontics (ABO) grading system. Statistical analysis was performed using a paired t-test to compare the outcomes between the two groups. Results: The average treatment time for the experimental group was significantly shorter, with a mean duration of 14.2 months (SD ± 1.8) compared to 18.6 months (SD ± 2.3) in the control group (P &lt; 0.01). The number of adjustment visits was reduced by 35% in the experimental group (mean = 8 visits) compared to the control group (mean = 12 visits). Furthermore, the quality of alignment, as measured by the ABO grading system, was significantly higher in the experimental group (mean score = 90.5) compared to the control group (mean score = 78.2) (P &lt; 0.05). Conclusion: The use of 3D-printed customized orthodontic brackets significantly reduces treatment time and improves the quality of orthodontic outcomes compared to conventional brackets. These findings suggest that customized brackets offer a promising approach for enhancing the efficiency and effectiveness of orthodontic treatment, potentially leading to better patient satisfaction and reduced clinical workload.

Evaluation of a novel large language model (LLM)-powered chatbot for oral boards scenarios

Abstract Purpose While previous studies have demonstrated that generative artificial intelligence (AI) can pass medical licensing exams, AI’s role as an examiner in complex, interactive assessments remains unknown. AI-powered chatbots could serve as educational tools to simulate oral examination dialogues. Here, we present initial validity evidence for an AI-powered chatbot designed for general surgery residents to prepare for the American Board of Surgery (ABS) Certifying Exam (CE). Methods We developed a chatbot using GPT-4 to simulate oral board scenarios. Scenarios were completed by general surgery residents from six different institutions. Two experienced surgeons evaluated the chatbot across five domains: inappropriate content, missing content, likelihood of harm, extent of harm, and hallucinations. We measured inter-rater reliability to determine evaluation consistency. Results Seventeen residents completed a total of 20 scenarios. Commonly tested topics included small bowel obstruction (30%), diverticulitis (20%), and breast disease (15%). Based on two independent reviewers, evaluation revealed 11–25% of chatbot simulations had no errors and an additional 11%–35% contained errors of minimal clinical significance. The chatbot limitations included incorrect management advice and critical omissions of information. Conclusions This study demonstrates the potential of an AI-powered chatbot in enhancing surgical education through oral board simulations. Despite challenges in accuracy and safety, the chatbot offers a novel approach to medical education, underscoring the need for further refinement and standardized evaluation frameworks. Incorporating domain-specific knowledge and expert insights is crucial for improving the efficacy of AI tools in medical education.

Physician Documentation of Social Determinants of Health: Results from Two National Surveys.

We measured physicians' (1) perceived importance of having access to social determinants of health (SDOH) data received from external providers in the electronic health record (EHR); (2) internal SDOH documentation practices in the EHR, including whether physicians document SDOH in a structured format that may facilitate use; and (3) use of EHR SDOH data to identify community resources and make referrals on behalf of patients. We conducted a secondary analysis of two national physician surveys. Respondents from the American Board of Family Medicine Recertification Survey (ABFM, n = 4040), a survey of family physicians fielded 2021-2022, and the National Physician Health IT Survey (NPHIT, n = 3006), a survey of outpatient physicians across specialty areas fielded in 2022. Under half of physicians felt that SDOH data were very important (ABFM: 44.8%, NPHIT: 30.8%). Although most physicians documented SDOH in the EHR (ABFM: 72%, NPHIT: 63.3%), fewer used structured documentation methods (ABFM: 56.3%, NPHIT: 33.2%). In both surveys, physicians who participated in value-based care initiatives, those for whom > 10% of their patient population was considered vulnerable, and those who felt that their clinic had the resources to address patients' social needs had higher likelihood of documenting SDOH. Sixty-two percent of family physicians reported using SDOH data for identifying resources and making referrals. In 2022, most physicians documented SDOH data in their EHR, yet fewer used structured methods, limiting data exchange opportunities to address patients' social needs. Under half of physicians considered access to external SDOH data to be "very" important, suggesting greater reliance on data collected internally and missed opportunities to identify patients who need support. Variation in perceived importance of SDOH data access and SDOH documentation by physician characteristics indicate opportunities to support adoption of structured documentation tools facilitating SDOH data capture and exchange to improve patient-centered care.

American board of orthodontics- discrepancy index (ABO-DI) as prognostic factor for the duration of orthodontic treatment: A cross-sectional retrospective study

To evaluate American Board of Orthodontics-Discrepancy Index (ABO-DI) as a prognostic factor in predicting the duration of orthodontic treatment.This cross-sectional retrospective study was conducted on the pre-treatment and post-treatment records of 151 consecutively de-bonded cases, who were treated between January 2016 and September 2013 with comprehensive orthodontic therapy. The ABO-DI was used to assess the pretreatment severity of malocclusion. The sample was divided into three groups based upon the discrepancy score calculated from pretreatment study model and lateral cephalogram; Group-1 (DI score &amp;#60;16; n= 65), Group-2 (DI score 16-25; n= 49) and Group-3 (DI score&amp;#62; 25; n=37). The duration of orthodontic treatment was calculated as total treatment time (in months) from the date of placement of initial brackets and archwires to the date when orthodontic appliances were removed. Spearman’s correlation test and One way ANOVA analysis followed by Post-Hoc tests for multiple comparisons were used to assess the association between the ABO-DI scores and duration of orthodontic treatment.The mean duration of treatment for Group-1, Group-2 and Group-3 was found to be 25.83±8.42, 28.16±10.55 and 28.84±9.61 months respectively, but there was no statistically significant relationship between the severity of malocclusion on the duration of comprehensive orthodontic treatment (P&amp;#62;0.05). An insignificant correlation (P=0.102, r= -0.134) between different groups of severity of DI scores and treatment duration was revealed with Spearman test.The duration of orthodontic treatment increased with increase in severity of malocclusion, however, it is not a reliable tool for predicting the treatment duration.

Effect of maxillary molars distalization using clear aligners and fixed orthodontic appliances on the positional and dimensional temporomandibular joint parameters: a three-dimensional comparative study

ObjectiveThe use of clear aligners (CAs) for orthodontic treatment has substantially increased in recent decades. However, limited empirical evidence exists regarding their potential effects on the temporomandibular joint (TMJ). The aim of this study was to assess the effect of maxillary molar distalization on the positional and dimensional TMJ parameters between CAs and conventional fixed orthodontic appliances (FAs) in skeletal class II malocclusion.MethodsThis is a retrospective cohort study examined 70 adult patients with skeletal class II malocclusion with similar baseline characteristics based on American Board of Orthodontics (ABO) discrepancy index scores. The patients were treated by maxillary distalization movement by CAs or FAs, of which there were two equal groups of 35 patients were included in each group. CBCTs on TMJs were performed before and after treatment through Anatomage Invivo Dental 6.0. The measured parameters included inclination, position, condyle and articular fossa dimensions, and the volumetric joint spaces.ResultsIn both groups, linear measurements of the maxillary molar position revealed significant improvement after treatment (P < 0.001). Regarding TMJ parameters, intra-group comparisons revealed significant changes in FA group in the anterioposterior condylar inclination and condylar position across the three planes. Additionally, the pretreatment-centric condylar position in the glenoid fossa was 45.7% and 40% in the CA and FA groups, respectively. After treatment, these percentages changed to 51.4% and 31.4%, respectively. In inter-group comparisons, significant changes were noted in the mediolateral condylar position, which was more inward in the FA group than the CA group.ConclusionThe FA group had more significant dimensional and positional changes in the mandibular condyle than the CA group; nevertheless, the changes are considered clinically negligible.

Scope of Practice Intentions Among Family Medicine Residents for Integrated Care of HIV and Hepatitis C Infection in People With Opioid Use Disorder

Background and Objectives: Because deaths from opioid overdoses have increased in the United States, family physicians are needed who can provide integrated care for a patient with HIV, hepatitis C, and opioid use disorder. We sought to describe the individual and residency characteristics of graduating family medicine residents who intend to practice such integrated care. Methods: We used 2017–2021 data from the American Board of Family Medicine Initial Certification Questionnaire. Our primary outcomes were individual and residency characteristics of resident graduates who intended to provide integrated care. We used logistic regression to assess independent associations with providing integrated care. Results: The response rate was 100% with 18,479 total respondents. After exclusions, our final sample size was 10,660 (57.7%) respondents. Of those, 782 (7.3%) respondents intended to practice integrated care. Using regression analyses, we found that resident graduates who intended to provide integrated care were more likely to be male, non-Hispanic or Latinx. After residency, they were more likely to intend to practice at a federally qualified health center, Indian Health Service, or nonfederal government clinic. Conclusions: Only 7% of residency graduates reported their intention to provide integrated care for people with opioid use disorder after residency. In response to a surging opioid crisis, policymakers, residency educators, and residency funders/sponsors should increase the workforce of family physicians who can provide this integrated care.

Surgical Training Pathways in the United Kingdom and the United States: Lessons for Resource-Limited Settings From High-Income Countries.

Background Surgical training is a critical component of healthcare, especially in high-income countries such as the United Kingdom (UK) and the United States (US), which have established distinct, well-organised training frameworks. Comparing these systems provides valuable insights that may enhance global surgical education, particularly in low- and middle-income countries, where training and retaining proficient surgeons are considerable challenges. Methodology This comparative study examines the surgical training systems in the UK and the US, focusing on key aspects, including training structure, competency-based assessments, and work-hour regulations. Data were sourced from regulatory organisations such as the General Medical Council, the Royal College of Surgeons, the Accreditation Council for Graduate Medical Education, and the American Board of Surgery. The analysis explores how elements of these models might be adapted to support sustainable surgical education frameworks in resource-limited environments. Ethical approval was not required due to the use of publicly accessible data and no patient involvement. Results The UK and US surgical training systems differ substantially in their structure, training duration, and specialisation timing. The UK employs a tiered approach, offering generalist experience before specialisation, while the US favours early specialisation directly after medical school. Both systems implement competency-based evaluations, though the US system places a greater emphasis on case volume and procedural exposure. Work-hour regulations also vary, with the UK capping weekly hours at 48 under the European Working Time Directive, compared to an 80-hour maximum in the US, which results in differing levels of trainee satisfaction and burnout rates. Conclusions The competency-based assessments in both the UK and the US offer adaptable frameworks for resource-limited settings. The phased training approach in the UK is well-suited for environments requiring versatile surgeons capable of handling a wide range of cases. By implementing these adaptable elements, along with cost-effective training innovations such as simulation tools, e-learning platforms, and international partnerships, resource-constrained regions can foster a sustainable, skilled surgical workforce. These insights offer pathways to improve healthcare outcomes and equity globally by enhancing surgical capacity in regions with limited resources.

Linking national primary care electronic health records to individual records from the U.S. Census Bureau's American Community Survey: evaluating the likelihood of linkage based on patient health.

To evaluate the likelihood of linking electronic health records (EHRs) to restricted individual-level American Community Survey (ACS) data based on patient health condition. Electronic health records (2019-2021) are derived from a primary care registry collected by the American Board of Family Medicine. These data were assigned anonymized person-level identifiers (Protected Identification Keys [PIKs]) at the U.S. Census Bureau. These records were then linked to restricted individual-level data from the ACS (2005-2022). We used logistic regressions to evaluate match rates for patients with health conditions across a range of severity: hypertension, diabetes, and chronic kidney disease. Among more than 2.8 million patients, 99.2% were assigned person-level identifiers (PIKs). There were some differences in the odds of receiving an identifier in adjusted models for patients with hypertension (OR = 1.70, 95% CI: 1.63, 1.77) and diabetes (OR = 1.17, 95% CI: 1.13, 1.22), relative to those without. There were only small differences in the odds of matching to ACS in adjusted models for patients with hypertension (OR = 1.03, 95% CI: 1.03, 1.04), diabetes (OR = 1.02, 95% CI: 1.01, 1.03), and chronic kidney disease (OR = 1.05, 95% CI: 1.03, 1.06), relative to those without. Our work supports evidence-building across government consistent with the Foundations for Evidence-Based Policymaking Act of 2018 and the goal of leveraging data as a strategic asset. Given the high PIK and ACS match rates, with small differences based on health condition, our findings suggest the feasibility of enhancing the utility of EHR data for research focused on health.