Critical Specialty Research Articles

Revitalizing obstetrics and gynecology, a pathway to restoring medicine in Republic of Korea

Background: In February 2024, the Korean government introduced the “Essential Medical Package,” along with an increase in medical school admissions of 2,000 students, resulting in a total annual intake of 5,058 for the beginning of 2025. This sudden policy shift precipitated significant turmoil within the medical sector, prompting many resident doctors to resign and medical students to take leaves of absence. Despite numerous appeals for the revision of these policies, the government has widely disregarded these concerns and adopted more restrictive measures, thereby exacerbating tensions within the healthcare community.Current Concepts: Despite Korea’s doctor-to-population ratio being lower than the OECD average, Korea demonstrates remarkable positive health indicators, including low avoidable mortality rates and high life expectancy. Nevertheless, critical specialties, particularly obstetrics and gynecology, are facing significant challenges. These challenges are compounded by policies that offer public health services such as complementary prenatal screenings, which reduce revenue for private clinics. Nevertheless, critical specialties, particularly obstetrics and gynecology, are facing significant challenges, compounded by policies that offer public health services, such as complementary prenatal screenings, which reduce revenue for private clinics. Consequently, this situation has exacerbated the decline of private obstetric services, placing additional strain on the healthcare system.Discussion and Conclusion: To effectively address the challenges facing the Korean healthcare system, it is imperative to implement targeted reforms that prioritize increasing compensation and mitigating legal risks for high-risk specialties, rather than merely expanding medical school admissions indiscriminately. Furthermore, transparent and data-driven workforce planning is essential to foster sustainable improvements that support the efficiency and accessibility of healthcare services in Korea. Without these reforms, there is a significant risk that the quality of medical services will continue to decline, thereby adversely affecting future generations’ access to essential healthcare.

Considerations to Optimize Structurally Responsive Work Environments for U.S. Military Specialty Physicians.

Recruitment, training, and retention of wartime critical specialty physicians may be stymied by discrimination and abuse. It is unclear to what extent the US combat specialty physicians witness or experience discrimination and abuse, whether they or others intervene, and if they would subsequently discourage people from entering their field. The present study surveyed US active duty anesthesiologists, emergency medicine physicians, and orthopedic surgeons (N = 243; 21% response rate). A generalized linear model evaluated the extent to which gender, specialty, service, and number of witnessed/experienced negative/stigmatizing comment/event types were associated with burnout. A bootstrapped mediation analysis evaluated whether gender and burnout were mediated by the number of comment/event types. The sample was majority non-Latine White (87%) and men (66%) with tri-service and specialty representation. The most commonly reported negative/stigmatizing comment/event types were related to pregnancy (62%) and parental leave (61%), followed by gender and assigned sex (42%), lactation (37%), and sexual harassment (35%). Of the respondents who witnessed/experienced such comments/events, self-intervention was reported after comments regarding lactation (43%), assigned sex and gender (42%), race and ethnicity (41%), pregnancy (41%), parental leave (37%), and sexual harassment (24%). Witnessing another person intervene was reported after sexual harassment (25%) and comments/events regarding race and ethnicity (24%), pregnancy (20%), assigned sex and gender (19%), lactation (19%), and parental leave (18%). Nonintervention was reported after comments/events related to parental leave (42%), pregnancy (38%), sexual harassment (26%), lactation (26%), assigned sex and gender (26%), and race and ethnicity (22%). Respondents reported moderate-to-high intervening likelihood, importance, and confidence. Respondents reporting neutral to extremely agree on prompts indicating that pregnant active duty physicians are trying to avoid deployment (P = .002) and expect special treatment that burdens the department (P = .007) were disproportionately men (36% and 38%, respectively) compared to women (14% and 18%, respectively). The highest proportion of neutral to extremely agree responses regarding discouraging specialty selection were reported in relation to transgender and gender diverse students (21%), followed by cisgender female students (18%); gay, lesbian, or bisexual+ students (17%); cisgender male students (13%); and racial and ethnic minoritized students (12%). In the primary model, the number of witnessed/experienced comment/event types was associated with greater burnout (0.13, 95% CI 0.06-0.20, P = .001), but women did not report significantly different levels of burnout than men (0.20, 95% CI -0.10 to 0.51, P = 0.20). The number of comment/event types mediated the relationship between gender and burnout (0.18, 95% CI 0.06, 0.34; P < .001). Although reported intervening confidence, likelihood, and importance were high, it is unclear whether perceptions correspond to awareness of intervention need and behaviors. Bivariate differences in burnout levels between men and women were fully explained by the number of comment types in the mediation model. Annual trainings may not effectively address workplace climate optimization; institutions should consider targeted policy and programmatic efforts to ensure effective, structurally responsive approaches.

New nurses’ transition to practice experience after completion of the enhancement training program in the Sultanate of Oman

In 2021, the Directorate General of Nursing Affairs (DGNA) at the Ministry of Health (MOH) in the Sultanate of Oman has established a 12-month training program for new nursing graduates known as the Enhancement Training Program (ETP). The program aims to intensively train novice nurses in seven critical specialties and equip them with the specialty knowledge, skills, and professional competence required to deliver safe and specialized care to critically ill patients. This study aims to determine the levels of confidence, comfort, satisfaction, stress, and experiences of transition-to-practice among nurses who completed the program successfully, and to assess the differences in the levels of confidence, comfort, satisfaction, stress, and experiences of transition-to-practice among the nurses participated in different specialties. The study sample target the first cohort of nurses who participated in the ETP from June 2021 to June 2022 and passed the program successfully (n = 313). Casey-Fink Graduate Nurse Experience Survey was utilized to evaluate the experiences of the participating nurses. Statistical Package for the Social Sciences (SPSS) version 29 software used to analyze the collected data by performing descriptive analysis using means and standard deviations. Inferential analysis (analysis of variance [ANOVA]) was conducted to assess the variance between the groups so as to identify any statistical differences among the means of all the specialty groups. The findings of this study provide evidence supporting the effectiveness of the ETP in boosting the confidence, comfort, and satisfaction of novice nurses.

Using Kern's Model to Redesign a Postgraduate Curriculum for Orthopaedic Physician Assistants.

Postgraduate physician assistant (PA) specialty training expands entry-level education, allowing PAs to work in concentrated fields. The United States Army - Baylor University Doctor of Science in PA Studies Orthopaedics program provides formal education to fill the capability gap caused by surgeon shortages in the military. Based on several sources of feedback, the authors recognized that the curriculum needed modernization and set forth to rewrite the curriculum. This article describes the use of Kern's 6-Step Approach for Curriculum Development for Medical Education to redesign a curriculum for an 18-month postgraduate doctoral program for military orthopaedic PAs. The resulting formal curriculum enables 4 geographically separated sites to execute an orthopaedic PA degree program that addresses a critical specialty care access challenge for the military. Kern's 6-Step approach could be used to design or redesign any PA educational content, from a single course to an entire degree program.

Strategies to Offer Uninterrupted Neurosurgical Care at a Tertiary Center in Makka amid COVID-19 Pandemic.

Background:Globally, there is a shooting pandemic that affected many healthcare systems. Healthcare facilities had to set up logistics to avoid being drained while facing a catastrophic health problem. There are currently no available vaccines or perfect therapies and also no certified immunity against that disease. Therefore, it is probable that healthcare systems will face it for an exceptionally long period. That will have a grave effect on the strategy of daily practice of different specialties' services at healthcare centers. Impossible decisions in usual workdays are now forcibly adopted for the sake of patients, care providers, and health resources.Methods:We try in a simple way to share tertiary center expertise in managing neurosurgical cases amid a dreadful healthcare crisis. Healthcare workers' safety and patient safety were typical priorities for neurosurgical service at King Abdullah Medical City. We expose the lines of management, triaging cases, the methods of handling confirmed and suspected neurosurgical patients, and strategies for discharging and following up patients. We identified hospital admission and discharge records starting from March 2020 till July to track the neurosurgical case burden and the state of service offered and the rate of infection among healthcare workers who participated in surgeries.Results:At the peak time of the COVID-19 pandemic in Makka starting from March till July, we have admitted 250 neurosurgical patients. About 210 (84%) of them did surgeries according to the triaging protocol described in the article. About 155 (62%) of those who did surgeries were urgent and the rest were borderline or semi-urgent. About 10 (4%) were severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and three of them died due to acute respiratory distress syndrome. Only two mortality cases were reported due to a neurological complication and not related to SARS-CoV-2 infection. The rest of the cases (98%) were discharged for follow-up without grave complications after they were offered the service. No neurosurgeons or anesthesia staff involved in offering the service were infected with SARS-CoV-2. Successful uninterrupted neurosurgical care was available for patients during that health crisis without any healthcare worker being infected.Conclusion:Following the suggested strategies, any center can provide the healthcare service amid any pandemic happening now or in the future without dismantling the normal health system, especially for life-saving cases in a critical specialty as neurosurgery.

Prevalence of Workaholism Among Egyptian Healthcare Workers With Assessment of Its Relation to Quality of Life, Mental Health and Burnout.

Introduction: Work is a social double edged weapon activity that may have positive and negative effects on individual's quality of life and health.Objectives: To estimate workaholism prevalence and to determine its effects on quality of life, mental health, and burnout among healthcare workers (HCWs).Methods: Using a cross-sectional study, 1,080 Egyptian participants distributed as HCWs and non-HCWs were recruited. The study included 4 questionnaires to assess workaholism, quality of life (QoL), Psychological capital questionnaire (PCQ), and General health questionnaire (GHQ). Maslach Burnout Inventory (MBI) was applied to critical specialty HCWs in addition to pro-inflammatory markers including Il6, TNFα, and CoQ10.Results: This study revealed that 24.4 and 24.8% of HCWs were workaholic and hardworking, respectively, in comparison to 5.9 and 28.1% among non-HCWs (P < 0.001). Somatic symptoms and anxiety/ insomnia domains of GHQ were higher among HCWs than non-HCWs (P < 0.001 and 0.002, respectively). QoL was significantly lower among HCWs than non-HCWs (P < 0.001). Workaholism was reported among 43.2% of HCWs with critical specialty (P < 0.001). Components of PCQ components were significantly higher among HCWs with critical specialty than non-critical HCWs while QoL showed the reverse (P < 0.05). Working excessively was a predictor to burnout [Emotional exhaustion (β = –0.23) and depersonalization (β = −0.25)] and TNFα (β = 0.41). Emotional exhaustion was a predictor to Il6 (β = 0.66), TNFα (β = 0.73), and CoQ10 (β = −0.78).Conclusion: There is a significant association between workaholism and psychologically poor-health and poor quality of life among HCWs. Critical specialty healthcare workers showed association between workaholism, burnout and pro-inflammatory markers. Addressing of personal characteristics, supporting factors in the work environment and periodic examination of the healthcare workers and responding accordingly is required.

Gender differences in the factors influencing the choice of future career among the final stage Turkish medical students

Background: Turkey has a marked increase in the proportion of female medical students and graduates doctors compared to males. However, females are still underrepresented in some disciplines and grouped in other branches of medicine. It is essential to regularly assess the medical students' trends toward the specialty and avoid the shortage and maldistribution in some critical specialties. This study aims to investigate the gender differences in Turkish medical students’ specialty preferences and influencing factors.&#x0D; Methods: A descriptive cross-sectional study carried out among final year students at the Bezmialem Vakif University (BVU), Faculty of Medicine in Istanbul, Turkey. Data collected from March to April 2018 using a pre-tested self-administered questionnaire included socio-demographic characteristics of the population, first choices for specialization, and the factors influencing those choices. An independent sample t-test performed to test the gender differences in different influencing factors. Data were analyzed using SPSS version 16.&#x0D; Results: A total of seventy (70) students (response rate of 69.5 %) included in the data analysis. The mean age of total respondents was 24.9 ± 0.96 (ranged 23-27), and the male to female ratio of students was approximately 1:1.4. Out of nineteen (19) factors, statistically significant gender differences noted in the mean scores of six factors. Male students were more influenced by family expectations (2.76 ± 0.87, p=0.008), geographical consideration (2.97 ± 0.91, p=0.053), and high income expectations (2.90 ± 0.90, p=0.024) compared to female students. However, female students were more influenced by personal interests (3.61 ± 0.49, p=0.041), personality characteristics (3.59 ± 0.55, p=0.010) and malpractice (2.73 ± 1.03, p=0.015) compared to male students.&#x0D; Conclusion: There is a significant difference between the sexes in terms of priorities; family, income, and geographical distribution significantly impacted on men, while women were more concerned with lifestyle, well-being and avoiding responsibility.

Direct enhancement of readiness for wartime critical specialties by civilian-military partnerships for neurosurgical care: residency training and beyond.

Military neurosurgery has played an integral role in the development and innovation of neurosurgery and neurocritical care in treating battlefield injuries. It is of paramount importance to continue to train and prepare the next generation of military neurosurgeons. For the Army, this is currently primarily achieved through the military neurosurgery residency at the National Capital Consortium and through full-time out-service positions at the Veterans Affairs-Department of Defense partnerships with the University of Florida, the University of Texas-San Antonio, and Baylor University. The authors describe the application process for military neurosurgery residency and highlight the training imparted to residents in a busy academic and level I trauma center at the University of Florida, with a focus on how case variety and volume at this particular civilian-partnered institution produces neurosurgeons who are prepared for the complexities of the battlefield. Further emphasis is also placed on collaboration for research as well as continuing education to maintain the skills of nondeployed neurosurgeons. With ongoing uncertainty regarding future conflict, it is critical to preserve and expand these civilian-military partnerships to maintain a standard level of readiness in order to face the unknown with the confidence befitting a military neurosurgeon.

The Peculiarities of Family Doctors Retraining in Georgia

&lt;p&gt;Working out of the human resources development policy and long-term plan, funding of critical specialties and employment of sought-after experts in coastal and mountainous regions, coordination and standardization of continuing and medical education are necessary. Geographical and financial availability of the first healthcare services, create the adequate conditions of the first healthcare team which one consists: appropriate equipment and physical infrastructure, medical documents, to acknowledge the necessity of team working in healthcare system and define the proper contract obligations for doctors, for the reason of medical service improvement quality in providing the Disease Control national recommendations and standards availability for regional doctors, encourage the audit systemspread information about the reform of Georgian healthcare in populations and healthcare professionals, encourage patient’s education, check the teaching programs of doctors retraining on which foundation will be able to create better conditions for practical skills. &lt;/p&gt;&lt;p&gt;Our country must encourage to hold some priority scientific researches as in the field of state as in international grant program. Above-mentioned can be implemented by the active collaboration with USA and European disease control leading medical schools or universities, scientific funds and other international partner organizations.&lt;/p&gt;

Similarities and Differences in Nurse-Reported Care Rationing Between Critical Care, Surgical, and Medical Specialties.

The aim of this study was to determine the similarities and differences in elements of nursing care that are commonly rationed in the critical care, medical, and surgical specialties within an acute hospital environment. Registered nurses who provide bedside nursing care within the medical, surgical, and critical specialties at a single center were invited to anonymously complete the self-administered MISSCARE questionnaire. The frequency of rationing for each individual care element within the 4 broader care groups (assessment, intervention-individual needs, intervention-basic care, and planning) of the MISSCARE questionnaire was determined. A mean score for each care group was also determined, and multiple regression analysis was undertaken to determine the demographic predictors of care rationing. Interventions related to basic care was the most frequently rationed care group in the critical care/emergency specialty (missed care mean of 50.1%), whereas planning was the most frequently rationed care group among both the medical (missed care mean of 43.6%) and surgical (missed care mean of 44.8%) specialties. Assessment was the least frequently rationed care group among all 3 specialties (missed care mean of 19.7%-26.7%). Length of time practicing as a registered nurse was an independent predictor of care rationing in the critical care/emergency specialty, and age older than 50 was an independent predictor in the medical specialty. There are numerous similarities and differences in care rationing between critical care, surgical, and medical nurses. The development and implementation of specialty-based strategies should be undertaken to reduce the incidence of nursing care rationing.

Sexually transmitted infection clinics as safety net providers: exploring the role of categorical sexually transmitted infection clinics in an era of health care reform.

For many individuals, the implementation of the US Affordable Care Act will involve a transition from public to private health care venues for sexually transmitted infection (STI) care and prevention. To anticipate challenges primary care providers may face and to inform the future role of publicly funded STI clinics, it is useful to consider their current functions. Data collected by 40 STI clinics that are a part of the Sexually Transmitted Disease Surveillance Network were used to describe patient demographic and behavioral characteristics, STI diagnoses, and laboratory testing data in 2010 and 2011. A total of 608,536 clinic visits were made by 363,607 unique patients. Most patients (61.9%) were male; 21.9% of men reported sex with men (MSM). Roughly half of patients were 20 to 29 years old (47.1%) and non-Hispanic black (56.2%). There were 212,765 STI diagnoses (mostly nonreportable) that required clinical examinations. A high volume of chlamydia, gonorrhea, and HIV testing was performed (>350,000 tests); the prevalence was 11.5% for chlamydia, 5.8% for gonorrhea, 0.9% for HIV, and varied greatly by sex and MSM status. Among MSM with chlamydia or gonorrhea, 40.1% (1811/4448) of chlamydial and 46.2% (3370/7300) of gonococcal infections were detected at extragenital sites. Sexually Transmitted Disease Surveillance Network clinics served populations with high STI rates. Given experience with diagnoses of both nonreportable and reportable STIs and extragenital chlamydia and gonorrhea testing, STI clinics comprise a critical specialty network in STI diagnosis, treatment, and prevention.

Physician Willingness to Respond to Disasters: What Can We Learn?

Physician Willingness to Respond to Disasters: What Can We Learn?

DOD and NGOs in Haiti ‐ A Successful Partnership

AbstractThe 2010 Haiti Earthquake was the deadliest single disaster in this Hemisphere, ever. International Aid Organizations and Governments rushed to assist the survivors. Among these, the US Department of Defense played a significant role. Alongside DoD however were a large number of NGO volunteers onboard the USNS Comfort hospital ship, which provided critical specialty skills. This partnership, DoD and NGOs, has already demonstrated significant benefit in lives saved and suffering mitigated. Various lessons learned are noted and recommendations for improvement in the way NGOs are sourced and integrated for these missions. However, the greatest benefit could be in future disaster response when synergies developed from combined training and exercises allow DoD and NGOs to respond seamlessly and effectively to another major disaster, together.

Editorial

‘So why do you want to do Acute Medicine?’ – it’s a common interview question, and one for which most prospective trainees will have a well-prepared answer. Sometimes the candidate will focus on the opportunities for multi-professional working and teamwork, as well as interactions with critical care and other specialities; however almost all will mention the wide variety of conditions with which acute physicians are faced in their daily practice. What may appear a simple problem at the time of presentation may have a twist in the tail which will catch out the unwary. The need to maintain a broad differential diagnosis is a key skill for the acute physician: I frequently need to remind trainees that ‘Query ACS – measure 12 hour troponin’ is not an acceptable management plan. It is crucial to remember that even when a condition like acute coronary syndrome has been ‘excluded’, a serious cause may still be lurking. Several of the articles in this edition illustrate such caveats. In the review of the diagnosis and management of aortic dissection, the variability of presentation is illustrated with a case where the onset of symptoms preceded the hospital admission by several weeks and was initially labelled as ‘musculoskeletal’. In this case it was the chest x-ray which raised the clinical suspicion when a change in the mediastinal contour was identified. However, serious spinal causes of chest pain, such as the spontaneous extradural haematoma on p76, will only be diagnosed by more complex imaging; this will be hard to arrange without a clear clinical indication. The rarity of this condition means that most will not have come across a case and will therefore be unaware of the need to consider this diagnosis. The importance of a careful history, refreshingly emphasised in the recent NICE guidance on chest pain of possible cardiac origin as summarised by Charlotte Cannon in this edition, cannot be understated. Many readers will have come across patients with erythema nodosum, referred as ‘unresolving cellulitis’ – often these turn out to have sarcoidosis as described in Dr Chakraborty’s case series, although other underlying causes need also to be considered. Cellulitis may also be a manifestation of a subcutaneous source of infection, particularly when it appears in an unusual site; Denzil May’s case illustrates the need to image the abdomen when presented with abdominal wall cellulites – on this occasion an underlying psoas abscess was the cause although appendix abscesses, inflammatory bowel disease, diverticular abscesses and pelvic collections also need to be considered. The opportunity to learn a practical procedure has been a subject of considerable debate amongst acute medical trainees over recent years, and has been highlighted in this journal in the past. Much of the focus in previous editions has been on echocardiography. Ultrasound is another practical procedure which is listed in the training curriculum for Acute Medicine, although the feasibility of training acute medical trainees in this area has not been fully evaluated. Dr Ismaeel’s study comparing the outcome of ultrasound undertaken at the bedside by an acute medical trainee and that undertaken in the radiology department may stimulate some debate on the value of this. This study looked specifically at diagnostic ultrasound of the abdomen and demonstrated that some conditions could be identified at the bedside, though probably not with enough reliability to prevent the need for a subsequent departmental ultrasound. The key is whether the specific questions can be answered by the ‘occasional’ sonographer using portable equipment: ‘are the bile ducts dilated?’, ‘are the kidneys obstructed?’, ‘are there metastases in the liver?’, ‘is there ascites or is it just fat?’ – knowing the answers to such questions can inf luence management out of hours, although currently most patients will have to wait until the morning for a scan. A formal training programme in acute medical ultrasound will need to focus clearly on these specific areas, rather than generic diagnostic ultrasound skills. Many readers will be familiar with the rapid turnover of AMU nursing staff, particularly at a junior level, which can undermine the ability to develop a stable workforce. In a questionnaire study in Birmingham and Dundee, consultant nurses Liz Lees and Liz Myers have produced some interesting data which may help to improve recruitment and retention of nurses on Acute Medical Units. It seems that, as with junior doctors, it is the variety which is the main attraction, as well as the being the main factor which keeps nurses interested in working on the AMU. Correspondence relating to this and any other issues relating to articles in this journal would be most welcome.

The rotation and assignment of imbalanced air force specialties: A policy analysis model

A dynamic model of a complex multi-echelon personnel system is presented in this paper. The system manages U.S. Air Force airman assignments in critical specialties. Some of these spe cialties are imbalanced with more personnel required overseas than can be supplied and still allow airmen sufficient tour length assignments in the continental United States. The model deals with inputs and outputs of personnel at the organizational level and provides a mechanism for testing the effects of alternative policies on system performance. A discussion of the advantages of the methodology over other techniques for this type of analysis is included.