The Designated Institutional Official (DIO) is a necessary but uncommon role in medical education. Every sponsoring institution (SI) in the USA that trains residents or fellows is required to have a DIO. Nationally, there are slightly more than 900 SIs. DIOs may oversee small-, medium-, or large-sized graduate medical education (GME) institutions. Based on size and complexity, the DIO may be the main person who orchestrates the day-to-day functions of GME or may manage a team who undertakes the work. Many of the DIO's responsibilities are prescribed by the Accreditation Council for Graduate Medical Education (ACGME), but how these responsibilities are completed is variable. At its essence, the role of the DIO is to ensure every resident and fellow receives a good educational experience and meets requirements for board certification. In addition, DIOs may take on roles as a human resource expert, as a strategic content expert for GME, as a developer of educational sites and curriculum, and a quality assurance person evaluating GME programs. The DIO role is likely to increase in scope and complexity as GME evolves, and the DIO is positioned to think strategically about larger topics pertinent to GME.

The resident call points system: A quantitative framework for equitable workload distribution in neurosurgical training.

From its origins in the late 1800s, colon and rectal surgery has evolved from itinerant practitioners to a highly specialized surgical discipline. We highlight the historical development and the current state of the colorectal surgery training programs. The American Proctologic Society (APS) was founded by Joseph M. Mathews in 1899 that catalyzed the formation of early training programs in University of Minnesota (1916) and Mayo Clinic (1919). The American Board of Colon and Rectal Surgery (ABCRS) was recognized as the eighteenth medical specialty board in 1949. Formal accreditation of the programs began in 1975, with the Accreditation Council of Graduate Medical Education (ACGME) gradually implementing standardized curricula and competency-based training milestones. The National Residency Match Program (NRMP) and Electronic Residency Application Service (ERAS) adopted in 1984 and 2003, respectively, further streamlined the application process. Training innovations like the laparoscopic education committees (1997) and robotic surgery programs (2010) bear testament to the dedication of the program directors to continually advance this field. With a structured curriculum, rigorous examinations, and a plethora of study resources, this specialty has evolved from informal apprenticeships to competency-based residency programs. Current challenges include grade inflation in evaluation, a 67% match rate (2024) despite program expansion, adapting to evolving trends in medical and surgical care, and mastering new surgical techniques in a limited amount of time. The collaboration between governing bodies ensures high-quality training standards for the colon and rectal surgeons of the future.

Previous research has clearly shown that surgeon case volume is directly correlated with surgical outcomes in arthroscopic surgery. This study aimed to evaluate the exposure to wrist and elbow arthroscopy that graduating orthopedic surgery residents and fellows receive. Accreditation Council for Graduate Medical Education (ACGME) case log data from 2014 to 2024 was reviewed for graduating orthopedic residents, hand surgery fellows, and orthopedic sports medicine fellows in the United States. Mean and median numbers of wrist and elbow arthroscopy cases logged per resident or fellow were compared to assess procedure volume. The 10th and 90th percentiles of case volumes were analyzed to assess variability. Trends were evaluated over time to determine changes in case exposure. Wrist arthroscopy volume reported by orthopedic residents decreased from 4.6±5 (median 3, range 0-46) to 3.0±3 (1, 0-23) cases per resident (p<0.001). Elbow arthroscopy volume decreased from 2.1±2 (2, 0-18) to 1.8±3 (1, 0-38) cases per resident (p<0.001). Among hand surgery fellows, wrist arthroscopy volume decreased from 18.5±13 (15, 3-102) to 14.4±8 (13, 5-65) cases per fellow (p<0.001), and elbow arthroscopy volume from 5.2±7 (4, 0-35) to 2.6±3 (1, 0-20) cases per fellow (p<0.001). Sports medicine fellow elbow arthroscopy volume decreased from 6.6±8 (4, 0-48) to 3.1±4 (2, 0-23) cases per fellow (p<0.001). Wrist arthroscopy volume was not reported for sports medicine fellows. Despite the established role of wrist arthroscopy in upper extremity orthopedic surgery, resident exposure is limited and has declined over recent years. Fellowship training has not offset this decline, with wrist and elbow arthroscopy volume decreasing significantly in hand and sports medicine fellowships. These trends raise concerns over preparedness to safely and independently perform these technically demanding procedures in practice after training. IV.

At the start of their professions, trainees pursuing bachelor's degrees in medicine and surgery participate in a long program that constitutes mainstream medical education. The practicalities surrounding anatomical study, whether by dissection, using cadaveric specimens, or prosection, is essential. However, it requires infrastructure and enough specimens, amongst other paraphernalia, making it challenging to teach effectively in low-resource settings. This narrative review explores the importance of anatomy dissection courses for undergraduate students at the University of Rwanda and how its influences support early career involvement. Unrestricted search was conducted in Google Scholar and PubMed/MEDLINE and other online databases. This focused-on anatomy education and dissection courses for undergraduate students. The significance of utilizing the clinical skills learned of undergraduate students whilst boosting self-confidence to become future successful surgeons. Additionally, the research abilities exhibited by undergraduate students were utilized to enhance their professional development and gain knowledge of anatomical variations when writing case reports. Moreover, various obstacles coincide with the pursuit of anatomical study in Rwanda that affects students enrolling in such anatomy dissection classes. These comprise a dearth of undergraduate students, poor infrastructure of standard laboratories, and insufficient numbers of cadavers. Since there is currently evidence that early involvement has a favorable impact on a student's career, we should discover methods to include medical students in dissection courses.

Medication prescription errors remain a major patient safety concern, while undergraduate training in prescription writing is still inconsistently addressed in medical curricula. To evaluate changes in medication prescription writing quality following an active educational intervention among undergraduate medical students. Quasi-experimental before-and-after study conducted with 40 third-semester medical students from a public university in Brazil. The intervention consisted of eight stages involving simulated prescription activities, collaborative discussion, and feedback sessions. Prescription quality was assessed using the QualiPresc instrument at baseline, immediately after the intervention, and at a 15-day follow-up. Repeated measures were analyzed using the Friedman test, considering a significance level of 5%. The intervention was associated with significant improvements in prescription quality scores, particularly for the indicators "date of birth," "allergy record," "pharmaceutical form," "route of administration," and "non-pharmacological recommendations" (p < 0.001). The mean total prescription quality score increased from 73.47 at baseline to 95.34 immediately after the intervention and remained higher than baseline at the 15-day follow-up (87.80), suggesting partial retention of learning. The active teaching method was associated with improvements in medication prescription writing quality among undergraduate medical students, with partial retention of learning after 15 days. Although causal inferences cannot be established due to the absence of a control group, the findings suggest that this educational strategy may represent a promising approach for prescription safety education.

Case-based learning (CBL) is widely used in undergraduate medical education, with demonstrable benefits for students across multiple domains. There is a paucity of data in the post-graduate setting. A robust training program is essential for specialty trainees in medical oncology, yet dedicated educational opportunities are limited by a busy clinical environment. This study aimed to evaluate the feasibility of a post-graduate trainee-led CBL program within a Medical Oncology Department at a major cancer centre in Australia. All eligible participants (3 registrars, 1 clinical fellow, 2 nurse practitioners (NPs), 1 post-graduate student NP) were invited to attend weekly CBL sessions over a 20-week period. Session parameters, such as attendance and duration, were recorded. Feasibility was assessed using 4 of Bowen's key areas: acceptability, demand, implementation and practicality. A questionnaire was completed by each participant following each session and on conclusion of the program. Researchers performed statistical analysis using Mann-Whitney U tests and conducted thematic analyses on qualitative data. Of 20 scheduled sessions, 14 (70%) ran without cancellation. Attendance rate was 66%, with most absences being attributed to leave. Mean session duration was 61.4min, with mean preparation time of 24.2min per participant. Participant perceived value was high (9.1/10) and significantly higher with faculty medical oncologist attendance (9.7 vs. 8.8, p = 0.001). Acceptability scores were excellent (9.4/10). CBL sessions were rated significantly higher than concurrent educational opportunities (9.1 vs. 8.1, p < 0.001). Coding of the qualitative data within participant surveys identified the following themes: CBL sessions (1) stimulated relevant and beneficial discussion, (2) were perceived positively, (3) were negatively affected by other clinical commitments, (4) were enhanced by the presence of a faculty medical oncologist, (5) generated a safe space for collaborative learning, (6) were time-efficient and (7) provided self-study opportunities. A postgraduate, trainee-led CBL program in medical oncology is feasible and was well received at our centre. It offers a promising complement to traditional teaching in a rapidly evolving field where faculty oncologist-led educational opportunities may be limited. Future studies could focus on the potential for virtual implementation to allow for collaboration between centres, to the benefit of rural medical oncology trainees.

Artificial intelligence (AI) is rapidly becoming an integral part of everyday clinical practice, including cardiology and cardiovascular surgery. As AI increasingly influences diagnostic and therapeutic decisions, physicians are expected to interact with these systems in a critical, safe, and ethically grounded manner. This narrative review aims to explore how AI can be systematically integrated into undergraduate and residency medical education, with a particular focus on curriculum design, teaching strategies, assessment models, and educational infrastructure, while considering the context of the Turkish medical education system. A narrative synthesis of international medical education literature, policy documents, and institutional reports was conducted without quantitative meta-analysis. The review was guided by the principles of human-in-the-loop clinical reasoning, ethical AI use, and patient safety. Effective integration of AI into medical education requires a longitudinal and staged curriculum spanning preclinical, clinical, and residency training. Assessment strategies must explicitly address AI-assisted decision-making and be supported by transparent institutional policies governing AI use in examinations, as well as by secure, regulation-compliant digital infrastructure. Educational approaches should encourage learners to critically appraise and contextualize AI outputs rather than accept them uncritically. The reviewed literature supports a competency-based educational framework that integrates AI literacy, ethical reasoning, and context-aware clinical judgment. AI education should be viewed as a core clinical competency that strengthens rather than replaces human judgment. Particularly in high-risk cardiovascular disciplines, a standardized, ethics-centered, and competency-based educational framework is essential to prepare future physicians for AI-augmented healthcare environments.

Disparities in women's health have been identified in clinical outcomes, research, and medical education. However, women's health education remains inconsistent in internal medicine training. Longitudinal women's health training tracks have proven positive impacts on trainees' confidence with women's health clinical practice, and graduates of these tracks go on to become leaders who further expand these efforts. Our objective was to update the 2023 Directory of Internal Medicine Residency and Fellowship Programs in Women's Health to provide trainees and clinician educators with a centralized list of U.S. internal medicine residency and fellowship women's health training programs. We contacted women's health education program leaders from the 2023 directory to update their program information. We sent a recruitment email to the Sex-and Gender-Based Women's Health Education Interest Group listserv of the Society of General Internal Medicine and used snowball sampling to identify new programs. New program leaders were sent an electronic Qualtrics survey to confirm current program status, contact information, website, capacity, educational offerings, and program highlights. This directory describes 29 graduate medical education training programs in women's health for internists, with 12 residency programs and 17 fellowship programs identified. This is an overall increase from the 25 programs in the 2023 directory. This directory is a practical resource for trainees seeking educational experiences and for medical educators seeking opportunities for collaboration and leadership in women's health. The increase in training opportunities is a step toward comprehensive medical education and equitable, high-quality care and research in women's health.

Publications influence selection into competitive gastroenterology fellowships, yet drivers of research productivity among current trainees are not well characterized. We evaluated whether training stage, institutional pedigree, and degree pathway are associated with research output among United States of America gastroenterology fellows. We performed a cross-sectional study of fellows listed on publicly available rosters from Accreditation Council for Graduate Medical Education (ACGME)-accredited adult gastroenterology fellowship programs (October-November 2025). PubMed-indexed publications were identified and categorized by training stage (medical school, residency, fellowship) and gastroenterology (GI)-specificity. Group comparisons used Mann-Whitney U tests. Poisson generalized estimating equation models clustered by program estimated adjusted incidence rate ratios (IRRs) for total publication counts. Among 776 fellows from 125 programs, PGY6 fellows had more GI-specific publications than PGY4 fellows (median 3 vs 2) and greater fellowship-period output. Training in top-ranked environments was associated with higher total and GI-specific publication counts, with the largest differences observed for top 20 fellowship environments. In adjusted analyses, top-ranked training affiliations remained independently associated with higher total publication output. Women had approximately 15% lower total publication output than men (adjusted IRR ≈0.85). International medical graduates had higher publication counts than non-IMGs, whereas U.S. DO graduates had lower counts. Research productivity among United States of America gastroenterology fellows varies by training stage, training environment, and degree pathway, likely reflecting opportunity and infrastructure as well as individual aptitude.

Introduction Medical students’ perceptions of the medical profession shape their identity and career decisions. However, little is known about how these perceptions evolve over the course of undergraduate medical education. This study addresses this gap by exploring how medical students’ views of the profession change across different years of training. Methods We employed an inductive constructivist approach to analyse data from 53,312 open-ended responses from the 2021 China Medical Student Survey (CMSS), representing over 120 medical schools across China. Natural language processing (NLP) techniques, including topic modeling and sentiment analysis, were used. We examined how students’ narrative descriptions of the medical profession and their sentiment scores varied across different years of undergraduate medical education. Results Students’ perceptions of the medical profession centred on two broad areas: academic aspects (specialised knowledge, skills, educational requirements, and lifelong learning) and career aspects (professional image and career prospect). Across all undergraduate medical education years, academic aspects appeared more frequently than career aspects. However, as students progressed through training, references to career prospect and educational requirements increased, indicating a developmental shift toward more pragmatic and future-oriented concerns. Sentiment analysis revealed consistently positive attitudes. However, the average sentiment scores gradually declined with each successive year. Discussion By examining students’ descriptions of the medical profession and their emotional tone, this study provides a clearer understanding of how views of the profession evolve throughout undergraduate medical education. The increasing attention to career-related concerns alongside the gradual decline in sentiment highlights the need for educational strategies that address students’ developing expectations, career planning needs, and emotional well-being. These nationally representative findings offer important insights into medical students’ perceptions of the profession, highlighting the value of NLP in analysing large-scale qualitative data and the need for future cross-cultural comparisons to explore how these perceptions evolve in diverse educational contexts.

Correctional facilities in the United States house many individuals with mental illness requiring psychiatric care. This study investigates didactic and clinical experiences and attitudes related to correctional psychiatry among psychiatry residency program directors and medical student clerkship directors. An online survey was distributed to assess the current landscape of learner exposure to correctional psychiatry, topics related to criminal legal involvement among people with mental illness, and attitudes toward correctional psychiatry. A total of 96 individuals responded to the survey (overall response rate of 16%). About half of clerkship director (45.2%) and program director (51.1%) respondents report affiliations with correctional institutions. Few residency programs have a mandatory rotation (24.4%) whereas a higher proportion offer elective rotations (57.8%). Although medical student clerkship directors identify teaching correctional health as important, medical students have limited exposure and education on core topics of correctional psychiatry, perhaps related to reported heightened safety concerns. Correctional settings offer an opportunity to expose future psychiatrists to the care of people with criminal legal involvement as well as individuals with serious mental illness needing care. We found variable experiences in the exposure, education, and availability of rotations related to correctional psychiatry. Educators should advocate for learners to have further opportunities in these needed areas.

BackgroundThe number of 1-year Accreditation Council for Graduate Medical Education (ACGME) fellowships continues to grow. The ACGME recommends a holistic curriculum with nonclinical areas, inclusive of educational sessions. Given the competing demands between clinical skill development, educational pursuits, and work-hour restrictions, we propose an andragogic curriculum using pediatric anesthesiology as the model fellowship.ObjectiveThe primary objective was to improve fellows’ perceptions of their educational experience during their fellowship year after implementing an andragogic holistic curriculum. Secondary objectives assessed improvements in diversity, equity, and inclusion (DEI) training and resources.MethodsThis was a single-center educational improvement project completed at Lucile Packard Children’s Hospital Stanford. Data were collected between 2014 and 2024. The new curriculum was introduced in 2021‐2022 and involved 12 different teaching modalities rooted in andragogic principles. A statistical process control p-chart was used to analyze the primary outcome based on the ACGME annual program evaluation. Outcomes were analyzed using censored regression modeling or a t test, depending on the presence of ceiling effects.ResultsFrom 2014 to 2024, 58 of 60 pediatric anesthesiology fellows completed the ACGME survey. A break in the statistical process control p-chart for educational content scores occurred during 2021‐2022, when the new curriculum was introduced. The mean difference was 0.89 (P<.001). Scores in DEI improved (mean difference 0.52; P=.03), and no difference was noted in resources (mean difference −0.13; P=.98).ConclusionsIntroduction of an andragogic curriculum into a pediatric anesthesiology fellowship program was associated with more favorable perceptions of educational content and DEI training.

Invited Commentary to "Reforming Surgical Graduate Medical Education Toward Accreditation Aligned with Readiness for Independent Practice" by Ellison, et al.

Brachytherapy for rectal cancer: An overview of clinical competency development in contemporary practice.

The rapid expansion of telemedicine has increased the relevance of teleconsultations in everyday clinical practice. However, the manner in which teleconsultation competencies are conceptualized, taught, and assessed in undergraduate medical education remains unclear. A narrative review was conducted using a transparent methodology to identify and select studies. Several bibliographic databases were searched using predefined eligibility criteria, focusing on educational interventions that specifically targeted teleconsultation competencies among undergraduate medical students. The selection process emphasized conceptual clarity, curricular intent, and the inclusion of empirically reported educational outcomes. The eligibility criteria were intentionally designed to identify studies that explicitly conceptualized teleconsultation as a distinct undergraduate clinical competency. The search process yielded 199 records. After screening and comprehensive full-text evaluation, only one study explicitly conceptualized teleconsultation as a distinct undergraduate clinical competency and met all predefined eligibility criteria. This study details a structured educational intervention that frames teleconsultation as a distinct clinical competency. The outcomes concerning communication, clinical reasoning in virtual environments, technical aspects of teleconsultation, and components of remote physical examination were reported. The principal finding was the identification of substantial evidence gaps in the conceptualization, assessment, and longitudinal teaching of teleconsultation competencies. Current evidence regarding the instruction of teleconsultation competencies in undergraduate medical education is limited. The prevailing literature addresses telemedicine primarily as a mode of care delivery rather than emphasizing teleconsultation as a distinct clinical skill. These observations highlight a discrepancy between contemporary clinical practice and undergraduate training, emphasizing the need for well-defined educational frameworks that incorporate teleconsultation competencies.

Grit in Undergraduate Medical Education: A Scoping Review

Resident Perspectives on Remediation: A Qualitative Study Informing a Learner‑Centered Model in Pediatric Residency Training.

Health advocacy is increasingly recognized as a core professional responsibility of physicians; however, formal training in advocacy remains limited within graduate medical education. Physiatrists are uniquely positioned to participate in advocacy given their care of individuals with disabilities and intrinsic interdisciplinary care coordination to navigate the social, economic, and systemic barriers affecting health outcomes for our patients. This manuscript reviews the current perceptions of physician advocacy, the existing advocacy training models across medical specialties, and the current state of advocacy opportunities and requirements within Physical Medicine and Rehabilitation (PM&R) residency education. Drawing on existing frameworks and educational models, we outline suggestions to integrate advocacy training into PM&R residency educational offerings. Incorporating advocacy education in PM&R training may better prepare residents to address health disparities, promote patient-centered systems change, and mitigate burnout by promoting engagement in professional activities that align with physiatrists' ethical and professional priorities.

Defining the core content for each scientific discipline in a modern preclinical medical education curriculum is critical to ensure optimal student learning and application of foundational knowledge for clinical practice. Attendees of the Association of Medical School Microbiology and Immunology Chairs (AMSMIC) Educational Strategies Workshop recently highlighted the need for updated medical microbiology learning objectives, given the shift in medical education toward less time for preclinical coursework and more integrated learning. Herein, we describe the process of developing a comprehensive, educator-driven set of knowledge objectives for medical microbiology. These objectives emphasize common pathogens, as well as pathogens associated with severe disease, organized by clinical presentation and disease processes. They also recognize newer pathogen identification methods used in clinical laboratories and provide flexibility to address emerging pathogens. Educators can use these objectives to refine curricula and define core content expected to appear on major medical licensure examinations.