Inadequate Confidence Research Articles

Awareness and Knowledge of the National Healthcare Transformation Program Among Public Health and Preventive Medicine Physicians in Saudi Arabia.

The Health Sector Transformation Program (HSTP) has been established as part of Saudi Vision 2030. Despite the significant progress achieved in previous years, the HSTP addresses multiple challenges. One of these challenges is that the current healthcare model prioritizes treatment over prevention. Therefore, prioritizing preventive healthcare measures is crucial. This study aims to assess the levels of awareness and knowledge among the public health and preventive medicine physicians in Saudi Arabia towards the national healthcare transformation program. In this cross-sectional study, we surveyed public health and preventive medicine physicians in Saudi Arabia. We collected data through a newly developed and validated self-administered questionnaire, which was distributed online. The survey questionnaire consisted of three sections: participants' background characteristics; measurement of public health and preventive medicine physicians' awareness of the HSTP and their confidence in their awareness; and measurement of the physicians' knowledge of the HSTP through six multiple-choice questions. In this study, 307 public health and preventive medicine physicians in Saudi Arabia participated. The mean age ± SD was 33.1 ± 5.1 years, with 54.7% being public health and preventive medicine residents, 33.2% specialists, and 12.1% consultants. Most participants showed high awareness of the HSTP and its strategic objectives. Over two-thirds correctly defined HSTP, value-based healthcare, and the new Model of Care (MOC), while about 50% demonstrated inadequate knowledge regarding Accountable Care Organizations (ACOs) and the "Keep Well" system. Older physicians, consultants, and those with more years of work experience had higher knowledge scores. Regression analysis revealed that job rank significantly influenced public health and preventive medicine physicians' knowledge of the HSTP. This study shows that while public health and preventive medicine physicians are generally aware of HSTP's objectives, they have inadequate confidence in their knowledge, highlighting the need for better information dissemination. Awareness of the MOC is high, but gaps persist in understanding specific components like the "Keep Well" initiatives. The study also found that job rank and experience influence knowledge levels, suggesting the need for broader dissemination of the HSTP concepts.

Peer review of GPT-4 technical report and systems card.

The study provides a comprehensive review of OpenAI's Generative Pre-trained Transformer 4 (GPT-4) technical report, with an emphasis on applications in high-risk settings like healthcare. A diverse team, including experts in artificial intelligence (AI), natural language processing, public health, law, policy, social science, healthcare research, and bioethics, analyzed the report against established peer review guidelines. The GPT-4 report shows a significant commitment to transparent AI research, particularly in creating a systems card for risk assessment and mitigation. However, it reveals limitations such as restricted access to training data, inadequate confidence and uncertainty estimations, and concerns over privacy and intellectual property rights. Key strengths identified include the considerable time and economic investment in transparent AI research and the creation of a comprehensive systems card. On the other hand, the lack of clarity in training processes and data raises concerns about encoded biases and interests in GPT-4. The report also lacks confidence and uncertainty estimations, crucial in high-risk areas like healthcare, and fails to address potential privacy and intellectual property issues. Furthermore, this study emphasizes the need for diverse, global involvement in developing and evaluating large language models (LLMs) to ensure broad societal benefits and mitigate risks. The paper presents recommendations such as improving data transparency, developing accountability frameworks, establishing confidence standards for LLM outputs in high-risk settings, and enhancing industry research review processes. It concludes that while GPT-4's report is a step towards open discussions on LLMs, more extensive interdisciplinary reviews are essential for addressing bias, harm, and risk concerns, especially in high-risk domains. The review aims to expand the understanding of LLMs in general and highlights the need for new reflection forms on how LLMs are reviewed, the data required for effective evaluation, and addressing critical issues like bias and risk.

The knowledge, confidence and attitudes of medical students in managing in-flight medical emergencies

In-flight medical emergencies (IMEs) are common during commercial airline flights. These events occur once every 100 to 1000 flights with pressurization corresponding to an altitude of 5000 to 8000 feet during the flight, low oxygen partial pressures and low humidity. This study was designed to evaluate the knowledge, confidence and attitudes of medical students in Saudi Arabia with regards to managing in-flight medical emergencies. A cross-sectional study targeting all medical students in Saudi Arabia was conducted using an online questionnaire. In total, we analyzed 378 medical students and interns; only 18% possessed an adequate perception of knowledge relating to IMEs; 36.8% felt assured in their IME response, 36.5% believed they could provide competent care, and only 34.5% considered their medical education was adequate for the treatment of IMEs. Our analyses showed that medical students in Saudi Arabia have inadequate confidence and knowledge in managing IMEs. Consequently, there is a significant gap in current medical school curricula in the Kingdom of Saudi Arabia that could be filled by implementing focused training on the management of IMEs.

Language Anxiety Among English Foreign Language Learners

The purpose of this study was to find out how much language anxiety EFL university students have, what causes it, and how they deal with it. This study aims to fill a gap in the literature regarding the causes of language anxiety, the causes, and how people cope with it, as most researchers have not yet combined those three factors into a single study. The current study used a mixed method,a questionnaire and a semi-structured interview were used. FLCAS was used as a questionnaire to collect quantitative data. At the same time, questionnaires and semi-structured interviews were used to select the qualitative method. This study included 40 male and female EFL university students from the Faculty of Business and Social Sciences at one of Jakarta’s private universities. Their ages range from 18 to 25 years. In this study, the questionnaire items revealed two levels of anxiety: 1) low anxiety (62%) and 2) moderate anxiety (38%). Three causes of language anxiety were identified using a combination of questionnaire items and semi-structured interviews: 1) Inadequate confidence in speaking English in class; 2) Fear of making mistakes when speaking English; and 3) Lack of vocabulary/grammar knowledge.
 Keywords: foreign language anxiety, speaking anxiety, FLCAS, level of anxiety, causes of anxiety

Influence of career commitment and employee competency on career management

The objective of the research on which this article is based was to comprehend the impact of career commitment and employee competency on the career management of information technology (IT) professionals in the Kathmandu Valley. The study employed an exploratory research design, drawing on social cognitive theory. Data were analysed using quantitative methods, specifically descriptive and inferential analysis, utilising a structured questionnaire. The study employed convenience sampling to collect data from 232 IT workers in Kathmandu Valley, utilising the KOBO Toolbox for data collection. Structural equation modelling (SEM) was employed for data analysis. The experience of stress and burnout, as well as feelings of inadequate confidence and insufficient training, are significant impediments to career management among IT professionals. The findings of the SEM analysis indicate that there exists a statistically significant relationship between career commitment and employee competency with respect to career management. The field of career management for IT professionals is currently in its nascent stage in Nepal. However, with increasing awareness among employers and individuals, its importance is steadily gaining momentum. Thus, it is imperative for HR managers to establish effective policies that facilitate the professional growth of employees.

Common Medical and Statistical Problems: The Dilemma of the Sample Size Calculation for Sensitivity and Specificity Estimation

Sample size calculation in biomedical practice is typically based on the problematic Wald method for a binomial proportion, with potentially dangerous consequences. This work highlights the need of incorporating the concept of conditional probability in sample size determination to avoid reduced sample sizes that lead to inadequate confidence intervals. Therefore, new definitions are proposed for coverage probability and expected length of confidence intervals for conditional probabilities, like sensitivity and specificity. The new definitions were used to assess seven confidence interval estimation methods. In order to determine the sample size, two procedures—an optimal one, based on the new definitions, and an approximation—were developed for each estimation method. Our findings confirm the similarity of the approximated sample sizes to the optimal ones. R code is provided to disseminate these methodological advances and translate them into biomedical practice.

Explicit and implicit monitoring in neurodegeneration and stroke

Monitoring is a complex multidimensional neurocognitive phenomenon. Patients with fronto-insular stroke (FIS), behavioural variant frontotemporal dementia (bvFTD) and Alzheimer’s disease (AD) show a lack of self-awareness, insight, and self-monitoring, which translate into anosognosia and daily behavioural impairments. Notably, they also present damage in key monitoring areas. While neuroscientific research on this domain has accrued in recent years, no previous study has compared monitoring performance across these brain diseases and none has applied a multiple lesion model approach combined with neuroimaging analysis. Here, we evaluated explicit and implicit monitoring in patients with focal stoke (FIS) and two types of dementia (bvFTD and AD) presenting damage in key monitoring areas. Participants performed a visual perception task and provided two types of report: confidence (explicit judgment of trust about their performance) and wagering (implicit reports which consisted in betting on their accuracy in the perceptual task). Then, damaged areas were analyzed via structural MRI to identify associations with potential behavioral deficits. In AD, inadequate confidence judgments were accompanied by poor wagering performance, demonstrating explicit and implicit monitoring impairments. By contrast, disorders of implicit monitoring in FIS and bvFTD patients occurred in the context of accurate confidence reports, suggesting a reduced ability to turn self-knowledge into appropriate wagering conducts. MRI analysis showed that ventromedial compromise was related to overconfidence, whereas fronto-temporo-insular damage was associated with excessive wagering. Therefore, joint assessment of explicit and implicit monitoring could favor a better differentiation of neurological profiles (frontal damage vs AD) and eventually contribute to delineating clinical interventions.

The Correlates of Nurses' Self-Efficacy for End-of-Life Care

Self-efficacy plays an important role in maintaining health-related behaviors in humans. Nursing staffs should understand the factors that influence self-efficacy in end-of-life (EOL) care in order to ensure their ability to provide appropriate palliative care to EOL-stage patients. To explore the important variables affecting the self-efficacy of nursing staffs in providing EOL care and the correlations between self-efficacy and these variables. This study adopted a descriptive, correlational design. The participants were convenience sampled from registered nurses employed at a teaching hospital in southern Taiwan. The data collection was cross-sectional and 214 registered nurses completed a structured questionnaire on knowledge, attitudes, and self-efficacy with regard to providing EOL care. The results indicated that that participants had (1) an average knowledge level of EOL care (13.99 ± 1.63), demonstrating that nursing staff need to improve their knowledge of EOL care, (2) an average level of attitude (46.74 ± 4.39), demonstrating a slightly positive attitude toward EOL care, and (3) an average level of self-efficacy (48.46 ± 10.37), demonstrating inadequate confidence in providing EOL care. A Pearson product-moment correlation analysis was conducted, showing significant and positive correlations between self-efficacy and the variables of EOL-care knowledge and attitude. Multiple regression analyses revealed that work unit, experience providing EOL care, knowledge regarding EOL care, and attitude toward providing EOL care together explained 42.54% of the variance in EOL care self-efficacy. Accurate knowledge about and positive attitude toward providing EOL care are important in fostering confidence in nurses to help patients and their family make appropriate medical decisions and to provide appropriate EOL care. Hospital administrations should provide onsite or offsite continuous education and, when appropriate, arrange interdisciplinary and cross-training programs to enhance the EOL-care-related experience and self-efficacy of nurses.

Addressing Diabetes in Global Communities through the Practical Implementation of Lifestyle Education: Lessons Learned from the Pacific Islands

It is well known that chronic diseases are strongly liked to poor lifestyle practices. These conditions are especially striking among low income, minority communities who bear a disproportionate burden of disease. Though practice guidelines for chronic disease prevention and management recommend that treatment begin with evidence-based lifestyle medicine, many physicians cite inadequate confidence and lack of knowledge and skill as the major barriers to counseling patients about lifestyle interventions. Furthermore, time constraints, clinical and administrative demands often make it challenging for primary care providers to deliver appropriate lifestyle related recommendations. Current changes in the healthcare climate and reimbursement structure, however, demand that we rethink current healthcare delivery models and prioritize preventive and lifestyle interventions so that sustainable positive health outcomes can be attained especially among vulnerable communities. Lifestyle medicine, defined as the evidence-based therapeutic approach to prevent, treat and reverse lifestyle-related chronic diseases. It offers promise in achieving this goal through community based offering and primary care integration utilizing multidisciplinary teams. Lifestyle education, among minority populations, however, requires thoughtful cultural considerations and adaptations. This article highlights strategies learned from international work among Pacific Islanders who suffer from a disproportionate burden of noncommunicable diseases; and offers recommendations on how diverse populations can be positively engaged to curb the rising diabetes epidemic both locally and internationally.

Phenomenon of moral distress through the aspect of interpretive interactionism.

Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses' values, the physician-nurse power hierarchy, and the influence of the culture. To analyze the main causes for moral distress with interpretive interactionism. A qualitative study was adopted. Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples. Approval from the Institutional Review Board of the Kaohsiung Medical University Hospital. Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician-nurse power hierarchy, and the Oriental culture affect nurses' goodness-based intention for patients, which deteriorates moral distress. The main cause for moral distress is the moral goodness of nurses. If nurses' goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients' right to know about their diseases, the choice of treatment, and patients' autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care. The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses' confidence and cultural sensitivity, so as to reduce the moral distress of nurses.

Noncompliance and its Contributing Factors among Patients with Tuberculosis

Tuberculosis remains a major public health problem worldwide. Noncompliance to tuberculosis treatment is the common, most important cause of failure of initial therapy. The aim of the study was to assess the noncompliance and its contributing factors among tuberculosis patients attending pulmonary outpatient department and isolation rooms of a selected hospital at Kochi. Descriptive research design was used for the study. Sampling was done using non probability convenient sampling method. Data was collected from 50 tuberculosis patients who had noncompliance using structured checklist and the association was assessed using chi-square test. The result showed that the major factors contributing to noncompliance were inadequate confidence level of patients about completion of treatment, getting irritable with the taste of the medication, discontinuing the treatment once the symptoms are resolved, and waiting for a long time to see the doctor. The factors related to noncompliance have shown association with certain demographic variables at p<0.05 such as age, job, marital status, and income.

Enhancing Thai Engineering Students’ Complaints and Apologies through Pragmatic Consciousness-Raising Approach (PCR)

Successful communication requires “Pragmatic Competence” or abilities to use appropriate language in transferring one’s needs while maintaining a positive relationship with the interactant (Thomas, 1995; Leech, 1983). This study was an attempt to investigate the pragmatic competence of Thai Engineering students when making complaints and apologies through twelve sessions of a pragmatic consciousness-raising approach (PCR). Perceptions toward the innovative teaching activities were also examined. Both qualitative and quantitative methods were used to collect data from forty-five engineering students (n=45) at a university in Thailand. Pre-test and posttest written discourse completion tests (WDCTs) were administered and a semi-structured interview was conducted. Three native speaker raters scored the performances through WDCTs using assessment criteria from Hudson (2001) and Duan (2008). For data analysis, paired-samples t-test was employed to compare the mean scores of students, while the researcher employed a Grounded Theory’s color coding technique (Strauss &amp; Corbin, 1998) to generate the findings on students’ perceptions about the innovative methods implemented. The results revealed significant development of students’ pragmalinguistic and sociopragmatic abilities in both complaints and apologies. Furthermore, participants perceived the PCR class to be beneficial in four areas: having more awareness of the impacts of social factors in language use, realizing the favor of indirect strategies, more understanding of nonverbal communication, and provision of motivating class atmosphere. However, some participants concerned about three aspects: inadequate confidence to use expressions learned in class in real communication, insufficient endeavor to develop grammar knowledge, and the test abilities of the roleplay test. The results confirm the teachability of pragmatic and the benefits of PCR in EFL contexts; whereas, students’ concern about learning through the approach might be helpful for further teaching practices.

What are the main barriers to healthy eating among families? A qualitative exploration of perceptions and experiences of Tehranian men

Despite women playing a pivotal role in shaping nutritional patterns in their families, it is the men whose ideas and preferences, after children, influence the selection and consumption of daily foods among Iranian families. This study focused on exploring the main barriers to healthy eating as experienced by male participants of the Tehran Lipid Glucose Study (TLGS). A grounded theory approach was used for analyzing participants' experiences and their perceptions regarding these barriers. Participants were 98 men, aged 25–65 years, selected and recruited from the TGLS cohort. Data collection was conducted through fourteen semi-structured focus group discussions, between 2008 and 2009. All interviews and focus group discussions were audio recorded and transcribed verbatim. Constant comparative analysis of the data was conducted manually according to the Strauss and Corbin analysis method. The most important barriers to healthy eating were: (i) Personal factors, which included two subthemes – lack of knowledge and personal taste, (ii) Communication and modeling included two subthemes – other individuals and media/advertisements; (iii) Modernization included two subthemes – nutrition transition and women's role; and (iv) Lack of access to healthy foods, which included four subthemes – Inadequate confidence, perceived risk, high cost and time limitations. Appropriate attention and prioritized policy-making to modify the socio-environmental barriers to healthy eating were explored in the current study, along with effective educational programs that could help to promote healthy eating among Iranian families.

Calorie Restriction in the Elderly People

Calorie Restriction in the Elderly People

Experimental Study on the Fundamental Characteristics of Recycled Concrete

At present, there are not any systematic researches on the fundamental performance of recycled concrete(RC). Thus it incites the inadequate confidence for the usage of RC. In this thesis, four different kinds of RC whose strength are C20、C25、C30、C35 respectively,are made using various mixing proportion. Then the influence rule of different recycled aggregate mixture quantities is drawn out, which consists the impacts on compressive strength, axial compressive strength, splitting strength, elastic modulus as well as the bending strength of RC. Meanwhile, the relation between the cubic compressive strength and the splitting strength, elastic modulus, axial compressive strength, bending strength is imitated, which provides study basis for the using of wasted concrete.

Physician Competencies for Prescribing Lifestyle Medicine

THE LEADING CAUSES OF DEATH FOR ADULTS IN THE United States are related to lifestyle—tobacco use, poor diet, physical inactivity, and excessive alcohol consumption. US residents with these risk factors have plenty of room for improvement—including those who are asymptomatic and those living with chronic disease. Health behaviors could greatly influence future health and well-being, especially among patients with chronic disease. However, only 11% of patients with diabetes follow accepted dietary recommendations for saturated fat intake, and 18% of patients with heart disease continue to smoke, barely better than the general population’s smoking rate. The enormous potential effects of health behavior change on mortality, morbidity, and health care costs provide ample motivation for the concept of lifestyle medicine, ie, evidencebased practice of assisting individuals and families to adopt and sustain behaviors that can improve health and quality of life. Examples of target patient behaviors include, but are not limited to, eliminating tobacco use, improving diet, increasing physical activity, and moderating alcohol consumption. Effectively motivating patients to change behavior can be a frustrating and difficult challenge. Merely encouraging patients at the end of an office visit to attempt such changes yields limited results. Success requires the development of specific healthy lifestyle action plans in partnership with patients and intentional follow-up in subsequent visits. For example, one study showed that when physicians provided structured counseling to sedentary adult patients, followed by a health educator booster call, the total length of the weekly walking exercises increased by 5 times that of patients in the control group who received standard care. Even though the most widely accepted, well-established chronic disease practice guidelines uniformly call for lifestyle change as the first line of therapy, physicians often do not follow these recommendations. For instance, obese patients are advised to lose weight only 36% of the time during regular examinations, a proportion that improves only slightly to 52% if a patient already has obesity-related comorbidities. Furthermore, only 28% of smokers reported that health care professionals had offered them assistance to quit smoking in the past year. Findings such as these reveal 2 important facts: Physicians cannot ascribe the entire responsibility for inadequate lifestyle changes to their patients, and clinicians must accept some responsibility for deficiencies in the quality of health care. Acknowledging the crucial role of environmental and community factors in creating and sustaining inappropriate health behaviors does not eliminate the duty of physicians to assist patients in making health behavior changes. Physicians also have cited inadequate confidence and lack of knowledge and skill as major barriers to counseling patients about lifestyle interventions. Among the 620 respondents in a survey of family physicians, only 49% felt competent prescribing weight loss programs for obese patients. Even though changing unhealthy behaviors is foundational to medical care, disease prevention, and health promotion, a physician’s trusted relationship with the patient must be augmented whenever possible by family support, an interdisciplinary health care team, and community organizations and agencies (BOX). To begin to address the identified gap in physicians’ armamentaria, a group of representatives from primary care medical specialties and other interested medical professional societies met and developed suggested lifestyle medicine competencies for primary care physicians. Further work continues in developing curricula, training materials, evaluation, and system-based practice tools and performance measures to help physicians achieve these goals. Although these suggested competencies were developed largely to guide continuing medical education activities for primary care and preventive care physicians, many of these individual competencies have relevance for all spe-

Commentary: The Importance of Musculoskeletal Medicine and Anatomy in Medical Education

Medical schools in the United States have continued to demonstrate deficiencies in musculoskeletal education. In response to the findings of numerous studies and to the objectives of the U.S. Bone and Joint Decade (an international collaborative movement sanctioned by the United Nations and the World Health Organization for the purpose of promoting awareness of musculoskeletal disease), several institutions, including Harvard Medical School, have reassessed the preclinical musculoskeletal curriculum at their respective medical schools. A cross-sectional survey at Harvard in 2004 found that students lacked clinical confidence in dealing with the musculoskeletal system. In addition, only one quarter of the graduating class of medical students passed a nationally validated exam in basic musculoskeletal competency. In 2005, 33 total hours of musculoskeletal medicine were added to the musculoskeletal blocks of the preclinical anatomy, pathophysiology, and physical examination courses. Alongside this movement toward more musculoskeletal education, there has been continued debate over the relevance and cost-effectiveness of cadaveric and surface anatomy labs. With the advent of advanced imaging technology, some argue that dissection anatomy is outdated and labor-intensive, whereas three-dimensional images are more accessible and time-effective for today's students. However, knowledge of anatomy is a critical foundation to learning musculoskeletal medicine. Thus, making room for more musculoskeletal curriculum time by cutting out cadaveric anatomy labs may ultimately be counterproductive.

The Panacea of Psychological Nourishment to Caregivers Taking Care of HIV/AIDS Clients: The Case of the Kanye Community Home-Based Care (CHBC) Programme in Botswana

The study is qualitative in design and explorative in nature, involving 82 registered primary caregivers and five CHBC nurses. The following were found to be challenges affecting psychological provision to caregivers: inadequate counselling, inadequate motivation and incentives, caregivers’ inadequate confidence with traditional and spiritual healers, inadequate spiritual support from faith-based organizations, and lack of support groups and debriefings. The study recommends: increased counselling, increased motivation and incentives, creating a link between traditional/spiritual healers with the modern medical system, expediting the formation of support groups, and having the programme institute and hold debriefings to increase the psychological well-being of caregivers, thereby increasing care productivity.

Knowledge and Opinions Regarding Oral Cancer Among Maryland Dental Students

Most oral cancers are diagnosed at late stages. Health care providers, particularly dentists, play a critical role in early detection of oral cancers and should be knowledgeable and skillful in oral cancer diagnosis. In this study, we assessed knowledge and opinions regarding oral cancer among dental students in Maryland. A cross-sectional survey was conducted among Maryland dental students in 2005. The response rate was 59.6%. Knowledge of oral cancer was low among freshmen and significantly different from other classes. There was no statistically significant difference between 2nd-, 3rd- and 4th-year students in terms of level of oral cancer knowledge. The results revealed inadequate confidence among junior and senior students with regard to oral cancer examination and lymph node palpation. Findings from this study identify areas that need reinforcement in Maryland dental school's curriculum regarding oral cancer education. This survey approach could be a model for other dental schools in the United States or overseas.

Current Practice of Microsurgery by Members of the American Society for Surgery of the Hand

First, to determine the percentage of members of the American Society for Surgery of the Hand (ASSH) that use microsurgical techniques as part of their surgery practice, and second, to identify factors limiting their use of these techniques. A 34-item, anonymous, Web-based survey was sent to all active ASSH members. Twelve items concerned demographics and 22 items addressed prior microsurgical training, current use of these techniques, factors currently limiting their use of these techniques, and potential methods to address these limiting factors. Responses were received from 561 of 1,238 of the ASSH members contacted (45% response rate). Most had residency training in orthopedics (N=460, 82%) or plastic surgery (N=79, 14%), followed by a hand fellowship in an orthopedic (N=363, 62%) or combined program (N=170, 30%). More than 54% (N=304) practiced privately, 33% (N=184) practiced in tertiary institutions, and the remainder practiced at regional centers. Of those responding, 505 (90%) stated that hand surgery constituted more than 50% of their practice, whereas for 527 (94%) respondents microsurgery comprised less than 25%. Most members (N=398, 71%) accepted emergency patients, of which 223 (56%) at a referral center. Three hundred sixteen respondents (56%) performed replantations, of whom 196 (62%) performed fewer than 5 per year. Four hundred fifteen respondents (74%) observed a decrease in replantation attempts over the past decade. This was attributed to refinement of indications (N=17, 83%), fewer patients with amputations (N=116, 28%), and declining reimbursement (N=344, 4%). Reasons for not personally performing replantations included busy elective schedules (N=125, 51%), inadequate confidence in performing replantations (N=96, 39%), and disappointment in results (N=56, 23%). Thirty percent (N=74) stated they would reconsider performing replantations if reimbursement was greater. Practice rates of examined microsurgical procedures ranged from 22% to 57%, although most had received microsurgical training. Despite rating their fellowship as excellent (N=393, 70%) or good (N=135, 24%), only 315 (56%) considered their present microsurgical skills to be above average. Many respondents believed that they would benefit from continuous training through continuing education courses. Educational, economic, and practical factors discourage the clinical application of microsurgical technique by hand surgeons. This unfavorable environment should be addressed by policy-making organizations and continuous surgical training. Other/Survey.