Practice Location Research Articles

Determinants of rural practice among a cohort of dental professionals in Australia

BackgroundMost research on tracking practice locations of health students has focused on medical students, particularly the factors influencing their choice to work in rural and remote areas. However, there is limited research on how rural origin and training in regional or rural settings affect the employment destinations of dental and oral health graduates. This paper explores the practice locations of dentistry and oral health therapy (OHT) graduates from rural backgrounds compared to those from metropolitan areas in Australia.Materials and methodsThe target population was dental and OHT graduates from La Trobe University’s Rural Health School (Australia) who completed their studies between 2009 and 2023. The graduates’ primary place of practice was sourced from the Australian Health Practitioners Regulation Agency (AHPRA) data. The 2019 Modified Monash Model (MMM) was used to categorise the students’ original place of residence by rurality and practice locations. Multivariable analyses were conducted to explore the association between home and practice locations while controlling for the effect of socio-demographic characteristics collected from students at enrolment.ResultsData were available for 819 graduates matched to the AHPRA register. Of these, 541 (66.1%) were dentists, and 278 (33.9%) were OHTs. The majority were female (56.7% dentists and 81.7% OHTs), 11.3% (dentists) and 21.6% (OHTs) of the graduates originated from rural and remote areas, 16.6% (dentists) and 18% (OHTs) from regional areas, and 72.1% (dentists) and 60.4% (OHTs) from metropolitan areas. Multinomial logistic regression analyses for dentists and OHTs identified that , having a regional background, or having a rural or remote background were the most significant predictors for regional, rural/remote practice over metropolitan areas.ConclusionRegional background is the strongest predictor for graduate dentists and OHTs practicing in Australia’s regional or rural and remote locations. Similarly, students from rural and remote locations were highly likely to practice in rural/ remote locations. Increasing the recruitment of students with rural backgrounds may positively impact graduates’ decisions to practice in rural areas.

The landscape of family medicine in India - A cross-sectional survey study.

Family medicine was recognized as a distinct specialty in India in the early 1980s, but it is at an early stage of implementation. There are few training programs, and little is known about family physicians' training, perceptions, and current practices. This paper describes the findings from the first national survey of family medicine in India. We administered the Landscape of Family Medicine in India survey to members of the Academy of Family Physicians of India and used a respondent-driven sampling approach to increase our reach between November 2020 and March 2021. Descriptive statistics were used to describe the data. Chi-square tests of independence were used to explore differences between family physicians who completed full-time in-person training versus those who completed part-time, blended or distance training and to look for associations between services provided and the rurality of practice location. We had 272 respondents. 61.0% of respondents completed a full-time in-person residency program, while 39.0% completed a part-time distance or blended-type program. Most respondents reported that postgraduate training in family medicine increased their confidence in practice, their scope of primary care practice, and the ability to work as a team with non-physician primary care providers, irrespective of the type of training. Family physicians appear to engage in comprehensive practice, with 88.9% practicing outpatient family medicine. Our sample found that the proportion of family physicians working in rural areas is higher than the proportion of all physicians in India, with 39.3% of our sample working rurally. Those who work rurally were more likely to offer minor office-based surgeries, casting and splints, and conduct vaginal deliveries. 48.3% of respondents work principally in the primary care sector. Postgraduate family medicine training should be scaled up to support improving gaps seen in primary care and primary health care.

Considerations for Perioperative Management Guidance Regarding GLP-1 Receptor Agonists: Evaluation of Current Practices and Future Directions.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have become increasingly prevalent and have the potential to delay gastric emptying. The American Society of Anesthesiologists (ASA) released guidance regarding the perioperative management of patients receiving GLP-1 RAs, but it is unclear the extent to which hospitals in the U.S. Military Health System have implemented policies consistent with this guidance. A questionnaire was sent to active duty anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) working in the U.S. Military Health System. The questions assessed the presence of institutional GLP-1 RA perioperative policies, adherence to the policy (if applicable), the basis and components of current and recommended future institutional policies, institutional tracking of policy implementation and outcomes, and knowledge, skills, barriers, and continuing medical education goals related to the perioperative management of patients receiving GLP-1 RAs. The response rate was 32% (N = 265); a little over half of the respondents were anesthesiologists (53%); and respondents' primary practices included over 50 institutions. More than half (54%) indicated that their primary practice location had a GLP-1 RA perioperative policy; 65% of whom indicated that they always followed the policy. In review of practice locations with >1 respondents, there was a lack of perfect agreement across most locations. The most commonly reported basis for the policy was ASA guidance (87%), followed by department leadership (37%). Barriers to any system-wide GLP-1 perioperative management policy included a lack of gastric ultrasound practice and comfort, as well as reported skills and knowledge, pressure not to cancel cases, scheduling problems, and productivity requirements. Formal policies were reported by most respondents, but inconsistencies within practice locations suggest that local policy implementation could be improved. Commonly reported barriers to future system-wide policy implementation provide data-driven information for system-wide efforts to improve policy success.

Continental Preferences in Reconstruction of Pharyngolaryngectomy Defects: A Multi-National Survey.

Reconstruction of total pharyngolaryngectomy defects may restore pharyngeal function and enable tracheoesophageal speech after resection of locoregionally advanced malignancy. Little remains known about variations in the practices and preferences of surgeons across differing global regions. A survey was sent to reconstructive head and neck surgeons across three continents with responses analyzed to evaluate trends. Of 155 respondents, 79.4% (n = 123) completed the survey including surgeons from North America (USA/Canada), the Indian Subcontinent (India/Bangladesh) and Australia/New Zealand. Among surgeons trained in pedicle flap reconstruction, only 47.5% performed these procedures after completion of training. Pedicle flaps were performed most frequently by surgeons from the Indian subcontinent. The anterolateral thigh flap was most popular among surgeons for free flap reconstruction, 58.5% (n = 72). This study demonstrates significant region-based variation in preferred reconstructive modality, suggesting location of practice and institutional experience influence the reconstructive algorithms of head and neck surgeons.

General practitioners’ clinical decision-making in patients that could have cancer: a vignette study comparing the Baltic states with four Nordic countries

Objective Relative one-year cancer survival rates in the Baltic states are lower than the European mean; in the Nordic countries they are higher than the mean. This study investigated the likelihood of General Practitioners (GPs) investigating or referring patients with a low but significant risk of cancer in these two regions, and how this was affected by GP demographics. Design A survey of GPs using clinical vignettes. Setting General Practice in Denmark, Estonia, Finland, Latvia, Lithuania, Norway, and Sweden. Subjects General Practitioners. Outcome measures A regional comparison of GPs’ stated immediate diagnostic actions (whether or not they would perform a key diagnostic test and/or refer to a specialist) for patients with a low but significant risk of cancer (between 1.2 and 3.6%). Results Of the 427 GPs that completed the questionnaire, those in the Baltic states, and GPs that were more experienced, were more likely to arrange a key diagnostic test and/or refer their patient to a specialist than those in Nordic Countries or who were less experienced (p < 0.001 for both measures). Neither GP sex nor practice location within a country showed a significant association with these measures. Conclusion While relative one-year cancer survival rates are lower in the Baltic states than in four Nordic countries, we found no evidence that this is due to their GPs’ reluctance to take immediate diagnostic action, as GPs in the Baltic states were more likely to investigate and/or refer at the first consultation. Research on patient and secondary care factors is needed to explain the survival differences.

Is intraoperative neuromonitoring the standard of care for pedicle screw placement surgery? A survey of neurosurgeons' practices.

Spine surgery is highly litigious; misplaced screws and intraoperative neuromonitoring frequently feature in lawsuits. Intraoperative neuromonitoring aims to prevent injury but its standards are debated, and literature suggests its benefits are mixed. We surveyed its use among neurosurgeons from the Congress of Neurological Surgeons with Pearson's chi-square test applied to analyse data within R. Among 188 respondents, 39.9% worked in private practice or academic institutions. Usage rates were 50.5% always, 27.7% never and 21.8% sometimes. Opinions on intraoperative neuromonitoring necessity varied, with 55% disagreeing and 32% agreeing. No differences were noted by practice type or location. Among intraoperative neuromonitoring users, 47% found it sensitive and specific, while 45% used it for medico-legal reasons. Of non-users, 26% preferred other technologies. Overall, the usage of intraoperative neuromonitoring is nuanced and opinions leaned more heavily toward its implementation not being a current standard of care in pedicle screw placement surgery.

Student and Physician Views of How the Dobbs Decision Affects Training and Practice Location Preferences: Cross-Sectional Questionnaire Study.

By allowing for abortion bans and restrictions to take effect in the majority of US states, the 2022 Dobbs v Jackson Women's Health Organization decision portends to have lasting impacts on patient care and the physician workforce. Notably, it is already beginning to impact practice location preferences of US health care workers, evidenced by declining application rates to residency programs in abortion-restrictive states since 2022. Yet, there remains a gap in the literature regarding why this trend exists. This study aims to describe what factors are driving the practice location preferences of medical students and physicians after the Dobbs decision. This study analyzes qualitative data from a web-based, cross-sectional study. In August 2022, a nonprobabilistic sample of physicians and medical students were surveyed on social media about the impact of overturning Roe v Wade on practice location preferences, which included the free-text question "Please share your thoughts about the overturning of Roe v Wade and how it will affect your decision about your (residency/job or fellowship) programs." A total of 3 independent team members completed an inductive thematic analysis of 524 free responses, resolving differences by discussion. Approximately 1 in 4 survey respondents also completed the free-response item (524/2063, 25.4%); a total of 219 were medical students, 129 were residents and fellows, and 176 were practicing physicians. Of them, approximately half (261/524, 50.5%) resided in states where abortion bans were in place or anticipated. Those who answered the free-response item were relatively more likely to hail from states with restrictive abortion bans (P<.001) compared to those who did not, with other demographic characteristics being largely similar between the groups. Inductive thematic analysis yielded 2 broad thematic categories: patient-related and workforce-related factors influencing practice decision preferences. The 3 most common themes overall were respondent concerns regarding their patient's access to care (249/524, 47.5%), their desire not to practice or train in a state with abortion restrictions regardless of current residence (249/524, 47.5%), and their personal belief that abortion bans are human rights and/or body autonomy violation (197/524, 37.6%). Some respondents stated that the Dobbs decision would not impact their choice of practice location (41/524, 7.8%), and some supported it (35/594, 6.7%). This study shows that abortion restrictions are having an impact on the practice location preferences of the physician workforce due to both patient care and personal factors. It is important that state policy makers and others who are considering abortion restrictions also consider how to address these concerns of physicians and medical students, to avoid worsening geographic maldistribution of physicians and worsening access to care from physicians for their citizens.

THE RATIO OF UROLOGISTS FOR EACH REGENCY AND CITY IN EAST JAVA INDONESIA AND THE INDICATORS AFFECTING THEIR DISTRIBUTION

Objective: Research on the distribution of urology in Indonesia, especially in East Java, has not been widely discussed. There are still several areas in East Java that do not have a urologist at all. We try to find out the factors underlying this distribution through several indicators. Material &amp; Methods: Data from all hospitals in East Java were compiled with data of urologists in East Java obtained from the Indonesian Urological Association, supplemented by information from social media and the telephone of the hospital operator. The number of urologists and hospitals with urology services is then correlated with the human development index, the education index, purchasing power index, health index, and regional minimum wage. Results: The ratio of urologists in each district and city in East Java is not evenly distributed, and likewise with the hospitals that provide urology services in each district and city in East Java. The ratio of urologists and the number of hospitals providing urology services are significantly related to the human development index, the education index, the purchasing power index, the health index, and the regional minimum wage. Conclusion: The location of a urologist's practice is related to the development of an area, which in this study is assessed through indicators of human development, education, health, and economy. Keywords: Urologist Ratio, East Java, Urology.

Factors Influencing Practice Decisions Among Plastic Surgery Residents and Early-Career Plastic Surgeons in Canada.

Introduction: Trends within the Canadian plastic surgery workforce demonstrated that most work in academic or medium-large community practice. Recent studies observed more plastic surgeons are incorporating aesthetics into their practice. This study aims to identify factors influencing how plastic surgery residents and early-career plastic surgeons in Canada choose their eventual practice with respect to practice type and practice location. Methods: A REDCap survey was distributed to plastic surgery residents and early-career plastic surgeons across Canada between February and May 2024. Demographics, training information, career information, and Likert-scale questions for factors involved in decision-making were surveyed. Data analysis included descriptive statistics and Fisher exact tests. Results: There were 45 residents and 30 early-career plastic surgeon respondents. Mixed practices that included aesthetics were the most popular practice types among residents (73%) and early-career surgeons (77%). Half (53%) of early-career surgeons were working in urban settings with more than 1 million people, and 44% of residents desired these locations. Hometown factors heavily influenced practice type and location (P < .0001), more than training experiences. Positive interactions (94%), operating time (90%), partner opinion (87%), and hospital resources (86%) were ranked as the most important factors involved in practice decisions. Conclusion: Mixed practices that include aesthetics were the most popular among our up-and-coming Canadian workforce, especially in urban settings. These changing practice trends may impact our ability as a specialty to adequately meet the needs of the Canadian population. Recruitment efforts should focus on promoting a supportive workplace and local environment, with adequate operating time and resources.

Determinants of First Practice Location among Canadian Geriatric Medicine Trainees and Recent Graduates: Findings of a Cross-sectional Survey in 2023.

There is a projected and growing gap of geriatricians in Canada. Geriatricians play a crucial role in addressing the health needs of older adults. We aimed to understand the factors that influence the choice of first-practice location for new geriatricians in the context of an aging Canadian population. We distributed an online survey to geriatric medicine subspecialty residents and recently licensed geriatricians in Canada. The survey was developed through expert opinions, career planning sessions, and a literature review. There were nine survey sections: general characteristics, location determinants, practice determinants, colleague determinants, support and space, non-clinical opportunities, income models, lifestyle factors, and recruitment determinants. The data were analyzed descriptively. A total of 61 respondents (51 English, 10 French) completed the survey. The respondents were new practicing geriatricians (37) and geriatric medicine residents (24). Most planned to practice in Ontario (26.2%) or Quebec (27.9%), and 75.4% were women. Flexibility in work-life balance (95.1%), collegiality (93.4%) and reasonable call schedules (93.4%) were the most important factors influencing first practice location. Income did not rank among the highest priorities for choosing the first practice location relative to other factors but was mentioned in open-ended responses to recruitment questions. This is the first survey identifying the determinants of first practice location in geriatric medicine in Canada. Work-life balance and collegial support are a priority for new geriatricians and may be the strongest incentives a program can provide. For recruitment, income incentives may be beneficial to building new specialized geriatric services. Future research will examine determinants of first practice location among Care of the Elderly clinicians.

Empowering physician leaders: UPMC’s breakthrough leadership development programme

In the ever-changing landscape of healthcare management, the role of physician leaders has become increasingly important. Physicians with strong leadership and management skills are well positioned to bring medical expertise to the business side of healthcare, benefiting their organisations immensely. Effective physician leaders also foster a healthier team environment, making a positive impact on their care team and patients. Traditional medical education, while strong in clinical training, typically falls short in adequately preparing physicians for leadership roles. This prompted the University of Pittsburgh Medical Center (UPMC) to launch an internal initiative to support physician leadership development. This case study looks at the journey from concept to successful implementation of UPMC’s inaugural leadership development programme for physicians. It also addresses the challenges of deploying the programme during a global pandemic and the lessons learned from the experience. Through internal surveys, UPMC recognised that physicians wanted professional growth and development opportunities. In 2017, UPMC formed an internal board of physician leaders to identify the specific learning needs of that population. In 2018, UPMC hired individuals dedicated to the creation of a leadership programme for physicians, now branded Physician Leadership Essentials (PLE). Before the programme’s launch, physicians were left to seek development outside the organisation. Following a pilot in 2019, the programme was deployed on a larger scale, starting in January 2020. As of 29 February 2024, 482 participants from various speciality and practice locations participated in 26 rolling cohorts of PLE. Twenty cohorts have completed the programme, resulting in 314 alumni. Today, there are six ongoing cohorts with 139 active participants. The programme exhibits 99.5 per cent favourability and a 92 per cent retention rate. Participants have completed 247 leadership challenge projects. This programme has fostered a culture of growth and development for physicians across UPMC and enhanced cross-functional and cross-departmental collaboration. It has also unlocked some of the untapped leadership talent of physician leaders, increasing not only their effectiveness but also their sense of professional fulfilment and engagement.

Challenges in oral health practice in Somalia: a call for regulatory strengthening and inclusion into primary healthcare services

BackgroundOral diseases remain a significant public health problem worldwide despite being largely preventable. Oral disorders such as dental caries, periodontal diseases, and oral cancers are highly prevalent chronic conditions that negatively impact quality of life. The oral health practice in Somalia has been evolving over the years, we therefore explored the challenges of oral health practice in a security-constrained poorly regulated environment to guide policy development.MethodsWe conducted a descriptive cross-sectional study among 15 oral health practitioners in Somalia. Using in-depth interviews, we gathered data on challenges working in private dental clinics and governmental institutions. Additionally, we gathered data on gender, age, marital status, profession, country of graduation, current location of practice, and years of clinical experience. Because the participants worked in different cities, we conducted interviews over the phone and recorded them. The data were analyzed via thematic analysis.ResultsIn this study, 9 of the participants were men and the median age was 29 years. Most of the participants (10) were dentists and remaining were dental specialists. The findings on challenges fall under four broad thematic areas: (1) Patient-related challenges; low patient literacy, preference for dental quacks, delay in seeking oral care, and dental phobia. (2) Institutional-related challenges: limited access to basic oral health services, oral health not an integral part of primary health care, and unregulated private dental clinics resulting in unqualified quacks practising as private caregivers. (3) Societal-related challenges, the absence of community-oriented preventive oral health services and low prioritization of oral health. (4) Personal-related challenges: female dentists in this study faced challenges related to the preference of male dentists and the shortage of oral health specialists in the country.ConclusionThis study reveals the need for the establishment and strengthening of regulation of oral services and its inclusion into the basic primary service package provided to the populace. It also calls for community enlightenment and more investment in dental health care in Somalia.Clinical trial numberNot applicable.

A survey of Canadian neurologists’ perspectives and preferences for laboratory reporting of CSF oligoclonal banding

IntroductionCerebrospinal fluid (CSF) oligoclonal banding (OCB) analysis aids in the diagnosis of multiple sclerosis (MS). Despite its clinical importance, there is profound variation in processes, reporting, and interpretation of CSF OCB and associated tests/indices across Canadian laboratories. This is likely due to the lack of clear, evidence-based recommendations on CSF OCB analysis processes and reporting. Here, we assessed the CSF OCB reporting needs and preferences of Canadian neurologists as a first step in clinical stakeholder engagement to aid in the development of CSF OCB reporting recommendations. MethodsA 16-question survey was sent to neurologists across Canada in January 2022, and it closed in March 2022. The survey included questions regarding location and length of clinical practice; preferred maximum time limit for paired CSF and serum samples; reporting preferences for CSF-specific OCB, banding patterns, and associated tests/indices; as well as the clinical utility of CSF OCB and associated tests/indices. ResultsTwenty-two neurologists from nine provinces participated, with a median practice length of 13 years. Most (64 %) preferred a 24-hour limit for paired serum and CSF sample collection. The majority (73 %) favored a cutoff of ≥ 2 CSF-specific bands for positivity, aligning with the 2017 McDonald criteria. Opinions varied on reporting the number of bands and listing specific conditions in the interpretive comments. Some highlighted the need for further research on band count interpretation and its clinical implications. All respondents found CSF OCB results useful, with 64 % valuing it more than other CSF tests for MS evaluation. ConclusionsOur survey reveals diverse preferences among Canadian neurologists for CSF OCB reporting. Stakeholder engagement and further research are crucial for standardized, improved MS diagnostic practices.

Practice Patterns of Graduates of a Rural Emergency Medicine Training Program

Introduction: Rural communities continue to face a shortage of emergency physicians despite the growing number of emergency medicine (EM) residencies. In rural areas, emergency physicians tend to be older, male, and White, and are less likely to have completed EM residency training or have board certification. There is also currently a higher rate of rural physicians leaving clinical practice than in urban emergency departments (ED). In this cross-sectional study we sought to identify the work environments of graduates of a rural EM residency program, and the strengths and weaknesses of such a program. Methods: We conducted a survey among 29 graduates of a community-based EM program to evaluate the effectiveness of a residency program in training physicians who will work in rural areas. The survey assessed the graduates’ perceptions of their level of preparedness, further training, and practice location after completing the program. Results are reported using descriptive statistics. Results: Twenty respondents completed the survey (69%). Most of them identified as male (60%), White (70%), and non-Hispanic or -Latino (80%). Seventy-five percent of the graduates work in counties with fewer than 1,000,000 inhabitants, and 70% work in community hospitals and EDs caring for fewer than 100,000 patients/year. Four (20%) declared to work in critical access hospitals. Overall, respondents felt confident in their residency training. Conclusion: A community-based EM training program may be an effective strategy for producing emergency physicians who go on to work in rural and smaller communities.

Antibiotics Knowledge and Prescription Patterns Among Dental Practitioners in Croatia, Bosnia and Herzegovina, and Serbia: A Comparative E-Survey with a Focus on Medically Healthy and Compromised Patients.

The non-specific prescription of antibiotics, especially in dentistry, contributes to the global problem of antimicrobial resistance and highlights the need for education on the proper use and serious consequences of overprescribing these drugs. The main objective of this study is to assess and evaluate antibiotic knowledge and prescribing patterns in dental practice in Croatia, Bosnia and Herzegovina, and Serbia, focusing on understanding the rationale for prescribing, adherence to evidence-based guidelines, and dentists' awareness of antibiotic resistance. A total of 795 dentists participated in this electronic cross-sectional survey (Croatia N = 336, Bosnia and Herzegovina N = 176, and Serbia N = 283). The study utilized a self-structured questionnaire to collect data on various aspects of antibiotic use, including knowledge, prescribing practices, awareness of guidelines, and demographic and professional information about dentists. Data analysis included the Mann-Whitney test, the Kruskal-Wallis test with post hoc analysis, and chi-square tests, with statistical significance set at p < 0.05. The overall score for the participants' knowledge of antibiotics was 6.40 ± 1.40 out of a maximum of eight points, which indicates a generally good level of knowledge among dentists. Factors such as gender, specialty, and practice location significantly influenced the level of knowledge (p < 0.05). However, actual prescribing practice was a cause for concern. Only 66.1% of Croatian dentists felt they had received adequate training during their studies, and even fewer in Serbia (48.4%) and Bosnia (46.6%). It is noteworthy that 9.7% of dentists in Bosnia and Herzegovina prescribe antibiotics at the request of patients, while 22.3% of Croatian and 25.4% of Serbian dentists do so. Many dentists prescribe no or only one antibiotic per week. In addition, 50.9% of Croatian dentists reported adverse effects related to the use of antibiotics, while only 31.3% of Bosnian and 33.6% of Serbian dentists reported similar experiences. While the study results indicate that dentists in the region generally possess good knowledge of antibiotic use, there are significant discrepancies between this knowledge and actual prescribing practices. This highlights the need for enhanced educational programs and awareness initiatives focused on proper antibiotic guidelines to improve prescribing behaviors.

Medical school service regions in Canada: exploring graduate retention rates across the medical education training continuum and into professional practice

ABSTRACT Purpose To create medical school service regions and examine national in-region graduate retention patterns across the medical education continuum and into professional practice as one approach to advancing social accountability in medical education. Methods Medical school service regions were created in Canada using publicly available data and mapped using Geographic Information System (GIS) software. Population size and density for each service region were calculated using census data. Retrospective data of medical graduates who completed their medical degrees between 2001–2015 (n = 19,971) were obtained from a centralized data repository and used to analyze in-region retention rates by medical specialty across the training continuum and five years into professional practice. Results Spatial inequities were observed across medical school service regions. Graduate retention patterns also varied across service region groups and medical specialties. Quebec (86.5%) and Ontario (80.4%) had above-average retention rates across the medical education continuum. Family medicine had the highest retention rates from undergraduate to postgraduate training (81.9%), while psychiatry had the highest retention rate across the training continuum and into professional practice (71.2%). The Alberta and British Columbia service region group demonstrated high retention rates across the training continuum and into professional practice and medical specialties, except for retention from undergraduate to postgraduate medical education. Conclusion This study highlights the importance of considering both medical specialty and practice location of graduates when planning and retaining the physician workforce. The observed retention patterns among graduates are a critical aspect of addressing societal needs and represent an intermediate step towards achieving health equity. Furthermore, graduate retention patterns serve as an outcome measure for schools to demonstrate their commitment to social accountability. Tracking and monitoring graduate outcomes may lead schools to actively collaborate with government agencies responsible for healthcare policy, which may ultimately improve physician workforce planning and promote more equitable healthcare access.

Where Are They Now? Attrition Rates of Emergency Medicine Residency Graduates by Gender

Prior studies examined the retention of women emergency physicians through residency training, but their career paths on completing residency are less well understood. Our primary objective was to identify a difference in attrition rates between binary genders of practicing clinical emergency physicians within 10 to 30 years after residency graduation. Our secondary aims investigated gender differences in geographic practice location, academic, and community practice. We hypothesized that women emergency physicians have higher rates of attrition from clinical practice than men. In this cohort study, we tracked employment over 10 to 30 years of graduates from allopathic emergency medicine residency programs established before 2005 and those who graduated before 2010. We obtained graduate lists from 21 residency programs representing geographically diverse training programs in the United States. We utilized public databases to investigate current licensure, board certification, practice location, and occupation for graduates more than 10 years after residency graduation. Physicians who do not practice clinically in emergency medicine or an emergency medicine subspecialty were placed in the "attrition" category. "Not available" was defined as those individuals who did not have adequate information available online. We analyzed differences in attrition of women and men emergency physicians in clinical practice in 2020. We also noted whether they worked in an academic or community setting and assessed their geographic clinical practice region. We identified a total of 4,170 graduates. Of those, 445 (10.6%) were excluded because of insufficient information. Of the 3,725 emergency medicine residency graduates, 71% were men. The attrition rate from clinical emergency medicine for men was 5.3% (95% confidence interval, 4.4% to 6.1%) and the attrition rate for women was 5.8% (95% confidence interval, 4.4% to 7.2%). The difference between the 2 proportions was -0.005 (95% confidence interval, -0.02 to 0.01). There were no gender differences in geographic location or practice type. We did not observe differences in attrition rates by gender in our sample from 21 programs over a 30-year period. The findings from this cohort are disparate from reports of recent emergency medicine graduates and identifying reasons for attrition of emergency physicians will be important to understanding the workforce needs of the future.

National Study Examining Excellence and Value in Physical Therapist Residency Education: Part 1-Design, Methods, and Results.

A challenge in health professions is training practitioners to navigate health care complexities, promote health, optimize outcomes, and advance their field. Physical therapist residency education offers a pathway to meet these needs in ways that "entry-level" (professional) education may not. Identifying key aspects of excellence in residency education and understanding its value in developing adaptive expertise will help devise strategies to enhance program, resident, and patient outcomes. The objective of this study was to examine current physical therapist residency education practices to identify and describe examples of excellence and value. A multi-site, multi-specialty qualitative case series was conducted, examining exemplary physical therapist residency programs and their contextual environments using a social constructivist theoretical lens. Six residency programs operating 20 individual residencies that were considered exemplar were selected for the study to participate in site visits. Qualitative case studies were generated from individual interviews, focus groups, review of artifacts, and field observations. The residencies were diverse in specialty area of practice, setting, and geographic location. A conceptual framework was generated grounded in the domains of excellence and value. These domains were connected by 3 signature indicators: (1) atmosphere of practice-based learning, (2) embodiment of professional formation, and (3) elevated practice. These signature indicators represent the aggregate effects of the interchange between the excellence and value domains which sustain residency education. This study builds upon the work of the Physical Therapist Education for the 21st Century (PTE-21) study and identifies key elements of excellence in residency education, the value of such education, and related outcomes. Findings from this study substantiate the need for a postprofessional phase of physical therapist education founded in practice-based learning encapsulated in residency education. Results from this study could have compelling and powerful implications on the dialogue and strategic direction in physical therapist residency education.

Culturally-relevant physical activity for public health promotion: global evidence synthesis

Abstract Background The WHO has noted the importance of cultural insights for health. Culturally-relevant physical activity has a growing evidence base in many regions and specific populations, but the scope and scale for global health promotion is underexplored. Methods A multinational expert team used a critical literature review method to: (1) define culturally-relevant physical activity; (2) delineate relevant characteristics supporting inclusion in population-level health promotion and surveillance; and (3) provide agenda setting in research, policy, and practice from a global public health promotion perspective. The critical review method, which evaluates rather than summarizes literature, was chosen as the research evidence is complex, broad, and has not been synthesized previously from this perspective. Results Culturally-relevant physical activity was defined as practices that include physical activity based on a population’s cultural customs. These can be Indigenous (e.g., hula, an Indigenous dance of Native Hawaiians) or regional (e.g., Shota (Shotë), an Albanian folk dance). Practices have shared characteristics that support multi-dimensional value for health, engagement, and healing. These include a collectivist, intergenerational component, passed from elders and shared forward with children as part of a community. Many have foundations in nature, a strength for health and wellbeing in green and blue spaces. Many include traditional art, clothing, accessories, and music with deep significance, including care for the tools and location of practice (e.g, drums, boats, land). Many practices would not be captured in harmonized public health surveillance systems despite their value. From this synthesis, research hypotheses were created and next steps proposed. Conclusions This evidence synthesis supports engagement, planning, uptake, policy, surveillance, and study of culturally-relevant physical activity for public health promotion locally and globally. Key messages • An important strength of culturally-relevant physical activity is that it is context and population specific. However, this may hide the scope and scale of the existing evidence supporting this work. • This evidence synthesis confirms how culturally-relevant physical activity is valuable globally across shared assets in research and practice, supporting next steps for public health promotion.

Comparing Traditional and Newer Glaucoma Procedures by Physician Experience and Practice Location in the United States.

Analysis of CMS Physician Payment data found that physician certification year, degree of urbanization, and estimated income by zip code were significant in predicting the proportion of traditional glaucoma procedures performed by each provider in the United States. The prevalence of microinvasive glaucoma surgery (MIGS) compared to traditional procedures has been increasing in glaucoma management. It is important to understand whether the uptake of new glaucoma procedures is associated with aspects of the physician practice. In this cross-sectional study, data on glaucoma procedure distribution, degree of urbanization and physician certification in the United States were extracted from the 2019 Centers for Medicare & Medicaid Services (CMS) Physician Payment and American Board of Ophthalmology databases. The distribution of traditional and MIGS procedure numbers for metropolitan versus non-metropolitan providers were visualized with boxplots and statistically compared using Mann-Whitney U tests. We used two-dimensional histograms and regression analyses to assess the relationship between certification year and volume of traditional versus MIGS procedures. A multivariable linear regression model was created using certification year, rural-urban commuting area (RUCA) code, and estimated income by practice zip code to predict the number and proportion of each type of glaucoma procedure. This study included 2625 providers from the CMS physician payment data who performed only traditional procedures (n=370), MIGS procedures (n=1727), or both procedure types (n=528) in 2019. The median number of MIGS procedures performed by each provider was greater in non-metropolitan areas (31 vs. 29, P=0.015) while the proportion of traditional procedures performed by each provider was greater in metropolitan areas (0.24 vs. 0.08, P<0.001). Regression analysis showed a positive relationship between certification year and the proportion of traditional procedures performed by each provider (P<0.001). Multivariable regression models found that certification year, RUCA code, and estimated income of practice location were all significant predictors (P<0.02) of the proportion of traditional procedures performed by each provider. In the United States, physicians in metropolitan areas and more recent certification years are more likely to perform a larger proportion of traditional procedures. This finding suggests that the distribution of glaucoma procedure types is related to physician factors such as degree of urbanization and duration of practice. More research is needed to better understand how such differences affect patient access and outcomes.