Medical Experience Research Articles

Changes in medical students’ research-related perceptions through student-engaged medical research curriculum experience

BackgroundThis study investigated changes in students’ perceptions related to research following a student-engaged medical research curriculum.MethodsThree surveys were administered to 112 medical students to examine the changes in their perceptions of the need for research competence, research interest, and research self-efficacy after each Medical Research Practice course.ResultsThe results revealed a decline in the perception of the need for research competence and research interest after Medical Research Practice 2, with a subsequent increase after Medical Research Practice 3. Conversely, research self-efficacy showed steady improvement throughout the curriculum. Additionally, students with prior research experience exhibited higher levels of perception of the need for research competence, research interest, and research self-efficacy than those without such experience.ConclusionThis study provides insights into how medical students’ perceptions change in relation to student-engaged medical research course experiences, supporting expanding research-related curricula and assisting in the development and systematic implementation of similar programs in other medical schools.

A comprehensive evaluation of the service quality of Chinas medical APP based on mobile phones

In light of the rapid advancement of internet-based healthcare and the consequent transformation in medical consultation modalities, an increasing number of individuals, particularly the younger demographic, are opting to seek medical advice or assistance via mobile phones through various online medical platforms or applications. However, the wide range of medical apps with different operational models, varying levels of expertise among resident specialists, and inconsistent quality of medical guidance presents a significant challenge for users in discerning which apps provide accurate and reliable guidance. Consequently, this study aims to comprehensively evaluate the service quality of domestic medical apps from multiple channels and perspectives by utilizing case studies. Rooted in educational materials and diagnostic guidelines for relative diseases, evaluation criteria and a quantitative scoring system are established in this study. The findings are indicated in terms of the accuracy and professionalism of medical consultation services and user experience. This study also proposes that domestic mobile medical apps should enhance their diagnostic quality, expand physician resources, standardize management practices, and strengthen platform infrastructure while developing new functionalities to benefit patients.

Effects of oral carbohydrate loading in patients scheduled for painless bidirectional endoscopy: a prospective randomized controlled trial

PurposeTraditional fasting causes considerable discomfort without added assurance of security, whereas oral carbohydrate beverage offers an alternative to improve medical experience. This study aims to explore the impact of different types and dosages of oral fluids loading before painless bidirectional endoscopy on the gastric emptying and wellbeing.Methods180 patients arranged for bidirectional endoscopy with intravenous anesthesia were randomized: patients in the control group (Group C) obeyed standard fasting; the 200 mL carbohydrate group (Group P1), 400 mL carbohydrate group (Group P2), 200 mL water group (Group W1) and 400 mL water group (Group W2) respectively consumed 200 mL or 400 mL corresponding clear liquids 2 h before the procedure. Gastric emptying metrics under ultrasound, subjective comfort indexes, periprocedural blood glucose and vital signs were contrasted among the groups.ResultsNo significant differences were detected in the gastric emptying including CSA (cross-sectional area), GV (gastric volume), cGV (corrected gastric volume) and the three-point grading system among groups, and none had a cGV > 1.5 mL/kg before anesthesia. Participants in Group P2 experienced less preprocedural thirst and mouth dryness, so as the postprocedural thirst, mouth dryness and hunger. Periprocedural blood glucose and MAP had the similar trend in all groups. The occurrence of hypotension, bradycardia, hypoxia, and the required norepinephrine was comparable among the groups.ConclusionsOral beverage loading with 200 mL or 400 mL can be safely applicated 2 h before painless bidirectional endoscopy without increasing the gastric volume. 400 mL carbohydrate solution effectively relieves the discomfort and could serve as a consideration.Trial registrationRegistered in the Chinese Clinical Trial Registry on December 5, 2023 (ChiCTR2300078319).

FP6.6 - Diagnosing the improvements required for enhancing the medical student ward round bedside teaching experience utilising a cohort of surgical teaching fellows

Abstract Aim After previously having mixed student feedback as a learning experience, our UK medical school have embedded a cohort of dedicated surgical teaching fellows into acute surgical ward rounds. Since this has happened, we aimed to further improve traditional Surgical Ward Round Bedside Teaching methods. Method Post event, retrospective, optional questionnaire formed of 5 Questions evaluated by a Likert scale and 2 open ended Questions. Presented to year 3, UK undergraduate medical students. Results 20 complete responses received. The majority of students strongly agreed that Surgical Ward Round Bedside Teaching sessions with dedicated fellows present were effective in enhancing clinical knowledge and skills. 90% strongly agreed that teaching fellows were engaging and approachable during Surgical Ward Round Bedside Teaching. Also 90% strongly agreed that they felt comfortable asking questions and seeking clarification during Surgical Ward Round Bedside Teaching sessions. However, only 60% strongly agreed that Surgical Ward Round Bedside Teaching sessions were well-organized and focused on relevant surgical/clinical cases. When asked ‘How could the bedside/Ward Round teaching sessions be improved?’ – Responses revolved around suggesting teaching in smaller groups, reminding wards/departments to expect students/clinical fellows, providing online resources or hand-outs before teaching, identifying teaching session objectives, and spend more time on history taking and examination sessions Conclusions The introduction of surgical teaching fellows has had a positive impact on the student Surgical Ward Round Bedside Teaching experience. There is still room for future refinement however and further enhancement strategies are in progress.

Medical students' initial experiences of the dissection room and interaction with body donors: A qualitative study of professional identity formation, educational benefits, and the experience of Pasifika students.

The first experience of medical students in the dissecting room (DR) likely influences professional identity formation (PIF). Sparse data exist exploring how exposure to the DR and body donors without undertaking dissection influences PIF, or how culture may influence this experience. This qualitative study explored students' first, non-dissection DR experience to determine how this contributes to PIF, including the impact of culture through a Pasifika-student lens. It also explored student perspectives on what learning opportunities are unique to this experience. Medical students with no prior DR experience were recruited and then interviewed after initial engagement with the DR and body donors. Questions included participant experiences, cultural perspectives, and how the DR differed from other teaching experiences. Interviews were recorded, transcribed, and analyzed thematically. Twenty students were interviewed (mean age 22 years, 12 females; 8 Pasifika) resulting in 520 min of audio recording (mean 26 min). Four primary themes were identified: professional identity formation, educational elements, death and spirituality, and cultural perspectives. Three subthemes including student experiences, behaviors, and environment were developed within each theme. Findings indicate development of PIF likely occurs from a single engagement with body donors without undertaking dissection, including recognition of professional role. Culture can play an important role for students, with several Pasifika students viewing the DR as a "cultural purgatory". Unique learning experiences are identified, such as cultural awareness around behaviors with the dead. The experience is an educational "threshold concept" where students likely undergo substantial developments in PIF, and educational initiatives to support students are outlined.

Public Perceptions of Enuresis: Insights From Online Communities in South Korea and the United States.

To establish a foundation for raising awareness and disseminating accurate information about enuresis-one of the most challenging conditions to discuss openly-this paper examines public perceptions of enuresis. This paper collected title and text data from posts related to enuresis on the top popular online platforms such Naver Cafe in South Korea and Reddit in the United States (US). The data along with the thematic subcommunities where the posts were uploaded, was analyzed and visualized using word cloud, Latent Dirichlet Allocation (LDA) topic modeling, and pyLDAvis. The findings reveal both similarities and differences in how the patients from the 2 countries addressed enuresis online. In both countries, enuresis symptoms were a daily concern, and individuals used online platforms as a space to talk about their experiences. However, South Koreans were more inclined to describe symptoms within region-based communities or mothers' forums, where they exchanged information and shared experiences before consulting a doctor. In contrast, US patients with medical experience or knowledge frequently discussed treatment processes, lifestyle adjustments, and medication options. South Koreans tend to be cautious when selecting and visiting hospitals, often relying on others for advice and preparation before seeking medical attention. Compared to online communities in the US, Korean users are more likely to seek preliminary diagnoses based on nonprofessional opinions. Consequently, it is important to lower the barriers for patients to access professional medical advice to mitigate the potential harm of relying on nonprofessional opinions. Additionally, there is a need to raise awareness so that adults can recognize and address their symptoms in a timely manner.

Black college women's preventive health behaviors: Applications of a Black Feminist-Womanist research paradigm

ObjectiveThe researchers applied Lindsay-Dennis' Black Feminist-Womanist research paradigm to Andersen's Behavioral Model for Health Service Use to guide initial research about Black American women's preventive health behaviors. MethodsThis article highlights this application, using interpretive phenomenological analysis for qualitative questions assessing how 40 Black college women define health and their experiences in health care. This was part of a larger convergent parallel mixed-methods approach in a 2022 cross-sectional online survey. ResultsParticipants defined health as a concept involving health literacy, physical and mental health, and being free from health conditions or disease. Regarding health-related lived experiences, negative experiences were more frequently reported than positive experiences. However, many participants reported both positive and negative health care related experiences. Predisposing, enabling, and need factors were all present in qualitative responses. ConclusionsThis article highlights the fit of a Black Feminist-Womanist research paradigm to Andersen's model to better understand Black women's health experiences and illustrates ways that medical mistrust, health literacy, and past experiences with health care can influence health service use. Areas for future research on barriers and facilitators to preventive care and implications for reducing health disparities are also discussed.

International students' perspectives on medical school and internship: 'Oh international? Are you international?'

International students account for a significant proportion of medical graduates Australia-wide, and most opting to remain in Australia for their first year of practice (Internship). Hence, understanding this particular demographic's perspectives is crucial for curriculum and workforce planning. Despite this, very few studies have addressed this demographic, and none have explored the impact of the COVID-19 pandemic on international medical students specifically. A qualitative design was used to explore the perspectives of final-year international medical students at an Australian medical school as they prepared for transition to internship during the COVID-19 pandemic. Participants engaged in a semi-structured interview about the pandemic's personal and professional implications. The data were analysed using inductive thematic analysis. Seven out of 34 final-year international medical students at the University of Adelaide participated. The main themes identified were that isolation was magnified, institutional support was lacking and that uncertainty was challenging. The pandemic did not deter participants from pursuing an Australian internship, as Australia was considered a desirable place for internship compared to their home countries. While the COVID-19 pandemic exacerbated the situation, many of the challenges identified by international students already existed. Issues such as social isolation, racial discrimination, financial hardship and lack of institutional support have been prevalent for decades. Insights from this study reveal a need to improve the medical school experience. Australian Universities have a responsibility to ensure fair treatment of international students by training faculty, implementing support programmes and ensuring an inclusive and culturally safe learning environment.

Internalized Sexual Stigma, Sexual Orientation Disclosure, and Patient Experience Among Gay Men and Lesbian Women in Taiwan: A Cross-Sectional Survey.

Purpose: Previous research has found that stigma, discrimination, and depression are associated with the sexual minority population's medical experiences. However, there is still a lack of relevant research results in Taiwan. This study investigated the health-seeking experiences and influencing factors of gay men and lesbian women in Taiwan. Methods: We recruited gay men and lesbian women through lesbian, gay, bisexual, and transgender (LGBT)-friendly websites and associations between November 2019 and June 2020. Surveys included the demographics, medical visiting experiences, Measure of Internalized Stigma, Patient Health Questionnaire-9, and Daily Heterosexist Experiences Questionnaire. Results: There were 270 participants, including 188 gay men and 82 lesbian women. Most respondents refused to disclose their sexual orientation to health care providers; some feared seeking medical care and preferred seeking LGBT-friendly health care services. Compared with lesbian women, gay men had higher levels of internalized sexual stigma, victimization, concealing sexual orientation, and experiences of medical staff denying services. Discrimination, depressive severity, and internalized sexual stigma affected the medical visit experience. Conclusion: In Taiwan, the health care experiences of gay men and lesbian women are affected by discrimination, internalized sexual stigma, and severe depression, while facing challenges of fear of seeking medical care or reluctance to disclose their sexual orientation.

Top tips for promoting positive professionalism through medical education

Background Professionalism is a requirement across all healthcare disciplines yet remains challenging to teach and difficult to evidence. Professionalism, as a subject matter, is increasingly recognised in undergraduate and postgraduate formal curricula, where historically, it has sat in the hidden curriculum space. The learning of professionalism is often complicated by its association with negative connotations and focus only being given to the topic only when it lapses. Methods The authors have strong medical education interests and experience in the teaching, learning and assessment of professionalism in inter-professional settings. They have used their extensive experience, collaborative work and the current literature to develop practical top tips to promote professionalism in medical education. Results The practical tips offered are supported by current literature and educational theory and aim to support other institutions, educators and clinicians to embed and promote professionalism in a positive, constructive and pedagogical way. Conclusions The learning of professionalism in medical education remains challenging. The practical tips aim to guide educators to consider innovative strategies and modern educational thinking but also cautions readers to challenge preconceived ideas on how this topic is best presented and embedded in curriculums.

Protection of children’s health in the environment of Russian emigration and the USSR in the conditions of the spread of infectious diseases in the 1920s–1930s

Introduction. The preservation of children’s health is an important state task, the success of which is largely determined by the socio-cultural context, traditions in the application of preventive measures and the provision of medical care. In this regard, it is indicative of the comparison of measures to preserve the health of schoolchildren in the “Russian schools” of the emigrant environment (on the example of schools in the Czechoslovakia and the Kingdom of Yugoslavia) and Soviet schools in the 1920s and 1930s in the conditions of the spread of infectious diseases. Materials and methods. The data sources were published reports of Russian educational institutions in exile, which contain information about the health of schoolchildren, data on the health of Soviet schoolchildren were obtained from collections of analytical works of the specified period. Results. The prevalence of infectious diseases in children among Russian emigration and in the USSR was comparable, with the exception of measles, cases of which were not recorded in emigrant educational institutions in the Czechoslovakia and the Kingdom of Yugoslavia. As the main preventive measures, disinfection and examinations were carried out, vaccinations were made. The living conditions of emigrants contributed to the spread of tuberculosis, the incidence of which among children of emigrants was higher than among the European population. Soviet and emigrant doctors agreed that the fight against infectious diseases should develop at the level of organized collectives (schools, kindergartens). Conclusion. Thus, emigrant doctors largely followed the medical traditions and experience that had developed in pre-revolutionary Russia. Nevertheless, the living conditions of emigrants and the lack of funds became factors that reduced the effectiveness of preventive measures and medical care. An important difference was that the events in the Soviet Union were carried out within the framework of the state policy on health protection, and in the emigrant environment were of a local nature, determined as a rule by the capabilities of specific educational institutions.

Correlation between psychological traits and the use of smart medical services in young and middle-aged adults: An observational study

BACKGROUND Psychological problems affect economic development. However, there is a huge gap between mental health service resources and mental health service needs. Existing mental health service technology and platforms cannot meet all the diverse mental health needs of people. Smart medicine is a new medical system based online that can effectively improve the quality and efficiency of medical services and make mental health services accessible. AIM To explore the level of intelligent medical use among young and middle-aged people and its correlation with psychological factors. METHODS Convenience sampling was used to select 200 young and middle-aged patients with medical experience at the Third People's Hospital of Chengdu between January 2022 and January 2023 as the research subjects. The general condition Questionnaire, Eysenck Personality Questionnaire, Symptom Checklist-90, General Health Questionnaire, and Smart Medical Service Use Intention Questionnaire were used to collect data. Pearson’s correlation was used to analyze the correlation between the participants’ willingness to use smart medical services and their personality characteristics, psychological symptoms, and mental health. RESULTS The results revealed that the mental health of young and middle-aged people was poor, and some had psychological problems such as anxiety, depression, and physical discomfort. Familiarity, acceptance, and usage of smart healthcare in this population are at a medium level, and these levels correlate with psychological characteristics. Acceptance was positively correlated with E, and negatively correlated with P, anxiety, fear, anxiety/insomnia, and social dysfunction. The degree of use was negatively correlated with P, obsessive-compulsive symptoms, depression, anxiety, hostility, paranoia, and somatic symptoms. CONCLUSION The familiarity, acceptance, and usage of smart medical services among the middle-aged and young groups are related to various psychological characteristics.

The effect of assessor expertise on reliability of analysis of video signs associated with concussion in Australian football

ObjectivesTo determine whether spotters with medical training and experience in managing concussion have higher inter-rater reliability and accuracy than non-medical personnel when identifying video signs associated with concussion in Australian football. DesignRetrospective cohort study. MethodsVideo clips were collected of all impacts potentially resulting in concussion during 2012 and 2013 Australian Football League (AFL) seasons. Raters were divided into medical doctors and a non-medical group comprising allied health practitioners (physiotherapists) and non-medical/non-allied health personnel (performance analysts). Raters assessed 102 randomly selected videos for signs of concussion. The inter-rater reliability was calculated. Sensitivity, specificity, positive and negative predictive values were calculated by comparing the rater responses to the consensus opinion from two highly experienced clinicians with expertise in concussion. ResultsNo statistically significant difference in inter-rater reliability was observed between the medical doctors and the non-medical group. Both groups demonstrated good to excellent agreement for slow to get up, clutching at head/face and facial injury. Both groups displayed intra-class coefficient >0.55 for no protective action-floppy, loss of responsiveness, and motor incoordination, and displayed lowest agreement for no protective action-tonic posturing, impact seizure and blank/vacant look. No statistically significant difference was found between the groups for sensitivity, specificity, positive and negative predictive values for correctly classifying video signs compared to the expert consensus opinion. ConclusionsAfter completing sufficient standardised training and testing, medical and non-medical personnel demonstrate comparable reliability in identifying video signs of concussion in professional Australian football and may be suitable for the role of video spotter.

Drug use practices and wound care experiences in the age of xylazine adulteration

Exposure to xylazine has been associated with wounds distinct from typical injection-related skin and soft tissue infections. We sought to understand drug use and wound care practices, and treatment experiences of people who use drugs (PWUD) in a high-prevalence area of xylazine adulteration. In August 2023, we surveyed adult PWUD reporting at least one past-year drug use-related wound across three Massachusetts syringe service programs. Using a representative illustration, participants indicated if they had experienced a xylazine wound in the past 90 days. We compared demographic, drug use factors, wound care, and medical treatment experiences among those with and without xylazine wounds. We also conducted additional content analysis of open-ended responses. Of the 171 respondents, 87 % (n=148) had a xylazine wound in the past 90 days. There were no statistically significant demographic differences between those with and without xylazine wounds. Among those primarily injecting (n=155), subcutaneous injection was nearly ten times more likely among people with xylazine wounds. For those with xylazine wounds (n=148), many engaged in heterogeneous wound self-treatment practices, and when seeking medical care, 74 % experienced healthcare stigma and 58 % had inadequate pain and withdrawal management. People with self-identified xylazine wounds were more likely to engage in subcutaneous injection and faced several barriers seeking medical wound treatment. Programs serving people exposed to xylazine should work to support safer injection practices, including alternatives to injecting and improving access to high-quality, effective wound care. Further study is warranted to understand the causes, promoters, and prevention of xylazine-related wounds.

Looking for Signs of Life: A Christian Perspective on Defining and Determining Death

Abstract Looking to Scripture through the eyes of contemporary medical experience, I analyze the meaning of the criteria used for determining death, specifically in the light of Jesus’ final moments and the resurrection of the Shunammite’s son in 2 Kings, chapter 4. I argue that four theses are consistent with, and informed by, these passages that can help guide Christian belief and decision-making about how death is determined in the clinical context: (1) death is neither permanent nor irreversible; (2) something like the “brain-dead” state is, at best, a confounding state that requires one to “pace and pray” or let go; (3) that the case for determining death by neurologic criteria depends on the “working togetherness” of the body’s parts for the sake of impacting its environment; and (4) that the practice of neurologically based death determination is a response to the problem of disaggregation of the human form into its organ systems that modern critical care medicine makes possible. I end with advice about how Christians might approach the debates over the law and practice, even if they cannot come to a consensus.

Medical Tourism Management

Medical tourism, the practice of traveling abroad for medical treatment, has gained substantial attention in recent years due to its implications for healthcare delivery and tourism industry dynamics. This paper investigates the management strategies employed in medical tourism destinations, focusing on enhancing healthcare services and tourism competitiveness. Utilizing secondary data from scholarly articles, reports, and industry publications, the research synthesizes existing knowledge on medical tourism management frameworks, destination competitiveness factors, patient experiences, and healthcare quality metrics. The study employs a qualitative analysis approach to distill key insights and patterns from the literature, shedding light on effective management practices and their impact on patient outcomes and destination attractiveness. Findings reveal the importance of strategic planning, collaboration between healthcare providers and tourism stakeholders, quality assurance mechanisms, and marketing strategies in optimizing medical tourism experiences. The paper discusses implications for policy development, industry regulations, and sustainable growth strategies in medical tourism destinations. By leveraging secondary data sources, this research contributes to a comprehensive understanding of medical tourism management dynamics, offering practical insights for healthcare providers, policymakers, and tourism professionals navigating this evolving landscape. Keywords- Medical tourism, Management strategies, Destination competitiveness, Healthcare quality

Evaluating the impacts of digital ECG denoising on the interpretive capabilities of healthcare professionals.

Electrocardiogram (ECG) interpretation is an essential skill across multiple medical disciplines; yet, studies have consistently identified deficiencies in the interpretive performance of healthcare professionals linked to a variety of educational and technological factors. Despite the established correlation between noise interference and erroneous diagnoses, research evaluating the impacts of digital denoising software on clinical ECG interpretation proficiency is lacking. Forty-eight participants from a variety of medical professions and experience levels were prospectively recruited for this study. Participants' capabilities in classifying common cardiac rhythms were evaluated using a sequential blinded and semi-blinded interpretation protocol on a challenging set of single-lead ECG signals (42 × 10 s) pre- and post-denoising with robust, cloud-based ECG processing software. Participants' ECG rhythm interpretation performance was greatest when raw and denoised signals were viewed in a combined format that enabled comparative evaluation. The combined view resulted in a 4.9% increase in mean rhythm classification accuracy (raw: 75.7% ± 14.5% vs. combined: 80.6% ± 12.5%, P = 0.0087), a 6.2% improvement in mean five-point graded confidence score (raw: 4.05 ± 0.58 vs. combined: 4.30 ± 0.48, P < 0.001), and 9.7% reduction in the mean proportion of undiagnosable data (raw: 14.2% ± 8.2% vs. combined: 4.5% ± 2.4%, P < 0.001), relative to raw signals alone. Participants also had a predominantly positive perception of denoising as it related to revealing previously unseen pathologies, improving ECG readability, and reducing time to diagnosis. Our findings have demonstrated that digital denoising software improves the efficacy of rhythm interpretation on single-lead ECGs, particularly when raw and denoised signals are provided in a combined viewing format, warranting further investigation into the impact of such technology on clinical decision-making and patient outcomes.

Endometriosis Online Communities: How Machine Learning Can Help Physicians Understand What Patients Are Discussing Online

Study ObjectiveUse machine learning to characterize the content of endometriosis online community posts and comments. DesignRetrospective Descriptive Study. SettingEndometriosis online health communities (OHCs) on the platform Reddit. ParticipantsUsers of the endometriosis OHCs r/Endo and r/endometriosis. InterventionsMachine learning was used to analyze thousands of posts made to endometriosis OHCs. Content of posts and comments was interpreted using topic modeling, persona identification, and intent labeling. Measurements included baseline characteristics of users, posts, and comments to the OHCs. Machine-learning techniques; topic modeling, intent labeling, and persona identification were used to identify the most common topics of conversation, the intents behind the posts, and the subjects of people discussed in posts. System performance was assessed via accuracy at F1-score. ResultsA total of 34 715 posts and 353 162 comments responding to posts were evaluated. The topics most likely to be a subject of a post were menstruation (8%), sharing symptoms (8%), medical appointments (8%), medical story (9%), and empathy (7%). The majority of posts were written with the intent of seeking information about endometriosis (49%) or seeking the experiences of others with endometriosis (29%). Users expressed a strong preference for surgeons performing excision rather than ablation of endometriosis. ConclusionEndometriosis OHCs are mostly used to learn about symptoms of endometriosis and share one's medical experiences. Posts and comments from users highlight the need for more empathy in the clinical care of endometriosis and easier access for patients to high-quality information about endometriosis.

Barriers to Engagement with Gastrointestinal Health Management

BackgroundAlthough behavioral interventions have been effective in gastrointestinal (GI) conditions, barriers exist in implementing these interventions into clinical practice. The majority of previously published studies have focused on workforce limitations and have not considered individual and social determinants of health (SDoH) factors that can impact engagement in GI behavioral healthcare.AimsTo characterize barriers to engagement in appointment attendance and health management, explore individual and SDoH factors impacting GI behavioral healthcare engagement, and identify barriers that occur more often for patients with SDoH-related vulnerability (low health literacy and/or financial insecurity).MethodsA survey was distributed to adult patients who had been seen in Gastroenterology at the Dartmouth-Hitchcock Medical Center from June 2022 to December 2022.ResultsOne hundred participants [mean age = 58 years, 57.1% women] completed the survey. SDoH vulnerability was present in 32.3% of the population. For the entire sample, 73% reported at least one barrier to accessing care and 75% reported at least one factor which impacted health management. Those with SDoH vulnerability reported significantly more barriers to attending appointments and to managing health. In addition, they were significantly more likely to endorse physical health problems, difficulty affording medical bills, pain, mobility issues, trauma experiences, significant stress, and difficulty with concentration.ConclusionsPatients in a GI clinic reported multiple barriers to accessing care and participating in health management. Innovative, multi-level strategies are needed to address barriers to ensure that all patients are able to obtain quality GI behavioral health services.

"When You're in It, It Feels Like It's Everything": Medical Students' Experience of Failure and Remediation in the United States and the Netherlands.

Medical training institutions worldwide must be prepared to remediate struggling learners, but there is little empirical evidence around learners' perspectives on remediation efforts. Research shows that emotion has a significant effect on learning, but it has not been well studied in remediation in medical education. Given the high stakes of remediation, understanding more about learners' emotional experience could lead to improvements in remediation programs. This study aimed to explore medical students' emotional experience of failure and remediation to offer opportunities to improve remediation. This study is a thematic analysis of data collected from July to September 2022 from one-to-one interviews with students from 4 institutions (2 in the United States and 2 in the Netherlands) who had not met expectations on 1 or more medical school assessment(s). Interview questions explored students' experiences with learning of and responding to a performance that was below expected standards, with probes around any mentions of emotions. Fourteen students participated: 9 from schools in the United States and 5 from schools in the Netherlands. The students perceived the failure and remediation event to be highly significant, reflecting negatively on their suitability for a career as a physician. We identified 5 themes: (1) shame was pervasive and only retrospectively perceived as unwarranted; (2) self-doubt was common and weighty; (3) resentment, blame, and other external-facing emotions were present but softened over time; (4) worry and stress related to perceived career effect differed across countries; and (5) students had mixed emotional reactions to the remediation process. Medical students have strong emotional responses to failure and remediation. Expecting and considering emotions such as shame, self-doubt, and anger could help educators design better remediation programs. Differences across countries may be at least partially explained by different degrees of time variability and flexibility within the curricula.