Medical Residents Research Articles

Psychological and pedagogical conditions for teaching residents of foreign language professional communication based on an integrated approach

Importance. Proficiency in a professional foreign language at the present stage is one of the key requirements determining competitiveness in the labor market. The formation of professional foreign-language communicative competence of medical specialists gives them access to specialized research and journals, since most of them are published exclusively in English. However, in practice, when receiving medical education in residency, the main attention is paid to the study of natural sciences, while learning a foreign language is of secondary importance. Using an integrated approach to learning, it becomes possible to organize a more effective educational process through a comprehensive study of a subject discipline and a foreign language in a single educational space. The purpose of this work is to identify the psychological and pedagogical conditions of training residents of foreign language professional communication based on an integrated approach.Research Methods. The study was conducted using theoretical and empirical methods that allow to study and analyze scientific and methodological literature on the organization of foreign language teaching based on an integrated subject-language approach. The analysis of the literature revealed certain patterns that actualize the need to comply with a number of psychological and pedagogical conditions when teaching residents of foreign language professional communication based on an integrated approach. Based on the available research, the external and internal factors underlying the psychological and pedagogical conditions aimed at optimizing the educational process were summarized.Results and Discussion. In the course of the conducted research, the following psychological and pedagogical conditions for teaching residents of foreign language professional communication based on an integrated approach were identified: 1) motivation of residents to study professional English; 2) possession of professional foreign language competence by residents at the Advanced Mid level on the ACTFL scale; 3) formation of an integrated course of professional foreign language communicative competence and competence in the field of professional communication by the teacher; 4) the methodological dominant in the educational process are professionally oriented cases.Conclusion. The process of teaching residents of foreign language professional communication is not an axiomatic phenomenon, therefore it is directly dependent on a number of psychological and pedagogical conditions. The identified psychological and pedagogical conditions are of a recommendatory nature and act as a starting point for teaching residents of foreign language professional communication based on an integrated approach. The results of the study can be used in the methodology of teaching foreign languages to medical students and residents.

Collaboration cognizance: Development of a self-assessment tool to measure intra-professional collaborative practices (IPCP) in postgraduate medical residents at tertiary care hospitals

BackgroundThe ever-evolving healthcare system of today demands physicians who steer their roles as treatment providers, managers and collaborators. Professionals are highly interdependent due to increased complexity of health problems and risk of errors increases with transitions in care. In hospitals, the main workforce is postgraduate residents; therefore, intraprofessional collaboration amongst residents is essential. Several instruments are available to evaluate interprofessional collaboration amongst physicians, nurses and hospital teams but none specifically assessed intra-professional collaborative practices amongst residents working in tertiary care hospitals in multi-disciplinary teams. This study intends to develop and validate an instrument to self-assess intraprofessional collaborative practices in postgraduate residents undergoing residency in multiple specialties at tertiary care hospitals.ApproachThis study on Instrument Development employed mixed method study design executed in two phases. In phase 1, six domains of intraprofessional collaborative practices were identified from literature and 35 items were developed. Fifteen experts participated in qualitative content validation and provided comments. To establish content validity in phase 2, content validity index (CVI) and content clarity average (CCA) were assessed by seventeen experts. Response process validity was established by cognitive interviewing of 5 postgraduate residents. Pilot testing was done on a sample of 407 residents. Cronbach’s alpha was determined, and confirmatory factor analysis established construct validity.ResultsDuring phase 1, items were modified based on qualitative feedback from 15 experts. In round 2, CVI and CCA were determined based on responses of 17 experts. The items having an I-CVI greater than 0.90 were accepted and six items underwent modifications as their I-CVI fell between 0.78 and 0.90. Similarly, four items with a CCA of less than 2.4 were modified to increase clarity. Cognitive interviews of participants on 30 items resulted in the deletion of 1 item and changes in 5 items. The final instrument had 29 items categorized under six constructs. All items had good factor loadings during CFA, so none was deleted. Cronbach’s Alpha α was 0.937.ConclusionIntraprofessional collaborative practices in residents is a valid and reliable self-assessment tool comprising 29 items measuring six constructs. It may be used by residents to assess their collaborative practices and incorporated in curricula to help develop collaborative practices and their assessment during training of postgraduate residents.

The Eternal Present: A Photovoice Study of the Experience of Geriatrics Residents During the COVID-19 Pandemic.

During the COVID-19 pandemic, medical residents had the task of being the frontline of the response, being exposed to high risk of infection, increased clinical duty, and long and irregular working hours in highly restricted environments, increasing their levels of stress. We sought to expose the experiences of a group of geriatrics residents during this period of change in their professional and personal lives through the photovoice methodology. Thirteen participants were recruited and had 2weeks to take photographs. The photographs were discussed in group meetings; the content of the conversations was transcribed and analyzed using interpretive description. Sixteen themes were identified. They were divided into personal life (11 themes) and life as a resident (5 themes). Adaptation was the main theme that came into discussion. The photographs and themes show how life changed for the participants, having a feeling of isolation, especially from their families, and highlighting their experiences as a team and community. While the pandemic, particularly at its beginning, was a period of uncertainty and a heavy load of work, it also provided learning and experience to this group of young physicians, which should not hide the fact that mental health concerns and burnout were a common situation. An online gallery was created which is publicly accessible.

Patients as knowledge partners in the context of complex chronic conditions

This article conveys how taking patient knowledge seriously can improve patient experience and further medical science. In clinical contexts related to infection-associated chronic conditions and other complex chronic illnesses, patient...

Impact of Medical Trainees on Efficiency and Productivity in the Emergency Department: Systematic Review and Narrative Synthesis.

Effective medical education must balance clinical service demands for institutions and learning needs of trainees. The question of whether these are competing demands or can serve complementary roles has profound impacts on graduate medical education, ranging from funding decisions to the willingness of community-based hospitals and physicians to include learners at their clinical sites. Our objective in this article was to systematically review the evidence on the impact of medical trainees on productivity and efficiency in the emergency department (ED). We queried PubMed, Embase, Scopus, and Web of Science from earliest available dates to March 2023. We identified all studies evaluating the impact of medical students and/or residents in the ED on commonly used productivity and efficiency metrics. Only studies in EDs in the United States were included. No additional filters were used. We assessed the risk of bias of included studies using the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool. Certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Study findings were combined in a narrative synthesis and reported according to PRISMA guidelines. The literature search yielded 3,390 unique articles for abstract screening. Eighty-one abstracts were identified as relevant to our PICO question (population, intervention, control, and outcomes), 76 of which had retrievable full-text articles and the themes of which were discussed in a narrative synthesis. We selected 13 of the full-text articles for final inclusion in a systematic review. Studies were roughly split between observational (6) and quasi-experimental (7) designs. The majority of studies (11) were single-site studies. Only two studies could be graded as low risk of bias per the ROBINS-I tool. Low-GRADE evidence suggests that students and residents decrease ED efficiency by a statistically small effect size of debatable clinical importance. Residents provide a moderate boost to ED productivity. Students do not produce a statistically or clinically significant impact on ED productivity. Residents increase emergency department relative value units revenue by $26.30 an hour, while students have no impact. Both types of learners decrease efficiency.

Barriers to Black Medical Students and Residents Pursuing and Completing Surgical Residency in Canada: A Qualitative Analysis.

The limited available data suggest that the Canadian surgical workforce does not reflect the racial diversity of the patient population it serves, despite the well-established benefits of patient-provider race concordance. There have been no studies to date that characterize the systemic and individual challenges faced by Black medical students in matching to and successfully finishing training in a surgical specialty within a Canadian context that can explain this underrepresentation. Using critical qualitative inquiry and purposive sampling to ensure sex, geographical, and student or trainee year heterogeneity, we recruited self-identifying Black medical students and surgical residents across Canada. Online in-depth semistructured interviews were conducted and transcribed verbatim. Transcripts were analyzed through an inductive reflexive narrative thematic process by 4 analysts. Twenty-seven participants including 18 medical students and 9 residents, were interviewed. The results showed 3 major themes that characterized their experiences: journey to and through medicine, perceptions of the surgical culture, and recommendations to improve the student experience. Medical students identified lack of mentorship and representation as well as experiences with racism as the main barriers to pursuing surgical training. Surgical trainees cited systemic racism, lack of representation, and insufficient safe spaces as the key deterrents to program completion. The intersection with sex exponentially increased these identified barriers. Except for a few surgical programs, medical schools across Canada do not offer a safe space for Black students and trainees to access and complete surgical training. An urgent change is needed to provide diverse mentorship that is transparent, acknowledges the real challenges related to systemic racism and biases, and is inclusive of different racial and ethnic backgrounds.

Characteristics of cardiologist training in Latin America: a survey of the Interamerican Society of Cardiology

Describe the characteristics of the different cardiology medical residencies in Latin America. Cross-sectional study that aims to evaluate the characteristics of cardiology residencies in Spanish-speaking countries of Latin America, through self-administered electronic surveys. Three hundred seven residents of 147 residences were surveyed. Mean age was 31 years and 63% were male. Ninety eight percent carry out their training in the capital city. The average total training time is 4.8 years. Forty four percent complete their residency in internal medicine prior to starting cardiology, and 10% have no prior training. In cardiology training is 3 years in most countries. Fifty four percent present academic activities every day and 16% only once or less, consisting of theoretical classes (93%), clinical cases (85%), bibliographic workshops (69%), and writing scientific papers (68%). Supervision is carried out by the chief resident (45%), resident coordinator (44%), resident instructor (27%) or the department head (54%), while 2.6% do not present supervision. The main rotations were echocardiography (99%), hemodynamics (96%), coronary unit (93%), and electrophysiology (92%). Residents highlighted the need to improve academic activities (23%) and scientific production (12%). There are important differences in the academic and practical training between the residences of the different countries of America.

Retrospective, Longitudinal, One-Group Study on the Implementation of Continuous Glucose Monitoring To Improve Quality of Care for Patients With Type I or II Diabetes Mellitus in an Internal Medicine Residency Continuity Community Clinic.

In this three-year retrospective study, data from 51 patients with type 1 or type 2 diabetes mellitus (DM), receiving a minimum of 3-4 insulin injections per day and self-monitoring their blood glucose (SMBG) four times a day, were derived from our internal medicine residency primary care clinic. The patients were equipped with a continuous glucose monitoring (CGM) device that shared 24-hour glucose data with the clinic. They were assigned to members of our CGM team, which included internal medicine or transitional year medical residents who functioned under the supervision of a board-certified endocrinologist. The residents, in consultation with our endocrinologist, assessed the patients' glucose management data and adjusted their treatment regimens biweekly by calling the patients, and monthly by seeing the patients in the clinic. Significant results from the study include a reduction in HbA1c from 9.9% to 7.6%, an average blood glucose decrement from 242 mg/dL to 169 mg/dL, a reduction in the incidence of mild hypoglycemia from below 70 mg/dL to 54 mg/dL, from 4.68% to 0.76% per day, and a more pronounced hypoglycemia with glucose less than 54 mg/dL from 3.1% per day to 0.2% per day. We observed a significant increase in the time in the range of the blood glucose from 33% to 67% per day. Furthermore, 9.5% of the patients in this study eventually discontinued their daily insulin injections and continued treatment with oral diabetic medications with or without the use of injectable GLP-1 receptors once a week. Our study affirms that CGM devices significantly improve glycemic control compared to SMBG, supporting its efficacy in optimizing glycemic control in real-world clinical practice. The results imply that this can be accomplished in internal medicine residency clinics and not exclusively in specialized endocrine clinics. As far as we know, this is the first study of its kind in a residency clinic in the USA. This study confirms the benefits of widening the application of CGM in DM, along with the challenges that must be overcome to realize the evidence-based benefits of this technology. CGM needs to become a part of routine monitoring for type 1 and type 2 DM.

A Survey of the Turkish Oncology Group (TOG): Are the Oncologists Trained for Decision Making on Geriatric Cancer Patients?

Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. Therefore, clinicians need enhanced competencies and skills to effectively care for this population. However, most clinicians receive minimal to no training in geriatrics. This study aims to evaluate the education and training levels in geriatric oncology among Turkish physicians and to understand the factors influencing oncologists' treatment decisions for geriatric cancer patients. A 24-question survey was prepared to obtain the participating physicians' demographic information, as well as to inquire whether they had received training during their medical education and residency on how to approach geriatric patients, in what process(es) they had received the training, whether they were currently treating geriatric patients, what they focused on when evaluating geriatric patients, and what they thought about their training and preparedness for approaching geriatric patients. The questionnaire was sent online to radiation and medical oncologists, and the link was published on the Turkish Society of Radiation Oncology and the Turkish Society of Medical Oncology websites. Two hundred and three physicians participated in the survey, 131 of whom were women. The median age was 41.66 years (24-69 years). One hundred and fifty-six physicians (76.1%) received specialty education at the university hospital. One hundred and three of them were radiation oncologists, and 80 were medical oncologists. Of the physicians, 19.7% received education in geriatrics before they specialized in oncology, and 6.9% said they were educated after specialization. When determining suitability for radiotherapy, 10.7% of radiation oncologists said that they use geriatric assessment tools. Similarly, 13.8% of medical oncologists claimed that they used geriatric assessment tools in determining suitability for chemotherapy. Of the physicians, 177 (86.3%) thought that geriatric evaluation could independently increase patient survival rate. Furthermore, patient cognitive status, functional status, physiological age, polypharmacy, geriatric specialist recommendations, inpatient services, patient relatives, and similar factors were found to be useful in treatment decisions. Finally, 92.7% of the participants believed that receiving education would have changed their perspectives on treating geriatric patients. Our results provide perspectives on developing knowledge on and skills in geriatric training among oncologists. Learning new approaches is necessary for oncologists who more frequently confront geriatric patients with cancer.

Geographic Trends in Ophthalmology Resident Physician Compensation and Cost-of-Living Expenses

Given that resident physician financial strain has been associated with poor outcomes, objective metrics to forecast financial well-being may be useful to (1) applicants when evaluating ophthalmology residency programs and (2) programs when determining resident benefits. To determine and compare the relative value of ophthalmology resident stipends plus benefits when adjusted for cost-of-living expenses and to analyze program characteristics associated with greater resident net incomes. In this cross-sectional study, the American Medical Association's Fellowship and Residency Electronic Interactive Database was used to identify US Accreditation Council for Graduate Medical Education-accredited ophthalmology residency programs. Resident physician stipends and stipends plus benefits as well as residency program characteristics from the 2023-2024 academic year were noted for all eligible programs. The Massachusetts Institute of Technology's Living Wage Calculator's required annual income (RAI) was selected as a surrogate to approximate cost-of-living expenses. Residency program characteristics, including affiliation, size, ranking, presence of housing benefit, and training year. The primary outcome was the annual stipend plus benefits income surplus (SPBIS) for each residency program, defined as the resident's stipend plus benefits (SPB) minus the RAI for the county in which the residency program is located. Secondary outcomes included income surplus variation by program characteristics. Of 116 ophthalmology residency programs analyzed, 37 (31.9%) were located in the Northeast, 36 (31.0%) in the South, 29 (25.0%) in the Midwest, and 14 (12.1%) in the West. The mean (SD) postgraduate year 1 resident annual SPB was $65 397 ($8205), and the median (IQR) was $63 986 ($59 992-$69 698). After adjusting for the cost of living, the mean (SD) SPBIS was $27 459 ($5734) and the median (IQR) was $27 380 ($23 625-$31 796). Annual cost-of-living expenses varied by as much as $8628 (95% CI, $6310-$10 947) and SPBIS varied by as much as $6283 (95% CI, $3367-$9198) between regions. Resident SPB increased by a mean (SD) of 3.97% (0.98%) for each subsequent training year (range, 0.93%-7.26%). Annual SPBIS increased by a mean (SD) of 9.48% (3.60%) for each subsequent training year. After adjusting for living costs, intraregional and interregional differences in SPBIS among ophthalmology residents can vary by thousands of dollars, impacting residents' financial security. Further discussion regarding compensation may lead to innovative strategies that aim to improve resident well-being and performance.

Correction: Ethics training as a crucial scope in the various specialties of the medical residency

Correction: Ethics training as a crucial scope in the various specialties of the medical residency

Estimating Cognitive Workload Using Task-Related Pupillary Responses in Simulated Drilling in Cochlear Implantation.

Training of temporal bone drilling requires more than mastering technical skills with the drill. Skills such as visual imagery, bimanual dexterity, and stress management need to be mastered along with precise knowledge of anatomy. In otorhinolaryngology, these psychomotor skills underlie performance in the drilling of the temporal bone for access to the inner ear in cochlear implant surgery. However, little is known about how psychomotor skills and workload management impact the practitioners' continuous and overall performance. To understand how the practitioner's workload and performance unfolds over time, we examine task-evoked pupillary responses (TEPR) of 22 medical students who performed transmastoid-posterior tympanotomy (TMPT) and removal of the bony overhang of the round window niche in a 3D-printed model of the temporal bone. We investigate how students' TEPR metrics (Average Pupil Size [APS], Index of Pupil Activity [IPA], and Low/High Index of Pupillary Activity [LHIPA]) and time spent in drilling phases correspond to the performance in key drilling phases. All TEPR measures revealed significant differences between key drilling phases that corresponded to the anticipated workload. Enlarging the facial recess lasted significantly longer than other phases. IPA captured significant increase of workload in thinning of the posterior canal wall, while APS revealed increased workload during the drilling of the bony overhang. Our findings contribute to the contemporary competency-based medical residency programs where objective and continuous monitoring of participants' progress allows to track progress in expertise acquisition. Laryngoscope, 2024.

Current status and the urgent need for a geriatric healthcare system in a super-aged society

Background: The Korean healthcare system is ill-equipped to manage geriatric diseases, even though we are on the verge of becoming a super-aged society.Current Concepts: In Korea’s delivery of healthcare system, which is centered on subspecialty care from primary to tertiary care, older adults with multiple chronic diseases are forced to receive fragmented care from multiple doctors. In medical education and residency programs, even the most fundamental concepts of geriatrics are misunderstood, and geriatricians receive inadequate training. Consequently, along with the rapidly growing elderly population, elderly patients with complex health problems, frailty, and dysfunction are deprived of the opportunity to achieve healthy aging by taking multiple medications and suffering from geriatric syndromes caused by fragmented medical care.Discussion and Conclusion: Establishing a system for training geriatricians and strengthening geriatric education is necessary to ensure existing specialists can assign them the role of primary care geriatricians. Additionally, person-centered, integrated geriatric care that requires appropriate management of various complex diseases, as well as maintenance of function and frailty prevention, will be possible by establishing a geriatric healthcare system that ranges from frailty prevention, polypharmacy management, and home visits in primary healthcare to multidisciplinary geriatric care and transitional care in tertiary healthcare. Implementing this strategy as early as possible will help older adults age well and reduce the caregiving burden in later life. This could also ease concerns regarding physician shortages induced by the rapidly growing elderly population.

Evaluating the effects of comprehensive simulation on central venous catheterization training: a comparative observational study

BackgroundSimulation-based training (SBT) is vital to complex medical procedures such as ultrasound guided central venous catheterization (US-IJCVC), where the experience level of the physician impacts the likelihood of incurring complications. The Dynamic Haptic Robotic Trainer (DHRT) was developed to train residents in CVC as an improvement over manikin trainers, however, the DHRT and manikin trainer both only provide training on one specific portion of CVC, needle insertion. As such, CVC SBT would benefit from more comprehensive training. An extended version of the DHRT was created, the DHRT + , to provide hands-on training and automated feedback on additional steps of CVC. The DHRT + includes a full CVC medical kit, a false vein channel, and a personalized, reactive interface. When used together, the DHRT and DHRT + systems provide comprehensive training on needle insertion and catheter placement for CVC. This study evaluates the impact of the DHRT + on resident self-efficacy and CVC skill gains as compared to training on the DHRT alone.MethodsForty-seven medical residents completed training on the DHRT and 59 residents received comprehensive training on the DHRT and the DHRT + . Each resident filled out a central line self-efficacy (CLSE) survey before and after undergoing training on the simulators. After simulation training, each resident did one full CVC on a manikin while being observed by an expert rater and graded on a US-IJCVC checklist.ResultsFor two items on the US-IJCVC checklist, “verbalizing consent” and “aspirating blood through the catheter”, the DHRT + group performed significantly better than the DHRT only group. Both training groups showed significant improvements in self-efficacy from before to after training. However, type of training received was a significant predictor for CLSE items “using the proper equipment in the proper order”, and “securing the catheter with suture and applying dressing” with the comprehensive training group that received additional training on the DHRT + showing higher post training self-efficacy.ConclusionsThe integration of comprehensive training into SBT has the potential to improve US-IJCVC education for both learning gains and self-efficacy.

The Quality of Family Medicine Team Conferences Through the Lens of a Director: An Autoethnography.

Introduction In rural medical settings, team conferences are essential for effective patient care, especially given the challenges of limited resources and personnel. These conferences promote collaborative discussions on patient management and serve as vital educational sessions. This study explores the dynamics and efficacy of team conferences in the family medicine department of a rural hospital to optimize patient care and educational outcomes. Methods This qualitative study used autoethnography at Unnan City Hospital, Unnan, Japan. Data collection included semi-structured interviews, direct observation, reflective field notes, and informal conversations with medical students, junior residents, and general medicine trainees. The focus was on conference interactions, educational content, and operational challenges. Data analysis involved coding and theming, with ongoing discussions among researchers and participants to refine findings. Results Three key themes emerged. First, patient outcomes suffered from a lack of professional awareness. Second, mutual understanding and individual autonomy enhanced team quality. Third, team healthcare quality improved through diverse and inclusive learning experiences. Effective facilitation, structured time management, and integrating practical bedside learning with theoretical discussions were crucial for optimizing team conferences. Psychological safety, respect for individual differences, and maintaining motivation were essential for productive team interactions. Conclusion The study highlights the importance of effective facilitation, time management, and integrating practical and theoretical learning in enhancing team conferences in rural medical settings. Psychological safety and mutual respect are vital for fostering a collaborative and motivated team environment. Addressing these factors can improve patient care and educational experiences. Future research should include diverse settings and quantitative measures to validate and refine these insights, enhancing team conferences in rural healthcare environments.

Internal Medicine and Internal Medicine-Pediatrics Residency Program Website Traffic Patterns Across Two Institutions and Five Electronic Residency Application Service (ERAS) Cycles.

Background Since the start of the COVID-19 pandemic in Spring 2020, medical residency program recruitment has become increasingly web-based due to the transition to virtual interviews. Although social media use by residency programs has soared during this time, applicant surveys show that official program websites remain the most used online resource. According to survey-based studies, the content that applicants favor on program websites tends to mirror their priorities in choosing programs. However, it is unclear whether applicant-reported priorities in program choice and website content truly drive program website traffic. In this analysis, we will elucidate website traffic patterns from two Internal Medicine residency programs and two Internal Medicine-Pediatrics programs, both in terms of the thematic content of high-traffic pages and changes in traffic patterns throughout the Electronic Residency Application Service (ERAS) application cycle. We will provide novel, data-driven guidance to residency program leadership regarding website content. Methodology For each of the four programs included in the analysis, total pageviews on a monthly basis were obtained for the annual ERAS application cycles taking place from 2017 through 2022. For one Internal Medicine program, data was only available for its current website from 2020 to 2022. The mean monthly pageviews were calculated for each page within each website. The total site traffic trends across each year and within high-traffic months were totaled as well. Results As expected, the highest traffic period for all programs in all years was the days before the application deadline, with a secondary, smaller spike in traffic around Match Day. In general, the most popular pages for all four programs were thematically in line with the top five applicant priorities in the 2022 National Resident Matching Program applicant survey, namely, geographic location, goodness of fit, program reputation, work/life balance, and current program residents. Three of the websites featured unique content that unexpectedly proved to be as popular as the top survey-reported topics, such as pages related to a new major clinical site, a new integrated subspecialty pathway, and, most profoundly, a pipeline program for certain applicants from groups that are underrepresented in medicine. Alumni career content was also heavily trafficked across all four programs. Conclusions Program directors should plan twice-yearly updates to residency program websites, timed to be finished by the start of the ERAS cycle in the fall, and again just before Match Day in March. Program directors should include specific, up-to-date information about unique program features. Future research should incorporate a more diverse variety of programs, software-based page content analysis, and traffic source data.

Student-to-Student: A Novel Approach to Community Outreach.

Community outreach is an established method for organizations to interact with the community. It is often done to help improve the community and its members by providing resources and educational opportunities. A growing crisis facing the United States of America is a worsening physician shortage, which will negatively impact many across the nation, especially vulnerable communities. The Student-to-Student organization offers a novel approach to community outreach by helping introduce and inspire high school students and young adults to pursue medicine. The organization is run by medical students and supervised by the College of Medicine faculty. It offers students from local high schools, community colleges, and undergraduate universities the opportunity to visit the medical college, where they can explore human anatomy and discuss the different facets of medicine and medical education with current medical students. This experience provides medical students with the ability to refine their public speaking abilities, gain leadership experience, improve their professional identity, and be involved in meaningful community outreach. These attributes also serve to enhance medical student residency applications at a time when uncertainties abound in the aftermath of Step One becoming pass/fail. The organization has run continuously since 1987 (except for one year during the COVID-19 pandemic). It has evolved over the years to become a high-performing organization that provides more than 80 tours yearly to thousands of students from the surrounding communities. This article aims to provide a detailed description of the history, organization, and impact of the Student-to-Student organization so that other medical students have a framework for implementing a similar program at their institution.

Puerto Rican physician’s recommendations to mitigate medical migration from Puerto Rico to the mainland United States

Puerto Rico (PR) is a United States (US) territory with a history of colonial violence, poverty, and government corruption. Due to these sociopolitical factors and natural disasters (e.g., hurricanes and earthquakes), there has been a sharp increase in PR residents migrating to the mainland US. Local media and professional health organizations focus on the impact of medical migration on the PR health system (e.g., health personnel shortages and long waiting periods for critical care). According to the PR College of Physicians and Surgeons, 365–500 physicians have left annually since 2014, which represents a crisis of access to health services. However, few studies have focused on ways to mitigate medical migration from PR to the US mainland. This article describes the recommendations provided by migrating and non-migrating Puerto Rican Physicians (PRPs) to mitigate medical migration from PR to the US mainland. We focus on qualitative data from a mixed-methods NIH-funded study (1R01MD014188) to explore factors that motivate or mitigate migration among migrating (n = 26) and non-migrating (n = 24) PRPs. Interviews were analyzed following thematic analysis guidelines. Results show the following themes: 1) strategies to retain early-career medical residents living in PR; 2) recommendations for local government on future health policy; and 3) work environment initiatives for health institutions to mitigate physician migration. Findings suggest multilevel efforts are required to mitigate medical migration in PR.

Psychometric properties of the Arabic version of PHEEM applied on a sample of medical residents in Syria

BackgroundThe clinical learning environment (CLE) plays a crucial role in shaping the learning experiences and professional development of medical professionals. Understanding and optimising this environment is essential for improving doctors’ knowledge acquisition, clinical skills, and overall well-being. The development of the Postgraduate Hospital Educational Environment Measure (PHEEM) and its translation to numerous languages has been a milestone in clinical education. Even though PHEEM was recently translated into Arabic, its psychometric properties in this form remain unevaluated. Therefore, this study aims to conduct a comprehensive psychometric analysis of the Arabic version of the PHEEM questionnaire.MethodsThis is a cross-sectional questionnaire survey validation study. The defined population were medical residents in Damascus, Syria. A paper-based survey as well as an online-based one were conducted using several non-probability sampling methods namely, convenience, river and, snowball sampling between June 15, 2023, and June 21, 2023. Both exploratory (EFA) and confirmatory (CFA) factor analyses were conducted. Several psychometric criteria were applied including scree plot, eigenvalue > 1.5 and the ‘proportion of variance accounted for’ criterion.ResultsA total of 543 participants completed the questionnaire (56.9% female). Kaiser-Meyer-Olkin measure for sample adequacy was high (0.937) and the P-value for Bartlett’s test was < 0.001. EFA revealed five meaningful factors which were labelled: perception of teachers, learner’s engagement and social participation, external regulation, work culture, and living conditions. These factors had the following eigenvalues: 12.6, 2.18, 2.03, 1.86, and 1.41 respectively, with a total explained variance of 43.45%. Cronbach’s Alpha was 0.938. CFA confirmed the model structure of EFA (SRMR = 0.067 and RMSEA = 0.066). The Average Variance Explained (AVE) value of any given factor was > 0.7.DiscussionThe Arabic PHEEM inventory demonstrated satisfactory psychometric properties. The extracted domains are of theoretical relevance to the psychosocial-material conceptual framework for learning environment. Nonetheless, this validation was performed in the Syrian context; therefore, future studies in other Arabic countries are recommended to support the applicability of Arabic PHEEM in the wide Arab World.

Suicide Literacy and Attitudes Toward Seeking Psychological Help among Medical Residents.

This study investigates suicide literacy, help-seeking attitudes, and related factors among medical residents. The study utilized a cross-sectional design and included all medical residents in Kerman University of Medical Sciences in 2023‒2024. We obtained demographic information, psychiatric history, and administered questionnaires about literacy of suicide (LOSS) and the Attitudes Toward Seeking Professional Psychological Help (ATSPPH-SF). A total of 157 residents with a mean age of 28.97±2.55 years participated. The prevalence of any psychiatric history was 17.83% (95% CI: 12.1‒23.56). Notably, more educated males displayed higher suicidal literacy (95% CI: 0.231‒0.567, P=0.032), while there was no significant difference in help-seeking attitudes between genders (P=0.755). Surgical residents scored lower than non-surgical specialties like pediatrics (mean difference=2.63, 95% CI: 0.23-5.03, P=0.023, effect size d=0.589). Older age positively correlated with help-seeking attitudes (r=0.158, P=0.049). Additionally, marital status, residency level, history of psychiatric illnesses and their types, previous use of psychiatric medications, and history of self-harm or suicide had no significant impact on suicide literacy scores or attitude toward help-seeking. A moderate association (r=0.367) was found between the suicide literacy and help-seeking attitude questionnaire scores. Despite relatively high suicide literacy, medical residents displayed average help-seeking attitudes, positioning them as a high-risk group. Urgent interventions are needed to enhance awareness of the importance of psychological support and to reduce stress and work pressure, indirectly mitigating the risk of suicide in this vulnerable population.