Medical School Training Research Articles

Elective placements for medical students in a regional Public Health Department in Ireland

Abstract Exposure to different specialties during medical school influences the subsequent career choice of students. We describe the development of elective student placements in Public Health in a regional Public Health Department (PHD) in Ireland which serves a population of just over one million. In September 2023, a collaboration to oversee the electives was established between our PHD (HSE Dublin and Midlands) and an academic institution (Trinity College Dublin (TCD)). An Elective Working Group (WG) was formed which developed learning objectives and an elective plan. The electives were scheduled for October and November 2023. The key learning objectives were for students to: • Develop an understanding of the role of Public Health across all domains, in our regional PHD and in Ireland; • Develop an understanding of the career pathway in Public Health Medicine in Ireland; • Contribute to a public health project within the PHD. The elective plan included approximately 15 1:1 tutorials across the public health domains, attendance at PHD meetings and a literature review-based project. Between October and November 2023, two students (one per month) were attached to the PHD. At the end of each elective, students presented project findings to the WG for discussion. Debrief sessions gathered feedback from the students, the WG and the TCD partner. Student feedback was overwhelmingly positive. Feedback suggested taking pairs of students at the same time may increase efficiency and capacity for future electives in our PHD. A collaborative approach to planning and coordinating the electives was crucial to its success. We are building on this experience to expand the electives with an increased number of students being facilitated by our PHD in 2024, providing students with greater opportunity to gain exposure to Public Health Medicine during medical training. Application and evaluation materials were refined which can be shared. Key messages • The success of the Public Health electives in our regional Public Health Department was underpinned by a collaborative academic partnership and a structured, coordinated approach. • Availability of Public Health electives during medical school training can support students to gain exposure to this specialty in a time when they are considering future career choices.

Comparison of Outcomes for Patients Treated by Allopathic vs Osteopathic Surgeons

There are 2 degree programs for licensed physicians in the US: allopathic medical doctorate (MD) and osteopathic doctorate (DO). However, evidence is limited as to whether outcomes differ between patients treated by MD vs DO surgeons. To evaluate differences in surgical outcomes and practice patterns by surgeon medical school training (MD vs DO). This retrospective cohort study used 100% Medicare claims data from inpatient hospitals providing surgical services from January 1, 2016, to December 31, 2019 among Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent 1 of the 14 most common surgical procedures. Data analysis was performed from January 17, 2023, to August 13, 2024. Medical school degree (MD vs DO). The primary outcome was 30-day mortality, and the secondary outcomes were readmissions and length of stay. To assess differences between surgeons by medical school training, a multivariable linear probability model was used, which was adjusted for hospital fixed effects and patient, procedure, and surgeon characteristics. Of the 2 360 108 total surgical procedures analyzed, 2 154 562 (91.3%) were performed by MD surgeons, and 205 546 (8.7%) were performed by DO surgeons. Of 43 651 total surgeons, most surgeons were MDs (39 339 [90.1%]), the median (SD) age was 49.0 (9.8) years, and 6649 surgeons (15.2%) were female. The mean (SD) age of patients undergoing surgical procedures was 74.9 (6.7) years, 1 353 818 of 2 360 108 patients (57.4%) were female, and 2 110 611 patients (89.4%) self-reported as White. DO surgeons were significantly more likely to operate on older patients (DO patient mean [SD] age: 75.3 [7.1] years; MD patient mean [SD] age: 74.8 [6.6]), female patients (DO: 60.2% of patients; MD: 57.1% of patients), and Medicaid dual-eligible patients (DO: 10.3% of patients; MD: 8.6% of patients). DOs performed a lower proportion of elective operations (DO: 74.2% vs MD: 80.2%) and were more likely to work in public hospitals (DO: 10.3%; MD: 9.5%) and nonteaching hospitals (DO: 57.9%; MD: 68.1%). There was no evidence that 30-day mortality differed between MD and DO surgeons (adjusted mortality rate, DO: 1.61%; MD: 1.58%; absolute risk difference [aRD], -0.04 percentage points; 95% CI, -0.11 to 0.04; P = .37). On secondary analyses, no difference was found in 30-day readmissions or length of stay between MD and DO surgeons. In this retrospective cohort study using Medicare data, there was no evidence that patient outcomes differed between MD and DO surgeons for common operations after adjusting for patient factors and practice settings.

Bridging the procedures skill gap from medical school to residency: a simulation-based mastery learning curriculum.

The transition from medical student to intern is a recognized educational gap. To help address this, the Association of American Medical Colleges developed the Core Entrustable Professional Activities for entering residency. As these metrics outline expectations for all graduating students regardless of specialty, the described procedural expectations are appropriately basic. However, in procedure-heavy specialties such as emergency medicine, the ability to perform advanced procedures continues to contribute to the disconnect between undergraduate and graduate medical education. To prepare our graduating students for their internship in emergency medicine, we developed a simulation-based mastery learning curriculum housed within a specialty-specific program. Our overall goal was to develop the students' procedural competency for central venous catheter placement and endotracheal intubation before graduation from medical school. Twenty-five students participated in a simulation-based mastery learning procedures curriculum for ultrasound-guided internal jugular central venous catheter placement and endotracheal intubation. Students underwent baseline assessment, deliberate practice, and post-test assessments. Both the baseline and post-test assessments used the same internally developed checklists with pre-established minimum passing scores. Despite completing an emergency medicine rotation and a critical care rotation, none of the students met the competency standard during their baseline assessments. All twenty-five students demonstrated competency on both procedures by the end of the curriculum. A second post-test was required to demonstrate achievement of the central venous catheter and endotracheal intubation minimum passing scores by 16% and 28% of students, respectively. Students demonstrated procedural competency for central venous catheter placement and endotracheal intubation by engaging in simulation-based mastery learning procedures curriculum as they completed their medical school training. With three instructional hours, students were able to achieve basic procedural competence for two common, high-risk procedures they will need to perform during emergency medicine residency training.

Knowledge, Attitudes, and Practices of Filipino Medical Interns on the Management of Superficial Cutaneous Mycoses: A Cross-sectional Study.

Superficial mycoses are one of the most common skin conditions encountered in the outpatient clinics, causing significant morbidity amongst patients. Since these are highly prevalent diseases of the skin, the general practitioner should be able to manage uncomplicated cases, with no need for evaluation by a specialist. The study aimed to determine the knowledge, attitudes, and practices of Filipino medical interns on the management of superficial cutaneous mycoses using a self-administered questionnaire. This may help identify possible gaps in knowledge, as well as obstacles these future clinicians may encounter when managing superficial mycoses. This in turn may assist in the development or improvement of dermatology training among medical students and continuing medical education programs amongst non-dermatologist physicians. This is a descriptive cross-sectional study among medical interns of the Philippine General Hospital to investigate their knowledge, attitudes, and practices regarding the management of superficial mycoses. Eligible participants were asked to complete an online self-administered survey questionnaire which assessed their capacity to recognize and manage uncomplicated superficial mycoses, and determined their attitudes regarding dermatology training in medical school. The study included 170 medical interns, with majority having only 1-4 weeks of cumulative duration of dermatology training in medical school. Many of the participants (67.1%) had inadequate overall knowledge scores, but this was not significantly associated with their cumulative duration of dermatology training, as well as with their frequency of encounters with superficial mycosis patients. Most deem dermatology training (92.4%) and learning about the management of superficial mycoses (91.2%) during medical school very important. Majority are interested in attending more courses or training in the subject. Recommendations to improve medical school training on superficial mycoses include more practical approach in dermatology modules, integration of dermatology electives in medical school, and longer duration of dermatology modules/rotations during medical school. While knowledge scores of medical interns were not significantly associated with the duration of their dermatology training during medical school as well as their encounters with patients with superficial mycoses, it is shown that they have low confidence scores regarding management of superficial mycoses. They deem that learning more about this disease and dermatology in general is vital to their medical education and are desirous of more training in this subject. Recommendations to improve medical school training on superficial mycoses include dermatology modules, rotations or electives in medical school. Additionally, better training during medical school, and formulation of clinical practice guidelines specific to cutaneous mycoses were recommended to improve healthcare delivery for patients with such diseases.

MCQs in-training examination scores of the surgical residency program in Thailand: the relationship between medical school vs public health-based training institutions

BackgroundThis study aims at investigating and evaluating the categorical knowledge of residency using an internet-based examination.MethodsAll in-training examinees from 32 Thailand’s general surgery residency training institutions participating in the online examination. One hundred fifty Multiple Choice questions (MCQs) were selected for this examination from a pool of previous MCQs used for board certification examinations. Baseline chracteristic of the examinee including residency year, training institution (medical schools and public health-based training institutions), regional-based area of the institution, overall test score, scoring by subcategory, total time to complete the examination, and the length of accredited as a training centre time were collected and analysed.ResultsTotal 613 examinees. The mean total score of 1st and 3rd year residency of a public health hospital institution differed from those with medical school-based training. On average, the scores in 4 out of 10 categories of residency from medical school training institutions were higher. However, residency from institutions with over 7 years of experience tended to score higher in the Liver, Biliary and Pancreas category.ConclusionsThe average scores of MCQs exams which reflect the medical knowledge for general surgical residency training at medical schools do not significantly differ from those of individuals undergoing public health training. Additionally, the mean scores of MCQs exams did not differ between high-experience training institutions and recent accredited training centers.

Sex diversity in spine surgery fellowship training: analysis of recent trends and program characteristics associated with increased diversity

BACKGROUND CONTEXTSex diversity in the spine surgery workforce remains limited. Accelerated efforts to recruit more female trainees into spine surgery fellowship training may help promote diversity and inclusion in the emerging spine surgery workforce. PURPOSEThis study assessed the representation of female trainees in spine surgery fellowship training and program factors associated with greater sex diversity among fellows. Study Design/SettingThis was a cross-sectional analysis of spine surgery fellows in the United States during the 2016–2017 to 2022–2023 academic years. PATIENT SAMPLEN/A. OUTCOME MEASURESRepresentation (%) and participation-to-prevalence ratios (PPRs) defined as the participation of female trainees in spine surgery fellowship training divided by the prevalence of female trainees in previous training cohorts. PPR values <0.8 indicated underrepresentation. METHODSSex diversity was assessed among spine surgery faculty, spine surgery fellows, orthopaedic surgery residents, neurosurgery residents, and allopathic medical students. Fellowship program characteristics associated with increased sex diversity were calculated with chi square tests. RESULTSThere were 693 spine surgery fellows and 41 were female (5.9%). Sex diversity in spine surgery fellowship training decreased over the study period (6.4% vs. 4.1%, p=.025). Female trainee representation in spine surgery fellowship training was less than that in orthopaedic surgery residency (14.2%, PPR=0.42), neurosurgery residency (17.1%, PPR=0.35), and allopathic medical school (47.6%, PPR=0.12) training (p<.001). There were 508 faculty at 78 spine surgery fellowships and 25 were female (4.9%). There were 3 female fellowship program directors (3.8%). Fellowship program characteristics associated with increased sex diversity included the presence of female faculty (p=.020). Additional program characteristics including geographic region, accreditation status, number of faculty and fellows were not associated with sex diversity (p>.05). CONCLUSIONSFemale representation in spine surgery fellowship training decreased over the study period and remains underrepresented relative to earlier stages of medical and surgical training. There was a positive association between female faculty and increased sex diversity among fellows. Greater efforts are needed to create training environments that promote diversity, equity, and inclusion in spine surgery fellowship training.

Medical student learning on a distributed training platform in rural district hospitals.

Decentralising medical school training enhances curriculum relevance, exposing students to generalist patient care in diverse contexts. The aim of the study was to understand the student experiences of learning during their 7-week Family Medicine rural rotation. Final year medical students who had completed their Family Medicine rotation in November 2022. A qualitative study involving 24 final year students (four semi- structured interviews and four focus group discussions [4 x 5 students]). All interviews were recorded, transcribed verbatim and analysed thematically. Analysis revealed positive learning experiences and identified the following themes: taking responsibility for learning, the generalist context, teaching and learning in context and managing the learning environment. Active participation in hospital activities, exposure to disorientating dilemmas that challenged assumptions and reflection on these experiences led to transformative learning and knowledge co-construction.Contribution:The study contributes to the discussion and reinforces the advantages of distributed, experiential training, highlighting the positive impact of meaningful participation and transformative learning opportunities.

Palliative care in a Graduate Entry Medical Curriculum: exploring students' attitudes on the importance of receiving teaching in palliative care.

As people live longer with life-limiting illnesses, there is greater need for skills and knowledge in palliative care (PC). Medical students should acquire the knowledge, attitudes, and confidence during training for future decision-making. However, most graduates across Europe feel unprepared to provide PC. To develop PC training for medical students, we must gain perspective on their understanding of PC and their learning needs. The aim was to investigate graduate entry medical students' views on the importance of education in PC and how well PC topics were covered within their curriculum. The objective was to highlight areas that could be reviewed for future PC curricula. In this prospective quantitative study, penultimate and final-year students were recruited from a graduate entry medical school. Ethical approval was granted. Students completed an online questionnaire. From 281 recruited students, 82 responded. Ninety-five percent of respondents felt everyone should have a PC rotation. The aspects of education perceived to be most important were knowledge of symptom control, communication, ethical issues, self-care, and grief. The only aspect considered well covered within the curriculum was ethical issues. Ninety-six percent of penultimate and 75% of final years wanted more teaching in PC. Graduate entry medical students view PC as a vital subject within their medical school training. The study highlights challenges in providing education and sufficient placement in PC to correlate with the respondents' perceived needs. The findings contribute to the growing literature surrounding the importance of PC education within the medical school curriculum.

Online digital health and informatics education for undergraduate nursing students in China: impacts and recommendations

BackgroundDigital health plays a vital role in healthcare services. Governments in many countries, including China, are increasingly advocating for the appropriate use of digital technologies to address significant health system challenges. It is crucial to incorporate digital health education into the curriculum for future nurses to adapt to the changes in the digital medical system. This study aimed to evaluate the impact of an online Digital Health and Informatics Course in China on the knowledge and comprehension of key digital health and informatics topics, self-assessment of nursing informatics competencies, and satisfaction among undergraduate nursing students. The findings of this study provide recommendations for the design and implementation of future digital health education.MethodsThis study employed a one-group, quasi-experimental mixed-methods design with pre- and post-assessments. The participants received digital health and informatics education through six three-hour online sessions in six interactive days, with online self-learning materials in between. An online quiz and focus group discussions pre- and post the course were designed to evaluate the knowledge and comprehension of key digital health and informatics topics. Also, a validated Chinese version of the Self-assessment of Nursing Informatics Competencies Scale was conducted pre- and post-course to assess self-assessment of nursing informatics competencies. Additionally, all students were invited to participate in an online survey with a performance-focused course evaluation form as well as focus group discussions to gather their feedback on the learning experience and their evaluations of the course.ResultsA total of 24 undergraduate nursing students were enrolled in the course. All students completed all sessions of this course, resulting in an attendance rate of 100%. Additionally, all students completed both pre- and post-assessments. In terms of the knowledge and comprehension of key digital health and informatics topics, scores of the quiz on knowledge assessment improved from the pre-test [mean pretest score: 78.33 (SD 6.005)] to the post-test [mean post-test score: 83.17 (SD 4.86)] upon completion of the course (P < 0.001). Also, students acknowledged that the course enhanced their knowledge and comprehension of informatics and digital health, the benefits of (nursing) informatics in clinical practice, and the role of health care professionals in informatics and digital health. In terms of self-assessment of nursing informatics competencies, scores on nursing informatics attitudes demonstrated significant improvement (P < 0.001). Furthermore, students reported high satisfaction with various aspects of this course, including the opportunity to explore broad horizons in informatics for future careers, engaging in group discussions, and analyzing case studies on the use of informatics and digital health in clinical practice.ConclusionsThis Online Digital Health and Informatics education effectively improved undergraduate nursing students’ knowledge and comprehension of the key digital health and informatics topics, nursing informatics attitudes in the self-assessment of nursing informatics competency with high levels of satisfaction. In order to ensure that future education in digital health and informatics for nursing students is in line with the technological advancements in clinical settings, it is necessary to foster collaboration between medical school training and clinical practice. This collaboration should involve the use of clinical examples to illustrate advanced digital health applications and the inclusion of practical exercises on the use of digital health technology in clinical settings.

Developing and delivering a migraine disparities and diagnosis undergraduate medical educational program to underrepresented in medicine medical student members of the Student National Medical Association: A pilot project.

Migraine is underdiagnosed. On average, medical students have approximately 3 h of exposure to headache education throughout medical school training. Moreover, some medical students have racially-based biases in pain. There is a paucity of underrepresented in medicine (UIM) headache practitioners. UIM practitioners are more likely to practice in underserved communities and provider-patient ethnic concordance may help eliminate healthcare disparities. The Student National Medical Association (SNMA) is an organization committed to supporting current and future UIM medical students and addressing the needs of underserved communities. The goal of this project was to develop and deliver a brief Migraine Diagnosis and Disparities Undergraduate Medical Education Program (MD2UMEP) to increase awareness of migraine diagnosis and disparities in UIM medical students in the SNMA. For connecting/relationship-building with SNMA, the SNMA Region V website was reviewed. Calls were made to Wayne State University School of Medicine (WSUSOM) Office of Diversity, Equity, and Inclusion (ODEI) explaining the educational initiative with subsequent emails to the Director of WSUSOM's ODEI followed by a video-conference meeting (VCM). VCMs were conducted with two SNMA member leaders from WSUSOM. A local and regional presentation/delivery of the MD2UMEP was planned. Communication was maintained electronically. For development/delivery of the MD2UMEP, headache literature was reviewed for key concepts underpinning migraine diagnosis and migraine disparities with a focus on African Americans. Slides with talking points were developed with references. Pre- and posttest questions were drafted and made accessible via a QR code. The MD2UMEP was presented and students completed the questionnaires. Descriptive statistics were used to quantify responses. The MD2UMEP work began July 31, 2021, with program delivered in final form on October 1, 2022. A professional relationship was established with SNMA leadership. A MD2UMEP was developed then administered at the 2022 SNMA Region V Medical Education Conference. Headache medicine was introduced to UIM SNMA medical students. Anonymously, nine individuals responded to the MD2UMEP pretest questions. Eight individuals answered the posttest questions. At the program's conclusion, UIM student performance improved on seven of 10 test questions on migraine diagnosis and disparities and remained at 100% on one of 10 test questions. On two of the questions, the number correct remained the same (although percentage overall increased due to the smaller denominator). There was a higher proportion of correct responses on the posttest. There is great need for migraine diagnosis and disparities education among medical students. A new migraine diagnosis and disparities program was developed for medical students. SNMA members were receptive to the MD2UMEP and it strengthened their knowledge of migraine diagnosis and disparities. This program exposed UIM medical students to headache medicine.

Compassionate Othering: the construction of refugee patients in medical students’ narratives – a qualitative study using story completion

BackgroundRefugees remain a marginalized population and are exposed to a variety of discriminatory processes, among them Othering which categorizes people as belonging or not-belonging according to certain ascribed characteristics. We explored how the narrative construction of refugee patients by medical students constitutes a form of Othering.MethodsUsing story completion, 124 5th year medical students at the Martin- Luther- University Halle-Wittenberg in October 2019 wrote a fictional story in response to a story stem situated in a medical practice. In a comparative approach, one patient presenting with abdominal pain lacks further characterization (version A) and the other is a refugee (version B). The stories were coded using qualitative content analysis by Mayring with a focus on content and narrative strategies (plot structure and perspective).ResultsWe identified four themes: characters, medical condition, access to care and provision of substandard care. The stories were predominantly framed with a medical or an interaction-based plot structure and written from a process-oriented perspective. The themes in version B, supported by their use of narrative strategies, were largely contextualized within the patients’ history of migration. An empathic depiction of patient B and the students’ compassion for the patients facing substandard care were key motifs as well.ConclusionThe perception of the version B patients predominantly as refugees establishes their construction as an Other. The students’ compassion acts as a representation of societal inequalities and remains an inept response without the tools to counter underlying discriminatory structures. Based on a discourse of deservingness, compassion alone therefore perpetuates Othering and highlights the need for structural competency training in medical school.

Navigating Cultural Challenges in Transplant Surgery: Insights from Turkish Surgeons.

To achieve expertise, transplant surgeons in Turkiye undergo rigorous training, including medical school, residency, compulsory service, and extensive training in transplant surgery. Despite their high academic and clinical knowledge level, success in transplant surgery heavily depends on cultural competency. Through semi-structured interviews with 21 transplant surgeons specializing in kidney and liver transplants in Ankara, this study reveals how health illiteracy, culture, and folklore create significant barriers. Surgeons navigate these challenges while enduring harsh working conditions. This research highlights the critical role of cultural competency in transplant surgery, emphasizing the necessity for surgeons to understand and address the diverse cultural needs of their patients. Key findings indicate that surgeons must balance medical expertise with cultural sensitivity to deliver effective care. This study identifies four main cultural barriers: spiritual trust, family politics, health illiteracy, and subcultural incompetency. Effective transplant surgery requires a combination of theoretical proficiency and cultural awareness to meet a patient's needs and improve surgical outcomes.

Persistent unmet need for surgical care in Western Uganda.

Treatable surgical diseases account for a significant proportion of the global burden of disease, particularly in low- and middle-income communities. The number of deaths owing to poor surgical care or its non-availability has been reported to exceed those from HIV/AIDS, tuberculosis and malaria combined. The Ugandan government and its development partners aim to put in place measures to achieve universal health coverage for all communities. These include construction and equipping health facilities, training of health workers, opening up road networks, and poverty alleviation programmes. However, these efforts have, as yet, fallen short as evidenced by external hernias remaining the leading cause of intestinal obstruction for more than 40 years. We recommend establishment of global surgery collaborations with rural-based medical training schools and other health facilities, essential surgical skills training for medical students, task shifting in surgical care and integration of regular surgical camps in the Uganda's healthcare delivery model.

Current state of undergraduate medical school training in transfusion medicine and its impact on postgraduate trainee knowledge.

Studies have described poor transfusion medicine (TM) knowledge in postgraduate trainees. The impact of undergraduate medical TM education on postgraduate knowledge is unclear. Canadian medical schools were surveyed on the number of hours dedicated to TM teaching and topics covered by curricula during 2016-2020. Postgraduate trainees attending Transfusion Camp in 2021 completed a pretest of 20 multiple-choice questions. The survey results and pretest scores were compared to evaluate the association between undergraduate medical TM education and pretest scores. The survey was completed by 16 of 17 Canadian medical schools. The number of hours (h) of TM teaching were <2 h (25%), 3-4 h (25%), and >4 h (50%). Twelve of 19 Transfusion Camp topics were covered in ≥50% of schools. Eleven medical schools provided ethics approvals/waivers to include trainee pretest scores in the analysis (N = 200). The median pretest scores by medical school ranged from 48% to 70%. No association was found between number of TM teaching hours and average pretest scores (p = .60). There was an association between higher postgraduate year level and individual pretest score (p < .0001). The analysis by topic demonstrated questions where trainees from different schools performed uniformly well or poorly; other topics showed considerable variation. Variation in quantity and content of undergraduate TM teaching exists across Canadian medical schools. In this limited assessment, the number of TM teaching hours was not associated with performance on the pretest. This study raises the opportunity to re-evaluate the delivery (content, timing, consistency) of TM education in undergraduate medical schools.

Why is surgery not popular among medical students and young doctors? - Review of literature

Introduction: Contemporary medicine is witnessing significant advancements in conservative treatment modalities. However, surgery remains paramount for radical cancer treatment and emergent conditions such as trauma, peritonitis, gastrointestinal obstruction, and cholecystitis. Despite the essential role of surgeons, there is a global trend indicating waning interest among medical students in pursuing surgical specialties. Concurrently, practicing surgeons report heightened levels of professional burnout, and many regions face a looming shortage of surgical professionals, posing a threat to healthcare quality. Brief Overview of Current Knowledge: Research conducted across Poland, Germany, Argentina, the United Kingdom, and Japan highlights the declining inclination towards surgery among medical students. Students cite unattractive working conditions, poor work-life balance, elevated stress levels, and limited avenues for scholarly growth as deterrents. Gender plays a role, with females expressing heightened concerns regarding work-life balance and family aspirations. Furthermore, the surgical work environment, inadequate preparatory training in medical schools, and prolonged working hours are identified as factors exacerbating burnout risk among surgeons. Summary: Professional burnout represents a significant concern among surgeons, impacting both their work satisfaction and patient safety. Despite the strides made in conservative medical therapies, surgery remains indispensable, yet its allure as a specialty is diminishing among medical students. Understanding and addressing the discouraging factors, along with promoting healthy work practices, may mitigate burnout and encourage young physicians to consider surgical careers.

Emerging Trends in the Prevalence of Military Medicine Interest Groups and Specialty Tracks at U.S. Medical Schools.

A challenge confronting health care is the national physician shortage, notably impacting the DoD's recruitment of military physicians. To address this, the Health Professions Scholarship Program is annually awarded to medical students to facilitate their transition into the U.S. Armed Forces. There is a glaring absence of military medical education in civilian schools to accommodate the unique interests of these students. While medical schools have adapted with interest groups and specialty tracks, the current presence of military medicine interest groups (MMIGs) and military medicine specialty tracks (MMSTs) remains under-explored. This study aimed to (1) update the prevalence of MMIGs in U.S. medical institutions, (2) identify the presence of MMSTs, and (3) compare military medicine involvement between allopathic and osteopathic programs. The study was approved for exempt status from the Kansas City University Institutional Review Board (study number 20,211,568-1). In a cross-sectional analysis, surveys were sent to 208 U.S. medical schools, with responses from student services or available public data from 200 institutions included in the final analysis. A secondary survey was sent to respondents who provided MMIG or MMST contacts. Results indicated that 62% (n = 124/200) of schools currently have an established MMIG, a modest growth from 56% (n = 70/125) in 2015 (p = .14). MMST prevalence, however, is minimal at 2.5% (5/200). Osteopathic institutions demonstrated a significantly greater engagement in military medicine education (88.7%) compared to allopathic schools (52.4%) (p < .001). This research underscores the need for comprehensive military medical training in medical schools to meet the interests and career aspirations of their students. Future studies should also evaluate the efficacy of MMIGs and MMSTs in preparing students for military medical roles.

A New Construct in Undergraduate Medical Education Health Humanities Outcomes: Humanistic Practice.

Proposed educational outcomes for the health humanities in medical education range from empathy to visual thinking skills to social accountability. This lack of widely agreed-upon high-level curricular goals limits humanities educators' ability to design purposeful curricula toward clear, common ends and threatens justifications for scarce curricular time. We propose a novel approach to the hoped-for outcomes of health humanities training in medical schools, which has the potential to encompass traditional health humanities knowledge, skills, and behaviors while also being concrete and measurable: humanistic practice. Humanistic practice, adapted from the concept of ethical sensitivity, is an intentional process of applying humanities knowledge and skills to a clinical scenario by 1) noticing that the scenario requires humanities knowledge or skills, 2) informing one's clinical and interpersonal strategy and behavior with humanities knowledge or skills, 3) reflecting on the effectiveness of the strategy and behavior, and 4) reorienting to develop new approaches for future practice. The construct of humanistic practice may help address some of the foundational problems in health humanities outcomes research since it transcends the traditional diverse content domains in the health humanities, can link patient and provider experiences, and may bridge the divide among the additive, curative, and intrinsic epistemic positions of humanities to medical education.

What are the barriers to health professionals' training on gender-affirming care from patients' and clinicians’ perspectives?

ObjectiveThe aim of the study is to identify the barriers to gender-affirming health care education for providers from the perspectives of patients and providers. MethodsA qualitative study based on grounded theory was conducted. Participants included transgender and gender diverse (TGD) patients seeking care, as well as resident physicians and attending physicians involved in care of patients seeking gender-affirming care. Semi-structured interviews were conducted over Zoom application and telephone calls. The study was conducted in Boston, Massachusetts, USA from November 2022 until February 2023. ResultsNine attending physicians, eight resident physicians, and fifteen patients were interviewed. Attending physicians noted barriers to include lack of formal training in medical school and residency, lack of adequate opportunities for faculty development to appropriately train resident physicians, lack of opportunities for trainees to provide dedicated clinical care, lack of community engagement initiatives, and need for additional training centered on cultural sensitivity and inclusivity. Resident physicians noted a lack of robust and longitudinal didactic curriculum, deficiency in dedicated clinical time, and inadequacy in interprofessional training as major barriers to their training. They noted that they generally felt unprepared to care for TGD patients. Patients' barriers included difficulty building trust in medical providers’ knowledge and skills, being addressed with incorrect names and pronouns, lacking a sense of belonging as a patient, as well as difficulty in arranging care due to lack of a centralized care system. ConclusionBarriers to gender-affirming education include lack of adequate and formal training, lack of professional development opportunities, inadequacy in a multidisciplinary approach to treatment and education, and inadequacy in cultural and sensitivity training. Findings of this qualitative study based on interviews may help facilitate addressing such barriers through creation of routine lecture-based didactic opportunities for providers, investment in faculty development, creation of gender-affirming clinics, providing opportunities for trainees to provide longitudinal care to TGD patients, creation of interdisciplinary training modules, community engagement, and implementation of a multidisciplinary care model, which may help improve gender-affirming care in the long-run.

Status and perception of point-of-care ultrasound education in Korean medical schools: A national cross-sectional study.

As point-of-care ultrasound (POCUS) is increasingly being used in clinical settings, ultrasound education is expanding into student curricula. We aimed to determine the status and awareness of POCUS education in Korean medical schools using a nationwide cross-sectional survey. In October 2021, a survey questionnaire consisting of 20 questions was distributed via e-mail to professors in the emergency medicine (EM) departments of Korean medical schools. The questionnaire encompassed 19 multiple-choice questions covering demographics, current education, perceptions, and barriers, and the final question was an open-ended inquiry seeking suggestions for POCUS education. All EM departments of the 40 medical schools responded, of which only 13 (33%) reported providing POCUS education. The implementation of POCUS education primarily occurred in the third and fourth years, with less than 4 hours of dedicated training time. Five schools offered a hands-on education. Among schools offering ultrasound education, POCUS training for trauma cases is the most common. Eight schools had designated professors responsible for POCUS education and only 2 possessed educational ultrasound devices. Of the respondents, 64% expressed the belief that POCUS education for medical students is necessary, whereas 36%, including those with neutral opinions, did not anticipate its importance. The identified barriers to POCUS education included faculty shortages (83%), infrastructure limitations (76%), training time constraints (74%), and a limited awareness of POCUS (29%). POCUS education in Korean medical schools was limited to a minority of EM departments (33%). To successfully implement POCUS education in medical curricula, it is crucial to clarify learning objectives, enhance faculty recognition, and improve the infrastructure. These findings provide valuable insights for advancing ultrasound training in medical schools to ensure the provision of high-quality POCUS education for future healthcare professionals.

Assessing the Knowledge and Comfort Level of US Family Medicine Residents Regarding Consenting and Confidentiality in Adolescent Health Care.

Organizations recommend providing confidential adolescent health care to reduce the consequences of high-risk health behaviors such as substance use, unhealthy eating patterns, and high-risk sexual behaviors. Family physicians are uniquely positioned to provide confidential counseling and care to this vulnerable population but must be trained to provide such care. This study describes the impact of formal and informal training on the knowledge of and comfort level in providing confidential adolescent healthcare among a sample of US Family Medicine residents. Electronic surveys were distributed to all Family Medicine residents throughout the United States. We used descriptive statistics and χ2 analysis where appropriate to determine the association between resident-reported receipt of training, confidence, and frequency in providing confidential adolescent health care. A total of 714 Family Medicine residents completed the survey. The majority reported no formal training in residency (50.3%). The receipt of formal and informal training in both medical school and residency was associated with a greater degree of comfort in providing confidential adolescent care and a higher likelihood of providing confidential time alone. Those reporting formal training were more likely to always provide confidential care (P = 0.001). Training focused on confidential adolescent health care in medical school or residency was associated with a greater degree of comfort and a higher likelihood of providing confidential adolescent health care.