Medical Shortages Research Articles

Introduction of Computer‐based Simulation for undergraduate Anatomy teaching

Introduction Medical schools face shortage of cadavers for teaching anatomy, more pronounced with COVID-19 pandemic and decrease in procurement of cadavers. Students over the years are getting averse to the cadaver due to awareness of dangers related to components of the embalming fluid like formaldehyde and complain of dissection as a stressful instruction. Aim To introduce and evaluate feasibility, acceptability and effectiveness of Computer Based Simulation (CBS) for teaching Anatomy to undergraduate students. Objectives To introduce Computer-based simulation for teaching human anatomy to medical undergraduates. To assess the feasibility and acceptability of Computer-based Simulation (CBS) teaching for human anatomy for medical undergraduates. To evaluate the effectiveness in learning human anatomy by online Computer Based Simulation teaching Methodology After obtaining ethics approval, this prospective crossover randomized controlled study was conducted online on two modules in the head and neck region by teaching on pre-prepared Videos by both cadaveric and computer simulation techniques. Pre and post test and anonymous feedback were taken Teachers’ perceptions of the students’ understanding of anatomy and the teaching methodology were assessed by written feedback forms. Results Significant difference was observed in mean score of both the techniques (p=0.033). The mean score of students taught via CBS was significantly higher than the cadaveric group. An overwhelming 88% of participants agreed that teaching via the CBS would be safer in the pandemic. Faculty was satisfied by CBS teaching as almost 90% of them appreciated the quality of student interaction and experience of teaching via CBS. Conclusions The study concludes that it is feasible to use computer-based simulation technique for teaching anatomy to Phase I MBBS students. The feedback given by the students showed that the CBS teaching method was acceptable to them as it gave them a good insight into 3- D understanding of the human body increased their understanding of the relations of body structures and organs and increased their capacity to grasp surface anatomy. It was an effective method of learning by the students and was found to induce a significant improvement in their understanding and perception. Teaching faculty also accepted computer-based simulation technique as an effective method of teaching.

Measuring accessibility to health care services for older bus passengers: A finer spatial resolution

Health care accessibility is a vital indicator for evaluating areas where there are medical shortages. However, due to the lack of population data with a satisfactory spatial resolution, efforts to accurately measure health care accessibility among older individuals have been hampered to some extent. To address this issue, we attempt to measure accessibility to health care services for older bus passengers in Nanjing, China, using a finer spatial resolution. More specifically, based on one month's worth of bus smart card data, a framework for identifying the home stations (i.e., a passenger's preferred station near their residence) of older passengers is developed to measure the aggregate demand at the bus stop scale. On this basis, a measurement that integrates the Gaussian two-step floating catchment area (2SFCA) and the adjusted 2SFCA methods (referred to as the adjusted Gaussian 2SFCA method) is proposed to measure accessibility to health care services for older people. The results show that: (1) almost all home stations experience inflated demand, especially those located in the suburbs; (2) despite abundant health care resources, home stations in urban districts are rarely identified as high accessibility stations, due to high demand densities among the older population; and (3) more attention should be paid to two types of home stations – those with a medical institution and those with bed shortages, respectively. The first type is predominantly distributed in the periphery of the city, in the suburbs where the travel time required to access the nearest health care service by bus is longer. The second type is mostly located in the outskirts of urban districts and in the central area of one suburb. These findings could help policy makers to implement more appropriate measures to design and reallocate health care resources.

An integrated addictions nursing subspecialty to expand the opioid use disorder and substance use disorder workforce

IntroductionIn the U.S. approximately11.4 million misused prescription pain relievers; 2.1 million had an OUD in 2017. The Addictions Nursing Subspecialty was created to address this epidemic by expanding a workforce trained in OUD/SUD screening, treatment, and prevention. A curriculum was developed that included integrated/telehealth health care settings in medical and mental health provider shortage areas during their last nine months of training. Courses were developed and taught by aninterprofessional team of university faculty and informed by evidence-based guidelines/clinical competencies for effective OUD/SUD screening/prevention, assessment, treatment, and recovery. Courses were also offered as electives for nursing, clinical-counseling, social work, and other health science disciplines emphasizing an interdisciplinary approach to healthcare.ObjectivesExpand the OUD/SUD trained workforce in areas with high OUD/SUD mortality rates and high mental health provider shortages emphasizing team-based integrated care and telehealth settings.MethodsProgram curriculum was informed by evidence-based guidelines/clinical competencies for effective OUD/SUD screening/prevention, assessment, treatment, and recovery using integrated care. Competencies included: Core Competencies for Integrated Behavioral Health and Primary Care that have been set forth by the Center for Integrated Health Solutions, telehealth competencies outlined in the recommended competencies by the National Organization of Nurse Practitioner Faculties (NONPF), and Core Competencies for Addictions Medicine by the American Board of Addictions Medicine.ResultsApproximately 11 students enrolled in courses received additions integrated/telehealth health care settings. Students responded positively to evaluations regarding timely feedback, unique approach (i.e. intrative content, short videos and discussions).ConclusionsThe Addictions Nursing subspecialty will continue to be offered allowing enrollment for nurses twice a year.

Evaluating medical education regulation changes in Brazil: workforce impact

BackgroundShortages and inequitable distribution of physicians is an obstacle to move towards Universal Health Coverage, especially in low-income and middle-income countries. In Brazil, expansion of medical school enrollment, curricula changes and recruitment programs were established to increase the number of physicians in underserved areas. This study seeks to analyze the impact of these measures in reduce inequities in access to medical education and physicians’ distribution.MethodsThis is an observational study that analyzes changes in the number of undergraduate medical places and number of physicians per inhabitants in different areas in Brazil between the years 2010 and 2018. Data regarding the number of undergraduate medical places, number and the practice location of physicians were obtained in public databases. Municipalities with less than 20,000 inhabitants were considered underserved areas. Data regarding access to antenatal visits were analyzed as a proxy for impact in access to healthcare.ResultsFrom 2010 to 2018, 19,519 new medical undergraduate places were created which represents an increase of 120.2%. The increase in the number of physicians engaged in the workforce throughout the period was 113,702 physicians, 74,771 of these physicians in the Unified Health System. The greatest increase in the physicians per 1000 inhabitants ratio in the municipalities with the smallest population, the lowest Gross Domestic Product per capita and in those located in the states with the lowest concentration of physicians occurred in the 2013–2015 period. Increase in physician supply improved access to antenatal care.ConclusionsThere was an expansion in the number of undergraduate medical places and medical workforce in all groups of municipalities assessed in Brazil. Medical undergraduate places expansion in the federal public schools was more efficient to reduce regional inequities in access to medical education than private sector expansion. The recruitment component of More Doctors for Brazil Program demonstrated effectiveness to increase the number of physicians in underserved areas. Our results indicate the importance of public policies to face inequities in access to medical education and physician shortages and the necessity of continuous assessment during the period of implementation, especially in the context of political and economic changes.

Management of abdominal emergencies in adults using telemedicine and artificial intelligence.

The terms "telemedicine" and "artificial intelligence" (AI) are used today throughout all fields of medicine, with varying degrees of relevance. If telemedicine corresponds to practices currently being developed to supply a high quality response to medical provider shortages in the general provision of healthcare and to specific regional challenges. Through the possibilities of "scalability" and the "augmented physician" that it has helped to create, AI may also constitute a revolution in our practices. In the management of surgical emergencies, abdominal pain is one of the most frequent complaints of patients who present for emergency consultation, and up to 20% of patients prove to have an organic lesion that will require surgical management. In view of the very large number of patients concerned, the variety of clinical presentations, the potential seriousness of the etiological pathology that sometimes involves a life-threatening prognosis, healthcare workers responsible for these patients have logically been led to regularly rely on imaging examinations, which remain the critical key to subsequent management. Therefore, it is not surprising that articles have been published in recent years concerning the potential contributions of telemedicine (and teleradiology) to the diagnostic management of these patients, and also concerning the contribution of AI (albeit still in its infancy) to aid in diagnosis and treatment, including surgery. This review article presents the existing data and proposes a collaborative vision of an optimized patient pathway, giving medical meaning to the use of these tools.

Cardiology Department Practices in the First Wave of the Coronavirus Disease Pandemic - A Nationwide Survey in Japan by the Japanese Circulation Society.

Background: From the early phase of the Coronavirus disease-2019 (COVID-19) pandemic, cardiologists have paid attention not only to COVID-19-associated cardiovascular sequelae, but also to treatment strategies for rescheduling non-urgent procedures. The chief objective of this study was to explore confirmed COVID-19 cardiology case experiences and departmental policies, and their regional heterogeneity in Japan.Methods and Results: We performed a retrospective analysis of a nationwide survey performed by the Japanese Circulation Society on April 13, 2020. The questionnaire included cardiology department experience with confirmed COVID-19 cases and restriction policies, and was sent to 1,360 certified cardiology training hospitals. Descriptive analysis and spatial autocorrelation analysis of each response were performed to reveal the heterogeneity of departmental policies. The response rate was 56.8% (773 replies). Only 16% of all responding hospitals experienced a COVID-19 cardiology case. High-risk procedures were restricted in more than one-fifth of hospitals, including transesophageal echocardiography (34.9%) and scheduled catheterization (39.5%). The presence of a cardiologist in the COVID-19 team, the number of board-certified cardiologists, any medical resource shortage and a state of emergency were positively correlated with any type of restriction.Conclusions: We found both low clinical case experiences with COVID-19 and restrictions of cardiovascular procedures during the first COVID-19 wave in Japan. Restrictions arising as a result of COVID-19 were affected by hospital- and country-level variables, such as a state of emergency.

A New Perspective for Improving the Human Resource Development of Primary Medical and Health Care Institutions: A Structural Equation Model Study.

In some countries, including China, primary health care is rarely utilized because of medical personnel shortages at primary medical and health care institutions (PMHCIs). Several studies suggest that the most effective solution is to guide qualified doctors and medical graduates to work in PMHCIs, but the studies and measures have been formulated only from the perspective of the government and PMHCIs; few have considered the subjective willingness of medical personnel. Therefore, it is necessary to explore the measures to develop human resources of PMHCIs from the guiding object. This research was divided into two parts based on implicit theory and a lexical approach. The first part collected the factors affecting their choosing PMHCIs for employment, and the second part used exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling (SEM) to explore the dimensions and paths of the influencing factors. At last, seven factors were obtained from the EFA, and the SEM hypothesis fit the data well. Internal Organization Development, Patient Factor, Remuneration and Development, and Family Support had a significantly positive effect on the Sense of Gain of medical personnel seeking employment at PMHCIs, whereas both Job Responsibilities and Condition of the City Where the PMHCI Is Located had no significant effect. In addition, the indirect effects of Internal Organization Development and Condition of the City Where the PMHCI Is Located on the Sense of Gain were significant. The Patient Factor, Family Support, and Remuneration and Development significantly mediated the relationship between the internal and external environment of the institution and the Sense of Gain, whereas the mediating effect of Job Responsibilities was not significant. The improvement of family support, remuneration and development, and patient factors increase the willingness of medical personnel to seek employment at PMHCIs. In addition, the internal and external environments of a PMHCI play a vital role in guiding medical personnel to PMHCIs for employment. This research provides theoretical support for improving the development of human resources, guiding medical personnel to work in PMHCIs, and promoting the use of primary care services.

Preferences for Artificial Intelligence Clinicians Before and During the COVID-19 Pandemic: Discrete Choice Experiment and Propensity Score Matching Study

BackgroundArtificial intelligence (AI) methods can potentially be used to relieve the pressure that the COVID-19 pandemic has exerted on public health. In cases of medical resource shortages caused by the pandemic, changes in people’s preferences for AI clinicians and traditional clinicians are worth exploring.ObjectiveWe aimed to quantify and compare people’s preferences for AI clinicians and traditional clinicians before and during the COVID-19 pandemic, and to assess whether people’s preferences were affected by the pressure of pandemic.MethodsWe used the propensity score matching method to match two different groups of respondents with similar demographic characteristics. Respondents were recruited in 2017 and 2020. A total of 2048 respondents (2017: n=1520; 2020: n=528) completed the questionnaire and were included in the analysis. Multinomial logit models and latent class models were used to assess people’s preferences for different diagnosis methods.ResultsIn total, 84.7% (1115/1317) of respondents in the 2017 group and 91.3% (482/528) of respondents in the 2020 group were confident that AI diagnosis methods would outperform human clinician diagnosis methods in the future. Both groups of matched respondents believed that the most important attribute of diagnosis was accuracy, and they preferred to receive combined diagnoses from both AI and human clinicians (2017: odds ratio [OR] 1.645, 95% CI 1.535-1.763; P<.001; 2020: OR 1.513, 95% CI 1.413-1.621; P<.001; reference: clinician diagnoses). The latent class model identified three classes with different attribute priorities. In class 1, preferences for combined diagnoses and accuracy remained constant in 2017 and 2020, and high accuracy (eg, 100% accuracy in 2017: OR 1.357, 95% CI 1.164-1.581) was preferred. In class 2, the matched data from 2017 were similar to those from 2020; combined diagnoses from both AI and human clinicians (2017: OR 1.204, 95% CI 1.039-1.394; P=.011; 2020: OR 2.009, 95% CI 1.826-2.211; P<.001; reference: clinician diagnoses) and an outpatient waiting time of 20 minutes (2017: OR 1.349, 95% CI 1.065-1.708; P<.001; 2020: OR 1.488, 95% CI 1.287-1.721; P<.001; reference: 0 minutes) were consistently preferred. In class 3, the respondents in the 2017 and 2020 groups preferred different diagnosis methods; respondents in the 2017 group preferred clinician diagnoses, whereas respondents in the 2020 group preferred AI diagnoses. In the latent class, which was stratified according to sex, all male and female respondents in the 2017 and 2020 groups believed that accuracy was the most important attribute of diagnosis.ConclusionsIndividuals’ preferences for receiving clinical diagnoses from AI and human clinicians were generally unaffected by the pandemic. Respondents believed that accuracy and expense were the most important attributes of diagnosis. These findings can be used to guide policies that are relevant to the development of AI-based health care.

Overview of the User Experience for Snorkeling Mask Designs during the COVID-19 Pandemic.

During the first wave of the COVID-19 pandemic, industries and academic institutes have collaborated to resolve the worldwide medical supply shortage issues. Innovative designs of 3D-printed items were proposed and developed by the maker community as a temporary solution to address the lack of personal protective equipment. An overview of global ongoing and past initiatives during the COVID-19 pandemic along with their challenges on retrofitting full-face snorkeling masks for healthcare applications such as splash-proof face shields, respirator masks and non-invasive ventilation systems are reported in this contribution. This study reviews these global initiatives and challenges. From our analysis, the present situation highlights the need to build solid networks between healthcare institutes and the different rapid prototyping initiatives. A clear feedback system needs to be implemented to facilitate effective collaboration between engineering (maker) and healthcare teams, to optimize the available human resources, and to achieve adequate product developments responding to the needs of healthcare workers.

Do access, quality and cost of general practice affect emergency department use?

Limited access, poor experience, and high out-of-pocket (OOP) costs of primary care services may lead to avoidable emergency department (ED) presentations. But, the evidence has been limited with most of the studies using surveys conducted in EDs. Using detailed health survey data of Australian women linked to multiple administrative datasets, we extend the literature by estimating the effects of access, costs, and experience of general practice (GP) services on the probability of ED attendance while accounting for a large set of health and socioeconomic covariates. Our findings suggest that improvements in access to primary care services can significantly reduce the demand for low acuity ED presentations. We also show that the impact of increased accessibility of GP services is expected to be the highest for socioeconomic vulnerable populations and patients whose access is the poorest. This evidence can be useful for the design of targeted policies aimed at improving access to doctors in particular areas that are socioeconomically disadvantaged and where medical skill shortages are significant. However, policies aimed at reduction in primary care OOP costs or improvement in the perception of GP quality are less likely to be effective in reducing the number of non-urgent ED presentations.

Detecting Cataract Using Smartphones.

Objective: Cataract, which is the clouding of the crystalline lens, is the most prevalent eye disease accounting for 51% of all eye diseases in the U.S. Cataract is a progressive disease, and its early detection is critical for preventing blindness. In this paper, an efficient approach to identify cataract disease by adopting luminance features using a smartphone is proposed. Methods: Initially, eye images captured by a smartphone were cropped to extract the lens, and the images were preprocessed to remove irrelevant background and noise by utilizing median filter and watershed transformation. Then, a novel luminance transformation from pixel brightness algorithm was introduced to extract lens image features. The luminance and texture features of different types of cataract disease images could be obtained accurately in this stage. Finally, by adopting support vector machines (SVM) as the classification method, cataract eyes were identified. Results: From all the images that we fed into our system, our method could diagnose diseased eyes with 96.6% accuracy, 93.4% specificity, and 93.75% sensitivity. Conclusion: The proposed method provides an affordable, rapid, easy-to-use, and versatile method for detecting cataracts by using smartphones without the use of bulky and expensive imaging devices. This methodcan be used for bedside telemedicine applications or in remote areas that have medical shortages. Previous smartphone-based cataract detection methods include texture feature analysis with 95 % accuracy, Gray Level Co-occurrence Matrix (GLCM) method with 89% accuracy, red reflex measurement method, and RGB color feature extraction method using cascade classifier with 90% accuracy. The accuracy of cataract detection in these studies is subject to changes in smartphone models and/or environmental conditions. However, our novel luminance-based method copes with different smartphone camera sensors and chroma variations, while operating independently from sensors’ color characteristics and changes in distances and camera angle. Clinical and Translational Impact—This study is an early/pre-clinical research proposing a novel luminance-based method of detecting cataract using smartphones for remote/at-home monitoring and telemedicine application.

Nursing Care Management Strategies in Isolation Wards during the COVID-19 Outbreak

Coronavirus disease 2019 (COVID-19) is highly infectious and has spread worldwide. Medical staff may be exposed to the infection under circumstances of medical supply shortages and improper protection. How to better protect medical staff has become the focus of all walks of life. Therefore, during the COVID-19 outbreak, timely adjustments and optimization of nursing management strategies in isolation wards are important for improving care quality and reducing the infection of medical staff. Based on a literature review and clinical nursing management practices, this article summarizes the nursing management strategies in isolation wards during the COVID-19 outbreak, aiming to provide references for clinical nursing managers.

Objektive Verlegungskriterien und proaktives Verlegungs­management zur Steuerung von intensivmedizinischen Kapazitäten

Despite the high number of intensive care beds in German hospitals compared to other European countries, intensive care medical shortages are common in daily clinical practice. This is due to a hardly established cross-departmental discharge and transfer management with missing objective discharge criteria, lack of personnel and bed closures. Aboveaverage lengths of stays and increased readmission rates to the intensive care unit also indicate an inefficient use of resources in German hospitals. Against this background, a systematic literature search was carried out on the current state of research on discharge criteria from the intensive care unit and transfer processes to follow-up wards. Between 1983 and 2020, 1,917 sources were found, 286 were selected as full text, 104 of which were considered relevant and used as the basis for this work. Approaches, such as a root cause analy- sis of bottleneck situations including the entire hospital system with its interdependent admission, transfer and discharge processes, and the use of electronic decision support in conjunction with standardised discharge criteria can improve the use of existing intensive care capacities and lead to safer and better patient flow. For better use of resources, the therapeutic outcome must be viewed along the entire clinical pathway in order to care for the right patient at the right place and at the right time. A standardised care transition management using objective discharge criteria could help to include the various stakeholders in the discharge decision and patient-transfer process to reflect patient-, caregiver-, process, and institution-specific factors, and ultimately to manage, proactively and efficiently, the available intensive care resources. Decision support in the discharge process using self-learning systems based on available data from patient data management systems is forward-looking, but must be validated more widely in clinical practice.

What triggers online help-seeking retransmission during the COVID-19 period? Empirical evidence from Chinese social media.

The past nine months witnessed COVID-19's fast-spreading at the global level. Limited by medical resources shortage and uneven facilities distribution, online help-seeking becomes an essential approach to cope with public health emergencies for many ordinaries. This study explores the driving forces behind the retransmission of online help-seeking posts. We built an analytical framework that emphasized content characteristics, including information completeness, proximity, support seeking type, disease severity, and emotion of help-seeking messages. A quantitative content analysis was conducted with a probability sample consisting of 727 posts. The results illustrate the importance of individual information completeness, high proximity, instrumental support seeking. This study also demonstrates slight inconformity with the severity principle but stresses the power of anger in help-seeking messages dissemination. As one of the first online help-seeking diffusion analyses in the COVID-19 period, our research provides a reference for constructing compelling and effective help-seeking posts during a particular period. It also reveals further possibilities for harnessing social media's power to promote reciprocal and cooperative actions as a response to this deepening global concern.

Drug shortage crisis in Sudan in times of COVID-19

Sudan is witnessing severe drugs, medicines, and medical supplies shortages, which present a major impediment to the provision of emergency healthcare services. Drug insecurity in Sudan is as a result of several accumulated factors, primarily due to worsening economic condition, inappropriate pricing policy, privatization of the pharmaceutical sector, poor manufacturing and weak weak weregulatory system. These could threaten patient health through replacement of highly efficacious medicines with less effective alternatives and by impacting the scheduling of urgent medical operations and procedures. Drug and medicine shortages are of catastrophic impact especially amid the current epidemic of COVID-19 where these are salient needs. Efforts should be quickly directed to ensure immediate access to pharmaceutical products and other essential health commodities. Effective policies on drug importation, production, pricing, and distribution should be established to avoid the consequences of an impending crisis.

Factors influencing medical students' choice of specialization: A gender based systematic review.

BackgroundStudents’ choice of medical specialties has evolved throughout year, with a growing interest in quality of life and in technological specialties. We investigated the repartition of such choices in the world and its influencing factors with a focus on the gender's influence, for helping policy-makers to deal with medical shortage and territorial to specialty disconnect.MethodsA systematic search was conducted on MEDLINE and Scopus from January 2010 to January 2020. Data extraction and analysis followed JBI and PRISMA recommendations. The selected articles had to focus on medical students, detail their choice of specialty, and look for factors influencing their choice. Articles were excluded if they only assessed the attractiveness of a specialty, or evaluated a public policy. This review was registered on PROSPERO, CRD 42020169227.Findings751 studies were screened, and fifty-four were included. Surgery and internal medicine were the most wanted specialties, both in occidental and non-occidental countries. The main factors influencing the choice of specialty were lifestyle, work-life balance and discipline interest, with variation across different countries. Gender clearly affected this choice with 63.7% of men willing radiology and 14.7% of men in obstetrics and gynecology.InterpretationInfluential factors vary with specialty and are affected by the country of residence. Gender has a great impact in students’ willingness to work in specific specialties. Policymakers should adapt their appealing strategies according to the country and the medical discipline concerned.FundingThe authors have no support or funding to report.

Bargain Hunting for Buffered Lidocaine: A Collaborative Discovery of Cost-saving Strategies That Can Improve Patient Care.

Buffered lidocaine is a local anesthetic option during percutaneous needle-directed procedures in the breast. At our institution, sodium bicarbonate (the buffer) is dispensed in volumes that frequently lead to medical waste and shortages. In this study, we describe how moving the buffering of lidocaine from the procedure room to our clinical hospital pharmacy results in a reduction in costs and improves satisfaction across the breast radiology department. While cost savings are difficult to tease out in practices that opt for bundled payments, we were able to access pricing and supply data and coordinate with our pharmacy to change our practice. Making these changes saves our practice $26 000 a year and allows us to continue to offer buffered lidocaine even during sodium bicarbonate shortages. This manuscript describes how these changes came about and their economic impact.

Using Digitally Distributed Manufacturing to Address Critical Needs

Abstract America Makes has mobilized the additive manufacturing community to work together to address the nation’s medical equipment shortages during the COVID-19 pandemic.

Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study

SummaryObjectivesTo investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors.DesignMixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis.SettingEight acute hospitals, England.Participants36 medical directors, consultants, junior doctors, nurses and manager, 198 documents.ResultsOver time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates.ConclusionsThe programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.

Medically Underserved Populations: The Athletic Trainer's Role

Context Health care cost continues to rise; the US continues to spend dramatically more money than other developed nations per individual without increased health outcomes. More individuals are finding it harder to get access to a health care provider, especially those in medically underserved areas and populations. Objective To increase the knowledge of the athletic training educator about medically underserved populations and the roles athletic trainers (ATs) play as leaders in health care delivery. Background Current and future physician shortages are known and are only going to increase as more than one-third of current primary care physicians are expected to retire in the next 10 years. Forty percent of the population lives in areas that are medically underserved and designated by the government as areas of professional medical shortage; patients in these areas are primarily served by primary care physicians. Synthesis As with access to physicians, access to ATs has been shown to be based upon socioeconomic status and presents more challenges for the medically underserved. Early access to health care providers has shown to be important in adolescents, as negative health behaviors can carry into adulthood, leading to poorer health-related outcomes throughout life. Recommendation(s) To ensure that athletic training educational programs include opportunities to provide service to the medically underserved, education on social determinates of health, and the means by which ATs can fill critical holes in providing care for these patients. More research is needed to validate ATs' roles in providing quality health care. Additionally, more research is needed around how AT education can help meet patient needs. Conclusion(s) As the athletic training profession continues to evolve and responds to the growing demands of the complex health care system, access to an AT may provide a vital bridge to overall health care for patients within medically underserved populations.