Medical Specialties Research Articles

Dental education amid armed conflict in Sudan: Unveiling the impact on training.

The ongoing conflict in Sudan has severely disrupted the health professions education, notably in dentistry. This study aims to explore the impact of the armed conflict on dental education and training. A mixed-method cross-sectional study encompassed 29 dental schools in Khartoum, Darfur, Kordofan States, and Merowe City. Five key informants from the Sudanese Medical Specialization Board, the Human Resource Development Administration, and a university offering clinical dental master's programs were interviewed. Quantitative data on attacks against dental schools were collected through a structured Google form, and qualitative data on postgraduate training were obtained through semi-structured key informant interviews. Findings reveal that 79.3% of dental schools faced military assaults, with 73.9% experiencing looting and 60.9% repurposed as military bases. Notably, 44.8% of schools shifted to online education,3.4% collaborated with other universities, and 27.6% adopted a combined approach. Key informants' interviews unveiled disruptions in specialty training and housemanship, limiting access to crucial training facilities. The primary proposed solution was overseas training. Recurrently emphasized strategies to enhance the resilience of the training system included establishing dental centers in all states, collaborating with external training bodies, and anticipating and preparing for potential disasters. The adverse effects of the conflict on both undergraduate and postgraduate dental education are discernible, manifested through resource limitations, a shortage of dental materials and supplies within training facilities, and direct disruptions to clinical training due to attacks on healthcare institutions. The imperative need for urgent interventions is underscored to alleviate these consequences and safeguard the continuity of educational and training efforts.

The Effect of Emotional Labour on Job Satisfaction and Organizational Commitment among Ayurveda Physicians in Sri Lanka

Similar to other medical specialities, Ayurvedic physicians have a distinct set of duties and responsibilities, with patient interaction playing a big role. In interpersonal interactions with patients, Ayurvedic physicians need to control their emotions. Emotional labour (EL) is the term used to describe the extreme patience and emotional control required to provide effective patient care. Previous researchers have not given adequate attention to studying the effect of EL on-job satisfaction (JS) and organizational commitment (OC), of Ayurvedic physicians. This research attempts to explore the effect of EL on JS and thereby OC, particularly among Ayurveda physicians in Sri Lanka. Primary data was gathered using multistage sampling from 331 Ayurvedic physicians in Sri Lanka for a structured questionnaire. The Partial Least Squires Structural Equation Model (PLS-SEM) was utilized to analyse the data, with the support of SmartPLS software. The results revealed that EL has a positive influence on OC while EL positively affects JS. The results further confirmed that JS has a positive effect on OC. Finally, the findings demonstrated that JS plays a partially mediating function in the connection between EL and OC. These findings help the advancement of existing knowledge by providing empirical evidence in the context of Ayurvedic physicians in Sri Lanka. Healthcare administrators and policymakers should pay attention to improving emotional labour, job happiness, and organizational commitment of Ayurvedic physicians to enhance patient care efficiency.

Feature Pyramid Network Based Spatial Attention and Cross‐Level Semantic Similarity for Diseases Segmentation From Capsule Endoscopy Images

ABSTRACTAs an emerging technology that uses a pill‐sized camera to visualize images of the digestive tract. Wireless capsule endoscopy (WCE) presents several advantages, since it is far less invasive, does not need sedation and has less possible complications compared to standard endoscopy. Hence, it might be exploited as alternative to the standard procedure. WCE is used to diagnosis a variety of gastro‐intestinal diseases such as polyps, ulcers, crohns disease, and hemorrhages. Nevertheless, WCE videos produced after a test may consist of thousands of frames per patient that must be viewed by medical specialists, besides, the capsule free mobility and technological limits cause production of a low quality images. Hence, development of an automatic tool based on artificial intelligence might be very helpful. Moreover, most state‐of‐the‐art works aim at images classification (normal/abnormal) while ignoring diseases segmentation. Therefore, in this work a novel method based on Feature Pyramid Network model is presented. This approach aims at diseases segmentation from WCE images. In this model, modules to optimize and combine features were employed. Specifically, semantic and spatial features were mutually compensated by spatial attention and cross‐level global feature fusion modules. The proposed method testing F1‐score and mean intersection over union are 94.149% and 89.414%, respectively, in the MICCAI 2017 dataset. In the KID Atlas dataset, the method achieved a testing F1‐score and mean intersection over union of 94.557% and 90.416%, respectively. Through the performance analysis, the mean intersection over union in the MICCAI 2017 dataset is 20.414%, 18.484%, 11.444%, 8.794% more than existing approaches. Moreover, the proposed scheme surpassed the methods used for comparison by 29.986% and 9.416% in terms of mean intersection over union in KID Atlas dataset. These results indicate that the proposed approach is promising in diseases segmentation from WCE images.

Experience of observation skill workshop intervention for ophthalmologists in fellowship training.

To gauge the impact of an interventional workshop conducted to measure the observation skills of 34 postgraduates during induction into an ophthalmology fellowship. A seven-hour workshop was conducted with the ophthalmology trainees. Trainees from the 2022 batch of ophthalmology fellowships (21 females and 13 males) were included in the study. The pre-workshop assessment comprised two non-clinical images to spot the difference and five clinical images from various subspecialties of ophthalmology. This was followed by workshop and Post workshop assessment. The pre- and post-observation grades of participants were then compared by masked ophthalmologists. The Wilcoxon signed-rank test was used to compare scores at two time points, with a p-value < 0.05 for statistical significance. Statistical analysis revealed that the observation skill score was significantly higher after the workshop intervention (M d = 4.00, n = 34) compared to the pre-workshop score (M d = 1.85, n = 34), p-value = 0.000. Workshops on specific/selected foundational skills, such as observation skills and communication skills, must be integrated into the curricula of basic medical degree and specialty medicine to equip medical professionals with attentive observation and deep learning.

Pathways to cancer care after a suspected cancer diagnosis in the emergency department: a survey of emergency physicians across Ontario.

Little is known about how patients are managed after a suspected cancer diagnosis through the emergency department. The objective of this study was to examine the ED management, specifically referral practices, for ten suspected cancer diagnoses by emergency physicians across Ontario and to explore variability in management by cancer-type and centre. An electronic survey was distributed to emergency physicians across Ontario, asking about referral practices for patients who could be discharged from the ED with one of ten suspected cancer diagnoses. Options for referral included: in-ED consult, outpatient medical or surgical specialists, surgical or medical oncology, and specialized cancer clinics. Data were described using frequencies and proportions. Variance partition coefficients were calculated to determine variation in responses attributed to differences between hospitals, with physicians nested within hospitals. 262 physicians from 54 EDs responded. Across most cancers, emergency physicians would refer to surgical specialists for further work-up; however, this ranged from 30.2% for lung cancer to 69.5% for head and neck cancer. For patients with an unknown primary malignancy, most physicians would refer to internal medicine clinic (34.3%) or obtain an in-ED consult (25.0%). Few physicians would refer directly to surgical or medical oncology from the ED. Comments suggest this may be due to oncologists requiring tissue confirmation of malignancy. Most referrals to specialized clinics were for suspected lung (30.2%) or breast cancer (19.5%); however, these appear to only be available at some centres. Variance in referrals between hospitals was lowest for breast cancer (variance partition coefficient = 8.6%) and highest for unknown primary malignancies (variance partition coefficient = 29.8%). Physician management of new suspected cancer varies between EDs and is specific to cancer type. Strategies to standardize access to cancer care in a timely and equitable way for patients with newly suspected cancer in the ED are needed.

Addressing disruptive medical staff behavior: a 3-year experience.

Menezes et al. describe their experience with the diagnosis and management of disruptive medical staff behavior in a private hospital between 2020 and 2022. Surgical medical specialties were found to demonstrate the highest prevalence of such behavior, and continual education of physicians regarding appropriate workplace behavior was found to be the most important management strategy to prevent unsafe work environments and strengthen an appropriate culture of safety. ■ Disruptive medical staff behavior potentially affects patient care. ■ Surgical specialties have the highest incidence of disruptive medical staff behavior. ■ Proper diagnosis and management is key to the mitigating disruptive medical staff behavior. To describe the 3-year long experience of addressing disruptive events by medical staff in a private hospital. The cross-sectional study that was conducted between 2020 and 2022, involved collection, analysis, and management of suspected cases of disruptive behavior by medical staff. Relevant information was collected from reports issued by health care leaders (69%), anonymous reports accessed from the health institution's intranet tool "SINAPSE" (19%), the compliance center (5%), customer attendance service (3.7%), the hospital board (2.3%), and the medical practice department (1%). Surgical specialties were responsible for 70.3% of the disruptive incidents, and the average time to outcome was 24.5 days, with most solutions involving guided education of physicians (92.7%). Management of disruptive behavior by medical staff is essential for the prevention of unsafe work environments and strengthening a culture of safety.

Abstracts of the Italian Society of Thoracic Endoscopy (SIET) 2024 Annual Congress

We are pleased to introduce the abstracts of the XXIII National Congress of the Italian Society of Thoracic Endoscopy (SIET), which will be held in Florence from 17 to 19 October 2024. The principal objectives of SIET are to (1) Promote research and innovation in the fields of thoracic surgery and endoscopy, facilitating the development and implementation of innovative techniques and technologies; (2) Provide education and training for surgeons, endoscopists, pulmonologists and other related specialties; and (3) Facilitate the exchange of knowledge with the aim of creating a cohesive and active scientific community. The Congress will address the integration of traditional surgical and endoscopic techniques with emerging technologies, with the goal of promoting innovation and education among professionals. The theme of integration will be explored throughout the programme, with a particular focus on the collaborative efforts of different medical specialties to improve patient outcomes. This event will host a multidisciplinary cohort comprising thoracic surgeons, endoscopists, pulmonologists, oncologists, pathologists, radiologists and anaesthetists, who will assume a pivotal role in the multidisciplinary sessions of the scientific programme. The Congress will include several core areas of expertise, including lung cancer, interventional endoscopy, pathology, and upper airway reconstruction. Emphasis will be placed on both the theoretical aspects of these subjects and their practical applications in patient care. The theme of integration will be explored throughout the programme, with particular attention on the impact of recent technological developments in the fields of thoracic surgery and endoscopy. Additionally, the Congress will examine the contributions of allied health professionals, including nurses, physiotherapists, and speech pathologists, to patient care.

Physician Altruism and Spending, Hospital Admissions, and Emergency Department Visits

Altruism-putting the patient first-is a fundamental component of physician professionalism. Evidence is lacking about the relationship between physician altruism, care quality, and spending. To determine whether there is a relationship between physician altruism, measures of quality, and spending, hypothesizing that altruistic physicians have better results. This cross-sectional study that used a validated economic experiment to measure altruism was carried out between October 2018 and November 2019 using a nationwide sample of US primary care physicians and cardiologists. Altruism data were linked to 2019 Medicare claims and multivariable regressions were used to examine the relationship between altruism and quality and spending measures. Overall, 250 physicians in 43 medical practices that varied in size, location, and ownership, and 7626 Medicare fee-for-service beneficiaries attributed to the physicians were included. The analysis was conducted from April 2022 to August 2024. Physicians completed a widely used modified dictator-game style web-based experiment; based on their responses, they were categorized as more or less altruistic. Potentially preventable hospital admissions, potentially preventable emergency department visits, and Medicare spending. In all, 1599 beneficiaries (21%) were attributed to the 45 physicians (18%) categorized as altruistic and 6027 patients were attributed to the 205 physicians not categorized as altruistic. Adjusting for patient, physician, and practice characteristics, patients of altruistic physicians had a lower likelihood of any potentially preventable admission (odds ratio [OR], 0.60; 95% CI, 0.38-0.97; P = .03) and any potentially preventable emergency department visit (OR, 0.64; CI, 0.43-0.94; P = .02). Adjusted spending was 9.26% lower (95% CI, -16.24% to -2.27%; P = .01). This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.

Sentiment analysis of letters of recommendation for a U.S. pain medicine fellowship from 2020 to 2023.

Letters of recommendation (LORs) are an important part of pain medicine fellowship applications that may be subject to implicit bias by the letter's author. This study evaluated letters of recommendation for applications to pain medicine fellowships in the United States to characterize biases and differences among applicants over four application cycles. This was a retrospective single-site cohort study. De-identified LORs were collected from 2020 to 2023 from one institution. The Valence Aware Dictionary and sEntiment Reasoner (VADER) natural language processing package scored positive LOR sentiment. In addition, the deep learning tool, Empath, scored LORs for 15 sentiments. Wilcoxon rank-sum and one-way ANOVA tests compared scores between applicant demographics: gender, race, medical school type, residency specialty, and chief resident status, as well as letter writers' academic position. Nine hundred and sixty-four applications were studied over four application cycles. Program directors wrote fewer words (p = 0.020) and less positively (p < 0.001) compared to department chairs and letter writers with neither position. Department chairs wrote with less "negative emotion" compared to both program directors and writers with neither position (p < 0.001). Anesthesiologist applicants received more letters highlighting "achievement" (p < 0.001) while PM&R applicants submitted letters with less "negative emotion" (p < 0.001) compared to other specialties. Chief residents' letters scored higher in "leader" sentiment (p < 0.001) and lower in "negative emotion" (p < 0.001). Linguistic content did not favor certain genders or races over others. However, disparities in LORs do exist depending on an applicant's specialty and chief resident status, as well as the academic status of the letter writer.

Interdisciplinary research in artificial intelligence: Lessons from COVID-19

Abstract Artificial intelligence (AI) is widely regarded as one of the most promising technologies for advancing science, fostering innovation, and solving global challenges. Recent years have seen a push for teamwork between experts from different fields and AI specialists, but the outcomes of these collaborations have yet to be studied. We focus on approximately 15,000 papers at the intersection of AI and COVID-19—arguably one of the major challenges of recent decades—and show that interdisciplinary collaborations between medical professionals and AI specialists have largely resulted in publications with low visibility and impact. Our findings suggest that impactful research depends less on the overall interdisciplinary of author teams and more on the diversity of knowledge they actually harness in their research. We conclude that team composition significantly influences the successful integration of new computational technologies into science and that obstacles still exist to effective interdisciplinary collaborations in the realm of AI.

Mapping the patient journey: utilizing clinical informatics for a conceptual approach to identify aspects of emergency department access block

BackgroundThe study aims to map the patient journey in a regional Emergency Department (ED), identify factors causing extended Length of Stay (LOS) in ED during pre-COVID (2016–2019), COVID (2020–2022) and post-COVID (2023), and analyse the patient journey using clinical informatics. Through systematic analysis and root cause identification, the study seeks to establish a learning health system. This system will enhance patient experiences and improve timely and effective care delivery.MethodsSummarized data on ED presentations data were sourced from January 2016 to August 2023 for a 294-bed regional hospital in New South Wales (NSW). The patient’s journey from ED to admission inpatient wards was analysed using clinical informatics. The time spent in each segment of the ED journey was analysed separately and subdivided by specialty for further analysis.ResultsPatient characteristics remained similar year on year. The average ED LOS increased from 5.59 h during the pre-COVID period (2016–2019) to 8.48 h during the COVID period (2020–2022) and 8.52 h during the post-COVID period (2023). The hospital’s bed occupancy rate remained consistent before and during the COVID-19 pandemic, with a slight improvement afterwards, except for a decrease in 2020. The occupancy rate for ED-accessible beds during the pre-COVID period is higher than during the COVID and post-COVID periods. The admission from ED to Inpatient wards decreased from 35% pre-COVID to 28% during COVID. Of the total LOS, the ‘Bed Request’ to ‘Bed Ready’ time segment increased from 11.41% in 2016 to 41.19% in 2022. The admission of medical specialty consistently made up most admissions (32%) which increased during the COVID. The medical specialty also spent the most time in the ED, peaking at 880 min in 2022.ConclusionClinical Informatics is an effective tool to visualise the bottlenecks in clinical workflows. The ‘Bed Request’ to ‘Bed Ready’ time segment was the largest contributor to ED LOS and may have been attributed to a lack of bed availability. Patients took an average of 50 min to be transferred to Inpatient wards upon admission. Future studies could utilize insights gained to develop specific key performance indicators aimed at improving ED LOS. Moreover, we are currently working on improving real-time access to inpatient beds but are currently hampered by the ‘manual update’ of bed status that is controlled by the individual wards. We aim to build an automated system that can monitor and update bed availability (e.g., patient discharge) with minimal human intervention.

Anti-Maintenance of Certification laws and older physician supply

The American Board of Medical Specialties (ABMS) mandates Maintenance of Certification (MOC) exams every ten years to improve patient care and physician skills, but some states consider it expensive and burdensome and have introduced anti-MOC laws. We exploited state-level staggered adoption of anti-MOC laws and found an additional 1.4–1.9 percentage point biannual increase in older physicians aged 60+ in states with anti-MOC laws, with no effect on younger physicians under 60. Our study suggests that anti-MOC laws improve the supply of older physicians.

Use of the Electronic Health Record to Improve Nursing Chart Preparation.

In a medical specialty clinic located in a rural community, a nursing team identified an opportunity to decrease the time nursing staff spent preparing charts for patients' upcoming clinical appointments. In collaboration with an informaticist, the nursing project team implemented a quality improvement project with a target goal of decreasing the average time spent preparing charts per patient by 20%, without increasing the number of discrepancies in the chart preparation process. The team used the define, measure, analyze, improve, and control framework to identify two interventions that could decrease time for chart preparation. A standardized chart preparation process was developed, and a condensed nursing view was created within the electronic health record. After the quality improvement project, the average time nurses spent on chart preparation per patient decreased by 18% after the standardized process and 16% after the condensed view was implemented.

Standardization through education of molecular pathology: a spotlight on the European Masters in Molecular Pathology.

Despite advancements in precision medicine, many cancer patients globally, particularly those in resource-constrained environments, face significant challenges in accessing high-quality molecular testing and targeted therapies. The considerable heterogeneity in molecular testing highlights the urgent need to harmonize practices across Europe and beyond, establishing a more standardized and consistent approach in MP laboratories. Professionals, especially molecular pathologists, must move beyond traditional education to cope with this heterogeneity. This perspective addresses critical issues in molecular pathology (MP), such as limited access to high-quality molecular testing, leading to disparities in cancer treatment, and the consequences of inconsistent practices. Recognizing the necessity for a standardized framework for education to address these issues, educational programs play a pivotal role in updating professionals' skills to achieve standardization in MP. European experts from the Steering Committee, the Pathology Section of the European Union of Medical Specialists, and the European Society of Pathology have proposed creating a comprehensive Master's degree program called the "European Masters in Molecular Pathology" (EMMP). This program emerges as a strategic response to the demand for a specialized and standardized framework for education in MP, catering to professionals who concurrently work and study. The program's design aligns with evidence-based education methods, ensuring effective learning and engagement while integrating computational pathology to analyze complex molecular data, enhance diagnostic accuracy, and improve treatment outcomes. EMMP's structured curriculum, strategic partnerships, and regular updates underscore its significance in standardizing MP practices. Exploring future developments, this perspective delves into technology integration and interdisciplinary collaboration, anticipating ongoing advances and harmonization. Challenges and future directions in MP education are discussed, emphasizing the necessity for dynamic curriculum updates, seamless technology integration, and interdisciplinary cooperation. This perspective underscores EMMP's pivotal role in preparing pathologists for this dynamic field, advocating continuous advancements in education and training to uphold excellence in MP practices and maintain the highest patient care standards.

How automated insurance authorization affects transparency, provider burden, and payer policies and processes: The true impact of prior authorization.

5 Background: Insurance prior authorization (PA) is pervasive in modern oncology treatment, with both Medical and Radiation Oncology ranked among the top 5 in a survey of PA burdens across all medical specialties. The cumbersome process delays patient care and increases provider friction, with a major contributor being the perceived lack of transparency regarding PA decisions. Challenges arise because policies are often located behind portal logins, are inaccessible within the clinical workflow, or are too broad to capture patient nuances. We hypothesized that integrating automated insurance authorization software into the clinical workflow would enhance transparency to payer policies. Additionally, we investigated whether these policies could predict whether authorizations would be issued. Methods: We tracked radiation medicine treatment PA requests at a multisite academic healthcare network. Cases were tracked utilizing a standard clinical EMR. We concurrently implemented InsightRT (Siris Medical, Division of TurningPoint Healthcare), an EMR-integrated software system, to automate authorization documentation by capturing and transmitting patient and treatment characteristics. The online portal informed whether a prescribed treatment met the payer policy and tracked the approval process. A pilot subset of physicians was transitioned to using InsightRT. Results: A total of 1418 non-Medicare/Medicaid PA requests were tracked, with 1235 using the traditional clinical workflow and 183 utilizing InsightRT. The software system indicated 162 (88.5%) were “in policy” and only 2 prescriptions were eventually denied. Of the 21 (11.5%) prescriptions that were "Out of Policy" as indicated by the software, only 1 was denied. Sensitivity and specificity of Insight RT policy determination was 98.8% and 97.6% respectively. Overall, there were 43 denials across a total of 1418 cases with payer review only downgrading or changing 4 cases out of 1418, or 0.3%. The other 39 denials were overturned, with 23 (59%) by peer-to-peer (P2P), and 16 (41%) by documentation review. Conclusions: Automated insurance prior authorization provides increased transparency to the provider with high sensitivity and specificity. However, improvements to payer policies and processes are needed to decrease unnecessary burden and delays to care, as the true impact of PA is limited to 0.3% in this cohort. All cases from 12/23 - 5/24. All Cases from non Medicare/Medicaid 1418 Cases processed in InsightRT 183 Cases processed in EMR and not InsightRT 1235 Denials 43 Overturned denials that went to P2P 23 Overturned denials that only needed clinical documentation 16 Cases with confirmed P2P that were downgraded 4 The True Impact of PA - % of all cases changed due to PA 0.30%

"Doctor ChatGPT, Can You Help Me?" The Patient's Perspective: Cross-Sectional Study.

Artificial intelligence and the language models derived from it, such as ChatGPT, offer immense possibilities, particularly in the field of medicine. It is already evident that ChatGPT can provide adequate and, in some cases, expert-level responses to health-related queries and advice for patients. However, it is currently unknown how patients perceive these capabilities, whether they can derive benefit from them, and whether potential risks, such as harmful suggestions, are detected by patients. This study aims to clarify whether patients can get useful and safe health care advice from an artificial intelligence chatbot assistant. This cross-sectional study was conducted using 100 publicly available health-related questions from 5 medical specialties (trauma, general surgery, otolaryngology, pediatrics, and internal medicine) from a web-based platform for patients. Responses generated by ChatGPT-4.0 and by an expert panel (EP) of experienced physicians from the aforementioned web-based platform were packed into 10 sets consisting of 10 questions each. The blinded evaluation was carried out by patients regarding empathy and usefulness (assessed through the question: "Would this answer have helped you?") on a scale from 1 to 5. As a control, evaluation was also performed by 3 physicians in each respective medical specialty, who were additionally asked about the potential harm of the response and its correctness. In total, 200 sets of questions were submitted by 64 patients (mean 45.7, SD 15.9 years; 29/64, 45.3% male), resulting in 2000 evaluated answers of ChatGPT and the EP each. ChatGPT scored higher in terms of empathy (4.18 vs 2.7; P<.001) and usefulness (4.04 vs 2.98; P<.001). Subanalysis revealed a small bias in terms of levels of empathy given by women in comparison with men (4.46 vs 4.14; P=.049). Ratings of ChatGPT were high regardless of the participant's age. The same highly significant results were observed in the evaluation of the respective specialist physicians. ChatGPT outperformed significantly in correctness (4.51 vs 3.55; P<.001). Specialists rated the usefulness (3.93 vs 4.59) and correctness (4.62 vs 3.84) significantly lower in potentially harmful responses from ChatGPT (P<.001). This was not the case among patients. The results indicate that ChatGPT is capable of supporting patients in health-related queries better than physicians, at least in terms of written advice through a web-based platform. In this study, ChatGPT's responses had a lower percentage of potentially harmful advice than the web-based EP. However, it is crucial to note that this finding is based on a specific study design and may not generalize to all health care settings. Alarmingly, patients are not able to independently recognize these potential dangers.

High-value care modeling: Evaluating cost conscious and potentially wasteful behaviors.

42 Background: Value-based care is key to decreasing waste, addressing increasing healthcare costs, and minimizing patient financial toxicity - especially in the treatment of high-cost diagnoses such as cancer. Medical student exposure to role-modeling of high-value care (HVC) behaviors may help shape professional identity formation and have long-term effects on future practices. Our study aimed to investigate the frequency and characteristics of faculty role-modeling of HVC in medical student core clinical rotations. Methods: A cross-sectional survey study was performed with third- and fourth-year medical students on clinical rotations at 11 U.S. medical schools. The survey assessed thirteen variables associated with cost conscious role-modeling behaviors or potentially wasteful role-modeling behaviors, as well as questions characterizing the rotation such behaviors were observed on, demographic information, and organizational culture around HVC. Results: Cost-conscious role-modeling behaviors were observed “sometimes” or “often” between 52.9-70.5% of the time across all clinical rotations, with the exception of observing a student or resident being praised for ordering a cost-effective diagnostic work-up (seen only 25.7% of the time). Potentially wasteful role modeling behaviors were observed “sometimes” or “often” 5%-14.3% of the time, except simultaneously ordering numerous tests before seeing results of initial screening tests (45.1%) and repeating tests rather than attempting to obtain recently performed test results (42.9%). HVC was most often observed on internal medicine rotations (58.3%) and least frequently on surgery rotations (34.5%). Attendings were significantly more likely to model HVC compared to residents/fellows in 5/7 domains. Organizational culture correlated with frequency of HVC behavior observed. Conclusions: HVC role-modeling behaviors, as observed by medical students, are variable across clinical rotations. HVC practices are essential not only within oncology, but across all medical specialties; future studies should strive to identify factors which promote or inhibit HVC modeling and understand differences between HVC education in undergraduate medical curriculum.

Bullying within specialist medical training in Australia: Analysis of the medical training survey, 2020-2023.

Bullying is common in medical specialist training in Australia. To understand bullying rates across medical specialist training programs, we analyse the recent Medical Training Survey, administered by the Medical Board of Australia to all registered medical practitioners. Medical Training Survey data were extracted and averaged from 2020 to 2023. Many speciality trainees reported personally experiencing or witnessing bullying. This was lowest in general practice (13% personally experienced and 15% witnessed) and highest in obstetrics and gynaecology (27% and 41%). The highest rate of bullying by supervisors was in surgery: 60% of surgical trainees stated that when they were bullied it was by their supervisor. Within psychiatry, 22% of trainees had personally experienced bullying and 32% of trainees had witnessed bullying. When they were bullied, the perpetrator was less commonly a supervisor (40%). In all specialities, there was a very low percentage of bullying which was reported, and was identified as having a satisfactory outcome: the most satisfactory outcomes (13%) were in general practice. Current rates of bullying for medical specialist trainees, the reluctance to report, as well as the lack of satisfactory outcomes, is of grave concern for Australian healthcare. This requires urgent attention at a systems level.

Beyond Morbidity and Mortality Conference: How Do We Learn From Special Cases?

Physicians experience scary cases in the course of usual medical practice. Cases of near misses, legal and ethical dilemmas, or unique clinical challenges are great sources of education. However, there is no format for presentation and dissemination of cases that do not meet criteria for morbidity and mortality (M&M) conferences. The Scary Cases Conference is an innovative educational forum for scrutiny and analysis of these challenging clinical cases. Scary Cases differs from traditional Morbidity and Mortality conferences as it explores outcomes beyond the scope of medical or surgical errors. From 2011 to 2021: 11 regional and 10 national "Otolaryngology Scary Cases" conferences and mini-seminars were held. The cases presented were analyzed for case specialty, area of management deemed troublesome, and compared to M&M conference criteria. 187 cases were presented. 62% percent of cases included traditional medical problems, whereas 21% involved legal issues, and 17% focused on ethical dilemmas. For the cases with medical problems, 31% involved airway obstruction, 17% nerve injuries, and 17% malignancy. 49% of cases would have met criteria for presentation at traditional M&M conferences. Of all the "scary cases," 25% were near misses and 26% represented ethical or legal dilemmas which would not be classified as morbitidy, mortality, or near miss. The Scary Cases provides a forum conducive to learning amongst peers and experts. It allows medical and surgical specialties to share the cases deemed most impactful. The M&M conference would only include half of such cases, but could be expanded beyond the traditional scope in the future.

Lifelong learning in cardiology: success through innovation : Use of e-learning in further education and training

Lifelong learning in cardiology is essential, as treatment standards, technologies and drug treatment are constantly evolving. In this respect e‑learning plays acentral role, enabling doctors to flexibly and efficiently expand their knowledge. There are various offerings, from medical students and specialist training to highly specialised expert knowledge. The e‑learning platforms have become an indispensable tool in specialist training. Another concept is the combination of face-to-face teaching and e‑learning, known as blended learning. This is particularly effective in medical training. These models enable flexible preparation and follow-up and appeal to different types of learners. Overall, e‑learning offers avaluable resource for flexibly and efficiently acquiring knowledge and keeping up to date.