Medical Specialties Research Articles

Pilot Study: Developing Curriculum to Prepare Fourth-Year Medical Students Applying for OBGYN Residency Within the Defense Health Agency.

Obstetrics and gynecology (OBGYN) is becoming increasingly competitive among medical specialties. As a result, many medical schools have frameworks to help their students increase their competitiveness to maximize chances of a successful match. However, "boot camps" have traditionally been geared toward the transition to intern year and not to sub-internships during the fourth year of medical school. We aimed to develop a boot camp for rising fourth-year medical students planning to apply into OBGYN before the initiation of their sub-internships and interview season. Sixteen students enrolled in this course led by faculty OBGYNs at our institution. We utilized a combination of mentorship, coaching, and education to achieve applicant success. The curriculum included formal lectures, surgical skills training, and focused feedback from our applicant development committee. Our response rate was 100% and 94% for the pre-intervention and post-intervention survey, respectively. Before the intervention, the majority of participants felt either neutral (47.4%) or unprepared (21.1%) regarding their knowledge before their sub-internships. However, after the intervention, all reported feeling more prepared for their rotations. All respondents either agreed (60%) or strongly agreed (40%) that the course increased their confidence in performing well on audition rotations. Our match rate increased from 62% for the class of 2022 (before this intervention) to 75% for the class of 2023. In light of the increasing residency match competitiveness, it is crucial to investigate programs that can assist students in developing stronger applications. This reproducible intervention utilizes few resources and can be implemented at most medical schools to better support their OBGYN applicants.

[Exploration and contemplation of homogenized education of specialists in pulmonary and critical care medicine at member hospitals of a hospital consortium].

Talent construction is the cornerstone to the establishment of a high-quality, homogeneous healthcare system in a healthcare consortium. Pulmonary and critical care medicine (PCCM) as the first pilot specialty, the standardized training of PCCM specialists has started and achieved remarkable results. The consortium member hospitals' physician specialist education is an important complement to PCCM training. The establishment of the consortium provides a new form of the education of physicians in PCCM, with the advantages of high quality teaching, wide coverage of staff and throughout the career development process. This article summarized the current status of physician specialty education in the member hospitals of the consortium, and further proposes the goal of homogenized specialty education for physicians in the member hospitals. And it analyzed in depth the problems that existed in the practice of training for hospital consortium member hospitals specialists, such as non-uniform level of instruction, non-systematic content of training, limited sources of teaching cases, and lack of teaching materials and equipment. For the medical consortium member hospital physician specialty education of in-depth thinking, we put forward the corresponding countermeasures. The aim of this study is to explore the homogenization of the specialty education system of pulmonary and critical care medicine in the member hospitals, in order to comprehensively improve the medical level of respiratory specialists in the member hospitals of the medical consortium.

Neuroleptic Malignant Syndrome - review of pathophysiology, clinical presentation, differentiation and management

Introduction and purpose: The number of invented and produced medications has increased over recent years. Besides their positive impact on health, they invariably provide various kinds of side effects. This review is focused on malignant neuroleptic syndrome, a rare condition with no fully confirmed pathogenesis, which at least partially can be explained as an adverse effect of blocking dopamine receptors. Even though it usually affects psychiatric or neurological patients, doctors of all medical specializations should stay alert, as the condition can often lead to premature death. Brief description of knowledge: The main symptoms associated with NMS are hypertonia, hyperpyrexia, autonomic instability and altered consciousness. They can appear in any configuration, sometimes followed by less characteristic manifestations. It should be primarily differentiated from serotonin syndrome, malignant hyperpyrexia and catatonia, mostly through the interview of those who have taken medications and undergone surgeries, as there are not any specific lab tests available. Fundamental treatment methods consist of neuroleptic withdrawal, intensive supportive care, drug administration and eventually ECT. Summary: NMS is an uncommon, severe disease that should be carefully considered in patients treated with neuroleptics. Due to its rarity and sudden onset, it appears to be problematic to conduct widespread research and studies, so there are still no concrete, consistent and unquestioned guidelines on recognizing and treating the condition.

Which Provider Specialties are Performing Diagnostic Procedures for Dysphagia in the United States?

Care of patients with dysphagia occurs at the intersection of several different medical specialties. Otolaryngologists are uniquely equipped to diagnose dysphagia given their specialized training, yet the extent to which otolaryngologists perform diagnostic procedures for dysphagia is unknown. The objective of this study was to characterize the specialty-level variation among providers performing diagnostic assessments for dysphagia. We performed a retrospective, cross-sectional analysis of dysphagia care utilization among Medicare beneficiaries from 2013 to 2021 using the CMS Physician & Other Practitioners by Provider and Service dataset. American Association of Medical Colleges (AAMC) data reports were used to determine the total number of providers per specialty. For each procedure and specialty, the percentage of providers performing >10 procedures annually and the average annual number of procedures per performing provider (non-radiology) were calculated. We analyzed nine common dysphagia diagnostic procedures, including manometry, 24-h pH testing, flexible endoscopic evaluation of swallowing (FEES), and modified barium swallow study (MBSS). Mean 3.7 (SD 1.4) otolaryngologists (0.04% of practicing) performed manometry testing annually, compared to 493 (69.3) gastroenterologists (3.3%). Less than 1% of practicing otolaryngologists (37.8 (8.0) (0.04%)) and gastroenterologists (51.6 (8.4), 0.35%) performed 24-h pH testing annually. FEES testing was most commonly performed by otolaryngologists; however, only 48 (6.3) providers (0.51% of practicing) performed these procedures annually. For MBSS, fewer otolaryngologists (5.2 (1.0), 0.05%) perform these assessments than other medical specialties. Each otolaryngologist performed 110.7 (52.5) studies annually, compared to 200.1 (68.0) per gastroenterologist. Otolaryngologists represent a small fraction of providers performing dysphagia-related diagnostic procedures despite a unique training within our specialty to comprehensively diagnose and manage this condition. 3 Laryngoscope, 2024.

Demystifying the MRCP exams for IMGs: the impact of five Nigerian Specialist Registrars through a virtual medical academy

‘There is a loftier ambition than to stand tall in theworld, it is to stoop down and raise mankind higher’ – Henry Van Dyke. The MRCP PACES exam is the last hurdle to climb for internal medicine registrars before they become a prestigious Member of the Royal College of Physicians United Kingdom. However, most International Medical Graduates (IMGs) do shy away from the medical specialty because of the failure rate of these exams. According to the Paces Spring Performance Report 2023, the failure rate of IMG in Paces was alarming compared with British Medical Graduates; Around 60% of IMGs failed the exam-700 IMGs in comparison to approximately 30–200% UK graduates [1, 2]. These disparities invigorated five Nigerian IMG registrars to bridge this gap through a free weekly virtual PACES exam for the last 40 weeks. We also started monthly MRCP Courses and PACES-centred MRCP Masterclasses to support International Medical Graduates to ace their PACE exams. Furthermore, through the power of representation, we are inspiring and attracting IMG doctors to the physician specialty [3]. Five Nigerian IMG registrars – ST4 to ST5, trainees of HEE in Acute Medicine, Neurology, Cardiology, and Stroke Medicine across diverse regions in England facilitated weekly tutorials up to three times weekly since June 2023 through the Zoom Platform. The success of the free tutorials led to the development of the Virtual PACES and created a need to start a Virtual MRCP PACES Course. We have facilitated more than 10 PACES courses, 15 Paces Mocks, 4 Neurology Masterclasses, and 4 Communication Master Classes. To the best of our knowledge, we are the first group to conduct a Successful Virtual PACES Mock exam. We have more than 500 International Medical Graduates on our social media platform who participate actively in all our educational courses. The majority of them live in the United Kingdom and completed their medical school in Asia, Africa, or Europe. To rate the impacts of our weekly IMG Paces tutorials, we decided to conduct an anonymous online survey. More than 50 doctors responded. More than 96% of the respondents were IMGs. A third of the respondents were Internal Medicine Trainees (IMTs) in the UK. About a third were trainee registrars and a third were in a non-training role. A third of our respondents have attempted paces before. More than about half of the respondents had attended more than five weekly sessions. When asked to ‘rate their strength in the paces content before attending Free PACES teaching’; more than half of respondents rated themselves as either poor or fair across all pace components, especially in Neurology, Communication, and Consultation [4]. When asked to rate their improvement in the PACES content after attending our free PACES teaching. More than 90% rated improvement across all the paces and approximately 60% of respondents said they ‘improved a lot’ in Communication, Consultation, and Neurology. When asked ‘how do you feel seeing fellow IMG Registrars taking you through the Sessions? More than 90% of respondents feel more confident, more supported, inspired, and more included to pass paces. Almost all respondents now have a more positive perception of IMG registrars following the tutorials [5]. Finally, for people who attend our courses and mocks, we have a success rate of more than 50% in the MRCP exams which is higher than the national average for IMGs. This bold and altruistic step taken by five Nigerian Specialist Registrars has bridged the gap to improve the success rates of IMGs in completing the MRCP PACES exam. We hope to extend this innovative platform to other specialties who are willing to collaborate with us in our quest to empower IMGs. Beyond that, we believe we are changing narratives and shaping the perception of Nigerian doctors, Nigeria, and Africa as a whole. That to us, becomes an ‘icing on the cake’.

АНАЛИЗ ДЕЯТЕЛЬНОСТИ ВРАЧЕЙ-ДЕРМАТОВЕНЕРОЛОГОВ, ОКАЗЫВАЮЩИХ МЕДИЦИНСКУЮ ПОМОЩЬ СЕЛЬСКОМУ НАСЕЛЕНИЮ В РЕСПУБЛИКЕ БАШКОРТОСТАН

Relevance. Currently, there is a low staffing of medical organizations with local doctors and medical specialists, including dermatovenerologists. This determines the low availability of primary medical care for the rural population for diseases of the skin and subcutaneous tissue. Purpose of the study. To analyze the activities of dermatovenerologists in providing primary specialized medical care to the rural population for diseases of the skin and subcutaneous tissue in the Republic of Bashkortostan. Materials and methods. The calculation of indicators characterizing the activities of dermatovenerologists in the Republic of Bashkortostan for 2017-2021 was carried out: the provision of the population with dermatovenereologists, staffing of regular positions of dermatovenereologists, staffing with individuals, part-time ratio, share of visits per one rural resident and one patient with skin diseases, number of visits in connection with the disease, in connection with the preventive purpose. Results. Level of supply of dermatovenerologists in the Republic of Bashkortostan in 2021. amounted to 0.54 per 10 thousand population. In recent years, the provision of dermatovenerologists in the rural population remains low: in 11.1% of rural areas there are no dermatovenerologists, and in 31.5% the level of provision is insufficient. For the period 2017-2021 a decrease in the number of visits to a dermatovenerologist for skin diseases was established by 16.3% (per rural resident from 0.29 to 0.24 visits per resident), as well as a decrease in the number of visits to a dermatovenerologist by 22.0% . (from 4.63 to 3.61 visits per patient). An extremely low volume of telemedicine consultations was revealed, which is a significant factor in reducing the availability of medical care for the rural population. Conclusions. In the Republic of Bashkortostan in recent years, the provision of dermatovenerologists for the rural population remains insufficient. Thus, there is a need to develop measures aimed at improving primary specialized medical care provided by dermatovenerologists to the rural population of the Republic of Bashkortostan.

Making a Statement: Positions of Professional Medical Organizations Towards Gender-Affirming Care.

Despite politically charged media coverage and legislation surrounding gender affirming care (GAC), many organizations have released position statements to provide scientifically backed clinical practice standards, combat misinformation, and inform medicolegal policies. The purpose of this study is to objectively assess the availability and the content of the official position statements of relevant medical professional organizations regarding GAC. A list of U.S. medical professional organizations with likely involvement in GAC based on medical or surgical specialties was compiled. For included organizations, we evaluated the availability, content, and publication year of positions on GAC through October 2023. When available, formal positions were categorized as supportive or unsupportive. A total of 314 professional medical organizations were screened for our study based on specialty, relevance to GAC, and issuance of patient guidelines or position statements. Inclusion criteria were met by 55 organizations. Most organizations (35, 63.6%) had formal position statements on GAC. Support for GAC was described in 97.1% (n=34). Further, 94.2% (n=33) of available statements explicitly addressed GAC in individuals less than 18 years old and were largely supportive (96.9%, n=32). This cross-sectional analysis demonstrates that a majority of multidisciplinary professional medical organizations with relevance to GAC have issued formal position statements on the topic. Available positions were overwhelmingly supportive of individualized access to gender-affirming therapies in adult and adolescent populations. However, silence from some organizations continues to represent a modifiable disparity in the provision of GAC.

A National Survey of Pregnancy and Parenthood Among Nephrology Trainees: A Focus on Nephrology Fellowship.

National and international policies on parental leave for physician trainees are inconsistent. Physician trainees, including nephrology fellows, may be at higher risk of pregnancy complications. Physician trainees face barriers in meeting their breastfeeding goals and in finding childcare due to nontraditional work hours with extended or unpredictable shifts. Here, we examine awareness of current policies in United States (US) nephrology fellowship programs regarding parental leave, pregnancy/breastfeeding accommodations, and fellows' perspectives on family planning. An anonymous, on-line survey of US nephrology fellows was undertaken from June 9 to August, 24, 2023. One hundred twenty nephrology fellows submitted the survey. A majority of fellow respondents were unaware of parental leave policies of their training programs (63%), Accreditation Council for Graduate Medical Education (ACGME) (75%), and/or American Board of Medical Specialties(ABMS) (75%). Forty two percent were unaware of the duration of parental leave at their program. Nearly 45% of all respondents were unsure if their program limited night shifts or shifts greater than 24 hours for pregnant trainees. Forty three percent reported they were unsure of lactation accommodations, and 40% were unsure of access to subsidized childcare. When fellows received work accommodations for pregnancy or parenthood, their work obligations were largely covered by co-fellows (60%) or attendings (38%). Over 60% of fellows agreed or strongly agreed that they would avoid a pregnancy in fellowship due to concern they would have to extend their training. Of the 40 fellows who chose to pursue pregnancy or parenthood during medical training, 75% did not change their career plans as a result. Most nephrology fellows were unaware of parental leave policies and pregnancy/lactation accommodations. While the topic itself has a broad impact to all physician trainees, there is need for improved awareness about national and local program policies among trainees across individual nephrology programs.

MedKnee: A New Deep Learning-Based Software for Automated Prediction of Radiographic Knee Osteoarthritis

In computer-aided medical diagnosis, deep learning techniques have shown that it is possible to offer performance similar to that of experienced medical specialists in the diagnosis of knee osteoarthritis. In this study, a new deep learning (DL) software, called “MedKnee” is developed to assist physicians in the diagnosis process of knee osteoarthritis according to the Kellgren and Lawrence (KL) score. To accomplish this task, 5000 knee X-ray images obtained from the Osteoarthritis Initiative public dataset (OAI) were divided into train, valid, and test datasets in a ratio of 7:1:2 with a balanced distribution across each KL grade. The pre-trained Xception model is used for transfer learning and then deployed in a Graphical User Interface (GUI) developed with Tkinter and Python. The suggested software was validated on an external public database, Medical Expert, and compared with a rheumatologist’s diagnosis on a local database, with the involvement of a radiologist for arbitration. The MedKnee achieved an accuracy of 95.36% when tested on Medical Expert-I and 94.94% on Medical Expert-II. In the local dataset, the developed tool and the rheumatologist agreed on 23 images out of 30 images (74%). The MedKnee’s satisfactory performance makes it an effective assistant for doctors in the assessment of knee osteoarthritis.

ПОДХОДЫ ФОРМИРОВАНИЯ МОТИВАЦИИ К ВЕДЕНИЮ ЗОЖ И ПРОВЕДЕНИЮ ПРОФИЛАКТИЧЕСКИХ МЕРОПРИЯТИЙ ПО УКРЕПЛЕНИЮ ЗДОРОВЬЯ У СТУДЕНТОВ МЕДИЦИНСКИХ УНИВЕРСИТЕТОВ

The priority direction of educational policy within the framework of the Priority 2030 academic strategic leadership program is to provide the country's healthcare with qualified and motivated medical personnel, in connection with which the requirements for clinical knowledge and skills, as well as for the skills of a modern doctor, are growing. Research, innovation and project activities become mandatory elements of educational programs, which are implemented through an individual educational trajectory to train specialists who meet a high standard of competencies. One of the directions of the individual educational trajectory is the creation of additional educational programs that expand the opportunities for students to obtain additional competencies. Purpose. On the basis of a sociological survey, to study students' satisfaction with the additional educational program aimed at the formation of professional competencies for training doctors to perform new labor functions in the formation of preventive programs, maintaining a healthy lifestyle and giving up bad habits. Materials and methods. The study includes the development of an additional professional program "Strengthening Public Health" using digital technologies in the field of preserving and strengthening public health, for the training of health professionals. Based on the results of the course of the additional professional program, a sociological survey was conducted in an online format through the Google Forms resource. A link to the survey was sent via email and WhatsApp messenger. Results. The data obtained in the course of the study allow us to see the problem of motivation of students who adhere or do not adhere to a healthy lifestyle and to develop measures aimed at attracting medical university students to physical education, sports and the formation of a healthy lifestyle. Conclusion. The formation of motivation for a healthy lifestyle among students of medical universities is one of the most significant areas of professional training of medical specialists.

Is Collaborative Care the Future of Medicine? Lessons Learned from the Care of Children with Colorectal Conditions

The treatment of patients with colorectal disorders requires care from a wide variety of medical and surgical specialties over the course of their lifetime. This is ideally handled by a collaborative center which facilitates the assessment and development of patient care among multiple specialties which can enhance the quality and implementation of treatment plans, improve communication among different specialties, decrease morbidity, and improve patient satisfaction and outcomes. This collaborative approach can serve as a model for other parts of medicine requiring a similar multi-disciplinary and integrated method of care delivery. We describe the process, as well as the lessons learned in developing such a program.

A systematic review of telemedicine for neuromuscular diseases: components and determinants of practice

IntroductionNeuromuscular diseases (NMDs) entail a group of mostly inherited genetic disorders with heterogeneous phenotypes impacting muscles, the central or peripheral nervous system. They can lead to severe disabilities and shortened lifespans. Despite their severity, NMDs often lack in public awareness and appropriate medical and social support. Telemedicine can improve patients’ and caregivers’ lives by enhancing continuity of and access to care. The first aim of this systematic review was to summarise the status quo of telemedicine services for patients with NMDs. Secondly, barriers and facilitators of the respective implementation processes should be analysed.MethodsThe databases PubMed, Web of Science and CENTRAL by Cochrane were searched in May 2022. To be truly explorative, any original evidence from any setting was included. Two independent researchers completed the screening process. Data was extracted and analysed using the taxonomy of Bashshur et al. (2011) and the Consolidated Framework for Implementation Research (CFIR).ResultsFifty-seven original papers were included in the systematic review. The results showed a high representation of teleconsultations and remote monitoring studies. Teleconsultations replaced in person appointments and telemonitoring mostly focused on ventilation. Physical therapy, pulmonology, neurology, and psychology were the most represented medical specialties. We found barriers and facilitators relating to implementation mainly referred to the intervention and the individuals involved. Technical errors and inaccessibility due to a lack of technical devices or the patient’s disability were stated as hindrances. A positive mindset of users as well as patient empowerment were necessary for the adoption of new technology. Technophobia or uncertainty around technology negatively impacted the implementation process.DiscussionThis systematic review provides an overview of the current use of telemedicine in patients with NMDs. The distribution of telemedicine interventions between the defined domains was very heterogenous. Previous research has neglected to fully describe the implementation process of telemedicine for NMDs.ConclusionThe evidence shows that telemedicine can benefit patients with NMDs in a multitude of ways. Therefore, health policies should endorse and incentivise the uptake of telemedicine by institutions and health care workers. Further research needs to be conducted to confirm the current evidence and close existing research gaps.

Building the workforce of tomorrow: The weighting of rural exposure in standardised curriculum vitae scoring criteria for entrance into Australian specialty training programs.

To determine the weighting of rural exposure within publicly available standardised curriculum vitae (CV) scoring criteria for trainee medical officer's applying into medical and surgical specialty training programs in Australia and New Zealand. An observational analysis of rural exposure point allocations within publicly available standardised CV scoring criteria for entrance into specialty training programs. All Australian and New Zealand medical and surgical specialties training programs outlined by the Australian Health Practitioner Regulation Agency (AHPRA) who publish publicly available standardised CV scoring criteria for entrance into specialty training were included. Of the 14 specialty training programs that publish publicly available standardised CV scoring criteria, 8/14 allocate points towards rural exposure. While the allocation of points within this scoring domain varies between the eight training programs, the mean weighting of rural exposure is 13.7%. The relative weighting of rural exposure varies between the eight specialty training programs who include rural exposure as a CV scoring criteria. The deliberate and strategic construction of CV scoring criteria and inclusion of rural exposure points is important to continue developing the Australian rural specialist workforce. Future development of standardised CV scoring criteria should continue to consider point allocation towards rural exposure and related activities to ensure that the requirements of rural Australian healthcare needs are met across medical and surgical specialties.

Challenges in provision of anesthesia to transgender patients in India: A scoping review

Abstract The care of transgender individuals has gained increasing attention in health-care settings, encompassing a wide range of medical specialties. Anesthesia is vital in perioperative care for them despite challenges like health-care access disparities, stigma, and discrimination. As they undergo routine surgeries or specific gender-affirming surgeries, anesthesia providers must be cognizant of anatomical, physiological, and psychosocial considerations that may impact the perioperative experience. Anesthesia for transgender individuals requires gender identity assessment, understanding of surgical needs, hormone therapy impact, preoperative assessments evaluating comorbidities, medication history, and psychosocial factors. Anesthesiologists should modify airway care and pain management techniques to accommodate patients’ preferences and gender-affirming surgical goals. They should also take into account any potential differences in the airways of transgender patients and optimize postoperative pain management in accordance with each patient’s particular surgical recovery. This article aims to focus on the perioperative care of transgender individuals, highlighting the distinct challenges encountered and potential solutions to address these unique issues.

The burden of atopic dermatitis in Australia: Medical care, treatment satisfaction, financial impact, long-term control and quality of life.

Atopic dermatitis patients and caregivers experience a high physical, mental and financial burden in Australia. We outline how the current care model impacts disease management and patients' quality of life via a survey of 265 Australian patients and caregivers to capture the experience of managing atopic dermatitis (AD) in Australia. Patients report an unsatisfactory quality of life and a high burden of disease with poor long-term control and low treatment satisfaction. They also reported changing spending and saving patterns to fund medical care. Patient experience improves with more specialised care that incorporates shared decision-making and patient/caregiver training beyond the clinic visit. These results highlight the need for improved general practitioner (GP) education, expedited access to medical specialists, greater patient involvement in treatment choices and more financial assistance to improve the experience of Australian patients and caregivers.

Urinary Incontinence in Active Female Young Adults: Healthcare Preferences, Priorities and Experiences.

There is a paucity of evidence on the healthcare preferences of active female young adults with urinary incontinence (UI). This research is aimed at examining the population's healthcare preferences and priorities and their characteristics and experiences to improve access to and use of services. This cross-sectional online survey study used a convenience community sample. Participants resided in Australia, were 18-30years old, had self-reported engagement in physical activity of any frequency and self-reported urine leakage in the previous 4 weeks and met other eligibility criteria. Data were analysed using descriptive analyses. Thirty-nine participants took part in the study. The majority engaged in recreational exercise (74.2%) and experienced UI of slight to moderate severity (82.9%). Participants preferred to access information and support anonymously online (71.4%) from general practitioners (58.8%), medical specialists (50.0%) or physiotherapists (44.1%). All participants wanted to be involved in the UI management decision-making process. Participants prioritised knowing information over cost (38.2%), changes to daily habits (35.3%) and potential risks or side effects (23.5%) when making decisions about management of UI. The results highlight the diversity among active female young adults with UI. They emphasise the need for shared decision making and highlight key information needs, providing the basis for the development of decision-making tools and protocols specific to this population. They demonstrate the need for anonymous online information and support, and draw attention to the presence of UI among young recreational exercisers, highlighting the importance of ensuring that information and support is available within this demographic.

Predictors of Plastic Surgery Applicant Success: An Analysis of the Texas STAR Database.

Integrated plastic surgery residency is one of the most competitive medical specialties. Although previous studies have surveyed integrated plastic surgery residency program directors regarding desired applicant characteristics, there is a paucity of literature assessing detailed application characteristics and reported match outcomes from applicants in recent application cycles. This study examines application characteristics associated with matching into integrated plastic surgery residency from 2017 to 2023. The authors accessed the Texas Seeking Transparency in Application to Residency database, which contains survey information from graduating medical students nationwide regarding residency application characteristics and specialties/programs to which applications were submitted. Characteristics of matched versus unmatched applicants between 2017 and 2023 were compared using χ2 and 2-sided, independent t tests. Univariate logistic regression models were used to assess predictors of a successful match. A total of 381 integrated plastic surgery residency applicants responded to the Texas Seeking Transparency in Application to Residency survey from 2017 to 2023. Mean United States Medical Licensing Exam Step 2 CK scores; the number of away rotations, interview offers, and honored clerkships; and Alpha Omega Alpha membership rate were significantly associated with and predictive of matching. Preference signaling of programs was associated with an increased interview offer rate. Higher board examination scores, increasing numbers of honored clerkships, away rotations, and Alpha Omega Alpha membership were identified as statistically significant predictors of matching into integrated plastic surgery residency. Prospective applicants should use this information to help guide their efforts in these areas that appear to be associated with a successful transition to residency.

Conscience-Based Barriers to Medical Aid in Dying: A Survey of Colorado Physicians.

Approximately 20% of the United States' population lives in a state or jurisdiction where medical aid in dying (MAiD) is legal. It is unknown how physicians' own barriers are associated with their provision of the spectrum of MAiD services. To measure physicians' religious and/or ethical barriers to providing MAiD services and how such barriers relate to physicians' intentions and behaviors. Three-wave cross-sectional survey fielded in Colorado in 2020-2021. Physicians providing care to patients likely clinically eligible for MAiD according to probabilistic sampling. Physicians self-reported barriers to their own participation in MAiD. We considered large ethical and/or religious barriers to be conscience-based barriers. We measured physicians' self-reported intention to participate and self-reported prior participation in MAiD since it was legalized in Colorado in 2017. We estimated differences in intention and behavior outcomes according to presence of conscience-based barriers, adjusting for physician gender, race/ethnicity, time in practice, and specialty. Among 300 respondents, 26% reported "large" ethical and/or religious barriers to their involvement in MAiD. Physicians with longer time in practice and those identifying as non-White were more likely to report conscience-based barriers to MAiD. Comparing physicians with and without conscience-based barriers to MAiD, we found no difference in ancillary participation (discussing, referring) but significant differences in direct participation (serving as consultant [5% vs. 31%] or attending [0% vs. 22%]). Approximately one-quarter of physicians likely to care for MAiD-eligible patients in Colorado reported religious and/or ethical barriers to MAiD. Despite religious and/or ethical barriers, the vast majority of physicians were willing to discuss MAiD and/or refer patients seeking MAiD services. These data provide important empirical foundation for policy from hospitals and health systems as well as medical specialty groups with official positions on MAiD.

A survey on the implementation of clinical medication reviews in community pharmacies within a multidisciplinary setting

BackgroundPolypharmacy is common in chronic medication users, which increases the risk of drug related problems. A suitable intervention is the clinical medication review (CMR) that was introduced in the Netherlands in 2012, but the effectiveness might be hindered by limited implementation in community pharmacies. Therefore our aim was to describe the current implementation of CMRs in Dutch community pharmacies and to identify barriers to the implementation.MethodsAn online questionnaire was developed based on the Consolidated Framework for Implementation Research (CFIR) and consisted of 58 questions with open ended, multiple choice or Likert-scale answering options. It was sent out to all Dutch community pharmacies (n = 1,953) in January 2021. Descriptive statistics were used.ResultsA total of 289 (14.8%) community pharmacies filled out the questionnaire. Most of the pharmacists agreed that a CMR has a positive effect on the quality of pharmacotherapy (91.3%) and on medication adherence (64.3%). Pharmacists structured CMRs according to available selection criteria or guidelines (92%). Pharmacists (90%) believed that jointly conducting a CMR with a general practitioner (GP) improved their mutual relationship, whereas 21% believed it improved the relationship with a medical specialist. Lack of time was reported by 43% of pharmacists and 80% (fully) agreed conducting CMRs with a medical specialist was complicated. Most pharmacists indicated that pharmacy technicians can assist in performing CMRs, but they rarely do in practice.ConclusionsLack of time and suboptimal collaboration with medical specialists are the most important barriers to the implementation of CMRs.

Medical specialties providing outpatient palliative care

Medical specialties providing outpatient palliative care