Medical Experience Research Articles

A Computational Protocol for the Knowledge-Based Assessment and Capture of Pathologies.

We propose that one of the main hurdles in delivering comprehensively informed care results from the challenges surrounding the extraction, representation, and retention of prior clinical experience and basic medical knowledge, as well as its translation into time- and context-informed actionable interventions. While emerging applications in artificial intelligence-based techniques, for example, large language models, offer impressive pattern association capabilities, they often fall short in producing human-readable explanations crucial to their integration into clinical care. Moreover, they require large well-defined and well-integrated data sets that typically conflict with the availability of such data in all but a few areas of medicine, for example, medical imaging and neuroimaging, noninvasive monitoring of bio-electrical activity, etc. In this chapter, we argue that approximate reasoning rooted in the knowledge that is explainable to the human clinician may offer attractive avenues for the introduction of such knowledge in a systematic way that supports formal retention, sharing, and reuse of new clinical and basic medical experience. We outline a conceptual protocol that targets the use of sparse and disparate data of different types and from different sources, seamlessly drawing on our collective experience and that of others. We illustrate the utility of such an integrative approach by applying the latter to the assessment and reconciliation of data from different experimental models, human and animal, in the example use case of a complex health condition.

Learning from the best: How medical-students construct role models in general practice during the COVID-19 pandemic and what factors influence this process, a qualitative study.

Background Role-modelling has been found to strongly influence speciality choice for medical students either positively or negatively. There is a deficit in recruitment toward general practice, set to exacerbate the shortfall in GP numbers over the coming decade in the face of spiralling demand. In medical school, students acquire knowledge, skills and start to form their professional identity by observation and interaction with medical educators through the process of role-modelling. Given the significance of this process, the present study attempted to explore the “lived experience” of medical students encountering potential role models during their GP placement using a qualitative method. Methods Following a design based upon the principles of Grounded Theory 10 qualitative interviews were conducted with third-year medical student volunteers at Warwick Medical School. Interviews were recorded, transcribed and analysed using theoretical axial coding demonstrating data saturation in key themes. Results Analysis of data gave insights regarding student perception of positive and negative role modelling in three corresponding domains: Personal Attributes, Student Relationship and Patient Relationships. Conclusions The findings offer unique insights into the influence and impact of GP role-modelling on medical student’s experiences and perceptions during a time of the Covid-19 pandemic and the immediate post-pandemic period and add to the wider body of literature by exploring the influences GP role-modelling has on medical student training experience. The findings support easily implementable recommendations to strengthen positive role modelling in the GP medical student placement context.

International medical graduates' experiences of clinical competency assessment in postgraduate and licensing examinations: A scoping review protocol.

An international medical graduate (IMG) is a doctor who has received their basic medical qualification from a medical school located in a different country from that in which they practice or intend to practice. IMGs are known to face difficulties in their working lives, including differential attainment in assessment. The objective of this review is to map key concepts and types of evidence in academic and gray literature relating to international medical graduates' experiences of clinical competency assessment and to identify knowledge gaps on this topic by systematically searching, selecting, and synthesizing existing knowledge. All studies will relate to IMGs. The concept of interest will be IMGs' experiences of assessment. The context will be postgraduate, licensing or credentialing medical assessments of clinical competence. This review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Seven electronic databases will be searched for literature published between 2009 and 2024: the Australian Education Index, British Education Index, ERIC, PubMed, PsycINFO, Scopus, and SocINDEX. Gray literature will be searched using Google, Google Scholar, and published reports from postgraduate training bodies and medical licensing organizations. Documents will be independently screened, selected, and extracted by two researchers using a piloted data-extraction tool. Data will be analyzed and presented in tables and in a narrative format. Trial resgistration: Scoping review registration: Open Science Framework: https://osf.io/8gdm7.

Evaluating the Educational Environment in a Private Medical College Through Students' Eyes: Insights from the DREEM Scale

Background: Medical students' learning experiences and success are greatly influenced by their educational environment. For this environment to be continuously improved and to be in line with changing educational standards, regular assessment is necessary. A validated instrument that is frequently used to assess educational climates in health science institutions is the Dundee Ready Education Environment Measure (DREEM). Aim and Objective: Using the DREEM scale, this study sought to evaluate the educational environment as perceived by PramukhSwami Medical College (PSMC) first-year MBBS students in order to pinpoint areas of strength and room for development. Methods: 86 first-year MBBS students at PSMC participated in a cross-sectional study. The 50 items in the DREEM questionnaire, which was divided into five domains—students' perceptions of learning (SPL), teachers (SPT), academic self-perception (SAP), atmosphere (SPA), and social self-perception (SSP)—were used to gather data. The mean scores for each domain were examined using descriptive statistics to pinpoint areas in need of development. To investigate disparities in perception, comparisons based on gender were also examined. Results: A generally positive educational environment was indicated by the overall mean DREEM score of 145 ± 11.45 out of 200. SPL (37 ± 2.7), SPT (30 ± 1.8), SAP (23 ± 2), SPA (35 ± 3), and SSP (20 ± 2) were the subscale scores. Significant differences in SPT, SPA, and SSP scores were found by gender-based analysis, with female students reporting higher satisfaction in some domains (P < 0.05). Conclusion: With high SPL and SPA scores, the results indicate that first-year MBBS students at PSMC have favorable opinions of their learning environment. To further improve student satisfaction and academic achievement, specific interventions could be beneficial in areas like SPT and SSP. These gaps might be successfully filled by putting peer support networks and faculty development programs into place. Frequent evaluation with DREEM can support ongoing.

From Evictions to Shame: Exploring Hysterectomy Through Metaphor

The present study analyzes metaphorical expressions related to hysterectomy in a diverse corpus comprising scientific texts, Reddit forums, and patient-authored articles and blogs. The research aims to understand how hysterectomy is discursively constructed and experienced by women. The corpus reveals a range of metaphors from clinical descriptions to personal and creative expressions. The analysis shows that metaphors not only reflect but also influence women's perceptions of their bodies and the procedure. The study identifies metaphors including the uterus as a 'tenant' or 'kidnapper,' and the procedure as an 'eviction' or a 'robbery', highlighting the emotional and psychological aspects of hysterectomy. Limitations include the corpus size, lack of metadata to establish more correlations, and its Western-centric perspective, suggesting the need for more inclusive research. The study contributes to the discourse on women's health, emphasizing the role of language in shaping medical experiences. It underscores the need for understanding metaphorical language to improve communication and support for women undergoing hysterectomy.

Rapid Transition to Virtual Learning in Postgraduate Medical Education during the COVID-19 Pandemic in Tanzania: A Qualitative Study.

The effect of the progressive utilization of virtual learning (VL) in postgraduate medical education (PGME) is contentious. During the COVID-19 pandemic, VL was up-scaled to bridge the education delivery gap. How this impacted learning experiences in PGME is an area that needs to be explored for the progressive context-specific application of VL. This phenomenological study aimed to explore the postgraduate medical faculty's and residents' experiences with the rapid shift to VL. Through an interpretivist paradigm, this study used in-depth individual semi-structured interviews and prompts to explore the full breadth of the participants' experiences. A purposive sampling method was used, and qualitative content analysis was employed in an iterative process until data saturation. Data was collected between January 2021 and July 2021. Member checking was done to ensure validity. The AKU-ERC granted ethical approval, with reference AKU/2020/098/fb. Ten participants were recruited for the study. Positive experiences were greater access to learning materials and improved learner confidence. In contrast, limited supervision, and lack of assurance of participants' engagement emerged as a negative VL experience. The components of critical thinking and problem-solving skills were unaffected by virtual case-based learning. However, the aspects of acquiring clinical and surgical skills emerged as a difficulty in accepting VL as a valid mode for attaining these competencies. To improve experiences of VL, participants' drive, engagement, technological inadequacies, and instructional design should be optimized.

"Where are you really from?": a qualitative study of Asian American medical provider experiences.

The COVID-19 pandemic highlighted how racially minoritized patients and clinicians have suffered racial discrimination. It also made visible the ways in which Asians across the globe experience racial hate and illuminated that the experiences of Asians in medicine are not often spotlighted. In the United States specifically, Asian Americans are not viewed as minoritized in medicine, yet their professional experiences are rarely highlighted. Informed by the discourses of the model minority, the forever foreigner, and ethnic lumping, we used Asian critical theory to explore how Asian American medical providers in Utah understand racial and ethnic identity and how these identities and experiences of racialization inform their professional identities. Using a case study approach, we identified and interviewed 23 physicians, physician assistants, and nurse practitioners (during spring 2022) who live in and practice medicine in Utah. Transcribed interviews were coded using reflective thematic analysis. Findings were organized into three themes: (1) feeling different, (2) experiences with discrimination, and (3) wrestling with the model minority myth. While Asian American medical providers experience not belonging, they also have the agency to disrupt discrimination and stereotypes. Asian American medical providers' racial and ethnic identities influence their professional interactions. Understanding the intersections of their social and professional identities are important to providing support for Asian medical providers, within the United States and beyond.

Evaluation of public's knowledge, attitude and experiences towards the generic medications in building healthcare policy.

The increasing cost of prescription drugs has high concern and associated with medication nonadherence and adverse health outcomes. The use of generic prescription drugs by the patients depends on if recommended by competent healthcare providers. Generic medicines, which are cheaper and bioequivalent to brand-name drugs, offer an opportunity to reduce healthcare expenditures of Saudi Arabia's healthcare system as per the Vision 2030 plan. Therefore, the current study was conducted to assess the population awareness, attitude and perception towards the generic medications particularly those locally manufactured in Saudi Arabia. We managed a cross-sectional, questionnaire-based study and included indices like demographic sections, knowledge of generic medications, perception of generic medication use, and previous experience. Data was collected over 12 weeks from February 2022 to April 2022 using an online survey tool. A study of 462 participants found that the majority were male (54.97%), young (55.4%), with a graduate or post-graduate degree (73.5%) and employed (43.29%). The majority reported good health, with 75.5% reporting good health. The study found significant differences in knowledge about generic drugs, their country of origin, and their benefits and utility. Most participants had positive attitudes towards generic medications, with 45% believing they are as effective as those from other countries. The study also revealed a significant difference in participants' experience and usage of medications particularly satisfaction to health outcome. Enhancing healthcare professionals' perceptions of generics can positively influence patient/consumer opinions and trust in generic medicines. Patients' high trust in prescribing physicians also influences these opinions, as their opinions can influence patient/consumer opinions.

Issues in the Adoption of Online Medical Care: Cross-Sectional Questionnaire Survey.

Telemedicine, or online medical care, has gained considerable attention worldwide. However, it has not been widely adopted in Japan, and the detailed status of received and provided online medical care and the reasons for its lack of popularity remain unknown. This study aims to investigate the current status of online medical care in Japan and the factors limiting its adoption from the perspective of both patients receiving and medical professionals providing online medical care. In total, 2 nationwide questionnaire surveys were conducted. The first survey, targeting both patients and healthy individuals, screened approximately 40,000 participants among 13 million people. The participants were selected to match the age distribution of the Japanese population based on government data, and their online medical care experience and medical visit status were recorded. To further investigate online medical care use and satisfaction, a web-based survey was conducted with 15% (6000/40,000) of the screened participants. The second survey, targeting medical professionals, was administered to a physician, a nurse, and a member of the administrative staff in each of 4900 randomly selected medical facilities to inquire about their online medical care practices and impressions. In addition, both surveys investigated the factors limiting online medical care expansion in Japan. The response rates among patients and healthy individuals targeted for the screening and main surveys were 92.5% (36,998/40,000) and ˃80% (1312/1478, 88.77%; 1281/1522, 84.17%; 404/478, 84.5%; and 2226/2522, 88.26% in 4 survey groups), respectively. The survey of medical professionals yielded 1552 responses (n=618, 39.82% physicians; n=428, 27.58% nurses; n=506, 32.6% administrative staff). Although the facility-level response rate was low (794/4900, 16.2%), some facility categories had relatively high response rates. Only 5.29% (1956/36,998) of the patients and healthy individuals had online medical care experience. When there were more hospitals nearby and they felt it was more work to see a physician in person, they were more likely to use online medical care (more nearby hospitals: adjusted odds ratio [aOR] 1.33, 95% CI 1.18-1.50; more work: aOR 1.48, 95% CI 1.35-1.63 per survey response point in the patient group). Similarly, these factors were substantially associated with satisfaction (more nearby hospitals: aOR 1.40, 95% CI 1.14-1.73; more work: aOR 1.50, 95% CI 1.27-1.76 per survey response point in the patient group). In both surveys, the most frequently selected factor preventing the widespread use of online medical care was patients' need to switch to face-to-face medical care for mandatory tests and procedures. Inadequate awareness of and education on online medical care were also frequently selected. Our nationwide surveys provided insights into the current status of online medical care in Japan and simultaneously identified several problems and issues related to it, which will be useful in promoting its wider adoption.

Risk Factors of Post-Traumatic Stress in Pediatric Solid Organ Transplant Recipients.

Life with end-stage organ failure is accompanied by an accumulation of traumatic medical or surgical experiences. Despite recovery after solid organ transplantation (SOT), many children and adolescents develop post-traumatic stress symptoms (PTSS). PTSS remain underappreciated as a major comorbidity in SOT programs, despite their association with decreased quality of life. We conducted a retrospective, cross-sectional study of 86 pediatric SOT recipients (17 heart, 44 kidney, and 25 liver) to evaluate potential determinants of PTSS. Trauma symptoms were measured by the Child Trauma Screening Questionnaire (CTSQ). Demographic, baseline, and contemporaneous factors were tested for independent association with CTSQ scores. The median post-transplant CTSQ score was 2 (IQR 1-4), and 22% were identified as high risk (score ≥5) for PTSD. Higher CTSQ scores were independently associated with the number of ICU days within the previous 12 months, the number of medications (complexity), and involvement with foster care in the primary model (R2 [adj.] = 0.26). The addition of the Family Impact Module improved the overall model (R2 [adj.] = 0.33), wherein higher family functioning was independently associated with lower CTSQ scores. An exploratory analysis of pre-transplant patients (n = 34) found a median pre-transplant CTSQ of 2 (IQR 1-6), suggesting that PTSS are onset before transplant and persist afterward. PTSS are highly prevalent in the SOT population. Risk factors include recent adverse medical experiences and complexity, whereas family stability may be protective. Additional research is needed to improve early ascertainment and support for patients at high risk of developing PTSS throughout their transplant journey.

How I Do It: Process Control in Medical Student Experiences of Surgery

ObjectiveExtreme variation exists in teaching and clinical exposure for medical students, both from specialty-to-specialty but also between universities. There is mounting literature highlighting the need to reform and standardise surgical education to allow for unified graduate competency. In line with the recommendations from the GMC2 and the Royal College of Surgeons England (RCSE) 3, Queens University Belfast (QUB) significantly revised their undergraduate medical programme. Within this new curriculum is the introduction of Specialty Focus week in Surgery. This report reviews the processes used in the introduction of this week. DesignThe initial curriculum was formulated with a weekly timetable consisting of tutorials, bedside teaching and students following a peri-operative case. Run charts were populated with an alert when feedback dropped below a certain standard, which then triggered an intervention. ParticipantsFeedback was collected via a QR code from the first 200 surgical student. SettingsBelfast City Hospital in association with Queens university Belfast (QUB) undergraduate surgical curriculum. ResultsRun charts resulted in an alert when feedback dropped below 8/10. Following this we implemented smaller group bedside teaching. There was a significant improvement in feedback post intervention (P=0.04) with no further alerts. Overall feedback had a non-significant feedback improvement post intervention (P=0.07) with once again, no further alerts. ConclusionThis review has shown how we have provided some standardisation of local surgical teaching, as well as having a process centred model of monitoring. This curriculum is easy to implement and could be reproduced elsewhere.

Impactful medical school experiences and choosing a career in neurosurgery: A new beginning for the national undergraduate neuroanatomy competition

Impactful medical school experiences and choosing a career in neurosurgery: A new beginning for the national undergraduate neuroanatomy competition

Hemodynamic monitoring- (NOT) anursing task?!

Ensuring adequate and stable hemodynamic conditions is an essential component of patient care in emergency and intensive care units. The assessment of circulatory status is complex and influenced by patient-specific characteristics, medical staff experience, and available equipment. Hemodynamic monitoring encompasses both invasive and noninvasive methods to monitor circulatory parameters. It supports patient management and ensures therapeutic success by alerting healthcare providers to deviations, including critical values. In practice, numerical data often receive more emphasis than comprehensive patient observation, potentially leading to misinterpretation. Advanced practice nurses (APNs) are highly qualified nursing professionals who work largely autonomously due to their advanced training. However, there is currently no uniform legal regulation for these professions in Germany. Clear definitions and nationwide regulations for related academic programs are necessary. Interprofessional collaboration, as well as the qualifications and numbers of nursing staff, significantly impact therapeutic outcomes. Hemodynamics involves the physical principles of blood flow and the assessment of vital parameters to ensure organ perfusion and oxygenation. The competence and knowledge of nursing staff are crucial for safe patient care. Local standard operating procedures (SOPs) should consider interprofessional collaboration and the qualifications of team members.

Improving Patient Experience and Team Engagement with Environmental Services: Application of Watson's Theory of Human Caring.

Patient experience and team engagement are key performance indicators in organizational strategic planning. Health-care organizations have a seldom-used resource within acute care settings that expands the ability to improve patients' experiences of their care as well as their own team engagement. Environmental services (ES) staff, the second largest health-care workforce, spend an average of 10 min per patient day interacting with patients and families. Few studies highlight how nursing theory may influence patient experience outside of the nursing role. This paper explores how ES staff at a non-profit rural 974-bed academic medical center impacted patient experience using nursing theory to promote a caring environment. Applying Watson's Theory of Human Caring and Caritas Processes© with ES team members beginning at leadership levels increased team engagement and improved patient experience. ES team members benefited from a professional nursing framework and from being integrated as a valued partner in advancing human caring.

Cost impact of the use of a universal cardiac implantable electronic devices remote monitoring solution: results of the Evidence RM study

Abstract Background Remote monitoring (RM) is considered the standard of care for patients with cardiac implantable electronic devices (CIED). In 2023 the HRS/EHRA/APHPRS/LAHRS expert consensus highlighted the potential interest of alert-based monitoring and the use of a third-party platform for RM management. By lightening the RM workload for clinical staff, valuable time and resources can be redirected towards patient care. Purpose This study aims to assess the impact on healthcare expenditures of the adoption of a Universal, vendor-neutral, and alert-focused remote monitoring (RM) platform for CIED in France, as opposed to the Conventional RM conducted via device specific manufacturers' platforms. Methods This study utilizes the French National Health Database (SNDS) to evaluate the effectiveness of RM solutions among patients with implantable cardioverter defibrillators (ICD), including cardiac resynchronization therapy defibrillators (CRT-D). All patients under RM were categorized based on the type of monitoring, either the Universal RM or the Conventional RM. The analysis was conducted on year 2019 and included only patients maintaining consistent RM solutions and device types throughout the entirety of the study period. To mitigate potential biases, costs were adjusted according to age, gender, device type, year of first implantation, year of RM initiation, medical center experience with RM, and Elixhauser score for comorbidities. Results Study cohort consisted of 36,401 patients (age 67.3 ± 13.0 years / male 78.4% / CRT-D 40.1%), 1,482 patients followed using the Universal RM platform and 34,419 patients monitored with the Conventional RM solutions. The study findings revealed a 4% decrease in corrected total costs and a notable 17.8% reduction in hospital costs among patients utilizing the Universal RM. Analysis further identified that this decrease in hospital expenses was primarily influenced by a reduction of the costs associated with cardiovascular diseases. Conversely, the group utilizing the Universal RM experienced a 7.9% increase in total outpatient costs compared to Conventional RM, while ambulatory visit costs remained unchanged. As costs incurred by patients were not included, total costs may however be underestimated. Patients under the Universal RM solution may benefit of more proactive preventive measures delivered through outpatient care. By addressing issues preemptively, critical conditions may be averted, enhancing overall patient management, and diminishing hospital costs. The adoption of a third-party Universal platform may thus yield to cost savings, exemplified by a negative Incremental Cost-Effectiveness Ratio (ICER) of -103€ per Day Alive and Out of Hospital (DAOH) as observed in this study. Conclusions The use of a third-party Universal RM platform showed a positive impact in terms of costs reduction for the French healthcare system on this ICD population.

Development and validation of a training course on proton pump inhibitor deprescription for general practitioners in a rural continuing medical education program: a pilot study

BackgroundDespite being cornerstone medications for managing gastrointestinal disorders, proton pump inhibitors (PPI) have raised concerns due to inappropriate prescribing and overutilization, their potential side effects, and interactions with other medications. General practitioners (GPs) provide long-term patient follow-up and are targets to promote PPI deprescribing to reach the widest possible population. GPs practicing in rural settings encounter unique challenges as their numbers dwindle and their workload increases. Hence, targeted educational interventions are crucial to promote appropriate prescribing practices in such underserved areas.MethodsWe developed a continuing medical education (CME) program focused on PPI deprescribing for GPs in rural settings. The program comprised of an interactive training session featuring clinical cases, an open discussion, and distribution of educational materials. We assessed the program’s effectiveness using a two-level Kirkpatrick model, evaluating participant satisfaction and knowledge levels through pre- and post-course questionnaires.ResultsThirty-three GPs participated, with 61.9% working in semi-rural and 38.1% in rural areas (21 responded to the 1st questionnaire, 14 to the 2nd ). Median medical experience was 6 years, with 61.9% serving as internship supervisors. Despite 95.2% acknowledging PPI overprescription, none had previously participated in dedicated PPI CME programs. The open discussion session provided valuable insights into various topics related to PPI use and gastrointestinal health. Participants expressed high satisfaction with the program (average rating of 9.1/10) and 92.9% reported changes in practice, including increased awareness of inappropriate PPI prescriptions. Indeed, 92.9% of GPs identified inappropriate PPI use following the course. 57.1% of participants utilized the provided educational materials. The main practice changes observed included an increased reassessment rate of PPI indications (71.4% at each renewal after vs. 19% before, 28.6% non-systematically after vs. 66.8% before, 0% rarely after vs. 14.3% before; p = 0.006), the necessity for more than one consultation to deprescribe (64.3% after vs. 23.8% before; p = 0.021), systematic utilization of gradual cessation of PPI (100% vs. 61.9%; p = 0.039) and more frequent use of additional medication (92.9% vs. 57.1%; p = 0.022), primarily antiacids (92.3%).ConclusionsOur study underscores the effectiveness of targeted CME programs in promoting appropriate prescribing practices and enhancing knowledge among GPs in rural settings. Despite the challenges encountered in deprescribing PPI, the program facilitated proactive approaches in managing treatment discontinuation failures. Tailored educational interventions are essential for mitigating medication prescribing challenges and improving patient outcomes in rural primary care settings.Trial registrationsNot applicable.

Physician development through interprofessional workplace interactions: A critical review.

Increasingly, medical training aims to develop physicians who are competent collaborators. Although interprofessional interactions are inevitable elements of medical trainees' workplace learning experiences, the existing literature lacks a cohesive model to conceptualise the learning potential residing in these interactions. We conducted a critical review of the health professions and related educational literatures to generate an empirically and theoretically informed description of medical trainees' workplace interactions with other health professionals, including learning mechanisms and outcomes. Informed by Teunissen's conceptualisation of workplace learning, we highlight the individual, social and situated dimensions of learning from interprofessional workplace interactions. Workplace interactions between medical trainees and other health professionals tend to be brief, spontaneous, informal and often implicit without the predefined educational goals and roles that structure trainees' relationships with physician supervisors. Yet they hold potential for developing trainees' knowledge and skills germane to the work of a physician as well as building their capacity for collaboration. Our review identified a spectrum of learning theories helpful for examining what and how trainees learn from these interactions. Self-regulated learning theories focus attention on how learning depends on trainees interpreting and judging the cues offered by other health professionals. Sociocultural frameworks including the zone of proximal development and legitimate peripheral participation emphasise the ways other health professionals support trainees in performing tasks at the border of their abilities and facilitate trainees' participation in clinical work. Both the landscapes of practice theory and cultural historical activity theory highlight the influence of surrounding social, cultural and material environments. These theories are unified into cohesive model and demonstrated through an illustrative example. Interprofessional workplace interactions harbour a range of learning opportunities for medical trainees. Capitalising on their potential can contribute to training collaborative practice-ready physicians alongside traditional intra-professional interactions between physicians and merits future research.

Undergraduate musculoskeletal ultrasound training based on current national guidelines—a prospective controlled study on transferability

IntroductionMusculoskeletal ultrasound (MSUS) is integral to routine clinical diagnostics for musculoskeletal and joint disorders. This study aims to establish and validate a sonography course tailored to undergraduate medical students acquiring MSUS-specific skills at a German university.MethodsA blended learning training concept, comprising 24 instruction sessions of 45 min each, was designed based on the current national guidelines of the German Society for Ultrasound in Medicine (DEGUM). This program was integrated into the clinical phase of the undergraduate students’ medical education. The self-perceived improvement in competency and the effectiveness of the course design were evaluated using a a 7-point Likert scale questionnaire. Objective learning success was evaluated via a written test and a “Direct Observation of Practical Skills” practical exam. Control groups included medical students without MSUS training (control group 1) and doctors who had completed DEGUM-certified basic MSUS courses (control group 2). Both control groups completed the written test, while control group 2 also took the practical final exam. The study involved 146 participants: 56 were allocated to the study group, 44 to control group 1, and 46 to control group 2.ResultsThe study group rated their skills significantly higher after the course (p < 0.01). Participants expressed high satisfaction with the course design, the teaching materials, and the teachers. The study group's performance on the final written test was comparable to those of control group 2 (p = 0.06) and significantly superior to control group 1 (p < 0.001). Additionally, the study group’s performance on the practical final exam was not significantly different from control group 2 (p = 0.28), with both groups achieving scores exceeding 80%.ConclusionBoth subjective and objective measures of learning suggest that an MSUS course designed for postgraduates can be effectively adapted for undergraduate medical students. Incorporating MSUS training into the clinical curriculum is recommended to enhance future medical professionals' educational experience and practical skills.

Chinese Expert Consensus on the Combination of Targeted Therapy and Immunotherapy with Locoregional Therapy for Intermediate/Advanced Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality, it ranks as the second most common cause of cancer deaths in China. Most HCC patients are first diagnosed at an advanced stage. In recent years, targeted therapy combined with immunotherapy has become the preferred regimen for systemic treatment of intermediate-advanced HCC, while targeted therapy combined with immunotherapy plus local treatment could further improve the efficacy in many clinical studies. To better guide the clinical treatment for effective and safe combination therapy, our interdisciplinary panel on the treatment of intermediate-advanced HCC comprising hepatologists, hepatobiliary surgeons, oncologists, radiologists, interventional radiologists and traditional Chinese medicine physicians have formulated this consensus based on current clinical studies and clinical medication experience for reference. The consensus contained 15 recommendations, including the applicable population and management, local treatment selection, conversion strategy, treatment strategy after tumor progression and management of common adverse reactions.

Medical students' tobacco consumption status and experiences with smoke-free law violations in enclosed spaces in Türkiye and Northern Cyprus

Medical students' tobacco consumption status and experiences with smoke-free law violations in enclosed spaces in Türkiye and Northern Cyprus