Shortage Of Physicians Research Articles

Attracting doctors to rural areas under the state program: performance indices

Introduction.The implementation of the state program “Zemsky Doctor” is one of the effective mechanisms to attract medical personnel to medical institutions located in rural areas. The purpose of the study. To analyze the indices for attracting doctors to medical institutionsss located in rural areas of the Russian Federation during Federal Research Institute for Health Organization and Informatics the period from 2015 to 2022 within the framework of the state program “Zemsky Doctor”. Materials and methods. The study used statistical data on eighty two subjects of the Russian Federation based on operational documented inquiries for the period from 2015 to 2022. Analytical and statistical methods were used in the research process. Descriptive statistics and correlation analysis was conducted using the Statistica package version 13.3. Results. During the study period, more than 33,000 physicians of various specialties were attracted and employed in rural areas. The index of the number of doctors attracted to rural areas under the program from 2015 to 2022 increased by 32.2%, from 0.9 to 1.19 per 10,000 rural population. When analyzing this index by regions of the Russian Federation, significant differences were revealed. Research limitations. The research materials are limited by the results of the analysis of quantitative data obtained as a result of an operational request to the subjects of the Russian Federation and statistical data of the forms of federal statistical observation. Conclusion. The study revealed the regions with the lowest level of the indice of physician supply also to have a low index of the number of doctors recruited under the program. The results of correlation analysis showed that in most of the Russian regions there is a direct dependence of the index of physician supply on the results of the implementation of the program “Zemsky Doctor”. The results of the program implementation have a significant impact on the staffing of medical organizations located in rural areas.

The rise of advanced practice provider independence bills: a misguided attempt to address the physician shortage.

In the past decade, the rise of state legislation that allows for advanced practice provider (APP) independence has grown steadily across the country. Most recently, Montana has enacted House Bill 313, which allows for physician assistant independent practice in primary care services. This is a concerning trend because there is a multitude of studies that demonstrate worsened patient outcomes and increased healthcare expenditures for care delivered by nonphysicians. There are also many unintended consequences that are likely to occur due to this inappropriate expansion of scope of practice for APPs. In this commentary, we outline the ramifications that are likely to occur in states such as Montana that enact legislation that expands the scope of practice for nonphysicians.

Physicians and the Production of Health: Returns to Health Care during the Mortality Transition

Abstract This paper investigates the returns to health care provision during the mortality transition. We construct a new panel data set covering German municipalities from 1928 to 1936. The endogeneity of health care supply is addressed by using the expulsion of Jewish physicians from statutory health insurance as exogenous variation in regional physician supply. Increases in the supply of physicians reduce infant mortality and mortality from common childhood diseases. Using a semiparametric control function approach, we find diminishing marginal returns to health care provision. The results are consistent with historical trends in infant mortality over the 20th century.

Barriers Facing Undocumented Medical Students Without DACA.

Despite predictions that the United States will experience a growing physician shortage in the coming decades, there remains a population of would-be clinicians who are barred from becoming licensed physicians because of their immigration status. Undocumented medical students who do not have DACA have to overcome many barriers to gain admittance to medical school, but because they lack work authorization in the United States, they are unable to enter residency training. In this article, the authors highlight the implications of this dilemma for academic medicine. After detailing the experiences of an undocumented medical student, they examine the historical and policy background of this barrier to licensure and board certification. The authors consider the most immediate option available to academic medical institutions: to create a viable training program that is an alternative to residency. Such an alternative training program would need to be equivalent in quality to an accredited residency program and enable its trainees to become board-certified but not be a form of employment. Finally, the authors conclude with a call for academic medicine to engage in advocacy in support of legislative solutions for undocumented young people.

An increasing number of states filled Conrad 30 waivers for recruiting international medical graduates.

To address physician shortages in the United States, Congress created the Conrad 30 visa waiver program allowing non-citizen international medical graduates to obtain visas to practice medicine in underserved areas. There is little information on whether states have effectively used the program. To fill the gap, we examined the growth and distribution of Conrad physicians between 2001 and 2020. We found that the number of states filling all of their annual allocated Conrad slots increased over the last two decades, yet one-half of the states still did not fill their allowed slots in 2020. Our analysis also revealed substantial variations across states in the number of Conrad physicians by specialty (eg, primary care physicians and psychiatrists), geography (eg, rural vs urban areas and physician shortage vs non-shortage areas). Our findings suggest that states can better use the Conrad program to meet healthcare needs across specialties and geographic areas.

WHEN PHYSICIAN SUPPLY DOES NOT MEET PATIENT DEMAND: A LOOMING EPIDEMIC IN VASCULAR AND RENAL CARE FOR A COMMUNITY WITH THE HIGHEST INCIDENCE OF END-STAGE RENAL DISEASE IN THE UNITED STATES.

South Texas and the Rio Grande Valley (RGV) are medically underserved-communities near the Texas-Mexico border with the highest incidence of end-stage renal disease (ESRD) in the nation, and a shortage of available full-time equivalent (FTE) specialty-physicians. Data on the incidence/prevalence of ESRD and workforce projections on vascular-surgeons and nephrologists were collected from the United States Renal Data System and Texas Department of State Health Services. We then merged data from both datasets to identify population-specific healthcare-trends. Texas had the highest rates of ESRD from 2016 to 2020, with its border regions leading the state. By 2032, vascular-surgery and nephrology are projected to have the 1st and 4th worst physician-shortages in the state respectively, with the percentage of these FTE specialty-physicians available to meet the need of the RGV ranging from 42.3 to 58.4​%. The RGV is experiencing increased rates of ESRD, while having a paradoxical-decline in specialty-physicians available to provide adequate care.

An Evaluation of a Virtual Seminar Series for Doctor of Nursing Students to Promote Advanced Nursing Practice.

Background: Advanced practice nurses (APNs) have been responding to worldwide changing patient comorbidities, inequalities within access to care, and a shortage of primary care physicians. The scope of practice for these nurses has been expanding internationally but varies across different jurisdictions. For a period of time during the COVID-19 pandemic, APN trainees' opportunities to work with international mentors in-person were limited. Objective: This study aimed to evaluate the effectiveness of a virtual seminar series in supporting growth in clinical judgment, skills in nursing leadership, and advocacy to optimize APNs' scope of practice. Methods: A preexperimental study was conducted in one cohort of students in the Doctor of Nursing (DN) program at The Chinese University of Hong Kong. A total of 10 prerecorded seminars were presented by nurse practitioners (NPs) in Canada on various disease topics. The evaluation of these seminars focused on the effectiveness of teaching by each speaker and the perceived confidence of learners in carrying out each domain of the APN scope of practice. Results: The study found that the virtual seminar series was effective in improving learners' perceived confidence in carrying out each domain of the APN scope of practice. The perceived teaching effectiveness of each speaker was also evaluated and found to be positive. Conclusions: The virtual seminar series was an effective strategy in supporting newly graduated APNs' professional transitions, particularly when opportunities for collaboration and education were limited due to the COVID-19 pandemic. Implications for Nursing: Mentorship, experiential learning, interprofessional training, and professional socialization are vital strategies for supporting APNs' professional development. The virtual seminar series can be an effective strategy for supporting APNs' scope of practice growth, especially in the current global pandemic context.

Migration policy and the supply of foreign physicians: Evidence from the Conrad 30 waiver program

In the United States, rural and low-income communities have difficulty attracting and retaining physicians, potentially adversely impacting health outcomes. With a limited supply of physicians completing medical school at US universities, foreign-born and educated physicians provide a potential source of supply in underserved areas. Although nearly a quarter of medical residents in US hospitals received their medical degrees abroad, the terms of the commonly used J-1 visa require a return to the home country for two years, which may limit the capacity of international medical graduates (IMGs) to pursue employment in the US market. Our analysis examines the extent to which reducing visa barriers impacts the supply of physicians at state and local levels, particularly in areas designated as medically underserved. The Conrad 30 Visa Waiver program gives states the opportunity to attract foreign IMGs to practice in underserved areas by waiving the two-year home residency requirement for those with J-1 visas and providing a path to obtaining US citizenship. Changes in the federal limit on the number of waivers per state, combined with variations in the state-level restrictions on eligible specialties and geographies in which physicians can work, provide evidence of the role of visa restrictions in limiting the supply of doctors. We find that the expansion of the cap on visa waivers increased the supply of IMGs in states impacted by the cap lift. There is little evidence of reductions in US-trained doctors in states where IMGs increases were the largest, suggesting little evidence for crowding out. Health Professional Shortage Areas (HPSAs) in states with fewer restrictions on the program had relatively more IMGs but no fewer US-trained doctors. Importantly, HPSAs in states with less restriction to the program also had relatively lower early mortality rates and lower COVID-19 death rates.

Balint groups' possible role in self-care and job satisfaction of general practitioners-Aqualitative study.

Concerns are growing when it comes to the shortage of primary care physicians, therefore it seems necessary to take acloser look at job satisfaction and self-care as one of many influences on career choice. Ahigher job satisfaction reduces the risk to experience burnout and job-related stress and in addition it will contribute to staying in the profession. The objective of this study is to investigate the impact of regular participation in Balint groups on job satisfaction and self-care among general practitioners. Descriptive qualitative study with semi-structured expert interviews of 7general practitioners. Thematical analysis of data and narrative summary. Atotal of 402 coded segments were categorized into 8main themes and 39subthemes. Interviewees emphasized changes in self-care and job satisfaction as aresult of Balint work and mentioned Balint work as aburnout prophylaxis for themselves. Competences that were learnt or improved through Balint work were described as well as aspects such as feedback and connection with colleagues or professional challenges and difficulties. The results of the study give rise to the assumption that regular participation in Balint groups might help to improve self-care, resilience, and contribute to job satisfaction. Further research is needed before ageneral recommendation can be made. Many positive aspects were described by the experts, while no harmful negative influences of Balint work were identified.

Depression, anxiety, stress and insomnia among foreign medical graduates appearing for foreign medical graduate's examination in India: A cross sectional study.

As a prerequisite to start a medical practice in India, Foreign Medical graduates on returning have to sit for FMGE (Foreign Medical Graduate's Exam), organized by NBE. The time and effort involved by the students with adjustments to various changes in educational and examination pattern may manifest as psychiatric morbidities while awaiting a positive outcome. To evaluate depression, anxiety, stress, and insomnia in Foreign Medical Graduate students and to understand the various factors associated with them. A total of 80 MBBS students appearing for FMGE were enrolled during the period of April 2023 to May 2023, after obtaining their written consent on the Google form to participate in this study. The participants answered a semi-structured proforma consisting of information about sociodemographic data, DASS-21 (depression, anxiety, and stress severity scale), ISI scale (insomnia severity index), and RSES (Rosenberg self-esteem scale). In this study, 76.2%, 80%, 72.5%, and 78.8% of students were found to be suffering from depression, anxiety, stress, and insomnia, respectively. A significant statistical correlation was found between anxiety and the students appearing for July FMGE 2023. Stress and depression were associated with insecurities/comparisons faced by the participants due to peers clearing the examination before them. Low self-esteem was associated with 3 or more failed attempts for FMGE and the presence of other stressors preceding/concurrent while preparing for FMGE. Clinical insomnia was found to be statistically significant with depression, anxiety as well as stress in this study. Multiple regression analysis showed that stress and anxiety predicted depression while the young age of the student, low socioeconomic status, low self-esteem, stress, and depression predicted anxiety. Stress was found to be associated with anxiety, depression, and insomnia. Insomnia was corelated with having extension in the UG course and stress while low self-esteem was corelated with students who were attempting for the July 2023 examination and anxiety. The significantly high proportion of psychiatric morbidities among Foreign Medical Graduates is suggestive of the need for the necessary psychological aid and counseling as these foreign medical graduates can be viewed as an opportunity to correct India's physician shortage.

Expectations And Motivations Of Young Occupational Medical Physicians: A Quantitative Survey Of Five German Academies

The aim of this study was to describe the characteristics of future occupational physicians and to evaluate their expectations from and motivations for undertaking postgraduate medical education courses in occupational medicine. This will provide a basis for further increasing the attractiveness of occupational medicine as a discipline in preventive medicine and counteracting the shortage of occupational medical physicians. At five locations in Germany, physicians in postgraduate medical education courses in occupational medicine were asked about their expectations from occupational medicine, their reasons for starting postgraduate medical education courses, and their assessment of these courses. The survey took place between 2018 and 2021. The data were analysed descriptively, and a cluster analysis was applied to identify the types of motives for continuing postgraduate medical education courses in occupational medicine. Of the 233 respondents, the majority were female (68.5%) and the mean age was 43.1 years (SD 7.9 years). The response at the State Chamber of Physicians of Saxony was 50% and at the remaining four academies was between 18% and 23%. The analysis revealed four different types of motives: "career & interest", "work & life balance", "self-employment" and "desire for change". Two-thirds of the participants were in favour of a greater integration of occupational medicine into medical school curriculum. The results suggest that there are different motives that lead physicians to pursue continuing education in occupational medicine. These motives should be considered when recruiting young occupational physicians.

The Supply of Surgical Specialists and Subspecialists to the U.S. Medicare Population: National Trends from 2013 to 2019.

The U.S. population is rapidly aging. The supply of surgeons needed to meet this demand should be evaluated. This study evaluated the trends in supply of Medicare surgeons by specialty and by U.S. state and region. All surgeons associated with a National Provider Identifier for cardiothoracic surgery, colorectal surgery, general surgery, gynecologic oncology, hand surgery, neurosurgery, obstetrics-gynecology, ophthalmology, oral and maxillofacial surgery, orthopedic surgery, otolaryngology, plastic and reconstructive surgery, surgical oncology, urology, and vascular surgery from 2013 to 2019 on the Centers for Medicare & Medicaid Services website were included. The absolute number of physicians was adjusted per 100,000 Medicare beneficiaries. Annual change was calculated by linear regression model, and the compound annual growth rate (CAGR) was calculated per specialty. The absolute number of physicians per 100,000 beneficiaries increased in 6 of 15 specialties during the study period. Vascular surgery had the largest annual increase (+0.23; CAGR, +2.75%), and obstetrics-gynecology had the largest annual decrease (-1.08; CAGR, -1.44%). Surgical oncology showed the largest positive CAGR (+4.20%). Oral and maxillofacial surgery had the largest negative CAGR (-2.86%). The Northeast was above the national average in supply for each specialty. The Midwest had the most specialties with positive CAGRs. The South did not meet the national average for physicians in any specialty. This analysis of 15 surgical specialties provides important context to predicted physician shortages to the Medicare population. The study found geographic variation by region across specialty, which has important implications for health care planning from the level of undergraduate medical education to provision of hospital resources. Overall, the supply of surgeons across all specialties may not be sufficient to meet the demand of the rapidly aging U.S. population. Future study is needed to evaluate why surgeons are leaving the Medicare program.

Evaluating the Effectiveness of African School of Hypertension for Non-Physician Health Workers, a Qualitative Study: QuASH Hypertension Study.

The implementation of task sharing and shifting (TSTS) policy as a way of addressing the shortage of physicians and reducing the burden of hypertension in Africa birthed the idea of the African School of Hypertension (ASH). The ASH is saddled with the responsibility of training non-physician health workers across Africa continent in the management of uncomplicated hypertension. To get feedback from some faculty members and students who participated in the first ASH programme. This was a cross-sectional exploratory qualitative study conducted among eight students and eight faculty members. Feedback from the program was obtained by conducting in-depth interviews centred on description of course content; expectations and knowledge acquired from ASH; level of interaction between students and faculty members; challenges faced during the ASH; level of implementation of acquired training; and suggestions to improve subsequent ASH programs. The course content of the ASH was described as simple, appropriate and adequate while interaction between students and faculty members were highly cordial and engaging. New knowledge about hypertension management was acquired by the students with different levels of implementation post-graduation. Some identified challenges with the ASH program were poor internet connectivity during lectures, non-uniformity of TSTS policies and hypertension management guidelines across Africa, technical problems with hypertension management app and low participation from other African countries apart from Nigeria. Some recommendations to improve ASH program were development of a uniform hypertension management guideline for Africans, wider publicity of the ASH, interpretation of lectures into French and Portuguese languages and improvement of internet connectivity. The ASH programme has largely achieved its objectives with the very encouraging feedback received from both faculty members and the students. Steps should be taken to address the identified challenges and implement the suggested recommendations in subsequent ASH program to sustain this success.

Assistance Programs to Medical Licensure for IMGs Living in the US

Background: International Medical Graduates who are not US citizens (non-USIMGs) have the potential to provide culturally and linguistically competent care for diverse patient populations in underserved areas, relieving US physician shortages. However, the migration experiences of physicians who start the process of US medical licensure after arriving make it less likely they will practice medicine in the US. The objective of this research was to identify and assess the number of programs and the range and type of support currently available to this population. Methods: A scoping review was conducted of non-profit physician career assistance programs for non-USIMGs already in the US when they begin the US medical licensure process. For-profit companies are excluded because they are generally prohibitively expensive for non-USIMGs. The keywords “physician reentry” were entered into Google, identifying individual programs as well as databases, which were searched using the same keywords. Program websites and email outreach were used to review services provided by identified programs. Inclusion criteria were that programs provide physician career assistance, provide services to physicians who have never been licensed to practice medicine in the US, and have a nonprofit model. Results: Seventeen non-profit programs were identified that provide a combination of educational guidance, courses, and clinical experience to non-USIMGs seeking US medical licensure. They have supported at least 276 non-USIMGs to match to residency programs. Discussion: Career assistance non-profit programs like these have the potential to help remediate the physician shortage while increasing diversity in the medical profession and addressing issues of equity.

Nurse Practitioners (NPs) as Game Changers in Tanzania Health Delivery System: Lessons Learnt from Fujita Bantane Hospital in Japan

AbstractShortage of physicians/doctors in the primary health care system has been evidenced in various countries. Among other things, these countries deployed nurse practitioners (NPs) in the health care delivery system to address this shortage. Countries in America, Europe, and Asia use NPs to address physicians/doctors shortage in the primary health care delivery systems. Various studies have shown that NPs have been deployed in primary health care facilities to curb these shortages.While in Tanzania shortage of physicians/doctors and other health professionals is evidenced in every sector of the health care system, nurses play a crucial role to cover this shortage by providing care and support for individuals and communities. Nurses work in various settings from being a nurse, counselor, laboratory technologist, social worker, educationist, and physician, to name a few. Nurses play a key role in preventing, diagnosing, and attending to common health problems. The question is, “When will the Tanzanian health delivery system recognize the pivotal role of these nurses and upgrade them to NPs?” This study suggests that deployment of NPs in Tanzania's health care systems could be a “game changer.” As a fellow on Critical Care Nursing Course at Fujita Health University Bantane Hospital in Japan, witnessed deployment of NPs in health care delivery and the reaped benefits are enormous; increased access to health care services, reduction in health care costs, reduced hospital stays, and customer satisfaction through client empowerment and comfort. This is an observational study of tasks performed by NPs in Fujita Health University Bantane Hospital and their relevance as a positive innovation to curb physician shortages for effective health care delivery. The duration of the study at Bantane Hospital was 2 months from January 15 to March 16, 2024. One-to-one interviews with NPs on duty were conducted. Also, collected and reviewed information from Tanzanian government Web sites, published government documents, and academic literature. Results show that NPs perform a lot of procedures that physicians/doctors were supposed to do. In the wards, theater, laboratories, and clinics, they play a pivotal role to curb shortage of physicians/doctors in health settings. NPs are an effective addition to medical facilities. They perform various procedures in the absence of the doctors. The findings from this study have important implications for improving health care delivery in Tanzania. NPs could be “game changers” in the health care landscape in Tanzania. Investment on nurses' education, proper training, and policy changes in nurse practice regulations are key for this to succeed.

Motivation to work and attitudes towards retirement among physicians

BackgroundThe healthcare system is currently in a state of tension due to a shortage of physicians, the early retirement of health care professionals and an increasing need for care within an (aging) society. Therefore, the aim of the present study was to examine physicians’ attitudes towards retirement and possible influencing factors on their motivation to work.MethodData were collected as part of a baseline survey of a long-term study. The sample includes a variety of physicians (n = 625), working in outpatient or inpatient care, who have not yet reached the retirement age of 67. The primary outcome was to survey attitudes towards retirement using the Motivation to Work scale. Work-related characteristics (e.g., with regard to contract or working hour) as well as job satisfaction, overall health, and burnout were also included in the analyses (correlations and linear regression models).ResultsAccording to the results, sociodemographic characteristics are not significantly related to motivation to work, whereas the other parameters (satisfaction, health, and burnout) influence attitudes towards retirement significantly.ConclusionsThe results underline the need to improve the occupational conditions of physicians across different medical settings. More research is needed to understand physicians‘ decision-making with regard to retirement, especially in terms of work-related characteristics and differences.

Factors associated with medical students’ career choice in different specialties: a multiple cross-sectional questionnaire study at a German medical school

BackgroundGiven the shortage and unequal distribution of physicians across specialties, we aimed to evaluate factors associated with medical students’ career choices, including background, personality traits, educational experience, personal interests, lifestyle considerations, and the awareness of work requirements.MethodsWe conducted multiple cross-sectional surveys of students; a 159-item online questionnaire was designed and students from three different stages of the six-year medical degree course (outset, clinical phase, and on graduation) were invited to complete the survey. Data were collected between May 2021 and April 2023.ResultsThe questionnaire was sent to 1406 students, of whom 683 replied (49%); 481 respondents were female (70%). The top specialty choices across the respondents were internal medicine, surgery, and general practice, with anaesthesiology, paediatric and adolescent medicine (ranging 11–15%), and obstetrics and gynaecology also receiving interest, with 6% undecided. In particular, female students lost interest in surgery during the course of study in favour of the other options. The choice of general practice was associated with more vocational training, prior positive experiences with the specialty, and lower grades in the university entry examination. Clinical clerkships in a specific (freely chosen) specialty aligned with career choice, while the final practical year did not have an impact on career decision-making. All students highly desired regulated working hours and work-life-balance; however, students choosing surgery rated these items as less important. Willingness to work in a hospital environment was highly associated with choosing anaesthesiology and surgery, whereas rural areas and practices were associated with general practice. Higher scores at agreeableness were associated with choosing paediatric and adolescent medicine by more female students, whereas lower neuroticism values were associated with the choice of anaesthesiology.ConclusionsThe results highlight the intricate nature of decision-making and shed light on various aspects that contribute to the process of selecting a specialty. By identifying and addressing influencing factors, we can develop targeted interventions and policies to enhance diversity and distribution across medical specialisations and to aim for high-quality and equitable healthcare that matches the specific needs of both individuals and the population as a whole.Graphical

Medical training program size and clinical staff productivity and turnover.

The objective of this analysis was to evaluate the effect of resident program training size on clinician productivity and turnover in the Veterans Health Administration (VHA), the largest education and training platform for medical professionals in the United States. We retrieved administrative data on training programs and training facilities from the VA Office of Academic Affiliations and the VHA Corporate Data Warehouse. Data on primary care physician shortage areas were retrieved from the Health Resources and Services Administration. We used a quasi-experimental instrumental variables 2SLS design and constructed an exogenous predicted training allocation treatment variable as a function of the total national training program allocation. The outcome was clinical staff productivity and turnover. Secondary analyses stratified results using Health Professional Shortage Areas data (HPSA). Data were obtained for a national dataset of 141 VHA medical facilities and 26 specialties that hosted training programs across 11 years from 2011 to 2021 (N = 132,177). Instrumental variables results showed that on average, an increase of one training slot in a specialty leads to a decrease of 0.039 visits per standardized clinic day (p < 0.001) and a 0.02 percentage point increase in turnover (p < 0.001). The direction of this association varied by specialty: while psychiatry and psychology specialties saw a decline in productivity, fields such as primary care and cardiology experienced an increase in productivity. HPSA stratified results indicate that negative effects on productivity and turnover are driven by areas with little to no primary care physician shortage, whereas shortage areas experienced a small increase in productivity and no effect on turnover. This quasi-experimental evaluation indicates that resident training program size is associated with reduced productivity and increased turnover in specialties such as psychiatry and in facilities with high baseline productivity. However, in specialties like primary care and cardiology, as well as areas with shortages of primary care, larger training programs are associated with increased productivity.

Collaborative leadership to empower nurses to implement ABCDE emergency nursing in an emergency department in Nepal

PurposeEmergency medicine can save lives and in 2018 the World Health Assembly passed resolution 72.16 ensuring the role of emergency care in all health systems. With a continued global shortage of emergency physicians, with many low-medium-income countries (LMIC) still to develop emergency medicine as a speciality, the role of emergency nurses is critical to deliver the WHO Emergency Care System Framework (WHO, 2018). Emergency medicine doctors play a critical role in collaborating with nurses, in emergency medicine where nurses are often the first clinicians are often the first clinicians to interact with patients in emergency care settings, making up the majority of health-care professionals in LMIC (Mamalelala, 2024). Yet emergency nursing has yet to become established in Nepal, where nurses are often recruited to emergency departments, without having received any training in emergency or critical care treatment and management. The purpose of this paper is to outline a collaborative leadership approach to co-design an airway, breathing, circulation, disability, exposure (ABCDE) structured approach to an emergency nursing training module designed for nurses to feel empowered in the emergency department and to report on its findings.Design/methodology/approachThis study draws upon mixed methodology research, enrolling 30 nurses (n = 30) from an emergency department in a tertiary hospital in Nepal through three stages of the project: Stage 1: training module co-design, collaborative leadership exploring the rationale for a training module and core features of design based on the ABCDE of emergency medicine; Stage 2: quantitative data were collected to assess baseline pre- and post-intervention knowledge and follow-up knowledge assessment at 30 and 45 days; Stage 3: qualitative data were collected with 24/30 (80%) nurses to evaluate the impact and application of the nurses ABCDE learning 7 months post-training. The qualitative survey was undertaken using online Google Forms.FindingsNurses were fully engaged in the co-design and collaboration of the development of an ABCDE training module which was delivered over 3 h. Full engagement was secured from all nurses in the department, and there were statistically significant advances in ABCDE emergency knowledge from the baseline, however, this knowledge began to decrease at 30 and 45 days. A follow-up qualitative survey was distributed to nurses seven months after training with an 80% return rate, which reported a range of examples of how nurses were continuing to apply their learning in practice.Originality/valueThis training module for emergency nurses was designed collaboratively from the “bottom up” in a tertiary hospital in Nepal, recognising the need to develop emergency nursing in the emergency department. The data revealed promising findings, while knowledge decreased from the post-training questionnaire, qualitative evidence revealed significant changes in practice, with the greatest reported change in the management of the airway. While this training module has made a difference in the quality of care provided, there is a need for a country-wide strategy in this area otherwise it is likely that such an initiative will only be developed by hospitals at a local level (Lecky, 2014). Education and training initiatives for nurses that focus on an evidence-based approach to clinical practice can bridge the workforce gap in the short term, however, the Government of Nepal must decide on establishing a recognised post-graduate sub-specialty in emergency nursing, the duration of training, who should be trained and what curriculum should be followed (Lecky, 2014).

Integrated image-based deep learning and language models for primary diabetes care

Primary diabetes care and diabetic retinopathy (DR) screening persist as major public health challenges due to a shortage of trained primary care physicians (PCPs), particularly in low-resource settings. Here, to bridge the gaps, we developed an integrated image–language system (DeepDR-LLM), combining a large language model (LLM module) and image-based deep learning (DeepDR-Transformer), to provide individualized diabetes management recommendations to PCPs. In a retrospective evaluation, the LLM module demonstrated comparable performance to PCPs and endocrinology residents when tested in English and outperformed PCPs and had comparable performance to endocrinology residents in Chinese. For identifying referable DR, the average PCP’s accuracy was 81.0% unassisted and 92.3% assisted by DeepDR-Transformer. Furthermore, we performed a single-center real-world prospective study, deploying DeepDR-LLM. We compared diabetes management adherence of patients under the unassisted PCP arm (n = 397) with those under the PCP+DeepDR-LLM arm (n = 372). Patients with newly diagnosed diabetes in the PCP+DeepDR-LLM arm showed better self-management behaviors throughout follow-up (P < 0.05). For patients with referral DR, those in the PCP+DeepDR-LLM arm were more likely to adhere to DR referrals (P < 0.01). Additionally, DeepDR-LLM deployment improved the quality and empathy level of management recommendations. Given its multifaceted performance, DeepDR-LLM holds promise as a digital solution for enhancing primary diabetes care and DR screening.