Physician Training Research Articles

Gastric ultrasound performance time and difficulty: a prospective observational study.

Point-of-care gastric ultrasound is an emerging tool in peri-operative practice. However, data on the technical challenges of gastric ultrasound, which are essential for optimised training, remain scarce. We analysed gastric ultrasound examinations performed after basic training to identify factors associated with difficulty. This was an analysis of data from a prospective observational study evaluating the potential impact of routine pre-operative gastric ultrasound on peri-operative management in adult patients undergoing elective or emergency surgery at a single centre. Before initiation, physicians received extensive structured training with at least 30 supervised gastric sonograms before independent practice. We then used regression models to identify factors associated with deviation from a predefined sonography algorithm, performance time and scan difficulty. Seventy-three trained physicians performed 2003 ultrasound scans. Median (IQR [range]) performance time was 5 (4-6 [1-20]) min, which was achieved after 20-27 scans following structured training. Patient characteristics associated with more difficult and longer duration scans were: increase in BMI per 5 kg.m-2 (odds ratio (95%CI) 1.57 (1.35-1.83), p < 0.001 for difficulty and percentage change coefficient (95%CI) 1.03 (1.02-1.05), p < 0.001 for duration); and male sex (odds ratio (95%CI) 3.31 (2.28-4.88), p < 0.001 for difficulty and percentage change coefficient (95%CI) 1.08 (1.04-1.12), p < 0.001, for duration). Trauma surgery (odds ratio (95%CI) 3.26 (1.88-5.68), p < 0.001), ASA physical status of 3 or 4 (odds ratio (95%CI) 1.86 (1.21-2.88), p = 0.0049) and emergency surgery (odds ratio (95%CI) 1.86 (1.20-2.89), p = 0.006) were associated with deviation from the predefined sonography algorithm. Approximately 50 scans are required to achieve a baseline performance of 5 min per gastric ultrasound. Future training programmes should focus on patients with obesity, male sex, higher ASA physical status and trauma.

The Center for Health Outcomes in Medicine Scholarship and Service (HOMES): Fostering and Supporting Physician-Initiated Research

Abstract Problem The U.S. physician scholar workforce, currently comprising less than 1.5% of U.S. physicians, continues to decrease, threatening national status as a global biomedical research leader. Academic medical center (AMC) trends away from tenure-track physician faculty appointments toward clinical faculty appointments have contributed to this decrease, but AMCs have limited strategies to equip clinical faculty to conduct research. Infrastructure fostering clinical faculty research may establish new mechanisms for expanding physician scholar workforce and supporting academic goals of clinical faculty. This article presents one such model, the Center for Health Outcomes in Medicine Scholarship and Service (HOMES), from the Department of Internal Medicine, The Ohio State University College of Medicine. Approach Established in 2019, HOMES provides research infrastructure, support, and mentorship tailored to clinical faculty needs. Multidisciplinary core faculty support research across 5 cores: clinical networks, biostatistics and secondary data, qualitative methods, mixed methods, and research ethics. HOMES services include research consultation, mentorship, microgrants, a training toolkit, and symposia. Outcomes In 4 years, HOMES supported 50 faculty on 99 projects. Forty-five (90%) of these faculty have reported scholarly output, including 127 national presentations, authorship on 41 peer-reviewed articles, and 53 grant submissions. Forty HOMES-supported grant submissions have received funding, and 4 HOMES-supported physicians in training have pursued or plan to pursue AMC research careers. Next Steps HOMES has fostered scholarly productivity among AMC physicians, competitive grant applications, and research focus among physicians in training. As demand for HOMES services increases, HOMES will prioritize projects based on their innovation and research skill development potential. Academic medical centers can apply HOMES lessons through fostering clinical faculty collaboration with multidisciplinary research teams and increasing research training opportunities for residents and fellows. National expansion of funding opportunities dedicated to building biomedical research capacity and expertise among clinical faculty can facilitate sustainable scaling of HOMES-like models.

Application of clinical thinking training system based on entrustable professional activities in emergency teaching.

Standardized training for resident physicians (STRP) is essential for improving their clinical skills. The standardized training for resident physicians in emergency medicine differs from other disciplines, focusing more on knowledge related to medical emergencies and emergency care skills requiring urgency and real-time response. There are specific differences in knowledge content, teaching methods, curriculum design, and career development compared to other specialties. As a national-level teaching base for emergency medicine, our hospital continuously explores and innovates in teaching models, discovering a model more suitable for emergency medicine. This study summarizes practical experience in teaching and assessment integration (TAA), evaluates teaching training effectiveness with the Clinical Thinking Training System (CTTS), and examines integrating this system with innovative teaching and assessment models' impact on resident physicians' clinical abilities. In our study, we selected residents who rotated in our department from July-December 2023 and randomly divided them into a reform group (n = 106) and a control group (n = 104). The reform group received training using the Clinical Thinking Training System (CTTS) while the control group received standard training consistent with the existing STRP framework. We integrate innovative teaching and assessment (TAA) modelsand theEntrustable Professional Activities(EPAs) scale to assess students' abilities, stratifying by grade level, background, and major to evaluate students' departmental rotation examination (DRE) and EPAs scores. The DRE scores and Mini-CEX scores were significantly higher in the reformed group compared to the control group. The final assessments showed the reform group scored significantly higher in first-case documentation and overall clinical thinking decision-making. Specifically, the reform group had significantly higher scores in first-case documentation for second-year, third-year, undergraduate, and graduate students, and non-emergency specialty students. The clinical thinking decision-making scores of the reform group were significantly higher across different years, specialties, and educational backgrounds. All the EPAs results indicated the CTTS improved treatment decision-making abilities among students with different years of training, educational backgrounds, and specialties. Moreover, the ability for continuous patient management improved to some extent among students in different years and with different educational backgrounds. The integration of innovative teaching and assessment models with the CTTS is more conducive to improving the examination performance and confidence in professional behavior of resident physicians.

Augmented reality for basic skills training in laparoscopic surgery: a systematic review and meta-analysis.

Augmented reality (AR) has emerged as a transformative technology in medical education, particularly in training basic laparoscopic skills. Despite its growing applications, the effectiveness of AR in this specific domain remains underexplored, with a lack of standardized assessment frameworks and inconsistent methodologies across studies. This systematic review and meta-analysis aimed to evaluate the effectiveness of AR in laparoscopic basic skills training for medical students and junior physicians. We conducted a systematic review and meta-analysis following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. Studies were selected based on their focus on AR applications in laparoscopic training, involving both randomized controlled trials and non-randomized studies. Inclusion criteria focused on medical students and novice surgeons, assessing educational outcomes such as Global Operative Assessment of Laparoscopic Skills (GOALS) Global, Objective Structured Assessment of Technical Skills (OSATS) Global, OSATS Specific, Training Time, and Subjective Workload. A total of 12 studies involving 434 participants met the inclusion criteria. The analysis revealed that AR technology significantly improved educational outcomes, with participants achieving higher GOALS and OSATS scores. Specifically, the mean difference for GOALS scores was 2.40 points (95% CI [1.30, 3.50], p < 0.001) and for OSATS scores, 7.71 points (95% CI [3.39, 12.03], p < 0.001). Additionally, AR-assisted training showed a reduction in subjective workload, with a mean decrease of 2.95 points (95% CI [- 4.95, - 0.95], p = 0.003). The findings indicate that AR significantly enhances laparoscopic training outcomes, facilitating improved technical skills, efficiency, and learner independence. However, variability in study designs and outcomes limits generalizability. Future research should focus on standardize AR training protocols and evaluate long-term effectiveness to fully leverage AR's potential in surgical education.

Abstract Su405: Effect Of A Visual Feedback Device On The Acquisition Of Cardiopulmonary Resuscitation Skills In Training Certified By The American Heart Association: Randomized Clinical Trial

Background: High-quality cardiopulmonary resuscitation (CPR) is fundamental for the success in the care of cardiorespiratory arrest. In CPR skills training, manequins with feedback on quality parameters have been employed and received varied evaluative results. The American Heart Association (AHA) encourages the use of feedback devices in CPR training; however, its effects have not been evaluated in courses certified by it. Research Questions: Training with visual feedback devices alters the learning of students in acquiring psychomotor skills in CPR? Goals: To evaluate the effect of a visual feedback device on CPR training, in AHA certified courses. Methods: A randomized clinical trial was conducted to estimate the intervention of a visual feedback device in practical CPR training for nurses, medical students and physicians in the Advanced Cardiovascular Life Support (ACLS) courses. For that, having as parameters the quality criteria determined by the AHA, we tried to compare the performance results of the trained students with objective feedback from the device and the trained students with subjective feedback from the instructor. Statistical analysis included chi-square test, Student's t test, Mann-Whitney u test, Spearman’s-rho correlation coefficient. Significance level considered was 0.05. A survey was registered with ClinicalTrials®, under resgistration NCT 04338490. Results: The sample consisted of 209 students; of these 119 (56.9%) were women, and 148 (70.8%) were physicians. The control group had 98 students, and the intervention group 111 students. The performance of students from both groups reached the criteria of quality in CPR. The group trained with a feedback device achieved, according to guidelines, better results in the rate of chest compressions, 78 (70.3%) versus 48 (49.0%), p &lt;0.01, and in return of the chest 100 (91; 100) versus 99 (78.25; 100), p &lt;0.03. As for the recommended compression fraction, 60% to 80%, both groups were above 60%; however, no student in the study reached 80%. Conclusions: The visual feedback device was effective in CPR training, improving students’ performance in the criteria of compression rates between 100 and 120/min and total return of the chest between compressions.

Amyloid Imaging Update: How the Amyloid Landscape Is Changing in Light of the Recent Food and Drug Administration Approval of Antiamyloid Therapeutics.

It has been some time since the Journal of Nuclear Medicine and Technology has published an article on best practices in amyloid imaging. In light of the recent Food and Drug Administration approval of new antiamyloid therapies (AATs) to decrease amyloid plaques in the brain and slow progression of mild cognitive impairment, and the potential increase in the number of amyloid PET scans being acquired to document amyloid plaques, the Journal of Nuclear Medicine and Technology felt it was a perfect time to publish a refresher on best practices. AATs are administered to help slow progression of mild cognitive impairment, allowing patients to live independently a little longer before having to give up their independence and move in with family or into an assisted living facility. Neurologists prescribing AATs must first document that the patient has amyloid plaques. To do this, amyloid PET can be performed, or a lumbar puncture can be used to look for amyloid plaques in the cerebrospinal fluid. Although the latter is more cost-effective and has no associated radiation exposure, it is highly invasive compared with amyloid PET. High-quality amyloid PET scans interpretated by a trained nuclear medicine physician are the first step and key to providing the dementia expert and patient with accurate information on amyloid status, allowing for the best decisions on patient management.

Emotional resilience and sense of danger among doctors in hospitals during periods of heightened tensions and warfare in Israel.

The "Iron Swords" War beginning in October 2023 led to unprecedented levels of shock and trauma across Israel, significantly impacting the Israeli population and medical personnel. This study aimed to evaluate and compare the perceived personal resilience and sense of danger among physicians in hospitals located in different conflict zone proximities in Israel during this period. A quantitative, cross-sectional study was conducted from March to August 2024, during an active phase of the war, using a structured anonymous questionnaire. Participants were 161 physicians from three hospitals: one in southern Israel near the Gaza Strip, another in northern Israel near the borders with Lebanon, Syria, and Jordan, and a third in central Israel near Tel Aviv. The survey measured personal resilience using the Connor-Davidson Resilience Scale (CD-RISC-10) and sense of danger using the Solomon & Prager scale. Statistical analyses included Kruskal-Wallis H test, multiple linear regression, two-way analysis of variance (ANOVA), and Sobel test for mediation effects. The final sample included 161 physicians (54 southern, 56 central, 51 northern). The mean resilience score was 31.14 ± 5.77, and the mean sense of danger score was 8.36 ± 4.15 (scales 0-40 and 0-20, respectively). Physicians in the southern hospital reported significantly higher sense of danger scores (p = 0.005). A trend towards lower resilience scores was noted among southern hospital physicians (p = 0.068) (p = 0.068). Two-way ANOVA revealed significant main effects of hospital location and gender on resilience (p = 0.046 and p = 0.003, respectively) and sense of danger (p = 0.005 and p = 0.062, respectively). Multiple regression analysis identified hospital location (β = -0.178, p = 0.023) and gender (β = 0.229, p = 0.004) as significant predictors of resilience. Mediation analysis indicated that personal resilience partially mediated the relationship between hospital location and sense of danger (indirect effect = 0.2896, p < 0.001). Physicians working near conflict zones report higher levels of perceived danger, though their resilience is comparable to peers in less threatened regions. Enhancing personal resilience is crucial to mitigate the heightened sense of danger. This could include regular resilience training, psychological support, and specific programs for single and childless physicians to improve safety perceptions. Additionally, fostering a supportive community with clear communication and robust emergency protocols is essential for enhancing staff resilience and safety in hospitals.

Exploring clinician perspectives of systems-based practice: A physician training challenge.

Systems-based practice (SBP) has been a competency in US graduate medical education for over 20 years, but it is not well implemented. SBP is loosely defined as physician's responsiveness to the larger system of healthcare. The aim of this study was to describe healthcare professionals' perspectives regarding: (1) their knowledge and beliefs about SBP and (2) their beliefs regarding factors in clinical learning environments (CLE) that facilitate or hinder operationalisation and learning of SBP. Semi-structured interviews were conducted between November 2020 and April 2021 with 42 individuals from four health systems. Participants were healthcare professionals involved in graduate medical education, including physicians and interprofessional clinicians (e.g., nursing staff). Interviews were transcribed and coded using a social constructivist, codebook thematic analysis approach and themes were agreed upon through discussion amongst the research team. Five themes were constructed: (1) SBP remains a challenge to define, (2) SBP may be intuitively understood, particularly when framed at the microsystem level, (3) SBP aligns with the Health Systems Science framework, (4) SBP learning must be intentionally integrated into the CLE, through training such as onboarding and (5) multidisciplinary settings and work processes are critical to engage in SBP. Workload compression is a barrier to SBP implementation. Healthcare professionals highlighted that current CLEs are not designed to prioritise SBP. Graduate medical education programmes may benefit from focusing systems content at the microsystem level and purposefully integrating onboarding procedures, clinical settings and rotations specifically designed to teach SBP into their residencies.

Valuing virtue in medicine: a closer look at CanMEDS

Abstract The CanMEDS-2015 Framework outlines seven key roles expected of practicing physicians: communicator, collaborator, manager, health advocate, scholar, and professional. Critics have expressed concern about the omission of a proposed eighth role, ‘Physician as Person’ relevant to humane qualities and personal resilience of the physician. Upon further analyses, the Framework has included several virtuous attributes in the roles of a physician as professional and communicator. However, it addresses certain virtues like creativity, love, and spirituality inadequately. Drawing on literature from Positive Psychology, the author categorizes and additional set of virtues into six classes: wisdom, courage, humanity, justice, temperance, and transcendence. Based on these, the author lists virtues and concepts relevant to a ‘Virtuous Role’ for physicians. The CanMEDS Framework should integrate these virtues as a foundational or overarching role and draw from Virtue Ethics in religious and philosophical traditions. This approach is timely, giving ongoing efforts to update and develop CanMEDS2025. By adopting a Virtuous Role within CanMEDS, we aim to train physicians who are technically skilled and deeply humane, meeting society's expectations for compassionate and virtuous healthcare professionals

Training physicians in motivational communication: An integrated knowledge transfer study protocol.

While behavior change counseling (BCC) targeting health risk behaviors has shown efficacy for improving patient health outcomes, barriers to knowledge translation have resulted in poor uptake among health care providers (HCPs). This article outlines the development of a new BCC training framework for HCPs, from inception to readiness for efficacy testing. It provides an example of integrated knowledge translation (iKT) used in alignment with the obesity-related behavioral intervention trials model. (a) A modified Delphi process identified essential BCC skills for HCPs; (b) a survey assessed HCP attitudes and training needs; (c) an online competency assessment tool was developed using iKT mixed methods; (d) a training program was developed and refined using a logic model; and (e) the program was optimized using iterative rounds of participant feedback. A future proof-of-concept trial (f) will determine the program's readiness for full efficacy testing. A Delphi panel (n = 46) identified 11 core BCC competencies for HCPs, defining "motivational communication." The HCP survey (n = 80) showed willingness to devote 4 hr to introductory training in BCC. The Motivational Communication Competency Assessment Test (MC-CAT: an online, interactive evaluation tool) and a motivational communication training program (MOTIVATOR: accredited for continuing education by the Royal College of Physicians and Surgeons of Canada) were collaboratively developed with knowledge users. The optimization process (n = 11) provided key feedback, with minor changes being made to the program. In developing a new BCC framework, obstacles to BCC implementation were addressed through an iterative iKT process. This should improve eventual intervention uptake. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating a multicomponent intervention for managing kidney outcomes among patients with moderate or advanced chronic kidney disease (CKD): protocol for the Strategies for Kidney Outcomes Prevention and Evaluation (SKOPE) randomized controlled trial

BackgroundChronic kidney disease (CKD) poses a global health challenge with high morbidity and mortality rates. Early detection and prompt intervention are critical in preventing progression to end-stage kidney disease (ESKD) and cardiovascular complications. Effective CKD management requires comprehensive care packages that integrate both pharmacological and non-pharmacological interventions within collaborative, team-based models, aiming to enhance patient outcomes and overall quality of life. The goal of the Strategies for Kidney Outcomes Prevention and Evaluation (SKOPE) study is to establish effective multicomponent intervention (MCI) strategies for evaluating and preventing kidney outcomes in patients with moderate to advanced CKD within primary care settings in Singapore.MethodsThis study is a 3-year randomized controlled trial among 896 participants aged between 40 and 80 years with moderate or advanced CKD in five government-subsidized polyclinics in Singapore. The components of the MCI are (1) nurses/service coordinators trained as health coaches for motivational conversation and CKD-specific lifestyle counseling on diet and exercise, using a hybrid follow-up approach of in-person, telephone, and secure video meetings; (2) training physicians in algorithm-based standardized management of CKD; (3) subsidy on SGLT2i medications for CKD; and (4) regular CKD case review meetings. The primary outcome is the estimated glomerular filtration rate (eGFR) total slope from randomization to final follow-up at 36 months.DiscussionIf shown to be effective, cost-effective, and acceptable, SKOPE should be considered for scaling country-wide and in similar regional healthcare systems.Trial registrationClinicalTrials.gov NCT05295368. Registered on March 25, 2022.

Impact of in-silico technologies in the development of high-risk medical devices on healthcare

Abstract This study examines the impact of in-silico technologies (IST), such as virtual cohorts and digital twins, on the development of high-risk medical devices within the healthcare sector. An iterative empirical approach combining a literature review, exploratory and in-depth interviews with stakeholders from academia, industry, regulators, healthcare professionals, and focus groups with patients across Europe, Japan, and the USA was employed to gain insight into the implications of IST on healthcare. The findings indicate that IST can reduce the time to market for medical devices, thereby facilitating faster, broader, and more equitable access for patients. The implementation of extensive early testing, optimized study designs and increased sample sizes in trials can facilitate the achievement of enhanced safety. The early identification of adverse effects can enhance the safety of medical devices and improve patient outcomes. Furthermore, IST may facilitate the inclusion of underrepresented groups, such as children, in clinical trials, thereby enhancing their representation in medical research. The reduction in costs associated with IST may facilitate innovation cycles. However, the impact on prices is contingent on competition. Furthermore, IST have the potential to reduce the need for animal testing. Nevertheless, several uncertainties and potential adverse effects have been identified. Physician training on new devices remains a bottleneck, which may limit the benefits of new products. Despite the advancements, a complete replacement of traditional clinical and preclinical trials with IST is not seen to be feasible. From a policy perspective, it is crucial to promote regulatory clarity by providing guidance for the usage of IST, to offer incentives for the adoption of IST, and to foster competition. These findings demonstrate the multifaceted potential benefits and challenges of IST, including enhanced safety, accessibility, and innovation in healthcare. Key messages • In-silico technologies can reduce time-to market of medical devices up medical device and improve safety for patients. • Challenges like physician training and regulatory guidance must be addressed to fully realize benefits of in silico technologies.

The Dutch practice of euthanasia and assisted suicide in patients suffering from psychiatric disorders: a qualitative case review study.

Euthanasia or assisted suicide (EAS) in patients suffering from a psychiatric disorder (PD) is a controversial topic worldwide. In the Netherlands, this practice is regulated by law. All cases of EAS have to be reported and are assessed by the Regional Euthanasia Review Committees (RTEs), who publish a selection of all cases on their website. To provide insight into the Dutch practice of EAS in patients suffering from a psychiatric disorder. We performed a retrospective case review study in which all published cases of EAS in patients suffering from a PD between 2017 and 2022 were analyzed. Not applicable. Characteristics of patients who died by EAS because of suffering from a PD, characteristics of the reporting physician and consultant(s) and the RTEs assessment of published cases. Of the 72 cases studied, the majority of patients were female (n=48, 67%), suffered from 3 or more conditions (n=38, 53%) and died by euthanasia instead of assistance in suicide (n=56, 78%). In 63% of cases (n=45), the life termination was performed by a physician from the Euthanasia Expertise center (EE). The RTEs' judgement that the case did not meet the due care criteria (n=11) was in all cases related to issues regarding the (advice of the) independent physician or psychiatric expert. This qualitative study shows that the RTEs attach great importance to a careful evaluation procedure of physicians handling EAS requests and to the physician demonstrating ability to reflect on his views, especially when the independent consultant evaluates the case different than the physician. Training for physicians and more transparency in the assessment of EAS requests in patients with a PD may lower the threshold for physicians to handle requests of these patients themselves. Not applicable.

Enhancing cardiology trainee competence through simulation-based pericardiocentesis training: a pilot programme evaluation

Abstract Introduction Cardiology training requires trainees to manage clinical duties whilst developing practical skills. Changes to the UK curriculum have resulted in reduced time available for procedural teaching. Pericardiocentesis is one of many required competencies. The Joint Royal College of Physicians Training Board cardiology curriculum cites the importance of simulation-based education to teach procedures. Procedural training encompasses the development of clinical reasoning alongside motor skills. Gange (1962) and Carless (2010) emphasized the importance of expert-guided practice, interactive teaching, and instant feedback in motor skills teaching to maximize the educational experience. Aim Develop a simulation teaching programme to enhance trainees' confidence and competency in pericardiocentesis. Procedures form part of a summative Direct Observation of Procedural Skills, enabling trainees to learn in a safe environment and use as evidence at their Annual Review of Competence Progression (ARCP). Method We developed a pilot programme for pericardiocentesis facilitated through high-fidelity equipment between February 2023 and February 2024. Participants were recruited through medical education departments. The sessions were delivered on a one-to-one basis by a cardiology consultant to facilitate discussion and interactivity. The teaching involved a core knowledge presentation, discussion of trainee experiences, case studies as examples, including review of echocardiography features. This was followed by clinical skills teaching of pericardiocentesis, utilizing a model, and transthoracic echocardiography. Trainees were sent anonymous feedback forms after the session. Results 46 cardiology registrars participated; 48% were within their first few years of training. 87% reported difficulty in practicing this skill in clinical practice due to: lack of exposure, other clinical responsibilities taking priority, and the need for consultant-delivered care on patients requiring an urgent or emergency procedure. Mean trainee confidence before teaching was 3.24 out of 5 (SD = 1.14), with a significant improvement to 4.48 (SD = 0.59 p&amp;lt;0.001). 52% improved in confidence by 1 unit and, 31% improved in confidence by 2 or more units. Trainees reported the following themes regarding the session: knowledgeable trainer, high fidelity equipment, instant feedback to predict, prevent, and overcome challenges, and a multi-modal approach to teaching, incorporating presentation and discussion on pericardial effusion, tamponade, and drainage. Conclusion Our programme offers a unique multi-modal teaching approach, with dedicated time with an expert. We supported the progress of 46 trainees and enhanced their training competencies. We aim to expand the programme to incorporate more procedures in line with growing curriculum requirements. Tracking trainee progress until ARCP outcomes will reveal the impact of simulation teaching on their experience and professional development.

Artificial intelligence-assisted focused cardiac ultrasound training: A survey among undergraduate medical students

Objectives: Focused cardiac ultrasound (FoCUS) is increasingly applied in many specialities, and adequate education and training of physicians is therefore mandatory. This study aimed to assess the impact of artificial intelligence (AI)-assisted interactive focused cardiac ultrasound (FoCUS) teaching session on undergraduate medical students’ confidence level and knowledge in cardiac ultrasound. Methods: The AI-assisted interactive FoCUS teaching session was held during the 9th National Undergraduate Cardiovascular Conference in London in March 2023 and all undergraduate medical students were invited to attend, and 79 students enrolled and attended the training. Two workshops were conducted each over 3-hour period. Each workshop consisted of a theoretical lecture followed by a supervised hands-on session by experts, first workshop trained 39 students and the second workshop trained 40 students. The students’ pre- and post-session knowledge and confidence levels were assessed by Likert-type-scale questionnaires filled in by the students before and immediately after the workshop. Results: A total of 61 pre-session and 52 post-session questionnaires were completed. Confidence level in ultrasound skills increased significantly for all six domains after the workshop, with the greatest improvement seen in obtaining basic cardiac views (p &lt; 0.001 for all six domains). Students strongly agreed about the effectiveness of the teaching session and supported the integration of ultrasound training into their medical curriculum. Conclusions: AI-assisted interactive FoCUS training can be an effective and powerful tool to increase ultrasound skills and confidence levels of undergraduate medical students. Integration of such ultrasound courses into the medical curriculum should therefore be considered.

The Impact of Standardized Training Resident on Pain Management in Patients with Advanced Lung Cancer.

This study aimed to investigate the effects of Standardized Training Resident on pharmacological interventions for pain management in patients with advanced lung cancer. A total of 84 patients with advanced lung cancer and associated pain were enrolled in the study from December 2019 to August 2023 and were divided into two groups based on their attending physician: a group managed by physician-ST Training Physicians (joint group) (n = 42) and physician-only group (usual group) (n = 42). The Brief Pain Inventory (BPI), oral morphine equivalent, and length of hospital stay. Furthermore, the Pain Management Index (PMI) was calculated. Health-related quality of life (HRQoL) was assessed at the 4-week follow-up using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). At week 4, compared to the usual group, the four BPI pain intensity categories were significantly lower in the joint group [worst pain: 4 (3-5) vs 8 (7-9); least pain: 1 (0-2) vs 3 (1-4); average pain: 2 (1-2) vs 5 (4-6); pain right now: 1.2 (0.7-1.9) vs 4 (3-5)] (all P > 0.05). The hospital stay duration was significantly reduced; for the seven pain interference categories, there were no significant improvements in the joint group. Significantly more patients achieved adequate pain control in the joint group than the usual group (p = .002). A reduction in OMEDD scores was observed for both cohorts, and the joint group's reduction was statistically more significant (p = 0.016). There were no significant differences in HRQoL between the two groups. Standardized Training for Radiation Oncology Physicians may lead to improved pharmacological interventions and enhanced pain relief. Recognizing the importance of these trainees in the healthcare team is crucial for achieving optimal pain management outcomes.

Dietary selenium intake, hypertension and cognitive function among US adults, NHANES 2011–2014

Dietary selenium intake and hypertension were associated with cognitive function, but it was limitedly understood whether the effect of selenium intake on cognitive function in older adults was modified by hypertension status. A total of 2416 participants aged ≥ 60 years old from the National Health and Nutrition Examination Survey in 2011–2014 were involved in this study. Selenium intake from foods was estimated using two non-consecutive 24-hour dietary recalls. Blood pressure was measured by trained personnel or physicians at a mobile testing center. Cognitive function was measured by Registry for Alzheimer’s disease (CERAD), the Animal Fluency test (AFT), and Digit Symbol Substitution Test (DSST). Among 2,416 participants, we found that higher dietary intake of selenium was associated with higher score on most tests (CERAD: Total Score: P for trend = 0.01; AFT: P for trend = 0.01; DSST: P for trend = 0.02) and hypertension was associated with lower score on each test (CEARD: Total Score (β = − 0.87, P = 0.03), CERAD: Delayed Recall Score (β = − 0.37, P = 0.04), AFT (β = − 0.88, P = 0.03), and DSST (β = − 2.72, P = 0.02). The interaction of hypertension status and dietary selenium intake on CERAD-immediate (P for interaction = 0.02) and DSST (P for interaction = 0.04) were statistical significance. In addition, hypertension did not mediate the association between dietary selenium intake and the four dimensions of cognition. The findings suggest that in older adults with hypertension, higher dietary selenium intake is associated with improved cognitive function, implying a potential nutritional strategy for preventing cognitive impairment in this population.

Extended Reality Applications in Otolaryngology Beyond the Operating Room: A Scoping Review.

Objective: Extended reality (XR) has increasing usage in medicine, especially surgical fields, but the scope of applications is largely limited to intraoperative navigation. The aim of this scoping review is to evaluate all the available literature on how XR technologies have been applied to otolaryngology-head and neck surgery (OHNS) beyond the operating room for applications such as patient education and interdisciplinary communication. Review Methods: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we systematically searched PubMed and Scopus. Studies were reviewed without temporal restriction. Inclusion criteria comprised English-language, peer-review papers or conference abstracts studying XR technologies for non-operative uses such as patient education, physician training, or interdisciplinary preoperative planning in the field of OHNS. Results: Database searching initially identified 1607 records. After filtering for duplicates, screening for relevance, and applying the inclusion criteria, 10 studies were ultimately included. This study identifies gaps in the existing literature and describes future applications and key areas of research. XR is a novel strategy for increasing patients' comprehension of their procedures and can facilitate improved communication and planning amongst a multidisciplinary surgical team during preoperative discussions. However, the existing literature is small in scale and has low statistical power for demonstrating clinical benefits. Conclusions: More robust studies are required to determine the true value of implementing XR. XR is a promising new technology with potential to advance education and patient care in OHNS. Ongoing research will continue to optimize the use of XR technology, ensuring safe and effective integration into clinical practice.

Attending to Power: Stakeholder Perspectives on Training Physicians to Address Intimate Partner Violence.

Intimate partner violence (IPV) is associated with a wide range of mental and physical health concerns. Research suggests that many physicians lack knowledge and skills to adequately respond to patients experiencing IPV. In order to better integrate physicians' contributions into intersectoral responses to IPV, we asked stakeholders with expertise and experience related to IPV about the knowledge, skills, attitudes, and behaviors they wanted them to have. Guided by principles of interpretive description, and using a key informant method, we conducted unstructured interviews with 18 stakeholders in IPV-related frontline, managerial, or policy roles in Ontario, Canada. Data collection and analysis proceeded iteratively through 2022; "thoughtful practitioners" outside the research team were recruited at key junctures to provide feedback on formative findings. Stakeholders suggested that "attending to power" should be a core principle for medical practice related to IPV. Attending to power encompassed understanding interactional, organizational, and structural power dynamics related to IPV and purposefully engaging with power, by taking action to empower people subjected to violence. Specific recommendations for practice concerned four focal contexts: relationships between partners, between patients and providers, between providers, and in social systems and structures. Strengthening physicians' capacity to attend to power dynamics relevant to their IPV practice is an important step in both improving medical care for people experiencing IPV and integrating physician contributions into other services and supports.

Vascular Anomalies Review of the Head and Neck for Physicians in Training

A basic understanding of vascular anomalies will aid physicians-in-training as they seek to properly diagnose and determine interventions for these patient presentations. The aim of this review is to create a resource for physicians in training that encompasses the most important clinical aspects of vascular anomalies. Vascular anomalies of the head and neck are divided into two categories: vascular tumors and vascular malformations. This review will first describe vascular tumors followed by vascular malformations. This review discusses major pathology found in both categories of vascular anomaly. Vascular anomalies are frequently found in pediatric populations and can persist into adulthood, making it important for trainees to identify them on physical exam. This developing field seeks to improve form, function, and quality of life for patients with vascular anomalies and often requires a multidisciplinary approach (i.e., otolaryngology, dermatology, genetics, plastic surgery, interventional radiology). Various medical and surgical treatment options are available. A basic knowledge of these anomalies will allow for accurate, early diagnosis and appropriate intervention which can ultimately improve patient outcomes. Search Strategy and Selection Criteria: The MEDLINE/PubMed database was searched for primary research and reviews discussing various vascular anomalies which include infantile hemangioma, congenital hemangioma, pyogenic granuloma, tufted angioma, kaposiform hemangioendothelioma, capillary malformations, lymphatic malformations, venous malformations, and arteriovenous malformations. This search was conducted from 7/5/2023 to 3/21/2024.