Residency Training Research Articles

Non-technical factors on ophthalmology education: a narrative review

Ophthalmology education is increasingly influenced by non-technical factors. This paper examines the multifaceted influences on ophthalmology education, focusing on direct and indirect factors that have shaped the training and wellbeing of ophthalmology students and residents. A systematic search of PubMed and Embase was carried out, searching date was from inception to 01/07/2024. A total of 8,232 articles were screened, of which 7,976 were excluded following abstract review. After reading the remaining 256 articles in full, a further 228 were excluded. A total of 28 original articles were included in this systematic review. The non-technical factors that influenced ophthalmology education included various crisis, inadequate curricular time, training resources, lack of training standardization and shortage of financial support and teaching resources. The review summarizes the influences on ophthalmology education of various non-technical factors, thereby helping educators improve the training methods.

Radiation Oncology Residency Training in Saudi Arabia: Direction in Attaining Competencies

Radiation Oncology Residency Training in Saudi Arabia: Direction in Attaining Competencies

Determinants of Telemedicine Acceptance among Doctors-to-the-Barrios (DTTBs) in the Philippines

Background. Telemedicine offers a solution to healthcare access issues, especially during the COVID-19 pandemic when physical distancing limited in-person visits. It can also be used by the Doctors-to-the-Barrios (DTTBs), who are often newly licensed physicians who have not undergone residency training yet, to remotely consult specialists and assist them in providing better healthcare recommendations to their patients. Understanding the acceptance of telemedicine particularly among DTTBs is crucial to optimizing its implementation, as local studies on this topic are lacking. Objective. The purpose of this study is to determine the factors affecting acceptance of telemedicine by the DTTBs. Methods. This study employed a descriptive and analytical cross-sectional research design from 2021 to 2022. Ethical approval was obtained prior to study implementation. Informed consent form was sent to all enrolled master’s students in the DTTB program. The study adapted the questionnaire utilized by Zailani et al. using a five-point Likert scale to identify the determinants of acceptance of telemedicine based on the following constructs: government policy, external supplier’s capacity, project team’s capacity, top management support, perceived usefulness, attitude, self-efficacy, acceptance of telemedicine, and organizational culture. Linear regression was performed to identify significant constructs that determine acceptance of telemedicine. All data were reported at 95% confidence interval. Results. total of 116/180 DTTBs participated in the study. Attitude (β=0.5849, p<0.01) and self-efficiency (β=0.5327, p<0.01) together with organizational culture had a significant positive impact on the acceptance of telemedicine. Conclusion. This study shows the current state of acceptance of telemedicine by our DTTBs. It highlights their positive attitude and self-efficiency towards telemedicine and the lack of support they receive from the government in funding and implementing telemedicine efforts despite its potential to address healthcare access issues.

The next generation of physician-researchers: undergraduate medical students' and residents' attitudes, challenges, and approaches towards addressing them.

Undergraduate medical education and residency training are critical periods for conducting research. Medical diagnoses and therapies are direct results of successful research efforts that have advanced several scientific fields. This review highlights the importance of incorporating scientific research training into the curricula of undergraduate medical education and residency programs. We utilized key databases such as PubMed, Web of Science, and Google Scholar to conduct a narrative review of English-language articles published between 2002 and 2024. Ultimately, we selected 49 studies that examined the attitudes of undergraduate medical students and residents toward research, the common challenges they encounter while participating in research activities, and the strategies that support and encourage their involvement, all in alignment with our study objectives and keywords. In addition, we identified several relevant themes, including the value of research experience in shaping well-rounded medical professionals; the integrity of research practices in residency selection, which addresses concerns such as the arms race and misrepresentation, as well as the balance between quality and quantity; striking a balance between research and clinical training while promoting equity and inclusion; and effective programs and mentorship strategies to enhance research engagement. Translating the positive attitudes of undergraduate medical students and residents into improved knowledge and practice necessitates the development of structured mentoring programs and advanced training systems. Institutions must provide the necessary tools, guidance, and support to overcome research barriers. This will help establish an environment in undergraduate medical education and residency training that values research, facilitates access to it, and integrates it into the curriculum. To address the critical shortage of physician-researchers and improve evidence-based medical practice, it is crucial for medical schools to focus on research education and create avenues for student involvement. By tackling research challenges and implementing supportive strategies, these efforts empower the next generation of physician-researchers to embrace research, contribute to medical progress, and uphold the highest standards of patient care.

Perceptions of Pharmacy Faculty Regarding Factors Contributing to Declining First-Time NAPLEX Pass Rates.

Identify perceptions from pharmacy faculty across the Academy concerning factors that may be influencing NAPLEX first-time pass rates to highlight potential focused areas of further research based on common experiences. An anonymous 43-item Qualtrics™ questionnaire was distributed to faculty members from the American Association of Colleges of Pharmacy. Questions were predominantly 5-point Likert scale items (5=very large impact) and encompassed six domains: pharmacy school factors, COVID-19 educational modifications, testing factors, standardized testing, applicant preparedness, and student factors. Demographic data as well as perceptions were reported with means and standard deviations. In total 600 responses were analyzed. Respondents were predominantly female (66%) and white (78%). Most had a Doctor of Pharmacy degree, residency training, and were practicing as a licensed pharmacist within the Southern and Midwestern US. Respondents indicated that the decline in NAPLEX first-time pass rates is a moderate to large problem (mean 3.64, standard deviation [SD] 0.891), and the top potential influencing factors include student quality (mean 3.99, SD 0.876), student's critical thinking (mean 3.90, SD 0.947), study habits (mean 3.74, SD 0.920), and admission standards (mean 3.67, SD 1.082). The top 4 factors indicated by respondents as impacting NAPLEX first-time pass rates were related to the student quality. This result highlights the importance of exploring issues related to pharmacy admissions and the need to implement effective strategies to support an increasing number of potentially less prepared pharmacy students.

Neurological Surgery Manpower Training and Density in Islamic Republic of Iran: A Population Study

BACKGROUND AND OBJECTIVES: Significant disparities in worldwide neurosurgical training and workforce distribution are prominent primarily in low-income and middle-income countries. Although Iran is considered a lower middle–income country, neurosurgical density and distribution in Iran has surpassed the recommended ratio of 1 neurosurgeon for every 100 000 population. The objective was to determine neurological surgery density and distribution in Iran and the factors significant in the relative success in training and allocation of neurosurgeons in Iran. METHODS: Review of PubMed and administration of site surveys of multiple data sources including Neurosurgical Society of Iran, Iranian Board of Neurological Surgery, Medical Council of Islamic Republic of Iran, Universities of Medical Sciences in Iran, and Ministry of Health and Higher Education of Iran. RESULTS: Over the 72-year period from 1952 to 2024, 1200 neurosurgeons have been trained and distributed in 31 provinces in Iran, attaining a ratio of 1.4/100 000 population. All but 40 neurosurgeons were trained after 1981, which coincided with the Iran-Iraq War. Decentralization of medical and neurosurgical residency training programs, resolving the immediate need for neurosurgeons managing penetrating traumatic brain and spinal cord injuries during the 1980 to 1988 Iran-Iraq War, and active participation of legislative and executive branches of government in solving health care disparities were major factors in meeting the needs of the country. At the present time, more than 555 neurosurgeons are practicing in Tehran Province, a proportion of 3.8 neurosurgeons for every 100 000 population, which indicates an element of disparity in density distribution across Iranian land. CONCLUSION: Legislative initiatives and government support of public health care delivery and decentralization of medical and residency training programs after the Iran-Iraq War and introduction of the Ministry of Health and Medical Education are considered the main reasons for the relative success in meeting the neurosurgical demand and manpower density. Still, further adjustment of distribution of manpower is needed.

Nutrition Training in Medical Education Among Family Medicine Residents in North Carolina

Background This study surveyed family medicine residents in North Carolina regarding the state of nutrition education in their residency training. In addition, the survey explored comfort levels with, and attitudes about, discussing nutrition with patients. Methods We administered an online questionnaire to family medicine residents in North Carolina (n = 384) asking about their history of nutrition training and their current attitudes about nutrition. The 24-item survey included both Yes and No and Likert-scale responses. Results All but one resident had received formal or informal nutrition training during their medical education. Residents overwhelmingly considered nutrition to be an important component of health care, although a majority felt physicians are inadequately trained in nutrition. Feeling comfortable discussing nutrition with patients regarding specific health conditions varied from 45% (gastrointestinal concerns) to 94% (cardiovascular disease) or 95% (diabetes) among residents. Limitations The volunteer sampling method used in the study may limit generalizability of the study findings to a broader population of family medicine residents. In addition, precisely defining “formal” and “informal” nutrition training on the survey questionnaire would help to clarify the role of nutrition education in shaping resident attitudes and practices. Conclusion This study shows that family medicine residents recognize the importance of nutrition education but do not feel adequately trained to provide it to patients. Given the abundance of evidence linking nutrition and health as well as an apparent interest among family medicine residents in nutrition education, this study supports the integration of nutrition training in medical education. Suggestions for how to accomplish this objective are provided.

Evaluating the Effectiveness of Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) Training for Family Medicine Residents in Saudi Arabia

Evaluating the Effectiveness of Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) Training for Family Medicine Residents in Saudi Arabia

Accuracy of O-RADS System in Differentiating Between Benign and Malignant Adnexal Masses Assessed via External Validation by Inexperienced Gynecologists

Objective: To evaluate the accuracy of the O-RADS system in differentiating between benign and malignant adnexal masses, as assessed by inexperienced gynecologists. Methods: Ten gynecologic residents attended a 20 h training course on the O-RADS system conducted by experienced examiners. Following the training, the residents performed ultrasound examinations on patients admitted with adnexal masses under supervision, recording the data in a database that included videos and still images. The senior author later accessed this ultrasound database and presented the cases offline to ten residents for O-RADS rating, with the raters being blinded to the final diagnosis. The efficacy of the O-RADS system by the residents and inter-observer variability were assessed. Results: A total of 201 adnexal masses meeting the inclusion criteria were evaluated, consisting of 136 (67.7%) benign masses and 65 (32.3%) malignant masses. The diagnostic performance of the O-RADS system showed a sensitivity of 90.8% (95% CI: 82.2–96.2%) and a specificity of 86.8% (95% CI: 80.4–91.8%). Inter-observer variability in scoring was analyzed using multi-rater Fleiss Kappa analysis, yielding Kappa indices of 0.642 (95% CI: 0.641–0.643). The false positive rate was primarily due to the misclassification of solid components in classic benign masses as O-RADS-4 or O-RADS-5. Conclusions: The O-RADS system demonstrates high diagnostic performance in distinguishing benign from malignant adnexal masses, even when used by inexperienced examiners. However, the false positive rate remains relatively high, mainly due to the over-interpretation of solid-appearing components in classic benign lesions. Despite this, inter-observer variability among non-expert raters was substantial. Incorporating O-RADS system training into residency programs is beneficial for inexperienced practitioners. This study could be an educational model for gynecologic residency training for other systems of sonographic features.

Problem-based learning on the WeChat public platform in radiation oncology residency training programs.

This study explored the effectiveness of a Problem-based Learning (PBL) teaching model on the WeChat public platform for radiation oncology residency training programs. The WeChat PBL program was initiated in 2019. The study recruited student participants, on a voluntary basis, who were in their first and second years of standardized training in radiation oncology. We selected classic and trending issues in radiation oncology as the two main teaching topics. Students in the PBL group searched for relevant literature, summarizing PowerPoint presentations or academic speeches on specific issues published on the professional WeChat public platform after an in-depth review by teachers. The final national standardized training examination scores for resident physicians were used to evaluate teaching effectiveness. The graduation scores of the PBL and non-PBL groups were compared, and a stratified analysis was conducted based on the year of participation to assess the teaching effectiveness of this model. Moreover, questionnaires were administered to evaluate students' experiences. Among the 36 students who joined the study in 2019, 16 (44.0%) voluntarily joined the PBL teaching group. Nine students started teaching PBL in their first year of residency, accounting for 47.4% of that year, and seven started in their second year, accounting for 41.2%. The average graduation scores of the PBL group were superior to those of the non-PBL-focused group for the same grade. The rate of high scores among students in the PBL group (56.3%) was higher than that of students in the non-PBL group (25%). Specifically, first-year residents who joined the PBL group had an average score of 92.3 ± 2.2, significantly higher than their non-PBL counterparts, who scored an average of 88.6 ± 4.6, showing a statistically significant advantage (p = 0.042). All students were satisfied with the PBL WeChat teaching and would recommend the PBL WeChat course to others. The PBL residency teaching model on the WeChat platform improved residency scores and garnered student satisfaction.

Feasibility of Using Inertial Measurement Units (IMUs) to Augment Cadaveric Temporal Training.

Insertional speed of cochlear implant electrode arrays (EA) during surgery is correlated with force. Low insertional speed, and therefore force, may allow for preservation of intracochlear structures leading to improved outcomes. Given the importance of low insertional speeds, we investigate the feasibility of using inertial sensors for kinematic analysis during EA insertion to augment otolaryngology-head and neck surgery training. Practicing otolaryngology surgeons were recruited and inertial measurement units (IMU; Metamotions+, MBIENTLAB Inc, San Jose, CA) consisting of accelerometers were used to measure hand speed during EA (Cochlear™Nucleus®CI522 cochlear implant with Slim Straight electrode, Cochlear Limited, Sydney, Australia) insertion into a cadaveric cochlea. A mixed regression model was utilized to determine differences in speed across trials within a surgeon. A total of nine trials were performed by three surgeons. The highest mean ± SD speed obtained was 8.4 ± 1.7 mm/s, and the highest speed was 22.5 mm/s. Mean speed was not significantly different across trials within surgeons (p > 0.05). IMUs are relatively inexpensive and relatively easy to use sensors that provide information on variables that may be of interest for otolaryngology resident training. The use of IMUs as part of advanced temporal training for cochlear electrode insertion can provide insight into hand speed, thereby allowing residents to train with specific regard to this variable. Future randomized-controlled trials can be carried out to determine whether IMUs are conducive to lower insertional speeds. NA Laryngoscope, 2024.

Assessing the Use of a Training Model Using Immersive Virtual Reality for Sacrospinous Fixation Surgery: A Pilot Study.

Sacrospinous fixation (SSF) is a surgical complex procedure for uterovaginal prolapse that may result in pudendal plexus and vascular damage. The objective was to evaluate a training model using virtual reality to perform SSF. We conducted a prospective single-center pilot study in the university's academic innovation department in November 2023. We recruited 20 participants, 10 gynecology resident surgeons (group 1) and 10 experienced gynecology surgeons (group 2). The mean age was 26.6 ± 0.6years in group 1 and 39.7 ± 3.1years in group 2. The satisfaction rate reached 90% in both groups. A scale from 1 to 4 (1 = not-at-all, 4 = completely) was used to assess participants' perceptions. The realism of the simulation was rated at 3.3 ± 0.1 in group 1 and 3.5 ± 0.2 in group 2 (p = 0.41), the haptic feedback was rated at 2.0 ± 0.3 and 1.8 ± 0.3 (p = 0.66), the mean exercise time was 6.4 ± 1.3min and 4.8 ± 0.7min (p = 0.58), and the mean success rate was 70.8 ± 3.2% and 83.5 ± 6.8% (p = 0.14). In group 2, left and right instruments were placed at 2.6 ± 0.8mm and 2.9 ± 0.7mm from the target respectively, and in group 1 at 4.8 ± 0.7mm and 3.8 ± 0.5mm respectively. Participants reported greater comfort in performing sacrospinous fixation after simulation training (3.0 ± 0.2 versus 2.3 ± 0.3, p = 0.17). Our virtual reality simulation model is feasible and accurate for SSF training for both residents and experienced surgeons with a high level of satisfaction. Virtual reality simulation improves technical skills and promotes surgical comfort.

Impact of a social media post on improving an existing residency program.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. A social media post prompted reflection and changes to a longstanding pharmacy residency program. Pharmacy leadership utilized consultants with expertise in pharmacy residency training to help facilitate change and introduce new ideas to tenured staff. Other health systems working to continuously improve their residency programs may benefit from our example. The guiding principles of the changes were to align with the new harmonized residency program standards and reduce preceptor burden and potential burnout. Changes were made to the entire program's design, including new leadership, changes to committee structure, reduced requirements for preceptors that were not required in the standards, and resident recruitment and onboarding. We encourage residency programs to regularly evaluate program structure, design, and conduct to ensure alignment with the organization's evolving priorities as well as its mission and vision.

Identity Work: A Qualitative Study of Residents’ Experiences Navigating Identity Struggles

Introduction: Medical training traditionally holds a deterministic view of professional socialization wherein many medical learners struggle to construct a professional identity. Previous research has demonstrated the dysfunctional norms and conflicting ideologies that create identity struggle, disproportionally affecting women and individuals underrepresented in medicine. Symbolic interactionism can help explain identity struggles, emphasizing the influence of socio-contextual factors on identity construction. The purpose of this study was to explore how residents navigate identity struggles during residency training. Method: We conducted a qualitative exploration of 12 residents in three specialties at three academic institutions in the United States. Participants engaged in rich picture drawings followed by one-on-one interviews. We coded transcript data and met regularly to identify themes related to residents’ experiences with navigating professional identity struggles. Results: We identified three main themes on navigating identity struggles: the weight of identity work, the isolating nature of identity work, and the navigation that occurs with and against socio-contextual currents. Residents described identity work as navigation like a boat at sea. This work felt weighty and at times overwhelming and residents often felt unable to discuss their identity struggles with others. Residents utilized what agency they had to either navigate with the current, navigating towards acceptable—albeit imperfect—paths forward, or attempting to go against the current to forge new paths through resistance. Discussion: This study highlights how context enables and constrains identity construction, how contextual constraints can create dissonance between identities, and the considerable effort required to reconcile dissonance and construct professional identities. Training program adjustments, enhanced resident support, and cultural shifts are required to sustain residents’ identity work. Medical professionals should engage in collective identity work to reimagine the profession’s identity by addressing dysfunctional cultural norms.

Increased individual workload for nuclear medicine physicians over the past years: 2008-2023 data from The Netherlands.

To investigate temporal trends in the individual workload of nuclear medicine physicians at a large tertiary care academic center between 2008 and 2023. This study analyzed the reporting workload of nuclear medicine physicians in a large tertiary care academic center in The Netherlands on 36 unique (randomly sampled) calendar days, for each year between 2008 and 2023. The average daily departmental workload (measured with relative value units) was calculated for each year between 2008 and 2023. The individual workload was calculated by dividing the average daily departmental workload in each year by the available full-time equivalent nuclear medicine physicians in each year. Mann-Kendall tests were used to assess for any temporal monotonic trends in individual workload and types of nuclear medicine procedures performed. Individual workload increased significantly between 2008 and 2023 (Mann-Kendall tau of 0.611, P = 0.001). Individual workload in 2023 was 86% higher than in 2008. The use of positron emission tomography (PET) increased significantly (Mann-Kendall tau of 0.912, P < 0.001) between 2008 and 2023. The use of diagnostic scintigraphy decreased significantly in the same period (Mann-Kendall tau of -0.817, P < 0.001). The use of DEXA also showed a significant decrease (Mann-Kendall tau of -0.467, P = 0.013), but this decrease was negligible on a relative scale. The number of therapeutic procedures (Mann-Kendall tau of -0.100, P = 0.626) remained statistically stable in this period. Our single-center study showed that the individual workload of nuclear medicine physicians has increased significantly between 2008 and 2023, driven by the rise in PET scans. The demand for both diagnostic and therapeutic nuclear medicine procedures and associated workload is expected to keep on increasing in the foreseeable future. This workload trend should be taken into account by policymakers involved in nuclear medicine staffing planning. A healthy balance between the nuclear medicine workforce and workload is necessary to maintain the quality of care, to be able to perform other important (academic) tasks such as research, educating and training medical students and residents, and management, and to prevent physician burnout and dropout.

Psychiatric learning experiences in PGY1 pharmacy residency training: A 5-year analysis.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. A growing shortage of mental health providers and the increasing prevalence and severity of mental illness necessitate a qualified pharmacist workforce to increase access and care. Psychiatric learning experiences (PLEs) completed during pharmacy residency training are one way to address this need. The purpose of this study was to characterize PLEs offered by postgraduate year 1 (PGY1) programs and completed by PGY1 residents over a 5-year period. A retrospective review of data from PharmAcademic was conducted. All ASHP-accredited PGY1 programs from the 2016-2017 through 2020-2021 residency years were included in the descriptive analysis. PLE presence was identified using a keyword search of learning experience titles and descriptions. A post hoc analysis was conducted to compare yearly PLE completion rates during the study period and annual completion rates relative to presence or absence of a postgraduate year 2 psychiatric pharmacy residency. Of 1,461 PGY1 programs, 511 programs (34.9%) offered a PLE. Most PLEs were elective (82%). During the study period, 20.8% of PGY1 residents completed a PLE despite 77% having access. PGY1 residents complete PLEs at low rates. The reasons for this are unclear and need to be further explored. The growing need for qualified pharmacists to care for patients with mental illness calls for strategies to increase mental health training, including greater completion of PLEs by PGY1 residents and an understanding of how PLEs are promoted to PGY1 residents.

Neurosurgery Fellowships and the Residencies That Enfold Them: A Nationwide Correlational Analysis.

Accredited neurosurgery fellowship training is available in 10 subspecialties and can sometimes be completed during the postgraduate year (PGY)-7 residency year. However, it is not clear whether there are sufficient residency graduates to fill the number of positions available, and residency curriculum structure to support enfolded training is evolving. Detailed information about the 117 accredited neurosurgery residency programs and the 282 accredited neurosurgery fellowships was obtained from the Accreditation Council for Graduate Medical Education and Committee on Advanced Subspecialty Training, respectively. Information about residency chief year structure (PGY-6 vs PGY-7) was obtained electronically from each program. An analysis was performed to correlate residency and fellowship training characteristics at each program. The total number of neurosurgery fellowship positions available per year (352) is much higher than the total number of residency positions (237). Eighty-eight (75%) institutions with a neurosurgery residency offer at least 1 fellowship, and 51 of these have more fellowships than graduating residents. The resident complement at each program correlates with the number of fellowships offered (r2 = .56, P < .05), and the average institutional resident complement where fellowships are offered is greater than 2 per year. Thirty-eight residencies (32%) use a PGY-6 chief model (allowing for enfolded fellowships), and these programs offer significantly more fellowship programs on average than those using a traditional PGY-7 chief model (3.0 vs 2.1, P < .05). For most subspecialties, a minority of fellowships are offered in programs with a PGY-6 chief model. The number of accredited neurosurgery subspecialty fellowship slots in the United States far exceeds the number of graduating neurosurgery residents. There is no standard for residency curriculum or enfolded fellowships, but smaller programs offer fewer opportunities for subspecialty training. There may be advantages to a uniform approach that standardizes subspecialty training across programs and matches fellowship availability to demand.

Implementing a resident-led transition-specific bootcamp curriculum during pediatric residency training: Our 3-year experience

ABSTRACT Objectives Postgraduate programs that use ‘bootcamps’ to help trainees transition into new clinical roles usually solely target entry to residency, failing to address other critical transition periods. We developed, implemented, and evaluated a resident-led transition-specific bootcamp curriculum in our Pediatrics program and described our first 3 years of experience. Methods Our bootcamp curriculum was developed around Kern’s framework. A needs assessment identified key transition periods (Incoming Resident [IR]; Night Float [NF]; Ward Senior [WS]). Teaching content and methods were informed by Residents-As-Teacher principles. Program evaluation included surveys exploring trainees’ satisfaction, and perceived knowledge and self-efficacy before and after bootcamp participation. For the IR bootcamp, knowledge and behaviour were objectively assessed through written examinations and Observed Structured Clinical Examinations (OSCEs). Results Twenty-seven pediatric residents participated in the IR bootcamp, 26 in the NF bootcamp, and 25 in the WS bootcamp. Trainees’ baseline self-reported knowledge and confidence around clinical skills taught showed an improving trend post-bootcamp in all transition periods. Strengths identified included the level-appropriate teaching content and residents’ engagement as teachers. Conclusions Bootcamps can help residents adapt to new roles and should target all key transitions within the training continuum. Capitalizing on resident leadership for bootcamp curriculum development and implementation is instrumental to its success.

Performance of Chatgpt in ophthalmology exam; human versus AI.

This cross-sectional study focuses on evaluating the success rate of ChatGPT in answering questions from the 'Resident Training Development Exam' and comparing these results with the performance of the ophthalmology residents. The 75 exam questions, across nine sections and three difficulty levels, were presented to ChatGPT. The responses and explanations were recorded. The readability and complexity of the explanations were analyzed and The Flesch Reading Ease (FRE) score (0-100) was recorded using the program named Readable. Residents were categorized into four groups based on their seniority. The overall and seniority-specific success rates of the residents were compared separately with ChatGPT. Out of 69 questions, ChatGPT answered 37 correctly (53.62%). The highest success was in Lens and Cataract (77.77%), and the lowest in Pediatric Ophthalmology and Strabismus (0.00%). Of 789 residents, overall accuracy was 50.37%. Seniority-specific accuracy rates were 43.49%, 51.30%, 54.91%, and 60.05% for 1st to 4th-year residents. ChatGPT ranked 292nd among residents. Difficulty-wise, 11 questions were easy, 44 moderate, and 14 difficult. ChatGPT's accuracy for each level was 63.63%, 54.54%, and 42.85%, respectively. The average FRE score of responses generated by ChatGPT was found to be 27.56 ± 12.40. ChatGPT correctly answered 53.6% of questions in an exam for residents. ChatGPT has a lower success rate on average than a 3rd year resident. The readability of responses provided by ChatGPT is low, and they are difficult to understand. As difficulty increases, ChatGPT's success decreases. Predictably, these results will change with more information loaded into ChatGPT.

The role of the stakeholders in sustainable ecotourism management at Malela Waterfall of Indonesia’s West Bandung

The purpose of this study is to address the issue of low local participation in ecotourism management in Indonesia, specifically at the Malela Waterfall ecotourism site in Cicadas Village, Rongga District, West Bandung Regency, West Java, Indonesia. The research method is action research, which includes observation data gathering, in-depth interviews, and Focus Group Discussions. The findings of the study show that by carrying out the process of developing social infrastructure, namely development that prioritizes strengthening human resources in carrying out social service functions in ecotourism activities such as skill training of residents in the field of ecotourism, massive ecotourism outreach, and strengthening social communities—Non-Governmental Organizations (NGOs) and youth organizations as ecotourism actors. This type of development serves to raise awareness and participation among local inhabitants in Malela Waterfall ecotourism in West Bandung Regency. This promotes harmony and mutually beneficial partnerships among all Malela Waterfall ecotourism stakeholders. Furthermore, increasing community participation benefits the well-being of residents in the tourist region.