Role Of Physician Research Articles

An Approach to Leadership Development and Patient Safety and Quality Improvement Education in the Context of Professional Identity Formation in Pre-Clinical Medical Students.

Leadership and patient safety and quality improvement (PSQI) are recognized as essential parts of a physician's role and identity, which are important for residency training. Providing adequate opportunities for undergraduate medical students to learn skills related to these areas, and their importance, is challenging. The Western University Professional Identity Course (WUPIC) was introduced to develop leadership and PSQI skills in second-year medical students while also aiming to instill these topics into their identities. The experiential learning portion was a series of student-led and physician-mentored PSQI projects in clinical settings that synthesized leadership and PSQI principles. Course evaluation was done through pre/post-student surveys and physician mentor semi-structured interviews. A total of 108 of 188 medical students (57.4%), and 11 mentors (20.7%), participated in the course evaluation. Student surveys and mentor interviews illustrated improved student ability to work in teams, self-lead, and engage in systems-level thinking through the course. Students improved their PSQI knowledge and comfort levels while also appreciating its importance. The findings from our study suggest that undergraduate medical students can be provided with an enriching leadership and PSQI experience through the implementation of faculty-mentored but student-led groups at the core of the curricular intervention. As students enter their clinical years, their first-hand PSQI experience will serve them well in increasing their capacity and confidence to take on leadership roles.

The Suicidal Patient in the Emergency Department Team-Based Learning Activity.

Emergency medicine resident physicians, (PGY1-4), medical students rotating in the emergency department. Emergency physicians have a duty to recognize and provide care for patients who attempt to harm themselves or commit suicide. Mental health-related chief complaints account for 12.5% of emergency department (ED) visits.1 Additionally, patients with depressive symptoms who are discharged from the ED are at the highest risk for suicidal thoughts and behaviors.1 Therefore, evaluating and screening for suicide and determining appropriate dispositions for this patient population is extremely important. This team-based learning (TBL) activity will help prepare residents and medical students to evaluate, recognize, and disposition this at-risk patient population. By the end of the session, participants will be able to: 1) describe risk factors for suicide; 2) summarize the emergency physician's role in assessing patients with psychiatric emergencies; 3) assess a patient using a mental status evaluation; 4) identify the criteria for involuntary psychiatric hold placement; 5) develop a safe discharge plan for patients experiencing depression; and 6) Formulate a plan for evaluating a suicidal patient who is acutely intoxicated. This team-based learning activity is a classic TBL that includes learner responsible content (LRC), an individual readiness assessment test (iRAT), a multiple choice group readiness assessment test (gRAT) with immediate feedback assessment technique (IF/AT), and a group application exercise (GAE). A post-TBL survey was provided to each participant. A Likert scale was used for the survey questions to assess the relevance of the session to emergency medicine practice, learner perception of knowledge gained, learner perception of improvement of clinical practice, session engagement, and session delivery. The post-activity evaluation had a response rate of 33% (11/33). Overall, all the participants "strongly agreed" (Likert 5/5) or "agreed" (Likert 4/5) that the session improved their knowledge of caring for the suicidal patient in the ED with an average score of 4.6/5. All participants "strongly agreed" (Likert 5/5) or "agreed" (Likert 4/5) that the material presented was relevant to their clinical practice in the ED for an average score of 4.6/5. Constructive feedback included requesting learner responsible content (LRC) be sent earlier than one week prior to the activity. Depression and suicidal ideation are common ED complaints. However, it can be difficult to evaluate these patients and select an appropriate disposition because their symptoms can range from benign to life-threatening. The team-based learning (TBL) session allows for discussion of the complexities of the depressed and suicidal patient. Learners found this TBL to be beneficial in providing a diagnostic pathway and treatment algorithm to manage these complex, high-risk patients. Suicide, depression, substance abuse, disposition, team-based learning.

Characteristics promoting behaviour change: physician experience with a coalition-led quality improvement initiative to reduce excessive laboratory test ordering

BackgroundAttempts have been made to reduce excessive laboratory test ordering; however, the problem persists and barriers to physician involvement in quality improvement (QI) remain. We sought to understand physician participation...

Factors related to Japanese internal medicine doctors’ retention or migration to rural areas: a nationwide retrospective cohort study

Internal medicine (IM) doctors in Japan play the role of primary care physicians; however, the shortage of rural physicians continues. This study aims to elucidate the association of age, sex, board certification, type of work, and main clinical work with the retention or migration of IM doctors to rural areas. This retrospective cohort study included 82,363 IM doctors in 2010, extracted from the national census data of medical doctors. The explanatory variables were age, sex, type of work, primary clinical work, and changes in board certification status. The outcome was retention or migration to rural areas. The first tertile of population density (PD) of municipalities defined as rural area. After stratifying the baseline ruralities as rural or non-rural areas, the odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. The analyses were also performed after age stratification (<39, 40-59, ≥60 years old). Among the rural areas, women had a significantly higher OR for retention, but obtaining board certification of IM subspecialties had a significantly lower OR. Among the non-rural areas, physicians who answered that their main work was IM without specific subspecialty and general had a significantly higher OR, but obtaining and maintaining board certification for IM subspecialties had a significantly lower OR for migration to rural areas. After age stratification, the higher OR of women for rural retention was significant only among those aged 40-59 years. Those aged under 40 and 40-59 years in the non-rural areas, who answered that their main work was IM without specific subspecialty had a significantly higher OR for migration to rural areas, and those aged 40-59 years in the rural areas who answered the same had a higher OR for rural retention. Obtaining and maintaining board certification of IM subspecialties are possible inhibiting factors for rural work, and IM doctors whose main work involves subspecialties tend to work in non-rural areas. Once rural work begins, more middle-aged female IM doctors continued rural work compared to male doctors.

Diferencijalna dijagnoza vertiga - prikazi slučajeva

Introduction: Vertigo represents illusion or hallucination of movement caused by disturbance of perception of own movements or movements of observed object. It is caused by dysfunction of the inner ear vestibular apparatus (peripheral vertigo) or parts of central nervous system (central vertigo). Making distinction between these two types is very important for the making of rational decision by emergency medicine physician. Case report I: Female, 69 years of age is referred to neurologist in Emergency Center for attacks of acute onset rotatory vertigo, horizontal nystagmus and severe autonomic disturbances provoked by movement. Anamnesis, clinical, neuroultrasound examinations and CT scan showed no signs of acute neurologic disease. Treatment of peripheral type vertigo with vasodilators was indicated and further continued with otolaryngologist follow up. Case report II: Male, 72 years of age was treated on Clinic of Neurology for infarction of left cerebellar hemisphere. Symptoms at onset were vertigo, headache, diplopia, nausea and vomiting. Neurological examination revealed right sided horizontalrotatory nystagmus with fine vertical nystagmus, astasia/abasia and right sided hemiparesis. Treatment included thrombolytic, antithrombotic and anticoagulant therapy, as well as established vascular risk treatment. Conclusion: Role of emergency physician in establishing of etiology of vertigo at the place of onset is very important. Detailed anamnesis about onset of symptoms and their duration, clinical examination, diagnostic (ABCD2) score, and therapeutic repositioning (Epley) maneuver ensure fast triage and shorter transport delays if necessary.

The CALVIH Study: How to Handle Renal Stones in Persons Living with HIV&amp;lt;sub&amp;gt;1&amp;lt;/sub&amp;gt;?

Background: Renal stone (RS) is a highly prevalent disease in our societies and is mostly secondary to lifestyle habits. HIV1 patients often experience RS, although specific risk factors are not known. Despite other priorities, comprehensive work-up should be offered to avoid recurrences (50% risk in 5 years). Purpose and Methods: The aim of the study is to describe how to handle RS in persons living with HIV1 and to suggest how the understanding of mechanisms involved in stone composition helps customize therapy and prevent recurrences. We prospectively performed a complete work-up in a cohort of 23 prevalent HIV1 patients referred to our highly-specialized center by HIV physicians. Results: Inclusion was secondary to a colic episode with spontaneous elimination of the stone (74%), bilateral (67%), not obstructive (67%); 53% underwent urologic interventions. Mean age was 34 ± 16 years old and BMI was 22.5 ± 3 (one-third with metabolic syndrome). History of RS showed only one episode (22%), >one (74%) or >4 (4%). Estimated GFR was 78 ± 24 ml/min/1.73m2 (mean Cr 101 ± 24 μmol/L), and 5 were classified CKD stage 3. Stone analysis was only available for 7 patients and in 6/7 patients, and calcium metabolism was fully explored (2 absorptive hypercalciuria, 4 renal primitive hypercalciuria). Retained mechanism for RS was uric acid dependent for one, oxalic acid dependent for three and calcium dependent for three. Very few patients were exposed to known environmental risk factors for RS, 3 were/had been exposed to darunavir and 3 to atazanavir, 1 to efavirenz, 1 to acetazolamide, 2 to allopurinol. Conclusion: RS in HIV1 patients is mostly not related to ARV. Understanding of renal stone composition is critical to prevent recurrences by offering specific dietetic counselling and therapy. The role of HIV physicians is important due to the high prevalence of RS in the context of HIV disease.

Uloga lekara fudbalskog tima u prevenciji i terapiji sportskih povreda

The roles of football team physician include assessment and improvement of general health of every member of a sports team through implementation of prevention programmes and risk assessment of sports injuries. A football team physician has an important role in preparticipation screening exam and reducing the risk of sport injuries by developing prevention strategies. The team physician implements the primary therapy and prevention of serious injuries and diseases which can cause fatal consequences to health status of a football player. Different musculoskeletal diseases could be a result of injuries caused by playing competitive football. First aid of these injuries is provided by the team doctor, by using adequate initial therapy. Team physician organises daily supervision and cooperation with players, which can lead to highly efficient interventions in treatment and prevention of sport injuries, with the goal of adequate monitoring of sports injuries.

DISPOSITIVOS INTRA-HOSPITALARES E PRÁTICAS ASSISTENCIAIS: IMPLICAÇÕES PARA A INTEGRALIDADE E CONTINUIDADE DO CUIDADO

ABSTRACT Objective: To analyze the care production in a public hospital and the devices used for comprehensive care. Method: This was a health interference study, in which data collection was carried out from September 2019 to June 2022. Observations and field researcher diary records, individual interviews were conducted with coordinators and managers, and focus groups with workers, of a large hospital in Belo Horizonte, Minas Gerais. The empirical material was submitted to thematic content analysis. Results: Devices that contribute to the construction of new management and care practices were identified. These included the Lean in Emergencies project (Fast Track, Kanban, and Huddles tools); the Internal Regulation Unit; the role of hospitalist physicians, co-managers, and shift coordinators; the work of the home care team within the hospital; and devices for interdisciplinary management, such as interdisciplinary bed runs, case discussions, and shared construction of therapeutic projects. Conclusion: The implemented devices contribute to the transformation of the health production model and work process in favor of integrating the hospital into the healthcare system.

RAG-SACA-3: ROLE OF PRIMARY CARE PHYSICIAN TO MANAGE HYPERTENSION IN A LOW-RESOURCE SETTING

Hypertension is a primary care clinical condition that is therefore best detected, managed, and followed at a primary care level by a primary care team led by a physician. However, the delivery of primary care services is not unique in all countries, especially in low- or lower-middle-income countries where primary care physicians used to manage hypertension in low-resource settings (LRS). This presentation will focus on the concept of LRS, a list of potential roles played by a primary care physician, and possible challenges usually face. Usually, the settings where health care systems do not meet the minimum standards set by the World Health Organization or any other quasigovernmental organization are considered LRS. However, there is no explicit definition for LRS. The major roles of a primary care physician in LRS are identification of an individual at high risk for HTN, proper screening, diagnosis with a proper communication strategy to inform about the diagnosis, cost-effective rational treatment with counseling, and finally follow-up. The primary care physician is at the heart of a team-based HTN care in an LRS and will provide supportive supervision to the team to ensure the best outcome: (i) increased patient enrollment, (ii) increased patient treatment rate, (iii) improve BP control rate, (iv) high treatment compliance (v) reduction of drug stock-outs. In LRS, without team-based care and shifting of tasks, it will be very difficult to ensure proper management. In general, a primary care physician will play a leadership role in a resource-poor setting to successfully implement an HTN management program.

Obstacles and Limitations in the Use of Protocols Responding Intimate Partner Violence Against Women from the Health System in Spain.

Intimate partner violence against women (IPVAW) is a public health problem that affects women worldwide. Consequently, victims frequently go to healthcare centers, usually with a cover reason. To address this problem, national and autonomic protocols to respond to IPVAW in health systems have been developed in Spain. In this regard, the role of primary care physicians (PCPs) will be essential for addressing IPVAW, but they could encounter obstacles in doing so. The purpose of this study was to explore how IPVAW is addressed in healthcare centers in Spain. This study synthesized the information available in the protocols to address IPVAW among health care workers in Spain and analyzed it according to World Health Organization (WHO) guidelines. Additionally, PCPs' perspectives on these protocols and the nature of IPVAW attention from healthcare centers were explored through a focus group. The findings displayed that, although the protocols mostly conform to WHO guidelines, they are insufficient to address IPVAW. Generally, PCPs were unaware of the existence of the protocols and referred to the lack of training in IPVAW and protocol use as one of the main obstacles to intervening, along with a lack of time and feelings as well as cultural, educational, and political factors. The adoption of measures to ensure that PCPs apply these protocols correctly and to approach PCPs' obstacles for addressing IPVAW in consultations will be crucial for the care of victims.

Perception, perceived scope, and potential barriers towards developing nurse practitioners cadre among health care providers and beneficiaries: A pilot study from Northern India.

The role of nurse practitioner (NP) emerged in early 1965 when general practitioners began working with nurses. Evidence across the world highlights the benefits achieved by the NP role. The Indian Nursing Council (INC) implemented a country-wide NP in critical care (NPCC) program with the approval of the ministry of health and family welfare (MoHFW) in 2017. The NP role is in its infancy in India. Hence, there is a need to assess the perception among beneficiaries and healthcare personnel. This study was conducted to assess the perception, perceived scope, and potential barriers for developing the role of NPs in India among beneficiaries and healthcare providers. A descriptive, cross-sectional pilot study was conducted at AIIMS Rishikesh, Uttarakhand, India, among 205 participants (84 beneficiaries, 78 nurses, and 43 physicians) using a proportionate stratified random sampling technique. Likert scales and socio-demographic sheets were used to assess the perception, perceived scope of practice, and potential barriers in developing a NP cadre in India. Descriptive and inferential statistics were used for analyzing data. The mean age of beneficiaries was 37.98, nurses was 27.58, and physicians was 28.13 years, respectively. 121 (61%) of participants were highly favored, and 77 (38%) were in favor of developing NP cadre in India. They considered it to be necessary, feasible, and acceptable in India. The feasibility and necessity of the perception domain were highly significant (P < 0.001 and P < 0.003, respectively). Nurses (mean ± SD: 35.36 ± 3.55) considered that NPs could have a wide range of practice followed by beneficiaries (mean ± SD: 38.17 ± 3.68) than physicians (mean ± SD: 34.75 ± 5.95). Lack of awareness, the nonexistence of cadre structure, lack of acceptance of the role of physicians, and lack of clear policy were the key potential barriers to develop an NP cadre in India. In this study, participants had favorable views on employing NPs in India; thus, this role will improve healthcare access for beneficiaries. NPs can carry out a wide range of practices.However, a lack of awareness, no cadre structure, and a lack of a clear policy may hinder the development of the NP cadre in India.

KNOWLEDGE AND PRACTICES RELATED TODIABETIC RETINOPATHY AMONG DIABETIC PATIENTS ATTENDING MEDICINE OUT PATIENT DEPARTMENT IN TERTIARY CARE HOSPITAL IN CHENGALPATTU DISTRICT

Aim: To assess the knowledge and practices related to diabetic retinopathy among diabetic patients attending medicine out patient department in tertiary care hospital in Chengalpattu district Design: hospital based cross sectional study Methods: study was conducted among 202 adult patients with diabetes between June 2021 to December 2021 , who attended medicine outpatient department in tertiary care hospital in Chengalpattu district. All patients were surveyed with a questionnaire regarding there Knowlegde and practices related to diabetic retinopathy. Statistical Analysis: SPSS software, CHI square test Results: A questionarre based responses was obtained from 202 patients diagnosed with diabetes .Age distribution of diabetes is predominantly high in 40 -60 years .75% of people are treated with oral hypoglycemic drugs .around 61% know that diabetes can cause eye disease .Regular eyecheck up is mandatory in diabetic patients was agreed by 52% patients.only 43% visit ophthalmologist for regular eye checkup in the contrary 83% visit physicians regularly for diabetic control. Conclusion: Our study emphasises the need for expanded educational programmes about DR, its risk factors, available treatments, and follow-up. In our study, the role of physicians was frighteningly minimal, which has to be emphasised.

A Comprehensive Review: Drug Interactions and Polypharmacy

The aim of our study is to identify the drug interactions due to polypharmacy. We tried to identify the possible risk factors, outcomes and management of polypharmacy especially in older patients. A medication interaction happens when the impact of one medication is changed by the presence of another. Many interfacing drugs can be controlled securely without making any mischief to the patient through cautious checking and dose change. Notwithstanding, prescriptions should possibly be regulated together if the outcomes are perceived and the danger of mischief is exceeded by the helpful benefits. Polypharmacy is portrayed as "the utilization of various meds or potentially the combination of a greater number of prescriptions than are clinically prescribed, speaking to superfluous medication use." Polypharmacy includes the number of meds taken by the patient, the provision of at least one wrong meds, or a combination of both, which can expand the danger for adverse medication occasions (ADEs), underutilization of drug, and redundancy of medication. Polypharmacy Management is an entire framework approach that upgrades the consideration of multimorbid patients through amplifying advantage while decreasing the dangers of improper polypharmacy. Prescription review and assessment is an intercession that should be ordinarily performed by clinical drug specialists to improve medicine harmlessness and drug therapy results, and guarantee ideal prescription use. There should be a proper and strong role and communication of Physicians, Pharmacists, and Patients in society, especially in developing countries. The potential risk factors should be identified like dietary factors interact with the drug therapy sothat adverse reactions can be identified and avoided.

A Comprehensive Review: Drug Interactions and Polypharmacy

The aim of our study is to identify the drug interactions due to polypharmacy. A medication interaction happens when the impact of one medication is changed in the presence of other. The effect of interfacing drugs can be controlled securely without causing any harm to the patient through cautious checking and dose change. Polypharmacy is portrayed as "the utilization of various medicines or potentially the combination of a greater number of prescriptions that are clinically prescribed, leading to superfluous medication use. Polypharmacy includes the number of medicines taken by the patient, the provision of at least one wrong medicine, or a combination of both, which can expand the danger for adverse medication occasions, underutilization of drug, and redundancy of medication. Polypharmacy Management is an entire framework approach that upgrades the consideration of multimorbid patients through amplifying advantage while decreasing the dangers of improper polypharmacy. The review and assessment of prescription is an intercession that should be ordinarily performed by clinical drug specialists to improve the drug therapy results, medicine’s adverse impact and guaranteed the use of ideal prescription. There should be a proper and strong role and communication of physicians, pharmacists, and patients in society, especially in developing countries. The potential risk factors should be identified, like the interaction of diet with the drug therapy so that adverse reactions can be identified and avoided.

Role of a Qualified Physician and Health Behavior in Effective Treatment of Cervical Spondylotic Myelopathy.

Objectives: This research investigated the impact of having a qualified physician on improving disease awareness and effective treatment for cervical spondylotic myelopathy. Previous studies have observed that patients with cervical spondylotic myelopathy are less satisfied with their treatment and medical facilities. This study hence aimed to investigate the role of a qualified physician and the moderating influence of health behavior between disease awareness and effective treatment for cervical spondylotic myelopathy. Methods: The primary data was collected from 144 cervical spondylotic myelopathy patients admitted in Meram Medical Faculty Hospital. A questionnaire on 5-point Likert scale was developed, whose items were checked for validity and reliability. The study adopted a cross- sectional approach, by conducting a normality test, correlation measurement of all variables like disease awareness, qualified physician and health behavior, and a regression analysis to explore the impact of independent variables on the dependent variable, and to test the hypotheses of the study. Results: The results of this research revealed that patients of cervical spondylotic myelopathy would get effective treatment when their health behavior is positive and when they have an awareness of the critical health situation. Conclusion: This research contributed a framework significantly to the research gap. It demonstrated the extraordinary practical and theoretical implications related to cervical spondylotic myelopathy. Future directions are also recommended by highlighting the limitations of this research, in order to continue to contribute to the effective treatment of cervical spondylotic myelopathy patients.

Knowledge and Attitudes of Turkish Physicians towards Human Monkeypox Disease and Related Vaccination: A Cross-Sectional Study.

Background: In May 2022, the monkeypox virus outbreak in multiple countries on various continents marked a potential resurgence of the disease as a global health issue. Considering the crucial role of physicians in mitigating the monkeypox outbreak, we sought to evaluate physicians’ knowledge, attitude, concerns, and vaccine acceptance for monkeypox, in the shadow of the COVID-19 pandemic. Methods: A large-scale, cross-sectional survey was conducted among 283 physicians between 20 August−2 September 2022, in Turkey. The participants’ sociodemographic characteristics, knowledge, attitudes, concerns, and vaccine acceptance toward monkeypox infection were collected via a questionnaire. Results: Our study revealed that 32.5% of physicians achieved a good level of knowledge; similarly, 31.4% of the physicians planned to have the monkeypox vaccine. Multivariate binary logistic regression analysis showed that female physicians (p = 0.031) and older people (≥30 vs. <30) were more likely to be knowledgeable about monkeypox (p = 0.007). We found that participants from divisions of internal medicine (p = 0.033) who knew about the monkeypox disease during medical school or residency (p = 0.005) and were previously exposed to COVID-19 disease (p = 0.005) were more likely to have a good knowledge score of monkeypox. We also found that physicians with a good knowledge score were more worried about monkeypox compared to COVID-19 (AOR: 2.22; 95% CI:1.13−4.33; p = 0.019). Additionally, those who had information on monkeypox during medical education (AOR = 2.16, 95% CI = 1.10−4.21; p = 0.024) were more likely to receive the smallpox vaccine to prevent monkeypox viral infection when available. Conclusions: The present study pointed out that physicians in Turkey have unsatisfactory levels of knowledge about the emerging monkeypox. This study results can impede attempts to detect and manage cases of monkeypox and should be addressed through appropriate and timely awareness and educational programs, alerts, and seminars. These might serve as the basis for policymakers’ decisions about promoting national monkeypox vaccination strategies and addressing potential vaccine hesitancy and misinformation when needed.

Role of individual physicians in pharmacovigilance.

Role of individual physicians in pharmacovigilance.

Role and Issues of Physicians in Industrial Accident Compensation Insurance System for Mesothelioma Development

目的．中皮腫患者は労災保険制度の申請ができる．しかし職業ばく露の評価は医師の負担になっており，石綿ばく露調査の体制において現場の医師の対応は明らかにされていない．方法．中皮腫患者90名に対して質問紙調査を行い，労災保険制度の申請（認定）を目的変数とし，「医師の対応」3項目と「労災保険制度の申請理由」5項目を説明変数としてステップワイズ法による回帰分析を行った．結果．患者は医師からの相談窓口への紹介が増加した場合，労災保険制度申請の増加がみいだされた（b=0.276，t［88］=2.336，p=0.021，β=0.242）．また患者会からの助言・指摘が増加した場合も労災保険制度申請の増加がみいだされた（b=0.569，t［88］=5.373，p＜0.05，β=0.497）．結論．労災保険制度の申請には医師が患者に対して相談窓口に紹介することが重要であり，医療機関における相談支援体制を整え，患者会と連携を深めることが課題である．

Perceptions of resources available for postgraduate family medicine training at a South African university

Clinical training is one of the roles of family physicians (FPs) in decentralised postgraduate training. Effective training requires skilled trainers and sufficient resources. Little is known about the resources available for decentralised clinical training in district health systems in low- to middle-income countries, especially in sub-Saharan Africa. To explore FPs' and registrars' perceptions of the available resources in a decentralised postgraduate family medicine (FM) training programme. Five decentralised training sites affiliated with the University of the Witwatersrand across two provinces in South Africa. This qualitative study forms part of a broader project evaluating a FM registrar training programme using the logic model. Semistructured interviews were conducted with a purposive sample of 11 FPs and 11 registrars. The interviews were transcribed verbatim and analysed thematically. Three themes were identified: 'Impact of resource constraints', 'Family physicians' skills and knowledge could be further improved' and 'Family physicians need additional support to optimise their training role'. The additional resources needed include more FPs, equipment, infrastructure and funding. Knowledge and skills of FPs were reported variable and needed further improvement. Additional support was required from peers, the district management and the university. Well-resourced decentralised training environments with sufficient skilled trainers and adequate resources are needed to positively influence FP training and supervision, especially in middle-income countries like South Africa.Contribution:Clinical trainers need adequate resources and support from peers, district management and the university for effective decentralised clinical training.

Comparing and Contrasting the Experiences of U.S. Medical Students During the COVID-19 and 1918 Influenza Pandemics.

In March 2020, medical students across the United States were pulled from their in-person responsibilities and learning in response to COVID-19. Leaders in the U.S. medical education system then began the arduous task of determining when, and how, to restore their full scope of training. This challenge was complicated by a paucity of readily available historical information about U.S. medical students in pandemics. To fill this knowledge gap, the authors collaborated with a medical history archivist to describe the experience of U.S. medical students during the 1918 influenza pandemic and compare it to the modern-day. The experiences and responsibilities of medical students differed tremendously between the 2 pandemics. In 1918, U.S. medical students typically were conscripted into clinical service if they did not volunteer, assuming the roles of physicians, physician assistants, and nurses, often with atypically high levels of autonomy. Medical students were at great risk during the 1918 pandemic; multiple medical schools recorded students dying from influenza. In contrast, during the early COVID-19 pandemic, U.S. medical students were removed from the clinical environment, even if they wanted to volunteer, assuming ancillary roles instead. Upon returning to the clinical environment, most were not permitted to care for COVID-19 patients. The few medical students who recorded personal narratives about 1918 felt that caring for patients with influenza significantly influenced their growth and development as future physicians. One of the few things U.S. medical education had in common between the 1918 and COVID-19 pandemics was a lack of preparedness that impaired readiness and increased confusion among medical students. As U.S. medical education reflects on its response to COVID-19, the authors hope that their findings will provide context for future discussions and decisions about the role of medical students in pandemics.