Specialty Training Research Articles

Surgical Specialty Outcome Differences for Major Spinal Procedures in Low-Acuity Patients.

Retrospective Cohort Study. There is an ongoing debate as to the influence of specialty training on spine surgery. Alomari et al. indicated the influence of specialty on ACDF procedures. However, deeper analysis into other spine procedures and lower-acuity procedures has yet to occur. In this study, we aim to determine if the outcomes of the low American Society of Anesthesiologists (ASA) classification (ASA 1&2) patients undergoing spine surgery vary based on whether the operating surgeon was an orthopedic surgeon or a neurosurgeon. The NSQIP databases from 2015 to 2021 were queried based on the CPT code for nine common spine procedures. Indicators of surgical course and successful outcomes were documented and compared between specialties. Neurosurgeons had minimally shorter operative times in the ASA 1&2 combined classification (ASA-C) group for cervical, lumbar, and combined spinal procedural groups. Neurosurgeons had a slightly lower percentage of perioperative transfusions in select ASA-C classes. Orthopedic surgeons had shorter lengths of stay for the cervical groups in ASA-C and ASA-1 classes (ASA-1). However, many specialty differences found in spine patients become less pronounced when considering only ASA-1 patients. Finally, postoperative complication outcomes and re-admission were similar between orthopedic and neurological surgeons in all cases. These results, while statistically significant, are very likely clinically insignificant. They demonstrate that both orthopedic surgeons and neurosurgeons perform spinal surgery exceedingly safely with similarly low complication rates. This lays the groundwork for future exploration and benchmarking of performance in spine surgeries across neurosurgery and orthopedics.

Pointing to success: a discussion of the role of professional achievements in the selection of specialist surgical trainees

In Australia and New Zealand, competitive selection processes for surgical specialty training programs often use a standardized curriculum vitae (CV) to assess criteria such as professional achievements. This review aims to assess the predictive validity, standardization, and implicit biases of these selection methods, as well as their implications for trainees and the diversity of surgical cohorts. The 2023 CV scoring criteria were collected for all available specialty surgical programs in Australia and New Zealand. In 2023, each of the 11 surgical craft programs published publicly available standardized CV scoring criteria. In this study, scored items that constitute 'professional achievements' were recorded and tabulated. Observational analysis of the collected data was then conducted. In 2023, each of the 11 specialty surgical craft programs published publicly available structured CVs, of which 10/11 allocated points for professional achievements. Designated points for professional achievements were classified as awards, scholarships, committee positions, and prior training courses: 4/11 programs offered points for scholarships/grants, 6/11 programs offered points for academic and/or non-academic prizes, and 8/11 programs offered points for professional development courses. Observational analysis of these findings suggests that professional achievements are desired in training program applicants. Variability in medical school opportunities and inherent heterogeneity reduce the CV's efficacy, unfairly disadvantaging some applicants. Observational analysis of hence highlights the need for future research to assess potential updates in CV parameters to enhance predictive validity, reduce bias, and promote diversity.

General practice trainee, supervisor and educator perspectives on the transitions in postgraduate training: a scoping review

Transitions are a period and a process, through which there is a longitudinal adaptation in response to changing circumstances in clinical practice and responsibilities. While the experience of the transition...

Notification of suspicion on the web page of the General Prosecutor’s Office and in the newspaper “Uryadovyi Kurier”: requirements and algorithm of publication

The study is aimed at analysing the legal acts establishing the procedure for publishing notices of suspicion on the website of the Prosecutor General’s Office and in the newspaper “Uryadovyi Kurier” and notices of suspicion already published in these sources, determining the requirements for them and developing an algorithm for publication for prosecutors and investigators. The author uses the methods of analysis and synthesis, induction and deduction, comparative legal, formal and logical, systemic and structural, graphical and other methods of scientific research. The article establishes that the Criminal Procedure Code of Ukraine defines the obligation of an investigator or prosecutor to serve a notice of suspicion by publishing it on the website of the Office of the Prosecutor General and in the mass media of national distribution. This method of delivery is possible for both general and special pre-trial investigation regimes. It is emphasised that the notice of suspicion to be published on the website and in the mass media of the national sphere of distribution have differences in content, format, data that may be made public, and place of publication. In order to prevent possible violations, the requirements for suspicion notifications are detailed and visualised in the form of a table. It is found that the procedure for publishing notices of suspicion for investigators and prosecutors is different. The author identifies the stages required for publishing notices of suspicion for investigators and prosecutors and develops appropriate algorithms. The findings of the study can be used in lawmaking activities in the development and improvement of regulations on this topic, in practical activities by investigators of pre-trial investigation bodies, prosecutors when serving a person with a notice of suspicion, in scientific activities to continue research in this area, in educational activities to prepare materials for teaching students, cadets, trainees in legal specialties and for advanced training of investigators and prosecutors.

Discussion on Talent Training Mode of Engineering Cost Major in Higher Vocational Colleges

With the rapid development of higher vocational education, the number of schools and enrollment has increased rapidly, and each specialty has been continuously refined. This has led to new challenges in the talent training of new specialties in higher vocational colleges in recent years. Based on the post ability standard of cost staff and the skill requirements of related posts, according to the characteristics of this major and guided by the idea of systematization of the work process, this paper discusses the problems existing in the talent training mode of higher vocational engineering cost major and provides some suggestions for the talent training and construction of higher vocational engineering cost major. It aims to promote continuous teaching reform in the future and the development of engineering cost majors in higher vocational colleges.

Observance of the labour rights of persons who have been deprived of their personal liberty as a result of armed aggression

Based on the monitoring of the Ukrainian Parliament Commissioner for Human Rights, the article reveals the state of observance of labour rights of civilian hostages. The article identifies problematic issues that obstruct the realisation of these rights of persons who have been deprived of their personal liberty as a result of armed aggression. It is noted that the Geneva Convention relative to the Protection of Civilian Persons in Time of War prohibits the taking of hostages. Failure to comply with the principles of international humanitarian law by representatives of the Russian Federation leads to the inability to ensure the protection of civilian hostages in accordance with international norms due to the unresolved nature of this issue. The Russian Federation, despite international norms, keeps such persons in captivity, does not notify them of their detention, does not provide them with the appropriate status, as a result of which the detained person cannot appeal against his or her detention, has no opportunity to report it. According to international standards, victims of enforced disappearances have the right to compensation from the state, which provides them with the maximum possible rehabilitation. It is noted that the protection of the constitutional rights of civilian hostages is provided for by the Law of Ukraine “On Social and Legal Protection of Persons in respect of whom the deprivation of personal liberty as a result of armed aggression against Ukraine and members of their families has been established”. In addition, it is noted that civilian hostages have the right to keep their jobs, but the law does not provide for the payment of wages. The article establishes that it is impossible to properly exercise the labour rights of employees who have become civilian hostages guaranteed by the Constitution of Ukraine. The emphasis is placed on the legislative gaps that do not allow civilian hostages to exercise the guaranteed right to credit their insurance period. The article provides for the crediting of insurance periods to civilian hostages, which affects social guarantees and, subsequently, the level of pension provision. Due to the uncertainty of the payer of the unified social contribution, such credit is not given for persons in respect of whom the deprivation of personal liberty as a result of armed aggression against Ukraine has been established. Deprivation of personal liberty is the basis for postponement or extension of annual leave and is also included in the length of service that gives the right to annual basic leave. Civilian hostages are additionally entitled to a one-time voucher to maintain their competitiveness in the labour market through retraining, specialisation, advanced training, and education in professions and specialities for priority economic activities. It is found that the problem of civilian hostages is closely related to the problem of missing persons. It is proved that there is a need to expand the labour rights of civilian hostages by guaranteeing the payment of wages.

Anesthesiological Preoperative Interview with a Palliative Care Patient: A Simulation-Based Experiment Using Standardized Patients.

Background and Objectives: Anesthesiologists come into contact with patients under palliative care in different clinical settings. They also routinely encounter these patients in their primary field of work, the operating room. Patients receiving palliative care who are scheduled for surgery will pose unique challenges in perioperative management, often presenting with advanced disease and with different psychosocial and ethical issues. This study aims to evaluate whether anesthesiologists without specialty training in palliative medicine will spot perioperative challenges presented by patients under palliative care and address them adequately. Materials and Methods: In this study, we simulated a preoperative anesthesiological interview using standardized patients and anesthesiologists (specialists as well as trainees). The standardized patients were asked to represent a patient under palliative care in need of surgery because of a mechanical ileus. We conducted 32 interviews, dividing the anesthesiologists into two groups. In one group, the standardized patients were instructed to address four problems, i.e., use of a port catheter for anesthesia, nausea and vomiting, pain medication, and an advance directive including a limitation of treatment (DNR-order). In the other group, these problems were also present, but were not actively addressed by the standardized patients if not asked for. The interviews were recorded, transcribed, and then analyzed. Results: In most cases, the medical problems were spontaneously identified and discussed. In only a few cases, however, was a therapy recommendation made for improved symptom control. The advance directive was spontaneously discussed by only 3 of the 32 (9%) anesthesiologists. In another 16 cases, the advance directive was discussed at the request of the standardized patients. The limitation of treatment stayed in place in all cases, and the discussion of the advance directives remained short, with an average duration of just over 5 min. Conclusions: In this study, the complex problems of patients under palliative care are not sufficiently taken into account in a preoperative anesthesiological interview. To improve treatment of the medical problems, therapists who have palliative medicine expertise, should be involved in the perioperative medical care, ideally as a multi-professional team. The discussion about perioperative limitations of treatment should be held beforehand, for example, as part of a structured advanced care planning discussion.

Clinician Willingness to Prescribe Medications for Opioid Use Disorder to Adolescents in Indiana.

Prescribing medications for opioid use disorders (MOUD), including buprenorphine, naltrexone, and methadone, to adolescents remains an underused evidence-based strategy for reducing harms associated with opioid use. To identify potential associations between clinician- and community-level characteristics regarding clinicians' self-reported willingness to prescribe MOUD to adolescents. This cross-sectional study included a phone survey of Indiana clinicians and spatial analysis of community-level characteristics. Clinicians were eligible for inclusion in analyses if actively providing health care and listed on the Buprenorphine Practitioner Locator website, a publicly available national registry of clinicians possessing a waiver to legally prescribe buprenorphine (ie, waivered clinicians). Community-level characteristics, including total population, rurality or urbanicity, percentage with incomes below the federal poverty line, and racial or ethnic makeup. Clinicians were asked about their willingness to prescribe MOUD to adolescents younger than 18 years if clinically indicated. Responses were recorded as no, yes, or yes with conditions. Among the 871 clinicians listed on the website as of July 2022, 832 were eligible for inclusion and contacted by phone. Among waivered clinicians, 759 (91.2%) reported being unwilling to prescribe MOUD to adolescents, 73 clinicians (8.8%) reported willingness to prescribe MOUD to adolescents, and only 24 (2.9%) would do so without conditions. A multivariable logistic regression model including spatially lagged community-level variables showed that, among areas with waivered clinicians, clinicians practicing in more populated areas were significantly less likely to prescribe to adolescents (β = 0.65; 95% CI, 0.49-0.87; P = .003). Similarly, those in more rural areas were significantly more likely to prescribe to adolescents (β = 1.27; 95% CI, 1.02-1.58; P = .03). Variation in clinician willingness to prescribe was not explained by other community-level characteristics. Among all waivered clinicians, advanced practice clinicians were less likely than physicians to report willingness to prescribe (β = 0.58; 95% CI, 0.35-0.97; P = .04), as were physicians without any specialty training relevant to MOUD prescribing when compared with family medicine clinicians (β = 0.40; 95% CI, 0.18-0.89; P = .03). A small subgroup of waivered clinicians had training in pediatrics (13 clinicians [1.6%]), and none were willing to prescribe MOUD to adolescents. From this cross-sectional study, it appears that Indiana adolescents continued to face gaps in access to MOUD treatment, despite its well-established efficacy. Programs that support primary care practitioners, including family medicine clinicians and pediatricians, in safe and appropriate use of MOUD in adolescents may bridge these gaps.

“Luck of the draw really”: a qualitative exploration of Australian trainee doctors’ experiences of mandatory research

BackgroundMany medical trainees, prior to achieving specialist status, are required to complete a mandatory research project, the usefulness of which has been debated. The aim of this study was to gain an in-depth understanding of trainees’ experiences and satisfaction of conducting such research projects in Australia.MethodsA qualitative descriptive approach was used. Semi-structured interviews with trainees were undertaken between May 2021 and June 2022. Australian medical trainees who had completed a research project as part of specialty training within the past five years were invited to participate. The purposive sample was drawn from participants in a survey on the same topic who had indicated interest in participating in an interview. Interviews explored trainees’ overall experience of and satisfaction with conducting research projects, as well as their perceptions of research training, support, barriers, enablers, and perceived benefits. Interviews were transcribed verbatim and thematically analysed.ResultsSixteen medical doctors from seven medical colleges were interviewed. Trainee experience and satisfaction was highly variable between participants and was shaped by four factors: 1) trainees entered their specialty training with their own perspectives on the value and purpose of the research project, informed by their previous experiences with research and perceived importance of research in their planned career path; 2) in conducting the project, enablers including protected time, supervisor support and institutional structures, were vital to shaping their experience; 3) trainees’ access to these enablers was variable, mediated by a combination of luck, and the trainees’ own drive and research skill; and 4) project outcomes, in terms of research merit, learning, career benefits and impacts on patient care.ConclusionsTrainee experiences of doing research were mixed, with positive experiences often attributed to chance rather than an intentionally structured learning experience. We believe alternatives to mandatory trainee research projects must be explored, including recognising other forms of research learning activities, and directing scarce resources to supporting the few trainees who plan to pursue clinician researcher careers.

OPEN SOURCE TEXTBOOK AS A RESOURCE FOR THE TEACHING-LEARNING PROCESS OF ALGEBRA IN INITIAL TRAINING OF MATHEMATICS TEACHERS

Objective: To determine the implications of the use of open source text in the teaching-learning process of algebraic structures in the initial teacher training of the mathematics specialty in a state university in Peru. Theoretical Framework: The conceptual and epistemic bases of open learning are systematically addressed through interactive texts, as well as the aspects related to the teaching-learning process in university higher education. Method: The study has a mixed approach, pre-experimental design and correlational level, the target population was mathematics education students and a sample of 46 randomly chosen students, data collection is carried out through a diagnostic questionnaire, another multiple alternative and an interview, in the study sample classes are held through the open source book; then the learning achieved at the conceptual level is evaluated. procedural of algebraic structures. Results and Discussion: In this research it is evident that students did not know the open source online text for the study of mathematics, but they have skills in the use of digital technology; but with the use of the digital book they assimilate the concepts, perform demonstrations and solve problems efficiently, raising their level of motivation towards learning. Thus, the relevant use of open source books significantly improves learning and the development of mathematical competence in students. Research Implications: Strengthening of interactive and personalized activities for a comprehensive training of mathematics content mediated by digital technology, reinforcing in a sustained way the culture and mathematical competence of teachers in initial training. Originality/Value: Implementation of an innovative approach in pedagogical practice, through the use of open resources for the assimilation of mathematical concepts and procedures in a dynamic, efficient and effective way. The value of research is evidenced in the praxis of didactic strategies in the context of the digital age, oriented to the knowledge of algebraic structures by mathematics teachers.

Experiences as a clinical teaching fellow: interviews with clinical teaching fellows in the West Midlands

BackgroundThe majority of junior doctors in the UK do not proceed directly into specialty training after completing mandatory foundation training but instead take a year out of training. A common post undertaken during a year out of training is a clinical teaching fellow (CTF) role which is used to provide undergraduate medical student teaching. There is only a small amount of literature available regarding CTF posts, and very little of this explores experiences or reasons for taking up such as post. An understanding of the reasons why doctors are choosing to work as CTFs and what their experiences are in post will contribute to how the role is further developed and utilised within the NHS. This study aimed to explore the experiences of CTFs employed in the West Midlands at NHS hospital Trusts.MethodsCTFs working in Trusts in the West Midlands region registered as students on the Education for Healthcare Professionals Post Graduate Certificate course at the University of Birmingham in August 2019 and 2020 who were enrolled in a longitudinal study were invited to take part in an individual interview asking about their experiences as CTFs.ResultsNine CTFs participated in an interview. Five main themes were identified which related to their experiences in post and plans for future careers. Participants reported choosing to undertake a CTF role due to wanting a break from clinical work and having previously enjoyed delivering teaching. Positive experiences in post included lifestyle related benefits and self-development opportunities. Challenges identified with the role included the impact of COVID-19 and volume of students.ConclusionThis is the first study to use interview methodology to explore experiences of CTFs, and has provided a valuable insight into the experiences of those in post in the West Midlands region. Understanding why doctors chose this job and what their experiences are could help to further develop and refine the role. To guarantee demands for teaching staff are met those employing CTFs should be aware of reasons why doctors apply for the post and ensure the post remains a desirable option.

Achieving excellence with interdisciplinary approaches in complex orthodontic adult patients

Over the last decades the percentage of adult orthodontic patients has substantially increased. Undeniably, an important motif for seeking orthodontic care at an older age is smile improvement, but this is not all. Frequently, impaired dentofacial aesthetics are combined with several other issues: severe dentoskeletal malocclusions; multiple tooth loss due to caries or endodontic failure; dental agenesis or trauma; periodontal breakdown; or functional problems, such as temporomandibular disorders or obstructive sleep apnoea. Therefore, comprehensive adult treatment mostly requires close collaboration of a team of equally well-trained dental specialists to select and execute the most suitable treatment option for the individual patient from day one. With joint planning, intensive communication with the patient and the involved specialists, and continuous monitoring of the treatment process, true patient-centred care can be delivered. In order to serve the individual patient best, the treating orthodontist does not only need thorough speciality training and continuing education, but furthermore, should be well-equipped with sufficient knowledge of the other dental fields of expertise. In combination with digital technology as an important tool for enhancing communication and efficient exchange of information between all involved team members, excellent joint clinical skills will take comprehensive interdisciplinary treatment to the next level.

Exploring how starting work during COVID-19 impacted post-foundation career decisions of new doctors: a mixed methods study

ObjectivesThis study addressed two research questions: What factors do doctors in training describe as influencing their choices to apply (or not apply) for specialty training during their Foundation Year 2?...

WP6.1 - A survey of the estimated cost of surgical consumable items within Ear, Nose, Throat departments

Abstract Aims Studies suggest that practitioners lack knowledge on cost of consumables and fail to appreciate the financial consequences of waste. We aimed to investigate this claim amongst ENT practitioners. Methods An online questionnaire, requiring cost estimations for 20 consumable items, was distributed to London ENT departments. Each item’s actual cost was compared with the average, median and interquartile range of the estimated price. An estimate was deemed ‘correct’ if it was within 20% of the actual price. Results 10.65% of all estimations were ‘correct’. There was no correlation between job role and cost-estimation accuracy. The most accurately estimated item was ‘fenestrated sterile drape’ (24.4%), the least was ‘1L bag of IV normal saline’ and ‘package of sterile sponges’ (0%). Conclusions We found poor cost appreciation of consumables amongst ENT surgeons. This could serve as a catalyst for the inclusion of health economics in specialty training curricula, improving cost-awareness.

Introducing simulation-based education to Genitourinary Medicine specialty training in the North West of England: A quality improvement project exploring trainee perspectives and impact.

Simulation-based education (SBE) provides enactive experiences for learners. This project explores the utility of SBE in GUM training. Phase 1 was a qualitative survey of GUM trainees across the UK exploring their views on SBE. Phase 2 involved roll-out of SBE to new GUM trainees. Feedback was subsequently obtained. Twenty-three participants were surveyed in phase 1. When asked to rate the relevance of SBE to curriculum competencies on a scale of 1 to 5 (1 = not relevant, 5 = highly relevant), the highest ratings (score ≥4) were for proctoscopy (4.1), IUD insertion (4.1), SDI removal (4.1), SDI insertion (4.0), and punch biopsy (4.0). All curriculum items scored ≥3. Eighty-three percent (n = 19) felt SBE will improve clinician confidence and competence. Following introduction of SBE, participants fed back on the relevance of the session. All 5 respondents rated the session ≥4 for addressing their clinical and curriculum goals. All respondents rated the session ≥4 for improving clinician confidence and competence. The session received an overall rating of 5, and respondents similarly rated 5 for more sessions. Trainees recognise the value of simulated learning experiences and its role in improving procedural competence and addressing bespoke human factor skills relevant to GUM.

Less than full-time training, barriers and future needs. A UK-wide online survey of doctors in training.

The the current views of less-than full-time (LTFT) training by both LTFT and full-time (FT) doctors in training, with regards to health and well-being, clinical and non-clinical opportunities, in addition to associated future workforce implications and challenges, are uncertain. We performed a cross-sectional study of UK-based doctors in training via an online questionnaire, designed and piloted by the Royal College of Physicians Edinburgh (RCPE) Trainees and Members Committee. Design was informed by prior investigation into LTFT training undertaken amongst similar populations by RCPE in 2019. The survey was distributed from May to September 2023 via email to trainees across the United Kingdom and was open to all specialties and training grades. The survey focused on lived experience of both LTFT and FT training, as well as perceived challenges for the future workforce. There were 648 responses from doctors in training across the United Kingdom, with an even spread of LTFT and FT trainees. Most responses (53%) were from trainees in medical specialties. Most LTFT trainees plan to train at this pace for more than 5 years. LTFT was commonly linked to improved work-life balance and well-being, with FT training perceived to feature high stress and burnout. Concerns around LTFT relate to administrative errors, reduced training opportunities and colleague prejudice. Trainees are concerned about LTFT leading to rota gaps and incoherent workforce planning around training numbers. With ever-increasing popularity in LTFT training, flexible and robust long-term workforce planning is necessary for the system to adapt to a new normal and improve retention of doctors in training.

Peculiarities of normative regulation training of specialists in security activities

The article deals with the peculiarities of professional training normative regulation of security personnel. It was found that there is no scientific research on the normative regulation of the qualification requirements that are put forward to the security personnel. The aim of the research is to prepare proposals for improving the regulatory regulation of security specialists’ training. To achieve the goals of the article, a complex of scientific methods was used: formal and dogmatic one - during the analysis of the provisions of normative legal acts in the sphere of security activities; comparative legal method - within the limits of comparing the norms of legislative and by-laws. The application of the methods of analysis, synthesis, induction and deduction made it possible to build a logical structure of the scientific article and draw reasonable conclusions regarding the optimization of normative regulation of the educational training of security specialists. The present research analyzed the history of legal regulation of security specialists’ training in Ukraine, identified shortcomings and gaps in the regulatory framework of this sphere of activity. It was established that the existing standards of higher education do not take into account the needs of subjects of security activities in the training of security personnel. It has been proven that the normative and legal framework in the sphere of security activities does not require specialists in organization of security measures to have a specialized higher education. It is justified that the bachelor’s degree holders (specialty «Personal and Property Security») and master’s degree holders (specialty «Security Activities and Safety») should not have different specializations. It was concluded that the differences can only be in the focus of the training specialties of bachelor’s and master’s degrees holders: for subjects of security activity - specialty 076 «Entrepreneurship, Trade and Exchange Activity», and for subjects of state security bodies - specialty 251 «State Security». On the basis of the conducted research, suggestions were made regarding the improvement of the Law of Ukraine «On Security Activities» dated March 22, 2012 and the Licensing Conditions for the Conduct of Security Activities, which were approved by the Resolution of the Cabinet of Ministers of Ukraine dated November 18, 2015 No. 960.

Pemberdayaan Masyrakat dalam Pengembangan Desa Wisata Berbasis Digital di Desa Gogik Kabupaten Semarang

Gogik is a village that has two hamlets, Gogik and Gintungan hamlets. Gogik Village is located in West Ungaran District, Semarang Regency, Central Java. The area of Gogik village is around 18,000 m2, with the border of the village area from the north namely Candirejo Village, east of PTPN IX, south of Gebugan Village, and west by Langensari Village. The climate of Gogik village is at an altitude of 600 meters above sea level with an average daily temperature of 27, so the atmosphere is very cool. Gogik Village is a village with a lot of potential in nature, culture and traditions that are still maintained today. As for one of the natural potentials that exist in the village such as: Semirang waterfall, Embung Sukoponco, Kebon Nutmeg PTP Ngobo, local food from Gogik Village, and of course the panoramic view of the foot of Mount Ungaran, as well as several other potentials. The potential is very much, of course, efforts are needed to optimize it to support Gogik Village as a digital-based Tourism Village. POKDARWIS is one of the tourism-aware organizations in Gogik village, with quite good community participation, but still not supported by qualified skills in using IT to promote the village's potential. This is certainly an obstacle in the development of digital-based tourism villages. Therefore, the UNNES service team will collaborate with the POKDARWIS institution (Tourism Awareness Group) Gogik Village, West Ungaran District, Semarang Regency to optimize regional potential through various kinds of digital-based tourism promotion training, production and packaging of regional specialties so that they can be used as souvenirs, utilization of drone media and video editing for promotion of Gogik village tourism. With innovation and creativity in promoting the natural potential that exists in Digital-based Gogik Village, it can have a big impact on improving the welfare of the village community. The output targets of this service are articles published in journals, articles published in mass media and activity videos.

Our House Won't Rebuild Itself: Peace, Love, and Hope as Tools to Transform Graduate Medical Education.

Graduate medical education (GME), the period of specialty and subspecialty training following attainment of a medical degree, is the final step in a continuum of medical education culminating in independent physician practice. This manuscript uses the metaphor "our house" to describe all aspects of the GME environment in which health care professionals and trainees learn and work. Our house's inhabitants have unequivocally stated that our house is in a state of disrepair. While physicians-in-training inevitably face challenges on their journey to independent practice, those from historically marginalized backgrounds face these challenges compounded by the disproportionate impact of identity-based harms. The authors use critical and liberatory theories to explore dominant power dynamics in GME, classifying identity-based harms as silence, pain, and despair. To strive for true transformation, the authors advocate for a new set of house rules, a different way of co-existing based on the principles of liberatory design. The authors call on readers to rebuild the house of GME by drawing parallels between the foundational human values of peace, love, and hope and the educational principles of psychological safety, identity safety, and belonging. To transform GME, our community must make space in our house for all individuals to join, and indeed, to rebuild together.

Continued improvement to imaging diagnosis and treatment triage of endometriosis: The role of the multi-disciplinary conference

Patient-centered endometriosis management tailored to the individual patient's subset of symptoms often requires highly sensitive and specific preoperative imaging. In the setting of a present ongoing learning curve among radiologists who interpret pelvis ultrasounds and MRIs for diagnosis of endometriosis, we have found that routine feedback between minimally invasive gynecology surgeons and radiologists, based on pre-operative imaging and postoperative laparoscopic findings, is essential for the continual improvement of imaging-based staging of endometriosis and empower pre-operative imaging as an important pillar of endometriosis management. We share illustrative patient cases, which, after collaborative discussion during our routine multi-institutional, multi-disciplinary conferences (MDCs) have led to improved patient counseling, better pre-surgical planning, and therefore improved patient satisfaction. Our endometriosis MDCs will continue to improve patient management in the future by providing a forum for trainees in medical, surgical, imaging, and pathology specialties to gain expertise directly from subspecialists, and participate in the care of these patients.