Systems-based Practice Research Articles

Resident Unions: Why Now and Will They Change Medical Education and Health Care?

During the COVID-19 pandemic, resident unions proliferated. While unionization resulted in increased compensation and benefits, the process of union negotiations may have created adversarial relationships between residents and their institutions' leadership, who residents depend on for supervision and the development of clinical expertise. Such adversarial relationships could affect the learning environment, which is critical to the delivery of high-quality care. In this commentary, the authors suggest that academic medical centers should offer residents an authentic seat at the institutional care delivery leadership table, ensuring residents' full participation in key organizational decisions. Doing so represents an alternative to unionization, with its potentially adversarial relationships, while still achieving a key goal of residents-to be included in the decisions that affect them and the care they provide. In this way, residents can use their unique understanding of the institutions' strengths and weaknesses to improve the quality of patient care and the learning environment. Such engagement can also help residents achieve competence in systems-based practice and provide a vital link between institutions and the patients and community they serve through health policy and advocacy activities.

Gender Differences in Clinical Performance Assessment of Internal Medicine Residents: A Longitudinal Analysis of the Influence of Faculty and Trainee Gender.

Competency-based medical education relies on equitable assessment. This study examined the influence of faculty and trainee gender on assessments of internal medicine (IM) resident performance over time. A longitudinal analysis of clinical performance assessments from 7 U.S. IM residency programs (July 2014-June 2019) was conducted. Core competency scores (patient care [PC], medical knowledge [MK], practice-based learning and improvement [PBLI], systems-based practice [SBP], professionalism [PROF], and interpersonal and communication skills [ICS]) were standardized across programs. Cross-classified mixed-effects linear regression evaluated the relationship between gender and standardized competency scores within training programs, while adjusting for multiple variables including IM In Training Examination percentile rank. Data included 9,346 evaluations by 1,011 faculty (552 [55%] men, 459 [45%] women) for 664 residents (358 [54%] men, 306 [46%] women). Initially, women residents' scores were significantly lower than men's in PC (estimated difference [standard error ] -0.097 [0.033], P = .004), MK (-0.145 [0.034], P < .001), and PBLI -0.090 [0.040], P = .022). PC, MK, PBLI, and SBP scores increased more over time for women residents than men (PC: 0.050 [0.015], P = .001; MK: 0.052 [0.015], P = .001; PBLI: 0.036 [0.018], P = .048; SBP: 0.036 [0.016], P = .027). PROF and ICS scores were comparable across gender. There was a significant interaction between faculty gender and postgraduate year (PGY) across all competencies but none between resident gender, faculty gender, and PGY, indicating that men and women faculty rated residents differently over time but were consistent in how they rated men and women residents. Gender-based assessment differences were variable across competencies and time. Women residents had lower scores initially but greater gains in "hard skill" (MK, PC, and PBLI) than in "soft skill" (ICS and PROF) competencies, suggesting assessment inequities. Efforts to ensure equitable assessment are needed.

Advancing Global Social Change: Systems Approaches to the Role of Nonprofits in Climate Policy

Abstract The existential threat of climate change requires reimagining foundational aspects of society, including jobs, transportation, energy, the built environment, natural resources, health, and water and food supplies. We argue that to realize such broad scale change requires systems thinking. In this introduction to the special issue on Nonprofits and Climate Policy, we outline four systems-based views of global social change, organized by source of change and assumptions about the technical rationality of the system: engineering, evolutionary, social constructivist, and (critical) realist. By elaborating this framework, we shed light on the fundamental assumptions embedded in climate advocacy and policymaking. Along with describing key scholarship and practice-based examples for each approach, we align the articles in this special issue with the four views of global social change to inspire systems-based research and practice at the nonprofit and climate policy intersection. We hope that creating more explicit accounts of the key beliefs and expectations about how social change occurs at a global systemic level will help to advance research and practice in sustainability.

A dearth of disability-related competencies in Accreditation Council for Graduate Medical Education's Milestones 2.0.

Despite the high prevalence of disability and the frequency with which people with disabilities encounter the health care system, physicians report inadequate knowledge regarding caring for their patients with disabilities. To determine the number and type of disability-related competencies in the Accreditation Council for Graduate Medical Education's Milestones 2.0. Cross-sectional analysis of publicly available data to identify, via key word search, the presence of disability-related competencies using disability-related terms derived from the World Health Organization's International Classification of Functioning Disability and Health. Accreditation Council for Graduate Medical Education's Milestones 2.0. N/A INTERVENTIONS: N/A MAIN OUTCOME MEASURE: Presence of disability-related competencies. Over one-third (37.5%) of specialties had zero disability-related competencies. Nineteen (59.4%) included an Interpersonal and Communication Skills Milestonethat mentions disability as a potential barrier to communication. No specialties had Systems-Based Practice or Practice-Based Learning and Improvement disability-related competencies. Physical medicine and rehabilitation (PM&R) had six disability-related competencies, preventive medicine occupational and environmental medicine had three, and otolaryngology and transition year each had two. A minority of medical and surgical specialties had disability-related competencies outside of the Interpersonal and Communication domain. With the rising prevalence of disability and the lack of physicians with expertise in the care of people with disability, the time is now to integrate disability competencies into residencies, especially for the primary care specialties.

Medical students’ experience and learning outcomes of overseas community involvement project: a qualitative study

BackgroundMedical students in Singapore engage in short term medical missions, locally known as Overseas Community Involvement Projects (OCIPs). Little is known about the learning outcomes of an OCIP and how this complements their medical education back home. Understanding this can help the medical educators structure the OCIP to optimise its learning value.ObjectivesThis study aims to gain an in-depth understanding of the experiences and learning outcomes of the medical students who participated in the OCIP.MethodsThis was a qualitative study involving Singaporean students from one medical school travelling to Nepal. Data was collected from reflective journals, overall group reflections and two focus group discussions. The data was thematically analysed using the Accreditation Council for Graduate Medical (ACGME) core competencies for medical professionals.ResultsThe data could be classified under various themes within the six domains of the ACGME framework. The study revealed themes of: humanism, socioeconomic and cultural determinants of health under the domain of patient care, application of medical knowledge, investigating and evaluating the needs of a population and feedback to drive improvement under the domain of practice-based learning and improvement, use of non-verbal cues and communicating across language barriers under the domain of interpersonal and communication skills, healthcare systems and delivery, resourcefulness and adaptability, health equity and accessibility under the domain of systems-based practice, ethics, role-modelling, teamwork and leadership skills, interprofessional skills and resilience under the domain of professionalism. Understanding the students’ motivations, utilising reflections, and following the patients’ journey facilitated attainment of these outcomes.ConclusionsThis OCIP experience translated to learning outcomes aligned with the ACGME framework. There is great potential for the experiential learning from a well-structured OCIP to help with personal and professional development and global health education.

The Predictive Performance of General Surgery Milestones on Post-Graduation Outcomes.

To establish whether Accreditation Council for Graduate Medical Education Milestones predict future performance of general surgery trainees. Milestones provide bi-annual assessments of trainee progress across six competencies. It is unknown whether the Milestones predict surgeon performance after the transition to independent practice. We performed a retrospective cohort study of surgeons with complete Milestone assessments in the fourth and fifth clinical years who treated patients in acute care hospitals within Florida, New York, and Pennsylvania, 2015-2018. To account for the multiple ways in which the Milestone assessments might predict post-graduation outcomes, we included 120 Milestones features in our elastic net machine learning models. The primary outcome was risk-adjusted patient death or serious morbidity. 278 general surgeons were included in the study. Milestone assessments 6-months into the fourth clinical year displayed a normal score distribution while multicollinearity and low score discrimination at the final assessment period were detected. Individual Milestones features from the Patient Care, Professionalism, and Systems-based Practice domains were most predictive of patient-related outcomes. For example, surgeons with worse patient outcomes had significantly lower scores in Patient Care 3 when compared to surgeons with better patient outcomes (High DSM, yes: 2.86 vs. no: 3.04, P=0.011). The Milestones features that were most predictive of better patient outcomes related to intraoperative skills, ethical principles, and patient navigation and safety, measured 12-18 months prior to graduation. The development of a parsimonious set of evidence-based Milestones that better correlate with surgeon experience could enhance surgical education.

Development of advanced practice nursing core competencies in Saudi Arabia: A modified Delphi study

BackgroundAdvanced practice nursing requires a diverse set of competencies that define what advanced practice nurses need to know and be able to do to deliver safe, effective, and high-quality healthcare. Given the lack of evidence regarding core competencies and the evolution of advanced practice nursing roles in Saudi Arabia, it is becoming increasingly important to develop core competencies to standardize educational and clinical training programs. ObjectiveTo define the core competencies of advanced practice nursing in Saudi Arabia. DesignUtilizing a modified Delphi design and snowball sampling technique, data were collected between April and July 2023 using an online questionnaire consisting of 28 core competencies that was developed based on an in-depth literature review and a critical analysis of advanced practice nursing core competencies published by leading professional organizations. Two rounds of Delphi surveys were conducted. SettingsThe study was set in clinical and academic settings in Saudi Arabia. ParticipantsNursing experts with graduate degrees as advanced practice nurses. ResultsIn Round 1, 34 advanced practice nursing experts reached full consensus on 24 of the 28 core competencies, and four core competencies reached partial consensus. Based on suggestions and feedback from the experts, the investigators revised ten core competencies to reflect the improvement suggestions and created three new core competencies. A total of 26 core competencies were used in Round 2, which achieved a full consensus among the 34 advanced practice nursing experts, under the following six core competency domains: knowledge of advanced practice nursing, person-centered care, professional improvement, professionalism, communication and interprofessional partnership, and leadership and system-based practice. ConclusionsGiven the need for a standardized competency framework, the 26 core competencies proposed in our study have the potential to guide education and training in academic programs and facilitate the implementation of advanced practice nursing in clinical settings.

Implementation of High-Value Care for Physical Therapy Residents Through Systems-Based Practice Curriculum Development: Case Report.

Systems-based practice is a core competency for physical therapy residents, best acquired through experiential learning. Peer health professions are further along than physical therapy in implementing curricula that support systems-based practice. Clinical and practice data in residency programs could provide for education in high-value care (HVC) as a foundation for systems-based practice. Our purpose was to develop and assess a HVC curriculum incorporating reflective practice to help residents achieve competency in systems-based practice. The Logic Model, which evaluates key components needed for success and sustainability, was used to identify resources for a curriculum in HVC. Two orthopedic physical therapy residents and 5 faculty mentors participated in didactic and mentoring sessions. A practice dashboard for each clinician was developed to facilitate resident-mentor discussions. Focus group input was used to refine the curriculum. The validated Systems Thinking Scale, the Quality Improvement Knowledge Application Tool Rubric, and the American Physical Therapy Association Residency Core Competency Score were used to assess residents' progress and to make comparisons to prior years' residents. The residents demonstrated increases in systems thinking and quality-improvement knowledge and improvements in clinical outcomes and practice efficiencies. Three themes emerged from semistructured interviews: challenges to HVC, current approach in HVC, and future-oriented thinking in HVC in practice. This study demonstrates that HVC activities and a personalized clinical dashboard in a physical therapy residency program can facilitate experiential learning of systems-based practice, a core competency for value-centered, inclusive practice.

Impact of colloidal silver nanoparticles (AgNPs) added for their antimicrobial efficacy on the compressive strength of poly(methyl methacrylate)-based acrylic denture base resin subjected to two different curing cycles: An in vitro study

Abstract Introduction: Colloidal silver nanoparticles (AgNPs) have been incorporated into acrylic resins to induce antimicrobial properties. However, as additives, they can influence the mechanical properties of the final product. The aim of the present study was to evaluate compressive strength of acrylic denture base resin incorporated with different concentrations of AgNPs subjected to two different curing cycles. Materials and Methods: Lucitone 199 acrylic denture base resin was used in the present in vitro study design because of its high-impact strength, while AgNPs were incorporated at 0.5% and 5% concentration by polymer mass. Specimens devoid of AgNPs were used as controls. The specimens were fabricated according to the American Dental Association specification No. 12 for denture base resin: Second revision, BS specification 2482 and tested for compressive strength using universal testing machine. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 19 (SPSS Inc., Chicago, IL, USA). Descriptive statistics was used to compare two different curing cycles; while one-way analysis of variance and Kruskal–Wallis H-test were used for statistical analysis. P &lt;0.05 was considered statistically significant. Results: Colloidal silver nanoparticles (AgNPs) incorporation at 0.5% concentration increased the mean compressive strength in both the short and long curing cycles by 5.3% and 8.3% respectively when compared with the control group. Conclusions: The findings of the present study suggested that the mean compressive strength of acrylic denture base resin modified with 0.5% concentration of AgNPs was above the control group, both in the short and long curing cycles. However, at 5% concentration of AgNPs, decrease in compressive strength compared to the control group was observed, both in short and long curing cycles, giving it a questionable prognosis, while the results were found to be statistically significant. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Systems-based practice, Medical knowledge.

“Environmental wellness” in family adoption program: A preassessment of awareness among 1st-year medical students

Abstract Introduction: In India, the National Medical Commission, introduced the concept of “Environmental health and wellness,” in the medical curriculum in the year 2020, to equip the future doctors in addressing complex issues such as climate change and health. As a part of the “Family adoption Program,” the students are required “to carry out and be a part of the environment protection and sustenance activities.” The study was done to assess the knowledge and practices of “environmental wellness (EW)” of 1st-year medical students. Materials and Methods: Using a cross-sectional study design, the study was conducted using a semi-structured, self-administered, online questionnaire, with sections on demographics, climate change, environmental laws, and wellness, after institutional ethics committee approval. Responses on aspects of EW were rated and scored as “never,” “rarely,” “sometimes,” “regularly,” and “always” from lowest to highest. Results were presented as frequency, proportion, percentages, and mean scores; Chi-square, F-test, and t-test were used as tests of association; P &lt; 0.05 considered statistically significant. Results: Of the 250 students, 212 were present during the preawareness generation session; 179 consented, with a response rate of 84.4%. Their mean age was 19.79 ± 1.76 years and 70.94% were females; 84.9% knew about appropriate state-level laws regarding environmental pollution. 77.65% had excellent, 16.20% good, and 6.15% had a fair level of EW scores. The females had a better attitude (P = 0.004) and practice (P = 0.037) in comparison to male students with regard to different aspects of EW. Conclusion: The students were well aware of EW, with the female students having better practices. Inculcating these good practices with regard to EW would help them to spread awareness regarding the same in the community, thereby helping them achieve the competency required in the field visits, which would help them with regard to percolating the importance of the environment in health and wellness, at the community level. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, Systems-based practice, and Professionalism.

Assessing the impact of the effect of ozone, casein phosphopeptide–amorphous calcium phosphate, silver diamine fluoride, and hydroxyapatite on remineralization of early carious lesions: An investigation using polarized light microscopic study

Abstract Introduction: A popular trend in dental offices, minimal intervention dentistry emphasizes using the least invasive treatments possible to minimize tissue loss and patient discomfort. The earliest indications of dental caries are white spot lesions that can remineralize. Thus, the effects of four different remineralizing agents on early carious lesions were assessed using polarized light microscopy. Materials and Methods: Teeth specimens were immersed in demineralizing agents to create subsurface demineralization. Subsequently, they were randomly assigned to various remineralization regimens, including ozonated water, casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), silver diamine fluoride (SDF), and hydroxyapatite. Each specimen underwent treatment twice daily for 3 min and was then placed in artificial saliva. Mineral content was evaluated at baseline, after demineralization, and during remineralization (on the 7th and 14th day) using a polarized microscopic examination. Results: Group 1 demonstrated the most effective remineralization, consistently displaying the lowest lesion depths at both the 7th and 14th days. Post hoc comparisons indicate significant differences between group 1 and other groups, emphasizing the potential superiority of the remineralization process in group 1 compared to the other treatment groups. Conclusion: Tooth samples treated with ozonated water, followed by CPP-ACP, SDF, and hydroxyapatite demonstrated a more profound level of remineralization. These agents, namely ozonated water, CPP-ACP, SDF, and hydroxyapatite, prove to be effective in reversing the early stages of enamel caries. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Systems-based practice, Medical knowledge.

Awareness of oral health status among parents and caretakers of adults with intellectual disabilities: A cross-sectional study

Abstract Introduction: Intellectual disability or mental retardation is general systemic disorder characterized by significant impairment in cognitive functions as well as deficits in adaptation-related behaviors. It affects the mind and body along with skills related to day-to-day life such as thought processes, speaking, and self-care. Individuals with any form of disability need extra assistance for attaining and preserving their health including oral health. Materials and Methods: This cross-sectional prospective study was conducted on 100 parents and caretakers of adults with intellectual disabilities. Ethical approval was obtained from the institutional ethical committee. Written informed consent was obtained from all participants. Inclusion criteria for disabled subjects were (a) individuals older than 12 years of age, (b) individuals with intellectual and cognitive disabilities, (c) disabled individuals who were under the care of full-term persons, and (d) subjects who provided complete cooperation during intraoral examinations. The inclusion criterion for caregivers and parents was that they provided assistance on a daily basis. A questionnaire was circulated among all the participants that contained questions on demographics, knowledge, and perception regarding oral health. Statistical analysis: Statistical tools paired “t” and Pearson’s correlation tests were used for performing statistical analysis using SPSS version 21.0 software. Results: Statistically significant knowledge levels and perceptions were obtained from all the study participants regarding the importance of maintaining sound oral health in persons with disabilities, i.e., intellectual disabilities. Conclusion: It is important to educate and reinforce the importance of oral health among caretakers and parents of intellectually disabled adults. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement, and Systems-based practice.

Patients’ attitudes concerning contributing factors and early detection of prostate cancer

Abstract Introduction: Prostate cancer (PCa) is the second most frequent malignancy (after lung cancer) in men in Iraq, counting 50,106 new cases and causing 3207 deaths in men. The objective of this study was to explore males’ attitudes concerning contributing factors and early detection for prostatic cancer. Materials and Methods: This hospital-based descriptive cross-sectional study used nonprobability purposive sampling technique to select men attending the hospital. The study period extended from September 18, 2023, to January 20, 2024. A structured self-administered questionnaire was used that contained questions organized in two sections. Section A: sociodemographic information with seven items; and Section B: attitude towards prostate cancer screening with twenty items on a 4-point Likert scale. The questionnaire used was adapted from a study conducted on the knowledge, attitudes, and screening surveys regarding prostate cancer. The collected data were coded and entered twice independently on Microsoft Excel then later exported and analysed using the Statistical Package for Social Science (SPSS) version 26.0. Results: One hundred and fifty men participated in the study. Participants ranged from 40 to 60 years, with a mean age of 48.48. The majority of men, 153 (90.0%), were married, while 10 (6.7%) were single. Nearly more than third of all participants (37.3%) hold bachelor education, whereas 14% of all men had diploma education. Sixty-six (44.0%) of the participants were employed, 57 (38%) were free work, and 19 (12.7%) were retired. Other sociodemographic characteristics are indicated. Most of the study participants (49%) had strong positive level, while (48%) of them had positive, and only 3% of the total participants had negative attitude about early detection and intention screening of PCa. Conclusions: The study revealed men had strong positive and strong attitude (49% vs. 48%), respectively, toward PCa screening. These findings indicate a need for increased public sensitization campaigns on PCa and its screening tests to improve public understanding about the disease with the aim of early detection. The following core competencies are addressed in this article: Medical knowledge, Patient care, Systems-based practice.

Educating Our Future Medical Leaders: An Innovative Longitudinal Course Across Surgical and Medical Specialties in Graduate Education.

Increasing healthcare system complexity, multidisciplinary care delivery, and the need to deliver high-quality, cost-effective care drive a critical need for leadership development. Currently, few examples of multidisciplinary leadership development exist in the medical education literature. The Accreditation Council for Graduate Medical Education (ACGME) has identified leadership domains as essential milestones in residency education, encompassing areas such as interpersonal communication, quality improvement, and systems-based practice. Presently, published GME leadership curricula vary widely in content, delivery, and duration and rarely include multispecialty cohorts. The study authors designed and implemented a longitudinal leadership curriculum for a multispecialty cohort of senior residents and fellows from multiple hospitals within a large integrated GME program. Between July 2022-June 2023, authors delivered 12 monthly sessions on core leadership concepts. Sessions delivered relevant work-based content via large-group didactics with embedded opportunities for small-group interactive experiential and reflective practice, critical thinking, and application. Thirty GME trainees participated in the longitudinal curriculum. Interval pre-/post-session assessments demonstrated significant improvement in composite scores for 6 of 9 sessions assessed. Participants rated each module's overall importance, applicability, and acceptability highly on a summative program evaluation. This longitudinal leadership curriculum adheres to best leadership development practices, demonstrates improvement in knowledge and self-reported attitudes and behaviors related to cognitive, character, and emotional leadership domains, and develops a psychologically safe community of practice for GME participants.

A case report of basosquamous carcinoma of thigh – An unusual location

Basosquamous cell carcinoma (BSC), also known as metatypical carcinoma, is an uncommon form of basal cell carcinoma (BCC) that is thought to be aggressive and more likely to spread to other parts of the body. The head-and-neck area is where it often first manifests itself. BSC is an uncommon tumor with diverse forms and unpredictable symptoms. Our case is a 75-year-old male with a nonhealing ulcer on his right thigh for 4–5 years. We received a biopsy from the margins, which revealed basosquamous carcinoma, which was confirmed by immunohistochemistry. The highly aggressive nature of the tumor, the higher incidence of recurrence, and the possibility of metastasis make an early diagnosis of BSC crucial which is differentiating it with BCC, in which the low risk of metastasis and recurrences is there, minimal risks are observed in limbs far from the cephalic region. Due to their clinical similarities, it is hard to distinguish between BSC and BCC clinically. Histopathology could aid in prompt diagnosis and precise treatment. An immunohistochemical examination might yield additional information for a more precise diagnosis. Here, we describe a rare case of BSC presented as unusually located ulcer on the thigh. The following core competencies are addressed in this article: Medical knowledge, Patient care and procedural skills, Systems-based practice.

Evaluation of the effects of different mouthwashes, acidic soft drinks, and herbal teas on shear bond strength of orthodontic stainless steel brackets: A stereomicroscopic study

Background: Premature debonding of brackets often turns out into orthodontic treatment failures and actual treatment delays. The aim of the present study was to evaluate the effects of different mouthwashes, acidic soft drinks, and herbal teas on the shear bond strength of metal (stainless steel) brackets used in orthodontic practice. Materials and methods: For the present study, 100 therapeutically extracted healthy premolar teeth with sound enamel surface were collected from patients who were scheduled for orthodontic treatment. The select teeth were cleansed, whereas the dried enamel surface was etched with 38% phosphoric acid for 15 s following which orthodontic stainless steel brackets (MBT 0.022 SLOT) were bonded with the help of composite resin (3M Unitek Transbond XT Light Cure Adhesive). The prepared teeth were divided into four groups depending on exposure to different mouthwashes, acidic soft drinks, and herbal teas. The shear bond strength values of the specimen were measured using a universal testing machine, whereas debonded surfaces were observed under a stereomicroscope. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 18.0 (SPSS Inc., Chicago, IL, USA). One-way analysis of variance and Tukey’s multiple post hoc procedures were used for statistical analysis. P &lt;0.05 was considered statistically significant. Results: The results obtained in the present study suggested that the highest mean shear bond strength observed was in case of Group II specimen with a mean value of 11.83 ± 1.92 MPa, whereas the least shear bond strength was observed in case of Group III specimen with a mean value of 10.33 ± 1.31 MPa, with the results being statistically significant (P = 0.014). Conclusions: Within the limitations of the present study, it was concluded that comparatively lesser/weaker shear bond strength values were observed in case of specimen belonging to Group III, wherein among the 30 teeth belonging to Group III, 12 teeth showed shear bond strength value of 9 MPa which was the lowest in the study. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Systems-based practice, Medical knowledge.

Teachers’ knowledge about communicable disease control at primary schools in Mosul City: A cross-sectional study

Introduction: In emergency situations, particularly complicated ones including the collapse of health services and disease control programs, a major cause of mortality and morbidity is limited access to health care and communicable diseases. The aim of the study is to assess the primary school teachers’ knowledge of communicable illness control in Mosul City. Materials and Methods: A descriptive cross-sectional study design was employed, utilizing a purposeful sample of 149 teachers. The study was carried out at Mosul City primary schools in the first quarter of 2024. A survey was made specifically for this purpose. It was made up of two parts. The data were analyzed using SPSS version 26. Results: Findings of the current study showed that 7 (4.7%) teachers only had excellent knowledge of communicable disease prevention and control, while the majority of teachers, 105 (70.5%), had poor knowledge of these topics. Conclusion: The majority of elementary school teachers in Mosul City lack sufficient information on managing communicable diseases. The study advised the essential to work with the Ministry of Health and Environment to implement educational programs on communicable diseases and preventive measures to raise their level of awareness regarding the prevention and control of communicable illnesses. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Systems-based practice.

A narrative literature review on new technologies for teaching anatomy

The study examines the integration of emerging technologies into anatomy education and focuses on the impact on learning results and student involvement. It uses a comprehensive literature search to identify technologies such as virtual reality, three-dimensional printing of anatomical models, augmented reality, artificial intelligence, virtual dissection, online resources, interactive software, haptic technology, anatomy software, simulation technology, gamification, mobile applications, and social media. The findings reveal that these technologies offer advantages such as enhanced interactive learning experiences, realistic simulations, and adaptability to various learning styles. However, challenges such as cost, ethical concerns, and specialized training accompany their implementation. The study concludes that the integration of advanced technologies in anatomy education has the potential to revolutionize the learning experience, fostering increased accessibility and engagement. The following core competencies are addressed in this article: Medical knowledge, Systems-based practice.

Navigating the Roadmap for Trauma-Informed Medical Education: Application of Undergraduate Medical Education Competencies.

Trauma is common in the United States, increases risk of long-term adverse health effects, and individuals who experience it often find seeking medical care difficult. Trauma-informed care (TIC) builds trust and fosters healing relationships between clinicians and patients; however medical education has lacked consistent training in TIC. Using recently published competencies for undergraduate medical education (UME), this manuscript provides curricular examples across 8 domains to assist faculty in developing educational content. The authors identified published curricula for each of the 8 competency domains using a published search strategy and publicly available database. Inclusion criteria were published works focused on UME in the United States; abstracts and curricula not focused on UME were excluded. The authors used a consensus-based process to review 15 eligible curricula for mapping with the competencies. Of 15 published UME curricula, 11 met criteria and exemplify each of the 8 UME competency domains. Most of the available curricula fall into the Knowledge for Practice and Patient Care domains. Most were offered in the first 2 years of medical school. Competency-based medical education for TIC is new, and most current educational offerings are foundational in nature. Additional innovation is needed in the competency domains of Professionalism, Systems-Based Practice, Interprofessional Collaboration, and Personal/Professional Development. This manuscript offers a set of curricular examples that can be used to aid efforts at implementing TIC competencies in UME; future work must focus on improving assessment methods and developmental sequencing as more students are exposed to TIC principles.

Systems-Based Practice 20 Years On: Navigating the System for Better Care.

Systems-based practice (SBP) was introduced as 1 of 6 core competencies in 1999 because of its recognized importance in the quality and safety of health care provided to patients. Nearly 25 years later, faculty and learners continue to struggle with understanding and implementing this essential competency, thus hindering the medical education community's ability to most effectively teach and learn this important competency.Milestones were first introduced in 2013 as one effort to support implementation of the general competencies. However, each specialty developed its milestones independently, leading to substantial heterogeneity in the narrative descriptions of competencies including SBP. The process to create Milestones 2.0, and more specifically, the Harmonized Milestones, took this experience into account and endeavored to create a shared language for SBP across all specialties and subspecialties. The 3 subcompetencies in SBP are now patient safety and quality improvement, systems-navigation for patient-centered care (coordination of care, transitions of care, local population health), and physician's role in health care systems (components of the system, costs and resources, transitions to practice). Milestones 2.0 are also now supported by new supplemental guides that provide specific real-world examples to help learners and faculty put SBP into the context of the complex health care environment.While substantially more resources and tools are now available to aid faculty and to serve as a guide for residents and fellows, much work to effectively implement SBP remains. This commentary will explore the evolutionary history of SBP, the challenges facing implementation, and suggestions for how programs can use the new milestone resources for SBP. The academic medicine community must work together to advance this competency as an essential part of professional development.