Physician Training Research Articles

The output of cataract surgery performed by trained non-ophthalmologist physicians in rural areas: study of cataract outcomes and up-take of services report 7.

Cataract is the leading cause of blindness worldwide and surgery can restore vision in most patients. Some patients have little access to surgical services due to lack of cataract surgeons and the unaffordable costs. In 2005 we built a service model that trained rural non-ophthalmologist physicians to perform cataract surgeries in rural China. This study evaluates the long-term impacts of this model. We conducted a retrospective cohort study to analyze patients' hand-written medical records and electronic outpatient record between January 2005 and December 2019 at two rural health clinics in Southern China. In total, 34,601 patients (49,942 eyes) underwent cataract surgery by non-ophthalmologist physicians from 2005 to 2019.Visual acuity was clearly documented in 38,251 eyes. Before surgery, the unaided distance visual acuity (UDVA) of 60.7% (23,205/38,251) eyes was less than 0.05 decimal. On the first day after surgery, the percentage of UDVA < 0.05 eyes was reduced to 6.0%, and 96.7% (36,980/38,251) of the eyes achieved a better UDVA compared to pre-operation. Surgical-related complications occurred in 218 eyes. The most common complication was posterior capsule rupture (114, 0.23%). 44.3% (15,341/34,601) of the patients chose to have a second eye cataract surgery (SECS) in the same clinic. At one of the outpatient clinics, 21,595 patients received basic eye care apart from cataract surgery between 2018 and 2020. Non-ophthalmologist physicians trained for cataract surgeries in rural clinics can improve cataract related visual acuity and basic eye care to the local population.

Supporting Care Transformation Through a Comprehensive Graduate Medical Education Curricular Program in a Department of Internal Medicine.

The imperative to train physicians in skills required to lead care transformation is increasingly recognized, yet few Graduate Medical Education (GME) programs exist to meet this need. Describe the development, outcomes, and lessons learned from a novel GME care transformation curricular program. Department of Internal Medicine (IM) at Dell Medical School at The University of Texas, Austin. Between 2020 and 2023, 33 IM residents and fellows completed training with participation in the Care Transformation program. Department leadership developed a comprehensive educational and experiential program that included (1) Dell Medical School-wide Distinction in Care Transformation curriculum; (2) Primary Care Residency track with care transformation projects; (3) participation in the national Veterans Affairs Chief Resident in Quality and Safety program; and (4) Hospital Medicine Fellowship in Quality and Safety. Each trainee led a care transformation project spanning a variety of topics and settings. Graduates who responded to a follow-up survey (22 of 33 graduates) reported they used skills learned through the program in their current roles and these experiences better prepared them for fellowship and/or faculty positions. The Care Transformation program provides real-world experiences and skillsets that are increasingly valuable in modern healthcare delivery.

The Place and Approaches of Family Medicine Doctors in the Health Management of CBRN Events: The Case of Türkiye

In this study, it was aimed to determine the level of knowledge of Family Medicine residents about Chemical, Biological, Radiological and Nuclear (CBRN) events, their risk assessments and their thoughts on the roles that CBRN events can play in healthcare services. As a multi-center and cross-sectional analytical study, 444 family medicine residents at the national level were included in the study via an online survey application method. The data form included a total of 25 questions prepared to evaluate the sociodemographic information of the participants and their evaluation, awareness, knowledge level, approach to events and general opinions regarding CBRN event risks. 91.7% of physicians evaluated their knowledge level as "very little" or "little" and 95.7% evaluated their preparation level as "very little" or "little". 77.3% of physicians think that family physicians should have a role in CBRN incidents. For a possible CBRN event in the next 5 years, physicians predict biological events as the highest risk and nuclear events as the lowest risk. The rate of physicians who stated that they had previously received CBRN training was 17.8%, and the rate of those who participated in the CBRN drill was only 0.9%. While 89.9% of the participants wanted to receive training on health management in CBRN incidents; 80.2% want the training to be included in the specialty curriculum. While the participants' level of knowledge about the symptoms that may develop after a CBRN event is high, when asked about the awareness of CBRN risks around their institutions, 79.3% of physicians stated that they were not aware. It was determined that the level of knowledge, preparation, training, practice and awareness of family physicians regarding CBRN events was low. On the other hand, their willingness to receive training and their belief that they had a role in CBRN incidents were found to be high. According to the data of our study, we evaluate that there is a need for institutional structuring against CBRN risks, including primary health care services, and we suggest that CBRN training modules should be included in specialty curricula, starting from medical faculties.

Effectiveness of PBL Pedagogy Combined with Flipped Classroom in the Standardized Training of Resident Physicians

Objective: To analyze the application effect of the problem-based learning (PBL) teaching method combined with flipped classrooms in the standardized training of gastroenterology residents. Methods: Sixty-five resident trainees who were admitted to the Department of Gastroenterology of the hospital from January to December 2023 were selected and divided into the control group (n = 33) and the observation group (n = 32) by random number division method. The control group implemented the traditional clinical teaching method, and the observation group implemented the PBL combined flipped classroom teaching method. The study compared the two groups’ discharge learning performance, trainees’ subjective feeling score, and teaching satisfaction score index. Results: The difference in basic knowledge scores between the two groups of trainees under different teaching modes was not statistically significant (P &gt; 0.05). However, the observation group was significantly higher than the control group in terms of the differences in case analysis, clinical operation skills, and total scores, and the differences were statistically significant (P &lt; 0.05). The trainees of the observation group were more satisfied with the teaching and learning process in terms of learning efficiency, clinical thinking, communication, faculty-student collegiality, teamwork, self-study ability, classroom atmosphere, independent learning, clinical thinking and other subjective feelings of the scores are higher than the control group, the difference is statistically significant (P &lt; 0.05). The observation group teaching total satisfaction rate is 96.87%, significantly higher than the control group’s 75.75% (P &lt; 0.05). Conclusion: The application of the PBL teaching method combined with flipped classroom in the standardized training of residents is effective, which can not only significantly improve the basic theory and practical operation performance of the trainees, but also help to improve their case analysis ability, clinical thinking ability, and doctor-patient communication ability, so it is worthwhile to popularize its application in the clinical scope.

Формирование характеристик самоактуализирующейся личности у студентов медицинского вуза

&lt;p&gt;Improving the quality of physician training includes the development of professionally important qualities during the period of study at a university. Psychological and pedagogical support for medical university students has not been sufficiently developed and is rarely implemented. The work is aimed at studying the formation of the qualities of a self-actualizing personality among medical university students. The authors developed and substantiated a model of psychological and pedagogical support for the formation of a complex of personal protective skills for future doctors. The authors presented the results of an empirical study obtained on a sample of 180 5th year medical university students with specialties in General Medicine and Dentistry (90 people &amp;ndash; experimental group participating in the experimental program, 90 people &amp;ndash; control group). The researchers used the self-actualization test technique of E. Shostrom in adaptation of L.Ya. Gozman and M.V. Crozat. The results obtained indicate that indicators of the characteristics of a self-actualizing personality change statistically significantly after participation in the experimental program. These studies can be used as an effective means of professional development for future and practicing doctors.&lt;/p&gt;

The trend of the quality of cause-of-death data and its association with socio-economic indicators in Serbia in the period 2005–19

This study aims to evaluate the temporal trend in the quality of cause-of-death data and garbage code profiles and to determine its association with socio-economic status in Serbia. A longitudinal study was assessed using data from mortality registers from 2005 to 2019. Computer application Analysis of Causes of National Deaths for Action (ANACONDA) calculates the distribution of garbage codes by severity and composite quality indicator: Vital Statistics Performance Index for Quality (VSPI(Q)). A relationship between VSPI(Q) and country development was estimated by analysing two socio-economic indicators: the Socio-demographic Index and the Human Development Index (HDI). Serbia indicates progress in strengthening cause-of-death statistics. The steady upward trend of the VSPI(Q) index has risen from 55.6 (medium quality) to 70.2 (high quality) over the examined years. Significant reduction of ‘Insufficiently specified causes with limited impact’ (Level 4) and an increase in the trend of ‘High-impact garbage codes’ (Levels 1 to 3) were evident. Decreased deaths of no policy value (annual percentage change of −1.41%) have manifested since 2014. A strong positive association between VSPI(Q) and socio-economic indicators was assessed, where the HDI has shown a stronger association with VSPI(Q). Improved socio-economic conditions on the national level are followed by enhanced cause-of-death data quality. Upcoming actions to improve quality should be directed at high-impact garbage codes. The study underlines the need to prioritise the education and training of physicians with a crucial role in death certification to overcome many cause-of-death quality issues identified in this assessment.

Characterization and Evaluation of a Government Health Center’s Bloodborne Pathogen Exposures (BBPE) Monitoring Program

Background: A vital role of hospital employee health is the management, characterization, and targeted prevention of bloodborne pathogen exposures (BPPE) among healthcare workers. A comprehensive review of a health center’s BPPE over time was conducted to identify areas for improvement and target education and training, given changes in BBPE standard operating procedures (SOPs) over time. Methods: A retrospective descriptive analysis was conducted on deidentified BBPE cases reported to employee health at VA Connecticut Healthcare System from 1995-2023 (N=296) using R statistical software. Results: The highest number of BBPE occurred among trainee physicians (N=103, 34.8%, especially surgery and internal medicine), registered nurses (N=60, 20.3%), and non-trainee physicians (N=45, 15.2%). The most frequently implicated devices were hollow-bore (N=103, 34.8%) and suture needles (N=60, 20.3%). Most BBPE occurred during surgical procedures (N=114, 38.5%) or medication administration (N=52, 17.6%). Over half of BBPE occurred during afternoons/nights (N=172, 58.1%). Over half occurred with use of personal protective equipment (PPE) (N=181, 61.1%). The majority of BBPE implicated finger injuries (N=220, 74.3%). Blood was the most frequently reported exposure (N=127, 42.9%), a similar percentage of records did not specifically name a body fluid type (N=121) or whether PPE was used (N=110). In most cases, the source patient was identified (N=282, 95.3%) and tested (N=272, 91.9%). Forty-three sources (14.5%) had positive BBP testing, which included HIV (N=14, 4.7%), hepatitis C (N=23, 7.8%), and hepatitis B (N=6, 2.0%). Most employees presented to employee health for initial evaluation (N=231, 78%) and underwent post-exposure testing (N=266, 89.9%); most had evidence of immunity to hepatitis B (N=246, 83.1%). Eighty-three employees (28%) received HIV PEP (average=1.9 days). Most records did not indicate if this was a first-time BBPE (N=250, 84.5%). No employee records indicated seroconversion for a bloodborne pathogen. Conclusions: Physicians and RNs, those performing surgical procedures and administering medications, and those on second and third shifts are at highest risk and may benefit from additional interventions such as exposure assessment or education. Required recordkeeping has been variable over time. Updated national SOPs have been adapted to employee health, though additional details could be considered for quality improvement purposes, such as duration of employment, level of training, and prior BBPE prevention education. It is unclear if some information such as history of BBPE or PPE use was elicited but not documented – this information could be helpful in management of BBPEs.

Physicians' Perceptions and Experiences Regarding Leadership: A Link Between Beliefs and Identity Formation.

Despite the development of national recommendations and training programs for effective leadership, junior and senior medical leaders often find themselves ill-prepared to take on these new responsibilities. This study aimed to explore physicians' perceptions, feelings, and beliefs regarding leadership and to provide recommendations regarding appropriate training and institutional post-training support. We conducted a qualitative study at the Geneva University Hospitals. A purposeful sample of residents (R), fellows (F), attending physicians (A), and chairpersons (CP) were invited to participate in focus groups (or semi-structured interviews) between April and June 2021. We investigated their understanding of leadership, self-perception as leaders, difficulties, and paths to improvement in their leadership skills. Focus groups were transcribed verbatim and analyzed both inductively and deductively using Fishbein's model of behavior prediction and Irby's professional identity formation framework. We conducted ten focus groups (R=3; F=4, A=2, and CP=1) and one interview (CP). Physicians expressed poor self-efficacy at all hierarchical levels: feelings of insecurity and confusion (R and F), frustration (A), and feeling stuck between divisional and institutional governance (CP). Such negative feelings were nurtured by personal beliefs with an intuitive and idealized representation of leadership. Beliefs focused more on personal characteristics rather than on skills, processes, or perceived institutional norms. Unclear expectations regarding physicians' role as leaders, overemphasis on academic achievement, and silo professional organizations fueled their feelings. Participants reported developing their leadership through trial and error, observing role models, and turning to personal resources rather than formal training. Our results show that physicians' leadership skills are still mainly acquired intuitively and that institutional norms do not encourage clarification of leadership roles and processes. Physician training in leadership skills, together with more explicit and clear institutional processes, may help to improve physicians' self-efficacy and develop their identity as leaders.

Refresh of a Clinical Skills Assessment for Physician Trainees.

The Royal Australasian College of Physicians (RACP) oversees physician training across Australia and Aotearoa New Zealand. Success in a written examination and clinical skills assessment (known as the clinical examination) at the mid-point of training is a requirement to progress from basic to advanced training. The clinical examination had evolved over many years without a review process. This paper describes the approach taken, the changes made and the evaluation undertaken as part of a formal review. A working party that included education experts and examiners experienced in the assessment of clinical skills was established. The purpose of the clinical examination and competencies being assessed were clarified and were linked to learning objectives. Significant changes to the marking and scoring approaches resulted in a more holistic approach to the assessment of candidate performance with greater transparency of standards. Evaluation over a 2-year period was undertaken before the adoption of the new approach in 2019. In 2017 testing of a new marking rubric occurred during the annual examination cycle which confirmed feasibility and acceptability. The following year an extensive trial utilising the new marking rubric and a new scoring approach took place involving 1142 examiners, 880 candidates and 5280 scoresheets which led to some minor modifications to the scoring system. The final marking and scoring approaches resulted in unchanged pass rates and improved inter-rater reliability. Feedback from examiners confirmed that the new marking and scoring approaches were easier to use and enabled better feedback on performance for candidates. The refresh of the RACP clinical examination has resulted in an assessment that has clarity of purpose, is linked to learning objectives, has greater transparency of expected standards, has improved inter-rater reliability, is well accepted by examiners and enables feedback on examination performance to candidates.

Identifying Community-Based Entrustable Professional Activities for Medical Students Through a Modified Delphi Process.

Recognition of the need for medical education to train physicians who are skilled at supporting population health and work beyond traditional health care settings is growing. Entrustable professional activities (EPAs) for medical students typically have centered around activities taking place in the clinical workplace; however, EPAs that involve working with community members in community contexts have not been clearly established. We used a three-stage online modified-Delphi method to identify community-based EPAs for University of Wisconsin School of Medicine and Public Health medical students. We recruited key stakeholders to participate and asked them, based on their experience, to generate a list of community-based tasks that they believed graduates should be trusted to perform. Subsequently, using a five-point anchored Likert scale (1=strongly disagree to 5=strongly agree), we asked participants to rate their level of agreement with each identified task becoming an EPA. An a priori definition of consensus was established. Twenty-two tasks reached consensus as potential community-based EPAs. The tasks with the highest mean ratings were "addressing trust issues with the medical community amongst the local population" (mean=4.71), "meeting with community members around a health topic" (mean=4.64), "identifying opportunities for disease prevention" (mean=4.64), and "identifying policies that impact community outcomes" (mean=4.57). The identified community-based tasks can support the augmentation of existing community-based curriculum and help identify areas for novel curriculum and assessment development. Lessons learned from this local effort could be helpful to other programs seeking to establish and refine community-based curricula.

American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2023-2024)

The American Board of Emergency Medicine gathers extensive background information on Accreditation Council of Graduate Medical Education-accredited emergency medicine residency and fellowship programs as well as the residents and fellows training in those programs. We present the 2024 annual report on the status of physicians training in ACGME-accredited emergency medicine training programs in the United States.

PERSISTENCE POSITIVITY OF LACTATE DEHYDROGENASE RAPID DIAGNOSTIC TESTS ANTIGENS IN PREGNANT WOMEN AFTER ANTIMALARIA TREATMENT IN SOME HOSPITALS IN KATSINA

Malaria is a life-threatening disease caused by parasites transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable. This study investigates the persistent positivity of Lactate Dehydrogenase (pLDH) Rapid diagnostic tests antigens in pregnant women after antimalarial treatment. The study was conducted in Turai Yaradua Maternity and Children’s Hospital Katsina and Federal Medical Centre Katsina. Samples were collected with the help of trained physicians. The result from this study shows that lactate dehydrogenase antigen persists in the blood after treatment with fensider (antimalaria drug). After administering the drug to the pregnant women found to be positive for malaria, it was observed that in all the age groups, day 3, day 7, and day 14 post-drug treatment were all still positive for malaria using the pLDH malaria rapid diagnostic tool. It was also observed that after 21 days post-treatment, all the different age groups were still positive for malaria except those aged 45 to 50 (95.0%). There is no statistically significant difference between the age of pregnancy p&gt;0.05. The percentage positivity of pLDH started changing day 21 in 3rd trimester and the change peak at day 28 post-drug treatment in all three trimesters. There is no statistical significance difference between the age of pregnancy p&gt;0.05. However, the first trimester shows the highest negative result (66.7%). It also shows that age, tribe, trimester of pregnancy, and occupation were statistically not associated with the persistence positivity of the pLDH. The parasite density might be responsible..

Correlating the level of patients' self-efficacy with paternalistic, consumerist, participative and training doctor relationships in dental offices

Self-efficacy—the belief in using abilities for a specific purpose—is an indicator of engagement. Self-efficacy anticipates the positive results of the actions undertaken due to the knowledge and skills possessed. Within the concept of self-efficacy, we will also mention generalized self-efficacy, i.e. a person's view of himself as capable of effectively performing a wide variety of tasks and performing in a wide variety of situations. Self-efficacy has an important role in learning and developing new skills and knowledge; this applies both to patients and to the doctor or medical staff. Perceived self-efficacy helps to account for such diverse phenomena as changes in coping behavior produced by different modes of influence, the level of physiological stress reactions, self-regulation of refractory behavior, resignation and discouragement from failure. By making a correlation between self-efficacy and the patient's behavior, we can also ascertain the psychobehavioral effect this has on the patient. The quantification of the patient's self-efficacy level is directly proportional to his possibility to overcome the disease along with the involvement of other direct or indirect factors.The study was carried out on a group of 157 patients (age range 18-74 years). The questionnaire with specific questions from the internationally recognized self-efficacy scale "The General Self-Efficacy Scale (GSE)" was used. The obtained results will follow the correlation of the self-efficacy level of the patients with the paternalistic, consumerist, participative and training physician relationship.

The Application of Distance Education Technology in Standardized Training of Resident Physicians in Primary Orientation Training

This paper explores the application of distance education technology in standardized training of resident physicians in primary orientation training. With the rapid development and popularization of distance education technology, the special needs faced by primary medical institutions in resident physician training are becoming increasingly prominent. By analyzing the current application state, it is found that distance education technology can effectively promote the sharing of high-quality educational resources, improve the flexibility and coverage of training, moreover, it also faces challenges such as technological equipment limitations and insufficient teacher-student interaction. To optimize the application effect, this paper proposes strategies such as strengthening technical support, optimizing teaching content and form, and establishing a sound training effect evaluation system. This study not only helps to improve the training quality of primary resident physicians, but also has important significance for improving the level of primary medical services. Looking to the future, distance education technology will play a greater role in the training of primary resident physicians, which is of great significance for improving the level of primary medical services.

Evaluating for Racial Disparities in the Utilization of Minimally Invasive Hysterectomy for the Treatment of Uterine Leiomyoma

Introduction: Minimally invasive hysterectomy (MIH) for benign gynecologic indications has many patient advantages over traditional abdominal hysterectomy (AH) including decreased hospital stay, decreased mortality, and faster recovery. Although MIH has been shown to improve outcomes as compared with abdominal hysterectomy, racial and socioeconomic disparities can impact patient access to the minimally invasive procedure. Previous studies have demonstrated that Black and Hispanic-identifying patients are significantly less likely to receive a MIH when compared to White patients. One proposed contributor to this finding is the higher rate and delayed diagnosis of uterine leiomyoma in Black patients compared to White patients. This disparity could delay diagnosis, and cause a larger leiomyoma necessitating use of abdominal hysterectomy. Another explanation in disparity is the physician training at hospitals in underserved areas. This study aims to investigate if race impacts access to MIH for leiomyoma at Carle Foundation Hospital in Urbana, Illinois. Methods: This retrospective analysis studied patients from 2011-2020 who received a hysterectomy at Carle Foundation Hospital for a primary diagnosis of leiomyoma. MIH included laparoscopic, vaginal, and robotic-assisted. Hysterectomies for malignancy were excluded. The demographic data included age, race, body mass index (BMI), type of hysterectomy, insurance, history of previous obstetric and abdominal surgeries, and uterine weight. The race categories included White, Black, and Others. Hispanic and Asian patients were placed into the other category due to the limited sample size. Descriptive statistics were used to evaluate the demographic data. Odd ratios were calculated to determine if a patient received a MIH over an AH based on race. An adjusted odds ratio was calculated to account for BMI, uterine weight, history of cesarean section, and previous abdominal surgery. Results: A total of 324 hysterectomies from 2011-2020 were performed for leiomyoma. Abdominal hysterectomies accounted for 32.1% and MIH accounted for 68.9%, with 7.4% being laparoscopic, 5.6% being vaginal, and 55.9% being robotic-assisted. The average age of White patients was 46.7 years old, and was higher than Black patients, 43.6 years old (p&lt;.01). The average BMI of Black patients was 34.6 kg/m2, and was higher than White patients, 30.3 34.6 kg/m2 (p&lt;.01). More White patients had commercial insurance at 83.5% compared to Black patients at 48.1% (p&lt;.01). More Black patients had Medicaid or Medicare at 50.6% compared to White patients at 14.8% (p&lt;.01). Black patients had an average uterine weight at 579.8g compared to White patients at 438.6g (p&lt;.05). The majority (73.7%) of White patients received a MIH, with 26.3% receiving an AH. Forty five percent of Black patients received an AH while 54.5% received a MIH. Conclusion: At Carle Foundation Hospital during the years 2011-2020, a lower percentage of African American patients, compared to white patients, received a minimally invasive hysterectomy in the treatment of uterine leiomyoma. Further analysis will investigate for the odds ratios of each group receiving a MIH and will adjust for BMI, uterine weight, obstetric and abdominal surgical history.

A Culture of Early Mobilization in Adult Intensive Care Units: Perspective and Competency of Physicians.

Early mobility (EM) is vital in the intensive care unit (ICU) to counteract immobility-related effects. A multidisciplinary approach is key, as it requires precise initiation knowledge. However, physicians' understanding of EM in adult ICU settings remains unexplored. This study was conducted to investigate the knowledge and clinical competency of physicians working in adult ICUs toward EM. This cross-sectional study enrolled 236 physicians to assess their knowledge of EM. A rigorously designed survey comprising 30 questions across the demographic, theoretical, and clinical domains was employed. The criteria for knowledge and competency were aligned with the minimum passing score (70%) stipulated for physician licensure by the medical regulatory authority in Saudi Arabia. Nearly 40% of the respondents had more than 5 years of experience. One-third of the respondents received theoretical knowledge about EM as part of their residency training, and only 4% of the respondents attended formal courses to enhance their knowledge. Almost all the respondents (95%) stated their awareness of EM benefits and its indications and contraindications and considered it safe to mobilize patients on mechanical ventilators. However, 62.3% of the respondents did not support EM for critically ill patients on mechanical ventilators until weaning. In contrast, 51.7% of respondents advised EM for agitated patients with RASS > 2. Only 113 (47.9%) physicians were competent in determining the suitability of ICU patients for EM. For critically ill patients who should be mobilized, nearly 60% of physicians refused to initiate EM. This study underscores insufficient practical knowledge of ICU physicians about EM criteria, which leads to suboptimal decisions, particularly in complex ICU cases. These findings emphasize the need for enhanced training and education of physicians working in adult ICU settings to optimize patient care and outcomes in critical care settings.

Simulation-based echocardiography learning contribution on training of medical residents.

Echocardiography is a pivotal exam in critically ill patients, a specific training is crucial. Medical residents often lack echocardiography practice. This study aims to evaluate the impact of simulation-based training on medical residents' echocardiography mastery. This interventional study was conducted among medical residents at the Simulation Center of the Faculty of Medicine in Monastir (CeSim) in January 2022. The intervention consisted of a theoretical training and a simulator-based practical training concerning echocardiography. Residents underwent evaluation before and after training through a "Pre-Test" and a "Post-Test," respectively, using a French-language questionnaire. Participation was entirely voluntary. A total of 28 medical residents participated in our study, with the majority being female (57.1%). The median age was 29 years (interquartile range: 28-31.75). Following training, the proportion of participants who reported having the necessary skills for echocardiography interpretation significantly increased (p<0.05). Respondents demonstrated significant improvements in their scores on theoretical tests and practical skills assessments. Concerning echocardiographic views, the percentage of participants who correctly identified the title of the parasternal small axis section increased from 53.6% before training to 100% after training (p <10-3). Significant enhancements were observed in all parameters evaluating the practice of echocardiographic sections by respondents on a mannequin after training, encompassing time to obtain the view, view quality, image quality, visualization of structures, interpretability, and image stability (p<10-3). There was a significant improvement in average response rates for echocardiographic clinical syndroms among medical residents before and after training. All participants emphasized the indispensability of ultrasound education in the training of physicians specializing in managing cardiopulmonary emergencies. This study reports the beneficial role of simulation-based training in enhancing the mastery of medical residents in echocardiography. Incorporating such training methods into their learning curricula is advisable.

Experiencing and enduring patient distress: the distress of palliative care patients and its emotional impact on physicians in training

BackgroundThe extreme vulnerability experienced by patients in palliative care may result in significant distress. These patients require appropriate care while not pathologizing their natural distress. Given the challenges of caring for people experiencing significant distress, it is important to understand what professionals in training may feel when caring for patients in palliative care. Therefore, the aim of this study was to explore how professionals in training feel when confronted with the distress of patients undergoing palliative care.MethodsA qualitative study employing interpretative phenomenological analysis was conducted. In 2022, 11 physicians in training were interviewed about their experiences with distressed patients due to palliative care. The interviews were conducted via video conference. The students participated in the national palliative care cross-training and were in their final year of residency training.ResultsThe interviews revealed the following five themes: feelings of powerlessness, duty to act, difficulty in building a relationship, feeling insecure about oneself, and creating a space for listening and relating. All participants felt powerless in front of their patient’s distress. Numerous defense mechanisms were identified that made the relationship with the patient difficult. Four participants described being able to create a space for listening and relating to their patients.ConclusionsA minority of students could establish a quality relationship with their distressed patients. Two concepts, interprofessional education and the patient-centered approach, were identified and could be developed in training.

Comparison of self-assessed and clinician-assessed hirsutism diagnosed according to the modified Ferriman-Gallwey scale among female outpatients in Brazil.

The aim of this study was to evaluate the efficacy of a self-assessment questionnaire for hirsutism using the latest cutoff values recommended by the Endocrine Society (ES) for Latin-American women and by the European Society for Human Reproduction and Embryology (ESHRE). Female premenopausal outpatients (n = 188) completed a self-assessment questionnaire, scoring hair presence across the nine areas evaluated by the modified Ferriman-Gallwey (mFG) scale. The results were compared with clinician-assessed scores rated independently by two trained physicians. Scores in the Hirsuta questionnaire, derived from self-assessment of five areas of the mFG scale, were also evaluated. The ethnic composition of the sample was as follows: 23.1% white, 25.8% black, 48.9% mixed, and 2.1% other backgrounds (Indigenous, Asian). The participants had age and BMI of (mean ± standard deviation) 33.7 ± 9.9 years and 29.8 ± 7.21 kg/m2, respectively. The most common areas of excessive hair growth were the chin, upper and lower abdomen, and thighs. Relative to clinician-assessed mFG scores, self-assessed mFG scores had an accuracy of 80% using ES criteria for hirsutism diagnosis, with a sensitivity of 95.45%, specificity of 56.25%, positive predictive value of 30.10%, and negative predictive value of 98.40%. Self-assessed mFG had lower accuracy (71%) for diagnosing hirsutism when the ESHRE criteria were applied. Self-assessed mFG had low specificity, limiting its application. The results of this study do not support the use of the self-assessed mFG or Hirsuta scores for diagnosing hirsutism in a clinical setting, although both scoring systems may be useful for screening hirsutism in epidemiological studies.

Exploring d/Deaf community perspectives regarding inclusive/accessible healthcare

Background: d/Deaf [1]patients face substantial barriers obtaining healthcare, including communication challenges, cultural differences, and unique psychosocial needs. Healthcare providers are generally undereducated on how to best care for this patient population. This project aims to identify healthcare disparities and areas for improvement in healthcare provider education from the d/Deaf-patient perspective. Methods: A 40-question survey was distributed to d/Deaf groups across the United States. Nine focused interviews were conducted with d/Deaf patients. Results: 62 d/Deaf individuals responded to the survey. Due to communication difficulties with healthcare providers, 33% did not access healthcare when needed, 52% had medical questions go unanswered, and nearly 40% did not understand their health. Focused interviews found that d/Deaf patients continue to face healthcare barriers due to communication difficulties, poor awareness of d/Deaf needs, and accessibility concerns. Survey and focused interview participants agreed improved healthcare provider education and awareness would improve their care. Discussion: Data suggest that multifactorial healthcare disparities continue to affect the d/Deaf population and d/Deaf patients believe improved education of healthcare providers is paramount to improve healthcare. Specific curricular areas to improve upon include: communication, cultural/psychosocial issues, and improved awareness of the d/Deaf community. Conclusions: The d/Deaf community faces substantial barriers to accessible healthcare that can be improved by improved healthcare provider curriculum and awareness. Keywords: Deaf, healthcare disparities, curriculum, health literacy, physician training.