Doctoral Training Research Articles

Analysis of the learning curve for unilateral biportal endoscopic technique using CUSUM method on fresh frozen cadavers

PurposeThis study aims to determine the learning curve for lumbar discectomy and nerve root decompression using the unilateral biportal endoscopic (UBE) technique on fresh frozen cadavers through linear regression and cumulative sum (CUSUM) analyses.MethodsThe analysis was conducted on three spine surgeons without UBE experience. They performed lumbar discectomy using the unilateral endoscopic technique on fresh frozen cadavers. Each physician performed operations on 40 lumbar spine segments, recording the time it took each physician to complete a segment of lumbar discectomy by UBE. The learning curve was assessed by linear regression and CUSUM analysis using SPSS 27.0 software and GraphPad Prism 8.0 software.ResultsAccording to the CUSUM analysis of the learning curve, the number of segments required to complete the learning phase for the three surgeons was 20, 16, and 20, respectively. With the increased number of operated segments, the operation time for each lumbar vertebral segment gradually decreased and stabilized.ConclusionsIn our study, spine surgeons without experience in UBE require 20 segments of surgery to overcome the UBE learning curve. Additionally, fresh frozen cadavers can effectively simulate real surgeries. Whenever possible, we should reasonably use fresh frozen cadavers for early UBE training of doctors, thereby better protecting the health and safety of patients.

Digitally Driven Short- and Intermediate-term Courses of Primary Care Psychiatry for Doctors: A Theme-based Analysis and Performance Audit.

The National Mental Health Survey of India 2015-2016 identified a substantial treatment gap in mental healthcare, emphasizing the urgent need for improved training of primary care doctors (PCDs) in managing psychiatric disorders. This study aimed to evaluate the effectiveness of three digitally delivered primary care psychiatry courses offered by the department of psychiatry in a tertiary neuropsychiatric center: the Certificate Course in Primary Mental Healthcare (CCPMH), the Diploma in Community Mental Health (DCMH), and the Diploma in Primary Care Psychiatry (DPCP). Based on the board of studies documents, including curriculum, delivery methods, accreditation criteria, and outcomes, a comparative and thematic analysis of the courses was conducted. The digital courses differed in duration, depth, and delivery methods. The DPCP, the most intensive and personalized program, was highly effective in translating knowledge into clinical practice. The CCPMH provided a foundational, short-term course for PCDs, while the DCMH covered a broader range of topics relevant to primary care psychiatry, supplemented with self-learning modules. All courses significantly contributed to reducing the mental health treatment gap by training a substantial number of PCDs. Digitally delivered courses are essential in addressing the mental health treatment gap in India. The DPCP, with its emphasis on practical training and personalized learning, demonstrates high effectiveness in equipping PCDs with the necessary skills to manage psychiatric disorders. However, further research is needed to evaluate long-term outcomes and to address the scalability and accessibility challenges of these.

A Model Framework for Cultivating Competencies in Trainee Doctors During Housemanship

Abstract: Knowledge and skills are essential to understanding, especially in organizational learning. Both elements are also expressed in housemanship learning. Knowledge and skills need to be balanced to ensure the competence of trainee doctors. Knowledge and skills must go hand in hand in ensuring that the born doctor is competent and efficient. Weaknesses in competence can interfere with work performance. Therefore, this study was conducted to examine several research objectives, namely (i) to identify the level of learning of trainee doctors during housemanship, (ii) to identify the level of competence of trainee doctors during housemanship, (iii) to examine the relationship between the level of learning of trainee doctors and competence, and (iv) to develop a model framework for learning strategies for trainee doctors during housemanship. The study uses a quantitative approach through the distribution of questionnaires. The study is conducted in a hospital in Johor. The study uses a purposive sampling method because the study sample focuses on trainee doctors undergoing housemanship in the second year only. The results of the study found that the level of learning and competence of trainee doctors is high, and there is a significant relationship between the level of learning and the competence of trainee doctors during housemanship. The researcher has also developed a learning strategy model for trainee doctors to reference future researchers. In conclusion, this study is important to ensure that the competency of trainee doctors can be achieved according to learning needs. In the long term, this study can be used as a learning development process during housemanship. This study is specific to the field of knowledge in the context of career development and learning. Abstrak: Pengetahuan dan kemahiran adalah dua kefahaman khususnya dalam pembelajaran organisasi Kedua-dua elemen ini turut dinyatakan dalam pembelajaran housemanship. Pengetahuan dan kemahiran perlu seimbang dalam memastikan kompetensi doktor pelatih. Peranan pengetahuan dan kemahiran perlu seiring dalam memastikan doktor yang dilahirkan adalah kompeten dan cekap. Kelemahan dalam kompetensi boleh mengganggu prestasi kerja. Justeru, kajian ini dijalankan untuk mengkaji beberapa objektif kajian iaitu (i) mengenalpasti tahap pembelajaran doktor pelatih semasa housemanship, (ii) mengenalpasti tahap kompetensi doktor pelatih semasa housemanship, (iii) mengkaji hubungan antara tahap pembelajaran doktor pelatih dengan kompetensi serta, (iv) membangunkan kerangka model strategi pembelajaran doktor pelatih semasa housemanship. Kajian menggunakan pendekatan kuantitatif menerusi edaran soal selidik. Lokasi kajian adalah di sebuah hospital di negeri Johor. Kajian menggunakan kaedah persampelan bertujuan kerana tumpuan sampel kajian adalah doktor pelatih yang sedang menjalani housemanship pada tahun kedua sahaja. Hasil kajian mendapati tahap pembelajaran dan kompetensi doktor pelatih adalah tinggi serta terdapat hubungan yang signifikan antara tahap pembelajaran dengan kompetensi doktor pelatih semasa housemanship. Pengkaji juga telah merangka sebuah model strategi pembelajaran doktor pelatih sebagai rujukan pengkaji akan datang. Kesimpulannya, kajian ini adalah penting untuk memastikan kompetensi doktor pelatih dapat dicapai mengikut keperluan pembelajaran. Dalam jangka masa yang panjang, kajian ini boleh digunakan sebagai proses pembangunan pembelajaran semasa housemanship. Kajian ini khusus untuk bidang ilmu dalam konteks pembangunan dan pembelajaran kerjaya.

Innovations in qualifying exams: toward student-centered doctoral training

Innovations in qualifying exams: toward student-centered doctoral training

Screening doctors in training for dyslexia: the benefits of an inclusive screening approach.

There is a lack of suitable screeners for dyslexia for doctors in training, as the typical adult screeners do not cater for the needs of capable medical graduates. The aim of this research is to create an inclusive screening and training process for doctors with undiagnosed dyslexia. This involved working with doctors to co-create a new dyslexia screener tool. We designed an innovative holistic dyslexia screening, assessment, and support system as part of a 3-year longitudinal study. Qualitative data was collected through the use of a dyslexia screener and case-study interviews with trainees in general practice and psychiatry. Interviews were thematically analyzed to explore dyslexic trainees' experiences of an inclusive approach to dyslexia screening and assessment. Out of the 103 trainees that were screened, 10 were found to have dyslexia, one dyspraxia, and another ADHD trait. Dyslexia-specific coaching, exam, and workplace accommodations were beneficial in dispelling stigma about dyslexia as well as supporting examination success. International Medical Graduate (IMG) trainees were also supported in this process. The case study participants' progression was tracked over 3years, and all subsequently passed their examinations. We recommend that all trainees are given access to this inclusive, holistic, medical-focused dyslexia screening process. Specifically, this can enable newly diagnosed trainees to access support and exam accommodation. In particular, greater understanding of dyslexia helps dispel stigma and enable better support, which has a positive impact on trainee well-being as well as progression.

Enhancing puncture skills training with generative AI and digital technologies: a parallel cohort study.

Traditional puncture skills training for refresher doctors faces limitations in effectiveness and efficiency. This study explored the application of generative AI (ChatGPT), templates, and digital imaging to enhance puncture skills training. 90 refresher doctors were enrolled sequentially into 3 groups: traditional training; template and digital imaging training; and ChatGPT, template and digital imaging training. Outcomes included theoretical knowledge, technical skills, and trainee satisfaction measured at baseline, post-training, and 3-month follow-up. The ChatGPT group increased theoretical knowledge scores by 17-21% over traditional training at post-training (81.6 ± 4.56 vs. 69.6 ± 4.58, p < 0.001) and follow-up (86.5 ± 4.08 vs. 71.3 ± 4.83, p < 0.001). It also outperformed template training by 4-5% at post-training (81.6 ± 4.56 vs. 78.5 ± 4.65, p = 0.032) and follow-up (86.5 ± 4.08 vs. 82.7 ± 4.68, p = 0.004). For technical skills, the ChatGPT (4.0 ± 0.32) and template (4.0 ± 0.18) groups showed similar scores at post-training, outperforming traditional training (3.6 ± 0.50) by 11% (p < 0.001). At follow-up, ChatGPT (4.0 ± 0.18) and template (4.0 ± 0.32) still exceeded traditional training (3.8 ± 0.43) by 5% (p = 0.071, p = 0.026). Learning curve analysis revealed fastest knowledge (slope 13.02) and skill (slope 0.62) acquisition for ChatGPT group over template (slope 11.28, 0.38) and traditional (slope 5.17, 0.53). ChatGPT responses showed 100% relevance, 50% completeness, 60% accuracy, with 15.9s response time. For training satisfaction, ChatGPT group had highest scores (4.2 ± 0.73), over template (3.8 ± 0.68) and traditional groups (2.6 ± 0.94) (p < 0.01). Integrating AI, templates and digital imaging significantly improved puncture knowledge and skills over traditional training. Combining technological innovations and AI shows promise for streamlining complex medical competency mastery.

BN SO33 - The complex benign multi-disciplinary team meeting - a paradigm shift in decision making for benign oesophagogastric surgery

Abstract Background Decision making in benign OG pathology can be particularly challenging given the overlap with functional disorders, such as reflux hypersensitivity. A specialist benign oesophagogastric (OG) multidisciplinary team (MDT) may improve our ability to triage potential surgical candidates from those with functional conditions. Unlike in OG cancer, there is a paucity of evidence to support an MDT based approach in benign OG surgery. This study aims to report our experience of introducing a specialist benign OG MDT in an OG tertiary centre in the UK, examining the effect on decision making and an assessment of its acceptability and utility to clinicians. Method A review of consecutive cases discussed in the specialist benign OG MDT since inception in 2022 was undertaken. We reviewed indications, treatment plans and outcomes, any alteration in treatment pathway and final decisions. The primary outcome was the proportion of patients with a change in management as a result of MDT discussion. Where applicable, results were reported using descriptive statistics. A seven-item electronic questionnaire was also circulated to MDT members (OG surgeons, specialist gastroenterologists, GI radiographers, GI physiologists, and doctors in training), to assess the acceptability and perceived utility of the meetings. Results 74 patient cases were discussed (median age 57.5 (25-79) years). 71/74 (96.0%) of referrals were made by OG surgeons, most commonly to discuss anti-reflux procedures (53/74 (71.6%)). 34/74 (45.9%) patients had undergone previous surgery, most commonly laparoscopic fundoplication. MDT discussion led to a change in management in 43/74 (58.1%) case with recommendations of further investigation (23.0%), further OG clinic review (18.9%) and 21.6% listed for surgery. 12/74 (16.2%) were referred to other specialist services, including clinical psychology. Survey confirmed that all MDT members found their understanding of oesophageal physiology and subsequent decision-making ability in clinic was greatly enhanced. Conclusion Our results show that the complex benign MDT is an effective tool, demonstrating changes to management in over half of cases discussed, including recommending surgery less frequently following specialist review of physiology investigations. Such tests effectively identify functional disorders, such as rumination, highlighting a need for clear onward referral pathways involving specialist psychologists. The meetings have also proven to be valuable learning tools for all attendees of all grades. We strongly believe that adopting an MDT approach to benign OG conditions will enhance collaborative decision making, improve patient outcomes and therefore should be nationally mandated and recommended through AUGIS guidelines.

DAH-Unet: A modified UNet for Semantic Segmentation of MRI images for brain tumour detection

Using sophisticated image processing techniques on brain MR images for medical image segmentation significantly improves the ability to detect tumors. It takes a lot of time and requires a doctor's training and experience to manually segment a brain tumor. To address this issue, we proposed a modification in Unet architecture called DAH-Unet that combines residual blocks, a rebuilt atrous spatial pyramid pooling (ASPP), and depth-wise convolutions. Also, a hybrid loss function which is explicitly aware of the boundaries is another thing we suggested. Experiments were conducted on two publicly available dataset and proved better in some metrics as compare to existing semantic segmentation models.

Game Evolution Research on the Choice of Training Strategies between Clinical Departments and Doctors under the Background of Hospital-Provided Training

Objective: This study aims to explore the dynamic game process of training participation strategies among hospitals, clinical departments, and newly recruited doctors, as well as the impact of hospital intervention on this process. By applying game evolution theory, a comprehensive model is constructed to analyze the decision-making logic of training participation and propose new training strategies to promote the professional growth of newly recruited doctors and improve hospital service quality. Methods: The stability of dynamic game equilibrium points was analyzed by constructing Jacobian matrices, considering nine different game scenarios with and without hospital intervention. An empirical study from a hospital was introduced to verify the theoretical model's predictions. Results: The study found that without hospital intervention, clinical departments and newly recruited doctors tend to choose not to participate in training. After hospital intervention, through the provision of resources and incentives, the participation and effectiveness of training significantly improved. Conclusion: The study reveals the crucial role of hospital intervention in promoting the participation of newly recruited doctors in training and proposes a training strategy that combines theory and practice. This strategy not only helps new doctors quickly adapt to the hospital environment but also improves the quality of medical services, providing talent support for the hospital's continuous development. It offers theory-based decision support for hospital managers and provides new ideas for the improvement of future medical education and practice.

DEVELOPMENT OF HIGHER MEDICAL EDUCATION ABROAD IN THE STUDIES OF UKRAINIAN COMPARATIVISTS

The article presents a synthesized historiographical analysis of Ukrainian pedagogical comparativistsʼ works on the development of higher medical education in foreign countries, identifying trends, achievements, bottlenecks, and prospects for studying this problem. The presented sample of dissertations, monographs, and textbooks demonstrated their narrow country-specific vector and similarity in formulating the subject of research. Historiographical and comparative analysis revealed similar approaches of scientists to determining trends in the development and functioning of national systems of professional training for doctors. These concern the preservation and expansion of decentralization in higher medical education management; strengthening the interaction of its various links; shifting emphasis in determining the prerequisites for the development of national higher medical education systems from “traditional” factors (political, socio-economic, cultural situation of the country, etc.) to clarifying the influences of international medical organizations and documents in the field of healthcare that substantiate general strategies for training doctors in higher medical education institutions, etc. Scientists also propose original approaches to studying the functioning of national systems of higher medical education. These are manifested in the development of authors periodizations and classifications of the specified process; thorough characteristics of university environments for training future doctors in different countries; comprehensive understanding of the determinants of their formation and development, which, in addition to social, economic, and cultural factors of the country's development, relate to the level of education of the population, its multiculturalism, the specifics of educational systems, etc. In these perspectives, the analyzed studies mark two main country-specific vectors of research in higher medical education: “overseas” (USA and Canada) and “European” (mainly Great Britain, Poland, and German-speaking countries).

ПІДГОТОВКА МАЙБУТНІХ ДОКТОРІВ ФІЛОСОФІЇ ЗА ОСВІТНЬО-НАУКОВОЮ ПРОГРАМОЮ «ТЕОРІЯ ТА МЕТОДИКА НАВЧАННЯ ХІМІЇ»

The article reveals the issue of training doctors of philosophy as an important condition for the development of the scientific and educational potential of modern society. The purpose of the article is to focus on the objective need to train Doctors of Philosophy in the subject specialty 014.06 Secondary Education (Chemistry) to ensure further development of the field of theory and methods of teaching chemistry and to reveal the content and structure of the educational and scientific programme «Theory and Methods of Teaching Chemistry», which is designed to ensure it. The statistical analysis of the provision of educational and scientific institutions of our country with highly qualified specialists in the theory and methodology of teaching chemistry demonstrates the objective need to train Doctors of Philosophy in the subject specialty 014.06 Secondary Education (Chemistry) of the field of knowledge 01 Education / Pedagogy both to ensure the quality of educational services at all levels of higher education and to promote the development of the scientific field of the theory and methodology of teaching chemistry as a whole. The article describes the educational and scientific programme «Theory and Methods of Teaching Chemistry» in the subject speciality 014.06 Secondary Education (Chemistry), field of knowledge 01 Education / Pedagogy, which is implemented at theVinnytsia Mykhailo Kotsiubynskyi State Pedagogical University . The purpose of the educational and research programme is to train specialists at the third (educational and research) level of higher education (eighth qualification level according to the National Qualifications Framework) who are able to formulate and solve complex scientific and practical problems in the field of theory and methods of teaching chemistry, organise and carry out research and educational activities. The programme defines the integral, general and special competences and formulates the learning outcomes to be demonstrated by a Doctor of Philosophy in the subject speciality 014.06 Secondary Education (Chemistry). The content of the educational and scientific components of the programme «Theory and Methods of Teaching Chemistry» is also revealed and the educational components that ensure the achievement of the programme learning outcomes are described.

Use of digital technologies in the activity of medical institutions

Introduction. Significant transformations are taking place in modern medicine: digitalization and re–equipment, changing standards of care — all this requires the availability of new IT competencies for medical professionals. The involvement of “non-doctors” (IT specialists) compensates for the needs of medical institutions, but qualitative changes in the training process of modern medical workers are necessary to solve the problem. The purpose is to study the needs for new competencies for medical professionals (IT doctors) and the need to attract “non—doctors” in modern conditions of digitalization of medicine. Materials and methods. The study is based on the analysis of secondary information obtained from the Federal Statistical Observation Form No. 30 and digital resources, as well as on the results of a mass questionnaire survey conducted in medical institutions of the Moscow Department of Health (n = 1499). Results. “Non-doctors” with IT competencies are increasingly in demand. The survey showed that certain functions of medical specialists can already be “transferred” to non-medical personnel, whose growth rate has exceeded 60% over the past 10 years. However, the training system provides the necessary IT competencies to a greater extent in technical specialties and to a lesser extent in medical ones. Research limitations. The analysis uses statistical data and the results of a mass questionnaire survey in medical institutions of the Moscow Healthcare Department, which is a representative sample for approximating the results for the entire general population. Conclusion. In the near future, it is necessary to train doctors according to new standards. The modernization of the training system taking into account new IT competencies in medicine and the development of the LongLife Learning (LLL) training system are becoming a reality. The increasing involvement of “non-doctors” to solve high-tech problems, the development of hardware and software complexes is undeniable. However, it is necessary to adapt them to the specifics of the industry development.

Perceived employability of international doctoral students in the UK: applying Bronfenbrenner’s ecological systems theory

ABSTRACT The quality of the UK’s doctorate training system plays a fundamental role in fostering vibrant research outputs and attracting global talent. However, while maintaining a consistently high standard of quality remains static and challenging, little is known about how the employability of international doctorate students is shaped and at what juncture it is opportune to support their employability during their research studies. This paper aims to understand the employability of international doctoral students within business schools at British universities, drawing on Urie Bronfenbrenner’s ecological systems theory as a framework. The qualitative study involves 15 international doctoral students from 9 business schools. The findings uncover various environmental systems impacting their employability. In addition, this study theoretically extends employability research by applying Bronfenbrenner’s ecological systems theory to provide a multi-layered understanding of international doctorate employability, offering a novel framework for targeted career support interventions. Further, the implications highlight the urgent need for tailored support to build industrial connections, promote departmental collaboration to scaffold a dynamic research environment, proffer multiple resource channels, and create employment opportunities both inside and outside of the university.

Workplace violence as a predictor of suicidal ideation in undergraduate internal physicians

The environments in which doctors in training operate have been distinguished by being rigid, hostile and routine. There is scientific evidence that people who are victims of workplace violence are more likely to suffer from depression, a disorder that has been associated with suicidal ideation. To predict suicidal ideation as a function of depressive symptoms and workplace violence in undergraduate internal physicians. The quantitative method was used through a non-experimental, cross-sectional, explanatory design with non-probabilistic convenience sampling. 117 medical students who were doing their internship in health centers in Sonora, Mexico participated. Participants responded to the Workplace Violence Scale (Mobbing), the Beck Depression Inventory, and the Beck Suicidal Ideation Scale. A high perception of workplace violence, moderate levels of depression and low levels of suicidal ideation were identified; Workplace violence was positively and significantly associated with depression and suicidal behavior. Furthermore, it was found that violence provides more explanation for suicidal behavior compared to depression. The predictive role of workplace violence in the suicidal behavior of undergraduate internal physicians is confirmed. Highlights the importance of developing prevention and intervention programs to reduce workplace violence in medical training environments.

‘What is ‘wellbeing’ to doctors in training, and how do we improve it? Results of a quantitative survey and thematic analysis of internal medicine trainees

IntroductionThe wellbeing of medical trainees has come into sharp focus in recent years, particularly since the COVID-19 pandemic. Workforce pressures are well documented, as is the need to retain staff. There are a number of initiatives to try and improve the wellbeing of staff, including the introduction of wellbeing and education dellows for stage 1 internal medicine trainees in some regions. We recognise that there is often a gap between what is offered and what is wanted or accessed by trainees. ObjectiveThis work aims to identify what ‘wellbeing’ means to this group of staff, and to provide evidence for interventions that they would find useful. MethodsWe distributed a survey to the target group of staff in London, followed by a series of structured interviews and focus groups. We used a practical thematic analysis to explore the determining factors of trainee wellbeing. Results156 trainees responded to the survey, and 15 participated in the interviews and focus groups. Seven themes were identified: culture, helplessness and distrust, individual circumstances, physiological needs/safety, rotas and work patterns, stress at work, and value. ConclusionThis study identifies several key factors related to medical trainee wellbeing. To our knowledge, it is the first looking specifically at stage 1 internal medicine trainees in the UK.

Iatrogenic Female Genitourinary Fistula in Uganda: Etiology, Twelve-Year Trends, and Risk Factors for Development Following Cesarean Section.

To describe the magnitude and trend of the iatrogenic genitourinary fistula in Uganda, and the risk factors for development following the Cesarean Section (CS). A retrospective review of charts of women with a confirmed diagnosis of genitourinary fistula at four regional fistula repair sites in Uganda between 2010 and 2021 was conducted. A fistula was classified as iatrogenic if it was; ureteric, vesico-cervical, vesico-uterine, or vaginal vault fistula that followed an obstetric or gynecological surgery. The annual proportions for the ischemic and iatrogenic fistula over the study period were compared. A sub group analysis of women with genitourinary fistula delivered by CS was done to determine the factors associated with iatrogenic fistula. Multivariable log binomial regression was performed to determine the independent risk factors. There were 521 women who presented with genito-urinary fistula of which, 169 (32.4%) were iatrogenic. Most of the iatrogenic fistulae followed CS (71%). The proportions of iatrogenic fistulae increased from 8/52 (9.6%) in 2010 to 38/88 (43.2%) in 2020. The risk factors for iatrogenic fistula following CS were; Grand-multiparity (OR = 5.8; 95% CI: 2.1-15.4), Repeat CS (OR = 4.1; 95% CI: 1.8-9.3), CS performed by an intern doctor (OR = 4.8; 95% CI: 1.5-15.5) and CS done at a Health Centre IV (OR = 4.5; 95% CI: 1.2-16.7). The magnitude of the iatrogenic genitourinary fistula in Uganda is high and most follow CS. There is an observed rising trend in iatrogenic fistula. The risk factors for iatrogenic fistula following CS are grandmultiparity, repeat CS, CS performed by intern doctors and CS performed at lower health facilities. There is a need for continuous training and supervision of lower cadre doctors involved in CS to reduce on the rising trend of iatrogenic fistula.

Consequences of career progression barriers experienced by doctors in GP training: an interpretative phenomenological study

ABSTRACT Background Despite commitment across national medical education and training bodies to tackle differential attainment (DA), alongside a wealth of research into contributing factors and solutions, progression in narrowing the gap has lagged. This study explores the lived experiences of doctors facing DA, career progression barriers and their wider consequences. Methods Interpretative phenomenological analysis was chosen as the methodological framework. The six doctors interviewed were released from General Practice training before enrolling in a ‘targeted’ intervention scheme designed to support them with training completion. Results The cohort included four international medical graduates and two graduates from the United Kingdom. Three participants were neurodiverse. Three inter-related themes were identified. 1) ‘Career insecurity’ is defined as uncertainty about career prospects and attainment of career goals. At varying points along their journey navigating through progression barriers, participants frequently questioned their futures and the decision to persist in the arduous pursuit of training completion. 2) ‘Psychological injury’ featured prominently in the experiences of the ‘targeted trainees’. Feelings of worthlessness, helplessness, low energy and mood, and ‘traumatic’ experiences were described. 3) ‘Social injury’ illustrates consequences to doctors’ familial and social contexts (including relationships), as well as wider societal consequences (such as attrition). Conclusion Our research evidences the consequences of DA and career progression barriers. We highlight the urgent need for escalated efforts in addressing the challenges faced by different groups of doctors and narrowing the attainment gap. Recommendations for interventions are included in our study.

Üçüncü Basamak Bir Hastanede Doktor ve Hemşirelerin Oksijen Tedavisi Konusundaki Eğitim ve Bilgi Durumu-Anket Çalışması

Objective: Oxygen therapy (OT) is the administration of oxygen (O2) at a concentration greater than that found in the atmosphere to prevent the symptoms of hypoxemia. The necessary knowledge, skills and attitudes of the staff while OT may affect the treatment outcomes. In our study, we aimed to determine the training and knowledge status of doctors and nurses working in our university hospital on OT. Methods: The cross-sectional study was completed with 231 participants after ethics committee approval. Data were obtained by hand-completion of questionnaires consisting of 23 questions to volunteer. According to the correct answers given to the questions investigating the level of knowledge, scores &gt;80% were classified as good knowledge level and &lt;60% as poor knowledge level. p&lt;0.05 was considered significant. Results: The number of employees reached by the survey was 422 and 85% of nurses and 62% of doctors stated that they had knowledge of OT application. Twenty seven percent of nurses and 42% of doctors were using guidelines for OT. Eighty six percent of doctors and 90% of nurses felt that training for OT was necessary and the most common sources of information were school education. The rate of good knowledge was 9.7% among nurses and 14.3% among doctors (p=0.418). Regarding the expected clinical outcomes of OT, 71% of physicians and 49% of nurses had a good level of knowledge (p&lt;0.001). Sixty four percent of physicians and 86% of nurses (p&lt;0.001) had a poor level of knowledge about lowflow OT and 49% of physicians and 69% of nurses had a poor level of knowledge (p=0.004) about indications for short-term OT. Most of the participants (87.7%) had poor knowledge about O2 toxicity. Conclusion: It was concluded that the majority of healthcare professionals have insufficient knowledge in OT and comprehensive training programs are needed at regular intervals. Keywords: Oxygen therapy, education, information, survey study

ETHICAL DILEMMAS IN MEDICAL CARE FOR WOMEN IN SITUATIONS OF SOCIAL VULNERABILITY: EXPANDING THE DEBATE ON MARGINALIZED POPULATIONS IN EDUCATION

This paper addresses reflections and discussions on the female figure in the context of social marginalization, linked to threats to human rights, with a focus on access to health care and quality longitudinal monitoring. This debate analyzes the historical process of marginalization and oppression amplified when women are inserted as street dwellers, enhancing the weaknesses of helplessness and substance abuse, thus aggravating violence and stigma. This is a narrative review of literature, of a reflective nature, associated with a report of an educational experience in the construction of a teaching methodology based on a fictitious case that triggers discussion and resolution of problems linked to human rights violations of marginalized women, in the light of philosophies of law and the study of public policies for undergraduate medical students. The development of the work shows the importance of expanding studies on this topic, focusing on historically invisible people, in a problematizing narrative, using the construction of clinical cases containing not only health needs for a resolution of medicalization, based strictly on biological diagnoses, but that challenge the reflective thinking of social medicine, directing the debate towards human rights lines, in a context of interprofessional dialogues and studies of public policies, as essential in the training of doctors committed to guaranteeing equity and access to the most neglected population segments in Brazil.

TB Care in Ukraine: Understanding Access Barriers at the Primary Healthcare Level

Abstract Background In the WHO European Region, Ukraine is a high-priority country for TB control, being one of nine globally with high rates of multidrug-resistant TB. The WHO emphasizes patient-centered TB care, prioritizing patients as key figures in the care continuum. Thus, our aim was to explore barriers impacting the accessibility of TB services for patients at the primary healthcare level (PHC) in Ukraine. Methods During December 2022-June 2023, a qualitative study was conducted across eight PHC facilities in the Kyiv, Odesa, Mykolayiv, and Volyn regions. The study comprised: 4 focus groups involving 27 family doctors, 16 in-depth interviews with managers and health authorities from regional and national levels, as well as 25 interviews with TB patients. All data was transcribed, manually coded and deductively analyzed. Results All participants highlighted the benefits for patients of providing TB care continuum at the PHC level, yet the program lacks clear requirements for training of family doctors and nurses. Overall family doctors perceived positively various TB training they received; but despite this, they expressed doubts and reported a lack of practical skills, affecting the quality of care provided. Patients highlighted several barriers in interacting with healthcare providers, including stigma and cases of dismissive behavior of healthcare workers, communication challenges, and breaches of patientś data confidentiality. Patients also mentioned self-stigma, and perceptions of family doctors as poorly trained in TB. Still, patients who received healthcare services from the same family doctor “during long time” positively described their experience with TB services too. Conclusions Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine. To achieve this, a comprehensive TB training program tailored for PHC family doctors and nurses should be developed and implemented. Key messages • Expanding TB healthcare services to primary healthcare levels in Ukraine can be beneficial for patients. Training primary healthcare staff can enhance TB care quality. • Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine.