Training Pathways Research Articles

The impact of Saudi Arabia – United States clinical pharmacy post-graduate training programs agreements on clinical pharmacy faculty in Saudi universities: A retrospective descriptive study focused on history and future recommendations

BackgroundThere has been a growing demand for clinical pharmacy services in the Kingdom of Saudi Arabia (KSA) in the past 3 decades. The Ministry of Education has established agreements with several institutions in the United States to secure clinical pharmacy residency and research fellowship programs opportunities for Saudi scholars. The aims of this study were to describe the Saudi scholars’ clinical pharmacy training pathways and their contribution to the pharmacy profession in KSA. MethodsThis is a retrospective, descriptive study conducted on clinical pharmacy faculty in governmental Saudi universities who graduated from the US until 2023. The study outcomes included the post-graduate year-1 (PGY-1) residency match rate, post-graduate year-2 (PGY-2) acceptance rate, the PGY-2 specialties of Saudi scholars, and the number of clinical pharmacy programs established in KSA. ResultsIn total, 115 Saudi scholars have pursued clinical pharmacy pathway in the US. The PGY-1 residency match rate was 80 % (92/115). In contrast, the PGY-2 acceptance rate was 60.9 % (70/115). The most common PGY-2 specialty was in infectious diseases (N = 17; 24 %). Two pharmacy colleges had established residency programs and 1 pharmacy college had established a research fellowship. ConclusionThe Ministry of Education's efforts for clinical pharmacy program agreements were fundamental for advancing clinical pharmacy in Saudi universities. A significant number of Saudi scholars returned to KSA with clinical pharmacy degrees. There are more opportunities for further development, including expanding the clinical pharmacy program collaboration in the US and increasing the number of residency and research fellowship positions in KSA.

Co-teaching among English pre-service teachers for integrated STEAM+CLIL education

In Spain, primary education teachers teaching subject matter in a foreign language through Content and Language Integrated Learning (CLIL) require new pedagogical competencies. Teaching in a second language often poses problems, as many teachers have no specific training in CLIL and often wish to gain greater self-confidence when teaching some subjects, for example, Natural Sciences, in a foreign language. In that scenario, two general objectives are proposed in this study within the framework of pre-service CLIL teacher training: to examine the impact of a co-teaching programme on the development of the pedagogical competences of pre-service English as a Foreign Language (EFL) teachers engaged in STEAM+CLIL integrated education; and 2) to study the impact of the programme on the perceived self-confidence of pre-service teachers when teaching CLIL. The results of this research involving three experimental cohorts of pre-service teachers showed an improvement in their pedagogical competencies at designing integrated STEAM+CLIL didactic units, compared to the respective control groups; and an increase in their perceived self-confidence when teaching EFL through CLIL. These results point towards an alternative pathway for primary school teacher training in a foreign language, particularly English. FUNDING INFORMATION. This research was funded by the European Commission which financed the research project STEAM Education and Foreign Language Learning in Europe - SeLFIE (2020-1-ES01-KA201-081850).

Exploring the Training Path of Music Teacher Education on Professionalism

Music education is the unity of the practical activity of music and the practice of education, and has a dual character. In school music education, the practical activities of music have the characteristics of presentational and expressive; the practical activities of education have the characteristics of goal and normative. For a long time, due to the ambiguous understanding of the dual nature of music education practice, it has led to insufficient integration of the music and education disciplines, unclear pathways for music teacher education and training, and little effectiveness in teaching and learning. Therefore, it is necessary to follow the characteristics of their respective disciplines on the basis of finding a point of integration of the disciplines and realizing the integration and unification of the two, so as to improve the mechanism of music teacher education and training.

Impact of Integrated Vascular Surgery Residency Training Pathway and Professional Development Time on Career Choice and Research Productivity

The limited availability of academic surgery positions has led to increased competition for these jobs. Integrated vascular surgery residency (IVSR) allows for earlier specialization, with some programs providing professional development time (PDT). We hypothesized that IVSR and PDT lead to academic employment and increased research productivity. This is a retrospective study of vascular surgery fellowship (VSF) and IVSR graduates. Training, number of publications, H-index, NIH funding, and employment history were collected using institutional websites, Doximity, Scopus, PubMed, and NIH Research Portfolio Reporting. After a review of the research protocol, the Association of Program Directors in Vascular Surgery (APDVS) provided a list of vascular surgery fellowship (VSF) and IVSR graduates. After review of the research protocol, the Association of Program Directors in Vascular Surgery (APDVS) provided a list of vascular surgery fellowship (VSF) and IVSR graduates. Training, number of publications, H-index, NIH funding, and employment history were collected using institutional websites, Doximity, Scopus, PubMed, and NIH Research Portfolio Reporting. From 2013-2017, comparison of IVSR (n=131) to VSF (n=603) graduates showed that IVSR graduates were more likely to be women (38.17% vs 28.19%; p = 0.024), be MD graduates (99.24% vs 93.37%; p = 0.008), attended programs in the northeast (41.98% vs 27.5%; p < 0.001), have advanced degrees (13.74% vs 6.97%; p = 0.01) and graduate from larger programs (median 15 vs 14 faculty; p = 0.013). There was no significant difference in number of publications per trainee by the end of training (median 4 vs 3; P=0.61) or annual trend in average number of publications. After training, there was no significant difference in the type of practice, academic affiliation, practice region, publication number, H-index, NIH funding, level of academic appointment, or leadership positions. From 2013-2019, a comparison of IVSR graduates with (n=32) and without PDT (n=190) demonstrated that those with PDT were more likely to be women (53.13% vs 34.74%; p = 0.038), have advanced degrees (28.12% vs 8.95%; p = 0.002), be at larger programs (median 14 vs 9 faculty; p < 0.001), train at a top 10 NIH funded program (65.62% vs 21.58%; p < 0.001) and publish more by the end of IVSR (median 9 vs 3; p < 0.001). Graduates with PDT were more likely to have academic employment and affiliation, a higher yearly publication rate, and greater H-index. IVSR and VSF graduates have comparable academic employment and research productivity. However, PDT during IVSR correlates with an eventual academic career and greater research productivity. This study supports the importance of PDT in developing academic vascular surgeons. It remains necessary to continue both IVSR and VSF training paradigms as healthcare needs of the population are met through both academic and non-academic surgeons.

Cross-sectional Survey of Medical student perceptions of And desires for Research and Training pathways (SMART): an analysis of prospective cohort study of UK medical students

Objective Clinician-scientists are critical to medical innovation and research. However, the number of clinician scientists in the UK has been declining steadily over the last decade. One of the cited reasons is poor student recruitment to academic training pathways. The SMART study aims to assess current student perceptions on research and identify key factors influencing whether a student is interested in research.DesignWe conducted a cross-sectional survey study between January and May 2022.SettingThis was a multi-centre national study with data collected across 40 universities offering medical courses in the UK.ParticipantsParticipants were UK medical students enrolled in medicine for 21/22 academic year.Main outcome and measureThe main outcomes were related to participant perceptions on research and whether they were interested in engaging with research in their future career. These measures were correlated with demographic and non-demographic details using regression analyses.ResultsOne thousand seven hundred seventy-four individuals participated in the SMART survey from 40 medical schools. Nearly half the participants felt there were barriers preventing them from doing research (46.67%) and almost three-quarters felt it was at least somewhat difficult to combine research with medical school (73.49%). Of the options available, most commonly students did not want to pursue an academic career (43.11%) or training pathway (42.49%). However, most participants felt it was useful to do research at medical school (59.54%) and were also interested in doing more research in the future (69.16%). Regression analysis identified many factors influencing student’s perceptions of research including year of study, gender, socioeconomic status, family background, research exposure at medical school, ethnicity, and country of pre-university education.ConclusionsThe SMART study is the first of its kind in the UK, shedding light on medical student perceptions. While some express strong interest in academic careers, a larger proportion show a broader interest in research. Demographic factors like gender, parental occupation, and socioeconomic status play a role. Further exploration is needed for specific groups to address barriers, promote research, and boost academic pathway recruitment.

Redefining ‘Careers’ and ‘Sustainable Careers’: A Qualitative Study with University Students

Contemporary society challenges traditional linear career progressions with the emergence of the ‘sustainable career’ concept. This dynamic career path spans different societal domains over time and involves individuals actively shaping their paths through actions and the interpretation of their experiences. The evolving socioeconomic contexts demand a reevaluation of career development processes, necessitating an examination of individual perspectives on what makes a career authentically sustainable. Despite this, in the Italian and Spanish contexts, a definition of the concept of career and sustainable careers rooted in individuals’ interpretations is still absent. This qualitative study is designed to fill the existing gap by exploring the definition of the concepts of ‘career’ and ‘sustainable career’ in an initial sample of Italian (N = 197) and Spanish (N = 193) students (323 females, 67 males) aged 18–30 years (M = 20.13; SD = 2.13). Participants answered open-ended questions about ‘career’ and ‘sustainable career’. Qualitative data analysis software identified key themes, and correspondence analysis explored differences between the Italian and Spanish samples. The findings reveal that the concept of a career encompasses an evolving sequence of work experiences, incorporating training pathways, a continuous commitment to personal growth goals, and professional satisfaction. A sustainable career extends this, emphasizing a healthy work–life balance and the often-overlooked dimension of social empowerment. This study offers a perspective for designing research and interventions aimed at promoting careers and work environments perceived as authentically sustainable.

Advancing primary care: Establishing family medicine specialty in Tanzania

Family medicine has existed as a training pathway through a private university in Tanzania since 2004. As global calls have increased to embrace primary health care as a pathway to ensuring universal health coverage, so has Tanzania recently turned to explore family medicine as a specialty to improve access to comprehensive, high-quality healthcare for her entire population. This article outlines ongoing efforts to define competencies and skills of a family medicine physician in Tanzania, engage government support and open the first public university training programme for family medicine postgraduate education.

Advancing primary care: Establishing family medicine specialty in Tanzania.

Family medicine has existed as a training pathway through a private university in Tanzania since 2004. As global calls have increased to embrace primary health care as a pathway to ensuring universal health coverage, so has Tanzania recently turned to explore family medicine as a specialty to improve access to comprehensive, high-quality healthcare for her entire population. This article outlines ongoing efforts to define competencies and skills of a family medicine physician in Tanzania, engage government support and open the first public university training programme for family medicine postgraduate education.

PP38 Designing A Training And Capacity Building Pathway In Patient Involvement

IntroductionThe Patient Involvement (PI) Interest Group of the Spanish Network of Health Technology Assessment Agencies (RedETS) was set up in 2017 by a group of health technology assessment (HTA) researchers interested in PI. Since its inception, training and capacity-building to support PI and patient-based evidence in HTA processes has been one of its main aims. The objective of this work was to identify the needs and priorities related to training and capacity building activities to be developed within the framework of the PI Interest Group.MethodsThe PI Interest Group met on November 14, 2022, for its Annual Meeting. The group discussed the needs, priorities and possibilities on training, and carried out a prioritization exercise. For this purpose, a self-reported and anonymous questionnaire was used, which included 16 training activities. Every item was scored with a Likert-type scale ranging from 0 to 10.ResultsThe questionnaire was answered by twenty participants. The most highly rated training activities (mean less than or equal to 8) were: qualitative evidence synthesis (8.75); PI case studies (basic (8.65) and advanced (8.56) level); quality assessment tools for qualitative evidence (8.37); and qualitative research (8.11). Other proposals scoring above 7 points were: ethical aspects related to PI, evaluation of patient participation and impact, identification and recruitment procedures, and discrete choice experiments. The group agreed to organize bi-monthly webinars and three structured training activities for the whole RedETS network on: Qualitative Evidence Synthesis, Qualitative Research and PI Case Studies.ConclusionsThe prioritization of training activities according to PI Interest Group members allowed planning a tailored capacity-building program adapted to the needs of RedETS.

Health professionals’ perceptions of patient safety competencies: psychometric properties of the French version of the H-PEPSS in France and Switzerland

BackgroundSeveral initiatives have been implemented to develop, manage, and assess patient safety (PS) competencies, which are considered as a serious public health issue across the world. The Health Professional Education in Patient Safety Survey (H-PEPSS) is widely used as a psychometric scale for evaluating perceived PS competencies but has not been validated in French. The purpose of the study was to investigate the main psychometric properties of the French version of the H-PEPSS.MethodsA total of 449 students enrolled in nursing and physiotherapy schools in France and French-speaking Switzerland completed a self-administered questionnaire. The 38 items of the H-PEPSS were translated into French following a committee approach. The scale’s construct validity was assessed using confirmatory factor analysis. Reliability of the six factors of the H-PEPSS was evaluated using Cronbach α and McDonald’s ω. Measurement invariance across countries and academic majors as well as discriminant validity were also investigated.ResultsAfter we removed one item, the H-PEPSS 6-factor model demonstrated adequate goodness-of-fit statistics (χ2[194] = 316.633, χ2/df = 1.632, p < 0.001, CFI = 0.934, TLI = 0.922, RMSEA = 0.041 [0.033, 0.049], SRMR = 0.044). The total score can be also used as an overall measure of PS competence (χ2[203] = 342.251, χ2/df = 1.686, p < 0.001, CFI = 0.925, TLI = 0.915, RMSEA = 0.043 [0.035, 0.051], SRMR = 0.047). One item was removed because of its high multicollinearity with other items. The reliability was deemed satisfactory (Cronbach α ≥ 0.60), except for the “Understanding human and environmental factors” subscale. Consistently, this subscale was often reported with the lowest reliability in previous studies. We confirmed scalar invariance between countries and partial scalar invariance between majors (ΔCFI ≤ 0.01). The heterotrait-monotrait ratio of correlations ranged from 0.63 to 0.91. In our results, country, academic year, and academic satisfaction were frequently the main predictors of self-reported PS competencies.ConclusionPerceived PS competencies can be assessed and fairly compared across France and Switzerland and across nursing and physiotherapy students. We discuss the relevance of the introduction of the H-PEPSS in the training pathway of health professions degree courses and the fallout in clinical contexts.

National trends in technique use for esophagectomy: Does primary surgeon specialty matter?

BackgroundCardiothoracic surgeons and general surgeons (including surgical oncologists) perform most esophagectomies. The purpose of this study was to explore whether specialty-driven differences in surgical techniques and the use of minimally invasive surgical approaches exist and are associated with postoperative outcomes after esophagectomy. MethodsThis was a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program esophagectomy-targeted participant user file (2016–2018). Patients who underwent esophagectomy were sorted into cardiothoracic and general surgeon cohorts based on surgeon specialty. Perioperative characteristics and postoperative outcomes were compared using the χ2 analysis or independent t test. Multivariable logistic regression controlling for perioperative variables was performed to generate risk-adjusted rates of postoperative outcomes compared by surgical specialty. ResultsOf 3,247 patients included, 1,792 (55.2%) underwent esophagectomy by cardiothoracic surgeons and 1,455 (44.5%) by general surgeons as the primary surgeon. Cardiothoracic surgeons were more likely to use traditional minimally invasive surgical (P = .0004) or open approaches (P < .0001) and less likely to use robotic (P = .04) or a hybrid robotic and traditional approaches (P < .0001). Cardiothoracic surgeons performed more Ivor Lewis esophagectomies and fewer transhiatal and McKeown esophagectomies (P < .0001). After risk adjustment, there were no differences in rates of postesophagectomy complications, such as anastomotic leaks or positive margins, between cardiothoracic surgeons and general surgeons (all P > .05). However, cardiothoracic surgeons were more likely than general surgeons to treat anastomotic leaks with surgery rather than procedural interventions (odds ratio = 1.76; 95% confidence interval, 1.24–2.52). ConclusionCardiothoracic surgeons and general surgeons use minimally invasive surgical subtypes differently when performing esophagectomy. However, there were no risk-adjusted differences in postoperative complications when compared by surgical subspecialty. Esophagectomy is being performed safely by surgeons with different specialties and training pathways.

The Impact of UK Medical Students' Demographics and Socioeconomic Factors on Their Self-Reported Familiarity With the Postgraduate Training Pathways and Application Process: Cross-Sectional Study.

UK medical graduates can apply for specialty training after completing a 2-year internship (foundation training). Postfoundation training application requirements vary depending on specialty but fundamentally require key skills such as teaching, research, and leadership. This study investigated whether medical student demographics impact their self-reported familiarity with the Post-Foundation Training Pathways (PFTPs) and Post-Foundation Application Process (PFAP). This was a cross-sectional study using a Bristol Online Survey. We invited all UK medical students to answer a range of questions about their demographics. Students were then asked to rank their familiarity with PFTPs and PFAP on a scale of 1 to 5 (1=least familiar and 5=most familiar). The responses were collected between March 2022 and April 2022 and exported for further analysis. Statistical analysis was conducted in Stata (version 17.1; StataCorp) using chi-square tests. A total of 850 students from 31 UK medical schools took part. There was a significant difference between gender and self-reported familiarity with PFTPs (P<.001) and PFAP (P<.001), with male students expressing higher familiarity. Similarly, there was a difference between ethnicity and self-reported familiarity with PFTPs (P=.02) and PFAP (P<.001), with White students more likely to express higher familiarity than their Black, Asian, or Mixed Ethnic counterparts. Lastly, there was an overall difference between medical background and age and self-reported familiarity with PFTPs and PFAP (all P<.001), with students from medical backgrounds and older students being more likely to express higher familiarity. The impact of gender, ethnicity, age, and medical background on students' self-reported familiarity with PFTPs and PFAP is significant. Further studies are required to evaluate the impact of these factors on tested knowledge of PFTPs and PFAP and whether this impacts the success rate of postfoundation applications.

Pediatric Consultation-Liaison (C-L) Psychiatry Training Pathways

This perspective piece reviews the current training pathways for pediatric consultation-liaison psychiatry. Significant workforce shortages of child and adolescent psychiatry over the past 3decades have led to the creation of new training pathways between pediatrics and child and adolescent psychiatry training programs to care for children whose medical and psychiatric management has become increasingly complex. There are now several options available to receive excellent training in pediatric consultation-liaison. Efforts to foster continued interactions and shared education between adult and pediatric consultation-liaison providers are likely to be beneficial to both disciplines given the astonishing advances in technology over the years that have allowed many patients with complex childhood medical disorders to survive into adulthood today.

HPB O06 Strategy, evolution and outcomes of a ‘unit-wide’ approach to robotic surgical training – evaluation of the experience in a high-volume tertiary hepatopancreaticobiliary unit

Abstract Background Robotic surgery has been a 'slow-burning' technology in HPB Surgery in the UK, partly due to availability of robotic systems due to more rapid adoption in other subspecialties. It has also been seen as the preserve of one or two early adopters, both within units and more widely. In this study we evaluate an alternative approach to starting a robotic programme, with an a priori intent to train multiple members of the same unit following a structured process and continuous real-time outcome evaluation. Methods The training programme was structured in line with the Intuitive console surgeon training pathway consisting of online modules, simulation training and laboratory courses. Case acquisition was in line with the suggested escalation of difficulty laid out in the paper by Farrugia et al (J Robotic Surg 2022). Surgeons trained in pairs, with the order determined by robotic availability and previous minimally-invasive HPB experience. Regular robotic access was secured by agreement with other robotic specialties. A prospective database of cases was maintained and regularly interrogated to evaluate outcomes at a unit and surgeon level. Results 245 cases were performed in 18 months. Case acquisition rate was similar for all surgeons. Unit volume slowed from a peak of 21 cases/month until acquisition of a 3rd Xi system, facilitating 3 regular HPB robotic lists/week. Following this both number and complexity of cases increased. All surgeons experienced a decrease in total numbers of complex cases in the first month, which had returned to baseline at 6 months (mean 9.25 v 3.5, p&amp;lt;0.05). Overall length of stay, HDU stay and conversion rates were lower than surgeon- and case-matched historical data, with no significant increase in complication rates. Conclusions The introduction of a unit-wide robotic programme is feasible and results in better robotic utilisation. Case acquisition can be maintained for all surgeons. A possible further benefit is a greater acceptance of the need to share the caseload for open and laparoscopic cases during the learning curve. Robotic access is key to successful implementation and must be assessed before the programme begins. Outcomes at a unit- and surgeon- level can be maintained or improved regardless of the career stage of the surgeon prior to beginning robotics.

Supply and demand of hepatopancreatobiliary surgeons in the United States

BackgroundHepatopancreatobiliary (HPB) surgery requires specialized training and adequate case volumes to maintain procedural proficiency and optimal outcomes. Studies of individual HPB surgeon supply related to annual HPB case demand are sparse. This study assesses the supply and demand of the HPB surgical workforce in the United States (US). MethodsThe National Inpatient Sample (NIS) was queried from 1998–2019 to estimate the number of HPB procedures performed. To approximate the number of HPB surgeons, models based on previous HPB workforce publications were employed. We then calculated the number of HPB surgeons needed to maintain volume-outcome thresholds at current reported levels of centralization. ResultsIn 2019, approximately 37,335 patients underwent inpatient HPB procedures in the US, while an estimated 905–1191 HPB surgeons were practicing. Assuming 50% centralization and an optimal volume-outcome threshold of 24 HPB cases-per-year, only 778 HPB surgeons were needed. Without adjustment in centralization, by 2030 there will be a demand of fewer than 12 annual cases per HPB surgeon. ConclusionThe current supply of HPB surgeons may exceed demand in the United States. Without alteration in training pathways or improved care centralization, by 2030, there will be insufficient HPB case volume per surgeon to maintain published volume-outcome standards.

Developing a nurse-led salbutamol weaning pathway for children and young people with asthma or viral-induced wheeze.

Acute asthma exacerbations and viral-induced wheeze are common presenting complaints on one general paediatric ward in a tertiary children's hospital in England. An inhaled beta 2 agonist, such as salbutamol, is the first-line treatment for these children and young people and they have frequent clinician reviews for salbutamol weaning before discharge. However, the informal salbutamol weaning practices used by nurses, as well as challenges in the recruitment and retention of paediatric trainee doctors, led to the development of a nurse-led salbutamol weaning pathway as a quality improvement project. Twelve nurses completed the associated nurse-led salbutamol weaning training, education and competency package and subsequently completed a questionnaire exploring their perceptions of the effect of the training package and pathway. After the training, all respondents reported feeling more confident in assessing the salbutamol requirements of children with wheeze. All of the respondents also felt that the introduction of the pathway and training would improve patient care and the confidence of children and young people, parents and carers in nurses' ability to assess children's salbutamol requirements. Time constraints were identified as a potential barrier to implementation of the pathway.

Abstract 023: Early Medical Student Introduction to Interventional Neurology: Integrating Neuroendovascular Simulation to Foster Engagement

Introduction Interventional Neurology (IN) is a rapidly expanding field, with new devices and techniques broadening the range of cerebrovascular diseases that can be treated (1). Despite this, medical students are not commonly exposed to IN either during their preclinical years or neurology clerkship. Other reports have indicated significant interest in IN through neurology residency despite a poorly structured pathway to the career (2). There remains a paucity of educational focus on endovascular specialties among medical schools; simulation‐based approaches present an opportunity to address this (3‐5). We piloted an engaging didactic and hands‐on Mentice® Neuroendovascular simulation seminar to increase awareness and interest in IN. Methods Through the Student Interest Group in Neurology (SIGN) at Emory School of Medicine, we recruited 20 students (55% M1, 5% M2, 30% M3, 10% M4; 50% female) to participate in an IN didactic and simulation seminar. Before and after the seminar, participants were administered a 28‐question survey regarding their knowledge of and interest in a career in IN. All participants provided consent. A didactic session led by a fellowship trained Interventional Neurologist and a simulation session including 3 stations: diagnostic angiography, thrombectomy, and aneurysm coiling. All participants rotated at all 3 stations and all questions were answered. Results The survey was broken into subjective and objective questions regarding student interest, familiarity, and knowledge of IN. The subjective questions were recorded on Likert scales from 1‐5 while objective questions focused on endovascular procedures and their indications. Exposure to IN was limited; 70% of medical students reported no formal exposure to the field. Prior to the event, only 30% of students were interested or very interested (4 or 5 on Likert scales) in a career in IN compared to 50% post‐survey. 20% of students felt familiar or very familiar with the field prior to the seminar compared to 50% post‐survey. More students recognized the training pathways to Neurointervention (Radiology, Neurosurgery, and Neurology), could name at least 3 IN procedures, and showed improved knowledge of basic IN treatments and pathology after the event. Conclusion Interventional Neurology remains a relatively new field and is often not included in traditional medical student curriculums, even at sites where training occurs within a Comprehensive Stroke Center. Our survey demonstrated the lack of knowledge and comfort level regarding IN amongst medical students. Uniquely curated seminars targeted at medical students can lead to an increase in awareness and interest in IN (6‐8). Early exposure has been shown to increase recruitment and dispel erroneous assumptions about the specialty (4). We believe these survey results show the importance of incorporating lecture and simulation based IN procedures for medical students, especially those interested in procedural specialties. Increasing students’ knowledge of IN also provides a better understanding of career options in neurology and the extent of therapeutic options a neurologist can offer patients (2,4).

Making change: the new principles of the World organization of general medicine (Wonca 2022) and territorial medicine in Italy.

The new european declaration "Core values and principles of general practice and family medicine" (Wonca Europe 2022) has been recently issued: which contributions can it provide to the discussion on the future of primary health medicine? And what challenges and changes would it impose in its application to the contexts of medical training, care services and clinical research in Italy? We analyse here the seven principles and values of the new declaration: 1) person-centred care; 2) continuity of care; 3) cooperation in care; 4) community-oriented care; 5) equity in care; 6) science-oriented care; 7) professionalism in care; and through them we reflect on the announced reforms of primary health care (Phc) policy. Indeed, these provide an important basis for a critical discussion regarding the reform of the primary care model, the evolution of the medical training pathway (pre- and post-graduate and therefore towards an adjustment of the specialty pathway of future general practitioners) and research Phc. Considering that the Phc health policies are experiencing a condition of permanent and apparently uncontrollable change, it is well to ask ourselves how and if these values-principles, which are considered fundamental at an international level, will be able to come to life in order to build a new therapeutic trust, specific to general practice and family medicine, both in the professional and disciplinary sphere.

Skills Alignment for Lifelong Learners in Higher Education: Smart Catalogues for Reskilling and Upskilling Pathways

The future of work and the ever-changing skills demand in the labour market has been a constant debate and pressing challenge for higher education institutions (HEI’s), governments and industry. In the current context, HEI’s must increase the transformational effect of education on people’s employability, on organizations’ competitiveness and on society’s progress. This paper presents the design and development of a mock-up career guidance tool to empower lifelong learners through digital reskilling and upskilling. We discuss the methods used for designing a skills alignment tool and a smart catalogue for identifying stackable training pathways in two specific disciplinary domains. The skills alignment methodology features a skill gap analysis (SGA) in the occupational domains of Data Science and Chemistry, linked to the evolution and demand of the European labour market through an ESCO compatible tool. The smart program catalog presents the necessary program information to facilitate the creation of stackable training pathways. Considerations are made for the importance of virtual career guidance tools for lifelong learners as we face the ever-changing demand of the labor market and as we continue to embrace online education, micro-credentialing and the digital transformation of higher education.

Untutored training pathway to achieve competence in esophagogastric endoscopic submucosal dissection in a Western center

Background and AimsEndoscopic submucosal dissection (ESD) has a long learning curve. We aimed to assess the efficacy of an ESD unsupervised training model for experienced endoscopists. MethodsStepwise training included visit to high-volume center, unsupervised training on an ex-vivo porcine model and in-vivo human upper GI cases with anatomical progression. Performance measures: en-bloc resection, R0 resection, complication rates and operative time. ResultsFollowing observation of 30 esophago-gastric ESDs and 15 un-tutored ex-vivo ESDs, five human cases of distal gastric ESDs were performed, followed by 55 unselected esophago-gastric cases. En-bloc and R0 resection rates were 93.0% and 80.7%, respectively. Operative time was 14.0 min/cm2 in stomach and 25.1 min/cm2 in esophagus, with evidence of learning curve for esophageal ESDs (first block 30.26 vs second block 14.81 min/cm2, p=0.01). ConclusionsUn-tutored training for esophago-gastric ESD is feasible and allows endoscopists, experienced in therapeutic endoscopy, to achieve the required standards towards competency.