Year Of Residency Research Articles

Impact of Subsequent Fellowship on Urology Chief Resident Case Log Volumes.

To characterize the impact of subsequent fellowship on the case log experience of trainees throughout their residency and specifically their chief resident year. Urology resident case logs from 2010 to 2022 were obtained from 13 institutions for total residency and chief years. Five categorized index procedures were included for analysis: General Urology; Endourology; Reconstructive Urology; Urologic Oncology; and Pediatric Urology. Subsequent fellowship data (yes/no and type) were available for 338. Regression models analyzed the interactions of case log volumes and subsequent fellowship RESULTS: Of the 338 residents, 141 (42%) went onto practice and 197 (58%) completed a fellowship including 53 in oncology, 44 in reconstruction, 43 in endourology, 29 in pediatric, and 28 in another nonindexed domain. A total of 419,353 cases were logged during training, including 125,319 (30%) during the chief resident year. The median number of total cases completed per resident increased irrespective of subsequent fellowship. Conversely, the median number of total cases completed during chief year declined with the slope of decline being significant in those residents not completing a fellowship [slope = -2.44, CI: (-4.66, -0.23), p-value = 0.031]. Temporal trends demonstrated that absence of subsequent fellowship was associated with decrease in chief resident cases across all index domains (p for all < 0.001). The specific type of fellowship, however, had no association with chief year trends. The median number of chief resident cases has declined, most significantly in those trainees not pursuing a fellowship, possibly reflecting a focus on urology encounters which are not captured in ACGME logs.

P1250 Spondyloarthritis before and after inflammatory bowel disease diagnosis and risk factors: a temporal trends analysis in a population-based cohort

Abstract Background Axial and peripheral spondyloarthritides (SpA) and inflammatory bowel disease (IBD) are immune-mediated diseases with overlap in clinical and immunological features. However, temporal correlation of SpA and IBD in individual patients is not well characterized. Methods We conducted a nationwide population-based study between January 1, 1998 and July 31, 2022 to determine SpA prevalence before, and incidence after IBD diagnosis. Using ICD-10 codes in cross-linked Danish registers, we identified all residents with IBD diagnosis between January 1, 2006 and July 31, 2014 as well as controls matched 1:5 on age, sex, calendar year, and municipality of residency. We determined the odds ratios of SpA in the IBD group in the preceding years. Using adjusted Cox regression analysis, we determined the hazard ratios of new-onset SpA following IBD diagnosis in the proceeding years. Results Of 111,696 individuals included in the study, 18,616 (16.7%) were diagnosed with IBD. The prevalence of SpA was higher in IBD cases relative to matched controls (Figure). The aOR of SpA among those who later developed IBD, UC, or CD, compared to matched controls, was 1.98 (95% CI 1.81, 2.17), 1.67 (95% CI 1.49, 1.87) and 2.76 (95% CI 2.37, 3.21), respectively, in the 8-year period preceding IBD diagnosis. The odds of SpA were highest in the 2 years preceding IBD diagnosis. Among those with IBD, UC, and CD, compared to those without IBD, the aHR of new-onset SpA was 2.47 (95% CI 2.30, 2.65), 2.18 (2.00, 2.37), and 3.20 (95% CI 2.84, 3.60), respectively. When stratifying the IBD effect of SpA on sex and age, both females and the age group 8-45 years had higher risks for SpA following IBD diagnosis, when compared to male and older age groups, respectively. Conclusion In a population-based cohort, we demonstrate that the odds of SpA diagnosis are increased at least up to 8 years preceding IBD diagnosis and are highest 2 years preceding IBD diagnosis. SpA risk is increased among those with IBD, particularly among women and young adults. These clinical associations can improve early diagnosis and treatment of both IBD and SpA.

P1087 Opioid Use Before and After Ulcerative Colitis Diagnosis: A Nationwide Cohort Study in Sweden 2006-2021

Abstract Background Opioid misuse has been declared in the US since 2017 [1]. Population-based studies to describe opioid use among adults with ulcerative colitis (UC) are scarce [2]. This study aimed to evaluate patterns of opioid use two years before and up to five years after UC diagnosis date among adults with UC compared to reference individuals in Sweden. Methods We conducted a nationwide cohort study including individuals aged ≥18 years with an incident UC diagnosis between 2008 and 2019, identified through two International Classification of Disease 10 code K51 recorded in the National Patient Register. Each patient with UC was matched with up to 10 reference individuals without inflammatory bowel disease (IBD) by birth year, sex, calendar year, and place of residence. Observation started on January 1, 2006, age 18, or 24 months before the first UC diagnosis date (index date), whichever came last, and ended at emigration, death, or December 31, 2021. Data on opioid dispensations were obtained from the Prescribed Drug Register. Opioid use was defined as ≥1 dispensed opioid prescription per six-months periods. We categorized opioids as weak (codeine combinations, tramadol, dextropropoxifen) and strong (oxycodone, morphine, hydromorphone, fentanyl, buprenorphine, tapentadol, petidine). Opioid use during 24 months before the index date was classified as non-use (no dispensations), intermittent use (≥1 dispensation in 1–3 of the four preceding six-month periods), or chronic use (≥1 dispensation in all four six-months periods). Mean daily doses (MDD) of opioids were calculated using oral morphine equivalents. Opioid use prevalence and MDDs were reported with 95% confidence intervals. Results The cohort included 20,265 patients with incident UC (48.7% female) and 185,973 reference individuals. At the index date, 2.4% of UC patients and 1.4% of reference individuals chronically used opioids, while 15.0% and 11.1% used opioids intermittently. Among patients with UC, opioid use increased right after the index date to 12.0% and stabilized at approximately 10% thereafter (Figure 1). The use of stronger opioids increased after diagnosis, while the use of weak opioids remained unchanged (data not shown). The MDD of opioids among patients with UC increased from 0.75 mg (0.60 mg in the reference group) at 18-24 months before the index date to 1.45 mg (0.65 mg in the reference group) at 54-60 months post-diagnosis. Conclusion Overall prevalence of opioid use among adults with UC increased only modestly following diagnosis, with a shift toward using stronger opioids. The main limitation of this research was the inability to account for illegal opioid use, which may result in underestimating the use of opioids among the reference group.

P1253 Temporal Trend of Opioid Prescriptions Among Adults with Ulcerative Colitis: A Nationwide Cohort Study in Sweden 2008-2021

Abstract Background The rising opioid misuse and related mortality led the US government to declare opioid use as a public health emergency in 2017 [1]. Population-based studies on opioid use in Ulcerative Colitis (UC) are scarce [2]. The aim of this study was to describe the time trend of opioid use among adults with UC compared to the general population in Sweden. Methods We conducted a nationwide cohort study including individuals aged ≥18 years with a UC diagnosis, identified via two ICD-10 code K51 registrations in the National Patient Register. Each patient with UC was matched with up to 10 reference individuals without inflammatory bowel disease (IBD) by birth year, sex, calendar year, and place of residence. Observation started on January 1, 2008, at age 18, or the date when the UC diagnosis definition was fulfilled (whichever came last) and ended at emigration, death, or December 31, 2021 (whichever came first). Data on opioid dispensations were obtained from the Prescribed Drug Register. Opioid use per calendar year was defined as ≥1dispensed opioid prescription. We categorized codeine combinations, tramadol, and dextropropoxifen opioids as weak and oxycodone, morphine, hydromorphone, fentanyl, buprenorphine, tapentadol, and petidine as strong. Annual prevalence estimates of opioid use were calculated, and joinpoint analysis was performed to explore the trend and to estimate annual percent change (APC) of opioids. Results The cohort included 59,983 patients with UC (47.4% female) and 539,505 reference individuals. Cancer diagnoses within two years prior to the index date were observed in 1.1% of UC patients and 0.7% of reference individuals, while psychiatric disorders were identified in 3.8% and 3.6%, respectively. During the observation period, UC patients had a higher prevalence of opioid use compared to reference individuals. The Joinpoint analysis revealed three distinct periods (Figure 1): slightly increasing from 2008-2014, followed by decreasing trends during 2015-2018 (APC: -2.45) and 2019–2021 (APC: -5.20). As shown in Figure 2, the prevalence of any annual opioid use among UC patients declined from 15.5% in 2008 (compared to 9.5% for reference individuals) to 13.0% in 2021 (8.0% for reference individuals). Conversely, strong opioid use among UC patients increased from 3.0% to 9.0% over the study period, compared to a rise from 1.0% to 4.0% among reference individuals. Conclusion Opioid use among UC patients in Sweden showed a modestly decreasing trend since 2015 similar to that in the general population. The main limitation of this research was the inability to account for illegal opioid use, which is likely to underestimate the use of opioids among the reference group.

P1221 Microscopic colitis and risk of venous thromboembolism: A nationwide matched cohort study

Abstract Background Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, have been associated with an increased risk of venous thromboembolism (VTE). However, data on VTE is lacking in large population-based cohorts of microscopic colitis (MC). We aimed to investigate the association between MC and VTE. Methods We included all Swedish adults (≥18 years) with MC without previous VTE (1990-2017, n=12,489, follow-up until 2021). MC and subtypes (collagenous colitis and lymphocytic colitis) were defined from prospectively recorded colorectal histopathology reports from all 28 pathology departments in Sweden. MC patients were matched for age, sex, calendar year and county of residence with up to five reference individuals (n=55,809) without MC or previous VTE from the general population. Sensitivity analyses included full sibling comparisons and stricter definition of VTE requiring a primary diagnosis of VTE. Incidence rates and multivariable-adjusted hazard ratios (aHRs) with 95% confidence interval (CI) were calculated using Cox proportional hazards modelling. Results Over a median of 10.0 years of follow-up, 755 (6.0%; 11.3/1000 person-years [95%CI 10.5-12.1]) VTE events occurred in individuals with MC and 2674 (4.8%; 8.6/1000 person-years [8.3-8.9]) in reference individuals. Individuals with MC had a higher overall relative risk of any VTE event compared with reference individuals (aHR 1.21 [1.11-1.32]), including higher risk of pulmonary embolism (aHR 1.23 [1.08-1.40]), deep vein thrombosis of the legs (aHR 1.16 [1.03-1.32), and other VTE events (aHR 1.31 [1.08-1.58]). Compared to full siblings, individuals with MC showed numerically, but statistically non-significant, higher relative risk of VTE (aHR 1.15 [0.98-1.35]). Restricting the outcome definition to VTE diagnoses recorded as the primary diagnosis, the estimate of any VTE event was similar for MC overall (aHR 1.26 [1.15-1.39]). In the stratified analyses of VTE there were no major differences in sex, age group, follow-up time, year of MC diagnosis, country of birth, and presence/absence of celiac disease diagnosis at the index date. Conclusion In this population-based study, individuals with MC had a 21% higher risk of VTE compared with reference individuals from the general population, equal to one extra VTE event for every 37 MC individuals followed for ten years.

Assessment of knowledge, practice, and barriers regarding neonatal pain care among pediatrics and pediatric surgical residents at a Tertiary Hospital, Addis Ababa, Ethiopia

Background: The growing knowledge in medicine has shown newborns can feel pain and that treating pain has benefits for the neonates in the short- and long-term. Despite the presence of expert consensus on neonatal pain scoring methods, neonatal pain remains unnoticed and under treated. Among others, effective pain management requires that the physicians caring for neonates be well informed, keen-eyed and amenable to ensure that neonatal pain care is multi-tiered and multifaceted. Objective: To assess the knowledge, practice and barriers regarding neonatal pain management among pediatric and pediatric surgical residents at Tikur Anbesa Specialized Hospital. Methods: Institution based cross sectional study using a self-administered questionnaire was employed from June 01- July 15, 2020 among all pediatrics and pediatric surgical residents. Data was analyzed using SPSS version 26.0 software. One way ANOVA was used to determine differences in means. Statistical, significance was set at p≤0.05. Results: Response rate was 96 % (104 out of 108 participants). The maximum and minimum score for the knowledge questions were 10 and 4 out of 10 respectively. The mean (SD) knowledge score was 8.5 (±1.4). Only 15.8% of residents reported using neonatal pain assessment tools on daily practice. The frequency of analgesia and non-pharmacologic measures for common neonatal procedures were sub-optimal and varied with the procedure. One-way ANOVA found no significant difference in neonatal pain care by specialty, knowledge status, experience, and residency year (P&gt;0.05). Most residents cited inadequate staff training (88.4%), absence of local neonatal pain guidelines (87.4%), and lack of pain assessment (63.2%) as barriers to optimal neonatal pain care. Conclusion: Despite the high knowledge score achieved by most of the residents, the use of analgesia and comfort measures for common neonatal procedures were not optimal, indicating a need for supervised practical application.

The impact of resident involvement and postgraduate year on head and neck surgery for obstructive sleep apnea.

To assess the impact of resident involvement and resident postgraduate year (PGY) on head and neck obstructive sleep apnea (OSA) surgical outcomes. We analyzed head and neck OSA surgeries from 2005-2012 via the National Surgical Quality Improvement Program database. Demographic, preoperative, and postoperative variables were analyzed via multivariate regression to determine the impact of resident involvement and resident PGY on 30-day outcomes. Of 975 surgeries, 234 (24.0%) involved a resident: 120 (51.3%) involved a junior (PGY 1-3) resident and 114 (48.7%) involved a senior (PGY 4-5) resident. Multivariate analysis showed no significant impact on surgical, medical, or overall complication rates with resident involvement (all p > 0.05). Likewise, after separation of involved residents into junior or senior cohorts based on PGY, neither junior nor senior resident involvement significantly increased the odds of medical, surgical, or overall complications compared to operations performed by the attending alone (all p > 0.05). Resident involvement significantly increased readmission rates (6.1% versus 1.4%, p = 0.041) and operation time (92.1 ± 59.9 minutes versus 53.6 ± 42.0 minutes, p < 0.001) when compared to cases without resident involvement. Resident involvement in OSA surgery does not significantly impact rates of surgical medical, or overall complications. However, resident involvement increases 30-day readmission rates and almost doubles operation time, suggesting that resident involvement in head and neck OSA surgery remains relatively safe but further efforts to improve efficiency are likely needed.

Doing Less Later: Seniorization of General Surgery Resident Operative Experience in the Entrustable Professional Activities at Veterans Affairs Hospitals.

Identify changes in general surgery resident autonomy and resident postgraduate year (PGY) level in Entrustable Professional Activity (EPA) cases over time. Retrospective cohort study. United States Veterans Affairs (VA) hospital system, 2004 to 2020. All patients undergoing operations in any of the 12 general surgery EPAs with identifiable operative components captured by the VA Surgical Quality Improvement Project database from 2004 to 2020. 452,549 cases were identified. Between 2004 and 2020, there was a 61.4% decrease in resident-performed cases and a 14.3% decrease in attending-assisted cases, with a concomitant 51.8% increase in attending-performed cases. All EPAs experienced a statistically significant decrease in resident autonomy over the study period, and a net transfer of cases from resident-performed to attending-performed. About 7 of 12 EPAs had significant increases in the resident PGY level of attending-assisted cases over the study period: abdominal wall hernia, benign/malignant breast, benign/malignant colon, cutaneous/subcutaneous neoplasm, gallbladder disease, inguinal hernia, and soft tissue infection. About 3 EPAs had significant increases in the resident PGY of resident-performed cases: abdominal wall hernia, benign/malignant breast, and inguinal hernia. Many of these changes represented seniorization of the operative experience by 3 to 12 months. There has been a continual decrease in resident operative autonomy across all general surgery EPAs at the VA. Furthermore, many EPA cases have shifted to more senior residents over time, delaying or deferring autonomous completion of these cases during training. Although these data were drawn from the VA system, the results likely reflect a continued decrease in autonomy for resident surgeons in other settings as well. As general surgery adapts to a competency-based educational model, action is needed to stabilize these changes for sustainable graduate surgical education.

The prevalence of musculoskeletal pain, and the risk factor among the residents; a cross-sectional study

Background: A considerable number of resident doctors experience musculoskeletal pain during their residency years. In this study, we seek to determine the prevalence of musculoskeletal pain, as well as its associated risk factors, among a sample of resident doctors. Methods: A cross-sectional study was conducted in the Internal Medicine Department of the Faculty of Medicine, with a total of 200 residents participating in filling in the paper-based questionnaire. Standardized Nordic Questionnaire, a modified version was utilized in our study. Results: The questionnaire was completed by 200 residents. They were between the ages of 24 and 29 years old, and females were (73%). (54%) of all of them had at least one musculoskeletal pain site in the previous week, while (86%) had at least one musculoskeletal pain site in the last year. On multivariate analysis, factors associated with musculoskeletal pain in the previous week and last year were a familial history of musculoskeletal pain (p = 0.0029) (p = 0.0002), respectively, and a history of trauma (p ≤ 0.001). Conclusion: Musculoskeletal pain had a high prevalence among these residents, especially females, those with a history of trauma, and those with a family history of musculoskeletal disorders. This major health problem should be known to medical institutions, and awareness programs are required, in addition to future multicenter and larger studies.

Morbidities and comorbidities associated with optic nerve hypoplasia and septo-optic-pituitary dysplasia.

To quantify optic nerve hypoplasia (ONH) and septo-optic-pituitary dysplasia (SOD) morbidities and comorbidities. A retrospective population-based study with a case-control design was undertaken using administrative health data from Manitoba, Canada. Cases were 124 patients with ONH or SOD (70 males, 54 females; age range 6 months-36 years 8 months [mean 13 years, SD 7 years 2 months]) diagnosed from 1990 to 2019, matched to 620 unrelated population-based controls (350 males, 270 females; age range 0-36 years 8 months [mean 12 years 5 months, SD 7 years 2 months]) on birth year, sex, and area of residence. Additionally, 76 cases with ONH or SOD (46 males, 30 females; age range 2 years 5 months-36 years 8 months [mean 13 years 11 months, SD 7 years 3 months]) were matched one-to-one with sibling controls (40 males, 36 females; age range 7 months-33 years 1 month [mean 11 years 8 months, SD 7 years 3 months]). We used χ2 or Fisher's exact tests to test for differences in prevalence in morbidities and comorbidities between cases and controls; odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Cox proportional hazards models were used to test for differences in subgroups of cases; hazard ratios and 95% CIs were estimated. Visual impairment and visual impairment with hypopituitarism were core morbidities associated with ONH and SOD cases respectively compared to unrelated controls (OR = 58.6, 95% CI = 22.5-152.5; OR = 243.4, 95% CI = 32.9-1799.0 respectively). Developmental delay or intellectual disability (OR = 6.9, 95% CI = 3.3-14.4), autism spectrum disorder (OR = 4.0, 95% CI = 2.0-8.3), epilepsy (OR = 14.9, 95% CI = 6.1-36.5), cerebral palsy (OR = 40.9, 95% CI = 14.0-119.6), and mood or anxiety disorders (OR = 1.7, 95% CI = 1.0-2.8) were the comorbidities more common among cases with ONH and SOD. Cases matched to siblings showed similar results except for mood and anxiety disorders. Visual impairment and visual impairment with hypopituitarism are the main morbidities in patients with ONH and SOD respectively, while developmental delay or intellectual disability, autism spectrum disorder, epilepsy, cerebral palsy, and mood or anxiety disorders are important comorbidities.

Knowledge, Attitude, and Perception Toward Evaluation of Acute Heart Failure Among Emergency Medicine Residents in Riyadh, Saudi Arabia.

Acute heart failure (AHF) poses significant challenges in clinical practice due to its varied clinical presentations and complex management strategies. Adequate confidence levels among medical residents in diagnosing and managing AHF are crucial for timely and effective patient care. This cross-sectional study aimed to assess medical residents' knowledge, attitude, and perception levels in diagnosing and managing AHF and explore factors influencing their confidence levels. A total of 52 medical residents from various specialties participated in the study. Based on different clinical parameters, participants completed a questionnaire assessing their confidence levels in diagnosing AHF. Descriptive statistics were used to summarize confidence levels, while chi-square tests explored associations between demographic/clinical factors and confidence levels. The majority of residents exhibited high confidence levels in diagnosing heart failure (HF) based on history and physical examination findings alone (22 (42.3%) and 16 (30.8%), respectively). However, confidence levels were lower when relying solely on laboratory tests and imaging modalities for diagnosis (17 (32.7%) and 18 (34.6%), respectively). Factors such as symptoms (e.g., dizziness) and availability of ultrasound equipment were associated with higher confidence levels (p < 0.05). However, demographic factors such as age, gender, and residency year did not significantly influence confidence levels (p > 0.05). Our study highlights variations in confidence levels among medical residents in diagnosing and managing AHF. While clinical assessment remains paramount, targeted educational interventions focusing on interpreting diagnostic tests and imaging findings are warranted to enhance residents' confidence levels and improve patient care.

The changing structure of the Lichia amia subpopulations captured by angling in the Zandvlei Estuary, Cape Peninsula, South Africa

The Lichia amia subpopulations of the Zandvlei Estuary were sampled using fly fishing from January 2010 to December 2016. A bloom of Prymnesium parvum decimated the ichthyofauna of Zandvlei in 2012. The mass–length relationship for the pre-bloom data is similar to that developed for L. amia elsewhere in South Africa. Length frequency data in conjunction with the date of capture show seasonal variations in the composition of the sample population. These two factors were used to divide the subpopulation into three components: (i) fish with fork lengths from 400 mm FL to 700 mm FL were present in the sample throughout the year; (ii) fish with < 400 mm FL, regarded as the latest recruits, were absent from the sample between August and February; and (iii) fish with > 700 mm FL, were caught mostly during the months of February to May. These large fish are thought to have matured sexually and leave Zandvlei in late May to join the eastward migration to spawning grounds. The subpopulation growth rate is greater than 20 mm/month in the first year of residence but declines to 10 mm/month or less in their last year.

Workforce Analysis of Laryngologists in the United States Between 1993 and 2022.

This study queries the US laryngology workforce geographic distribution and density and models laryngology workforce trends through 2050. A national database of fellowship-trained laryngologists (FTLs) and nonfellowship-trained laryngologists (nFTLs) practicing primarily laryngology was formed by identifying laryngologists via internet search, with validation by regional laryngologists and senior laryngologists on this manuscript. Demographic variables included residency and/or fellowship graduation year, institutional affiliation, and practice zip code. US Census Bureau population data and projections were grouped by hospital referral region (HRR), as defined by the Dartmouth Healthcare Atlas. The National Resident Matching Program (NRMP) provided annual fellowship match data from 2012 to 2022. As of May 2023, there were 349 active laryngologists in the United States, including 303 FTLs. The median practice length for all laryngologists was 11 years. HRRs with the largest number of laryngologists were Manhattan, Boston, and Los Angeles, with 23, 16, and 14 respectively. One hundred and ninety-four of 306 (63%) HRRs did not have an active, primary laryngologist. The national median density of people per laryngologist including HRRs with at least one laryngologist was 645,160. Assuming a 35-year practice horizon prior to workforce exit and holding the 2018-2022 NRMP average of 18 fellows constant, the number of forecasted laryngologists by 2040 would be 568-an increase of 66%. To date, no comprehensive database of practicing US laryngologists nor laryngology workforce forecast exists. Based on current benchmarks, the laryngology workforce would increase by 66% by 2040, ideally addressing the current dearth of laryngologists in low-density areas. NA Laryngoscope, 2024.

Migration-related risk of psychosomatic disorders in socially healthy young adults who experience significant emotional and mental loads

BACKGROUND: There is a paucity of scientific literature investigating the potential correlation between the geographical distance between an individual's initial and final place of residence and the risk of psychosomatic disorders in those experiencing significant emotional and mental loads. AIM: To develop an integrative index for the assessment of the risk of psychosomatic disorders in young adults who are changing their place of residence. MATERIAL AND METHODS: The study included medical students at the Volgograd State Medical University (97 males and 99 females between the ages of 18 and 22 years). The proportion of non-residents was 44% (45 respondents) of males and 60% (61 respondents) of females. The cross-sectional study was performed during the spring examinations in June 2023, i.e., at 9 months after the start of the academic year and change of residence by non-resident students. The symptoms of psychosomatic disorders were identified using the Gurvich Psychological Adaptation Test. The Giessen Subjective Complaints List and the Hospital Anxiety and Depression Scale (HADS) were used to report somatic symptoms and anxiety/depression, respectively. The severity of suicidal ideation was assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS). The geographical distance (km) between an individual's initial and final place of residence distances was calculated. RESULTS: A direct, statistically significant correlation has been identified between the severity of psychosomatic disorders and the distance travelled by young adults migrating from their place of previous residence to their final destination. The potential for migration-related risk of medical conditions is classified into four categories based on geographical distance intervals: up to 20 km, up to 400 km, up to 800 km, and over 800 km. The critical values of the migration-related risk of psychosomatic disorders have been calculated for males and females. The most significant risk factor for the onset of psychosomatic disorders in young adults is the geographical distance between their current place of residence and their previous place of residence, with a range of 400 to 800 km. CONCLUSION: The correlation between the geographical distance between an individual's initial and final place of residence and the risk of psychosomatic disorders in those in those experiencing significant emotional and mental loads has been described.

Assessment of Ophthalmology Residency Training in Switzerland: A Trainee-Based Survey.

This study aimed to evaluate the current status of ophthalmology residency training in Switzerland and provide insights for enhancing training programs. The survey covered demographic data such as gender, age, workplace, and year of residency, as well as working conditions, current practical and diagnostic skills, interest in scientific work, and future plans. It consisted of 16 multiple choice questions (MCQ), 5 multiple select questions (MSQ), 8 free-text, 6 Net Promoter Score (NPS), and 4 Likert scale questions. All Young Swiss Ophthalmologists (YSO) members received an invitation to participate in the survey using an online form. All collected data were anonymized, and participants provided their consent for data collection, analysis, and publication. The survey assessed the perspectives of 63 Swiss ophthalmology residents on their training experiences. Respondents indicated the greatest interest in specializing in cataract and vitreoretinal surgery, followed by cornea, glaucoma, refractive surgery, and lid surgery. They also expressed a great need for improved supervision, structured curricula, and alignment of clinical and research duties. While pursuing additional surgical training and private practice autonomy, residents also expressed a preference for balanced workloads that emphasize patient care over full-time academic work. The survey indicates a need to standardize ophthalmology residency training in Switzerland to ensure comprehensive and uniform education. It also highlights specific areas for improvement, such as the absence of surgical training. Ongoing assessments are necessary to evaluate future developments.

Clinical Reasoning and Knowledge Assessment of Rheumatology Residents Compared to AI Models: A Pilot Study.

Background: The integration of artificial intelligence (AI) in medicine has progressed from rule-based systems to advanced models and is showing potential in clinical decision-making. In this study, the psychological impact of AI collaboration in clinical practice is assessed, highlighting its role as a support tool for medical residents. This study aimed to compare clinical decision-making approaches of junior rheumatology residents with both trained and untrained AI models in clinical reasoning, pre-diagnosis, first-line, and second-line management stages. Methods: Ten junior rheumatology residents and two GPT-4 models (trained and untrained) responded to 10 clinical cases, encompassing diagnostic and treatment challenges in inflammatory arthritis. The cases were evaluated using the Revised-IDEA (R-IDEA) scoring system and additional case management metrics. In addition to scoring clinical case performance, residents' attitudes toward AI integration in clinical practice were assessed through a structured questionnaire, focusing on perceptions of AI's potential after reviewing the trained GPT-4's answers. Results: Trained GPT-4 outperformed residents across all stages, achieving significantly higher median R-IDEA scores and superior performance in pre-diagnosis, first-line, and second-line management phases. Residents expressed a positive attitude toward AI integration, with 60% favoring AI as a supportive tool in clinical practice, anticipating benefits in competence, fatigue, and burnout. Conclusions: Trained GPT-4 models outperform junior residents in clinical reasoning and management of rheumatology cases. Residents' positive attitudes toward AI suggest its potential as a supportive tool to enhance confidence and reduce uncertainty in clinical practice. Trained GPT-4 may be used as a supplementary tool during the early years of residency.

The Social Impact of Sports Habits on Sustainable Tourism Perceptions: A Case Study in Alt Urgell

This study examines the relationship between residents’ sports habits and their attitudes toward sustainable tourism in the rural region of Alt Urgell. Recognizing the importance of physical activity for health and well-being, this research aims to understand how regular participation in outdoor sports influences perceptions of sustainable tourism and how demographic factors moderate this relationship. A quantitative survey was conducted with a sample of 416 residents, achieving a 95% confidence level and a 4.8% margin of error. Inferential statistical analysis revealed significant correlations between sports habits and attitudes toward sustainable tourism. Results highlight slight differences in perception between genders, with men showing stronger support for community-driven economic initiatives. Variations based on years of residency were observed, with long-term residents expressing greater concern for sustainability. Participation in outdoor sports and attendance at sports events positively influenced perceptions of sustainable tourism. While some hypotheses were confirmed, others were rejected, indicating complexities in the relationship between sports habits and sustainable tourism perceptions. This study concludes by emphasizing the need for targeted educational interventions and inclusive policies to promote sustainable development in the region and suggests directions for future research to further explore these dynamics.

Medical Communication Training: The Effect of Gender and Experience and Goals of Care Discussions.

Communication skills are increasingly recognized as a crucial component of medical training; however, little is known about the efficacy of various training methods when considering diverse student backgrounds, such as gender and prior training experience (ie, year of residency). This study explores medical learners' perceptions of effective communication in conducting goals of care (GOC) discussions with patients after receiving communication training as well as assessing for differences in preparedness for GOC discussions by gender and prior training experience. This study included a sample of 114 residents in either their first, second, or third year of Internal Medicine residency. Participants took part in the communication training and completed pre- and postsurveys on perceived effectiveness in GOC discussions. We used multivariate analyses to examine residents' perceptions of preparedness as defined by residents perceived effectiveness of care, confidence in having GOC discussions with patients, confidence in making recommendations that align with patient values, and the perceived value of GOC training. We found that after communication training, most residents, regardless of gender or year of residency, felt more effective in having healthcare conversations with patients and making GOC healthcare recommendations. The effect of training was statistically significant when considering either interaction with gender or year of residency. We have also discovered statistically significant differences in the experiences of male and female residents when it comes to engaging in GOC discussions, based on their prior training in medical school. Female participants reported an increased frequency of practicing GOC discussions between years 2 and 3, whereas male participants reported the increase occurring between years 1 and 2. The study shows that the same curriculum is effective for residents at each level of training, but more research on the interaction effect between prior training and gender is needed.

Exploring the quality of life of pediatric trainees: Mixed-method explanatory design.

Healthcare workers are at a higher risk of burnout. The aim of the study was to explore the professional quality of life (QOL) i.e. {Compassion Satisfaction (CS), Burnout (BO) and Secondary Traumatic Stress (STS)} and association of different trainee factors on QOL amongst Pediatric specialty trainees at a private tertiary care hospital in Karachi, Pakistan. By using a mixed methods explanatory design, pediatric trainees experience of the prior year was measured in 2019 and 2020 through a predefined scale at Aga Khan University Hospital, Professional Quality of Life (ProQOL), followed by focused group discussions. Mean sums of CS, BO and STS were the primary measures assessed and the associations of different trainee factors were to explore experiences of Pediatric trainees towards the residency program, themes and subthemes were created after focused group discussions. We surveyed a total of 118 pediatric responses (n=60 and n=58) during two years.Trainees from both years showed similar moderate level for mean sum of scores for all three components; CS, BO and STS. No significant association was observed with gender, place of living or year of residency. Opinions and perceptions of the trainees in qualitative analysis revealed both positive and negative impacts on the quality of life of the trainees. This study delves into the professional quality of life and offers valuable understanding into the specific events encountered by trainees.

Medical Resident Perceptions of Distress during Training.

This study used a qualitative research approach to grounded theory to identify factors that contributed to resident distress during 2021-2022 in multiple different specialties and at different postgraduate years of residency. By better understanding these contributors to distress, the aim was to inform the design of optimal interventions to reduce burnout and other emotional distress. The residents enrolled in this study completed a demographic survey and semistructured interview. Interviews were recorded and transcribed. Data analysis included developing codes inductively, grouping codes into categories, and describing themes. Recruitment continued until data analysis indicated theoretical saturation/sufficiency had been reached. A qualitative research approach to grounded theory was used to identify themes and relationships among themes to better understand how the sources of distress affected the trainees of various specialties and postgraduate levels of training. Thirty-three participants (15 medical-based, 9 hospital-based, and 9 surgical-based residents) participated in interviews between 2021 and 2022. Seven themes described sources of distress and potential ameliorating factors: workload, support and community, culture, resident outlook, institutional resources, work-life balance, and coronavirus disease 2019. The grounded theory highlights that these factors can collectively influence work-life balance and distress. The findings of the grounded theory qualitative analysis were used to examine ways to better mitigate the sources of distress that the residents enrolled in this study described. As institutions strive to diminish distress among residents, they can consider opportunities to assess environmental factors and design targeted interventions for their institutions or programs.