Young Doctors Research Articles

Online medical consultation in China: Demand-side analysis of obese patients' preferences and willingness-to-pay for online obesity consultations.

With obesity a major health concern and call on healthcare resources in China, we explored the preferences and willingness to pay (WTP) for obesity OMC, including the influencing factors behind WTP and preferences. We recruited 400 obese participants to undertake a discrete choice experiment (DCE) and the contingent value method (CVM) survey. We used CVM to measure obese participants' WTP for one-click services (OCS) and used DCE to estimate obesity participants' preferences and WTP for OMC with different attributes. Obese participants were willing to pay more than RMB80 on average for OCS, and more than 50% of participants had a WTP over RMB50 and 5% had a WTP over RMB300, reflecting the strong willingness of Chinese obese patients to pay for OMC. Educational background, income, ethnicity, previous OMC experience and accessibility to offline hospitals with different levels impacted WTP. The relative importance score of attributes in descending order was cost, doctors' hospital level, doctors' level, online waiting time, consultation time and consultation form. Obese patients preferred lower cost, doctors from higher-level hospitals, doctors with higher expertise levels, shorter waiting time and consultation duration, and telephone consultation were preferred. 30-min waiting time, 15-min consultation duration and telephone consultation were the most economically efficient set we found. To maximize health resources, provincial tertiary and municipal hospitals face different paths to developing obesity OMC platforms. We encouraged young doctors to use OMC. OMC regulators should implement consumer protection policies to optimize OMC pricing and address potential 'unfair' pricing.

How can we help doctors stay in rural areas of Japan? A comparison in medical students' attitudes toward general practice and clinical research of a medical school in Japan and in Sweden.

In Sweden, primary healthcare centers play an important role in the performance of general practice, education, and clinical research. In Japan, general physicians or general practitioners are expected to be more active in the small-scale hospitals and clinics in rural areas. This study aimed to explore the differences in attitudes toward general practice and clinical research among medical students in Japan and Sweden to present solutions to help doctors stay in rural areas of Japan. This cross-sectional study was conducted at two medical schools in Japan and Sweden in 2018, using an anonymous and self-administered questionnaire survey that comprised 16 items including 9 items on clinical research. Participants were 154 medical students (response rate: 69.4% for 222 students) in Japan and 56 (27.1% for 201 students) in Sweden. The proportion of medical students who wanted to become general physicians was greater in Japan than in Sweden (Japan:Sweden=36.4%:17.9%; P=0.012). Although fewer Japanese students wanted to conduct research in rural areas than Swedish students (43.5%:57.1%; P<0.001), the positive proportion of Japanese students working in clinical research and/or taking an academic degree in rural areas was greater than that of Swedish students (52.0%:23.2%; P=0.032). As Swedish medical students and young doctors learn considerably from primary healthcare centers, their attitudes toward clinical research are more developed than those of their Japanese counterparts. However, more Japanese medical students than Swedish students wish to become general practitioners, and they are likely to strive to conduct clinical research at small-scale hospitals/clinics in rural areas. Therefore, the improvement of the clinical research environment in small-scale hospitals and clinics in rural areas is needed at the earliest in Japan.

Problems of adaptation of young doctors in the beginning of their careers at the primary health care

Problems of adaptation of young doctors in the beginning of their careers at the primary health care

The lighthouse in the medical ocean－growth record from a freshman student to a young doctor

The lighthouse in the medical ocean－growth record from a freshman student to a young doctor

New advances in pediatric nephrology: ESPN 2023 results

On September 28 — October 1, 2023, the European Society for Paediatric Nephrology (ESPN) 55th Annual Meeting was held in Vilnius, Lithuania, where new achievements in the world of pediatric nephrology were presented. The program included 66 sessions with reports, continuing medical education courses, 117 invited speakers, meetings of working groups on various issues of pediatric nephrology were held, about 450 abstracts were printed and 292 poster presentations were discussed, inclu­ding two by authors from Ukraine. Courses for young doctors, preparing them for the international exam, and 5-minute reports by well-known specialists became interesting in the organization of continuing medical education, which significantly increased the amount of presented material. Among the innovative approaches in pediatric nephrology, the following drugs have been considered: finerenone (a selective non-steroidal mineralocorticoid receptor antagonist), sparsentan (an angiotensin/endothelin receptor antagonist) for Alport syndrome, focal segmental glomerulosclerosis, IgA nephropathy, dapagliflozin (a sodium-glucose cotransporter 2 inhibitor) for chronic kidney disease and pioglitazone for proteinuria. New approaches have been introduced: to IgA nephropathy — proteinuria control with angiotensin-converting enzyme inhibitors (ACEi), tonsillectomy, rituximab, eculizumab; to focal segmental glomerulosclerosis — plasmapheresis, rituximab (CD20), ofatumumab (CD20), abatacept (CD80/86), belatacept (CD80/86), daratumumab (CD38); to membranous nephropathy — proteinuria control with ACEi, rituximab, calcineurin inhibitors, glucocorticoids, cyclophosphamide; to membranoproliferative glomerulonephritis — proteinuria control with ACEi; to C3 glomerulopathy — proteinuria control with ACEi, eculizumab. Specific provisions of the BK polyomavirus (BKPyV) guidelines were considered, in particular, monthly screening for BKPyV-DNAemia in blood plasma is suggested until month 9, then every 3 months until month 24, after which additional screening every 3 months until the end of the third year after transplantation in pediatric kidney recipients (C, weak). In pediatric patients with stable renal function and high BKPyV-DNAemia, despite reduction in immunosuppressive therapy, we suggest consideration of renal allograft biopsy, as creatinine elevation may be decreased in children with significant renal involvement, including rejection (A, strong).

Nascent Entrepreneurial Behaviour Among Medical Students in Malaysia: The Role of Sociodemographic Factors

Entrepreneurship is a viable option for young doctors looking for careers beyond patient care. Nascent entrepreneurial behaviour is said to predict future entrepreneurship. To understand whether medical students possess an entrepreneurial spirit, this research aimed to assess nascent entrepreneurial behaviour among students at a private medical school in Malaysia and the sociodemographic factors influencing it. A quantitative approach with a cross-sectional survey design was employed. The data were collected from 318 medical students selected by a disproportionate stratified random sampling technique. The respondents rated their nascent entrepreneurial behaviour on a 13-item selfadministered questionnaire. The responses obtained were analysed using descriptive and inferential statistical tests. Medical students in Malaysia showed moderately low levels of nascent entrepreneurial behaviour. Among the sociodemographic factors, gender and marital status significantly influenced nascent entrepreneurial behaviour among the medical students. The year of study, ethnicity and family income were insignificant. The low level of nascent entrepreneurial behaviour among medical students in Malaysia implies that they are likelier to be job seekers than job creators. Therefore, higher education institutions across the globe need to foster entrepreneurial values in all students, irrespective of their chosen field of study. An understanding of the sociodemographic factors that influence nascent entrepreneurial behaviour will help policymakers plan remedial steps to inculcate an entrepreneurial mindset among medical students.

AI-augmented clinical decision in paediatric appendicitis: can an AI-generated model improve trainees' diagnostic capability?

The utilisation of the AiPAD model in diagnosing paediatric appendicitis has significant potential to improve trainees' diagnostic accuracy, approaching the level of an expert supervisor. This hybrid approach combining AI and expert knowledge holds promise for enhancing diagnostic capabilities, reducing medical errors and improving patient outcomes. • Sharpening clinical judgement for pediatric appendicitis takes time and seasoned exposure. Traditional training leaves junior doctors yearning for a faster path to diagnostic mastery. • AI-generated models unlock the secrets of expert intuition, crafting an explicit guide for juniors to rapidly elevate their diagnostic skills. This leapfrog advancement empowers young doctors, democratizing medical expertise and paving the way for brighter outcomes in clinical training.

Examination Approaches to Brachial Plexus Injury for Neurosurgical Residents.

Brachial plexus injury is a severe peripheral nerve injury that affects the upper extremities and causes functional damage and disability. A detailed and accurate clinical examination is required to accurately localise the site of injury. This video manuscript aims to provide guidelines for the structured assessment of a patient with brachial plexus injury, specifically tailored to Malaysian medical students and trainees. A video demonstrating the examination of the brachial plexus was made. This video, created at the School of Medical Sciences at Universiti Sains Malaysia (USM), demonstrates the proper examination technique for brachial plexus. We hope that this video will help students and young doctors evaluate patients with brachial plexus injury and reach accurate localisation of the injury.

Improving Postgraduate Medical Training In Germany: A Proposal

Postgraduate (vocational, residency) training in Germany is regulated by the Physicians' Chamber in each federal state. Although training requirements are specified in detail by regulatory documents, young doctors are left on their own to find training posts and suitable learning experiences. There are no programmes in place to support trainees nor to identify the need of the health care system regarding the composition of its medical workforce. Hospitals and practices pay salaries to physicians in training from funding obtained for services they provide. We propose a systematic and continuing process of identifying gaps in the workforce. Disciplines with a lack of qualified doctors will be supported by additional funds directed to practices and hospitals. Regional rotation schemes will coordinate and improve the quality of training. Apart from an administrative overhead, this system of regulation will not need additional resources because a limited part of current budgets will be explicitly channelled into salaries for trainees in specialties for which there is a higher need than into others.

Save the Saviors: How to Minimize Sudden and Premature Death Among Doctors?

During the past few years, the sudden death of young medical processionals in India shocked the entire ophthalmic fraternity. One of the most important reasons is overwork, stress, lack of physical activity, and lack of regular health checkups. Young and middle-aged doctors are in a critical period of their family and professional career development. Not only do they hope to make breakthroughs in clinical services as well as academic research, but they also face pressure from patients and their families. The escalation of contradictions between doctors and patients has also become an increasing mental burden in the practice of many medical professionals. We suggest that each and every ophthalmologist/doctor should take responsibility for his/her own health. Medical professionals/ophthalmologists should regularly perform aerobic exercise or connect with families and friends for support instead of excessive smoking and drinking. Besides, regular medical checkups of blood pressure, blood sugar, ECG, echocardiography, etc) effectively detect and decrease the risk of potential diseases such as diabetes, coronary artery disease, hypertension, and stroke. Government, non-government organizations, medical/ophthalmic societies, and media should help to improve the working environment and re-establish doctor-patient trust, which may further decrease the sense of”stress/burnout” for doctors. A change of lifestyle and healthy work-life balance – adding yoga, exercise, and meditation to reduce stress, maintain quality eating, and maintain body weight can save many young doctor/ophthalmologist lives.

Health system barriers to timely routine measles vaccinations in rural southwest China: a qualitative study on the perspectives of township vaccination professionals and village doctors

ObjectivesA well-functioning health system ensures timely routine measles vaccinations for age-appropriate children, minimising measles risk. However, there is limited knowledge about the impact of the performance of immunisation programmes in...

Who is Facing Higher Increased Demand After the Online-Offline Channel Integration? Evidence from Public Hospitals in China.

In recent years, the medical industry has been significantly impacted by internet technology, especially with the growing integration of online and offline channel within public hospitals. Our study aims to explore the effects of hospitals' online-offline channel integration on doctors' offline visits and investigate how the effects of integration varied across doctors with different professional titles. Our study employs a panel dataset from a large comprehensive hospital in China and conducts staggered difference-in-differences (DID) approach. We find that online-offline channel integration within public hospitals is associated with about 15.5% increase in offline visits, and the 1% growth of monthly number of online visits is associated with about 10.6% monthly offline visits increase. Furthermore, our results indicate that the effectiveness of online-offline channel integration is more pronounced for doctors with lower professional titles compared to those with higher professional titles. Our study provides evidence for policymakers and hospital managers that integrating online and offline channels can optimize the distribution of medical personnel resources within public hospitals. We recommend that young or less-experienced doctors actively participate in hospital-operated online platforms to enhance their professional skills through practical experience.

Informal consultations: a case report of a young doctor as a patient

Introduction: Informal consultations are medical acts characterized by the individual's self-referral to a doctor, without clinical record or adequate follow-up. Despite controversy, this practice is an integral part of medical culture. This case report highlights the importance of understanding the consequences of informal consultations and the desirability of a preventive attitude towards one’s own health. Case description: A 28-year-old female health professional requests an informal consultation due to low-back pain after two months of evolution where a tentative diagnosis and treatment plan were brainstormed. Symptom aggravation led her to a formal ortho-traumatology consultation, whereupon she was definitively diagnosed with a herniated lumbar disc, and a treatment plan was discussed and implemented, with good outcomes. Commentary: This case reveals the complexity of clinical communication and psychosocial context involving informal consultations. Healthcare professionals are particularly susceptible to belittling signs and symptoms, using informal consultations to tackle the clinical situation quickly and be able to work, but without really addressing the underlying problem.

Phase de consolidation (docteur junior) en oncologie–radiothérapie en France : état des lieux et perspectives

PurposeThe last year of the radiotherapy oncology internship in France has become a phase of empowerment, called “junior doctor”, allowing interns to validate acts previously reserved only for senior doctors. This study focused on the responsibilities given to the first promotion of junior doctors in France and their feelings on this new status. Material and methodsA cross-sectional survey was carried out by the French associations of interns and young doctors in oncology, Aerio and SFjRO. A questionnaire was sent to the class referents of each city for transmission to the junior doctors of the year 2021–2022 from September 1st to November 30th, 2022. The questions concerned training, the modalities of this year and the feelings. Responses were analyzed anonymously using R. 4.3.1 software. ResultsFor radiation oncology, 33 responses were obtained from 21 cities. For most junior doctors, three to four localizations (51%) were performed with an average of five new patients per week. The contours were reviewed either systematically (51%) or only at the beginning (32%). Dosimetry was reported as never countersigned in 19%; 80% of junior doctors described having been the only radiation oncologist during multidisciplinary staff meetings. The two main areas of improvement were theoretical training (45%) and legal frameworks/contracts (42%). ConclusionThese results relating to the first class of junior doctors showed an overall agreement with the recommendations of the Cnec. Feedback from interns was positive. The supervision of brachytherapy and dosimetry activities, the presence alone in multidisciplinary panel remained points of vigilance.

5.N. Round table: Violence against healthcare workers: why it is a policy issue and how to respond effectively?

Abstract Background Violence against healthcare workers increased sharply during the COVID-19 pandemic, and this trend seems to continue. This development is exacerbating workforce stress and healthcare workers’ physical and mental health risks. The attacks are not limited to the workplace and have spilled-over to social media and the private sphere. A transsectoral and multi-professional governance approach may help us to better understand the complexity and different forms of violence. Four major target groups and forms of violence can be identified for non-conflict settings. These include attacks against frontline healthcare workers and migrant and minority groups, and gender-based or sexual violence. The threats go beyond the individual healthcare worker and affect healthcare and the retention of the workforce and, finally, the institutions of the healthcare state, their representatives and the humanitarian values of societies. Objectives This panel workshop aims to critically discuss violence against healthcare workers as both a public health crisis and a political problem. The goal is to highlight the need for action and explore policy solutions. We argue that public health can and should play an important role in raising awareness and improving the prevention of violence and the protection of healthcare workers. Public health provides an appropriate framework and policy platform for connecting different stakeholder groups and establishing coordination across sectors, professional groups, and policy areas. The workshop adds new evidence and burning questions to the healthcare workforce debate: (1) What do we know about violence, and how do frontline healthcare workers experience the threats? (2) What do healthcare workers need, and what is known about existing policy responses? (3) How can we raise awareness of the problem and stand up against violence? (4) What can management and policy do, and how can they join forces? The panel opens with an introduction by the organisers, including a brief overview of the problem and the presentation of a comprehensive framework for research and governance action. Then two important frontline professional groups, young doctors and paramedics, provide deeper insights into the day-to-day experiences and threats. Reflections on the policy solutions from an international perspective of management (EHMA) and policy (WHO Europe) follow. The moderated panel sets the scene for an interactive discussion with the audience in the second part. The workshop connects key stakeholders in the field and explores new solutions to respond more effectively to violence against healthcare workers and to build connections to the broader ‘Time to Act’ healthcare workforce debate. Key messages • Violence prevention must become a health policy and management priority to improve individual protection and wellbeing, as well as the retention of the healthcare workforce. • Action against violence towards healthcare workers must be taken on all levels of governance and against all forms of violence, including gender-based and racialised violence. Speakers/Panelists Michelle Falkenbach European Observatory on Health Systems and Policies, Brussels, Belgium Matthias Bonigut University Hospital, Ludwig Maximilian University of Munich, Munich, Germany Ellen McCourt European Junior Doctors, Brussels, Belgium George Valiotis European Health Management Association, Brussels, Belgium Tomas Zapata WHO/Europe, Copenhagen, Denmark

The scope of psychosocial factors among resident physicians and their links to occupational burnout

Abstract Background High work demand, low authority and decision-making latitude and constantly changing situations put residents’ physicians under increased pressure, causing burnout resulting in reduced workability and wellness. The awareness of the most critical factors is crucial for the development of preventive occupational interventions to reduce burnout and stress. Methods A cross-sectional study was conducted. Data were collected with the Job Content Questionnaire (JCQ) and Copenhagen Burnout Inventory (CBI) from 233 hospital resident physicians. Results The descriptive analysis showed that the psychosocial work environment was negative in the resident physicians’ population - about a third (35.5%) of respondents had low job skill discretion and 40% complained about weak decision-making authority therefore 45% were classified as having low job control. More than one-third (39.1%) of respondents had high job demands and about a quarter had weak co-worker and supervisor support (24.9% and 24.5% respectively) and 37% felt insecure at work. The statistical analysis showed a high frequency of personal (PB), work-related (WB) and client-related burnout (CB) - 53.6%, 62.2%, and 33% respectively. The multiple stepwise regression models for each burnout dimension revealed that job skill discretion was found to have a buffering effect and reduced personal and work-related burnout odds by an average of 12% and 16% respectively. Each one-unit increase in job demands score increased the probability of all burnout dimensions by an average of 9% (PB), 13% (WB) and 18% (CB). The increase in scores of insecurity at work increased the probability of PB (B = 1.2) and CB (B = 1.3). The co-workers’ support reduced the probability of CB by 20%. Conclusions The result of this study indicated that promoting job skills discretion and co-workers’ support and reducing job demands and insecurity at work could be the most effective way to reduce occupational burnout among young physicians. Key messages • Physicians residents are particularly vulnerable to occupational burnout. • In solving the issue of professional burnout among young doctors, the focus must be directed to ensuring work control and optimizing workload.

Convolutional-neural-network-based radiographs evaluation assisting in early diagnosis of the periodontal bone loss via periapical radiograph

Background/PurposeThe preciseness of detecting periodontal bone loss is examiners dependent, and this leads to low reliability. The need for automated assistance systems on dental radiographic images has been increased. To the best of our knowledge, no studies have quantitatively and automatically staged periodontitis using dental periapical radiographs. The purpose of this study was to evaluate periodontal bone loss and periodontitis stage on dental periapical radiographs using deep convolutional neural networks (CNNs). Materials and methods336 periapical radiographic images (teeth: 390) between January 2017 and December 2019 were collected and de-identified. All periapical radiographic image datasets were divided into training dataset (n = 82, teeth: 123) and test dataset (n = 336, teeth: 390). For creating an optimal deep CNN algorithm model, the training datasets were directly used for the segmentation and individual tooth detection. To evaluate the diagnostic power, we calculated the degree of alveolar bone loss deviation between our proposed method and ground truth, the Pearson correlation coefficients (PCC), and the diagnostic accuracy of the proposed method in the test datasets. ResultsThe periodontal bone loss degree deviation between our proposed method and the ground truth drawn by the three periodontists was 6.5 %. In addition, the overall PCC value of our proposed system and the periodontists’ diagnoses was 0.828 (P < 0.01). The total diagnostic accuracy of our proposed method was 72.8 %. The diagnostic accuracy was highest for stage III (97.0 %). ConclusionThis tool helps with diagnosis and prevents omission, and this may be especially helpful for inexperienced younger doctors and doctors in underdeveloped countries. It could also dramatically reduce the workload of clinicians and timely access to periodontist care for people requiring advanced periodontal treatment.

Medical ethics and compliance amongst physician groups: a self-assessed survey in a hospital in Southeast Nigeria.

Being a doctor remains a moral enterprise as he is expected to make some medical decisions based on ethical principles during encounter with patients. The objective of this study was to investigate the knowledge and application of medical ethical principles amongst physician groups in a Hospital in Enugu, Nigeria. This was a cross-sectional self-assessed study conducted amongst medical doctors in five specialty groups in a teaching hospital in Enugu, Nigeria.Descriptive and inferential statistics were used to summarize the items and determine whether significant differences on knowledge and application of medical ethics existed amongst the physician groups in the treatment of patients. Observance and compliance with medical ethical conduct was highest among doctors that were aged 55 years and above. In sex, male doctors had higher ethical conduct compliance than female doctors. Comparing the doctors by rank, medical officers, consultants and senior registrars respectively had the highest ethical conduct. Knowledge and practice of medical ethics were mostly deficient among younger Nigerian and female doctors. Remedying the situation will require better curricula both at the undergraduate and post-graduate medical school programmes for doctor trainees. Requiring certification in bioethics for license renewal will also help in resolving and improving the knowledge gap.

Health beyond clinical protocol: institutional traps and limitations of modern medicine

The article is aimed to describe the ineffective health care mechanisms and find ways to overcome them. Some variants of institutional dysfunctions (or institutional traps) in medical practice are considered. The resort to natural methods of healing and self-healing is regarded as a way to overcome various institutional dysfunctions. The work combines several qualitative methods: a non-standardized survey of experts (doctors), included observation (25 years of work as a doctor and independent use of natural healing methods for the past 12 years), and analysis of documents, literary sources and messages on the topic of self-healing in relevant Facebook groups. The themes of the talks with doctors were health self- management and alternative healing practices (intensive physical exercises, medical fasting, and breathing exercises). During conversations with the doctors found that only some senior doctors have positive experience of using therapeutic fasting and breathing exercises (both personal and clinical), and young doctors who have been working in medicine for over 10-20 years are not familiar with these methods ("because this treatment is not carried out according to the approved clinical protocols”, and “we treat according to modern protocols"). The most problematic points of the use of such health practices and the reasons for their increase in society are discussed. It is concluded that both in the institutional and ideological aspect, the essential component of the public health institute should be outside the scope of official medicine, which is aimed at the use of medicinal and high-tech means of treatment and prevention.

Promoting South Asian primary care research and projecting family medicine practitioner-scholars: A matter of critical importance

ABSTRACT South Asia, constituting India, Pakistan, Bangladesh, Nepal, Sri Lanka and Bhutan represents the most populous region in the world burdened with significant multilevel poverty. Primary care is well-documented to reduce the burden of diseases (both chronic and acute) and associated morbidity and mortality; be cost-effective and improve health outcomes and health equity for both individuals and populations. Any field, for it to stay relevant and to effectively achieve its stated mission, needs to produce its own knowledge through research. This translates into patient care, practice models, education, and advocacy for health systems strengthening and reform. In primary care, weaving experiential wisdom with clinical evidence lies at the heart of translation. In this editorial, we highlight: a) that local context, in terms of geography, community, culture, language and beliefs, influences the clinical context and practice and therefore research. Thus, relying on primary care research done elsewhere in the globe will not suffice; b) effective primary care is based on a generalist approach that involves certain ways of being, knowing, perceiving, and doing guided by the values of humility and intellectual curiosity, diversity and inclusion, equity, holistic approach to evidence, integrity, transparency, accountability and adaptability, and communication; and c) that the South Asian Region (SAR) has a number of groups experimenting and innovating with various healthcare delivery systems, much of which is not known to the larger field. The WONCA SAR Primary Care Research Network has been set up to facilitate and support scholarship, writing, and publication in primary care especially by practising family physicians. In conclusion, it will be critical to simultaneously promote grounded theory research that integrates both the family medicine/primary care perspective and the voices of families and address the ‘hidden curriculum’ that shapes the attitudes and aspirations of young doctors at both the undergraduate and postgraduate level. Family Physicians treat a variety of patients on a daily basis, in order to improve the quality of care and impact of primary care, it is imperative that the understanding and application of research is enhanced by specialists of this discipline.