Young Physicians Research Articles

P1023 Variability in Mesalazine Management for Ulcerative Proctitis Include Doses, Route of Administration and Use of Fecal Calprotectin: Insights from Clinical Practice Across Spain Beyond Clinical Guidelines

Abstract Background Despite universal use of mesalazine in ulcerative colitis treatment, many aspects of clinical practice remain unclear or are not even addressed in clinical guidelines, leading to significant variations in mesalazine management among clinicians. We aimed to gather different approaches of mesalazine use in ulcerative proctitis (UP). Methods After discussion of a clinical case, a predefined questionnaire was anonymously answered throughout a series of meetings held at 10 different locations in Spain. Results were categorized according to experience levels and inflammatory bowel disease (IBD) focus. Results 259 IBD treating gastroenterologists were engaged; 84% had <10 years of experience and 25% had a specific focus on IBD. Most participants (84%) manage UP based on clinical symptoms (i.e. fecal urgency). In case of a clinically moderate-severe UP, 81% would initiate treatment with high dose of combined mesalazine, while 11% proposed only suppositories. 60% of participants would assess response at 4 weeks. If clinical remission achieved, 85% would use fecal calprotectin (FC) to assess deep remission. Upon initial failure of combined mesalazine treatment at standard dose, 59% attempt optimizing mesalazine doses, while 38% add beclomethasone dipropionate. Younger physicians without specific focus on IBD prefer modifying mesalazine doses (70.5% vs 37.1%), (P=0,006), whereas more experienced physicians with monographic dedication prefer adding beclomethasone dipropionate (60% vs 29.4%), (P=0,006). For maintenance therapy (oral or topical mesalazine) the most important drivers in therapeutic decision-making were severity of the initial flare (40%) and patient preferences (36%). After a moderate-severe flare of UP, 80% would recommend maintenance therapy with high dose oral mesalazine and 3 suppositories/week. For monitoring, less experienced physicians and those not working in IBD units more frequently relied only on clinical parameters (26.6% vs. 8.7%, p=0.01), using FC to a lesser extent (73% vs. 88%, p=0.1) compared to more experienced and IBD focused physicians. In the case of elevated FC in asymptomatic patients, 49% would prefer to scope, while 47% increase mesalazine dose directly. The preferred high dose of mesalazine was 4g (55%) or 4-5g (44%). 73% would not reduce the dose upon achieving remission. Only 75% actively investigate therapeutic adherence. Conclusion Management of mesalazine in UP patients is highly heterogeneous, and clinical guidelines do not address all issues arising in clinical practice. Nevertheless, clinicians in our setting often use high oral and rectal mesalazine doses for both induction and maintenance and they commonly monitor patients using FC.

Barriers and Facilitators in Continuous Medical Education Related to Allogeneic Stem Cell Transplantation: A Qualitative Study of Physicians

Introduction: This study explored qualitatively, in a sample of German hematologists working in clinical allogeneic hematopoietic stem cell transplantation (alloHSCT), perceptions of barriers and facilitators to participate in continuous medical education (CME), to provide detailed information on how to improve participation in CME activities related to alloHSCT, which may also be applicable to other areas of medicine. Methods: Based on a recruitment campaign of the German Association for Hematopoietic Stem Cell Transplantation (DAG-HSZT), 21 semi-structured telephone interviews were conducted, transcribed, and analyzed using framework analysis. Results: Three clusters of barriers were identified that explain why alloHSCT physicians may or may not participate in CME: individual constraints (e.g., better networking, young physicians being overwhelmed by the complexity of alloHSCT), structural constraints (e.g., time and financial issues, tailoring CME courses according to the targeted audience), and content-related constraints (e.g., requirement of CME sessions, provision of an overview of CME courses, more flexible offers). We discuss the ten most frequently raised issues, including the use of incentives and the need for support at the start of residency, staff shortages, and requirements for learning sessions. Conclusion: There is a need for a paradigm shift in CME related to alloHSCT toward a more individualized and needs-based approach. Close monitoring of residents’ needs and learning progress, as well as feedback systems, could help identify appropriate CME courses that should be integrated into a tiered learning system. CME should be more targeted to specific audiences (i.e., residents, fellows, and attendees) to provide training that is tailored to individual CME needs. On-demand courses can help balance work and family obligations. Finally, peer-reviewed, up-to-date information platforms should be expanded.

Sichtweisen einer Stichprobe überwiegend jüngerer Ärztinnen und Ärzte zum ärztlich-assistierten Suizid

ZusammenfassungHintergrundAm 26.02.2020 hat das Bundesverfassungsgericht den § 217 StGB, der die geschäftsmäßige Förderung der Selbsttötung unter Strafe stellte, für nichtig erklärt. Seitdem wird eine mögliche gesetzliche Neuregelung diskutiert. Ziel dieser Studie war es, Wissen, Erfahrungen und Einstellungen jüngerer Ärztinnen und Ärzte zur Suizidassistenz zu untersuchen.MethodenVon November 2022 bis März 2023 wurde eine quantitative Umfrage in Fortbildungskursen zur Notfallmedizin, Intensivmedizin und Hämatologie durchgeführt und deskriptiv ausgewertet.ErgebnisseInsgesamt wurden 1163 Datensätze (Rücklaufquote 82,1 %) ausgewertet. 90,8 % der Befragten hatten bereits Sterbende betreut. 62,3 % befürworteten eine Suizidassistenz nur bei Menschen in palliativen Behandlungssituationen, 20,1 % befürworteten Suizidassistenz unabhängig vom Gesundheitszustand des Menschen. 33,1 % wurden bereits um Suizidassistenz gebeten. 3,3 % hatten persönlich bei einer Suizidassistenz mitgewirkt. 71,0 % kannten den Inhalt des Bundesverfassungsgerichtsurteils zum § 217 nicht, 72,0 % waren über die Gesetzesvorschläge zur Neuregelung des assistierten Suizids nicht informiert. 66,4 % sahen Ärztinnen und Ärzte als die richtigen Ansprechpartner, um über die Zulässigkeit eines Suizidwunsches zu entscheiden.DiskussionDie Untersuchung zeigt, dass jüngere Ärztinnen und Ärzte einen deutlichen Unterschied in ihrer Haltung zur Suizidassistenz zwischen Menschen ohne Vorerkrankungen und solchen in palliativen Behandlungssituationen machen. Weitere Untersuchungen über die Ursachen der häufigen Unkenntnis der normativen Grundlagen sind notwendig. Die Ergebnisse legen nahe, dass mehr Aufklärungsarbeit über Suizidalternativen und palliativmedizinische Versorgungsmöglichkeiten geleistet werden muss.

The Road Well Traveled: Making Choices, Ensuring Progress While Heeding the "Clarion Call".

The career path of everyone is quite unique based on the goals and the choices we make, and success can take time to unfold. My career choices have been greatly influenced by remarkable mentors and opportunities. Reciprocally I have had the pleasure, as a faculty member, department chair, and medical school dean to mentor promising young physicians and scientists to launch successful careers. We need to continue to attract physicians and scientists to academic medicine to ensure that our field continues to innovate and improve the lives of our patients. To influence positive change, we must stay relentlessly focused and have faith that success will come.

Prevalence of sexual dysfunction and pursuit of sexual medicine evaluation among male physicians-a survey.

We sought to characterize the prevalence of sexual dysfunction and barriers to treatment among male physicians. Between June and December 2022, male physicians were invited to complete a questionnaire regarding sexual function. Surveys were disseminated electronically via social media and professional medical societies using Qualtrics (Provo, UT). In totla, 235 responses were included in the final analysis. The mean age of respondents was 36.3 ± 7.4 years (range 23-72). 27 (11.5%) reported having seen a doctor for sexual health. Of these 27, 40.7% saw a physician for erectile dysfunction, 29.6% for low libido, 22.2% for premature ejaculation, 7.4% for delayed ejaculation, and 33.3% for other concerns. An additional 29 (12.3%) considered establishing care for sexual issues but didn't, mostly due to being too busy. 46 (19.6%) respondents reported having taken medication to improve erectile function. Therefore, in a cohort of young male physicians, 23.8% had seen or considered seeing a doctor for sexual health concerns, and nearly 1 in 5 had taken medication for erectile dysfunction. Male physicians appear to be at higher risk for sexual dysfunction than the general population and face significant and unique barriers in access to care for sexual dysfunction.

Leadership in ophthalmology training : Opportunities and risks of medical specialist education.

Medical specialist training requires constant improvement and adaptation of the contents to the current situation. Nowadays, young physicians have the opportunity to select among the most renowned institutions and can choose the one most qualified for their training. Hospitals on the other hand still have the desire to recruit highly qualified physicians for their resident programs, which requires agood, well-rounded and reliable offer by the department under good leadership. Thus, among other issues amodern and multilingual homepage is already an important instrument for successfully addressing applicants and winning them over for the department. In addition to awell-planned and structured training plan (e.g., the "Homburg Curriculum") and aso-called "resident guide", many other additional offers are nowadays part of asuccessful training, such as structured internal and external specialist training courses, well thought out research concepts available to all interested parties, wet labs for practical exercises on pig's eyes and as the latest most innovative addition, avirtual reality simulator. Due to astructured curriculum with regular continuous education during the daily early morning meetings and an exchange program with another university eye hospital, not only the residents can benefit but ultimately also the department itself. In addition, future specialists are involved in the respective organization (so-called "service teams") from the very beginning. This conveys agreat deal of knowledge and expertise but also organizational skills and thus improves the quality of training. In any case, standardized residency training with aview beyond the horizon, which is transparently organized and reliably carried out, improves the quality of training in order to become acertified ophthalmologist and increases the satisfaction of the residents. Adepartment which is committed and can offer awide range of services will benefit from motivated and satisfied employees in agood interpersonal climate, which in the end benefits not only the team but also the patients.

The Social Construction of Interpersonal Trust in Therapeutic Relationships between Young Adults and Physicians in Cameroon

Trust is a fundamental and key component of all interpersonal relationships, and most especially of therapeutic relationships between patients and physicians. Anchored within a social constructionist theoretical framework and employing a qualitative study approach, this study which engages 350 participants sought to investigate the socially embedded nature of trust as it occurs in therapeutic relationships between young adult patients and physicians, and to identify the cognitive and affective elements that interact to build trust. Going further from social trust, the warrant for trust generally given to physicians in virtue of their training and accreditation, the encounter between the young adult patient and the doctor during consultation and treatment, produces an on-going and interactive relationship in which impressions are created, expectations of technical and interpersonal competencies of the individual physician are either met or contradicted, and interpretations are formed as the basis for behaviour and attitudes. Trust emerges as a product of social interaction, and it allows the patient to take the ‘leap of faith” at the point of vulnerability where all uncertainties are suspended.

Scale Development for "Great Research Mentors" and Its Relationship to Mentees' Psychological Burnout in Young Physician Researchers.

Fostering the research skills of young physician scientists is essential to increase the level of medical research in Japan. We aimed to clarify the mentor characteristics associated with a decreased risk of mentees' psychological burnout. A task team comprising medical doctors, researchers, nurses, and other healthcare professionals developed 35 items related to the characteristics of research mentors. In 2015, we recruited 258 physician researchers who were awarded a new Grant-in-Aid for Young Scientists between 2014-2015 and asked them to score 35 items on a five-point Likert scale. We developed a large research mentor scale using factor analysis and investigated which characteristics (i.e., domains) of the developed scale would be associated with a decreased level of psychological burnout measured by the Copenhagen Burnout Inventory. Maximum likelihood factor analysis with varimax rotation found three domains with 16 items. The three domains were labeled "Building a good trust relationship" (6 items, Cronbach's alpha = 0.889), "Mentorship in research" (6 items, alpha = 0.853), and "Established and authorized mentor" (3 items, alpha = 0.882). Multivariate linear regression models demonstrated that "Mentorship in research" was inversely associated with personal burnout (PBO) (beta = -6.25, p = 0.014) and work-related burnout (WBO) (beta = -4.76, p = 0.029); and "Building a good trust relationship" was inversely associated with client-related burnout (CBO) (beta = -4.91, p = 0.014). A great research mentor may be encouraged to have mentorship in research and a trusting relationship with mentees for mental health support.

Response to the urgent need to train family doctors in geriatrics : residency in long term care facilities

Family doctors have to provide the geriatric cares needed by an aging population. In particular, the increased complexity of care needs in the population living in long term care facilities (LCTF) raises several challenges. One of these challenges is the adequate training of physicians working in LCTF as well as the next generation. Residency programs in LTCFs for future general practioners has demonstrated their value abroad. We describe here the creation of a residency program in LTCF for family doctors in Canton Vaud. Since its beginning in 2020, the program has not only trained young physicians but has also improved interprofessionality and strengthened the training of other healthcare professionals.

Mentoring in a hospital setting: where do we stand?

Mentoring has long been a cornerstone of medical training, facilitating knowledge transfer and supporting the professional progression of learners. Today, it could play a crucial role in the professional fulfillment of young doctors navigating an increasingly complex and demanding hospital environment. However, current mentoring programs appear under-powered and hampered by significant organizational challenges. This article describes existing mentoring formats, assesses their strengths and weaknesses and suggests strategies to enhance traditional models and better address the contemporary needs of young physicians.

Building and validating an artificial intelligence model to identify tracheobronchopathia osteochondroplastica by using bronchoscopic images.

Given the rarity of tracheobronchopathia osteochondroplastica (TO), many young doctors in primary hospitals are unable to identify TO based on bronchoscopy findings. To build an artificial intelligence (AI) model for differentiating TO from other multinodular airway diseases by using bronchoscopic images. We designed the study by comparing the imaging data of patients undergoing bronchoscopy from January 2010 to October 2022 by using EfficientNet. Bronchoscopic images of 21 patients with TO at Anhui Chest Hospital from October 2019 to October 2022 were collected for external validation. Bronchoscopic images of patients with multinodular airway lesions (including TO, amyloidosis, tumors, and inflammation) and without airway lesions in the First Affiliated Hospital of Guangzhou Medical University were collected. The images were randomized (4:1) into training and validation groups based on different diseases and utilized for deep learning by convolutional neural networks (CNNs). We enrolled 201 patients with multinodular airway disease (38, 15, 75, and 73 patients with TO, amyloidosis, tumors, and inflammation, respectively) and 213 without any airway lesions. To find multinodular lesion images for deep learning, we utilized 2183 bronchoscopic images of multinodular lesions (including TO, amyloidosis, tumor, and inflammation) and compared them with images without any airway lesions (1733). The accuracy of multinodular lesion identification was 98.9%. Further, the accuracy of TO detection based on the bronchoscopic images of multinodular lesions was 89.2%. Regarding external validation (using images from 21 patients with TO), all patients could be diagnosed with TO; the accuracy was 89.8%. We built an AI model that could differentiate TO from other multinodular airway diseases (mainly amyloidosis, tumors, and inflammation) by using bronchoscopic images. The model could help young physicians identify this rare airway disease.

Position paper on postgraduate medical education on the occasion of hospital reform - postgraduate medical education must be considered. A joint position paper by Bündnis Junge Ärztinnen und Ärzte and AG Junge Gastroenterologie of the DGVS as well as the Young DGN.

The Bündnis Junger Ärztinnen und Ärzte (BJÄ, Alliance of Young Physicians in Germany) has presented a position paper (PP) on Postgraduate Medical Education (PGME) against the background of an unfolding hospital reform in Germany, and they describe existing deficits of PGME in Germany. Based on this, demands were made of legislators, employers and medical associations which could result in a sweeping reformation of PGME. Hospital reforms can only be accomplished with well trained and motivated physicians. In this respect the BJÄ regards the reform of hospitals and the health-care system as a chance for a reform of PGME, which is long overdue. Legislative competence for PGME lies with the States of the Federal Republic of Germany and this warrants an adjustment of state medical association laws to accommodate the demands of the BJÄ. Generally PGME must be taken into consideration in all health-care legislation, in analogy to the meanwhile globally adopted principle of "Health in all Politics (HiAP)". The BJÄ has made every endeavour to produce this PP. The responsible stakeholders and actors in the health-care system would be well-advised to take the position paper seriously with a dwindling physician work force in hospitals and serious quality deficits in PGME. Hence, the BJÄ must be comprehensively supported. They need congenial partners to define the scientific foundation of all their demands, to test their application under real life conditions in hospital and outpatient care, to pursue research on the impact on patient care and on the intended transformation of the health-care system. This might best be accomplished by partnering with a scientific Association for Postgraduate Medical Education as has been the case in many countries for decades.

The improvement of medical education within the framework of scientific educational cluster

The article presents analysis of problems of training of physicians. The defects of professional orientation of applicants were noted, resulting in the fact that 19% of students already during their studies choose not to work in health care after graduation. Besides, deficiency of practical experience among students, as well imbalance of training of specialists in various specialties, shortage of budget places in residency, dissatisfaction of young physicians with working conditions and its schedule was registered. The authors propose complex of measures developing professional orientation of applicants, improving quality of education in medical universities and assisting their employment and successful adaptation in medical organizations.

Factors associated with work-related musculoskeletal disorders among medical and surgical residents

Objective: This study was conducted to identify work-related musculoskeletal disorders (WMSDs) among medical and surgical residents in Saudi Arabia and the possible associated risk factors. Methods: A cross-sectional study was conducted from January to June, 2023 among all medical and surgical residents working in the hospitals of Riyadh Second Health Cluster in Saudi Arabia. A previously validated, published and self-administered Nordic Musculoskeletal Questionnaire (NMQ) was distributed. Results: Out of 120 invited participants, 82 residents (response rate of 68.33%) were included in this study. Of which, 43 (52.4%) were general surgery residents and 39 (47.6%) were internal medicine residents. The most frequently reported anatomical sites for musculoskeletal complaints in the 12 months preceding the survey were the ankle/feet (51.2%), shoulder (48.8%), lower back (48.8%), and neck (46.5%). Multivariate logistic regression analysis revealed that the risk of having WMSDs among residents who practiced physical activity with a frequency of more than three times a week was 59% lower than those who never practiced exercise (adjusted odds ratio= 0.41; 95% confidence interval: 0.09–0.083, p = 0.003). Conclusion: A high proportion of young physicians working in general surgery or internal medicine reported WMSDs at different anatomical sites of the body. Therefore, they are recommended to attain comfortable body posture in operating/procedure rooms, perform regular physical exercise, and maintain normal body weight as preventive strategies against WMSDs.

Response to the urgent need to train family doctors in geriatrics : residency in long term care facilities

Family doctors have to provide the geriatric cares needed by an aging population. In particular, the increased complexity of care needs in the population living in long term care facilities (LCTF) raises several challenges. One of these challenges is the adequate training of physicians working in LCTF as well as the next generation. Residency programs in LTCFs for future general practioners has demonstrated their value abroad. We describe here the creation of a residency program in LTCF for family doctors in Canton Vaud. Since its beginning in 2020, the program has not only trained young physicians but has also improved interprofessionality and strengthened the training of other healthcare professionals.

Domestic researchers who have made important contributions to the study of digestive system diseases: images in art. Iryna Ivanivna Degtyareva

In her article, the author does not provide biographical data of Professor Iryna Ivanovna Degtyareva, but shares thoughts, feelings, memories about the Teacher. Iryna Ivanivna Degtyareva was an outstanding person in every aspect. The author was amazed by her remarkable appearance when she first met her in 1976. She was a striking lady who captivated by her charm, talent, and, most importantly, professionalism. Then, Iryna Ivanivna was appointed as a reviewer of the candidate’s dissertation by N. B. Gubergrits before approbation. Iryna Ivanivna spent almost the whole day with N. B. Gubergrits, a young physician who had just graduated from a medical university, since it was her first time meeting her. The two of them sat until late at the department of faculty therapy of the Kyiv Medical Institute, where Iryna Ivanivna worked at the time. Her remarks were undoubtedly well‑grounded. However, Iryna Ivanivna did not only provide criticism; she offered instant guidance on how to fix errors and avoid “sharp edges”, all the while pointing out the advantages of the work. Then, like lately, everything was fair. Inflexibility accompanied this justice. Iryna Ivanivna’s first major lesson was to work hard and overcome barriers in the pursuit of truth and results. This extraordinary lady and scientist had a great intellect, tolerance for students’ mistakes, total loyalty to them, and unwavering determination to work with them. N. B. Gubergrits sought Professor Iryna Ivanivna Degtyareva’s consultation for her doctoral dissertation as a result. Iryna Ivanivna’s brilliant mind «burst out» with ideas that she genuinely shared with her students. The contribution of Iryna Ivanivna to the doctoral dissertation of N. B. Gubergrits and her title of professor are enormous. Much has been achieved with her help. Iryna Ivanivna took great pride in her students, including Ihor Mykolayovych Skrypnyk, Mykhaylo Yuriyovych Kolomoyets, and Natalya Vyacheslavivna Kharchenko. To her, they were more than just students. She looked after them in life as well as in science. Many clinicians use Iryna Ivanivna’s monographs as reference textbooks, including «Clinical Gastroenterology» and «Peptic Ulcer».

Effects of the COVID-19 pandemic on the mental health of medical students and young physicians in Germany: Gender-specific results of an online survey

BackgroundHealthcare workers and medical students faced new challenges during the COVID-19 pandemic. Processes within many hospitals were completely disrupted. In addition, the face to face teaching of medical students was drastically reduced. Those at risk of developing mental health problems appear to be younger health care workers and women. ObjectiveTo investigate potential COVID-19 pandemic-related gender differences in psychological distress among medical students and physicians in their first years of practice. Design and settingAn anonymous survey was carried out online between December 1, 2021, and March 31, 2022, at the Mannheim Medical Faculty and the Würzburg Medical Faculty, Germany, after obtaining informed consent. Primary outcome measures were changes in anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS), and changes in participants' current quality of life using the WHO Quality of Life BREF. ResultsThe results show wave-like courses for perceived anxiety and burden overlapping with the course of the COVID-19 incidence. In comparison to men, women showed a significant higher increase in HADS (p = 0.005) and a reduced life quality (p = 0.007) after COVID-19. Both sexes showed different frequencies of the factors influencing quality of life, with the presence of a previous mental illness and mean anxiety having a significant higher negative impact in women. ConclusionFuture and young female physicians reported a disproportionate higher burden during COVID-19 compared to their male colleges. These observations suggest an increased need for support and prevention efforts especially in this vulnerable population.

Innovative telemedicine technology usage in rare diseases management in primary care in a COVID-19 pandemic era: Lessons learnt and recommendations for future practice

COVID-19 affected routine healthcare significantly and impaired the capability of healthcare organizations to deliver quality healthcare to achieve expected patient outcomes, including the care of patients with rare diseases. The rationale for this review is to highlight the important contribution of telemedicine technology to improving care quality of patients with rare diseases in a pandemic era. Aims and Objective: To explore the role and impact of telemedicine digital technology usage and user satisfaction in patients with rare diseases in the last two years since the COVID-19 pandemic. Methodology: An electronic database search was conducted using the PRISMA guide with search terms ‘telemedicine’ and ‘rare diseases’ in the last 2 years since the COVID-19 pandemic. The final search identified about 10 papers after screening, applying the exclusion criteria and sorting for eligibility and relevance. Results: Of the 10 papers reviewed, 6 were research articles while 4 were review articles. For the research papers there were 5239 participants or responders in total, with 1476 (28.2%) patients, 50 (0.01%) carers and 3713 (70.9%) clinicians and workers. The average age recorded by 4 of the research papers was 43.4 years while one paper particularly emphasized that telemedicine digital technology was used preferably by clinicians below 50 years of age. 52.5% of Clinician and Worker participants in 2 Studies were Male while 47.5% were Female, while only 22% of patient participants were Male, with 78% being Female. One paper recorded the proportion of patients who used telemedicine as 22.8 %, a second recorded the highest proportion of clinicians’ telemedicine usage as 59.8%, a third paper concluded the highest number of carers who were satisfied with telemedicine usage was 90%, with 58% also supporting its usage and a fourth recorded that 86% of patients were satisfied with its usage. However, another paper recorded that 26% of clinicians (psychiatrists) were not keen to use telemedicine. Conclusion: This review concludes that there is some evidence that telemedicine digital technology is a viable option and can be a long-term solution to primary care patients’ access to quality care in the post-pandemic era, including patients with rare diseases. International collaboration of clinicians via electronic or digital platforms will enhance quality of care, especially targeted to younger male physicians below the age of 50. Guidelines and protocol for its use within governmental laws and legal boundaries need to be strictly followed to ensure patient safety, reduce waiting times and achieve positive patient outcomes.

Gender difference of geographic distribution of physicians in Japan: three-point analysis of 1994, 2004 and 2014

BackgroundJapan's medical education system produces 9,000 graduates annually. Despite the government's implementation of several strategies, including increasing the number of doctors trained, the country still struggles with a shortage of physicians in rural areas. This study examined this issue, focusing on gender and considering years of physician experience, demographic and geographic factors.MethodsWe analyzed the Physician Census from 1994, 2004, and 2014, examining data on physicians’ gender and the number of years since licensure. To correct the impact of municipal mergers, the analysis was aligned with the number of municipalities in 2014 (1741). We examined data from each physician (gender and years of medical experience) and analyzed the demographic and geographic distribution trend using Spearman correlation coefficients. We then used the Gini coefficient to evaluate the distribution change of physicians based on gender and years of experience.ResultsThe number of physicians increased 1.29-fold over the 20-year observation period (1.23-fold for male physicians and 2.17-fold for female physicians), and the percentage of female physicians increased from 13.4% to 20.4%. We found that 87.7% of physicians were concentrated in the top 1/3 municipalities in terms of population. The number of female physicians was higher at 91.8% compared to 86.8% for male physicians. The Gini coefficients were lower for veteran physicians of both sexes than for younger physicians. The Gini coefficient for all physicians was 0.315–0.298–0.298 (male physicians: 0.311–0.289–0.283, female physicians: 0.394–0.385–0.395) The Gini coefficients for female compared to male physicians were higher in all age groups, showing that The distribution of female physicians is skewed toward urban areas.ConclusionFemale physicians are less distributed in rural areas than male physicians. In addition, despite the fact that the number of female physicians has increased more than male physicians over the past 20 years, the geographic ubiquity of female physicians has not improved. Since the trend of increasing the number of female physicians is expected to continue in the future, it is necessary to take some measures, such as providing a work-life balance suitable for female physicians.

Physician Perceptions of Cannabidiol (CBD) and Cannabis in Sports Medicine and Performance.

There is growing evidence regarding cannabinoid use in sports medicine and performance, especially cannabidiol (CBD). This study aims to determine if sports medicine physicians are recommending cannabinoids for therapeutic purposes, as well as analyze perceptions of cannabinoids within sports medicine and performance. Physician members of the American Medical Society for Sports Medicine (AMSSM) completed an anonymous survey on demographics, CBD and Cannabis recommendations, as well as attitudes toward cannabinoid products within sports medicine. Factors associated with CBD and cannabis recommendations as well as perceptual differences were found using multivariate regression modelling. Responses from 333 physicians were recorded. The following groups were less likely to agree with allowing cannabis for recreational purposes: female gender (coeff. = 0.79 (0.33-1.25), p=0.001), increasing age (coeff. = 0.04 (0.02, 0.07), p < 0.001), and rural respondents (compared to baseline urban, coeff. = 1.16 (0.36, 1.95), p=0.004). Similarly, these three factors were associated with a higher likelihood of disagreeing with WADA removing cannabis from the prohibited substance list and with the NCAA allowing CBD use by collegiate athletes (p ≤ 0.045). CBD was less likely to be recommended by pediatricians, rural physicians, and academic physicians (p ≤ 0.030). Male physicians and younger physicians were less likely to identify cannabis as performance-enhancing (p ≤ 0.042). Sports medicine physicians have varying views on cannabinoids. While sports medicine physicians generally have favorable attitudes toward CBD and cannabis, these perceptions appear to be significantly affected by age, practice type, and gender.