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Recent developments in the portability, flexibility, and affordability of augmented reality technology allow it to address some limitations of current medical training. This pilot study aims to determine whether augmented reality can enhance the detection and identification of subtle cues used to make accurate medical diagnoses. We randomly assigned five participants to a control group, where they received diagnostic training by reading a standard textbook, and an experimental group, where they received diagnostic training by a combination of reading a standard textbook and augmented reality-based training. All participants were tested with a tension pneumothorax scenario, where they listed symptoms and made a diagnosis. We recorded the time until a final diagnosis was made and categorized the diagnosis and symptoms as accurate or inaccurate. A two-tailed t-test was used to assess differences between groups. The experimental group correctly identified more symptoms than the control group (average 12 vs. 5). These results indicate the potential of AR-based training to enhance detection and identification of cues in medical diagnostics.

Physicians with history of unprofessional behaviour during their medical training are shown to be 3 times more likely to have board disciplinary action later in their career. One realm in which unprofessional behaviour takes place is the phenomenon of unverifiable publications or "ghost publications." To that end, this study aims to assess the rate of ghost publications among a recent cohort of Canadian Plastic Surgery residency applicants to determine if this phenomenon is geographic in nature.The current study was a retrospective, cross-sectional observational study; a review of all residency applications submitted to a single Canadian Plastic Surgery residency program from 2015 to 2018 was performed and all their listed publications were verified for accuracy. The review was conducted by a third party librarian and a research coordinator blinded to the authors identifying information. "Ghost publication" was defined as any publication listed as "published," "accepted," or "in-press" that did not exist in the literature.A total of 196 applications of 186 applicants were submitted over the span of 4 years. A total of 362 publications listed as peer-reviewed articles, belonging to 114 applications were extracted and reviewed. Among the 362 publications listed as peer-reviewed articles, 2 could not be found in the literature (0.55%). Additionally, 42 citations were found with 48 minor differences than what was cited.The rate of ghost publications among recent applicants to a Plastic Surgery residency program is low (less than 1%). Future studies should investigate methods to further improve and instill the value of professionalism in our future plastic surgery trainees.Il est démontré que les médecins qui adoptent un comportement non professionnel pendant leur formation risquent trois fois plus de recevoir des sanctions disciplinaires de leur ordre pendant leur carrière. Le phénomène des publications non vérifiables, ou publications fictives, représente l’un des volets du comportement non professionnel. La présente étude vise à évaluer la fréquence de publications fictives dans une récente cohorte de candidats canadiens à la résidence en plasturgie pour déterminer si ce phénomène est de nature géographique.Dans la présente étude d’observation transversale et rétrospective, toutes les candidatures en résidence déposées à un seul programme de résidence canadien en plasturgie entre 2015 et 2018 ont été examinées, et l’exactitude de toutes les publications présentées a été vérifiée. Un tiers bibliothécaire et un coordonnateur de recherche ne connaissant pas les données nominatives des auteurs ont effectué l’analyse. Une publication fictive désignait toute publication présentée comme « publiée », « acceptée » ou « sous presse », mais qui n’existait pas dans les revues scientifiques.Au total, 196 demandes de 186 candidats ont été déposées sur une période de quatre ans. Les chercheurs ont extrait et examiné 362 publications présentées comme des articles dotés d’un comité de lecture, cités par 114 candidats. De ces 362 publications, les chercheurs n’en ont pas trouvé deux dans les revues scientifiques (0,55 %) et ont relevé 42 citations comportant 48 différences mineures par rapport à la version originale.Les récents candidats à un programme de résidence en plasturgie s’approprient peu de publications fictives (moins de 1 %). De prochaines études devraient porter sur des méthodes pour améliorer et inculquer la valeur du professionnalisme chez les futurs résidents en plasturgie.

While many of the challenges of contemporary medical training are characterized uniformly as “burnout,” such a diagnosis is nonspecific and overlooks the degree to which the flourishing of medical practitioners depends on the development and exercise of virtue. The virtue of hope, in particular, is indispensable to sound medical practice generally and the flourishing of trainees. It is only through sound apprehension of the nature of the virtue of hope, the challenges to the cultivation of hope that residency poses, and practices that allow such cultivation, that contemporary trainees can learn to care well for patients and flourish in their own right. Summary: While the general term “burnout” is used to describe many of the challenges of contemporary medical training, a more precise characterization that unifies these challenges is a deficiency of the virtue of hope. Medical trainees face many obstacles to the cultivation of hope during training, but learning both to correctly identify this deficiency, and practices which prove a fitting response, offers a way forward.

Introduction The Federation of the Royal Colleges of Physicians of the UK provides UK equivalent Core Medical Training (CMT), now Internal Medicine Training (IMT), with six partners internationally. The objective of this study was to support the quality management and accreditation of those programmes. Methods A short, simple trainee questionnaire was designed and implemented online to produce data that could be compared with the Joint Royal Colleges of Physicians Training Board (JRCPTB) analysis of the UK national General Medical Council (GMC) questionnaire. Survey included first three of the current six international partners of JRCPTB: one site in Iceland and the other two in India. Results Over 90% trainee engagement was achieved, and the results are compatible and related to the UK experience. No serious issues were identified that need immediate action and the output was used for discussion about training and service at all three sites. Good satisfaction with the programme was found in all three sites. Conclusion A simple online questionnaire can have good engagement with trainees on an international basis and produce useful information that helps trainees and trainers discuss the care of their patients and improve training

The aim of this study was to analyze a potential association between resident training level/specialty type and correct identification of external ear deformities/external ear anatomy. A Qualtrics survey was distributed via email to all pertinent residency programs in the United States. The survey captured specialty type (Otolaryngology, Pediatrics, and Plastic Surgery) and level of training (PGY 1-2 and PGY 3+). The assessment asked residents to identify 10 clinically relevant external ear deformities and 10 normal pinna anatomic subunits. Chi-square tests were used to examine the association between the level of training/specialty type and performance on individual survey items. To examine group performance on overall mean scores of the external ear deformity/external ear anatomy survey, a t-test and factorial analysis of variance (ANOVA) were used. Responses from 105 residents were analyzed. Senior residents (PGY 3+) performed significantly better in correctly identifying Microtia Grade 3, Question Mark ear, and Cryptotia as compared to junior residents (PGY 1-2). Senior residents performed significantly better in the identification of external ear deformities ( P = .002) and normal pinna anatomical subunits ( P < .001). Otolaryngology and Plastic Surgery residents performed significantly better in the identification of external ear deformities ( P < .001) and normal pinna anatomical subunits ( P < .001) than Pediatrics. There were no significant interaction effects between the level of training and the specialty type on either ear deformity or normal pinna anatomy identification. Residents had a 34.5% success rate of identifying ear deformities and showed improved confidence in identification when exposed to a digital-based examination. Improved education methods for detection will help with timely correction of ear deformities.

European medical schools are recruiting increasing numbers of international students. This study explores the impact of cultural backgrounds and language on the transition of international medical students to the clinical years of their training when they are predominantly based in hospitals and interacting with health professional staff and patients. A mixed-methods study was undertaken, incorporating 31 peer interviews and a focus group discussion and the development and conducting of an online survey ( n = 144; 50% response rate). We compared levels of social adjustment and integration between the students on a regional basis. Overall students adjusted well, but there were statistically significant regional differences in social adjustment and integration. The impact of communication difficulties from a language and cultural practice perspective was a dominant challenge highlighted, as was the differences in hospital culture and interprofessional communication norms. International medical students experience many challenges and benefits from studying in a multicultural environment. More nuanced demographic data need to be collected on admission to assist in potentially identifying those who may experience difficulties with academic and daily life transitions. In addition, all students in a multicultural environment would benefit from a program of acculturation for personal and career development.

This article explores ethical issues raised by Primary Care Physicians (PCPs) when diagnosing depression and caring for cross-cultural patients. This study was conducted in three primary care clinics within a major metropolitan area in the Southeastern United States. The PCPs were from a variety of ethnocultural backgrounds including South Asian, Hispanic, East Asian and Caucasian. While medical education training and guidelines aim to teach physicians about the nuances of cross-cultural patient interaction, PCPs report that past experiences guide them in navigating cross-cultural conversations and patient care. In this study, semi-structured interviews were conducted with seven PCPs which were transcribed and underwent thematic analysis to explore how patients’ cultural backgrounds and understanding of depression affected PCPs’ reasoning and diagnosing of depression in patients from different cultural backgrounds. Ethical issues that arose included: limiting treatment options, expressing a patient’s mental health diagnosis in a biomedical sense to reduce stigma, and somatization of mental health symptoms. Ethical implications, such as lack of autonomy, unnecessary testing, and the possible misuse of healthcare resources are discussed.

Simulation-based medical training is an increasingly used method to improve the technical and non-technical performance of clinical staff. An essential part of training is the debriefing of the participants, often using audio, video, or even eye tracking recordings. We conducted a practice-oriented feasibility study to test an eye tracking data preparation procedure, which automatically provided information about the gaze distribution on areas of interest such as the vital sign monitor or the patient simulator. We acquired eye tracking data during three simulation scenarios and provided gaze distribution data for debriefing within 30 minutes. Additionally, we qualitatively evaluated the usefulness of the generated eye tracking data for debriefings. Participating students and debriefers were mostly positive about the data provided; however, future research should improve the technical side of the procedure and investigate best practices regarding how to present and use the data in debriefings.

Background Skin diseases are among the most common diseases encountered by healthcare professionals. Despite this, dedicated dermatology teaching is limited in most Canadian medical school training programs. This is especially true of clinical skills training. Objectives To determine the impact of early introduction of dermatology clinical skills in Canadian undergraduate medical training. Secondary objectives included examining the impact of having sessions co-led by a clinician with expertise in the field of dermatology. Methods A half-day dermatology clinical skills session was introduced in the University of Toronto preclerkship medical school during the dermatology week. Sessions were co-led by staff or resident dermatologists. Sessions were evaluated using student pre- and postclinical skills test scores, as well as experience questionnaires completed by both tutors and students. Results The clinical skills session was well received by both students and tutors, with no cumulative score less than 4.34 on a 5-point Likert scale. The majority of students agreed or strongly agreed that the introduction of clinical skills in the early years of the curriculum facilitated learning consolidation (99.5%). Comparison of pre- and post-test scores showed that students’ dermatology comprehension improved by an average of 12.1% following completion of the session. In questionnaire responses, students and nondermatology co-tutors emphasized the impact of having an expert in the field of dermatology co-lead the session. Conclusions Students valued early clinical skills exposure to dermatology and felt it enhanced their knowledge and abilities. This study demonstrates learning consolidation when dermatologic didactic teachings are paired with practical clinical skills sessions.

Two leading causes of survivable combat deaths are hemorrhage and airway compromise. Although individual medical-training competency requirements are met using human-patient simulation (HPS), the evaluation of fidelity and HPS impact on training outcomes are not well documented. Research has documented physical fidelity concerns when comparing human anatomy to simulators, but has largely overlooked informational needs such as visual, auditory, and tactile cues for patient assessment. Training impact is often characterized by changes in confidence; however, the Dunning-Kruger effect suggests that overconfidence is pervasive. The purpose of this paper is to provide perspective on the research needs to ensure human-patient simulation meets the requirements for combat-medic training.

Manikins have traditionally been used to train ultrasound-guided Central Venous Catheterization (CVC), but are static in nature and require an expert observer to provide feedback. As a result, virtual simulation and personalized learning has been increasingly adopted in medical education to efficiently provide quantitative feedback. The Dynamic Haptic Robotic Trainer (DHRT) trains surgical residents in CVC needle insertions by simulating various patient profiles and presenting personalized feedback on objective performance. However, no studies have examined the learning gains of the personalized learning feedback or the relation of feedback to what the user is focusing on during the training. Thus, this study was developed to determine the effectiveness of the current personalized learning interface through a long-term investigation with 7 surgical residents. The eye tracking analysis showed that residents spent significantly more time fixated on percent aspiration throughout the study; the more time participants spent looking at the Number of Insertions, Percent Aspiration and the Angle of Insertion on the DHRT GUI, the better they performed on subsequent trials on the DHRT system.

Foundational academic medical texts facilitate foundational understanding of disease recognition in medical students. Significant underrepresentation of darker skin tones and overrepresentation of lighter skin tones in dermatologic texts, general medical texts, and scientific literature is observed. This compromises the clinical tools of trainees when it comes to darker skin tones. Text publishers and editors are steadily beginning to address these disparities, but bottom-up change from trainees is necessary to comprehensively address this issue. In this article the authors propose institutional review panels as a framework for building awareness of underrepresentation of darker skin tones and ensuring that faculty intentionally share diverse presentations in didactics. They also propose trainee engagement in building diverse medical image libraries and including texts on skin of color in institutional libraries. Empowering trainees to be advocates and call out any implicit or explicit biases in image selection can engender change in this area of medical education.

A random survey was performed by ORC International Telephone CARAVAN®, on 24–27 March 2016, by trained interviewers. The aim of this survey was to gain further understanding of public perceptions in the United States of laboratory animal use, specifically for the purposes of medical training. Five statements were read in random order to the participants, who were then asked whether they agreed or disagreed with the statement. Survey responses were obtained from 1011 participants. For the combined statements: “If effective non-animal methods are available to train a) medical students and physicians, b) emergency physicians and paramedics, and c) paediatricians, those methods should be used instead of live animals”, most respondents (82–83%) agreed. For the statement: “You want your doctor to be trained by using methods that replicate human anatomy instead of live animals”, most respondents (84%) agreed. For the statement: “If effective non-animal methods are available, it is morally wrong or unethical to use live animals to train medical students, physicians and paramedics”, 67% of respondents agreed. Responses were similar among the 15 pre-specified demographic subgroups. Given that effective non-animal training methods are readily available, the survey suggests that a substantial majority of the public wants the use of animals in medical training to cease.

The word ‘anesthesiology’ was coined in 1902 by Mathias J. Seifert, MD, of Chicago, Illinois. Seifert was an accomplished musician before he commenced his medical training. After graduation in 1901 he held academic positions in medicine and gynaecology before being appointed Professor of Physical Diagnosis and Anesthesiology at the College of Dentistry, University of Illinois. He was later appointed Professor of Surgery at the Chicago Hospital College of Medicine.

A comprehensive history of medical sex education in the USA is missing from the literature, and much of the recent literature on sexuality education within medical training in the USA relies on survey research, which reveals little about the nature and content of medical sex education, and the meanings of sexuality that are produced and transmitted within it. In this article I provide a brief historical overview of medical sex education in the USA to provide context for my ethnographic study of the ways in which sexuality education was conceptualized and executed at a top-twenty American medical school. Although faculty members at this medical school believed that sexuality was important to medical practice and thus important to teach about within medical education, teachings about sexuality were fragmented and did not produce a consistent set of messages about what sexuality means or how it might matter to medical practice. I show how formal knowledge about sexuality has been and continues to be as elusive within medical education as anywhere else, and discuss historical continuities in the perceived barriers to providing medical sex education. In addition to increasing our understanding of how medical knowledge about sexuality is produced and transmitted, this research expands the study of sex education beyond contexts in which its intended purpose is to influence the personal behavior of its subjects.

Introduction D13 is a nationally agreed bespoke medical training package for specialist firearms police officers introduced in 2010. Patient report forms are completed after every episode of care provision. Methods A review of patient report forms submitted by police firearms officers in five regions of England over the five years since the introduction of D13. Results Officers attended a large range of incidents, both traumatic and medical, minor and life critical. The majority (69.5%) were responded to as part of a normal police response, while 30.5% of cases were due to primary firearm deployments. Catastrophic haemorrhage was dealt with in 8.1% of cases including the use of haemostatic dressings and tourniquet application. Airway interventions were required in 36.1% of patients and 50.4% required interventions for external bleeding. Discussion From a background of a minimum of 18 h for Standard and 24 h for Enhanced courses and with regular simulation refreshers, specialist police officers, who are part of a robust clinical governance process, play an important role in providing immediate medical care in non-permissive or dangerous environments where ambulance personnel will not be present and when the officers are frequently first on scene.

Teacher residency programs (modeled after the clinical residency model in medical training) show great promise in helping local school systems build a highly capable and diverse teaching workforce. Jointly run by districts and nearby universities, these programs recruit teaching candidates, pair them with carefully selected mentor teachers, and give them a gradual introduction to classroom instruction while simultaneously moving them through a graduate-level course of study. While such programs are not yet widespread — since the first residency was launched in 2001, roughly 50 others have been created nationwide — early research findings suggest they provide an effective means of recruiting, preparing, supporting, and retaining excellent teachers.

Cardiopulmonary resuscitation manikins are used for training personnel in performing cardiopulmonary resuscitation. State-of-the-art cardiopulmonary resuscitation manikins are still anatomically and physiologically low-fidelity designs. The aim of this research was to design a manikin that offers high anatomical and physiological fidelity and has a cardiac and respiratory system along with integrated flow sensors to monitor cardiac output and air displacement in response to cardiopulmonary resuscitation. This manikin was designed in accordance with anatomical dimensions using a polyoxymethylene rib cage connected to a vertebral column from an anatomical female model. The respiratory system was composed of silicon-coated memory foam mimicking lungs, a polyvinylchloride bronchus and a latex trachea. The cardiovascular system was composed of two sets of latex tubing representing the pulmonary and aortic arteries which were connected to latex balloons mimicking the ventricles and lumped abdominal volumes, respectively. These balloons were filled with Life/form simulation blood and placed inside polyether foam. The respiratory and cardiovascular systems were equipped with flow sensors to gather data in response to chest compressions. Three non-medical professionals performed chest compressions on this manikin yielding data corresponding to force–displacement while the flow sensors provided feedback. The force–displacement tests on this manikin show a desirable nonlinear behaviour mimicking chest compressions during cardiopulmonary resuscitation in humans. In addition, the flow sensors provide valuable data on the internal effects of cardiopulmonary resuscitation. In conclusion, scientifically designed and anatomically high-fidelity designs of cardiopulmonary resuscitation manikins that embed flow sensors can improve physiological fidelity and provide useful feedback data.

Introduction: Misconceptions surrounding the discipline of plastic surgery are widespread public and medical students and professionals, as well. The purpose of this study was to explore how the inclusion of plastic surgery rotation into the medical curriculum affects medical students’ knowledge, attitudes, and preferences regarding plastic surgery specialization and referral. Design and Methods: A descriptive-correlational design was utilized to collect data from 200 medical students in the final two years of education from two separate six-year medical programs in Jordan. Data was collected using self-reported questionnaires regarding knowledge of surgical procedures allocation, attitude towards plastic surgery, preference of specialization, and benefits of plastic surgery to physicians and patients. Results: Analysis showed that medical students of plastic surgery integrate rotation (program A) had a higher average score of correct procedure-allocation (M=12.57, SD = 3.14), compared to non-integrated plastic surgery rotation program (program B) (M=8.29, SD=3.05) . About 83% (n =83) of students in program A had their knowledge on plastic surgery from direct exposure to a plastic surgeon, compared to 43% (n=43) of program B, and 24% (n=24) of students in program A reported that their perception of plastic surgery influenced by media compared to 62% (n=62) of those in program B. Conclusions: Medical students exposed to plastic surgery education are more confident about procedures of plastic surgery and had more reliable sources of knowledge about plastic surgery than those who were not exposed to plastic surgery rotation. Significance for public health Plastic surgery procedures contribute to large proportion of the worldwide surgical disease burden. Appropriate and timely intervention using plastic surgery has significant impact on multiple medical conditions and reduce cost of complications. Plastic surgery interventions acknowledged as low cost to resolve disabling conditions. However, misconception about plastic surgery may contribute in delayed referral and untimely and inappropriate intervention that may cause further burden to individuals; medically and economically. Comparing between medical programs that include plastic rotation and those who are not will increase the public health awareness, and in particular among medical staff, regarding benefits and needs of plastic surgery interventions to health of individuals. Major medical conditions such as deformities and disabilities can be resolved with timely plastic surgery interventions that improves health of people and lowering medical cost and burden of diseases.

The adaptive instruction provided by Intelligent Tutoring Systems (ITSs) tailors direction, support, and feedback to enhance/maintain the learning needs (e.g., lack of knowledge or skill) of each individual. Today, ITSs are generally developed to support desktop training applications, with the most common domains involving cognitive problem solving tasks (e.g., mathematics and physics). In recent years, implementations of game-based tutors authored using the Generalized Intelligent Framework for Tutoring (GIFT), an open-source tutoring architecture, provided tailored training experiences for military tasks through desktop applications (e.g., games including Virtual Battlespace and Virtual Medic). However, these game-based desktop tutors have also been limited to adaptive instruction for cognitive tasks (e.g., problem solving and decision-making). The military requires adaptive instruction to extend beyond the desktop to be compatible with the physical nature of many tasks performed by soldiers, sailors, and airmen. This article examines how commercial sensor technologies might be adapted to work with GIFT and support tailored computer-guided instruction in the psychomotor domain for a military medical training task, specifically hemorrhage control. Toward this goal, we evaluated the usability and system features of commercial smart glasses and pressure-sensing technologies. Smart glasses were selected as the focus of this study over handheld mobile devices in order to promote a hands-free experience during the training of hemorrhage-control tasks on a mannequin. Pressure sensors were selected to provide direct measures of effectiveness during the application of tourniquets and pressure bandages. Each set of technologies (smart glasses and pressure sensors) was evaluated not with respect to each other, but with respect to their capabilities to support adaptive instruction in the wild at the learner’s point-of-need and criteria based on established usability heuristics. Instruction in the wild is training provided in an environment outside the classroom and areas where tracking and sensing infrastructure are available (e.g., deployed areas of operation). We examined a wide range of features and capabilities, and evaluated their compatibility with the hemorrhage-control task, to answer the following question: what system design features (e.g., usability and interaction) are needed to support adaptive instruction for this individual psychomotor task at the point-of-need in locations where no formal training infrastructure is available?

Background The Pavlik harness is the most common initial treatment for developmental dysplasia of the hip worldwide. During treatment, parents are required to re-apply the harness at home. Teaching parents how to apply the harness is therefore paramount to success. While simulated learning for medical training is commonplace, it has not yet been trialed in teaching parents how to apply a Pavlik harness. Methods A group of parents underwent a simulated learning module for Pavlik harness application. Parents were evaluated pre- and post-exposure and at one month after testing. A validated objective structured assessment of technical skill (OSATS) and a global rating scale (GRS) specific to Pavlik harness application were used for evaluation. A control group of parents was also tested at both time points. A clinical expert group was used to determine competency. ANOVA and t tests were used to assess differences between groups and over time. Results Parent scores on the OSATS improved to the level of expert clinicians both immediately post-intervention and at retention testing. However, on the GRS, only half were considered competent due to their inability to achieve the required hip positions. The control group did not improve nor were they considered competent. Conclusions The use of a simulated learning module improves both the confidence and skill level of parents in the application of the Pavlik harness. However, the challenges parents face in understanding the more detailed subtleties of medical care suggest that they still require an appropriate level of supervision by clinicians to ensure effective treatment.

Farmer’s son William Cooke completed his medical training at Barts before embarking on a 60-year career as a general practitioner in and around London. In 1819, he was a co-founder, and for 20 years secretary, of the Hunterian Society which continues to provide education to its members. He was the author of several books where his views on the importance of post-mortem examinations and the interrelationships of body and mind in disease were discussed. He was a prominent non-conformist and became a deacon in the Congregational Church. He died in 1873, aged 87.

Doulas are maternity support workers who provide supportive care to women in childbirth. Doulas do not have medical training, yet they offer an important but underused type of expertise. Certification is not required for work as a doula. This study analyzes the role of certification in legitimating doulas’ alternative knowledge about childbirth. Do doulas believe that certification matters for establishing their work as legitimate to mothers and/or to medical clinicians? Certification allows physicians to practice medicine, lawyers to practice law, and teachers to educate students. Why do some doulas get certified by national or international organizations while others do not? To explore these questions, this article uses narrative data from 25 interviews with doulas in the southwestern United States. The majority of these doulas (80 percent) had completed or were in the process of completing their certification. Results indicate that although doulas believe that experience providing support is their primary source of knowledge and defines their expertise among clients, many also argue that certification makes their role legitimate to medical clinicians. Recent changes in health care may give doulas greater access to women most in need of their care, but certification could play a crucial role in gaining this access.

Purpose According to a national survey of over 900 Canadian medical students, the stereotype of an isolated radiologist working in a dark room persists. The purpose of this study is to use qualitative methods to explore the ways exposure to radiology in medical school impacts students’ opinions and perceptions of radiology and radiologists. Methods After receiving ethics approval, 4 focus groups were conducted, 1 per year of undergraduate medical training at Western University. The transcribed audio recordings and accompanying field notes, together with the open-ended questions obtained from the national survey, were analyzed using thematic analysis. Results Five hundred sixty students in medical school years 1 and 2 (preclerkship) participated in the national survey and 18 in the focus groups; 336 students in years 3 and 4 [clerkship] participated in the national survey and 10 in the focus groups. Three major findings emerged from the analysis of the data. First, stereotypes are perpetuated mainly through informal interactions. Second, there is limited exposure to radiology and radiologists in medical school, especially in preclerkship. Third, students want to know what to expect if they choose a career in radiology. Conclusions Medical students, especially those in preclerkship, are seeking accurate information to modify or reinforce radiology stereotypes. Limited exposure makes interactions with students impactful and mentorship essential. Students want meaningful interactions with radiologists and radiology residents.

Background Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and cost-effective skill set when implemented in primary care settings regarding hazardous alcohol use. This study assesses the impact of medical resident SBIRT training across 3 specialties and identifies predictors of change in trainee behavior, attitudes, and knowledge over 12 months. Methods This program's substance use SBIRT training was developed and tailored to fit diverse curricular objectives and settings across an array of medical residency programs in South Texas. The 329 residents training in pediatrics, family medicine, and internal medicine during 2009–2012 constituted the trainee group reported in this analysis. Surveys assessing SBIRT-related knowledge, current practice, confidence, role responsibility, attitudes, beliefs, and readiness to change were completed by 234 (71%) trainees at 3 time points: pre-training, then 30 days and 12 months post-initial training. Results SBIRT-related knowledge, confidence, and practice increased from pre-training to 12-month follow-up. Residents who reported the least amount of pre-training clinical and/or prior academic exposure to substance use reported the greatest SBIRT practice increases. When controlling for demographic and prior exposure variables, the largest contributor to variance in SBIRT practice was attributed to residents’ confidence in their SBIRT skills. Conclusions SBIRT training that employs diverse educational methodologies as part of customizing the training to residency specialties can similarly enhance SBIRT-related knowledge, confidence, and practice. Trainee report of limited prior clinical or academic exposure to substance use and/or low confidence regarding SBIRT skills and their professional role responsibilities related to substance use predicted trainee success and sustained SBIRT strategy application. When customizing SBIRT training, curriculum developers should consider leveraging and capacity building related to those factors predicting continued use of SBIRT practices.

The research presented in this paper focuses on best practice analyses for a non-traditional electronic medical record (EMR) application. CampDoc, an electronic medical records system specifically designed for day and overnight camps as well as small care facilities (e.g. daycare centers) was examined. Over 12, 000 camps operate in America, looking after 11, 000, 000 people each year making them a unique application for EMRs (American Camping Association, 2012). The analysts' goals were to improve upon the user experience within CampDoc by increasing the ease of use and the clarity of content via human factors techniques. Specific emphasis was placed on understanding and designing for users who might not possess medical training and identifying how medicine is practiced in non-traditional medical settings.

In India, rural medical practitioners (RMPs) practice allopathic, homeopathic, and other modern systems of medicine without formal medical training. However, the quality of treatment offered remains questionable. The present study systematically examines the knowledge, practices, and competencies of the RMPs. While about 80% of RMPs can diagnose common diseases and treat them, 25% are involved in inappropriate practices like unsafe abortion and unsafe childbirth. Hence, there is an urgent need for appropriate intervention to reduce potential harm and improve care provided.

This commentary looks at the introduction of a rural paramedic practitioner (RPP). A RPP is a rural paramedic that has completed advanced medical training in primary health care and is able to provide prehospital, hospital and primary health care.

Purpose: To describe antimicrobial stewardship programs (ASPs) of acute and long-term acute care (LTAC) hospitals in Houston, Texas. Methods: Two-part survey to clinical pharmacists and pharmacy directors. All acute care and LTAC facilities from the Harris County Medical Society database were invited to participate. Results: In part 1 of the telephone survey, 82 facilities within Houston, Harris county, were contacted by telephone of which 51 responded (response rate: 62%). Of respondents, 55% (n = 28) reported having an active ASP and 8% (n = 4) planned implementation within 12 months. Acute care and LTAC hospitals reported ASPs in 57% and 67% of facilities, respectively. Physician champions were involved in 71% (n = 20) of active ASPs; clinical pharmacists were involved in 75% (n = 21) of programs. In part II, 22 (43%) facilities completed the online survey; postprescription review with feedback was used in facilities with an ASP and medical training program (5 of 5) while formulary restriction was in facilities without stewardship or medical training (6 of 8). Conclusion: This is the first major survey of ASP in a major metropolitan area. The stewardship effort in the city of Houston is encouraging; we expect the number of stewardship programs in all facilities will continue to rise as focus on antimicrobial resistance grows.

The System for Evaluation of Teaching Qualities (SETQ) was developed as a formative system for the continuous evaluation and development of physicians’ teaching performance in graduate medical training. It has been seven years since the introduction and initial exploratory psychometric analysis of the SETQ questionnaires. This study investigates the validity and reliability of the SETQ questionnaires across hospitals and medical specialties using confirmatory factor analyses (CFAs), reliability analysis, and generalizability analysis. The SETQ questionnaires were tested in a sample of 3,025 physicians and 2,848 trainees in 46 hospitals. The CFA revealed acceptable fit of the data to the previously identified five-factor model. The high internal consistency estimates suggest satisfactory reliability of the subscales. These results provide robust evidence for the validity and reliability of the SETQ questionnaires for evaluating physicians’ teaching performance.

Medical decision-making largely depends on the caregiver’s fundamental knowledge of anatomy. To this end, the authors discuss a cost-effective augmented reality system for simulated medical research and education. First, we define augmented reality. Second, we will review the history of augmented reality in medical training. Third, we will discuss some of the human factors principles associated with augmented reality training systems. Fourth, we will describe our insight and methods for building a Simulated Medical Augmented Reality Training (SMART) system, which can be used as an alternative training tool for medical and anatomy students. Finally, we will outline five steps that can be taken to build a SMART system.

Objective. American parents were surveyed to isolate demographic factors that predict reliance on a pediatrician, the American Academy of Pediatrics (AAP), or both for media guidance. We then investigated whether reliance on these resources resulted in different media practices with children. Methods. A nationally representative survey was conducted (n = 1454). Parents were asked what medical professionals they relied on for advice and reported relevant home media practices related to their child. Results. In all, 29% reported relying on their pediatrician, 24.9% said that they relied on the AAP, and 14.9% of all parents said they relied on both. Those following the AAP’s media guidelines were more likely to prohibit bedroom television and to follow all guidelines. Conclusions. The relatively low reliance on the AAP and pediatricians for media guidance suggest that more outreach is necessary. However, parents who report relying on the AAP for advice are more likely to enact these recommendations.

Calvin Wells was the leading palaeopathologist in the UK between the later 1950s and the early 1970s. He studied medicine at University College London but failed in anatomy and qualified in 1933 with the Conjoint Diploma (MRCS, LRCP). After qualification he began to study obstetrics and after war service in the RAMC he settled in Norfolk (UK), established a small general practice and took up palaeopathology. Although he was usually conservative in diagnosis he tended to over-interpret signs in the skeleton, often publishing descriptions that were more fiction than science. He held firm views on the way in which palaeopathology should be undertaken and in particular he resented the entry into the field of anthropologists without medical training. His major contributions to palaeopathology were related to the study of cremations and the introduction of the notion of pseudopathology, and his writings on these subjects have scarcely been improved upon since. He was extremely well read, warm and encouraging to those with archaeological or medical qualifications, but vituperative about those he disliked. His bone reports, which are a major proportion of his published output, generally were highly regarded but his writing is often marred by sexual innuendo and vulgarity which does his memory little credit.

In the USA, the general public want the use of animals in medical training to cease, but, at least in Australia, some teachers want it to continue, even when effective non-animal alternatives are available.

Background: Medical education can help alleviate the chronic undersupply of physicians to rural communities. Providing students with early rural clinical experiences may allow the gaining of necessary knowledge and skills to practice and live rurally, as well as the desire to do so. Purpose: This study aims to provide a detailed understanding of Remote and Rural Community Placements (RRCPs) which occur in the second year of a Doctor of Medicine programme. Methodology/Approach: Using a thematic analysis approach, we examined the experiences of students and preceptors in the RRCP. Data were collected using semi-structured interviews and focus groups. Findings/Conclusions: Students valued RRCPs as a formative clinical experience and preceptors gained professionally from participating. The RRCPs enhanced students regard for, and knowledge of, rural medicine. Yet, contrary to the stated aims of the placement, students spent very little time in activities outside of the clinic, neither learning about the community nor about the life of a physician as a community member. Implications: Medical educators should recognise that students and preceptors will inevitably place different value on the different sociocultural and perceptual aspects of placements, namely clinical and non-clinical. As such, the curriculum should draw clearly articulated links between each.

Background Research on incorporating integrative medicine (IM) into medical training is increasing. Programs and organizations around IM have been established, but there has not previously been a needs assessment focused on integrating IM into psychiatry training. Objectives The results of a needs assessment of training directors and faculty, focused on interest and priorities for developing an IM curriculum for psychiatry training programs, are described. Methods Psychiatry Training Directors and faculty were invited to participate in a detailed electronic survey. Areas of inquiry included (a) IM content areas to include in training; (b) IM approaches to specific medical conditions; (c) existing IM content; (d) importance, interest, and strategies for IM training; and (e) availability of wellness programs for trainees. Results Thirty-six respondents from psychiatry training programs completed the survey. Of the training programs represented by the respondents, 50% indicated that they currently had IM content in their curriculum; only 11.8% of them rated their programs’ existing IM content as sufficient. Content areas rated most highly for inclusion in a psychiatry IM curriculum included sleep health, motivational interviewing, and self-care. Respondents indicated incorporating IM into the psychiatry training curriculum (47%) or as an elective (44%) as the desired implementation strategy, with experiential onsite activities demonstrating IM topics (67%) and online modules supplemented by local faculty (58%) as the 2 most desirable learning formats. Significant barriers identified were time constraints, lack of faculty expertise in IM, current lack of curricular requirements for IM competencies, and budgetary limitations. Conclusion Responses to the survey suggest that faculty need support and additional education in implementing IM training. A standardized, online curriculum could help meet that need. Our results also indicate that wellness programs for residents are currently inadequate; bolstering them could help address burnout and increase the knowledge psychiatrists have of IM modalities. The types of institutions represented by faculty interested in further developing IM offerings vary considerably, as do their current efforts to integrate IM into training programs.