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Background: As the population ages, musculoskeletal disorders are a prominent contributory factor to loss of mobility and autonomy. Pain is a predictor of disability and worsening frailty and the role of the chronic pain specialist in the management of this cohort cannot be overstated. With growing requirements for pain specialists, we sought to identify barriers to recruitment within this specialty., Aims: Establish baseline attitudes and perceived barriers towards a career in pain medicine among Irish anaesthesiology trainees. Suggest a framework to improve recruitment to the specialty., Methods: Ethical approval was obtained. A web-based questionnaire was sent to all anaesthesiologists in training in the Republic of Ireland. Data was analyzed using SPSS., Results: Two hundred forty-eight trainees received the questionnaire, 59 responded. 54.2% male, 45.8% female. 79.7% had previous clinical exposure to pain medicine, most of whom had spent over one month with a service. Only 10.2% of respondents were considering a career in pain medicine. Factors that attracted trainees to the subspeciality included: interventional practice (81%), variation in clinical practice (66.7%), autonomy of practice (61.9%) and perceived good work-life balance (42.9%). Deterrents from the subspecialty included a psychologically challenging patient cohort (69.5%), frequency of clinics (50.8%), and additional exams (32.2%). When asked how to improve engagement with the speciality, 62% suggested earlier exposure to the speciality and 32.2% suggested increased frequency of formal teaching and workshops., Conclusions: Increased exposure of trainees to the specialty during early stages of training may improve future recruitment to the subspecialty in Ireland., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Artificial intelligence chatbots, like ChatGPT, have become powerful tools that are disrupting how humans interact with technology. The potential uses within medicine are vast. In medical education, these chatbots have shown improvements, in a short time span, in generalized medical examinations. We evaluated the overall performance and improvement between ChatGPT 3.5 and 4.0 in a test of pediatric cardiology knowledge. ChatGPT 3.5 and ChatGPT 4.0 were used to answer text-based multiple-choice questions derived from a Pediatric Cardiology Board Review textbook. Each chatbot was given an 88 question test, subcategorized into 11 topics. We excluded questions with modalities other than text (sound clips or images). Statistical analysis was done using an unpaired two-tailed t-test. Of the same 88 questions, ChatGPT 4.0 answered 66% of the questions correctly (n = 58/88) which was significantly greater (p < 0.0001) than ChatGPT 3.5, which only answered 38% (33/88). The ChatGPT 4.0 version also did better on each subspeciality topic as compared to ChatGPT 3.5. While acknowledging that ChatGPT does not yet offer subspecialty level knowledge in pediatric cardiology, the performance in pediatric cardiology educational assessments showed a considerable improvement in a short period of time between ChatGPT 3.5 and 4.0., (© 2024. Crown.)

Chat Generative Pre-Trained Transformer (ChatGPT) has been a growing point of interest in medical education yet has not been assessed in the field of bioethics. This study evaluated the accuracy of ChatGPT-3.5 (April 2023 version) in answering text-based, multiple choice bioethics questions at the level of US third-year and fourth-year medical students. A total of 114 bioethical questions were identified from the widely utilised question banks UWorld and AMBOSS. Accuracy, bioethical categories, difficulty levels, specialty data, error analysis and character count were analysed. We found that ChatGPT had an accuracy of 59.6%, with greater accuracy in topics surrounding death and patient-physician relationships and performed poorly on questions pertaining to informed consent. Of all the specialties, it performed best in paediatrics. Yet, certain specialties and bioethical categories were under-represented. Among the errors made, it tended towards content errors and application errors. There were no significant associations between character count and accuracy. Nevertheless, this investigation contributes to the ongoing dialogue on artificial intelligence's (AI) role in healthcare and medical education, advocating for further research to fully understand AI systems' capabilities and constraints in the nuanced field of medical bioethics., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Rehabilitation services are essential interventions designed to optimize functioning and reduce disability in individuals with health conditions. Eight core professions offer rehabilitation services: audiology, occupational therapy, physical and rehabilitation medicine, physiotherapy, psychology, prosthetics and orthotics, rehabilitation nursing, and speech-language pathology. These professions often work together to provide patient-centered care. Each rehabilitation profession has developed its own international or national document to describe entry-level competencies. However, it is not evident in the literature whether rehabilitation professions share the same core competencies. Therefore, we explored the international standards for rehabilitation professions to identify commonalities and differences in entry-level professionals' required core competencies. A thematic analysis of current, published, international, or national entry-level competencies documents was conducted to determine commonalities and differences in the core competence requirements for the eight rehabilitation professions. The following four themes were evident across all professions: (a) evidence-based clinical practice knowledge and skills; (b) culturally competent communication and collaboration; (c) professional reasoning and behaviors; and (d) interprofessional collaboration. This thematic analysis highlighted the commonalities among rehabilitation professionals and may be used to provide a greater understanding of how rehabilitation professionals can support and work together on interprofessional teams.

Introduction: The purpose of this study is to explore current perceptions within the military surgery community to stratify key obstacles to pursuing a career in academic surgery and identify opportunities for mitigation., Methods: After receiving institutional review board approval, an anonymous electronic survey was distributed to military surgeons across all branches. Survey response data were collected and analyzed using chi-square test., Results: The response rate was approximately 22%. Of those who responded to the survey, most are interested in an academic career (61.5%); however, 64% believe this to be much more difficult as a military surgeon than as a civilian surgeon. The top three perceived obstacles include administrative obstacles (76.4%), operational commitments (65.8%), and lack of funding for academic pursuits (62.7%). Most respondents indicated that they have never received formal education regarding how to apply for research funding (84.5%) and most do not have a research mentor (60.9%). Additionally, 42.9% state that obstacles to an academic career in surgery impact their decision to leave the military. Younger surgeons were more likely to leave the military upon completion of their service commitment (67.9% versus 46.4% aged 20-39 y, P = 0.02)., Conclusions: We characterized the perceived challenges to academic surgery within the military. These barriers between academic surgery and military service risk medical force attrition, particularly in future generations of surgeons. Dedicated faculty billets (positions) with limited operational demands as well as associated mentorship and research funding may enhance the retention and productivity of military surgeons., (Published by Elsevier Inc.)

Background: Artificial intelligence (AI) has the potential to revolutionize the way medicine is learned, taught, and practiced, and medical education must prepare learners for these inevitable changes. Academic medicine has, however, been slow to embrace recent AI advances. Since its launch in November 2022, ChatGPT has emerged as a fast and user-friendly large language model that can assist health care professionals, medical educators, students, trainees, and patients. While many studies focus on the technology's capabilities, potential, and risks, there is a gap in studying the perspective of end users., Objective: The aim of this study was to gauge the experiences and perspectives of graduating medical students on ChatGPT and AI in their training and future careers., Methods: A cross-sectional web-based survey of recently graduated medical students was conducted in an international academic medical center between May 5, 2023, and June 13, 2023. Descriptive statistics were used to tabulate variable frequencies., Results: Of 325 applicants to the residency programs, 265 completed the survey (an 81.5% response rate). The vast majority of respondents denied using ChatGPT in medical school, with 20.4% (n=54) using it to help complete written assessments and only 9.4% using the technology in their clinical work (n=25). More students planned to use it during residency, primarily for exploring new medical topics and research (n=168, 63.4%) and exam preparation (n=151, 57%). Male students were significantly more likely to believe that AI will improve diagnostic accuracy (n=47, 51.7% vs n=69, 39.7%; P=.001), reduce medical error (n=53, 58.2% vs n=71, 40.8%; P=.002), and improve patient care (n=60, 65.9% vs n=95, 54.6%; P=.007). Previous experience with AI was significantly associated with positive AI perception in terms of improving patient care, decreasing medical errors and misdiagnoses, and increasing the accuracy of diagnoses (P=.001, P<.001, P=.008, respectively)., Conclusions: The surveyed medical students had minimal formal and informal experience with AI tools and limited perceptions of the potential uses of AI in health care but had overall positive views of ChatGPT and AI and were optimistic about the future of AI in medical education and health care. Structured curricula and formal policies and guidelines are needed to adequately prepare medical learners for the forthcoming integration of AI in medicine., (©Saif M I Alkhaaldi, Carl H Kassab, Zakia Dimassi, Leen Oyoun Alsoud, Maha Al Fahim, Cynthia Al Hageh, Halah Ibrahim. Originally published in JMIR Medical Education (https://mededu.jmir.org), 22.12.2023.)

Oral and maxillofacial pathology, the branch of dentistry concerning clinical and histopathological diagnosis of pathologies of the oral and maxillofacial region, started to develop in Colombia in the mid- 19 th century. Since 1950s, dedicated dental clinicians from different dental schools played an important role in its inception and subsequent development. The first significant wave of progress occurred in the 1970s with the appearance of the first formally trained oral pathologists. It was sometime in the late 1980s and early 1990s that dentists Ines Velez and Benjamin Herazo had separate initiatives and created the first oral pathology postgraduate programs in Bogotá. It was in the late 80's and early 90's that dentists Ines Velez and Benjamin Herazo had their own initiatives and created the first oral pathology postgraduate programs in the city of Bogotá. A concomitant of their achievements was the establishment of the first on-site oral pathology biopsies units and registers at Colegio Odontãlogico Colombiano, Pontificia Universidad Javeriana and Escuela Colombiana de Medicina dental schools. The programs have trained many dentists in the field over the years and two of them remain active and fully accredited. The past and present contributions and leaderships of some academic figures and graduates have allowed a steady evolution of the specialty nationwide. Currently, the ability to manage and overcome educational and professional challenges is necessary to advance the growth of this specialty in this country., (Copyright 2023 © American Academy of the History of Dentistry.)

Background: Prior studies report that most published medical education research is unfunded. We sought to determine the extent and sources of funding for medical education research articles published in leading journals, and how these have changed in the last two decades., Methods: All research articles published in Academic Medicine, Advances in Health Sciences Education, Medical Education and Medical Teacher in 1999, 2004, 2009, 2014, and 2019 were reviewed for funding declarations. Funding sources were categorised as: government; university; healthcare organisation; private not-for-profit organisation; and for-profit company. Time trends were analysed using the Cochran-Armitage test., Results: 1822 articles were analysed. Over the aggregate 20-year period, 44% of all articles reported funding, with the proportion increasing from 30% in 1999 to 50% in 2019 ( p  < .001). The proportion of articles with government (10% to 16%, p  = .049), university (6% to 17% p  < .001), and not-for-profit funding sources (15% to 20%, p  = .04) increased. Proportions of healthcare (3% to 4%, p  = .45) and for-profit funding (2% to 1%, p  = .25) did not significantly change with time., Conclusions: Over the last 20 years, the proportion of funded published medical education research has significantly increased, as has funding from government, universities, and not-for-profit sources. This may assist researchers in identifying funders with a track record of supporting medical education research, and enhances transparency of where research funding in the field originates.

Background: Advancing healthcare access and quality for underserved populations requires a diverse, culturally competent interprofessional workforce. However, high educational debt may influence career choice of healthcare professionals. In the United States, health professions lack insight into the maximum educational debt that can be supported by current entry-level salaries. The purpose of this interprofessional economic analysis was to examine whether average educational debt for US healthcare graduates is supportable by entry-level salaries. Additionally, the study explored whether trainees from minoritized backgrounds graduate with more educational debt than their peers in physical therapy., Methods: The study modeled maximum educational debt service ratios for 12 healthcare professions and 6 physician specialties, incorporating profession-specific estimates of entry-level salary, salary growth, national average debt, and 4 loan repayment scenarios offered by the US Department of Education Office of Student Financial Aid. Net present value (NPV) provided an estimate for lifetime "economic power" for the modeled careers. The study used a unique data source available from a single profession (physical therapy, N = 4,954) to examine whether educational debt thresholds based on the repayment model varied between minoritized groups and non-minoritized peers., Results: High salary physician specialties (e.g. obstetrics/gynecology, surgery) and professions without graduate debt (e.g. registered nurse) met debt ratio targets under any repayment plan. Professions with strong salary growth and moderate debt (e.g. physician assistant) required extended repayment plans but had high career NPV. Careers with low salary growth and high debt relative to salary (e.g. physical therapy) had career NPV at the lowest range of modeled professions. 29% of physical therapy students graduated with more debt than could be supported by entry-level salaries. Physical therapy students from minoritized groups graduated with 10-30% more debt than their non-minoritized peers., Conclusions: Graduates from most healthcare professions required extended repayment plans (higher interest) to meet debt ratio benchmarks. For several healthcare professions, low debt relative to salary protected career NPV. Students from minoritized groups incurred higher debt than their peers in physical therapy., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: This study aims to compare trainee self-assessment with supervisor assessment to identify differences in correlations of the demographic data and evaluate whether the instrument can be utilized to identify underperforming trainees., Design: A novel instrument was designed based off the Royal Australasian College of Surgeons original 9 competencies utilizing the JDocs framework and covers 48-items across all surgical competencies. A multiple regression model using age, gender, postgraduate year, IMG status, and level of training as the variables was performed with backwards elimination, and pairwise comparisons made to identify the degree and direction of influence each variable contributed to trainee and supervisor ratings., Setting: Surgical trainees employed in tertiary centers within the Australian Capital Territory and South-East New South Wales health network in Australia., Participants: A total of 36 of 59 (61%) trainees responded. Two grossly incomplete responses were excluded from further analysis resulting in 34 completed self-assessments for analysis. There was a total of 68 supervisor assessments provided by 25 different nominated supervisors. Of these assessments, 67 were fully completed and one was partially complete., Results: We identified that for both self-ratings and supervisor ratings, the most significant correlation is with the postgraduate year of the trainee, with correlation identified in 7 out of 9 competencies, although in different competency domains. International Medical Graduate status is associated in 2 of 9 self-ratings, and in 3 of 9 supervisor ratings. Underperforming trainees were able to be identified through supervisor assessment but not self-assessment., Conclusion: The supervisor assessment form was able to identify underperforming trainees. Our findings resonate with existing literature in other specialty fields, and surgical units that employ assessment forms should feel more confident in the interpretation of the data and provision of feedback to trainees., Competing Interests: DECLARATION OF COMPETING INTEREST None, (Copyright © 2023 Association of Program Directors in Surgery. All rights reserved.)

We present historical accounts of congenital heart surgery since the early 1900s, as our specialty evolved from individual heroic efforts into an established and sophisticated surgical specialty with consistent and excellent results. We highlight colleagues and intrepid pioneers who have strived to solve seemingly insurmountable problems during this remarkable journey and celebrate continued success into the 21st century with surgical advances that have resulted in innovative operations, database inquiries, quality measures, new techniques of medical illustration, and the establishment of the Congenital Heart Surgeons' Society, which has become the leading organization dedicated to congenital heart surgery in North America.

Hong Kong is a well-developed city with outstanding healthcare services, leading to the highest life expectancy in the world. Paradoxically, the quality of end-of-life care in this city lagged behind that of many other high-income regions. Possibly, the advances in medicine contribute to the death denial culture, hindering communication about end-of-life care. This paper discusses challenges arisen due to poor public awareness and professional training and local initiatives to promote advance care planning in the community., (Copyright © 2023. Published by Elsevier GmbH.)

Background: Although pediatric residents frequently order blood products, transfusion medicine (TM) education is both limited and unstandardized during postgraduate training. Using Delphi methodology, this study aimed to identify and prioritize which pediatric TM curricular topics are most important to inform postgraduate training in TM for general pediatricians and pediatric subspecialists., Methods: A national panel of experts iteratively rated potential curricular topics, on a 5-point scale, to determine their priority for inclusion within a TM curriculum. After each round, responses were analyzed. Topics receiving a mean rating <3/5 were removed from subsequent rounds and remaining topics were resent to the panel for further ratings until consensus was achieved, defined as Cronbach α ≥ 0.95. At conclusion of the Delphi process, topics rated ≥4/5 were considered core curricular topics, while topics rated ≥3 to <4 were considered extended topics., Results: Forty-five TM experts from 17 Canadian institutions and 12 subspecialties completed the first Delphi round and 31 completed the second. Fifty-seven potential curricular topics were generated from a systematic literature review and Delphi panelists. Two survey rounds were completed before consensus was achieved. Seventy-three topics in six domains reached consensus: 31 core curricular topics and 42 extended topics. There were no significant differences in ratings between TM and non-TM specialists., Discussion: A multispecialty Delphi panel reached consensus in identification of curricular topics for pediatric resident physicians. These results set the stage to develop a pediatric TM curriculum that will be foundational for pediatric trainees to enhance learning and improve transfusion safety., (© 2023 AABB.)

Currently, the education of the history of medicine in South Korea has established a solid foundation. Since Kim Du-jong (1896-1988) began giving medical history lectures at Severance Medical College in 1946, a total of 22 universities-over half of the 40 total universities-have implemented medical history education in the curriculum as of 2023. Furthermore, several textbooks and translations summarizing Western and Korean medical history have been published. However, despite this expansion, there has been little discussion on how to implement medical history education for students. To address this gap, this study examines the period and structure of medical history education, as well as various teaching methods, while considering their respective advantages and disadvantages. Firstly, there are two main approaches to implementing medical history education. One approach integrates medical history throughout the entire educational process, while the other concentrates on specific stages of education. Both approaches extend beyond undergraduate education and encompass medical education after graduation. The former emphasizes integration with basic medical and clinical education, while the latter focuses on ensuring educational coherence. Secondly, the structure of medical history courses can be broadly categorized as chronological or thematic. Within the chronological approach, there are two subcategories: general and periodic. The general method is traditionally used in history education but may be rigid in structure and fail to engage students' interest. On the other hand, the period method conveys multidimensional and comprehensive understanding of different periods but may make it challenging to grasp the overall flow of history, resulting in fragmentation of the course. Thematic structure can be further divided into topic-centered and field-specific methods. Both approaches allow for adjusting the content and arrangement of courses based on student interests and teaching conditions, but they present challenges in maintaining the coherence of the entire course. Lastly, the teaching methods in medical history education can be categorized into traditional lectures, small-group discussions, and individual research guidance. Most medical history courses adopt a lecture-based teaching method, which effectively provides diverse knowledge to medical students who may be unfamiliar with historical research and methodology. However, due to the one-directional nature of the instruction and the passive role of the learners, it can be challenging to stimulate learners' motivation or assess their understanding. Consequently, recent changes try to incorporate active learning through small-group discussions and individual research guidance.

Background: Headache disorders are among the most common and disabling medical conditions worldwide, have a great societal impact and are a common reason to seek medical care. Headache disorders are often misdiagnosed and undertreated, and the number of headache fellowship-trained physicians cannot meet patient demand. Educational initiatives for non-headache-specialist clinicians may be an avenue to increase clinician competency and patient access to appropriate management., Objective: To undertake a scoping review of the educational initiatives in headache medicine for medical students, trainees, general practitioners/primary care physicians, and neurologists., Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews, an author (M.D.), with the help of a medical librarian, conducted a search of the Embase, Ovid Medline, and PsychInfo databases for articles related to medical educational initiatives on headache medicine in medical students, residents, and physicians over the last 20 years., Results: A total of 17 articles met the inclusion criteria for this scoping review. Six articles were identified for medical students, seven for general practitioners/primary care physicians, one for emergency medicine residents, two for neurology residents, and one for neurologists. Certain educational initiatives were headache-focused while others had headaches as one of the educational topics. Educational content was delivered and assessed via diverse and innovative means, such as flipped classroom, simulation, theatrical performance, repeated quizzing and study, and a formalized headache elective., Conclusion: Education initiatives in headache medicine are important to improve competency and patient access to appropriate management of various headache disorders. Future research should focus on using innovative and evidence-based methods of content delivery, knowledge, and procedural assessment, and evaluating changes in practice behaviors., (© 2023 American Headache Society.)

Background: Marine medicine is one of the medical fields that deals with the health and safety of people related to the sea but the marine medicine syllabus for education to the students is not specified yet. The present study aimed to develop the marine medicine syllabus to medical sciences students education., Methods: This study was conducted in three phases. First, a literature review was conducted to find the concepts and topics related to marine medicine. Second, a content analysis research method was conducted. Data collection was done first by using semi-structured interviews with the 12 experts in marine medicine. Sampling was purposeful and continued until data saturation was reached. The information obtained from the interviews was analyzed by conventional content analysis with Geranheim's method. The found topics in the literature review and content analysis of interviews were combined and formed the initial draft of the marine medicine syllabus, which was validated with the Delphi method in the third phase. The Delphi was conducted in two rounds and the panel consisted of 18 experts in the field of marine medicine. After the completion of each round, the items that had less than 80% consensus among the participants were removed and the remaining topics after round two formed the final syllabus of the marine medicine., Results: The findings showed that the marine medicine syllabus should include an overview of marine medicine, health at sea, common physical diseases and injuries at sea, subsurface medicine and hyperbaric, safety action in marine incidents, medical care at sea, psychology at sea and medical examinations of people working at sea main topics and their sub topics., Conclusions: Marine medicine is an extent and specialized medical field which has been neglected and it is necessary to teach this lesson to medical sciences students with the syllabus found in the present study., (© 2023. The Author(s).)

Background: In education, lecturers play a crucial role in facilitating students' learning process. However, only a few studies explored which lecturers' characteristics can facilitate this process in higher education for rehabilitation healthcare professionals. Starting from students' perspectives, our qualitative study investigated the lecturers' characteristics that facilitate students' learning process in the rehabilitation sciences., Methods: A qualitative interview study. We enrolled students attending the 2nd year of the Master of Science (MSc) degree in 'Rehabilitation Sciences of Healthcare Professions'. Different themes were generated following a 'Reflexive Thematic Analysis'., Results: Thirteen students completed the interviews. From their analysis, we generated five themes. Specifically, a lecturer that facilitates students' learning process should be: 1) 'A Performer who Interacts with the Classroom', 2) A Flexible Planner who Adopts Innovative Teaching Skills', 3) 'A Motivator who Embraces Transformational Leadership', 4) 'A Facilitator Who Encourages a Constructive Learning Context' and 5) 'A Coach who Devises Strategies to Reach Shared Learning Goals'., Conclusions: The results of this study underscore the importance for lecturers in rehabilitation to cultivate a diverse set of skills drawn from the arts and performance, education, team building and leadership to facilitate students' learning process. By developing these skills, lecturers can design lessons that are worth attending not only for their relevant content but also for their value in human experience., (© 2023. The Author(s).)

Background: Widening participation (WP) for underrepresented students through six-year gateway courses helps to widen the demographic representation of doctors in the UK. 'Most students from gateway courses graduate, even though many enter with lower grades than standard entry medicine students.' This study aims to compare the graduate outcomes of gateway and SEM cohorts from the same universities., Methods: Data from 2007-13 from the UK Medical Education Database (UKMED) were available for graduates of gateway and SEM courses at three UK medical schools. Outcome measures were passing an entry exam on the first attempt, Annual Review of Competency Progression (ARCP) outcome and being offered a level one training position from the first application. The univariate analysis compared the two groups. Logistic regressions, predicting outcomes by course type, controlled for attainment on completion of medical school., Results: Four thousand four hundred forty-five doctors were included in the analysis. There was no difference found in the ARCP outcome between gateway and SEM graduates. Gateway graduates were less likely to pass their first attempt at any membership exam than graduates of SEM courses (39% vs 63%). Gateway graduates were less likely to be offered a level 1 training position on their first application (75% vs 82%). Graduates of gateway courses were more likely to apply to General Practitioner (GP) training programmes than SEM graduates (56% vs 39%)., Conclusions: Gateway courses increase the diversity of backgrounds represented within the profession and importantly the number of applications to GP training. However, differences in cohort performance are shown to continue to exist in the postgraduate arena and further research is required to ascertain the reasons for this., (© 2023. The Author(s).)

Historians and physicians have struggled to incorporate history into American medical education for over a century. Most efforts focus on local initiatives targeting a narrow audience. We describe a novel method involving the American College of Surgeons, a national organization with tens of thousands of members. Capitalizing on its infrastructure and influence over the field, we have implemented a variety of ventures that include panel sessions at meetings, poster competitions, travel grants, themed breakfasts, online communities, and other such projects. This programming has reached thousands of participants, ranging from pre-medical students to retired physicians, and it has increased both the exposure to and production of surgical history. Our article describes the process of establishing this nationally coordinated enterprise in the hopes that other medical specialties can emulate it and further the study of and appreciation for medical history., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Doctors-in-training often receive an inadequate dermatology education. Furthermore, studies have highlighted the under-representation of skin of colour (SOC) in dermatological teaching, learning resources and research. Our image-based questionnaire, distributed to all internal medicine trainees in southwest England, highlighted knowledge gaps regarding SOC among training physicians. It is intrinsically more challenging for clinicians to confidently formulate dermatological diagnoses in SOC. In this review, we provide guidance for physicians to help make the diagnostic process more straightforward. First, we outline how skin colour is determined and classified. We discuss how inflammation presents in SOC, with the typical 'erythema' that physicians often associate with inflammation being a less prominent feature in darker skin tones. We then summarise nine important conditions that we believe physicians working in all specialties should be able to identify in patients with SOC, covering both conditions encountered on the medical take and conditions disproportionately affecting individuals with SOC. The population of the UK is rapidly diversifying; thus, as physicians, we have a professional duty to educate ourselves on dermatological conditions in SOC to provide the best quality of care for all our patients, regardless of their skin type., (© Royal College of Physicians 2023. All rights reserved.)

Aims: The aims of the study were to identify factors affecting nurses' decision to undergo specialist education and choose a specialty and to describe differences between specialization areas with different types of care., Design: A descriptive cross-sectional design., Methods: A survey was conducted among specialist nurse students in three nursing colleges in Sweden (n = 227). Instruments such as Big Five Inventory and RAND-36 and items earlier used by Bexelius and Olsson were included. Survey data were analysed by using descriptive and analytical statistics, and for open-ended question qualitative content analysis was used., Results: Wage benefit during the education was regarded by 47% as an incentive to start studies. Most of the specialist nurse students considered an opportunity for new tasks (75%), new areas of responsibility (75%), intellectual challenges (72%) and higher wages (71%) to be of high importance when choosing a specialty. However, the students in specialization areas with transitory care-rated challenges regarding the practical skills (84%) and the occurrence of acute events (82%) higher., Conclusion: Although higher wages were important to make nurses feel that they will get value from the education, there were also other important aspects, such as opportunity for new tasks, new areas of responsibility and intellectual challenges that influenced nurses' willingness to undergo a specialist education. Our findings provide employers with the useful information to guide and influence nurses' decisions to enter specialist education and their choice of specialist area., (© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

The fields of genetics and genomics have greatly expanded across medicine through the development of new technologies that have revealed genetic contributions to a wide array of traits and diseases. Thus, the development of widely available educational resources for all healthcare providers is essential to ensure the timely and appropriate utilization of genetics and genomics patient care. In 2020, the National Human Genome Research Institute released a call for new proposals to develop accessible, sustainable online education for health providers. This paper describes the efforts of the six teams awarded to reach the goal of providing genetic and genomic training modules that are broadly available for busy clinicians.

Negotiating a resource package as a potential new department chair is common practice in academic medicine. The foundations for this negotiation include the historical presence of the department in relation to the broader institution, projections for future growth, accounting for mission/vision, resource needs (space, personnel, finances, etc), faculty and staff development, and external partnerships within and outside the institution. Despite similarities in this process across departments, many nuances influence the development of a specific new chair package, such as, department size; desires, perspectives and talents of the incoming chair, the department faculty, the medical school and dean; prevailing agendas and mission imperatives; and the overall priorities of the institution. With strategy and forethought, a new chair package can promote a successful chair tenure and departmental growth. Assembled through the Association of Departments of Family Medicine with input from several dozen department chairs and senior leaders, this is intended to serve as a practical guide to new chair packages for chair candidates., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Obstructive sleep apnoea (OSA) is a common condition with a range of short- and long-term health implications. Providing patient-centred care is a key principle to ensure patients are well informed and empowered to participate in clinical decision making. This study aimed to develop a patient-centred sleep study report for patients with obstructive sleep apnoea and to determine whether or not its implementation led to improved patient understanding of their disease., Methods: The study was performed in two phases. The first phase utilised the Delphi-survey technique to develop and critically appraise a patient-centred sleep study report (PCSR) for patients with OSA, to accurately and simply convey key components of the patient's diagnosis and management. The second phase was a prospective, randomised controlled trial to assess the effect of the PCSR on patient knowledge, self-efficacy, and understanding as measured through validated patient questionnaires., Results: The PCSR was developed on key concepts deemed to be important by the surveyed physicians, senior sleep scientists and patients. This included ensuring the results were customised, highlighting the patient's apnoea-hypopnea index, oxygen desaturation index and arousal index and limiting technical information to a few key pieces. Patients randomised to receive the PCSR had improved understanding and perceived patient-physician interaction compared to those randomised to standard care., Conclusion: The development and implementation of the PCSR was feasible and improved patient understanding and perceived patient-physician interaction in patients with moderate to severe OSA. Whether or not use of the PCSR will translate to improved compliance with therapy will require further evaluation., (© 2022. The Author(s).)

Background: Although allergic diseases are among the most important health disorders, allergology is not anchored as an independent subject in the clinical part of medical studies in Germany., Objective: As all universities and institutes face the same challenge, the aim of our project was to establish exemplary coordination and networking of education in allergology at one location in agreement with all involved departments and institutes. Particularly, Comprehensive Allergy Centers (CAC) offer an established infrastructure via which the revised allergology education program can be transferred to other universities., Materials and Methods: After an extensive inventory of the current allergological curriculum at the University Medical Center Göttingen, a new teaching concept was developed in interdisciplinary consensus, supplemented by first-time provision of additional digital contents ("blended learning"), and finally evaluated., Results: Initially, we observed a high level of fragmentation in the teaching of allergology in the clinical study sections of human medicine, with no coordination between the 12 clinical departments/institutes involved and no coherent framework for the specific learning content. Within the established structure of the interdisciplinary CAC, we revised, coordinated, and defined key areas for improved student education in clinical allergology. The allocation of new interactive learning elements as well as supplementary materials for self-studies was welcomed by the students and positively evaluated. A survey among students after completing the former vs. current curricula showed significant improvements in achieving the desired educational objectives., (© 2022. The Author(s).)

Since 2010, the postgraduate training diploma in laboratory medicine has experienced a strong decline in its attractiveness to French medical students. This work aims to objectify and quantify this decline between 2004 and 2021. To do so, we have carried out an analyze of the trend to choose laboratory medicine after the national ranking review performed by all French students. Then, we have also compiled the data on the right to change one’s mind and final quits from laboratory medicine postgraduate training. The laboratory medicine reform has led to deep changes in its organization. The accreditation requirements, the laboratories grouping, as well as the financialization of this activity have strongly changed the work of laboratory physician and impacted its attractiveness for the young generations.

Learning digital competencies can be successful if the information is also tried out immediately using interactive elements. However, interactive teaching poses a particular challenge, especially in large group formats. Various strategies are used to promote interaction, but there is little known about the results. This article shows different strategies and evaluates their influence on the interaction rate in a large group course over two terms that teaches digital medicine. Log files and participation in surveys as well as participation in chat were quantitatively evaluated. In addition, the chat messages themselves were evaluated qualitatively. For the evaluation, relation to the total number of participants was particularly relevant in order to be able to determine an interaction rate in the individual course sessions. A maximum average interaction rate of 90.97% could be determined over the entire term while the participants wrote an average of 3.96 comments during a session in the chat. In summary, this research could show that interactive elements should be well planned and used at regular intervals in order to reap the benefits.

Machine learning and artificial intelligence (AI)-driven technologies are contributing significantly to various facets of medicine and care management. It is likely that the next generation of healthcare professionals will be confronted with a series of innovations that are powered by AI, and they may not have sufficient time during their professional tenure to learn about the underlying machine learning frameworks that are driving these systems. Educating the aspiring clinicians and care providers with the right foundational courses in machine learning as part of postsecondary education will likely transform them as high-tech physicians and care providers of the future., (Copyright © 2022 The Author. Published by Elsevier B.V. All rights reserved.)

Background: The medical specialty choice of physicians directly affects the healthcare system, community wellbeing, and their own professional life. It is therefore important to identify its underlying factors to predict such medical career choices and to draw up a comprehensive evidence-based public health policy and health human resources planning. The present qualitative study aimed to identify these determinants of career choices through semi-structured interviews with medical doctors in the context of country-specific social and cultural characteristics., Methods: The present qualitative study was carried out in 2019-2020 at Shiraz University of Medical Sciences (Shiraz, Iran). The target population was medical students, junior doctors, and medical residents. The purposive sampling method was used to recruit the participants and sampling continued until data saturation, i.e., no new information could be extracted. Data were collected through individual, face-to-face, semi-structured interviews and analyzed using the conventional content analysis method. Inductive thematic analysis was used to interpret the data based on which a thematic map was developed illustrating the factors influencing medical specialty preferences in Iran. Data trustworthiness was assessed according to the criteria proposed by Guba and Lincoln., Results: Analysis of the interview data resulted in three main themes and fourteen sub-themes. The main themes were "Personal determinants", "Career-related factors", and "Interpersonal influences". The most important sub-themes were personal interests, income, and prestige., Conclusion: The determinants influencing the specialty preferences of Iranian medical doctors are identified. Our findings will facilitate the development of a comprehensive evidence-based public health policy, health human resources planning, and appropriate medical education policy., (Copyright: © Iranian Journal of Medical Sciences.)

Background: Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the 'deliberate practice of improving performance through practising beyond one's comfort level under guidance'. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs., Methods: Krishna's Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA's Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions., Results: The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs., Conclusion: Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy's Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation's role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development., (© 2022. The Author(s).)

Assessing competence is a tremendous challenge in medical education. There are two contrasting approaches in competence assessment: an analytic approach that aims to precisely measure observable constituents and facets of competence and a holistic approach that focuses on a comprehensive assessment of competences in complex real situations reflecting actual performance. We would like to contribute to the existing discourse about medical competence and its assessment by proposing an approach that can provide orientation for the development of competence-based assessment concepts in undergraduate and postgraduate medical education. The approach follows Kane's framework of an "argument-based approach" to validity and is based on insights into task complexity, testing and learning theories as well as the importance of the learning environment. It describes a continuum from analytic to holistic approaches to assess the constituents and facets of competence to performance. We conclude that the complexity of a task should determine the selection of the assessment and suggest to use this approach to reorganize and adapt competence assessment., (© 2021. The Author(s).)

Introduction: While there have been many studies reviewing factors considered by medical students in deciding on a specialty, there is a relative paucity of data in how these factors differ between males and females. The aim of this study was to determine if there are differences in how male and female medical students' value various factors in choosing a career path in medicine., Methods: A survey of basic demographic information and a Likert-based questionnaire addressing various factors in specialty choice was sent to all military medical students in the class of 2019., Results: The survey response rate was 30%. Amongst the students that completed the survey, 72% were male and 28% were female. The majority of students were less than 27 years old (52%) and Caucasian (76%). Female medical students placed more importance in exposure to third year clerkships (P = 0.004) and gender diversity within the specialty (P = 0.03) than their male counterparts. There was no statistical difference in opinions of significant others or family members, desire to have a family, or having a well-balanced life between female, and male medical students., Conclusion: Female medical students valued exposure to third year clerkships and gender diversity more than their male colleagues when choosing a future specialty. These findings suggest that a strategic focus should be placed on mentoring female medical students in order to promote a diverse medical workforce., (Published by Elsevier Inc.)

Competing Interests: Competing interests: None declared.

Introduction: Rural physiotherapy is a challenging area of practice that requires clinicians to respond to the unique factors that contribute to rurality. This study aimed to outline an introductory set of competencies that contribute to effective physiotherapy practice in rural Australia., Methods: A three-round Delphi study was undertaken using a panel of expert physiotherapists. The panel was asked to provide open-ended responses to the following question: 'What unique knowledge, skills, abilities, attributes or other characteristics do physiotherapists need to possess, or learn in order to provide effective physiotherapy specifically in a rural or remote setting?' These responses were then thematically analysed to create competencies. The competencies were evaluated in the subsequent rounds by the Delphi panel. Consensus was set at 80%. Rural and remote experts were determined through criteria including duration of practice, established expert frameworks, and self- or peer nomination. The publicly accessible Australian Physiotherapy Association database was used to access the contact details of 222 physiotherapists working in rural and remote locations across all Australian states and territories. Seventeen expert physiotherapists met inclusion criteria and consented to participation., Results: Seventeen expert physiotherapists completed round one with a 100% response rate. Analysis of the expert panel responses yielded an initial 24 competencies. The second round had a response rate of 94.1%, and the third round 93.8%. A final set of 19 competencies was established. The knowledge, skills and attributes featured in the competencies relate to responsivity to rural locality, adapting to individual community needs and problem solving in response to challenges to practising in rural and remote locations., Conclusion: This study has introduced a set of competencies that may contribute towards effective physiotherapy practice in the rural setting. The competencies provide a common language for physiotherapists and their employers, and may be used to guide training or mentorship in this setting.

To evaluate the quality of radiation oncology training in Poland and to identify difficulties and needs of radiation oncology trainees (ROTs), an anonymous online survey using Google Forms was conducted in November 2018. All ROTs from Poland (n = 154) were invited to complete the survey. The survey consisted of 30 questions and regarded aspects such as satisfaction from training, cooperation with the supervisor, and education. During the study period, 105 ROTs from 22 Polish cities responded (the response rate was 68%). Almost 85% were satisfied with the choice of specialty, 43% with training and 81% with the teaching place. Clinical cooperation with the supervisor was described as difficult by 25%. With education, 38% of responders experienced obstacles and another 25% stated that educational cooperation with their supervisor was none. "Good practice" understood as treatment according to the latest guidelines or internal protocols were reported by 71%. Obligatory traineeships were shorter than recommended according to 67% of the responders, usually due to shortage of medical staff. Almost two-thirds of ROTs work only in clinics, while 34% perform both clinical and scientific work. The responders suggested that the introduction of organ-specified courses is an appropriate modification of the current program. Noteworthy, current diagnostic imaging and physics courses are not sufficient for the majority of participants (81% and 80%, respectively). Radiation oncology training is conducted relatively well in Poland. Some hospitals need to improve clinical and educational cooperation between trainees and their supervisors., (© 2020. The Author(s).)

Nutrition is a foundation of health and one of six pillars of Lifestyle Medicine. The importance of nutrition in clinical care is now widely recognized by health care professionals and the public. However, clinicians are not comfortable counselling their patients on nutrition due to inadequate or lack of training, leaving a significant need in patient care. This gap can be closed with evidence-based curricula in medical schools and in the trainings of other health care professionals. This communication presents the current state of nutrition knowledge in health care, emphasizing nutrition education for physicians, and presents a model of how pre- through post-professional health care providers may become proficient in nutrition counseling including appropriate referral to more specialized providers. With these skills, health care professionals will be able to initiate patient-centered lifestyle plans. This includes improving diet and utilization of team-based medicine and referrals.

Objective: To foster implementation of genomic testing in medical care by providing a cadre of physicians with 'hands on' experience in genomics, positioning them as opinion leaders in their medical speciality. This paper presents qualitative evaluation of immediate outcomes, in particular its impact on peer interactions., Methods: Program design and delivery was informed by implementation science, behavior change and experiential learning theories. Inductive content analysis of transcribed audio-recordings from semi-structured post-project interviews with all participants (n = 12) was conducted., Results: Participants reported the immersion experience improved their genomic capability, established them as credible genomic experts within their speciality and altered their practice in genomic medicine. Participants reported strengthening and widening of peer-to-peer and interdisciplinary communication, with both passive diffusion and active dissemination of information to peers. Some also became a resource for genetic professionals., Conclusions: Genomic immersion participants described elements which support sustained integration of an innovation, including immediate changes (e.g. use of genomic tests) and wider impacts (e.g. professional networks)., Practice Implications: This study supports a role for immersion as a successful strategy for enhancing engagement of non-geneticist physicians in genomics. Additional study is needed to understand how immersion experiences change the delivery of genomic services at the provider, practice and health system level., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: A public health student service was set up by the French government in 2018 with the aim of increasing awareness of primary health promotion among the 47,000 students of medicine and other health professions. It is an annual program involving community-based actions on nutrition, physical activity, addiction or sexuality. Our objective was to evaluate its implementation at local level and the different experiences of the stakeholders., Methods: A quasi-experimental study using process evaluation was performed in a Faculty of Medicine in Paris. Quantitative and qualitative data were collected from medical students who carried out preventive health actions, in the institutions in which the actions took place and from a subsample of beneficiaries., Results: One hundred and eight actions were carried out by 341 students in 23 educational or social institutions, mostly high schools (n = 12, 52%). Two thirds of the students did not feel sufficiently prepared to deliver preventive health interventions (65.7%, 224/341); however the beneficiaries found that the interventions were good (278/280, 99,2%). Nineteen (83%) of the host institutions agreed to welcome health service students again, of which 9 required some modifications. For students, the reporting of a satisfactory health service experience was associated with the reporting of skills or knowledge acquisition (p < 0.01). Delivering actions in high schools and to a medium-sized number of beneficiaries per week was associated with students' satisfaction. No effect of gender or theme of prevention was observed. For 248/341 (72.7%) students, the public health service program prompts them to address prevention issues in the future., Conclusion: The public health service undertaken by medical students through the program is a feasible and acceptable means of delivering preventive actions. Reinforcement of training and closer interaction with the host institutions would improve results.

Introduction: Choosing a medical specialty is a complex decision comprised of a combination of intrinsic and extrinsic factors that can include economic status, personal interest, input from mentors, and personality traits. The fictional world of Harry Potter, a generational literary phenomenon, describes 4 distinct houses in the wizarding Hogwarts school; each valuing particular traits of mortality that correspond with personality types. As such, we hypothesized that with each medical specialty often attracting particular personalities, the percentage of residents who self-sorted into the different Hogwarts' houses would vary depending on their chosen specialty., Methods: A web survey was sent out nationwide to surgical coordinators and residents, collecting demographic information and responses regarding specialty type and Hogwarts' house self-sorting., Results: The survey was completed by 251 residents (49.4% from surgical specialties) with a 12.6% response rate of surgical coordinator dissemination and a 43.1% resident response rate at Carolinas Medical Center. Surgical specialties were found to have significantly fewer self-sorted Hufflepuffs (p = 0.002) and more Slytherins (p = 0.0061) than nonsurgical specialties. General surgery had significantly more Gryffindors (p = 0.04) and fewer Hufflepuffs (p = 0.0017) whereas orthopedic surgery had significantly more Slytherins (p = 0.0282). Pediatrics had significantly fewer Gryffindors (p = 0.0096) and more Hufflepuffs (p = 0.0006). Obstetrics and gynecology had significantly fewer Gryffindors (p = 0.0082) and the highest percentage of Ravenclaws when compared to all other specialties (35.3% vs 19.9%; p = 0.1344). Family medicine had no self-proclaimed Slytherins., Conclusions: The discrepancies between specialties in the ratios of residents per Hogwarts house highlights that certain attributes may be more essential, advantageous, or complementary to a specific specialty. This information may guide medical students in choosing a satisfying and successful career path., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: General surgery and surgical subspecialty residents account for nearly 19% of US medical residents; however, it is well known that many surgical residents fail to graduate from their residency training program. We sought to comprehensively evaluate recent trends in nonprogression rates among surgical residents., Design: This is a retrospective study on residents during the 2007 to 2016 academic years. We calculated the annualized progression failure rate by extracting the total number of residents who progress to the next level of training per year, total number of residents who failed to progress per year, and reasons for discontinuing residency. Proportions of residents who failed to progress were calculated to estimate potential differences in progression failure rates among different specialties across time., Setting: We evaluated information provided by the Accreditation Council for Graduate Medical Education during the 2007 to 2016 academic years., Participants: Surgical and nonsurgical residents of Accreditation Council for Graduate Medical Education accredited programs during the period 2007 to 2016., Results: Overall, 2.67% of surgical residents did not progress to the next level each year. This proportion is higher in surgical specialties than in nonsurgical ones. Nonprogression rates for individual surgical specialties ranged from 0.4% to 4.1% on average per year. In addition, observed changes in rates and reasons for attrition varied across individual specialties. Of the surgical residents who failed to progress, more than 50% transferred to a different program, 40% withdrew, and 9% were dismissed., Conclusions: Our findings indicate that surgical residents are more likely to leave their initial residency program prior to completion than residents in medical specialties. Annualized ratios among subspecialties vary. General surgeons were the most likely and otolaryngology residents the least likely to discontinue their training., (Copyright © 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

An estimated 42% of Australians who consult complementary medicine (CM) practitioners have a mental health diagnosis. Preparedness of CM practitioners in managing such diagnoses is currently unknown. A cross-sectional survey of 257 CM practitioners who reported caring for people with a mental health diagnosis. Practitioners' mental health literacy, educational needs, and confidence in the assessment, management, and treatment of mental health--including suicide risk--were analysed. Most (59.1%) participants had no formal qualifications in mental health and 44.3% indicated they had not completed any training in psychological therapies. Only 20% were trained in mindfulness-based techniques or goal setting. Over 50% reported their undergraduate qualification contained insufficient mental health content to prepare them for clinical practice. Over one-half had attended continuing professional education on mental health. Practitioners reported greater confidence in assessing, managing, and treating mental wellbeing over complex mental health disorders and suicide risk. These findings uncovered a deficit in the CM practitioner's surveyed mental health education. As these CM practitioners are a primary point of contact for patients with mental health diagnoses, there is a critical need to expedite skills development in this workforce to support the delivery of safe and effective primary mental health care.

Social media has become an integral part of daily life and its use is becoming increasingly intertwined with the healthcare sector. Instagram is a free photo and video sharing social media application that has been utilised extensively in visually rich fields within medicine. Herein, we discuss the advantages and disadvantages of its use in modern medicine., (© 2019 Royal Australasian College of Physicians.)