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Transgender and gender diverse (TGD) youth, particularly transgender youth of color, experience barriers to most, if not all, types of care across the United States. Consequently, clinicians are concerned about the increase of anti-transgender policies in the United States, with many states now restricting gender-affirming care. In this manuscript, we suggest several empirically based techniques to provide quality clinical care. We also share resources to support TGD youth and their families, while accommodating for some of these newer restrictions on the care that clinicians are able to provide. Ongoing training and awareness in these techniques will allow clinicians and their health care institutions to more effectively and immediately respond to anti-transgender policies and be able to provide care. By continuing to advocate for some of these strategies, there is potential to reduce the health inequities that many TGD youth experience. Prioritizing screening for gender discrimination, creating a safe space for TGD youth, and providing immediate clinical strategies to reduce distress can reduce symptoms of depression and suicide. These changes, albeit small, will allow clinicians to feel more comfortable providing gender affirming care through holistic changes in clinical practices and care. [ABSTRACT FROM AUTHOR]

Training needs of Special Operations Forces (SOF) medics were surveyed and new training initiatives have been created to meet their needs. SOF medics perform an array of medical procedures in austere environments with minimal supervision. Medical skills decay over time after initial training and the perceived training needs of active SOF medics were unclear. To fill this gap, active SOF medics (n=57) completed a survey that included confidence ratings and indications of whether additional training would make them more proficient in 70 medical knowledge and procedural skills, assembled into categories by a panel of experts (airway, trauma, neuro, differential diagnosis, administrative, infection, critical care, environmental, other). Data were analyzed with analysis of variance (ANOVA) and nonparametric statistics at P<.05. Confidence was highest in the trauma, administrative, and airway categories, and lowest in the infection, differential diagnosis, and neuro categories (P<.05 or less). Categories indicating the greatest need for additional training were environmental and critical care, while those indicating lowest need were the airway and trauma categories (P=.05). Additional training was endorsed by >75% of participants in each category. SOF medics also wanted additional training in all areas, preferably hands-on with live patients in realistic scenarios, taught by experienced medics. Findings highlight the training needs of SOF medics and demonstrate the value of bottom-up feedback toward optimizing sustainment training. Based on present findings, two TACMED (Tactical Medicine) Divisions at the SOF Echelon III level were created to meet the sustainment training needs of SOF medics., Competing Interests: The authors have no financial relationships relevant to this article to disclose., (2024.)

Background: International medical electives are a well-established part of the curriculum of many western medical schools. It is widely accepted that these electives contribute to improved clinical examination and communication skills. Overseas electives also exert a strong influence over future career decisions and often pave the way for later international work. Whilst the positive outcomes are known, little information exists regarding elective preferences and destinations overall, information that could help optimise a safe learning experience and maximise the potential for one of the highlights of medical education. In order to obtain analytical data that could assist medical elective framework development, we systematically reviewed the two largest German online databases cataloguing abroad elective testimonies.Results: We identified 856 overseas elective reports uploaded within the last five years. European destinations were the most sought-after choice among German-speaking medical students. Interest in abroad electives in the United States (U.S.), a traditionally popular destination, was much lower than expected. U.S. elective reports accounted for only 3 % of long-term electives. Electives in low- and middle-income countries were generally less popular than electives in high-income countries. General surgery was the most popular elective discipline, followed by Emergency Medicine and Gynaecology and Obstetrics.Conclusions: We observed a large inhomogeneity in German-speaking medical students' elective choices, potentially influenced by financial and organizational aspects as well as geopolitical developments. This highlights a crucial challenge for medical schools and other organizations involved in elective planning. In light of regional differences, our data suggest that a "one size fits all" preparation is not pertinent to optimize students' elective experience. Country- or region-specific pre-departure trainings and more individualized elective frameworks might be necessary to address these differences and to ensure a safe learning experience for students. [ABSTRACT FROM AUTHOR]

Deep currents of cultural change are having an effect on the medical profession, beginning with gradual decreases in membership numbers in county, state, and national organizations that influence education, training, policy making in the health care sector, and political lobbying, and with gradual increases in membership numbers in specialty organizations that provide educational materials and meeting venues for physicians to remain current in their specialties and to develop and maintain professional relationships. Concurrent with the demographic changes, medical professionalism has become a growing movement to organize accepted professional behaviors into ten commitments, two of which, improving access to care and just distribution of finite resources, are consistent with Russel) L. Gruen's concept of civic mindedness. There are also increasing numbers of physician-activists who are emphasizing the need for greater civic engagement. Medical institutions have the opportunity to build on these commitments to inculcate strong social skills and civic attitudes and behaviors at all levels of education, training, and medical practice for the betterment of patients and for the greater public health of the community and the country. [ABSTRACT FROM AUTHOR]

Distinct pedagogical approaches within medical curricula in France and in the U.S. reflect a growing recognition of the importance of nutrition to address major public health challenges. However, recent generations of medical students have expressed mixed opinions regarding nutrition education. What pedagogical approach may improve nutrition education? Despite different medical systems, students from both France and the U.S. share similar concerns and expectations, that nutrition knowledge must be embedded in the curriculum and must be engaging. Hands-on, system-based, epistemological, and multidisciplinary approaches need better articulation to forge a robust medical curriculum. In the rapidly changing contexts of medicine and public awareness, social science research may facilitate recommendations for improved nutrition education.

Purpose: International studies document that lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) patients face significant health disparities. Studies exploring the attitudes, knowledge, preparedness and comfort levels of healthcare students towards LGBTQI+ health have been conducted in the United States, United Kingdom and Malaysia. This study aims to investigate stigma in healthcare for LGBTQI+ patients in Singapore, and possible upstream factors within medical education., Methods: This mixed-methods study adopts a convergent parallel design. The Health Stigma and Discrimination Framework was referenced to devise in-depth interviews with representatives from 13 LGBTQI-affirming non-governmental organisations, analysed through thematic analysis. 320 clinical medical students were surveyed about attitudes, knowledge, comfort, preparedness, and perceived importance of/towards LGBTQI+ health, analysed via descriptive statistics and multivariate regression., Results: Prevailing stigma in Singaporean society against LGBTQI+ individuals is exacerbated in healthcare settings. Doctors were cited as unfamiliar or uncomfortable with LGBTQI+ health, possibly from lack of training. Among medical students surveyed, the median composite attitudes, comfort and preparedness index was 3.30 (Interquartile Range (IQR) = 0.50), 3.17 (IQR = 0.83), 2.50 (IQR = 1.00) respectively. Only 12.19% of students answered all 11 true-false questions about LGBTQI+ health correctly., Conclusion: Medical students in Singapore have scored sub-optimally in their knowledge and preparedness towards LGBTQI+ health, while interpersonal and structural stigma in healthcare towards LGBTQI+ people in Singapore negatively affects health and wellbeing. These findings are an impetus to improve medical training in this area. High scores among medical students in attitudes, comfort and perceived importance of LGBTQI+ topics demonstrate that there is space for LGBTQI+ health in the local medical education curriculum. Curricular interventions can prioritise content knowledge, communication skills and sensitivity.

This letter responds to the article "Love Your Patient as Yourself: On Reviving the Broken Heart of American Medical Ethics," by Tyler Tate and Joseph Clair, in the March‐April 2023 issue of the Hastings Center Report. [ABSTRACT FROM AUTHOR]

This reflective essay is an attempt to organize trends in feedback I have observed during ten years of coursework, conversations, and correspondence with former students associated with the Medical Humanities Program at Baylor University. Over the years, recurrent themes arise when speaking with alumni about whether and how their medical humanities experience intersects with their current training. I have identified five particular domains in which baccalaureate medical humanities training affects students' subsequent healthcare professions training and practice: context and complementarity, clinical relevance, reflective practice, professional preparedness and vocational calling. I created an instrument of open-ended questions for each of these categories and posted it to social media with an invitation for alumni to respond. This informal survey was conceived as an exploratory exercise with the intent to help generate a foundation for more formal qualitative research in these five domains. In this essay, I offer my own reflections together with those of former students on the impact of baccalaureate-level medical humanities training in order to illustrate the benefits in each domain for subsequent healthcare training and practice. The need for qualitative research that explores the impact of baccalaureate medical humanities merits collaboration between multiple centers of investigation across many disciplines, and across the divide between premedical and medical educators. [ABSTRACT FROM AUTHOR]

Purpose: Although pediatricians are primary care providers for most adolescents, pediatric residents receive limited training on long-acting reversible contraceptive (LARC) methods. This study aimed to characterize pediatric resident comfort with placing contraceptive implants and intrauterine devices (IUDs) and assess pediatric resident interest in obtaining this training., Methods: Pediatric residents in the United States were invited to participate in a survey assessing comfort with LARC methods and interest in LARC training during pediatric residency. Bivariate comparisons used Chi-square and Wilcoxon rank sum testing. Multivariate logistic regression was used to assess associations between primary outcomes and covariates including geographic region, training level, and career plans., Results: Six hundred twenty seven pediatric residents across the United States completed the survey. Participants were predominantly female (68.4%, n = 429), self-identified their race as White (66.1%, n = 412), and anticipated a career in a subspecialty other than Adolescent Medicine (53.0%, n = 326). Most residents were confident counseling patients on the risks and benefits, side effects, and effective use of contraceptive implants (55.6%, n = 344) and both hormonal and nonhormonal IUDs (53.0%, n = 324). Few residents reported comfort with inserting contraceptive implants (13.6%, n = 84) or IUDs (6.3%, n = 39), with most of these respondents having learned these skills as a medical student. Most participants believed that residents should receive training on insertion of contraceptive implants (72.3%, n = 447) and IUDs (62.5%, n = 374)., Discussion: Although most pediatric residents believe LARC training should be a component of pediatric residency training, few pediatric residents are comfortable with provision of this care., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

This paper reviews the current status of medical humanities courses in Canadian undergraduate medical school curricula as a foundation for ethics and professionalism training. It studies relevant literature and compares the course offerings of the 17 Canadian medical schools as presented on the official school websites and course calendars. It discusses how medical humanities courses have grown to become an integral part of the medical education syllabus in many schools. Programs specifically dedicated to humanities are also reviewed. [ABSTRACT FROM AUTHOR]

An unprecedented number of Americans have been incarcerated in the past generation. In addition, arrests are concentrated in low-income, predominantly nonwhite communities where people are more likely to be medically underserved. As a result, rates of physical and mental illnesses are far higher among prison and jail inmates than among the general public. We review the health profiles of the incarcerated; health care in correctional facilities; and incarceration's repercussions for public health in the communities to which inmates return upon release. The review concludes with recommendations that public health and medical practitioners capitalize on the public health opportunities provided by correctional settings to reach medically underserved communities, while simultaneously advocating for fundamental system change to reduce unnecessary incarceration. [ABSTRACT FROM AUTHOR]

By exploring the central legal principles and issues regarding usage of the dead body in healthcare and especially in medical training, this article aims at drawing some general conclusions on the legal status of the dead body and the protection of the deceased's integrity, dignity and autonomy. The article demonstrates that the use of the cadaveric body for scientific and educational purposes involves a redrawing of the traditional boundaries between the decent and the indecent, making these acts acceptable that would otherwise be regarded as assaults on the sanctity of bodily boundaries. This is made possible by the fact that the underlying principle of dignity is not perceived to be of an absolute nature when applicable to deceased persons. [ABSTRACT FROM AUTHOR]

Background: The transition from medical resident to subspecialty fellow is a critical time period in fellowship training that has not been well described. The current practices of fellow orientation in pulmonary and critical care training programs are not known. Objectives: The aim of this study was to describe orientation practices for training programs in the United States. Methods: A 10-question survey was sent via e-mail to program directors of pulmonary/critical care fellowship programs identified on the American Thoracic Society (ATS) webpage of current programs. Results: Eighty-seven programs responded (61.7%), of which 86% had a formal orientation program. The mean time spent in fellow orientation was 5–10 h in didactic sessions and 0–5 h in wet labs. The most frequent didactic sessions were bronchoscopy in 69 programs (80.2%), pulmonary function testing in 63 programs (73.3%) and orientation to hospital services in 63 programs (73.3%). The most frequent use of wet labs was in bronchoscopy training in 60 programs (81.1%) and ventilators in 45 programs (60.8%). Simulators were used in 37 programs (43%). The majority reported that these areas were covered with on the job training, without a formal designated orientation. Conclusion: This survey demonstrated that early fellow training differs across programs in both time spent and clinical and procedural topics covered. An early, standardized approach to clinical and procedural training can assure appropriate exposure that cannot be guaranteed by on the job training. To provide justification for such an approach, clinical outcomes need to be correlated with training methods. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Though there has been growing attention to the impact of the coronavirus pandemic on the career trajectories of current health care workers, research remains sparse on how those in earlier stages of medical education have been affected by the pandemic. To better understand the pandemic's influence on pre-medical students' professional trajectories, this study draws on 48 interviews with freshmen and sophomore pre-medical students at a private university in the northeastern United States. For many students, witnessing physicians' role during the pandemic made them more aware of both the vulnerability of physicians and the limits of their power in the medical field and society at large. Notably, students primarily explained the risks that physicians confronted as an individual professional expectation rather than a structural concern in the medical system. Despite acknowledging these risks, students emphasized that the pandemic had reinforced their interest in becoming a physician by validating their perception of the vital role that physicians play in society. Additionally, they expressed greater concern about meeting expectations for admission to medical school in light of additional barriers due to COVID-19. This study builds upon existing literature on the medical profession by both centering earlier stages of education and examining processes of socialization during times of crisis. More broadly, these findings indicate a need for greater attention to the normalization of health care workers' sacrifices, as well as the potential exacerbation of existing inequities in pre-medical education during the pandemic. • Pre-medical students express that the pandemic validated their interest in becoming a physician. • Students largely describe risks physicians confronted during COVID-19 as necessary sacrifice. • Students are concerned about immediate disruptions that may influence their academic progress. • COVID-19 reveals a need to address existing obstacles in pre-medical education. [ABSTRACT FROM AUTHOR]

The millennial generation has become the largest generation thus far and continues to grow, as it makes up a substantial part of the workforce. Often misunderstood, those identifying as millennials offer skills, traits, and characteristics that previous generations have been unable to provide. Learning to understand these millennials and all they have to offer serves key to a successful training program or practice. A millennial's understanding of technology, grasp of patient-provider relationships, and desire to work hard contribute to their success as urologists., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Patients with end-stage renal disease have high mortality and symptom burden. Past studies demonstrated that nephrologists do not feel prepared to care for their patients at the end of life. We sought to characterize current palliative and end-of-life care education received during nephrology fellowship and compare this with data from 2003., Study Design: Cross-sectional online survey of second-year nephrology trainees. Responses were compared to a similar survey in 2003., Setting & Participants: 104 US nephrology fellowship programs in 2013., Measurements: Quality of training in and attitudes toward end-of-life care and knowledge and preparedness to provide nephrology-specific end-of-life care., Results: Of 204 fellows included for analysis (response rate, 65%), significantly more thought it was moderately to very important to learn to provide care at end of life in 2013 compared to 2003 (95% vs 54%; P<0.001). Nearly all (99%) fellows in both surveys believed physicians have a responsibility to help patients at end of life. Ranking of teaching quality during fellowship in all areas (mean, 4.1±0.8 on a scale of 0-5 [0, poor; 5, excellent]) and specific to end-of-life care (mean, 2.4±1.1) was unchanged from 2003, but knowledge of the annual gross mortality rate for dialysis patients was nominally worse in 2013 because only 57% versus 67% in 2003 answered correctly (P=0.05). To an open-ended question asking what would most improve fellows' end-of-life care education, the most common response was a required palliative medicine rotation during fellowship., Limitations: Assessments were based on fellows' subjective perceptions., Conclusions: Nephrology fellows increasingly believe they should learn to provide end-of-life care during fellowship. However, perceptions about the quality of this teaching have not improved during the past decade. Palliative care training should be integrated into nephrology fellowship curricula., (Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

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., (© The Author(s) 2014.)