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Rosen B, Miaari S. Arab representation in Israeli healthcare professions: achievements, challenges and opportunities. Isr J Health Policy Res 2025; 14:7. [PMID: 39894798 PMCID: PMC11789336 DOI: 10.1186/s13584-024-00663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 12/12/2024] [Indexed: 02/04/2025] Open
Abstract
BACKGROUND Israel is a multiethnic society with a population of 9.8 million at the end of 2023. Israeli Arabs (i.e., Arab Palestinian citizens of Israel) account for 21% of the Israel's overall population, 22% of its working age population and 16% of the employed population. This study has several objectives: (1) To provide an overview of the current representation of Israeli Arabs in four key health care professions (medicine, nursing, dentistry, and pharmacy) in terms of employment, licensure, and professional studies; (2) To document changes in those parameters over the past decade, subject to limitations of data availability; (3) To provide a broader context on the employment of Israeli Arabs; (4) To explore the policy implications of the key findings. METHODS Estimates of employment levels are based on the Labor Force Survey (LFS) of the Central Bureau of Statistics (CBS). Data on licensure (i.e., professional qualification) and place of professional studies were extracted from the Ministry of Health report series entitled "The Health Care Professions". Data on enrollment in degree programs in Israel was provided by the Council of Higher Education. Important background information was elicited from relevant policy documents and policy experts. RESULTS In 2023, among employed Israelis up to age 67, Arabs constituted approximately one-quarter of Israel's physicians (25%), nurses (27%), and dentists (27%), and half of Israel's pharmacists (49%). These percentages are substantially higher than they were in 2010, with the increase being particularly marked in the case of physicians (25% versus 8%). The number of new licenses granted annually increased significantly between 2010 and 2022 for both Arabs and Jews in each of the professions covered. The percentage of newly licensed professionals who are Arab increased substantially among physicians and nurses, while remaining stable among dentists and pharmacists. In medicine, dentistry, and pharmacy, many of the licensed Arab health professionals had studied outside of Israel; this phenomenon also exists for nursing but is less widespread there. In the 2022/3 academic year, the percentage of first-degree students in Israeli colleges and universities who were Arab was 70% in pharmacy, 33% in nursing, 23% in dentistry, and 9% in medicine. Between 2012/3 and 2022/3 the percentage of first-degree students who are Arab increased substantially for pharmacy, declined slightly for nursing, and declined substantially for medicine and dentistry. CONCLUSIONS Arab professionals play a substantial and recently increased role in the provision of health care services in Israel. It is important to recognize, appreciate, and maintain this substantial role. Moreover, its potential as a model for sectors other than health care should be explored. To build on achievements to date, and to promote continued progress, policymakers should expand access to health professional education within Israel, upgrade the skills of graduates of non-Israeli universities, promote diversity in leadership positions and key specialties, and expand specialty care services in Arab localities.
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Affiliation(s)
- Bruce Rosen
- Myers-JDC-Brookdale Institute, Jerusalem, Israel.
- The Hebrew University, Jerusalem, Israel.
| | - Sami Miaari
- Tel Aviv University, Tel Aviv, Israel
- Yale University, New Haven, CT, USA
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Roussin CJ, Ng G, Fey MK, Lipshaw JA, Arantes HP, Rudolph JW. Readiness planning: how to go beyond "buy-in" to achieve curricular success and front-line performance. Adv Simul (Lond) 2024; 9:50. [PMID: 39716251 DOI: 10.1186/s41077-024-00317-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 11/12/2024] [Indexed: 12/25/2024] Open
Abstract
Simulation program staff and leadership often struggle to partner with front-line healthcare workers, their managers, and health system leaders. Simulation-based learning programs are too often seen as burdensome add-ons rather than essential mechanisms supporting clinical workforce readiness. Healthcare system leaders grappling with declining morale, economic pressure, and too few qualified staff often don't see how simulation can help them, and we simulation program leaders can't seem to bridge this gap. Without clear guidance from front-line clinicians and leaders, the challenge of building and maintaining sustainably relevant simulation offerings can seem overwhelming. We argue that three blind spots have limited our ability to see the path to collaborations that support front-line workforce readiness: We wrongly assume that our rigor in designing and delivering programs will lead to front-line participant engagement and positive impact, we overestimate the existence of shared priorities, mindsets, and expertise with our would-be partners, and we contribute to building a façade of superficial education compliance that distracts from vital skill development. How do we design simulation-based training programs that are valued, supported, and sustained by key partners over time? (1) By seeing ourselves as partners first and designers second; (2) by using a boundary spanning design process that shifts the primary psychological ownership of training outcomes to our partners; and (3) by focusing this shared design process on workforce readiness for the situations that our healthcare partners care about most. Drawing on lessons from more than 800 readiness plans developed by participants in our courses and the authors' successes and mistakes in partnering with healthcare teams for front-line readiness, we introduce the concepts, commitments, and practices of "readiness planning" along with three detailed examples of readiness planning in action.
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Affiliation(s)
- Christopher J Roussin
- Applied Learning for Performance and Safety (ALPS), Center for Medical Simulation, 100 First Avenue, Suite 400, Boston, MA, 02129, USA.
- Harvard Medical School, Boston, USA.
- Department of Anesthesia Critical Care and Pain Medicine, Center for Medical Simulation, Beth Israel Deaconess Medical Center, 100 First Avenue, Suite 400, Boston, MA, 02129, USA.
| | - Grace Ng
- Faculty Development Programs, Center for Medical Simulation, 100 First Avenue, Suite 400, Boston, MA, 02129, USA
| | - Mary K Fey
- Applied Learning for Performance and Safety (ALPS), Center for Medical Simulation, 100 First Avenue, Suite 400, Boston, MA, 02129, USA
| | - James A Lipshaw
- Instructional Design & Media, Center for Medical Simulation, 100 First Avenue, Suite 400, Boston, MA, 02129, USA
| | - Henrique P Arantes
- IMEPAC, 1889 Minas Gerais Street, Araguari, Minas Gerais, Brazil
- Hospital Universitario Sagrada Familia (HUSF), 1889 Minas Gerais Street, Araguari, Minas Gerais, Brazil
| | - Jenny W Rudolph
- Harvard Medical School, Boston, USA
- Department of Anesthesia Critical Care and Pain Medicine, Center for Medical Simulation, Beth Israel Deaconess Medical Center, 100 First Avenue, Suite 400, Boston, MA, 02129, USA
- Innovation, Center for Medical Simulation, 100 First Avenue, Suite 400, Boston, MA, 02129, USA
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Leung J, Tao B, Binda DD, Baker MB, Jhaveri A, Norris MC. Residency Wellness: A Historical Narrative Review. JOURNAL OF SURGICAL EDUCATION 2024; 81:103294. [PMID: 39378673 DOI: 10.1016/j.jsurg.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 08/14/2024] [Accepted: 09/18/2024] [Indexed: 10/10/2024]
Abstract
INTRODUCTION The structure of medical residency in the United States has experienced significant changes, paralleling advances in medical science and education. While these changes have enhanced medical training, they have introduced challenges, particularly in resident wellness. The well-being of residents is critical for patient care and the healthcare system. This review aims to provide an overview of the historical trends in medical residency, focusing on the evolution of resident wellness and its associated challenges. METHODS A narrative review was conducted, examining the evolution and challenges of medical residency with an emphasis on resident wellness. An exhaustive literature search on January 25, 2024 was conducted across PubMed, Web of Science, and Google Scholar. The search utilized keywords related to medical residency, wellness, and educational reforms. Articles were selected based on relevance and robust evidence, and information was organized into thematic categories for narrative synthesis. RESULTS The search yielded 57 publications that met the inclusion criteria. Historical trends revealed a shift from an apprenticeship model to formalized training programs, with each phase bringing unique challenges to resident wellness. The Flexner Report's influence on standardizing medical education, the rise of modern residency programs, and the recognition of burnout as a significant issue were key developments. Policy changes, technological impacts, and the COVID-19 pandemic have further shaped residency training and wellness. Studies highlight the need for interventions addressing burnout and promoting wellness, with varied approaches across specialties and institutions. CONCLUSION Residency burnout has been a growing concern since the 1970s, exacerbated by advancements in medicine, technology, and recent global events like the COVID-19 pandemic. Although awareness has increased, the need remains to address burnout and promote wellness during residency. Further research is warranted to develop effective interventions and adapt training to meet the evolving needs of residents.
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Affiliation(s)
- Jacob Leung
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Brian Tao
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Dhanesh D Binda
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA; Department of Anesthesiology, Montefiore Medical Center, Bronx, New York, USA.
| | - Maxwell B Baker
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA; Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Ansel Jhaveri
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Mark C Norris
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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McKee M. The Sovietisation of British medicine. J R Soc Med 2024; 117:192-196. [PMID: 38986488 PMCID: PMC11299121 DOI: 10.1177/01410768241257986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Affiliation(s)
- Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
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Alperin M, Alarab M, Botros-Brey S, Drutz H, King J, Shynlova O. The Future of Basic Science: Development of the Next Generation of Mechanistic Researchers in Female Pelvic Medicine. Int Urogynecol J 2024; 35:775-779. [PMID: 38523162 DOI: 10.1007/s00192-024-05766-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The International Urogynecological Association (IUGA) brought together senior and junior members actively engaged in scholarly and educational activities for a consensus conference centered on developing a strategy for sustainable training of the next generation of mechanistic researchers in female pelvic medicine. METHODS Four a priori identified major foci were explored in a half-day virtual consensus conference. Participants included representatives from various countries and disciplines with diverse backgrounds-clinicians, physician-scientists, and basic scientists in the fields of urogynecology, biomechanical engineering, and molecular biology. Following a keynote address, each focus area was first tackled by a dedicated breakout group, led by the Chair(s) of the most relevant IUGA committees. The break-out sessions were followed by an iterative discussion among all attendees to identify mitigating strategies to address the shortage of mechanistic researchers in the field of female pelvic medicine. RESULTS The major focus areas included: research priorities for IUGA basic science scholar program; viable strategies for sustainable basic science mentorship; core competencies in basic science training; and the challenges of conducting complex mechanistic experiments in low-resource countries. Key gaps in knowledge and core competencies that should be incorporated into fellowship/graduate training were identified, and existing training modalities were discussed. Recommendations were made for pragmatic approaches to increasing the exposure of trainees to learning tools to enable sustainable training of the next generation of basic science researchers in female pelvic medicine worldwide. CONCLUSIONS The attendees presented multiple perspectives to gain consensus regarding critical areas of need for training future generations of mechanistic researchers. Recommendations for a sustainable Basic Science Scholar Program were developed using IUGA as a platform. The overarching goal of such a program is to ensure a successful bench-to-bedside-and-back circuit in Urogynecology and Pelvic Reconstructive Surgery, ultimately improving lives of millions of women worldwide through scientifically rational effective preventative and therapeutic interventions.
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Affiliation(s)
- Marianna Alperin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Pelvic Reconstructive Surgery, University of California, San Diego, San Diego, CA, 92037, USA.
- Sanford Consortium for Regenerative Medicine, La Jolla, CA, 92037, USA.
| | - May Alarab
- Sinai Health System, Department of Obstetrics & Gynecology, Division of Urogynecology, University of Toronto, Toronto, ON, Canada
| | - Sylvia Botros-Brey
- Departments of Urology, OB/GYN & Medical Education, University of Texas Health, San Antonio, TX, USA
| | - Harold Drutz
- Sinai Health System, Department of Obstetrics & Gynecology, Division of Urogynecology, University of Toronto, Toronto, ON, Canada
| | - Jenny King
- Pelvic Floor Unit, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Oksana Shynlova
- Sinai Health System, Department of Obstetrics & Gynecology, Division of Urogynecology, University of Toronto, Toronto, ON, Canada
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Crowley R, Pugach D, Williams M, Goldman J, Hilden D, Schultz AF, Beachy M. Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care: A Position Paper From the American College of Physicians. Ann Intern Med 2024; 177:65-67. [PMID: 38145573 DOI: 10.7326/m23-2260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Team-based care models such as the Patient-Centered Medical Home are associated with improved patient health outcomes, better team coordination and collaboration, and increased well-being among health care professionals. Despite these attributes, hindrances to wider adoption remain. In addition, some health care professionals have sought to practice independent of the physician-led health care team, potentially undermining patient access to physicians who have the skills and training to deliver whole-person, comprehensive, and longitudinal care. In this paper, the American College of Physicians reaffirms the importance of the physician-led health care team and offers policy recommendations on professionalism, payment models, training, licensure, and research to support the expansion of dynamic clinical care teams.
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Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C., D.P., M.W.)
| | - David Pugach
- American College of Physicians, Washington, DC (R.C., D.P., M.W.)
| | - Margo Williams
- American College of Physicians, Washington, DC (R.C., D.P., M.W.)
| | - Jason Goldman
- Charles E. Schmidt College of Medicine, Boca Raton, Florida (J.G.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | | | - Micah Beachy
- University of Nebraska Medical Center, Omaha, Nebraska (M.B.)
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Hindin DI, Mazzei M, Chandragiri S, DuBose L, Threeton D, Lassa J, Azagury DE. A National Study on Training Innovation in US Medical Education. Cureus 2023; 15:e46433. [PMID: 37927762 PMCID: PMC10622174 DOI: 10.7759/cureus.46433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Traditional medical education has leaned heavily on memorization, pattern recognition, and learned algorithmic thinking. Increasingly, however, creativity and innovation are becoming recognized as a valuable component of medical education. In this national survey of Association of American Medical Colleges (AAMC) member institutions, we seek to examine the current landscape of exposure to innovation-related training within the formal academic setting. Methods Surveys were distributed to 168 of 171 AAMC-member institutions (the remaining three were excluded from the study for lack of publicly available contact information). Questions assessed exposure for medical students among four defined innovation pillars as follows: (1) medical humanities, (2) design thinking, (3) entrepreneurship, or (4) technology transfer. Chi-squared analysis was used to assess statistical significance between schools, comparing schools ranked in the top 20 by the US News and World Report against non-top 20 respondents, and comparing schools that serve as National Institutes of Health (NIH) Clinical and Translational Science Awards (CTSA) program hubs against non-CTSA schools. Heat maps for geospatial visualization of data were created using ArcGIS (ArcMAP 10.6) software (Redlands, CA: Environmental Systems Research Institute). Results The overall response rate was 94.2% with 161 schools responding. Among respondents, 101 (63%) reported having medical humanities curricula at their institution. Design thinking offerings were noted at 51/161 (32%) institutions. Support for entrepreneurship was observed at 51/161 institutions (32%), and technology transfer infrastructure was confirmed at 42/161 (26%) of institutions. No statistically significant difference was found between top 20 schools and lower 141 schools when comparing schools with no innovation programs or one or more innovation programs (p=0.592), or all four innovation programs (p=0.108). CTSA programs, however, did show a statistically significant difference (p<0.00001) when comparing schools with no innovation programs vs. one or more programs, but not when comparing to schools with all four innovation programs (p=0.639). Conclusion This study demonstrated an overwhelming prevalence of innovation programs in today's AAMC medical schools, with over 75% of surveyed institutions offering at least one innovation program. No statistically significant trend was seen in the presence of zero programs, one or more, or all four programs between top 20 programs and the remaining 141. CTSA hub schools, however, were significantly more likely to have at least one program vs. none compared to non-CTSA hub schools. Future studies would be valuable to assess the long-term impact of this trend on medical student education.
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Affiliation(s)
- David I Hindin
- Department of Surgery, Stanford University School of Medicine, Stanford, USA
| | - Michael Mazzei
- Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, USA
| | | | - Lauren DuBose
- Department of Bioengineering, Temple University, Philadelphia, USA
| | | | - Jerry Lassa
- Department of Mathematics, Northwestern University, Evanston, USA
| | - Dan E Azagury
- Department of Surgery, Stanford University School of Medicine, Stanford, USA
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Alzerwi NAN. Flexner has fallen: Transitions in medical education system across time, a gradual return to pre-Flexnerian state (de-Flexnerization). World J Clin Cases 2023; 11:4966-4974. [PMID: 37583863 PMCID: PMC10424023 DOI: 10.12998/wjcc.v11.i21.4966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/29/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023] Open
Abstract
The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner, his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur. He could say what other reformers could not, due to their links to the medical education community. But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students, the decline in the number and quality of investigator initiated research among clinical researchers, lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis, poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes. The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations. This de-Flexnerization trend and regression to pre-Flexnerian era standards, ideologies, structures, processes, and attitudes, are bound to beget pre-Flexnerian outcomes, for you get what you designed for.
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Affiliation(s)
- Nasser A N Alzerwi
- Department of Surgery, Majmaah University, Majmaah 11952, Riyadh, Saudi Arabia
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Nzenwa IC, Iqbal HA, Bazira PJ. Exploring the inclusion of anatomical variation in medical education. ANATOMICAL SCIENCES EDUCATION 2023; 16:531-546. [PMID: 36637969 DOI: 10.1002/ase.2254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/24/2022] [Accepted: 01/07/2023] [Indexed: 05/11/2023]
Abstract
The role of anatomical variability in safe clinical practice is underappreciated. A lack of familiarity of anatomical variations is at the center of a multitude of medical and surgical errors. The recent rise in litigation due to such errors suggests that patient care may be compromised. This makes the knowledge of anatomical variation essential to medical education. Empirical studies were identified by searching several databases and repositories, and the Medical Education Research Quality Instrument (MERSQI) was used to assess study quality. Eight studies were eligible for this systematic review; three of which were conference abstracts. Thematic summary of these studies yielded six themes namely: (1) importance of anatomical variation in medical education; (2) the ideal time to introduce anatomical variation in medical education; (3) important anatomical variations to include in medical education; (4) approaches to teaching anatomical variation; (5) assessing knowledge on anatomical variation; (6) barriers to including anatomical variation in medical education. Including anatomical variations in medical education would improve clinical reasoning and surgical outcomes. Following the completion of this review, three recommendations were made: (1) increasing the emphasis of anatomical variation in medical education; (2) developing more resources for anatomical variation education; (3) investigating the implications of lack of knowledge of anatomical variation in medical education through further research.
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Affiliation(s)
- Ikemsinachi C Nzenwa
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Kingston upon Hull, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Hassan A Iqbal
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Kingston upon Hull, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Peter J Bazira
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Kingston upon Hull, UK
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Leiphrakpam PD, Are C. Competency-Based Medical Education (CBME): an Overview and Relevance to the Education of Future Surgical Oncologists. Indian J Surg Oncol 2023:1-11. [PMID: 37363708 PMCID: PMC9990571 DOI: 10.1007/s13193-023-01716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 06/28/2023] Open
Abstract
In the next two decades, the global cancer burden is expected to rise by 47%, and the demand for global cancer surgery will increase by 52%. At present, only 25% of the estimated 80% of patients needing surgical intervention have access to timely surgical care. The shortage of a trained workforce of surgical oncologists is one of the main barriers to providing the optimal surgical intervention needed for cancer patients. Some of the contributing factors to the shortage of trained surgical oncologists are variations in the current global educational platforms, long training programs, and physician burnout. Therefore, the availability of a credible training framework and a sustainable certification pipeline for future surgical oncologists is critical to meet the global demand for an adequate healthcare workforce. The current surgical oncology educational program is a time-based construct that trains surgeons to function seamlessly in the multidisciplinary care of cancer patients. However, there is a lack of flexibility in the training framework and timeline despite differences in trainees' abilities. Developing a globally acceptable standard curriculum for surgical oncology training based on the competency-based medical education (CBME) framework and tailoring it to local needs can increase the surgical oncology workforce ready to tackle the rising cancer burden. However, successful implementation of the global CBME-based surgical oncology training curriculum requires an innovative approach to ensure that this framework produces a competent surgical oncologist that meets the local needs.
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Affiliation(s)
- Premila D. Leiphrakpam
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5524 USA
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-6880 USA
| | - Chandrakanth Are
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5524 USA
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-6880 USA
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Marcum JA. Patient-oriented research and the shiny object syndrome. J Eval Clin Pract 2023. [PMID: 36866413 DOI: 10.1111/jep.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/04/2023]
Affiliation(s)
- James A Marcum
- Department of Philosophy, Baylor University, Waco, Texas, USA
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12
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Morsy L. Carnegie and Rockefeller's Philanthropic Legacy: Exclusion of African Americans From Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:313-316. [PMID: 36512812 DOI: 10.1097/acm.0000000000005092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In the first 3 decades of the 20th century, John D. Rockefeller Sr. and Andrew Carnegie used their philanthropy to support 2 main mechanisms that functioned to exclude African American doctors from medical education and the medical profession. First, Carnegie funded the Flexner report, recommending reforms to medical education including the closure of most Black medical schools. Next, Rockefeller's General Education Board (GEB) funded restructures to medical education without equal support to ensure Black medical schools could keep up with changing standards. For every dollar the GEB donated to Black medical schools between 1902 and 1919, it donated $123 to White schools. During that period, for every dollar the GEB donated to White medical schools per White resident, it donated about $0.07 to Black schools per African American resident. Next, Rockefeller's philanthropy supported a system of school education that underprepared African American candidates to meet the requirements needed to enter medicine. For African American children, the GEB supported a kind of schooling termed industrial education, which emphasized manual training (e.g., skills related to agricultural science and efficiency). In 1933, industrial education schools were located in 57% of all Southern counties, and two-thirds of African Americans who attended primary and secondary school received an education that followed the industrial education curriculum. Industrial education underprepared candidates for applying to medical school, completing a medical school curriculum, and passing a medical board examination. This article examines how these 2 mechanisms had lasting and harmful effects on the underrepresentation of African American doctors in the medical workforce. These insights provide a broad and collective understanding of the early role of philanthropy in excluding African Americans from the medical profession, which is a crucial first step toward developing interventions to help redress racial discrepancies in the medical profession that persist today.
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Affiliation(s)
- Leila Morsy
- L. Morsy is senior lecturer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia; ORCID: https://orcid.org/0000-0002-7131-7473
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Origins of the PCP Shortage. Dela J Public Health 2022; 8:18-19. [PMID: 36751583 PMCID: PMC9894073 DOI: 10.32481/djph.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Bernstein J. Not the Last Word: My Flexner Retort. Clin Orthop Relat Res 2022; 480:2091-2094. [PMID: 36149629 PMCID: PMC9555893 DOI: 10.1097/corr.0000000000002425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Joseph Bernstein
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Miloslavsky EM, Besche HC, Calderwood SB, Chang BS, Dienstag JL, King RW, Mitchell RN, Schwartzstein RM, Thomas H, Hundert EM, Flanagan JG. Advanced Integrated Science Courses: Building a Skill Set to Engage With the Interface of Research and Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1467-1473. [PMID: 35108233 DOI: 10.1097/acm.0000000000004612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Scientific research has been changing medical practice at an increasing pace. To keep up with this change, physicians of the future will need to be lifelong learners with the skills to engage with emerging science and translate it into clinical care. How medical schools can best prepare students for ongoing scientific change remains unclear. Adding to the challenge is reduced time allocated to basic science in curricula and rapid expansion of relevant scientific fields. A return to science with greater depth after clinical clerkships has been suggested, although few schools have adopted such curricula and implementation can present challenges. The authors describe an innovation at Harvard Medical School, the Advanced Integrated Science Courses (AISCs), which are taken after core clerkships. Students are required to take 2 such courses, which are offered in a variety of topics. Rather than factual content, the learning objectives are a set of generalizable skills to enable students to critically evaluate emerging research and its relationship to medical practice. Making these generalizable skills the defining principle of the courses has several important advantages: it allows standardization of acquired skills to be combined with diverse course topics ranging from basic to translational and population sciences; students can choose courses and projects aligned with their interests, thereby enhancing engagement, curiosity, and career relevance; schools can tailor course offerings to the interests of local faculty; and the generalizable skills delineate a unique purpose of these courses within the overall medical school curriculum. For the 3 years AISCs have been offered, students rated the courses highly and reported learning the intended skill set effectively. The AISC concept addresses the challenge of preparing students for this era of rapidly expanding science and should be readily adaptable to other medical schools.
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Affiliation(s)
- Eli M Miloslavsky
- E.M. Miloslavsky is assistant professor of medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Henrike C Besche
- H.C. Besche is lecturer in cell biology, Harvard Medical School, Boston, Massachusetts
| | - Stephen B Calderwood
- S.B. Calderwood is professor of medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bernard S Chang
- B.S. Chang is professor of neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jules L Dienstag
- J.L. Dienstag is professor of medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Randall W King
- R.W. King is professor of cell biology, Harvard Medical School, Boston, Massachusetts
| | - Richard N Mitchell
- R.N. Mitchell is professor of pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Richard M Schwartzstein
- R.M. Schwartzstein is professor of medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Horatio Thomas
- H. Thomas was an MD student at Harvard Medical School, Boston, Massachusetts, during initial design of the AISC curriculum. He is a resident in radiation oncology, University of California, San Francisco, California
| | - Edward M Hundert
- E.M. Hundert is dean for medical education and professor in residence of global health and social medicine and medical education, Harvard Medical School, Boston, Massachusetts
| | - John G Flanagan
- J.G. Flanagan is professor of cell biology, Harvard Medical School, Boston, Massachusetts
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Bismantara H, Ahern S, Teede HJ, Liew D. Academic health science centre models across the developing countries and lessons for implementation in Indonesia: a scoping review. BMJ Open 2022; 12:e051937. [PMID: 36691121 PMCID: PMC9453943 DOI: 10.1136/bmjopen-2021-051937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/10/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To describe models of academic health science centres (AHSCs) across developing countries, in order to inform AHSC development in Indonesia. DESIGN Scoping review with systematic methods. DATA SOURCES Ovid MEDLINE, ProQuest Central, Wiley online library, Scopus and Web of Sciences were searched for relevant publications from 1 January 2015 to 1 December 2020. 'Grey literature' was hand searched by targeted website searches, Google searches, as well as personal communication held with stakeholders in Indonesia specifically. Relevant articles regarding AHSCs in developing countries are included. The review would be synthesised to focus on the purpose, structure and core activities of AHSCs. Strategies for success were also considered. RESULTS Twenty-six recognised AHSCs in developing countries were identified, located in Asia (n=13), Europe (n=1), South America (n=7) and Africa (n=5). Innovation, health system improvement and enhancement in academic capacity were the common visions. Most centres are functionally integrated and university-led. Most AHSCs include community health services to complement primary stakeholders such as academic institutions and hospitals. Limited information was identified regarding patient and public involvement and workforce capacity building. Five AHSCs have been piloted in Indonesia since 2018, integrating universities, academic hospitals and provincial health offices. However, information regarding their core activities and successes is limited. CONCLUSIONS The review suggests that limited published data are available on AHSC models in developing countries, but they still provide important insight into AHSC development in Indonesia. Innovation and health systems strengthening are the common visions. Functional integration with university leadership is the most common model of governance. Other than universities and hospitals, community health centres, research centres and regional health offices are common partners. There is a little description of community engagement and workforce capacity building.
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Affiliation(s)
- Haryo Bismantara
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Partners Academic Health Science Centre, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Affiliation(s)
- Thirusha Naidu
- School of Nursing and Public Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4041, South Africa.
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
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Guo MZ, Allen J, Sakumoto M, Pahwa A, Santhosh L. Reimagining Undergraduate Medical Education in a Post-COVID-19 Landscape. J Gen Intern Med 2022; 37:2297-2301. [PMID: 35710661 PMCID: PMC9202962 DOI: 10.1007/s11606-022-07503-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/23/2022] [Indexed: 12/01/2022]
Abstract
Online education due to the COVID-19 pandemic caused many medical schools to increasingly employ asynchronous and virtual learning that favored student independence and flexibility. At the same time, the COVID-19 pandemic highlighted existing shortcomings of the healthcare field in providing for marginalized and underserved communities. This perspective piece details the authors' opinions as medical students and medical educators on how to leverage the aspects of pandemic medical education to train physicians who can better address these needs.
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Affiliation(s)
- Matthew Z Guo
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jawara Allen
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Matthew Sakumoto
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Amit Pahwa
- Department of Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lekshmi Santhosh
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.
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Bibliometric analysis of orthopaedic related publications by Indian authors from the last decade. J Clin Orthop Trauma 2022; 25:101775. [PMID: 35127442 PMCID: PMC8808162 DOI: 10.1016/j.jcot.2022.101775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Bibliometric studies have been established methods of analysing publications on a particular topic. These studies have been done on various orthopaedic topics and are increasing. The advantages of these studies have been highlighted in previous publications. Although some studies have been done on Indian publications from other specialties, those analysing Indian Orthopaedic Publications are lacking. METHODS We performed a search in Scopus to look for all publications related to orthopaedics from India. Our search strategy in Scopus included ((TITLE-ABS-KEY(Orthopaedics OR Orthopaedics) AND AFFIL(India)) AND PUBYEAR > 2009 AND PUBYEAR < 2020) which resulted in 3270 articles on 02/11/2021. We analyzed the most publishing universities, city, state, specialty, authors, and anatomic location of these publications. We also mined the data to draw word clouds based on data obtained from the titles of articles, keywords and the affiliations of each of the articles published. RESULTS Tamil Nadu and New Delhi and their institutes appear to be the epicenter of publication activities in Orthopaedics in India. There has been a healthy trend of growth of articles in the orthopaedic specialty. Since there is a significant overlap of technology and engineering, it is not surprising to see engineering and technology institutes among the top 10 published institutes and even journals for the publications on orthopaedics. CONCLUSION There has been a steady increase in the number of publications in the last decade. New Delhi and its Universities and Institutes appear to contribute the majority of citations and publications related to orthopaedics. Journal of Clinical Orthopaedics and Trauma was the most publishing journal for Indian authors on Orthopaedic related articles.
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20
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Rayburn WF, Xierali IM. Subspecialization in Obstetrics and Gynecology: Is It Affecting the Future Availability of Women's Health Specialists? Obstet Gynecol Clin North Am 2021; 48:737-744. [PMID: 34756293 DOI: 10.1016/j.ogc.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The growth in the number of obstetrics and gynecology resident graduates pursuing fellowships has exceeded growth in the number of resident graduates, because more fellowship programs are being developed in more subspecialties rather than additional residency programs. Approximately 1 in 4 residents pursues subspecialty training, compared with 1 in 12 in 2001. The number of fellowships remains competitive, because nearly all programs fill their match and the number of applicants exceeds the number of positions. Graduating residents who serve as frontline women's health specialists need to serve as leaders of interprofessional teams to better serve their patients, especially in underserved areas.
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Affiliation(s)
- William F Rayburn
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA.
| | - Imam M Xierali
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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21
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Johnson CD, Green BN. Looking back at the lawsuit that transformed the chiropractic profession part 2: Rise of the American Medical Association. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:25-44. [PMID: 34544158 PMCID: PMC8493523 DOI: 10.7899/jce-21-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/07/2021] [Accepted: 04/21/2021] [Indexed: 05/07/2023]
Abstract
OBJECTIVE This paper is the second in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated anti-trust law by restraining chiropractors' business practices. The purpose of this paper is to provide a brief review of the history of how the AMA rose to dominate health care in the United States, and within this social context, how the chiropractic profession fought to survive in the first half of the 20th century. METHODS This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 papers following a successive timeline. This paper is the second of the series that explores the growth of medicine and the chiropractic profession. RESULTS The AMA's code of ethics established in 1847 continued to direct organized medicine's actions to exclude other health professions. During the early 1900s, the AMA established itself as "regular medicine." They labeled other types of medicine and health care professions, such as chiropractic, as "irregulars" claiming that they were cultists and quacks. In addition to the rise in power of the AMA, a report written by Abraham Flexner helped to solidify the AMA's control over health care. Chiropractic as a profession was emerging and developing in practice, education, and science. The few resources available to chiropractors were used to defend their profession against attacks from organized medicine and to secure legislation to legalize the practice of chiropractic. After years of struggle, the last state in the US legalized chiropractic 79 years after the birth of the profession. CONCLUSION In the first part of the 20th century, the AMA was amassing power as chiropractic was just emerging as a profession. Events such as publication of Flexner's report and development of the medical basic science laws helped to entrench the AMA's monopoly on health care. The health care environment shaped how chiropractic grew as a profession. Chiropractic practice, education, and science were challenged by trying to develop outside of the medical establishment. These events added to the tensions between the professions that ultimately resulted in the Wilk v AMA lawsuit.
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22
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Khan AM, D'Arcy CE, Olimpo JT. A historical perspective on training students to create standardized maps of novel brain structure: Newly-uncovered resonances between past and present research-based neuroanatomy curricula. Neurosci Lett 2021; 759:136052. [PMID: 34139317 PMCID: PMC8445161 DOI: 10.1016/j.neulet.2021.136052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/08/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
Recent efforts to reform postsecondary STEM education in the U.S. have resulted in the creation of course-based undergraduate research experiences (CUREs), which, among other outcomes, have successfully retained freshmen in their chosen STEM majors and provided them with a greater sense of identity as scientists by enabling them to experience how research is conducted in a laboratory setting. In 2014, we launched our own laboratory-based CURE, Brain Mapping & Connectomics (BMC). Now in its seventh year, BMC trains University of Texas at El Paso (UTEP) undergraduates to identify and label neuron populations in the rat brain, analyze their cytoarchitecture, and draw their detailed chemoarchitecture onto standardized rat brain atlas maps in stereotaxic space. Significantly, some BMC students produce atlas drawings derived from their coursework or from further independent study after the course that are being presented and/or published in the scientific literature. These maps should prove useful to neuroscientists seeking to experimentally target elusive neuron populations. Here, we review the procedures taught in BMC that have empowered students to learn about the scientific process. We contextualize our efforts with those similarly carried out over a century ago to reform U.S. medical education. Notably, we have uncovered historical records that highlight interesting resonances between our curriculum and that created at the Johns Hopkins University Medical School (JHUMS) in the 1890s. Although the two programs are over a century apart and were created for students of differing career levels, many aspects between them are strikingly similar, including the unique atlas-based brain mapping methods they encouraged students to learn. A notable example of these efforts was the brain atlas maps published by Florence Sabin, a JHUMS student who later became the first woman to be elected to the U.S. National Academy of Sciences. We conclude by discussing how the revitalization of century-old methods and their dissemination to the next generation of scientists in BMC not only provides student benefit and academic development, but also acts to preserve what are increasingly becoming "lost arts" critical for advancing neuroscience - brain histology, cytoarchitectonics, and atlas-based mapping of novel brain structure.
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Affiliation(s)
- Arshad M Khan
- UTEP Systems Neuroscience Laboratory, The University of Texas at El Paso, El Paso, TX 79968, USA; Department of Biological Sciences, The University of Texas at El Paso, El Paso, TX 79968, USA; Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX 79968, USA; UTEP PERSIST Brain Mapping and Connectomics Teaching Laboratory, The University of Texas at El Paso, El Paso, TX 79968, USA; BUILDing SCHOLARS Program, The University of Texas at El Paso, El Paso, TX 79968, USA; UTEP RISE Program, The University of Texas at El Paso, El Paso, TX 79968, USA; UTEP Neuroscience Bachelor of Science Degree Program, The University of Texas at El Paso, El Paso, TX 79968, USA.
| | - Christina E D'Arcy
- UTEP Systems Neuroscience Laboratory, The University of Texas at El Paso, El Paso, TX 79968, USA; Biology Education Research Group, The University of Texas at El Paso, El Paso, TX 79968, USA; Department of Biological Sciences, The University of Texas at El Paso, El Paso, TX 79968, USA; Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX 79968, USA; UTEP PERSIST Brain Mapping and Connectomics Teaching Laboratory, The University of Texas at El Paso, El Paso, TX 79968, USA; BUILDing SCHOLARS Program, The University of Texas at El Paso, El Paso, TX 79968, USA.
| | - Jeffrey T Olimpo
- Biology Education Research Group, The University of Texas at El Paso, El Paso, TX 79968, USA; Department of Biological Sciences, The University of Texas at El Paso, El Paso, TX 79968, USA; Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX 79968, USA; BUILDing SCHOLARS Program, The University of Texas at El Paso, El Paso, TX 79968, USA
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Racial disparities in vascular surgery: An analysis of race and ethnicity among U.S. medical students, general surgery residents, vascular surgery trainees, and the vascular surgery workforce. J Vasc Surg 2021; 74:33S-46S. [PMID: 34303458 DOI: 10.1016/j.jvs.2021.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/13/2021] [Indexed: 11/21/2022]
Abstract
The ever-increasing diversity of the U.S. population has resulted in a challenge to a vascular surgery workforce that does not represent the national demographics. Educational institutions, medical organizations, and medical agencies, through initiatives and programs, have attempted to increase the number of underrepresented minorities, with, however, only modest changes during the past 30 years. Several obstacles have been identified, some of which include racism, issues of finances, lack of mentors and scholarly activities, and inequity in promotion. In the present study, we have reviewed the reported data addressing these concerns and provided guidance toward the amelioration of these issues with the hope of constructive change toward encouraging a diverse vascular surgery workforce.
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Riviello JJ, Erklauer J. Evidence-Based Protocols in Child Neurology. Neurol Clin 2021; 39:883-895. [PMID: 34215392 DOI: 10.1016/j.ncl.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Medical care has become more complex as the scientific method has expanded medical knowledge. Medicine is also now practiced across different medical systems of varying complexity, and creating standard treatment guidelines is one way of establishing uniform treatment across these systems. The creation of guidelines ensures the delivery of quality medical care and improved patient outcomes. Evidence-based medicine is the application of scientific research to produce these treatment guidelines. This article shall focus on the current treatment guidelines used for inpatient pediatric neurology.
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Affiliation(s)
- James J Riviello
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA.
| | - Jennifer Erklauer
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA; Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA
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Southworth E, Gleason SH. COVID 19: A Cause for Pause in Undergraduate Medical Education and Catalyst for Innovation. HEC Forum 2021; 33:125-142. [PMID: 33481144 PMCID: PMC7821447 DOI: 10.1007/s10730-020-09433-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
As the world held its breath for news surrounding COVID-19 and hunkered down amidst stay-at-home orders, medical students across the U.S. wondered if they would be called to serve on the front lines of the pandemic. Medical school administrators faced the challenge of protecting learners while also minimizing harm to their medical education. This balancing act raised critical questions in medical education as institutions reacted to changing guidelines. COVID-19 has punctuated already contentious areas of medical education and has forced institutions and organizations to take quick action. From the perspectives of a recent medical school graduate and current resident (ES) and a practicing clinician-educator (SHG), we examine the pandemic's impact on undergraduate medical education through an ethical lens. First, we explore the value of medical education, what drives this value, and how COVID-19 may alter it. We next consider student choice and how shifts toward utilitarianism in healthcare during a pandemic may affect learning and career exploration. Then, we inquire how access to technology may impact the experience of medical students from diverse backgrounds and varied institutions during a rapid shift to socially distanced learning. We identify vulnerabilities for students at several phases of the journey: premedical, preclinical, clinical, and preparation for residency. Finally, we address the hidden curriculum of COVID-19, its potential erosion of empathy among current medical students, and possible long-term consequences for future physicians and patients.
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Affiliation(s)
- Elizabeth Southworth
- Department of Obstetrics and Gynecology, University of Michigan L4001 Women's Hospital, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-0276, USA.
| | - Sara H Gleason
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
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Roberts LW. Advancing Equity in Academic Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:771-772. [PMID: 34031293 DOI: 10.1097/acm.0000000000004068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Boland RJ, Amonoo HL. The Psychiatric Clinics of North America Special Issue on Medical Education. Psychiatr Clin North Am 2021; 44:xiii-xvii. [PMID: 34049653 DOI: 10.1016/j.psc.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Robert J Boland
- The Menninger Clinic, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Hermioni L Amonoo
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Norman AH, Tesser CD. Medicina de família e prevenção quaternária. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2021. [DOI: 10.5712/rbmfc16(43)2502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Este artigo revisita a constituição da medicina de família e comunidade (MFC) como especialidade médica e as suas raízes que favoreceram o nascimento do conceito de prevenção quaternária (P4). Evidencia que a tradição da medicina à beira de leito, a função-filtro dos MFCs - fortalecida por sistemas nacionais de saúde organizados a partir da atenção primária à saúde (APS) – e, a abordagem biográfica de Balint, favoreceram o processo de proteção da saúde dos pacientes. Desde seus primórdios, a MFC esteve vinculada a uma abordagem holística, humanista e integral da pessoa, coerente com a P4. Entretanto, dois momentos históricos tensionaram a abordagem da MFC. O primeiro foi a estruturação da biomedicina especializada nos hospitais, que centrou a abordagem nas doenças vistas como lesões corporais. O segundo foi o nascimento da medicina baseada em evidências (MBE), na década de 1990, que refinou o modelo biomédico amplificando o grau de abstração das intervenções biomédicas, vinculando-as às medidas de impacto no coletivo dos doentes. A medicina hospitalar e a MBE trouxeram avanços importantes ao cuidado, mas ampliaram seu potencial iatrogênico. A MBE construiu uma hierarquia de evidências de tamanha valorização na comunidade médico-científica que vem sendo aplicada acriticamente de forma protocolar. Esse processo vem afastando a abordagem holística e individualizada dos MFC, multiplicando o potencial de danos iatrogênicos e a medicalização. Existe uma necessidade redobrada da P4, a ser informada pela MBE e simultaneamente aplicada à própria MBE. A P4 implica um olhar crítico do MFC sobre o modus operandi da biomedicina, de maneira a viabilizar uma prática humanizada e desmedicalizante na APS.
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Ramalho AR, Vieira-Marques PM, Magalhães-Alves C, Severo M, Ferreira MA, Falcão-Pires I. Electives in the medical curriculum - an opportunity to achieve students' satisfaction? BMC MEDICAL EDUCATION 2020; 20:449. [PMID: 33225951 PMCID: PMC7681969 DOI: 10.1186/s12909-020-02269-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 09/28/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Electives are perceived by medical students as a valuable, highly regarded experience, allowing them to customize learning experiences and enabling them to early differentiate during medical training. The present work aims to uncover students' major determinants of satisfaction and how they interfere with their future elective choices in order to identify the best approach to implement electives in medical curricula. METHODS A cross-sectional study was conducted through a written evaluation survey concerning the electives available in the academic year 2015-2016. Our institution provides 106 electives to students from the 2nd to the 5th year. Students' satisfaction was assessed through a validated questionnaire with eight sentences expressing opinions related to electives global satisfaction. Data from 538 inquiries from 229 students were analyzed quantitatively using regression and correlation models, and qualitatively through phenomenography. RESULTS Quantitative analysis of the questionnaires allowed to establish both: 1) The determinants of students' satisfaction with electives, which were Agreement with teaching and learning methodologies, followed by Agreement with assessment methodologies employed, Perception of the workload demanded and Requirement for continuous work and 2) The predictors of students preferences in the following years, namely, Agreement with assessment methodologies employed, Classes attendance and Ranking of the allocated elective established in the previous year. Qualitative analysis of questionnaires revealed that students consider electives as being innovative and interesting, claiming that some, for their relevant content, could be integrated into the medical core curriculum. CONCLUSIONS Our work raises awareness on the best practices when it comes to electives' organization to meet students' satisfaction. We can conclude that medical schools should measure students satisfaction as a tool to organize and predict future needs of electives and placements when designing and implementing this alternative student-centred curriculum or even to improve the existing practices regarding electives in medical courses.
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Affiliation(s)
- Ana Rita Ramalho
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine of University of Porto, Porto, Portugal
| | - P. M. Vieira-Marques
- CINTESIS - Center for Research in Health Technologies and Information Systems. Faculty of Medicine, University of Porto, Porto, Portugal
| | - C. Magalhães-Alves
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - M. Severo
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine of University of Porto, Porto, Portugal
| | - M. A. Ferreira
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine of University of Porto, Porto, Portugal
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - I. Falcão-Pires
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal
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McDaniel CM, Forlenza EM, Kessler MW. Effect of Shortened Preclinical Curriculum on Medical Student Musculoskeletal Knowledge and Confidence: An Institutional Survey. JOURNAL OF SURGICAL EDUCATION 2020; 77:1414-1421. [PMID: 32747324 DOI: 10.1016/j.jsurg.2020.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Musculoskeletal education is underrepresented in American medical school curricula, and many medical schools have recently shifted toward a condensed preclinical period. Given that musculoskeletal diseases represent a large and growing social and economic burden, it is imperative that medical students be properly prepared to care for patients with musculoskeletal disorders, regardless of intended specialty. METHODS A survey was sent to all medical students enrolled full-time at our institution during the 2018 to 2019 academic year. First year students had not yet received musculoskeletal instruction, second-year students had completed a shortened musculoskeletal curriculum of 49 total hours, and third- and fourth-year respondents had completed a longer 78 hour musculoskeletal curriculum. Respondents were asked to rank their confidence in their musculoskeletal knowledge, their interest in orthopaedics, followed by the well-validated Freedman and Bernstein musculoskeletal knowledge assessment and a demographics section asking had respondents completed an orthopaedic surgery clinical rotation, if they had other clinical orthopaedic experience, class year, intended clinical specialty, and gender. RESULTS There were 179 responses to the survey, comprising 53 first-year, 54 second-year, and 72 third- and fourth-year students. The longer musculoskeletal curriculum was associated with significantly improved performance compared to the shorter musculoskeletal curriculum (p < 0.0001). Completion of a clinical orthopedics rotation was associated with significantly improved performance than not completing a rotation (p < 0.001), regardless of if non-rotators had other orthopedic experience (p = 0.001) or if they did not (p < 0.001). There was no difference in score (p = 0.94) or musculoskeletal knowledge confidence (p = 0.09) between males and females. Intending to pursue orthopedics was associated with significantly higher scores (p < 0.001) and significantly higher confidence (p = 0.02). CONCLUSIONS As shortening preclinical musculoskeletal curricula worsens musculoskeletal performance, medical schools should consider requiring orthopedic clinical rotations to maintain musculoskeletal competency of graduates.
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Affiliation(s)
- Claire M McDaniel
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Enrico M Forlenza
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Michael W Kessler
- Department of Orthopaedics, Medstar Georgetown University Hospital, Washington, District of Columbia
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Rao R, Hawkins M, Ulrich T, Gatlin G, Mabry G, Mishra C. The Evolving Role of Public Health in Medical Education. Front Public Health 2020; 8:251. [PMID: 32714890 PMCID: PMC7344251 DOI: 10.3389/fpubh.2020.00251] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 05/20/2020] [Indexed: 11/15/2022] Open
Abstract
Medical education in the twentieth century was largely influenced by the Flexner Report, with significant proportions of instruction dedicated to the molecular underpinnings of the pathologic pathways and minimal mention of the socio-ecological determinants of health. When examining the predominant diseases of the twenty first century landscape, widening health disparities, and significant changes in the United States healthcare system, it is imperative to view wellness and sickness in a broader public health context rather than a singular focus of the biomedical model. While undergraduate opportunities to study public health are on the rise in the United States, there is a parallel urgency for medical curricula to recognize the importance of the complex interrelated socio-ecological root causes of health, well-being, and illness. In order to reduce the risk of non-communicable diseases and increase health equity, it is necessary for medical education to integrate core public health knowledge and competencies. Contemporary health challenges require a public health approach, in addition to clinical skills, for physicians to provide equitable care. The COVID-19 pandemic further underscores the necessity to mitigate the effects of socio-ecological determinants of health. Seven key recommendations are presented from a training to practice timeline emphasizing the important linkages between medical education, socio-ecological influences on health, and public health. As the health challenges in society and communities shift, so too must training of future physicians. There is a need and an opportunity for medicine and public health to address the shared health challenges of our global society.
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Affiliation(s)
- Ravi Rao
- Independent Researcher, Los Angeles, CA, United States
| | - Melissa Hawkins
- Department of Health Studies, College of Arts and Sciences, American University, Washington, DC, United States
| | - Trina Ulrich
- Department of Health Studies, College of Arts and Sciences, American University, Washington, DC, United States
| | - Greta Gatlin
- Department of Health Studies, College of Arts and Sciences, American University, Washington, DC, United States
| | - Guadalupe Mabry
- Department of Health Studies, College of Arts and Sciences, American University, Washington, DC, United States
| | - Chaitanya Mishra
- Department of Health Studies, College of Arts and Sciences, American University, Washington, DC, United States
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Sharma PR, Alsaffarini KWB. Preparation for practice and the arguments for standardisation in view of the forthcoming medical licensing exam: A literature review. MEDICAL TEACHER 2020; 42:451-456. [PMID: 31928279 DOI: 10.1080/0142159x.2019.1708291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aims: The aim of this paper is to address whether the introduction of a national licensing exam will improve preparedness for practice. This review will explore and identify the areas in which UK medical graduates are feeling underprepared. In addition, this review will discuss the need for the Medical Licensing Assessment in the UK.Methods: A literature search of several databases was performed in December 2018. Studies which identified the areas in which medical graduates were prepared/unprepared for, and those which explored whether UK medical schools were adequately preparing their graduates for practice, were included. Studies exploring the preparedness of international medical graduates were excluded.Results: Sixteen articles met the final inclusion criteria and are included in this review. All the final studies are cross-sectional and are varied in their use of methods used, with the vast majority using questionnaires to identify the preparedness of medical students and junior doctors.Conclusions: This review conveys that junior doctors are mostly underprepared in emergency work. This can be associated to a lack of exposure to emergency situations during their undergraduate training. Moreover, this review suggests that the preparedness of medical graduates may remain unaffected by the implementation of the MLA.
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Affiliation(s)
- Parivrudh R Sharma
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kareem W B Alsaffarini
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Bressers G, Wallenburg I, Stalmeijer R, Oude Egbrink M, Lombarts K. Patient safety in medical residency training: Balancing bravery and checklists. Health (London) 2020; 25:494-512. [PMID: 31960708 DOI: 10.1177/1363459319899444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Distributing responsibility for patient safety between individual professionals and organisational systems is a pressing issue in contemporary healthcare. This article draws on Habermas' distinction between 'lifeworld' and 'system' to explore patient-safety culture in medical residency training. Sociological accounts of medical training have indicated that applying systemic solutions in patient-safety training and practice may conflict with residents' needs. Residents would navigate safety systems to get their work done and safeguard learning opportunities, acting 'in between' the system and traditional processes of socialisation and learning on the job. Our ethnographic study reveals how residents seek to connect system and professional-based learning, and do them together in situated manners that evolve in the course of medical training. We reveal three themes that closely align with the residents' developmental process of maturing during training and on the job to become 'real' physicians: (1) coming to grips with the job; (2) working around safety procedures; and (3) moving on to independence. A more explicit focus on learning to deal with uncertainty may enable residents to become more skilled in balancing safety systems.
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Wang C, Chen S, Zhu J, Li W. China's new 4 + 4 medical education programme. Lancet 2019; 394:1121-1123. [PMID: 31571588 DOI: 10.1016/s0140-6736(19)32178-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; Chinese Academy of Engineering, Beijing, China.
| | - Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Jiming Zhu
- Research Centre for Public Health and Institute for Hospital Management, Tsinghua University, Beijing, China
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Butts CA, Speer JJ, Brady JJ, Stephenson RJ, Langenau E, DiTomasso R, Fresa K, Becker M, Sesso A. Introduction to Clerkship: Bridging the Gap Between Preclinical and Clinical Medical Education. J Osteopath Med 2019; 119:578-587. [PMID: 31449304 DOI: 10.7556/jaoa.2019.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Despite a diverse range of curricular advancements to address the difficult transition from classroom learning to clinical training during medical education, hurdles persist. A 4-week course was designed at the Philadelphia College of Osteopathic Medicine (PCOM) to make this transition easier. Objectives To determine whether PCOM students' comfort and preparedness increased after taking a 4-week clinical transition course before third-year clinical clerkships, and to determine whether faculty perceptions of student preparedness and comfort were improved after participation in the course compared with previous third-year students. Methods Second-year osteopathic medical students at PCOM participated in a 4-week course, Introduction to Clinical Clerkship (I2C). The course included 16 small-group exercises, which all took place before students began their third-year clerkship rotations. The exercises in the course extended beyond the skills learned during their classroom years. Students were given a pre- and postcourse survey to evaluate their comfort level with 58 different aspects of clinical practice. Participating faculty were surveyed to evaluate their perception of student preparedness and comfort compared with previous third-year students who had not undergone the exercise. Results After completing the I2C course, third-year osteopathic medical students (n=232) reported increased comfort with 57 of the 58 learning objectives and each of the 5 coded clinical competency areas (patient assessment, effective communication, hospital logistics, procedural skills, and core knowledge) (P<.01). Preceptors reported that students who completed the I2C course were more prepared (54.5%) and more comfortable (63.4%) with clinical duties, as compared with their recollections of previous third-year osteopathic medical students. Conclusion Within the 5 competencies, students on average felt more comfortable and were perceived by faculty as better prepared than previous students who had not taken the I2C course. The establishment of a preclinical transition exercise appears to help bridge the gap between the preclinical and clinical years. This learning model allows medical students to feel both more comfortable and better prepared throughout the transition from classroom learning to clinical rotations.
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Woodruff JN. Accounting for complexity in medical education: a model of adaptive behaviour in medicine. MEDICAL EDUCATION 2019; 53:861-873. [PMID: 31106901 DOI: 10.1111/medu.13905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/07/2019] [Accepted: 04/04/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT Medicine is practised in complex systems. Physicians engage in clinical and operational problems that are dynamic and lack full transparency. As a consequence, the behaviour of medical systems and diseases is often unpredictable. Medical science has equipped physicians with powerful tools to favourably impact health, but a reductionist approach alone is insufficient to optimally address the complex challenges posed by illness and public health. Concepts from complexity science, such as continuous quality improvement and teamwork, strive to fill the gap between biomedical knowledge and the realities of practice. However, the superficial treatment of these systems-thinking concepts in medical education has distorted their implementation and undermined their impact. 'Systems thinking' has been conflated with 'systematic thinking'; concepts which are adaptive in nature are being taught as standardised, reductionist tools. METHODS Using concepts from complexity science, the history of science and psychology, this problem is outlined and a theoretical model of professional development is proposed. RESULTS This model proposes that complex problem solving and adaptive behaviour, not technical expertise, are distinguishing features of professionalism. DISCUSSION The impact of this model on our understanding of physician autonomy, professionalism, teamwork and continuous quality improvement is discussed. This model has significant implications for the structure and content of medical education. Strategies for enhancing medical training, including interventions in recruitment, the curriculum and evaluation, are reviewed. Such adjustments would prepare trainees to more effectively utilise biomedical knowledge and tools in the complex high-stakes reality of medical practice.
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Affiliation(s)
- James N Woodruff
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
- The Pritzker School of Medicine, Chicago, Illinois, USA
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Whitcomb DC. Primer on Precision Medicine for Complex Chronic Disorders. Clin Transl Gastroenterol 2019; 10:e00067. [PMID: 31335357 PMCID: PMC6708660 DOI: 10.14309/ctg.0000000000000067] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022] Open
Abstract
Precision medicine promises patients with complex disorders the right treatment for the right patient at the right dose at the right time with expectation of better health at a lower cost. The demand for precision medicine highlights the limitations of modern Western medicine. Modern Western medicine is a population-based, top-down approach that uses pathology to define disease. Precision medicine is a bottom-up approach that identifies predisease disorders using genetics, biomarkers, and modeling to prevent disease. This primer demonstrates the contrasting strengths and limitations of each paradigm and why precision medicine will eventually deliver on the promises.
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Affiliation(s)
- David C. Whitcomb
- Department of Medicine, Cell Biology and Molecular Physiology, and Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Anderson MC, Love LM, Haggar FL. Looking Beyond the Physician Educator: the Evolving Roles of Instructional Designers in Medical Education. MEDICAL SCIENCE EDUCATOR 2019; 29:507-513. [PMID: 34457508 PMCID: PMC8368409 DOI: 10.1007/s40670-019-00720-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To explore how instructional designers (IDs) view their work and give insight to organizations intending to hire for this role. METHOD In 2018, a 28-question survey was utilized to examine the role of instructional designers in medical education and their contributions as educational professionals. The survey was sent to members of the DR-ED listserv, the Instructional Designer listserv through AAMC, relevant EDUCAUSE listservs, and via Twitter in April 2018. Quantitative and qualitative results were analyzed. The target population was determined as those who self-identify as working in instructional design in medical education, understanding that titles of IDs may vary widely in academic medicine. RESULTS Participants in this study (72) were self-identified as 45 (63%) females and 23 (32%) males. Among the degrees held by participants, 33 (46%) hold a terminal degree, 37 (51%) a master's degree, and 2 (3%) a bachelor's degree. Seven (9%) of institutions employ one ID and 27 (36%) employ two to five IDs, and 19 (25%) of the participants did not know how many instructional designers were employed by their organization. Participants reported that 22 (40%) specialize in more than one type of work such as database development, classroom technology, faculty development, and assessment/evaluation. CONCLUSION There is a wide variety of work environments for IDs in academic medicine; these range from large academic research institutions to consultant companies. A significant portion of IDs advise faculty on pedagogy and teaching best practices and develop professional development training. Job titles for IDs are also varied, representative of a wide range of influence within academic medicine organizations. ID expertise that was considered most commonly needed in academic medicine includes familiarity with learning management systems, multimedia literacy, and pedagogy.
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Affiliation(s)
- Max C. Anderson
- College of Medicine, University of Illinois, 1853 W Polk Street, Chicago, IL USA
| | - Linda M. Love
- Department of Psychiatry, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Faye L. Haggar
- Department of Anesthesiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
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Rao AR, Clarke D. Exploring relationships between medical college rankings and performance with big data. BIG DATA ANALYTICS 2019. [DOI: 10.1186/s41044-019-0040-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Schwartz CC, Ajjarapu AS, Stamy CD, Schwinn DA. Comprehensive history of 3-year and accelerated US medical school programs: a century in review. MEDICAL EDUCATION ONLINE 2018; 23:1530557. [PMID: 30376794 PMCID: PMC6211283 DOI: 10.1080/10872981.2018.1530557] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/23/2018] [Accepted: 09/14/2018] [Indexed: 05/13/2023]
Abstract
Within the context of major medical education curricular reform ongoing in the United States, a subset of schools has re-initiated accelerated (3-year) medical education. It would be helpful for education leaders to pause and consider historical reasons such accelerated medical schools were started, and then abandoned, over the last century to proactively address important issues. As no comprehensive historical review of 3-year medical education exists, we examined all articles published on this topic since 1900. In general, US medical educational curricula began standardizing into 4-year programs in the early 1900s through contributions from William Osler, Abraham Flexner, and establishment of the American Medical Association (AMA) Council of Medical Education (CME). During WWII (1939-1945), accelerated 3-year medical school programs were initiated as a novel approach to address physician shortages; government incentives were used to boost the number of 3-year medical schools along with changed laws aiding licensure for graduates. However, this quick solution generated questions regarding physician competency, resulting in rallying cries for oversight of 3-year programs. Expansion of 3-year MD programs slowed from 1950s to 1960s until federal legislation was passed between the 1960s and the 1970s to support training healthcare workers. With renewed government financial incentives and stated desire to increase physician numbers and reduce student debt, a second rapid expansion of 3-year medical programs occurred in the 1970s. Later that decade, a second decline occurred in these programs, reportedly due to discontinuation of government funding, declining physician shortage, and dissatisfaction expressed by students and faculty. The current wave of 3-year MD programs, beginning in 2010, represents a 'third wave' for these programs. In this article, we identify common societal and pedagogical themes from historical experiences with accelerated medical education. These findings should provide today's medical education leaders a historical context from which to design and optimize accelerated medical education curricula.
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Affiliation(s)
- Christine C. Schwartz
- Departments of Anesthesia (DAS), Biochemistry (DAS), Pharmacology (DAS), University of Iowa, Iowa City, IA, USA
| | - Aparna S. Ajjarapu
- Departments of Anesthesia (DAS), Biochemistry (DAS), Pharmacology (DAS), University of Iowa, Iowa City, IA, USA
| | - Chris D. Stamy
- Departments of Anesthesia (DAS), Biochemistry (DAS), Pharmacology (DAS), University of Iowa, Iowa City, IA, USA
| | - Debra A. Schwinn
- Departments of Anesthesia (DAS), Biochemistry (DAS), Pharmacology (DAS), University of Iowa, Iowa City, IA, USA
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Strahinjevich B, Simpson JK. The schism in chiropractic through the eyes of a 1st year chiropractic student. Chiropr Man Therap 2018; 26:2. [PMID: 29372046 PMCID: PMC5769380 DOI: 10.1186/s12998-017-0171-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022] Open
Abstract
Since its inception, the chiropractic profession has been divided along ideological fault lines. These divisions have led to a profession wide schism, which has limited mainstream acceptance, utilisation, social authority and integration. The authors explore the historical origins of this schism, taking time to consider historical context, religiosity, perpetuating factors, logical fallacies and siege mentality. Evidence is then provided for a way forward, based on the positioning of chiropractors as mainstream partners in health care.
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Affiliation(s)
| | - J. Keith Simpson
- Discipline of Chiropractic, Murdoch University, Perth, WA Australia
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Skinner D, Rosenberger K. Toward a More Humanistic American Medical Profession: An Analysis of Premedical Web Sites From Ohio's Undergraduate Institutions. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2018; 5:2382120518756337. [PMID: 29468201 PMCID: PMC5814026 DOI: 10.1177/2382120518756337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/08/2018] [Indexed: 06/08/2023]
Abstract
In response to changes in health care, American medical schools are transforming their curricula to cultivate empathy, promote professionalism, and increase cultural competency. Many scholars argue that an infusion of the humanities in premedical and medical training may help achieve these ends. This study analyzes Web-based messaging of Ohio's undergraduate institutions to assess premedical advising attitudes toward humanities-based coursework and majors. Results suggest that although many institutions acknowledge the humanities, most steer students toward science majors; strong advocates of the humanities tend to have religious or other special commitments, and instead of acknowledging the intrinsic value that the humanities might have for future physicians, most institutions promote the humanities because entrance exams now contain related material.
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Affiliation(s)
- Daniel Skinner
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
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Zavlin D, Jubbal KT, Noé JG, Gansbacher B. A comparison of medical education in Germany and the United States: from applying to medical school to the beginnings of residency. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2017; 15:Doc15. [PMID: 29051721 PMCID: PMC5617919 DOI: 10.3205/000256] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/04/2017] [Indexed: 11/30/2022]
Abstract
Both Germany and the United States of America have a long tradition of science and medical excellence reaching back as far as the nineteenth century. The same tribute must be paid to the medical educational system in both countries. Despite significant initial similarities and cross-inspiration, the paths from enrolling in a medical university to graduating as a medical doctor in Germany and the US seem to have become much different. To fill a void in literature, the authors’ objective therefore is to delineate both structures of medical education in an up-to-date review and examine their current differences and similarities. Recent medical publications, legal guidelines of governmental or official organizations, articles in media, as well as the authors’ personal experiences are used as sources of this report. Tuition loans of over $200,000 are not uncommon for students in the US after graduating from medical schools, which are often private institutions. In Germany, however, the vast majority of medical universities are tax-funded and, for this reason, free of tuition. Significant differences and surprisingly multiple similarities exist between these two systems, despite one depending on government and the other on private organizations. Germany currently employs an integrated medical curriculum that typically begins right after high school and consists of a 2-year long pre-clinical segment teaching basic sciences and a 4-year clinical segment leading medical students to the practical aspects of medicine. On the other hand, the US education is a two-stage process. After successful completion of a Bachelor’s degree in college, an American student goes through a 4-year medical program encompassing 2 years of basic science and 2 years of clinical training. In this review, we will address some of these similarities and major differences.
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Affiliation(s)
- Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, USA
| | - Kevin T Jubbal
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Jonas G Noé
- Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Bernd Gansbacher
- Institute of Molecular Immunology & Experimental Oncology, Technical University Munich, Munich, Germany
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Chae SJ, Kim M, Chang KH, Chung YS. Potential bias factors that affect the course evaluation of students in preclinical courses. KOREAN JOURNAL OF MEDICAL EDUCATION 2017; 29:73-80. [PMID: 28597870 PMCID: PMC5465435 DOI: 10.3946/kjme.2017.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/24/2017] [Accepted: 04/06/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE We aim to identify what potential bias factors affected students' overall course evaluation, and to observe what factors should be considered in the curriculum evaluation system of medical schools. METHODS This study analyzed students' ratings of preclinical instructions at the Ajou University School of Medicine. The ratings of instructions involved 41 first-year and 45 second-year medical students. RESULTS There was a statistically significant difference between years of study and ratings' scoring. Learning difficulty, learning amount, student assessment, and teacher preparation from second-year students were significantly higher than first-year students (p<0.05). The analysis results revealed that student assessment was the predictor of ratings from first-year students, while teacher preparation was the predictor of ratings from second-year students. CONCLUSION We found significant interactions between year of study and the students' rating results. We were able to confirm that satisfaction of instructions factors perceived by medical students were different for the characteristics of courses. Our results may be an important resource for evaluating preclinical curriculums.
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Affiliation(s)
- Su Jin Chae
- Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Korea
- Office of Medical Education, Ajou University School of Medicine, Suwon, Korea
| | - Miran Kim
- Office of Medical Education, Ajou University School of Medicine, Suwon, Korea
- Department of Obstetrics & Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Ki Hong Chang
- Office of Medical Education, Ajou University School of Medicine, Suwon, Korea
| | - Yoon-Sok Chung
- Office of Medical Education, Ajou University School of Medicine, Suwon, Korea
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
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Ghias K, Khan KS, Ali R, Azfar S, Ahmed R. Stretching the boundaries of medical education A case of medical college embracing humanities and social sciences in medical education. Pak J Med Sci 2016; 32:911-6. [PMID: 27648038 PMCID: PMC5017101 DOI: 10.12669/pjms.324.10237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/21/2016] [Accepted: 06/25/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Aga Khan University, a private medical college, had a vision of producing physicians who are not only scientifically competent, but also socially sensitive, the latter by exposure of medical students to a broad-based curriculum. The objective of this study was to identify the genesis of broad-based education and its integration into the undergraduate medical education program as the Humanities and Social Sciences (HASS) course. METHODS A qualitative methodology was used for this study. Sources of data included document review and in-depth key informant interviews. Nvivo software was utilized to extract themes. RESULTS The study revealed the process of operationalization of the institutional vision to produce competent and culturally sensitive physicians. The delay in the establishment of the Faculty of Arts and Sciences, which was expected to take a lead role in the delivery of a broad-based education, led to the development of an innovative HASS course in the medical curriculum. The study also identified availability of faculty and resistance from students as challenges faced in the implementation and evolution of HASS. CONCLUSIONS The description of the journey and viability of integration of HASS into the medical curriculum offers a model to medical colleges seeking ways to produce socially sensitive physicians.
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Affiliation(s)
- Kulsoom Ghias
- Kulsoom Ghias, PhD. Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Kausar S Khan
- Kausar S Khan, MA. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rukhsana Ali
- Rukhsana Ali, MA. Curriculum Office, Aga Khan University, Karachi, Pakistan
| | - Shireen Azfar
- Shireen Azfar, MA. Office of the President, Aga Khan University, Karachi, Pakistan
| | - Rashida Ahmed
- Rashida Ahmed, MBBS, FCPS, MHPE. Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Fernandez-Moure JS. Lost in Translation: The Gap in Scientific Advancements and Clinical Application. Front Bioeng Biotechnol 2016; 4:43. [PMID: 27376058 PMCID: PMC4891347 DOI: 10.3389/fbioe.2016.00043] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/17/2016] [Indexed: 02/04/2023] Open
Abstract
The evolution of medicine and medical technology hinges on the successful translation of basic science research from the bench to clinical implementation at the bedside. Out of the increasing need to facilitate the transfer of scientific knowledge to patients, translational research has emerged. Significant leaps in improving global health, such as antibiotics, vaccinations, and cancer therapies, have all seen successes under this paradigm, yet today, it has become increasingly difficult to realize this ideal scenario. As hospital revenue demand increases, and financial support declines, clinician-protected research time has been limited. Researchers, likewise, have been forced to abandon time- and resource-consuming translational research to focus on publication-generating work to maintain funding and professional advancement. Compared to the surge in scientific innovation and new fields of science, realization of transformational scientific findings in device development and materials sciences has significantly lagged behind. Herein, we describe: how the current scientific paradigm struggles in the new health-care landscape; the obstacles met by translational researchers; and solutions, both public and private, to overcoming those obstacles. We must rethink the old dogma of academia and reinvent the traditional pathways of research in order to truly impact the health-care arena and ultimately those that matter most: the patient.
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Affiliation(s)
- Joseph S Fernandez-Moure
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA; Surgical Advanced Technologies Laboratory, Department of Regenerative and Biomimetic Medicine, Houston Methodist Research Institute, Houston, TX, USA
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Empirical redefinition of comprehensive health and well-being in the older adults of the United States. Proc Natl Acad Sci U S A 2016; 113:E3071-80. [PMID: 27185911 DOI: 10.1073/pnas.1514968113] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The World Health Organization (WHO) defines health as a "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Despite general acceptance of this comprehensive definition, there has been little rigorous scientific attempt to use it to measure and assess population health. Instead, the dominant model of health is a disease-centered Medical Model (MM), which actively ignores many relevant domains. In contrast to the MM, we approach this issue through a Comprehensive Model (CM) of health consistent with the WHO definition, giving statistically equal consideration to multiple health domains, including medical, physical, psychological, functional, and sensory measures. We apply a data-driven latent class analysis (LCA) to model 54 specific health variables from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of US community-dwelling older adults. We first apply the LCA to the MM, identifying five health classes differentiated primarily by having diabetes and hypertension. The CM identifies a broader range of six health classes, including two "emergent" classes completely obscured by the MM. We find that specific medical diagnoses (cancer and hypertension) and health behaviors (smoking) are far less important than mental health (loneliness), sensory function (hearing), mobility, and bone fractures in defining vulnerable health classes. Although the MM places two-thirds of the US population into "robust health" classes, the CM reveals that one-half belong to less healthy classes, independently associated with higher mortality. This reconceptualization has important implications for medical care delivery, preventive health practices, and resource allocation.
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Gelber SE, Taubel D, Chervenak FA. American medical education: the evolution of excellence. J Perinat Med 2016; 44:411-3. [PMID: 25719291 DOI: 10.1515/jpm-2014-0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Weinstein RS, Krupinski EA, Weinstein JB, Graham AR, Barker GP, Erps KA, Holtrust AL, Holcomb MJ. Flexner 3.0-Democratization of Medical Knowledge for the 21st Century: Teaching Medical Science Using K-12 General Pathology as a Gateway Course. Acad Pathol 2016; 3:2374289516636132. [PMID: 28725762 PMCID: PMC5497903 DOI: 10.1177/2374289516636132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 11/16/2022] Open
Abstract
A medical school general pathology course has been reformatted into a K-12 general pathology course. This new course has been implemented at a series of 7 to 12 grade levels and the student outcomes compared. Typically, topics covered mirrored those in a medical school general pathology course serving as an introduction to the mechanisms of diseases. Assessment of student performance was based on their score on a multiple-choice final examination modeled after an examination given to medical students. Two Tucson area schools, in a charter school network, participated in the study. Statistical analysis of examination performances showed that there were no significant differences as a function of school (F = 0.258, P = .6128), with students at school A having an average test scores of 87.03 (standard deviation = 8.99) and school B 86.00 (standard deviation = 8.18; F = 0.258, P = .6128). Analysis of variance was also conducted on the test scores as a function of gender and class grade. There were no significant differences as a function of gender (F = 0.608, P = .4382), with females having an average score of 87.18 (standard deviation = 7.24) and males 85.61 (standard deviation = 9.85). There were also no significant differences as a function of grade level (F = 0.627, P = .6003), with 7th graders having an average of 85.10 (standard deviation = 8.90), 8th graders 86.00 (standard deviation = 9.95), 9th graders 89.67 (standard deviation = 5.52), and 12th graders 86.90 (standard deviation = 7.52). The results demonstrated that middle and upper school students performed equally well in K-12 general pathology. Student course evaluations showed that the course met the student's expectations. One class voted K-12 general pathology their "elective course-of-the-year."
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Affiliation(s)
- Ronald S Weinstein
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA.,Arizona Telemedicine Program, University of Arizona Health Sciences Center, Tucson, AZ, USA
| | - Elizabeth A Krupinski
- Arizona Telemedicine Program, University of Arizona Health Sciences Center, Tucson, AZ, USA.,Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | | | - Anna R Graham
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Gail P Barker
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Kristine A Erps
- Arizona Telemedicine Program, University of Arizona Health Sciences Center, Tucson, AZ, USA
| | - Angelette L Holtrust
- Arizona Telemedicine Program, University of Arizona Health Sciences Center, Tucson, AZ, USA
| | - Michael J Holcomb
- Arizona Telemedicine Program, University of Arizona Health Sciences Center, Tucson, AZ, USA
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Whitcomb DC, Frulloni L, Garg P, Greer JB, Schneider A, Yadav D, Shimosegawa T. Chronic pancreatitis: An international draft consensus proposal for a new mechanistic definition. Pancreatology 2016; 16:218-24. [PMID: 26924663 PMCID: PMC6042966 DOI: 10.1016/j.pan.2016.02.001] [Citation(s) in RCA: 335] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND A definition of chronic pancreatitis (CP) is needed for diagnosis and distinguishing CP from other disorders. Previous definitions focused on morphology. Advances in epidemiology, genetics, molecular biology, modeling and other disciplines provide new insights into pathogenesis of CP, and allow CP to be better defined. METHODS Expert physician-scientists from the United States, India, Europe and Japan reviewed medical and scientific literature and clinical experiences. Competing views and approaches were debated until a new consensus definition was reached. RESULTS CP has been defined as 'a continuing inflammatory disease of the pancreas, characterized by irreversible morphological change, and typically causing pain and/or permanent loss of function'. Focusing on abnormal morphology makes early diagnosis challenging and excludes inflammation without fibrosis, atrophy, endocrine and exocrine dysfunction, pain syndromes and metaplasia. A new mechanistic definition is proposed--'Chronic pancreatitis is a pathologic fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental and/or other risk factors who develop persistent pathologic responses to parenchymal injury or stress.' In addition, "Common features of established and advanced CP include pancreatic atrophy, fibrosis, pain syndromes, duct distortion and strictures, calcifications, pancreatic exocrine dysfunction, pancreatic endocrine dysfunction and dysplasia." This definition recognizes the complex nature of CP, separates risk factors from disease activity markers and disease endpoints, and allows for a rational approach to early diagnosis, classification and prognosis. CONCLUSIONS Initial agreement on a mechanistic definition of CP has been reached. This definition should be debated in rebuttals and endorsements, among experts and pancreatic societies until international consensus is reached.
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Affiliation(s)
- David C Whitcomb
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Cell Biology and Molecular Physiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Luca Frulloni
- Department of Medicine, Gastroenterology Unit, Pancreas Center, University of Verona, Verona, Italy
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Julia B Greer
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexander Schneider
- Department of Medicine II, University Medical Centre Manheim, University of Heidelberg, Mannheim, Germany
| | - Dhiraj Yadav
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tooru Shimosegawa
- Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
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