RESUMEN

Education is a sustainable long-term measure to address the global burden of neurosurgical disease. Neurosurgery residencies in high-income countries are accredited by a regional governing body and incorporate various educational activities. Few opportunities for training may be present in low-income and middle-income countries due to a lack of neurosurgery residency programs, tuition, and health care workforce reductions. Core components of a neurosurgical training curriculum include operative room experience, clinical rounds, managing inpatients, and educational conferences. A gold standard for neurosurgical education is essential for creating comprehensive training experience, though training must be contextually appropriate.

Asunto(s)

RESUMEN

This article explores the transformative partnership between Duke Global Neurosurgery and Neurology (DGNN) and Uganda, emphasizing the power of dyads in international collaboration. It details the partnership's focus on service, research, and training, highlighting key accomplishments like the establishment of a neurosurgery residency program, expansion of services, and an epilepsy clinic. Challenges such as resource constraints and cross-cultural collaboration are addressed. Recommendations are provided for developing similar partnerships, underlining the importance of mutual respect, shared goals, and long-term commitment. The DGNN-Uganda dyad is a blueprint for leveraging collaboration to improve global neurosurgical care and reduce health care inequities.

Asunto(s)

RESUMEN

Neurosurgical education and training are the essential tenets for the development of a sustainable workforce. However, opportunities for training are limited in most parts of the world due to socioeconomic constraints and an inadequate workforce. This global deficit has triggered a huge drive to expand training opportunities. Although training programs are increasing numerically, most of these programs focus on basic residency training with no opportunities for fellowships and continuing education. Herein, we use the Foundation of International Education in Neurological Surgery as a global success model to elucidate on the role of fellowships, distant continuing education, and funding in neurosurgery.

Asunto(s)

RESUMEN

This article delves into academic global neurosurgeons' role in addressing the inequities in neurosurgical care globally. It outlines a comprehensive training framework incorporating global health education, research, and leadership development into neurosurgery residency programs. The article highlights the importance of interdisciplinary collaboration, cultural humility, and sustainable partnerships and advocates for a holistic approach to global neurosurgery. It underscores the necessity of integrating global health principles into neurosurgical training and practice, aiming to cultivate a new generation of neurosurgeons equipped to tackle the complex health challenges of our interconnected world.

Asunto(s)

RESUMEN

Introduction: burnout is a syndrome characterized by emotional exhaustion, depersonalization and emotional exhaustion that occurs due to exposure to stressful conditions over a long period. It can lead to poor job performance, apathy, and lack of productivity. This study looks at the prevalence of burnout in medical interns in a tertiary hospital in South Africa and the factors that may contribute to burnout. Methods: an analytical cross-sectional study was conducted. Medical interns working in Chris Hani Baragwanath Hospital in 2019 were invited to participate. The participants filled questionnaire that had demographic information, the Maslach Burnout Inventory Scale, a scale to rate the rotations that they believed contributed towards their burnout and factors they think contributed towards their burnout. Our data was analyzed using Stata. Results: out of a possible 165 potential participants, 101 medical interns enrolled. 95% of the participants reported burnout. Statistically significant factors contributing towards burnout were lack of resources and poor relations with support staff and senior staff. The medical rotation that was reported by the participants to contribute most towards their burnout was internal medicine. Conclusion: burnout in this population of medical interns is alarmingly high. Higher than reported in similar studies in South Africa and internationally.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

While the proliferation of diversity, equity, and inclusion (DEI) initiatives among medical schools and residency training programs has provided important benefits of demographic and experiential diversity among medical trainees, there has not been a similar emphasis upon the importance of moral diversity in medical training. Enhanced attention to the importance of moral diversity and the centrality of conscience to medical practice might allow trainees to better interface with the morally diverse patients they serve, learn important virtues like humility, patience, and tolerance, and deepen their understanding of and appreciation for alternative moral viewpoints among their fellow practitioners.

Asunto(s)

RESUMEN

Background: Rational prescription writing is an important skill to master during internship. This Quality Improvement (QI) project aimed to understand the state of prescription writing among interns posted in the Department of Psychiatry, analyze the causes responsible for errors in prescription writing and bring about a change in the current practice. Methods: The MBBS interns are posted in the Department of Psychiatry for 15 days. During day 1 to day 5 of their posting, a pre intervention phase was conducted wherein prescriptions written by interns in the Department of Psychiatry were collected. The prescriptions were scored based on 14 criteria which were selected based on World Health Organization (WHO) guidelines and Medical Council of India (MCI) ideal prescription format. During PDSA (Plan Do Study Act) Cycle 1, an educational handout was distributed to the interns containing the MCI ideal prescription format and WHO guidelines regarding prescription writing. The brochure was also verbally explained to the interns. From day 7 to day 15 of their posting, prescriptions written by the interns were collected. The prescriptions were scored using the same criteria. Results: During the pre intervention phase the mean total score of prescriptions was 9.54 ± 1.003. There was a significant improvement in the mean total score to 10.26 ± 0.746. There was a 7.54% improvement. There was also a significant improvement in several individual criteria. Conclusions: The first PDSA cycle was successful in improving the quality of prescription writing among interns posted in the Department of Psychiatry. There is a need to implement more PDSA cycles to improve the quality still further.

Asunto(s)

RESUMEN

INTRODUCTION: The operating room is no longer the ideal place for early surgica training of cardiothoracic surgery residents, forcing the search for simulation-based learning options. The study's aim was the construction and surgicaltraining of coronary anastomosis in a portable, low-cost, homemade simulator. METHODS: This is an observational, analytical, and multicenter study. The simulator was built with common materials and was evaluated with the Objective Structured Assessment ofTechnical Skills (or OSATS) Modified. All junior and senior residents from nine national cardiothoracic surgery centers were considered for 90 days. Operative skill acquisition and time in the creation of side-to-side (S-T-S), end-to-side (E-T-S), and end-to-end (E-T-E) coronary anastomoses were evaluated. All sessions were recorded and evaluated by a single senior cardiothoracic surgeon during two time periods. RESULTS: One hundred and forty residents were assessed in 270 sessions. In junior residents, a significant improvement in final scores was identified in S-T-S (use of Castroviejo needle holder, needle angles, and needle transfer) (P<0.05). In seniors, a significant improvement was identified in S-T-S (graft orientation, appropriate spacing, use of forceps, angles, and needle transfer) anastomoses (P<0.05). A significant improvement in the final anastomosis time of senior residents over junior residents was identified in S-T-S (8.11 vs. 11.22 minutes), E-T-S (7.93 vs. 10.10 minutes), and E-T-E (6.56 vs. 9.68 minutes) (P=0.039). CONCLUSION: Our portable and low-cost coronary anastomosis simulator is effective in improving operative skills in cardiothoracic surgery residents; therefore, skills acquired through simulation-based training transfer have a positive impact on the surgical environment.

Asunto(s)

RESUMEN

Background Recent advancements, including image processing capabilities, present new potential applications of large language models such as ChatGPT (OpenAI), a generative pretrained transformer, in radiology. However, baseline performance of ChatGPT in radiology-related tasks is understudied. Purpose To evaluate the performance of GPT-4 with vision (GPT-4V) on radiology in-training examination questions, including those with images, to gauge the model's baseline knowledge in radiology. Materials and Methods In this prospective study, conducted between September 2023 and March 2024, the September 2023 release of GPT-4V was assessed using 386 retired questions (189 image-based and 197 text-only questions) from the American College of Radiology Diagnostic Radiology In-Training Examinations. Nine question pairs were identified as duplicates; only the first instance of each duplicate was considered in ChatGPT's assessment. A subanalysis assessed the impact of different zero-shot prompts on performance. Statistical analysis included χ2 tests of independence to ascertain whether the performance of GPT-4V varied between question types or subspecialty. The McNemar test was used to evaluate performance differences between the prompts, with Benjamin-Hochberg adjustment of the P values conducted to control the false discovery rate (FDR). A P value threshold of less than.05 denoted statistical significance. Results GPT-4V correctly answered 246 (65.3%) of the 377 unique questions, with significantly higher accuracy on text-only questions (81.5%, 159 of 195) than on image-based questions (47.8%, 87 of 182) (χ2 test, P < .001). Subanalysis revealed differences between prompts on text-based questions, where chain-of-thought prompting outperformed long instruction by 6.1% (McNemar, P = .02; FDR = 0.063), basic prompting by 6.8% (P = .009, FDR = 0.044), and the original prompting style by 8.9% (P = .001, FDR = 0.014). No differences were observed between prompts on image-based questions with P values of .27 to >.99. Conclusion While GPT-4V demonstrated a level of competence in text-based questions, it showed deficits interpreting radiologic images. © RSNA, 2024 See also the editorial by Deng in this issue.

Asunto(s)

RESUMEN

OBJECTIVES: Hypertension (HTN) affects nearly half of US adults. Our multi-institutional survey revealed that Internal Medicine residents lack proficiency in advanced HTN topics. We developed a curriculum to address knowledge gaps in these topics and aimed to assess the effects of the curriculum on residents' confidence, desire for future training, and knowledge in advanced HTN topics. METHODS: HTN experts taught four advanced topics in HTN: conducting a workup for secondary HTN, managing HTN in chronic kidney disease, managing HTN in patients who are or may become pregnant, and managing hypertensive urgency (severe asymptomatic HTN) in the outpatient setting. The setting of the curriculum was an ambulatory educational half-day, during which residents rotated through small-group sessions dedicated to each HTN topic. We developed pre-, immediate post-, and 8 weeks postcurriculum surveys assessing residents' confidence and desire for future training in the four topics (4-point Likert scales), and multiple-choice quizzes to assess changes in knowledge. We used repeated-measures analysis of variance to compare means between time points for surveys and quizzes. RESULTS: A total of 112 Internal Medicine residents participated in the curriculum. The mean confidence scores for all four topics increased from 1.79 to 2.61 precurriculum to 2.90 to 3.45 immediately postcurriculum (all P < 0.001) and remained higher (2.53-3.18) than precurriculum at 8 weeks postcurriculum (all P < 0.02). The mean desire for future training scores decreased from 2.74 to 2.96 precurriculum to 2.06 to 2.36 immediately postcurriculum (all P < 0.001 except for managing HTN in patients who are or may become pregnant, which was P = 0.17) and remained lower (2.08-2.36) than precurriculum at 8 weeks postcurriculum (all P ≤ 0.003). The mean knowledge score increased from 48% precurriculum to 62% immediate postcurriculum (P < 0.001) and remained higher (55%) than precurriculum at 8 weeks postcurriculum (P = 0.015). CONCLUSIONS: A curriculum on advanced HTN topics produced durable gains in confidence and knowledge and partially satisfied the desire for future learning among Internal Medicine residents.

Asunto(s)

RESUMEN

BACKGROUND: ChatGPT has been tested in health care, including the US Medical Licensing Examination and specialty exams, showing near-passing results. Its performance in the field of anesthesiology has been assessed using English board examination questions; however, its effectiveness in Korea remains unexplored. OBJECTIVE: This study investigated the problem-solving performance of ChatGPT in the fields of anesthesiology and pain medicine in the Korean language context, highlighted advancements in artificial intelligence (AI), and explored its potential applications in medical education. METHODS: We investigated the performance (number of correct answers/number of questions) of GPT-4, GPT-3.5, and CLOVA X in the fields of anesthesiology and pain medicine, using in-training examinations that have been administered to Korean anesthesiology residents over the past 5 years, with an annual composition of 100 questions. Questions containing images, diagrams, or photographs were excluded from the analysis. Furthermore, to assess the performance differences of the GPT across different languages, we conducted a comparative analysis of the GPT-4's problem-solving proficiency using both the original Korean texts and their English translations. RESULTS: A total of 398 questions were analyzed. GPT-4 (67.8%) demonstrated a significantly better overall performance than GPT-3.5 (37.2%) and CLOVA-X (36.7%). However, GPT-3.5 and CLOVA X did not show significant differences in their overall performance. Additionally, the GPT-4 showed superior performance on questions translated into English, indicating a language processing discrepancy (English: 75.4% vs Korean: 67.8%; difference 7.5%; 95% CI 3.1%-11.9%; P=.001). CONCLUSIONS: This study underscores the potential of AI tools, such as ChatGPT, in medical education and practice but emphasizes the need for cautious application and further refinement, especially in non-English medical contexts. The findings suggest that although AI advancements are promising, they require careful evaluation and development to ensure acceptable performance across diverse linguistic and professional settings.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: Health Advocacy is considered one of the most difficult skills to teach. Many medical learners feel ill-equipped in social competencies and identify it as a significant gap in their medical training. Experiential learning has recently been emerging as a more effective method to teach health advocacy. The Post Graduate Medical Education (PGME) Health Advocacy Day is a new experiential learning curriculum designed to teach important competencies of health advocacy and social accountability to post-graduate medical residents at the University of Ottawa in Ottawa, Canada. The objective of this mixed-methods study was to assess resident experiences. METHODS: Second-year trainees from all adult residency programs attended the Advocacy Day as part of a mandatory academic day. All participants completed a mandatory pre-and post-session quiz to assess knowledge of key topics before and after the course. We also distributed a voluntary survey to all participants and invited residents to participate in semi-structured interviews to provide feedback on the course. We used descriptive statistics to analyze quiz scores and survey results and conducted a paired t-test of pre and post-test quiz scores. We also performed a thematic analysis of qualitative feedback, specifically survey comments and semi-structured interviews. RESULTS: One hundred and eighty-three residents participated in the Advocacy Day and 112 (61.2%) completed the post-course survey. Ten residents volunteered to be interviewed. Respondents were generally satisfied by the session and felt it was of good quality. Most residents felt the course enhanced their ability to advocate for individual patients or communities (N = 80; 71.5%) and understand patients and families' lived experience with illness (N = 87; 77.5%). Most residents also felt the course improved their knowledge of the impact of social determinants of health (N = 91; 81.2%) and increased their awareness of local resources that can support patients and their families (N = 88; 78.3%). Visiting community sites in-person and meeting persons with lived experiences were highlighted as the most valuable components of the course. CONCLUSION: Experiential learning can be integrated within post-graduate medical curricula to teach health advocacy competencies. Future studies should examine the longitudinal impact of the curricula, to determine whether shifts in perspectives persist over time.

Asunto(s)

RESUMEN

Introduction: Recognizing the need for more opportunities to learn about health equity within military graduate medical education (GME), we developed a resident-led curriculum to introduce these concepts from a military cultural competency lens. The Impact of Racism on Health module focuses on structural racism and health disparities. Methods: This 60-minute module was presented to ear, nose, and throat (ENT) and pediatrics residents and fellows. It includes a case presentation of an adolescent with an asthma exacerbation, a large-group discussion about social determinants of health and structural racism, and a small-group discussion/debrief conceptualizing the case. Results: Thirty pediatrics residents and 15 ENT residents participated in this activity with a 46% and 60% pretest response rate, respectively. A two-sample Mann-Whitney U test showed statistically significant improvement (p = .005) in knowledge related to structural racism between the pretest (M = 0.5, SD = 0.3) and posttest (M = 0.7, SD = 0.1) knowledge assessments with a small effect size (r = 0.4; Z = 2.8). Discussion: We demonstrated that interactive teaching methods can be used to educate military GME trainees on the impact of structural racism on health outcomes for military health care beneficiaries. Understanding the role of structural racism in the context of military health care using curricula that highlight military-specific health disparities is essential to understanding the role of the military physician in systemically addressing health disparities.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: The quality of education and the learning environment significantly influence dental trainees' success and experiences. However, the impact of the educational environment on dental residents in Saudi Arabia remains unexplored. This study aimed to assess the educational environment among dental residents at King Abdulaziz Medical City (KAMC) using the Postgraduate Hospital Educational Environment Measure (PHEEM) instrument, shedding light on its influence and providing insights for improvement. METHODS: A cross-sectional survey was conducted among 85 dental residents from various specialties at King Abdulaziz Medical City in Riyadh, Saudi Arabia, using the PHEEM instrument to evaluate the educational environment. Data analysis involved descriptive statistics, the Shapiro-Wilk test for score normality, and comparative analyses to explore the relationships between PHEEM scores and sociodemographic characteristics, specialties, residency years, and health habits. RESULTS: A total of 85 dental residents completed the survey. The majority of participants were aged 25 years and older (96.5%), female (56.5%), and single (78.8%). Most of the participating dental residents were Saudi board orthodontic residents (18.8%), and they were at the R2 level of training (32.9%). 88.2% were non-smokers, and 78.8% of them practiced physical activity. The PHEEM assessment revealed an overall score of 117.12 out of 160, with subscale scores of 41.54 out of 56 for role autonomy, 44.66 out of 60 for teaching, and 30.92 out of 44 for social support. Factors like age, marital status, and smoking were associated with lower scores, while being female and physically active were linked to higher scores. Notably, R3 residents had significantly lower scores than R1 residents (p < 0.05). CONCLUSION: This study evaluated the educational environment in Saudi board dental programs at KAMC, revealing an overall positive atmosphere but highlighting the need for improvement in certain areas. Despite some limitations, this research represents a significant step toward assessing and enhancing the educational environment for dental residents in Saudi Arabia, ultimately ensuring a better learning environment for future dental professionals.

Asunto(s)

RESUMEN

BACKGROUND: Improving the professional competency of nursing students during the internship is critical. This study aimed to compare the professional competency and anxiety of nursing students trained based on two internship models. METHODS: This is a two-group posttest-only quasi-experimental design study. One hundred nursing students who passed internship models A (a previous internship model) and B (an intervention with more educator support and a more planned and programmed process) were randomly enrolled in this study. Internship model groups A and B were conducted for the students in semesters 7 and 8. The outcomes assessed in both groups were "The Competency Inventory for Registered Nurses" and Spielberger "State-Trait Anxiety Inventory". T-test and MANOVA were used to analyze the data. RESULTS: The mean scores of competency were 134.56 (SD = 43.23) and 160.19 (SD = 35.81) for the nursing students in the internship model groups A and B, respectively. The mean scores of nursing students' anxiety were 92.14 (SD = 15.36) and 80.44 (SD = 18.16) in the internship model groups A and B, respectively. MANOVA test showed a significant difference between the groups regarding professional competency (F = 10.34, p = 0.002) and anxiety (F = 11.31, p = 0.001). CONCLUSIONS: The internship model group B could improve the professional competency of nursing students to a great extent and they experienced mild anxiety; it is suggested that this intervention should be done for nursing students. Conducting more studies to evaluate the effect of this model on the nursing students' competency and anxiety after graduation and as a novice nurse is suggested.

Asunto(s)