Search

As the United States Navy transitions from Operation Iraqi Freedom/Operation Enduring Freedom to preparing for a near-peer competition, an increasing focus of wartime strategy relies upon a network of distributed naval assets for total sea control, known as Distributed Maritime Operations (DMO). Historically, embedded medical personnel have provided care at sea in times of war. Recent reviews of shipboard and evacuated mass casualty incidents have alluded to weaknesses in the existing Navy Medicine approach that will require advances in care provision to sustain high-quality care that would benefit from industry and civilian academic collaboration. To gain input from civilian prehospital expertise and insight, the current DMO and Navy En-Route Care (ERC) systems must be plainly described for non-Navy military and civilian leaders, clinicians, and researchers to understand. N/A In this review, we translate US Navy structure and vernacular into common civilian and non-Navy language, describe the maritime role-tiered ERC system, elucidate the medical assets on each naval warship, and discuss clinician levels and capabilities while deployed to help communicate the inherent challenges of US Navy maritime medical care during routine operations, casualty treatment, stabilization, and evacuation. We describe the roles of care, clinician levels, and medical assets within the Navy ERC system for researchers and military leaders who aim to mitigate the inherent challenges of future maritime trauma care in the age of Distributed Maritime Operations. This paper lays the framework of the Navy deployed medical system to enable research in maritime en-route care, and prompt inclusion of identified solutions into common use in the US Navy. [ABSTRACT FROM AUTHOR]

Background: Little is known about the experiences of transgender and gender non-binary (TNB) physicians in medical residency training programs. Aim: To identify the self-reported experiences and needs of TNB individuals during medical residency in United States training programs. Methods: An online, anonymous survey of TNB current residents and recent graduates was designed. Results: A total of 26 respondents completed the survey. The most common reported gender identity was non-binary or gender queer (n = 11, 42.3%) and male or transgender man (n = 7, 26.9%). About half of participants (n = 14, 53.8%) had undergone gender affirming interventions prior to residency. Most participants (n = 19, 73.1%) did not know all the gender affirming healthcare benefits offered by their program. The majority (n = 21, 80.8%) also reported 2 hours or less of transgender-related didactics in residency. Respondents were most likely to disclose their gender identity to other residents (n = 19, 73.1%) and faculty (n = 19, 73.1%) and were least likely to disclose their identity to patients (n = 6, 23.1%). Most respondents (n = 15, 57.7%) stated that program faculty and staff communicated support for their gender identity. Most participants (n = 16, 61.5%) reported that they perceived transgender residents to be treated similarly to their non-transgender peers in their training program, while the remainder (n = 7, 26.9%) disagreed or strongly disagreed. Nevertheless, approximately three-quarters of trainees (n = 22, 84.6%) self-reported microaggressions during their training program and non-binary and transfeminine trainees were more likely to report these experiences than transmasculine people. Nearly a quarter of transfeminine and non-binary participants reported macroaggressions, with none of the transmasculine respondents reporting these negative experiences. Most macroaggressions were from program faculty. Discussion: This study highlights that while most physicians in residency report support from their program for their TNB identity, TNB physicians still experience significant barriers and prejudices throughout training and more action is needed among program faculty for support of TNB trainees. [ABSTRACT FROM AUTHOR]

An online survey of 691 clinicians who use hypnosis was conducted in 31 countries to gain a broad real-world picture of current practices, views, and experiences in clinical hypnosis. Among 36 common clinical uses, stress reduction, wellbeing and self-esteem-enhancement, surgery preparations, anxiety interventions, mindfulness facilitation, and labor and childbirth applications were the most frequently rated as highly effective (each by ≥70% of raters) in the clinicians' own experience. Adverse hypnosis-associated effects had been encountered by 55% of clinicians but were generally short-lived and very rarely judged as serious. The most common hypnosis approaches used were Ericksonian (71%), hypnotic relaxation therapy (55%), and traditional hypnosis (50%). Almost all respondents reported regularly using other therapeutic modalities alongside hypnosis. Among a range of client variables potentially affecting therapy, most clinicians rated hypnotist-client rapport (88%) and client motivation (75%) as very or extremely important factors for successful hypnotherapy. The majority of respondents had conducted hypnosis treatment via teletherapy, and 54% of those estimated it to be as effective as in-person treatment. [ABSTRACT FROM AUTHOR]

We analyze gender and racial disparities in academic otolaryngology from 2007 to 2018 in the United States (US). A cross-sectional retrospective analysis was done using data from the American Association of Medical Colleges. The distribution of gender and race, academic ranks, tenure tracks, and degrees was reported. The total number of otolaryngologists increased from 1,490 to 2,239, where 53 percent were females. All races experienced an increase; however, Whites and Asians had a greater increase compared to Black and Hispanics. Regarding percentages at different ranks, White were the majority (>50 percent) in every category. As for tenure, the general trend was a decrease in the total number of tenured physicians from 327 in 2007 to 318 in 2018, where Black, Hispanic, and Asian tenured physicians increased, while White tenured physicians decreased. White male otolaryngologists were the majority for every subgroup (>60 percent), whereas Black faculty made up less than 1 percent of tenured category. Female representation gradually increased for all levels of tenure. As for all degrees, Whites were the majority for all levels of education (>60 percent). There were some improvements in the representations for the females in all and Asians on the tenure track. However, progress for the URM remains an elusive dream. [ABSTRACT FROM AUTHOR]

Issue: As U.S. healthcare systems plan for future physician workforce needs, the systemic impacts of climate change, a worldwide environmental and health crisis, have not been factored in. The current focus on increasing the number of trained physicians and optimizing efficiencies in healthcare delivery may be insufficient. Graduate medical education (GME) priorities and training should be considered in order to prepare a climate-educated physician workforce. Evidence: We used a holistic lens to explore the available literature regarding the intersection of future physician workforce needs, GME program priorities, and resident education within the larger context of climate change. Our interinstitutional, transdisciplinary team brought perspectives from their own fields, including climate science, climate and health research, and medical education to provide recommendations for building a climate-educated physician workforce. Implications: Acknowledging and preparing for the effects of climate change on the physician workforce will require identification of workforce gaps, changes to GME program priorities, and education of trainees on the health and societal impacts of climate change. Alignment of GME training with workforce considerations and climate action and adaptation initiatives will be critical in ensuring the U.S. has a climate-educated physician workforce capable of addressing health and healthcare system challenges. This article offers a number of recommendations for physician workforce priorities, resident education, and system-level changes to better prepare for the health and health system impacts of climate change. [ABSTRACT FROM AUTHOR]