Search

There are too few oncologists to meet the increasing burden imposed by the rising incidence of cancer. This results from issues with the retention of established oncologists and longstanding challenges to the recruitment of adequate numbers of trainees. To counter this, the British Oncology Network for Undergraduate Societies (BONUS) devised an online oncology careers event for medical students and junior doctors who are yet to select a specialty. An online careers event was devised with a focus on oncology practice and related subspecialties, as well as research. Event attendees were asked to respond to piloted pre- and post-event surveys. Knowledge and attitudes towards a career in oncology were evaluated using Likert scale and multiple-choice questions. A systematic literature search was carried out to contextualise these data. Of the 73 attendees, 44 (60%) participants completed both the pre- and post-event surveys; 79.5% of attendees believed that information on a career in oncology is lacking in medical training. This viewpoint was supported by the systematic review, which highlighted a need for relevant focussed interventions targeted at medical students and fledgling doctors. The education event led to an increase in the median reported understanding of the oncology career pathway from 6.0 to 8.0 (P < 0.05 and P < 0.001), as well as the likelihood of pursuing a career in oncology (8.0–9.0; P < 0.05). It was also associated with a proportional increase in medical and surgical oncology interest, albeit with a fall in interest in clinical and interventional oncology as well as academia. A targeted online careers event increases knowledge of and interest in a career in oncology, albeit predominantly for medical and surgical subspecialties. Broader initiatives based on our model should be developed and careers in academia as well as clinical and interventional oncology emphasised. • Most attendees reported undergraduate oncology rotations were 2 weeks or less in duration. • Attendees reported limited knowledge on what a career in oncology entails. • Targeted online events increase knowledge of and interest in a career in oncology. • Interest in medical and surgical oncology increased post-event. [ABSTRACT FROM AUTHOR]

La dernière année de l'internat d'oncologie-radiothérapie en France est devenue une phase d'autonomisation, dite de « docteur junior », permettant aux internes la validation d'actes réservés auparavant uniquement aux médecins séniors. Cette étude s'est focalisée sur les responsabilités données à la première promotion de docteur junior et à leur opinion sur ce nouveau de statut. Une enquête transversale a été réalisée par les associations françaises d'internes et de jeunes médecins en oncologie, l'Association pour l'enseignement et la recherche des internes en oncologie (Aerio) et la Société française des jeunes radiothérapeutes oncologues (SFjRO). Un questionnaire a été adressé aux référents de promotion de chaque ville pour transmission aux docteurs juniors de l'année 2021–2022 du 1er septembre au 30 novembre 2022. Les questions concernaient la formation, les modalités de cette année et les impressions. Les réponses ont été analysées anonymement via le logiciel R. 4.3.1. Pour l'oncologie–radiothérapie, 33 réponses ont été obtenues, de 21 villes. Pour l'essentiel des docteurs juniors, trois ou quatre localisations (51 %) ont été réalisées avec en moyenne cinq nouveaux patients par semaine. Les contours ont été revus soit systématiquement (51 %), soit uniquement au début (32 %). La dosimétrie a été rapportée comme jamais contresignée chez 19 %. Quatre-vingt pour cent des docteurs juniors ont déclaré avoir été seul(e) oncologue radiothérapeute lors de réunion de concertation pluridisciplinaire. Les deux axes principaux d'amélioration étaient la formation théorique (45 %) et sur les cadres légaux/contrats (42 %). L'analyse des résultats portant sur cette première promotion montre une globale concordance avec les recommandations du Collège national des enseignants en cancérologie (Cnec). Les retours des docteurs juniors sont positifs. La supervision des activités de curiethérapie et de dosimétries, la présence seule en réunion de concertation pluridisciplinaire restent des points de vigilance. The last year of the radiotherapy oncology internship in France has become a phase of empowerment, called "junior doctor", allowing interns to validate acts previously reserved only for senior doctors. This study focused on the responsibilities given to the first promotion of junior doctors in France and their feelings on this new status. A cross-sectional survey was carried out by the French associations of interns and young doctors in oncology, Aerio and SFjRO. A questionnaire was sent to the class referents of each city for transmission to the junior doctors of the year 2021–2022 from September 1st to November 30th, 2022. The questions concerned training, the modalities of this year and the feelings. Responses were analyzed anonymously using R. 4.3.1 software. For radiation oncology, 33 responses were obtained from 21 cities. For most junior doctors, three to four localizations (51%) were performed with an average of five new patients per week. The contours were reviewed either systematically (51%) or only at the beginning (32%). Dosimetry was reported as never countersigned in 19%; 80% of junior doctors described having been the only radiation oncologist during multidisciplinary staff meetings. The two main areas of improvement were theoretical training (45%) and legal frameworks/contracts (42%). These results relating to the first class of junior doctors showed an overall agreement with the recommendations of the Cnec. Feedback from interns was positive. The supervision of brachytherapy and dosimetry activities, the presence alone in multidisciplinary panel remained points of vigilance. [ABSTRACT FROM AUTHOR]

• Using an experimental approach, this study explored if video-based coaching improves preservice teachers' interactional skills and how the prior level of preservice teachers' beliefs about children, effective teaching knowledge, ability of identifying effective teaching behavior, and interactional practices predict the change in interactional skills. • Fifty-six preservice teachers from a Chinese university participated in this study during their internship. • After one semester of coaching, preservice teachers improved in the Emotional Support domain of teacher-child interactions. • Preservice teachers' higher levels of child-centered beliefs and initially lower levels of knowledge of effective teaching, ability of identifying effective teaching behavior, and teacher-child interactional skills related to a greater increase in interactional skills during the internship. Based on the Teaching Through Interaction (TTI; Hamre et al., 2013) framework and the observational tool Classroom Assessment Scoring System (CLASS; Pianta, La Paro, et al., 2008), some professional development (PD) programs combined with video-based coaching had been developed. Previous studies have well-documented the effects of these PD programs on in-service teachers' mastery of interactional skills; however, little research has been done on the effects for preservice teachers. In the current study, we aimed to explore: (1) if video-based coaching improves preservice teachers' interactional skills, and (2) how the personal characteristics of teachers (whether they attend coaching or not) predict the change of interactional skills during their practicum. Using an experimental approach, the study recruited 56 preservice teachers from a Chinese university to participate in the assessment and intervention. Results showed that preservice teachers in the coaching group who received one semester of sustained and individualized coaching support demonstrated a greater improvement in teacher-child interaction skills in the Emotional Support domain than those in the control group. Further, preservice teachers' higher levels of child-centered beliefs and initially lower levels of knowledge of effective teaching, ability of identifying effective teaching behavior, and teacher-child interactional skills related to a greater increase in interactional skills during the internship. These findings shed light on how to design effective preparation programs for preservice teachers during their practicum. [ABSTRACT FROM AUTHOR]

We describe the demand for interns in the U.S. using ads from an internship-specific website. We find that internships are more likely to be paid when more closely associated with a specific occupation, when the local labor market has lower unemployment, and when the local and federal minimum wage are the same. A résumé audit study with about 11,000 applications reveals that employers are more likely to respond positively when internship applicants have previous internship experience. Particularly for unpaid internships, employers are also less likely to respond to applicants with black-sounding names and when the applicant is more distant from the firm. [ABSTRACT FROM AUTHOR]

A clinical internship is currently required by the American Board of Radiology prior to Radiology residency. The purpose of this investigation is to evaluate practicing radiologists' perspectives on the value of the internship and their recommendations for optimization. A five-minute online survey was distributed via email to practicing radiologist members of the American College of Radiology. A total of 566 completed responses (11.3% response rate) were received. Most respondents agreed that their internship was essential for improving non-radiology clinical knowledge (84%) and affirming their decision to become a radiologist (74%). Most respondents (59%) disagree that the one-year internship before residency should be eliminated. Most (53%) of the radiologists in an academic practice agreed that internship should be integrated into Radiology residency. If radiologists were to redesign the internship ("PreRad Internship"), a majority of the respondents would include training in other medical specialties (71%), working along technologists (55%) and informatics/AI/computer science (54%). While the greatest proportion (50%) of interventional radiologists reported a Surgery internship would be the most beneficial for their primary subspecialty (50%), diagnostic radiologists most commonly (27%) reported the PreRad Internship would be the most beneficial. The greatest proportions of Abdominal-, Breast-, and Neuroradiology-trained respondents reported a PreRad Internship would be the most beneficial internship for their primary field of subspecialty Radiology practice (32%, 36%, and 33%, respectively). The internship before Radiology residency offers some benefits but could be further optimized. There is support from practicing radiologists for a redesigned, more Radiology-specific PreRad Internship. • If radiologists were to redesign the internship ("PreRad Internship"), most would include training in other specialties and working with technologists. • Diagnostic radiologists most commonly reported a PreRad internship would be the most beneficial for their primary subspecialty. [ABSTRACT FROM AUTHOR]

Des inquiétudes grandissent depuis plusieurs années chez nos maîtres, quant à la qualité et à la quantité de la formation en chirurgie plastique en France. Elles se basent principalement sur la diminution du temps de travail des internes, l'apparition de nouveaux internes de la Génération Z à former, et enfin la pluridisciplinarité de la chirurgie plastique dans le contexte actuel de surspécialisation des services formateurs. Afin d'objectiver ces inquiétudes, un sondage a été réalisé parmi les internes et jeunes chefs de chirurgie plastique français pour évaluer leur formation à la spécialité depuis 2019. Nous avons ensuite recherché dans la loi, des possibilités pour pallier ces inquiétudes. Tous les répondants pensent que leur formation à la spécialité est incomplète, et peu d'entre eux ont pu la compléter par des stages hors subdivision ou des visites de praticiens privés. Or, dans la loi, il est possible de réaliser trois stages hors subdivisions, des stages hors Centre Hospitalo-Universitaire (CHU) en établissements privés de santé, et des stages ou échanges internationaux. Au terme de cette analyse, nous proposons trois solutions pour optimiser la formation en chirurgie plastique en France : un système d'échange d'internes, l'ouverture de terrains de stage dans des établissements privés de santé, et enfin, faciliter la réalisation d'aides opératoires auprès de praticiens libéraux. Avec ces solutions, le champ de formation des internes pourrait s'étendre d'une région à la France entière. Ces solutions pourraient aisément s'appliquer à d'autres spécialités, chirurgicales et médicales. Concerns have been growing for several years among masters, as to the quality and quantity of training in plastic surgery in France. They are mainly based on the reduction in the working time of residents, the appearance of new residents from generation Z to be trained, and finally the multidisciplinarity of plastic surgery in the current context of overspecialization of training center. In order to objectify these concerns, a survey was carried out among French residents and young heads of plastic surgery to assess their training in the specialty since 2019. We then looked in the law for possibilities to alleviate these concerns. All the respondents think that their training in the specialty is incomplete, and few of them have been able to supplement it with rotations outside the subdivision or visits from private practitioners. However, in the law, it is possible to carry out: three residents rotations outside the subdivision, clinics rotations and international exchanges. At the end of this analysis, we propose three solutions to optimize training in plastic surgery in France: a system of exchange of residents, the opening of residents rotations in clinics, and finally, to facilitate the realization of operating aids with private practitioners. With these solutions, the field of training for residents could extend from one region to the whole of France. These solutions could easily be applied to other specialties, surgical and medical. [ABSTRACT FROM AUTHOR]

Caring for children with acute illness is a challenge in limited-resource settings, especially when diagnostic imaging is limited or unavailable. We developed a training program in cardiac and lung point-of-care ultrasound (POCUS) for pediatric patients in eastern Uganda. Fourteen trainees including physicians, resident physicians and midlevels received training in cardiac and lung POCUS. Training included formal lectures, hands-on skills practice and individualized teaching sessions. Assessment included written knowledge assessment, direct observation and longitudinal image review. Blinded review of 237 consecutive ultrasound studies revealed satisfactory image quality (94.2% for lung and 93% for cardiac) and accurate image interpretation. Sensitivity and specificity of image interpretation were 0.93 (0.75-0.99) and 0.94 (0.78-0.99) for lung and 0.86 (0.71-0.95) and 0.94 (0.84-0.99) for cardiac compared with expert review. All trainees passed written knowledge assessments. After training, 100% of trainees reported that they would use POCUS in clinical activity and thought it would improve patient outcomes. Our training program indicated that trainees were able to perform high-quality cardiac and lung POCUS for pediatric patients with accurate interpretation. This builds a foundation for future studies addressing how POCUS can change outcomes for children in limited-resource settings. [ABSTRACT FROM AUTHOR]

Aim: To investigate the level of statistical support available to UK radiology trainees, and to gather opinions regarding how support may affect their current and future research aspirations.Materials and Methods: An online survey was developed, piloted, and distributed to radiology trainees via the UK Radiology Academic Network for Trainees and training programme directors. Research experience, research aspirations, available and desired statistical support, and attitudes to statistics were surveyed and responses were collated.Results: Seventy-nine responses were received, only two (3%) of whom had allocated time for research. Only three (4%) respondents were content with their statistical support whereas 25 (32%) reported insufficient statistical support; 13 (52%) of these believed this impacted "considerably" on research aspirations. Sixty-six (84%) respondents desired dedicated statistical support, 40 (61%) of whom stated the amount required would likely be "moderate" and 26 (39%) "significant". Respondents believed support would be most helpful to analyse data already collected (41 responses, 54%) rather than research planning (25, 33%). Most respondents (60, 76%) had used self-help methods to learn research statistics but only 21 (35%) found this useful.Conclusion: Training schemes must improve the provision, access to, and awareness of statistical support so that any research efforts are performed to a high standard. Trainees should not be expected to participate in research without sufficient time, mentorship, and statistical support. [ABSTRACT FROM AUTHOR]

Objective: To survey 2022 Urology Residency Match applicants on their away rotation experiences to better understand the impact of pandemic changes, including the one in-person away rotation limit, on interviews and match outcomes.Methods: An anonymous post-match online survey was distributed to applicants of study-participating institutions. Data was prospectively collected regarding respondent demographics, away rotation experiences, interviews, utilization of preference signaling, and overall match outcomes.Results: In total, 230 applicants completed the survey. Respondents prioritized geography (28.1%), program reputation (26.1%), and early notification (25.6%) as the top factors in determining whether to accept a rotation offer. The majority (93%) participated in a single away rotation, with nearly all respondents being offered a virtual interview from the program where they completed a visiting clerkship. Of those who declined away rotation offers, 56% were not offered an interview at the program they declined an offer from. The majority matched at either their home institution (20.8%), a program where they submitted a preference signal (22.2%), or a program where they completed an in-person away rotation (13%). Despite 46.3% of respondents reporting that their match outcome was negatively affected by the ability to rotate at only one away rotation, the majority were satisfied (70%) with their rotation selection based on match results.Conclusions: For applicants, participation in visiting rotations plays a significant role in the match process. Further research regarding mechanisms to optimize the away rotation application process is needed as the capacity to do visiting electives expands in the post-pandemic environment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of an etonogestrel implant training program within a primary care Internal Medicine residency training program.Study Design: We surveyed graduates of our primary care Internal Medicine residency program in the Bronx, New York who performed implant procedures though the first 32 months after implementation of a monthly faculty-supervised resident implant clinic. We assessed the number of implants placed and removed per graduate, and surveyed graduates' satisfaction with the implant training program, perceived competence with implant procedures, and intent and ability to perform implant procedures and barriers to performing implant procedures postgraduation.Results: Between July 2017 and February 2020, 14 residents placed a total of 34 devices and removed four. All 14 program graduates completed the survey in August 2020. All but one respondent felt this training was valuable and 11 felt competent placing implants without supervision. Although 10 planned to provide implants following graduation, none have been able to, largely because of credentialing and clinic-practice level barriers.Conclusions: The primary care Internal Medicine program graduates we surveyed (n = 14) valued our etonogestrel implant training program and perceived competence, particularly with implant placement. However, even those who intended to provide etonogestrel implants postgraduation were unable to do so.Implications: Internal Medicine residents trained to place and remove etonogestrel implants are most comfortable with implant placement. However, these physicians may face barriers related to credentialing and ambulatory practice scope when attempting to provide this care in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: To develop a novel "bootcamp" simulation-based curriculum to introduce common urologic procedures and to improve readiness for performing them at bedside.Methods: Three hundred twenty-five third-year medical students at our single institution participated in a hands-on simulation "boot camp" over a 2-year accrual period. This curriculum was designed to teach basic urologic bedside procedures (ie, Foley catheter placement, Bladder irrigation) to third year medical students prior to the start of their surgical clerkships in a live instructional setting with direct feedback from instructors. The objective aspects of the study consisted of a survey administered to study participants following participation in the simulation boot camp, as well as pre- and post-module assessments.Results: Medical students self-reported knowledge gains following the simulation session (P < .001), with 45.8% increase in procedural confidence. Additionally, students reported that the educational intervention was beneficial to their understanding of the subject matter (P < .001), were "very likely" to recommend the session to another medical student (P < .001), and felt that educational intervention better prepared them for an upcoming national exam (P < .001). Finally, the greatest gains were seen for those students who self-reported lower precurriculum knowledge (P < .001).Conclusions: Findings from our M3 "boot camp" led to self-reported gains in subject matter knowledge following the hands-on simulation curriculum, indicating that this type of educational intervention can be beneficial in preparing medical students for common bedside procedures. [ABSTRACT FROM AUTHOR]

Objective: To investigate how to optimise resident engagement during workplace learning of shared decision-making (SDM) by understanding their educational needs.Methods: A qualitative multicentre study was conducted using video-stimulated interviews with 17 residents in General Practice. Video recordings of residents' recent clinical encounters were used to facilitate reflection on their educational needs.Results: Data analysis resulted in five themes regarding residents' educational needs for learning SDM: acquiring knowledge and skills needed to perform SDM; practising SDM; reflection and feedback; longitudinal and integrated training; and awareness and motivation for performing SDM.Conclusion: Residents expressed a need for continuous attention to be paid to SDM during postgraduate medical education. That would help them engage in two parallel learning processes: acquiring the knowledge and skills necessary to perform SDM, and practising SDM in the clinical workplace. Alignment between the educational curriculum, workplace learning and resident learning activities is essential to operationalise SDM attitude, knowledge and skills into clinical performance.Practice Implications: The identified educational needs provide ingredients for fostering the development of SDM proficiency. The findings suggest that residents and clinical supervisors need parallel training to bridge the gap between education and clinical practice when learning SDM. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with effective scholarly activity and identify barriers to research during urology residency.Methods: An online survey was sent to 134 urology residency program directors in the United States. The survey assessed program characteristics, available support, and barriers for scholarly activity. Logistic regression analysis was used to identify characteristics of programs in the top quintile for success in scholarly activity.Results: There was a 40% response rate (n = 40). The majority of programs (86%) were university affiliated. Nearly all programs (98%) require participation in scholarly activity as a requirement for graduation. There were 3 primary outcomes evaluated: participation in original research, published scholarly activity and presentation of scholarly activity. Factors significantly associated with participation in original research were required research time (P = 0.06), lack of experienced faculty (P = 0.006), statistical and IRB support (P = 0.03, P = 0.01), funding (P = 0.02), and research curriculum (P = 0.006). Factors significantly associated with publication in peer reviewed journals were lack of funding and experienced faculty (P = 0.07, P = 0.01). Factors significantly associated with presentation of scholarly activity included research director (P = 0.05), chairman support (P = 0.02), research training (P = 0.03), protected time for faculty (P = 0.07), and faculty /resident attitudes toward conducting scholarly activity (P = 0.08, P = 0.02) and resident promotion linked to scholarly activity (P = 0.01).Conclusion: Training urology residents in research is essential. Current methods and available resources are variable. Programs should identify resources and barriers that have the greatest impact on resident success in scholarly activity, and may implement changes to improve productivity within their program. [ABSTRACT FROM AUTHOR]

Objective: To describe the manufacture of the nonbiological kidney cavity puncture trainer under ultrasound control and its benefits during the 30-day learning course of junior residents.Methods: Ten junior residents were included in this work. Each participant performed a kidney puncture on the described simulator under ultrasound control every day for a 30-day practical course. Also, ten urologists were included in the work and performed punctures on the trainer; the results obtained were compared with the residents' results on the 1st and 30th days of the study. The Face, content, construct, and criterion validities of the simulator have been defined. The residents also assessed the change in tactile sensations after the simulator's integrity restore and the increase in their motivation for a more in-depth study of all aspects of kidney puncture.Results: All residents could independently perform a kidney puncture on the simulator through the calyx papilla, which was statistically significant compared with the results on day 1 of training. When comparing the final results of the residents with the urologists' ones, there were similar. Face, content, and construct validity were 4/5, 5/5, and 4.5/5. There was no change in tactile sensations during the everyday restoration of the simulator's integrity. All residents noted the positive effect of the described simulator on their motivation in mastering percutaneous kidney puncture.Conclusion: The described simulator allows young residents to gain experience performing punctures of the kidney cavity, which positively affects their motivation to improve obtained skills further. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to sample the opinions of radiation oncologists and trainees in the United States regarding residency expansion, what action(s) should be taken to limit residency supply, if any, and the proposed Accreditation Council for Graduate Medical Education (ACGME) changes.Methods and Materials: An online survey was distributed to 1048 attending radiation oncologists by e-mail and approximately 800 residents through their program coordinators. The survey asked respondents to rank how strongly they agreed with certain statements regarding residency supply, possible solutions to address any perceived oversupply, and the proposed ACGME changes on a 1-to-10 disagreement-to-agreement scale. The 16% response rate yielded 294 responses for analysis.Results: Of the respondents, 90 (30%) were residents, and 204 (70%) were attendings, of whom 117 (57%) were academic and 87 (43%) were nonacademic. Eighty-six percent agreed that there is a residency oversupply issue, and 91% agreed that actions should be taken to limit residency expansion. On χ2 test, residents and attendings were similarly likely to agree that there is a residency oversupply issue (93% and 89%, P = .27), although residents were more likely to agree that this oversupply should be acted upon compared with attendings (100% and 88%, P < .01). Regarding possible solutions, respondents were most likely to agree that further expansion should be limited (90%), program requirements should be made more stringent (76%), and the use of the Supplemental Offer and Acceptance Program should be limited (69%). Proposed ACGME changes that respondents were most likely to agree with included requiring that programs have modern image guidance, stereotactic radiation therapy, and brachytherapy techniques (98%) and have 4+ faculty members and maintain a faculty-to-resident ratio of >1.5:1 (86%). Case log minimums most supported to be increased were 4 uterus (65%) and 11 postmastectomy breast (61%) simulations.Conclusions: The majority of respondents agree that there is a residency oversupply issue and that actions should be taken to limit residency expansion and make program requirements more stringent. [ABSTRACT FROM AUTHOR]

To examine the prevalence of mental health symptoms among medical interns working for the first time as physicians in a large tertiary hospital in Israel during the 1st COVID year. All interns who worked for at least 2 months during the 1st COVID year (March 2020–February 2021) at the Tel-Aviv Sourasky Medical Center (TASMC), a large tertiary general hospital in Israel were approached simultaneously during April–May 2021, and were requested to fill in an online survey. In each questionnaire, the interns were asked to refer to the worst time they endured the symptoms described. Included were all medical. Depression and anxiety symptoms, post-traumatic stress symptoms and Burnout measures were evaluated using validated questionnaires. Depressive/anxiety symptoms were defined as primary end measures. We assessed the association between depression and anxiety symptoms, and demographic, post-traumatic and burnout measures. 145 out of 188 interns completed the study (77% overall response rate). The mean age was 30.36 ± 2.97. Almost half the interns (47%) reported depression/anxiety symptoms. The high depression/anxiety group was characterized by a lower mean age (29.87 ± 2.93 vs. 30.92 ± 2.91, p = 0.041), higher post-traumatic symptoms (15.62 ± 13.32 vs. 3.63 ± 5.59, p < 0.0001) and higher scores in 2/3 burnout subscales - emotional exhaustion (5.09 ± 1.29 vs. 3.61 ± 1.38, p = 0.000001) and depersonalization (3.83 ± 1.71 vs. 2.94 ± 1.46, p = 0.002). 11.4% of interns in the full sample reported they used cannabis or alcohol as "self-medication". medical interns serving for their first year as physicians during the COVID pandemic, developed mental symptoms in alarming numbers. The findings point to a crucial need to implement active interventions to protect these doctors, so that they can safely embark on their medical careers, specifically in times of global health crises. [ABSTRACT FROM AUTHOR]

A high proportion of health professionals in training suffer from work-related stress and may develop a burnout syndrome. To study the incidence of burnout after the first year of residency in a teaching hospital and to identify baseline psychological, psychosocial work conditions, and biological risk factors. We assessed the following in a prospective cohort of residents at baseline (first month residence) and after 1 year: background factors (socio-demographics, psychiatric history), perceived stress score (Perceived Stress Scale), Maslach Burnout Inventory score, and psychosocial factors (Job Content Questionnaire). Blood samples were obtained to study serum cortisol, IL-6, and TNF-α concentrations. The cumulative incidence was modelled by multivariate log-binomial regression analysis. We included 71 participants with a female majority (64.8%), age 26.4 (2.65) years, psychiatric history in 20%, and burnout in 13%. Among those without burnout initially (N = 59), it had developed by 1 year in 22% of residents. Increased job demand (RR = 1.259, 95%CI = 1.019–1.556, p = 0.033) and decreased cortisol levels (RR = 0.877, 95%CI = 0.778–0.989, p = 0.032) predicted burnout after 1 year of residency among medical trainees. Burnout syndrome develops in 22% of residents by 1 year of training and can be predicted by increased work demands and decreased cortisol levels. • Burnout and psychosocial risk factors in residents have been extensibely studied, but most of the evidence comes from cross-sectional studies. • Few burnout studies in residents have included biological markers related to stress and immunity. • The results support early detection of both psychosocial work conditions and biological risk factors in order to design strategies for preventing resident burnout [ABSTRACT FROM AUTHOR]

Purpose: Although supported by most men and women, paternity leave is heavily underused across industries owing in part to external pressures and inconsistent availability. The goal of this study was to assess the use of paternity leave in radiation oncology (RO) practices and identify any associated barriers.Methods and Materials: A 36-item survey was distributed via e-mail to 536 male domestic RO attending and resident physicians. Questions assessed paternity leave policies, use, and departmental support. Data were collected using Research Electronic Data Capture from January to February 2021. Descriptive statistics were obtained for analysis, and logistic regression was performed to analyze the association between practice type and presence of policy.Results: The survey response rate was 20% (n = 108), with 98% of participants completing all applicable questions. Respondents included 63 attending physicians (58%) and 45 resident physicians (42%). The median age of all respondents was 35 years. Among all participants, 51 (47%) stated their practice had a formal paternity leave policy. The median time allowed for leave was 4 weeks (range, 0.5 weeks to unlimited), whereas the median time taken was 2 weeks (range, 0.5-12 weeks). Sixteen men felt pressure to take less leave than what was allowed by their policy, and 46% of men stated that in retrospect, they would have taken more time off for paternity leave.Conclusions: To the authors' knowledge, this is the first study to investigate the use of paternity leave in RO practices in the United States. Integrating expanded family leave policies, including specifically allowing for paternity leave and accompanying these policies with cultural changes acknowledging the importance of family leave, would be beneficial to improving quality of life and work-life balance for parents. [ABSTRACT FROM AUTHOR]

Context: Entrustable professional activities (EPAs) translate competencies into explicit, practical terms that clearly state the expected roles and responsibilities of clinicians who have achieved proficiency and expertise in a field. EPAs are defined for Hospice and Palliative Medicine physicians but not for other members of Hospice and Palliative Care (HAPC) interprofessional teams, including pharmacists.Objectives: The objective of this study was to develop EPAs for HAPC pharmacists.Methods: An 11-member workgroup of HAPC pharmacists was convened to develop candidate EPAs using nominal group and modified-Delphi methods. Content validity index was used as a measure of consensus, defined a priori at ≥ 60%. Vetting occurred via intra- and interprofessional stakeholder reactor groups and a national survey of HAPC pharmacists.Results: Following an iterative process of workgroup and stakeholder consensus-building, 15 HAPC pharmacist EPAs were developed. Among the workgroup, all 15 EPAs reached ≥ 70% consensus, indicating appropriate internal validity. In a national survey of 185 HAPC pharmacists with a 20% response rate, 13 EPAs were rated by most respondents as "essential" and 2 were rated by most respondents as "important but not essential." Respondents indicated the 15 EPA set represented the core professional activities of HAPC pharmacists well (median rating of 5 on a Likert-like scale, IQR 1).Conclusion: Fifteen consensus EPAs describe essential activities of HAPC pharmacists in direct patient care, leadership, education, and scholarship. These EPAs will further guide pharmacist training programs, HAPC services seeking to incorporate a specialized pharmacist on the team, and currently practicing HAPC pharmacists. [ABSTRACT FROM AUTHOR]

Objective: To describe how emergency medicine resident physicians discuss diagnostic uncertainty during a simulated ED discharge discussion.Methods: A secondary content analysis of simulated clinical encounter audiotapes completed by emergency medicine residents across two sites.Results: When discussing lack of diagnosis, residents explained the evaluation revealed no cause for symptoms, noted concerning diagnoses that were excluded, and acknowledged both symptoms and patients' feelings. Residents used explicit and implicit language to discuss diagnostic uncertainty with similar frequency. Almost half of the residents discussed the ED role as focused on emergent illness to give patients context for their uncertain diagnoses. However, 28% of residents in this study did not discuss diagnostic uncertainty in any form. All residents provided reassurance.Conclusion: Residents use a range of approaches to discuss diagnostic uncertainty with patients at the time of a simulated ED discharge, with some residents omitting discussion of uncertainty entirely.Practice Implications: These findings represent the current state of communication, which needs improvement. These findings do not immediately transfer to clinical practice recommendations, but rather support a need for both further study and development of formal communication training on this topic. [ABSTRACT FROM AUTHOR]

Peer recovery support services (PRSS) for substance use disorder (SUD) are a flexible and evidence-based intervention employed across multiple settings and for a variety of populations. These services have expanded over the past two decades, but there is little research on recruitment and training of prospective peer workers – the peer to career pipeline. This study observed training outcomes for applicants to a peer worker scholarship program in Texas. A total of 448 participants provided baseline personal history information, and a subset of participants (n = 239) completed optional psychosocial surveys. Logistic regression analysis tested associations of personal history and psychosocial variables with three training stage completion outcomes: classroom training completion, placement at an internship site, and full certification. The greatest decline in advancement between stages occurred in the transition between classroom training (78.1 % of participants completed) and internship placement (43.3 % of participants completed). Participants were diverse in terms of race/ethnicity and life experiences salient to the peer worker role, but Hispanic/Latinx peer workers were under-represented. Past work with a SUD peer worker, age, and having a bachelor's degree were each positively associated with training stage completion across multiple models, while having basic technological access, being a woman, and veteran status were each positively associated with training stage completion in only one model. Years since recovery initiation date, non-monosexual orientation, White race, and quality of life were each negatively associated with training stage completion in only one model. The existing peer workforce may be a key source of recruitment for new peer workers; thus retention of existing workers is key to ensuring continued expansion of these services. Additional support may be required to recruit and retain younger peer worker trainees, men trainees, Hispanic/Latinx trainees, trainees who lack basic technological access, or trainees without bachelor's degrees. Unanswered questions about the peer workforce remain and must be addressed to ensure that an appropriately diverse workforce is recruited, that disparities in training outcomes are minimized or prevented, and that existing peer workers are well-supported. • Securing an internship is the greatest barrier in the peer to career pipeline. • Current peer workers may be an important source of training support. • Several key groups are under-recruited or may need more support during training. [ABSTRACT FROM AUTHOR]

Background: Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may provide a useful adjunct to traditional simulation skills training.Objective: To evaluate (1) use of an app for teaching communication skills about diagnostic uncertainty, (2) feedback on app use, and (3) the association between use and skill mastery.Patient Involvement: The app under study is designed to improve doctor-patient communication.Methods: The study was a planned sub-analysis of a randomized controlled waitlist trial with emergency medicine resident physicians randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty. The curriculum included a web-based interactive module and the app. Metrics describing participants' use of the app, feedback on use, and association of use and achieving mastery in communicating diagnostic uncertainty are reported. Differences between groups utilizing the app were analyzed using Chi-squared test; logistic regression assessed the association between app use and achieving mastery of the communication skill.Results: Among 109 participants completing the trial, only 34 (31.2%) used the app. Most participants engaged with the app on one occasion for a median of 50 min (IQR 31, 87). Senior residents were more likely to use the app than junior residents (41.3% vs 23.8%, p=0.05). Overall reviews were positive; 76% reported the app helped them learn. There was no significant association between app use and achieving mastery of the communication skill in the trial [OR 2.1, 95% CI (0.91-4.84)].Discussion: Despite positive reviews of app use, overall use was low and there was no association with achieving mastery.Practical Value: Offering an app as an auxiliary training opportunity may be beneficial to some residents, but shouldn't be planned for use as a primary didactic modality unless there is evidence for effectiveness and use is mandated.Availability Of Data and Materials: The datasets generated and/or analyzed during the current study are not publicly available since some data may be identifiable but are available from the corresponding author on reasonable request. [ABSTRACT FROM AUTHOR]

Background: Specialty training in cardiovascular diseases is consistently perceived to have adverse job conditions and interfere with family life. There is a dearth of universal workforce support for trainees who become parents during training.Objectives: This study sought to identify parental policies across cardiovascular training programs internationally.Methods: An Internet-based international survey study available from August 2020 to October 2020 was sent via social media. The survey was administered 1 time and anonymously. Participants shared experiences regarding parental benefits/policies and perception of barriers for trainees. Participants were divided into 3 groups: training program directors, trainees pregnant during cardiology fellowship, and trainees not pregnant during training.Results: A total of 417 replies were received from physicians, including 47 responses (11.3%) from training program directors, 146 responses (35%) from current or former trainees pregnant during cardiology training, and 224 responses (53.7%) from current or former trainees that were not pregnant during cardiology training. Among trainees, 280 (67.1%) were parents during training. Family benefits and policies were not uniformly available across institutions, and knowledge regarding the existence of such policies was low. Average parental leave ranged from 1 to 2 months in the United States compared with >4 months outside the United States, and in all countries, paternity leave was uncommon (only 11 participants [2.6%]). Coverage during family leave was primarily provided by peers (n = 184 [44.1%]), and 168 (91.3%) were without additional monetary or time compensation.Conclusions: This is the first international survey evaluating and comparing parental benefits and policies among cardiovascular training programs. There is great variability among institutions, highlighting disparities in real-world experiences. [ABSTRACT FROM AUTHOR]

The burden of vascular diseases and complexity of their management have been growing. Vascular medicine specialists may help to bridge gaps in care, especially as part of multidisciplinary teams. However, there is a limited number of vascular medicine specialists because of constraints in training. Despite established pathways for training in vascular medicine, there are obstacles that restrict completion of training in dedicated programs. A key factor is lack of funding as a result of inadequate recognition by key national accrediting and credentialing organizations. A concerted effort is required to overcome the obstacles to expand vascular medicine training programs and ultimately the pool of vascular medicine specialists. Well-trained vascular medicine specialists will be well positioned to ease the burden of vascular disease and optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Radiation oncologists need to have more than sound clinical and technical competencies. To optimize care for patients and advance all aspects of radiation oncology (RO), radiation oncologists must also be effective leaders. Embedding systematic leadership education into RO training programs is challenging. This study examined RO residents' perspectives and preferences relating to leadership education. Such data inform the integration of universal leadership learning into RO training in Australia and New Zealand and identify priority areas to facilitate successful leadership development initiatives in RO training programs worldwide.Methods and Materials: Semistructured telephone interviews were conducted with 13 RO residents across 8 Australian training departments and all stages of training. Data from transcriptions of taped interviews were coded by at least 2 researchers and collected to saturation. Qualitative thematic analysis was conducted using an iterative inductive process to develop codes into themes and subthemes. Representative quotes were collated to illustrate subthemes.Results: Four key themes related to leadership education were identified and labeled as follows: (1) recognition, credibility, and value of education; (2) logistics of formal learning; (3) real-world opportunities ("seeing and doing"); and (4) one size does not fit all. Residents unanimously reported that formal leadership education was important and that aspects of becoming a good leader could be learned. Organizational and cultural factors emerged as either barriers or facilitators to learning. There was strong support for interactive methods of learning, and role-modeling by senior colleagues was identified as having a major effect on junior learners.Conclusions: This study offers insight into RO residents' perspectives of and preferences for their own leadership development. The findings have practical implications for the design of effective RO leadership programs and bring the RO field one step closer to the ultimate goal of enhancing leadership capability for all RO professionals. [ABSTRACT FROM AUTHOR]

This article describes a survey-based study of graduate medical residents and fellows in an integrated health system. The study explores pain curricula, learner perspectives about pain education, and learner knowledge, attitudes, and confidence. Results indicate that pain education in the graduate medical setting is inadequate to meet learner needs. [ABSTRACT FROM AUTHOR]

Background: Workplace-based assessment (WBA) is key to a competency-based assessment strategy. Concomitantly with our programme's launch of competency-based medical education, we developed an entrustment-based WBA, the Anesthesia Clinical Encounter Assessment (ACEA), to assess readiness for independent practice of competencies essential to perioperative patient care. This study aimed to examine validity evidence of the ACEA during postgraduate anaesthesiology training.Methods: The ACEA comprises an eight-item global rating scale (GRS), an overall independence rating, an eight-item checklist, and case details. ACEA data were extracted for University of Toronto anaesthesia residents from July 2017 to January 2020 from the programme's online assessment portal. Validity evidence was generated following Messick's validity framework, including response process, internal structure, relations with other variables, and consequences.Results: We analysed 8664 assessments for 137 residents completed by 342 assessors. From generalisability analysis, 10 independent observations (two assessments each from five assessors) were sufficient to achieve a reliability threshold of ≥0.70 for in-training assessments. A composite GRS score of 3.65/5 provided optimal sensitivity (93.6%) and specificity (90.8%) for determining entrustment on receiver operator characteristic curve analysis. Test-retest reliability was high (intraclass correlation coefficient [ICC2,1]=0.81) for matched assessments within 14 days of each other. Composite GRS scores differed significantly between residents based on their training level (P<0.0001) and correlated highly with overall independence (0.91, P<0.001). The internal consistency of the GRS (α=0.96) was excellent.Conclusions: This study supports the validity of the ACEA for assessing the competence of residents performing perioperative care and supports its use in competency-based anaesthesiology training. [ABSTRACT FROM AUTHOR]

During Spring 2021, eight students at the University of the Pacific participated in an internship where they performed a DEI audit of the library's book and music score collection. An internship is one documented type of High-Impact Practices and research studies show that High-Impact Practices lead to higher retention and graduation rates. Deep learning occurred as student interns participated in developing the methodology, evaluating book and music score collections, reading assigned articles pertaining to DEI in librarianship and publishing, and providing recommendations on closing identified collection gaps. To evaluate their learning, the interns were asked to complete three surveys at the beginning, middle, and end of the project. These surveys were evaluated by a mixed methods research approach to incorporate qualitative and quantitative data in assessing the student interns' understanding of library collections, the publishing industry, and academic DEI issues. This study contributes to the literature on High-Impact Practices in academic libraries by describing a unique and valuable way to involve students in diversifying the library collection. [ABSTRACT FROM AUTHOR]

Background: Completing an emergency medicine (EM) away rotation is integral to matching successfully into an EM residency program. The demand for EM away rotations (ARs) drives students to submit numerous applications without evidence-based recommendations to guide stakeholders on the approach or number to submit.Objectives: We conducted a survey study of EM-bound fourth-year medical students to gain insight into their AR application experiences, outcomes, and perceptions.Methods: We distributed a 40-item questionnaire to EM applicants in Fall 2018 via e-mail through the Clerkship Directors in Emergency Medicine, Council of Residency Directors in EM, and Emergency Medicine Residents' Association listservs. Responses were evaluated using quantitative and qualitative analysis. Primary outcomes were the number of AR applications submitted and AR offers received by students. Secondary outcomes were students' self-assessment of their competitiveness, differences in AR application numbers by degree type, sources of student advising, and student perceptions of the AR application process.Results: There were 253 respondents, consisting of 192 allopathic (MD) and 61 osteopathic (DO) medical students, who met the inclusion criteria, representing about 10% of the applicant pool. On average, students submitted 13.97 applications (95% confidence interval [CI] 11.59-16.35), received 3.25 offers (95% CI 3.01-3.49), and accepted 2.22 offers (95% CI 2.08-2.36). DO candidates submitted twice as many applications as MD candidates while experiencing a similar rate of offers received. Peer influence (n = 154, 61%), peer online advising networks (n = 83, 33%), and self-assessment (n = 114, 45%) were the most often reported causes of increased applications; cost (n = 104, 41%) and geographic limitations (n = 114, 45%) were the most often reported causes of decreased applications. Open-response analysis revealed frustration with lack of standardization (n = 44, 29.5%), insufficient transparency on available positions (n = 37, 24.8%), limited communication (n = 30, 20.1%), and cost (n = 12, 8.1%).Conclusions: This study showed that, as a whole, students received one away rotation offer for every four to five applications submitted. It clarified factors contributing to increased EM away rotation application submissions and associated stressors inherent in the application experience. Our findings offer insights to inform advising recommendations. They also suggest that stakeholders consider standardizing the process and improve communication over spot availability and application status. [ABSTRACT FROM AUTHOR]

Clinical informatics is a young, diverse and rapidly growing field. We asked eight clinical informaticians from a variety of oncology specialties, training pathways and careers for personal narratives to illustrate the wide spectrum of clinical informatics careers. Primary clinical specialties included radiation oncology, medical/haematology oncology and palliative care. Training pathways included fellowship, non-fellowship formal training and informal training. Careers included clinical care, research, operations and industry. We summarised common themes and advice for trainees. We hope to raise awareness of clinical informatics among trainees and oncologists to reveal new career opportunities and to avoid inadvertently taking clinical informatics and informaticians for granted. [ABSTRACT FROM AUTHOR]

The article discusses professional support for junior doctors for managing trainee doctors; and mentions attitudes and barriers to physicians receiving assistance for personal and professional struggles.

Objective: The number of cesarean deliveries on maternal request (CDMR) is unknown in France. We aimed to evaluate the rate of obstetricians willing to perform a CDMR in 2020 in Paris and to compare OB/GYN seniors' and residents' points of view about CDMR using six hypothetical clinical scenarios.Study Design: A survey was conducted between January to March 2020 with an anonymous self-administrated questionnaire sent by email to OB/GYN seniors working in 16 public and private maternity units and residents of Paris. Questionnaire was based on previous peer-reviewed literature. Socio professional characteristics were collected. OB/GYN seniors were asked if they agree to perform a CDMR and have already done one. OB/GYN seniors' and residents' points of view on six hypothetical clinical scenarios (CDMR, scarred uterus, breech presentation, multiple pregnancy, history of perineal tears or stillbirth) were compared.Results: Eighty-three OB/GYN seniors and one hundred and fifteen residents answered to our questionnaire. Twenty-three (27,7%) OB/GYN seniors were ready to perform a CDMR, mostly because they think that mode of delivery is a woman's choice. Physicians working in a private maternity unit or having an exclusive private practice were significantly more willing to perform a cesarean delivery on maternal request. No differences were found between the OB/GYN seniors' and residents' point of view on the six hypothetical clinical scenarios. A third of OB/GYN seniors and residents reported having done at least one CDMR during their career or during their residency.Conclusion: One out of four OB/GYN senior interviewed is ready to perform a CDMR in Paris in 2020. OB/GYN seniors and residents share the same point of view concerning CDMR. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether there is a correlation between the proportion of female faculty and residents at urology residency programs and the proportion of females matched to those programs.Materials and Methods: We utilized official results from 3 consecutive AUA match cycles from 2018 - 2020 to obtain the number of females matched to each program. The number of female residents and faculty members in each program was acquired through querying program websites and contact with residency program coordinators. The correlation between the proportion of females in the newly matched class of residents and the proportion of current female faculty members and residents in that program was calculated for each match cycle.Results: There was a positive correlation between the proportion of matched female applicants and the proportion of female residents in each program for the 2018, 2019, and 2020 match cycles (R = 0.23, P = .01; R = 0.21, P = .02, R = 0.11, p <.001, respectively). There was a positive correlation between the proportion of matched female applicants and the proportion of female faculty at their matched program in the 2018 and 2020 match cycles (R = 0.22, P = .02; R = 0.06, P < .01, respectively). There was no significant predilection of females matching to programs with a female program director or chairperson, and geographic location of program (based on AUA section) did not appear to influence female applicant match rates.Conclusion: There has been a consistent trend in the proportion of matched female applicants to urology programs correlating positively with the proportion of female residents at those programs over the past three years. This is indicative of the increased potential for female mentorship and leadership opportunities. Further research is needed to investigate the factors that draw female applicants to urology programs with increased female representation. [ABSTRACT FROM AUTHOR]

Context: Seriously ill Black patients receive lower quality palliative care than White patients. Equitable access requires palliative care skills training for all physicians. Historically Black Colleges and Universities (HBCUs) play a key role in educating Black physicians and have less access to palliative care resources.Objective: To investigate palliative care attitudes and experiences among primary care residents at HBCUs.Methods: Internal Medicine and Family Medicine residents at two HBCUs completed an online survey assessing attitudes towards palliative care and teaching and clinical experiences in palliative care. We performed a descriptive analysis of survey items.Results: Among 91 residents who completed the survey (response rate 48%), 65% were women and 68% Black. Most (96%) said that learning about palliative care was moderately/very important to their career; however, two-thirds of respondents considered care for dying patients to be depressing and half reported receiving negative messages about palliative care from other physicians. Residents reported receiving less teaching about providing palliative care (5.4 ± 2.3 on 10-point scale) than about managing sepsis (8.3 ± 1.8; P < 0.05). Fewer residents rated their palliative care education as "Excellent" or "Very Good" compared to their overall education (13% vs 70%; P < 0.05).Conclusion: In the first survey exploring palliative care education at HBCUs, residents viewed palliative care as important but described the quality of their palliative care education as poor. This study highlights opportunities for improving palliative care education at HBCUs as a step toward addressing disparities in serious illness care. [ABSTRACT FROM AUTHOR]

Objective: To explore work-arounds at faith-based obstetrics and gynecology residency programs to accomplish family planning training.Study Design: We invited educational stakeholders to participate in telephone interviews that elicited strategies for overcoming barriers to family planning training in religious settings.Results: Eighteen out of 30 invited programs leaders participated. Work-arounds included reliance on non-contraceptive indications for contraception and permanent contraception provision, obtaining ethics committee approvals for service provision, and developing partnerships with offsite centers for training.Conclusion: Ob-gyn residency programs affiliated with religious hospitals utilize various work-arounds for family planning training and patient care. These findings may inform other programs that face similar barriers, secondary to institutional or governmental restrictions. [ABSTRACT FROM AUTHOR]

This research explored the ways in which current liaison librarians feel their LIS programs prepared them for their role, focusing on two research questions: To what extent do librarians working as liaisons in academic institutions in the US and Canada feel their LIS programs prepared them for their liaison role? How much of the preparation of librarians to be liaisons can be attributed to their programs' curriculum, especially in terms of where in the curriculum the liaison role is addressed? Results of a survey of 366 liaisons demonstrate that across a variety of contexts, most respondents feel their programs prepared them to be liaisons, but those who completed the academic library track more often than expected indicated feeling prepared. A majority of participants indicated non-curriculum experiences, such as assistantships, paid employment, and internships in academic libraries, as useful in their preparation, with one exception: those who completed online programs less often than expected indicated non-curricular experiences as useful in preparation for their current liaison role. Overall, the most useful courses cited included specialized courses, reference, instruction, and collection management, suggesting some preparation from core courses, but additional preparation coming from elective courses not always taken by or available to everyone. [ABSTRACT FROM AUTHOR]

There is a lack of information about what Master of Library Science students are looking for in graduate employment positions in a library. Little is known about how students select graduate employment positions to apply for and what they understand about the tasks in position descriptions. This study sought to answer the questions: what factors are important for students in deciding about graduate employment in a library, and what do graduate students understand about graduate employment jobs in health sciences libraries? A think-aloud protocol was used. Participants read four graduate employment position descriptions and answered semi-structured interview questions about desire to apply for the positions and interest in health sciences librarianship. Eighteen participants completed interviews. Interviews were coded anonymously and independently by the authors using grounded theory. Results report on responses to position characteristics; interest in job projects; decision to apply; and interest in health sciences. Graduate employment position descriptions can be improved to be more attractive to students by providing flexible work arrangements and allowing students to select projects that align with career aspirations. Many students are not exposed to health sciences librarianship during their program, once exposed, interest levels increased. • Background information is limited about how Master of Library Science (MLS) students choose graduate employment. • Job descriptions for academic health sciences positions are jargon heavy. • MLS graduate students are seeking flexible opportunities that can accommodate life responsibilities. • MLS students seek positions that allow for professional growth and hands on experience while in a graduate program. [ABSTRACT FROM AUTHOR]

Rural nursing education stands as a way to contribute to a sustainable nurse workforce in rural areas. Different approaches to organizing rural nursing education are described in the existing literature. To explore scientific reviews about rural nursing education and synthesize current knowledge as "best practice" recommendations for rural nursing education regarding the required organization of rural nursing education programs, what are the competencies required to function as a nurse in rural health-care settings, and the key environmental features for learning in rural nursing education programs. An umbrella review. Nursing students, newly graduated nurses, and clinical supervisors involved in nursing education in rural areas. A systematic literature search was conducted. Of the 276 review articles found, 93 were screened by title and abstract and 27 were screened in full text. The period searched was 2000–2022, and the literature search was peer-reviewed and published. The Joanna Briggs Institute (JBI) methodology for umbrella reviews guided the design, search, and the reporting of the findings of the included reviews. Four reviewers screened for inclusion and exclusion using Covidence in a double blinded process. The analysis was guided by the JBI guidelines for umbrella review syntheses. Two reviewers conducted the analysis. Sixteen reviews were included; eight scoping reviews, six integrative reviews, one narrative review, and one rapid review. The synthesis of current evidence provides the following "best practice" suggestions: (a) fostering context-sensitive and collaboratively designed education environments is recommended; (b) integrating curricula tailored for the nursing role and rural practice is recommended (c) establishing a supportive learning environment that encourages students' motivation and academic success; and (d) clinical placements in locally developed learning settings address the educational needs required for practice in the rural workforce. Rural nursing education needs to be properly aligned with the context and health-care development, to educate nurses who can meet the community's needs today and in the future. A well-functioning collaboration between university faculty and local community stakeholders in a co-creation process stands out as vital to build a sustainable, flexible, rural nursing education program. Umbrella review: Flexible, co-created education might be "best practice" in rural undergraduate nursing programs. [ABSTRACT FROM AUTHOR]

Few studies have addressed how well prepared interns feel to manage older persons, and what aspects of their learning and teaching have facilitated this. We explored medical interns' self-assessed preparedness for dealing with older hospital in-patients, using an online survey. Response rate was 36.8% (21/57), with graduates from 7 universities and 11/21 female. Asked 'How prepared have you felt for managing older patients in hospital?', median Likert score (1–5) was 3. However, 19/21 felt able to manage the last older patient seen. Self-assessed preparedness to manage different aspects of aged care varied. 'Real-life experience on the wards' (19/21) was the favored teaching tool. Identification of such self-assessed gaps will better inform teaching of aged care to medical students and junior doctors. [ABSTRACT FROM AUTHOR]

The literature on professional socialization focuses on how students adopt and internalize professional identities and values, and assumes that boundary work is essential to learning how best to practice their profession. However, a focus on boundary work in the context of midwifery training - which is embedded in the gendered and hierarchical landscape of maternity care - is lacking. Thus, this article examines how Canadian student-midwives learn to navigate and negotiate interprofessional boundaries. Grounded in a symbolic interactionist approach, it draws on 31 semi-structured qualitative interviews from a mixed-methods national study on midwifery retention, explores how midwifery students make sense of the tensions among midwives, physicians, and nurses, and describes what strategies they utilize when navigating boundaries. Our analysis, based in constructivist grounded theory, revealed that participants learned about interprofessional tensions in clinical placement encounters via direct or indirect interactions with other healthcare professionals, and that strategies to navigate these tensions included educating others about midwifery training and adopting a learner identity. This article proposes that the process of professional socialization enables to reshape professional boundaries and that students are not only learners but also agents of change. These findings may yield practical applications in health education by highlighting opportunities for improving interprofessional collaborations. • Boundary work is part of professional socialization process. • Professional boundaries are ambiguous in midwifery but they are understudied. • This paper examines boundary work among 31 Canadian midwifery students. • The boundaries were clear with physicians but blurred in communication with nurses. • Learning about boundaries, students recreated them but also became agents of change. [ABSTRACT FROM AUTHOR]