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A detailed, unbiased perspective of the inter-relations among medical fields could help students make informed decisions on their future career plans. Using a data-driven approach, the inter-relations among different medical fields were decomposed and clustered based on the similarity of their working environments.Publicly available, aggregate databases were merged into a single rich dataset containing demographic, working environment and remuneration information for physicians across Canada. These data were collected from the Canadian Institute for Health Information, the Canadian Medical Association, and the Institute for Clinical Evaluative Sciences, primarily from 2018 to 2019. The merged dataset includes 25 unique medical specialties, each with 36 indicator variables. Latent Profile Analysis (LPA) was used to group specialties into distinct clusters based on relatedness.The 25 medical specialties were decomposed into seven clusters (latent variables) that were chosen based on the Bayesian Information Criterion. The Kruskal-Wallis test identified eight indicator variables that significantly differed between the seven profiles. These variables included income, work settings and payment styles. Variables that did not significantly vary between profiles included demographics, professional satisfaction, and work-life balance satisfaction.The 25 analyzed medical specialties were grouped in an unsupervised manner into seven profiles via LPA. These profiles correspond to expected and meaningful groups of specialties that share a common theme and set of indicator variables (e.g. procedurally-focused, clinic-based practice). These profiles can help aspiring physicians narrow down and guide specialty choice., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

For diversity to exist in the medical graduate workforce, students from all backgrounds should have equitable opportunities of employment. Specialties have utilized a minimal threshold for USMLE Step 1 score when screening applicants for residency interviews. The OHSU SOM class of 2021 completed a 14-question voluntary survey on their Step 1 score and the following non-modifiable risk factors: Adverse Childhood Experience score (ACEs), sex, gender, Underrepresented in Medicine status (URiM), family income during adolescence, highest degree held by a guardian, discrimination experience during medical school, federal/state assistance use, and rural versus urban primary home. Descriptive statistics and unadjusted risk ratios were applied to study the relation between Step 1 score and non-modifiable risk factors as well as certain non-modifiable risk factors and ACEs ≥ 3. The mean Step 1 score was 230 (213, 247). Of the students, 28.2% identified ACEs ≥ 3, 13.6% were considered URiM, and 65.4% were female. URiM were 2.34 (1.30, 4.23),females were 2.77 (1.06-7.29), and those who experienced discrimination in medical school were 4.25 (1.85, 9.77) times more likely to have ACEs ≥ 3. Students who had ACEs ≥ 3 were 3.58 (1.75, 7.29) times less likely to meet a minimal threshold for residency interviews of 220. These are the first results to demonstrate a relationship between Step 1 score and ACEs. Those who identified as URiM, females, and those who experienced discrimination in medical school were at a higher risk of ACEs of ≥ 3. Step 1 transitioned to pass/fail in January 2022. However, the first application cycle that residencies will see pass/fail scoring is 2023-2024, and fellowships will continue to see scored Step 1 until, at the earliest, the 2026-2027 application cycle. These data contribute to a foundation of research that could apply to Step 2CK testing scores, and help to inform decisions about the diversity and equity of the residency interview process.

In France, both students from medicine and pharmacy background can have access to the residency in laboratory medicine (LM). The current curriculum of LM residency includes an early choice of option after the first two years of residency, which subsequently guides the rest of the training. This study aimed to analyze these choice and motivational factors, since its implementation in 2017. A national survey was conducted among LM residents and former residents who underwent the early option choice process. A questionnaire was developed and sent to residents via Google Forms. Several groups of items corresponding to potential motivational factors were included and rated on a 5-point Likert scale. A psychometric analysis allowed to identify the main motivational factors. A total of 178 responses from 24 residency regions were recorded. The median age was 28 years, with a slight female predominance (52%), and three-quarters of the participants had a pharmacy training background. The "hematology and immunology" option was the most chosen (35%). The psychometric analysis enabled to identify 7 motivational factors, and the most important is the training during the residency, which weights approximately 21 % in the choice. Several associations have been observed between the motivational factors and the background training, origin, the chosen option and the planned career. Several factors influence the choice of early option among LM residents, and some of these factors are associated with the background training, origin, chosen option and planned career.

Rationale: Transverse spinal cord infarction (SCI) is rare but highly disabling. Aortic thrombosis was described as one of the most common etiologies. Thromboembolic complications associated with intravenous immunoglobulin (IVIG) have been reported., Patient Concerns: A previously well, 64-year-old man who was given the treatment of IVIG (0.4 g/kg/d for 5 days) for exfoliative dermatitis 2 weeks before, progressively developed flaccid paraplegia of lower extremities, loss of all sensations below T3 level and urinary incontinence within 50 minutes., Diagnoses: A diagnosis of SCI and pulmonary embolism was made. IVIG was considered the possible cause., Interventions: Anticoagulation treatment and continuous rehabilitation were administered., Outcomes: The neurologic deficiency of the patient was partially improved at the 3-year follow-up., Lessons: The rapid development of severe deficits within 4 hours mostly contributes to the diagnosis of SCI. Heightened awareness of possible thrombotic events is encouraged for a month-long period following IVIG therapy., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Medical history contributes approximately 80% to a diagnosis, although physical examinations and laboratory investigations increase a physician's confidence in the medical diagnosis. The concept of artificial intelligence (AI) was first proposed more than 70 years ago. Recently, its role in various fields of medicine has grown remarkably. However, no studies have evaluated the importance of patient history in AI-assisted medical diagnosis., Objective: This study explored the contribution of patient history to AI-assisted medical diagnoses and assessed the accuracy of ChatGPT in reaching a clinical diagnosis based on the medical history provided., Methods: Using clinical vignettes of 30 cases identified in The BMJ, we evaluated the accuracy of diagnoses generated by ChatGPT. We compared the diagnoses made by ChatGPT based solely on medical history with the correct diagnoses. We also compared the diagnoses made by ChatGPT after incorporating additional physical examination findings and laboratory data alongside history with the correct diagnoses., Results: ChatGPT accurately diagnosed 76.6% (23/30) of the cases with only the medical history, consistent with previous research targeting physicians. We also found that this rate was 93.3% (28/30) when additional information was included., Conclusions: Although adding additional information improves diagnostic accuracy, patient history remains a significant factor in AI-assisted medical diagnosis. Thus, when using AI in medical diagnosis, it is crucial to include pertinent and correct patient histories for an accurate diagnosis. Our findings emphasize the continued significance of patient history in clinical diagnoses in this age and highlight the need for its integration into AI-assisted medical diagnosis systems., (© Fumitoshi Fukuzawa, Yasutaka Yanagita, Daiki Yokokawa, Shun Uchida, Shiho Yamashita, Yu Li, Kiyoshi Shikino, Tomoko Tsukamoto, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka. Originally published in JMIR Medical Education (https://mededu.jmir.org).)

Background: Modern healthcare systems require the right mix of medical specialties for effective provision of high-quality services. Despite increased availability of general physicians and specialists, Türkiye lags behind high-income countries in terms of availability of specialists. The purpose of the study is to identify several specific factors that affect the choice of medical specialization., Methods: All 350 medical school graduates in a specialty examination preparation bootcamp were requested to participate in the survey and 333 completed the self-administered questionnaire. The survey asked questions about factors affecting choice of medical specialty by medical graduates., Results: The empirical results indicate that surgical specialties, compared to other broad medical specializations, are selected because of its higher income-earning potential and social prestige. The likelihood of selecting surgical specialties is negatively affected by rigorousness of the training program, high work-load, risk of malpractice lawsuits and risk of workplace violence. Male participants were 2.8 times more likely to select surgery specialty compared to basic medical science. Basic medical science areas were selected at a higher rate by female graduates and graduates with high level of academic performance in medical schools., Conclusions: It is critically important to improve trust and inter-personal communications between the patients and physicians in all specialties to lower the likelihood of malpractice lawsuits and workplace violence. Policy-makers may adopt policies to affect income earning potential and social prestige of targeted specializations to improve their supply., (© 2024. The Author(s).)

Objectives: Despite progress toward equal representation by sex in medical practice, women remain underrepresented in many specialties. This study sought to examine the current state of gender equality among recently graduated doctors in multiple specialties., Methods: Deidentified demographics, standardized examination scores, and Match results were gathered for 829 graduates. Participants were selected from an allopathic medical school between 2016 and 2020. Nineteen students (2.29%) were excluded from the study. Descriptive statistics were calculated, and χ 2 tests for independence were used to compare proportions between reported sex and specialty and program Match results. One-way analysis of variance was then performed to test for differences in US Medical Licensing Examination Step 1 and Step 2 scores between sexes. P < 0.05 was considered statistically significant., Results: Of the 829 individuals studied, 44.6% were women. A significantly smaller proportion of women matched into the most competitive specialties, despite no significant difference in US Medical Licensing Examination Step 1 scores between sexes. Furthermore, there was an overall significant trend of women matching into more competitive programs for any given specialty., Conclusions: In this study, we found that men matched into more highly competitive specialties, whereas women matched into more competitive residency program locations. Further research is needed to determine why women matched into specific specialties at lower rates than their male peers and seek to understand how sex affects the narrative of specialty choice.

Background: Long years of school/training have shown to be associated with infertility and pregnancy complications. Rates of infertility and pregnancy complications were compared among women in demanding professional careers to better understand career differences impacting family planning., Methods: Inclusion criteria : English-speaking, childbearing professional women in surgery, medicine, law, and engineering. Exclusion criteria: men and women not in professional careers mentioned and non-childbearing women. Male-dominated fields identified to select non-medical female professionals. Top medical, law, and engineering schools' female faculty were surveyed from October 2022 to December 2022. Descriptive analysis and chi-squared tests were performed., Results: 2302 surveys were distributed and 268 responses were obtained (11.6%): 121 non-surgeon physicians, 120 lawyers/other doctorate degree holders, and 27 other/unknown. Data analysis included prior study's surgeon data. The median age (IQR = 25%, 75%) of the surgeons was 40y (36,45), non-surgeon physicians 43y (37,50), and law/other doctorates 38y (35,46). Delayed childbearing was observed in 65.0% surgeons, 66.1% non-surgeon physicians, and 57.5% law/other doctorates ( P < .001). Pregnancy loss <10wks was observed in 35.3% surgeons, 33.9% non-surgeon physicians, and 30.8% law/other doctorates ( P < .001). Infertility testing was performed in 43.0% non-surgeon physicians and 34.2% law/other doctorates ( P < .001). Assisted reproductive technology was utilized by 24.9% surgeons, 43.0% non-surgeon physicians, and 21.7% law/other doctorates ( P < .001)., Discussion: Surgeons/physicians suffer more childbearing complications than other professional women., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The significance of thought differences has always held importance in medicine, but it could be considered as increasingly acknowledged and valued to a greater extent in recent times as more emphasis is placed on diversity, equity, and inclusion. These unique perspectives have been examined according to race, gender, and ethnicity, but there is limited published data examining the prevalence of leadership roles within surgical departments in terms of training background. Our main objective is to identify trends in surgical leaders' education, and emphasize training diversity in surgical leadership., Design: A descriptive study of the training background of all surgical academic leaders., Setting: This internet search was performed at a tertiary care, academic medical center., Participants: Academic chairpersons, division directors, and program directors., Results: 124 programs had pertinent information available. There was a mean of 7.6 leaders per institute examined: total 939 positions (119 chairs, 704 division directors, 116 program directors). 90/119 (76%) of the Chairs led at institutions outside of the places they completed their training. 4/119 (3%) did all their training at the same institution they chaired. 25/119 (21%) completed at least some but not all their training there, and later rose to the role of Chair. Among division directors, 217/704 (31%) did some training at that institution, and program directors were significantly more likely to have completed some training at their current institute (53/116, 46%; p = 0.001). There were no statistically significant differences when examined geographically. Women made up 18% of the leaders and were significantly more likely to lead as program director rather than a chair or division director (p < 0.001)., Conclusion: A majority of surgery chairs hold positions at institutions where they did not complete their medical training. This suggests that outside perspective could be a contributing factor when searching for this position., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Traumatic spinal injury is leading cause of mortality and morbidity among the people of productive age group. This study aim to find the cause of spinal injury, site ,and mode of injury, treatment option given so that a preventive measures and create awareness among people of this region., Methods: This is a prospective observation study done in Karnali Academy of Health Sciences from December 2021 to January 2023. Performa was filled to collect data. Data were entered in excel sheet and transported to SPSS 16.0 and statistical analysis was done ., Results: Out of 117 patients male population had higher incidence of spinal trauma (69.2%) with average age 43.9 years . Fall injury was the commonest mode of injury. 65.8% had injury at the thoracolumbar junction followed by lumbar, thoracic and cervical respectively. Cervical injury patients had higher incidence of neurological deficit. The average duration of trauma to hospital presentation was 10.9±11.2 hours. 19.7 % were operated and 6.8 % of patients were referred to other center., Conclusions: Fall injury being the commonest mode of injury in this art of world, prevention and awareness should be raised about the spinal trauma and its consequences. Adequate equipment with health facilities to the distant hospital may reduce the referral rate and duration of presentation to the hospital which ultimately prevent the further damage to the cord.

Background: Somatisation is a highly prevalent psychiatric syndrome in both women and men, in which psychological distress is manifested in physical symptoms without a medical explanation. Many patients with somatisation disorder are high healthcare utilisers, particularly at emergency departments. Unnecessary investigations and diagnostic operations occur frequently, which cause both patient suffering and a significant burden on the healthcare system. Emergency department physicians' awareness of somatisation and its manifestations has not previously been studied. This study aimed to investigate awareness about somatisation disorder among physicians working at emergency departments in western Sweden, and to explore differences between gender, specialty, and work experience., Methods: A web-based, cross-sectional survey consisting of six dichotomous questions about somatisation disorder was conducted, in December 2021 - January 2022, among licensed physicians of various specialties working at emergency departments in western Sweden. Descriptive analyses and comparative analyses were performed to investigate differences between gender, type of specialty, and years of practice. Data were analysed using chi 2 tests and Fisher's exact test., Results: Of the 526 eligible physicians who received the survey, 241 responded; response rate 45.8%. The majority of the respondents (56.4%) were women, and most (35.3%) were specialised in obstetrics/gynaecology. Average years of work experience was 11.1 (SD 8.7) years. Although 71% of respondents were aware of the diagnosis, only 7% knew the diagnostic criteria and only 6% had ever diagnosed a patient with somatisation disorder. Female physicians were more aware of underlying factors than their male colleagues (55.7% vs. 38.2%; p = .010). Type of specialty or years of practice did not affect awareness., Conclusions: Awareness of somatisation disorder is low among physicians working at emergency departments in western Sweden. The findings suggest a need to increase awareness and knowledge and provide training in diagnosing the condition, to ensure correct decisions and optimal patient management. Clinical guidelines need to be developed to support diagnosis, investigation, and treatment, in Sweden as well as internationally., (© 2024. The Author(s).)

Objective: To determine the characteristics of medical practitioners designated 'top doctor' or 'Top Doc' in the UK press., Design: Observational study of news stories related to the term top doctor (or Top Doc) with analysis using data from publicly available databases., Setting: News reports in the UK press accessed via a database from national newspapers from 1 January 2019 to 31 December 2019, prior to the COVID-19 pandemic. Stories relating to disciplinary/criminal matters were analysed separately., Main Outcome Measures: Results were cross-referenced with the General Medical Council register of medical practitioners for gender, year of qualification, whether on the general practitioner (GP) or the specialist register, and if on the specialist register, which specialty., Results: There was a gender divide, with 80% of so-called top doctors being male. National top doctors had been qualified for a median time of 31 years. Top doctors are widely spread among specialties; 21% of top doctors were on the GP register. Officers of the British Medical Association and the various Royal Colleges are also well represented. 'Top doctors' facing disciplinary proceedings are more overwhelmingly male, working in hospital specialties and less obviously eminent in their field., Conclusion: There is no clear definition of a 'top doctor', nor are there objective leadership criteria for journalists to use when applying this label. Establishing a definition of 'top doctor', for instance, via the UK Faculty for Medical Leadership and Management, which offers postnominals and accreditation for high-achieving medical professionals, may reduce subjectivity., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Physician marriage is a valuable indicator of how vocational factors (e.g. work hours, stressors) impact satisfaction in relationships and physician wellness overall. Previous studies suggest that gender and specialty influence marriage satisfaction for physicians, though these often come from limited, local, cohorts. A cross-sectional survey was designed and distributed to publicly available email addresses representing academic and private practice physician organizations across the United States, receiving 321 responses (253 complete). Responses included data on demographics, medical specialty, age at marriage, stage of training at marriage, number of children, and factors leading to marital satisfaction/distress. A multivariable ordinal logistic regression was conducted to find associations between survey variables and marriage satisfaction. Survey results indicated that 86.5% of physicians have been married (average age at first marriage was 27.8 years old), and the rate of first marriages ending is at least 14.7%. Men had significantly more children than women. Physicians married at least once averaged 1.98 children. "Other" specialty physicians had significantly more children on average than psychiatrists. Marrying before medical school predicted practicing in private practice settings. Job stress, work hours, children, and sex were most frequently sources of marital distress, while strong communication, finances, and children were most frequently sources of marital stability. Sex differences were also found in distressing and stabilizing marital factors: Female physicians were more likely to cite their spouse's work hours and job stress as sources of marital distress. Finally, surgery specialty and Judaism were associated with higher marriage satisfaction, whereas possession of an M.D. degree was associated with lower marriage satisfaction. This study elucidated new perspectives on physician marriage and families based on specialty, practice setting, and stage of training at marriage. Future studies may focus on factors mediating specialty and sex's impact on having children and marriage satisfaction. To our knowledge, this study is the first physician marriage survey which integrates multiple factors in the analysis of physician marriages., (© 2024. The Author(s).)

Despite growing visibility of the trans population in Israel, there has been limited research on trans healthcare in a local context, particularly in the field of primary care medicine. Primary care encompasses services provided in locally distributed clinics and has a crucial role in providing both preventive and specialized healthcare. The aim of this study is to outline barriers to trans-inclusive primary care and measures employed by the trans community to overcome them. Biopower and counter-conduct are used as analytical frameworks to examine the trans-exclusionary features of the Israeli healthcare system and steps taken to resist it. To examine these issues, 19 medical care professionals and 20 trans people and activists were interviewed, and a variety of relevant texts were analyzed. Our results indicate trans-exclusionary features in primary healthcare, such as ambiguity regarding trans-inclusive services offered, sex-specific treatments, and lack of medical training programs dedicated to the trans population. To overcome these difficulties, the Israeli trans community has accumulated communal experiential knowledge and transferred it to physicians and policymakers in a localized and informal manner. We argue that by using informal practices, the trans community can provide support and information to its own members as well as operate alongside power systems, albeit in a slow and lengthy manner. More generally, the findings of this study highlight howf patient activism is employed by marginalized populations, who face not only health disparities, but institutional discrimination as well., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To investigate whether the process of conferring academic rank or components of the promotion packet contribute to the lack of parity in academic advancement for women and individuals underrepresented in medicine (URMs)., Patients and Methods: We retrospectively reviewed prospective promotion applications to the position of associate professor or professor at Mayo Clinic from January 2, 2015, through July 1, 2019. Individuals with doctorate degrees who applied for either rank were included in the study. Data collected included demographic characteristics, curriculum vitae at time of application, committee score sheets, and deferral and approval decisions. Deferral rates for women compared with men and for URMs compared with non-URMs was the primary outcome., Results: Of 462 people who applied for associate professor, 10% (n=46) were deferred. Those promoted had worked longer at Mayo Clinic (median, 6 years vs 2 years; P=.01), had more mentees (median, 6 vs 4; P=.02), authored more publications (median [interquartile range (IQR)], 39 [32-52] vs 30 [24-35]; P<.001), and were more likely to be on a National Institutes of Health or institutional grant (P<.05). Of the 320 people who applied for professor, 8.8% (n=28) were deferred. Those promoted had authored more publications (median [IQR], 77 [60-99] vs 56 [44-66]; P<.001) and were less likely to hold an elected office to a professional society (22.6% vs 39.3%; P=.05). There was no significant association between deferral status and sex (P>.4) or race/ethnicity (P>.9) for either rank., Conclusion: The process for academic advancement for professorships does not contribute to the gap in promotion rates for women and URMs., (Copyright © 2023 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Introduction: U.S. Navy Medicine's temporary limited duty (LIMDU) program is the primary vehicle for managing the medical care and subsequent career outcomes of the ill and injured active component (AC) Sailors and Marines to ensure a medically ready force. Before the LIMDU Sailor and Marine Readiness Tracker System (SMART) came online, it was very difficult to examine LIMDU program administration metrics, patients' experiences during LIMDU, and their subsequent health and career outcomes. This study examined the LIMDU patient population's demographic, military career, and LIMDU-specific characteristics; identified characteristics that differed significantly by military service; and evaluated potentially modifiable factors associated with patient outcomes., Materials and Methods: A comprehensive SMART extract was used to identify all AC Sailors and Marines in active LIMDU status between October 1, 2016, and September 30, 2019. The SMART extract was merged with comprehensive administrative military personnel data by patient identifiers to create a longitudinal dataset and to conduct descriptive statistics, bivariate, and multivariate logistic regression analyses for this study. The sample included 26,591 AC Sailors and Marines with complete SMART and military personnel records who ended LIMDU on or before September 30, 2019., Results: During the study's 3-year period, Navy Medicine's rate of initial LIMDU entry by AC personnel increased each year from 2,041 in FY2017 to 2,424 in FY2019 per 100,000 personnel. At the time of initial entry, most LIMDU patients were male (76%), E4-E6 paygrades (54%), and had a single diagnosis recorded in their SMART records (66%). Pain patients (23%) constituted the largest diagnostic group, followed closely by musculoskeletal patients (23%), and then mental and behavioral health patients (20%). Variables that might reflect administration practices of the program did not differ significantly by service, suggesting good internal standardization of LIMDU administration across Navy Medicine. However, bivariate and multivariate analyses identified significant differences by service for almost all personal demographic, LIMDU-specific, and post-LIMDU military career sample characteristics measured at the last LIMDU close date or later. Study results suggested that the Navy and Marine Corps referred Sailors and Marines to start LIMDU for different medical reasons; to receive care from different military treatment facilities; to close LIMDU with different final actions; and to experience different post-LIMDU career outcomes., Conclusion: Navy Medicine's SMART data is an important new resource for LIMDU program evaluation and population-level patient research, despite the data limitations and concerns identified and addressed by this study. The study results provide a baseline empirical understanding about the LIMDU patient population. Further research is necessary to interrogate the validity of these results over a longer period and to initiate other lines of inquiry. While the construction of the larger project's LIMDU patient population longitudinal dataset required a significant initial investment, future dividends from ongoing work are anticipated. Results derived from verified SMART data will benefit Navy Medicine, operational commands, and LIMDU patients alike by informing continuing efforts to improve patient health and career outcomes, identify and implement best clinical and administrative practices, and optimize force readiness., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Physician explicit and implicit biases involving race and sexual orientation (SO) affect patient and provider experiences in healthcare settings. An anonymous survey was disseminated nationally to graduating medical students, residents, and practicing physicians to evaluate SO and racial biases across medical specialties. SO explicit and implicit bias were measured with the Attitudes toward Lesbians and Gay Men Scale, short form (ATLG-S) and Gay-Straight Implicit Association Test (IAT). Racial explicit and implicit bias were measured with the Quick Discrimination Index (QDI) and the Black-White IAT. Medical specialty was associated with racial explicit bias and specialty prestige with Black-White IAT score. Medical specialty and specialty prestige were not associated with SO bias. Female sex, sexual and gender minority (SGM) identity, and decreased religiosity were associated with reduced SO and racial bias. Provider race was associated with racial implicit and explicit bias.

Introduction: Promoting the inclusion of trans and non-binary (TNB) medical trainees is a key step in building an inclusive health workforce well-positioned to provide high-quality healthcare to all patients. Existing data on the experiences of TNB physicians and trainees describe widespread challenges related to prejudice and discrimination, with most trainees concealing their gender identity for fear of discrimination. We aimed to understand how TNB medical students have experienced professionalism and professional identity formation., Methods: This was a secondary analysis of data gathered in a constructivist grounded theory study. The authors conducted semi-structured qualitative interviews in 2017 with seven current or recently graduated TNB Canadian medical students., Results and Discussion: From medical school application to graduation, TNB medical students reported feeling tensions between meeting expectations of professionalism, being their authentic selves, and seeking to avoid conscious and implicit biases. These tensions played out around issues of disclosure, foregrounding identity through impression management, and responding to identity exemplars. The tension between TNB trainees' desire to bring their whole selves to the practice of medicine and feeling pressured to de-emphasize their gender is ironic when considering the increased call for medical trainees from equity-seeking communities. The most commonly used behavioural frameworks of professionalism were inherited from prior generations and restrict students whose experiences and community-based knowledge are most needed. Demands of professionalism that are incompatible with authentic professional identity development place an inordinate burden on trainees whose identities have been excluded from normative concepts of the professional, including TNB trainees., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Introduction: The possibility of balancing career and family is meanwhile a central concern for most physicians when choosing a job. The aim of this study was to identify current barriers and opportunities for physician education and career planning., Methods: This cross-sectional study was conducted as an online survey between 11/2021 and 02/2022 and targeted physicians at all career levels in Germany who were members of a clinical professional association. Alternative and consent questions were used to assess experiences/attitudes toward various aspects of life and career planning, as well as alternative work and parental leave models, depending on gender, specialty, and hierarchical level., Results: The majority of the 2060 participants were female (69%) and had children (66%). Many childless residents reported that they felt they had to choose between children and a career. The majority of female residents, specialists and attending physicians (Ø 55.5%) stated that they had experienced career losses as a result of taking parental leave, while most men did not share this experience (Ø 53.7%). 92% of all participants agreed with the statement that men and women have different career opportunities. Job-sharing models were considered feasible at all levels of the hierarchy by an average of 55.6% of all medical executives., Conclusion: Parenthood and the use of parental leave and part-time work appear to have a significant impact on the career paths of those surveyed. Although the majority of directors of medical training programs are open to job-sharing models, further measures are needed in order to equalize career opportunities for men and women., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Oberberg et al.)

Background: Ambulatory Health Care Networks (Amb-HCN) are circuits of patient referral and counter-referral that emerge, explicitly or spontaneously, between doctors who provide care in their offices. Finding a meaningful analytical representation for the organic and hierarchical functioning of an Amb-HCN may have managerial and health policymaking implications. We aimed to characterize the structural and functional topology of an Amb-HCN of a private health insurance provider (PHIP) using objective metrics from graph theory., Methods: This is a cross-sectional quantitative study with a secondary data analysis study design. A Social Network Analysis (SNA) was conducted using office visits performed between April 1, 2021 and May 15, 2022, retrieved from secondary administrative claim databases from a PHIP in Belo Horizonte, Southeastern Brazil. Included were beneficiaries of a healthcare plan not restricting the location or physician caring for the patient. A directional and weighted network was constructed, where doctors were the vertices and patient referrals between doctors, within 7-45 days, were the network edges. Vertex-level SNA measures were calculated and grouped into three theoretical constructs: patient follow-up (aimed at assessing the doctor's pattern of patient follow-up); relationship with authorities (which assessed whether the doctor is an authority or contributes to his or her colleague's authority status); and centrality (aimed at positioning the doctor relative to the network graph). To characterize physician profiles within each dimension based on SNA metrics results, a K-means cluster analysis was conducted. The resulting physician clusters were assigned labels that sought to be representative of the observed values of the vertex metrics within the clusters., Findings: Overall, 666,263 individuals performed 3,863,222 office visits with 4,554 physicians. A total of 577 physicians (12.7%) had very low consultation productivity and contributed very little to the network (i.e., about 1.1% of all referrals made or received), being excluded from subsequent doctor profiles analysis. Cluster analysis found 951 (23.9%) doctors to be central in the graph and 1,258 (31.6%) to be peripheral; 883 (22.2%) to be authorities and 266 (6.7%) as seeking authorities; 3,684 (92.6%) mostly shared patients with colleagues, with patient follow-up intensities ranging from weak to strong. Wide profile dispersion was observed among specialties and, more interestingly, within specialties. Non-primary-care medical specialties (e.g., cardiology, endocrinology etc.) were associated with central profile in the graph, while surgical specialties predominated in the periphery, along with pediatrics. Only pediatrics was associated with strong and prevalent (i.e., low patient sharing pattern) follow-up. Many doctors from internal medicine and family medicine had unexpectedly weak and shared patient follow-up profiles. Doctor profiles exhibited pairwise relationships with each other and with the number of chronic comorbidities of the patients they treated. For example, physicians identified as authorities were frequently central and treated patients with more comorbidities. Ten medical communities were identified with clear territorial and specialty segregation., Conclusions: Viewing the Amb-HCN as a social network provided a topological and functional representation with potentially meaningful and actionable emerging insights into the most influential actors and specialties, functional hierarchies, factors that lead to self-constituted medical communities, and dispersion from expected patterns within medical specialties., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Biscione, Domingues da Silva. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Importance: Food-as-medicine programs are becoming increasingly common, and rigorous evidence is needed regarding their effects on health., Objective: To test whether an intensive food-as-medicine program for patients with diabetes and food insecurity improves glycemic control and affects health care use., Design, Setting, and Participants: This stratified randomized clinical trial using a wait list design was conducted from April 19, 2019, to September 16, 2022, with patients followed up for 1 year. Patients were randomly assigned to either participate in the program immediately (treatment group) or 6 months later (control group). The trial took place at 2 sites, 1 rural and 1 urban, of a large, integrated health system in the mid-Atlantic region of the US. Eligibility required a diagnosis of type 2 diabetes, a hemoglobin A1c (HbA1c) level of 8% or higher, food insecurity, and residence within the service area of the participating clinics., Intervention: The comprehensive program provided healthy groceries for 10 meals per week for an entire household, plus dietitian consultations, nurse evaluations, health coaching, and diabetes education. The program duration was typically 1 year., Main Outcomes and Measures: The primary outcome was HbA1c level at 6 months. Secondary outcomes included other biometric measures, health care use, and self-reported diet and healthy behaviors, at both 6 months and 12 months., Results: Of 3712 patients assessed for eligibility, 3168 were contacted, 1064 were deemed eligible, 500 consented to participate and were randomized, and 465 (mean [SD] age, 54.6 [11.8] years; 255 [54.8%] female) completed the study. Of those patients, 349 (mean [SD] age, 55.4 [11.2] years; 187 [53.6%] female) had laboratory test results at 6 months after enrollment. Both the treatment (n = 170) and control (n = 179) groups experienced a substantial decline in HbA1c levels at 6 months, resulting in a nonsignificant, between-group adjusted mean difference in HbA1c levels of -0.10 (95% CI, -0.46 to 0.25; P = .57). Access to the program increased preventive health care, including more mean (SD) dietitian visits (2.7 [1.8] vs 0.6 [1.3] visits in the treatment and control groups, respectively), patients with active prescription drug orders for metformin (134 [58.26] vs 119 [50.64]) and glucagon-like peptide 1 medications (114 [49.56] vs 83 [35.32]), and participants reporting an improved diet from 1 year earlier (153 of 164 [93.3%] vs 132 of 171 [77.2%])., Conclusions and Relevance: In this randomized clinical trial, an intensive food-as-medicine program increased engagement with preventive health care but did not improve glycemic control compared with usual care among adult participants. Programs targeted to individuals with elevated biomarkers require a control group to demonstrate effectiveness to account for improvements that occur without the intervention. Additional research is needed to design food-as-medicine programs that improve health., Trial Registration: ClinicalTrials.gov Identifier: NCT03718832.

Background: As the population ages, musculoskeletal disorders are a prominent contributory factor to loss of mobility and autonomy. Pain is a predictor of disability and worsening frailty and the role of the chronic pain specialist in the management of this cohort cannot be overstated. With growing requirements for pain specialists, we sought to identify barriers to recruitment within this specialty., Aims: Establish baseline attitudes and perceived barriers towards a career in pain medicine among Irish anaesthesiology trainees. Suggest a framework to improve recruitment to the specialty., Methods: Ethical approval was obtained. A web-based questionnaire was sent to all anaesthesiologists in training in the Republic of Ireland. Data was analyzed using SPSS., Results: Two hundred forty-eight trainees received the questionnaire, 59 responded. 54.2% male, 45.8% female. 79.7% had previous clinical exposure to pain medicine, most of whom had spent over one month with a service. Only 10.2% of respondents were considering a career in pain medicine. Factors that attracted trainees to the subspeciality included: interventional practice (81%), variation in clinical practice (66.7%), autonomy of practice (61.9%) and perceived good work-life balance (42.9%). Deterrents from the subspecialty included a psychologically challenging patient cohort (69.5%), frequency of clinics (50.8%), and additional exams (32.2%). When asked how to improve engagement with the speciality, 62% suggested earlier exposure to the speciality and 32.2% suggested increased frequency of formal teaching and workshops., Conclusions: Increased exposure of trainees to the specialty during early stages of training may improve future recruitment to the subspecialty in Ireland., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Purpose: To assess interrater reliability and examiners' characteristics, especially specialty, associated with scoring of neurology objective structured clinical examination (OSCE)., Material and Methods: During a neurology mock OSCE, five randomly chosen students volunteers were filmed while performing 1 of the 5 stations. Video recordings were scored by physicians from the Lyon and Clermont-Ferrand university teaching hospitals to assess students performance using both a checklist scoring and a global rating scale. Interrater reliability between examiners were assessed using intraclass coefficient correlation. Multivariable linear regression models including video recording as random effect dependent variable were performed to detect factors associated with scoring., Results: Thirty examiners including 15 (50%) neurologists participated. The intraclass correlation coefficient of checklist scores and global ratings between examiners were 0.71 (CI95% [0.45-0.95]) and 0.54 (CI95% [0.28-0.91]), respectively. In multivariable analyses, no factor was associated with checklist scores, while male gender of examiner was associated with lower global rating ( β  coefficient = -0.37; CI 95% [-0.62-0.11])., Conclusions: Our study demonstrated through a video-based scoring method that agreement among examiners was good using checklist scoring while moderate using global rating scale in neurology OSCE. Examiner's specialty did not affect scoring whereas gender was associated with global rating scale.

Objective: To evaluate trends in opioid prescribing rates following pediatric urologic surgery., Methods: We queried the TriNetX Research database for patients under age 18 who underwent one of seven common pediatric urology procedures. We identified the proportion of patients that received an oral opioid prescription within 5days of surgery. The primary analysis evaluated the trend in postoperative opioid prescriptions using 3-month intervals from January 2010 to December 2022. We performed an interrupted time series analysis assessing trends in opioid prescribing patterns both before and after the American Academy of Pediatrics challenge., Results: Of the 81,644 pediatric urology procedures, 29,595 (36.2%) received a postoperative opioid prescription, including 29.8% of circumcisions, 25.8% of hydrocelectomies, 39.6% of hypospadias repairs, 42.7% of pyeloplasties, 42.8% of ureteral reimplants. For all procedures we observed rising rates of opioid prescribing, increasing by 0.9% per 3-month interval prior to the challenge statement release from 2010 to 2018. We observed an overall significant decrease in opioid prescribing by 2.2% per 3-month interval following the challenge statement release. Additionally, since 2018, there was a significant decrease in opioid prescribing in all of the race, ethnicity, and age cohorts., Conclusion: Opioid prescribing following pediatric urology procedures has sharply decreased following the 2018 American Academy of Pediatrics challenge statement which underscores the value of cross-specialty quality improvement initiatives. Nonetheless, opioid prescribing remains high with potential racial or age disparities that warrant further investigation., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Young doctors' choice of medical specialty is essential to maintaining a sufficient health workforce and developing a sustainable healthcare system. The choice of specialization is the result of numerous factors, including doctors' preferences, population needs, and the number of available residency slots. The aim of this article is to explore the factors taken into consideration by young Polish physicians in choosing their future specialty., Methods: We have conducted 30 structured interviews with randomly selected recent medical school graduates (17 female and 13 male). The study was conducted from December 2022 until February 2023 using online platforms. Data from in-depth interviews were coded using NVivo Release 1.6.1. Then thematic analysis was performed., Results: Respondents indicated remuneration and career-associated factors as the main determinants, emphasizing that work-life balance, personal motivations, and the flexibility to choose the type of workplace (hospital vs. outpatient clinic) were even more important. Young doctors expect flexibility in working hours and better working conditions in future work, and these factors are important when choosing a medical specialty. Significant difficulties during the selection of medical specialty include limited residency slots in preferred specializations and lack of knowledge concerning the everyday aspects of work in a particular specialty., Conclusions: Factors and limitations influencing the choice of medical specialty should be taken into account by policymakers to address the shortages of doctors in deficit specialties. Knowledge about doctors' preferences regarding their medical specialty could support the development of targeted policies to increase the attractiveness of deficit specialties and reduce the uneven distribution of medical staff., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Michalik et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Research about academic medicine women faculty has focused on comparisons of men and women or specific groups who achieved leadership. To better understand the low percentages of women in academic medicine leadership, attention should be paid to the career continuum within genders. Study findings will inform policies and programs to support women in building careers and acquiring leadership positions. Materials and Methods: Association of American Medical Colleges (AAMC) StandPoint Faculty Engagement Survey data are used to describe and compare women assistant, associate and full professors' perceptions of (1) career development and advancement opportunities, and (2) a culture and climate that fosters diversity, equity, and inclusion. Specific similarities and differences with men are highlighted. Results: Fifty-nine percent of women respondents were assistant, 25% associate, and 16% full professors. Associate professors of both genders were the least satisfied on the main measures. Women were less satisfied than men at each career stage across the majority of variables. Among women, fewer than half of full and associate professors, and 52% of assistant professors believe they can express their opinions without fear of retribution. While the majority at all ranks (69%-75%) report feeling respected in the workplace, among those who did not, the highest percentage of disrespect based on gender was among associate professors. Conclusions: The perceptions of >7,500 academic medicine women faculty, representing different generations and ranks, underscore the need to broadly address gender inequity and sexism throughout the career continuum. It identifies the mid-career stage as a challenging experience for both men and women. Women, especially at the associate professor rank, remain a critically dissatisfied and underresourced group that is at risk for underutilization and potentially exit from academic medicine. All ranks of women need career development and equitable policies to support their sense of belonging and career advancement.

Background: While the number of women entering medicine has steadily increased since the 1970s in Canada, the gender composition along each stage of the medical training pathway has not been comprehensively reported. We therefore sought to systematically examine the gender composition of students, residents, and practicing physicians over the past 30 years in Canada., Results: In this cross-sectional analysis of Canadian medical trainees including MD applicants (137,096 male, 169,099 female), MD students (126,422 male, 152, 967 female), MD graduates (29,413 male, 34,173 female), residents by the decade (24,425 male, 28,506 female) and practicing surgeons (total 7,457 male, 3,457 female), we find that increased female representation in medicine is not matched by representation in surgery, with the key being the specialty choice process. The likelihood of female applicants matriculating to medical school was less than male applicants in the 90s (OR 0.92, 95% CI 0.92-0.93), greater in the early 2000s (OR 1.03, 95% CI 1.03-1.04), and has since balanced out (OR 1.00, 95% CI 1.00-1.01), with medical school classes being nearly 60% female for the past two decades. Despite this, females have remained underrepresented in most surgical residency programs, with odds of female medical students entering surgical residency other than Ob/Gyn being about half that of male students (OR 0.56, 95% CI 0.44-0.71), resulting in a slow increase in practicing female surgeons of less than 0.5% per year in many surgical disciplines and projected parity decades or centuries in the future., Conclusions: While undergraduate medical education has been majority female in Canada for nearly three decades, females remain greatly underrepresented in the physician workforce within surgical specialties. To build a representative medical workforce equipped to care for diverse patient populations, factors influencing the specialty choices of early career physicians will need to be examined and addressed., (© 2024. The Author(s).)

Gender dysphoria (GD) is marked by an incongruence between a person's biological sex at birth, and their felt gender (or gender identity). There is continuing debate regarding the benefits and drawbacks of physiological treatment of GD in children, a pathway, beginning with endocrine treatment to suppress puberty. Currently, the main alternative to physiological treatment consists of the so-called "wait-and-see" approach, which often includes counseling or other psychotherapeutic treatment. In this paper, we argue in favor of a "third pathway" for the diagnosis and treatment of GD in youths. To make our case, we draw on a recent development in bioethics: the phenomenological approach. Scholars such as Slatman and Svenaeus have argued that the extent to which the body can (or should be) manipulated or reconstructed through medical intervention is not only determined by consideration of ethical frameworks and social and legal norms. Rather, we must also take account of patients' personal experience of their body, the personal and social values associated with it, and their understanding of its situation in their life: their narrative identities. We apply this phenomenological approach to medicine and nursing to the diagnosis and treatment of GD in youth. In particular, we discuss Zahavi and Martiny's conception of the phenomenological interview, in order to show that narrative techniques can assist in the process of gender identification and in the treatment of youth presenting with GD. We focus on two case studies that highlight the relevance of a narrative-based interview in relations between patients, HCPs, and family, to expose the influence of social ideologies on how young people presenting with GD experience their bodies and gender., (© The Author(s) 2023. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The influence of sex and gender on neurologic disease has become increasingly recognized in science and medicine. This is evident across a woman's lifespan especially during periods of hormonal transitions. Leaders in neurology have advocated for the importance of sex and gender-enriched clinical care, education, and research. The scope of women's neurology spans across a woman's life including puberty, adolescence, peripartum care, menopause, and aging. Women's neurology is a new subspecialty that aligns with a specific patient population and intersects with established neurology subspecialties and other specialties such as obstetrics, maternal fetal medicine, endocrinology, and psychiatry. Its establishment and collaboration with existing and emerging fields enables a more comprehensive approach to neurologic illness through the lens of sex and gender. Women's neurology is rapidly evolving through increased focus at academic centers, including expanded women's neurology curricula, dedicated women's neurology fellowship programs, improved understanding of sex and gender issues in neurosciences, and expansion of therapeutic options. Herein, we describe the history of the women's neurology field, emerging need for women's neurology specialists, information about training and career opportunities, and future directions.

Introduction: There is a gender gap in the surgical field worldwide. Brazil and low- and middle-income countries generally tend to have a more profound gap. Therefore, we aim to assess the gender distribution in Brazilian surgical residencies., Methods: From a national residencies' database, we collected residency entering years, names, and surgical subspecialties. We classified gender from the names using Gender API software and performed linear regression, binomial, and chi-square tests., Results: From 81,979 doctors (1931-2020), 36.6% were women (P < 0.001). Of 13 subspecialties, regarding the absolute numbers of women, only neurosurgery and plastic surgery did not significantly differ between gender per year. There was a statistically significant growth in the proportional rates of female representation among most of the surgical residencies analyzed. Overall, the least women's representation was in urology (3.8%). From all subspecialties analyzed, both genders had a significant linear absolute increase over the years (P < 0.05), except for obstetrics-gynecology and pediatric surgery for men. Until 1990, all surgical programs had at least one woman resident, except for colorectal surgery., Conclusions: Although there is an overall lack of women surgeons in Brazil, we observed an increase in women in surgical residencies. Therefore, the study may demonstrate a future change in the Brazilian gender equity scenario and reflect the growing representation of women in medicine in Brazil, except for some surgical specialties., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Technical learning in surgical training is multifaceted and existing literature suggests a positive relationship between case volume and proficiency. Little is known about factors associated with a decreased volume of operative experience. This study aimed to identify resident and program factors associated with general surgery residents (GSR) in the bottom quartile of logged case volume upon program completion., Methods: A post hoc analysis of a multicenter study was used to examine case logs for categorical GSR. Participants included graduates between 2010 and 2020 from 20 programs. Residents below and above the 25th percentile for total operative volume were compared., Results: The present study includes 1343 GSR who graduated over the 11-y period. In total, 336 residents were below the 25th percentile and 1007 residents were above the 25th percentile. Those below the 25th percentile were more likely to be female (41% versus 34%, P = 0.02), identify as underrepresented in medicine (22% versus 14%, P < 0.01), and pursue fellowship (86% versus 80%, P = 0.01) compared to those above the 25th percentile. Residents below the 25th percentile were more likely to have graduated from a low volume program (55% versus 25%, P < 0.01) and from top National Institutes of Health funded institutions (57% versus 52%, P = 0.01)., Conclusions: This study identified individual and program characteristics associated with lower operative volume of GSR. Understanding such characteristics will aid surgical educators to achieve better equity in training., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Artificial intelligence (AI) has the potential to revolutionize the way medicine is learned, taught, and practiced, and medical education must prepare learners for these inevitable changes. Academic medicine has, however, been slow to embrace recent AI advances. Since its launch in November 2022, ChatGPT has emerged as a fast and user-friendly large language model that can assist health care professionals, medical educators, students, trainees, and patients. While many studies focus on the technology's capabilities, potential, and risks, there is a gap in studying the perspective of end users., Objective: The aim of this study was to gauge the experiences and perspectives of graduating medical students on ChatGPT and AI in their training and future careers., Methods: A cross-sectional web-based survey of recently graduated medical students was conducted in an international academic medical center between May 5, 2023, and June 13, 2023. Descriptive statistics were used to tabulate variable frequencies., Results: Of 325 applicants to the residency programs, 265 completed the survey (an 81.5% response rate). The vast majority of respondents denied using ChatGPT in medical school, with 20.4% (n=54) using it to help complete written assessments and only 9.4% using the technology in their clinical work (n=25). More students planned to use it during residency, primarily for exploring new medical topics and research (n=168, 63.4%) and exam preparation (n=151, 57%). Male students were significantly more likely to believe that AI will improve diagnostic accuracy (n=47, 51.7% vs n=69, 39.7%; P=.001), reduce medical error (n=53, 58.2% vs n=71, 40.8%; P=.002), and improve patient care (n=60, 65.9% vs n=95, 54.6%; P=.007). Previous experience with AI was significantly associated with positive AI perception in terms of improving patient care, decreasing medical errors and misdiagnoses, and increasing the accuracy of diagnoses (P=.001, P<.001, P=.008, respectively)., Conclusions: The surveyed medical students had minimal formal and informal experience with AI tools and limited perceptions of the potential uses of AI in health care but had overall positive views of ChatGPT and AI and were optimistic about the future of AI in medical education and health care. Structured curricula and formal policies and guidelines are needed to adequately prepare medical learners for the forthcoming integration of AI in medicine., (©Saif M I Alkhaaldi, Carl H Kassab, Zakia Dimassi, Leen Oyoun Alsoud, Maha Al Fahim, Cynthia Al Hageh, Halah Ibrahim. Originally published in JMIR Medical Education (https://mededu.jmir.org), 22.12.2023.)

Arthur Conan Doyle's medical and writing careers intertwined and his work has a history of being read in the light of his medical expertise. He wrote at a time when the professionalisation and specialisation of medicine had resulted in an increasing distance between the profession and the public, yet general practitioners relied financially on maintaining good relationships with their patients and popular medical journalism proliferated. A variety of contrasting voices often disseminated narratives of medical science. These conflicting developments raised questions of authority and expertise in relation to the construction of medicine in the popular imagination: how is knowledge constructed? Who should disseminate it? How and by whom is authority conferred? How can the general population judge experts in medical science? These are questions explored more widely in Conan Doyle's writing as he examines the relationship between expertise and authority. In the early 1890s, Conan Doyle wrote for the popular, mass-market periodical The Idler: An Illustrated Magazine His contributions to it address these questions of authority and expertise for a lay audience. First establishing the medical context of doctor/patient relationships in which these questions arose, this article undertakes a close reading of these mostly rarely studied single-issue stories and articles as a means of ascertaining how Conan Doyle and his illustrators identified the relationship between competing narratives, expertise and authority. It argues that rather than maintaining a distance between public and professional, Conan Doyle's illustrated work demonstrates to his readers that there are ways to successfully navigate the appearance of authority and recognise expertise as they confront entangled representations of advances in medical science., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: Anatomy is a crucial part of medical education, and there have been attempts to improve this field by utilizing various methods. With the advancement of technology, three-dimensional (3D) materials have gained popularity and become a matter of debate about their effectiveness compared to two-dimensional (2D) sources. This research aims to analyze the effectiveness of 3D PDFs compared to 2D atlases., Methods: This study is a randomized controlled trial involving 87 Year-1 and Year-2 medical students at Gazi University Faculty of Medicine, Turkey. The study was conducted in two steps. In Step-1, students were randomized to watch lecture videos on liver anatomy and male genitalia anatomy supplemented with either a 3D PDF (intervention group) or 2D atlas (control group) images. Following the video lectures, a test (immediate test) was administered. In Step-2, the same test (delayed test) was administered 10 days after the immediate test. The test scores were compared between the intervention and control groups. In addition to the descriptive analyses, Chi-square and Mann-Whitney U tests were performed., Results: In the immediate test, while there was no significant difference between the groups for the liver test (p > 0.05), 3D PDF group's scores (Median = 24.50) was significantly higher than the 2D atlas group's in the genitalia test (Median = 21.00), (p = 0.017). The effect size (Cohen's d) was 0.57. In the delayed test, there was no significant difference between the groups in the liver and genitalia tests (p > 0.05). However, the effect size in the immediate genitalia test was 0.40. Year-1 students' immediate test of genitalia performances were significantly higher in the 3D PDF group (Median = 24.00) than the 2D atlas group (Median = 19.00), (p = 0.016). The effect size was 0.76. Also, Year-1 students' 3D PDF group (Median = 20.50) presented with significantly higher performance than the 2D atlas group (Median = 12.00), (p = 0.044) in the delayed test of genitalia, with the 0.63 effect size., Conclusion: 3D PDF is more effective than 2D atlases in teaching anatomy, especially to initial learners. It is particularly useful for teaching complex anatomical structures, such as male genitalia, compared to the liver. Hence, it may be a valuable tool for medical teachers to utilize during lectures., (© 2023. The Author(s).)

Objective: To summarize the experience of facial nerve(FN) preservation in microsurgical treatment of vestibular schwannoma (VS) resection via suboccipital retrosigmoid approach and to analyze the influencing factors of facial function prognosis in short-term and long-term period. Methods: Patients with VS who underwent microsurgery via suboccipital retrosigmoid approach by the skull base surgery team in Huashan Hospital from January 2013 to February 2018 were enrolled. A total of 308 patients were included in this study, including 132 males and 176 females. The average age was 47.9 year-old (Range: 17-79 year-old). The patient's clinical data and FN function prognosis were recorded. Univariate and multivariate analysis by SPSS 23.0 statistical software were performed to evaluate the factors affecting facial function prognosis and its recovery. Results: Gross total resection was achieved in 304 cases, and subtotal resection was in 4 cases. The facial nerve preservation rate anatomically was 99.4%. The facial nerve of 2 cases was thin due to large tumor compression and severed, and a one-stage reconstruction was performed during surgery.Of the 308 patients, 300 cases were successfully followed up, and 8 cases were lost to follow-up. The mean follow-up time was 52 months. In short-term (2 weeks after surgery), satisfactory facial nerve function (House-Brackmann (H-B) grade Ⅰ-Ⅱ) was achieved in 96 cases, and 212 cases were unsatisfactory function (H-B grade Ⅲ-Ⅵ). After 1 year, 198 were satisfactory function and 97 were unsatisfactory. After 3 years, 219 were satisfactory function and 75 were unsatisfactory. Five years later, 155 were satisfactory function and 34 were unsatisfactory. According to the results of logistic regression analysis, the impact factors of FN function in short-term were tumor size ( P =0.011) and stimulation threshold (ST) of EMG monitoring ( P <0.001). The impact factors in long-term were tumor size ( P =0.005), ST of EMG monitoring ( P =0.005) and FN rehabilitation training. Conclusions: Tumor diameter is an independent factor related to FN function, and the larger the tumor, the worse the postoperative FN function. The ST of EMG (ST≤0.05 mA) can predict short-term and long-term FN function. The systematic facial rehabilitation training can effectively promote the recovery of FN after surgery.

Introduction: The career intentions of medical students can exert influence on service provision and medical staffing in the health services. It is vital for a specialty's development and sustainability that it has a constant stream of trainees into it annually. An appreciation of how a specialty is viewed by medical students can be used as an opportunity for early intervention in order to improve perception of the specialty and reduce future workforce problems, such as retention and attrition within obstetrics and gynaecology (O&G). We aimed to analyse positive and negative factors of the specialty of O&G as perceived by medical students in order to gain insight into changes that need to be made to improve recruitment and retention into the specialty., Methods: A 70-item structured questionnaire consisting of demographic information and 5-point Likert scale questions relating to O&G was administered to final year medical students in the Republic of Ireland. Data were analysed with descriptive statistics, logistic regression, and odds ratios as appropriate., Results: Of 195 medical students approached, 134 completed the questionnaire, a response rate of 68.7%. The majority were female (55.2%, n = 74) and 76.1% of respondents (n = 102) were Direct Entry Medicine students, with the remainder Graduate Entry Medicine students. 30.8% (n = 41) of students who responded scored 6 or more on a 10-point Likert scale when asked about their likelihood of considering a career in O&G. Students' clerkship experience factored heavily into their perception of the specialty and was more likely to be positive if they experienced direct consultant engagement and the opportunity for hands-on experience. Lifestyle factors, litigation and media were found to be deterrents to considering the specialty after graduation., Conclusions: This study demonstrates the importance of good clerkship experience in fostering an interest amongst undergraduates in O&G. Educators and those working within the specialty should showcase the strengths of the specialty during undergraduate education, and work on ameliorating deterrents to ultimately provide a structured approach to improving recruitment into O&G., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ní hÉalaithe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Animal rehabilitation centres provide a unique opportunity to study the microbiome of wild animals because subjects will be handled for their treatment and can therefore be sampled longitudinally. However, rehabilitation may have unintended consequences on the animals' microbiome because of a less varied and suboptimal diet, possible medical treatment and exposure to a different environment and human handlers. Our study describes the gut microbiome of two large seal cohorts, 50 pups (0-30 days old at arrival) and 23 weaners (more than 60 days old at arrival) of stranded harbour seals admitted for rehabilitation at the Sealcentre Pieterburen in the Netherlands, and the effect of rehabilitation on it. Faecal samples were collected from all seals at arrival, two times during rehabilitation and before release. Only seals that did not receive antimicrobial treatment were included in the study. The average time in rehabilitation was 95 days for the pups and 63 days for the weaners. We observed that during rehabilitation, there was an increase in the relative abundance of some of the Campylobacterota spp and Actinobacteriota spp. The alpha diversity of the pups' microbiome increased significantly during their rehabilitation (p-value <0.05), while there were no significant changes in alpha diversity over time for weaners. We hypothesize that aging is the main reason for the observed changes in the pups' microbiome. At release, the sex of a seal pup was significantly associated with the microbiome's alpha (i.e., Shannon diversity was higher for male pups, p-value <0.001) and beta diversity (p-value 0.001). For weaners, variation in the microbiome composition (beta diversity) at release was partly explained by sex and age of the seal (p-values 0.002 and 0.003 respectively). We mainly observed variables known to change the gut microbiome composition (e.g., age and sex) and conclude that rehabilitation in itself had only minor effects on the gut microbiome of seal pups and seal weaners., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Rubio-Garcia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Agenesis of the posterior cruciate ligament (PCL) is a rare disorder often found in conjunction with various other abnormalities within the knee. A 15-year-old adolescent boy presented with an absent PCL, leading to intermittent symptoms. At the age of 20 years, the patient underwent arthroscopically assisted PCL reconstruction. The patient was permitted to weightbear immediately after the procedure and started physical therapy 4 weeks after the procedure. No complications were encountered at the 2-year follow-up., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Objectives: Despite their overrepresentation, female physicians continue to have lower rates of promotion compared with male physicians. Teaching evaluations play a role in physician advancement. Few studies have investigated gender disparity in resident evaluations of pediatric faculty. We hypothesized that gender disparities in resident evaluations of faculty exist and vary across subspecialties and primary work environments., Methods: Pediatric faculty institution-specific evaluations completed by residents from January 1, 2015, to March 9, 2020, were obtained from a single academic center. Mean ratings of faculty performance were compared by gender using a Wilcoxon 2-sample test., Results: Fifteen-thousand one-hundred and forty-two evaluations (5091 of male faculty and 10 051 of female faculty) were included. Female faculty were rated higher in overall teaching ability (female = 4.67 versus male = 4.65; P = .004). There was no statistical difference in the mean ratings of male and female faculty in the inpatient setting, whereas outpatient female faculty were rated higher in overall teaching ability (female = 4.79 versus male = 4.73; P = .005). For general pediatric faculty, females received higher ratings for overall teaching ability (female = 4.75 versus male = 4.70; P < .001). By contrast, there was no difference in ratings of subspecialty pediatric faculty., Conclusions: Pediatric female faculty were statistically rated higher than male faculty in overall teaching ability, although these findings may not be educationally significant. The difference was driven by evaluations in the outpatient setting and for general pediatricians. This study is one of the first in pediatrics adding to the continued investigation of gender disparities in academic medicine., (Copyright © 2023 by the American Academy of Pediatrics.)

John Greenwood (1760-1819) was George Washington's preferred dentist. He practiced in New York and made at least one of eight sets of dentures Washington wore (currently in the collection of the New York Academy of Medicine (NYAM). We know very little about John Greenwood's (JG) formal education, except that he came from a famous family of dentists. He inherited from his father, Isaac Greenwood, one important book of the time, John Hunter's 1778 treatise, A Natural History of the Human Teeth . That copy was donated to the New York Academy of Medicine by descendants of John Greenwood. Recently, we became aware of extensive marginalia that John Greenwood wrote in this book. The present article describes John Greenwood's opinion on a variety of dental subjects such as the causes and mechanisms of tooth destruction and gum disease and the presence of microscopic annamalcula that were thought to be connected to poor oral hygiene. Although John Greenwood was self-educated, his observations are surprisingly insightful and at least 37 years ahead of what was described in the contemporary literature., (Copyright 2023 © American Academy of the History of Dentistry.)

Robert James Graves, a native of Dublin, Ireland, was a physician rather than a surgeon; however, his name is well-known to all general and endocrine surgeons. He was born in Dublin, Ireland, and received his BA and MB degrees from Trinity College (formerly, Dublin University). After further studies throughout Europe, he received his "licentiate" from the Royal College of Physicians of Ireland in 1820 and was appointed Physician to the Meath Hospital in Dublin in 1821. Graves received many honors during his career including the following: King's Professor in the Institute of Medicine (1824); President of the Royal College of Physicians of Ireland (1843-44); and a Fellow of the Royal Society (FRS, 1849). In addition, he was a prominent member of the Irish School of Medicine which also included William Stokes (1804-1878) (Cheyne-Stokes breathing, Stokes-Adams attacks) and Dominic Corrigan (1802-1880) (Corrigan's pulse). Graves' description of exophthalmic goiter was in 1835, some 49 years after that of Caleb Hillier Parry (1755-1822) of Bath, England; however, Bath's report was not published till 1825 or 3 years after his death. Graves' disease is still the eponym applied to this form of hyperthyroidism in the United States., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Intellectual Abilities, as defined in the twelfth edition of the classification manual of the American Association on Intellectual and Developmental Disabilities, are a fundamental part of the rehabilitation process, also understood as functional rehabilitation or the rehabilitation of specific more or less complex functions, in a paradoxical game of mirrors even in the rehabilitation of intellectual functions themselves. Intellectual Disability changes the rules of the game, all the more radically the more severe it is, exacerbating the importance of multidimensional assessment of residual abilities and impaired functions on the basis of which to define realistic goals and choose the tools of rehabilitation and the ways of implementing therapeutic programs in a team effort that consists of the professionals, family and care givers, as well as the disabled person to the extent that he or she is able to actively participate in conducting his or her own rehabilitation.

Background: The future composition of a country's physician workforce depends on medical students' choices of specialties. Students' familiarity with the job market (the healthcare system) they are about to enter and the influence job market conditions have on their choices has not been well explored. This study focuses on whether and how the healthcare system's employment landscape is taken into consideration by medical students and whether this facet adds information about the specialty selection process., Methods: Fifth-year medical students completed a questionnaire querying their knowledge and perceptions of the national healthcare system, selection criteria for choosing a specialty and a post-residency work position. Data were analyzed with two-tailed Student's t-tests and multivariable regression analysis., Results: The questionnaire was completed by 242 students (49% women). Forty per cent were interested in a specialty where it is 'easy to find work' and 64% in a specialty that 'provides job security'. Only 12% were attracted to specialties with empty positions due to a workforce shortage. A high salary was considered an important selection criterion by 45% of students, who were also not deterred by specialties with surplus workforce, especially, if accompanied by high salaries or controllable lifestyles. Only 17% thought it would be easy to find a residency in any hospital in the specialty they chose, reflecting the low rate (3%) of positive responses to the statement that 'there are sufficient residency positions in all specialties'., Conclusions: This study demonstrated the utility of querying medical students about their market awareness when investigating the specialty selection process. Students' poor rating of selection criteria, such as specialties with ease in finding jobs because they are suffering workforce shortages and have empty positions, provide insights and concerns for healthcare leaders. It should aid them in approaching the challenge of attracting students to specialties with workforce shortfalls.KEY MESSAGESThis study demonstrated the feasibility and potential value of adding queries about market awareness when investigating the medical student specialty selection process.Medical students were more interested in a specialty that provides job security than one where it is easy to find work.It could be useful for the healthcare leadership and medical educators in all countries to learn what medical students know about their national healthcare system and whether they need to add more healthcare delivery and system subjects to their curricula.

Objectives: To assess the gender composition of upper-level specialty-specific editor positions among United States (U.S.) medical society-affiliated journals and to evaluate the equitable inclusion of women and women physicians. Materials and Methods: The gender composition of upper-level ( e.g. , editor-in-chief, deputy) specialty-specific editor positions among 39 U.S. medical society-affiliated journals as of January 5, 2023, was analyzed. Editor positions below the level of associate editor were excluded. Parity (50:50 representation) and equity (compared with the proportion of practicing physicians in each medical specialty) benchmarks were utilized to determine if women are underrepresented in editor positions. Results: A total of 862 editor positions among 39 journals were assessed. Women held 32.9% (284/862) of positions (95% confidence interval [CI]: 29.9%-36.2%), significantly less than expected based on the U.S. population ( p  < 0.001). Physicians comprised 90.8% (783/862) of positions, of whom 30.4% (238/783) were women physicians (95% CI: 27.3%-33.7%), significantly less than expected ( p  < 0.001). Thirty-three (84.6%, 95% CI: 70.3%-92.8%) journals were below parity for women overall, whereas 34 (87.2%, 95% CI: 73.3%-94.4%) were below parity for women physicians. Fourteen (35.9%, 95% CI: 22.7%-51.6%) journals were below equity for women physicians. Notably, 13 (33.3%, 95% CI: 20.6%-49.0%) journals were below both parity and equity for women overall and women physicians. Conclusions: This study reveals mixed results in the equitable inclusion of women in editor positions of journals affiliated with U.S. medical societies. Despite the equitable inclusion of women in editorial roles being a remediable issue, approximately one third of journals affiliated with major U.S. medical societies remain inequitable.

This article interrogates the scientific conference as a means by which the organizers of the World League for Sexual Reform's 1929 conference attempted to marshal the 'scientific spirit' in order to present progressive sexual reform as a rational and scientifically informed undertaking. The conference was carefully curated to make the sex reform movement (and the assorted characters that gathered under its banner) look serious, legitimate and, most importantly, scientific. The conference was also an attempt by organizer Norman Haire to exert control over the strategy of sexology, an enterprise that put him at odds with other prominent sexologists of the time. Crucially, Haire understood sexology as inherently intellectually interdisciplinary, but was strategically convinced that the only sound rubric through which to promote and gain acceptance for the movement was through medical science. This central debate, about how best to define the contested concept of sexology, continues among historians today. By examining how the 1929 conference organizers wrestled to define their sex-reforming remit and how they curated the conference to that end, this paper will offer a window onto the mechanisms via which adherents of intellectual communities contend with heterogeneity, how we judge forms of knowledge and, ultimately, what constitutes science.

Society awards are an important component of recognition in medicine and for career advancement such as promotion. Multiple studies conducted in pediatrics and gastroenterology have shown underrepresentation of women awardees even in fields with a higher proportion of women than men. To our knowledge, no such studies have been conducted in pediatric gastroenterology. We hypothesized that among all recipients, women would be underrepresented when compared to men and that women were more likely to be given teaching awards compared to other career achievement awards. We collected data on recipients of major recognition award presented by The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition from 1987 to 2022. We found that 80.90% of the awards had been given to men and that most nominators were men. This study highlights inequities in women recipients for major awards and presents an opportunity for a call for action to examine and address the factors contributing to this gender inequity., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Building a score from a questionnaire to predict a binary gold standard is a common research question in psychology and health sciences. When building this score, researchers may have to choose between statistical performance and simplicity. A practical question is to what extent it is worth sacrificing the former to improve the latter. We investigated this research question using real data, in which the aim was to predict an alcohol use disorder (AUD) diagnosis from 20 self-reported binary questions in young Swiss men (n = 233, mean age = 26). We compared the statistical performance using the area under the ROC curve (AUC) of (a) a "refined score" obtained by logistic regression and several simplified versions of it ("simple scores"): with (b) 3, (c) 2, and (d) 1 digit(s), and (e) a "sum score" that did not allow negative coefficients. We used four estimation methods: (a) maximum likelihood, (b) backward selection, (c) LASSO, and (d) ridge penalty. We also used bootstrap procedures to correct for optimism. Simple scores, especially sum scores, performed almost identically or even slightly better than the refined score (respective ranges of corrected AUCs for refined and sum scores: 0.828-0.848, 0.835-0.850), with the best performance been achieved by LASSO. Our example data demonstrated that simplifying a score to predict a binary outcome does not necessarily imply a major loss in statistical performance, while it may improve its implementation, interpretation, and acceptability. Our study thus provides further empirical evidence of the potential benefits of using sum scores in psychology and health sciences., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Rousson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)