Concerns are rising regarding the quality, validity, and reliability of clinical research findings in medical literature. This investigation sought to identify the most cited orthopedic clinical studies and assess the replicability of the findings reported. Web of Science was used to identify the top ten orthopedic surgery journals by impact factor from which primary comparative studies cited at least 250 times were identified. A second literature search identified follow-up studies relevant to the respective primary studies. Studies investigating the same intervention via parallel methodology were summarized and their conclusions compared to their respective highly cited primary study. Seven primary highly cited clinical studies met inclusion criteria. A literature search identified and screened 1163 follow-up articles, of which 79 met inclusion criteria. Of these, 70.9% (56/79) of studies were randomized clinical trials, 7.6% (6/79) were multicenter in nature, and 67% (53/79) were classified as level I evidence. Average subject cohort size in the follow-up studies was 365 patients (range, 10-4564). The rate of coming to the same conclusion as the primary study was 45.5% (36/79). The rate of different conclusions from the primary studies was 26.6% (21/79). Additionally, 16.5% (13/79) found a weaker correlation, and 11.4% (9/79) neither agreed nor disagreed with the primary study. No significant association existed between study design, level of evidence, or study size and agreement or disagreement with the original paper (P > .05). Less than 50% of replicating follow-up studies support the effects demonstrated by highly cited comparative studies in orthopedic literature, which is a lower rate than that reported by other areas of medicine. Difficulty performing large, high-level-of-evidence studies and publication bias likely contribute to this observation. Based on these findings we believe that replication of prior research, emphasis on research quality, and conscious awareness of the limitations of clinical research are critical to the quality of orthopedic literature.
School nurses play a critical role in student well-being, underscoring their growing importance in both education and health care systems. Research consistently demonstrates their contributions to individual student care and broader population health. This resident-led project explored community-based partnerships to facilitate mutual learning between school nurses and graduate medical education (GME) physicians. Conducted during the 2023-2024 academic year, this quality initiative (QI) involved the Medical City Healthcare (HCA Healthcare) GME programs and North Texas school districts. Educational resources were delivered through in-person teaching sessions led by resident physicians and hands-on medical simulations. School nurses who attended the Continuing Nursing Education (CNE) event completed program evaluations including Net Promotor Score, Likert-style, and open-ended questions. The program evaluation follows Kirkpatrick's levels of evaluation: Reaction, Learning, Behavior, and Results. A total of 1183 school nursing staff from 32 North Texas school districts received training on musculoskeletal (MSK) injuries and concussions at 22 events within 12 Medical City Healthcare locations. At the conclusion of the sessions, 85% (n = 914) of participants reported that they would implement changes in their clinical practice or apply the knowledge gained. Nurses rated the presentations highly, with an average score of 4.2 out of 5, and the program achieved a Net Promoter Score of 91%, equating to a "World Class" designation. A 1-year post-event follow-up yielded an overall positive outcome of 91.3%, exceeding the 85% goal. These findings underscore the potential for GME programs to support community-based initiatives such as school nurse education, improving nursing application of recent evidence-based approaches to care, and strengthening interdisciplinary collaboration. Additionally, this model offers GME trainees valuable opportunities to apply evidence-based medicine in real-world settings, reinforcing their knowledge and professional development.
Traumatic brain injuries (TBI) are a significant and growing health issue, leading to over 200 000 hospitalizations annually in the United States. Cranial nerve (CN) injuries accompanying TBI can severely impact patients' quality of life. This review aims to address the gap in research regarding the severity, mechanisms of injury, and associated intracranial injuries, emphasizing the importance of early detection and intervention. A comprehensive literature search was conducted across databases such as PubMed and Ovid using key terms, including "cranial nerve injury," "cranial nerve palsy," "traumatic brain injury," and "Glasgow Coma Scale." Inclusion criteria encompassed studies reporting CN injuries with TBI, categorized by Glasgow Coma Scale (GCS) scores, and the mechanisms of injury. A total of 14 studies were reviewed, integrating data from adult and pediatric populations. The incidence of CN injuries in TBI patients varies in the literature, with studies reporting rates between 5%-23%. Data revealed significant occurrences of CN injuries in mild (GCS scores 13-15), moderate (GCS scores 9-12), and severe (GCS scores < 9) TBI. Common mechanisms of injury included automobile accidents and falls; crush injuries were a notably common mechanism of injury in pediatric patients with TBI. Associated injuries included skull base fractures (38.9%), subdural hematomas (16.6%), epidural hematomas (18.9%), and subarachnoid hemorrhage (25.6%). Early detection and intervention were found to be critical in improving patient outcomes, with delays leading to increased disability and poor prognosis. The high prevalence of CN injuries in even mild cases of TBIs emphasizes the need for physicians to be equipped to assess, diagnose, and treat CN deficits in all forms of neurological trauma. By acknowledging common mechanisms of injury and associated intracranial injuries, we can elucidate the possibility of CN damage in order to facilitate early recognition and treatment. The identification of CN injury also suggests the importance of investigating other intracranial injuries such as skull base fractures, epidural or subdural hematomas, and hemorrhage.
While ethnic disparities in appendicitis outcomes have been previously documented, limited data exist regarding their influence on the incidence of complicated appendicitis within population covered by universal health insurance. This study aimed to assess whether ethnicity (Israeli Jewes vs. Israeli Arabs) is independntly accosioated with the risk of complicated appendicitis in the context of Israel’s universal healthcare system. All adult patients who underwent appendectomy at our institution between January 2010 and December 2021. The primary outcome was appendicitis severity, categorized as complicated or uncomplicated based on pathology reports. Secondary outcomes included length of hospital stay and rehospitalization within six months. Univariable and multivariable logistic regression analyses were performed to identify factors associated with complicated appendicitis. A total of 2,943 patients were included. In the multivariable logistic regression analysis, prolonged in-hospital delay before surgery exceeding 12 h increased the risk of complicated appendicitis (OR = 1.41; 95% CI: 1.14–1.75; p = 0.002). Age over 60 years doubled the risk of complicated appendicitis compared to younger patients (OR = 2.42; 95% CI: 1.81–3.24; p < 0.001). Although Jewish patients were older and had higher rates of complicated appendicitis, ethnicity was not independently associated with complicated appendicitis after adjustment for age, comorbidities, and surgical delay. Ethnicity was not an independent risk factor for complicated appendicitis in a population with universal health coverage. Older age and prolonged in-hospital delay were the primary predictors of complicated disease.
Although chronic obstructive pulmonary disease (COPD) increasingly affects women, they remain under-represented in randomized controlled trials (RCTs). Understanding enrollment patterns is essential to ensure the generalizability of COPD therapeutic evidence. We systematically identified RCTs of pharmacologic interventions for COPD published between 2010 and 2024. For each trial, we calculated the Enrollment Disparity Difference (EDD)-defined as the trial's percentage of women minus the Global Burden of Disease (GBD) sex-specific prevalence. Random-effects meta-analyses were conducted to pool EDD across trials; heterogeneity was explored using subgroup analyses (region, sample size, therapy class, age group, funding source) and meta-regression models. Temporal trends were evaluated, and a weighted annual EDD trajectory with forecasted values through 2026 was generated. A total of 190 RCTs were included. Women comprised 31.7% of enrolled participants. Pooled EDD was -0.21 (95% CI, -0.22 to -0.19), indicating relative underrepresentation. Heterogeneity was very high (I2 = 100%). Underrepresentation varied significantly across regions, with the greatest gaps observed in Asia and Africa and the smallest in North and South America. Age was a significant moderator (β = -0.0070 per year, p = 0.0006), with greater disparities in trials enrolling older patients. Industry funding, sample size, and therapy class were not significant predictors. A continuous-year meta-regression demonstrated an improvement in female representation over time (β = 0.0068 per year, p = 0.0269). Women remain underrepresented in COPD RCTs. Although modest improvements have occurred, significant gaps persist. Ensuring equitable representation is essential for generating evidence that reflects the COPD population. Chronic obstructive pulmonary disease (COPD) affects both men and women, but women are often underrepresented in medical research. This underrepresentation matters because women often experience COPD differently than men. They may have more shortness of breath, different types of lung disease, different responses to inhalers, and higher rates of anxiety and depression related to their illness. To understand how well women are included in COPD clinical trials, we reviewed 190 randomized controlled trials that tested medications for COPD. We found that women were consistently underrepresented: on average, trials enrolled about 20% fewer women than expected based on real-world disease patterns. When trials do not include enough women, the results may not fully reflect how well treatments work for everyone. This can affect how confidently doctors can use evidence from trial to guide treatment decisions for their patients specifically women. We also found that women’s representation in trials has slowly improved over time, especially after 2020, but there is still a substantial gap. Overall, our findings highlight the need for more inclusive research practices, such as broader eligibility criteria, targeted recruitment of women, and routine reporting of trial results separately for men and women. Ensuring that clinical trials reflect the real-world population with COPD is essential for developing treatments that work for everyone.
As medical education evolves, innovative techniques are being explored to enhance learning and engagement. While existing literature on gamification in medical education primarily focuses on graduate medical education, its application in other fields, such as nursing or emergency medical services (EMS), remains underexplored. This study evaluates the feasibility of using gamification to teach EMS personnel about patient capacity assessment and examines its impact on the frequency of pre-hospital transport. A relay race with 3 stations was developed by emergency medicine residents, EMS fellows, and emergency medicine and emergency medical services teaching faculty to teach capacity assessment. Each station challenged participants to accurately identify and recall key components of patient capacity through differing approaches. Points were awarded and time until completion was recorded at each station to incentivize participation. A researcher-generated survey was completed before and after the activity to measure each participants' comfort with and knowledge of determining patient capacity. Data on patient volume and non-transport cases were analyzed from electronic patient care records between April 2023 and March 2024. Paired student t-tests and chi-square tests were used for statistical analysis. Fifty-seven paramedics participated, with 44 completing both pre-activity and post-activity surveys. Participants reported high satisfaction (average 4.65/5) and motivation (average 4.45/5). Post-activity surveys indicated an increase in confidence in determining patient capacity (P = .07). Over half of the participants improved their post-activity test scores, with an overall 12% increase in performance (P < .05). In the subsequent 6 months post-activity, there was a notable decrease in non-transport cases (18.3% to 15.2%). The findings of this study suggest that gamification is a viable method for teaching the topic of medical capacity to EMS providers in an engaging manner. Future studies should compare gamification with traditional teaching methods and explore its long-term impact and applicability to other medical topics and professionals. Limitations include the small, unequal sample size, focus on a single topic, lack of assessment of longer-term knowledge retention, and use of a non-validated survey.
Carotid artery stenosis and coronary artery disease are often co-morbid, with a prevalence of concurrent carotid and coronary artery stenosis approaching 50%. The optimal treatment for these patients has long been debated, with open carotid revascularization generally reserved for those with severe symptomatic carotid disease that precludes cardiac surgery. In this scenario, the role of less-invasive carotid artery stenting, particularly transcarotid arterial revascularization (TCAR), remains controversial and is not yet well studied. This study aims to present our outcomes and methodology for treating severe carotid stenosis with TCAR prior to cardiac surgery. A retrospective chart review of the previous 656 TCAR procedures performed from 2013 to 2024 identified 15 TCAR procedures conducted during the same hospital admission before cardiac surgery. The primary endpoint was 30-day stroke and myocardial infarction (MI). Secondary endpoints included operative time, cranial nerve (CN) injury, neck hematoma, length of stay, arterial dissection, and death. Fifteen patients underwent TCAR before cardiac surgery. Of these, 73.33% were men, with a median age of 65.98 years. Eighty percent of the cohort was asymptomatic, and the majority of the cohort had greater than 80% stenosis. Bridging anticoagulation treatment included aspirin and either heparin infusion (60.0%, n = 9), intravenous antiplatelet therapy such as cangrelor or eptifibatide (33.33%, n = 5), or subcutaneous enoxaparin (6.67%, n = 1). No patients experienced MI, stroke, CN injury, neck hematoma, or arterial dissection within 30 days. There were no deaths within 30 days. In our initial experience with TCAR prior to cardiac surgery, there were no cerebrovascular complications, suggesting the feasibility of same admission TCAR and cardiac surgery. In our experience, a range of anticoagulation bridging therapies did not result in apparent stent thrombosis and can be employed until the cardiac surgeon deems it safe to initiate oral dual antiplatelet therapy. Further studies with larger datasets are required to support the broader adoption of TCAR prior to heart surgery in patients with concurrent, severe cardiac and carotid disease.
Description This painting depicts young Asclepius under the guidance of Chiron, the wise centaur renowned for his knowledge of healing and medicine. In Greek mythology, Asclepius was entrusted to Chiron after Apollo recognized his potential. Within the nurturing environment of Chiron's home, Asclepius absorbed lessons on the use of medicinal herbs, wound treatment, and the foundational principles of care, skills that would eventually elevate him to become the Greek God of Medicine. The herbs symbolize hands-on learning and the practical foundation of healing, while the book signifies the accumulation and sharing of knowledge, showing how medical innovation progresses through study, collaboration, and the passing of wisdom. It's not just the transfer of knowledge, but the intentionality and patience in Chiron's teaching, mirrored in Asclepius's focused and reverent attention. This scene illustrates the timeless impact of mentorship and deliberate instruction. It shows that mastery is not instant but cultivated through observation, practice, and careful guidance. The relationship between teacher and student is depicted as a partnership in growth, emphasizing that the development of skill and wisdom requires patience, trust, and attentive presence. Medicine is not merely a collection of facts, but a craft honed through experience and human connection. The painting captures the essence of how knowledge is passed from teacher to student, highlighting the enduring importance of mentorship in shaping not only skill, but character and empathy.
Integrating palliative care into intensive care unit (ICU) practice is an essential component of comprehensive patient management, ensuring that critical interventions are aligned with patient-centered care objectives. This study aims to evaluate the impact of palliative care consultation (PCC) on clinical interventions, patient outcomes, and decision-making processes in a community-based medical-surgical ICUs. We conducted a prospective, observational, single-center cohort study of critically ill adult patients in a community-based medical-surgical ICU. Patients were grouped by the presence (PCCP) or absence (PCCA) of palliative care consultation. Primary outcomes included differences in clinical interventions (mechanical ventilation, vasoactive medications, renal replacement therapy, family meetings, code status changes, pain management, and comfort care directives). Secondary outcomes included ICU clinical course (Sequential Organ Failure Assessment (SOFA) score at 72 hours, length of ICU/hospital stay, ICU readmission, discharge disposition). Logistic regression was used to identify predictors for PCC involvement. Of 387 patients included, 27.6% (n = 107) received PCC. The PCCP group exhibited significantly higher use of non-invasive (46.7% vs 27.5%, P < .001) and invasive mechanical ventilation (62.6% vs 28.6%, P < .001), vasoactive medications (37.4% vs 20.4%, P < .05), and renal replacement therapy (9.3% vs 3.2%, P < .05). Additionally, PCCP patients more frequently underwent family meetings within 72 hours (75% vs 62.6%, P < .05), adopted DNR status (46.7% vs 7.9%, P < .001), and transitioned to comfort care and palliative extubation measures. Multivariate analysis identified higher SOFA scores within 24 hours of admission (odds ratio (OR) 1.16; 95% confidence interval (CI) 1.05-1.28) and age 85 or older (OR 0.19; 95% CI 0.05-0.72) as independent predictors of PCC involvement. Palliative care consultations in critically ill patients are associated with intensified clinical interventions, increased morbidity and mortality, and more frequent discussions regarding advanced directives and comfort-oriented care measures in a community-based mixed ICU. Future research should further elucidate the impact of PCC on patient and family satisfaction within ICU contexts.
Description The integration of artificial intelligence (AI) and machine learning (ML) into health care holds the potential to revolutionize patient care by enhancing clinical decision-making, improving diagnostic accuracy, and reducing costs. Despite this promise, adoption remains limited due to a range of technical, regulatory, educational, and cultural barriers. This paper examines these challenges and proposes strategies to support safe and effective implementation of AI in clinical practice. Key barriers include the lack of model interpretability, often referred to as the "black box" problem, which undermines clinician trust and accountability in clinical settings, evolving regulatory frameworks and unresolved questions surrounding liability, and persistent concerns regarding data quality, access, and privacy. In addition, bias in AI models remains a critical issue with implications for health equity. Beyond these established challenges, emerging barriers include a disconnect between academically developed models and real-world clinical development, as well as the need for substantial transformation in medical education to address AI assisted clinical workflows. The increasing use of AI in core clinical tasks, such as documentation and diagnostic support, also raises concerns regarding the potential erosion of fundamental clinical skills. Without deliberate training strategies, reliance on AI may compromise the development and maintenance of independent clinical reasoning. To address these challenges, this paper emphasizes the importance of interdisciplinary collaboration, transparent and interpretable model development, modernization of medical education, and the establishment of adaptive regulatory and ethical frameworks. Ultimately, the successful integration of AI in health care will depend on aligning technological innovation with clinical trust, education, and patient centered care.
Scholarly activity (SA) is a requirement of the Accreditation Council on Graduate Medical Education (ACGME); however, many programs struggle with interpreting ACGME trainee requirements and lack standardized tools to effectively communicate, document, and track individualized, resident-centered approaches to SA. This educational project aimed to develop a universal educational graduate medical education (GME) SA plan and scorecard tool to establish shared program expectations, provide formative and summative feedback on SA progression, track SA, and support individualized SA pathways aligned with residents' professional goals. In May 2022, faculty, associate program directors, and program directors within the North Texas Division of HCA Healthcare created the division-specific Resident GME Scholarly Activity Plan and Scorecard. The tool was introduced during didactic rollout sessions within the first 3 months of the 2022-2023 academic year. These residents completed a pre-didactic and post-didactic survey about the plan and scorecard using a 9-item, 4-point Likert and 5-point rating scale. Once approved, the tool was introduced at each new intern class during orientation and reinforced throughout their tenure. Scholarly activity productivity and utilization were measured over a 41-month period (October 2022-March 2026) across 12 programs. In 2022, participating residents (n = 142 pre and n = 152 post out of N = 298 total, a 51% response rate completed a pre-implementation didactic and post-implementation didactic survey. The mean overall score across the 9-item survey increased from 2.79 prior to the didactic session to 3.30 following the session, representing an absolute increase of 0.61 points (18.3%).Between October 2022-March 2026, a total of 548 residents used the plan and scorecard. Of these, 459 (83.8%) residents pursued the generalist track and 88 (16.1%) selected a fellowship-focused scholarly track. Forty-four fellowship-track residents (8%) remain in training and are actively using the scorecard. Forty-three fellowship-track residents (7.85%) successfully matched into their preferred fellowship programs. Eleven fellowship-track residents (2.01%) did not complete the recommended components outlined in the tool and did not match. Regardless of track, all residents met ACGME, HCA Healthcare, and program SA requirements. Scholarly productivity increased annually following implementation, from 45 projects in 2022, to 180 projects in 2023, 381 projects in 2024, and 461 projects in 2025. Implementation of a standardized tool provided SA structure and clarity for residents across a variety of ACGME programs and career pathways. Using an individualized, resident-centered approach to SA may promote scholarly productivity, increased tracking to meet graduation requirements, as well as fostering career development.
Patients with cancer are routinely prescribed extended-spectrum antibiotics despite overall low multidrug-resistant organism (MDRO) prevalence. Evidence for effective strategies to reduce antibiotic overuse in this population is limited. To evaluate the association of computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO risk estimates with empiric extended-spectrum antibiotic use in patients with cancer. This secondary analysis of the 4 Intelligent Stewardship Prompts to Improve Real-Time Empiric Antibiotic Selection (INSPIRE) cluster randomized clinical trials identified non-critically ill hospitalized adults (aged ≥18 years) with discharge diagnosis codes for hematologic or solid organ malignant tumors in the INSPIRE pneumonia, urinary tract infection (UTI), abdominal, and skin and soft tissue infection (SSTI) trials. Each trial evaluated the effect of CPOE prompts that used real-time patient-specific electronic health record data to estimate MDRO infection risk for patients prescribed extended-spectrum antibiotics during the first 3 hospital days; the prompt recommended standard-spectrum antibiotics when the risk of antibiotic-resistant infection was less than 10%. Extended-spectrum antibiotic days of therapy were evaluated using as-randomized, adjusted difference-in-difference analyses with generalized linear mixed-effects models and clustering by patient, hospital, and period. Days to intensive care unit transfer, hospital length of stay, hospital readmissions, and in-hospital mortality were also assessed. In all trials, 36 861 patients (mean [SD] age, 69.0 [13.6] years; 19 076 [52%] female), including 18 272 baseline and 18 589 intervention patients, had cancer. Extended-spectrum antibiotic days of therapy decreased by 27% (rate ratio [RR], 0.73; 95% CI, 0.67-0.80; P < .001) in the pneumonia trial, 24% (RR, 0.76; 95% CI, 0.68-0.84; P < .001) in the UTI trial, 17% (RR, 0.83; 95% CI, 0.74-0.92; P < .001) in the SSTI trial, and 24% (RR, 0.76; 95% CI, 0.69-0.84; P < .001) in the abdominal infection trial. Pre-post changes in hospital length of stay, intensive care unit transfers, readmissions, and in-hospital mortality were similar in the 2 groups. In this secondary analysis of randomized clinical trials, an antibiotic stewardship bundle that included CPOE prompts recommending standard-spectrum antibiotics for patients at low risk for antimicrobial-resistant infections was associated with reduced extended-spectrum antibiotic use in non-critically ill patients with cancer who were hospitalized with community-acquired pneumonia, UTI, SSTI, or abdominal infection, without observed differences in safety outcomes. The findings support scalable, low-burden strategies to improve antimicrobial use in patients with cancer, a population with limited evidence to guide stewardship. ClinicalTrials.gov Identifiers: NCT05423756, NCT05423743, NCT03697070, NCT03697096.
Understanding the impact of psychiatric pre-existing conditions (PsyPECs) on trauma outcomes is crucial, as trauma is the leading cause of mortality for Americans aged 1-45. Although previous regional studies have shown higher mortality rates and longer hospital length of stay (H-LOS) for injured patients with PsyPECs, this has not been studied at the national level. The purpose of this study is to identify the PsyPECs associated with mechanism of injury and other outcomes in adult patients admitted for trauma in the United States' trauma centers. Data were extracted from the National Trauma Data Bank (NTDB). There were 5301 patients who had PsyPECs, out of 2 636 037 patients in NTDB that met inclusion criteria. The PsyPECs studied were schizophrenia, bipolar disorder, major depressive disorder (MDD), and anxiety disorders, including generalized anxiety, panic, specific phobias, and other unspecified anxiety disorders. Regression analyses were conducted, adjusting for age, sex, and status on diabetes mellitus and obesity. Falls as the mechanism of injury were more likely to occur among patients with an anxiety disorder, MDD, or bipolar disorder. Patients with schizophrenia, bipolar disorder, or MDD had higher odds of stabbing injuries (cut/pierce). However, patients with an anxiety disorder had decreased odds of stabbing injuries. Patients with schizophrenia or bipolar disorder were more likely to be hit by a car compared to patients without PsyPECs. Patients with an anxiety disorder had higher odds of intensive care unit readmission. A longer H-LOS was associated with patients with schizophrenia (1.30 days), bipolar disorder (2.15 days), MDD (0.58 days), or anxiety disorder (0.76 days) compared to patients without those PsyPECs. Pre-existing psychiatric conditions impact traumatic injury mechanisms, injury type, and outcomes. This study indicates the need for further research on this population. Incorporating mental health into trauma care plans may improve outcomes. Understanding the role that psychiatric illnesses may play in injury and recovery is essential for delivering high quality, effective trauma care.
Ongoing improvement and evaluation of clinical care are essential to maintaining high standards. The Accreditation Council for Graduate Medical Education (ACGME) requires all accredited family medicine programs to provide quality improvement (QI) education. Given competing educational demands, residency programs must adopt innovative approaches to teaching QI. This article describes an individualized approach to QI education that we implemented in our family medicine residency program and the outcome of its evaluation. Guided by a logic model and evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, this quasi-experimental 1-group pre-test-post-test study (July 2022-June 2023) involved all second-year family medicine residents during a protected QI month. Residents participated in a 1-on-1 session with a QI expert, completed a 10-item baseline knowledge survey, received 4 weekly mentoring meetings to develop a QI charter to address resident-selected quality gap, and completed an online QI module. Knowledge was reassessed at the month's end, and an end-of-year survey evaluated perceptions and sustainability. The program achieved 100% reach with the participation of all 12 residents. Knowledge scores improved from 6.25 (±2.2) to 9.0 (±0.95) out of 10 (P < .001). Adoption was high, with all residents completing the module and a QI charter; implementation fidelity was 100%. Ten residents (83%) completed the end-of-year survey, unanimously reporting improved understanding of QI and confidence to lead future projects. An individualized mentoring approach to QI education was feasible and effective, enhancing resident knowledge and readiness to design targeted improvement initiatives.
Residents report barriers to engaging in scholarly activity despite this being a common requirement across residency programs. Two commonly reported barriers are a lack of mentorship by faculty and a lack of ideas for projects that meet the criteria for scholarly activity. The study objective is to describe the effect of an intervention to address a lack of mentorship and a lack of ideas for scholarly activities. A retrospective cohort design was utilized to investigate changes in scholarly activity between 2 academic years. An internal medicine residency program with 30 residents and 17 faculty members participated in an educational innovation in the 2022/2023 academic year. Residents in the previous academic year (n = 30) served as the comparison group. The faculty brainstormed ideas for new projects and provided sign-up sheets with quick response (QR) codes. First-year residents had to either sign up for a project or have their own protocol developed within 3 months of beginning residency. The intervention group participated in more original research projects, presentations, and publications in PubMed indexed journals than the comparison group. The most notable increase was in presentations at regional and national conferences, which rose from 3 to 7. Participation in projects across other post-graduate year groups also increased. Faculty members brainstorming ideas, providing a hard deadline for first year residents, and the use of a QR code to recruit residents to existing research teams provided a cheap, easily implemented scholarly activity intervention. Other programs may benefit from adopting a similar program if possible.
Leadership competency development is a pivotal component of physician professional identity formation (PIF), and its instruction across undergraduate medical education (UME) institutions is diverse. Near-Peer Educator Programs (NPEPs) foster experiential leadership development through teaching junior learners. We evaluated the impact of participation in a structured longitudinal NPEP on medical students' self-reflections of their leadership growth. Medical students serving as Near-Peer Educators (NPEs) were invited to complete a baseline survey prior to facilitating any sessions and a follow-up survey after facilitating more than 1 session. The surveys, measured using a 7-point Likert scale, were modeled on a validated clinical educator self-assessment tool and questions were aligned to reflect seven leadership competencies defined as developmentally appropriate for graduating medical students. Baseline surveys measured self-perception of leadership skills before participation, while follow-up surveys assessed perceived improvement and practice of these skills. Fifty-eight new NPEs completed the baseline survey, and 82 students completed the follow-up survey. At baseline, NPE's self-ratings were highest for the team dynamics (5.2 ± 1.2), and diversity, equity, inclusion, and belonging (5.5 ± 1.2) competencies. In the follow-up survey, students reported significant improvements across all leadership domains, with the highest improvement scores in fostering adaptive learning and growth mindset (5.6 ± 1.2) and developing emotional intelligence (5.6 ± 1.2). Participation in a NPEP improved perception of competency across various leadership domains, contributing to the PIF of medical students. Near-peer educator programs offer a well-established, adaptable model for integrating experiential and longitudinal leadership training into UME curricula.
Patient experience is increasingly used as a public quality metric, but its relationship to hospital safety grades remains incompletely characterized because patient reported experience and technical safety measures capture different dimensions of care. We performed a retrospective cross-sectional analysis of publicly available hospital level data from 2023. Leapfrog Hospital Safety Grades were linked with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience scores. The linked dataset included 1,442 U.S. hospitals; 1,390 hospitals with letter grades A through F were included in grade stratified and regression analyses. HCAHPS domains were analyzed on a 1-5 scale, with higher scores indicating more favorable patient reported experience. One way ANOVA compared mean HCAHPS scores across Leapfrog grades. Multivariable logistic regression with hospital size adjustment evaluated HCAHPS domains associated with Leapfrog Grade A versus grades B through F. Mean HCAHPS domain scores declined across most domains as Leapfrog grades worsened from A to F. In multivariable analysis, nurse communication was associated with higher odds of receiving a Grade A safety rating (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.11 to 2.13; p = 0.01), as was the hospital recommendation score (OR 1.54, 95% CI 1.15 to 2.06; p = 0.004). Doctor communication showed an inverse conditional association (OR 0.75, 95% CI 0.59 to 0.97; p = 0.03). Other HCAHPS domains were not independently associated with Grade A after adjustment. Hospitals with higher Leapfrog safety grades generally had more favorable patient reported experience scores, and nurse communication and hospital recommendation were the most clinically interpretable independent predictors of Grade A status. The inverse association for doctor communication should be interpreted cautiously because HCAHPS domains are correlated and the analysis used hospital level cross-sectional data. These findings support the complementary role of patient experience in hospital quality assessment but do not establish causality.
Assessment of lower limb alignment is a cornerstone of orthopaedics. Few studies look at rotational alignment in the axial plane as measured by femoral version (FV) and tibial torsion (TT), both of which have implications for hip, knee, and ankle pathology. This review provides an overview of the axial rotation and evaluates CT-based measurement methods for FV and TT to identify the most reliable and reproducible techniques for use in clinical practice. A systematic PRISMA-guided review assessed original CT-based methods, examining inter- and intraobserver reliability (intraclass correlation coefficient (ICC)), frequency of use, and validation. Seven FV and nine TT CT-based techniques were identified. FV had a weighted mean of 17.8° anteversion (-9° to 60°). TT had a weighted mean of 30.8° (2° to 82°). ICCs ranged from good to excellent. The Murphy method (FV) and Goutallier method (TT) had the highest reliability and clinical utility. Lower limb axial rotational profile plays an important role in the management of hip, knee, and ankle arthroplasty surgery as well as many other orthopaedic pathologies. The Murphy and Goutallier methods should be adopted as standard for measuring FV and TT. Their high reproducibility and validation make them ideal for consistent clinical and research use.
The American Board of Surgery (ABS) requires trainees to pass both a written qualifying examination (ABSQE) and oral certifying examination (ABSCE) to achieve board certification. The high-stakes nature of the ABSCE, which assesses knowledge, clinical judgment, and decision-making, necessitates extensive preparation. To address the challenges of the ABSCE format and associated trainee stress, structured mock oral programs have been developed. Here we evaluate the impact of structured mock oral sessions on residents' comfort levels and familiarity with the ABSCE at a single institution. A mixed-methods survey was given to 50 general surgery residents in different training years who participated in 1-hour individual mock oral sessions with an attending surgeon between August 2021 and February 2024. The survey assessed demographic information, previous oral board practice experience, confidence describing the test format, and identified common pitfalls before and after the session. Statistical analyses using McNemar's chi-square test and a thematic analysis of open-ended responses were performed. We observed a significant increase (70% of participants) in residents' reported confidence while describing the ABSCE format and identifying common pitfalls (68% of participants) after the sessions, compared to pre-implementation of the mock oral practice sessions. Many residents (97.9%) found value in frequent mock oral sessions. Residents identified insufficient practice, clinical experience, and time for preparation as barriers to their success. Repeated, low-stakes mock oral practice sessions and protected educational time are valued by residents and could enhance examination readiness, thereby improving ABSCE pass rates (68%, prior to the 1:1 mock oral sessions, to 83% after the sessions were implemented). Future studies should explore the nationwide impact of integrating regular formal mock oral sessions into surgical residency programs.
Benign transient hyperphosphatasemia (BTH) in children is characterized by temporary highly elevated serum alkaline phosphatase (ALP) activity in the absence of liver or bone disease and a return to normal within 3 to 4 months. Since its first description in the 1950s, several cases of BTH in infants and children have been reported. Although there is no known etiology for this illness, it has been associated with viral infections. This condition has rarely been seen in the adult population, and there is scarce available information. The sialylation of the ALP isoenzymes decreases their renal clearance from the circulation; however, the pathophysiology behind the increased sialylation of the ALP is uncertain. This is a 62-year-old female with a history of hypertension who was seen for a routine checkup and was found to have elevated ALP. The patient reports a family history of primary biliary cirrhosis. Routine labs showed an isolated elevation of ALP at 1496 U/L (normal range is 44 to 147 U/L). A physical examination and review of systems revealed no evidence of liver disease or bone abnormalities. Lipase, thyroid-stimulating hormone (TSH), T3, T4, parathyroid hormone, vitamin D, electrolytes, and markers for autoimmunity and tumors were found within normal limits. The abdominal ultrasound, the computerized tomography (CT) with contrast of the abdomen, and the bone survey were unremarkable. Alkaline phosphatase electrophoresis showed equally elevated liver and bone isoenzymes with a typical pattern of BTH. Serial ALP levels showed normalization by week 8 from the initial abnormal level. Benign transient hyperphosphatasemia is a rare condition mostly seen in children, and it is even rarer for it to present in adults. It is speculated that BTH is caused by a transient decrease in the clearance of ALP. The adult presentation of BTH is poorly described in medical literature, limiting the ability of medical providers to make an early diagnosis and avoiding extensive investigations.