Prostate cancer (PCa) imaging is increasingly central to diagnosis, staging, and follow-up. Several scoring systems have been proposed to standardize interpretation and facilitate clinical decision-making across modalities. In magnetic resonance imaging (MRI), besides the well-established Prostate Imaging Reporting and Data System score for PCa diagnosis and the Prostate Imaging Quality score for image quality, it is possible to interpret prostate MRI findings using: The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation score in active surveillance, the Prostate Imaging after Focal Ablation or the Transatlantic Recommendations for Prostate Gland Evaluation with MRI After Focal Therapy after focal therapy, or the Prostate Imaging for Recurrence Reporting after prostatectomy or radiotherapy. Beyond MRI, the Prosate Imaging for MRI Instead of Measurements of Aggressive disease in Recurrent/Risk Yields (PRIMARY) scores support prostate-specific membrane antigen-positron emission tomography (PSMA-PET) interpretation, whereas the Prostate Risk Identification using Micro-ultrasound score enables real-time risk assessment and targeted biopsy guidance using the new microultrasound (US) technology. In this mini review, we aim to summarize the current evidence on intraprostatic imaging scoring systems for MRI, PSMA-PET, and US, providing a hands-on guide with practical insights to support their interpretation and routine clinical use. PATIENT SUMMARY: Imaging plays an increasingly important role in prostate cancer management, from diagnosis to treatment planning and follow-up. To help clinicians interpret imaging results consistently, several standardized scoring systems have been developed for intraprostatic imaging. For magnetic resonance imaging, the most used score (Prostate Imaging Reporting and Data System) helps identify suspicious areas that require biopsy to guide biopsy decisions, whereas other scores are used to monitor the disease over time or after treatment. Newer imaging techniques, including prostate-specific membrane antigen-positron emission tomography and microultrasound, also have dedicated scoring systems to standardize reporting. Understanding these tools helps clinicians make more informed decisions and tailor the management of patients.
IntroductionCorrect inhaler technique is of utmost importance in the optimal delivery of therapeutics utilized for respiratory illnesses. Previous research suggests that the ability of both patients and providers to correctly use these inhalers is sub-optimal and is associated with poorer patient outcomes. Further education about inhaler types and technique as part of residency education could serve to correct these trends.MethodsFamily medicine residents were taught correct inhaler technique with an inhaler training device (In-CheckTM DIAL G16) using a didactic lecture with hands-on teaching exercise utilizing pharmacy interprofessional teaching. We assessed pre- and post-intervention comfort and knowledge of correct inhaler technique.ResultsTwenty of twenty-seven eligible family medicine residents attended an interdisciplinary workshop with clinical pharmacists with the purpose of improving inhaler technique comfort level and knowledge. A pre- and post-knowledge test and comfort questionnaire were provided to those participating. Comfort levels with prescribing different inhaler types increased after the intervention and knowledge of different inhalers improved.ConclusionUse of an inhaler training device coupled with an interdisciplinary lecture format improved provider knowledge of correct inhaler technique and comfort with prescribing inhalers.
Artificial intelligence (AI) is increasingly being used in many aspects of society, including health care and education. AI has the potential to enhance health care delivery, education, and administration. Health care trainees will be required to master these AI technologies. To teach trainees to effectively and ethically leverage AI technologies, educators must be appropriately trained and empowered to use these technologies. We developed a health professions education course to enable health care professionals to overcome their fears and concerns about integrating multimodal generative AI technologies in daily practice. The course was also designed to foster generative AI skills and confidence in educational, administrative, research, and clinical activities. Using a multimethod approach, we analyzed data gathered from three different sources using the 6-phase reflexive thematic analysis by Braun and Clarke. This involved familiarization with the data sources, generating initial codes, developing, refining, and defining the themes, and finally, writing up the results. Our findings indicate that 16 of 21 (76%) learners initially described apprehension or fear toward AI technologies. After experiential engagement with AI technologies together with their peers, they were able to shift their perspectives and gain confidence to integrate AI tools in their daily practice. A brief 6-week continuing professional development course on the use of AI technologies for health care professional educators, focused on experiential and peer-based learning, resulted in shifts in perception, affect, and behavior toward AI technologies. It also propelled learners to shift increasingly outward in their discussion, application, and preliminary advocacy for AI technologies in their daily practice.
Electrical impedance tomography (EIT) provides a noninvasive means of assessing posture-related end-expiratory lung impedance and the regional distribution of ventilation. However, the physiological effects of specific bedside postures, including the hands-on-knees and tripod positions, have not been fully characterized using EIT in spontaneously breathing individuals. We aimed to compare the end-expiratory lung impedance and regional ventilation distribution of healthy volunteers across a range of postures as a physiological proof-of-concept to inform future clinical investigations. The regional end-expiratory lung impedances (ΔEELI) of 20 healthy male subjects who adopted the 6 following postures were compared: supine, prone, sitting, tripod, hands-on-knees, and standing. The distribution of ventilation between the dorsal and ventral lung regions was also analyzed for each posture. The Wilcoxon test with the Holm-Bonferroni correction was used to compare the datasets. Compared with the supine posture, the hands-on-knees posture was associated with the highest global ΔEELI (3.58 units, 95% CI: 2.81-4.58, P < .001), followed by the tripod position (2.16 units, 95% CI: 1.69-3.47, P < .001). With respect to the regional ventilation, dorsal ventilation was significantly better for all other postures versus the supine posture, particularly for the hands-on-knees and tripod position (ΔEELI in the dorsal region 2.77 units, 95% CI: 2.02-3.33, and 2.02 units, 95% CI: 1.35-2.64, respectively; both P < .001). In healthy men, the hands-on-knees and tripod postures were associated with greater global and dorsal end-expiratory lung impedance and a more dorsal ventilation distribution. Whether these physiological observations might translate to clinically meaningful improvements in patients with respiratory disease warrants further investigation in clinical studies.
Next Generation Sequencing (NGS) based microbial surveillance has become a critical tool for public health initiatives, providing insights into complex interactions within microbial communities. This understanding can be used to facilitate outbreak investigations, pathogen surveillance, and resistance prevention. However, current sample preparation methods are prone to human error and sample bias resulting in skewed Gram +/- coverages and low yields. Methods that have been optimized for non-bias extraction, like mechanical bead beating, are not easily integrated with automation, preventing widespread scalability. Here, we present an innovative, fully automated method that integrates enzymatic lysis, extraction, and library preparation in a single-operator, single-cartridge workflow. The workflow was designed to substantially reduce hands-on time and minimize Gram-stain-related biased extraction. A capillary-based liquid handler is leveraged to reduce hands-on time from 8 to 10 h to less than 45 min. Using mixed microbial communities, we demonstrated that the workflow consistently produces high-quality sequencing libraries with an average yield of 80.5 ng/µL, average quality score of 33.6, and using the ZymoBIOMICS Microbial Community Standard, a 2.46-fold improvement in Gram-positive representation relative to a standard lysis protocol. To our knowledge, this is the first demonstration of a fully integrated capillary-based workflow combining enzymatic lysis, extraction, and library preparation compatible with low-throughput platforms. While automated NGS preparation systems exist, they predominantly rely on high-throughput liquid handling robotics, require separate equipment/workflows for extraction and library preparation, or do not support unified workflows for Gram-positive and Gram-negative extraction. The present approach addresses the low-throughput, cost-sensitive, rapid-turnaround requirements of public health and clinical microbiology settings. This proof-of-concept study demonstrates a fully automated workflow for microbial NGS sample preparation, benchmarked on a standardized mock community. This work offers a transformational engineering foundation with the potential to increase efficiency and reproducibility of pathogen genomics workflows, enabling faster outbreak detection and more comprehensive surveillance programs.
Occupational therapy practitioners (OTPs) are vital members of the multidisciplinary team involved in caring for pediatric clients diagnosed with arthrogryposis multiplex congenita (AMC). However, a shortage of educational resources on AMC has led to gaps in knowledge and OTPs feeling inadequately prepared to provide comprehensive care. A 4-h continuing education (CE) course on caring for pediatric clients with AMC was designed using evidence-based literature and structured using the person-environment-occupation model. The occupation-based model guided learners to understand how therapy can intervene to improve occupational performance. The course was presented at the Texas Occupational Therapy Association 2024 Conference. Ten learners completed a pre- and postcourse examination, pre- and postcourse self-assessment, and course evaluation. Results indicated significant changes (p < 0.001) in knowledge acquisition, awareness, and preparedness to care for pediatric clients with AMC. Learners expressed greater clinical reasoning following the completion of clinical vignettes and hands-on activities. Overall, learners found the course to be well-developed. The development and implementation of the CE course led to significant changes in learners' awareness and preparedness to treat pediatric clients with AMC. OTPs should utilize advanced training CE courses based on learning theories and hands-on training opportunities to ensure safe and appropriate care. Future research should investigate longitudinal changes in learning and the impact of course design on learning.
Point-of-care ultrasound is essential in the initial assessment of polytrauma patients. The E-FAST protocol enables rapid detection of intra-abdominal free fluid, pericardial effusion, and pneumothorax, with particular usefulness in prehospital settings. However, ultrasound training among emergency nursing staff remains limited, especially within Advanced Life Support (ALS) mobile units. To evaluate the effect of a brief, structured training program on the acquisition of competencies for obtaining E-FAST windows in ALS mobile units nurses, assessing knowledge, technical skills, scanning sequence, and perceived confidence. A quasi-experimental pre-post intervention study was conducted with nurses with ≥6 months of experience in emergency or prehospital care. The intervention included baseline assessment, a 2-h theoretical module, high-fidelity simulation with Ultrasound Mentor®, and hands-on practice with human models. Final assessment combined a theoretical test, simulator-based practical evaluation, and scanning with a real ultrasound device. Knowledge, execution times, and confidence levels were recorded. Fourteen nurses participated, most without previous ultrasound training (85.7%). Initial confidence was low and improved significantly after the intervention. Theoretical performance increased in 5 of the 6 evaluated items, reaching up to 92.9% accuracy in key content areas. Practical assessment demonstrated an organized scanning sequence and appropriate times for prehospital care (medians of 118 s [IQR 24.5] in advanced simulation and 237 s [IQR 33.3] using a real ultrasound device). The program enabled the acquisition of essential skills even in professionals without prior ultrasound experience. The combination of theory, simulation, and hands-on practice facilitated rapid competency transfer and protocol standardization. A brief training program improves ALS mobile units nurses' competence and confidence in obtaining E-FAST windows, supporting the safe integration of point-of-care ultrasound into prehospital care.
Point-of-care ultrasound (POCUS) is increasingly used in inpatient settings to evaluate patients. Common applications include cardiac, lung, hemodynamic assessment, and venous access. Teaching and achieving competency in these applications are highly resource intensive and require hours of dedicated faculty support. We evaluated the impact of a hybrid asynchronous and hands-on inpatient POCUS curriculum for family medicine residents transitioning from intern to senior roles. Family medicine residents participated in an inpatient POCUS course during a dedicated 2 week transition period between postgraduate years (PGYs) 1 and 2. The curriculum included 100 minutes of asynchronous precourse videos followed by a 4 hour in-person session with POCUS trained faculty. The hands-on session included scanning live patients and ultrasound-guided venous access on homemade task trainers. Participants completed pre- and postintervention surveys as well as a written examination. Thirteen family medicine residents completed the course. Participants reported an increase in overall comfort with inpatient POCUS, with a mean improvement of 0.9 points on a 5-point Likert scale composite score (p<0.001). Self-reported comfort improved across all domains, including image acquisition, image interpretation, and clinical integration. Written examination scores did not improve preintervention (64.1%) to postintervention (65.4%) intervention (P = 0.78). A brief hybrid inpatient POCUS course was associated with improved confidence in performing and integrating POCUS exam types for the inpatient setting, but did not result in improvement in a written knowledge assessment. These findings suggest that a short introductory boot camp can be beneficial and may be strengthened with a longitudinal curricula and more robust competency assessments.
This quality improvement project aims to evaluate the perceived benefits among early-career dentists in managing furcal perforations using a simulated clinical environment. The project focuses on the use of 3D printed models with furcal perforation and hydraulic calcium silicate-based cement to repair it, coupled with magnification tools. The project was conducted over 2 years with two cohorts of dental core trainees. Each cohort participated in a half-day program. The session consisted of theoretical training on the causes, prognosis and management of perforations and was followed by hands-on practice, where trainees repaired furcal perforations on 3D printed teeth using hydraulic calcium silicate-based cement. Pre- and post-intervention surveys were administered to assess changes in knowledge, confidence and perceived competence. Trainees reported increased confidence in managing furcal perforations post-training. The use of 3D printed teeth provided a realistic and controlled environment for practice, with the opportunity to use hydraulic calcium silicate-based cement and magnification for effective repairs. Early-career dentists benefit significantly from practical experience in a simulated environment. The combination of theoretical knowledge and hands-on practice using advanced materials and tools improves their competence in managing furcal perforations, potentially leading to better clinical outcomes. This project underscores the importance of simulation-based training in dental education and its role in enhancing procedural skills and confidence among trainees.
Despite the national rollout of the Helping Babies Breathe (HBB) program, neonatal mortality due to birth asphyxia remains a major challenge in Tanzania. Evidence shows that there is inadequate competence (including knowledge, skills, and attitudes) in newborn resuscitation among medical and nursing interns as they transition into practice. The traditional method of a one-day instructor-led HBB model provides little hands-on practice. Integrating low-fidelity simulation with blended learning may contribute to better transfer of learning and offer a more sustainable model for skills retention. To evaluate the efficacy of interprofessional low-fidelity simulation with a blended-learning approach among medical and nursing interns' HBB knowledge and skills in Dar es Salaam. A controlled quasi-experimental design was used with 128 participants. Stratified random sampling by profession was used to select participants for the two groups (64 in the intervention group, 64 in the control group). The intervention group received a 2-h instructor-led online session and two days (16 h total) of hands-on low-fidelity simulation, guided by the HBB 2nd Edition curriculum (which emphasises the Golden Minute, preparation for birth, initial steps including stimulation and warming, bag-mask ventilation, and post-resuscitation care through interactive case-based scenarios and paired practice). The control group received reading materials and continued with their business-as-usual practice. Knowledge (17-item MCQ) and skills (18-item checklist) were assessed at baseline, immediately after intervention, and six weeks post-intervention for both groups. Data were analysed using IBM SPSS version 27, with an independent t-test and a linear mixed model (LMM). β coefficients represent adjusted mean differences from linear mixed models. The groups were similar at baseline. The intervention group showed significant improvements compared with the control group. Knowledge score increased by β = 5.39 immediately post-intervention post-training, and by β = 3.90 in six weeks (both p < 0.001). Skills improved by β = 5.36 immediately and β = 3.47 at six weeks (both p < 0.001). Low-fidelity simulation with blended learning significantly improved HBB knowledge and skills among interns, with effects sustained at six weeks. This approach is practical and scalable for strengthening newborn resuscitation capacity in resource-limited settings. Trial registered to Pan African Trial Registry with Reg no PACTR202512785351089.
Pressure injury prevention relies heavily on nurses' ability to recognize risk, implement preventive measures and respond promptly to early skin changes. Before developing large-scale training programs, it is important to understand nurses' current self-rated competence and their learning needs. This study assessed clinical nurses' self-rated knowledge, attitudes, self-reported practices and training needs related to pressure injury prevention in a multicenter sample. A multicenter cross-sectional survey was conducted among 997 clinical nurses from 34 hospitals. Data were collected using an online questionnaire covering demographic characteristics, self-rated pressure injury-related knowledge, attitudes, self-reported preventive practices and training needs. Domain scores were standardized to a 0-100 scale. Descriptive analyses were used to summarize item-level findings and training needs. Subgroup comparisons were performed to examine differences in knowledge, attitude and practice (KAP) domain scores across professional and institutional groups. Exploratory multivariable linear regression was used to examine factors associated with self-reported practice scores. The mean standardized scores for self-rated knowledge, attitude and self-reported practice were 91.24 ± 10.87, 95.05 ± 9.38 and 77.44 ± 20.23, respectively. Attitude scores were high, while self-reported practice scores were lower and more widely distributed. Areas requiring further attention included dressing use, stage-specific management, pressure-relief strategies, consultation with wound, ostomy and continence specialist teams, and wound photo documentation. Nurses working in hospitals with pressure injury specialist teams reported higher KAP domain scores. In exploratory multivariable analysis, hospital specialist team status was associated with higher self-reported practice scores after adjustment. Training needs were high, with hands-on bedside instruction, online video learning and continuing education lectures being the most preferred approaches. This multicenter survey showed that nurses generally held positive attitudes toward pressure injury prevention, but gaps remained in self-rated knowledge and self-reported practice, especially in areas requiring clinical judgment, documentation and hands-on skills. These findings may inform the development of needs-based, blended education that combines online learning with bedside guidance, case-based discussion and specialist team input.
This study aims to investigate the impact of the Philosophy for Children (P4C) education program on preschool children's executive functioning skills in an out-of-school learning environment. The study used a mixed-methods approach, combining a pre-test-post-test control group experimental design with in-depth interviews. Quantitative data were collected using the Executive Functioning Skills Scale (EFSS), developed by the researchers, while qualitative data were gathered through a Semi-Structured Interview Form. The research involved 37 children (17 in the experimental group and 20 in the control group) and 17 parents, who participated in a 16-session Out-of-School Learning Environment Philosophy for Children (OSLE-P4C) program held in various settings, including libraries, museums, and forests. Quantitative analyses conducted after the eight-week OSLE-P4C education program showed a significant improvement in the executive functioning skills of children in the experimental group (p < 0.05). The mean total executive functioning score of the experimental group (x̄ = 52.59) was notably higher than that of the control group (x̄ = 32.85). This large effect size (η2 = 0.94) supports the program's effectiveness. The retention test (x̄ = 56.71) indicated that the gains remained evident one month after the initial assessment. Qualitative results showed that the program led to tangible, positive changes in children, particularly in socialization, creativity, attention, and planning. The quantitative and qualitative findings demonstrate that the OSLE-P4C training program contributes to the development of executive function skills in preschool children. Hands-on learning and exposure to diverse environments enhanced the program's effectiveness.
Continuous renal replacement therapy (CRRT) is a technically complex, high-risk ICU therapy in which preventable interruptions, alarm-related downtime, and circuit failure remain common and strongly influenced by clinician-dependent troubleshooting. High workforce turnover and variable local mentorship further limit consistent skills acquisition, while institutional heterogeneity in practice persists across settings. Despite these realities, structured CRRT training and validated competency assessment frameworks remain inconsistently implemented, creating a critical gap between clinical demands and current educational infrastructure. Simulation-based education offers a uniquely suitable strategy to address these gaps by enabling safe, reproducible deliberate practice of rare-but-critical events, structured development of higher-order decision-making, and multidisciplinary rehearsal of time-sensitive troubleshooting. This narrative review synthesizes current evidence on simulation-based CRRT training, spanning traditional low- and high-fidelity in-person approaches as well as technology-enhanced virtual modalities such as screen-based platforms, virtual/augmented reality environments, and embedded learning analytics. We highlight how these approaches can improve accessibility and scalability by delivering standardized, repeatable practice of high-risk workflows (e.g., circuit setup, alarm management, escalation decision-making) across institutions with variable equipment, faculty expertise, and local CRRT volume. We also review emerging artificial intelligence-enabled approaches, including adaptive simulation engines and large language model-driven virtual patients, that may enable dynamic scenario progression, performance-targeted feedback, and more cognitively realistic longitudinal patient trajectories. Finally, we propose practical principles for integrating simulation modalities in a layered framework aligned with competency domains and cognitive demands, while emphasizing how digital innovation could augment hands-on practice, bedside supervision, and expert mentorship to improve CRRT competency, standardization, equity, and safety worldwide.
Long COVID is a prevalent condition characterised by pain, fatigue, disability, and a multitude of health issues. There are various treatment options for managing long COVID symptoms, including non-pharmacological interventions like physiotherapy and rehabilitation, which can be effectively delivered either in institutional care settings or via telerehabilitation. This three-arm randomised controlled trial included 145 participants selected from a population-based cohort in eight administrative divisions in Bangladesh. Participants aged 18 and above diagnosed with chronic fatigue syndrome (CFS) secondary to long COVID were included and history of fatigue, cardiovascular, neuro-musculoskeletal, or respiratory diseases, or red flag signs were excluded. Participants were allocated to three groups: hospital-based rehabilitation (HBR), telerehabilitation (TR), or a home programme (HP). Interventions consisted of an individualised exercise programme. The HBR and TR groups received physiotherapist-supervised sessions with sessions lasting 45 min, twice weekly for 8 weeks. And the HP group performed exercises independently following structured instruction. Fatigue, the primary outcome, was measured using the Chalder fatigue scale, while secondary outcomes were quality of life measured using the 36-item Short Form Survey (SF-36), disability-adjusted life years (DALYs), and cardiorespiratory parameters (blood pressure, pulse rate, oxygen saturation, and lung capacity). Between 1st July 2023 and 31st December 2023, 145 participants were enrolled, with a mean age of 46.1 ± 6.7 years. After 8 weeks of intervention, the among-group within-group comparison showed a significant difference in fatigue level (HBR: P < 0.001; TR: P < 0.001; HP: P < 0.321), physical functioning (HBR: P < 0.001; TR: P < 0.001; HP: P < 0.057), and episodic disability (HBR; TR; HP: P < 0.001) among the participants when comparing them between the groups. In multiple comparisons, results showed that differences were observed in the Chalder fatigue scale, physical functioning, and episodic disability between all groups. Hospital-based rehabilitation showed a lower mean score compared to telerehabilitation (p < 0.0001) and the home programme (p < 0.0001). Additionally, telerehabilitation was significantly better than the home programme (p < 0.0001), indicating hospital-based rehabilitation's superior efficacy in reducing fatigue, improving physical function, and reducing disability. Physiotherapy as hands-on implementation in a hospital setting was substantially more effective than telerehabilitation. Training healthcare professionals to improve accessibility to rehabilitation would help mitigate the consequences of long COVID-19. The trial was registered with the clinical trial registry of India (CTRI/2023/03/050808. Registered on 17/03/2023).
Maggot debridement therapy (MDT) is a biotherapeutic approach that uses sterile larvae to remove necrotic tissue and promote wound healing. Although its effectiveness in managing chronic wounds is well established, clinical adoption remains limited. Nurses are central to wound care, yet little is known about their MDT knowledge in Malaysia. This study assesses nurses' knowledge of MDT and examined the influence of demographic, professional, and educational factors within a tertiary teaching hospital setting. A cross-sectional study was conducted among 165 nurses selected through random sampling. Data were collected using a validated self-administered questionnaire assessing sociodemographic data, professional experience, and MDT knowledge. Descriptive statistics were used to summarize data, and Pearson chi square and Fisher's Exact test were applied to determine associations between knowledge levels and key variables. The mean age of participants was 32.72 years. Of these, 41.8% had 6-10 years of experience, 89.7% held a nursing diploma, and 87.9% had heard of MDT. Only 26.1% demonstrated high knowledge, while 52.7% showed low knowledge. A significant association was found between knowledge level and having heard of MDT (p = 0.040) and having performed MDT (p = 0.025). Nurses demonstrated limited knowledge and practical experience in Maggot Debridement Therapy despite general awareness of its clinical value. Knowledge was significantly associated with prior exposure and hands-on experience, underscoring the importance of experiential learning. Incorporating MDT into nursing curricula, continuous professional development, and institutional protocols is crucial to enhance evidence-based wound care and clinical adoption.
Teaching in the field of "Medical Microbiology, Virology, and Hygiene" focuses on the development of clinical competence in infection medicine, primarily achieved through time- and cost-intensive practical courses, which often compete with other educational offerings. These courses must address the defining feature of transmissibility of infectious agents, with far-reaching consequences for individual patients, their environments, society, animals, and the broader ecosystem (One-Health concept). Understanding the complexity of pathogen-associated risks requires comprehensive knowledge in epidemiology, prevention, diagnostics, and therapy of infectious diseases. Ensuring long-term resilience in the medical profession against the challenges of infectious diseases can only be achieved through fostering infection-related competencies in medical students. Qualified infection diagnostics are a core competence for independent, evidence-based medical practice. Proficiency in rapid and appropriate infection diagnostics is indispensable, as it forms the foundation for rational antimicrobial therapy. This is critical in preventing the misuse of antibiotics, which is the primary cause of the development of multidrug-resistant pathogens. Additionally, rapid infection diagnostics play a central role in controlling outbreaks and interrupting infection chains. In virology, microbiology, and hygiene, prompt medical intervention is likewise essential, as the interpretation of infection diagnostics depends heavily on factors like the timing of infection, clinical context, and pre-existing conditions or vaccinations. Correct sample collection, selection of appropriate tests, and the critical evaluation of microbiological and virological findings are essential medical competencies, which cannot be shifted to self-learning formats but can only be acquired through structured, practice-oriented education including hands-on-training. These competencies are central to infection diagnostics, prevention, and therapy. Die Lehre im Fach „Medizinische Mikrobiologie, Virologie und Hygiene“ zeichnet sich durch die Vermittlung von infektionsmedizinischen Handlungskompetenzen aus. Dies geschieht zumeist in zeit- und kostenintensiven praktischen Kursen, die im Wettbewerb mit anderen Lehrveranstaltungen stehen. Die Lehrveranstaltungen müssen dabei zwingend das Alleinstellungsmerkmal der Übertragbarkeit von Infektionserregern mit den weitreichenden Auswirkungen auf den individuellen Patienten, das Patientenumfeld, die Gesellschaft, Tiere und Umwelt berücksichtigen (One-Health-Konzept). Das Verständnis für die Komplexität dieser erregerassoziierten Risiken erfordert ein belastbares Wissen zur Epidemiologie, Prävention, Diagnostik und Therapie von Infektionserkrankungen. Eine auch zukünftig gesicherte ärztliche Resilienz gegenüber den infektionsmedizinischen Herausforderungen ist nur über infektionsmedizinische Handlungskompetenzen bei Studierenden der Humanmedizin zu erreichen. Hierbei stellt das Verständnis für eine qualifizierte Infektionsdiagnostik eine Kernkompetenz für jegliche eigenverantwortliche Ausübung wissenschaftlich-begründeter und evidenzbasierter ärztlicher Tätigkeit dar. Kenntnis und Einsatz adäquater und schneller Infektionsdiagnostik sind unabdingbar, weil nur sie als Grundlage der rationalen antimikrobiellen Therapie den missbräuchlichen Antibiotikaeinsatz verhindern, der die Hauptursache für die Entwicklung multiresistenter Krankheitserreger ist. Darüber hinaus spielt eine schnelle Infektionsdiagnostik bei der Eindämmung von Ausbrüchen und Unterbrechung von Infektionsketten eine zentrale Rolle. Ein rasches ärztliches Handeln ist im hochdynamischen Kompetenzfeld der Virologie, Mikrobiologie und Hygiene gleichermaßen gefordert, da Aussagekraft und Interpretation der Infektionsdiagnostik stark vom Infektionszeitpunkt, dem klinischen Kontext sowie von Impfungen oder Vorerkrankungen abhängen. Die korrekte Probenentnahme, die Auswahl des geeigneten Testverfahrens sowie die kritische Bewertung mikrobiologischer und virologischer Befunde sind essenzielle ärztliche Handlungskompetenzen, die keinesfalls im Selbststudium, sondern nur in einer strukturierten praxisorientierten Ausbildung mit praktischen Übungen erworben werden können und zentrale Elemente der Infektionsdiagnostik, -prävention und -therapie darstellen.
Dermatology education relies heavily on visual learning, yet students exhibit diverse learning preferences categorized by the VARK model: Visual (V), Auditory (A), Reading/Writing (R), and Kinesthetic (K). Traditional teaching utilizing two-dimensional (2D) images primarily benefits visual learners whilst lacking tactile engagement. Three-dimensional (3D) skin lesion models address this limitation by incorporating kinesthetic learning, thereby enhancing students' comprehension of lesion morphology and texture. To evaluate student perceptions and preferences regarding the integration of 3D skin lesion models with 2D images in a station-based dermatology learning approach. Most students (90.2%) preferred the combined approach utilizing both modalities. 2D images received marginally higher ratings than 3D models for diagnostic skill development (7.3 ± 3.0 vs. 6.8 ± 3.0) and clinical application (7.2 ± 3.0 vs. 6.7 ± 3.1). The primary advantages of 3D models were hands-on practice (74.5%), enhanced palpation skills (57.8%), and interactive learning opportunities. The integration of 3D models with 2D images was well accepted by students and supports a multimodal learning approach aligned with VARK learning preferences. These findings suggest that 3D models may serve as a useful complementary tool in dermatology education. Further studies are needed to evaluate their impact on objective learning outcomes and clinical performance in diverse educational settings.
Primary care continues to face pressure to improve clinical outcomes with limited resources. Point-of-care ultrasound (POCUS) offers potential value by improving diagnostic efficiency and procedural safety; yet early adoption in family medicine has been limited by faculty expertise, time constraints, and infrastructure barriers. In 2014, we developed a structured POCUS curriculum to address resident demand and programmatic gaps in family medicine training. We implemented a 4-week required postgraduate year (PGY) one ultrasound rotation designed to function with limited faculty availability. The curriculum integrates asynchronous learning, simulation, supervised scanning with standardized patients and sonographers, structured image review, and competency assessment. Residents complete a defined number of scans in high-yield applications including cardiac, lung, abdominal aorta, venous thrombosis, musculoskeletal/soft tissue, and obstetric ultrasound. Longitudinal reinforcement was later added through quarterly hands-on sessions and a PGY-3 advanced ultrasound rotation emphasizing competency reassessment and near-peer teaching. Over 10 years, faculty capacity expanded primarily through training program graduates. An alumni survey (2015-2022 graduates; 58% response rate) demonstrated continued POCUS use in 44% of respondents, with higher utilization among rural physicians and billing rates exceeding national primary care averages. Common barriers included time constraints and equipment access, while skin/soft tissue, musculoskeletal, and procedural applications were most frequently used. A scalable, longitudinal POCUS curriculum in family medicine is feasible despite limited protected faculty time. Tailoring training to anticipated practice settings, emphasizing ambulatory-relevant applications, and addressing workflow and billing education may improve long-term adoption and sustainability.
Medicaid spent over 129 billion dollars on home- and community-based services (HCBS) in 2022. However, complex financing structures obscure which services are used, who uses them, and how use varies across states. Using 100% of national Medicaid claims data from 2021, we characterize HCBS use among dual-eligible adults aged 65 and older, distinguishing between direct care services (services that provide hands-on assistance with functional needs) and non-direct care services (eg, transportation and case management), which are often grouped together in the literature. We find that 38% of older duals used any Medicaid-funded HCBS in 2021, and 26% used direct care, with direct care users being older, sicker, and more likely to have dementia than non-users. We also find that the share of older duals using direct care varies more than 4-fold between the lowest and highest utilization states, with states that finance personal care as a State Plan benefit, rather than exclusively through waiver programs, generally having greater utilization. In light of potential funding cuts, our findings highlight the large but uneven role that Medicaid plays in financing direct care for a vulnerable population of older adults, which can be critical for them to remain in their homes and communities.
Mastery of vascular anastomosis is a fundamental skill for surgical trainees, yet opportunities for hands-on practice are often limited by equipment availability and concerns regarding patient safety. Simulation-based training offers an effective solution; however, many existing models lack objective performance assessment. This study evaluated a novel vascular anastomosis simulation model incorporating an integrated leakage testing system designed to provide immediate structured feedback. A prospective pre-post interventional study was conducted involving 39 general surgery residents (postgraduate years 1-4). Participants initially performed an end-to-end vascular anastomosis on the simulation model without prior instruction. They subsequently received standardized video-based instruction followed by supervised practice and repeated the procedure. Performance outcomes included anastomosis completion time and leakage grading assessed under controlled pressure conditions. Trainee satisfaction was evaluated using a validated simulation-based learning questionnaire. Following the educational intervention, the proportion of procedures demonstrating severe leakage (Grade 3) decreased significantly from 69.3% to 28.1% (p = 0.001). Mean anastomosis completion time improved from 22.18 ± 8.45 min to 18.42 ± 6.88 min. Second- and third-year residents demonstrated statistically significant reductions in procedural time. All participants (100%) agreed that simulation-based learning was a useful educational strategy, and 70% reported a perceived improvement in psychomotor skills. This novel vascular anastomosis simulation model, with integrated leakage testing, was associated with improved simulator-based performance outcomes and procedural efficiency among surgical residents. The model provides a reproducible and low-cost platform for vascular anastomosis practice and structured performance assessment. Further studies are needed to establish its validity, long-term retention of simulator-based performance outcomes, and the potential relationship between simulator and operative performance.