Postgraduate Medical Journal最新文献

{"title":"Closure debt: the hidden educational deficit of fragmented clinical training.","authors":"Waseem Jerjes, Azeem Majeed","doi":"10.1093/postmj/qgag139","DOIUrl":"https://doi.org/10.1093/postmj/qgag139","url":null,"abstract":"<p><strong>Background: </strong>Clinical trainees often make decisions without ever learning how the patient's story ended. We call the cumulative educational deficit created by these unfinished cases closure debt. It is distinct from continuity of care, continuity of supervision, feedback, and diagnostic error education. Closure debt emerges when contemporary training systems separate decisions from endings through shift work, frequent rotations, handovers, shared ownership, weak case attribution, and poorly designed access to outcome information.</p><p><strong>Argument: </strong>We argue that missing endings weaken diagnostic calibration, reflective practice, professional accountability, and systems learning. We also advise against indiscriminate follow-up. Outcome information can create hindsight bias, distort assessment, overload learners, and become punitive if returned without structure, context, and psychological safety. We propose a selective closure system for postgraduate training: identify high-yield cases, attribute them meaningfully to learners or teams, generate concise outcome digests, prompt brief structured reflection, provide coached interpretation when needed, and separate developmental closure from summative scoring.</p><p><strong>Conclusion: </strong>Closure should be treated as a designed feature of clinical education rather than a matter of individual curiosity or chance. Medical education does not require universal follow-up of every patient; it requires reliable closure for the right cases, in the right format, protected from the wrong uses. Designing for closure may help training programmes reconnect exposure with consequence and make clinical learning more honest, developmental, and more aware of system effects across rotations, placements, and busy clinical learning environments.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kounis syndrome: not as rare as presumed? Two cases of type II within a single month.","authors":"Yasemin Akgul Balaban, Ozan Koksal","doi":"10.1093/postmj/qgag138","DOIUrl":"https://doi.org/10.1093/postmj/qgag138","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rage against the machine? Artificial intelligence in medicine: recognising risks and reasonable responses-a personal view.","authors":"Michael Trimble","doi":"10.1093/postmj/qgag125","DOIUrl":"https://doi.org/10.1093/postmj/qgag125","url":null,"abstract":"<p><p>This review aims to consider the practical, ethical, and social implications of the widespread application of artificial intelligence systems in healthcare and wider society and to highlight some of the risks inherent with the technology. A cautious and informed approach is advocated, and users are encouraged to avoid the dangers of cognitive offloading and skills erosion.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vulnerability assessment at Emergency Department triage: between feasibility, reproducibility, and prognostic value.","authors":"Tanguy Espejo, Christian H Nickel, Fabienne Hilpert","doi":"10.1093/postmj/qgag136","DOIUrl":"https://doi.org/10.1093/postmj/qgag136","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between controlling nutritional status (CONUT) scores, osteopenia, and osteoporosis during menopausal transition: a NHANES study.","authors":"Po-Yao Chuang, Tien-Yu Yang, Kuo-Chin Huang, Yao-Hung Tsai, Ling-Yun Cheng, Ying-Chen Lu","doi":"10.1093/postmj/qgag056","DOIUrl":"10.1093/postmj/qgag056","url":null,"abstract":"<p><strong>Background: </strong>Osteopenia and osteoporosis commonly affect women during the menopausal transition. The controlling nutritional status (CONUT) score, a marker of nutritional health, has been linked to various clinical outcomes, but its relationship with bone health in menopause remains unclear. This study examined associations between CONUT scores and osteopenia and osteoporosis in menopausal women.</p><p><strong>Methods: </strong>Data from 1188 women aged 45-55 years in the 2005-2010 National Health and Nutrition Examination Survey (NHANES) were analyzed, representing 19.5 million U.S. women. Bone mineral density (BMD) at the femur sites was assessed using dual-energy X-ray absorptiometry (DEXA), and T-scores defined osteopenia and osteoporosis. CONUT scores were derived from serum albumin, total cholesterol, and lymphocyte count. Logistic regression evaluated associations between CONUT scores and bone health outcomes, adjusting for confounders. Analyses were stratified by body mass index (BMI > 25 vs. ≤ 25 kg/m2).</p><p><strong>Results: </strong>Women with higher CONUT scores (≥2) had significantly greater odds of osteopenia (adjusted odds ratio [aOR] = 1.82; 95% CI: 1.06-3.13; P = .031). No significant association was observed between CONUT scores and osteoporosis (P = .091). In BMI-stratified analysis, the association between high CONUT scores and osteopenia was stronger among women with BMI > 25 kg/m2 (aOR = 2.66; 95% CI: 1.41-5.01; P = .003).</p><p><strong>Conclusions: </strong>Poor nutritional status, as reflected by higher CONUT scores, is associated with higher likelihood of osteopenia in women undergoing menopausal transition, especially those with higher BMI. Key messages What is already known on this topic: Osteopenia and osteoporosis occur commonly in women undergoing menopausal transition. Use of controlling nutritional status (CONUT) scores to assess nutritional health, has been associated with various health outcomes, but the CONUT role in bone health during menopause has not been explored. What this study adds: This study examined the association between nutritional status, as assessed by the CONUT score, and bone health in women during the menopausal transition. The results demonstrated that poorer nutritional status was significantly associated with a higher likelihood of osteopenia, particularly among individuals with higher BMI. How this study might affect research, practice, or policy: These findings suggest that attention to nutritional status may contribute to strategies aimed at preventing early bone deterioration.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"909-915"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Think like a surgeon: the T-DODAR tool for problem solving in oral examinations and clinical practice.","authors":"Petrut Gogalniceanu, Stefano Artusa, Cameron Ruckley","doi":"10.1093/postmj/qgaf146","DOIUrl":"10.1093/postmj/qgaf146","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"970-974"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building global learning networks: a practical guide for medical educators.","authors":"Jun Jie Lim, Amani Mansour Mohmad Alnimr, Iveren Winifred Nyinoh, Elsa Sanatombi Devi, Joanna Matthan, Paul Stephen Hubbard, Thomas Quinn, Dara Stanescu, Vrinda Nayak","doi":"10.1093/postmj/qgaf213","DOIUrl":"10.1093/postmj/qgaf213","url":null,"abstract":"<p><p>As healthcare becomes increasingly globalized, postgraduate medical education must evolve to prepare clinicians for an increasingly interconnected, diverse, and intercultural healthcare landscape. This article offers nine practical tips for designing and sustaining global learning networks-virtual, collaborative frameworks that connect trainees, educators, and institutions across borders. The recommendations are organized under four themes: (1) designing equitable curricula, (2) facilitating global collaboration, (3) developing culturally competent educators and learners, and (4) sustaining and evaluating learning networks. These recommendations are grounded in the theoretical frameworks of systems thinking and communities of practice. We emphasize co-created curricula, digital platforms for international engagement, culturally responsive pedagogy, inclusive assessment strategies, and decentralized leadership models. Each tip is grounded in peer-reviewed literature, international case studies, and lessons from our collaborative experiences. We address barriers such as time zones, resource inequities, and quality assurance. By embedding global perspectives into postgraduate programmes, global learning networks strengthen intercultural competence, enhance professional identity formation, expand access to medical education in low-resource settings, and foster mutual learning across diverse health systems. This guide supports postgraduate medical educators in cultivating culturally competent clinicians and advancing a more equitable, collaborative, and resilient global healthcare workforce.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"953-959"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-analysis of randomized controlled trials comparing outcomes of artificial intelligence-based teaching versus traditional-based teaching in medical education.","authors":"Pratyush Pillai, Shayan Saadat, Imogen Ward, Shahab Hajibandeh, Shahin Hajibandeh","doi":"10.1093/postmj/qgag077","DOIUrl":"10.1093/postmj/qgag077","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate comparative outcomes of artificial Intelligence (AI)-based and traditional-based teaching in medical education.</p><p><strong>Methods: </strong>The literature search was carried out in CENTRAL, CINAHL, Web of Science, MEDLINE, and EMBASE to identify randomized controlled trials (RCTs) comparing AI-based versus traditional-based teachings in medical education. Estimate of effect size was determined for knowledge score, skills score, and teaching satisfaction score via fixed-effect modelling.</p><p><strong>Results: </strong>Fourteen RCTs enrolling 1116 students who received AI-based teaching (n = 558) or traditional-based teaching (n = 558) were included. The use of AI-based teaching was associated with significantly higher knowledge score (standardized mean difference (SMD): 0.36, 95% CI, 0.24-0.49, P < .00001), skills score (SMD: 0.78, 95% CI, 0.57-0.99, P < .00001), and teaching satisfaction score (SMD: 0.97, 95% CI, 0.66-1.29, P < .00001) compared to the traditional-based teaching. Subgroup analyses with respect to the practical course, theoretical course, duration of course shorter or longer than 1 week were consistent with the main analyses. Meta-regression analysis demonstrated that practical course significantly increased estimate effect for knowledge score (P = .002) and skills score (P = .0001).</p><p><strong>Conclusions: </strong>Meta-analysis of best available evidence (level 1a) indicates that AI-based teaching significantly improves student's knowledge, skills, and satisfactions compared to traditional teaching. However, the available evidence may be subject to publication and reporting bias with high between-study heterogeneity. Future studies should evaluate AI-based teaching in postgraduate settings including speciality and even subspecialties trainings. Key messages What is already known on this topic: Growing evidence from randomized controlled trials demonstrated positive impact of artificial intelligence (AI) in medical education when compared to the traditional approaches. What this study adds: Meta-analysis of best available evidence (level 1a) indicates that AI-based teaching significantly improves student's knowledge, skills, and satisfactions compared to traditional teaching. How this study might affect research, practice, or policy: This study suggests that Future studies should evaluate AI-based teaching in postgraduate settings including speciality and even subspecialties trainings.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"916-924"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased food prices and changes in food consumption behavior: an early precursor to malnutrition, and widespread food insecurity among the Egyptian population.","authors":"Nadira Mansour Hassan, Shimaa Mohamed Koabar","doi":"10.1093/postmj/qgag078","DOIUrl":"10.1093/postmj/qgag078","url":null,"abstract":"<p><strong>Background: </strong>Recent increases in food prices in Egypt have raised concerns about their impact on dietary patterns and household food security (FS), particularly among economically vulnerable groups, forcing families to reduce dietary diversity and nutrient intake. This may indirectly contribute to an increased risk of malnutrition and chronic diseases.</p><p><strong>Aim: </strong>To identify changes in food consumption behavior (food choices and dietary patterns) among Egyptian households following food inflation and determine the levels and predictors of food insecurity (FI).</p><p><strong>Methods: </strong>An online cross-sectional survey of 723 Egyptian households from June to December 2024. Data was collected using a pretested structured questionnaire targeting household heads. The tool assessed sociodemographic characteristics, food consumption changes, and FS status.</p><p><strong>Results: </strong>Most participants reported increased food expenditure (58.2%) with dietary shift toward cheaper carbohydrate-rich staple foods (55.2%). Reduced consumption of animal protein and dairy products was also observed. Overall, 64.6% of households experienced FI: 15.8% mild, 27.5% moderate, and 20.3% severe levels. Significant predictors of FI included female respondents (OR = 2.425, P < .001), maternal unemployment [odds ratio (OR) = 1.597, P = .018], low household income (OR = 1.774, P = .001), maternal financial responsibility (OR = 3.432, P < .001), the presence of a family member with chronic disease (OR = 1.748, P = .002), and a current smoking father (OR = 1.711, P = .004).</p><p><strong>Conclusion: </strong>Increased food prices lead to changes in food consumption patterns with shifts toward less nutritionally valuable foods and deprive most households of FS. Therefore, there is an urgent need for national nutrition health education programs to help households optimize the use of limited household budgets to achieve a balanced diet.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"925-934"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deucravacitinib-induced cutaneous hypersensitivity reactions.","authors":"Qirui Wang, Peng Qu, Xitong Zhao, Xiaoqi Yang, Suiting Ao, Pingping Song, Xiaofeng Shan, Baoqi Yang","doi":"10.1093/postmj/qgag028","DOIUrl":"10.1093/postmj/qgag028","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"960-961"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147459445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}