Postgraduate Medical Journal最新文献

{"title":"Burnout among medical residents: key drivers and practical mitigating strategies.","authors":"Isaac K S Ng, Sarah Z L Tham, Kar Mun Chong, Wilson G W Goh, Christopher Thong, Kevin Soon Hwee Teo","doi":"10.1093/postmj/qgae179","DOIUrl":"10.1093/postmj/qgae179","url":null,"abstract":"<p><p>Burnout is a prevalent phenomenon in medicine, affecting >50% of physicians and up to 60% of medical residents. This has negative consequences for both doctors' mental health and job satisfaction as well as patient care quality. While numerous studies have explored the causes, psychological effects, and workplace solutions, we aim to practicalize the issue from the perspectives of residents by discussing three key drivers of burnout and offering actionable, multipronged strategies that may be able to tackle these root causes effectively. From review of relevant literature and personal reflections/experiences, we identified three key factors that contribute to resident burnout, namely, (i) inherent physician attributes, (ii) mismatched expectations of the medical profession, and (iii) stressful nature of clinical work and residency training for junior physicians. We offer practical strategies that can be implemented by various stakeholders in a concerted manner to target these three areas, namely, to inculcate and foster accurate perception of the medical profession at the outset, develop psychological strength/resilience among medical residents, and make practical improvements to working and training environments.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"475-480"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838663","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":"Policy and perceptions of pregnancy during training among residents of various subspecialties.","authors":"Jessica C Morgan, Thomas Owens, Molly C Carmack, Alexis Braverman, Quetzal A Class","doi":"10.1093/postmj/qgae164","DOIUrl":"10.1093/postmj/qgae164","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of the study: &lt;/strong&gt;Increased risk for adverse birth outcomes, long work hours, limited control over one's own schedule, and concern for making up time may color resident perceptions of their pregnancy during residency. We aimed to survey residents across four different specialties about their personal experiences with pregnancy during training.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Using a novel, validated, anonymous web-based survey instrument, we assessed experiences around pregnancy during residency training nation-wide. The survey was sent to 123 academic medical training programs in the fields of internal medicine (IM), pediatrics, obstetrics/gynecology (OB/GYN), and general surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 278 residents reported to have delivered, or their partner delivered, during residency. Of those, 38.1% (n = 103) were trainees in OB/GYN, 21.9% (n = 59) were in IM, 21.1% (n = 57) were in pediatrics, and 18.9% (n = 51) were surgery. Most responders (67.6%, n = 188) were 30-34 years old. We did not note birth outcome difference across specialties. OB/GYN trainees attended fewer prenatal visits [X2(6, 228) = 47.84, p &lt; 0.001] compared with trainees in other specialties. Pediatric trainees reported to feel more supported when coordinating parental leave [X2(6, 268) = 17.17, p &lt; 0.01], took longer leaves [X2(18, 228) = 39.68, p &lt; 0.01], and felt perceived as more \"capable\" upon return [X2(6, 267) = 15.02, p &lt; 0.05]. A total of 79.6% of respondents would encourage pregnancy during residency.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We identified differences across specialties in policy and perceptions of pregnancy during training that impact residency quality of life. It is important to address disparities across specialties and ensure resident wellness.   What is already known on this topic: Pregnancy during residency training is common. Previous literature suggests physicians experience higher rates of adverse pregnancy outcomes compared with the general population. Parental leave policies for residents are limited and/or unpublished. Further, little is known about how residents feel about informing their program and co-residents of their pregnancy and how they navigate antepartum and postpartum appointments and leave. What this study adds: We conducted an anonymous, nation-wide survey of residents training in 4 major medical specialties. We examine resident perceptions of informing their program leadership and co-residents of their pregnancy or their partner's pregnancy. We also measure birth outcomes, if there was a clear parental leave policy in place, and the length of parental leave taken by residents. How this study might affect research, practice, or policy: Our findings suggest that parental leave policies need attention and clarity across medical specialties. Further, the perceived or real culture surrounding the normative occurrence of pregnancy during residency could also be improved. Despite th","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"441-446"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688460","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":"ChatGPT versus expert feedback on clinical reasoning questions and their effect on learning: a randomized controlled trial.","authors":"Feray Ekin Çiçek, Müşerref Ülker, Menekşe Özer, Yavuz Selim Kıyak","doi":"10.1093/postmj/qgae170","DOIUrl":"10.1093/postmj/qgae170","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effectiveness of ChatGPT-generated feedback compared to expert-written feedback in improving clinical reasoning skills among first-year medical students.</p><p><strong>Methods: </strong>This is a randomized controlled trial conducted at a single medical school and involved 129 first-year medical students who were randomly assigned to two groups. Both groups completed three formative tests with feedback on urinary tract infections (UTIs; uncomplicated, complicated, pyelonephritis) over five consecutive days as a spaced repetition, receiving either expert-written feedback (control, n = 65) or ChatGPT-generated feedback (experiment, n = 64). Clinical reasoning skills were assessed using Key-Features Questions (KFQs) immediately after the intervention and 10 days later. Students' critical approach to artificial intelligence (AI) was also measured before and after disclosing the AI involvement in feedback generation.</p><p><strong>Results: </strong>There was no significant difference between the mean scores of the control (immediate: 78.5 ± 20.6 delayed: 78.0 ± 21.2) and experiment (immediate: 74.7 ± 15.1, delayed: 76.0 ± 14.5) groups in overall performance on Key-Features Questions (out of 120 points) immediately (P = .26) or after 10 days (P = .57), with small effect sizes. However, the control group outperformed the ChatGPT group in complicated urinary tract infection cases (P < .001). The experiment group showed a significantly higher critical approach to AI after disclosing, with medium-large effect sizes.</p><p><strong>Conclusions: </strong>ChatGPT-generated feedback can be an effective alternative to expert feedback in improving clinical reasoning skills in medical students, particularly in resource-constrained settings with limited expert availability. However, AI-generated feedback may lack the nuance needed for more complex cases, emphasizing the need for expert review. Additionally, exposure to the drawbacks in AI-generated feedback can enhance students' critical approach towards AI-generated educational content.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"458-463"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829650","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":"The protective role of basal metabolic rate in cognitive decline: evidence from epidemiological and genetic studies.","authors":"Tianwei Meng, Changxing Liu, Boyu Wang, Chengjia Li, Jiawen Liu, Jia Chen, Yidi Ma, Rui Qie","doi":"10.1093/postmj/qgae159","DOIUrl":"10.1093/postmj/qgae159","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to explore the relationship between basal metabolic rate (BMR) and cognitive impairment and assess the potential of BMR as a protective factor against cognitive decline.</p><p><strong>Methods: </strong>This investigation initially conducted a cross-sectional study of American adults from 2011 to 2014 using data from the National Health and Nutrition Examination Survey. It examined the correlation between participants' BMR and cognitive functions, exploring the association with cognitive impairment. Subsequently, publicly available genome-wide association study data was used to examine potential causal links between genetically determined BMR and specific cognitive disorders using Mendelian randomization.</p><p><strong>Results: </strong>Cross-sectional findings revealed a significant positive correlation between higher BMR and cognitive scores. In Mendelian randomization analysis, BMR demonstrated an inverse causal relationship with Alzheimer's disease and Parkinson's dementia, suggesting BMR as a potential protective factor against these diseases. No causal links were found with vascular dementia, Lewy body dementia, and frontotemporal dementia.</p><p><strong>Conclusion: </strong>This study supports the role of BMR as a potential protective factor against Alzheimer's disease and Parkinson's dementia, suggesting that BMR may play an important role in preventing cognitive decline. However, due to the limitations of cross-sectional studies, further prospective studies and broader demographic samples are necessary to verify these results and explore underlying biological mechanisms. Key messages What is already known on this topic: Existing knowledge suggests a close relationship between BMR and health and cognitive functions, but detailed studies on its connection with specific cognitive impairments are still needed. What this study adds: This study found a significant positive correlation between higher BMR and cognitive improvement, potentially aiding in the prevention of Alzheimer's and Parkinson's dementia. How this study might affect research, practice, or policy: This finding guides public health strategies and personalized medicine, emphasizing the necessity for further research to validate BMR's protective effects.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"417-426"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639607","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":"Improving senior medical workforce retention at a large teaching hospital trust.","authors":"Sarah Longwell, Hamish McLure, Sunjay Jain","doi":"10.1093/postmj/qgae152","DOIUrl":"10.1093/postmj/qgae152","url":null,"abstract":"<p><strong>Purpose: </strong>To understand senior clinicians' current thinking regarding retirement at a large teaching hospital trust, the reasons behind it, and what the trust can do to improve retention of these valuable staff.</p><p><strong>Methods: </strong>An anonymized survey followed by qualitative study from a focus group. Data from these were analysed using a thematic analysis. Participants were senior clinicians currently employed or who had taken retirement from the trust in the preceding 12 months. In total 140 respondents completed the survey, giving a response rate of 65%; 8 senior clinicians attended the focus group.</p><p><strong>Results: </strong>The commonest reasons for taking retirement were wanting to pursue leisure interests, reaching a pensionable age, and feeling unable to sustain their workloads. A significant proportion, 29%, also cited that they did not feel valued. The commonest factors that would encourage respondents to remain at work included increased flexibility, reduced hours, and ability to come off on-call rotas. The main themes from the focus group were focusing on well-being, personalized conversations, and better/more accessible information.</p><p><strong>Conclusion: </strong>Our project identified a number of reasons why clinicians are considering taking retirement, with a major theme of feeling valued underpinning decisions. This could influence strategies to help retain these experienced members of staff. We made a series of recommendations. If enacted, these would have a wider-reaching impact on more junior medical staff, aiding them to consider their own late-stage careers. They are also applicable and could easily be adapted when considering retention of other valued professionals within the trust. Key messages What is already known on this topic-We know that there is currently a medical workforce crisis at a time of greatest patient need, with an ageing workforce and senior staff who are choosing to retire early. Previous studies have reviewed the reasons behind these decisions but not specifically looked at changes that can be implemented at a local level to improve retention. What this study adds-We combined both quantitative and qualitative data from senior clinicians at a large teaching hospital trust in the North of England to understand current thinking regarding retirement and what the trust could do to improve their retention. How this study might affect research, practice, or policy-From our study we were able to make a series of recommendations that can be implemented at a local level to inform medical retention policies. These will also have wider impacts on junior medical staff and could be expanded to other healthcare professionals.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"435-440"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676632","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":"Resting metabolic rate in obesity.","authors":"LingHong Huang, ZhiFeng Guo, ZhengRong Jiang, YaJing Xu, HuiBin Huang","doi":"10.1093/postmj/qgae153","DOIUrl":"10.1093/postmj/qgae153","url":null,"abstract":"<p><p>The prevalence of obesity has continued to rise, and obesity and its attendant metabolic disorders are major global health threat factors. Among the current interventions for obesity, none have demonstrated sustained efficacy in achieving long-term outcomes. So, the identification of therapeutic targets is of paramount importance in the advancement and sustainability of obesity. Resting metabolic rate (RMR) constitutes 60%-75% of total energy expenditure and serves a crucial function in maintaining energy balance. Nevertheless, there exists considerable heterogeneity in RMR among individuals. Low RMR is associated with weight gain, elevating the susceptibility to obesity-related ailments. Hence, RMR will be the main focus of interest in the study of obesity treatment. In this review, we will elucidate the influence factors and mechanisms of action of RMR in obesity, with particular emphasis on the effects of obesity treatment on RMR and the alterations and influence factors of RMR in special types of populations with obesity.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"396-410"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676635","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":"Recipient selection for lung transplantation: perspective in decision-making.","authors":"Ertan Saribas, Sevinc Citak","doi":"10.1093/postmj/qgae144","DOIUrl":"10.1093/postmj/qgae144","url":null,"abstract":"<p><strong>Background: </strong>To determine the conditions that prevented transplant in patients referred to our center due to end-stage lung disease.</p><p><strong>Study design: </strong>Descriptive study.</p><p><strong>Place and duration of the study: </strong>Department of lung transplant clinic, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey, from December 2017 to January 2022.</p><p><strong>Methods: </strong>Patients with end-stage lung disease referred to our clinic were retrospectively evaluated with regard to reasons for exclusion, diagnosis, and demographic data. The Karnofsky Performance Status scoring scale was used to measure the functional status of the patients.</p><p><strong>Results: </strong>A total of 311 patients were evaluated during the study period. The mean age was 44.2 (range 4-73) years. There were 207 (66.6%) male patients. The most common indications were idiopathic interstitial pneumonia in 104 (33.4%) patients, chronic obstructive pulmonary disease in 53 (17%) patients, bronchiectasis in 49 (15.7%) patients, and cystic fibrosis in 28 (9%) patients. Of the patients, 106 (34%) were not appropriate candidates for a lung transplant. The most common reasons for refusal were preventable situations such as activity limitation and poor performance in 53 (50%) patients, weight in 49 (46.2%) patients, and smoking in 10 (9.4%) patients.</p><p><strong>Conclusion: </strong>Impaired performance status was the most common cause of lung transplant exclusion. Weight and smoking were preventable causes of exclusion. Implementing pulmonary rehabilitation in very few patients was the most important handicap. It is believed that providing optimal treatment with a multidisciplinary approach and timely referral to transplant centers will significantly reduce the reasons for exclusion. Key message What is already known on this topic?  Referring lung transplant candidates to clinics at the earliest stage is essential for assessing their condition and exploring treatment options. What this study adds?  Factors like smoking, obesity, and muscle loss can hinder the transplantation process; thus, timely interventions are crucial. The primary reason for excluding candidates from lung transplantation is the decline in performance status. How this study might affect research, practice or policy?  Programs focused on smoking cessation, weight management, and muscle strengthening can play a vital role in enhancing patients' health before transplantation. It is imperative to expand and enhance the accessibility of pulmonary rehabilitation programs.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"411-416"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472938","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":"Correction to: Contribution of nebulized budesonide before bronchoscopy, a prospective clinical study.","authors":"","doi":"10.1093/postmj/qgaf035","DOIUrl":"10.1093/postmj/qgaf035","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"496"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425958","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":"Causal relationship between benign prostatic hyperplasia and prostate cancer: a bidirectional Mendelian randomization analysis.","authors":"Yi Zhang, Guangyang Ou, Rongkang Li, Lei Peng, Jianguo Shi","doi":"10.1093/postmj/qgae163","DOIUrl":"10.1093/postmj/qgae163","url":null,"abstract":"<p><strong>Objective: </strong>Our aim is to explore the relation between benign prostatic hyperplasia (BPH) and prostate cancer (PCa) from a genetic level utilizing Mendelian randomization (MR).</p><p><strong>Methods: </strong>The IEU genome-wide association studies database was surveyed for single nucleotide polymorphisms (SNPs) associated with BPH, PCa, and PCa (validation cohort). Single nucleotide polymorphisms were subjected to stringent quality control based on rigorous screening criteria. BPH and PCa risk were evaluated using the inverse-variance weighted method (IVW), MR-Egger, simple mode, weighted median, and weighted mode. Horizontal pleiotropy of single nucleotide polymorphisms was assessed using the MR-Egger intercept test, while heterogeneity was evaluated using Cochran's Q test. Reverse causality was assessed by evaluating PCa as the exposure and BPH as the outcome. A validation database was used to verify the exposure and outcome.</p><p><strong>Results: </strong>The risk of PCa increased significantly with genetically predicted BPH (IVW: OR [95% CI] = 1.3849 × 107 [2330, 8.2294 × 1010], P = 2.0814 × 10-4). In reverse MR analysis, PCa also increased the risk of BPH (IVW: OR [95% CI] = 1.0011 [1.0003, 1.0019], P = 0.0031). The findings were consistent with the MR analysis results of the PCa validation cohort. Sensitivity analyses indicated the presence of heterogeneity but no horizontal pleiotropy.</p><p><strong>Conclusion: </strong>The study presents proof of a significant bidirectional causal relationship between genetically predicted BPH and an increased risk of PCa. Key message Three research questions and three bullet points  What is already known on this topic?  Observational studies suggest a controversial relationship between BPH and PCa. MR allows investigation of causality using genetic variants as instrumental variables (IVs). What does this study add?  The study presents proof of a significant bidirectional causal relationship between genetically predicted BPH and an increased risk of PCa. How this study might affect research, practice, or policy?  Recognizing the bidirectional relationship between BPH and PCa, men diagnosed with BPH may benefit from more stringent PCa screening protocols.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"427-434"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639606","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":"Cholecystectomy and cancer risk: evidence from National Health and Nutrition Examination Survey and Mendelian randomization.","authors":"Changlong Wei, Xiaofang Wang","doi":"10.1093/postmj/qgae135","DOIUrl":"10.1093/postmj/qgae135","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"489-491"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372669","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}