Postgraduate Medical Journal最新文献

{"title":"Resilience or endurance? When training culture rewards survival over learning.","authors":"Waseem Jerjes","doi":"10.1093/postmj/qgaf061","DOIUrl":"https://doi.org/10.1093/postmj/qgaf061","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053325","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":"Using freedom of information requests to access novel data sources in health professions education research.","authors":"Sophie E Yale, Megan E L Brown, Matthew H V Byrne","doi":"10.1093/postmj/qgae166","DOIUrl":"10.1093/postmj/qgae166","url":null,"abstract":"<p><p>Educators and researchers are reliant upon access to data to drive teaching methods, curricular improvements, and progress in medical education research. However, data are not always accessible, due to resource constraints, institutional policies, and privacy concerns. Researchers have attempted to access novel data sources through surveys, semistructured interviews, and databases; however, these methodologies are limited. To improve access to data, Freedom of Information (FOI) Acts grant researchers the ability to formally request data that any public institute holds. Researchers have been reluctant to use this tool due to negative perceptions, despite its unique benefits. To increase awareness of this underutilized methodology, we summarize the process of FOI Act requests, its strengths and weaknesses, and the ways in which health professions education can leverage FOI requests within research. We provide examples of the use of FOI requests as a research method within adjacent fields and nascent use within the field of health professions research. In doing so, we hope to highlight how FOI requests can be a useful tool in health professions education researchers and its potential to increase access to unique data sources.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"481-486"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732103","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 key to addressing the issue of academic misconduct in the medical field is to reform the evaluation system.","authors":"Hongnan Ye","doi":"10.1093/postmj/qgae134","DOIUrl":"10.1093/postmj/qgae134","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"492-493"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372670","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 role of NGOs and humanitarian organizations in enhancing surgical capacity in Africa: lessons learned and future directions-a narrative review.","authors":"Hajar Nasir Tukur, Olivier Uwishema, Fatima Soufan, Ruth Girum Tamir, Jack Wellington","doi":"10.1093/postmj/qgae137","DOIUrl":"10.1093/postmj/qgae137","url":null,"abstract":"<p><strong>Introduction: </strong>Significant inequities exist in surgical care accessibility across marginalized African communities. Non-governmental organizations (NGOs) and humanitarian groups are vital in supporting Africa's surgical infrastructure. This narrative review explores the current status of surgical care in Africa, highlighting NGO initiatives, past challenges, and future opportunities.</p><p><strong>Methods: </strong>A narrative review was conducted using PubMed/Medline, ScienceDirect, and other relevant organizational websites.</p><p><strong>Results: </strong>Over 90% of patients in Africa lack access to proper surgical care due to funding shortages, inadequate resources, and a lack of skilled personnel. NGOs have addressed these gaps through successful initiatives, including fundraising and training, although past failures emphasize the need for clearer objectives and sustainable strategies.</p><p><strong>Discussion: </strong>Future efforts should prioritize addressing cultural sensitivities, setting realistic goals, and leveraging telemedicine. NGOs and humanitarian organizations will remain critical to improving surgical care for underserved populations in Africa.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"389-395"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564729","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":"We are all flawed. Fewer are less flawed than others.","authors":"Philip D Welsby","doi":"10.1093/postmj/qgaf002","DOIUrl":"10.1093/postmj/qgaf002","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"494-495"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010310","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":"Evaluating safety and efficacy of plastic versus metal stenting in malignant hilar biliary obstruction: a systematic review and meta-analysis of randomized controlled trials.","authors":"Xinjie Luo, Zhicheng Huang, Kamran Ali, Khizar Hayat","doi":"10.1093/postmj/qgae165","DOIUrl":"10.1093/postmj/qgae165","url":null,"abstract":"<p><strong>Background: </strong>Stenting malignant hilar biliary obstruction (MHBO) is challenging due to its complex structure, and it is less effective than blockages in the distal bile duct area. Plastic stents (PSs) and metal stents (MSs) are commonly used for stenting MHBO. This study aims to compare the outcomes of PSs and MSs in MHBO patients.</p><p><strong>Methods: </strong>We conducted a search of medical databases up to March 2024. Using a fixed-effect model, we analyzed the risk ratios (RRs) of the outcomes between the PS and MS groups. We calculated the RR for clinical and technical success, reinterventions, and adverse events, as well as the hazard ratio (HR) for survival and stent patency.</p><p><strong>Results: </strong>This analysis includes five randomized controlled trials (RCTs) that met the inclusion criteria, comprising a total of 322 patients (156 in the PS group and 166 in the MS group). Significant differences (P < .05) in favor of the MS group were found in the reinterventions (RR 1.80, 95% CI 1.07-3.04), and stent patency (HR 0.54, 95% CI 0.32-0.90). There were no significant differences (P > 0.05) between the PS and MS groups regarding technical success (RR 1.01, 95% CI 0.94-1.09), clinical success (RR 0.86, 95% CI 0.69-1.07), overall survival (HR 0.71, 95% CI 0.47-1.05), stent migration (RR 0.69, 95% CI 0.08-6.02), stent occlusion (RR1.32, 95% CI 0.97-1.81), and adverse events (RR 0.80, 95% CI 0.53-1.20).</p><p><strong>Conclusion: </strong>Both PS and MS are effective for managing MHBO, while MS offers greater efficacy in increased stent patency and lower reintervention rates. Key message What is already known on this topic Metal stents (MSs) and plastic stents (PSs) are used for palliative treatment of malignant hilar biliary obstruction (MHBO). MSs significantly reduced the need for reinterventions compared to PSs in patients with MHBO. What this study adds There were no significant differences between MSs and PSs in terms of technical success, clinical success, overall survival, stent migration, stent occlusion, or adverse events. How this study might affect research, practice, or policy The study's findings may prompt researchers to design more targeted studies to further investigate these specific outcomes in MHBO patients. The results encourage endoscopists to consider patient-specific factors, such as life expectancy and preference for minimizing recurrent procedures, when choosing between MSs and PSs for MHBO.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"447-457"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687680","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":"When trimethoprim-sulfamethoxazole goes rogue.","authors":"Tina H Dao, Christopher D Jackson","doi":"10.1093/postmj/qgae192","DOIUrl":"10.1093/postmj/qgae192","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"487-488"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953786","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":"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}