Perspectives on Medical Education最新文献

{"title":"Novice Experts: Exploring Fellows' Perspectives on the Transition from Residency to Fellowship.","authors":"Laura E Chiel, Michael Fishman, Erik Driessen, Ariel S Winn","doi":"10.5334/pme.1654","DOIUrl":"10.5334/pme.1654","url":null,"abstract":"<p><strong>Introduction: </strong>Advanced training experiences are required in certain countries for subspecialization. In the United States, a decline in Milestones and in levels of supervision for Entrustable Professional Activities for incoming subspecialty fellows has been described and attributed to changes in context that fellows experience. We aimed to explore this transition to advanced training, and specifically to describe which contextual factors are salient to fellows at the residency to fellowship transition and the supports available for a smooth transition to fellowship.</p><p><strong>Methods: </strong>Using contextual competence as a sensitizing concept, ten semi-structured interviews with first- and second-year pediatric subspecialty fellows from three subspecialties were performed at a large academic medical center in 2023, using thematic analysis informed by elements of constructivist grounded theory.</p><p><strong>Results: </strong>Contextual factors that impacted the transition included changes in systems, necessary knowledge, and roles and responsibilities. At times, participants describe a tension between feeling like novices while simultaneously feeling like they should have more expertise than they had. Supports in navigating this tension, and in navigating the transition more generally, included formal orientations, fellow behaviors and perspective, and input from others.</p><p><strong>Conclusions: </strong>The transition to advanced training is characterized, at times, by experiencing tension between feeling like a novice while feeling like one should have expertise, with fellows' own behaviors and the support of those around them being essential to fellows' smooth transition. While fellowship programs offer orientations, systems-level solutions for supporting fellows' navigation of the transition are underexplored.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"66-73"},"PeriodicalIF":4.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Learner to Provider: Navigating Role Tensions in Postgraduate Medical Training Through Activity Theory.","authors":"Sin-Yee Patty Kwong, Shiuan-Ruey Yu, Kuo-Chen Liao, Shu-Chen Liao, Cheng-Ting Hsiao, Chung-Hsien Chaou","doi":"10.5334/pme.1499","DOIUrl":"10.5334/pme.1499","url":null,"abstract":"<p><strong>Introduction: </strong>The transition from medical school to residency, especially during the postgraduate year (PGY) internship, poses unique challenges as graduates navigate clinical practice complexities. Understanding PGYs' experiences is crucial for developing effective support strategies to promote their professional growth and well-being.</p><p><strong>Methods: </strong>This qualitative, longitudinal study followed ten PGYs from August 2021 to July 2023, using biannual audio diary based on open-ended questions to capture their experiences. Data analysis, guided by Activity Theory, focused on role conflicts and contradictions as PGYs transitioned from learners to practicing physicians.</p><p><strong>Results: </strong>The analysis revealed prevalent role conflicts and contradictions, primarily due to the tension between the PGYs' roles as learner and healthcare provider. Differences in objectives between PGYs and practicing doctors further exacerbated these conflicts, leading to clashes in priorities and care approaches. Consequently, PGYs experienced reality shock, lack of confidence, and feelings of incompetence, compounded by heavy workloads and exhaustion. These findings underscored the need for support and resources to help PGYs navigate these challenges and succeed in their healthcare roles.</p><p><strong>Discussions: </strong>Using Activity Theory to analyze the inherent challenges and contradictions within the PGY experience, this study offers insights for enhancing PGY preparedness, fostering both professional development and well-being. Drawing on recommendations supported by existing literature, which are stratified by tools, rules, and division of labor, we propose targeted strategies to address specific facets of the PGY role, thereby improving the overall training environment. This research highlights the need for tailored interventions to support PGYs through the challenging transition into clinical practice.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"55-65"},"PeriodicalIF":4.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teach the Unteachable with a Virtual Reality (VR) Brain Death Scenario - 800 Students and 3 Years of Experience.","authors":"Anna Junga, Pascal Kockwelp, Dimitar Valkov, Henriette Schulze, Philipp Bozdere, Ole Hätscher, Helmut Ahrens, Bernhard Marschall, Benjamin Risse, Markus Holling","doi":"10.5334/pme.1427","DOIUrl":"10.5334/pme.1427","url":null,"abstract":"<p><strong>Introduction: </strong>Traditionally, clinical education has combined classroom theory with hospital-based practical experiences. Over the past 50 years, simulation-based training, particularly virtual reality (VR), has gained prominence for its flexibility and scalability. This article describes the development, implementation and evaluation of a VR-based brain death diagnostic training module at the University of Münster over a three-year period.</p><p><strong>Methods: </strong>A multidisciplinary team developed the VR scenario to simulate a realistic intensive care unit, in line with German guidelines for brain death diagnosis. The module includes a tutorial and a preparatory video podcast to accommodate varying levels of VR experience. The course maintained its former small-group format, integrating VR to replace a manikin-based brain death examination. A randomized pilot study compared the traditional and VR-based approaches.</p><p><strong>Results: </strong>Feedback from over 800 students indicated a strong preference for VR training, with a significant increase in perceived competence in brain death diagnosis. The VR module also increased the individual training time and provided more varied clinical scenarios than traditional methods. Continuous feedback led to iterative improvements, including reflex simulations and improved hardware management.</p><p><strong>Discussion: </strong>The VR-based training was well received, demonstrating its potential to revolutionize medical education by providing immersive, realistic simulations. Challenges such as initial hardware adaptation and high personnel costs were addressed through comprehensive tutorials and structural adjustments. The success of this module has led to the development of additional VR courses, optimizing the use of hardware and justifying the initial investment.</p><p><strong>Conclusion: </strong>The integration of VR into medical education at the University of Münster has proven effective, enhancing student engagement and competence in brain death diagnosis. The positive outcomes suggest a promising future for VR in medical education, highlighting the importance of innovative tools in the preparation of future medical professionals. Efforts are continuing to broaden the application and accessibility of VR-based training.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"44-54"},"PeriodicalIF":4.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing IPE in a Workplace Setting: Educational Design Research Promotes Transformative Participation.","authors":"Marco A C Versluis, Lizzy-Sara Zöllner, Sofia Papadopoulou, Relinde van der Stouwe, Marie-Josée C de Haan-Gremme, Anna H C Tsiamparlis-Wildeboer, Héleen Helmholt, Marco Antonio de Carvalho-Filho","doi":"10.5334/pme.1546","DOIUrl":"10.5334/pme.1546","url":null,"abstract":"<p><strong>Background: </strong>Educators struggle to implement Interprofessional Education (IPE) in workplace settings. We adopted an educational design research (EDR) approach to implement an IPE activity and establish design principles supporting IPE implementation in workplace settings.</p><p><strong>Method: </strong>We adopted an iterative process of analysis/exploration, design/construction and evaluation/reflection. We performed a scoping review, visited examples of IPE initiatives and involved workplace professionals to define preliminary design principles for implementation. An IPE activity was implemented where students from nursing, midwifery and medicine care for patients together. Continuous reflection during the EDR process supported the refinement of design principles.</p><p><strong>Results: </strong>We describe 14 design principles for implementation of IPE: (1) Set an objective; (2) Make the project evidence informed and theory driven; (3) Nurture a growth mindset; (4) Stimulate transformative participation; (5) Be aware of culture; (6) Support faculty members; (7) Align learning outcomes (8) Design formative and reflective assessment methods; (9) Position within an authentic context; (10) Facilitate informal interaction; (11) Balance patients' safety with attributing responsibility; (12) Align with the workplace, seize opportunities to improve interprofessional collaboration; (13) Evaluate the implementation; AND (14) Trust the process. The design principles related to three overarching concerns describing IPE implementation as a change process: patient safety, workflow and culture.</p><p><strong>Discussion: </strong>The 14 design principles support context sensitive IPE implementation in the workplace. The EDR approach nurtured transformative participation, empowering stakeholders to participate and contribute to design and decision making. This resulted in an evidence informed, interprofessional cocreation process <i>in</i> and <i>with</i> the workplace that was aligned with existing workflow and organizational culture.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"31-43"},"PeriodicalIF":4.8,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seeing Ourselves in Others: Understanding and Addressing Biases in Medical School Admissions Processes.","authors":"Khadija Ahmed, Tisha Joy, Javeed Sukhera","doi":"10.5334/pme.1643","DOIUrl":"10.5334/pme.1643","url":null,"abstract":"<p><strong>Purpose: </strong>Medical school admissions is a vital area for advancing diversity, equity, and inclusion (DEI). Integrating bias recognition and management (BRM) within the context of admissions is critical in advancing DEI. However, there is a dearth of empirically informed literature on BRM in the admissions context. Therefore, this study sought to explore how individuals involved in admissions decisions process and integrate bias related feedback.</p><p><strong>Methods: </strong>The authors conducted a qualitative exploratory study using constructivist grounded theory. 21 semi-structured interviews were conducted with various participants in the admissions process at a North American medical school who had participated in bias related training. Participants included medical school faculty, senior medical students, and community volunteers.</p><p><strong>Results: </strong>Overall, participants expressed diverse perspectives on their personal biases and how these biases impact admissions decisions. Their reflections were shaped by their identities, values, and priorities, which varied based on whether they were faculty members, students, or community members. Participants also highlighted that their biases influenced their perceptions of the ideal admissions candidate, thus influencing their decision-making process. They emphasized the need for more opportunities to engage in dialogue with peers to openly share and discuss how to recognize and manage their biases.</p><p><strong>Conclusion: </strong>Our study suggests that fostering critical reflection about identity tensions, building and sustaining a community of practice, and facilitating sustained dialogue may provide admissions committees with an evidence-informed, meaningful, and sustained approach to advancing DEI through bias recognition and management.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"20-30"},"PeriodicalIF":4.8,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could the R2C2 Feedback and Coaching Model Enhance Feedback Literacy Behaviors: A Qualitative Study Exploring Learner-Preceptor Feedback Conversations.","authors":"Subha Ramani, Heather Armson, Tessa Hanmore, Rachelle Lee-Krueger, Karen D Könings, Amanda Roze des Ordons, Marygrace Zetkulic, Joan Sargeant, Jocelyn M Lockyer","doi":"10.5334/pme.1368","DOIUrl":"10.5334/pme.1368","url":null,"abstract":"<p><strong>Introduction: </strong>Feedback literacy (FBL) is a critical skill for learners encompassing four behaviors: appreciating feedback, making judgements, managing affect, and taking action. Little guidance has been available for clinical preceptors to promote FBL. The R2C2 feedback and coaching model that guides teachers through building Relationships, exploring Reactions and Reflections, discussing Content and Coaching to co-develop an action plan for follow-up may support FBL. This study sought to identify whether R2C2 conversations operationalized FBL behaviors and the factors that appeared to influence FBL.</p><p><strong>Methods: </strong>Based on data from a multi-institutional, qualitative study involving 15 dyads of learners (residents and medical students) and their physician preceptors, a secondary analysis of R2C2-guided feedback conversations and debriefing interviews was undertaken. A framework analysis mapped the data to FBL behaviors and explored factors that impacted behaviors in the context of the research and theories underpinning R2C2 and FBL.</p><p><strong>Results: </strong>Most elements of FBL behaviors were demonstrated in R2C2 conversations. Appreciating feedback and making judgements were most consistently noted. There was less evidence of managing affect as learners indicated acceptance of feedback. There was variability in the co-creation of action plans. Some created action plans, others had incomplete or no plan for immediate action or follow-up. FBL appeared to be impacted by learner-preceptor relationships, active learner engagement in feedback discussions, and personal characteristics.</p><p><strong>Discussion: </strong>Our analysis demonstrated that effective use of the R2C2 model could enhance FBL behaviors provided attention was paid to optimizing all phases of R2C2, particularly co-creation of action plans for follow-up.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"9-19"},"PeriodicalIF":4.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing the Next Era in Assessment.","authors":"Alina Smirnova, Michael A Barone, Sondra Zabar, Adina Kalet","doi":"10.5334/pme.1551","DOIUrl":"10.5334/pme.1551","url":null,"abstract":"<p><p>In this introduction, the guest editors of the \"Next Era in Assessment\" special collection frame the invited papers by envisioning a next era in assessment of medical education, based on ideas developed during a summit that convened professional and educational leaders and scholars. The authors posit that the next era of assessment will focus unambiguously on serving patients and the health of society, reflect its sociocultural context, and support learners' longitudinal growth and development. As such, assessment will be characterized as transformational, development-oriented and socially accountable. The authors introduce the papers in this special collection, which represent elements of a roadmap towards the next era in assessment by exploring several foundational considerations that will make the next era successful. These include the equally important issues of (1) focusing on accountability, trust and power in assessment, (2) addressing implementation and contextualization of assessment systems, (3) optimizing the use of technology in assessment, (4) establishing infrastructure for data sharing and data storage, (5) developing a vocabulary around emerging sources of assessment data, and (6) reconceptualizing validity around patient care and learner equity. Attending to these priority areas will help leaders create authentic assessment systems that are responsive to learners' and society's needs, while reaping the full promise of competency-based medical education (CBME) as well as emerging data science and artificial intelligence technologies.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"1-8"},"PeriodicalIF":4.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11720857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking Bad News to Learners: How Well Does the SPIKES Clinical Model Translate?","authors":"Lynnea M Mills, Olle Ten Cate, Christy Boscardin, Patricia S O'Sullivan","doi":"10.5334/pme.1521","DOIUrl":"10.5334/pme.1521","url":null,"abstract":"<p><p>When health professions learners do not meet standards on assessments, educators need to share this information with the learners and determine next steps to improve their performance. Those conversations can be difficult, and educators may lack confidence or skill in holding them. For clinician-educators with experience sharing challenging news with patients, using an analogy from clinical settings may help with these conversations in the education context. One common model in the clinical setting for 'breaking bad news' to patients is SPIKES: Set-up, Perception, Invitation, Knowledge, Emotion, and Summary/Strategy. The authors reviewed evidence in the education setting, particularly from the remediation literature, to consider how the SPIKES model might translate from clinical settings to those in which educators must share 'bad news' with learners about their academic performance. Based on available guidelines and evidence, the authors advocate that the SPIKES model can serve as a useful framework to help educators incorporate, by way of analogy, key components into these conversations, and increase the likelihood of successful outcomes.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"684-692"},"PeriodicalIF":4.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Outcomes Are Associated with Learning About Colonialism and Its Impacts on Indigenous Peoples in Health Professional Programs? A Critical Integrative Review.","authors":"Carolyn M Melro, Kimberly Matheson, Amy Bombay","doi":"10.5334/pme.1407","DOIUrl":"10.5334/pme.1407","url":null,"abstract":"<p><strong>Background: </strong>The Truth and Reconciliation Commission of Canada called upon health professional programs to teach about historical and on-going colonalism. Since these calls to action, there has been an increase in educational opportunities on the topic. Although it is generally assumed that learning about colonialism will reduce racism and improve allyship towards Indigenous Peoples, an evaluation of this assumption is needed.</p><p><strong>Purpose: </strong>An integrated review of the literature was conducted to assess how participation in educational experiences is associated with learner outcomes and how they may vary according to course design considerations including the guiding framework, content foci, mode of delivery, activities, and duration.</p><p><strong>Methods: </strong>Studies assessing outcomes of educational activities related to the legacy of colonialism identified in a previous scoping review, as well as any such studies published since then were included in the present study. Data synthesis was performed using content analysis of the results and discussions presented in the included papers.</p><p><strong>Results: </strong>A review of 15 papers identified a backfire effect that was only evident among the studies that included a delayed post-evaluation timeframe. In two educational experiences, it was found that learners were more likely to express unfavourable attitudes towards Indigenous Peoples post-training. These educational opportunities were designed using a cultural safety framework and followed a similar course delivery (e.g., viewing of vodcasts, use of case studies) and provided similar content (historical policies, Indigenous cultural beliefs and practices).</p><p><strong>Conclusions: </strong>The findings should be interpreted with caution but point to plausible implications related to the backfire effect of educational opportunities on learners' attitudes towards Indigenous Peoples post-training.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"677-683"},"PeriodicalIF":4.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physicians' Social Skills - Conceptualization, Taxonomy, and Behavioral Assessment.","authors":"Simon M Breil, Dorothee Amelung, Sebastian Oberst, Torsten Rollinger, Helmut Ahrens, Amelie Garbe, Martina Kadmon, Bernhard Marschall, Mitja D Back, Harm Peters","doi":"10.5334/pme.1171","DOIUrl":"10.5334/pme.1171","url":null,"abstract":"<p><p>Social skills (e.g., assertiveness, empathy, ability to accept criticism) are essential for the medical profession and therefore also for the selection and development of medical students. However, the term \"social skills\" is understood differently in different contexts. There is no agreed upon taxonomy for classifying physicians' social skills, and skills with the same meaning often have different names. This conceptual ambiguity presents a hurdle to cross-context communication and to the development of methods to assess social skills. Drawing from behavioral psychology, we aim to contribute to a better understanding of social skills in the medical context. To this end, we introduce a theoretically and empirically informed taxonomy that can be used to integrate the large number of different social skills. We consider how skills manifest at the behavioral level to ensure that we focus only on skills that are actually observable, distinguishable, and measurable. Here, behavioral research has shown that three overarching skill dimensions can be seen in interpersonal situations and are clearly distinguishable from each other: <i>agency skill</i> (i.e., getting ahead in social situations), <i>communion skill</i> (i.e., getting along in social situations), and <i>interpersonal resilience</i> (i.e., staying calm in social situations). We show that almost all social skills relevant for physicians fit into this structure. The approach presented allows redundant descriptions to be combined under three clearly distinguishable and behavior-based dimensions of social skills. This approach has implications for the assessment of social skills in both the selection and development of students.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"635-645"},"PeriodicalIF":4.8,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}