Preparing internal medicine trainees for their intensive care rotations: What are we doing across the UK?

Internal medicine trainees (IMTs) comprise a significant portion of rotational junior doctors in intensive care units (ICUs) in the UK. Provision of formal training for this role is highly variable, delivered by only 67% of units responding to our UK-wide survey. Topics most often covered in formal training include renal medicine, airway management, pharmacology, ventilators, vascular access and assessing the critically unwell patient. The results of the survey have been used to design a follow-up national survey of IMTs to elicit their perceived training needs when undertaking their intensive care medicine rotation.

A systematic review of medical practitioners' retention and application of basic sciences to clinical practice.

BACKGROUND: Medical education offers the foundational base for future healthcare professionals, with basic sciences playing a pivotal role in providing essential knowledge and skills for clinical practice. However, the long-term retention and application of this knowledge in clinical practice remain a significant challenge. This systematic review synthesised global evidence from diverse studies on the short / long-term retention and clinical application of basic sciences among medical doctors. METHODS: A comprehensive search was conducted across six databases, including Web of Science, Scopus, Medline, CINAHL, Emcare, and Informit. The review included studies that encompassed a variety of study designs, participant groups, and educational interventions. The Quality Assessment with Diverse Studies (QuADS) tool was utilised to assess the quality of the reviewed studies. RESULTS: A total of 10 studies were included in the review. The findings revealed that rehearsals significantly optimise the retention of basic science knowledge among medical practitioners. Retention varied by discipline, with medical practitioners retaining more knowledge in anatomy (mean scores ranging from 45.0 to 82.9%), while microbiology had the lowest retention score (39.1%). Factors influencing retention included age, gender, and curriculum type. Educational interventions such as targeted courses, integration of basic sciences with clinical skills, generative retrieval and continuous quality improvement in the curriculum were found to enhance both knowledge retention and clinical reasoning. The concept of 'encapsulated knowledge' demonstrates that integrated basic science knowledge helps in synthesising clinical presentations, reducing the need for detailed recall as clinical experience increases. The reviewed studies primarily involved interns and surgeons, leaving a significant gap in research for specialties like internal medicine and primary care/ general practice. CONCLUSION: Detailed retention of basic science knowledge may diminish over time; however, the conceptual framework remains essential for ongoing learning and clinical reasoning. This review's findings highlight the need for specialised educational interventions to improve long-term retention. Continuous professional development and targeted educational techniques are vital for maintaining clinical competence and applying basic science knowledge effectively throughout a medical career. Further research is needed to address gaps in specialty-specific knowledge application and the impact of different instructional methods.

A global assessment of kidney care workforce.

BACKGROUND: An adequate workforce is needed to guarantee optimal kidney care. We used the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to provide an assessment of the global kidney care workforce. METHODS: We conducted a multinational cross-sectional survey to evaluate the global capacity of kidney care and assessed data on the number of adult and paediatric nephrologists, the number of trainees in nephrology and shortages of various cadres of the workforce for kidney care. Data are presented according to the ISN region and World Bank income categories. RESULTS: Overall, stakeholders from 167 countries responded to the survey. The median global prevalence of nephrologists was 11.75 per million population (pmp) (interquartile range [IQR] 1.78-24.76). Four regions had median nephrologist prevalences below the global median: Africa (1.12 pmp), South Asia (1.81 pmp), Oceania and Southeast Asia (3.18 pmp) and newly independent states and Russia (9.78 pmp). The overall prevalence of paediatric nephrologists was 0.69 pmp (IQR 0.03-1.78), while overall nephrology trainee prevalence was 1.15 pmp (IQR 0.18-3.81), with significant variations across both regions and World Bank income groups. More than half of the countries reported shortages of transplant surgeons (65%), nephrologists (64%), vascular access coordinators (59%), dialysis nurses (58%) and interventional radiologists (54%), with severe shortages reported in low- and lower-middle-income countries. CONCLUSIONS: There are significant limitations in the available kidney care workforce in large parts of the world. To ensure the delivery of optimal kidney care worldwide, it is essential to develop national and international strategies and training capacity to address workforce shortages.

Understanding Differences in Medical Student Perceptions of Treatment Adherence Based on Weight Status in Pediatric Care.

Obesity biases in healthcare are detrimental. We explored medical student beliefs underlying perceptions that child-mother dyads with obesity are less likely to be treatment adherent. Participants viewed scenes of a 12-year-old, female virtual human presenting to a physician with back pain, accompanied by her mother. Patient and mother weight cues were manipulated across scenes. Out of 120, 35 participants perceived dyads with obesity as less adherent to hypothetical pain-related treatment recommendations relative to dyads with healthy weight. These participants were informed and asked why. Responses were analyzed for themes. Fifty-two responses revealed three codes relating to participants' explanation of why they perceived lower adherence for dyads with obesity-obesity is associated with: 1) non-compliance with general health recommendations, 2) internal traits/factors (i.e., mothers' less health consciousness, mental strength), 3) external factors (i.e., lower health literacy, socioeconomic status). The association of obesity with lower adherence is a bias that may exist among medical students and originate from assumptions about prior health adherence and maternal traits, some disparaging in nature. Such bias has potential to contribute to healthcare disparities. Findings highlight the utility of qualitative methods to understand beliefs driving perceptions and design bias-reducing interventions to trainee needs.

Research on fatigue detection of flight trainees based on face EMF feature model combination with PSO-CNN algorithm.

Even though the capability of aircraft manufacturing has improved, human factors still play a pivotal role in flight accidents. For example, fatigue-related accidents are a common factor in human-led accidents. Hence, pilots' precise fatigue detections could help increase the flight safety of airplanes. The article suggests a model to recognize fatigue by implementing the convolutional neural network (CNN) by implementing flight trainees' face attributions. First, the flight trainees' face attributions are derived by a method called the land-air call process when the flight simulation is run. Then, sixty-eight points of face attributions are detected by employing the Dlib package. Fatigue attribution points were derived based on the face attribution points to construct a model called EMF to detect face fatigue. Finally, the proposed PSO-CNN algorithm is implemented to learn and train the dataset, and the network algorithm achieves a recognition ratio of 93.9% on the test set, which can efficiently pinpoint the flight trainees' fatigue level. Also, the reliability of the proposed algorithm is validated by comparing two machine learning models.

Evaluation of the effect of death education based on the Peace of Mind Tea House: a randomized controlled trial of nursing trainees at Xiamen University, China.

BACKGROUND: There are few studies on death education models for nursing students in China. It is of great significance to construct a model of nursing students' death education combined with clinical practice. This study aims to evaluate the effect of death education on nursing students based on the Peace of Mind Tea House. METHODS: The randomized controlled trial commenced from February 7 to March 18, 2021,featuring a two-month intercession at a hospital situated in Xiamen, China. The research subjects were chosen using a convenient sampling approach with nursing students from the hospital's internship program. Ninety-two participants were enrolled, with 46 in each group. Thirteen participants were lost to follow-up, corresponding to 14% of the total study population. The samples were then allocated randomly into either the intervention group or the control group. In addition to their hospital internship, the intervention group participated in six death education courses that focused on cognitive, emotional, and motor skills as well as the "Peace of Mind Tea House" program. Control participants will undergo regular internships. Before and two weeks after the course, both groups were evaluated for death anxiety, attitude towards death, and the meaning of life to assess the intervention's effectiveness. RESULTS: In the fear of death item of the Death Attitude Scale and the meaning of life section, the post-test score minus the pre-test score of the intervention group were 2.50 ± 3.90 (p = 0.011), and 8.90 ± 11.07 (p = 0.035), respectively. During the communication and sharing session of the reassurance card activity, 41 participants (95.3%) found the activity meaningful. CONCLUSION: Our data analysis demonstrates that nursing students have accepted and acknowledged the Peace of Mind Tea House-based education on death, which positively impacted their attitudes towards deathand the meaning of life. The content of death education should be integrated with traditional culture, and a new model of death education should be constructed with the Heart to Heart cards as its core. This research presents proof of the efficacy of implementing appropriate death education for nursing students, and provides a successful intervention plan to alleviate their future death anxiety and develop a positive outlook on death. TRIAL REGISTRATION: This study was approved by the Ethical Committee of Xiamen University School of Medicine (No. XDYX202304K21)(Date:18/01/2021). Written consent to participate was obtained from all the students.

Evaluation of a Multi-Site Cancer Health Disparities Research Training Program for Underrepresented Undergraduate and Medical Students.

Diversifying the biomedical research workforce is crucial for eliminating cancer health disparities. To address this need, Moffitt Cancer Center and Louisiana State University Health Sciences formed the Southeast Partnership for Improving Research and Training in Cancer Health Disparities (SPIRIT-CHD). A key component of SPIRIT-CHD is the Cancer Research Education Program (CREP), designed to train underrepresented undergraduate and medical students in biomedical science research. The CREP featured an 8-week summer internship with a web-based curriculum, community outreach, and mentored research experiences. Three cohorts (n = 39) completed the CREP. Students were evaluated before and after the internship using the Goal Attainment Scale (GAS), Science Teaching Efficacy Belief Instrument (STEBI), and Research Appraisal Inventory (RAI), modified to assess CREP outcomes. These scales measured students' intentions to pursue cancer research careers, self-efficacy in communicating scientific information, and perceived research abilities. Paired test results showed significant increases (p < 0.001) in scores across the scales (GAS, STEBI, RAI) pre- and post-training. Trainees reported heightened intentions to pursue cancer research careers (GAS; mean increase of 5.3, p < 0.001) and greater self-efficacy in relaying scientific information (STEBI; mean increase of 9.2, p < 0.001). They also showed increased self-confidence in conducting research (RAI; mean increase of 58.2, p < 0.001). These findings demonstrate the program's success in fostering interest in cancer research careers and enhancing research confidence. Results support the development of programs like CREP to positively impact the academic and professional trajectories of underrepresented students, ultimately creating a more diverse and inclusive biomedical research workforce equipped to address health disparities.

Substance Use Disorder Stigma and Professional Decision Making Among Pre-Professional Healthcare Trainees.

Provider stigma toward people who have substance use disorders (SUDs) may be a barrier to effective treatment delivery. The purpose of this study was to measure provider stigma among healthcare professionals-in-training and determine whether stigma levels were associated with professional decision making. A sample of 240 participants were recruited from the following academic programs at a large university in the southeastern United States: Nursing, Social Work, Counseling, Marriage and Family Therapy, and Psychology. Through an online, anonymous survey, provider stigma and other constructs were measured. The participants were also asked to make two hypothetical professional decisions: one regarding their choice to provide treatment for an SUD patient and the other regarding their likelihood of attending a professional development event (i.e., conference session) on the topic of SUDs. Results showed that self-reported stigma toward patients with SUDs was associated with a reduced likelihood of choosing to provide treatment for a patient with SUD (compared to patients with other conditions) and a reduced likelihood of attending SUD training at an upcoming conference (compared to other conference topics). Results have potential implications for the development of training programs for pre-professional healthcare trainees.

Exploring Student Perspectives of the Dietetics Profession Using a Professional Socialization Lens.

Purpose: We aimed to explore student perspectives of the dietetics profession using a professional socialization lens.Methods: We conducted qualitative semi-structured interviews, virtually or by phone, with 25 dietetic undergraduate/graduate students or interns in 2020/21. Transcripts were thematically analyzed.Results: All participants identified as female, averaged 25 years old at the time of the interviews, and were in different stages of their education. Two themes captured their perspectives of the profession: dietitians have technical expertise and professional identities are evolving. Technical expertise was focused on scientific understandings of how individuals consume and utilize food, and how (mostly Western) food should be prepared for safety and maximum nutrition. Participants perceived dietetics as a white, feminized profession with dietitians' role to aid in weight loss; participants actively sought to resist these stereotypes, notably through social media.Conclusions: While holding technical expertise continues to be embedded as a key component of dietetics identity, student professional socialization is also being shaped by social media, racial justice, and body positivity movements. This socialization process is likely to influence changes to the profession as students enter practice.

Differences in coaching in single- versus dual-console robotic cases: a mixed-methods study.

BACKGROUND: A growing importance has been placed on development of trainee robotic surgical skills through simulation curricula and intraoperative experience. However, few studies have examined how console case type impacts learning outcomes. We sought to evaluate how intraoperative coaching and resident autonomy differ based on the use of a single- versus dual-console robot. METHODS: Robotic single- and dual-console cases from February to September 2023 at a single institution were included. Faculty and trainees wore microphones to capture audio during the case. Pre/post surveys were administered, which included metrics on faculty coaching based on the Wisconsin Surgical Coaching Rubric (WiSCoR) and on trainee technical performance based on the Global Evaluative Assessment of Robotic Skills (GEARS). Statistical analysis of survey data was performed using SPSS. Audio from cases was coded by 2 researchers with a deductive approach using WiSCoR as a framework. RESULTS: Data were collected for 7 (38.9%) single and 11 (61.1%) dual-console cases across 9 case types from 4 surgical specialties. Chi-square analysis demonstrated no significant difference in percentage of case trainee spent in the operating surgeon role based on trainee level or console case type. Independent t-tests showed no significant difference in trainee autonomy, trainee performance, or faculty coaching scores based on console case type. Trainees rated faculty highest in WiSCoR Domains 1 (sharing responsibility) and 3 (providing constructive feedback). Qualitative analysis showed that for single-console cases, Domain 4 (goal setting) was most represented (34.0% of comments), while for dual-console cases, Domain 1 was most represented (37.0% of comments). CONCLUSIONS: Qualitative analysis highlights that despite similar survey-based faculty ratings across domains, coaching on self-reflection (Domain 2) is infrequently done, highlighting an opportunity for improvement in this area of coaching during robotic surgery.

Patched but Still Leaky: An Update on the Pipeline for Women in Gastroenterology.

BACKGROUND: Women remain underrepresented in gastroenterology (GI). Studies have identified that a lack of formal mentorship for women contributes to this underrepresentation. While many GI divisions have adopted models for supporting GI fellows and faculty, there is a gap in our knowledge regarding mentorship options for internal medicine (IM) residents interested in GI. AIMS: To evaluate representation of women at each level of their career (resident, fellow, and attending) and examine trends in representation of women in GI compared to other IM subspecialties. METHODS: We analyzed AAMC Physician Specialty Data Reports to compare gender representation and growth of women representation across all IM subspecialties and residencies from 2007 to 2021. RESULTS: In 2021, 44.3% of IM residents, 37.8% of GI fellows, and 19.7% of actively practicing attending gastroenterologists were women. Since 2007, GI comprised significantly lower proportions of women attendings except for cardiology, and lower representation in fellows, except for cardiology and nephrology, than other IM subspecialties (p < 0.001). There was a consistently higher proportion of women GI fellows than attendings over the past 14 years (p < 0.01). CONCLUSIONS: GI has among the lowest representation of women at each career level compared to other IM subspecialties. Given the previously reported preference of gender congruent mentoring, the underrepresentation of senior academic gastroenterologists who are women may be a contributing factor to lower proportions of women trainees choosing to pursue GI.

Exploring learning characteristics and progression of GP trainees based in regional, rural and remote settings: A qualitative study.

OBJECTIVE: Globally, most doctors train and work in metropolitan areas but a key strategy for developing the rural health workforce is expanding rural training. The aim of this study was to describe the scope and quality of learning along with skill acquisition of GP trainees based in regional, rural, and remote settings. SETTING: Regional, rural and remote settings in Queensland Australia excluding Brisbane. PARTICIPANTS: Thirty-seven general practice trainees who had undertaken their first community placement were recruited from regional, rural and remote learning settings within Queensland. DESIGN: Qualitative descriptive methodology based on constructionist epistemology was employed which allowed for the exploration of current GP trainees' experiences. Trainees were interviewed and data were thematically analysed as to the scope and quality of learning by the setting of training. Learning experiences were then mapped against the Dreyfus and Dreyfus model to explore skill acquisition. RESULTS: In terms of the scope and quality of learning, rural and remote trainees mainly focused on the diverse and unique (sometimes challenging) experiences their setting offered compared with regionally based trainees. Mapping of the trainee comments to the Dreyfus model of skill acquisition demonstrated that regardless of setting, equivalent learning occurred by GP trainees. CONCLUSIONS: This exploratory study provides evidence that rural and remote learning may provide a more diverse and challenging experience. It suggests an equivalence of quality of education and skill acquisition across settings rural, regional and remote. This suggests that the training distribution policies may not disadvantage GP trainees and the scope and quality of more remote learning may increase uptake of remote placements.

Brain Drain: A Cross-Sectional Study Evaluating Migration Intentions of Neurosurgery Trainees in Pakistan.

Background Pakistan has a significant proportion of medical graduates who intend to leave the country for better opportunities abroad, leading to a brain drain. However, the push and pull factors within neurosurgery remain unexplored, emphasizing the need for evaluation to enact policy changes. Materials and Methods We conducted a nationwide survey across 22 College of Physicians and Surgeons of Pakistan accredited neurosurgery training centers in all provinces of Pakistan. SPSS version 26 and STATA 15 were used for data analysis. Results We collected responses from 120 neurosurgery trainees across Pakistan. Trainees were categorized into two groups: those intending to leave (64%) and those intending to stay (36%) in Pakistan. A significant association was observed between the availability of fellowship training in the residents' hospital and the decision to leave or remain in Pakistan ( p = 0.034). About 67.5% of our respondents did not have any publication, and among the intention to leave group, a greater percentage had academic involvement, when compared with the stay group. A significant association ( p = 0.012) was also observed between the decision to leave or remain in Pakistan and the number of publications in nonindexed journals. Conclusion There remains a need for improvement in the standard of training provided by neurosurgery programs across the country. Our study found that disparities in research and academic exposure, as well as the lack of fellowship opportunities, may serve as stimuli for residents to leave Pakistan.

Perspectives of persons in charge regarding support for the health and daily lives of female technical intern trainees who migrate to Japan: a qualitative study.

Objectives: Migrant technical intern trainees who migrate to Japan have become essential to the Japanese labour force, especially in rural areas. Persons in charge of supervising organisations and training coordinators both support the trainees' health and daily lives during their stay in Japan. This support is significant for trainees as it helps them access and interact with Japanese society. This study explored the perspectives of persons in charge of female technical trainees regarding support for the latter's health and daily lives. Materials and Methods: Semi-structured interviews were conducted with 14 persons in charge of female technical trainees, followed by a thematic analysis of the interview data to extract key themes. Results: Four primary themes emerged: fostered beliefs and roles, cultural considerations and health support, language considerations, and concerns about female trainees in relationships. These considerations and support developed solely through experience of persons in charge of female trainees. Additionally, those in charge expressed concerns about trainees being involved in a relationship. However, no specific measures, such as providing female trainees with information, have been taken. Conclusion: Persons in charge of female technical intern trainees need to be provided opportunities to learn about cultural considerations and providing health support for their trainees. Furthermore, the cooperation of health professionals with supervising organisations and training facilities is essential to promote the healthy lives of technical intern trainees. These insights can contribute to the development of an integrated community-based approach to support the health and daily lives of female trainees.

A Coaching-Based Leadership Program for Women Postdoctoral Fellows at the National Cancer Institute that Cultivates Self-confidence and Persistence in STEMM.

Despite making strides in gender equality, women in Science, Technology, Engineering, Mathematics, and Medicine (STEMM) continue to face a persistent underrepresentation in leadership roles. In an effort to reverse this trend, the National Cancer Institute created the Sallie Rosen Kaplan (SRK) Postdoctoral Fellowship, a year-long coaching-based leadership training program. The SRK program aims to empower women to explore careers across a broad range of fields, including academia, industry, and government, and to excel in leadership positions in those fields. Analyzing a decade of data from 111 participants, we describe the positive impact of the SRK program on participant's self-reported capabilities. Increased self-confidence, improved time management and work/life balance, enhanced goal-setting and attainment skills, and strengthened communication and relationship-building abilities are highlighted as statistically significant outcomes. Moreover, the program's emphasis on coaching, mentorship, peer cohort support, and building lasting professional relationships also contributed to high ratings for satisfaction and value of the program. Successful programs like SRK can serve as a model for institutions striving to close gender gaps in leadership.

Unrestricted Learning Opportunities for Trainees in Behavior Analysis: A Survey of Current Practices.

Individuals seeking certification as a board certified behavior analyst (BCBA) by the Behavior Analyst Certification Board (BACB) must meet certain eligibility requirements. In addition to passing the BCBA examination, such requirements include completion of a master's degree, behavior-analytic coursework, and supervised practical fieldwork. In accruing fieldwork hours, trainees must be provided with the opportunity to complete unrestricted activities. The BACB defines unrestricted activities as ". . . those that are most likely to be performed by a BCBA," and requires that 60% of fieldwork hours are comprised of these activities (BACB, 2022b). Fieldwork hours may be accrued across a number of different host sites (e.g., hospital units, schools, community locations), with each host site having different day-to-day responsibilities affecting how these opportunities are provided. Therefore, exploration of the provision of these opportunities and the barriers to providing these opportunities is warranted. The current study sought to determine the current practices involved in provision of opportunities to gain fieldwork experience hours towards BCBA certification; in particular, practices related to unrestricted fieldwork activities. Results indicate that, although unrestricted learning opportunities are often provided to trainees, contingencies present within the day-to-day operations of a clinical environment can be hampering. A discussion of the implications of these barriers and potential solutions are included.

Assessing the presence of sustainability education in the curriculum of medical students and surgical trainees in Africa: A cross-sectional study.

Background and Aims: Integrating sustainability principles into medical and surgical curricula raises awareness and empowers future healthcare professionals to adopt sustainable practices, reducing the environmental impact of surgical care. This study aims to assess the presence of sustainability education in African medical schools and surgical residency curricula to inform policymakers and educators in African healthcare systems. Methods: This cross-sectional study was undertaken through an online survey among medical students and surgical trainees in African countries to describe the presence of sustainability education in surgical training programs and medical curricula across Africa. The results of this survey were reported in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: A total of 141 participants from 17 countries responded to our e-survey, primarily consisting of undergraduate medical students (92.2%, n = 130). Only 9.2% of participants reported familiarity with the concept of sustainability in surgical care, and 60.3% stated that they had yet to receive any education on sustainability. Waste management was the most commonly taught sustainability topic among those who confirmed the presence of sustainability education in their curricula. Additionally, 76% of participants reported not participating in sustainability-related projects during their training. Conclusion: This study highlights the urgent need for comprehensive integration of sustainability principles in surgical care and identifies barriers, such as a lack of awareness and resources to this integration. Addressing these gaps and implementing the suggested approaches can lead to more environmentally conscious and socially responsible surgical systems in Africa.

Implementation and evaluation of a mentorship program in clinical master in family medicine during the COVID-19 pandemic at the Arabian Gulf University: a longitudinal study.

BACKGROUND: We implemented a contextualized innovative mentorship program in the Clinical Master in Family Medicine (CMFM) program established in April 2020 at Arabian Gulf University. In this paper, we describe the process of this program and derive the major challenges faced by trainees and related corrective actions and their outcomes on high-risk trainees for optimal performance. METHODS: We conducted a mixed-method longitudinal study of 80 trainees, analyzing information extracted from the Moodle learning platform about five key performance indicators as well as the contents (quantitative and qualitative) of mentoring meeting reports submitted through a validated online form between 2020 and 2022. We analyzed frequencies and themes of challenges and compared trainees' performance according to time and level of risk. RESULTS: The follow-up of all 80 trainees in two cohorts (40 for each cohort) shows that most are female (93.75%) and the mean age is 30.00 ± 2.19 years with a ratio of mentors to mentees of 1 to 5. Meetings are conducted through phone calls, virtually, and face-to-face in 62%, 29%, and 8.3% respectively. The mean number and duration of meetings are 30.88 ± 2.31 and 20.08 ± 9.50 min respectively. Time management is the most reported challenge (41.3%), followed by health, social, and psychological-related issues in 7.6%, 4.6%, and 3% respectively. We extracted four main themes related to trainees, settings of training, e-Portfolio, and the COVID-19 pandemic. The mentorship program captured 12 trainees at high risk for low academic progress (12%) of whom six graduated on time and the remaining had to repeat a few courses the following terms. The performance of the program is stable over time (mean GPA of 3.30 (SE = 0.03), versus 3.34 (SE = 0.05) for cohorts 1 and 2 in the two years respectively, (P = 0.33). However, it is slightly lower among high-risk trainees compared to the remaining (GPA = 3.35 (SE = 0.03) versus 3.14 (SE = 0.08), P = 0.043) though above the minimum of the threshold of 3 out of 4, required for the master's degree. CONCLUSION: The mentorship program captured the struggling trainees and permitted to implement pertinent corrective actions timely, particularly in the context of a two-year intensive CMFM program during the COVID-19 pandemic.

Associations Between Food Insecurity and Diet Quality Among Graduate Students and Postdoctoral Trainees in the Health Sciences at a Private University in Boston: A Cross-Sectional Study.

Background: Food insecurity is a pivotal determinant of health outcomes. Little evidence exists on the association between food insecurity and health behaviors and outcomes, including diet quality, among graduate students or postdoctoral trainees. Objectives: This study aimed to examine the association between food insecurity and diet quality among graduate students and postdoctoral trainees at 3 health-focused graduate schools (public health, medical, and dental medicine) within Harvard University. Methods: Between April and June 2023, 1287 graduate students and 458 postdoctoral trainees at the health-focused schools within Harvard University completed a web-based survey. The primary exposure was food security status, assessed using the United States Household Food Security Survey Module. The primary outcome was diet quality, measured using the 30-day Prime Diet Quality Score screener (ranges from 0 to 126, with higher scores indicating healthier diets). The associations between food insecurity and diet quality were examined using multivariable regression models, adjusting for sociodemographic covariates. Results: Among graduate students, compared with those with high food security, diet quality was significantly lower among those experiencing marginal food security [ß: -4.7; 95% confidence interval (CI): -6.5, -2.9], low food security (ß: -5.4; 95% CI: -7.6, -3.3), and very low food security (ß: -4.4; 95% CI: -7.4, -1.4). Poor diet quality included lower intake frequencies of vegetables, fruits, beans/peas/soy products, nuts/seeds, poultry, fish, low-fat dairy, and liquid oils, and higher intake frequencies of refined grains/baked products, sugar-sweetened beverages, and fried foods. Among postdoctoral trainees, compared with those with high food security, diet quality was significantly lower among those experiencing low food security (ß: -5.1; 95% CI: -8.8, -1.4), and very low food security (ß: -5.2; 95% CI: -10.2, -0.2). Poor diet quality included lower intake frequencies of dark green leafy vegetables, other fruits, and whole grains. Conclusions: Graduate students and postdoctoral trainees who experienced degrees of food insecurity reported lower diet quality. These observations underscore the need for policies and interventions to simultaneously reduce food insecurity and improve diet quality.

Current State of Safe Pregnancy Policies for the US Surgical Trainee.

Objective: Define current practices and protocols in surgical training programs for pregnant trainees. Study Design: Cross sectional. Setting: Academic surgical training programs in the United States. Methods: A validated 20-question survey was sent via email to program directors and coordinators of US surgical training programs, including otolaryngology head & neck surgery (OHNS), plastic surgery, vascular surgery, and general surgery. The survey was issued in November and December 2022 and data were collected until January 2023. This study was approved for exemption by the Minimal Risk Research IRB at the University of Wisconsin Madison (ID number 2022-1370). Results: Surveys were emailed to 608 surgical programs, and the response rate was 23.5% (143/608) including 45 OHNS programs. When asked if their program has a policy in place for pregnant trainees, 84.4% responded yes, and 82.4% responded that they were satisfied with their policy. Subsequent questions addressed individual policies and risk factors facing pregnant trainees. 60.3% of programs report providing protected time off for miscarriages. Only 36.9% provide information to pregnant trainees regarding workplace exposures that pose a risk of fetal anomaly or miscarriage. Only 47.1% incorporate rest breaks for pregnant trainees, and only 20% protect the number of hours a pregnant trainee operates per week. 24.2% adjust overnight shifts or call schedules for pregnant trainees, and of those that adjust call shifts, 20% require pregnant trainees to "make up" these missed call shifts. Less than half (40%) of programs have a contingency plan in place for supporting nonchild-bearing residents who may take on the work of their colleagues during pregnancy or postpartum. Conclusion: While a majority of training programs report a pregnancy policy in place for trainees, most of these policies appear to be severely deficient in addressing critical aspects of surgical training that place both fetus and mother at significant risk of complications. This data indicates a need for a safe pregnancy protocol in order to protect both surgeon and fetus.