Peer Assessment of Student Presentations: Key Takeaways and Lessons Learned.

Background Students' presentations are a teaching-learning tool where students not only study and understand a topic but also teach their peers, thereby learning the art and skill of effective presentation. Aims The study aimed to evaluate peer assessments in students' presentations and find their role and application in improving presentation skills among students through feedback and course correction. Methods A group of students every week from a class of 125 was assigned a topic to present to the rest of their batch students who evaluated their presentation on a rubric shared via a Google Form link. The number of students who gave responses was noted. The responses were also shared with the presenters. The evaluator faculty moderated and discussed the areas for possible improvement and course correction. The students also filled out a feedback form on the entire exercise after presentations from the entire batch. Results The quality of students' presentation skills improved with subsequent students over the period. The students learned about their areas of improvement. Through the feedback form, students shared their reasons not to give a presentation. However, most of them found the exercise beneficial. Conclusions Peer assessment can be a credible mode for improving presentation skills with the active participation of other students and provide a learning method based on others' performances. Peer responses provide for self-evaluation and self-reflection. This type of survey among different institutions will identify students' flaws, help them improve and self-evaluate, and add to the current literature.

Bridging the digital health divide-patient experiences with mobile integrated health and facilitated telehealth by community-level indicators of health disparity.

OBJECTIVE: Evaluate the impact of community tele-paramedicine (CTP) on patient experience and satisfaction relative to community-level indicators of health disparity. MATERIALS AND METHODS: This mixed-methods study evaluates patient-reported satisfaction and experience with CTP, a facilitated telehealth program combining in-home paramedic visits with video visits by emergency physicians. Anonymous post-CTP visit survey responses and themes derived from directed content analysis of in-depth interviews from participants of a randomized clinical trial of mobile integrated health and telehealth were stratified into high, moderate, and low health disparity Community Health Districts (CHD) according to the 2018 New York City (NYC) Community Health Survey. RESULTS: Among 232 CTP patients, 55% resided in high or moderate disparity CHDs but accounted for 66% of visits between April 2019 and October 2021. CHDs with the highest proportion of CTP visits were more adversely impacted by social determinants of health relative to the NYC average. Satisfaction surveys were completed in 37% of 2078 CTP visits between February 2021 and March 2023 demonstrating high patient satisfaction that did not vary by community-level health disparity. Qualitative interviews conducted with 19 patients identified differing perspectives on the value of CTP: patients in high-disparity CHDs expressed themes aligned with improved health literacy, self-efficacy, and a more engaged health system, whereas those from low-disparity CHDs focused on convenience and uniquely identified redundancies in at-home services. CONCLUSIONS: This mixed-methods analysis suggests CTP bridges the digital health divide by facilitating telehealth in communities negatively impacted by health disparities.

Racial/Ethnic Disparities in Aortic Valve Replacement Among Medicare Beneficiaries in the United States, 2012-2019.

PURPOSE: There are concerns that transcatheter or surgical aortic valve replacement (TAVR/SAVR) procedures are preferentially available to White patients. Our objective was to examine differences in utilization of aortic valve replacement and outcomes by race/ethnicity in the US for patients with aortic stenosis. METHODS: We performed a serial cross-sectional cohort study of 299,976 Medicare beneficiaries hospitalized with principal diagnosis of aortic stenosis between 2012 and 2019 stratified by self-reported race/ethnicity (Black, Hispanic, Asian, Native American, and White). Outcomes included aortic valve replacement rates within 6 months of index hospitalization and associated procedural outcomes, including 30-day readmission, 30-day and 1-year mortality. RESULTS: Within 6 months of an index admission for aortic stenosis, 86.8% (122,457 SAVR; 138,026 TAVR) patients underwent aortic valve replacement. Overall, compared with White people, Black (HR 0.87 [0.85-0.89]), Hispanic (0.92 [0.88-0.96]), and Asian (0.95 [0.91-0.99]) people were less likely to receive aortic valve replacement. Among patients who were admitted emergently/urgently, White patients (41.1%, 95% CI, 40.7-41.4) had a significantly higher aortic valve replacement rate compared with Black (29.6%, 95% CI, 28.3-30.9), Hispanic (36.6%, 95% CI, 34.0-39.3), and Asian patients (35.4%, 95% CI, 32.3-38.9). Aortic valve replacement rates increased annually for all race/ethnicities. There were no significant differences in 30-day or 1-year mortality by race/ethnicity. CONCLUSIONS: Aortic valve replacement rates within 6 months of aortic stenosis admission are lower for Black, Hispanic, and Asian people compared to White people. These race-related differences in aortic stenosis treatment reflect complex issues in diagnosis and management, warranting a comprehensive reassessment of the entire care spectrum for disadvantaged populations.

Optimization of the Illumina COVIDSeq™ protocol for decentralized, cost-effective genomic surveillance.

A decentralized surveillance system to identify local outbreaks and monitor SARS-CoV-2 Variants of Concern is one of the primary strategies for the pandemic's containment. Although next-generation sequencing (NGS) is a gold standard for genomic surveillance and variant discovery, the technology is still cost-prohibitive for decentralized sequencing, particularly in small independent labs with limited resources. We have optimized the Illumina COVIDSeq™ protocol for the Illumina MiniSeq instrument to reduce cost without compromising accuracy. We slashed the library preparation cost by half by using 50% of recommended reagents at each step and normalizing the libraries before pooling to achieve uniform coverage. Reagent-only cost (∼$43.27/sample) for SARS-CoV-2 variant analysis with this normalized input protocol on MiniSeq instruments is comparable to what is achieved on high throughput instruments such as NextSeq and NovaSeq. Using this modified protocol, we tested 153 clinical samples, and 90% of genomic coverage was achieved for 142/153 samples analyzed in this study. The lineage was correctly assigned to all samples (152/153) except for one. This modified protocol can help laboratories with constrained resources to contribute in decentralized COVID-19 surveillance in the post-vaccination era.

Assessment of Safety of a Fully Implanted Endovascular Brain-Computer Interface for Severe Paralysis in 4 Patients: The Stentrode With Thought-Controlled Digital Switch (SWITCH) Study.

Importance: Brain-computer interface (BCI) implants have previously required craniotomy to deliver penetrating or surface electrodes to the brain. Whether a minimally invasive endovascular technique to deliver recording electrodes through the jugular vein to superior sagittal sinus is safe and feasible is unknown. Objective: To assess the safety of an endovascular BCI and feasibility of using the system to control a computer by thought. Design, Setting, and Participants: The Stentrode With Thought-Controlled Digital Switch (SWITCH) study, a single-center, prospective, first in-human study, evaluated 5 patients with severe bilateral upper-limb paralysis, with a follow-up of 12 months. From a referred sample, 4 patients with amyotrophic lateral sclerosis and 1 with primary lateral sclerosis met inclusion criteria and were enrolled in the study. Surgical procedures and follow-up visits were performed at the Royal Melbourne Hospital, Parkville, Australia. Training sessions were performed at patients' homes and at a university clinic. The study start date was May 27, 2019, and final follow-up was completed January 9, 2022. Interventions: Recording devices were delivered via catheter and connected to subcutaneous electronic units. Devices communicated wirelessly to an external device for personal computer control. Main Outcomes and Measures: The primary safety end point was device-related serious adverse events resulting in death or permanent increased disability. Secondary end points were blood vessel occlusion and device migration. Exploratory end points were signal fidelity and stability over 12 months, number of distinct commands created by neuronal activity, and use of system for digital device control. Results: Of 4 patients included in analyses, all were male, and the mean (SD) age was 61 (17) years. Patients with preserved motor cortex activity and suitable venous anatomy were implanted. Each completed 12-month follow-up with no serious adverse events and no vessel occlusion or device migration. Mean (SD) signal bandwidth was 233 (16) Hz and was stable throughout study in all 4 patients (SD range across all sessions, 7-32 Hz). At least 5 attempted movement types were decoded offline, and each patient successfully controlled a computer with the BCI. Conclusions and Relevance: Endovascular access to the sensorimotor cortex is an alternative to placing BCI electrodes in or on the dura by open-brain surgery. These final safety and feasibility data from the first in-human SWITCH study indicate that it is possible to record neural signals from a blood vessel. The favorable safety profile could promote wider and more rapid translation of BCI to people with paralysis. Trial Registration: ClinicalTrials.gov Identifier: NCT03834857.

Impact of Medicaid Expansion on Rhinologic Cancer Presentation, Treatment, and Outcomes.

OBJECTIVE: The United States Patient Protection and Affordable Care Act allocated funds for states to expand Medicaid coverage. However, several states declined expansion. We aim to determine whether Medicaid expansion is associated with healthcare coverage, cancer stage at diagnosis, treatment, and survival among patients with rhinologic cancer. Rhinologic cancer was defined to include cancer of the nasal cavity, paranasal sinus, nasopharynx, or olfactory nerve. STUDY DESIGN: Cohort study. METHODS: Patients diagnosed with primary rhinologic malignancies between 2007 to 2016 were extracted from the National Cancer Institute Surveillance, Epidemiology, End Results (SEER) registry. Patients were grouped by diagnosis before and after 2014 (when Medicaid expansion became effective) and whether their state had expanded Medicaid. Multivariable logistic regression controlling for age, sex, race, ethnicity, and income/education was utilized to examine associations between Medicaid expansion/insurance status and stage at diagnosis, treatment, and survival. Overall and disease-specific survival were examined using Kaplan-Meier analysis. RESULTS: Analysis included 10,164 patients. The proportion of uninsured patients decreased after 2014 (2.4%) compared to before 2014 (4.8%, P < .001). After 2014, patients in nonexpanded states were more likely to be diagnosed with advanced stage disease compared to patients in expanded states (N = 2,364; OR = 1.27, 95% CI 1.01-1.60). Being uninsured in any state was associated with advanced stage disease at diagnosis (OR = 1.75, 95% CI 1.41-2.22) and increased risk of disease-specific death (HR = 1.54, 95% CI 1.32-1.82). Survival measures were not associated with diagnosis before versus after 2014 or Medicaid expansion. CONCLUSIONS: Patients lacking insurance or residing in nonexpanded states may be more likely to present with advanced stage rhinologic cancer. Longitudinal studies should validate these findings. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:43-50, 2023.

Socioeconomic Predictors of Access to Care for Patients with Operatively Managed Pancreatic Cancer in New York State.

PURPOSE: We evaluated how race and socioeconomic factors impact access to high-volume surgical centers, treatment initiation, and postoperative care for pancreatic cancer in a state with robust safety net insurance coverage and healthcare infrastructure. METHODS: The New York Statewide Planning and Research Cooperative System was analyzed. Patients with pancreatic cancer resected from 2007 to 2017 were identified by ICD and CPT codes. Primary outcomes included surgery at low-volume facilities (< 20 pancreatectomies/year), time to therapy initiation, and time to postoperative surveillance imaging (within 60-180 days after surgery). RESULTS: In total, 3312 patients underwent pancreatectomy across 124 facilities. Median age was 67 years (IQR 59, 75) and 55% of patients were male. Most (72.7%) had surgery at high-volume centers. On multivariable analysis, odds ratios for surgery at low-volume centers were increased for Black race (2.21 (95% CI 1.69-2.88)), Asian race (1.64 (95% CI 1.09-2.43)), Hispanic ethnicity (1.68 (95% CI 1.24-2.28)), Medicaid insurance (2.52 (95% CI 1.79-3.56)), no insurance (2.24 (95% CI 1.38-3.61)), lowest income quartile (3.31 (95% CI 2.14-5.32)), and rural zip code (2.49 (95% CI 1.69-3.65)). Patients treated at low-volume centers waited longer to initiate treatment (hazard ratio (HR) 0.91 (95% CI 0.81-1.01)). Black patients underwent the least surveillance imaging (50.4%; p < 0.0001), while Asian (HR 2.04, 95% CI 1.40-2.98)) and Hispanic patients (HR 1.36 (95% CI 1.00-1.84)) were more likely to have surveillance imaging. CONCLUSIONS: Race independently affected access to high-volume facilities and surveillance imaging. When considered in light of other accumulating evidence, future efforts might investigate the perceptions and logistical considerations noted by providers and patients alike to identify the etiology of these disparities and then institute corrective measures.

Association of Race, Ethnicity, and Socioeconomic Status With Esthesioneuroblastoma Presentation, Treatment, and Survival.

OBJECTIVE: Socioeconomic and other demographic factors are associated with outcomes in head and neck cancer. This study uses a national cancer database to explore how patient race, ethnicity, and socioeconomic status (SES) are associated with esthesioneuroblastoma outcomes, including 5-year disease-specific survival (DSS), conditional DSS, stage at diagnosis, and treatment. STUDY DESIGN: Retrospective cohort analysis. SETTING: Patients with esthesioneuroblastomas between 1973 and 2015 from the SEER registry (Surveillance, Epidemiology, and End Results). METHODS: The National Cancer Institute Yost Index, a census tract-level composite score composed of 7 parameters, was used to categorize the SES of patients. Kaplan-Meier analysis and Cox regression were conducted to assess DSS. Conditional DSS was calculated per estimates from simplified Cox models. Logistic regression was conducted to identify risk factors for advanced cancer stage at diagnosis and the likelihood of receiving multimodal therapy. RESULTS: Complete data were included for 561 patients. DSS was significantly associated with SES (log-rank, P < .01) but not race. According to Cox regression, DSS was worse for the lowest SES tertile vs the highest (hazard ratio, 1.70 [95% CI, 1.05-2.75]; P = .03). Patients of the lowest SES tertile exhibited an increased risk of advanced cancer stage at diagnosis as compared with the highest SES tertile (odds ratio, 1.84 [95% CI, 1.06-3.30]; P = .035). Black patients (odds ratio, 0.44 [95% CI, 0.24-0.84]; P = .011) were less likely than other patients to receive multimodal therapy. SES alone was not associated with receiving multimodal therapy. CONCLUSION: SES is significantly associated with DSS and conditional DSS for patients with esthesioneuroblastomas. Inequalities in access to care and treatment likely contribute to these disparities.

Assessment of health-related quality of life in cancer patients undergoing treatment using Health Utilities Index (HUI-3®) in East Delhi, India.

Background: Health-related quality of life (HRQOL) is a construct that focuses on the capacity for living afforded by the health status of a patient. Measurement of HRQOL allows a composite estimation of the capacity for living of a patient and can help capture the suffering experienced by the patient due to adverse effects of therapeutic interventions. This study was conducted to understand the health-related quality of life of cancer patients undergoing various modalities of treatment to generate evidence source for need-based intervention, to assess patients diagnosed with cancers, using Health Utilities Index - 3 (HUI-3®) and assign them single-score values to gauge HRQOL and to measure the various domains of HRQOL and change in HRQOL after a period of three months of treatment. Methods: A descriptive, longitudinal study was conducted amongst patients aged more than 18 years, who were diagnosed with cancer at a tertiary care multispecialty hospital in New Delhi. They were administered a standardized HUI-3 Questionnaire® and their responses were recorded, simultaneously. Statistical significance for change in HRQOL score was assessed with paired t-test. Multivariate linear regression was used to identify the various correlates of HRQOL. Results: The mean (± standard deviation) overall HRQOL score for all participants was 0.71 (± 0.262) [range=-0.09 to 1.00]. A follow-up assessment was carried out after three months and changes in health scores were subsequently recorded. A significant decrease in mean overall HRQOL score was seen for the entire group after three months of having been administered treatment. Single-attributes of emotion and ambulation were maximally affected amongst cancer patients after three months of treatment. On linear regression analyses, baseline HRQOL was a significant correlate of HRQOL at follow-up after three months. Conclusion: ">Addressing the HRQOL of a cancer patient before starting treatment would address morbidity that might be present even after three months.

Cardiac Computed Tomography as a Diagnostic Modality for the Assessment of Complex Congenital Heart Disease Management.

Here, we present a case of partial anomalous pulmonary venous return with the superior type of sinus venosus atrial septal defect. This case also had unusually persistent left-sided superior vena cava, which could not be diagnosed well in preoperative transthoracic echocardiography and required contrast-enhanced cardiac computed tomography scanning for proper diagnosing, operative planning, and avoidance of intraoperative problems. Postoperative, cardiac computed tomography scanning was also done to confirm adequate management.

An Evaluation of Kiosks for Direct-to-Consumer Telemedicine Using the National Quality Forum Assessment Framework.

Background: Evaluation of direct-to-consumer (DTC) telemedicine programs has focused on care delivery via personal electronic devices. Telemedicine kiosks for the delivery of virtual urgent care services have not been systematically described. Introduction: Our institution has placed kiosks for DTC urgent care in pharmacies. These kiosks can be used without a personal electronic device. Materials and Methods: Retrospective review of adult patients using pharmacy-based kiosks (kiosk) or personal electronic devices (app) for DTC evaluation. Data for patient characteristics, wait time, technical quality, visit duration diagnosis codes, follow-up recommendations, and whether the patient was traveling were compared. Results were interpreted using the National Quality Forum framework for telemedicine service evaluation, focused on access, experience, and effectiveness. Comparisons were made using chi-square test, Student's t-test, and Wilcoxon rank-sum tests. Results: Over 1 year there were 1,996 DTC visits; 238 (12%) initiated from kiosks. Kiosk patients were slightly older (mean age 38 ± 13 vs. 35 ± 11; p < 0.001), more likely to be male (52% vs. 39%; p < 0.001), more likely to be remote from home (25% vs. 3%; p < 0.001), and had less technical difficulty (10% vs. 19%; p = 0.003). Referral for urgent in-person evaluation was low in both groups (10% kiosk vs. 16%; app p = 0.017). Discussion: Kiosks may increase access to care and improve technical experience. Low urgent referral rates suggest effective care for both types of visit. Conclusions: Despite their potential advantages, kiosk visits accounted for a minority of overall visits for our DTC telemedicine service line, and daily use of each kiosk location was low.

Innovations in Emergency Nursing: Transforming Emergency Care Through a Novel Nurse-Driven ED Telehealth Express Care Service.

PROBLEM: Emergency department overcrowding and acuity are significant challenges to patients and staff. Low-acuity patients have extended wait times, and decreased satisfaction can have a negative effect on patient flow. METHODS: A multidisciplinary ED team developed and launched the first ED-based Telehealth Express Care Service, where patients who present to the emergency department with minor complaints are offered a "virtual visit" with a board-certified emergency physician located remotely. RESULTS: More than 6 months into the program, more than 1,300 patients have been treated. These patients experienced decreased length of stay (2.5 hours to 38 minutes) and increased satisfaction. The program is very well received by staff members who appreciate its efficiency. DISCUSSION: Telehealth has the potential to optimize ED efficiency, increase patient satisfaction, and promote safe, high-quality provision of care.

Assessment of Salivary Catalase, a-Amylase, and Cotinine Levels in Chronic Smokers: A Comparative Study.

INTRODUCTION: One of the common practices observed in many parts of the world is smoking, of which tobacco forms an important constituent which is burned and inhaled. Smoking is known to have potential effect on body's immune system, antioxidants level, and salivary cotinine levels. Hence, we planned the present study to evaluate the impact of cigarette smoke on salivary anti-oxidant levels and cotinine levels in smokers and nonsmokers. MATERIALS AND METHODS: The present study included assessment of salivary parameters of smokers and nonsmokers. A total of 400 subjects were analyzed, of which 200 were active smokers and 200 were nonsmokers. Unstimulated salivary samples were taken and assessment of a-amylase levels was done using biochemical kit and spectrophotometer. Assessment of salivary catalase (CAT) activity was done using Luck method. For the determination of cotinine levels, Bioassay Technology Laboratory kit was used using enzyme-linked immunosorbent assay (ELISA) technique. After the assessment of levels of all the salivary parameters, all the data were recorded, compiled, and analyzed. RESULTS: a-Amylase in smokers and nonsmokers group was found to be 206.25 and 169.85 U/mL respectively. Nonsignificant results were obtained while comparing the salivary a-amylase levels among the two study groups. Nonsignificant results were obtained while comparing the salivary CAT levels among the smokers and nonsmokers group. We observed statistically significant results while comparing mean cotinine levels among smokers group and nonsmokers group. CONCLUSION: Alteration in cotinine levels occurs in smokers in comparison to nonsmokers. CLINICAL SIGNIFICANCE: Smoking can cause harmful effect on the oral mucous membrane by altering salivary defense components.

Revised Kuppuswamy's Socioeconomic Status Scale: Explained and Updated.

Some of the facets of the Kuppuswamy's socioeconomic status scale sometimes create confusion and require explanation on how to classify, and need some minor updates to bring the scale up-to-date. This article provides a revised scale that allows for the real-time update of the scale.

Proposed minimal panel of antibodies for cost-effectiveness and accuracy in acute leukemias immunophenotyping: Prospective study at a tertiary care center.

INTRODUCTION: Flowcytometry has an essential role in the diagnosis and classification of acute leukemias. However, there exists a great degree of inter-laboratory variability on issues like panel selection, antibody combinations, gating strategies, fluorochromes, and clonal selection. AIM: The primary aim of this study was to derive a minimal panel of antibodies and evaluate its diagnostic usefulness in acute leukemias by flowcytometry by using the detailed immune-phenotype of different lineage-specific or non-specific markers. MATERIALS AND METHODS: This prospective observational study involved 400 newly diagnosed cases of acute leukemias. Bone marrow aspirate samples were subjected to morphological evaluation, cytogenetics and flow cytometric immunophenotyping. RESULTS: A minimal panel of eight antibodies comprising of CD45/CD34/CD19/MPO/cytoCD3/CD64/CD117/CD79a was derived by applying different permutations and combinations with a diagnostic yield of 97.5%. The minimal panel was further validated by testing in an independent cohort of patients with similar demographic characteristics, where it showed a high diagnostic yield of 98% in comparison with the screening panels proposed by other recently published studies. CONCLUSION: It may be concluded that the diagnostic performance of the eight antibody panel is better than most other panels used across the different laboratories in terms of yield, number of antibodies used and the scientific approach used to derive and validate the results and so henceforth may be applied in any setting with limited resources for better diagnostic accuracy.

Assessment of antidotal efficacy of cholinesterase reactivators against paraoxon: In vitro reactivation kinetics and physicochemical properties.

The search of proficient oximes as reactivators of irreversibly inhibited-AChE by organophosphate poisoning necessitates an appropriate assessment of their physicochemical properties and reactivation kinetics. Therefore, herein acid dissociation constant; pKa, lipophilicity; logP, polar surface area, hydrogen bond donor and acceptor counts of structurally different oximes (two tertiary oximes and thirteen pyridinium aldoxime derivatives) have been evaluated. The experimentally obtained data for pKa has been comparatively analyzed by using non-linear regression. Further the tested oximes were screened through in vitro reactivation kinetics against paraoxon-inhibited AChE. The pKa values of all the examined oximes were within the range of 7.50-9.53. pKa values of uncharged and mono-pyridinium oximes were in good correlation with their reactivation potency. The high negative logP values of pyridinium oxime reactivators indicate their high hydrophilic character; hence oximes with improved lipophilicity should be designed for the development of novel and more potent antidotes. Propane and butane linked oximes were superior reactivators than xylene linked bis-oxime reactivators. It is concluded from the present study that pKa value is not only ruled by the position of oximino functionality in the pyridinium ring, but also by the position of linker. Although, pyridinium oximes are proved to be better reactivators but their lipophilicity has to be improved.

Cancer related knowledge and behavior among women across various socio-economic strata: A study from Delhi, India.

BACKGROUND: Cancer is predicted to be an increasingly important cause of morbidity and mortality in the next few decades worldwide. One important step in reducing the burden of morbidity and mortality from cancers is awareness among the population about the causes and prevention of cancers. OBJECTIVE: To study the knowledge and preventive behavior regarding common cancers among the women from an area of Delhi, India. STUDY DESIGN: Cross-sectional study. SETTING: Four purposively selected residential areas representing various socio-economic strata, in North-East Delhi. PARTICIPANTS: One thousand two hundred and six women in the age group 18-60 years. STATISTICAL ANALYSIS: Proportions, Chi-square test. RESULTS: Majority of the women (43.9%) were graduates while 10.4% were illiterate. The awareness about breast cancer was maximum with 73.8% of the respondents being aware about it. The proportions of women aware about the other cancers were low. Only 52 (4.3%) had ever been for a preventive check-up for cancer. The most common cancer checkup for which the respondents reported visiting a hospital was, breast cancer. Among the respondents, 46 (3.8%) reported having a female member in their family who ever had cancer. Five hundred and seventy seven (47.8%) had not seen any message regarding cancers common in females in any mass media. Women with a higher education level, having a female family member with cancer, and those who could recall mass media message regarding cancers, were significantly more likely to have had a preventive cancer checkup for self. CONCLUSION: The knowledge and actual preventive behavior about cancers was found to be low among the women. Increased mass media exposure and targeted strategies can possibly increase the awareness and the cancer-related health behavior among the women.

What impedes working in rural areas? A study of aspiring doctors in the National Capital Region, India.

INTRODUCTION: The rural health system in India has long been disadvantaged by a shortage of health staff, including doctors. Providing medical students with a rural clinical placement has been suggested as one strategy to overcome this shortage. This study examined the attitudes of and inclination to rural healthcare careers among medical students. METHODS: A cross-sectional study was performed on 201 students (147 males and 54 females) from two medical colleges in the National Capital Region (NCR) of India. A pre-tested semi-open-ended questionnaire was used to obtain information about students' socio-demographic characteristics and their views about a rural health career. Students' open-ended responses were collated and coded into broad categories. RESULTS: Of the respondents, 160 (79.6%) had a rural background. The current status of rural health services in India was rated as unsatisfactory by 178 students (88.6%). In total 110 (54.7%) indicated an interest in working in a rural area after graduation with 68 (33.8%) willing to set up their practice in a rural area. Students with a rural background were more likely to be willing to practice in a rural area. Those whose parents were highly qualified (postgraduate education or higher) were significantly less likely to practice in a rural area (p=0.004). Potential benefits of working in a rural area included 'health services for the poor/ benefit for the nation', and 'gain of knowledge about rural people and their diseases'. Potential drawbacks included 'lack of infrastructural facilities', 'less salary' and 'low standard of living'. A majority of the students believe the undergraduate medical curriculum needed modification to improve student awareness of rural needs. CONCLUSION: The medical students surveyed had a positive view of the importance of rural health care. However, factors such as infrastructure and salary were perceived as potential barriers to a career in rural health. The findings are a starting point to understanding the attitude of medical students towards rural health care and designing specific strategies to overcome the shortage of rural doctors in India.