Predictors of academic career progression among early career physician-scientists via an intensive research training program abroad: a case study.

BACKGROUND: Despite extensive efforts to revitalize the physician-scientist pipeline, attrition has been observed along the physician-scientist developmental pathway. Research exposure during clinical training is considered an important factor favoring the decision to pursue an academic career pathway. METHODS: The authors sought to identify factors associated with academic career progression among junior physician-scientists following the completion of an intensive research training program, using the framework of the Social Cognitive Career Theory (SCCT), to benefit the design of efforts to revitalize the physician-scientist career pipeline. We conducted a retrospective study of 108 physicians who completed a long-term research training program abroad during residency, or within a few years post-residency completion, between 2010 and 2017. With potential predictors of academic career progression prioritized by SCCT, multivariable logistic regression was used to identify predictors of sustained research involvement, high productivity and high research competency after training, respectively. The SCCT was used to illuminate our findings. RESULTS: Co-publications with training supervisors abroad and medical oncology/pediatric oncology as a clinical specialty were positively associated with sustained research involvement and high productivity. Joining the training program after the age of 36 was negatively associated with high research competency. All of the predictors shared a common feature of high correlation with both self-efficacy and environmental elements, the reciprocal interactions of which may affect the career progression of physician-scientists. CONCLUSIONS: Insights gained through this analysis provide policy recommendations for the designing of efforts to revitalize the physician-scientist career pipeline. Priorities should be given to institutional oversight to ensure strengthened self-efficacy at the beginning of one's academic career, by providing long-term research training opportunities to young residents and promoting co-publications with their training supervisors during the training. In order to avoid the negative impact to self-efficacy caused by patient-related burnout or academic isolation, academic medical centers should take measures to guarantee protected research time, and to develop a positive culture encouraging mentoring relationships between junior and experienced physician-scientists in medical departments.

Radiation Oncologists' Perceptions of Adopting an Artificial Intelligence-Assisted Contouring Technology: Model Development and Questionnaire Study.

BACKGROUND: An artificial intelligence (AI)-assisted contouring system benefits radiation oncologists by saving time and improving treatment accuracy. Yet, there is much hope and fear surrounding such technologies, and this fear can manifest as resistance from health care professionals, which can lead to the failure of AI projects. OBJECTIVE: The objective of this study was to develop and test a model for investigating the factors that drive radiation oncologists' acceptance of AI contouring technology in a Chinese context. METHODS: A model of AI-assisted contouring technology acceptance was developed based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model by adding the variables of perceived risk and resistance that were proposed in this study. The model included 8 constructs with 29 questionnaire items. A total of 307 respondents completed the questionnaires. Structural equation modeling was conducted to evaluate the model's path effects, significance, and fitness. RESULTS: The overall fitness indices for the model were evaluated and showed that the model was a good fit to the data. Behavioral intention was significantly affected by performance expectancy (ß=.155; P=.01), social influence (ß=.365; P<.001), and facilitating conditions (ß=.459; P<.001). Effort expectancy (ß=.055; P=.45), perceived risk (ß=-.048; P=.35), and resistance bias (ß=-.020; P=.63) did not significantly affect behavioral intention. CONCLUSIONS: The physicians' overall perceptions of an AI-assisted technology for radiation contouring were high. Technology resistance among Chinese radiation oncologists was low and not related to behavioral intention. Not all of the factors in the Venkatesh UTAUT model applied to AI technology adoption among physicians in a Chinese context.

Who decides? Shared decision-making among colorectal cancer surgery patients in China.

PURPOSE: Patient-centered care (PCC) and shared decision-making (SDM) is advised within the English medical literature for its positive impact. The benefits of such approaches are said to foster increased trust, patient decision satisfaction, and even better outcomes. Looking at a Chinese cancer hospital, this research sought to understand how surgical decision-making was made among colorectal cancer patients. METHODS: Observations (n = 36) and semi-structured interviews (n = 24) were conducted with patients and family members. RESULTS: In the observations, 69.4% of the participating families made the decision to undergo surgery at the end of the consultation. In the interviews, three main themes emerged in regard to the characteristics in the family decision-making model, and they included three structural elements: the patient's sick role, family functional structure, and control of information. CONCLUSION: This study showed that the Chinese decision-making model is different from the western SDM model. In the Chinese context, family members dominated the decision-making process which raised concerns around informed consent. This may benefit patients insofar as receiving timely treatment in the short term but at the same time may be at the expense of limiting patient's autonomy. The promotion of a new model or a model encompassing family-centered care values may be more appropriate in clinical practice in China that can address the issues around informed consent.