ABSTRACT
In the past decade, the rise of state legislation that allows for advanced practice provider (APP) independence has grown steadily across the country. Most recently, Montana has enacted House Bill 313, which allows for physician assistant independent practice in primary care services. This is a concerning trend because there is a multitude of studies that demonstrate worsened patient outcomes and increased healthcare expenditures for care delivered by nonphysicians. There are also many unintended consequences that are likely to occur due to this inappropriate expansion of scope of practice for APPs. In this commentary, we outline the ramifications that are likely to occur in states such as Montana that enact legislation that expands the scope of practice for nonphysicians.
ABSTRACT
Artificial intelligence has experienced explosive growth in the past year that will have implications in all aspects of our lives, including medicine. In order to train a physician workforce that understands these new advancements, medical educators must take steps now to ensure that physicians are adequately trained in medical school, residency, and fellowship programs to become proficient in the usage of artificial intelligence in medical practice. This manuscript discusses the various considerations that leadership within medical training programs should be mindful of when deciding how to best integrate artificial intelligence into their curricula.
Subject(s)
Minority Groups , Schools, Medical , Humans , School Admission Criteria , Rural PopulationABSTRACT
Longitudinal human gut microbiome datasets generated using community-level, sequence-based approaches often report a sub-set of long-lived "resident" taxa that rarely, if ever, are lost. This result contrasts with population-level turnover of resident clones on the order of months to years. We hypothesized that the disconnect between these results is due to a relative lack of simultaneous discrimination of the human gut microbiome at both the community and population-levels. Here, we present results of a small, longitudinal cohort study (n = 8 participants) of healthy human adults that identifies static and dynamic members of the gut microbiome at the clone level based on cultivation/genetic discrimination and at the operational taxonomic unit/amplified sequence variant levels based on 16S rRNA sequencing. We provide evidence that there is little "stability" within resident clonal populations of the common gut microbiome bacterial family, Enterobacteriaceae. Given that clones can vary substantially in genome content and that evolutionary processes operate on the population level, these results question the biological relevance of apparent stability at higher taxonomic levels.