Perception of Debt During Resident Education-A Systematic Review.

Debt is a common issue among medical residents in the United States. This review attempts 1) to evaluate the level of debt among residents, 2) to assess perceptions toward debt among residents, 3) to determine debt-management options pursued, and 4) to gauge whether levels of debt affect resident career choices. A systematic literature search of articles published between January 2012 and January 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed. The combination of search terms of (financial literacy OR debt) AND (residency OR graduate medical education) were utilized. Primary outcome measures assessed were the levels of debt and perceptions toward the debt. Secondary outcome measures were debt-management options pursued and whether debt affected career choices for residents. Twenty-one studies evaluating a total of 15,585 residents were included in this systematic review. Levels of debt greater than $200,000 were not uncommon across residents and debt burdens are increasing. Greater levels of debt are associated with increased stress and anxiety. Residents reported multiple debt-management options pursued, including loan forbearance, moonlighting, income-based repayment models, military financial support, and loan forgiveness programs. Those with increased levels of debt were less likely to pursue subspecialty training and academic employment positions. The findings conclude that residents carry a substantial amount of debt, and it is a common source of stress and anxiety. Although there are many different avenues that are pursued for debt repayment, levels of debt appear to affect decisions to pursue subspecialty training and to pursue academic positions. Strategies or programs aimed at reducing the debt burden felt by residents could be of great value.

The Case for Needed Financial Literacy Curriculum During Resident Education.

OBJECTIVE: Personal physician finance is an overlooked source of stress that negatively impacts resident wellbeing with formal financial education often left out of medical training. This study attempts to (1) evaluate the perceptions of financial literacy, (2) determine the level of financial education incorporated across residency programs, and (3) evaluate the resources that residents utilize to obtain information about managing their personal finances. DESIGN: A systematic literature search of articles published between January 2012 to January 2022, in the MEDLINE, EMBASE, and Cochrane databases was performed during February 2022]. The combination of search terms included: (financial literacy OR debt) AND (residency OR graduate medical education). The primary outcome measures included the perception of financial literacy during residency and the type of financial education incorporated during residency. Secondary outcomes included resources utilized to obtain financial education. PARTICIPANTS: Twenty-three studies evaluating a total of 5146 residents were included in this systematic review. RESULTS: The 42% to 79% of residents responded in surveys that they had "below average" understanding of finance, investing, and savings and that they felt unprepared to handle future financial decisions. 79% to 95% of respondents agreed that personal finance should be taught during residency training. The included studies also demonstrate that residents seek education through personal research, through a family member, or through attending outside financial planning seminars or courses. CONCLUSION: This study demonstrates that the majority of residents feel underprepared when making financial decisions and that formal financial education should be incorporated during their residency training. Educating residents can help mitigate financial stress which can improve physician well-being, reduce attrition, and result in better patient care. LEVEL OF EVIDENCE: IV.

In Situ Hybridization in Zebrafish Larvae and Juveniles during Mesonephros Development.

The zebrafish forms two kidney structures in its lifetime. The pronephros (embryonic kidney) forms during embryonic development and begins to function at 2 days post fertilization. Consisting of only two nephrons, the pronephros serves as the sole kidney during larval life until more renal function is required due to the increasing body mass. To cope with this higher demand, the mesonephros (adult kidney) begins to form during metamorphosis. The new primary nephrons fuse to the pronephros and form connected lumens. Then, secondary nephrons fuse to primary ones (and so on) to create a branching network in the mesonephros. The vast majority of research is focused on the pronephros due to the ease of using embryos. Thus, there is a need to develop techniques to study older and larger larvae and juvenile fish to better understand mesonephros development. Here, an in situ hybridization protocol for gene expression analysis is optimized for probe penetration, washing of probes and antibodies, and bleaching of pigments to better visualize the mesonephros. The Tg(lhx1a-EGFP) transgenic line is used to label progenitor cells and the distal tubules of nascent nephrons. This protocol fills a gap in mesonephros research. It is a crucial model for understanding how new kidney tissues form and integrate with existing nephrons and provide insights into regenerative therapies.