Student debt of UK dental students and recent graduates.

Introduction Studies conducted in 2013 estimated the total average debt of UK dental students in their final year. Student tuition fees in the UK have increased over time and maintenance grants abolished. With the current landscape changing, it's important to understand the effect on dental students and the current total debt upon graduation.Aims Quantify the level of debt among dental students graduating in 2021/2022 and the two years prior, understand the impact of debt, and investigate socioeconomic differences.Materials and methods An online survey with final year UK dental students and recent graduates was conducted, resulting in 103 valid responses. The survey design was adapted from a validated British Dental Association (BDA) survey conducted in 2013.Results The mean total debt among respondents was £52,922.12, a substantial increase compared to the BDA data reported in 2013, with commercial and informal loans doubling from 2013 to 2022. Three-in-five (60.2%) experienced financial difficulties during their studies. Significant differences were found among socioeconomic groups.Conclusion Findings from this study show that dental student debt continues to grow, having detrimental impacts on students and their studies, specifically those from lower income households. Interventions should focus on addressing these issues.

The association between student loan debt and perceived socioeconomic status and problematic drinking and mental health symptoms: A preliminary investigation.

U.S. young adults face the largest student loan burden in history, rising income inequality, and economic uncertainty. Personal debt and other financial stressors have been associated with problematic drinking and mental health symptoms. In this paper, we investigated whether student loan debt was more strongly linked to problem drinking and mental health symptoms among those in lower positions of socioeconomic status (SES) and those who perceived greater [in]stability in their SES (SES-instability). Using data from a larger study of college graduates, we investigated SES, SES-instability, student debt, and their 2-way interactions on problematic drinking and mental health symptoms. College graduates (N = 331), who were two years post-graduation, completed measures assessing student debt, perceived SES, SES-instability, problematic drinking, and mental health symptoms (depression, anxiety, and stress). The hypotheses and data analysis plan were registered prior to conducting analyses. The expected unique, positive associations of SES-instability with problematic drinking and mental health symptoms were supported. SES was uniquely linked with problematic drinking only and in the opposite direction as predicted. Student debt was uniquely and positively linked to stress only. The expected interactions were largely supported for SES-instability and student debt-i.e., the associations of student debt with problematic drinking, anxiety, and stress were stronger (more positive) for those with greater SES-instability. The expected interactions for SES and student debt were null. Though data are cross-sectional and come from an educationally-privileged group, study findings provide preliminary evidence of links between young adult student loan debt, greater SES-instability, and their drinking/mental health.

Telemedicine in medical education: An example of a digital preparatory course for the clinical traineeship - a pre-post comparison.

Introduction: Telemedicine is a significant component of healthcare in most disciplines, giving great importance to the education of young physicians in this field. However, the topic of telemedicine has not yet been implemented in medical schools' curricula. This paper makes an important contribution to closing this gap by designing, implementing and evaluating a course with telemedical components. Using the example of a clinical traineeship preparation course, we investigated the extent to which integrated telemedical modules can contribute to the subjective confidence of students with regard to knowledge and confidence in performing practical telemedical skills, such as doctor-patient communication, taking medical histories, and applying handover techniques. Project description: The course evaluation was descriptive. Subjective confidence in clinical telemedicine skills was assessed before and after completion of the course using an online questionnaire and calculated in a pre-post design using Wilcoxon's signed-rank test. Results: The course was rated "very good" (31%) and "good" (54.2%) by the vast majority of students. The results of the Wilcoxon test show significant increases in students' feelings of confidence in performing practical telemedicine skills for all items. Discussion: This study shows that telemedicine modules integrated in a digital preparatory course contribute positively to students' subjective confidence in terms of knowledge and confidence in performing practical telemedicine skills. Specifically, this paper illustrates that professional digital doctor-patient communication, digital documentation of a medical history, and handoff techniques can be learned through telemedicine course content. Conclusion: Telemedicine modules increase students' subjective confidence in performing practical telemedicine skills. Practical telemedicine course content can thus reduce uncertainty in the use of telemedicine and prepare future physicians for its use.

Outcomes of States' Loan Repayment and Forgiveness Programs From the Perspective of Safety Net Practice Administrators.

BACKGROUND: Nearly every state offers loan repayment (LRP) and some offer loan forgiveness to clinicians who commit to work in safety net practices. The effectiveness of these programs from the perspective of safety net practices is largely unknown. OBJECTIVES: To assess safety net practice administrators' assessments of key outcomes for the 3 principal types of state service programs: LRPs funded by states, LRPs funded jointly by states and National Health Service Corps, and loan forgiveness programs. SUBJECTS: Administrators of safety net sites where primary care, behavioral health and dental health clinicians began serving in 26 state service programs in 14 states from 2011 to 2018. Survey responses were received from 455 administrators reporting on 754 of 1380 clinicians (54.6%). OUTCOME MEASURES: Administrators' ratings of their sites' difficulty recruiting clinicians; relative ease, quickness and cost of recruiting the participating (index) clinician with the service program; program expected effects on participants' retention; participants' job performance. RESULTS: Most administrators (66.1%) reported that recruiting clinicians of the index clinician's discipline is generally difficult but made easier (81.7%) and quicker (65.4%) with the service program, but only sometimes less expensive (34.8%). 78.8% of administrators anticipate that the clinicians will remain longer because of program participation. Participants are perceived to practice good quality care (96.9%) and be positive contributors (92.4%). Administrators' assessments are generally similar for the 3 types of programs. CONCLUSIONS: Administrators of safety net practices generally perceive states' loan repayment and loan forgiveness programs succeed in helping them recruit and retain good clinicians.

Physician Loans: Understanding and Overcoming an Epidemic.

BACKGROUND: Plastic surgeons face increasing financial pressure from debt, largely in two forms: education and practice loans. The authors aim to provide perspective and context when assessing their individual situations while providing straightforward and evidence-based guidance for plastic surgeons to effectively manage their physician loan burden. METHODS: Data from the Association of American Medical Colleges Medical School Graduation Questionnaire were used and analyzed. Resources for physician loans (both public and private) were also explored to determine options available to physicians. RESULTS: By graduation, the education debt for the average medical graduate is roughly $200,000. Medical school debt makes up the majority of education debt, with the 4-year cost of attendance for the class of 2020 at over $275,000 for over half of all medical schools. Over the past decade, the median cost of attendance has grown at a faster rate than median debt levels at a rate double that of inflation. CONCLUSIONS: The two major forms of debt facing plastic surgeons are educational and practice debt. Through financial education and the enactment of sound financial strategies, these debts can be effectively managed, improving physician well-being and bringing the focus more squarely back on patient care.

Organizational support, training and equipment are key determinants of burnout among dialysis healthcare professionals during the COVID-19 pandemic.

INTRODUCTION: Burnout was already found to be an important factor in the professional landscape of nephrology prior to the COVID-19 outbreak and is expected to worsen during the pandemic. OBJECTIVES: The aim of our study was to assess pandemic experiences, perceptions, and burnout among Polish dialysis unit professionals in the COVID-19 period. PARTICIPANTS AND METHODS: A survey, which consisted of a Pandemic Experiences and Perceptions Survey (PEPS) and a Maslach Burnout Inventory was distributed online to Polish dialysis units. The study group comprised 379 participants (215 nurses, 148 physicians, and 16 respondents of other professions). RESULTS: The pandemic largely affected or completely dominated the work of dialysis units according to 53.4% and 25.5% of nurses responding to the PEPS, respectively. Among physicians, the prevalence was 55.5% and 15.4% of participants, respectively. Serious or life-threatening risk was perceived by 72.1% and 11.9% of dialysis healthcare professionals, respectively. Furthermore, 74.6% of the study participants stated that their work in a dialysis setting amidst the pandemic was felt to be associated with serious risk for their relatives. Adequate personal protective equipment and information from management decreased burnout among dialysis staff. Burnout was lower in all dimensions among those participants who felt more in control of their exposure to infection, provided by proper training, equipment, and support (p = 0.0004 for emotional exhaustion, p = 0.0007 for depersonalization, and p < 0.0001 for feelings of personal accomplishment). CONCLUSIONS: The COVID-19 pandemic has largely affected the work in dialysis units. Providing proper training, equipment, and support may decrease burnout among dialysis staff.

Can olfactory training support improvement of memory functioning in patients with mild cognitive disorders? / Czy trening wechowy moze sprzyjac usprawnianiu funkcjonowania poznawczego u pacjentów z lagodnymi zaburzeniami poznawczymi?

OBJECTIVES: According to some theoretical interpretations of the olfactory training effects, the training may indirectly exert positive influence on cognitive functioning in patients with Alzheimer's dementia. The mechanism of action is stimulation of cerebral blood flow in areas of brain which are shared by olfactory and memory processes. The aim of this article is to verify a hypothesis that the olfactory training improves memory and attention functions in patients with amnestic mild cognitive impairment. METHODS: Participants with amnestic mild cognitive impairment (N = 35; 17 males and 18 females) constituted their own control group. During the first 12 weeks from the baseline evaluation no therapeutic actions were performed. The subjects underwent control neuropsychological assessment and entered in the second stage of the study. In that stage they were subjected to a daily olfactory training, which included two a few-minute-long sessions per day, which were performed for the following 3 months. Subject's memory functioning was measured at three time points: at the baseline, after 3 months and after 6 months (from the baseline). Cross-over assignment was used as the intervention method -which means that the participants constituted their own control group. The scales employed in the study to measure memory and attention were: ACE-III, CVLT, and MMSE. RESULTS: Statistically significant improvement in memory functions measured with the CVLT, MMSE, ACE-III Memory, and ACE-III Total Score was obtained. It is considered an artefact related to practice effects, not true training results. Moreover, trend suggesting improvement on the ACE-III Attention was noted as well. CONCLUSIONS: The authors review theoretical implications of the conducted study. Methodological challenges pertaining to the study design are discussed and future research directions are proposed.

Sistemas de apoio à decisão clínica e desfecho clínico na Atenção Primária à Saúde: uma revisão sistemática / Clinical decision support systems and clinical outcomes in Primary Health Care: a systematic review

Esta revisão sistemática aborda o uso de Sistemas de Suporte à Decisão Clínica (SADC) nos atendimentos realizados na Atenção Primária à Saúde (APS), identificando relações existentes entre o uso dos sistemas e os desfechos clínicos. Foram selecionados trabalhos, estudos em português e inglês, sem restrição ao cenário brasileiro, encontrados em diferentes bases de dados. Os resultados demonstram que os SADC ainda se encontram em estágio de desenvolvimento e refinamento, com aplicação ainda incipiente nas mais diversas patologias e condições clínicas. São raros os ensaios clínicos que tracem os desfechos clínicos primários, levando ao acúmulo de dados apenas sobre desfechos secundários ou compostos, dificultando a avaliação dos sistemas. Há indicativos de relativa eficiência no uso dos SADC para situações de diagnóstico e prevenção, com eficiência limitada na fase de tratamento. Finalmente, não existem dados suficientes para afirmar se os SADC geram desfechos clínicos primários mais favoráveis ou desfavoráveis na APS.

This systematic review addresses the use of Clinical Decision Support Systems (CDSS) in Primary Health Care (PHC), identifying relationships between the use of the Systems and clinical outcomes. The research employed selected studies in Portuguese and English, with no restriction to the Brazilian scenario, found in different databases. Results demonstrate that CDSS are still in the development and refinement stage, and their application is still incipient for the most diverse pathologies and clinical conditions. Clinical trials that trace the primary clinical outcomes are rare, leading to the accumulation of data only on secondary or compound outcomes, making it difficult to evaluate the systems. There are indications of relative efficiency in the use of CDSS for diagnosis and prevention situations, with limited efficiency in the treatment phase. Finally, there is insufficient data to establish whether CDSS generates more favorable or unfavorable primary clinical outcomes in PHC.

Student Debt and Cardiovascular Disease Risk Among U.S. Adults in Early Mid-Life.

INTRODUCTION: Student loan debt has become common for young adults in the U.S. and is correlated with poor physical and mental health. It is unclear how the accumulation or repayment of student debt is associated with longer-term cardiovascular risks and chronic inflammation. METHODS: Nationally representative data collected between 1994 and 2018 from >4,000 participants of a U.S. cohort study were analyzed in 2021 to assess the associations among change in student debt between young adulthood and early mid-life, 30-year Framingham cardiovascular disease risk scores, and C-reactive protein levels. RESULTS: Ordinary least squares regression revealed higher cardiovascular disease and C-reactive protein risks among those in households who became indebted or were consistently in debt between young adulthood and early mid-life than among those in households who were either never in debt or repaid their loans. This pattern persisted after adjustments for degree completion, socioeconomic measures, and other sources of debt. CONCLUSIONS: These findings provide a benchmark for widening health inequalities among a cohort bearing more student debt than any other in U.S. HISTORY: As student debt accumulates, within-cohort disparities in cardiovascular disease and related morbidities may undermine the health benefits of postsecondary education.

Experiences of United States Graduates at the Latin American Medical School in Cuba: A Road Less Traveled.

OBJECTIVES: Determine if United States graduates of the Latin American Medical School in Cuba: 1) provide primary health care to disadvantaged populations; 2) complete licensing exams and obtain residencies; and 3) accrue additional debt during their medical education. METHODS: A Qualtrics secure web-based survey was provided to 158 graduates via email, completed anonymously. Responses were compiled and descriptive statistics generated. RESULTS: Fifty-six valid surveys were returned, for a response rate of 35.4%. Chi-square analysis showed no statistically significant differences between survey respondents and the sampling frame. Most graduates are people of color; 68% work in clinical medicine; of these, 90% are in primary care, with 100% serving disadvantaged populations. Most accrued no further educational loan debt. CONCLUSIONS: United States graduates of the Latin American Medical School work in primary care with disadvantaged populations. Graduates accrue little additional student loan debt.

Student loan debt and financial education: a qualitative analysis of resident perceptions and implications for resident well-being.

High educational debt is prevalent among resident physicians and correlates with adverse well-being outcomes, including symptoms of stress and burnout. Residents also report low financial literacy levels, affecting financial well-being. Understanding resident viewpoints toward financial well-being initiatives is crucial to develop targeted resident financial well-being programs. This study aims to examine residents' experiences financing their medical education and how these experiences influence well-being and attitudes toward financial education in residency. We recruited residents from a Southern California health system with residency programs in Family Medicine, Internal Medicine, General Surgery, Orthopaedic Surgery, and Psychiatry. We contacted residents by email and text message to participate in semi-structured interviews. We conducted interviews from October 2020 to March 2021 and analyzed 59 resident interviews using reflexive thematic analysis. Among residents, 76% (45/59) had ≥ $200,000 in student loans. Residents perceived mounting medical education debt as unfairly burdensome for trainees engaged in socially beneficial work, leaving residents feeling undervalued - a feeling heightened by the stressors of the COVID-19 pandemic - and hampering well-being. Compartmentalizing debt attenuated financial stressors but often made financial education seem less pressing. A subset of residents described how financial planning restored some agency and enhanced well-being, noting that protected didactic time for financial education was crucial. Resident interviews provide practical guidance regarding designing financial education sessions. Desired education included managing debt, retirement planning, and the business of medicine. How residents framed educational debt and their degree of financial literacy impacted their well-being and sense of agency. Residents proposed that residency programs can aid in stress mitigation by providing residents with skills to help manage debt and plan for retirement. To reduce clinician indebtedness, this approach needs to occur in tandem with systemic changes to financing medical education.

Associations between career choice and educational debt for fourth-year students of US veterinary schools and colleges, 2001-2021.

OBJECTIVE: To determine whether career choice and starting salary of new DVM graduates in the US were associated with their educational debt accrued during veterinary school. SAMPLE: Up to 48,527 fourth-year students at US veterinary schools who responded to the AVMA Senior Survey in 2001 through 2021 and accepted a full-time position or advanced education opportunity. PROCEDURES: To determine whether career choice was associated with educational debt, multiple linear regression was performed, controlling for graduation year, gender, age, marital status, having children, tuition level, and school location. The correlation between educational debt and starting salary was also determined. RESULTS: On average, mean educational debt increased by $6,110 each successive year. A mean of 60.5% of respondents accepted positions in private practice (public practice, 3.3%; advanced education, 36.2%). Respondents choosing public practice had a mean of $24,913 less debt than those choosing advanced education, controlling for other factors. Respondents choosing public practice also had less debt than those choosing private practice, but debt did not differ significantly between private practice and advanced education. The correlation between educational debt and starting salary was significant but low (r = 0.177). CLINICAL RELEVANCE: Findings suggested that the amount of debt incurred during veterinary school was associated with new veterinarians' career paths. Notably, graduates with higher debt levels appeared to seek higher paying jobs or clinical training that might lead to higher paying jobs, leaving public practice-a field in which critical needs have been identified-underrepresented despite the availability of loan forgiveness programs and other incentives.

Practice Ownership Intentions of Pediatric Dentistry Residents and the Influence of Educational Debt.

Purpose: The purpose of this study was to investigate the interest in practice ownership among pediatric dentistry residents and influencing factors, particularly educational debt. Methods: An invitation to participate in an anonymous survey was sent to 933 pediatric dentistry residents training in the United States in the spring of 2020. Results: The survey response rate was 32.9 percent. Of the respondents, 61.2 percent reported being extremely or very interested in practice ownership and 49.8 percent anticipated becoming a practice owner within five years of graduation. An inverse relationship was seen between one's level of comfort in assuming a business loan to acquire a practice and having an educational debt burden of $400,000 or greater (P=0.002). Practice management preparation was the most common concern related to future practice ownership. Those feeling completely, very, or moderately prepared to manage a dental practice were over 40 percent more likely to be extremely or very interested in practice ownership than were those who felt slightly or not at all prepared (P<0.001). Conclusions: There appears to be broad interest in practice ownership among pediatric dentistry residents. Relatively high educational debt may negatively influence future practice ownership, but it may be less influential than other factors.