Gender and racial trends among neurology residents: an overview.

Diversification of academic medicine improves healthcare standards and patient outcomes. Gender and racial inequalities are major challenges faced by the healthcare system. This article reviews the trends of gender and racial disparity among residents of neurology. This retrospective analysis of the annual Accreditation Council for Graduate Medical Education Data Resource Books encompassed all residents at US neurology residency training programmes from the year 2007 to 2018. The representation of women steadily increased, with an absolute increase of 3% from the year 2007 to 2018. Although the absolute change (%) increased for the White race, Asian/Pacific Islander, Black/African Americans, there was a decrease seen in the Hispanic representation in neurology residents from the year 2011 to 2018. There was no change seen for the Native Americans/Alaskans. Our study concluded that gender and racial disparity persists in the recruitment of residents in neurology. This study highlights the need for targeted interventions to address gender and racial disparity among residents of neurology. Further studies are needed to explore etiological factors to address gender and racial disparity.

Analysis of driving simulator performance for post-call orthopaedic surgery residents.

PURPOSE: Despite the associations between workhours, fatigue and motor vehicle accidents, driving abilities for residents post-call have been infrequently analysed. Our purpose was to compare orthopaedic surgery resident performance on a driving simulator after a night of call compared with their baseline. STUDY DESIGN: All residents from a single orthopaedic programme were asked to complete baseline and post-call driving simulator assessments and surveys. The primary outcome measure was brake reaction time (BRT) and secondary outcome measures included lane variance, speed variance and accidents on the driving simulator. RESULTS: All 19 orthopaedic residents agreed to participate. Compared with the baseline assessment, residents demonstrated significantly higher levels of sleepiness on the Stanford Sleepiness Scale post-call (1.6 vs 3.4; p<0.0001). Despite higher levels of fatigue post-call, there was no statistically significant differences between baseline and post-call assessments for mean BRT, accidents, lane variation and speed variation. CONCLUSIONS: These data suggest that for orthopaedic residents, driving simulator performance does not appear to be worse after a single night of call compared with baseline. Future collaborative, multicentre investigations on post-call driving safety that incorporate different call types and frequencies are necessary to better define the impact of post-call fatigue on driving performance. Recognising that motor vehicle accidents remain the leading cause of death for people under the age of 30 years, these continued areas of study are necessary to truly establish a culture of resident safety.

The Birkenhead drill suggests 'women and children first': government and society's reversal of the drill during the COVID-19 pandemic, left children last and cannot be allowed to continue.

The Birkenhead drill states that in the time of crisis, the correct action is to prioritise the weakest and most vulnerable, in that example, women and children. Ethically this has been well analysed in terms of the intrinsic value of the human versus any utilitarian calculus of worth to society's function. We do not attempt to re-analyse this but do note that standard pandemic planning often disadvantages the weak and vulnerable in terms of allocation of resources to those with a greater chance of functional survival. We more argue from a debt that society owes its children in terms of the sacrifices they have made in terms of school, social life, healthcare and overall welfare during the pandemic from which they were at markedly less risk than adults. Society owes a debt to its young, and this on top of pre-existing commitments to the them that most nations fail to realise, calls for prioritisation of children and young people's issues as society rebuilds. The effects of poverty and systemic racism on many children must be tackled; so too the existential threats of climate change and pollution. COVID-19 provides a once in a generation opportunity to create a kinder, fairer society. Early signs are not good: Pub re-opening prioritised over school re-opening; no significant investment in children's services or women's health, a significant determinant of children's welfare. We highlight the way COVID-19 has, and continues, to harm children and argue that the contemporary erosion of the Birkenhead principle is simply amoral.

Indian medical graduates in New Zealand: does anyone win?

Medical migration has become a global phenomenon, partly led by easier air travel, economic factors and the expansion of medical technology. New Zealand has gradually evolved from being 'bicultural' to a multicultural, multitextured society. The movement of the Indian people, particularly Indian physicians, will be the focus of this paper. In the last three decades, migration eligibility in New Zealand has changed from countries of origin or ability to speak English, to profession and skills. Despite struggling with its own issues, New Zealand has proven to be a preferred destination for Indian medical graduates (IMGs). India is widely recognised as the largest 'donor country' for doctors, many of whom go on to establish themselves as leaders and prominent figures in their field. This migration involves three parties: India as a donor country, New Zealand as a recipient country and IMGs as the drivers of this process. Factors behind this growing phenomenon are examined and recommendations are made so that all three parties can benefit from it.

Prevalence and factors associated with advanced care directives in a motor neuron disease multidisciplinary clinic in Australia.

OBJECTIVES: Motor neuron disease (MND) is a neurodegenerative disorder leading to functional decline and death. Multidisciplinary MND clinics provide an integrated approach to management and facilitate discussion on advanced care directives (ACDs). The study objectives are to analyse (1) the prevalence of ACD in our MND clinic, (2) the relationship between ACD and patient demographics and (3) the relationship between ACD decision-making and variables such as NIV, PEG, hospital admissions and location of death. METHODS: Using clinic records, all patients who attended the MND clinic in Liverpool Hospital between November 2014 and November 2019 were analysed. Data include MND subtypes, symptom onset to time of diagnosis, time of diagnosis to death, location and reason of death. ACD prevalence, non-invasive ventilation (NIV) and percutaneous endoscopic gastrostomy (PEG) requirements were analysed. RESULTS: There were 78 patients; M:F=1:1. 44 (56%) patients were limb onset, 28 (36%) bulbar onset, 4 primary lateral sclerosis and 2 flail limb syndrome presentations. 27% patients completed ACDs, while 32% patients declined ACDs. Patients born in Australia or in a majority English-speaking country were more likely to complete ACDs compared to those born in a non-English-speaking country. There was no significant correlation between ACD completion and age, gender, MND subtype, symptom duration, NIV, PEG feeding, location of death. CONCLUSION: One-quarter of patients completed ACDs. ACDs did not correlate with patient age, gender, MND subtype and symptom duration or decision-making regarding NIV, PEG feeding or location of death. Further studies are needed to address factors influencing patients' decisions regarding ACDs.

Medical eponyms: redeeming or not the long-standing tradition.

BACKGROUND: Healthcare workers often use terms such as Apgar, Babinski or Glasgow in their routine duties. These terms are used worldwide; they are universal and recognised in various languages. Medical eponyms are immutable by the nature; they save valuable time by streamlining communication among health professionals. However, some of these terms lack accuracy and lead to confusion. OBJECTIVE AND METHODS: This perspective article aims to analyse the current status of the divergent trends about redeeming (or not) the long-standing tradition of using medical eponyms. Multiple positions regarding the use of these terms have been expressed in the medical literature, and these are summarised in the manuscript. Although, this compilation is based primarily on the author's medical background and experience. RESULTS: There is an interesting debate in the scientific community about the suitability of certain eponyms. Defenders and detractors argue a broad spectrum of points, but there is still no international consensus. The use of classical, ethical and well-recognised medical eponyms will remain a cornerstone in daily clinical settings, textbooks and medical journals. However, their use can be inconsistent or confused in specific conditions, and they can be influenced by local geography and culture. CONCLUSIONS: There is a need to refrain from using unethical and controversial eponyms throughout the whole of science. Further academic and scientific efforts should be addressed to provide a structural systematisation, semantic classification and etymological categorisation on the use of medical eponyms.

Ethics surrounding the medical evacuation of catastrophically injured individuals from an operational theatre of war.

Although prolonging life is usually in the best interests of patients, the British Medical Association states that it is not appropriate to prolong life with no regard to its quality. Medical advances both on the battlefield and within the field hospitals have resulted in the unexpected survival of a number of British personnel, and in some cases, soldiers are being repatriated with injuries categorised as 'catastrophic'. This paper considers medical ethics based on the Beauchamp and Childress Four Principles framework with regard to whether catastrophically injured individuals should be repatriated without any prior advanced directive and without evaluation of future quality of life.

Honorary authorship in postgraduate medical training.

OBJECTIVES: To determine whether postgraduate medical trainees are exposed to honorary authorship, whether they are aware of the topic and if they believe that further support and education concerning this issue is needed. METHODS: Postgraduate medical trainees were contacted by email with a link to our questionnaire on two occasions (2 and 26 February 2014) and then contacted in person (June-November 2014). The questionnaire topics included demographics, authorship practice beliefs and experience, and authorship policy-related questions. We also determined the proportion of perceived, International Committee of Medical Journal Editors (ICMJE)-defined and unperceived honorary authorship in the respondent group. RESULTS: The response rate was 27.7%. The prevalence of perceived, ICMJE-defined and unperceived honorary authorship was 38.1%, 57.3% and 24.2%, respectively; 90.1% were unaware of the ICMJE authorship criteria, 92.6% were unaware of a support system for authorship disputes, but 91.8% believed such a system should be implemented and 93.3% believed medical trainees and faculty should be instructed on authorship guidelines. CONCLUSIONS: A paradigm shift from the current system is needed, where enforcement of ethical authorship practices is shifted away from journal editors. Instruction on the topic should be provided to medical trainees throughout medical school and continued during further training. A process should also be outlined to resolve authorship disputes. These measures may encourage researchers to have an open discussion on the topic prior to the commencement of a research project, and to resolve authorship conflicts in a constructive manner. We also hope this paper encourages further work on the topic.

Medical student views on the use of Facebook profile screening by residency admissions committees.

PURPOSE: Previous research has shown that >50% of residency programmes indicate that inappropriate Facebook postings could be grounds for rejecting a student applicant. This study sought to understand medical students' views regarding the impact of their Facebook postings on the residency admissions process. STUDY DESIGN: In 2011-2012, we conducted a national survey of 7144 randomly selected medical students representing 10% of current enrollees in US medical schools. Students were presented with a hypothetical scenario of a residency admissions committee searching Facebook and finding inappropriate pictures of a student, and were asked how the committee ought to regard these pictures. RESULTS: The response rate was 30% (2109/7144). Respondents did not differ from medical students nationally with regard to type of medical school and regional representation. Of the three options provided, the majority of respondents (63.5%) indicated 'the pictures should be considered along with other factors, but should not be grounds for automatic rejection of the application'. A third (33.7%) believed 'the pictures should have no bearing on my application; the pictures are irrelevant'. A small minority of respondents (2.8%) felt 'the pictures should be grounds for automatic rejection of the application'. CONCLUSIONS: That the views of students regarding the consequences of their online activity differ so greatly from the views of residency admissions committees speaks to the need for better communication between these parties. It also presents opportunities for medical schools to help students in their residency application process by increasing awareness of social media screening strategies used by some residency programmes, and fostering self-awareness around the use of social media during medical school and especially during the residency application process.

A qualitative study of the use of the four quadrant approach to assist ethical decision-making during deployment.

AIM: The aim of the study was to explore how useful clinicians deployed to the Field Hospital in Afghanistan found using the four quadrant approach (4QA) as a tool to aid ethical decision-making. In addition, the study aimed to determine whether the 4QA needed to be amended to make it more effective in assisting the ethical decision-making process for military health professionals on deployment. METHOD: A qualitative pilot study in two phases was undertaken between September 2012 and January 2013. In Phase I, senior deployed clinicians completed a pro forma of the 4QA on cases that potentially raised ethical issues. Thirteen pro formas were submitted on four cases; the Deployed Medical Director submitted a log of 14 cases that had involved using the 4QA. Phase II consisted of interviews with five senior clinicians who had recently returned from deployment in Afghanistan to discuss their experiences and perceptions of using the 4QA. RESULTS: Phase I identified a variation in the level of detail recorded and where that information was placed on the quadrant. Four themes were generated from Phase II. These included the characteristics of ethical decisions; the processes used to make ethical decisions; use, usefulness and limitations of the 4QA; and views about training in ethics. The findings suggested that amendments to the pro forma may improve its utility. CONCLUSIONS: The 4QA is a useful tool within an operational setting but amending its diagrammatic presentation could improve its effectiveness. Pre-deployment training should include practising using the quadrant as described in Clinical Guidelines for Operations. This is particularly important as the participants relied heavily on experience to help them make ethical decisions, and this experience may not be available in future operations outside Afghanistan.

Ethical issues in the application of genome-wide association studies to US military recruitment and personnel assignments.

Genome-wide association studies seek to associate an organism's genotypes with phenotypes. The goal of such research is to identify specific genetic variants that may be used to predict an individual's risk for a specific physical or mental disease. Recently, it has been recommended that policymakers in the USA should employ genomic surveillance so that it can be used for initial military personnel selection and personnel assignments. However, such a proposal highlights the necessity of subjecting such recommendations to rigorous ethical analysis, including concerns regarding recruitment, transparency and the return of genetic results.

Assessment of the understanding and awareness of bioethics among healthcare professionals in all public and private hospitals of Haripur district, Pakistan: a multicentre cross-sectional study.

OBJECTIVE: To assess the level of bioethics awareness among healthcare professionals in Pakistan, focusing on the associations with sociodemographic characteristics, training and teaching of ethics, medical ethics practice and specific ethical issues. DESIGN: Cross-sectional study. SETTING: Public and private hospitals in Haripur, Pakistan. PARTICIPANTS: A total of 647 healthcare professionals participated in this study. METHODS: This study was conducted between March and May 2023, following Strengthening the Reporting of Observational Studies in Epidemiology checklist criterion, involving healthcare professionals with at least 6 months of experience in patient care practice. Providers under close supervision are advised not to respond to the bioethics knowledge, attitudes and practices survey form due to potential ethical dilemmas. RESULTS: Both physicians and non-physicians need to know more about bioethics. There was a significant difference (p<0.05) in ethical training and teaching based on job categories/designations, with ethical views differing greatly by job designation. Specific ethical issues, such as accepting gifts from patients and pharmaceutical companies, referral fees, advising specific products, disclosure of medical errors, patient confidentiality, not informing patients fully about treatment and performing tasks for financial gain, showed significant associations (p<0.05) with healthcare professional's designation. Ethical awareness scores also showed significant differences (p<0.05) based on age, ethnicity, place of posting, professional experience and the organisation's ethical guidelines. CONCLUSION: This study highlighted a notable gap in the understanding of certain ethical concerns among healthcare professionals, with nurses showing relatively lower awareness of healthcare practice compared with other professionals. Addressing these issues through targeted training and robust ethical guidelines is critical to improving patient care in Pakistan's healthcare system.