Search Results (31)

Online adaptive radiotherapy (ART) is rapidly transforming clinical radiation oncology by enabling adaptation of treatment plans based on patient-specific anatomical and biological changes. However, most medical physics training programs lack structured education in ART. To address this critical gap, the Medical Physics Adaptive Radiotherapy (MPART) Fellowship was established at our center to train post-residency or practicing physicists in advanced adaptive technologies and workflows. The MPART Fellowship is a two-year program that provides immersive, platform-specific training in CBCT-guided (Varian Ethos), MR-guided (Elekta Unity), and PET-guided (RefleXion X1) radiotherapy. Fellows undergo modular clinical rotations, hands-on training, and dedicated research projects. The curriculum incorporates competencies in imaging, contouring, online planning, quality assurance, and team-based decision-making. Evaluation is based on the Accreditation Council for Graduate Medical Education competency domains and includes milestone tracking, mentor reviews, and structured presentations. The fellowship attracted applicants from both domestic and international institutions, reflecting strong demand for formal ART training. Out of 22 applications, two fellows have been successfully recruited into the program since 2024. Fellows actively participate in all phases of adaptive workflows and are expected to function at near-attending levels by the second year of their training. Each fellow also leads at least one translational or operational research project aimed at improving ART delivery. Fellows contribute to clinical coverage and lead developmental projects, resulting in presentations and publications at the national and international levels. The MPART Fellowship addresses a vital educational need by equipping medical physicists with the advanced competencies necessary for implementing and leading ART. This program offers a replicable framework for other institutions seeking to advance precision radiation therapy through structured post-residency training in adaptive radiotherapy. As this fellowship program is still in its early phase of establishment, the primary goal of this paper is to introduce the structure, framework, and implementation model of the program. Comprehensive outcome analyses—such as quantitative assessments, fellow feedback, and longitudinal competency evaluations—will be incorporated in future work as additional cohorts complete training. Full article

Graduate Medical Education trainees’ wellness has become an important topic in academic medicine. The Accreditation Council for Graduate Medical Education (ACGME) requires oversight, education, and resources, understanding that medical training happens within a complex environment. Patients, personal and psychosocial issues, overlays, administrative demands, and intense oversight at various levels add additional elements of complexity and stress. The demographics of medicine are changing, with a greater proportion of women, minorities, and international medical graduates entering training with different needs and greater expectations. GME trainees constitute a population with unique needs that demand an adaptable and broad approach toward wellbeing and training success. The University of Texas Health San Antonio (UTHSA) created the Wellness Home, a comprehensive and adaptable model inspired by those used in primary care, where support is offered to trainees and training programs. It addresses issues beyond mental health management by including interventions such as coaching, access to medical services, or financial literacy. We present here a detailed description of the program and a rationale for developing this holistic approach in other institutions. Case studies are used to illustrate the complex needs of trainees and the innovative approaches used in their support. Usage data is presented as additional evidence that this model is increasingly and successfully being used. Full article

International medical graduates (IMGs) make up a significant proportion of general practitioners (GPs) in high-income countries such as the United Kingdom (UK), the United States of America (USA), Australia, and Canada. This paper compares views about IMGs with their own views in relation to the timing of GP placements in GP specialty training programs in the UK. It presents an inductive thematic analysis of focus groups with GP specialty trainers and trainees (149 participants across 32 focus groups), examining opinions about the ideal timing of GP placements. Trainers and home graduates argued that for home graduates, the ideal sequence depends on the trainee’s previous experience. They also suggested that IMGs should start in a hospital placement to develop familiarity with the healthcare system. In contrast, most IMGs expressed a preference for starting in a GP placement, so that they can gain an understanding of the requirements of their specialty as early as possible. There is a contrast between what IMGs said about themselves and the views shared by trainers and home graduates. This highlights the need to involve IMGs in the design of support programs targeted towards them. Recommendations include tailoring training to account for individual career paths and providing training about the healthcare system before the start of the first placement. This could improve the efficiency of GP training programs at a time of extreme pressure on healthcare systems and training providers. Full article

To address healthcare workforce shortages, Poland has experienced a significant expansion in medical education, characterized by a tripling of accredited institutions and a fourfold increase in student admissions over the past two decades. However, in 2024, the suspension of admission quotas for six newly established universities was due to concerns over accreditation of medical degree programs (MD). Given the ongoing discussions in the European Union (EU) member states about the importance of maintaining educational quality and upholding quality standards, this study seeks to thoughtfully examine trends in admissions and the institutional growth of medical education from 2004 to 2024. It draws upon the policies established by the Ministry of Health and the Polish Accreditation Committee (PKA) throughout this timeframe, while also providing an overview of the PKA’s responses to quality assurance. Study findings indicate a misalignment between institutional growth (11 to 39, 254.6% increase) and compliance with education quality, particularly in newly established programs. This study also advocates a more robust, competency-driven framework and continuous quality improvement mechanisms, as enhanced by the international standards to overcome the limitations of Poland’s current accreditation and quality assurance system in medical education. Specifically, to strengthen the institutional capacity of the accreditation body, it would be necessary to introduce the outcome-based evaluation that tracks graduate’s clinical competence, and institutional performance transparency through public reporting. This study emphasizes the critical need to align accreditation processes with national health workforce planning. This alignment is vital for establishing pathways for programs that may be underperforming in their capacity to produce a healthcare workforce that is adequately equipped for both purpose and practice across all regions. Full article

Background: During the past years, brain drain has become an international problem. A shortage of human resources in the medical field revealed its challenges during the COVID-19 pandemic. Despite the large number of medical school graduates in Egypt, the reports of the World Health Organization and the Egyptian Medical Syndicate indicate a yearly decline in the number of physicians in Egypt. The aim of this study is to determine the factors affecting Egyptian physicians’ intention to leave Egypt to work in another country. Methods: This is a cross-sectional study with a self-administered questionnaire via the snowball sampling technique that focused on Egyptian physicians who graduated from Egyptian universities and were working in Egypt. The outcome measures include the migration intentions of physicians and their satisfaction with different aspects of work, their family and housing conditions, and their demographic characteristics. Results: The questionnaire was answered by 249 Egyptian physicians, 140 of whom were living in Egypt. The findings revealed that 66.4% of the sample in Egypt were considering working abroad. Work satisfaction was the main factor affecting the decisions of physicians in Egypt; the physicians with a lower satisfaction score were 20 times more likely to leave their country. Additionally, physicians who classified themselves as having a low economic status, being younger, or who were male were more likely to leave. Conclusion: Egypt may suffer major resource losses as a result of the high degree of dissatisfaction among physicians regarding their working conditions. To realize Egypt’s Vision 2030 for health and economic progress, policymakers need to address the driving factors and take probable intervention measures to reduce the drain of our physicians. Full article

A major aspect of transition of care is the patient handover, during which miscommunication can significantly cause medical error and harm in patient care. Few medical schools in the U.S. offer formalized instructions on patient handovers, with most medical students learning from interns and residents through unstructured teaching. The aim of this study was to assess the effectiveness of a patient handover curriculum we developed for fourth-year medical students to increase their confidence and skills. Graduating fourth-year medical students (N = 98) enrolled in a two-week Transition to Residency (TTR) course attended an interactive session on patient handovers. During this session, students were presented with the I-PASS (illness severity, patient summary, action items, situation awareness and contingency planning, synthesis by receiver) mnemonic, went over case vignettes, and practiced giving and receiving handovers with a partner using the I-PASS template. At the end of TTR, students participated in an OSCE (Objective Structured Clinical Exam) activity that consisted of two standardized patient cases on blood transfusion and informed consent. Overall, our students did well with including important information in their Patient Summary (P: Case Scenario 1 Mean Score 56%; Case Scenario 2 Mean Score: 68%) and Action List (A: Case Scenario 2 Mean Score; 78%; Case Scenario 2 Mean Score: 87%) in their simulated patient case scenario. Pre-and-post survey results also indicated a significant improvement on student level of confidence (agreed or strongly agreed) in giving a patient handover (Pre: 53.1%; Post: 93.6%, p < 0.001), in receiving a patient handover (Pre: 58.2%; Post: 92.5%, p < 0.001), and in knowing what pertinent information to include in a patient handover (Pre: 62.2%; Post: 89.4%, p < 0.001). This study underscores the importance of systematic and repeated patient handover education throughout medical school training. Full article

The forced migration of tens of thousands of refugee doctors exacerbates a phenomenon referred to as “brain waste”. Based on the Arksey and O’Malley model, this scoping review conducted in SCOPUS, ProQuest, CINAHL, and ERIC via EBSCO examines three decades of peer-reviewed literature (1990–2022) on resettled Afghan and Arab refugee International Medical Graduates (rIMGs) attempting, most often unsuccessfully, relicensing/professional reentry in the USA, Canada, the EU, Australia, and New Zealand. The search identified 760 unique citations, of which only 16 met the inclusion/exclusion criteria. Included publications explored (1) systemic and personal barriers to rIMG professional reentry and (2) existing supporting reentry programs and policy recommendations. The findings point to inconsistencies in evaluating medical education credentials and to racial profiling, inequities, and discrimination in residency interviews. The support provided by some programs was perceived as inadequate, confusing, biased, and gendered. The rIMG personal barriers identified included refugees’ unique limitations and life adversities. The review grasps a collection of isolated support programs with widely varying learning performance, unclear buy-in from residency program directors, and weak policy impacts. This analysis highlights the need for legislated and standardized rIMG reentry support programs to reduce physician shortages, health disparities, and, ultimately, IMG brain waste. Full article

International medical graduates (IMGs) account for 25% of the physician workforce in the United States, yet little is known about their professional identity formation (PIF). This qualitative study explores the process of PIF in IMG residents with special attention to how they integrate their intersectional marginalized personal identities. Method: Using a social constructivist approach, the researchers conducted semi-structured individual interviews with 15 IMG resident physicians in the United States. The authors analyzed the data using a constant comparison approach and identified themes by consensus. Results: Participants described their PIF journey beginning before starting residencies in the US. Their PIF was challenging due to structural barriers associated with their immigrant status. Furthermore, participants reported more difficulties with PIF if they did not look white. When their pre-existing professional and personal identities clashed with the American professional norm, the residents suppressed or compartmentalized these pre-existing identities. However, participants also reported that their diverse personal identities could be assets to the provision of care for diverse patient populations. Conclusions: This study reveals the identity tension experienced by IMGs in their PIF journey and the different strategies they employed to navigate the conflicts with American professional norms. This study suggests reimagining PIF frameworks to cultivate a more diverse physician workforce. Full article

This essay is based on a case study of international medical graduates (IMGs) in Canada who migrated from sub-Saharan Africa. The chapter examines how narratives of race are situated and deployed in the field of medicine and can produce some aversive social–psychological landscapes in the credentialing and the professional-entry process as it relates to persons of African descent. It will show that, often without predetermination or intent, professionals of African descent in Canada are highly susceptible to implicit racial associations and implicit racial stereotyping in relation to evaluations of character, credentials, and culture. The article exposes some of the critical intersections of common experience, such as: (a) cultural deficit bias—Whiteness as an institutionalized cultural capital attribute; (b) confirmation bias—reaching a negative conclusion and working backwards to find evidence to support it; (c) repurposed sub-Saharan Blackness stereotypes—binary forms of techno-scamming and fraud; and (d) biased deception judgement—where the accuracy of deception judgements deteriorates when made across cultures. These social psychological phenomena result in significantly disproportionate returns on their foreign education and labour market experience for Black medical professionals that require decisive efforts in changing the narratives. Full article

Background: This article investigates the determinants of the intention to migrate of nursing students at a major medical university in Romania and relates them to major international developments, specifically the Brexit referendum and the COVID-19 pandemic. Methods: An online survey about the intention to migrate was made available to nursing students at the University of Medicine and Pharmacy “Iuliu Hațieganu”, Cluj-Napoca, Romania, in 2016 (before Brexit) and again in 2016 (after Brexit), 2017, 2018, and 2021 and 2022 (during the pandemic). A total of 549 students responded (response rate: 84.6%). Results: Before the Brexit referendum, 62.6% of the respondents had a plan to seek employment abroad, whereas after the Brexit referendum, only 34.7% indicated that they had such a plan after graduation. Before the pandemic, 43.6% of the students expressed an intention to work abroad, while during the pandemic, only 19.8% had such plans. Conclusions: This study documented the effect of significant international developments—such as the Brexit referendum and the COVID-19 pandemic—on decreasing the intention to migrate. As expected, the change in preference for the UK as a destination country changed dramatically. Additionally, the study provides both theoretical and empirical insights into the types of and the consistency of preparation for migration of nursing students. Full article

Refugee decisions to vaccinate for COVID-19 are a complex interplay of factors which include individual perceptions, access barriers, trust, and COVID-19 specific factors, which contribute to lower vaccine uptake. To address this, the WHO calls for localized solutions to increase COVID-19 vaccine uptake for refugees and evidence to inform future vaccination efforts. However, limited evidence engages directly with refugees about their experiences with COVID-19 vaccinations. To address this gap, researchers conducted qualitative interviews (N = 61) with refugees (n = 45), sponsors of refugees (n = 3), and key informants (n = 13) connected to local COVID-19 vaccination efforts for refugees in Calgary. Thematic analysis was conducted to synthesize themes related to vaccine perspectives, vaccination experiences, and patient intersections with policies and systems. Findings reveal that refugees benefit from ample services that are delivered at various stages, that are not solely related to vaccinations, and which create multiple positive touch points with health and immigration systems. This builds trust and vaccine confidence and promotes COVID-19 vaccine uptake. Despite multiple factors affecting vaccination decisions, a key reason for vaccination was timely and credible information delivered through trusted intermediaries and in an environment that addressed refugee needs and concerns. As refugees placed trust and relationships at the core of decision-making and vaccination, it is recommended that healthcare systems work through trust and relationships to reach refugees. This can be targeted through culturally responsive healthcare delivery that meets patients where they are, including barrier reduction measures such as translation and on-site vaccinations, and educational and outreach partnerships with private groups, community organizations and leaders. Full article

Background and objectives: Diet is a leading modifiable factor for the development of non-communicable diseases. The effective use of dietary interventions and advice should be an integral part of clinical care and medical doctors should be the most reliable and trusted source of nutrition information. The adequacy of nutrition training in medical education remains an issue of concern and most graduating medical students rate their nutrition competency as inadequate. There is no minimum standard of compulsory hours designated for nutrition in Bulgarian medical universities, nutrition classes are elective, and total assigned academic hours vary from 15 to 30. The aim of the current survey was to assess the self-perceived confidence in nutrition knowledge and skills of medical interns, obtained during medical training. Methods: A cross-sectional survey was conducted in February–March 2023. A total of 15 survey questions were formulated to assess the comprehensive medical training, nutrition knowledge and practical skills in dietary assessment, and preparedness to provide nutrition guidelines and dietary counselling. A five-point Likert scale was applied to assess the level of confidence. Results and discussion: A total of 53 interns responded to the survey with a response rate of 44%. Most participants were well confident about the diet-non-communicable disease relationship (64%), body composition and chronic diseases (76%), and the effect of diet on type-2-diabetes (68%), but fewer were familiar with food-drug interactions (8%) and were not prepared to provide food-based dietary guidelines to patients (12%). The interns were confident when interpreting laboratory nutrition tests (68%) and were ready to use anthropometric measurements (60%). About one-third of interns fully agreed that evaluation of nutritional status (36%) and dietary intake (28%) should be a part of every patient’s routine examination and 28% thought that nutrition counselling was not a part of their duties. Only 12% of the respondents were confident in their capacity to provide nutritional consultations. The strengthening of the medical curriculum with more mandatory nutrition classes will benefit physicians’ capacity in diet therapy counselling. Full article

Aim: This study aimed to analyze the reliability and validity of a Korean version of the Nursing Student Attitudes and Knowledge Toward Lesbian, Gay, Bisexual, and Transgender Patients (K-NAKL) Scale, which measures health and heterosexual attitudes toward LGBT individuals. Background: Lesbian, gay, bisexual, and transgender (LGBT) individuals often face discrimination and a lack of care experience on the part of healthcare professionals. Introduction: In South Korea, the current knowledge and attitude measurement tools for medical staff regarding LGBT individuals are limited, as they only focus on homosexuality and do not account for different sexual orientations. Methods: The participants were 217 nursing college students aged 18–25. The item–total correlations method and Cronbach’s alpha coefficient were used to analyze internal consistency reliability. Face validity, content validity, construct validity, and criterion validity testing were conducted to establish scale validity. We made sure to follow STROBE guidelines when carrying out this research. Results: The K-NAKL is a culturally appropriate instrument used to measure the attitudes and knowledge of Korean nursing students when it comes to LGBT health. Discussion: As LGBT health is increasingly gaining social interest, the nursing education curriculum needs to produce culturally competent graduates to meet the health needs of this vulnerable and marginalized population. The current study contributes to that goal. Conclusion: The K-NAKL is a valid and reliable tool with which to measure attitudes and knowledge regarding LGBT health among Korean nursing students. Implications for nursing: The K-NAKL can enable Korean nursing students to increase their knowledge and improve their attitudes when caring for the LGBT population. Implications for nursing policy and health policy: The study highlights the importance of incorporating LGBT-related health education into nursing curricula and developing inclusive policies to improve the quality of care and health outcomes for LGBT individuals. Full article

Many developed countries admit internationally educated physicians (IEPs) as highly skilled migrants. The majority of IEPs arrive with the intention of becoming licensed physicians to no avail, resulting in underemployment and underutilization of this highly skilled group of people. Alternative careers in the health and wellness sector provide IEPs opportunities to use their skills and reclaim their lost professional identity; however, this path also includes great challenges. In this study, we determined factors that affect IEPs’ decisions regarding their choice of alternative jobs. We conducted eight focus groups with 42 IEPs in Canada. Factors affecting IEPs’ career decisions were related to their individual situations and tangible aspects of career exploration, including resources and skills. A number of factors were associated with IEPs’ personal interests and goals, such as a passion for a particular career, which also varied across participants. Overall, IEPs interested in alternative careers took an adaptive approach, largely influenced by the need to earn a living in a foreign country and accommodate family needs and responsibilities. Full article

The Graduate Medical Education (GME) became an essential part of the physician’s professional curriculum all over the world, no matter the specific model developed across different countries. The “Residency” represents the main GME model in North America, where it is regulated and organized according to the standards of the Accreditation Council for Graduate Medical Education (ACGME). This model has been exported outside North America through the ACGME International (ACGME-I) program. This article reports the first experience of implementing an ACGME-oriented Pediatric Residency Program in Central Asia at the Nazarbayev University School of Medicine in the Republic of Kazakhstan. The vision, general project, main organizational aspects, and challenges of this Pediatric Residency Program are described and discussed in this article. Full article