Explore the vast range of titles available.

NHS trusts are starting to use multiple factors beyond just waiting times and clinical priority to allocate care. This is important to avoid the elective care backlog exacerbating health inequalities, writes Riddhi Shenoy

Virtual Reality (VR) eye trackers provide portable and objective tools for neuro-ophthalmic testing. This study aimed to assess the reliability and reproducibility of an emerging VR-based eye tracker (BulbiCAM) in healthy participants and compare its utility to an existing wearable eye-tracking system (PupilLabs Neon), thereby laying the groundwork for the future studies of clinical feasibility. Thirty-nine healthy participants underwent BulbiCAM testing across two visits, with inter-visit reproducibility evaluated using intra-class correlation coefficients. Pupillary light reflex assessments were conducted with both devices, allowing paired comparisons. Participant feedback demonstrated high acceptability, with 89% reporting the test as comfortable and 81.5% experiencing no eye strain or fatigue. BulbiCAM showed high reproducibility for pupil and pursuit tests (ICC = 0.76–0.88), though saccade reproducibility was lower (ICC = 0.46–0.62) which indicates limited reliability for saccade metrics. Key pupillometric parameters showed strong agreement between devices, with minimal bias observed in baseline diameter (-0.48 mm), peak constriction (-0.56 mm), constriction velocity (0.22 mm/s), and duration (-0.052 s). These findings support the potential clinical feasibility and reliability of BulbiCAM for both research and patient testing, offering a promising alternative for objective neuro-ophthalmic assessment.

Papilledema describes optic nerve head (ONH) swelling due to raised intracranial pressure which can lead to complications including visual loss. Differentiating it from pseudopapilledema is often challenging and may require invasive investigations. Optical Coherence Tomography (OCT) is a non-invasive imaging modality, allowing visualisation of the ONH. We identified OCT-derived biomarkers for papilledema and pseudopapilledema in the existing literature. 213 patients with confirmed papilledema, optic disc drusen (ODD), tilted optic discs (TOD) or crowded optic discs (COD) were included. OCT scans were analysed for qualitative and quantitative biomarkers, with sensitivity, specificity, and AUC calculated for individual and combined biomarkers. Logistic regression modelling including qualitative biomarkers to differentiate papilledema from ODD and COD demonstrated a sensitivity and specificity of 89% and AUC of 0.96. Inclusion of TOD reduced the sensitivity of the model to 66%. In a model differentiating papilledema from TOD, the best-performing biomarker achieved a sensitivity of 87%, specificity of 61% and AUC of 0.83. Using qualitative biomarkers, we identified a model with high sensitivity and specificity to differentiate papilledema from ODD and COD. Quantitative biomarkers displayed high AUCs for differentiating TOD from papilledema. Our findings show that OCT demonstrates promising utility in differentiating papilledema from pseudopapilledema.

Ali Abdall-Razak Tel +44 79 201 4001Email ali.abdall-razak@outlook.comThe application to the United Kingdom foundation programme (UKFP) is a generally uncompetitive process. Across the country, there are 20 foundation schools that a graduate can rank, in order of their preference. Each foundation school will have a specific number of positions available and, depending on a variety of reasons, will receive different levels of application of a first-preference basis. Overall, across the 20 schools, 6998 positions were advertised in 2019, with 7421 first-preference applications made - putting the overall competition ratio at 1.06 applications per position.1 Of course, while some foundation schools, such asWest Midlands North (which received just 117 first-preference applications to its 252 positions) are entirely uncompetitive, others, such as the North Central and East London foundation school (which received 672 first-preference applications to its 337 positions) are far more competitive.

Background/Objectives: The diagnosis and prognosis of arrested foveal development or foveal hypoplasia (FH) can be made using the Leicester grading system for FH and optical coherence tomography (OCT). In clinical practice, ophthalmologists and ophthalmic health professionals with varying experience consult patients with FH; however, to date, the FH grading system has only been validated amongst experts. We compare the inter-grader and intra-grade agreement of healthcare professionals against expert consensus across all grades of FH. Methods: Handheld and table-mounted OCT images (n = 341) were graded independently at a single centre by experts (n = 3) with over six years of experience and “novice” medical and allied health professionals (n = 5) with less than three years of experience. Sensitivity, specificity, and Cohen’s kappa scores were calculated for each grader, and expert vs. novice performance was compared. Results: All graders showed high sensitivity (median 97% (IQR: 94–99)) and specificity (median 94% (IQR: 90–95)) in identifying the presence or absence of FH. No significant difference was seen in specificity between expert and novice graders, but experts had significantly greater diagnostic sensitivity (median difference = 5.3%, H = 5.00, p = 0.025). Expert graders had the highest agreement with the ground truth and novice graders showed great variability in grading uncommon grades, such as atypical FH. The proposed causes of misclassification included macular decentring in handheld OCT scans in children. Conclusions: Ophthalmologists of varying experience and allied health professionals can accurately identify FH using handheld and table-mounted OCT images. FH identification and paediatric OCT interpretation can be improved in wider ophthalmic clinical settings through the education of ophthalmic staff.

IntroductionHealth conferences provide opportunities highly beneficial for career development, knowledge exchange and networking.1 Conference inequity has been shown in the literature with underrepresentation from low and middle income countries (LMICs).1 Diverse geographical speaker representation could contribute to a more scientifically comprehensive range of topics, research results, and perceptions.2 Underrepresentation of women has also been shown at various medical conferences, although this disparity is thought to be improving over time.2 3 The International Forum of Quality and Safety (Forum) is a series of international conferences that aim to promote knowledge exchange for patient benefit, particularly through identifying global solutions to regional needs.4 There has been progressive emphasis on patient participation and increasing ethnic diversity in recent forums. This study aims to audit the global distribution of speakers and representation of women speakers at the International Forum of Quality and Safety.MethodsAll publicly available past programmes from the International Forum of Quality and Safety website were analysed (https://internationalforum.bmj.com/previous-forums/). Speakers and their affiliated country listed for oral sessions, workshops and presentations were collected by two auditors (RS and YR). Poster presenters' data were excluded as no complete data was publicly available. Similarly, online conferences were excluded due to incomplete speaker data on the website. Researchers also analysed publicly available speaker biographies to gather self-reported gender data if available. Data were analysed in Microsoft Excel. Global distribution of speakers and representation of women speakers were analysed over time as proportion of total speakers for each forum each year. Speaker data were gathered from 2016–2024 for 13 Forums, of which seven took place in Europe and six took place in Asia or Australia. Of the Europe based Forums, three took place the United Kingdom (UK), two in Sweden, one in the Netherlands and one in Denmark. Of the southern hemisphere Forums, three took place in Australia, one in Taiwan, one in Singapore and one in Malaysia.ResultsFrom all listed speakers across 13 Forums, over 70% of speakers were either from the UK, Australia, Sweden or USA, with the UK representing 35.6% of all speakers. Across the Europe-based Forums, 70% of speakers were from the UK, Sweden or USA, followed by the Netherlands and Denmark. Across the southern hemisphere Forums, over 70% of speakers were either from Australia, Singapore, the UK or USA, of which 41.5% speakers were from Australia.Median number of speakers for the Europe based Forums was 192 (IQR: 188, 217). Median number of speakers for the Asia or Australia based Forums was 115.5 (IQR: 73.25, 120.75). Generally, countries hosting the Forum had higher speaker representation in that particular Forum in comparison to other countries. Overall, the Forum appears to have good representation from women speakers across all Forums from 2022–2024.Data collection was limited to that which were publicly available. The listed affiliated country of each speaker does not indicate ethnicity of the speaker. More accurate methods of assessing diversity may include surveys administered at the time of registration.This audit of speakers at the International Forum of Quality and Safety shows equal representation of women speakers but overrepresentation of speakers from high income countries. Further data is needed to understand distribution by culture and ethnicity and more accurate data would be needed to understand gender representation. Further investigation is required to understand barriers to participation of people from LMICs to the Forum. Data on diversity of poster presenters and attendees may also be useful to identify potential groups to engage further. Further investigation is needed on career stages of speakers, poster displayers and attendees.Conflict of InterestNo conflicts of interest to declare.

Medical students are required by the General Medical Council to reflect on their practice but few opportunities are presented for group-based reflection at medical school.A two-session near-peer led reflective practice course was created for intercalating medical students undertaking group coursework. The first session involved a group discussion of one student’s team experience to analyse causative factors for the feelings and behaviours of individual members that weaken group response to challenges. Students also discussed their existing reflective practice and created their own course learning objectives to foster commitment. The second observed session consisted of students conducting their own reflective exercise to their peers.From the discussions, students most frequently reported a reluctance to assign leadership roles in peer groups, as it was discordant with the ingrained group social dynamic. Following the course, students were much more willing to generate an action plan to approach challenging team members for an honest and collaborative conversation. Student feedback emphasised the value of near-peer observation in encouraging information sharing with the group and discouraging relapse into counter-productive discussion and blaming. Following the course, students also reported using increased and broader opportunities for reflection and this was unrelated to the outcome of the situation.These findings show students are an untapped resource for developing better, sustainable and more accessible reflective practice in medical education. It suggests the value of near-peers as role models to favourably cast the active pursuit of reflection, thereby increasing student internalisation of group reflection. Student-led reflective groups may address important gaps in the development of leadership skills in medical education. These skills have utmost relevance in training students to become part of the clinical workforce and improving patient safety.