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The WhatsApp smartphone app is the most widely used instant messaging app in the world. Recent studies reported the use of WhatsApp for educational purposes, but there is no prospective study comparing WhatsApp's pedagogical effectiveness to that of any other teaching modality. The main objective of this study was to measure the impact of a learning program via WhatsApp on clinical reasoning in medical residents. This prospective, randomized, multicenter study was conducted among first- and second-year anesthesiology residents (offline recruitment) from four university hospitals in France. Residents were randomized in two groups of online teaching (WhatsApp and control). The WhatsApp group benefited from daily delivery of teaching documents on the WhatsApp app and a weekly clinical case supervised by a senior physician. In the control group, residents had access to the same documents via a traditional computer electronic learning (e-learning) platform. Medical reasoning was self-assessed online by a script concordance test (SCT; primary parameter), and medical knowledge was assessed using multiple-choice questions (MCQs). The residents also completed an online satisfaction questionnaire. In this study, 62 residents were randomized (32 to the WhatsApp group and 30 to the control group) and 22 residents in each group answered the online final evaluation. We found a difference between the WhatsApp and control groups for SCTs (60% [SD 9%] vs 68% [SD 11%]; P=.006) but no difference for MCQs (18/30 [SD 4] vs 16/30 [SD 4]; P=.22). Concerning satisfaction, there was a better global satisfaction rate in the WhatsApp group than in the control group (8/10 [interquartile range 8-9] vs 8/10 [interquartile range 8-8]; P=.049). Compared to traditional e-learning, the use of WhatsApp for teaching residents was associated with worse clinical reasoning despite better global appreciation. The use of WhatsApp probably contributes to the dispersion of attention linked to the use of the smartphone. The impact of smartphones on clinical reasoning should be studied further.

In this cluster-randomized trial involving 63 internal-medicine residency programs governed by either the 2011 ACGME duty-hour rules or more flexible duty-hour rules, flexible duty-hour policies did not increase 30-day mortality or adversely affect several other patient safety outcomes.

There is growing recognition that the ultimate success of China's ambitious health reform (enacted in 2009) and higher education reform (1998) depends on well educated health professionals who have the clinical, ethical, and human competencies necessary for the provision of quality services. In this Review, we describe and analyse graduate education of doctors in China by discussing the country's health workforce and their clinical residency education. China has launched a new system called the 5 + 3 (5 year undergraduate and 3 year residency [standardised residency training]), which aims to set national quality standards. To improve understanding for the Chinese model, we present a comparative perspective with systems from the UK and USA. To succeed, the 5 + 3 model will need to overcome major challenges of accreditation and certification, alternative education pathways, and China's unique degree and credentialing system. We conclude by reviewing the challenges of clinical competencies in China, especially the complementarity of specialist training and general practitioner training, which are essential for the quality and equity of China's health-care system.

In this randomized trial comparing ACGME duty-hour policies with more flexible policies for surgical residents, the flexible policies resulted in noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality. In response to concerns about patient safety and resident well-being, the Accreditation Council for Graduate Medical Education (ACGME) introduced national regulations in 2003 that limited resident duty periods to 80 hours per week, capped overnight shift lengths, and mandated minimum time off between shifts. 1 , 2 Concerns persisted, 3 and in 2011, the ACGME implemented further restrictions to shorten maximum shift lengths for interns and increase time off after overnight on-call duty for residents. 1 , 4 , 5 Although most observers agree that some duty-hour regulation was necessary, critics cite a weak evidence base for the 2003 and 2011 reforms. 3 , 6 , 7 Several retrospective . . .

Internal medicine residency programs were randomly assigned to standard duty-hour policies or to flexible policies without limits on shift length and time off. Interns in programs with flexible policies did not have a superior educational experience.

Rapid response teams (RRTs) are critical to the timely and appropriate management of acutely decompensating patients. In the academic setting, the vital role of RRT leader is often filled by a junior resident physician who may lack the necessary medical knowledge and experience. Cognitive aids help improve guideline adherence and may support resident performance as they transition into leadership roles. This study evaluated the impact of a rapid response mobile application on intern performance during simulated rapid response events. This randomized controlled trial compared the performance of interns in two simulated rapid response scenarios with and without access to the rapid response mobile application. The scenarios included anaphylaxis and supraventricular tachycardia (SVT). Simulations were video recorded and coded by trained raters. Interns in all specialties at our institution. Outcomes included (1) time to ordering critical medications (epinephrine and adenosine), (2) overall clinical performance using a checklist-based performance measure, and (3) usability of the mobile application. Enrollment and data collection occurred between November 2022 and February 2023. Forty-four interns from 12 specialties were randomized to the intervention group (N = 22) and the control group (N = 22). Time to order critical medications was significantly reduced in the intervention group compared to control for anaphylaxis (P < 0.005) and SVT (P < 0.005). The intervention group had significantly higher performance scores compared to the control group for the anaphylaxis portion (P < 0.006). Usability scores for the rapid response toolkit were good. Access to a rapid response mobile application improved the quality of care administered by interns during two simulated rapid response scenarios as determined by a decrease in time to ordering critical medications and improved performance scores. The intervention group found the mobile application to be usable. This work adds to existing literature supporting the use of technology-based cognitive aids to improve patient care.

In a cluster-randomized trial involving resident physicians working in pediatric ICUs, resident physicians were randomly assigned to schedules that included shifts of 24 hours or more or to schedules with shifts of 16 hours or less. Contrary to the authors’ hypothesis, resident physicians made fewer serious medical errors when they followed the extended schedule.

The current program-centric algorithm for the National Resident Matching Program (NRMP) primarily uses the program's ranking of students to determine a match. Concerns that the existing algorithm favors programs over students, recent findings that the program's ranking of applicants is not associated with resident performance, and disruptions of existing screening methods and metrics have prompted reevaluation of the current algorithm relative to a student-centric algorithm, in which student ranking of programs is primary and program ranking of students is secondary. To compare program-centric and student-centric algorithms for the NRMP participants. This cross-sectional study used randomized computer-generated data reflecting the NRMP match for 2018, 2019, and 2020, capturing more than 50 000 students and more than 4000 programs in 23 specialties, to compare the 2 algorithms. The same simulated students, programs, and rankings were exposed to the 2 algorithms, running 2300 simulations in the overall analysis and 1000 simulations in each of 23 specialties. The percentage of students who did and did not match, the percentage of students who matched to their top-ranked and top-5-ranked programs, and the program's rank of the last student matched per position were examined. The 2 algorithms were not different in percentage of students matched overall (eg, for 2020, program-centric: 59% [95% CI, 57%-61%]; student-centric: 58% [95% CI, 56%-60%]; P = .73). The student-centric algorithm, relative to the program-centric algorithm, matched a significantly higher percentage of students to their first-ranked program (eg, for 2020, 50% [95% CI, 48%-52%] vs 14% [95% CI, 13%-15%]; P < .001) and to their top-5-ranked programs (eg, for 2020, 60% [95% CI, 58%-62%] vs 46% [95% CI, 44%-48%]; P < .001). However, the last position was filled with students who had lower program rankings in the student-centric algorithm vs the program-centric algorithm (2 [95% CI, 1-2] vs 8 [95% CI, 6-10]; P < .001). In this study, the 2 algorithms were not different in the percentage of students matched overall. However, the student-centric algorithm matched a significantly higher percentage of students to their preferred programs. The program-centric algorithm was associated with a lower program's last matched student rank. Further research is needed on the algorithms' associations with cost and time demands in the match, postmatch resident and program performance, and fit with a changing environment.