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\"It is the wrong time to get sick. Speeding down the highway on the way to work, her two little girls sleeping in the back seat, medical resident Claire Rawlings doesn't have time for the nausea overtaking her. But as the world tilts sideways, she pulls into a gas station, runs to the bathroom, and passes out. When she wakes up minutes later, her car--and her daughters--are gone. The police have no leads, and the weight of guilt presses down on Claire as each hour passes with no trace of her girls. All she has to hold on to are her strained marriage, a potentially unreliable witness who emerges days later, and the desperate but unquenchable belief that her daughters are out there somewhere. As hopeful and uplifting as it is devastating, Little Lovely Things is the story of a family shattered by unthinkable tragedy, and the unexpected intersection of heartbreak and hope.\"-- Provided by publisher.

Objective Standardized training for resident physicians in China has been carried out for 10 years, and various new teaching methods have been widely applied in it. The quality of internal medicine teaching is directly related to whether the trainees can master the corresponding clinical skills well and become qualified clinical physicians. The purpose of this study is to systematically evaluate the effectiveness of all teaching methods in Chinese standardized training of internal medicine residents. Methods This study was registered in Inplasy. A comprehensive search of databases, including English and Chinese, was conducted from inception to 30 July 2023. Eligible studies included cohort study and randomized controlled trials (RCT) of all teaching methods in Chinese standardized training of internal medicine residents. A network meta-analysis (NMA) was performed using STATA 16.0. Statistical analysis was done using the mean and standard deviation. The literature quality and risks of bias was assessed using RevMan 5.3. Results A total of 74 articles including 5004 Chinese participants were retrieved, involving 13 interventions, of which 65 were RCT and 9 were cohort studies. This study demonstrated that, in comparison to lecture-based learning (LBL), the integration of problem-based learning (PBL) with WeChat significantly enhanced students' theoretical scores (SMD = 2.3; 95% CI 1.19–3.42; P  < 0.05; Sucra = 88%) and decreased the number of dissatisfied students (OR = 0.06; 95% CI 0.01–0.27; P  < 0.05; Sucra = 89%). Team-based learning (TBL) was beneficial in improving practical performance (SMD = 2.32; 95% CI 0.74–3.9; P  < 0.05; Sucra = 80.1%). Additionally, the PBL combined with clinical practice (PBL + CP) teaching method significantly enhanced students' performance in medical record analysis (SMD = 4.84; 95% CI 3.08–6.59; P  < 0.05; Sucra = 99.9%). Furthermore, PBL effectively improved students' self-directed learning abilities (SMD = 1.98; 95% CI 0.05–3.91; P  < 0.05; Sucra = 75.8%). Conclusion New teaching methods represented by PBL + Wechat, CBL + Wechat, PBL + CBL are more effective in improving the academic performance of Chinese resident physicians in standardized training compared to control therapy, and have gained more recognition from students.

From Residency to Retireme nt tells the stories of twenty American doctors over the last half century, which saw a period of continuous, turbulent, and transformative changes to the U.S. health care system. The cohort's experiences are reflective of the generation of physicians who came of age as presidents Carter and Reagan began to focus on costs and benefits of health services. Mizrahi observed and interviewed these physicians in six timeframes ending in 2016. Beginning with medical school in the mid-1970s, these physicians reveal the myriad fluctuations and uncertainties in their professional practice, working conditions, collegial relationships, and patient interactions. In their own words, they provide a \"view from the front lines\" both in academic and community settings. They disclose the satisfactions and strains in coping with macro policies enacted by government and insurance companies over their career trajectory. They describe their residency in internal medicine in a large southern urban medical center as a \"siege mentality\" which lessened as they began their careers, in Getting Rid of Patients , the title of Mizrahi's first book (1986). As these doctors moved on in their professional lives more of their experiences were discussed in terms of dissatisfaction with financial remuneration, emotional gratification, and intellectual fulfillment. Such moments of career frustration, however, were also interspersed with moments of satisfaction at different stages of their medical careers. Particularly revealing was whether they were optimistic about the future at each stage of their career and whether they would recommend a medical career to their children. Mizrahi's subjects also divulge their private feelings of disillusionment and fear of failure given the malpractice epidemic and lawsuits threatened or actually brought against so many doctors. Mizrahi's work, covering almost fifty years, provides rarely viewed insights into the lives of physicians over a professional life span.

Medical residents in hospitals are often required to be on duty for long hours. In 2003 the organization overseeing graduate medical education adopted common program requirements to restrict resident workweeks, including limits to an average of 80 hours over 4 weeks and the longest consecutive period of work to 30 hours in order to protect patients and residents from unsafe conditions resulting from excessive fatigue. Resident Duty Hours provides a timely examination of how those requirements were implemented and their impact on safety, education, and the training institutions. An in-depth review of the evidence on sleep and human performance indicated a need to increase opportunities for sleep during residency training to prevent acute and chronic sleep deprivation and minimize the risk of fatigue-related errors. In addition to recommending opportunities for on-duty sleep during long duty periods and breaks for sleep of appropriate lengths between work periods, the committee also recommends enhancements of supervision, appropriate workload, and changes in the work environment to improve conditions for safety and learning. All residents, medical educators, those involved with academic training institutions, specialty societies, professional groups, and consumer/patient safety organizations will find this book useful to advocate for an improved culture of safety.

The integration of oral health and primary care offers promising solutions to overcome barriers hindering patient access to oral health care. However, primary care providers require training in basic preventive oral health care and information regarding interprofessional practice opportunities. The purpose of this feasibility study was to examine the perspective of families, learners, faculty, and administrators who engaged in an interprofessional training experience for family medicine residents and dental hygiene students. Family medicine residents and dental hygiene students participated in an interprofessional oral health integration training experience, which included didactic, preclinical, and clinical components. The clinical experience was conducted during a Medicaid Managed Care clinic session, which included the participation of children who had not undergone a well-child visit within the past year. The care teams were comprised of a family medicine resident and dental hygiene student, who collaborated on the provision of preventive oral health care services, including oral examinations, preventive interventions, patient education, and care coordination. Qualitative data gathered using field notes, focus groups, and key informant interviews were analyzed to identify themes from care team, patient/family, and administrative perspectives. The care teams provided preventive health oral health care services to 10 pediatric patients during their well child visit. Patients and family members reported appreciating the convenience and value of the care provided. The experience was well received by family medicine residents, dental hygiene students, and clinical faculty members, who highlighted the value of the experience in expanding access to care. The family medicine residents reported the training and interprofessional practice opportunity to be highly valuable, reporting better preparation for the identification, evaluation, and treatment of oral conditions that they may have otherwise overlooked or misdiagnosed. This interprofessional educational experience demonstrates the potential value of integrating preventive oral health in primary care visits for children. This care integration may be especially helpful for populations that experience barriers to oral health care. Results of this study suggest that expanding interprofessional education between dental hygiene programs and family medicine residencies may be beneficial for preparing the future workforce for integrated care. Additional research is needed to formalize training models that support integration and promote interprofessional collaboration and practice.

Background It is unclear whether recruitment into academia will keep pace with attrition. Examining the events and opportunities that occur in residency, including the Chief Resident (CR) opportunity, will add to the pre-existing understanding about the proximate step to academic career choice. We evaluated whether there is an association between CR and type of employment the following year. Given that minoritized communities are underrepresented in academics, we evaluated whether the association varies by race-ethnicity. Methods We performed a cross-sectional analysis using de-identified individual-level data from the Graduate Medical Education (GME) Track, a national database and tracking system, from 2005 to 2020. The GME Track pulls data from the National GME census and is managed by the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA). Participants were residents in their final year of training. Exposure variable was CR status (y/n). Main outcome was intended employment type the following year (fellowship, academic, other, or private practice [referent]). Multinomial logistic regression was used to estimate the adjusted odds ratio (aOR) and 95% confidence intervals. We assessed, through interaction analyses, how intended employment varied by self-identified race-ethnicity. Results Among the study population ( N  = 450,598), 103,204 (22.9%) were CRs. CRs had increased odds of pursuing academics (1.04, 95% CI 1.01–1.06), but decreased odds of fellowship (0.76, 95% CI 0.75–0.78) or other careers (0.63, 95% CI 0.62–0.65) in comparison to private practice. Interaction analysis was significant ( p  < 0.0001). CRs who were Asian (1.13, 95% CI 1.07–1.19), Black (1.16, 95% CI 1.05–1.29), or multiracial (1.10, 95%CI 1.01–1.21), but not those who were Hispanic (0.94, 95% CI 0.83–1.08) or White (0.99, 95% CI 0.96–1.03) had increased odds of pursuing academics compared to non-CRs in those same race-ethnic categories. Conclusions CR was associated with the odds of initiating academic careers, which varied by race-ethnicity. The CR opportunity can be leveraged to diversify the pipeline into academic medicine.

Background Quality of life (QOL) is an important component in assessing people’s health. Environmental quality can influence people’s QOL in the physical health, psychological, social relationships and environment domains. QOL in the four domains, overall QOL and general heath of residents living in the Kowloon Peninsula of Hong Kong were assessed. The association between satisfaction with the neighborhood environment and QOL, and health-related behaviors which mediated the effect were investigated. Methods A sample of 317 residents completed a questionnaire which comprised the WHOQOL-BREF (Hong Kong version) to assess QOL, the International Physical Activity Questionnaire (IPAQ) to study physical activities, and questions on satisfaction with the neighborhood environment, health-related behaviors and socio-demographics. One-way ANOVA and linear regression were used to study the associations between environmental satisfaction and QOL in the four domains, overall QOL and general health, followed by assessing the relationships between environmental satisfaction and the potential health-related behavior mediators with regression tests. Mediation analysis was conducted using multiple linear regressions to study the effects of environmental satisfaction on QOL in the four domains, overall QOL and general health, as well as the potential mediating roles played by various health-related behaviors. A P -value of < 0.05 was considered as statistically significant. Results The residents had a relatively higher physical health mean score of 70.83 ± 12.69, and a lower environmental mean score of 61.98 ± 13.76. Moderate satisfaction with the neighborhood environment had a significant relationship with QOL in the psychological domain (β = 0.170, P  = 0.006), however, this effect was partially mediated by the non-smoking behavior of the residents (β = 0.143, P  = 0.022). Conclusions Our residents had lower QOL in the physical health and psychological domains but similar QOL in the social relationships and environmental domains compared to other countries. Only QOL in the psychological domain could be predicted by the satisfaction with the neighborhood environment, and non-smoking status was a partial mediator of the effect of moderate environmental satisfaction on QOL in the psychological domain. Refrain from smoking seems to be able to lower the influence of neighborhood environment on people’s QOL in the psychological domain to a certain extent.

M thodes : Nous avons proc d une tude prospective transversale pour caract riser les possibilit s de formation en traumatologie au sein des programmes canadiens de traumatologie. Les donn es ont t recueillies durant 1 semaine l' t et 1 semaine l'hiver. Nous avons compil les possibilit s de formation par site et par saison et appliqu un mod le d'analyse multivari e pour valuer les facteurs associ s une probabilit plus grande d'interventions.