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Introduction: Competency-based teaching is the preferred approach for anaesthesia training, however, limited data exists on Portuguese residents' exposure to essential competencies. This study aimed to evaluate their daily exposure to seven selected competencies from the 2022 European Training Requirements (ETR).

Methods: A cross-sectional survey was conducted amongst 350 Portuguese anaesthesia residents, throughout a 10 working day period, using a questionnaire with 170 questions. Participants were on either anaesthesia or intensive care unit rotation. Demographic data and scores of exposures to selected competencies were gathered. Statistical analyses included descriptive statistics, comparison of means and a Linear Mixed Model using the restricted maximum likelihood estimation method. The significance threshold was set at p < 0.05.

Results: Regarding ETR competency exposure, no statistical differences were found based on gender. Residents reported statistically significant higher levels of exposure to competencies while in anaesthesia rotations, except for lung, cardiac and Point-of Care ultrasound. Apart from ultrasound and academic research activities, the maximum exposure level was attained only during anaesthesia rotations. There was no reported exposure to airway ultrasound in any rotation. Exposure to academic research activities, in a scale from 0 to 5, was on average below one. The average reported values for direct patient communication were the highest. As expected, the fifth-year residents reported overall higher scores. Residents from the North reported lower scores for general anaesthesia maintenance, peripheral regional anaesthesia, airway intubation and ventilation management, but higher scores of exposures to academic research activities.

Discussion: Adopting a national logbook, formative regular assessment, supporting the trainers as well as strategies to improve competencies in academic research activities and ultrasound training are recommendations to improve the Portuguese training curricula.

Conclusion: Addressing the gaps between expected and monitored competencies contributes to the advancement of anaesthesiology training. The survey drew attention to the ETR among the residents.

Trial registration: Not applicable - registered on OSF Registries.

Introduction: The integration of online learning in health professions education has grown rapidly, offering flexibility to learners worldwide. Asynchronous online learning allows residents to engage with educational content at a time convenient for them, accommodating their demanding schedules. This study aims to reveal how residents approach asynchronous online learning during their residency training.

Methods: The Resident Study Log, an asynchronous learning tool, was introduced in a teaching hospital in Japan. This tool facilitated residents to share daily reflections on their learning experiences, allowing supervising physicians outside of their regular clinical teams to provide feedback. Posts shared between April 2020 and July 2021 were reviewed. The outcome measured included the frequency and timing of posts as well as residents' satisfaction and perceived burden, which were assessed through anonymous surveys.

Results: A total of 31 residents participated during the study period, posting 599 entries on the Resident Study Log, averaging one post per resident every two days. Participants reported an average satisfaction score of 5.3 out of 6.0 (6-point Likert scale, where 1 indicated 'not satisfied at all' and 6 indicated 'very satisfied'), while the perceived burden averaged 4.0 out of 6.0 (6-point Likert scale, where 1 indicated 'not burdensome at all' and 6 indicated 'very burdensome'). Notably, posting activity peaked at around 23:00, with 17.4% of posts created between midnight and 5:00.

Conclusion: The Resident Study Log was a simple, low-cost tool, with high satisfaction levels among residents. However, the late-night posting pattern raises concerns about resident well-being and sleep hygiene. As asynchronous learning is increasingly more prevalent, it is crucial to ensure it does not inadvertently impose hidden burdens on learners' overall well-being.

Growing work highlights the importance of diversity, equity, and inclusion (DEI) initiatives in graduate medical education. Few studies have employed participatory research approaches to solicit trainee perspectives related to DEI. Our goal was to utilize group concept mapping (GCM), a mixed-methods participatory research approach, to describe resident perspectives on DEI within a large pediatric residency program. To organize and represent their perspectives on DEI, trainees completed brainstorming, sorting/rating, and interpretation activities in accordance with GCM methodology. Activities occurred via two synchronous discussion sessions (brainstorming and interpretation) and an electronic survey (sorting/rating). Items from the brainstorming session were sorted (i.e. grouped into categories by similarity) and rated (i.e. ranked on perceived importance and likelihood to change) by participants individually. Multidimensional scaling and hierarchical clustering were used to generate point maps, cluster maps, and go-zone illustrations for use in the interpretation session. We present data regarding participant characteristics and engagement, results from GCM activities, and action steps from this process. There were a total of 127 trainees in the residency program in 2021-2022. Participation varied across activities (brainstorming session: 21 participants; sorting/rating: 48 participants; interpretation session: 20 participants). A total of 64 unique items were generated from brainstorming. Five clusters emerged: 1) city factors, 2) institutional factors, 3) program representation, 4) program components, 5) non-DEI program perks. Program representation and program components clusters were rated as the most important and the most likely to be changed. Participants identified several action steps during the interpretation session which were shared with institutional leadership to direct programmatic reform. We demonstrate the utility of GCM, a structured and scalable participatory research method, to characterize trainee perceptions of DEI in graduate medical education.

International medical students (IMS; non-U.S. citizens/permanent residents) greatly enhance the diversity of U.S. medical schools and serve in areas of greatest healthcare needs. Despite 15% of the US population being foreign born, international students represent < 2% of US-MD matriculants. Factors that contribute to this underrepresentation of IMS remain unknown. In this study, we analyzed the accessibility, quality, and inclusivity of publicly available admissions and financial aid policies at all US-MD schools, with the goal of evaluating potential institutional and informational barriers faced by IMS. Institutional webpages and American Association of Medical College (AAMC) databases were searched from May-July 2023 to gather IMS-specific admissions and financial aid information from 153 accredited US-MD schools. Two-tailed t-test or chi-square analysis was used to examine differences. An inductive thematic approach was used to qualitatively categorize institutional webpage friendliness. While 45% (69/153) of U.S.-MD schools reported accepting IMS, only 18% (27/153) admitted students without restrictions (e.g., Canadians only, state/religious preference). Further, 38% (26/69) of the schools that accept IMS did not provide financial aid information, while nearly two-thirds of the remaining schools required proof of personal financial ability with no institutional/federal support. International students also entered schools with a higher average Medical College Admission Test (MCAT) score and Grade Point Average (GPA). In the national AAMC databases, 19 additional programs were listed as accepting IMS although the institutional webpages stated otherwise; the databases also lacked details on specific restrictions posed by the majority of institutions. Of all 153 webpages, only 14% were deemed 'international friendly.' Restrictive admissions and financial aid policies as well as the poor quality and access to information are major barriers that affect IMS. Strategies that aim to overcome these challenges can greatly help advance diversity, equity, and inclusion in medical education.

Background: Anti-racism curricula are increasingly being recognized as an integral component of medical education. To our knowledge, there has not yet been a publication exploring resident perspectives from multiple institutions and explicitly representing both underrepresented in medicine (UIM) and non-UIM perspectives.

Objective: To explore and compare UIM and non-UIM pediatric residents' perspectives on the content and qualities of meaningful anti-racism curricula.

Methods: We performed an IRB-approved multi-institutional, qualitative study that incorporated Sotto-Santiago et al's conceptual framework for anti-racism education. Between February and May 2021, we conducted focus groups of UIM and non-UIM pediatric residents at three large residency programs in the United States. We developed focus group guides using literature review, expert consensus, feedback from study team racial equity experts, and piloting. Focus groups were conducted virtually, audio-recorded, and transcribed verbatim. We employed thematic analysis to code transcripts, create categories, and develop themes until we reached thematic sufficiency. We completed member checking to ensure trustworthiness of themes.

Results: Forty residents participated (19 UIM and 21 non-UIM) in a total of six focus groups. We identified 7 themes, summarized as: 1) racism in medicine is pervasive, therefore (2) anti-racism education is critical to the development of competent physicians, and 3) education should extend to all healthcare providers. 4) Residents desired education focused on action-oriented strategies to advance anti-racism, 5) taught by those with both learned and lived experiences with racism, 6) in a psychologically safe space for UIM residents, and 7) with adequate time and financial resources for successful implementation and engagement.

Conclusion: Our multi-institutional study affirms the need for pediatric resident anti-racism education, promotes co-creation as a method to affect culture change, and provides practical strategies for curricular design and implementation.

Aspiring to become a physician is a natural expectation for applicants to medical school. However, choosing a career in medicine is a critical decision, especially in countries where high school students can apply to medical school without an undergraduate degree. Students may select a medical career for various reasons, including parental pressure and academic performance. The question of whether there are students who enroll in medical school without clear intentions of becoming doctors has not been extensively investigated in the literature. We conducted a retrospective study at a national university in Japan. Given the scarcity of research examining medical students who did not have a clear intention to become doctors at the time of admission, we created a survey. The questionnaire asked students whether they had clear intentions to become doctors upon enrollment, and those who responded affirmatively were defined as students with clear intentions to become doctors at admission and assigned to the first group. The second group was composed of students who entered medical school without clear intentions to become doctors. We then compared the differences in sociodemographic characteristics and career determinants between these groups using statistical methods, including Chi-square tests and logistic regression. The collection rate of the questionnaire was 76.2%. We found that 28.8% of students at a national medical school in Japan entered medical school without clear intentions of becoming doctors. For these students, 'parental expectations' and 'peer influence' were identified as significant career determinants. No sociodemographic characteristics showed significant associations with the ambiguity of students' intentions to pursue a medical career at admission. This study confirmed that some students enroll in medical school without clear intentions of becoming doctors. The background factors related to this type of student were parental expectations and the influence of peers on career choice.

When clinician-educators and medical education researchers use and discuss medical education research, they can advance innovation in medical education as well as improve its quality. To facilitate the use and discussions of medical education research, we created a prefatory visual representation of key medical education research topics and associated experts. We conducted one-on-one virtual interviews with medical education journal editorial board members to identify what they perceived as key medical education research topics as well as who they associated, as experts, with each of the identified topics. We used content analysis to create categories representing key topics and noted occurrences of named experts. Twenty-one editorial board members, representing nine of the top medical education journals, participated. From the data we created a figure entitled, Medical Education Research Library. The library includes 13 research topics, with assessment as the most prevalent. It also notes recognized experts, including van der Vleuten, ten Cate, and Norman. The key medical education research topics identified and included in the library align with what others have identified as trends in the literature. Selected topics, including workplace-based learning, equity, diversity, and inclusion, physician wellbeing and burnout, and social accountability, are emerging. Once transformed into an open educational resource, clinician-educators and medical education researchers can use and contribute to the functional library. Such continuous expansion will generate better awareness and recognition of diverse perspectives. The functional library will help to innovate and improve the quality of medical education through evidence-informed practices and scholarship.

India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India - resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.

Academics in medicine are frequently asked to serve on panels to discuss their clinical, research, education, administrative or personal expertise. While panel discussions are often the highlight of a conference or event, in the medical literature, there is very little published on how an individual can effectively prepare and present as an expert panelist. This paper offers guidelines that will enable academics to prepare, deliver, and engage in active dialogue during a panel discussion. Specific tactics include how to accept invitations to serve on a panel, conducting pre-panel conference meetings and background research, preparing concise opening statements and new insights, connecting with the audience, answering questions in a collaborative spirit, and debriefing after the panel. These guidelines will be valuable to any individual invited to serve on a panel discussion and will promote future panelists in engaging in constructive and fulfilling dialogue, with the ultimate goal of leaving the audience with a greater understanding of the topic of discourse.

Introduction: People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and other sexual/gender minorities (LGBTQ+) may experience discrimination when seeking healthcare. Medical students should be trained in inclusive and affirming care for LGBTQ+ patients. This narrative literature review explores the landscape of interventions and evaluations related to LGBTQ+ health content taught in medical schools in the USA and suggests strategies for further curriculum development.

Methods: PubMed, ERIC, and Education Research Complete databases were systematically searched for peer-reviewed articles on LGBTQ+ health in medical student education in the USA published between 1 January 2011-6 February 2023. Articles were screened for eligibility and data was abstracted from all eligible articles. Data abstraction included the type of intervention or evaluation, sample population and size, and key outcomes.

Results: One hundred thirty-four articles met inclusion criteria and were reviewed. This includes 6 (4.5%) that evaluate existing curriculum, 77 (57.5%) study the impact of curriculum components and interventions, 36 (26.9%) evaluate student knowledge and learning experiences, and 15 (11.2%) describe the development of broad learning objectives and curriculum. Eight studies identified student knowledge gaps related to gender identity and affirming care and these topics were covered in 34 curriculum interventions.

Conclusion: Medical student education is important to address health disparities faced by the LGBTQ+ community, and has been an increasingly studied topic in the USA. A variety of curriculum interventions at single institutions show promise in enhancing student knowledge and training in LGBTQ+ health. Despite this, multiple studies indicate that students report inadequate education on certain topics with limitations in their knowledge and preparedness to care for LGBTQ+ patients, particularly transgender and gender diverse patients. Additional integration of LGBTQ+ curriculum content in areas of perceived deficits could help better prepare future physicians to care for LGBTQ+ patients and populations.