Future healthcare journal最新文献

[This corrects the article DOI: 10.1016/j.fhj.2024.100148.].

[This corrects the article DOI: 10.7861/fhj.2022-0145.].

Within this piece, we discuss the benefits and challenges of being a doctor in the pure general internal (GIM) medicine training programme within the NHS. We argue that having more resident doctors training in GIM within the NHS would provide a wonderful learning opportunity and a sustainable approach to the increasingly multimorbid patient cohort. It is also a discussion of the experience applying for and training within the new GIM curriculum. We discuss some of the future workstreams and consultant opportunities that may be available and compare single CCT GIM with other training courses. As the Royal College of Physicians is currently encouraging the role of the generalist within medical practice in the NHS, it is hoped that this piece may encourage further discussion on this topic.

Fast-growing megacities face a critical logistical challenge: urban congestion significantly disrupts emergency medical systems, delaying access to urgent care and compromising patient outcomes. High traffic density, particularly during peak hours, undermines ambulance responsiveness and the equitable provision of emergency services. While existing solutions - such as compact emergency vehicles, medical drones and intelligent traffic management systems - offer promising improvements, they remain insufficient in isolation. Addressing this issue requires a systemic and coordinated response involving local authorities, emergency services, urban planners and citizens. This opinion paper argues for the integration of logistics and healthcare planning within urban policy frameworks, emphasising the need for strategic infrastructure investment and enhanced inter-agency coordination. The relevance of this analysis extends beyond local contexts: it directly contributes to international public health agendas, particularly the World Health Organization's recommendations on emergency preparedness and different United Nations' sustainable development goals. Ensuring rapid and equitable access to emergency care is no longer an operational concern alone - it is a public health and social equity imperative.

The General Medical Council (GMC) National training survey is a powerful tool that allows us to understand the quality of training based on feedback from resident doctors. The results of the 2022 study indicated that the training satisfaction in our cardiology department was below the national average in United Kingdom. We used local surveys and feedback meetings to better understands the nuances of our training environment and we successfully implemented change using the Kotter's 8-step change model to improve training satisfaction. The GMC survey results in 2024 showed that our changes resulted in a significant increase in the categories of overall satisfaction (82.22 from 48.33, p < 0.0001), local teaching (77.14 from 23.67, p < 0.0001) and rota design (62.5 from 19.79, p < 0.0001).

Introduction: Electives are short placements during medical school lasting 2-8 weeks, serving as an opportunity to engage with different healthcare systems and cultures and to travel overseas. However, amid increasing alarm about climate change, interest in the sustainability of electives and alternative elective formats are gaining attention.

Methods: A scoping review of MEDLINE, Embase, ERIC, Web of Science SCOPUS, WHO Globus Index Medicus and Scielo was conducted with double-blind screening to identify previous efforts to quantify carbon costs of electives. To quantify the carbon dioxide (CO₂) emissions of electives, we created an approach based on the fuel efficiency of aircraft used for long-haul travel, distances from the UK to popular elective destinations and the average occupancy rates of aeroplanes. These results were compared with results from seven existing resources: MyClimate, ICAO, Google Flights, C Level and EcoTree.

Results: The review did not identify any previous studies estimating the environmental costs of medical student electives. All of the 7,575 records revealed by the database search were excluded following full-text screening. Our estimates of the CO₂ emissions from round-trip flights from Heathrow Airport, London, UK to the 10 most popular elective destinations were: Australia: 2,995 kg/person, USA: 1,039 kg/person, New Zealand: 3,316 kg/person, Canada: 941 kg/person, India: 1,185 kg/person, South Africa: 1,705 kg/person, Malaysia: 1,867 kg/person, Tanzania: 1,322 kg/person, Ireland: 79 kg/person.

Conclusion: This is the first study to quantify the carbon footprint of international medical electives. Our bespoke calculations, which generally agree with the results from established tools, reveal that CO₂ emissions from international travel for electives are substantial, compared to the average annual CO₂ emissions of 7,000 kg per person in the UK. This study provides evidence to motivate the design and delivery of alternative elective programmes.

Delivering meaningful change in healthcare is less about new discoveries and more about ensuring adoption at scale of what is already known to work. Implementation science (IS) studies the methods that support systematic uptake of evidence-based practices into routine care. Yet traditional strategies - like policy mandates, staff training alone, or the passive spread of information - often fail to deliver sustained change. This paper introduces the foundational principles of IS, critiques conventional approaches, and shares lessons learned from national-scale digital implementation efforts in Wales. Key IS enablers, including leadership, stakeholder alignment, readiness and feedback systems, are described in practical terms. We aim to make IS accessible for healthcare leaders and clinicians seeking to reduce variation and embed innovation at scale.

Introduction: Occupational burnout among clinical care providers, due in part to documentation burden, has reached crisis level. This study measured the effect of using new clinical documentation software, an 'ambient clinical intelligence' (ACI) program, to reduce the documentation workload and improve provider wellbeing.

Methods: This was a randomised, control study with a step-wedge design. Providers were randomly assigned to use ACI early or late in the study. Medical records metadata captured time spent on documentation. Measures of burden and burnout were collected monthly.

Results: ACI significantly reduced documentation burden, provider frustration and burnout. Providers spent less documentation time each day, and 2.5 h less per week of off-hours documentation.

Discussion: This study demonstrates that the use of ACI does indeed relieve the documentation burden and had both subjective and objective benefits. The widespread use of ACI has the potential to alleviate the crisis of physician burnout.

This article explains how gambling policy in the UK perpetuates exceptionalism by, among other things, promoting a way of understanding the drivers of gambling harm that is highly favourable to the interests of the industry and its political allies. It argues that this exceptionalism should come to an end, that completely transformative ways of thinking about this industry are possible, and considers what that would mean for gambling legislation and research. This is achieved by taking the reader on a reflective journey that involves stepping back and critiquing the taken for granted by posing a set of thought-provoking rhetorical questions. In order to support the case against exceptionalism, the article makes illuminating comparisons between gambling and other industries.