Indonesian physicians working in rural and remote areas must be equipped not only with generic competencies but also with the attributes and skills necessary to provide health care services without compromising quality. This study sought to reach a consensus on the attributes and competencies that are viewed as essential and important for working effectively as an early career doctor in rural and remote practice in Indonesia. A two-round Delphi study was conducted by reference to 27 consenting physicians working in rural and remote Indonesia. Forty-three items covering 9 attributes and 34 competencies were sent to these physicians to be rated on a Likert scale ranging from 1 to 5 in terms of their importance for effective rural and remote practice. Nine attributes and 29 competencies progressed to Round 2. All nine attributes and 29 competencies were identified as essential or important for junior physicians\' ability to be effective in their practice. The essential attributes included professional quality related to prioritising the rural community. The essential competencies included medical skills, professional behaviour, interprofessional skills, health promotion and connection to the rural community. The consensus thus reached on these essential and important attributes and competencies can inform curriculum development for the undergraduate and postgraduate training of junior rural and remote physicians.

BACKGROUND: In emergency and critical-care medicine, focused cardiac ultrasound (FoCUS) is indispensable for assessing a patient\'s cardiac status. The aim of this study was to establish and validate a peer-to-peer-supported ultrasound course for learning FoCUS-specific skills during undergraduate studies at a German university.
METHODS: A 1-day, 12 teaching units training course was developed for students in the clinical section of medical college, with content based on the current national guidelines. A total of 217 students participated in the study (97 in the course group and 120 in the control group). The course and the participants\' subjective assessment of improved skills were evaluated using a questionnaire (7-point Likert scale; 7 = complete agreement and 1 = no agreement at all). Objective learning gains were assessed by tests before and after the course. These consisted of a test of figural intelligence (eight items) and a test of technical knowledge (13 items).
RESULTS: The course participants experienced significant improvement (P < 0.001) from before to after the course, with a large effect size of η2part = 0.26. In addition, the course group had significantly better results (P < 0.001) than the control group in the post-test, with a medium to large effect size of η2part = 0.14. No significant differences (P = 0.27) were detected in the test section on figural intelligence. The evaluations showed that the participants had a high degree of satisfaction with the course approach, teaching materials, and tutors. There was also a positive increase in their subjective assessment of their own skills, including areas such as technical knowledge, ultrasound anatomy, and performance of the examination.
CONCLUSIONS: The results of both the objective learning assessment and the subjective evaluations suggest that a FoCUS course originally intended for qualified physicians is equally suitable for students. With the development and provision of modern digital teaching media, even more students will be able to benefit from this approach in the future.

OBJECTIVE: Despite recommendations that palliative care education should be in all health professional programmes, such education is ad-hoc and variable. To reduce variability, the European Association of Palliative Care (EAPC) published a comprehensive guideline for curricula development. This study evaluates a new palliative and end-of-life care course for medical undergraduates aligned with the EAPC guidelines, focusing on knowledge, skills and attitudes.
METHODS: Final-year medical students were surveyed using two validated questionnaires: Self Efficacy in Palliative Care (SEP-C) and Thanatophobia scale (TS). We compared the intervention group, that were exposed to an integrated palliative medicine course throughout the three clinical years, with a control group that were not exposed to the new educational intervention.
RESULTS: For self-efficacy, the intervention group had statistically significantly higher scores than the control arm. The control group had high scores compared with international data. Positive attitudes to dying patients were low and did not differ between the two groups.
CONCLUSIONS: A well-designed palliative and end-of-life curriculum that is aligned to EAPC guidelines increases the self-efficacy of medical students in managing palliative patients but has little effect on attitudes to dying people. This is likely to be influenced by other factors such as the need for experiential learning.

BACKGROUND: As the role of AI in healthcare continues to expand there is increasing awareness of the potential pitfalls of AI and the need for guidance to avoid them.
OBJECTIVE: To provide ethical guidance on developing narrow AI applications for surgical training curricula. We define standardised approaches to developing AI driven applications in surgical training that address current recognised ethical implications of utilising AI on surgical data. We aim to describe an ethical approach based on the current evidence, understanding of AI and available technologies, by seeking consensus from an expert committee.
METHODS: The project was carried out in 3 phases: (1) A steering group was formed to review the literature and summarize current evidence. (2) A larger expert panel convened and discussed the ethical implications of AI application based on the current evidence. A survey was created, with input from panel members. (3) Thirdly, panel-based consensus findings were determined using an online Delphi process to formulate guidance. 30 experts in AI implementation and/or training including clinicians, academics and industry contributed. The Delphi process underwent 3 rounds. Additions to the second and third-round surveys were formulated based on the answers and comments from previous rounds. Consensus opinion was defined as ≥ 80% agreement.
RESULTS: There was 100% response from all 3 rounds. The resulting formulated guidance showed good internal consistency, with a Cronbach alpha of >0.8. There was 100% consensus that there is currently a lack of guidance on the utilisation of AI in the setting of robotic surgical training. Consensus was reached in multiple areas, including: 1. Data protection and privacy; 2. Reproducibility and transparency; 3. Predictive analytics; 4. Inherent biases; 5. Areas of training most likely to benefit from AI.
CONCLUSIONS: Using the Delphi methodology, we achieved international consensus among experts to develop and reach content validation for guidance on ethical implications of AI in surgical training. Providing an ethical foundation for launching narrow AI applications in surgical training. This guidance will require further validation.
UNASSIGNED: As the role of AI in healthcare continues to expand there is increasing awareness of the potential pitfalls of AI and the need for guidance to avoid them.In this paper we provide guidance on ethical implications of AI in surgical training.

The Academy for Gerontology in Higher Education (AGHE) in 2014 approved the first integrative \"Gerontology Competencies for Undergraduate and Graduate Education\"©. This article describes the background, thought development, guiding framework and consensus process for its construction. A modified Delphi method utilizing seven review rounds within three developmental cycles, with gerontology educators from 30 institutions, achieved input and consensus. The comprehensive framework has ten major domains, employs three categories each including multiple selective competencies. Six Category I competencies are essential orientations to gerontology. Four Category II competencies are \"interactional\" processes of knowing and doing across the field. Category III provides eight selective competencies for sectors where gerontologists may work. From educators\' feedback, gerontology characteristics emerged: multi-system approaches; interdisciplinary; communication of older adults\' \"voices\" and strengths; research utilization. The discussion includes the contribution of competency-based gerontology to students and aging workforce development as well as next steps, outcome measurement, levelling and accreditation.

OBJECTIVE: The number of available simulation-based models for technical skills training in ophthalmology is rapidly increasing, and development of training programmes around these procedures should follow a structured approach. The aim of this study was to identify all technical procedures that should be integrated in a simulation-based curriculum in ophthalmology.
METHODS: Key opinion leaders involved in the education of ophthalmologists in Denmark including heads of departments, heads of clinical education, professors and board members of the society were invited to participate in a three-round Delphi process. Round 1 aimed at identifying technical procedures that physicians should be able to perform competently when completing specialty training; round 2 involved characterization of each procedure including frequency, number of operators, risk and/or discomfort for patients associated with an inexperienced physician, and feasibility of simulation-based training; round 3 included a priority ranking of procedures.
RESULTS: The response rate for each round was 71%, 64% and 64%, respectively. Sixty-five procedures were reduced to 25 prioritized procedures during the three rounds. Two-thirds of the procedures that were identified and highly prioritized were therapeutic procedures such as intravitreal injection therapy, yttrium-aluminium-garnet laser iridotomy/capsulotomy, minor ocular surface procedures and retinal argon laser therapy. The diagnostic procedures that were prioritized were ocular ultrasound, superficial keratectomy and optical coherence tomography (OCT).
CONCLUSIONS: The Delphi process identified and prioritized 25 procedures that should be practised in a simulation-based environment to achieve competency before working with patients. The list may be used to guide the development of future training programmes for ophthalmologists.

This study explores the long-term effectiveness of a newly developed clinical skills curriculum.
Students (N = 40) were exposed to a newly developed, simulation-based, clinical breast exam (CBE) curriculum. The same students returned one year later to perform the CBE and were compared to a convenience sample of medical students (N = 15) attending a national conferences. All students were given a clinical vignette and performed the CBE. CBE techniques were video recorded. Chi-squared tests were used to assess differences in CBE technique.
Students exposed to a structured curriculum performed physical examination techniques more consistent with national guidelines than the random, national student sample. Structured curriculum students were more organized, likely to use two hands, a linear search pattern, and include the nipple-areolar complex during the CBE compared to national sample (p < 0.01).
Students exposed to a structured skills curriculum more consistently performed the CBE according to national guidelines. The variability in technique compared with the national sample of students calls for major improvements in adoption and implementation of structured skills curricula.

BACKGROUND: Over the last four decades, the health status of Maldivian people improved considerably, as reflected in child and maternal mortality indicators and the eradication or control of many communicable diseases. However, changing disease patterns are now undermining these successes, so the local public health practitioners need new skills to perform effectively in this changing environment. To address these needs, in 2013 the Faculty of Health Sciences of the Maldives National University developed the country\'s first Master of Public Health (MPH) program.
METHODS: The process commenced with a wide scoping exercise and an analysis of the curricular structure of MPH programs of high-ranking universities. Thereafter, a stakeholder consultation using consensus methods reached agreement on overall course structure and the competencies required for local MPH graduates. Subsequently, a working group developed course descriptors and identified local public health research priorities, which could be addressed by MPH students.
RESULTS: Ten semistructured interviews explored specific training needs of prospective MPH students, key public health competencies required by local employers and preferred MPH training models. The recommendations informed a nominal group meeting, where participants agreed on MPH core competencies, overall curricular structure and core subjects. The 17 public health electives put forward by the group were prioritized using an online Delphi process. Participants ranked them by their propensity to address local public health needs and the locally available teaching expertise. The first student cohort commenced their MPH studies in January 2014.
CONCLUSIONS: Consensus methods allowed a broad stakeholder engagement with public health curriculum development and the creation of a country-specific curriculum, informed by local realities and needs.