OBJECTIVE: The SARS-CoV-2 pandemic is a destabilizing experience for medical students and resident doctors and troubles their training in the hospital setting. This narrative review aims to identify the effect of health crises on the academic and personal lives of medical trainees and to develop solutions to support them.
METHODS: EducationSource, MedLine and PsychInfo were consulted on June 30th and December 16th, 2020 to identify the articles explaining the effect of SARS-CoV-1 (2002), A/H1N1 (2009) or SARS-CoV-2 (ongoing) on medical learners. Exclusion criteria included policy papers, letters to the editor or articles detailing the impact on undergraduate medical curricula, on nonmedical trainees, on the residency application process, or the physical impact of the disease. The quality of the selected papers was appraised using CASP for qualitative studies and NHLBI-NIH for cross-sectional studies.
RESULTS: Ninety-four manuscripts were initially generated and 229, secondarily, of which respectively 14 and 16 were included in the final analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and reviewed qualitatively. It was found that the learners consider their education compromised by exam delays, the suspension of academic activities, and elective surgeries. Anxiety associated with this academic disruption developed. Burnout is exacerbated by the heightened workload. The main difference between the two searches was the long-term effect of COVID-19, including the opportunity for didactic innovation, the worry regarding professional identity formation and the development of mental health issues. The proposed solutions varied from continuous access to mental health resources to the follow-up of learners\' well-being.
CONCLUSIONS: It would be interesting to assess the impact of medical trainees\' specialty and country\'s development on their experience with COVID-19.

OBJECTIVE: The RANZCP conducted an anonymous survey of 7200 members (trainees and psychiatrists) in December 2023, receiving 1269 responses, representing the views of roughly 1 in 6 members, and of the respondents, three quarters reported experiencing burnout in the last 3 years. We provide a commentary, citing evidence from relevant previous research, discussing the implications and proposing potential interventions.
CONCLUSIONS: Members of the RANZCP reported worsening workforce shortages, with 9 in 10 respondents stating that these negatively impacted patient care, and 7 in 10 experiencing symptoms of burnout. Eighty per cent identified workforce shortages as the top contributing factor to such burnout. The aetiology of workforce shortages and burnout is likely due to operational and structural shortfalls in psychiatric services. However, public and private sector employment information was not included in the report. There are a range of strategic, evidence-based interventions to address the psychiatrist and trainee workforce challenges, comprising general healthcare service as well as specific initiatives. Based on the findings of the report, such interventions are needed, now.

BACKGROUND: Laparoscopic appendectomy is a common procedure and introduced early in general surgical training. How internal (i.e. surgeon\'s experience) or external (i.e. disease severity) may affect procedure performance is not well-studied. The aim of this study was to evaluate factors that may have an influence on the performance scores for surgical trainees.
METHODS: A prospective, observational cohort study of laparoscopic appendectomies performed by surgical trainees (experience < 4 years) operating under supervision. Trainers evaluated trainees\' overall performance on a 6-point scale for proficiency. Perioperative data were recorded, including appendicitis severity, operating time and the overall difficulty of the procedure as assessed by the trainer. A \"Challenging\" procedure was defined as a combination of either/or \"perforation\" and \"difficult\". Trainees who had performed > 30 appendectomies were defined as \"experienced\". The trainees were asked if they had used simulation or web-based tools the week prior to surgery.
RESULTS: 142 procedure evaluation forms were included of which 19 (13%) were \"perforated\", 14 (10%) \"difficult\" and 24 (17%) \"Challenging\". Perforated appendicitis was strongly associated with procedure difficulty (OR 21.2, 95% CI 6.0-75.6). Experienced trainees performed \"proficient\" more often than non-experienced (OR 34.5, 95% CI 6.8-176.5). \"Difficult\" procedures were inversely associated with proficiency (OR 0.1, 95% CI 0.0-0.9). In \"Challenging\" procedures, identifying the appendix had lowest proficiency (OR 0.4, 95% CI 0.1-0.9). The procedures assessed as \"difficult\" had significantly longer operating time with a median (IQR) of 90 (75-100) min compared to 59 (25-120) min for the non-difficult (p < 0.001).
CONCLUSIONS: Both internal and external factors contribute to the performance score. Perforated appendicitis, technical difficult procedures and trainee experience all play a role, but a \"difficult\" procedure had most overall impact on proficiency evaluation.

暂无摘要。

BACKGROUND: A standardized approach to prepare trainees for the job search has not been described. The objective of this study was to describe and evaluate an educational series on the job search for Neonatal-Perinatal Medicine (NPM) fellows and identify participants\' job search knowledge gaps.
METHODS: During the 2020-2021 academic year, we created a virtual, seven-part job search series for NPM fellows that required no funding. The series has been repeated annually. We use REDCap surveys to register participants, collect baseline/demographic information, and evaluate the series\' impact at the beginning and end of the job search timeline.
RESULTS: In the 2021-2022 academic year, 290 individuals registered for the series, and 89% completed the baseline/demographic survey. The majority were NPM fellows (89%). Early career neonatologists, NPM hospitalists, and pediatric residents also utilized the series (11%). Less than 25% reported being \"knowledgeable\" or \"very knowledgeable\" of core job search components, including the timeline of the job search, contract negotiation, and the general roles and responsibilities of junior faculty. Of those who completed the final job search survey and underwent a job search (60%, 97 of 162), the majority (86%) felt that career planning during training was stressful and believed that job search preparation should be structured into the NPM fellowship curriculum (81%). Many felt that the Job Search Series was helpful in elucidating components of the job search.
CONCLUSIONS: We identified several knowledge gaps in NPM fellows\' understanding of how to find, prepare for, and negotiate their first post-training job. We strongly believe these knowledge gaps are not unique to NPM fellows and that all graduate medical education trainees would benefit from a similar, easy-to-implement, no-cost series.

Meta-research, also known as \"research on research\" is a field of study that investigates the methods, reporting, reproducibility, evaluation, and incentives along the research continuum. Meta-research literacy is imperative to ensure high quality, transparent and reproducible primary data or meta-research products. In this commentary, we propose that early career researchers should be trained in meta-research as a foundation to develop a deeper understanding of the research process and ability to appraise the research literature and design high-quality original studies, irrespective of their chosen field of study. We discuss the importance of meta-research and open science from the perspective of an early career trainee, highlighting essential areas for growth and obstacles one may encounter.

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BACKGROUND: Therapeutic endoscopy and gastroenterology fellows often participate in endoscopic retrograde cholangiopancreatography (ERCP) during their training period. However, it is generally feared that trainee involvement may increase ERCP-related complications, mainly because of the side-viewing nature of the endoscope and the higher risk of pancreatic duct cannulation. There is no concrete evidence to support this notion. This systematic review and meta-analysis aims to investigate the resultsof trainee participation on adverse events related to ERCP.
METHODS: PubMed, EMBASE, Google Scholar, SCOPUS, and Web of Science databases were searched from inception to 31 May 2023 for studies evaluating the ERCP outcomes defined as success rates, procedure time, failed attempts, and adverse events with and without trainee participation. A random effect model was used to perform the meta-analysis, and heterogeneity was assessed using the I2 statistics.
RESULTS: Seven studies were included in the final analysis, including 17,088 ERCPs. The pooled odds ratio (pOR) of success rate, incomplete/failed attempts in the trainee and no trainee groups were 0.466 (95% CI 0.13 to 1.66, I2 = 97.8%, p = 0.239) and 3.2 (95% CI 0.70 to 14.55), I2 = 98.5%, p = 0.134), respectively. The pOR of post-ERCP pancreatitis and bleeding in the trainee vs. no trainee groups was 0.97 (95% CI 0.76 to 1.23, I2 = 0%, p = 0.78) and 1.3 (95% CI 0.59 to 2.83, I2 = 49%, p = 0.54). The pOR of all adverse events in both groups was 1.028 (95% CI 0.917 to 1.152, I2 = 0%, p = 0.636). Surprisingly, the pooled std mean difference for the procedure time was 0.217 (95% - 0.093 to 0.05, I2 = 98.5%, p = 0.17).
CONCLUSIONS: This meta-analysis comprising of 17,088 ERCPs in seven studies demonstrated comparable ERCP outcomes related to trainee participation regarding success rates, procedure time, and adverse events. Trainees\' involvement in ERCP within a proper teaching setting appears safe and does not compromise the overall procedure\'s success.

BACKGROUND: Disposable duodenoscopes and duodenoscopes with disposable endcaps are being used in clinical practice to reduce or eliminate the risk of transmitting infections. The study aim was to assess perceptions and experiences regarding the use of these duodenoscopes among advanced endoscopy fellows in a nationally representative sample.
METHODS: A 17-item electronic survey was sent to 74 advanced endoscopy training programs. The survey was completed by 50 participants and their responses were included for analysis.
RESULTS: Most participants were from academic training programs (82.7%) and identified as being in their 7th year of post graduate training (92%; PGY-7). Participants performed an average of 414 ERCPs. 29% reported difficulty with cannulation using disposable duodenoscopes versus 15.7% with duodenoscopes with disposable endcaps (vs. standard duodenoscope). 96% of trainees perceived disposable duodenoscopes as not cost effective and 92% stated they would not use this device during independent practice. 100% of trainees stated that they would use duodenoscopes with disposable endcaps during independent practice. For their most challenging cases, 90% of trainees preferred using standard reprocessable duodenoscopes while no trainee indicated they would prefer using a disposable duodenoscope in this scenario. 82% of participants stated that disposable duodenoscopes and disposable endcaps should be used exclusively or preferentially for high-risk patients citing cost, functionality, and concerns regarding environmental impact.
CONCLUSIONS: Advanced endoscopy fellows perceive disposable duodenoscopes as impacting technical maneuverability. Concerns about functionality, cost effectiveness and environmental impact are barriers to adoption.

UNASSIGNED: The housemanship period is a peculiar time in a doctor\'s career, and some have described it as a \"Nuisance year\" during which the junior doctor assumes many roles at the same time - as a doctor of his patients, a student of his trainers (Resident doctors and Consultants) and a teacher of medical students. He is also at the same time undergoing training and research to practice as a professional in an increasingly competitive society-https://youtu.be/SaaQmMHy_qI.
UNASSIGNED: A typical House officer is seen neatly dressed with black circles around the eyes depicting tiredness, ward coat pockets stuffed with enough materials to start up a new ward; ranging from continuation sheets, syringes, water for injection, capillary tubes, hand gloves, investigation forms, commonly used drugs, cannula, tourniquet et cetera, smart shoes and feet ready to move on large doses of caffeine, and with carbonated drinks at arm\'s reach for a quick glucose rush for the day.He or she is faced with institutional problems, staff and workplace disharmony ranging from lack of adequate residential apartment for interns, early daily resumption and retires much later than the team to effectively carry out the work plan among acute shortage of staff. Majority of interns also try to adapt to the internship workings because they are new to the system, and some health workers typically try to take advantage of them which sometimes interfere with their work and the intern struggles to give the patients his best. Despite all these, the house officer interacts with the patient and relatives more often than the rest of the team. He builds the trust, respect, and confidence the patient has for the team as he represents not only himself but also the team.
UNASSIGNED: As once said by Sir William Osler - the great physician whose name is still being invoked in modern day medicine - that \"his time was ripe for him, and he was ripe for his time\". Trainees must always make themselves \"ripe for their time\", and the relevant authorities must also make time \"ripe for trainees\". The ideal scenario will then be a nexus of an ideal trainee and an ideal work environment.