The Eastern Association for the Surgery of Trauma is a 501(c)(3) medical association of American trauma surgeons. It has over 2,000 members who meet at an annual four-day conference. Its official journal is the Journal of Trauma and Acute Care Surgery.
Culturally competent communication is important for minimizing disparities in healthcare access and quality and is a focus of undergraduate medical education. The Eastern Association for the Surgery of Trauma has partnered with communication experts to offer a virtual communication course to medical students from the United States and Saudi Arabia. The course, now in its sixth year, is presented in five weekly modules using Zoom technology. Each class focuses on a unique communication skill and involves one hour of skills practice with actors, facilitated by a physician. We conducted, recorded, and transcribed three focus groups to elicit students’ reflections on the class and the impact on their patient-centered communication. Twenty-four students and 10 faculty from 17 medical schools in Saudi Arabia and the US participated, supported by 19 actors. Twelve students (both Saudi and US-based) participated in the focus groups. Broad themes identified in data analysis included communication skills, cultural competency, and professionalism. Participants reported improved patient-centered communication confidence and reflected on the influence of cultural context in gender roles and family authority. Students appreciated the clinical relevance of classroom knowledge in practice. This international communication course prepared students to respond respectfully and sensitively to patients from diverse cultures and exposed medical students to varied cultural expectations and practices. Students completing the course reported increased self-confidence executing important patient-centered medical interviews, appreciated the opportunity to apply concepts learned in classrooms, and demonstrated positive attributes of medical professionalism when participating in class.
Hyperparameter optimization (HPO) can materially affect the performance of deep learning (DL) image classifiers, but there is little empirical guidance on how to derive the validation signal that drives it, especially for the small sample sizes common in fields such as medical imaging. We compared three HPO protocols in terms of absolute performance-estimation error (AEE; the absolute difference between the winning configuration's validation AUROC and its test AUROC): fixed holdout (F), reshuffled holdout (R), and 5-fold cross-validation (C). The search space, sampler, training procedure, architecture, and test set were held identical across protocols. We evaluated the protocols on three public datasets spanning two regimes: binary medical imaging (RSNA pneumonia radiographs and binarized HAM10000 skin lesions) and 200-class natural imaging (Tiny ImageNet), across a range of development set sizes n and two backbones (ResNet-18 on all datasets, Vision Transformer (ViT-S/16) on RSNA). On the medical datasets, every point estimate favored cross-validation over both holdout protocols, with reductions in AEE largest at small sample sizes and diminishing as n increased. This pattern remained robust under conservative family-wise adjustment. On Tiny ImageNet, AEE was negligible under all three protocols. Test AUROC was generally similar among protocols. Fixed holdout had lower mean AEE than reshuffled holdout in 11 of 12 medical conditions, although this secondary finding was less uniformly supported. For small-sample medical image classification, we recommend cross-validation-based HPO when computational resources permit because it trades additional computation for a more reliable development-time estimate of subsequent test performance.
Abstract Two recent articles in the Journal of Analytical Psychology (JAP) outlined different conceptualizations of gender and gender‐affirming care. Tyminski (2024) advocated for an updated, expansive model of gender, whereas Marchiano, Papert and Withers (2025) referred to what is considered a more traditional Jungian framing of gender. This paper examines the premises of each perspective, and what evidence supports each perspective. This paper critiques claims that that the evidence does not support a gender‐affirming perspective, and that gender‐affirming perspectives are potentially harmful to clients.
