The Virginia Tech Carilion School of Medicine is a public, medical school at Virginia Polytechnic Institute and State University (Virginia Tech) located in Roanoke, Virginia. The medical school is associated with a university-level research institute called the Fralin Biomedical Research Institute at VTC. Formed as a public–private partnership with the Carilion Clinic, the medical school grants the Doctor of Medicine (M.D.) degree to its graduates. Initially a private institution from 2008-2018, the medical school became an official college of Virginia Tech on July 1, 2018.D.D.
Background Health systems science (HSS) education is an increasingly important component of undergraduate medical education. Despite curricular advances, the ways in which clinicians implement health systems science knowledge in everyday clinical practice, health systems thinking, remains understudied. A better understanding of how clinicians engage in health systems thinking to address everyday problems in clinical contexts is needed. Methods We conducted semi-structured interviews with 10 expert clinicians experienced in undergraduate medical education, health systems science, and curriculum development to identify components of competent health systems thinking. Interview questions were informed by ecological systems theory and literature on learning professional competencies. Results Through interviews with experts, we have come to define health systems thinking (HST) as "an approach to solving problems in healthcare systems that utilizes a deeper understanding of interconnections and behavior of the entire system. As a skill, it coordinates the application of clinical and HSS knowledge and skills toward solving a contextual problem in the healthcare environment."Clinician comments support the idea that HST is a metacognitive process rather than a specific subset of knowledge domains or affective attributes.This process requires that clinicians understand and navigate pressures on patient care originating from surrounding meso-and macro-systems. Conclusions Medical students require more explicit exposure to HSS knowledge being implemented in clinical environments, and varied examples highlighting how meso-and macro-system patterns can impact individual patient care. This metacognitive integration of HSS knowledge into everyday clinical practice is critical for preparing medical students to meet the requirements of the accreditation council for graduate medical education (ACGME) core competencies in residency programs. Health systems thinking requires a method of operational assessment to provide students feedback and highlight targeted interventions for further development.
Background Antivirals remain an important treatment strategy for persons who experience severe and life-threatening COVID-19. Ensitrelvir is an oral 3CL protease inhibitor with potent antiviral activity. Methods We conducted an international randomized, placebo-controlled trial of ensitrelvir with standard of care (SOC) among adults hospitalized for COVID-19. The primary outcome was clinical recovery assessed by the days to recovery scale through day 60 (DRS-60), analyzed using a Van Elteren test. Results From 2023 to 2025, 589 participants received blinded study treatment (293 ensitrelvir and 296 placebo). Median age was 69 years, 49% were female, 68% were White, and SOC commonly included corticosteroids (61% and 54%) and remdesivir (62% and 60%) in ensitrelvir and placebo groups, respectively. Median DRS-60 category was 6 (IQR: 3-15) in the ensitrelvir and 5.5 (IQR: 3-12) in the placebo group (P = .19), and the OR was 0.82 (95% CI: 0.62-1.09) for a better DRS-60 category with ensitrelvir. Ensitrelvir participants had lower detectable viral antigen in plasma at Day 5 (13.4% vs 25.1%; P < .001). There was no difference in secondary clinical outcomes or prespecified safety outcomes, though the mortality rate was 6.1% vs 4.4% and the frequency of hemorrhagic events was 3.4% vs 0.3% among ensitrelvir and placebo groups, respectively. Conclusions Ensitrelvir treatment did not improve clinical recovery in addition to SOC for adults hospitalized for COVID-19. The lower illness severity in the Omicron era compared with earlier periods in the COVID-19 pandemic and high use of remdesivir and corticosteroids, may have contributed to the lack of clinical benefit.
Cancer care generates vast quantities of data including clinical records, pathology images, radiology scans, and molecular profiles, yet these modalities are rarely integrated in a systematic, automated manner within routine clinical workflows, remaining largely siloed across separate departmental and technical systems. Foundation model-driven embeddings—or numerical representations (vectors) that summarize complex data such as text, images, and molecular profiles —offer a framework to integrate these data streams into unified patient representations. Here we examine the HONeYBEE platform’s approach to multimodal integration in oncology, situate it within broader developments in representation learning, and clinical and technical challenges that may shape its path to implementation1.
Eye metrics have been widely used to differentiate laparoscopic skill levels between novice and expert surgeons. However, surgical expertise develops over time and little is known about how gaze behavior evolves during this skill progression. This study investigated how visual attention changes with practice and how it differs across learners with varying rates of skill acquisition for the peg transfer task from the Fundamentals of Laparoscopic Surgery curriculum. Eye gaze data were collected from twenty-nine novice participants as they practiced the peg transfer task until reaching proficiency or completing six training sessions. Results showed that practice led to increased visual focus on task-critical areas and more frequent gaze toward future target locations. Notably, faster learners adopted feedforward gaze behaviors earlier and more consistently than others. These findings suggest that the early development of efficient visual control is closely associated with accelerated psychomotor skill acquisition, providing the basis for using eye metrics as an objective tool for surgical skill assessment and training.
