Summary Objectives To estimate the prevalence of multiple long-term conditions (MLTC) among people accessing hospital care in North East England, and to assess associations with age, sex, ethnicity and neighbourhood deprivation. Design Analysis of electronic health records. Setting Secondary care. Participants All adults, 18 years and above, with ≥ 1 admission to Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH) between July 2018 and June 2019 (N = 88,117, 51% women) or between July 2021 and June 2022 (N = 83,036, 51% women). Main outcome measures MLTC; ≥2 long-term conditions. Results Between July 2018 and June 2019, overall prevalence of MLTC was 49.6%, and between July 2021 and June 2022 it was 61.0%. Older age and living in a more deprived neighbourhood were consistently associated with increased risk of MLTC, whereby people living in the most deprived neighbourhoods had a prevalence of MLTC equivalent to people from the least deprived neighbourhoods a decade older. Associations between neighbourhood deprivation and increased MLTC risk were stronger in younger adults; relative risk of MLTC was 1.74 (95% confidence interval: 1.49–2.02) when comparing people aged 30–39 living in the most and least deprived neighbourhoods. Conclusions Among adults accessing inpatient hospital care in North East England, the prevalence of MLTC is high in all age groups, has increased since the COVID-19 pandemic and has a greater impact on younger adults from more deprived neighbourhoods. This highlights the sheer scale of the challenge that MLTC present in hospitals and the value of harnessing information at a local level as we look to redesign hospital care fit for the future.
Summary Objectives To assess how UK postgraduate medical organisations have responded to calls for action on structural racism, and to examine the extent to which anti-racism is embedded in postgraduate medical curricula and learning outcomes. Design We conducted a review of publicly available statements and commitments from organisations responsible for postgraduate medical education, and a content analysis of all General Medical Council (GMC)-approved postgraduate curricula. Search terms related to racism, ethnicity, religion and discrimination were used, with double-coding of extracted data and inductive thematic analysis of relevant learning outcomes. Settings United Kingdom. Participants Twenty-one organisations responsible for postgraduate medical training and all 102 GMC-approved postgraduate medical curricula. Main outcome measures Presence of explicit anti-racism commitments, inclusion of education-related actions and accountability mechanisms, and representation of racism and its impacts on health within assessed curricular competencies. Results Sixteen organisations (76%) had public commitments addressing racism or related issues, with ten (48%) including education-related measures and five (24%) specifying accountability mechanisms. Across 102 curricula, only 11 (11%) mentioned racism, and just 10 included it in learning outcomes, largely confined to three specialities. Mentions of race, ethnicity and religion were more common but often lacked reference to structural drivers of health inequalities. No curricula addressed xenophobia, Islamophobia, antisemitism or decolonisation. Conclusions Despite widespread institutional commitments, anti-racism is minimally represented in UK postgraduate medical curricula. There is an urgent need to integrate explicit anti-racism competencies into training to equip doctors with the knowledge and skills required to address structural determinants of health and reduce inequalities.
Summary Objective To develop the conceptual framework for an MLTC-specific patient-reported outcome measure (PROM), the Symptom Burden Questionnaire™ for MLTC (SBQ™-MLTC). Design Mixed-methods study: (1) symptom list generation; (2) assessment of list face validity; and (3) construction of a conceptual framework. Setting Concept elicitation and conceptual framework development using existing PROMs identified through the Mapi Research Trust PROQOLID eCOA database and AI-generated symptom lists. Participants Fifty-one condition-specific PROMs with evidence of patient involvement during concept elicitation were included for symptom extraction. ChatGPT-4 generated symptom lists for 24 conditions prevalent in MLTC. Seventeen healthcare practitioners reviewed symptom relevance and contributed to refinement of the conceptual framework. Main outcome measures Identification, refinement, and organisation of relevant MLTC symptoms into body system and functional domains, and development of the SBQ™-MLTC's conceptual framework. Results ePROVIDE searches in July and August 2023 identified 51 condition-specific PROMs for 24 conditions prevalent in MLTC. ChatGPT-4 was prompted to generate a list of 75 symptoms for each condition. A merged list of 2202 symptoms was iteratively reduced to 190 symptoms for healthcare practitioner review. The final conceptual framework included 151 symptoms spanning 18 body system and functional domains. Conclusions This study represents the first phase in the development of an MLTC-specific PROM of symptom burden. Generative AI output triangulated with content from existing PROMs and healthcare practitioner review proved a feasible approach to concept elicitation. Planned cognitive debriefing will confirm content validity of the SBQ™-MLTC for people with lived experience. In the future, the SBQ™-MLTC could support integrated, symptom-led approaches for clinical management of MLTC.
Objective The Women's Health Initiative (WHI), a randomized controlled trial, found no overall health benefit of menopausal hormone therapy. Our objective was to evaluate the hypothesis that initiating hormonal therapy prior to age 60 or within a few years after the last menstrual period provides health benefits in menopausal women. Design A search was conducted in MEDLINE, Scopus, and ClinicalTrials.gov from inception until August 26, 2025. Randomized controlled trials in which at least one arm was a pharmaceutical oestrogen and one arm was a placebo were included. We required studies to present clinical health outcomes. Setting Systematic review Participants Menopausal women age 60 or younger or within a short time of the last menstrual period, as defined by individual study authors. Main outcome measures Studies were categorized based on primary endpoints, namely cardiovascular disease, cancer, depression, and cognition. Risk of bias was assessed using a standard tool. The reliability of conclusions was assessed using the core GRADE method. Results Thirty-one papers, reporting on seventeen randomized controlled trials, met eligibility criteria. Menopausal hormone therapy in young menopausal women was not shown to have beneficial effects on cardiovascular disease, cancer, depression, or cognition with the exception of some cardiovascular endpoints in women on oestrogen alone in the WHI, a finding not confirmed in other randomized controlled trials and not confirmed in women with vasomotor symptoms. Conclusions Menopausal hormone therapy in young menopausal women has not been shown in randomized controlled trials to have beneficial effects on cardiovascular disease, cancer, depression, or cognition.
Objectives This study looks at the number of cancellations by companies and refusals by Health Canada of new drug applications from 1 June 2019 to 1 July 2025 and the amount of information given for the decisions taken. Design Cross-sectional. Setting Canada. Participants New drug applications. Main outcome measures Number of applications cancelled or refused and reasons for decisions. Results There were 270 regulatory decisions of which 33 (12.2%) were either cancelled by the company (30) or refused by Health Canada (3). In 10 of the 30 cases where the submission was cancelled, there was no information about the reason for the company's decision. In the remaining 20 cases, the website just said that a decision had been made by the company. Two of the three refusals by Health Canada were because of concerns about safety and efficacy and quality-related issues. The third refusal was due to deficiencies and/or significant omissions in the clinical and non-clinical information. In the 30 submissions cancelled by the company, there was no information about what Health Canada thought in 6 cases. In 16 cases, Health Canada had not completed its evaluation, and in the remaining 8, the evaluation was completed. Conclusion Over 12% of new drug submissions to Health Canada are either cancelled or refused. Health Canada does not always fully communicate the information that it has regarding the reasons for these decisions and needs to be much more transparent about its decision-making.
Objective To ascertain the impact of a 3-month pause in the NHS Breast Screening Programme (NHSBSP) during COVID-19 on numbers, characteristics and outcomes of breast cancer patients Design We compared numbers, referral sources (NHSBSP/GP), tumour characteristics, treatments, and survival before and during COVID-19 using chi-square tests and Kaplan-Meier estimates. Patients were grouped into: (a) all cases from 2019 to 2021 ( n = 3353) and (b) six selected months in 2019 and 2020 ( n = 325). Setting The study was conducted with the breast units of two large London NHS hospitals as a local audit to understand the impact of COVID-19 on breast cancer management. Participants Patients diagnosed with breast cancer from 2019 to 2021 were analysed. Main outcome measures Temporal variation in the number of breast cancer cases by referral source and the impact of the pause in screening mammography due to the COVID-19 pandemic on changes in tumour characteristics, treatments and survival. Results Overall, there were 31% fewer patients in 2020 vs. 2019 (886 vs. 1281, p = .002), due to fewer screen-detected (851 vs. 398) rather than symptomatic cases (432 vs. 459), p < .00001), with no corresponding increase in 2021 ( n = 1186) In the detailed analysis, there were significantly fewer grade 1 cancers (11/120 vs. 37/204, p = .028) in 2020 vs. 2019, but there was no stage shift from smaller or less advanced (node-negative) tumours to larger or more advanced tumours, and no difference in extent of surgery, i.e., ratios of breast conservation to mastectomy, or sentinel node biopsy to axillary clearance. There was no difference in time from referral to diagnosis between the two time periods. The median follow-up was 3.8 years; K-M survival curves overlapped, with no difference in 3-year survival (90.5% vs. 91.7%, HR=1.09, p = .83). Conclusions During the COVID-19-induced NHSBSP pause, good-prognosis (grade 1) cancers reduced without an increase in larger, or node-positive cancers, or more extensive surgery, and 3-year survival remained unchanged, suggesting that pausing NHSBSP may have avoided overdiagnosis without causing harm.
Summary Objective Hormone replacement therapy (HRT) is used to manage menopausal symptoms, but its perioperative use raises concerns about increased venous thromboembolism (VTE) risk. Clinical guidelines vary, with some advising temporary discontinuation before surgery. This scoping review aims to synthesise evidence and guidance on whether perioperative cessation of HRT influences postoperative VTE risk. Design A systematic search of PubMed and the Cochrane Library identified studies evaluating pre-operative HRT and VTE outcomes. Search terms included Hormone Replacement Therapy, HRT, Venous Thromboembolism, Venous Thrombosis, Pulmonary Embolism, Perioperative Care and Surgical Procedures, Operative. Participants Studies included adult women on HRT undergoing surgery and assessed discontinuation and VTE risk. Data were synthesised narratively. Results The search identified 246 records, four of which met the inclusion criteria: three primary studies and one systematic review. Only one study compared perioperative continuation versus cessation of HRT and found no significant increase in postoperative VTE with continued use. Other studies examined HRT among multiple VTE risk factors, with inconsistent findings. Clinical guidelines recognise oral oestrogen as a VTE risk factor and distinguish between higher-risk oral and lower-risk transdermal formulations; however, few provide explicit perioperative recommendations. Conclusion Evidence is limited and insufficient to support routine perioperative HRT cessation. The only comparative study found no significant increase in VTE with continuation, though limitations restrict interpretation. Overall, the literature reflects uncertainty. Given limited and heterogeneous data, perioperative HRT management should be individualised. Further prospective research is needed to determine whether temporary withdrawal, particularly of oral oestrogen, reduces postoperative VTE risk.
Objectives This qualitative study captured the perspectives of patients and healthcare professionals to better understand COVID-19 vaccine decision-making among South Asians in London. Design In-depth semi-structured telephone and virtual interviews were conducted using convenience and purposive sampling to explore narratives about COVID-19 decision-making processes, pandemic experiences, and perceptions of living through a period of unprecedented uncertainty and turbulence. Setting UK. Participants 12 London-based individuals including patients, clinicians, and a medical receptionist. Main Outcome Measures Respondents were categorised as either COVID-19 vaccine compliant or non-compliant based on their vaccination status. Results The variation and dynamic nature of the vaccination trajectories described in this study suggest that the decision to vaccinate or not against COVID-19 comprises a fluid, continually evolving process shaped by personal experiences and ongoing risk assessments. This study examines the possibility that some individuals form an ‘epistemic community of uncertainty,’ influenced by the pervasive ‘infodemic’ surrounding COVID-19 vaccines, which has created substantial ambiguity about truth and trust, reminiscent of the Rashōmon effect. Developing a nuanced understanding of this effect in the context of the COVID-19 era is a critical step towards addressing such ambiguity and fostering deeper critical thinking about vaccine decision-making. Conclusions This research highlights the need for more flexible and innovative strategies to navigate the complex factors influencing decision-making. Furthermore, the study advocates for a more refined and discerning personalised approach to engagement, which is vital for improving scientific and health literacy within society and overcoming common barriers to making informed and autonomous choices.
Objective:To map the global research on the impact of plastic-based health products and their packaging across the product lifecycle in order to inform equitable, sustainable governance for the role of plastics in health products. Design:A scoping review of primary research and systematic reviews examining plastic-related outcomes in the context of health products or packaging using a systematic search of the MEDLINE, EMBASE, SCOPUS, GEOBASE and Compendex databases November 2024 with no date or language restrictions. Setting:Studies spanning global and disciplinary contexts. Participants:Primary research or systematic reviews that examined plastic-related outcomes in the context of health products or packaging. Main outcome measures:We descriptively analyzed characteristics and outcomes of the included articles according to the product lifecycle stage. Results:We screened 14,695 articles and included 572 articles published between 1960-2024. Only 8% (45/572) of articles studied more than one lifecycle stage. The evidence is otherwise siloed by focus, setting, and discipline: articles focused on clinical use and storage outcomes (266/572, 46.5%), were conducted primarily in high income countries (230/266, 86.5%) and within biomedical disciplines (207/266, 86.5%); articles focused on end-of-life outcomes (n=257/572, 44.9%) were conducted more frequently in middle-income countries (158/257, 61.7%), and within engineering and environmental sciences (208/257, 80.9%). We documented a multi-decade interest in plasticizer leaching from plastic devices and packaging. Conclusions:A research agenda that is lifecycle oriented, prevention focused, and precautionary will produce robust, actionable evidence to support treaty decision-making and implementation. We conclude with recommendations for research priorities that include interventions to reduce the use of plastics in healthcare, to measure the health and environmental impacts of the chemicals in plastics, and identification and assessment of safe, toxics-free, sustainable alternatives.
Objective:High Intensity Users (HIUs) of Urgent and Emergency Care (UEC) services account for disproportionately high numbers of Emergency Department (ED) attendances, ambulance journeys and non-elective admissions. This review aimed to assess the quality and completeness of evidence for understanding the characteristics of HIUs, how best to identify and differentiate them, the effectiveness of services to support them, and to identify areas for further research. Design:Scoping review of UK-based peer-reviewed literature. Setting:Four databases (January 2010 to October 2025) - additional grey literature identified through hand searching and Google searches. Participants:Twenty-eight published articles (19 peer-reviewed papers, 9 grey literature). Main outcome measures:HIU definitions, descriptions, effectiveness of care, characteristics of successful programmes and interventions. Results:HIUs are generally defined by the frequency of UEC use rather than diagnosis or need, despite being highly heterogeneous. The national model of care adopted in England relies largely on individual Case Managers supporting small numbers of HIUs. Although most published evaluations report reductions in ED attendances and admissions, and positive impacts on individual well-being, they are generally small, uncontrolled, and short-term with poorly defined interventions and minimal evidence that they reduce overall demand on UEC services. Conclusions:Further research is needed to better characterise HIUs, drivers of their behaviour and risk factors to determine which HIUs benefit from which interventions. Services need to operate at scale using near-real time data, be integrated with health as well as social care services, and use standardised, granular definitions of HIUs to guide appropriate interventions.
Objective: To assess the relationship between GP experience, phone and website access measures, and NHS App use. Design: An ecological study using practice-level NHS App usage data between March 2020 and June 2022. GP practice codes were used to link patient-reported experience and ease of access scores from the General Practice Patient Survey to the NHS App data. Practices were grouped into five quintiles based on experience and access measures, and negative binomial regressions were used to estimate Incident Rate Ratios (IRR) comparing NHS App usage across quintiles. Models were adjusted for age, sex, deprivation, ethnicity and long-term healthcare needs. Setting: General practices across the NHS in England. Participants: Patients registered at 6386 GP practices in England. Main Outcomes: Weekly rates of NHS App functions used (registrations, logins, prescriptions ordered, medical record views and appointments booked) per 1000 GP-registered population. Results: Fully adjusted models found lower NHS App use in practices with the highest patient experience. Registration rates were 3.5% lower in practices with the highest vs. lowest experience scores (IRR 0.96, p < 0.001) and logins were 5.2% lower (IRR 0.95, p < 0.001). Practices with better phone access had 27.0% higher prescription orders (IRR highest vs. lowest = 1.27, p < 0.001), and 57.8% higher appointment bookings (IRR highest vs. lowest = 1.58, p < 0.001). Prescriptions were 7.7% higher in practices with the highest vs. lowest web access scores (IRR 1.08, p < 0.001). Conclusion: NHS App use was lower in practices with the highest patient experience, but generally higher in practices with better phone and web access. Results highlight the need for coordinated action to improve access and patient satisfaction.
Objectives The aim of this study is to investigate potential inter-continental mental health differences in journalists covering climate-related events. Design Descriptive, cross sectional. Setting Internet-based study. Participants Journalists recruited from the Oxford Climate Journalist Network: 268 of 561 (48.6%) journalists from 89 countries completed the study. Main Outcome Measures Questions related to physical threat and loss secondary to climate change. Symptoms of anxiety (Generalized Anxiety Disorder-7-item scale [GAD-7]), depression (Patient Health Questionnaire-9 [PHQ-9]), posttraumatic stress disorder (PCL-5) and Moral Injury (Toronto Moral Injury Scale for Journalists [TMIS-J]). Results More African and Asian journalists felt physically threatened than journalists in Europe (p < .001 and p = .002, respectively). More journalists in Africa had lost a family member to climate change than journalists in the Americas (p = .009), and Asia and Europe (p < .001 for both). More journalists in Africa, Asia, and the Americas had lost a friend to climate change compared to journalists in Europe (p < .001, p = .003, and p = .001, respectively). There were higher PTSD-intrusion scores in African and Asian than European journalists (p = .001 and p < .001, respectively) and higher PTSD-avoidance scores in African and Asian than European journalists (p = .014 and p = .001, respectively. African and Asian journalists were less likely to receive psychotherapy than European journalists (p < .001 for both). Conclusions Given the enduring challenges posed by climate change, addressing these inequalities in journalists' care should not be delayed any further.
Objective:The scientific evidence indicates little or no difference in the effectiveness or cost of using of metered-dose inhalers (MDIs) versus nebulisation to treat acute asthma in the emergency department (ED). However, the use of MDIs raises questions of environmental impact. Our objective was to compare the ecological footprint of salbutamol administered by MDI versus nebulisation. Design:Life cycle assessment in which we inventoried and quantified the resources extracted and pollutants emitted by each therapeutic option, from the manufacturing of medication and equipment to their disposal by incineration. Setting:EDs of the CHU de Québec-Université Laval (Canada). Participants:Not applicable. Main outcome measures:Each item of life cycle inventory data was translated into CO2-equivalent emissions (CO2eq) using the IPCC2021/GWP100 method. Results were estimated for the administration of one and three treatments of 800 µg of salbutamol by MDI and 5 mg by nebulisation (standard doses for adults and children ≥ 24 kg). Results:One and three ED-administered treatments with salbutamol emit respectively 1.9 and 4.0 kg of CO2eq via MDI versus 0.9 and 1.0 kg via nebulisation, which corresponds to 5.5 and 11.6 km and to 2.7 and 2.8 km travelled in a subcompact car. Each series of eight inhalations from an MDI releases 1.1 kg of CO2eq due to emission of the hydrofluoroalkane propellant. Conclusions:Considering the absence or minimal difference in clinical effectiveness, this study suggests that nebulisation may be a more eco-efficient administration route than MDIs in the emergency treatment of asthma.Trail registration: N/A.
Objectives:To evaluate the incidence, management, and outcomes of Acute Respiratory Distress Syndrome (ARDS) in Sub-Saharan Africa (SSA), and to identify challenges related to healthcare infrastructure and resource availability. Design:Systematic review of published studies on ARDS in SSA. Setting:Studies conducted across hospitals and intensive care units in 11 countries within Sub-Saharan Africa between 2000 and 2024. Participants:Adult patients diagnosed with ARDS. Main Outcome Measures:Prevalence of ARDS, patient demographics, management strategies, availability of critical care resources, and mortality rates. Results:Thirteen studies met the inclusion criteria. ARDS prevalence varied widely, ranging from 2.4% to 100%. The Kigali modification of the Berlin criteria was most frequently applied, reflecting limited access to chest radiography and arterial blood gas analysis. Pneumonia, sepsis, and trauma were the predominant causes, with infectious diseases such as HIV, tuberculosis, and malaria contributing substantially. Access to invasive mechanical ventilation and other critical care resources was limited. Reported mortality rates ranged from 22% to 77%. Conclusions:ARDS represents a major but under-recognised cause of morbidity and mortality in SSA. Resource limitations, including inadequate diagnostic capacity and restricted access to mechanical ventilation, likely contribute to poor outcomes. Efforts to strengthen critical care infrastructure, provide targeted training, and adapt diagnostic criteria for low-resource environments are urgently needed. Further research should explore regional variations and context-appropriate interventions to improve ARDS care across SSA.
Intra-ocular corticosteroids have the potential to cause adrenal insufficiency when used long term. Patients and clinicians should be counselled on the risks of long-term steroid use and consider appropriate monitoring.
We aim to highlight the diagnostic challenges in differentiating Behcet's syndrome from Crohn's disease, in patients presenting with overlapping clinical features, highlighting the importance of comprehensive clinical evaluation for appropriate management and prognostication.
Objective:A cause of death is a specific disease or injury which directly led to the death whereas a mode of death which is a mechanism such as respiratory failure, cardiac arrest or cardiac failure but does not provide the cause of death. We sought to establish the scale of use of cardiovascular mode and other non-specific codes as causes of death. Design:We extracted the mortality statistics recorded between 2013 and 2021 and then selected cardiovascular codes. Setting:The Office for National Statistics mortality data. Participants:Deceased individuals from England and Wales. Main outcome measures:Cause of death. Results:Of 4,852,897 deaths, 836,741 (17.2%) had cardiovascular codes. Of these, 103,160 (12.3%) were labelled as modes and 35,784 (4.3%) were non-specific causes. Modes increased from 5862 in 2013 to 14,641 in 2021. Modes included 56,291 (6.7%) as arrhythmia and 46,787 (5.6%) as heart failure. Non-specific included 12,192 (1.46%) myocardial degeneration and 6573 (0.79%) cardiomegaly. Non-specific cardiomyopathies included other cardiomyopathies (207) and cardiomyopathy, unspecified (2984). Conclusions:Modes of death are being used in a notable proportion of medical certificates and this is increasing which is worrying and does not provide the underlying cause of the death. It is important that a cause of death is given so that underlying heritable cardiac conditions, such as channelopathy or cardiomyopathy, are identified. This enables referral of blood relatives for cardiological screening and intervention. ICD-11 will help address some of the non-specific causes of death with the inclusion of codes for sudden arrhythmic death syndrome and arrhythmogenic cardiomyopathy. Autopsy is essential to establish a cause of death where only a mode of death can be given without clarification of a causative disease.
Objectives:Ethnic minority and migrant healthcare workers (HCWs) constitute 24% of the UK's National Health Service. Migration status, often overlooked in Human Resources records, is associated with their placement within the Agenda for Change (AfC) pay bands. Therefore, we analysed the association between ethnicity, migration status, and AfC pay bands using data from the UK-REACH cohort study. Design:Cross-sectional study. Setting:UK-REACH cohort using baseline data collected via online questionnaires across various healthcare settings. Participants:Healthcare workers from a broad range of professional roles across the UK, recruited between December 2020 and February 2021. Main outcome measures:We used multivariable generalised ordered logistic regression models to examine the associations between ethnicity, migration status and AfC pay bands, adjusting for sex, education level, job role, and years qualified. Results:We found that Overseas-born ethnic minority HCWs were less likely to be in higher AfC pay bands compared to their White UK-born counterparts. Specifically, Asian Overseas-born and Black Overseas-born HCWs reported significantly lower odds of being in higher pay bands compared to White UK-born workers. Conclusions:Overseas-born HCWs from ethnic minorities resided in lower paid roles than White UK HCWs. Our study is the first to highlight a link between migration status and the AfC pay band and to explore interactions between ethnicity and migration within this context. Our data highlights the need for policymakers to incorporate migration status into NHS-wide electronic records to address career progression and pay inequities.
Spontaneous pneumothorax is a rare complication of lung cancer. In this report, we present a case of a patient with recurrent pneumothorax undergoing routine bullectomy and pleurodesis and lung adenocarcinoma is diagnosed incidentally. The prognosis for patients with untreated lung cancer has always been unfavourable with a median survival time of only 10 to 14 months, even for early-stage disease. Once the diagnosis is established, an effective treatment should be instituted without delay. Spontaneous pneumothorax is a rare manifestation of lung cancer and the relative risk for developing lung cancer should be considered with the patients with recurrent spontaneous pneumothorax.
Objectives This study aims to quantitatively assess the baseline level of self-perceived cultural competency preparedness and skillfulness among medical and health professions students from 21 universities around the world utilizing a previously validated and standardized testing tool. Design Cross-sectional study. Setting The International Collaboration and Exchange Program (ICEP), a global exchange initiative for junior medical and health professions students spanning 21 universities across four continents. Participants A total of 753 students from the 2021 and 2022 ICEP cohorts. Main Outcome Measures Students self-evaluated their cultural competency skills on a 5-point Likert-type scale encompassing different areas of competency. Multiple linear regression was performed to identify contributors to cultural competency levels. Results Upon rating how skillful they are at interacting with culturally diverse patients, North American students reported the highest scores with a mean of 3.22, while Australian students showed the lowest score of 2.82. When analyzing students’ stages of study, those in clinical years of medical schools scored the highest at 3.29. Significant variations were observed in the cultural competency self-rating scores among students based on their respective regions ( p < .005) and program types/stages ( p < .05). Notably, students in their clinical years of school consistently rated themselves higher compared to their preclinical counterparts ( p < .05). Furthermore, students from Europe displayed elevated self-ratings compared to the other regions ( p < .005). Conclusions Though these participants represent a highly motivated subgroup of students, potentially limiting result generalizability, the findings emphasize that regional differences exist. Given the multifaceted nature of cultural competency, the results suggest that factors such as educational stage, age, and region may influence students’ perceived competency levels.
