Artificial intelligence (AI) is rapidly being integrated across the landscape of graduate medical education (GME) with applications spanning the residency application and selection process, clinical training and post graduate practice. This paper reviews the history of AI in GME and its current integration across the GME continuum, highlighting its benefits, limitations and challenges. AI enhances training through improved efficiency, personalized education, reduced clerical burden, workflow optimization, and diagnostic support. However, significant concerns persist, including bias in algorithmic decision-making, threats to authenticity in application materials, erosion of clinical reasoning skills with overreliance on AI, and unclear accountability for its use in clinical care. To address these challenges, we propose the establishment of a multidisciplinary committee to standardize AI use, promote ethical implementation, improve AI literacy, reduce bias, and ensure equitable outcomes.
BACKGROUND:Diseases of the skin and subcutaneous tissue represent a crucial yet understudied contributor to morbidity and mortality, particularly in older adults. Despite an aging population and substantial disease burden, national mortality patterns, temporal trends, and demographic disparities remain poorly described. METHODS:This study utilized CDC WONDER Underlying Cause of Death data from 1968 to 2023 to identify deaths amongst U.S adults aged ≥65 years attributed to skin and subcutaneous tissue diseases. Age-adjusted mortality rates (AAMRs) per 100,000, crude mortality rates (CMRs) per 100,000, average annual percent change (AAPC), and annual percent change (APC) by period were calculated and stratified by sex, race, age, census region, and state. RESULTS:A total of 161,822 deaths from skin and subcutaneous tissue disease occurred among U.S. adults ≥65 years from 1968 to 2023. Overall AAMRs increased from 6.74 in 1968 to 9.83 in 2023 (AAPC: 0.91; 95% CI: 0.76 to 1.12, p < 0.001), and the greatest rate of increase in AAMRs was from 7.60 in 2017 to 9.83 in 2023 (APC: 5.65; 95% CI: 3.60 to 10.14, p < 0.001). Women had a similar mean AAMR (9.10) to men (8.75); however, men had a greater rise in AAMR, increasing from 6.41 in 1968 to 10.00 in 2023 (AAPC: 1.17; 95% CI 1.01 to 1.39, p < 0.001). White Americans had a lower mean AAMR (7.87) than Black or African Americans (23.15), but had a greater rise in AAMR, increasing from 6.37 in 1968 to 9.59 in 2023 (AAPC: 1.02; 95% CI 0.87 to 1.20, p < 0.001). Regionally, the South had the greatest mean AAMR (10.72), but had the lowest rate of increase in AAMR, increasing from 8.23 in 1968 to 9.54 in 2023 (AAPC: 0.65; 95% CI: 0.47 to 0.90, p < 0.001). State-wise deaths were highest in New York (n = 12,682, 7.92%) and lowest in Alaska (n = 119, 0.07%). CONCLUSION:Skin and subcutaneous tissue-related disease mortality significantly rose from 1968 to 2023, with recent mortality trends highlighting a cause for concern. The marked heterogeneity in disease burden between demographic and geographical groups highlights the urgent need for equitable and targeted public health interventions.
The study aimed to assess the prevalence and severity of post-traumatic stress disorder (PTSD) among Aksum City Massacre Survivors in Tigray, Ethiopia. Using a community-based cross-sectional design, data were collected from 439 participants with the PCL-5 scale. Statistical analyses were conducted in SPSS version 26 using descriptive and inferential methods, including means, standard deviations, frequencies, percentages, independent-sample t-tests, and ANOVA. Results showed a high prevalence (58.5%) and severe levels (40.3%) of PTSD among the survivors. No significant differences were found across sex, age, or educational status. The findings highlight an urgent need for collaborative interventions and resource mobilization to address the severe mental health challenges faced by this population.
Background Residency programs are responsible for ensuring that trainees understand and are able to address health disparities. Despite this requirement, individual residency training programs face challenges in achieving this aim. However, graduate medical education (GME) offices have the potential to overcome these barriers. Objective To describe the development and implementation of a GME-wide virtual health equity orientation workshop and self-reported learner outcomes. Methods Incoming residents participated in a GME-wide virtual health equity orientation workshop in June 2023 and completed pre-, post-workshop, and six-month post-workshop surveys. We used chi-squared tests and Fisher exact tests as appropriate to compare pre-post workshop scores for multiple choice questions and used rank-sum tests to compare pre-post self-assessed knowledge and confidence scores. Results There were 234 residents who participated in the workshop and 80% of residents consented for their information to be included for research. There was a significant increase in self-assessed knowledge and confidence scores in the pre-post comparison, but self-assessed behavior scores fell to baseline at six months. Over 85% of incoming residents had previously received formal education on racism and discrimination based on gender identity and sexual orientation. However, only 62% had previously received formal education on ableism in medicine. Additionally, 94% of the participants found the workshop relevant to their needs, and 85% stated that they learned a new skill. Conclusions A GME-wide orientation workshop designed to promote knowledge of health equity topics is feasible and well received. This workshop showed a positive impact in self-assessed knowledge and confidence but should be reinforced with longitudinal programming.
Artificial intelligence is rapidly entering clinical practice, yet many physicians-especially those in solo or small-group settings-lack the guidance and evaluation resources needed to use these tools safely. Because state medical boards regulate physicians rather than AI developers, clinicians remain fully accountable when AI‑assisted care contributes to patient harm. This article outlines the risks posed by opaque algorithms, hallucinated outputs, omissions, and inequitable model performance, while emphasizing that AI should augment-not replace-clinical judgment. Drawing on recent research and the Federation of State Medical Boards' 2024 guidance, the article clarifies professional responsibilities related to competence, documentation, informed consent, privacy, and bias mitigation. A practical toolkit offers actionable steps for evaluating AI tools, establishing verification protocols, monitoring performance, and ensuring transparency with patients. The article concludes that responsible physician engagement is essential to realizing AI's benefits while preserving patient safety, professional accountability, and equitable care.
Despite the documented benefits of a diverse physician workforce, significant barriers continue to limit some students' success within the clinical clerkship phase of their medical education. These students may experience unintended bias in grading and assessment that can limit their access to future opportunities. Anti-bias training is one strategy used to address these shortcomings in the assessment process. However, anti-bias training has been shown to be ineffective, resented by participants, and can even result in the opposite of its intended effects. Innovative training strategies to support equitable student success are therefore critical. Here we present the lessons learned from implementing a pilot medical education training program for clerkship directors to avoid these issues. To reduce unintended assessment bias students face during their clinical clerkships, a fall seminar for clerkship directors was designed and implemented at the UCLA David Geffen School of Medicine (DGSOM). These directors participated in ten monthly Zoom sessions and one culminating four-hour in-person seminar on the UCLA campus in August 2024. Psychological topics related to bias, such as intergroup dynamics, ingroup favoritism, and social dominance theory, were openly discussed with and among the faculty. To enable continuous improvement, a pre-, mid-year, and post-evaluation was administered to participants to capture participants' perceptions of the effectiveness of the training, materials, and the program. Mid-year evaluations found the Zoom sessions ineffective at increasing participants' understanding of anti-bias constructs and led to negative perceptions and resistance to the training. The transition to an in-person seminar was made accordingly. The seminar yielded much higher satisfaction, negligible resistance, and much higher perceived comprehension rates than the online format. The clerkship directors' post-seminar evaluations greatly increased across all measures. It appears that having a social psychologist co-lead an in-person seminar with a leading DGSOM physician, along with other changes, was critical to the success of the in-person seminar.
Building and sustaining a diverse health care workforce including members of underrepresented groups (URG) requires overcoming an intricate web of structural barriers and their downstream sequelae that conspire to perpetuate underrepresentation of many groups of Americans in science, technology, engineering, math, and medicine (STEMM). These include students from low income, marginalized racial and ethnic minority, gender minority, disabled, female, rural and other groups. Several recent efforts to better recognize and work through these barriers and capture talented URG youth in STEMM have targeted investments mainly at the undergraduate and graduate level, but some even earlier at the K-12 levels. A major strategy of increasing STEMM educational opportunities are short-term URG training programs designed to fill gaps in traditional education systems, that collectively have been termed the biomedical pipeline. Unfortunately, putting more trainees into a series of disconnected and leaky pipes have had only a limited impact and led to funders questioning investment in URG student/trainee pipelines. This is primarily predicated on a belief that the issue is with the ability of the students, when it is the fallacy of the pipeline as presently constructed. While our existing efforts to capture untapped URG talent and develop them into outstanding biomedical scientists and health professionals is crucial to advance the health of our nation, until we embrace and address the root cause of the existing inequities, our ability to improve representation for all groups in the biomedical and health professionals workforce will remain a pipe dream.
BACKGROUND:Hypertension (HTN) remains a key contributor to adverse outcomes in older adults with Alzheimer's disease (AD), which itself is the seventh leading cause of death in the U.S., affecting over 120,000 Americans annually. The co-existence of these conditions significantly increases the risk of morbidity and mortality, and despite their strong relationship, long-term mortality trends accounting for both conditions have not been assessed. This study examines trends and disparities in AD mortality among older patients (aged ≥ 65 years) with HTN in the U.S. from 1999 to 2023. METHODS:Mortality records of older patients listing AD as the primary cause of death and HTN as a contributing cause were evaluated from 1999 to 2023 using the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were computed per 100,000 population, and annual percent changes (APCs) were derived to assess temporal trends across different demographics and geographies. RESULTS:Overall, 314,914 mortalities were attributed to AD in patients with HTN, with overall AAMRs increasing from 1999 (7.1) to 2023 (41.1). Females (AAMR: 31.6) experienced higher rates than males (AAMR: 20.7). Rates peaked among NH African Americans (AAMR: 31.8), followed by NH Whites (AAMR: 28.3) and Hispanics (AAMR: 22.3). Adults aged 85+ years (AAMR: 142.3) had higher rates compared with those aged 75-84 (AAMR: 25.1) and 65-74 years (AAMR: 2.5). Geographically, AAMRs were highest in the West region (AAMR: 31.5) and among non-metropolitan residents (AAMR: 27.9) compared to metropolitan residents (AAMR: 25.03). Trend analysis revealed statistically significant APCs (p < 0.05) across all evaluated demographic and geographic subgroups. CONCLUSION:This sharp, six-fold rise in AD and HTN-related mortality highlights a compounding public health challenge. The significant disparities observed in the disproportionate burden on females, NH African Americans, and non-metropolitan residents likely reflect intersecting biological vulnerabilities and structural inequities in healthcare access. These findings stress the urgent need for targeted health policy strategies and the proactive clinical management of comorbid conditions to protect these high-risk populations.
INTRODUCTION:This scoping review mapped peer-reviewed literature on support resources available to underrepresented in medicine (URM) medical students during the pre-clerkship phase. The review examined what types of support mechanisms have been documented and how research on URM student support has evolved over time, particularly given the elimination of race-conscious admissions policies and the rollback of diversity, equity, and inclusion initiatives. METHODS:The PRISMA-ScR framework guided the methodology. Comprehensive searches were conducted across Medline-Ovid, PsycINFO-Ovid, and Scopus, supplemented by Google Scholar libraries and citation tracing. Scopus citation tracking identified publication trends from 1960-2024. Inclusion criteria required peer-reviewed, English-language studies focusing on URM pre-clerkship populations in the United States. Article screening, de-duplication, and data extraction were completed using Covidence. RESULTS:Of 463 identified articles, 190 duplicates were removed, leaving 273 for screening. Full-text review yielded 37 articles spanning qualitative, quantitative, mixed-methods, and evidence synthesis designs. Analysis revealed six primary support categories: social support, mentorship and advising, financial support, academic support, mental health support, and basic needs support. Publication volume demonstrated steady growth since the early 2000s, with notable increases between 2019 and 2024. DISCUSSION:The findings challenge deficit-based models by demonstrating that URM student persistence requires multi-dimensional support beyond academic preparation. Research attention across categories was notably uneven, with basic needs, mental health, and financial support receiving less attention despite their importance. American Indian, Alaska Native, Native Hawaiian, and Pacific Islander populations were absent as specific study populations. CONCLUSIONS:Significant gaps persist regarding intervention effectiveness, technology-enhanced learning, and support for underrepresented Indigenous populations. These findings underscore the need for evidence-based retention strategies as institutions navigate a rapidly changing policy landscape. This review establishes a pre-AI baseline against which future shifts in student support can be measured.
Dr. Grady Orange was a baseball player in the Negro National League (NNL) from 1925 to 1930, and then a practicing physician until his sudden death. Born in 1900, in Terrell, Texas, Grady was raised in the Jim Crow South. There were economic and societal barriers for African Americans, including access to well-paying jobs and opportunities for career advancement. Hospitals were segregated, as black doctors faced barriers to medical education and were often not permitted to practice in white institutions. After Orange’s baseball career, using NNL salaries to cover costs, he turned his focus to completing medical school and graduated at the top of his class. Dr. Orange devoted time beyond his medical practice, often educating his community and giving talks on tuberculosis, syphilis, and other public health topics. Dr. Orange and other players of his era helped pave the way towards baseball integration and the start of the modern-day civil rights movement in the United States. Studying Dr. Grady Orange’s biography helps preserve both his life’s impact and provide a history of baseball, segregation, and medicine.
Infectious mononucleosis has frequently been associated with splenic pathology, most significantly splenic rupture, but splenic infarction has been reported as a rare complication. Our case describes a 24-year-old male with a mononucleosis-like illness but with a negative heterophile antibody (Monospot), who later returned with left upper quadrant pain and was diagnosed with splenic infarct on contrast computed tomography. His Epstein-Barr Virus polymerase chain reaction returned positive, and workup for an underlying hematologic cause of thromboembolism was negative. This report draws attention to the complication of splenic infarct in infectious mononucleosis, the importance of searching for causes of hypercoagulability, malignancy and patent foramen ovale, and the need for further guidance on optimal management.
PURPOSE:To help create an inclusive environment, it is important to understand the experience of racism from medical students. The purpose of this study was to 1) Understand the experience of racism from medical students at two geographically similar medical schools but one being a Predominately White Institution (PWI) and the other a Historically Black College and University (HBCU), 2) Recognize similarities and differences in the racism students experience, and 3) Explore why students do not report the experienced racism. METHODS:Third- and fourth-year medical students from HBCU and PWI medical schools were recruited via e-mail for this phenomenological qualitative study. Consent and demographic data were collected via Research Electronic Data Capture (REDCap). Focus groups and one-on-one interviews were conducted via virtual platform by a trained moderator. Transcriptions of the recordings were analyzed by the research team to code and establish themes. The research team collected enough data that, when analyzed, provided sufficiency of information. RESULTS:Four focus groups and 9 one-on-one interviews were conducted with 23 total participants. Students from both medical schools raised 7 common themes and 2 sub-themes involving sources of racism, negative effects of racism, coping mechanisms, and opportunities to combat racism. Students from the HBCU discussed the positive effects of having faculty who share racial concordance with learners. Students from the PWI discussed experiences with racism from attendings. Students from both institutions discussed a fear of reprisal and a sense of futility as barriers to reporting racism. CONCLUSION:Our study provides a deeper understanding of students' perspectives of their experiences with racism during their medical education. These insights may support interventions medical schools can take to be anti-racist and inclusive.
BACKGROUND:Financial toxicity refers to the financial strain caused by the costs of medical care, indirect cost, and lost wages. In stroke survivors, financial toxicity is particularly severe due to the high costs of acute care, rehabilitation, and long-term disability resulting from stroke, often leading to delayed care and worse health outcomes. Evaluating variations in the financial toxicity of stroke among racial and ethnic groups is crucial because disparities in healthcare access, socioeconomic status, and insurance coverage can exacerbate the financial burden for certain populations. Understanding these differences can inform policies to reduce inequities for underserved groups. METHODS:Individual-level income and wealth values were calculated from self-reported financial data in the Medical Expenditure Panel Survey collected between 2018 and 2021. The analysis employed fixed effects regression to control for unobserved individual heterogeneity, thereby isolating the impact of stroke on income and wealth from other time-invariant personal characteristics with greater accuracy than other analytic methods. Interaction terms were included to assess the differential impacts of stroke on racial and ethnic groups. Due to changing financial dynamics, individuals over age 65 were assessed differentials financial dynamics Heckman regression models tested the robustness of findings to skewness in the distribution of income and wealth. RESULTS:About 2.73% (N = 414) of respondents under age 65 and 10.8% (N = 667) of respondents aged 65 and above reported having had a stroke. After controlling for demographic, health, and household characteristics, stroke was associated with 13% to 15% reduction in income among those less than age 65 and a 16% to 18% reduction is wealth among those age 65 and above. Stroke had a disparate impact on the income of young Black (-10.04%) and Hispanic (-19.19%) respondents and the wealth of older Black (-6.05%) and Hispanic (-3.01%) respondents. These findings were consistent across different model specifications, highlighting the robustness of the results. CONCLUSION:This study offers robust estimates of the financial impact of stroke indicating significantly difference financial burdens among Black and Hispanic respondents. These findings indicate the need to address the income and wealth impacts of stroke to mitigate financial toxicity in vulnerable populations.
INTRODUCTION:Osteoporosis and osteopenia are major health problems in women, particularly after menopause, and may share pathogenic mechanisms with early osteoarthritic changes. This study evaluated the relationship between bone fragility, oxidative stress, inflammation, trace element imbalance, and subclinical cartilage degradation in Iraqi women. MATERIALS AND METHODS:A total of 120 women aged 24-75 years were enrolled and classified into three groups: control (n = 40), osteopenia (n = 40), and osteoporosis (n = 40) based on BMD and T-scores measured by DEXA. Serum zinc, copper, ferritin, CRP, total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), and cartilage-related biomarkers (Coll2-1NO2, COMP, MMP-3) were determined. RESULTS:Osteopenic and osteoporotic women had significantly lower BMC, BMD, and T-scores, and higher TOS, OSI, CRP, ferritin, and copper, with reduced zinc and TAC compared with controls. Postmenopausal women with osteoporosis showed marked increases in Coll2-1NO2, COMP, and MMP-3. MMP-3 correlated positively with age in both osteopenic and osteoporotic women, while zinc showed a protective inverse association with Coll2-1NO2. Logistic regression identified zinc deficiency, copper excess, oxidative stress markers, and cartilage biomarkers as independent predictors of osteoporosis, with TOS, OSI, and MMP-3 also predicting osteopenia. CONCLUSIONS:Zinc deficiency, copper excess, oxidative stress imbalance, and elevated cartilage degradation markers were associated with reduced bone density, particularly in postmenopausal women with osteoporosis. These findings suggest a possible link between bone fragility and subclinical cartilage degradation; however, given the cross-sectional design and modest sample size, these markers should be interpreted as associated biochemical indicators rather than validated biomarkers for risk prediction or early detection.
Dermatologic diagnosis is fundamentally visual, yet minimally melanated skin has historically predominated in educational imagery used for medical training. The limited representation of brown and black skin in dermatologic preclinical education may contribute to delayed recognition of disease and reduced diagnosis confidence among trainees and physicians caring for patients with skin of color. Promoting visual equity within medical student preclinical education therefore represents an important step toward improving health outcomes in patients of color. In this cross-sectional study, preclinical dermatology and rheumatology teaching materials at the University of California, San Diego were systematically examined using a standardized image-based protocol. Clinical images were classified according to the Massey-Martin New Immigrant Survey Skin Color Scale and collapsed into three analytic groups: Light/White, Medium/Brown, and Dark/Black. These groups were further analyzed by instructional week and disease category. Across 507 clinical images, lighter skin tones predominated: light/white (n = 304, 60%), medium/brown (n = 147, 29%), and dark/black (n = 56, 11%), a distribution that deviated significantly from equal representation (χ² = 186.26, p < 0.001). Disease-level stratification revealed underrepresentation of dark/black skin tones across all analyzed disease categories. These findings highlight persistent gaps in skin tone diversity within preclinical curricula and demonstrate the feasibility of a standardized, reproducible framework for evaluating visual representation in dermatologic education. Establishing scalable equity audits across medical schools may enable institutional benchmarking and ultimately contribute to more equitable dermatologic diagnosis and care.
Health disparities persist across race and ethnicity within our health care system. The environments in which we live and work, and the opportunities and resources available to us contribute to social determinants often inextricable from race and ethnicity that influence and affect our health. While racial and ethnic disparities in perioperative health outcomes have traditionally been attributed to underlying comorbidities, the scope and lens with which social determinants of health play a role are often underestimated. Furthermore, there is limited research on unconscious bias within medicine despite multiple studies that demonstrate minoritized populations inequitably receive lower quality of care. This review article evaluates differences in health outcomes across race and ethnicity as experienced in the preoperative, intraoperative, and postoperative contexts.
