The study, published in Frontiers in Cardiovascular Medicine, was led by Ilia Davarashvili of the cardiology department at Leumit Health Care in Jerusalem, together with colleagues at Tel Aviv University, Ariel University, and Laniado Medical Center in Israel. The team conducted a retrospective, population-based matched cohort study using longitudinal electronic health records from Leumit Health Services, a nationwide health maintenance organization in Israel serving approximately 730,000 members. The analysis covered pregnancies documented between January 2020 and December 2025, a period spanning the original pandemic waves through the Omicron era.

The researchers identified 5,879 candidate pregnancies with a first documented COVID-19 infection during pregnancy, of which 5,776 met eligibility criteria. These were matched one-to-one, without replacement, to women without documented COVID-19 during pregnancy, drawn from a pool of 48,965 eligible pregnancies. Matching variables included ethnic sector, socioeconomic status, birth year, body mass index category, number of fetuses, number of prior COVID-19 vaccine doses, the calendar quarter of the estimated last menstrual period, and first-pregnancy status, with maternal age used to rank candidates within strata. The final analytical cohort comprised 4,068 COVID-19-exposed women and 4,068 matched controls, a total of 8,136 pregnancies.

The matching process was effective. Mean maternal age was 28.79 years in the exposed group versus 28.67 years in controls, pre-pregnancy weight was nearly identical, and chronic conditions were well balanced: pre-existing hypertension affected 9.05 percent of the COVID-19 group and 8.81 percent of controls, smoking 6.95 versus 7.64 percent, and diabetes mellitus 0.93 versus 0.69 percent, none of which differed significantly. Baseline cardiac histories, including valve disease and prior myocarditis, were similarly comparable between the two groups.

The primary outcome was a composite of major adverse cardiovascular events: myocarditis, cardiomyopathy, atrial fibrillation or flutter, congestive heart failure, myocardial infarction, pulmonary embolism, or deep venous thrombosis. Outcomes were assessed from 30 days after the estimated last menstrual period through one year thereafter, anchored to the pregnancy rather than to the infection date. The result was striking in its symmetry: six major cardiovascular events occurred in each group, an incidence of 0.15 percent in both, with an odds ratio of exactly 1.00 and a 95 percent confidence interval of 0.27 to 3.74. No cases of atrial fibrillation or flutter were recorded in either group during follow-up, and individual components such as myocarditis, cardiomyopathy, heart failure, pulmonary embolism, and deep venous thrombosis showed no statistically significant differences.

What did differ were symptoms rather than structural cardiac diagnoses. Cough was recorded in 6.88 percent of the COVID-19 group versus 4.87 percent of controls, an odds ratio of 1.45 with a confidence interval of 1.19 to 1.75. Backache was recorded in 13.8 percent versus 11.8 percent, an odds ratio of 1.20. Chest pain showed a non-significant trend toward higher rates in the infected group, at 2.11 versus 1.60 percent, and headache followed a similar pattern. The authors note that these symptom differences may relate to post-acute manifestations described after COVID-19, but that the study did not apply a formal Long-COVID definition and cannot establish that these symptoms represent that syndrome. Notably, the excess in backache was accompanied by a baseline imbalance in the same symptom, so differences in care-seeking or symptom-reporting behavior cannot be excluded.

The biological backdrop made the null result somewhat unexpected. Pregnancy imposes a substantial physiological stress test on the maternal cardiovascular system, with blood volume increasing by 40 to 50 percent, cardiac output rising, and baseline heart rate elevated. SARS-CoV-2, meanwhile, is known to cause myocardial injury through direct viral effects, hypoxia, and COVID-19-associated coagulopathy, a syndrome involving endothelial dysfunction, platelet activation, immunothrombosis, and dysregulated coagulation. Because pregnancy itself is a hypercoagulable state, the interaction of these two processes seemed biologically plausible as a driver of cardiac complications. The authors suggest that the maternal cardiovascular reserve proved resilient enough to compensate for this combined burden in the majority of community-managed cases.

The findings align with the multicenter CORONA-VTE-Network study by Bikdeli and colleagues, which followed 169 pregnant outpatients with COVID-19 for 90 days and observed only two venous thromboembolic events and no non-thrombotic cardiovascular events. They contrast, however, with studies such as those by Metz and colleagues at 17 US hospitals and Ferrara and colleagues in California, which reported increased serious maternal morbidity associated with SARS-CoV-2 infection. The authors emphasize that those studies measured broad composites of obstetric, respiratory, thrombotic, and systemic complications rather than specific cardiovascular endpoints, and largely focused on hospitalized or peripartum populations exposed to greater physiological stress. Their message is that cardiovascular risk observed in hospitalized cohorts should not necessarily be extrapolated to ambulatory pregnant women with generally mild disease.

One important caveat concerns thrombosis. The absence of a statistically significant increase in pulmonary embolism or deep vein thrombosis in this cohort should not be read as evidence that SARS-CoV-2 poses no thrombotic risk in pregnancy. Large registry studies have reported elevated relative risks: Bruno and colleagues found an adjusted hazard ratio of 2.62 for venous thromboembolism from pregnancy through six weeks postpartum among infected women, and Örtqvist and colleagues, using Swedish and Norwegian registry data, reported a hazard ratio of 4.63 in the first two weeks after infection, although absolute event numbers remained low. With only a handful of events in the present cohort, the study was underpowered to detect such differences, and the authors caution that their findings demonstrate uncommon clinically apparent events rather than the absence of any effect on thrombotic risk.

The authors also propose a possible protective mechanism rooted in the immunology of pregnancy. Successful pregnancy involves a shift toward a Th2-type cytokine profile that promotes fetal tolerance, a state associated with spontaneous remission of certain autoimmune diseases such as rheumatoid arthritis. Because severe COVID-19 myocardial injury is thought to be driven by dysregulated immune activation, endothelial inflammation, and cytokine-mediated tissue damage, the relatively controlled inflammatory environment of uncomplicated pregnancy might partially blunt the cytokine storm seen in severe infection. The researchers stress that this hypothesis remains speculative and requires confirmation in prospective mechanistic studies.

For clinicians, the practical message is one of reassurance with vigilance. In the absence of severe respiratory distress or red-flag clinical signs, COVID-19 infection in an ambulatory pregnant patient does not appear to warrant a radical departure from standard obstetric and cardiac monitoring protocols. The study has limitations typical of retrospective electronic record research, including possible documentation bias, incomplete data on in-hospital clinical course, the inability to classify infection severity by objective measures such as oxygen saturation, and a design that excluded pregnancies ending in first-trimester loss. Variant-specific viral data were also unavailable. Still, sensitivity analyses restricted to unvaccinated pregnancies and stratified by pre-Omicron versus Omicron-dominant periods, as well as matched-pair analyses using conditional logistic regression and exact McNemar tests, all yielded consistent results. For the vast majority of pregnant women managed in the community, the cardiovascular course of COVID-19 appears favorable.

Subject of Research: Cardiovascular outcomes of COVID-19 infection during pregnancy in ambulatory care settings

Article Title: Cardiovascular complications as a consequence of coronavirus infection in pregnant women managed in ambulatory settings

Article References: Davarashvili, I., Israel, A., Vinker, S., & Hochler, H. (2026). Cardiovascular complications as a consequence of coronavirus infection in pregnant women managed in ambulatory settings. Frontiers in Cardiovascular Medicine, 13, Article 1907396. https://doi.org/10.3389/fcvm.2026.1907396

Image Credits: AI Generated

DOI: 10.3389/fcvm.2026.1907396

Keywords: COVID-19, pregnancy, cardiovascular complications, myocarditis, venous thromboembolism, ambulatory care, matched cohort study, electronic health records, SARS-CoV-2, maternal health, epidemiology, Frontiers in Cardiovascular Medicine

The article, authored by medical education experts writing on behalf of the Society of General Internal Medicine and the Association of Chiefs and Leaders of General Internal Medicine Hess Initiative Work Group, was led by Tovah Tripp, M.D., associate professor of Internal Medicine at the Hackensack Meridian School of Medicine. Tripp also serves as the school’s Internal Medicine clerkship director and practices as a primary-care physician within Hackensack Meridian Health, giving her a dual vantage point as both an educator shaping curricula and a clinician experiencing the workforce shortage firsthand. Her team’s central contention is that the structure of American medical education itself contributes to the pipeline problem, and that fixing it will require coordinated action from medical schools and the bodies that accredit them.

At the heart of the paper is what the authors identify as a critical gap in what educators shorthand as med ed. While graduate medical education, the residency phase that follows medical school, mandates ambulatory training, neither the Liaison Committee on Medical Education nor the Association of American Medical Colleges requires specific outpatient exposure during the undergraduate years. The LCME accredits medical education programs leading to the M.D. degree in the United States and Canada, and the AAMC represents academic medicine institutions nationwide, so requirements set by these bodies ripple through every medical school in the country. Without a mandated minimum of outpatient, community-based clinical exposure, the authors argue, students may complete their formative training years with limited meaningful contact with general internal medicine and primary care.

This is a missed opportunity, according to the experts, because the years of medical school are precisely when many students form durable impressions about which specialties are prestigious, intellectually satisfying, and professionally rewarding. The authors write that investing in undergraduate medical education experiences is essential to rebuild the primary care pipeline and to create a generation of physicians who understand the value and role of primary care within the healthcare system, regardless of their ultimate specialty. In other words, even students who go on to become surgeons, radiologists, or hospitalists benefit from understanding what primary care does, and the healthcare system as a whole benefits when future specialists train alongside and respect their generalist colleagues.

To translate that principle into practice, the paper synthesizes existing literature into interrelated pathways for boosting primary care’s importance to doctors-in-training. The first pathway addresses the ecosystem of primary care itself. The authors call for mitigation of the administrative burdens and debt loads that weigh on primary-care clinicians, arguing that these pressures diminish the perceived value of the clinical role to learners. When students watch their mentors spend hours wrestling with documentation and billing rather than caring for patients, the message about the specialty’s day-to-day reality is hard to miss. The authors also point to leveraging artificial intelligence and team models of learning as tools that can lift some of that burden and make the clinical environment more attractive and educational.

The second pathway focuses on the faculty who teach primary care. Clinical educators in general internal medicine often juggle patient care, teaching, and administrative duties without commensurate recognition or compensation. The paper proposes developing faculty through a range of incentives, including educational relative value units, a mechanism by which teaching time is counted and rewarded within clinical compensation systems, as well as tax credits. Additional supports include protected time for educational work and flexible schedules, among other give-backs. The underlying logic is straightforward: a pipeline cannot be built by exhausted, undervalued teachers, and institutions that want to grow the next generation of generalists must invest in the ones they already have.

The third pathway centers on enriching the student’s experience of primary care during clerkships and mentorships. Clerkships are the rotational clinical courses that place third- and fourth-year medical students alongside practicing physicians, and they are widely regarded as among the most influential experiences in specialty decision-making. The authors argue that high-quality, well-mentored ambulatory rotations would heighten the perceived value of primary care careers, giving students a realistic and positive picture of what longitudinal patient relationships, preventive medicine, and community-based practice actually look like. A clerkship that is poorly organized or treated as an afterthought sends the opposite signal, regardless of how meaningful the underlying work may be.

Timing is a recurring theme throughout the paper. The authors emphasize that specialty choices are often solidified long before residency, making early interventions absolutely critical. By the time students apply to residency programs, many have already made implicit decisions shaped by their clinical exposures, their mentors, their debt levels, and their perceptions of different specialties’ lifestyles and prestige. Waiting until graduate medical education to cultivate interest in primary care, the authors suggest, is too late for many learners. Accordingly, they call on medical schools and accrediting bodies to mandate minimum ambulatory rotation requirements to ensure that primary care remains a visible and viable choice when the time comes for students to commit to a specialty.

The authors are careful to frame their proposals with appropriate humility. There is not a single fix for this kind of systemic problem, Tripp said, but well-thought-out strategies can nudge the trend in a positive direction. That framing reflects the reality that the primary-care shortage is the product of many converging forces, including compensation disparities between primary care and procedural specialties, administrative workload, educational debt, and the cultural status of different specialties within academic medicine. No curricular mandate alone can undo all of that, but the authors contend that a coordinated set of reforms across the ecosystem, the faculty, and the student experience can shift the trajectory meaningfully over time.

The paper, titled Improving the Ambulatory General Internal Medicine Experience in Undergraduate Medical Education: a Call for Action, was published on August 10, 2026, and is presented as a commentary rather than an original research study, synthesizing existing evidence into an actionable framework for educators and policymakers. The authors report no funding or financial support for the completion of the paper. Its publication arrives at a moment when the shortage of primary-care physicians has become a pressing national concern, with communities across the country struggling to recruit and retain generalists. By directing attention to the earliest stage of physician training and calling for national coordination among medical schools and accreditors, the HMSOM-led team hopes to convert a widely acknowledged problem into a concrete agenda, one clerkship, one mentor, and one policy change at a time.

Subject of Research: Strengthening the primary care physician pipeline through reforms in undergraduate medical education

Article Title: National call-to-action needed to strengthen primary care pipeline in medical education: HMSOM Educators

Article References: National call-to-action needed to strengthen primary care pipeline in medical education: HMSOM Educators. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: primary care, medical education, undergraduate medical education, ambulatory care, clerkships, LCME, AAMC, physician workforce, general internal medicine, faculty development, mentorship, health policy

The study, published in the Journal of General Internal Medicine, was led by Aubrey Samost-Williams of McGovern Medical School at the University of Texas Health Science Center at Houston, together with a multidisciplinary team spanning team science, anthropology, patient safety, and resilience engineering. The stakes are high: patients with a non-English language preference suffer harmful medical errors at higher rates than English-speaking patients, and those who experience diagnostic errors report more difficulty understanding follow-up instructions and more trouble finding interpreters when they need them. Language barriers are associated with disparities in clinical testing, delayed or missed diagnoses, and unplanned hospital readmissions.

To understand what interpreters actually contribute to safety, the team conducted three virtual focus groups with 17 current or former certified medical interpreters recruited from a large company providing interpretation services at more than 30,000 sites across the United States, Canada, and the United Kingdom. The focus group participants were a seasoned group, with between 5 and 24 years of experience, all fluent in English and Spanish, and all experienced with in-person, video remote, and phone interpretation. Five additional former interpreters reviewed the findings and checked that the researchers’ interpretations matched their lived experience. The analysis followed COREQ qualitative research guidelines and was approved by an institutional review board.

The analytical framework came from an unexpected corner of safety science: resilience engineering. Erik Hollnagel’s definition of a resilient healthcare system describes one that can adjust its functioning before, during, or after disturbances so that it sustains required performance under both expected and unexpected conditions. Hollnagel identifies four resilience potentials—the potential to respond, to monitor, to learn, and to anticipate. Rather than asking interpreters simply what their job involves, the researchers asked them to describe their experiences during ambulatory diagnostic visits for new or worsening symptoms, then mapped what they heard onto these four potentials.

The results revealed eleven behaviors clustered within the four potentials. Under the potential to respond, interpreters described managing the flow of communication during appointments, using verbal and nonverbal cues to keep patients and clinicians speaking in short phrases that allow more accurate interpretation. They described strengthening the patient’s voice, ensuring that tone and emotion survived the crossing between languages, and even mirroring a patient’s hesitancy in their own delivery when they sensed the patient was holding something back. They saw their role as extending from the moment a patient arrives until the moment they leave, helping patients schedule follow-up appointments and understand next steps. Some even described stepping in when they overheard inaccurate machine-generated Spanish drifting out of a clinic room they were merely walking past.

That last detail is a striking one, because it shows interpreters already acting as human quality-control agents for the very technologies meant to replace them. The study also found that interpreters monitor three things continuously during an encounter: the patient’s emotions and understanding, the dynamics of the clinical team, and the impact of technology on communication quality. Interpreters noted that patients often tell the clinician they have no questions, only to turn to the interpreter afterward to ask about a clinical detail—a disconnect that a word-for-word translation tool would never flag. Interpreters also reported miscommunications stemming directly from newer AI translation tools, and vulnerabilities in video-based interpretation such as poor connections and badly placed screens.

The potential to learn emerged from two sources. Interpreters frequently share a cultural background with the patient even when the clinician does not, positioning them to notice when a cultural misunderstanding could derail the diagnostic process. They described extracting sensitive information a patient would not otherwise disclose and navigating culturally mismatched diagnostic tests that could have profoundly affected the outcome. Over time, they also grew more confident speaking up and advocating for patients within the boundaries of company policies and national interpreter standards of practice.

The potential to anticipate proved perhaps the most sophisticated. Interpreters used cultural knowledge to predict which patients might not return for follow-up testing. In some cultures, they explained, medicine is viewed as infallible—so if symptoms persist after a first appointment, the patient assumes the fault must be their own. By surfacing that belief to the clinical team, an interpreter could prompt the clinician to address the concern preemptively, before it caused a patient to disappear from follow-up. Interpreters also proposed system-level improvements, such as formal guidelines for when virtual versus in-person interpretation is appropriate, and gender-matched interpreters for sensitive appointments in urology, gynecology, or mental health.

Crucially, the researchers found that these potentials do not operate in isolation. Monitoring behaviors feed responding behaviors: noticing a patient’s confusion allows the interpreter to intervene before a miscommunication hardens into a diagnostic error. Learning feeds anticipating: cultural knowledge gained over years lets an interpreter predict which patients need closer safety monitoring. This interlocking web of perception, judgment, and action is precisely what current AI interpretation tools lack. Those tools focus on rendering the words being exchanged, in written or spoken form, and do not account for the cultural brokering, emotional surveillance, team monitoring, and threat anticipation that human interpreters perform as a matter of course.

The implications for the healthcare industry are uncomfortable but clear. Interpreters are a finite and expensive resource, and institutions are understandably eager to swap them for cheap, always-available AI systems. But the study warns that measuring an AI tool purely by language accuracy threshold would miss the safety functions that human interpreters quietly provide. The authors suggest two paths forward. One is to design AI tools that integrate additional data sources, such as video or electronic health record data, to flag when a patient is at risk of misunderstanding or when cultural differences may be relevant. The other is a model of AI as teammate, in which AI handles raw language conversion while a human interpreter supervises and takes on the broader advocate and navigator role. The researchers also identified barriers on the human side: medical hierarchies can make it hard for an interpreter to challenge a clinician, and interpreters often noticed safety threats—poor team dynamics, patients unlikely to return—without feeling empowered to act. Short pre-appointment briefings, in which clinicians explicitly invite interpreters to voice safety concerns, emerged as a simple, powerful remedy. The study’s limitations are real: it captures only interpreters’ self-reported experiences, not the perspectives of patients or clinicians, and future work will need to test AI tools against human interpreters in real-world settings. But the core message is already actionable. As hospitals race to deploy voice-to-voice machine translation and even real-time in-ear interpretation devices, the quiet safety work of human interpreters—responding, monitoring, learning, and anticipating—must be designed into the workflow, or the resilience that protects millions of patients will simply vanish with the interpreter.

Subject of Research: The safety roles of medical interpreters beyond language translation and their implications for AI interpretation tools

Article Title: The Role of Interpreters in Supporting Resilience and Implications for Artificial Intelligence

Article References: Samost-Williams, A., Wermuth, P., Fernández Castillo, G., Zipkin, R., Hanley, K., Xie, Y., Newton, M. E., Salas, E., Tannenbaum, S., Wiig, S., Thomas, E. J., & Bell, S. K. (2026). The Role of Interpreters in Supporting Resilience and Implications for Artificial Intelligence. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10850-4

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10850-4

Keywords: medical interpreters, patient safety, resilience engineering, diagnostic error, artificial intelligence, language barriers, ambulatory care, qualitative research, healthcare disparities, machine translation, cultural brokering, Hollnagel resilience potentials

The scale of the problem the study addresses is hard to overstate. Documentation in the electronic health record is frequently cited as a primary driver of physician burnout, a phenomenon that has worsened across the American medical workforce in recent years. National surveys have tracked rising burnout and declining satisfaction with work-life integration among physicians compared with the general working population, and health services researchers have estimated the enormous expenditures attributable to burnout-related turnover in primary care. Burnout is not merely a matter of professional misery; systematic reviews have linked it to degraded quality and safety of care, and studies of electronic health record use have connected heavy documentation loads to clinician stress, reduced productivity, and even physician turnover.

Residents occupy a particularly exposed position in this landscape. These are physicians in post-graduate training, typically in their second or third year of residency when working in continuity clinics, and they must learn to navigate the electronic health record while simultaneously learning medicine itself. Prior research has shown that physicians receive little formal training in efficient record use, that there is enormous variability in how individual clinicians document, and that this variation carries potential consequences for patient harm. Earlier studies have also documented the phenomenon known as note bloat—the progressive swelling of clinical notes with copied text, redundant information, and boilerplate that obscures the signal a busy clinician actually needs.

The Mount Sinai team designed their study to test whether standardization could attack these problems directly. They compared fifty-two second-year and fifty-five third-year internal medicine residents who practiced under the new standardized system with historical control groups of fifty-five second-year and forty-nine third-year residents who had worked in the same urban academic clinic before the change. The intervention itself had three components: standardized documentation templates, standardized medication ordering practices, and mandatory training on how to use them, supplemented by incentivized opportunities for residents to practice the new documentation methods. The design was a pre-post difference-in-differences evaluation, a quasi-experimental approach that compares changes over time in the intervention group against changes in the control group, helping to separate the effect of the intervention from broader trends in documentation behavior.

What makes the study technically interesting is that the researchers did not rely on self-reported time savings, which are notoriously unreliable. Instead, they mined objective electronic health record efficiency metrics, measuring the time residents spent per appointment on chart review, note writing, and placing orders. They also measured the length of notes in characters and, critically, tracked the number of characters of text copied from prior notes and pasted into current notes—a direct window into how much of each note was genuinely new clinical thinking versus recycled text. These granular behavioral metrics, increasingly available through vendor analytics platforms, allow researchers to dissect exactly where documentation time goes and how interventions change clinician behavior at the keystroke level.

The results were striking. The intervention was associated with an 18.8-minute decrease in per-encounter documentation time for residents during their second post-graduate year and a 12.0-minute decrease during their third year, both statistically significant at p less than 0.0001. To put that in perspective, a resident seeing a full panel of patients in an afternoon clinic could recover well over an hour of previously lost time each session. Note length collapsed as well: second-year residents produced notes shorter by 3,650 characters, a 43.3 percent reduction, while third-year residents trimmed 1,608 characters, or 17.7 percent. Perhaps most telling was the fate of copy-paste text, the hallmark of note bloat, which fell by 66.7 percent among second-year residents and 74.6 percent among third-year residents.

The pattern across training years is itself informative. Second-year residents, who were encountering the standardized system as relatively fresh users of the outpatient record, showed larger absolute and relative improvements than third-year residents, who had already spent a year forming documentation habits under the old system. This is consistent with what learning scientists have long described about skill acquisition: early habits are more malleable, and interventions that shape practice from the start of a training stage may have an easier time than those asking experienced users to unlearn entrenched workflows. It suggests that residency programs considering similar reforms may get the biggest returns by introducing standardization at the moment residents first begin outpatient continuity work.

The well-being findings, however, are a cautionary coda. The researchers administered the Mini-Z survey, a validated instrument for assessing worklife and burnout in medical settings, before and after the intervention. Among the forty-two residents who completed the pre-intervention survey and the twenty-eight who completed the post-intervention survey, there were no significant changes in overall Mini-Z scores. There was one encouraging signal: a single-item burnout question improved from 3.2 before the intervention to 3.7 afterward, a statistically significant shift on a scale where the direction of improvement reflects lower burnout. But the authors are candid about the limitation—response rates to the well-being questions were low, and the analysis was underpowered to detect anything but large effects. Efficiency, in other words, demonstrably improved; whether that efficiency translated into residents feeling better about their work remains an open question.

This ambiguity matters because the relationship between documentation time and burnout is not a simple one-to-one pipeline. Prior studies have found associations between electronic health record design and use factors and clinician stress, and between after-hours record time and turnover intentions, but burnout is a multidimensional phenomenon shaped by workload, autonomy, meaning in work, and organizational culture. Freeing up nineteen minutes per visit may reduce one specific stressor without moving global well-being scores, especially over the relatively short window of a pre-post study. It is also possible that the residents who felt most burdened were the least likely to complete the follow-up survey, biasing the results in either direction. The study was deemed quality improvement by the Mount Sinai Department of Medicine Quality Improvement Committee and exempted from informed consent, reflecting its operational rather than experimental framing.

The findings arrive at a moment when the field is wrestling with how to reduce documentation burden at scale. Ambient artificial intelligence scribes, which listen to clinical encounters and draft notes automatically, have shown promising effects on documentation time in recent studies across primary care and emergency settings, and systematic reviews of artificial intelligence tools for clinical documentation are accumulating rapidly. But such technologies are expensive, raise new questions about accuracy and oversight, and remain unevenly deployed. The Mount Sinai study is a useful counterweight: a structured, low-cost intervention of templates, ordering standards, and training—implemented within an existing commercial record system—produced large, objectively measured efficiency gains without waiting for artificial intelligence to mature. For residency programs and clinics confronting documentation overload today, the message is that a meaningful share of the burden is not inherent to the software but to how it is used, and that how it is used can be taught, standardized, and measured.

Subject of Research: Effect of standardized outpatient electronic health record documentation on internal medicine resident efficiency and well-being

Article Title: The Impact of Outpatient Documentation Standardization on Internal Medicine Resident Efficiency and Well-Being

Article References: Kutscher, E., Halket, D., Feinberg, A., Blum, C., Koransky, A., Tamler, R., Federman, A., & Fishman, M. (2026). The Impact of Outpatient Documentation Standardization on Internal Medicine Resident Efficiency and Well-Being. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10858-w

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10858-w

Keywords: electronic health records, documentation burden, physician burnout, internal medicine residency, note templates, clinical efficiency, copy-paste text, Mini-Z survey, graduate medical education, difference-in-differences, ambulatory care, well-being

CPX-351 is not an ordinary chemotherapy combination. It encapsulates cytarabine and daunorubicin within liposomes at a fixed five-to-one molar ratio, allowing the two agents to be delivered together and to persist in the bloodstream for longer than conventional formulations. This pharmacokinetic profile improves drug uptake by leukaemic blasts and has demonstrated clinical benefit for patients whose disease arises from prior therapy or carries myelodysplasia-related genetic changes, groups that historically fared poorly with standard induction regimens. Because the drug can be administered in both inpatient and outpatient settings, clinicians have increasingly explored ambulatory delivery as a way to spare hospital beds, reduce exposure to nosocomial infections, and preserve patients’ autonomy during a demanding course of intensive treatment.

To formalize this practice, a steering group of nine haematologists with hands-on experience in outpatient CPX-351 treatment was assembled from institutions across Europe and Australia. The group drafted a series of consensus statements organized into six key domains covering patient selection, definitions of treatment settings, the anticipated benefits of outpatient care, patient and caregiver requirements, healthcare system prerequisites, and practical measures for optimizing delivery. Their statements were then subjected to validation by a much wider panel: an online survey of 200 haematologists drawn from Australia, France, Germany, Italy, the United Kingdom, and Spain, all of whom had experience with intensive chemotherapy and outpatient care for AML. Agreement was measured on a four-point Likert scale, with consensus defined as at least seventy-five percent agreement for each statement.

The results were strikingly decisive. Forty-two of the forty-three statements, ninety-eight percent of the total, achieved consensus, and thirty-one of them reached agreement levels of ninety percent or higher. Such near-unanimity among two hundred specialists spanning six countries and diverse healthcare systems is uncommon in Delphi studies and signals that the clinical community has converged on a coherent view of how outpatient CPX-351 delivery should be approached. High alignment emerged particularly around the identification of suitable patients and the definition of what constitutes an appropriate outpatient treatment setting, the foundational questions that determine whether a given individual can safely receive intensive liposomal chemotherapy without overnight admission to a hematology ward.

When it came to the benefits of outpatient treatment, the panel expressed its strongest agreement on potential advantages for hospital resourcing, an issue of acute relevance as many hematology units face chronic bed shortages. Respondents also strongly endorsed improvements in patients’ physical and psychological status and in quality of life, reflecting a broader movement in oncology toward care models that respect patients’ daily lives. For older or comorbid patients with t-AML or AML-MRC, who may already be coping with the consequences of prior malignancy treatment, the ability to undergo induction chemotherapy while sleeping in their own beds, staying connected to family, and avoiding the disorientation of prolonged hospitalization carries real therapeutic and emotional weight.

The consensus did not shy away from the prerequisites that make such a model viable. The survey highlighted significant agreement on key patient and caregiver requirements, including cognitive and physical abilities sufficient to recognize and report emerging problems, reliable communication channels with the treating team, and reasonable access to the hospital or an affiliated emergency facility. These criteria acknowledge the central paradox of ambulatory intensive chemotherapy: the treatment is administered outside the ward, but the risk of febrile neutropenia, bleeding, and other complications remains, so patients must be selected, educated, and supported with the same rigor applied to any inpatient induction regimen.

Healthcare system requirements formed another domain of strong agreement. Respondents emphasized the need for explicit hospital protocols, adequate available resources, and robust systems for managing complications when they arise. In practice, this means that outpatient CPX-351 programs cannot simply be layered onto existing services without investment. They demand dedicated staff training, clearly defined escalation pathways, rapid-access clinics or equivalent mechanisms for same-day assessment, and coordination across the multidisciplinary team, including haematologists, nurses, pharmacists, and emergency physicians who may encounter these patients between scheduled visits. The consensus framework effectively functions as a checklist for institutions considering launching such a service.

Beyond eligibility and infrastructure, the panel endorsed a set of practical measures to optimize day-to-day delivery. These included the use of patient assessment tools to standardize selection and monitoring, structured collection of patient feedback, ongoing staff education, deliberate coordination among multidisciplinary team members, and the systematic sharing of best practices across centers. Although the authors acknowledge that challenges may differ across countries and healthcare settings, with reimbursement structures, geographic distances, and staffing models varying widely, the consensus provides clear, transferable guidance on safe and effective outpatient administration. For centers with less experience in ambulatory delivery of CPX-351, the document offers a ready-made starting point grounded in the collective judgment of the international hematology community.

The significance of this work extends beyond a single drug. Intensive chemotherapy for acute myeloid leukaemia has traditionally been synonymous with weeks of hospitalization, a model that burdens patients, families, and health systems alike. As liposomal and targeted therapies broaden the options for older and frailer patients, and as ambulatory care models prove their worth in other malignancies, structured consensus documents like this one will play an increasingly important role in translating clinical trial evidence into safe everyday practice. The near-total agreement achieved here suggests that outpatient CPX-351 treatment for t-AML and AML-MRC is no longer an experimental convenience but an emerging standard of care, provided that centers adhere to the patient-selection criteria, monitoring requirements, and multidisciplinary safeguards that the international panel has now so clearly defined.

Subject of Research: Outpatient delivery of CPX-351 liposomal cytarabine-daunorubicin for therapy-related acute myeloid leukaemia and AML with myelodysplasia-related changes

Article Title: Optimising CPX-351 (liposomal cytarabine-daunorubicin) treatment for t-AML/AML-MRC patients in the outpatient setting: a modified Delphi consensus

Article References: Mehta, P., Martínez-Roca, A., Cahalin, P., McNamara, C., Salamero, O., Martelli, M. P., Franke, G.-N., Capelli, D., de Andrés-Nogales, F., Francia, R., Lassman, E., & Conn, J. (2026). Optimising CPX-351 (liposomal cytarabine-daunorubicin) treatment for t-AML/AML-MRC patients in the outpatient setting: a modified Delphi consensus. Annals of Hematology. https://doi.org/10.1007/s00277-026-07220-9

Image Credits: AI Generated

DOI: 10.1007/s00277-026-07220-9

Keywords: CPX-351, acute myeloid leukaemia, t-AML, AML-MRC, liposomal cytarabine-daunorubicin, outpatient care, Delphi consensus, haematology, chemotherapy, ambulatory care, patient selection, quality of life

The study was led by researchers from the Faculty of Medicine at the University of Peradeniya, including Jananie Abeygunasekera, Anushka Sachini, Malindi Kulathunga, Chathurika Abeysekara, Dulanjana Senavirathna, and microbiologist Veranja Liyanapathirana. Drawing on a descriptive cross-sectional design, the team surveyed 351 adult visitors attending the outpatient department of a tertiary care hospital. Participants were recruited consecutively using convenience sampling, meaning the researchers enrolled eligible adults as they presented, and data were collected through a structured self-administered questionnaire. The instrument probed perceptions of physicians’ attire and grooming, as well as beliefs about infection-related risks tied to what doctors wear. Statistical associations between perceptions and sociodemographic characteristics were tested using Pearson’s chi-square test or Fisher’s exact test, with significance set at a p-value below 0.05.

The headline result is unambiguous: scrubs dominate patient preferences. Some 200 participants, or 57.0 percent, identified scrubs as the preferred attire for male doctors, while 194, or 55.3 percent, said the same for female physicians. This preference was not uniform across the age spectrum. Among young adults, 65.5 percent favored scrubs for male doctors, compared with 54.2 percent of middle-aged adults and only 34.1 percent of older adults, a difference that was highly statistically significant. The same generational gradient appeared for female doctors, with 63.0 percent of young adults, 52.8 percent of middle-aged adults, and 34.1 percent of older adults preferring scrubs.

As enthusiasm for scrubs waned with age, preference for traditional attire climbed. The saree, a garment with deep cultural resonance in Sri Lanka, was favored for female physicians by 18.2 percent of young adults, 35.9 percent of middle-aged adults, and 54.5 percent of older adults, a pattern that reached strong statistical significance. The authors interpret this shift through a sociocultural lens: younger patients appear to associate modern, standardized clinical dress with professionalism and hygiene, while older patients may read traditional attire as a marker of respectability, identity, and trustworthiness. In other words, what counts as an appropriate doctor’s look is not a fixed visual code but one negotiated between global medical conventions and local cultural expectations.

Beyond aesthetics, the study tapped into a growing scientific concern: clothing as a fomite. Textiles in clinical environments can harbor bacteria and other microorganisms, and several studies worldwide have documented contamination of white coats, neckties, and sleeves. The Sri Lankan patients surveyed were notably aware of this risk. Fully 283 participants, or 80.6 percent, knew that microorganisms could survive on clothing, and 192, or 54.7 percent, perceived physicians’ attire as a potential source of infection. That more than half of ordinary outpatients independently view clothing as an infection vector underscores how far public awareness of cross-contamination has penetrated, even outside hospital wards.

When it came to ranking garments by infection risk, patients again converged on scrubs. Among those who viewed attire as a potential infection source, 136, or 70.8 percent, judged scrubs the lowest-risk option for male physicians, and 135, or 70.3 percent, said the same for female physicians. A remarkable 164 participants, or 85.4 percent of this subgroup, also considered short-sleeved attire more favorable for effective hand hygiene. This detail aligns neatly with infection control doctrine: bare forearms allow thorough hand and wrist washing, whereas long sleeves can dip into sinks, contact patients, and retain moisture and microbes. Patients, it seems, have internalized the same practical logic that guides hospital hygiene protocols.

The study fills a conspicuous gap in the literature. Much of the existing research on physician attire has been conducted in high-income settings such as the United Kingdom, the United States, and Japan, where debates have swung from the traditional white coat to bare-below-the-elbows policies. Evidence from South Asia and other low- and middle-income contexts has been sparse, despite the fact that cultural norms, climate, laundry infrastructure, and hospital resourcing differ substantially. By documenting patient perspectives at a major Sri Lankan hospital, the Peradeniya team provides data that hospital administrators and professional bodies in the region can use to ground attire policies in patient sentiment rather than imported assumptions.

The findings carry practical implications for hospitals weighing dress codes. Because scrubs are simultaneously the most preferred attire and the garment perceived as carrying the lowest infection risk, they occupy a rare sweet spot where patient preference and infection prevention goals coincide. Uniform scrub programs could, in principle, strengthen both patient confidence and hygiene practice, particularly if paired with short sleeves and institutional laundering, which reduces the burden on individual clinicians to maintain garment cleanliness. At the same time, the age-dependent preference for traditional attire suggests that any transition toward standardized dress should be communicated sensitively, since older patients may experience such changes as a loss of familiarity or respect. Grooming, too, emerged as part of the equation, with tidy appearance functioning in patients’ eyes as a proxy for both professionalism and safety.

The researchers caution that their findings come from a single tertiary care outpatient department and used convenience sampling, so the results may not generalize to all Sri Lankan patients or to inpatient settings. Still, the study, which received no external funding and was approved by the Ethics Review Committee of the Faculty of Medicine at the University of Peradeniya under protocol number 2024/EC/SP/02, adds an important data point to a global conversation about how doctors should dress. Its central message resonates well beyond Central Sri Lanka: a physician’s appearance is never merely cosmetic. To the patients who watch clinicians walk into the examination room, clothing communicates competence, cleanliness, and care, and it can either reassure or quietly alarm. As hospitals worldwide refine attire policies in the name of infection control, this study is a reminder that patients are not passive observers of those choices. They bring their own expectations, shaped by generation and culture, about what a safe and trustworthy doctor looks like, and those expectations deserve a seat at the policy table.

The symbolic weight of the white coat is worth recalling when interpreting these results. The garment entered medical fashion in the late nineteenth century, when physicians adopted laboratory dress to signal that medicine was becoming a scientific discipline grounded in germ theory and antiseptic practice. Over the following century the coat became so entrenched that many institutions staged formal ceremonies in which students received their first coat as a rite of passage. The Sri Lankan findings suggest that this historical emblem no longer commands automatic deference, at least among younger outpatients, who appear to associate standardized clinical uniforms rather than traditional professional dress with modern, hygienic care.

The study’s methodology merits some attention for readers weighing its conclusions. Because participants were surveyed with a self-administered questionnaire in an outpatient waiting area, the results capture stated perceptions rather than observed behavior. Perception and behavior can diverge: a patient may prefer scrubs yet still trust a physician in a saree once a consultation begins. The cross-sectional design also means the age gradient documented by the researchers could reflect either generational differences that will persist as younger cohorts age, or a life-stage effect in which attitudes toward traditional dress shift with maturity. Longitudinal work would be needed to separate these possibilities.

The finding that 80.6 percent of participants knew microorganisms can survive on clothing is striking given that textile contamination is a relatively technical concept. Research in other settings has recovered pathogenic bacteria, including staphylococci and enteric organisms, from the sleeves, pockets, and lapels of clinical garments, and contamination rates appear to rise with the frequency of patient contact and the interval between laundering. Whether contaminated attire translates into actual transmission of infection to patients remains difficult to prove, and direct evidence linking physician clothing to hospital-acquired infections is limited. This uncertainty has shaped policy debates, since some national guidance has restricted long sleeves and neckties on precautionary grounds even without definitive transmission data.

The Sri Lankan context adds further nuance. In tropical climates, lightweight and easily laundered garments offer practical advantages, and institutional laundering of hospital-owned scrubs can guarantee washing temperatures and detergent standards that home laundering of personal coats may not achieve. For hospitals in resource-constrained settings, however, supplying multiple sets of scrubs to every clinician carries real costs, which helps explain why traditional attire and personal white coats remain widespread across South Asia. Any move toward uniform programs must therefore balance patient preferences and infection control logic against procurement, laundry capacity, and staff acceptance.

Finally, the study highlights how patients themselves have become sophisticated participants in infection prevention culture. Public experience with hand hygiene campaigns and, more recently, pandemic-era messaging has familiarized ordinary people with concepts such as fomites and cross-contamination. That more than half of surveyed outpatients spontaneously identified clothing as a potential infection source indicates that hospitals can no longer assume attire is a neutral or invisible element of care. Patient-facing communication about dress codes, including why particular garments are chosen, may itself become a tool for building confidence in outpatient settings.

Subject of Research: Patient perceptions of physician attire and grooming and their perceived infection risks in outpatient care in Sri Lanka

Article Title: Patient perceptions of physician attire and perceived infection risk associated with attire and grooming in outpatient care at a tertiary care hospital in Central Sri Lanka

Article References: Abeygunasekera, J., Sachini, A., Kulathunga, M., Abeysekara, C., Senavirathna, D., & Liyanapathirana, V. (2026). Patient perceptions of physician attire and perceived infection risk associated with attire and grooming in outpatient care at a tertiary care hospital in Central Sri Lanka. Discover Social Science and Health. https://doi.org/10.1007/s44155-026-00481-9

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00481-9

Keywords: physician attire, patient perceptions, infection control, cross infection, scrubs, ambulatory care, hand hygiene, cultural factors, Sri Lanka, developing countries, tertiary care hospital, grooming