The research team, led by Yang Wang and Guojie Wang of the First People’s Hospital of Kashi Prefecture, together with colleagues from Sun Yat-sen University and Southern Medical University, focused on a setting that is increasingly common across many parts of the world: a multiethnic primary care environment where radiographers and patients may not share a first language, workloads are high, and training has traditionally been handed down through informal apprenticeship. In such settings, the technical quality of radiographs can quietly erode, and the reasons are rarely a single obvious failure. Instead, they emerge from an interlocking web of communication barriers, time pressure, and inconsistent instruction — problems that conventional one-to-one mentoring is poorly equipped to solve.

To understand exactly what was going wrong, the researchers began with a rigorous baseline measurement. They randomly sampled 120 chest X-rays produced by six junior radiographers, each with three or fewer years of experience, working under the conventional apprenticeship model. Two blinded radiologists independently scored each image using a validated 12-point assessment tool covering multiple domains of technical quality. Before scoring, the team confirmed that the radiologists agreed with one another to a high degree: on a random subsample of 30 images, the intraclass correlation coefficient calculated with a two-way random-effects model reached 0.821, a level generally interpreted as excellent agreement. The baseline results were sobering. The mean image-quality score was 9.56, with a standard deviation of 1.11, and only 19.17 percent of the chest X-rays achieved the threshold of diagnostic excellence.

Identifying why those images fell short required a systematic diagnostic step. The team applied an Ishikawa, or fishbone, analysis — a root-cause method that maps potential contributing factors across categories such as people, processes, equipment, and environment. They then used a weighted scoring approach, designated the 5-3-1 method, to prioritize the factors by importance, and calculated the percentage of suboptimal cases attributable to each. Three dominant barriers emerged. First, language discordance between radiographers and patients led to non-cooperation during positioning and breath-holding instructions, a problem of particular salience in multiethnic communities where patients may speak any of several languages. Second, high clinical workloads left little time for careful technique or reflection on errors. Third, and perhaps most fundamentally, the absence of standardized training meant that each junior radiographer had learned slightly different habits, with no shared standard operating procedures to anchor practice.

The intervention that followed was built on the Plan-Do-Check-Act cycle, a quality improvement framework better known from manufacturing and industrial engineering than from medical education. In the Plan phase, the team translated the root-cause findings into targeted educational objectives, developing standardized operating procedures and bilingual communication protocols designed to bridge the language gap between staff and patients. The Do phase involved a one-month structured training program in which the six junior radiographers received standardized instruction, practiced under supervision, and participated in peer review of one another’s images. The Check phase measured the results against the baseline, and the Act phase consolidated what worked and fed remaining deficiencies into the next cycle. Crucially, the framework treats training not as a one-off course but as a continuous loop of measurement and refinement — an instructional design model rather than merely a management slogan.

The results were striking. After the intervention, the researchers evaluated 150 chest X-rays, with each of the six radiographers contributing 25 post-intervention images to complement the 20 pre-intervention images they had each supplied at baseline. The mean image-quality score rose to 11.03, with a standard deviation of 0.82, and the proportion of chest X-rays achieving diagnostic excellence surged from 19.17 percent to 80.67 percent, a difference that was statistically significant at P less than 0.001. Because images from the same radiographer are not independent observations, the team’s primary analysis used a linear mixed-effects model, which accounts for clustering within individuals. This model estimated that post-intervention scores increased by 1.395 points relative to baseline, a result significant at P less than 0.01. Importantly, the improvement was not driven by one or two star performers: all six radiographers showed consistent gains, and six of the seven assessed image-quality domains improved.

The statistical architecture of the study deserves attention, because it addresses a common weakness in before-and-after educational research. Pre-post comparisons that ignore clustering can overstate significance by treating repeated measures from the same person as independent data points. By specifying radiographer as a random effect in the mixed model, the authors allowed each participant to serve, in effect, as their own control while properly quantifying between-person variability. The combination of blinded, dual-reader scoring with verified inter-rater reliability and cluster-aware statistics gives the findings a methodological solidity that many quality improvement reports lack, even though the design remains observational and cannot prove causation with the certainty of a randomized trial.

Beyond the six radiographers in the core study, the team scaled the approach into a regional continuing medical education program. Under this program, 354 primary care radiographers across the region were trained using the same PDCA-based standardized curriculum, and 349 of them — 98.59 percent — passed the certification assessment. This pass rate suggests that the framework is not only effective for a small cohort under close supervision but is also scalable as a credentialing mechanism. The authors argue that integrating standardized instruction, peer review, bilingual protocols, and image-quality-focused credentialing within a PDCA structure offers a coherent alternative to apprenticeship models that were never designed for high-throughput, linguistically diverse screening environments.

The implications extend well beyond one prefecture in Xinjiang. Multiethnic, multilingual patient populations are a feature of health systems on every continent, and language discordance is a documented source of error throughout medicine, including imaging. The finding that a substantial share of suboptimal radiographs traced back to patient non-cooperation rooted in communication failure is a reminder that image quality is a team and systems property, not solely a function of the radiographer’s hands. Bilingual instruction cards, standardized coaching scripts for breath-holding, and positioning aids are inexpensive interventions, yet they appear to have contributed to gains that no amount of extra equipment spending could replicate. For screening programs targeting tuberculosis and other lung infections, where every missed or uninterpretable film carries a real epidemiological cost, the economics of such training are compelling.

Caveats remain, and the authors are careful to frame their conclusions appropriately. The study reports short-term outcomes in a single region, and the association between the PDCA intervention and improved performance, while statistically robust, was observed rather than experimentally isolated; secular trends, seasonal workload variation, or a Hawthorne effect from being observed cannot be fully excluded. Whether the gains persist after the intensity of the program fades, and whether they translate into measurably better clinical outcomes such as improved tuberculosis detection, will require follow-up studies. The study was also exempted from formal ethical review because it analyzed anonymized image-quality data not linked to employment evaluations, and patient data were fully anonymized. Still, the central message stands out with unusual clarity for the field: when the barriers to good imaging are systematically diagnosed and training is rebuilt as a continuous, measured cycle rather than an inherited craft, the quality of the images — and potentially the quality of the diagnoses built upon them — can change dramatically in a matter of weeks.

Subject of Research: PDCA-based standardized training to improve chest X-ray image quality among junior radiographers

Article Title: PDCA cycle-based standardized training and CXR image-quality performance of radiographers in multiethnic communities: a pre-post quality improvement study

Article References: Wang, Y., Liu, X., Feng, J., Zou, K., Zhou, R., Wang, X., Qiu, Y., & Wang, G. (2026). PDCA cycle-based standardized training and CXR image-quality performance of radiographers in multiethnic communities: a pre-post quality improvement study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10586-z

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10586-z

Keywords: chest X-ray, radiographer training, PDCA cycle, quality improvement, continuing medical education, image quality, multiethnic communities, language discordance, linear mixed-effects model, standardized training, lung disease screening, BMC Medical Education

The research team, led by Renae D. Schmidt and Daniel J. Feaster at the University of Miami’s Miller School of Medicine, together with colleagues at Columbia University and the University of Chicago, analyzed data from a nationally representative survey of U.S. primary care and emergency department physicians conducted between October 2020 and October 2022. The survey achieved a Council of American Survey Research Organizations response rate of 53.6 percent, a respectable figure for physician surveys, and the analysis included 855 physicians. Because the sample was designed to be nationally representative, the results offer one of the clearer windows to date into how training and attitudes intersect across the frontline settings where most Americans first encounter the health system.

The researchers examined three distinct strands of addiction education: hours of training received during medical school, hours received during residency, and participation in Continuing Medical Education, the ongoing coursework practicing physicians complete throughout their careers. They also measured each physician’s perceived capability to care for individuals with substance use disorders, essentially a self-assessed sense of competence. Stigma was assessed with validated instruments, including the Drug and Drug Problems Perceptions Questionnaire and the Medical Condition Regard Scale, which capture how providers emotionally and cognitively regard patients with drug-related problems. Clinical practice was measured by whether physicians reported providing treatments such as medication for opioid use disorder, behavioral counseling, and treatment for alcohol and other drug use disorders.

The statistical architecture of the study was as important as its findings. Because primary care physicians and emergency department physicians were surveyed with overlapping instruments, the team used generalized estimating equations, a regression framework that handles correlated observations and allows estimates to be pooled across physician types while adjusting for covariates including sex, race and ethnicity, years since degree, and physician type. This approach let the investigators isolate the association of training with stigma and practice while holding demographic and career factors constant, and then to test whether perceived capability sat on the causal pathway between training and stigma.

The headline result is strikingly consistent across substances. More addiction training was associated with lower stigma toward patients with alcohol use disorders, with a standardized coefficient of negative 2.42 that was statistically significant at the one percent level. The same pattern held for stimulant use disorders, where the coefficient was negative 2.78, and for opioid use disorders, where it was negative 2.48. In other words, physicians who reported more training expressed measurably less stigmatizing regard for patients regardless of which substance was involved, a notable finding given that stimulant use disorders lack FDA-approved medications and are often viewed with particular pessimism in clinical settings.

Training was also linked to what physicians actually did, not just how they felt. Each increment of training was associated with higher odds of providing treatment: a prevalence ratio of 1.19 for treating alcohol use disorders, 1.09 for providing medication for opioid use disorder, 1.10 for delivering behavioral counseling for opioid use disorder, and 1.14 for treating disorders related to other drugs. These ratios were statistically significant, and while the magnitudes may look modest, they compound across a workforce of hundreds of thousands of physicians and millions of patients. In a country where only a small fraction of people with substance use disorders receive any treatment at all, shifting the delivery behavior of frontline physicians even slightly could translate into a substantial public health effect.

The most conceptually interesting finding concerns mediation. Higher perceived capability was itself strongly associated with lower stigma toward patients with alcohol, stimulant, and opioid use disorders, with coefficients of negative 0.55, negative 0.51, and negative 0.59 respectively, all highly significant. When the researchers accounted for perceived capability in their models, the direct effect of training on stigma disappeared. Yet the indirect effect of training, operating through perceived capability, remained significant for all three disorder types, with coefficients of negative 0.11 for alcohol, negative 0.09 for stimulants, and negative 0.11 for opioids. This pattern indicates full mediation: training reduces stigma not by directly changing attitudes, but by building physicians’ confidence in their own clinical competence.

That mechanism carries real weight for how medical education should be designed. If stigma were driven primarily by moral judgment or personal bias, remediation would require attitude-focused interventions, such as contact-based anti-stigma campaigns. But if, as this study suggests, stigmatizing attitudes toward patients with substance use disorders flow substantially from a sense of being unprepared, then the remedy is skills-based: teach physicians to screen, diagnose, prescribe, and counsel, and the negative regard tends to recede on its own. This reframing aligns with a broader shift in addiction medicine away from viewing provider stigma as an intractable cultural problem and toward viewing it as a trainable deficit, one that responds to the same pedagogical tools used for any other clinical competency.

The study’s limitations deserve honest attention. As an exploratory secondary analysis of cross-sectional data, it cannot establish causality or direction; it is possible that less stigmatizing physicians seek out more training rather than training reducing stigma, or that unmeasured factors, such as institutional culture or personal exposure to addiction, shape both training uptake and attitudes. Stigma and capability were self-reported, which introduces the possibility of social desirability bias, and the survey period overlapped with the COVID-19 pandemic, a time of unusual strain on both primary care and emergency departments. The authors also note that the long-term durability of training effects, and how specific training content maps onto specific outcomes, remains under-explored, making this an open field for longitudinal work.

Even with those caveats, the implications are concrete. The research was supported by the National Institute on Drug Abuse through the National Drug Abuse Treatment Clinical Trials Network, a infrastructure designed to move evidence-based addiction treatment into routine care, and the message for that mission is clear. Medical schools and residency programs that treat addiction medicine as a marginal elective may be inadvertently cultivating the very stigma they hope to eliminate, while continuing education requirements that build hands-on capability, including the prescribing of medications for opioid use disorder, offer a scalable lever for change. With overdose and alcohol-related mortality remaining leading causes of death in the United States, and with primary care and emergency departments serving as the front door to care for most patients, equipping physicians with genuine competence may be the most efficient anti-stigma intervention available. The study, published open access under a Creative Commons license, adds to a growing body of evidence that the antidote to stigma is not simply empathy training but mastery, and that every hour of addiction education a physician receives may ripple outward into better, more equitable care for one of medicine’s most underserved patient populations.

Subject of Research: Associations between physician addiction training, stigma toward patients with substance use disorders, and clinical treatment practices in U.S. primary care and emergency medicine

Article Title: Associations of addiction training with attitudes and clinical practices: a cross-sectional survey of primary care and emergency department physicians in the US

Article References: Schmidt, R. D., Gravlin, A., Duan, R., Gonzalez, S. T., DiCamillo, C. A., Gooden, L. K., Pollack, H. A., Parish, C. L., Metsch, L. R., Horigian, V. E., & Feaster, D. J. (2026). Associations of addiction training with attitudes and clinical practices: a cross-sectional survey of primary care and emergency department physicians in the US. Addiction Science & Clinical Practice. https://doi.org/10.1186/s13722-026-00722-x

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00722-x

Keywords: addiction training, substance use disorder, provider stigma, medical education, primary care, emergency medicine, opioid use disorder, alcohol use disorder, continuing medical education, perceived capability, cross-sectional survey, medication for opioid use disorder

Infantile epileptic spasms syndrome, historically known as West syndrome, is a developmental and epileptic encephalopathy that typically emerges in the first year of life. Its signature manifestation is the epileptic spasm: a sudden, brief contraction of the trunk and limb muscles that can resemble a startle reflex, colic, or reflux. Clusters of these spasms often occur on waking, and because they are so easily mistaken for benign infant behaviors, the condition is notorious for slipping past the first clinician who sees it. The electroencephalographic hallmark, hypsarrhythmia, is a chaotic, disorganized pattern of very high-voltage waves that reflects profound cerebral dysfunction. Treatment with adrenocorticotropic hormone, oral corticosteroids, or vigabatrin is time-sensitive, and international guidance emphasizes that prompt initiation of therapy substantially improves developmental outcomes.

The stakes are amplified in settings where pediatric neurologists are scarce. In Palestine, access to subspecialty neurology services is limited, which means frontline physicians, including general practitioners, family medicine specialists, and pediatricians working in district hospitals and clinics, effectively serve as the diagnostic gatekeepers. If they fail to recognize spasms, order an urgent electroencephalogram, and escalate the case, the window for effective treatment can close before the child ever reaches a specialist. This structural reality is precisely what motivated the research team, led by investigators at Al-Quds University and collaborating institutions including An-Najah National University and Palestine Polytechnic University, to measure how prepared the frontline actually is.

Between March and June 2026, the team administered a structured, self-administered questionnaire to pediatricians, general practitioners, family medicine specialists, and residents in pediatrics or family medicine practicing across the West Bank. The instrument was designed around the established knowledge, attitudes, and practices framework, a standard tool in health-services research for diagnosing gaps that can be targeted by training. Knowledge was assessed with twenty items scored from zero to twenty, attitudes with twelve Likert-scale items ranging from twelve to sixty, and clinical practices with ten scenario-based items scored from zero to twenty-eight. Knowledge was then categorized as poor at or below fifty percent, fair between fifty and seventy percent, and good above seventy percent, a threshold the authors treated as the adequacy benchmark for safe practice.

The headline numbers are sobering. Overall, 48.7 percent of participants demonstrated good knowledge, 53.0 percent held positive attitudes, and 52.5 percent exhibited good clinical practices. The mean knowledge score was 13.5 out of 20, equivalent to 67.4 percent, which fell statistically significantly below the 70 percent adequacy benchmark. In other words, the average physician in the sample sat just under the line that the investigators considered minimally acceptable, and nearly half of the cohort fell clearly below it. The authors report that the most pronounced deficits concerned the etiology and prognosis of the syndrome, domains that determine whether a clinician understands why urgent action matters and what the child’s future looks like without it.

The stratified analysis revealed a steep gradient across specialties. Pediatricians scored 15.8 on knowledge, compared with 11.6 for primary care physicians and 13.3 for residents, a difference that was highly significant. The same pattern held for attitudes, with mean scores of 44.5, 40.7, and 41.2 respectively, and for practices, where pediatricians averaged 20.4 against 15.9 for primary care physicians and 17.4 for residents. This hierarchy is clinically consequential because primary care physicians are often the first, and sometimes the only, medical professionals a worried parent consults when a baby begins exhibiting unusual movements. The group least equipped to recognize the syndrome is, in this system, positioned at the front door.

The statistical architecture of the study went beyond simple group comparisons. The team used independent samples t-tests and one-way analysis of variance to compare subgroups, Pearson correlations to probe relationships between the three domains, and multiple linear regression to identify independent predictors while controlling for confounders. The correlations were telling: knowledge tracked strongly with practices, with a correlation coefficient of 0.645, and moderately with attitudes at 0.380. This suggests that what doctors know about infantile spasms is tightly coupled to what they actually do when confronted with a suspected case, and that attitudinal readiness alone cannot compensate for missing factual knowledge. In the regression models, specialty group and male gender emerged as the strongest independent predictors of all three scores, indicating that the knowledge gap is not evenly distributed and that training interventions should be targeted rather than generic.

Perhaps the most actionable finding concerns perceived barriers. When asked what most impedes early diagnosis, 37.7 percent of respondents identified lack of provider awareness as the leading obstacle. That figure is striking because it comes from the physicians themselves: the frontline workforce recognizes that its own awareness is the bottleneck. Unlike resource constraints or referral bottlenecks, which require systemic investment, provider awareness is a problem that continuing medical education can, in principle, address directly. The authors conclude that targeted continuing medical education programs, particularly for primary care physicians and residents, have the potential to improve early recognition and management of the syndrome in Palestine.

The study’s design carries both strengths and limitations worth noting. The sample of 419 participants is large for a survey of this kind, and the scenario-based practice items move beyond self-report by asking clinicians to respond to realistic clinical vignettes. The instrument’s content validity was assessed using the scale-level content validity index, and the analysis included checks for multicollinearity using variance inflation factors. However, as a cross-sectional survey, it captures a snapshot rather than a trajectory, and self-administered questionnaires are inherently vulnerable to response bias. The authors also note that the findings apply to the West Bank and may not generalize to other health systems, although the pattern of specialty-dependent knowledge gaps echoes concerns raised in studies from other resource-limited settings.

For the global child-neurology community, the Palestinian data sharpen a broader message. Infantile epileptic spasms syndrome is among the most time-critical diagnoses in medicine, yet its presentation mimics ordinary infant behaviors, and its victims cannot describe their symptoms. Where pediatric neurologists are plentiful, the frontline still matters; where they are scarce, the frontline is everything. The Palestinian study suggests that a modest, well-aimed educational intervention, focused on the primary care physicians and residents who see these babies first, could shift outcomes for a condition in which the difference between prompt and delayed treatment is measured in a child’s lifelong cognitive trajectory. The research was approved by the Al-Quds University Research Ethics Committee and conducted in accordance with the Declaration of Helsinki, with informed consent from all participants, and it appears in the open-access literature so that clinicians and educators elsewhere can build on it.

Subject of Research: Physician knowledge, attitudes, and practices regarding infantile epileptic spasms syndrome in Palestine

Article Title: Infantile spasms in Palestine: knowledge, attitudes, and practices among pediatric and primary care physicians and residents

Article References: Alhaddar, M., Darawsheh, R., Shalalfa, N., Ewidat, S., Abu-Hanieh, D., Abdallah, N., Mohsen, M., Almahdi, A., Alhouseini, M., Nasser, A., Elbaou, B., Alwawi, A., & Zrineh, A. (2026). Infantile spasms in Palestine: knowledge, attitudes, and practices among pediatric and primary care physicians and residents. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07816-0

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07816-0

Keywords: infantile spasms, infantile epileptic spasms syndrome, West syndrome, pediatric epilepsy, primary care, Palestine, West Bank, knowledge attitudes practices, continuing medical education, neurodevelopmental disorders, EEG, diagnostic delay

Access Programs are state-level or regionally organized services that give obstetricians, family physicians, midwives, nurses, and other frontline perinatal clinicians rapid access to psychiatric expertise. Instead of referring a pregnant or postpartum patient to a psychiatrist who may be booked out for months, a clinician can call a dedicated line, speak with a perinatal psychiatrist, and receive guidance on screening, diagnosis, medication management, and referral. The model, described in earlier work in Health Affairs, is designed to build the capacity of the existing workforce rather than expand the psychiatrist workforce itself. Training is a central pillar of that capacity-building mission, and the new study set out to characterize exactly what that training looks like in practice.

The research team used a multi-method design that combined surveys of thirteen programs, semi-structured interviews with twenty-eight Access Program team members, and a review of policy and procedure documents that were either publicly available or supplied by the programs themselves. This triangulation of data sources allowed the investigators to capture both the formal, documented ambitions of each program and the lived, operational realities described by the people who deliver the training. The study received Institutional Review Board approval at Rutgers University and was funded by the Patient-Centered Outcomes Research Institute, the Perigee Fund, and the Centers for Disease Control and Prevention, with a forty-two-member community advisory board advising the work.

One of the most revealing findings concerns the sheer variety of training goals. Programs articulated between one and four distinct objectives, with a mean of 2.2 goals per program. Three broad themes dominated. The first was increasing awareness and utilization of the Access Program itself, essentially using education as an outreach mechanism so that clinicians know the consultation line exists and feel confident picking up the phone. The second was increasing perinatal mental health knowledge and clinical skills, from recognizing postpartum depression and anxiety to managing psychiatric medications during pregnancy and lactation. The third, and arguably the most ambitious, was affecting clinic-level or systems-level change, embedding screening protocols, referral pathways, and collaborative care structures into the routine workflow of obstetric and primary care practices.

The educational methods deployed to pursue these goals were equally heterogeneous. Trainings were delivered both virtually and in person, a flexibility that proved essential during and after the COVID-19 pandemic, which accelerated the adoption of remote continuing professional development across medicine. Programs used toolkits, didactic sessions, and innovative approaches tailored to the specific setting and learner population of each program. Some emphasized Project ECHO-style videoconferencing sessions, a model in which community clinicians present real cases to a hub of specialists and receive mentorship, an approach previously documented in psychiatric workforce development literature. Others relied on one-on-one outreach, grand rounds presentations, or integration with existing quality improvement initiatives. The customization reflects a core principle of adult learning theory: education is most effective when it is anchored in the actual clinical problems and practice environments of the learners.

The learners themselves spanned the full spectrum of the perinatal care workforce. Obstetric clinicians, including obstetricians, midwives, and nurses, were the most obvious audience, given that they see pregnant and postpartum patients repeatedly and are often the first point of contact for emerging psychiatric symptoms. Primary care clinicians, who increasingly manage postpartum follow-up, were another key group. Mental health clinicians, who may lack specific training in the pharmacological and diagnostic complexities of treating psychiatric illness during pregnancy and lactation, also participated. This breadth matters because perinatal mental health problems do not respect disciplinary boundaries; a patient may disclose suicidal thoughts to her pediatrician at a newborn visit or describe panic attacks to her family physician months after delivery.

A particularly important analytical contribution of the study is its attention to alignment between goals and methods. The investigators found that in several cases, the educational methods programs chose were well matched to their stated training goals. A program aiming primarily to boost utilization of its consultation line, for example, might prioritize brief awareness-raising presentations at professional society meetings, while a program pursuing systems change might invest in longitudinal curricula and practice facilitation. The authors frame this analysis using established continuing medical education frameworks, including the widely cited outcome levels articulated by Moore and colleagues, which range from learner participation and satisfaction through knowledge and competence to performance in practice and, ultimately, patient and population health outcomes. Mapping Access Program training onto this hierarchy provides a conceptual scaffold for future evaluation.

Perhaps the most conceptually rich finding is the description of mutually reinforcing interactions between training and other Access Program components. Training does not operate in isolation. A clinician who attends a workshop on perinatal depression is more likely to call the consultation line when a difficult case arises, and each consultation call itself functions as a micro-educational encounter that builds skills and confidence. Technical assistance provided to clinics on implementing screening protocols similarly reinforces lessons from formal trainings. The study therefore conceptualizes formal training as one strand of a multicomponent intervention, with expected effects cascading from clinician awareness, knowledge, and skills through to clinic and systems change, and ultimately to improved outcomes for pregnant and postpartum people.

The stakes of this work are considerable. Meta-analytic evidence indicates that antenatal depression is associated with adverse birth outcomes in US populations, and maternal depression in pregnancy has been linked to impaired early child development. Pregnancy-related deaths data from Maternal Mortality Review Committees show that mental health conditions are a leading contributor, and the perinatal depression treatment cascade literature documents how many affected individuals never receive adequate care. Professional organizations, including the American College of Obstetricians and Gynecologists, have issued clinical practice guidelines calling for universal screening and appropriate treatment of mental health conditions during pregnancy and the postpartum period, yet workforce shortages mean that most frontline clinicians receive little formal psychiatric education. Surveys of obstetrics and gynecology residency programs have documented limited psychiatric training, leaving many clinicians unprepared to manage the conditions they are expected to screen for.

The study’s authors argue that the varying training goals and approaches they documented can inform how Access Programs and other psychiatric consultation programs develop or modify their professional training offerings. The work also provides a practical framework for summarizing training activities, aligning them with program goals, and evaluating them as part of a coherent intervention rather than as isolated educational events. For a field in which perinatal mental health conditions often go unrecognized, undiagnosed, and untreated, the message is clear: building clinician capacity through thoughtfully designed, goal-aligned training, embedded within a system of consultation and support, may be one of the most scalable strategies available for transforming perinatal mental health care in the United States. As more states launch or expand Access Programs, the lessons from these fourteen programs offer a roadmap for turning psychiatric expertise into widespread clinical competence.

Subject of Research: Professional training activities of US Perinatal Psychiatry Access Programs

Article Title: Professional Training by Perinatal Psychiatry Access Programs: Multi-Method Approach to Characterize the State of the US Access Programs

Article References: Cowley, D. S., Veerakumar, E., Schaefer, A. J., Bhat, A., Sheldrick, R. C., Davis, W., Byatt, N., & Mackie, T. I. (2026). Professional Training by Perinatal Psychiatry Access Programs: Multi-Method Approach to Characterize the State of the US Access Programs. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02445-2

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02445-2

Keywords: perinatal mental health, psychiatry access programs, clinician training, professional development, workforce development, perinatal depression, consultation programs, continuing medical education, obstetric care, systems change, maternal health, psychiatric consultation

The study, published in Global Surgical Education, the Journal of the Association for Surgical Education, was led by Joey Liang and colleagues at Duke University School of Medicine, together with senior author Ash Patel of Duke’s Division of Plastic, Maxillofacial, and Oral Surgery. The team set out to answer a deceptively simple question: do the learning objectives attached to continuing medical education sessions at a national plastic surgery meeting actually meet the guidelines promoted by the Accreditation Council for Continuing Medical Education, the body that accredits CME in the United States? To find out, they systematically audited the objectives from two consecutive years of the conference.

Learning objectives are the short, verb-driven statements that appear at the start of a lecture or session, promising what attendees will be able to do afterward. Educational researchers consider them far more than administrative boilerplate. Well-crafted objectives contextualize an educational activity, set clear expectations for the learning task, and focus both educator and learner on the intended outcome. Poorly written objectives, by contrast, leave learners guessing about what they are supposed to gain, and they make it nearly impossible to assess whether the session worked. In the CME context, where the ultimate goal is to change clinical behavior and improve patient outcomes, vague objectives may be one reason that traditional conference-style education has struggled to demonstrate lasting impact on physician practice.

The Duke team analyzed learning objectives from CME programming sessions at Plastic Surgery The Meeting in both 2023 and 2024. Sessions with missing or incomplete objectives were excluded from the analysis. The final dataset included 193 CME sessions, yielding a total of 510 individual learning objectives. Each objective was scored against two of the most widely used frameworks in health professions education: the SMART framework, which asks whether a goal is Specific, Measurable, Attainable, Relevant, and Time-Bound, and Bloom’s Taxonomy, the classic six-level hierarchy of cognitive learning that runs from remembering and understanding up through applying, analyzing, evaluating, and creating.

The results revealed a striking split. On the positive side, the objectives were generally Attainable, Relevant, and Time-Bound, meaning that session organizers were setting realistic goals tied to the content being taught within a defined timeframe. But the picture darkened considerably on the two criteria that matter most for accountability. Only 54.5 percent of objectives were judged Specific, meaning nearly half described learning goals too loosely to guide either teaching or assessment. Worse still, just 20.4 percent of objectives were Measurable, meaning that for roughly four out of every five objectives, there was no way to tell whether the promised learning had actually occurred. An objective that cannot be measured, education researchers argue, is functionally an aspiration rather than a plan.

Bloom’s Taxonomy told a similar story of low cognitive ambition. The mean Bloom’s level across all 510 objectives was just 2.02 out of a possible 6. The objectives clustered heavily at the bottom two rungs of the hierarchy: 37.3 percent targeted the Remember level, the simple recall of facts, and 40.0 percent targeted the Understand level, a step up but still far from the higher-order thinking that practicing surgeons might need to integrate new evidence into complex operative decisions. Only a small minority of objectives asked learners to apply, analyze, evaluate, or create. For an audience of experienced clinicians facing sophisticated reconstructive and aesthetic challenges, the researchers suggest, such low-level objectives may undersell both the learners and the material.

One of the study’s most technically interesting findings concerned discordant verbs. In Bloom’s framework, each cognitive level is associated with characteristic action verbs: an objective at the Remember level might use verbs like list or identify, while an Apply-level objective might use demonstrate or implement. When a writer pairs a verb from one level with a learning goal that actually belongs to another, the objective becomes internally contradictory. The researchers found that 92 objectives, or 18.0 percent of the total, used such discordant verbs. The most common mismatch, accounting for 32 of those 92 cases, was the use of verbs from the Understand category for learning goals that actually sat at the Remember level. In other words, sessions frequently promised understanding while only demanding recall, a subtle but consequential mismatch for anyone trying to gauge what a lecture will deliver.

The quality of objectives was not uniform across the conference. When the researchers compared program tracks, the different thematic streams of the meeting, they found statistically significant differences in the distribution of Bloom’s Taxonomy levels, with p values below 0.001, as well as in the proportion of Specific objectives and Measurable objectives, with p values of 0.001 or lower and 0.004 respectively. This variation suggests that the problem is not a single institutional failing but a diffuse one: some tracks consistently produce better objectives than others, and there is no shared standard being applied across the meeting’s programming. The authors argue that to enable effective implementation into clinical practice, CME activities in plastic surgery should include well-written objectives that align with the complexity and purpose of each activity, with verbs matched to their intended learning levels and outcomes that are specific and measurable.

The findings land within a broader and often sobering literature on CME effectiveness. Decades of research, including influential syntheses published in JAMA and the CHEST evidence-based guidelines, have found that passive, lecture-heavy formats like traditional conferences tend to produce modest changes in physician knowledge and even smaller changes in actual practice behavior. Educational theorists from Malcolm Knowles onward have argued that adult learners, particularly experienced professionals, learn best when objectives are explicit, self-directed, and oriented toward problems they will face in practice. Meanwhile, studies of accredited continuing professional development activities in other fields have found that the majority do not even target clinical behavior change. Poorly written objectives both reflect and reinforce that gap: if a session never commits to a measurable outcome, no one can be blamed when none occurs.

What makes this study notable is its scale and its specificity. Rather than surveying attitudes, the Duke team audited the actual written objectives from 193 sessions across two years of a major national meeting, applying standardized frameworks that are taught in every medical education curriculum. The practical implications are straightforward. Meeting organizers could require objectives to pass a SMART and Bloom’s screen before sessions are accredited; presenters could receive brief training in verb selection and objective writing; and accreditors could make measurability a hard criterion rather than a soft expectation. For the surgeons who sacrifice operating time and pay registration fees to attend, the message is equally clear: the value of a conference hour depends heavily on whether the session promised something concrete in the first place. As CME systems worldwide face pressure to demonstrate real-world impact, this audit of plastic surgery’s largest meeting offers a candid, quantifiable starting point for reform.

Subject of Research: Quality of learning objectives in continuing medical education programming at a national plastic surgery meeting

Article Title: Analysis of learning objective quality in national plastic surgery meeting continuing medical education programming sessions

Article References: Liang, J., Pillai, T., Yapuncich, G., Mohamed, L., Hibshman, N., & Patel, A. (2026). Analysis of learning objective quality in national plastic surgery meeting continuing medical education programming sessions. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 136. https://doi.org/10.1007/s44186-026-00540-4

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00540-4

Keywords: continuing medical education, plastic surgery, learning objectives, Bloom's Taxonomy, SMART framework, medical education, ACCME, surgical education, professional development, Duke University, conference programming, clinical practice change

Professor Renate Schnabel of Hamburg will serve as congress president for the main Herztage program, which is published under the banner Kardiologie Aktuell. Schnabel is a well-known figure in cardiovascular epidemiology and heart-failure research, and her appointment signals a program expected to bridge population-level cardiovascular science with clinical practice. The rhythm-focused Deutsche Rhythmus Tage will be led by Priv.-Doz. Anja Schade of Bad Neustadt, while Professor Tanja Katharina Rudolph of Bad Oeynhausen will preside over AGIK Live, the interventional component of the meeting.

Basic science receives dedicated organizational attention at the congress. Professor Harald Langer of Mannheim and Professor Rabea Hinkel of Göttingen will organize the Basic Science Meeting, a strand designed to connect laboratory-level cardiovascular research with translational and clinical audiences. In addition, the Akademieforen, a series of academy forums aimed at continuing medical education, will be coordinated by Professor Christiane Tiefenbacher of Wesel and Professor Albrecht Elsässer of Oldenburg. This layered structure reflects the congress’s dual role as a scientific meeting and a professional training platform for German-speaking cardiology.

The scientific program is supported by a searchable online abstract database, accessible through the congress website at herzmedizin.de. According to the announcement, the database allows physicians and allied professionals to search documents by keyword, giving attendees a tool to navigate the full scientific program before arriving in Hamburg. Abstract-driven sessions remain a core mechanism through which new clinical trial results, registry analyses, and mechanistic studies enter the public record at European cardiology meetings.

The venue itself carries weight in the European cardiology calendar. The Congress Center Hamburg is a regular host for large medical congresses, and a late-September slot positions the Herztage after the summer lull in the conference season and ahead of the autumn wave of major international meetings. For German cardiovascular medicine, the Herztage function as the principal national forum where late-breaking science, guideline updates, and health-policy debates converge under one roof.

The announcement appeared in Clinical Research in Cardiology, the official journal of the German Cardiac Society, published by Springer Nature. The journal serves as a standing venue for society communications, original research, and reviews in cardiovascular medicine, and its publication of the congress notice gives the meeting details a citable, version-of-record home. The published record notes that Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations, a standard publisher’s note for internationally distributed academic content.

For clinicians planning continuing education, the division of the congress into distinct strands matters practically. The main Herztage program under Schnabel typically spans the breadth of cardiovascular medicine, while the Deutsche Rhythmus Tage under Schade concentrates on arrhythmia management, including device therapy and electrophysiology. AGIK Live, under Rudolph, is associated with the Arbeitsgemeinschaft Interventionelle Kardiologie, the interventional cardiology working group of the German Cardiac Society, and traditionally features live case transmissions from catheterization laboratories, a format that lets attendees observe real-time procedural decision-making.

The basic science meeting organized by Langer and Hinkel underscores a broader trend in European cardiology congresses: the deliberate integration of molecular and preclinical research into clinically oriented programs. Hinkel’s work in cardiovascular gene therapy and regenerative approaches, and Langer’s background in thrombosis and platelet biology, illustrate the translational orientation that the organizers bring to this strand. By pairing basic scientists with clinical leadership across the congress, the German Cardiac Society positions the Herztage as a venue where bench-to-bedside conversations are structurally embedded rather than incidental.

The Akademieforen, coordinated by Tiefenbacher and Elsässer, extend the congress’s educational reach. These forums are designed as interactive academy sessions rather than passive lecture formats, and they typically address case-based learning, guideline application, and emerging diagnostic and therapeutic techniques. Their inclusion alongside the scientific and interventional strands reflects the society’s effort to serve trainees, established clinicians, and allied professionals within a single meeting architecture.

Registration and program details are distributed through the German Cardiac Society’s congress platform, and the abstract database linked in the announcement is expected to grow as submission cycles close. With the congress presidents named and the Hamburg dates fixed, the organizational skeleton of DGK Herztage 2026 is now public, giving researchers, clinicians, and industry participants the framework they need to plan submissions, sessions, and attendance for what remains the flagship annual meeting of German cardiovascular medicine.

Subject of Research: The DGK Herztage 2026 cardiology congress announcement

Article Title: DGK Herztage 2026

Article References: DGK Herztage 2026. (2026). Clinical Research in Cardiology. https://doi.org/10.1007/s00392-026-03036-9

Image Credits: AI Generated

DOI: 10.1007/s00392-026-03036-9

Keywords: cardiology, DGK Herztage 2026, German Cardiac Society, Hamburg, clinical research, arrhythmia, interventional cardiology, basic science, medical congress, Clinical Research in Cardiology, continuing medical education, cardiovascular medicine

The work, led by dermatologists and collaborators at Penn State, including Matthew Helm, Jordan Willis, Thomas N. Helm, Kelly Gerard, and Galen Foulke, tested whether the Extension for Community Healthcare Outcomes, or ECHO, model could be adapted to dermatologic biologic education. Project ECHO, originally developed at the University of New Mexico to train rural clinicians in hepatitis C management, operates on a simple but powerful premise: rather than routing patients to distant specialists, it routes specialist knowledge to the clinicians patients already see. Academic experts deliver short didactic presentations over videoconference, then participants discuss real cases together, building competence through repeated, case-based learning rather than one-off lectures.

The rationale for applying this model to biologics is grounded in a well-documented distribution problem. Research published in JAMA Dermatology found substantial disparities in dermatologist density between urban and rural counties in the United States, and more recent calls to action in the dermatology literature have emphasized that rural patients face long travel distances and long waits for specialty appointments. For conditions like chronic plaque psoriasis, where network meta-analyses of systemic treatments show that biologic agents often outperform older systemic therapies, the consequence is a two-tiered system: patients near academic centers access cutting-edge therapy while those in rural areas may go undertreated. Studies of health care resource use for psoriasis have shown that where a patient lives materially changes the care they receive.

Compounding the geography problem is the nature of the medications themselves. Biologics are large, complex proteins typically administered by injection, and their use demands knowledge of drug classes and targets, screening requirements, monitoring protocols, side effect recognition, and the labyrinthine prior authorization processes insurers impose. Surveys of physicians have found that hesitation to prescribe biologics often stems less from skepticism about efficacy than from unfamiliarity with logistics, safety management, and the paperwork of patient assistance programs. That unfamiliarity is precisely what a structured telementoring curriculum can address, and it is what the Penn State team set out to test.

The pilot was deliberately small and pragmatic. Before recruitment, the team used a survey to assess whether the program was feasible to run in their setting. They then recruited eight primary care providers through flyers and email for an eight-session series accredited for continuing medical education credit. Each session followed the classic ECHO structure: a 20-minute talk from an expert on topics such as the major biologic classes, their approved dermatologic indications, monitoring and adverse effects, and strategies for navigating prior authorization, followed by case-based discussions in which participants brought their own clinical dilemmas to the group. A pharmacist collaborator contributed expertise on prescription assistance programs, a crucial and often overlooked barrier to getting these drugs into patients’ hands.

To measure whether the curriculum moved the needle, the researchers administered surveys after each session, asking participants to self-report changes in their knowledge of biologics, their ability to care for patients who might be candidates for these drugs, their plans to change their practice, and their sense of professional isolation around biologic prescribing. Professional isolation is a recurring theme in rural medicine: clinicians who rarely interact with specialists can lose confidence in managing complex therapy, and that lost confidence translates directly into patients who are never offered the treatment. Implementation science frameworks, including validated measures of implementation outcomes referenced by the authors, informed the survey design.

The results, while preliminary, were encouraging across all measured domains. After the sessions, participants reported increased knowledge of dermatologic biologics, improved confidence in their ability to care for relevant patients, concrete plans to change their practice, and a decreased sense of professional isolation. In other words, the program did not just transfer information; it appears to have shifted self-efficacy, the belief that one can competently manage a therapy, which behavioral research consistently identifies as a key determinant of whether new practices are adopted. For a short pilot with eight participants, that pattern of self-reported movement in the intended direction is a meaningful proof of concept.

The study’s authors are careful about scope. This was a short report on a pilot program, not a trial with objective endpoints; self-reported knowledge gains are not the same as demonstrated prescribing competence, and eight providers cannot represent the full landscape of rural primary care. The participants did not consent to public sharing of their data, so detailed results are not available. Still, the findings align with a growing evidence base. A dermatology-focused ECHO program reported in Rural and Remote Health in 2018 already demonstrated the model’s promise for extending dermatologic expertise, and the landmark New England Journal of Medicine study that launched ECHO showed primary care providers could achieve hepatitis C cure rates comparable to specialists when properly mentored. The dermatologic biologic application extends that logic to one of the most consequential therapeutic shifts in modern skin medicine.

Equity considerations give the work added urgency. Studies of safety-net clinics and uninsured psoriasis populations have documented persistent barriers to biologic access even when patients do reach specialty care, suggesting that the problem spans both referral pathways and prescribing behavior. If telementoring can equip primary care providers, who see patients where they live, to identify biologic candidates, initiate workups, navigate payer requirements, and connect patients to assistance programs, it addresses the access bottleneck at multiple points simultaneously. The ECHO model’s low cost and reliance on existing videoconference infrastructure make it especially attractive for health systems with limited resources.

The Penn State pilot, supported in part by grants from the National Center for Advancing Translational Sciences and reviewed as exempt by the university’s institutional review board, offers a template rather than a finished solution. Larger cohorts, objective measures of prescribing quality and patient outcomes, and longer follow-up will be needed before telementoring can be declared a validated route to biologic access in underserved communities. But the conceptual advance is clear and, in an era when virtual education has become routine, timely. The medications that can clear a patient’s skin and transform their psychological wellbeing already exist; the challenge is moving expertise, not patients, across the distance between academic medical centers and the rural exam rooms where care actually happens. A modest series of 20-minute talks and shared cases may prove to be a surprisingly effective bridge.

Subject of Research: Telementoring of primary care providers in dermatologic biologic therapy to expand access in underserved rural communities

Article Title: Expanding access to biologics: a pilot ECHO program for primary care providers

Article References: Helm, M., Willis, J., Helm, T. N., Gerard, K., & Foulke, G. (2026). Expanding access to biologics: a pilot ECHO program for primary care providers. Archives of Dermatological Research, 318(1), Article 472. https://doi.org/10.1007/s00403-026-04976-y

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04976-y

Keywords: Project ECHO, biologics, telementoring, rural dermatology, primary care, psoriasis, atopic dermatitis, access to care, continuing medical education, health equity, Expanding, access

The conference’s opening session on Saturday, October 3, will pair AAP President Andrew Racine, MD, PhD, FAAP, with a keynote speaker whose reach dwarfs that of most medical journals. Mikhail Varshavski, D.O., known to his audience of more than 30 million people as “Doctor Mike,” has built one of the largest physician-led platforms on social media, using short-form video and long-form commentary to counter medical misinformation. His presence at the podium signals a deliberate strategic choice by the Academy: rather than treating viral health content as a rival to clinical authority, the organization is bringing its most successful practitioners of that medium inside the tent.

That theme continues in a panel discussion featuring pediatricians who have cultivated substantial followings across different platforms, including Tommy Martin, MD, FAAP; Ari Brown, MD, FAAP; and Leah Rappaport, MD, FAAP. Paul Tran, MD, FAAP will moderate an audience-driven discussion and question-and-answer session, with the panelists available to take questions from both attendees and the media. According to the Academy, the panel is designed to provide practical guidance for physicians who want to communicate more effectively with families, covering how health messaging must be adapted to the distinct formats, algorithms and audience expectations of different social media platforms.

The underlying problem these sessions address is well documented in the communication research literature. Health misinformation spreads faster and farther on social networks than corrective content, in part because false or emotionally charged claims generate more engagement than nuanced clinical guidance. Parents searching for answers about vaccines, nutrition, screen time, sleep safety or developmental concerns frequently encounter content produced by non-experts before they encounter advice from credentialed clinicians. Pediatricians who build authentic followings occupy a rare position in that ecosystem: they combine formal medical training with the fluency in platform conventions that determines whether content is seen at all.

Elizabeth Murray, DO, FAAP, who chairs the AAP national conference steering committee, framed the meeting’s communication focus as an extension of pediatricians’ core professional duties rather than a departure from them. “Today, more than ever, it’s important to provide clear, accurate health information in our roles as pediatricians, family partners and patient advocates,” Murray said in the Academy’s announcement. “We look forward to learning and sharing our best guidance for caring for families and for each other.” The remark captures the dual mandate that has come to define contemporary pediatric practice: delivering evidence-based care in the clinic while also meeting families in the digital spaces where their health questions actually arise.

Beyond its communication programming, the conference functions as the Academy’s principal annual vehicle for disseminating new pediatric research and continuing education. The scientific program spans a wide range of pediatric topics, with sessions presented both in person and through a virtual poster hall, alongside a comprehensive library of on-demand sessions that extends access to attendees who cannot travel or who wish to revisit material after the live meeting. Abstracts scheduled for presentation at the conference will be published on the conference website at 6 a.m. PDT on Friday, October 2, giving journalists and researchers a structured preview of the findings to be discussed. Embargoed news releases will be available through EurekAlert! and on request, following the embargo conventions that govern major biomedical meetings.

The meeting’s format reflects broader trends in how large medical societies structure their flagship events. Hybrid delivery, combining in-person attendance with livestreamed and on-demand content, has become standard practice since the pandemic reshaped expectations for professional conferences. For an organization representing 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists, the hybrid model serves a practical purpose: pediatricians practice in settings ranging from academic medical centers to small community clinics, and continuing education must reach all of them. The on-demand library in particular allows time-pressed clinicians to engage with research presentations on their own schedules, an accessibility consideration that increasingly determines the reach of scientific meetings.

The San Diego program also extends beyond the convention hall into community engagement, a longstanding feature of AAP national meetings. On Friday, October 3, beginning at 9:30 a.m., pediatricians will join “I Love a Clean San Diego,” an environmental organization that has worked to keep the city clean since 1954, for a beach clean-up at Fiesta Island. Shuttles will transport volunteers to the island for the outdoor event, which will include a game of Trash Bingo, and the collected trash will be weighed at the end to quantify the group’s impact. The activity pairs the conference’s scientific agenda with a visible demonstration of the environmental health concerns, from pollution to climate exposure, that pediatricians increasingly address as part of child well-being.

Physical activity gets its own showcase on Monday, October 5, when the annual AAP Friends of Children Fund 5K Fun Run & Walk takes participants along the historic boardwalk bordering San Diego Bay. The run begins at Marina Terrace at the Marriott Marquis San Diego Marina, with a warm-up at 6:45 a.m. PDT and the event running from 7 to 9 a.m. Such events serve a dual function at medical conferences: they raise money for the Academy’s Friends of Children Fund, which supports child health initiatives, and they model the kind of healthy behavior that pediatricians counsel families to adopt. For an organization dedicated to the health, safety and well-being of infants, children, adolescents and young adults, the symbolism of thousands of physicians running together along the waterfront is not incidental.

For journalists, the Academy has established clear access procedures for the meeting. Reporters planning to attend in person or virtually must review the AAP Media Guidelines and seek credentials in advance of the conference, with press credentials also required for the Fiesta Island clean-up. Media inquiries can be directed to Lisa Robinson at lrobinson@aap.org or Alex Hulvalchick at ahulvalchick@aap.org. Conference information, including the full program, is available on the AAP Experience website. As the meeting opens, the Academy’s bet is that the credibility of pediatric medicine, accumulated over decades of clinical practice and research, can be extended into the attention economy, one carefully crafted post, panel and keynote at a time.

Subject of Research: Pediatric medical communication and social media engagement at the American Academy of Pediatrics annual conference

Article Title: American Academy of Pediatrics hosts national conference in San Diego, welcomes pediatrician influencers

Article References: American Academy of Pediatrics hosts national conference in San Diego, welcomes pediatrician influencers. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: American Academy of Pediatrics, pediatrics, medical conference, Doctor Mike, health misinformation, social media, physician influencers, San Diego, medical education, child health, science communication, continuing medical education

The research, conducted by the Education and Training Working Group of the European Reference Network for rare bone diseases, known as ERN BOND, together with colleagues from the European Reference Network on rare endocrine conditions, Endo-ERN, set out to map the entire education and training landscape for rare bone and mineral disorders, or RBMDs, across Europe. ERN BOND is one of 24 European Reference Networks approved by the European Commission in 2017, created to achieve cross-border excellence in care by connecting accredited expertise centers. The network initially brought together 38 fully accredited centers from 10 member states, including the United Kingdom until its withdrawal from the EU in January 2020, and now reaches 49 health care providers in 19 member states. Endo-ERN, with its own thematic group dedicated to rare calcium and phosphate disorders that directly affect bone mineralization, represents the complementary endocrine expertise needed to care for these patients.

To capture the true scope of existing educational activity, the team designed a comprehensive 56-question online survey combining open-ended, multiple-choice, and closed-ended questions. The instrument was organized into four sections covering the background and educational activities of respondents, the scope of undergraduate and postgraduate teaching in RBMDs, the assessment of educational competence, and future plans for education in the field. Dissemination took place over two months, from September to November 2019, through the SurveyMonkey platform, with an external specialized agency, Weber Shandwick, handling data collection and preliminary analysis in close consultation with the working group. To avoid duplication, only one response per health care provider was accepted, and data from the two networks were analyzed separately.

The response was striking. Of the 38 ERN BOND health care providers invited, 31 participated, an 82 percent response rate, while 38 of the 78 Endo-ERN providers took part, a 49 percent rate. Collectively, 69 individual, non-duplicate respondents from 20 of the 28 European member states participating at the time provided a detailed account of how they learn, teach, and maintain competence in this rarefied field. The respondents were overwhelmingly experienced: most ERN BOND participants were over 50 years of age, and 84 percent had more than 20 years of clinical practice, compared with 55 percent of Endo-ERN respondents. More than two-thirds of ERN BOND respondents and 89 percent of Endo-ERN respondents worked in academic hospital settings or mixed academic and non-academic institutions, and none worked in private practice. ERN BOND respondents were primarily pediatric endocrinologists, followed by clinical geneticists and adult endocrinologists, with orthopedic surgeons, rheumatologists, and radiologists also represented.

When it came to seeking information about rare bone and mineral disorders, both networks relied heavily on PubMed Central, used by 90 percent of ERN BOND and 100 percent of Endo-ERN respondents. The second most popular tool was remarkably low-tech: emailing or phoning a colleague with specific disease expertise, a practice reported by 81 percent of ERN BOND and 58 percent of Endo-ERN respondents. This finding highlights the enduring importance of short lines of communication within the rare bone community, regardless of national borders. Disease classification tools such as OMIM and Orphanet were also widely used, particularly by ERN BOND respondents, and every ERN BOND respondent reported membership in at least one national, European, or international scientific society, including bone-focused organizations such as the European Calcified Tissue Society, the American Society for Bone and Mineral Research, and the International Osteoporosis Foundation.

The survey also quantified how these experts learn on a weekly basis. Among ERN BOND respondents, 84 percent reported spending more than two hours per week on learning and 74 percent on teaching about RBMDs, with similar figures among Endo-ERN participants. Educational activities most commonly involved online literature searches, attendance of Meet the Expert sessions, and RBMD-related courses. Yet the survey exposed notable disparities between the networks: 79 percent of Endo-ERN respondents had never attended a webinar in the previous three years, compared with 35 percent of ERN BOND respondents; 55 percent had never completed continuing medical education in the field, compared with 23 percent; and half had never taken a course on RBMDs, compared with 13 percent.

Undergraduate teaching offered a somewhat brighter picture. Two-thirds of respondents from both networks reported that RBMDs were included in the medical school curriculum, with teaching spread across the six-year program, though most hours were concentrated toward the end. Formal, teacher-driven lectures dominated, used by two-thirds of institutions, while interactive seminars, small-group tutorials, and case-based teaching played smaller roles. Online tools such as e-learning modules, video lectures, and webinars were used by only 32 percent of institutions. At the postgraduate level, education in RBMDs was concentrated in endocrinology, pediatrics, and genetics, with formal lectures and learning on the job cited as the most frequent tools by both networks. When asked what measures would best address training needs, 55 percent of ERN BOND and 77 percent of Endo-ERN respondents pointed to training workshops and seminars, while remarkably few endorsed webinars or e-learning as sufficient on their own.

Perhaps the most sobering findings concerned clinical guidelines and competence assessment. Seventeen percent of ERN BOND respondents reported having no available guidelines at all for RBMDs, and among Endo-ERN respondents that figure rose to 48 percent. Online access to guidelines through center websites was poor for both networks, with less than a quarter of respondents indicating such availability. Competence assessment was compulsory for 55 percent of ERN BOND and 43 percent of Endo-ERN respondents, but its components varied widely, from numbers of patients seen to continuing education credits to specialized procedures such as bone biopsy. When asked to identify the major gaps in knowledge and competence, both networks converged on the same answer: specialist training and specialist education, followed by gaps in the education of other health care professionals involved in the management of these patients.

The appetite for change was nearly universal. All but a handful of respondents from both networks supported the creation of a common educational platform to develop a cross-border educational program in rare bone and mineral disorders. Respondents identified the European Commission, through ERN BOND or special calls for educational initiatives, as the most appropriate funding source, and estimated the potential candidate pool for a specialized program at up to 20 individuals per country across all relevant specialties and stakeholders. The survey data have already informed concrete action: since May 2021, ERN BOND has delivered 36 freely accessible webinars with over 650 live participants, including a series co-organized with the European Calcified Tissue Society and others delivered with the ERICA project and the European Joint Programme on Rare Diseases. The network has also intensified use of its Clinical Patient Management System, a secure web-based platform that allows clinicians to collaborate across borders on rare and complex cases through virtual consultations, effectively bringing experts to the patient rather than patients to the experts.

The authors conclude that the findings underscore an unfulfilled need for accredited Clinical Practice Guidelines for RBMDs, for structured competence assessment in the field, and above all for an education and training program with a uniform structure for developing teaching material, common formats and platforms, and secure funding. The willingness of experts from both networks to support shared educational projects, they argue, is a promising foundation for the next phase: a comprehensive, harmonized, and accessible cross-border program that includes training exchange fellowships and focused workshops, ensuring that expertise in these rare disorders is not lost with a retiring generation but passed on, systematically, to the clinicians who will care for these patients next.

Subject of Research: Education and training gaps for rare bone and mineral disorders among European Reference Network providers

Article Title: Baseline survey on the scope of education and training for rare bone and mineral diseases

Article References: Hamdy, N. A. T., Iotova, V., Casareto, L., Gallerani, E., Pereira, A., Sangiorgi, L., & for the ERN BOND Education & Training Working Group (2026). Baseline survey on the scope of education and training for rare bone and mineral diseases. Archives of Osteoporosis, 21(1), Article 140. https://doi.org/10.1007/s11657-026-01773-y

Image Credits: AI Generated

DOI: 10.1007/s11657-026-01773-y

Keywords: rare bone and mineral disorders, ERN BOND, Endo-ERN, European Reference Networks, medical education, health care professionals, clinical guidelines, competence assessment, cross-border health care, rare diseases, training workshops, continuing medical education