The term burnout entered the vocabulary from the world of industry and occupational psychology, popularized in the 1970s to describe workers whose emotional reserves had been depleted by demanding jobs. Its conceptual logic, the authors note, places the burden of recovery on the individual: if you are burnt out, you must cultivate resilience, practice mindfulness, take better care of yourself, and restore your own depleted reserves. Hospital wellness programs, resilience training modules, and app-based meditation subscriptions are the institutional descendants of this framing. Critics have long observed that such interventions treat a structural problem as a personal deficiency, effectively asking clinicians to adapt to conditions that may themselves be the pathology.

Moral injury, by contrast, was borrowed from the world of war. Originally developed to describe the psychological wound suffered by soldiers who were forced to participate in, or witness, events that transgressed their deepest moral commitments, the term migrated into medicine during the COVID-19 pandemic. Clinicians described being forced by staffing shortages, productivity targets, and insurance constraints to deliver care they believed was inadequate or even harmful. The moral injury framing, the authors acknowledge, has one clear advantage over burnout: it points the finger at systems rather than individuals, and it has energized calls for organizational reform, better staffing ratios, and reduced administrative burden. Yet even moral injury, they argue, tells only part of the story.

What both terms miss, according to the review, is love. Clinicians do not grieve their working conditions the way an assembly-line worker might; they grieve because they entered medicine out of a commitment to healing, to being present with suffering people, and to a vocation that once felt meaningful. The pain they experience when that vocation is frustrated is closer to the ache of a strained friendship or a lost love than to the exhaustion of an overworked laborer or the wound of a soldier. Heartache, the authors propose, comes from the world of love, and it names a sense of loss, lament, and enduring devotion to a beloved profession that burnout and moral injury cannot articulate. A heartbroken person does not simply need rest or a reformed workplace; they need communities that can hold grief, sustain hope, and imagine creative renewal.

The philosophical architecture of the argument draws on an unexpected source: the later work of Ludwig Wittgenstein. Rather than offering a strict definition of heartache, the authors employ Wittgenstein’s concept of family resemblance, the idea that certain phenomena are connected not by a single shared essence but by a network of overlapping similarities. They apply the same method to the reform projects they survey, identifying recurring features—hospitality, a capacity for teaching new ways of speaking and seeing, and deep wells of ethical, spiritual, and practical resources—rather than a rigid template. This approach allows diverse local experiments to be recognized as kin without forcing them into a standardized program, a deliberate contrast with the top-down wellness initiatives the authors criticize.

The review catalogs concrete examples of such communities across academic medical training programs and hospital systems. At Duke Divinity School, the Theology, Medicine, and Culture Initiative brings clinicians into sustained theological study and communal reflection on the ends of medicine. At Loyola University Chicago’s Stritch School of Medicine, the Physician’s Vocation Program invites students to examine medicine as a calling rather than merely a career. At Columbia University, Lydia Dugdale leads a Character Cooperative that uses shared meals—explicitly modeled on the communal feast depicted in the film Babette’s Feast—to form medical students in habits of attention and gratitude. At Wake Forest University School of Medicine, physician assistant educator Ethan Stonerook hosts dinners and a project called Planting Sequoias, which encourages trainees to invest in slow, long-horizon growth rather than the metrics of immediate productivity.

Surgical training, often considered the most punishing corner of medical education, features prominently as well. Ryan Antiel and Eberly lead a project called The Good Surgeon, which reframes surgical formation around accompaniment and proximity to patients rather than technical output alone. Related scholarship published in the Hastings Center Report argued for an ethic of accompaniment in surgical care, drawing on the legacy of the physician-anthropologist Paul Farmer, whose insistence on standing with the poor exemplified the kind of fidelity the heartache framework celebrates. Elsewhere, surgical residents have explored practices such as Sabbath-keeping as a form of resistance to a culture of ceaseless work, cultivating attention as a spiritual and clinical discipline rather than another productivity hack.

The authors are candid about the structural forces their proposal must contend with. They situate the present malaise within a longer history, noting that the Flexner Report of 1910, while standardizing medical education, also devastated training opportunities for Black physicians and embedded a reductionist, factory-model logic in American medical schools. They cite contemporary pressures ranging from the erosion of public trust in physicians documented in large pandemic-era surveys, to the financial toxicity experienced by patients, to the disorienting arrival of artificial intelligence in clinical decision-making, which studies suggest can shift patients’ trust depending on whether the machine agrees with the doctor. Against this backdrop, the heartache framework does not promise policy fixes; instead it insists that local communities of virtue and friendship are the places where the healer’s pain is most deeply felt and from which the most creative responses can best emerge.

The intellectual lineage of the argument is wide. The authors draw on the farmer-philosopher Wendell Berry’s essay Health Is Membership, which argues that health is inseparable from belonging to a community; on Nicholas Wolterstorff’s Lament for a Son, a meditation on grief that legitimizes lament as a form of love; on Aristotle’s account of friendship in the Nicomachean Ethics; and on the activist Dorothy Day’s conviction that community, however difficult, is the only setting in which love becomes practical. They also invoke the political anthropologist James C. Scott’s critique of state schemes that fail because they ignore local knowledge, using it to warn against national wellness mandates imposed from above. The physician’s calling, in this account, is sustained not by resilience training but by fidelity to trust—a virtue articulated decades ago by the ethicists Edmund Pellegrino and David Thomasma.

Whether the heartache framework can scale remains an open question, and the authors’ own disclosure of competing interests—several lead the very programs they describe—signals that this is a movement advocating for its own model rather than a detached evaluation. Still, the review arrives at a moment when physician burnout has reached what major outlets have called distressing levels, when loneliness among trainees is being studied as a clinical-ethical problem in its own right, and when commentators in the New England Journal of Medicine are asking whether medicine can reclaim agency, belief, and joy. By relocating the problem from the vocabulary of industry and war to the vocabulary of love, the Duke-led team offers clinicians something the standard wellness discourse cannot: permission to grieve, an account of why the grief is honorable, and a map of communities where that grief can be transformed into renewal. The rough ground, they suggest, is exactly where reform must begin.

Subject of Research: Reframing clinician distress as heartache rather than burnout or moral injury, with community-based models of medical formation

Article Title: The Healer’s Heartache: Reforming Medicine from the Rough Ground

Article References: Eberly, J. B., Jr., Curlin, F., Kinghorn, W., Frush, B. W., Antiel, R. M., Dugdale, L. S., Hardt, J., Kornu, K., Michel, A., Moyse, A., Nussbaum, A. M., Pickell, T., Stonerook, E., & McCarty, B. (2026). The Healer’s Heartache: Reforming Medicine from the Rough Ground. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10827-3

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10827-3

Keywords: heartache, burnout, moral injury, physician wellbeing, medical education, medical humanities, virtue ethics, friendship, clinical training, Duke University, Journal of General Internal Medicine, moral formation

Methadone remains one of the most effective treatments for opioid use disorder, reducing illicit opioid use, overdose risk, and mortality when taken consistently under medical supervision. Yet in the United States, access to methadone is tightly constrained by a regulatory architecture unlike that governing any other medication. Patients must typically travel daily to a specialized opioid treatment program, often called a methadone clinic, to receive their doses under observation. These clinics are concentrated in urban areas, leaving large swaths of rural America effectively unserved. The result is a treatment system in which the medication with the strongest evidence base is also the hardest to obtain, a paradox that has drawn increasing criticism from addiction medicine specialists and public health researchers alike.

One proposed solution is the pharmacy medication unit, a model in which a licensed pharmacy partners with an opioid treatment program to administer or dispense methadone at the pharmacy’s location. Under this arrangement, known formally as pharmacy administration and dispensing of methadone for opioid use disorder, the opioid treatment program retains medical responsibility for the patient while the pharmacy serves as a convenient, community-embedded point of access. Federal regulations permit such arrangements, and they have been used in other countries for decades, but the model remains rare in the United States. The Duke-led survey was designed to answer a deceptively simple question: are American pharmacists ready to take on this role?

The answer, in many respects, is cautiously encouraging. Of the 585 pharmacists surveyed, 57.2 percent expressed confidence in their ability to develop a partnership with an opioid treatment program to establish or participate in a pharmacy methadone medication unit. Meanwhile, 39.2 percent believed that most of their peers would be interested in participating in such a program, and 25.1 percent said they themselves were likely to build a partnership with an opioid treatment program to take part. These numbers suggest a meaningful reservoir of professional goodwill that could be tapped if the structural obstacles were addressed.

But the survey also exposed profound gaps in awareness and experience. Only 6.2 percent of respondents reported having ever worked at an opioid treatment program, and just 37.9 percent were aware that federal and state regulations already allow pharmacy-based methadone medication units. In other words, most pharmacists have never encountered the model, and most do not know it is even legal. That combination of unfamiliarity and regulatory opacity represents a formidable barrier, because pharmacists who do not know a practice exists are unlikely to advocate for it, pursue training in it, or negotiate the partnerships it requires.

The statistical analysis uncovered patterns in who felt most prepared. Pharmacists who were male, who identified with a racial category other than White or Asian, who practiced in the Western United States rather than the Northeast, who worked at an independent pharmacy rather than a hospital or clinic pharmacy, and who were owners, partners, or managers rather than staff pharmacists reported higher odds of feeling confident in their ability to forge a partnership with an opioid treatment program. Similar demographic patterns emerged for stated intention to participate, with male pharmacists, Asian pharmacists, and those in the other race category showing increased odds of expressing willingness to build such partnerships. The findings on practice setting and role are particularly telling: pharmacists with greater autonomy and decision-making authority, such as independent pharmacy owners, appear more inclined to embrace the model, suggesting that institutional flexibility matters as much as individual attitude.

When asked about barriers, the surveyed pharmacists were candid. Concerns about workload topped the list, reflecting the daily dosing schedule that methadone treatment typically demands and the staffing pressures already straining community pharmacies. Regulatory complexity and liability exposure also weighed heavily, as did a lack of training specific to methadone dispensing and the needs of patients with opioid use disorder. These concerns are not trivial. Methadone carries a narrow therapeutic window, and dispensing it safely requires knowledge of drug interactions, overdose risk, and the clinical protocols that opioid treatment programs follow. Pharmacists accustomed to filling prescriptions for chronic conditions would need structured education and clear practice guidelines before taking on the responsibility.

Yet the perceived benefits were equally compelling. Pharmacists pointed to improved access to treatment as the primary advantage, noting that pharmacies are often open extended hours, located in neighborhoods far from any clinic, and already trusted by the communities they serve. Expanding the number of dispensing points could reduce the daily travel burden that forces many patients to choose between holding a job and receiving their medication. Pharmacists also highlighted the potential to serve more patients overall and, notably, to reduce the stigma that many patients associate with standing in line at a methadone clinic. Receiving treatment at a neighborhood pharmacy, alongside neighbors picking up blood pressure medication or antibiotics, could normalize addiction treatment in a way that specialized clinics cannot.

The study’s authors argue that translating this latent willingness into actual practice will require coordinated action. They call for collective efforts among state pharmacy boards, pharmacist associations, and opioid treatment-related authorities to develop feasible program designs and to establish clear guidelines and training requirements for pharmacies and pharmacists wishing to participate in methadone medication units. Continuing pharmacy education could address the knowledge gap, while regulatory clarification could ease liability concerns. The survey was funded by the National Institute on Drug Abuse and approved by the Duke University Health System Institutional Review Board, and the authors report no competing interests.

As the opioid epidemic continues to claim lives across the country, the survey offers both a warning and an invitation. The warning is that good intentions alone will not build a pharmacy-based methadone system; without training, regulatory guidance, and deliberate partnership structures, the model will remain a footnote in addiction treatment policy. The invitation is that a substantial share of the pharmacy profession is already prepared to say yes, waiting only for the systems, education, and institutional support that would allow them to do so safely. If policymakers and professional bodies respond to that readiness, the corner pharmacy could soon become one of the most important front lines in the fight against opioid overdose, bringing a proven medication to patients in the communities where they live and work rather than behind the doors of distant clinics.

Subject of Research: Pharmacist readiness for pharmacy-based methadone dispensing for opioid use disorder in the United States

Article Title: Pharmacy administration and dispensing of methadone for opioid use disorder: a survey of U.S. pharmacists

Article References: Wu, L.-T., Easter, M., Gilbert, A., Hagemeier, N., & Schwartz, R. P. (2026). Pharmacy administration and dispensing of methadone for opioid use disorder: a survey of U.S. pharmacists. Addiction Science & Clinical Practice. https://doi.org/10.1186/s13722-026-00724-9

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00724-9

Keywords: methadone, opioid use disorder, pharmacists, opioid treatment program, medication unit, pharmacy practice, survey research, opioid epidemic, treatment access, harm reduction, drug policy, Duke University

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

The ASPIRES Program, short for Advancing Student Preparedness and Involvement for Representation and Equity in Surgery, was established at Duke to address a persistent pipeline problem. Longitudinal studies have documented declining racial and ethnic representation across 16 US clinical academic specialties, and national analyses of general surgery residency programs show that underrepresented minorities remain a small fraction of trainees. Prior research has linked this shortfall to disparities in mentorship access, which several studies identify as a decisive factor in whether underrepresented students pursue surgical careers at all.

To understand what students actually want from such a program, the research team turned to a simple but powerful data source. At the start of the program, every participant answered the question: Why are you interested in participating in ASPIRES? The team collected 73 de-identified responses across four cohorts from 2021 to 2024, achieving a 100 percent response rate. The respondents were predominantly Black or African American at 65 percent, with 35 percent identifying as Latinx or Hispanic and 64 percent as women, providing a demographic portrait of the students these pipeline initiatives are designed to reach.

The analytical approach followed established qualitative methodology. Two independent reviewers coded the responses using NVivo 14 software and a 26-factor thematic codebook developed iteratively as patterns emerged from the text. When the reviewers disagreed on how a passage should be coded, they resolved the discrepancy by consensus. This kind of thematic analysis is a standard tool in medical education research, allowing investigators to move beyond surface statements and identify the underlying drivers of student behavior across a large body of free-text responses.

Five core motivators emerged from the analysis: mentorship, preparation, exposure, career facilitation, and environment. The most frequently cited theme was mentorship itself, appearing in 63 percent of responses, followed by career preparation at 44 percent and a desire for representation or community at 41 percent. Roughly one in three students said they wanted early exposure and opportunities to explore surgical careers. In other words, students were not primarily asking for handholding; they were seeking relationships, roadmap knowledge, and a sense that people like them belong in the operating room.

Equally instructive were the themes that barely registered. Only 6.7 percent of students cited experiential learning as a motivation, and just 13.3 percent mentioned wanting insight into navigating the so-called hidden curriculum, the unspoken norms, networks, and expectations that often determine success in academic medicine. For program designers, this suggests students may not yet recognize how much of the professional socialization process is invisible to them, or they may prioritize visible resources like faculty contact over subtler forms of guidance during the first year.

The study’s central conclusion is one of reassurance: what students sought aligned closely with what ASPIRES was built to provide. That alignment matters because mismatched expectations are a known failure mode in mentorship. When a program promises skill development but students arrive seeking belonging, or vice versa, both mentors and mentees can end up frustrated. Here, the emphasis on identity-conscious mentorship, meaning mentorship that explicitly centers shared identity and belonging rather than treating it as an afterthought, appears to meet students exactly where they are.

The findings sit within a broader and growing evidence base. A 2026 systematic review in the American Journal of Surgery examined the availability of mentorship for underrepresented minorities in surgery and surgical subspecialties, while other studies have shown that structured mentorship programs can improve surgical residency match rates for underrepresented learners. Related initiatives such as LEAGUES, which focuses on leadership exposure for gender and minority equity in surgery, and a four-year follow-up of a preclinical mentorship and early exposure program published in the same journal, reinforce the idea that sustained, structured pipelines can move the needle on representation.

Why does surgical diversity matter beyond the profession itself? Prior research indicates that minority physicians are more likely to care for underserved patients, suggesting that a diversified surgical workforce could play a direct role in addressing health disparities. Meanwhile, the literature on stereotype threat documents how women and minorities exit science and medicine pathways when environments fail to signal belonging. Pipeline programs that combine technical preparation with community-building attack the problem from both ends at once, which may explain why the students in this study overwhelmingly valued representation alongside mentorship.

The Duke team concludes that ASPIRES represents a promising and scalable model for advancing equity in surgical education, and the data support that optimism: a complete response rate across four cohorts, clear thematic demand, and demonstrated alignment with program goals. The challenge ahead is replication and scale. If other institutions can adopt similar identity-conscious mentorship structures and measure student expectations as rigorously, the long path from first-year lecture hall to operating suite may become measurably more navigable for the students surgery has historically left behind.

Subject of Research: Motivations of first-year underrepresented medical students joining a surgical mentorship pipeline program

Article Title: First-year medical students’ motivations for joining an underrepresented minority mentorship program: are we meeting expectations?

Article References: Yanez, G., Soto, A. L., Zasloff, R. A., Mensah-Mamfo, M., Odei, A. D., Gomes, P. V., Medina, C. K., Reeves, R., Eward, W. C., DiLalla, G. A., & Vatsaas, C. J. (2026). First-year medical students’ motivations for joining an underrepresented minority mentorship program: are we meeting expectations?. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 159. https://doi.org/10.1007/s44186-026-00560-0

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00560-0

Keywords: mentorship, underrepresented in medicine, surgery, medical education, pipeline programs, ASPIRES, thematic analysis, health equity, Duke University, surgical careers, representation, hidden curriculum