A new cross-sectional survey published in the journal Pharmacia offers one of the first glimpses into this question in Bulgaria. Researchers from the Bulgarian pharmaceutical community surveyed 55 adult patients suffering from chronic pain persisting for more than three months, dividing them into two analytical groups: 18 patients, or 32.7 percent, with diagnosed neurodegenerative diseases, and 37 patients, or 67.3 percent, with chronic pain but no neurodegenerative diagnosis. Between May and September 2025, participants completed a structured anonymous questionnaire covering demographics, clinical characteristics, pain intensity measured on a 0 to 10 visual analog scale, anxiety levels on a five-point self-reported scale, and their awareness, experience, and openness toward CBD products. All participation was voluntary and anonymous, conducted under informed consent and in line with the Declaration of Helsinki.

The demographic picture reflected the classic epidemiology of chronic neurological disease. Nearly two thirds of respondents, 36 of the 55 participants, were women, and the majority were aged between 46 and 65 years. The cohort was notably well educated, with 74.5 percent holding higher education qualifications and more than half, 52.7 percent, possessing a master’s degree. The symptom burden was substantial: 89.1 percent of participants reported regular use of analgesic medications, and the mean anxiety score of 3.36 with a standard deviation of 1.14 pointed to moderate-to-high emotional distress across the sample. These were not curious bystanders but patients actively managing significant daily symptoms.

The headline finding is striking in its clarity. Although 61.8 percent of participants had heard of CBD products, only 14.5 percent considered themselves fully informed about the therapeutic effects, safety profile, and appropriate use of cannabidiol. Despite this knowledge gap, an overwhelming 85.5 percent said they would be willing to use CBD if a healthcare professional recommended it. Statistical analysis confirmed that prior awareness of CBD was significantly associated with willingness to use it, with a p-value of 0.001, and that participants familiar with CBD were far more likely to have previously tried CBD products, at p < 0.001. In other words, familiarity breeds both uptake and openness, while general awareness alone leaves most patients navigating uncertain territory.

Perhaps the most biologically telling result concerns the relationship between pain and anxiety. Spearman rank correlation analysis revealed a statistically significant moderate positive correlation between pain intensity and anxiety levels, with rho equal to 0.449 and p < 0.001, meaning that patients in greater physical discomfort consistently reported greater emotional distress. This pattern fits the increasingly accepted biopsychosocial model of chronic pain, which treats pain not merely as a sensory phenomenon but as a condition intertwined with impaired emotional regulation, sleep disturbance, reduced physical functioning, and diminished quality of life. In progressive neurodegenerative disease, where disability advances and prognostic uncertainty looms, this feedback loop between body and mind may become even more pronounced.

The comparative analysis between diagnostic groups sharpened this picture further. Patients with neurodegenerative diseases reported significantly higher anxiety levels than respondents without such conditions, at p < 0.05, consistent with international evidence that anxiety is common in Parkinson’s disease, multiple sclerosis, and Alzheimer’s disease and is linked to poorer treatment outcomes and increased caregiver burden. Equally revealing were the motivations behind CBD interest in each group. Neurodegenerative patients primarily hoped CBD might slow disease progression, improve sleep, and reduce anxiety, while those without neurological diagnoses associated CBD chiefly with direct pain relief. Interestingly, participants who were informed about CBD reported significantly higher pain and anxiety scores than the uninformed, suggesting that patients with the most refractory symptoms are the ones actively searching for alternatives beyond conventional pharmacotherapy.

The barriers that emerged are as informative as the enthusiasm. The most commonly cited obstacle was the absence of adequate medical guidance on dosing, safety, and potential drug interactions, leaving many participants uncertain how CBD could be used appropriately. Fear of adverse effects ranked second, and remarkably, some respondents continued to associate CBD with the psychotropic effects of recreational cannabis, despite CBD’s fundamentally different pharmacology. Economic factors compounded the problem, with the high cost of high-quality CBD products identified as a serious limitation for long-term use, particularly among participants older than 65 years. Lack of sufficient information, concerns about drug interactions, legal uncertainty, and fear of psychoactive effects thus combined to form a formidable wall between patient interest and safe practice.

These results align with international surveys, which have similarly documented high willingness among patients to try cannabinoid-based therapies, and they illuminate a persistent paradox of the CBD boom: public perceptions frequently outrun the strength of the underlying clinical evidence. Systematic reviews suggest cannabinoids may deliver modest benefits in chronic neuropathic pain and multiple sclerosis-related symptoms, but significant uncertainties remain regarding long-term safety, optimal dosing, drug interactions, and standardized protocols, given the relative scarcity of large-scale randomized controlled trials. Meanwhile, many participants perceived CBD as a safer and more natural alternative to conventional analgesics and anxiolytics, a view likely shaped by media exposure and commercial advertising rather than clinical data, raising the risk of unrealistic expectations and unsupervised self-medication.

One clinically practical detail concerns formulation preferences. Among available pharmaceutical forms, oral dosage formats such as capsules and tablets were preferred over oils and topical preparations, possibly because they resemble conventional medicines and are perceived as more medically acceptable and easier to administer. This preference may inform future pharmaceutical development and patient-centered formulation design for cannabinoid-based therapies, and it hints that patients may be more receptive to CBD delivered through familiar routes of administration than raw extracts or artisanal products.

The study’s authors are candid about its limitations: the sample of 55 patients is small and limits generalizability, the cross-sectional design cannot establish causal relationships between symptom severity and attitudes, and self-reported data may carry recall bias. Even so, the findings carry a clear message for clinicians and policymakers. Healthcare professionals remain the most trusted sources of therapeutic information for these patients, yet previous research shows that physicians and pharmacists themselves often report insufficient education in cannabinoid pharmacology, indications, and safety monitoring. Closing this informational gap, through improved professional training in the endocannabinoid system, clearer regulation of product quality and pricing, and evidence-based clinical guidelines for chronic neurological conditions, may determine whether the enormous patient enthusiasm documented here translates into safe, supervised, and genuinely effective therapeutic use, or dissipates into unregulated self-medication with products of uncertain quality.

Subject of Research: Patient awareness, attitudes, and willingness to use cannabidiol among Bulgarian patients with neurodegenerative diseases and chronic pain

Article Title: Attitudes toward cannabidiol use among Bulgarian patients with neurodegenerative diseases and chronic pain

Article References: Gesheva, T., Boycheva, N., Todorova, G., & Mihaylova, A. (2026). Attitudes toward cannabidiol use among Bulgarian patients with neurodegenerative diseases and chronic pain. Pharmacia, 73, Article e203129. https://doi.org/10.3897/pharmacia.73.e203129

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e203129

Keywords: cannabidiol, CBD, chronic pain, neurodegenerative diseases, Parkinson's disease, multiple sclerosis, anxiety, patient attitudes, Bulgaria, endocannabinoid system, survey study, pharmacology

The research, led by Dr. Georgia M. Vasilakis of the UPMC Heart & Vascular Institute alongside Dr. Kaitlyn E. McSurdy, Dr. Kathryn Berlacher, and Dr. Natalie Stokes, is a cross-sectional survey study — a snapshot in time of attitudes and behaviors across a single academic medical community. Cross-sectional designs like this one capture prevalence and perception rather than causation, but they are precisely the instrument needed when a technology has spread faster than the literature describing it. Graduate medical education, the period when medical school graduates train as residents and fellows under faculty supervision, is an especially revealing setting, because it pairs the least experienced clinicians with the most experienced ones and asks how both groups respond to the same unfamiliar technology.

The urgency of the question is hard to overstate. Generative AI systems — large language models that can draft prose, summarize evidence, answer clinical questions, and simulate patient encounters — have penetrated professional life at a pace with few precedents in medicine. Surveys of physicians conducted by the American Medical Association in 2026, cited in the study’s bibliography, document rapidly shifting sentiment toward augmented intelligence in clinical practice. Yet formal guidance has lagged well behind adoption. A 2025 report from the Association of American Medical Colleges found that artificial intelligence curricula remain unevenly implemented across U.S. and Canadian medical schools, meaning many trainees arrive in residency having never received structured instruction in what these tools can do, when they fail, or how their outputs should be verified.

That gap between use and instruction is the study’s central concern. The title’s nautical metaphor — sailing by the stars — is deliberate. Generative AI offers trainees a navigational aid: a quick answer on a busy call night, a draft of a difficult patient message, a summary of a dense guideline document. But stars can mislead. Large language models generate text by predicting plausible word sequences, not by verifying truth, and they can produce confident, fluent, entirely fabricated content — the phenomenon known as hallucination. A resident who consults an AI system at three in the morning may be consulting something that sounds authoritative and is wrong in ways that are difficult to detect without exactly the expertise the trainee is still developing.

The study’s authors situate their work within a growing but still thin body of evidence. Previous research by Cervantes and colleagues, published in the Journal of Investigative Medicine in 2024, examined medical educators’ perceptions of generative AI and found a profession divided — intrigued by the technology’s potential, wary of its risks to rigor and to the development of clinical reasoning. A 2025 review in the New England Journal of Medicine by Abdulnour, Gin, and Boscardin went further, proposing educational strategies for the clinical supervision of AI use itself, arguing that supervising how trainees engage with AI should become as routine as supervising how they prescribe medications or interpret electrocardiograms. The Pittsburgh survey adds empirical ground truth to that theoretical framework by asking what is actually happening in one large academic center.

The stakes of the question extend beyond individual competence into the architecture of medical training itself. Residency is built on graduated responsibility: interns perform supervised tasks, seniors direct teams, attendings hold ultimate accountability. Generative AI scrambles this hierarchy in an unfamiliar way, because it gives the most junior member of the team access to something resembling expert-level output without any guarantee of expert-level accuracy. A 2023 randomized vignette study published in JAMA by Jabbour and colleagues measured this directly, testing whether AI assistance improved diagnostic reasoning for hospitalized patients — and found that the benefits were neither automatic nor uniformly distributed, underscoring that how the tool is deployed matters as much as whether it is deployed at all.

There is also a subtler cognitive risk that the study’s framework acknowledges: the phenomenon of cognitive offloading. Research published in the journal Societies in 2025 by Gerlich examined how reliance on AI tools correlates with diminished engagement in critical thinking, a finding with obvious resonance for a profession whose core skill is precisely disciplined, skeptical reasoning. If a trainee learns to accept an AI-generated differential diagnosis without interrogating it, the technology may quietly erode the very habit of mind that residency exists to build. Conversely, if trainees are taught to treat AI output the way they treat a consultant’s recommendation — as an informed opinion to be weighed, checked, and integrated — the technology could sharpen rather than soften clinical judgment. Which outcome prevails depends heavily on the norms that faculty model and programs codify, which is exactly why measuring both groups’ behaviors matters.

The Pittsburgh team’s design reflects that dual focus. By surveying trainees and faculty within graduate medical education at the same institution, the researchers could capture the full supervision chain: the people most likely to reach for these tools and the people responsible for evaluating the work those tools touch. Portions of the work were presented as a poster at the University of Pittsburgh Graduate Medical Education Connect Conference in February 2026 and as a plenary session at the medical center’s Department of Research Day in May 2026, before the full paper was accepted on August 13, 2026 and published online on August 31, 2026. The authors report no funding and no competing interests, and the study involved no patients or protected health information, sparing it the privacy entanglements that often complicate clinical AI research. In a move that strengthens the study’s transparency, the datasets generated and analyzed are publicly available in the Harvard Dataverse repository, allowing other researchers to interrogate the findings independently.

What makes this study resonant beyond academic medicine is the broader economic and social evidence it aligns with. A widely discussed 2023 field experiment by Dell’Acqua, McFowland, Mollick, and colleagues described the performance of AI on knowledge work as a jagged technological frontier: tasks on one side of an invisible boundary are transformed by AI assistance, while superficially similar tasks just beyond it see little benefit or outright harm. Medicine sits squarely astride that frontier. Drafting administrative text and surfacing literature are tasks where generative models excel; nuanced diagnostic reasoning under uncertainty remains stubbornly human. The problem, as the Pittsburgh survey implicitly frames it, is that trainees and faculty may not agree on where the boundary lies — or may not know it exists at all.

The study’s ultimate contribution may be less a single statistic than a reframing of institutional responsibility. Sailing by the stars served generations of navigators well, but only because the stars’ positions were meticulously cataloged, their small motions understood, and their limitations respected. Generative AI in medical training deserves the same treatment: not prohibition, not blind adoption, but rigorous charting of where it helps, where it misleads, and what competencies trainees must retain regardless of how capable the tools become. The Pittsburgh team — clinicians embedded in the very training environment they studied — have supplied one of the careful navigational fixes the field now needs. As residency programs across the country confront trainees already carrying these tools in their pockets, the question the study poses is no longer whether graduate medical education will engage with generative AI, but whether it will do so with a map or by guesswork.

Subject of Research: Generative AI use among graduate medical education trainees and faculty physicians

Article Title: Sailing by the Stars: A Cross-Sectional Survey Study of Generative AI Use Among GME Trainees and Faculty

Article References: Vasilakis, G. M., McSurdy, K. E., Berlacher, K., & Stokes, N. (2026). Sailing by the Stars: A Cross-Sectional Survey Study of Generative AI Use Among GME Trainees and Faculty. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10751-6

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10751-6

Keywords: generative artificial intelligence, graduate medical education, medical education, residency training, survey study, clinical supervision, physicians, large language models, cognitive offloading, academic medicine, Journal of General Internal Medicine, hallucination

The enthusiasm is notable given the demographic reality of spine care. Degenerative spine disease disproportionately affects older adults, and 42 percent of the survey respondents were over 65 years old. Yet age, the study suggests, is not the barrier many clinicians might assume. When the researchers tested associations statistically, younger age was significantly linked to greater openness to VR-based diagnostic education (p = 0.035) and to learning about surgery (p = 0.007), but openness to medical technology in general was largely independent of age, prior VR experience, and education level. Formal schooling made no measurable difference at all: highest educational degree showed no significant association with openness to VR or likelihood of use. In other words, the drivers of enthusiasm appear to be experiential — familiarity, exposure, and perceived usefulness — rather than demographic.

That distinction between general technology openness and VR-specific receptivity runs throughout the statistical analysis. Using Spearman’s rank correlations with Bonferroni correction, the team found very strong relationships between a patient’s openness to technology that teaches about diagnoses and their openness to VR for the same purpose (ρ = 0.79, p < 0.001), and similarly for learning about surgery (ρ = 0.82, p < 0.001). General tech openness also predicted the stated likelihood of trying VR education (ρ = 0.63–0.66, p < 0.001). Meanwhile, prior VR use was significantly associated with openness to VR specifically for learning about diagnoses (p = 0.046, ρ = 0.19). The pattern suggests that once a patient is comfortable with digital tools broadly, the jump to immersive technology is a small one — and that hands-on experience with VR itself adds a further increment of willingness.

When patients rated specific potential benefits on a five-point Likert scale, the most compelling use case was procedural rehearsal. Nearly 72 percent agreed or strongly agreed that they would feel more prepared for surgery if they could watch a VR simulation of their own procedure, and a similar proportion — 61 percent — believed VR could reduce preoperative anxiety. A slim majority, about 58 percent, agreed the technology could help them understand their medical condition better than traditional verbal or written explanations. These are clinically meaningful hopes, because preoperative anxiety is not a trivial inconvenience: prior research links it to higher complication rates, more severe postoperative pain, and longer recoveries. VR, by letting patients explore a three-dimensional model built from their own MRI or CT data, promises to compress complex anatomy into an intuitive experience that a pamphlet or a hurried office conversation cannot match.

But enthusiasm is not uniform, and this is where the study makes its most distinctive contribution. Rather than treating the cohort as a single bloc of average opinions, the researchers applied an exploratory cluster analysis — partitioning around medoids (PAM) — to sort patients with similar response patterns. Because survey data mix continuous Likert ratings, categorical demographics, and binary answers, they used Gower distance, a metric designed to handle heterogeneous data types. Silhouette analysis identified three as the optimal number of clusters, and bootstrap resampling with 500 iterations confirmed the partition was reproducible, with Jaccard similarity indices ranging from 0.786 to 0.888, values generally interpreted as good-to-high stability.

The three clusters are vividly different. The first, dubbed Tech-Savvy Professionals (n = 41), comprised mostly middle-aged patients aged 31 to 65, nearly half of whom had medical work experience, and 76 percent of whom had actually used VR before. They showed the highest openness to both technology and VR, rated the likelihood of trying VR education at 8.9 out of 10, and only 15 percent worried about understanding the technology. The second cluster, Open-Minded Novices (n = 37), is perhaps the most intriguing: despite zero prior VR experience among its members, their openness scores matched the first group, with the same mean likelihood of 8.9 — though 32 percent expressed concerns about grasping the technology. The third cluster, Skeptics (n = 36), skewed heavily over 65, had the lowest familiarity, a mean likelihood of only 6.6, and 86 percent flagged difficulty understanding the technology as a concern; just 39 percent would use VR for postoperative rehabilitation.

The authors are careful about what these clusters do and do not mean. The mean silhouette width of 0.210 — below the conventional threshold of 0.25, and echoed by a value of 0.23 from an independent hierarchical clustering method — indicates limited separation between groups. Patient attitudes toward VR, they caution, likely exist along a continuum rather than as discrete subgroups, and the clusters should be treated as hypothesis-generating profiles, not validated clinical phenotypes. Still, the framework has practical implications. Open-Minded Novices may need only low-barrier exposure and guidance to become adopters, while Skeptics may require targeted, experiential interventions. Prior research on older adults supports that approach: in one study cited by the team, attitudes toward head-mounted VR shifted from neutral to positive after direct exposure.

The barriers patients named are refreshingly concrete. The most common concern was difficulty understanding the technology (42.98 percent), followed by motion sickness (24.56 percent) and time constraints (16.67 percent). Some respondents also worried that VR might displace the human element of surgical consultation — one participant put it bluntly, noting that “the human factor is far better” — while others raised accuracy, personalization, cost, and physical discomfort with headsets. The authors emphasize that successful implementation will hinge on designing experiences that are intuitive, time-efficient, comfortable, and explicitly complementary to the surgeon-patient relationship rather than a substitute for it.

Contextually, the study fills a real gap. A 2022 systematic review of VR in neurosurgery found that only about 5 percent of studies were patient-oriented, and patients remain underrepresented across the broader field of extended reality in neurosurgery, where research has concentrated on surgeon training, neuronavigation, and pain management. Earlier intervention studies — including a randomized controlled trial showing lower preoperative anxiety and higher preparedness among surgical patients given VR — hinted at the benefits, but baseline patient attitudes before implementation had been largely unmeasured. This survey, conducted in two neurosurgical offices (one suburban, one urban) with a five-to-ten-minute anonymous questionnaire, provides that missing snapshot, though the authors acknowledge limitations: the cross-sectional, single-center design, possible sampling bias from voluntary waiting-room recruitment, exclusion of 18 percent of surveys below an 80 percent completion threshold, a non-validated survey instrument, and the absence of any actual VR exposure during data collection.

The bottom line is encouraging for anyone hoping to see immersive technology in the preoperative waiting room. Patients facing spine surgery — a population that is older, often anxious, and drowning in unfamiliar medical jargon — are broadly ready and willing to put on a headset if it helps them understand what is about to happen to their bodies. The challenge ahead is not persuading patients but engineering for them: validating these exploratory response patterns prospectively, measuring hard endpoints like comprehension scores and anxiety measures after real exposure, and tailoring the experience so that the tech-savvy are challenged, the open-minded novices are guided, and the skeptics are won over one intuitive demo at a time.

Subject of Research: Patient attitudes toward virtual reality in spine surgery education

Article Title: Exploratory clustering of spine surgery patients’ attitudes toward virtual reality

Article References: Gabriel, E. D., Wu, A. Q., Sollenberger, C. H., Rani, N. S., Malhotra, N. R., Welch, W. C., Ozturk, A. K., Shin, J. H., Godzik, J., & Judy, B. F. (2026). Exploratory clustering of spine surgery patients’ attitudes toward virtual reality. Frontiers in Virtual Reality, 7, Article 1948670. https://doi.org/10.3389/frvir.2026.1948670

Image Credits: AI Generated

DOI: 10.3389/frvir.2026.1948670

Keywords: virtual reality, spine surgery, patient education, cluster analysis, neurosurgery, preoperative anxiety, patient attitudes, survey study, healthcare technology, Gower distance, partitioning around medoids, technology acceptance

The research, conducted by Sławomir Mika of the Upper Silesian School of Ultrasonography in Chorzów, Poland, together with colleagues from WSB University, Jan Kochanowski University, and the Medical University of Silesia, surveyed 521 healthcare professionals who completed ultrasound courses at the single training center. Using a retrospective post-then-pre survey design, participants rated their own ultrasound competence on a scale from 0 to 100, both as they recalled it before the course and as they perceived it after completing the training. The results were unambiguous: the mean retrospectively assessed pre-course score was just 40.2 out of 100, while the mean post-course score climbed to 77.3 out of 100, a jump of nearly 37 points that was statistically significant in paired comparisons using the Wilcoxon signed-rank test.

That magnitude of improvement is remarkable, but the study’s real significance lies in what happened after participants returned to their clinical environments. A full 84.1 percent of respondents reported a positive change in their daily practice following the course, and 77.2 percent said they felt increased confidence when making ultrasound-based clinical decisions. Perhaps most telling from a practical standpoint, 70.3 percent of participants reported that they had implemented at least one new ultrasound technique into their routine work. In other words, the training did not simply inflate confidence on a questionnaire; it appeared to translate into changed behavior at the bedside, where clinicians were actually deploying new scanning skills on real patients.

Satisfaction with the training was similarly high. The mean overall satisfaction score reached 90.6 out of 100, and 92 percent of respondents rated their satisfaction above 80 on the same scale. These figures matter because postgraduate medical education is expensive, time-consuming, and often competing with demanding clinical schedules. Courses that fail to engage learners or fail to produce perceived practical value are quickly abandoned. The near-universal satisfaction reported here suggests that structured, hands-on ultrasound curricula can achieve something that many continuing medical education formats struggle with: learners who feel the training was worth their time and who can point to concrete changes in how they practice.

The technical foundations of point-of-care ultrasonography, often abbreviated as POCUS, help explain why structured training is so critical. Unlike conventional diagnostic imaging performed by sonographers and interpreted by radiologists, POCUS is performed and interpreted by the treating clinician in real time, answering focused clinical questions such as whether a patient in shock has a poorly filling heart, whether a patient with breathlessness has a pleural effusion, or whether vascular access can be secured with ultrasound guidance. The technique relies on recognizing characteristic echo patterns, understanding probe positioning and machine settings, and integrating findings instantly into clinical decision-making. Errors in image acquisition or interpretation can lead directly to misdiagnosis, which is why professional societies worldwide have emphasized that POCUS competence requires deliberate, supervised training rather than informal learning at the bedside.

The study’s participants came through courses organized by the Upper Silesian School of Ultrasonography, a Polish training institution, and the research team emphasizes that the program was structured rather than ad hoc. While the published abstract does not detail every curricular component, the concept of structured ultrasound training generally implies a defined sequence of theoretical instruction, demonstration, supervised hands-on scanning practice, and assessment of progression. This stands in contrast to the historical pattern in many specialties, where clinicians learned ultrasound opportunistically from colleagues or through brief workshops with little follow-up. The authors, who include anesthesiology and intensive care specialist Hanna Misiołek of the Medical University of Silesia, frame the work as a response to the growing need for effective postgraduate ultrasound education as POCUS spreads across anesthesiology, intensive care, emergency medicine, and beyond.

One of the most intriguing findings is that the appetite for learning did not diminish with competence. Approximately 76 percent of the 521 participants, or 396 respondents, expressed a need for further ultrasound training even after completing their courses. This pattern reflects a growing recognition among ultrasound educators that competence in POCUS is not a binary achievement but a continuum, spanning basic image acquisition, pattern recognition, and eventually advanced applications such as echocardiography or ultrasound-guided procedures. The finding suggests that well-designed introductory courses may function less as endpoints and more as gateways, opening clinicians’ eyes to what ultrasound can do and motivating them to pursue progressively more sophisticated skills.

The authors are careful, and rightly so, about the limits of their methodology. Because pre-course competence was assessed retrospectively, after the training had already occurred, participants may have underestimated their earlier abilities once they knew what they had since learned, a well-documented cognitive bias in post-then-pre survey designs. More importantly, the study relied entirely on self-assessed competence rather than objective measures such as proctored image-quality assessments, standardized practical examinations, or validated competency instruments. No patient-related outcomes were measured either, so the study cannot demonstrate that the reported changes in practice improved diagnosis or treatment. The authors explicitly state that the findings should be interpreted as participants’ perceived educational and clinical benefits rather than objectively demonstrated effects, a caveat that distinguishes responsible educational research from overclaiming.

Those limitations do not diminish the study’s practical relevance. Self-assessed confidence and perceived practice change are meaningful outcomes in postgraduate education, particularly when collected from a large cohort of 521 practicing professionals, and they align with a substantial body of literature showing that clinicians who feel competent are more likely to use a skill, while those who feel untrained tend to avoid it. The single-center design, acknowledged in the study’s title, means the results describe one training program’s participants rather than a nationally representative sample, and the survey-based observational approach means no causal claims can be made with certainty. Still, the consistency of the findings, spanning competence scores, satisfaction, confidence in decision-making, and reported implementation of new techniques, paints a coherent picture of a training format that learners experience as genuinely transformative.

As portable ultrasound continues its march from specialist tool to everyday instrument, studies like this one will shape how health systems invest in training. The message from Upper Silesia is twofold: structured postgraduate ultrasound education can produce large perceived gains in competence and real changes in clinical behavior, and even highly satisfied graduates recognize that one course is only the beginning. For the clinicians scanned, probed, and examined in this survey, the ultrasound machine at the bedside is no longer an intimidating black box but a working extension of their physical examination, and they want to learn more.

Subject of Research: Structured point-of-care ultrasonography training and its impact on self-assessed competence and clinical practice among healthcare professionals

Article Title: Impact of structured ultrasonography training on clinical practice and self-assessed competence among healthcare professionals: a single-center study

Article References: Mika, S., Wilk, M., Gil-Mika, M., Gola, W., & Misiołek, H. (2026). Impact of structured ultrasonography training on clinical practice and self-assessed competence among healthcare professionals: a single-center study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10612-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10612-0

Keywords: point-of-care ultrasonography, POCUS, medical education, ultrasound training, self-assessed competence, healthcare professionals, postgraduate training, clinical practice, survey study, anesthesiology, intensive care, BMC Medical Education

The study took the form of a cross-sectional, two-cohort survey conducted at German university hospitals. Rather than following a single group over time, the researchers captured a snapshot of two distinct points along the neurology training pipeline: medical students who had not yet committed to a specialty, and residents already working in neurology departments. This design allowed the team to compare how career motivations form before specialization with how they evolve once doctors are inside the specialty. Data were collected through structured questionnaires supplemented by open-ended questions, a mixed-methods approach that combines the statistical power of standardized items with the nuance of free-text responses. In total, 79 medical students and 56 neurology residents participated, corresponding to response rates of 44 percent among students and 32 percent among residents. The study was conducted in accordance with the Declaration of Helsinki, participation was anonymous, and no patient data were collected.

The central question the researchers posed was deceptively simple: what actually drives career and specialization decisions in neurology? The answer, drawn from both cohorts, converged on three dominant factors. The specialty itself, with its intellectual appeal and clinical fascination, ranked as the most important influence on career choices. Good teaching experiences came second, pointing to the decisive role that educators and structured learning play at every stage of medical training. Workplace conditions rounded out the top three, a finding that foreshadowed the study’s most troubling results. For students contemplating neurology as a future, and for residents already living that future, the intrinsic qualities of the field and the quality of instruction mattered more than external incentives.

Among medical students, the survey revealed high levels of career motivation. Students entering the pipeline were not drifting into neurology by default; they arrived with purpose and a positive orientation toward their professional futures. This is significant for workforce planning because it suggests that the recruitment side of the German neurology pipeline is not fundamentally broken. The raw material of the future workforce is motivated, engaged, and drawn to the specialty for reasons that are intrinsic rather than transactional. The specialty’s scientific richness, spanning stroke, epilepsy, neurodegenerative disease, neuroimmunology, and the rapidly advancing interface with neuroscience research, appears to exert a strong pull on the next generation of physicians.

The resident cohort told a more complicated story. On one hand, residents maintained high levels of engagement and demonstrated marked loyalty to neurology as a specialty. They had not soured on the field itself; their commitment to the discipline remained intact. On the other hand, the same residents reported severe structural deficits in their everyday work life and in their residency programs. This divergence, between affection for the specialty and frustration with its conditions, is the conceptual heart of the study and the source of its evocative title: enthusiasm and structural frustration coexisting in the same individuals at the same time.

This pattern matters because decades of organizational research show that engaged, loyal employees do not leave because they stop caring about their work. They leave because the structures around them make sustained caring unsustainable. Severe structural deficits in residency programs, which may encompass workload, supervision, curriculum organization, and the daily conditions of clinical practice, act as a slow drain on even the most committed trainees. The German health system already faces critical physician shortages in neurology, a specialty whose demographic relevance is only growing as populations age and the burden of stroke, dementia, and Parkinson’s disease rises. Losing trained neurologists not because they fall out of love with the brain but because the training environment fails them represents an avoidable loss that the health system can ill afford.

The methodological choices of the study deserve attention. By surveying two cohorts at a single point in time, the researchers could triangulate across the pipeline: students reveal what attracts people into neurology, while residents reveal what the specialty actually delivers once they arrive. The mixed-methods design strengthens the findings, because structured questionnaire items allow quantitative comparison between groups, while open-ended questions capture the texture of experience that rating scales miss. The response rates, 44 percent for students and 32 percent for residents, are typical for physician surveys, though the authors characterize the study as exploratory, meaning the findings are intended to generate hypotheses and inform interventions rather than to provide definitive population-level estimates. The study was conducted in a university hospital setting, which means the results speak most directly to academic neurology departments, though university hospitals train a substantial share of the specialty’s future workforce.

The practical implications are direct. Because the most important factors shaping career decisions are the specialty itself, teaching quality, and workplace conditions, interventions can be targeted with unusual precision. Strengthening structured teaching throughout residency protects the second pillar. Improving workplace conditions and residency program organization addresses the third, and the residents’ own reports of severe structural deficits provide a ready-made agenda for reform. The authors explicitly frame their results as evidence-based guidance: the deficits residents describe are concrete and, in principle, addressable through deliberate program design rather than vague exhortations to professionalism or resilience. For departments competing for scarce trainees, the message is that the specialty’s intrinsic appeal is already doing the recruitment work; retention now depends on whether the working environment matches the enthusiasm it inherits.

There is also a broader lesson for medical workforce research. Studies of physician shortages often focus on compensation or on aggregate headcounts, treating specialists as interchangeable units of labor. This study inverts that view by showing that the same individuals can be simultaneously the specialty’s strongest advocates and its sharpest critics. Loyalty to neurology survived despite the structural deficits residents reported, which means the emotional foundation of the workforce is intact even as its material foundation erodes. Policy responses that address only pay risk missing the point; what residents appear to need are training programs and workplaces worthy of their commitment. Conversely, the findings offer grounds for optimism: because the deficits are structural, they are modifiable, and because motivation is high, improvements are likely to yield returns quickly.

As Germany confronts a future in which neurological disease will claim an ever-larger share of the health burden, the question raised by this research is whether the country can convert the evident enthusiasm of its young neurologists into a stable, retained workforce. The study’s answer is conditional. The passion is there, the teaching infrastructure matters enormously, and the workplace conditions that currently frustrate residents are known, named, and within reach of institutional reform. What remains is the will to act on the evidence. For a specialty defined by its understanding of the nervous system, the prescription is unusually clear: protect the enthusiasm, repair the structure, and the pipeline may yet hold.

Subject of Research: Career decision-making and retention factors in German neurology training

Article Title: Enthusiasm and structural frustration? Insights from an exploratory cross-sectional two-cohort study into career decision-making and retention factors in German neurology

Article References: Prokop, G., Biesalski, A.-S., Krause, M., Rebmann, P. S., Piel, J. H. A., & Schmidt-Graf, F. (2026). Enthusiasm and structural frustration? Insights from an exploratory cross-sectional two-cohort study into career decision-making and retention factors in German neurology. BMC Medical Education, 26(1), Article 1586. https://doi.org/10.1186/s12909-026-10515-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10515-0

Keywords: neurology, medical education, residency, career decision-making, physician shortage, workforce retention, Germany, university hospitals, workplace conditions, survey study, medical students, mixed methods

The study, led by Lina Schreiber, Henrik Teuber, Hans-Christoph Pape, and Christiane Barthel from the Department of Traumatology at Universitätsspital Zürich, with Barthel also affiliated with Schulthess Klinik in Zurich, set out to answer two deceptively simple questions: how available and structured is trauma bay training for residents, and how do these junior physicians perceive the two dominant educational tools in the field, Advanced Trauma Life Support courses and simulation-based training? ATLS, a standardized, internationally recognized framework developed to systematize the early care of injured patients, has long been considered the backbone of trauma education, while simulation training places teams in realistic, often high-fidelity mock resuscitations where errors can be made and corrected without any risk to a living patient.

To capture the reality on the ground, the researchers designed a cross-sectional, web-based survey that was voluntary and anonymous. Participants were resident physicians involved in trauma bay care across three countries, and the self-developed questionnaire probed their training exposure, their perceived preparedness, and selected organizational aspects of trauma bay management, comparing responses across specialties and training levels. A total of 124 residents completed the survey, a sample that, while modest, spans a meaningful range of hospital environments, from large university centers to smaller regional institutions, and therefore offers a rare window into how educational opportunity is distributed in real-world health systems.

The statistical findings are telling. Participation in ATLS courses or trauma bay simulation training was significantly associated with the type of hospital where a resident worked, with a p-value of 0.033, and with the resident’s training level, at p = 0.002. In practical terms, this means that whether a young doctor has access to formalized trauma education is not simply a matter of personal initiative but is strongly shaped by institutional context and seniority. Residents at certain hospitals and at certain stages of training are systematically more likely to receive structured preparation, while others may face their first real polytrauma resuscitation with little more than observation and on-the-job learning.

Perhaps the most striking number in the study concerns perceived safety. Residents who had attended ATLS courses reported significantly higher self-assessed safety in trauma bay management than those without such training, with mean scores of 3.67 versus 2.91 on the survey scale, a difference the authors report as statistically significant at p = 0.0024. While self-reported confidence is not the same as measured competence, the gap is substantial and aligns with a broader body of literature suggesting that standardized trauma courses translate into providers who feel, and often perform, more securely in the resuscitation room. Earlier work cited by the authors, including long-term follow-up of ATLS programs and systematic reviews of high-fidelity team-based simulation in acute care settings, supports the idea that structured training builds both technical skill and the non-technical abilities, such as communication and leadership, that trauma care demands.

Yet access to that training remains the exception rather than the rule for many residents. Fewer than half of the survey respondents reported having access to regular trauma bay simulation training, a finding that will surprise few who have worked in resource-constrained hospitals but that carries real weight for educators and policymakers. Simulation is expensive and logistically complex: it requires mannequins or in-situ setups, protected time for multidisciplinary teams that include surgeons, anesthesiologists, and emergency physicians, and trained instructors who can debrief effectively. The survey’s data suggest that these resources are concentrated unevenly, leaving the quality of a resident’s trauma education partly dependent on the postal code of their hospital.

The study also examined the quieter, organizational details of trauma bay culture that rarely make headlines but shape daily practice. Functional identification badges, which clarify each team member’s role during a resuscitation, were most commonly used in university hospitals and were viewed positively by 63.0 percent of participants. Supervisory support was generally rated as good or very good, an encouraging signal that senior staff are present and engaged when juniors take on trauma responsibilities. On the more troubling side, unprofessional communication within trauma teams was reported by a minority of respondents, though most described it as occurring rarely. Even infrequent unprofessional behavior in a high-stakes environment is not trivial; crisis resource management research has long emphasized that clear, respectful communication is a safety-critical component of team performance under pressure.

The authors are careful about what their data can and cannot show. As a descriptive, cross-sectional survey, the study captures perceptions and self-reported exposure at a single point in time rather than measuring objective performance or patient outcomes. The association between ATLS participation and perceived safety, for example, could reflect the genuine benefit of the courses, but could also reflect selection effects, since residents at better-resourced institutions may both receive more training and feel more confident for related reasons. Still, the authors argue that these descriptive data provide a foundation for future discussions on how postgraduate trauma education should be organized and delivered, particularly in health systems where trauma bay staffing and training structures vary widely between hospital types.

The findings land at a moment when trauma education is evolving rapidly. The literature the authors draw on includes studies of virtual reality simulation to enhance ATLS training, randomized controlled trials of extended reality simulators, and interprofessional in-situ simulation programs modeled on ATLS principles that have demonstrated measurable learning gains. If immersive technologies continue to lower the cost and logistical barriers of realistic team training, the inequities documented in this survey could become easier to correct, allowing smaller hospitals to offer their residents simulation experiences once reserved for major academic centers. Conversely, without deliberate policy attention, the association between hospital type and training access may persist or widen.

For now, the study’s central message is hard to ignore: a resident’s readiness to manage a crashing polytrauma patient should not be a lottery of institutional circumstance. With fewer than half of surveyed residents reporting regular simulation access, and with ATLS participation clearly linked to greater perceived safety, the authors’ data give educators across Switzerland, Austria, Germany, and beyond a concrete benchmark. The trauma bay will always be an unforgiving classroom, but the survey suggests that with standardized courses, consistent simulation, clear role identification, and supportive supervision, the medical profession can make its steepest learning curve a far safer one for both doctors and the patients who depend on them.

Subject of Research: Simulation-based trauma bay training and ATLS education for resident physicians

Article Title: Advancing trauma training: a survey study on simulation training and trauma bay management for resident doctors

Article References: Schreiber, L., Teuber, H., Pape, H.-C., & Barthel, C. (2026). Advancing trauma training: a survey study on simulation training and trauma bay management for resident doctors. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 128. https://doi.org/10.1007/s44186-026-00533-3

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00533-3

Keywords: trauma bay, simulation-based training, ATLS, resident physicians, polytrauma, medical education, trauma surgery, perceived safety, survey study, residency training, Switzerland, Germany

The study, conducted by Laureen Fröhlich and Andreas H. Mahnken at Marburg University, distributed an anonymous 47-item online questionnaire to 300 fifth-year medical students taking regular radiology courses across two academic terms, between winter 2023 and summer 2024. Eighty-five students completed the survey, a response rate of 28.3 percent, with 67 percent female participants and a mean age of 24.9 years. The questionnaire, based on previously published survey instruments, covered demographic data, students’ knowledge of interventional radiology compared with other disciplines, their familiarity with specific procedures including oncologic, vascular and non-vascular interventions, and their understanding of the specialty’s clinical role. Students completed the survey without any prior teaching intervention, providing a genuine baseline of what five years of medical school had taught them. The study was approved by the institutional ethics committee.

The headline finding is a paradox of awareness without understanding. Every single participant, 100 percent, knew that interventional radiology exists alongside diagnostic radiology. But only 36.5 percent had any prior exposure to the field during their studies, and 67.1 percent rated their own knowledge of it as poor. Not a single student rated their knowledge as excellent, and only 4.7 percent considered it good. The gap between perceived and actual understanding was particularly revealing: 63.5 percent of students claimed to know which diseases interventional radiology could treat, and 58.8 percent said they were aware of the available procedures, yet when tested objectively on specific interventions, their performance collapsed. Only about a third, 35.7 percent, felt they knew when a patient should even be referred to the specialty.

The procedural knowledge test laid bare the blind spot. Students were presented with twelve exemplary interventional radiology procedures and correctly assigned only seven of them to the field. Vascular interventions fared well: 96.5 percent correctly identified arterial revascularization as an interventional radiology procedure, followed by percutaneous angioplasty at 92.9 percent, endovascular aortic repair at 88.2 percent, treatment of arterial bleeding at 84.5 percent and inferior vena cava filter implantation at 76.2 percent. But the oncologic procedures, the very heart of interventional oncology, were recognized far less often. Venous access port implantation for chemotherapy was correctly assigned by only 54.1 percent of students and hepatic artery infusion chemotherapy by 50.6 percent. Fewer than half correctly identified thermal ablation of renal tumors at 48.8 percent, hepatic tumor ablation at 43.5 percent or image-guided lung biopsy at 42.4 percent. Non-vascular procedures fared worst of all, with vertebroplasty recognized by a mere 20 percent of respondents.

The confusion extended beyond ignorance to outright misattribution. Of the five non-interventional-radiology procedures included as distractors, the majority of students failed to correctly exclude any of them. Removal of adrenal tumors and radiation therapy for bone metastases were correctly recognized as outside the field by only 45.8 percent and 42.4 percent of students respectively, while local treatment of rheumatoid arthritis and proton therapy for pancreatic tumors were correctly flagged by just 37.6 percent and 35.3 percent. In other words, many future physicians cannot reliably distinguish what interventional radiologists do from what surgeons, radiation oncologists or nuclear medicine specialists do, a deficit with real clinical consequences, since referring physicians who misunderstand a specialty’s therapeutic potential may delay or miss referrals and exclude minimally invasive, organ-sparing options from multidisciplinary treatment planning.

Students’ picture of the specialty’s clinical structure was similarly incomplete. On the positive side, 97.6 percent recognized that interventional radiology treats patients with serious illnesses, and around 96 percent acknowledged that it performs potentially life-saving interventions. But when asked about the organizational reality of modern practice, understanding wavered: 69 percent assumed interventional radiology departments run their own outpatient clinics, 65.5 percent believed they admit patients independently, and 64.3 percent thought they conduct ward rounds, while only 41.7 percent knew such departments may have their own inpatient beds. These structures are increasingly common as the specialty evolves from a procedural referral service into a fully clinical discipline responsible for the entire patient pathway, from initial consultation through admission, inpatient care, discharge and follow-up.

The career implications may be the most consequential finding of all. Although 70.6 percent of students expressed interest in interventional radiology, and 61.2 percent wanted to learn more about it, radiology as a career was decisively rejected. Not one student said they would definitely consider it, only 5.9 percent said rather yes, and 78.8 percent ruled it out as rather not or definitely not an option. The most cited reason, given by 57.6 percent, was too little patient contact, followed by too much work on the computer at 51.8 percent and simple lack of interest at 50.6 percent. The authors note that this perception of radiologists as isolated, screen-bound technicians is a widespread stereotype, reinforced by low exposure during training and by the shortage of interventional radiology-managed inpatient beds that limits bedside teaching. A European survey by the Cardiovascular and Interventional Radiological Society of Europe’s Trainee Forum found the same trend, with limited patient interaction the most cited deterrent.

This recruitment crisis arrives at precisely the wrong moment. Cancer remains one of the foremost causes of death worldwide, with 19.3 million new cases and nearly 10 million cancer-related deaths in 2020, and the global burden is projected to rise by 47 percent to approximately 28.4 million new cases annually by 2040. Meanwhile, a shortfall of around 10 million healthcare workers is anticipated by 2030, and shortages of clinical radiologists and interventional radiology specialists, worsened by aging, retirement and burnout, are particularly alarming because these specialties are critical for cancer diagnosis, staging and minimally invasive treatment. Crucially, unlike vascular interventions, which are often performed by other disciplines, interventional oncology procedures are carried out exclusively by interventional radiologists, meaning a shortage of incoming talent could directly limit the quality and accessibility of minimally invasive cancer therapy for years to come.

Part of the problem is structural. In the United States, interventional radiology has been recognized as a primary medical specialty since 2012, and the Integrated Interventional Radiology Residency introduced in 2016 established a structured six-year training pathway reflecting the discipline’s full clinical scope. In Europe, no standardized framework exists: in most countries, including Germany, interventional radiology holds no official subspecialty status and is instead embedded within radiology. It is entirely absent from Germany’s official national undergraduate medical curriculum. CIRSE has developed curricula, including an Interventional Radiology Curriculum for Medical Students that treats interventional oncology as a core area, but implementation of these non-mandatory frameworks remains inconsistent and dependent on local initiative. The result, the authors argue, is a self-perpetuating cycle in which invisibility in the curriculum breeds ignorance among students, ignorance deters career interest, and dwindling recruitment deepens the workforce shortage that keeps the specialty too stretched to teach.

Breaking that cycle, the researchers conclude, requires action on several fronts: establishing formal structural recognition of interventional radiology as a specialty or subspecialty, integrating it and interventional oncology into mandatory undergraduate modules, expanding teaching formats from lectures and symposia to bedside teaching and interdisciplinary case discussions, actively promoting the field as the clinical, patient-facing discipline it has become, and harmonizing training standards across Europe. The evidence suggests even modest interventions work, as short lectures and targeted teaching have been shown to improve student knowledge and career consideration. The authors acknowledge limitations, including the single-institution design, the 28.3 percent response rate that may have attracted students already interested in the field, and the use of predefined answer options that may have shaped responses about career objections. Still, the message is difficult to ignore: a field capable of burning away tumors through a pinhole cannot afford to remain, in the minds of the physicians who will soon refer patients to it, out of sight and out of mind.

Subject of Research: Medical students' knowledge and awareness of interventional oncology and interventional radiology in undergraduate medical education

Article Title: Out of sight, out of mind: interventional oncology’s underrepresentation in undergraduate medical education

Article References: Fröhlich, L., & Mahnken, A. H. (2025). Out of sight, out of mind: interventional oncology’s underrepresentation in undergraduate medical education. CVIR Oncology, 1(1), Article 23. https://doi.org/10.1007/s44343-025-00020-4

Image Credits: AI Generated

DOI: 10.1007/s44343-025-00020-4

Keywords: interventional radiology, interventional oncology, medical education, undergraduate curriculum, cancer treatment, tumor ablation, medical students, workforce shortage, radiology career, Germany, survey study, minimally invasive therapy

The research, led by Kamini Vasudev of the Schulich School of Medicine and Dentistry at Western University, together with James Ross, Arlene G. MacDougall, Emma Kalapun, and Tara A. Burra of the University of Toronto, set out to answer a deceptively simple question: what are Canadian psychiatry residents actually being taught about improving the systems in which they will practice? In 2024, the team distributed a Qualtrics survey to all seventeen Canadian psychiatry residency programs, asking program directors to confirm whether their program had a quality improvement curriculum and, if so, to describe its content and their experiences delivering it. To triangulate the survey data, the researchers also reviewed the websites of every program for any mention of quality improvement education.

The response rate alone tells part of the story. Twelve of the seventeen programs, or 70.6 percent, replied to the survey. Among those twelve, eight, or 66.7 percent, indicated that they deliver a quality improvement curriculum. But only five of those eight, representing 41.7 percent of respondents, shared a structured curriculum when asked, while the remaining three did not provide one. Four programs, a full third of respondents, reported that they do not deliver a quality improvement curriculum at all. Two of those four teach introductory quality improvement content, with one program sharing PowerPoint slides from a lecture, and the other two reported the complete absence of any formalized quality improvement curriculum or related materials.

The picture darkens further when the five non-responding programs are considered. The researchers turned to the public websites of these programs as a proxy for what they might offer. Only one of the five mentions quality improvement work on its psychiatry residency website, and even that reference appears as a possible elective nonclinical rotation. The remaining four programs have no mention of quality improvement anywhere on their websites. Taken together, the survey and website review paint a portrait of a national training landscape in which a psychiatry resident’s exposure to quality improvement depends heavily on where they happen to train, ranging from structured curricula with shared materials, to a single introductory lecture, to nothing whatsoever.

Why does this matter so much? The technical answer lies in what quality improvement actually is. Unlike clinical research, which seeks to generate generalizable knowledge, quality improvement applies iterative cycles of measurement and change, often formalized as the Plan-Do-Study-Act cycle, to local systems of care. Practitioners identify a gap between current performance and a desired standard, define measurable outcomes, analyze the processes and contextual forces driving the gap, intervene, remeasure, and adjust. The skill set draws on epidemiology, data literacy, human factors engineering, and implementation science. It is the mechanism by which health systems convert good intentions into reliably better care, and it is increasingly embedded in the accreditation architecture of medical education on both sides of the border.

In Canada, the Royal College of Physicians and Surgeons of Canada requires psychiatry residents to demonstrate competencies in quality improvement under the CanMEDS framework, which positions the physician not only as a medical expert but also as a scholar, leader, and health advocate. The framework’s 2015 iteration explicitly elevated the role of physicians as agents of system-level improvement. In the United States, the Accreditation Council for Graduate Medical Education embeds quality improvement and patient safety requirements in its Common Program Requirements and in specialty-specific milestones. A 2018 content analysis of twenty-six sets of ACGME milestones, cited in the study, concluded that every graduating resident needs foundational knowledge in quality improvement and patient safety. The Association of American Medical Colleges has likewise published competencies in quality improvement and patient safety spanning the entire learning continuum, and recent cross-specialty analyses of entrustable professional activity guides have asked whether quality and safety are adequately represented in the tasks trainees must be trusted to perform.

Against this regulatory backdrop, the Canadian findings read as a gap between mandate and reality. The study’s authors argue that action is needed to provide quality improvement education to all residents, not only to meet certification requirements but also to address unmet societal mental health care needs. That second rationale is not rhetorical decoration. Mental health care in Canada, as in much of the world, faces chronic access problems, long wait times, and well-documented variability in the quality of care delivered. Research cited in the paper has documented changing practice patterns among Ontario psychiatrists with implications for access, and international work has emphasized that measuring and improving the quality of mental health care is a global priority. Youth mental health, in particular, has been described by Canadian researchers as deserving top priority in health care planning. When the system charged with training the next generation of psychiatrists leaves a third of its trainees without formal quality improvement education, it forfeits a powerful lever for addressing those systemic failures.

The study also situates itself within a substantial literature on how quality improvement should be taught, and why teaching it well is difficult. Realist reviews of quality improvement curricula in undergraduate and postgraduate medical education have identified the characteristics of successful programs, including experiential learning, protected time, faculty mentorship, and integration with real clinical projects rather than classroom abstraction alone. Systematic reviews have repeatedly found that lecture-based teaching produces knowledge gains but that durable skill development requires residents to actually conduct improvement projects within their clinical environments. Prior studies in psychiatry specifically have tested various models: a prospective cohort study found that an experiential quality improvement training program during residency improved residents’ confidence and knowledge; work on residents-as-teachers showed gains in quality improvement knowledge and skills; and a 2021 study identified barriers to resident engagement in quality improvement initiatives in psychiatry, including time pressures, competing clinical demands, and a perceived lack of relevance. More recent contributions have developed and evaluated dedicated quality improvement curricula for psychiatry residents, contextualized quality improvement and systems-based practice within psychiatric clinical teaching settings, and even created novel leadership roles, such as patient safety and quality improvement resident representatives, to improve peer engagement with root cause analyses.

What the new Canadian survey adds to this literature is a national baseline, and the baseline is sobering. The authors describe considerable variability in postgraduate quality improvement education practices across Canadian psychiatry programs, a diplomatic phrasing for a system in which some residents graduate having led data-informed improvement projects and others graduate having never encountered the discipline beyond, at best, a single lecture. The methodological approach, combining direct survey of program directors with systematic website review, has inherent limitations that the authors implicitly acknowledge: program directors’ self-reports may not capture informal teaching, and website silence does not prove curricular absence, as the non-responding programs could not be directly assessed. Still, the convergence of the two data sources, with two responding programs reporting a complete absence of formalized quality improvement education and four non-responding programs showing no online trace of it, suggests the variability is real rather than an artifact of measurement.

The implications extend beyond Canada’s borders. Psychiatry residency programs in the United Kingdom operate under Royal College of Psychiatrists curricula, and American programs face ACGME requirements, yet the Canadian experience suggests that formal requirements do not automatically translate into uniform implementation. The study’s authors, who have themselves published a primer on applying quality improvement to clinical practice for psychiatrists and an evaluation of a quality improvement module for psychiatry residents, frame the solution as a matter of both compliance and mission. Certification bodies can demand competence, but the deeper argument is that psychiatrists equipped with quality improvement skills are better positioned to close the persistent gaps in mental health care that no individual clinician, however skilled, can fix alone. As health systems worldwide grapple with rising mental health needs and constrained resources, the finding that a third of Canadian psychiatry programs report no formal quality improvement curriculum is less a bureaucratic footnote than a warning about how the specialty’s future workforce will, or will not, be prepared to improve the systems it inherits.

Subject of Research: The status of quality improvement education in Canadian psychiatry residency programs

Article Title: Status of Quality Improvement Curricula in Psychiatry Residency Programs Across Canada

Article References: Vasudev, K., Ross, J., MacDougall, A. G., Kalapun, E., & Burra, T. A. (2026). Status of Quality Improvement Curricula in Psychiatry Residency Programs Across Canada. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02432-7

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02432-7

Keywords: quality improvement, psychiatry residency, medical education, Canada, curriculum, patient safety, CanMEDS, graduate medical education, program directors, mental health care, survey study, Royal College

The study recruited 231 patients receiving inpatient or outpatient psychiatric care and 194 mental health professionals, including specialist psychiatrists, residents, psychologists, psychotherapists, psychiatric nurses, and allied therapists. Patients completed validated measures of sexual functioning, psychological well-being, and communication about sexuality, while clinicians answered questions about their attitudes, clinical practice, and professional training. The patient sample was predominantly middle-aged, with affective disorders, somatoform conditions, attention-deficit/hyperactivity disorder, sleep disorders, and post-traumatic stress disorder among the most common diagnoses. Nearly nine in ten patients were taking psychotropic medication, primarily antidepressants and antipsychotics, both of which are well documented to interfere with desire, arousal, orgasm, and satisfaction.

The scale of sexual dysfunction reported by patients was remarkable. Using the German version of the Sexual Behaviour Questionnaire, which assesses desire, arousal, orgasm, and satisfaction over the preceding three months, 100 percent of women and 97 percent of men screened positive for at least one indicator of impaired sexual functioning. Yet only 18.7 percent of patients described themselves as sexually satisfied. Almost half reported no sexual activity at all during the previous three months, and 87 percent scored below the clinical cut-off on the WHO-5 Well-Being Index, indicating reduced psychological well-being. The authors caution that the instrument uses a low threshold and may capture mild or transient impairments, and that self-selection effects may have inflated the figures, but they argue the pattern is consistent with prior research showing markedly elevated rates of sexual dysfunction in psychiatric populations compared with the general population.

The epidemiological backdrop makes the findings more consequential. In the representative German GeSiD study, about a third of men and nearly half of women reported at least one sexual problem in the past year, and roughly 13 percent of men and 17 percent of women met ICD-11 criteria for a distressing sexual dysfunction. Among people with psychiatric disorders, prevalence estimates climb dramatically, ranging from 45 to 93 percent in depressive disorders, 33 to 75 percent in anxiety disorders, around 60 percent in schizophrenia, and 25 to 81 percent in obsessive-compulsive disorder. Psychotropic drugs compound the problem: selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and antipsychotics are all associated with decreased libido, erectile dysfunction, delayed orgasm, and anorgasmia, effects that can undermine treatment adherence, mood, and relationship satisfaction.

Against this clinical backdrop, the survey’s communication data are sobering. Although 62 percent of patients considered sexuality an important topic in psychiatric treatment and 44 percent wanted clinicians to initiate such discussions, only 12.5 percent reported that a clinician had addressed it, and just 19.6 percent had raised the topic themselves. Clinicians, by contrast, reported addressing sexuality far more often: 62.1 percent of specialist psychiatrists and 44 percent of psychotherapists said they actively discussed sexual health, compared with only about a quarter of residents and roughly 10 percent of nursing staff and allied professionals. This mismatch between what clinicians believe they do and what patients report experiencing echoes earlier international research and constitutes what the authors describe as a clinically and ethically relevant communication gap.

Statistical analysis revealed what drives clinicians to engage with the topic. Across all occupational groups, perceived importance of sexual health, confidence in discussing it, viewing sexuality as part of one’s professional role, and years of professional experience all significantly predicted whether clinicians actively addressed sexuality. Among physicians specifically, a multiple regression showed that greater confidence and more years of experience were the significant predictors of actively discussing sexual issues with patients. Notably, perceived adequacy of training did not predict communication behavior, suggesting that formal education is failing to translate into practice and that clinicians rely heavily on experiential learning rather than structured instruction.

The training deficit was perhaps the study’s most consistent finding. More than 80 percent of clinicians reported that sexual health had been insufficiently covered during their education, and fewer than half felt adequately trained or confident in addressing sexual issues. Only a small proportion of physicians recommended pharmacological treatment for sexual dysfunction, with 5.9 percent of residents compared with 55.6 percent of specialists doing so. The authors argue that targeted training emphasizing experiential and communication-based approaches, including role-play, simulated encounters, and supervised practice, could strengthen clinicians’ confidence where curricular content alone has not.

The study also highlights structural and interpersonal dynamics that keep sexuality out of psychiatric consultations. Patients often perceive sexual concerns as sensitive or shameful and expect clinicians to signal openness first, while clinicians cite time constraints, personal discomfort, fear of offending patients, and unclear role boundaries within multidisciplinary teams. The researchers suggest practical remedies: standardized screening items, dedicated documentation fields, supervision that addresses sexual health, and coordinated intake approaches in which designated team members are responsible for specific assessment domains. They also emphasize that clinician-initiated enquiry should be paired with an explicit statement that patients may decline to answer, preserving agency and reducing pressure.

As an exploratory pilot, the study has limitations that the authors acknowledge candidly. The sample was regionally restricted and modest in size, self-selection may have overrepresented patients concerned about sexual issues, and the cross-sectional design precludes causal inference. The Sexual Behaviour Questionnaire, though validated, was primarily evaluated in patients with schizophrenia and offers only binary male and female versions, which may introduce bias for non-binary and intersex individuals. The predominantly female patient sample and the high proportion of patients on antidepressants and antipsychotics likely inflated observed dysfunction prevalence. The authors stress that all findings should be treated as hypothesis-generating rather than confirmatory.

Nevertheless, the central message is clear. Both patients and clinicians regard sexual health as important, yet conversations about it remain rare, largely because clinicians lack confidence and formal preparation. The authors call for future research on the effectiveness of educational programs and their impact on patient engagement, adherence, and therapeutic outcomes, as well as on interpersonal factors such as clinician and patient gender and age. Until then, the study stands as evidence that integrating sexual health into routine psychiatric assessment, through training, screening, and institutional support, is an essential step toward genuinely holistic, patient-centred mental health care.

Subject of Research: Communication about sexual health between psychiatric patients and mental health clinicians, and the training needed to close the gap

Article Title: Sexual Health in Psychiatry: Bridging the Communication Gap and Training Needs between Patients and Clinicians – A Cross-Sectional Exploratory Pilot Study

Article References: Schweitzer, T., Martl, P., Dubrovin Leão, D., Hammerl, L., Halms, T., Domani, K., vom Baur, S., Eder, A.-S., Rabenstein, A., Rüther, T., Hasan, A., & Gertzen, M. (2026). Sexual Health in Psychiatry: Bridging the Communication Gap and Training Needs between Patients and Clinicians – A Cross-Sectional Exploratory Pilot Study. Community Mental Health Journal. https://doi.org/10.1007/s10597-026-01716-4

Image Credits: AI Generated

DOI: 10.1007/s10597-026-01716-4

Keywords: sexual health, psychiatry, sexual dysfunction, patient-clinician communication, mental health care, psychotropic medication, clinician training, medical education, survey study, well-being, antidepressants, stigma