The study, led by researchers at the University Medical Center Hamburg-Eppendorf, used a custom-developed anonymous online questionnaire to collect data from resident surgeons working predominantly at German university hospitals. The survey was designed to assess the quality of training experiences, perceptions of career progression, workload distribution, emotional well-being, and the allocation of time between administrative and patient care tasks. The authors followed the internationally recognized CHERRIES checklist for reporting internet e-surveys, and the study complied with the Declaration of Helsinki. The goal was explicitly exploratory: to provide a basis for discussing reform possibilities that better support current and future demands on surgeons, at a time when the medical system is facing increasing systemic workload pressures and a developing shortage of doctors.

The raw numbers on working time are striking. Among the 186 residents who responded fully to the survey, 44.1 percent reported working more than 55 hours per week, a workload that sits well beyond what most occupational health frameworks would consider sustainable for cognitive and manual performance. Surgical residency has always been demanding, but the survey suggests the demands are increasingly misaligned with the core purpose of surgical training. When asked to rank how their working time is distributed, 72.0 percent of respondents ranked administrative tasks first, while only 4.3 percent ranked surgical procedures first. In other words, the single largest claim on a young surgeon’s day is not the operating room but the desk, a distribution that raises uncomfortable questions about what residents are actually being trained to do and how much hands-on operative experience they can realistically accumulate.

That misalignment shows up directly in the training data. Structured training programs were lacking for 88.7 percent of respondents, meaning that the overwhelming majority of surgical residents in the sample are learning their craft without the benefit of a formalized curriculum, defined milestones, or systematic supervision structures. Surgical exposure fared little better: 74.2 percent reported insufficient surgical exposure, indicating that most residents feel they are not getting enough time in the operating room or enough hands-on procedural experience to develop the skills their specialty demands. For a discipline in which operative competence is built through repetition, graduated autonomy, and deliberate practice under expert guidance, these figures suggest that the apprenticeship model at the heart of surgical education is failing to deliver its most basic promise to a large fraction of trainees.

The survey also probed professional readiness, and the results were mixed in a revealing way. On one hand, 67.2 percent of residents felt confident in their ability to adapt to emerging technology, a reassuring signal that the incoming generation is not technophobic and expects to engage with innovations such as robotic and digital surgical platforms. On the other hand, 51.0 percent felt unprepared for independent research. This is a significant gap for an academic specialty in which university hospitals are expected to produce not only competent operators but also clinician-scientists who advance surgical knowledge. If half of the residents training at Germany’s premier academic centers feel unequipped to design, conduct, and publish research, the pipeline of future surgical innovators and faculty may be at risk, with downstream consequences for the pace of surgical progress itself.

The career outlook data may be the most consequential part of the study. 42.9 percent of respondents said they were considering leaving their position within three years, and 67.7 percent expressed pessimism about their future work-life balance. These are not marginal sentiments; they represent a potential exodus of nearly half the surveyed cohort within a single training cycle. The authors connect this directly to the broader context of a developing shortage of doctors, arguing that the well-being of resident surgeons is a critical factor for sustainable healthcare delivery. Attrition at this scale would not merely inconvenience hospital staffing planners; it would compound existing workforce shortages precisely in a specialty that already struggles to fill positions, and it would do so at the moment when demographic change is increasing demand for surgical care across an aging population.

Perhaps most sobering is what residents think about the system itself. 81.1 percent disagreed that the healthcare system is prepared for surgical innovation, and 88.7 percent cited insufficient staffing to meet demographic changes. The residents’ assessment of the healthcare system’s readiness for future challenges was, in the authors’ words, poor. This is a remarkable verdict from the people who will inherit the system: the very trainees who are expected to carry surgical practice into an era of robotics, artificial intelligence, and minimally invasive techniques do not believe the institutions training them are structurally ready for that transition. Combined with the staffing concerns, the data suggest that residents perceive a widening gap between what the healthcare system will need and what it is currently building capacity to deliver.

The study’s methodology deserves a note of caution as well as confidence. As a cross-sectional questionnaire-based survey, it captures a snapshot in time and reflects the perceptions of those who chose to respond, predominantly at university hospitals, so the findings are exploratory rather than definitive and may not generalize to every German hospital or every surgical specialty. The authors are transparent about this, framing the work as a direct questionnaire-based effort to highlight surgical residents’ perspectives and provide an exploratory basis for discussing reform possibilities. The survey was conducted anonymously through an online platform, and participants provided consent for participation and data publication on completion of the questionnaire, with responses of those who declined publication omitted. The study was determined not to require ethical consultation under the Hamburg Chamber Act for the Medical Professions, and the authors declare no funding and no competing interests.

What makes the findings resonate beyond Germany is that they echo a global conversation about surgical training reform, burnout, and workforce sustainability. The specific numbers may be German, but the underlying tensions, excessive hours, administrative burden crowding out clinical and operative time, the absence of structured curricula, and the erosion of work-life balance, are recognizable to surgical educators worldwide. The authors argue that the gaps they identified in structured training programs and surgical exposure could lead to staff shortages and insufficient preparation for independent research and professional fulfillment in the future. In a field where the training pipeline takes more than a decade from medical school to independent surgical practice, delays in reform today translate into shortages a decade from now, when the demographic wave of aging patients will be at its peak.

The study’s publication comes at a moment when health systems across Europe are grappling with how to sustain specialist care under mounting demographic and economic pressure. By giving surgical residents a direct voice, the Hamburg-Eppendorf team has produced data that hospital administrators, surgical societies, and policymakers can use to argue for concrete changes: protected operative training time, structured curricula with defined milestones, reduced administrative load, and realistic staffing plans. Whether those reforms materialize will determine whether the 186 residents who answered this survey represent a warning that was heeded, or the leading edge of a quiet exodus from one of medicine’s most demanding and most essential specialties.

Subject of Research: Workload demands, surgical education and training among resident surgeons in Germany: a cross-sectional questionnaire-based study

Article Title: Workload demands, surgical education and training among resident surgeons in Germany: a cross-sectional questionnaire-based study

Article References: Schmidt, H. C., Le, M., Sennert, M., Meißner, K., Hampe, L., Preukschas, A. A., Nickel, F., Goetz, M., Wise, P. A., & Cizmic, A. (2026). Workload demands, surgical education and training among resident surgeons in Germany: a cross-sectional questionnaire-based study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10519-w

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10519-w

Keywords: surgical residency, medical education, workload, burnout, Germany, university hospitals, surgical training, workforce shortage, healthcare policy, resident surgeons, career attrition, BMC Medical Education

The study, led by Di Hu and colleagues, surveyed 203 pediatric residents at a single tertiary teaching hospital in 2026 using a structured questionnaire covering demographics, training motivation, training quality, professional identity, work stress, psychological status, and social support. Nearly three quarters of the respondents, 72.91 percent, were women, reflecting the heavily female composition of China’s pediatric trainee population. The researchers analyzed the responses with descriptive statistics and used logistic regression to identify which factors were independently associated with negative emotional states, a methodological choice that allows them to separate real predictors of distress from mere correlations.

On the surface, the training itself looks solid. A striking 94.09 percent of residents reported having adequate opportunities for clinical practice, and 93.11 percent said they were satisfied with the quality of teaching they received. For a training program cranking out the next generation of children’s doctors, those are encouraging numbers. The technical machinery of residency, the ward rotations, the supervised procedures, the didactic teaching, appears to be functioning largely as designed. If the goal were simply to teach residents how to practice pediatrics, the system would seem to be succeeding.

But the numbers underneath tell a far darker story. Only 23.65 percent of residents said they felt proud of their pediatric career, and just 55.66 percent were willing to commit to pediatrics long term. Most alarmingly, 74.38 percent had considered leaving the profession or changing careers altogether. In other words, three out of every four trainees in this cohort had seriously weighed walking away from pediatric medicine, the very field China desperately needs them to enter and stay in.

The mental health data help explain why. Seventy point nine four percent of residents reported experiencing negative emotions over the preceding three months. Anxiety was the most common, affecting 57.64 percent of respondents, followed by burnout at 42.86 percent and depression at 18.72 percent. These are not trivial rates. Burnout at nearly 43 percent among trainees who have not yet even entered independent practice suggests that the stressors are baked into the training environment itself, not merely a byproduct of seniority or caseload accumulation over years.

When the researchers asked residents what was driving this distress, three stressors dominated. High workload was cited by 76.35 percent of respondents. Tense patient-physician relationships, a well-documented problem in Chinese healthcare where distrust and occasional violence against clinicians have eroded the doctor-patient relationship, affected 69.95 percent. And 67 percent pointed to a mismatch between their income and their effort, a complaint that carries particular weight in pediatrics, historically one of the lowest-paying specialties in Chinese hospitals.

The logistic regression analysis sharpened the picture by identifying which factors independently predicted negative emotions after adjusting for other variables. Residents who perceived insufficient social recognition of their profession had 2.89 times the odds of reporting negative emotions compared with those who did not, a finding that was statistically significant at p equals 0.012. Low professional pride more than doubled the odds, with an adjusted odds ratio of 2.44 at p equals 0.030. High workload raised the odds by 2.34 times at p equals 0.027. The pattern is coherent: residents who feel unseen, undervalued, and overworked are the ones drowning emotionally, and these three drivers reinforce one another in a feedback loop that erodes both identity and wellbeing.

What residents themselves want changed is telling. Compensation and benefits topped the list, with 77.34 percent naming it as a priority for improvement. Training content optimization came second at 60.59 percent, and psychological support was third at 46.31 percent. The ranking makes intuitive sense: you cannot fix burnout with mindfulness workshops when the underlying grievances are financial and structural. The authors argue that urgent interventions are needed on multiple fronts, including salary reform, psychological support infrastructure, optimization of training content, career development services, and enhanced social recognition of pediatricians as a profession.

The findings carry implications well beyond a single training base in Chongqing. Pediatric workforce shortages are a global phenomenon, driven in many countries by low pay relative to other specialties, high emotional demands, and litigious or strained family interactions. The Chinese data add a specific warning: even when the educational quality of training is high, a program can fail at retention if it ignores professional identity and mental health. A resident who learns excellent pediatric medicine but graduates feeling underpaid, unrecognized, and emotionally exhausted is not a success story for the health system.

The study has limitations worth noting. It is a cross-sectional survey from a single center, so the 203 respondents represent one snapshot at one institution rather than a nationally representative sample, and the design cannot establish causation between the identified factors and psychological distress. The authors also note that the study was reviewed by the Institutional Review Board of the Children’s Hospital of Chongqing Medical University, which granted an exemption from formal ethical review because the survey was anonymous, low-risk, and involved no clinical intervention or patient data. Still, the scale of the reported distress, three quarters of trainees considering career exit, is hard to dismiss as an artifact. If China wants more pediatricians, the survey’s message is blunt: better teaching will not be enough. The country will have to make pediatric careers worth staying in, with pay that matches the workload, psychological support that trainees actually use, and a society that treats children’s doctors as the essential professionals they are.

Subject of Research: Mental health, professional identity, and training quality among pediatric residents in China

Article Title: Current status and recommendations for pediatric residency training: a cross-sectional survey of 203 residents from a single training base in China

Article References: Hu, D., Hu, Y., Fan, Y., Yang, Z., Tang, X., Li, M., & Pan, B. (2026). Current status and recommendations for pediatric residency training: a cross-sectional survey of 203 residents from a single training base in China. BMC Medical Education. https://doi.org/10.1186/s12909-026-10632-w

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10632-w

Keywords: pediatrics, residency training, burnout, mental health, professional identity, physician workforce, China, medical education, social support, workforce shortage, anxiety, compensation

The review is a methodological exercise in disciplined frustration. Ratnapradipa and her colleagues, drawing on the Behavioral Health Education Center of Nebraska and collaborators across the University of Nebraska system, set out to answer three deceptively simple questions. What behavioral health education pathways have actually been implemented in the United States? Which programs are effective at helping students accumulate credits toward a credential, license, or degree, obtain a degree, and earn industry-recognized credentials or licensure? And are there common effective factors that cut across successful programs? To answer them, the team followed the PRISMA Extension for Scoping Reviews and borrowed the What Works review protocol, a framework originally designed for evaluating postsecondary career and technical education interventions. That choice matters, because it forced the researchers to hold behavioral health pathway programs to the same evidentiary standard used to judge whether vocational pipelines in any field move people closer to gainful, credentialed employment.

The search itself tells a story about the state of the literature. Six databases were combed for articles on post-secondary behavioral health pathway programs in the United States that led to eligibility to practice, including teaching and research roles, published since 2004. The team applied strict inclusion rules: studies had to describe an actual intervention, not just a program description or an opinion. They excluded everything that could not plausibly move an individual closer to graduation, including retention-focused studies, wellness programs, specialized content like collaborative care models, delivery modalities such as remote mentoring, and specific training techniques. After de-duplication, the initial search yielded 2,068 articles. Ninety-seven survived to full-text review. Seven met all criteria. Seven. In twenty years of American behavioral health workforce policy built on the promise of pathway programs, the researchers could find only seven studies rigorous enough to even attempt an answer.

What those seven studies reveal is a field that has converged on a recipe without ever testing whether the recipe produces a meal. Psychiatry programs were the most frequently evaluated, which the authors note reflects the specialty’s acute shortage and its institutional resources rather than any evidence of superiority. The programs varied widely in type, in the number of participants they served, in the length of the intervention, and in how they were funded. But the formats shared a consistent architecture: every program integrated some combination of didactic classroom instruction, clinical or community-based experiential learning, mentoring relationships, and scholarly or research activities. All of the programs were university-based and delivered in person. In other words, the field has an intuitive, plausible model of how to grow a behavioral health professional: teach them, immerse them, mentor them, and get them doing research early. What the field lacks is proof that this model outperforms the ordinary route through graduate school.

The outcome measures reported across the seven studies were, in the reviewers’ assessment, a patchwork. Some programs tracked credit accumulation toward completion of a credential, license, or degree. Others measured degree attainment, licensure rates, or the earning of industry-recognized credentials. The heterogeneity is not a trivial formatting problem; it is the central obstacle to knowing whether pathway programs deliver a return on investment. When every study defines success differently, measures it differently, and reports it incompletely, no synthesis is possible. The researchers attempted to evaluate the programs against the What Works protocol, which grades interventions on the strength of their evidence, and found the effort hampered at every turn by incomplete data. Programs that sounded impressive in their promotional materials could not demonstrate, in their published evaluations, that participants were actually more likely to graduate, get licensed, or enter practice than comparable students who never enrolled.

This is where the review stops being an academic exercise and becomes a policy alarm. Behavioral health pathway programs are frequently recommended in federal reports, state workforce plans, and institutional strategic documents as a primary means of addressing provider shortages. Grant programs have been established around the concept. Medical schools, counseling departments, and social work programs have built pipeline initiatives on the strength of that recommendation. Yet the evidence base supporting the recommendation, as this review demonstrates, consists of a handful of studies with inconsistent measures, incomplete reporting, and methodological designs too weak to isolate the effect of the pathway itself. The authors’ conclusion is measured but pointed: robust evaluation, stronger methodology, and consistent data reporting are needed to truly evaluate pathway program efficacy and return on investment. Translated from academic English, that means the country is spending money and political capital on an intervention whose effectiveness has never been established.

The timing could hardly be worse. The behavioral health shortage is not an abstract workforce statistic; it shows up in emergency departments boarding psychiatric patients, in rural counties with no prescribing clinician within a hundred miles, in waitlists that stretch months for a therapy appointment. Every unfilled seat in a psychiatry residency, every counseling graduate who never obtains licensure, every social work student who leaves the field before credentialing represents care that never reaches a person in crisis. If pathway programs work, scaling them is one of the highest-leverage moves available to American health policy. If they do not work, or if only some of their components work, then scaling them blindly wastes scarce training resources while the shortage deepens. The review’s finding that the field cannot currently tell the difference between those scenarios is, arguably, the single most important sentence in the paper.

There is a deeper structural lesson buried in the methodology, and it extends well beyond behavioral health. The What Works protocol exists because career and technical education research went through its own reckoning, learning that intuitive program designs and enthusiastic outcome narratives are no substitute for controlled comparison and consistent metrics. The behavioral health education field is now confronting the same reckoning two decades late. The seven qualifying studies were all university-based and in-person, which means the review also cannot speak to the growing universe of online, hybrid, and community-college-based pathways that have proliferated as institutions scramble to expand capacity. The evidence gap is not just about whether the classic pipeline model works; it is about whether anyone is generating comparable data across the full modern landscape of how students actually train.

The path forward, as the authors frame it, is neither mysterious nor cheap. Programs need to commit to evaluation designs that can support causal inference, ideally with comparison groups of similar students who did not participate. They need to standardize outcome measures around the milestones that matter: credits accumulated, degrees conferred, licenses earned, and, ultimately, practice in shortage areas. They need to report their data completely, including the results that do not flatter the program. Funders, who hold the leverage, could require all of this as a condition of support. None of these steps requires new science; they require the discipline to treat education interventions with the same rigor expected of a clinical trial. The seven studies that survived this review prove the field can produce qualifying evidence. The 2,061 articles that did not survive prove how rarely it bothers.

For now, the honest summary of two decades of American behavioral health pathway programming is this: the model is plausible, the need is desperate, the programs are being built, and the proof is not there. Ratnapradipa and her colleagues have done the field the uncomfortable favor of counting, and the count is seven. Whether the next decade of pipeline programs looks like the last one, with enthusiasm outrunning evidence, or whether this review becomes the turning point where behavioral health education starts measuring what it claims to achieve, will depend on whether institutions and funders are willing to treat the question as open. The shortage gives them every incentive to get the answer right. The patients waiting for a clinician who does not yet exist are, in effect, the control group for a study nobody has run yet.

Subject of Research: Evaluation of behavioral health education pathway intervention programs addressing the U.S. workforce shortage

Article Title: Scoping review of behavioral health education pathway intervention programs in the United States

Article References: Ratnapradipa, K. L., Buckland, S., Buche, J., Poppert Cordts, K. M., Chasek, C., DeLizza, A., Bhale, D., Doyle, M., Mone, V., & Watanabe-Galloway, S. (2026). Scoping review of behavioral health education pathway intervention programs in the United States. BMC Medical Education. https://doi.org/10.1186/s12909-026-10432-2

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10432-2

Keywords: behavioral health, workforce shortage, pathway programs, scoping review, medical education, psychiatry, program evaluation, health policy, licensure, pipeline programs, BMC Medical Education, United States

The numbers are sobering. Radioactive iodine-131, the oldest, cheapest, and most established radionuclide therapy—used to treat differentiated thyroid cancer—is available in only 28 of 54 African countries, or 51.9 percent. More advanced theranostic agents fare far worse. Lutetium-177-PSMA, a radioligand therapy approved by the U.S. FDA in March 2022 for metastatic castration-resistant prostate cancer, is offered in just seven countries (13.0 percent). Lu-177-DOTATATE, used for neuroendocrine tumors, reaches six countries (11.1 percent), and I-131-MIBG for neuroblastoma is available in only three (5.6 percent). Bone palliation agents such as strontium-89 and samarium-153 reach just five countries.

These gaps collide with an escalating disease burden. According to GLOBOCAN 2022 data cited in the review, Africa records approximately 1.19 million new cancer cases and 764,000 cancer deaths annually. The International Agency for Research on Cancer projects that figure will climb to 2.1 million new cases per year by 2040—roughly a doubling. The continent’s cancer mortality-to-incidence ratio stands at 0.64, more than double North America’s 0.29, a statistic the author attributes to late-stage presentation and inadequate treatment access. Prostate cancer, the third most common malignancy in Africa with about 106,000 new cases in 2022, is precisely the disease that Lu-177-PSMA targets—yet it is addressable with that therapy in only a seventh of the continent’s nations.

The review’s most striking contribution is its economic modeling. The author compared the cost of locally produced radiopharmaceuticals against imported agents, normalizing all figures to 2025 U.S. dollars. The results are dramatic: locally produced Lu-177-PSMA costs between US$1,500 and US$3,000 per cycle, while the imported version runs approximately US$42,500—a cost reduction ratio of 1:28.3, equivalent to a 93 to 96 percent saving. Lu-177-DOTATATE shows a similar pattern, dropping from US$35,000 imported to US$2,000–4,000 locally produced. Even radioiodine, the workhorse therapy, becomes 85 to 97 percent cheaper when made domestically. A sensitivity analysis across low, base-case, and high-cost scenarios confirmed reductions of 90 to 97 percent throughout.

The model’s assumptions are laid out in detail. Local production costs were derived from NTP Radioisotopes-published African market pricing and European cost-utility analyses, while imported costs came from published trial supplementary data. The model assumes cyclotron production with specific activity of 3.0–5.0 TBq/mg per IAEA technical specifications, facility setup costs of US$15–25 million amortized over 20 years at 500 doses per year, and regulatory and cold-chain overhead of 15–25 percent of production cost. The author is careful to note that the headline 10-year investment estimate of US$545–995 million is a modeled planning-range projection derived from IAEA unit costs and published benchmarks, not an empirically measured figure.

Workforce shortages emerge as perhaps the deepest constraint. Africa has approximately 0.18 nuclear medicine physicians per million population, based on 247 registered physicians across 29 surveyed countries extrapolated to the continental population using UN 2024 estimates. Europe, by comparison, has 3.1 per million and North America 4.2—a 17- to 23-fold disparity. Reaching even a conservative target of one physician per million would require roughly 1,400 specialists; the current deficit exceeds 1,150. More than 70 percent of existing nuclear medicine physicians are concentrated in just four countries—South Africa, Egypt, Nigeria, and Morocco—leaving 50 nations with minimal or no specialist coverage.

Infrastructure tells a parallel story. Three countries—South Africa, Egypt, and Morocco—account for the majority of the continent’s nuclear medicine capacity, achieving 0.8 gamma cameras per million population. The continental average is 0.12 cameras per million, far below the IAEA minimum recommendation of 1.0. Most starkly, 31 of 54 African countries have no nuclear medicine facilities whatsoever. The continent has an estimated 145 SPECT/CT systems, 38 PET/CT scanners, and only 8 cyclotrons—the particle accelerators needed to produce radionuclides locally.

The clinical stakes are concrete. Radioiodine therapy for differentiated thyroid cancer achieves 10-year survival rates exceeding 90 percent when available, meaning its absence in 26 African countries represents a preventable mortality burden. Lu-177-PSMA extended overall survival by a median of 4.0 months in the landmark VISION trial, and actinium-225-PSMA has shown further promise in the multicenter WARMTH Act study. Lu-177-DOTATATE significantly extended progression-free survival in the NETTER-1 trial for neuroendocrine tumors. Bone palliation with Sr-89 or Sm-153-EDTMP provides effective symptom control for painful metastatic bone disease, yet remains available in only five countries—an enormous palliative care gap with direct quality-of-life implications.

Based on the quantitative evidence, the review proposes a phased strategic roadmap for 2026 to 2036. Phase one (2026–2028) would expand radioiodine therapy to 35 countries and establish three regional cyclotron hubs. Phase two (2028–2031) would introduce Lu-177 therapies in 15 countries and install 50 new SPECT/CT systems. Phase three (2031–2036) targets one camera per million population in 15 countries and AI-integrated reporting in 20. Rwanda’s planned cyclotron launch in early 2026 and South Africa’s established NTP Radioisotopes production infrastructure are cited as proof of feasibility, with an East African hub model—Kenya supplying Uganda and Tanzania—offering a scalable template modeled on pharmaceutical supply chains.

The author acknowledges limitations: the review was conducted by a single author without independent dual screening, infrastructure data rely heavily on one 2026 survey covering 29 countries, cost estimates may not capture regional pricing variation, and comprehensive workforce registries covering all 54 nations do not exist. Twenty-eight percent of included studies carried moderate-to-high risk of bias, though a sensitivity analysis excluding high-bias sources did not materially alter the primary conclusions. Still, the central message stands: radionuclide therapy availability in Africa is profoundly inadequate relative to disease burden, but economic modeling demonstrates that local production and regional hub models can cut costs by more than 90 percent—making these therapies economically feasible for resource-limited settings, provided political will and initial capital investment are secured. Under the proposed therapy-first framework, radioiodine (low cost, high burden) and Lu-177-PSMA (high cost, rising burden) emerge as the highest investment priorities.

Subject of Research: Availability, accessibility, and economic feasibility of radionuclide cancer therapies across Africa

Article Title: Availability, accessibility, and economic feasibility of radionuclide therapies in Africa: a systematic review and quantitative infrastructure analysis

Article References: Ibrahim, E. A. (2026). Availability, accessibility, and economic feasibility of radionuclide therapies in Africa: a systematic review and quantitative infrastructure analysis. Frontiers in Nuclear Medicine, 6, Article 1825650. https://doi.org/10.3389/fnume.2026.1825650

Image Credits: AI Generated

DOI: 10.3389/fnume.2026.1825650

Keywords: radionuclide therapy, nuclear medicine, Africa, Lu-177-PSMA, radioiodine I-131, theranostics, cancer burden, radiopharmaceuticals, health economics, workforce shortage, cyclotron infrastructure, IAEA Rays of Hope

Researchers from the Finnish Institute of Occupational Health and Aalto University interviewed 49 managers working in Finnish health and social care organizations between June and October 2024, as part of the EU-funded JACARDI research project. The interviews, conducted via Teams and lasting between 40 and 105 minutes, produced 740 pages of transcripts. Participants ranged from supervisors of fewer than ten employees to leaders of more than fifty, and their backgrounds varied widely: only 20 of the 49 had formal management education, and managerial experience spanned from under five years to more than twenty. The researchers analyzed the transcripts using deductive content analysis built around four dimensions of a concept they call work ability literacy: knowledge, understanding, motivation, and practical choices.

Work ability literacy is a young concept. It was originally defined as understanding the demands and effects of work on one’s health and work ability, and acting on that understanding to promote it. The researchers extended the idea by borrowing from health literacy, the ability to access, understand, appraise, and use information and services to maintain good health. In the workplace version, this means not only knowing what supports work ability but having the motivation and competence to act on that knowledge, whether the work ability in question is one’s own or that of employees. Managers, as representatives of the employer with legal responsibilities for employee safety, sit at a pivotal point in this system.

The findings reveal a strikingly fragmented picture. Managers drew their knowledge from three main sources: organizational information channels, personal experience and education, and interactions within the work community. Yet the organizational channels varied enormously, both between organizations and even between units of the same organization. All participating organizations had established work ability guidelines, and managers could call on occupational health services, human resources specialists, and in some cases dedicated workplace wellbeing planners. But many managers lacked the ability, skills, or opportunities to apply these policies in practice. Although organizations provided quantitative and qualitative indicators such as wellbeing surveys and workplace assessments, managers mostly relied on sickness absence alerts, the bluntest instrument available.

Experience, it turns out, was the most trusted teacher. Managers repeatedly emphasized know-how accumulated through years of work, describing it as learning the hard way. Practical experience sharpened their skill in engaging with employees and interpreting signs of strain, and it boosted their self-efficacy in handling sick leave processes. Educational backgrounds were diverse, but a consistent pattern emerged: managers whose views aligned with a broad understanding of work ability were also the ones who described further training as important for themselves. Interaction within the work community served as a third knowledge channel, with trusting relationships, daily conversations, personal observation, and attentive listening helping managers anticipate changes in an employee’s capacity. Team size, however, limited this channel; some managers reported so many subordinates that personal contact with each was nearly impossible.

Why did managers bother at all? Motivation clustered around three justifications: ensuring effective organizational operations, fulfilling managerial responsibilities, and supporting employee wellbeing. Many framed work ability support as the most important part of their job and pointed to their legal duty as employer representatives. Yet uncertainty shadowed this duty. Managers were unsure where their responsibilities began and ended, noted that they are not entitled to information about an employee’s health unless the employee discloses it, and some felt a conflict between the obligation to support work ability and the means actually available to them. A minority argued that work ability is primarily the individual’s own responsibility. Notably, the importance of work ability for care quality and patient safety went unmentioned in the interviews.

How managers understood work ability itself varied in ways that mattered. Some saw it primarily as an individual attribute, a matter of physical and mental health, motivation, and private-life habits such as exercise, sleep, and nutrition. In the data, this narrow view was clearly associated with weaknesses in other dimensions: managers who saw work ability as a personal trait often did not recognize supporting it as part of their own role. Most managers, by contrast, emphasized balancing personal resources against job demands and adapting work when needed. A third group articulated a holistic view, recognizing that work ability can be maintained, enhanced, and even created through how work is organized, oriented, and led. But even these managers drew a sharp line when the subject turned to themselves: leadership and the work environment became irrelevant to their own work ability, which they treated as a purely personal matter of lifestyle and limiting workload.

Practical choices followed the same pattern. Managers described modifying work content through shift planning, reduced hours, lighter duties, and ergonomic support; referring employees to occupational health services; offering social support through trust, presence, and listening; enhancing professional skills through training and career discussions; and promoting healthy lifestyles and recovery. What stands out is the timing. Corrective measures for diminished work ability dominated, and managers frequently described actions as proactive even when work ability had already declined, suggesting that proactivity was understood mainly as preventing prolonged sickness absence or permanent work disability rather than preventing decline in the first place. Experiences with occupational health services ranged from smooth collaboration to months-long waits for appointments, including with work psychologists, which managers identified as a light solution often delayed by half a year.

The study’s discussion zeroes in on the most concerning finding: even managers who were competent and committed, and who viewed employee work ability holistically, addressed their own work ability only through personal actions. The authors note that no previous studies directly support this observation, though earlier work among occupational health nurses showed a similar tendency to equate work ability literacy with health, personal attributes, and life situation. The different dimensions of literacy proved tightly intertwined, so gaps in knowledge rippled into narrow understanding, weakened motivation, and reactive decision-making. The researchers also raise questions about whether employers’ administrations and higher leadership possess adequate understanding of work ability and its strategic management, given how dependent support measures are on organizational structures.

The conclusion is a call for a systemic shift. To move from individual-focused, corrective measures toward preventive support at the work community and organizational level, organizations must recognize the importance of work demands and their effects, support managers at the strategic level, and provide adequate resources, clearly defined goals and responsibilities, and more education on the contents of work ability literacy. The authors emphasize skills and possibilities to prevent work disability as especially urgent. With workforce shortages in health and social care an urgent global challenge, the study suggests that extending working lives and sustaining an adequate labor force may depend less on heroic individual resilience and more on whether the managers who hold the system together are equipped, educated, and resourced to understand work ability before it fails.

Subject of Research: Work ability literacy among managers in the health and social care sector – a qualitative study

Article Title: Work ability literacy among managers in the health and social care sector – a qualitative study

Article References: Korkiakangas, E., Paavolainen, M., Selander, K., Nikunlaakso, R., Kaartinen, M., Koivisto, T., Nevanperä, N., & Laitinen, J. (2026). Work ability literacy among managers in the health and social care sector – a qualitative study. International Journal of Public Health, 71, Article 1610014. https://doi.org/10.3389/ijph.2026.1610014

Image Credits: AI Generated

DOI: 10.3389/ijph.2026.1610014

Keywords: work ability literacy, health and social care managers, occupational health, qualitative study, Finland, workforce shortage, work disability prevention, managerial competence, employee wellbeing, health literacy, public health, JACARDI project

The original analysis, published earlier in 2026 in the same journal under the title Untangling the Web of Hepatitis C Risk in Rural Communities, drew on the authors’ combined expertise in behavioral science, community health education, and clinical medicine. Bailey, who leads the correspondence from the Center on Drug and Alcohol Research at the University of Kentucky, has spent her career examining how substance use environments drive infectious disease transmission in Appalachia and similar regions. Tarplin brings a public health perspective on how community-level education and prevention infrastructure function, while Kang contributes the clinical vantage point of a physician-scientist embedded in pediatric and general care systems. Together, the three argued that hepatitis C in rural areas follows a distinctive epidemiological pattern shaped by limited treatment capacity, dispersed populations, and the evolving landscape of injection drug use.

The technical core of their argument rests on the recognition that hepatitis C virus, a blood-borne RNA virus of the Flaviviridae family, spreads efficiently through even small-volume blood exposures. In urban contexts, transmission has historically clustered around dense networks of people who inject drugs, prison systems, and specific healthcare lapses. Rural settings invert many of these assumptions. Population dispersion means that risk networks are geographically stretched, yet socially tight: a small number of individuals may connect otherwise distant counties through shared equipment, transportation routes, or drug supply chains. The authors contend that standard surveillance models, calibrated to urban outbreak dynamics, systematically underestimate how quickly infection can propagate across a rural county once introduced.

Compounding this structural vulnerability is the well-documented shortage of primary care capacity in rural America. The authors anchor their reply in the framework established by the National Academies of Sciences, Engineering, and Medicine’s 2021 consensus report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, which they cite as a foundational reference. That report characterized primary care as the only component of the health system for which universal continuous coverage produces better population health outcomes, and it warned that the erosion of rural primary care infrastructure undermines every downstream preventive service. For hepatitis C, the implications are direct: screening for the virus, linkage to curative antiviral therapy, and harm-reduction counseling all depend on a functioning primary care layer that many rural counties lack entirely.

The second pillar of the authors’ evidence base is a 2024 synthesis published in BMC Primary Care by Endalamaw and colleagues, which systematically reviewed barriers and strategies for primary health care workforce development. That synthesis identified chronic workforce shortages, maldistribution of trained clinicians, and weak retention mechanisms as persistent obstacles to primary care delivery in underserved areas. Bailey, Tarplin, and Kang invoke this literature to argue that hepatitis C elimination targets in rural regions are not primarily limited by virology or pharmacology. Direct-acting antiviral regimens cure more than 95 percent of chronic infections in as little as eight to twelve weeks of oral therapy. The bottleneck, they maintain, is the human infrastructure required to identify infected individuals, initiate treatment, and prevent reinfection and onward transmission.

The exchange that prompted the response letter illustrates how contested these interpretive frameworks remain. A prior letter to the editor had challenged elements of the original analysis, and the authors’ reply, published under the title Response to Re: Untangling the Web of Hepatitis C Risk in Rural Communities, defends their framing while engaging the critique on its merits. Scientific correspondence of this kind serves a technical function beyond academic courtesy: it forces explicit articulation of the causal assumptions underlying risk models, exposes points of disagreement about data interpretation, and refines the conceptual vocabulary that future empirical studies will inherit. In infectious disease epidemiology, where models of transmission dynamics directly inform resource allocation, such exchanges carry practical weight.

The stakes of this debate are grounded in a sober epidemiological reality. Hepatitis C virus chronically infects an estimated 2.4 million people in the United States, and the opioid-driven injection drug use crisis that intensified after 2010 produced sharp increases in acute hepatitis C incidence precisely in the rural counties least equipped to respond. The virus’s biology amplifies the challenge: most acute infections are asymptomatic or mildly symptomatic, allowing silent propagation through networks before clinical detection. Chronic infection, if untreated, progresses over decades toward hepatic fibrosis, cirrhosis, and hepatocellular carcinoma. The availability of curative therapy since 2013 transformed the disease into an elimination target, and the World Health Organization has set goals for viral hepatitis elimination by 2030, but those goals presuppose detection and treatment systems that rural America often cannot assemble.

The authors’ interdisciplinary composition reflects the analytical stance they defend. Bailey’s affiliation with a department of behavioral science and a center on drug and alcohol research signals attention to the behavioral substrate of transmission, the patterns of drug use, equipment sharing, and social network structure that determine where the virus moves. Tarplin’s community health education background foregrounds prevention messaging and the design of interventions that reach dispersed populations. Kang’s clinical position grounds the analysis in the realities of care delivery, where screening protocols, electronic health record triggers, and referral pathways determine whether a positive antibody test becomes a cured patient or a lost opportunity. The letter’s single-sentence contribution statement, crediting all three authors with conceptualization and writing of the original draft, underscores the deliberately integrated character of the argument.

The correspondence also carries methodological implications for how rural health research is conducted and evaluated. The authors’ web metaphor, the image of hepatitis C risk as an interlaced network rather than a linear chain of causes, resists reduction to any single intervention point. A syringe services program addresses one strand; telehealth-based treatment expands another; workforce development strengthens the clinical node; transportation assistance loosens the geographic constraints that bind the network together. The critique and response cycle, by testing which strands bear the most load, helps prioritize interventions empirically rather than ideologically. The authors report no funding associated with the letter and declare no competing interests, and the journal’s editorial process, from submission on 31 July to acceptance on 5 October 2026, moved the exchange into the published record within a single quarter.

What emerges from the exchange is a research agenda rather than a closed argument. The authors’ reply positions rural hepatitis C risk as a problem that demands simultaneous attention to virology, behavioral science, health services organization, and rural sociology, the very subject categories under which the journal indexes the work. As elimination timelines approach, the letter stands as a reminder that the final mile of infectious disease control is rarely a laboratory problem. It is a problem of networks, of geography, of workforce, and of the quiet structural choices that determine whether a curable virus persists in the communities least able to fight it. The technical conversation between Bailey, Tarplin, Kang, and their critics will continue in the literature, but its practical destination is fixed: translating a web of risk into a web of response.

Subject of Research: Hepatitis C virus transmission risk and primary care barriers in rural communities

Article Title: Response to Re: Untangling the Web of Hepatitis C Risk in Rural Communities

Article References: Bailey, A., Tarplin, S., & Kang, A. (2026). Response to Re: Untangling the Web of Hepatitis C Risk in Rural Communities. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10934-1

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10934-1

Keywords: hepatitis C, rural health, primary care, viral hepatitis, infectious disease epidemiology, harm reduction, workforce shortage, opioid crisis, direct-acting antivirals, health disparities, correspondence, public health

The paradox at the heart of the study deserves closer examination, because it reveals something important about how care systems fail. When professionals were asked to rate the forty-three proposed measures on both urgency and feasibility, a clear pattern emerged: the ideas they considered most transformative were also the ones they saw as structurally out of reach. This is not a matter of professionals being pessimistic or unimaginative. Rather, it reflects a genuine tension in public sector reform, where the changes that would matter most often require shifts in funding streams, legislation, or inter-agency governance that no single professional or institution can deliver alone. Measures that can be implemented within the walls of one clinic or school tend to score high on feasibility but modest on urgency, while measures demanding coordination across ministries, school districts, and care networks score high on urgency but stall at the implementation stage.

The concept mapping method itself is worth understanding, because it differs substantially from conventional survey or interview approaches. In a typical qualitative study, researchers code and categorize participant statements themselves, which introduces an interpretive layer between what stakeholders said and what the final analysis reports. Concept mapping inverts this logic. After the brainstorming phase, in which participants generated statements in response to a single focus prompt, the professionals themselves sorted the statements into groups that made sense to them and rated each one on urgency and feasibility. Multidimensional scaling and hierarchical cluster analysis then translated these sorting decisions into a visual map, in which statements that were sorted together by many participants appear close to one another, and natural groupings emerge as clusters. The result is a conceptual framework built from the collective mental model of the frontline workforce rather than from the assumptions of researchers, which is precisely why the method is valued in participatory public health research.

The composition of the participant group also shaped what the study could reveal. The thirty-three professionals came from seventeen institutions spanning the three main pillars of the Slovak care system for adolescents: preventive-counselling services, social care, and healthcare. Psychologists, special needs educators, educational counsellors, social workers, and child psychiatrists all contributed, which means the map reflects the system as seen from multiple vantage points rather than from a single professional culture. This breadth matters because barriers to implementation are often invisible from inside one sector. A school counsellor may see clearly how rigid educational structures block early intervention, while a child psychiatrist may see how referral pathways fragment care, and a social worker may see how legislative gaps leave families without support. Only by combining these perspectives can the full architecture of the problem come into view.

One notable feature of the sample deserves attention: all participants were women. The authors note that this reflects the strongly feminized character of the helping professions involved, which is a well-documented pattern across Europe and beyond. Teaching, social work, and psychology have long been dominated by female workforces, and this demographic reality has implications for how these sectors are valued, resourced, and heard in policy debates. Occupations staffed predominantly by women tend to receive lower pay and lower status, and the professionals within them may have less access to the decision-making arenas where system-level reforms are actually negotiated. The fact that the most urgent but least feasible measures cluster around legislation and system governance may partly reflect this dynamic: the people who understand the problems best are often the furthest from the levers of structural change.

The finding that school system changes dominated the urgent-but-infeasible cluster aligns with a substantial body of international evidence on adolescent mental health services. Schools are where adolescents spend most of their time, making them uniquely positioned for prevention and early identification, yet educational institutions are frequently organized around academic mandates rather than health objectives. Teachers and school counsellors face competing demands, limited training in mental health, and institutional cultures that may treat behavioural problems as disciplinary matters rather than health needs. International frameworks, including recommendations from the World Health Organization on school-based mental health promotion, have repeatedly called for closer integration between education and health sectors, but such integration requires changes to curricula, funding formulas, and professional roles that resist incremental reform.

System fragmentation, the second major theme in the findings, is a challenge that transcends national borders. Care for adolescents with emotional and behavioural problems typically involves multiple agencies with separate budgets, reporting structures, and professional cultures. An adolescent might simultaneously be in contact with a school counsellor, a social worker, and a child psychiatrist, with each professional bound by confidentiality rules and institutional procedures that make information sharing difficult. Families often describe the experience of navigating such systems as exhausting, forced to retell their story to each new provider and to piece together a coherent care plan on their own. When professionals themselves identify transparency and functioning of the care system as urgent priorities, they are essentially confirming from the inside what service users report from the outside: the system behaves less like a network and more like a set of parallel silos.

The third cluster, concerning legislative conditions for adolescents with emotional and behavioural problems, points to a layer of the problem that is often absent from clinical discussions. Legal frameworks determine who can consent to treatment, what information can be shared between agencies, what obligations schools have toward students with behavioural difficulties, and what support families are entitled to receive. When these frameworks are outdated, ambiguous, or misaligned with the realities of adolescent development, frontline professionals are left making judgement calls in a legal grey zone. The Slovak context adds a specific dimension here, as the country has been undergoing gradual reforms of its child protection and social services legislation, and professionals working in the system must constantly adapt to shifting regulatory requirements while managing heavy caseloads.

Workforce capacity, highlighted in the study’s conclusions, connects all three clusters. Slovakia, like many European countries, faces shortages of child psychiatrists, clinical psychologists, and specialized social workers, particularly outside major cities. The concentration of services in Kosice, the country’s second-largest city, illustrates a common pattern in which expertise clusters in urban centres while rural and disadvantaged regions struggle with vacancies and long waiting times. Training pipelines for child mental health professionals are long, and attrition due to burnout and low pay compounds the shortage. Any measure that expands the scope of services, whether through school-based programmes or integrated care pathways, ultimately depends on having enough qualified people to deliver them, which is why workforce development cannot be separated from system reform.

The methodological choices of the study also carry implications for how its findings should be read. The response rate of 82.5 percent is strong for research involving busy professionals, and the non-participants were predominantly managers citing workload, which suggests the findings may underrepresent managerial perspectives on implementation barriers. This is a meaningful limitation, since managers are often the very people who must authorize resource allocations and procedural changes. At the same time, the participation of frontline workers in all three phases of the concept mapping process, from brainstorming through interpretation, strengthens the claim that the identified barriers reflect genuine practice realities rather than researcher preconceptions.

The distinction this study draws between urgency and feasibility offers a useful template for future research and policy work. Prioritization exercises in health services research often conflate the two dimensions, asking stakeholders simply what should be done first. By separating measures that are urgent and feasible from those that are urgent but infeasible, the researchers effectively created a diagnostic map of the system’s structural constraints. The urgent-and-feasible measures, reported in the team’s earlier work, constitute a near-term agenda that institutions could begin pursuing immediately. The urgent-but-infeasible measures documented here constitute something different: an agenda for advocacy, pointing to the specific structural reforms, in schools, in system governance, and in legislation, that would need sustained political attention over years rather than months.

For other countries grappling with rising rates of adolescent emotional and behavioural problems, the Slovak case offers lessons that extend well beyond its borders. The prevalence figures reported in the study, with European estimates ranging from under six percent to nearly thirty-seven percent depending on the measure and population, indicate that no country has solved this problem. The specific barriers identified in eastern Slovakia, such as fragmented referral pathways and rigid school structures, have close analogues in high-income countries across Europe and North America. The participatory approach used here, which treats frontline professionals as experts in their own right rather than as passive subjects of research, could be replicated in other settings to generate locally grounded implementation agendas. What the study ultimately demonstrates is that the knowledge needed to reform adolescent psychosocial care already exists within the workforce; the challenge is building the political and institutional machinery to act on it.

Subject of Research: Barriers to implementing urgent improvements in psychosocial care for adolescents with emotional and behavioural problems, as identified by care professionals through concept mapping.

Article Title: Professionals’ perspectives on barriers to improving psychosocial care for adolescents with emotional and behavioural problems – a concept mapping case study

Article References: Paclikova, K., Bosakova, L., Dankulincova Veselska, Z., Tavel, P., & Reijneveld, S. A. (2026). Professionals’ perspectives on barriers to improving psychosocial care for adolescents with emotional and behavioural problems – a concept mapping case study. International Journal of Public Health, 71, Article 1610058. https://doi.org/10.3389/ijph.2026.1610058

Image Credits: AI Generated

DOI: 10.3389/ijph.2026.1610058

Keywords: adolescent mental health, psychosocial care, emotional and behavioural problems, concept mapping, health systems, Slovakia, school system reform, workforce shortage, system fragmentation, implementation barriers, public health, care professionals

The findings arrive at a precarious moment for the specialty. Obstetrics and gynecology is the only predominantly female surgical specialty in American medicine, and it is confronting a well-documented national shortage of practicing obstetricians and gynecologists. At the same time, shifting reproductive health policies at the state and federal level have placed additional work-life and legal pressures on practitioners. Against that backdrop, losing trainees to burnout, depression, or attrition carries consequences that extend well beyond the individual physician, threatening the continuity of care for patients who depend on OB-GYNs for everything from routine preventive screening to complex surgical intervention and childbirth.

The research was conducted as part of the Health Equity and Retention in Obstetrics and Gynecology Project, known as HERO, a national research effort focused on understanding the factors that shape the OB-GYN workforce. The project’s co-principal investigators are Helen Kang Morgan, a clinical professor in the Department of Obstetrics and Gynecology at the University of Michigan Medical School and senior author of the new study, and Abigail Ford Winkel of the New York University Grossman School of Medicine. The HERO team’s central goal is to identify ways to support physicians and keep them working in the specialty, ensuring that patients continue to have access to the care OB-GYNs provide. Morgan argues that the data reveal a systemic failure to address the mental health of trainees. A very large portion of those entering the specialty are struggling and not getting the help they need, she noted, and the field is not having meaningful discussions about how to help them. She suggested that shifting mental health services from an opt-in model, where residents must actively seek assistance, to one in which every resident automatically receives some form of support could be a promising step, pointing to evidence that such approaches have shown promise elsewhere.

The study drew on data collected through the larger Intern Health Study, a longitudinal research effort that for more than 20 years has enrolled annual cohorts of graduating medical students. Close to 30,000 interns across all fields of medicine have taken part, agreeing to track their mood, sleep, activity, and other measures as a way of studying the mental health impact of the known stresses of residency training. This long-running dataset offers a unique window on the triggers of depression and potential prevention strategies, with implications that could reach far beyond the medical profession itself, since the stresses of residency, long hours, disrupted sleep, and high-stakes performance, mirror conditions found in many demanding occupations.

The Intern Health Study focuses specifically on young physicians in their first year of training because that period is intensely stressful. Interns face long work hours, varying sleep and work schedules, and the pressure of acquiring clinical skills while trying not to make mistakes that could harm patients. In the OB-GYN analysis, 88 percent of the first-year residents studied were women, matching the current composition of the United States resident population in the field. More than 1,270 of them completed standardized depression screening tests and other surveys both before and during their intern year, providing a before-and-after picture of how the training environment reshapes mental health.

Elena Frank, director of the Intern Health Study and an associate research scientist at the Michigan Neuroscience Institute, explained that the analysis identified several factors most closely related to changes in depressive symptom scores between the pre-internship survey and those taken during training. Some of these factors predated residency entirely: a self-reported history of depression, depression symptoms present before the internship began, and higher scores on the personality trait known as neuroticism. Others were rooted in the training experience itself, including fewer sleep hours, higher work hours, and involvement in medical errors. The distinction matters for prevention, because while individual vulnerability cannot easily be changed, the structural features of residency, scheduling, workload, and error support systems, are within the control of program directors and training institutions.

Broader findings from the Intern Health Study reinforce the role of sleep and scheduling. Previous analyses have shown a higher risk of developing depression during the intern year among physicians with irregular sleep patterns and among those who work longer hours or more unpredictable schedules. There are, however, encouraging trends in the overall data. As hospitals that run residency programs and the national organizations that govern training have revised work hour rules and added support options, depressive symptoms still increase during intern year for many trainees, but the average size of that increase has decreased by 24 percent over time. Notably, this improvement has occurred more slowly in surgical training programs, a category that includes obstetrics and gynecology, suggesting that the specialty’s particular demands may require targeted interventions rather than one-size-fits-all reforms.

The study data were collected between 2009 and 2024, and the research effort is still expanding. In August 2026, in partnership with the HERO project, more than 500 prior OB-GYN intern participants completed follow-up surveys assessing their recent work and family experiences and well-being. More than 60 practicing OB-GYNs who completed the survey have volunteered to take part in interviews about their experiences since training. Frank, who is also a co-investigator on the HERO Project, said the data are still being gathered and analyzed. She also noted that the model is exportable: other medical and surgical specialties could partner with the Intern Health Study team to collect specialty-specific data in the same way the OB-GYN team did, allowing each field to understand its own unique stressors and retention challenges.

Beyond resident mental health, the HERO team is examining how the OB-GYN workforce has been affected by reproductive health policy decisions at the state and federal level, including the mental health and legal strain those decisions impose and the potential for supportive interventions tailored by region. The team recently published findings in the Journal of Women’s Health showing substantial geographic variation in the conditions under which members of the specialty are expected to deliver care. Those differences include baseline population health, access constraints, and system-level pressures. The researchers found that these conditions, and outcomes for patients, varied particularly based on policies related to reproductive care as well as rurality, meaning that two equally skilled OB-GYNs may face radically different professional environments depending on where they practice.

The HERO Project’s other research efforts are currently under way with support from philanthropic funding, and partners at hospitals, medical schools, and clinics across the country are participating. The OB-GYN intern analysis itself was supported by the Josiah Macy Jr. Foundation, while the Intern Health Study was originally supported by the National Institute of Mental Health, part of the National Institutes of Health. In addition to Morgan, Winkel, and Frank, the study’s authors include Julia Rossi, Zhuo Zhao, Karina Pereira-Lima, and Srijan Sen, the Intern Health Study’s principal investigator, who directs the Eisenberg Family Depression Center at the University of Michigan. Taken together, the work paints a picture of a specialty at a crossroads: a workforce that is overwhelmingly female, chronically stretched, and disproportionately exposed to policy turbulence, entering training with a one-in-three risk of depression and a help-seeking rate that lags far behind the need. The researchers’ message to the institutions that train these physicians is straightforward. Automatic, universal mental health support, rather than a system that waits for residents to ask for help, could protect both the physicians of tomorrow and the patients who will depend on them.

Subject of Research: Depression and mental health among first-year obstetrics and gynecology residents in the United States

Article Title: Depression in OB-GYN residents needs more attention, study suggests

Article References: Depression in OB-GYN residents needs more attention, study suggests. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: OB-GYN residents, depression, intern year, physician mental health, residency training, HERO Project, Intern Health Study, workforce shortage, reproductive health policy, sleep deprivation, medical errors, women in medicine

Emergency department crowding occurs when the number of patients arriving at a hospital exceeds the number of available inpatient beds to which they can be admitted. The result is a bottleneck: patients who need admission remain in the emergency department, often boarding in hallways, while new arrivals compete for limited treatment space. Crowding is associated with treatment delays, medication errors, and worse clinical outcomes, and it has worsened nationally as hospitals operate with razor-thin inpatient capacity. The Penn-led team approached the problem from a distinctive angle. Rather than measuring crowding solely through administrative data, they asked the people who experience hospital capacity firsthand, the nurses themselves, whether their units had enough staff to get the work done, and then linked those reports to objective emergency department performance measures across a large multi-state sample.

The scale of the analysis is notable. Drawing on survey and administrative data from 410 hospitals across ten states, the researchers examined how nurse-reported staffing inadequacy in both emergency departments and inpatient units correlated with three key indicators: overall patient length of stay in the emergency department, length of stay for patients presenting with behavioral health conditions, and the percentage of patients who left before being seen by a provider. These measures are widely used benchmarks of emergency care quality, and the Joint Commission recommends that hospitals keep the leave-without-being-seen rate below 2 percent and behavioral health length of stay under 4 hours. The average hospital in the study failed both benchmarks, with 2.8 percent of patients leaving without being seen and behavioral health patients waiting an average of 5.5 hours.

The statistical associations the team uncovered were striking in their consistency. A one standard deviation increase in emergency department nurse staffing inadequacy was associated with an 18-minute increase in emergency department length of stay for patients being observed for behavioral health conditions, a 9-minute increase in overall patient length of stay, and a 0.4 percentage point increase in the proportion of patients leaving before being seen by a provider. In a system handling millions of visits annually, shifts of this magnitude translate into enormous cumulative delays. A 9-minute increase in average length of stay may sound modest for any single patient, but multiplied across every patient in a busy department every day, it compounds into hours of added queue time that push waiting rooms past their physical and clinical limits.

Perhaps the most consequential finding concerns the inpatient side of the hospital. The study found that staffing inadequacy reported by nurses working on inpatient units was associated with an 18-minute increase in emergency department length of stay for patients presenting with behavioral health conditions. This detail matters because it underscores that emergency department crowding is not confined to the emergency department itself. When inpatient units lack enough nurses to safely staff their beds, admitted patients cannot be transferred out of the emergency department in a timely way, and the entire flow of the hospital backs up. Jane Muir, PhD, MSHP, RN, Assistant Professor in the Department of Family and Community Health and CHOPR core faculty, who served as first author, framed the mechanism plainly: crowding occurs when hospitals do not have enough resources to admit patients into a bed, whether in the emergency department or on inpatient units.

The prevalence of the problem is itself a headline. More than 60 percent of emergency department nurses and 58 percent of inpatient nurses in the study reported that there were not enough staff to get the work done in their hospital. These are not marginal shortfalls at a handful of struggling institutions; they describe the typical condition of American hospital nursing. Muir stated that nurses are caring for more patients than they can safely manage, and that the findings suggest high nurse workloads are contributing to excessive delays in emergency department care. Her formulation of the capacity problem has already resonated widely in health policy circles: a hospital bed without a nurse to staff it is not an available bed. In other words, counting licensed beds or physical infrastructure dramatically overstates the true admission capacity of a hospital whose nursing workforce is stretched thin.

What distinguishes this study from much of the prior literature on staffing is its forward-looking, quantitative projection of what improvement would achieve. The researchers modeled the effect of funding additional bedside nurse positions across the 410 study hospitals and estimated that improving nurse staffing adequacy would be associated with more than 5,000 additional patients treated, due to shorter emergency department lengths of stay, and more than 250 patients retained in care who would otherwise have left the waiting room before being seen. Those retained patients represent a particularly important population, because people who leave without being seen frequently include those with time-sensitive conditions, and their departure represents both a clinical risk and a lost opportunity for early intervention. The projection suggests that staffing investment functions, in effect, as added emergency care capacity without constructing a single new room.

The policy implications extend into ongoing national debates about minimum staffing standards. Muir emphasized that hospitals can create more funded positions for bedside nurses to alleviate chronic understaffing conditions and solve long wait times in emergency departments, adding that the study emphasizes that safe nurse staffing matters to move the needle on safer, timelier care for the public. The findings align with a growing body of work from the same research group, including studies linking better nurse staffing to shorter emergency department boarding times and evidence-based safe minimum nurse staffing requirements developed from Pennsylvania hospital data. Together, this research program builds a case that staffing adequacy is among the most modifiable determinants of hospital performance, one that administrators and legislators can act on directly rather than treating crowding as an inevitable consequence of patient demand.

The study was supported by the National Institute of Nursing Research of the National Institutes of Health under award numbers R01NR014855, T32NR007104, and R01NR021707, reflecting sustained federal investment in the science of nurse staffing and patient outcomes. Co-authors include Linda H. Aiken, Daniela Golinelli, Karen B. Lasater, and Matthew D. McHugh, all of Penn Nursing’s Center for Health Outcomes and Policy Research, a group whose decades of survey-linked outcomes research have repeatedly connected nurse work environments to patient survival, readmission rates, and now emergency care timeliness. For hospital leaders weighing budget priorities, the message of this study is unusually actionable: every unfilled nursing position is not simply a human resources gap but a quantifiable source of waiting room delay, and funding those positions may be one of the most cost-effective strategies available for restoring timely access to emergency care.

Subject of Research: The relationship between hospital nurse staffing adequacy and emergency department crowding, length of stay, and patients leaving without being seen

Article Title: Safer nurse workloads could alleviate emergency department crowding

Article References: Safer nurse workloads could alleviate emergency department crowding. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: emergency department crowding, nurse staffing, nurse workload, patient length of stay, behavioral health, hospital capacity, boarding, Penn Nursing, Medical Care, health policy, patient outcomes, workforce shortage

The study, published in Global Surgical Education, the journal of the Association for Surgical Education, set out to answer a deceptively simple question: can a validated instrument for tracking operative trust, originally built for general surgery, work in an environment where every case is long, complex, and uniformly life-or-death? The answer, according to the research team led by Megan L. Schultz and Gurjit Sandhu, is a resounding yes—and the data they gathered reveal just how tightly trust and hands-on opportunity are linked.

The stakes could hardly be higher. Cardiac surgery training is in trouble. Work-hour restrictions, heightened patient safety concerns, and growing scrutiny of surgical outcomes have all chipped away at the traditional model of graded responsibility, in which trainees earn progressively more independence as their skills mature. Meanwhile, the patients themselves have changed: advances in interventional cardiology mean that the straightforward teaching cases of previous generations are increasingly rare, and those who do reach the operating table carry more comorbidities than ever. Cardiac surgery, as a leader in outcomes transparency, has felt these pressures acutely.

The consequences are measurable. Many cardiothoracic trainees now graduate without routinely performing common procedures such as off-pump coronary artery bypass grafting or mitral valve repair. More than half of recent graduates report insufficient exposure to minimally invasive, robotic, and congenital cardiac operations. In 2024, more than a quarter of examinees failed the thoracic oral board certification exam on their first attempt—the highest failure rate in more than a decade. Layered on top of this is a looming workforce crisis: the Health Resources and Services Administration projects a 34 percent shortage of cardiothoracic surgeons in the United States by 2037. Against that backdrop, understanding how trust is built—or withheld—in the operating room becomes a matter of national workforce planning, not just pedagogy.

The instrument at the heart of the study is called OpTrust, a tool previously validated in general, vascular, and plastic surgery. It measures two intertwined phenomena: faculty entrustment, the willingness of the attending surgeon to delegate, and trainee entrustability, the behaviors the trainee displays that warrant that delegation. Raters score five behavioral domains—the types of questions asked, the operative plan, instruction, problem solving, and trainee leadership—on a scale from 1, indicating low entrustability, to 4, indicating full entrustability. Because prior work has shown the five domains collapse into a single construct, the scores are averaged into one number for each surgeon and trainee, then combined into a total dyad score ranging from 1 to 7, where 7 means the trainee operated autonomously.

What makes the new work distinctive is the Cardiac OpTrust supplement, a specialty-specific addition that grounds those abstract trust scores in fifteen concrete surgical benchmarks drawn from the shared sequence of nearly every cardiac operation using cardiopulmonary bypass. The benchmarks run from incision and sternotomy through internal mammary artery harvest, cannulation stitches, heparin administration, aortic cannulation, initiation of bypass, application and removal of the cross-clamp, cessation of bypass, protamine administration, decannulation, chest tube placement, and closure. For each benchmark, a trained third-party observer simply recorded who performed it: the faculty surgeon or the trainee. That binary record, stacked against the trust scores, turns the rhythm of a cardiac case into a granular map of autonomy.

Between November 2022 and June 2023, trained research assistants observed forty-nine elective cardiac operations at the University of Michigan, a large quaternary care academic medical center. The raters underwent standardized training and had to achieve at least 80 percent interrater reliability before collecting data independently. They observed from incision until the attending surgeon left the room, scoring faculty and trainees simultaneously but independently. The observed cases included twenty mitral or tricuspid valve repairs or replacements, twenty aortic valve or aortic root operations, eight coronary bypass grafting cases, and one combined bypass and mitral repair, generating scores for twenty-six unique faculty-trainee pairings drawn from twelve trainees and seven attending surgeons.

The results were strikingly consistent. Mean faculty entrustment was 2.46 on the four-point scale, mean trainee entrustability 2.47, and mean total dyad entrustment 3.93 on the seven-point scale, with trainees completing an average of 8.33 of the fifteen benchmarks per case. Crucially, entrustment scores were significantly higher for benchmarks the trainee completed than for those the attending kept. Spearman’s rank correlation confirmed strong positive associations between trainee benchmark completion and faculty entrustment, trainee entrustability, and total entrustment, with correlation coefficients of 0.66, 0.62, and 0.65 respectively.

Poisson regression quantified the relationship with even sharper precision. Each one-unit increase in faculty entrustment corresponded to a 32 percent increase in the number of benchmarks performed by the trainee, rising from an expected 5.36 benchmarks at low entrustment to 12.61 at full entrustment. Each unit increase in trainee entrustability behaviors predicted a 36 percent increase, from 5.17 to 13.00 benchmarks. And each unit increase in total dyad entrustment predicted a 16 percent increase, from 5.17 to 13.02. All associations were statistically significant at p less than 0.001. In plain terms: when trust goes up, the scalpel changes hands far more often.

Two benchmarks—protamine administration and cessation of cardiopulmonary bypass—did not reach statistical significance, though they followed the same trend. The authors note that these two tasks uniquely capture leadership and team management rather than pure technical skill, hinting at a fascinating distinction: entrusting a trainee to sew may be psychologically different from entrusting a trainee to direct the perfusionist, anesthesiologist, and nurses through the delicate transition off the heart-lung machine. Whether the principles of entrustment extend to these so-called soft skills remains an open question for future research.

The study’s limitations are candidly acknowledged. It was a single-institution pilot, so variability across cases, participants, and centers may shape how Cardiac OpTrust performs elsewhere. All faculty observed were male, reflecting the composition of the department at the time, while 51 percent of trainees were female—programs with different demographics may show different patterns. The tool also demands significant human resources, since it relies on independent raters physically present in the operating room. That investment, however, buys something self-report tools like SIMPL and Zwisch cannot: real-time, third-party observation free of recall bias. Previous work suggests the observer’s presence does not disrupt the operative experience, and the Hawthorne effect, while impossible to eliminate entirely, appears limited.

There is also an important conceptual caveat: OpTrust measures entrustment, not technical proficiency. A trainee may be handed tasks without being competent, or possess skill without being granted autonomy. The binary benchmark design records who performed each step, not how well. Still, because greater entrustment has been linked to operative performance in prior studies, optimizing trust in the cardiac operating room may yield tangible benefits for trainee competency and confidence. The benchmarks also deliberately exclude skills performed during the cross-clamp period, such as distal anastomoses in bypass grafting, since the pilot’s case volume was insufficient to draw meaningful conclusions about case-specific techniques; future iterations may add them.

The timing of this work is significant for structural reasons as well. Accredited general surgery programs have already integrated Entrustable Professional Activities into their curricula, vascular surgery programs are following, and cardiothoracic programs will likely face the same transition toward competency-based training soon. Tools like Cardiac OpTrust could provide the measurement backbone for that shift, replacing crude case counts with nuanced, behaviorally anchored assessments of when and why trainees are actually allowed to operate.

For now, the message from Ann Arbor is both simple and quietly radical: trust in the operating room is not an ineffable chemistry but an observable, countable phenomenon—and it can be studied, taught, and perhaps deliberately cultivated. As the authors argue, trainees can even use the OpTrust behavioral descriptions as a roadmap, incorporating the specific behaviors that signal readiness for greater independence. With further multi-center validation, the moment-by-moment choreography of trust in the cardiac operating room may finally become something educators can see, measure, and improve—one sternotomy, one cannulation, one cross-clamp at a time.

Subject of Research: Measuring intraoperative entrustment and trainee autonomy in cardiac surgery operating rooms

Article Title: Understanding and measuring intraoperative entrustment in the cardiac surgery operating room

Article References: Schultz, M. L., Theall, A. C. P., Ozuna-Harrison, R., Buchanan, D., Tubbs, D., Evans, J., Matusko, N., Bolling, S. F., & Sandhu, G. (2026). Understanding and measuring intraoperative entrustment in the cardiac surgery operating room. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 193. https://doi.org/10.1007/s44186-026-00595-3

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00595-3

Keywords: cardiac surgery, surgical education, entrustment, trainee autonomy, OpTrust, operating room, cardiopulmonary bypass, competency-based training, surgical benchmarks, faculty-trainee dyad, psychometrics, workforce shortage