Postgrad Med J
· 2026 May · PMID 42213525
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PURPOSE OF THE STUDY: To conduct a comprehensive bibliometric analysis of publications in the Postgraduate Medical Journal from 1927 to 2025, examining publication trends, citation impact, authorship characteristics, ins...PURPOSE OF THE STUDY: To conduct a comprehensive bibliometric analysis of publications in the Postgraduate Medical Journal from 1927 to 2025, examining publication trends, citation impact, authorship characteristics, institutional productivity, international collaborations, and thematic evolution. STUDY DESIGN: Bibliometric analysis of publications indexed in SCOPUS. Data were retrieved and analysed using established bibliometric tools to evaluate publication output, document types, citation patterns, contributing countries and institutions, collaborative networks, and keyword-based thematic trends. RESULTS: A total of 18,169 publications were identified, receiving 210,317 citations, with an average of 11.57 citations per paper. Research articles accounted for the majority of publications (67.81%), followed by review articles (13.18%). Although fewer in number, review articles demonstrated nearly threefold higher citation impact compared with research articles. The United Kingdom contributed the highest number of publications, while increasing contributions from more than 100 countries, particularly the United States, India, and China, reflected the journal's expanding international reach. Keyword and thematic analyses highlighted major research focus areas including medical education, chronic diseases, and clinically oriented research topics. CONCLUSIONS: The Postgraduate Medical Journal has maintained a strong and sustained scholarly influence over nearly a century of publication. Its evolving international collaborations and broad thematic coverage underscore its continuing importance in postgraduate medical education and clinically relevant research worldwide.
Postgrad Med J
· 2026 May · PMID 42213512
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BACKGROUND: Over the past century, medical education has undergone a profound transformation, evolving from unregulated apprenticeships into a highly structured, competency-based continuum of lifelong learning. This revi...BACKGROUND: Over the past century, medical education has undergone a profound transformation, evolving from unregulated apprenticeships into a highly structured, competency-based continuum of lifelong learning. This review delineates the centenary changes in global medical education, highlighting the structural, pedagogical, and philosophical milestones that have shaped the modern healthcare workforce. METHODS: A comprehensive narrative review of historical and contemporary medical education literature was conducted. Electronic databases including PubMed, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed articles, policy declarations, and historical texts published between 1910 and 2025. Search strategies utilized Medical Subject Headings and keywords such as "history of medical education," "competency-based education," "social accountability," "curriculum reform," and "artificial intelligence." RESULTS: The 1910 Flexner Report established the biomedical university-based model, which dominated the 20th century but inadvertently created rigid departmental silos. Subsequent reforms dismantled these silos in favor of integrated, problem-based learning. The 1988 Edinburgh Declaration and the 2010 Lancet Commission catalyzed a paradigm shift toward social accountability, systems-based practice, and Competency-Based Medical Education. Concurrently, regional trajectories in India, Africa, Asia, and Latin America highlight the post-colonial push for standardized, socially responsive curricula. Today, the integration of artificial intelligence and immersive simulations offers unprecedented opportunities for personalized learning, though it presents socio-technical challenges, including the digital divide and algorithmic bias. Additionally, academic medicine faces a crisis in preserving the physician-scientist identity amidst shifting evaluation metrics. CONCLUSION: To produce an agile workforce capable of meeting the complex epidemiological demands of 2050, medical education must harmonize relentless technological innovation with the humanistic imperative of socially accountable, equitable patient care.
Postgrad Med J
· 2026 May · PMID 42213511
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Emergency presentations in cancer patients have increased mortality higher admission rates and longer lengths of inpatient stay than non-cancer patients. There are an increasing number of acute cancer presentations that...Emergency presentations in cancer patients have increased mortality higher admission rates and longer lengths of inpatient stay than non-cancer patients. There are an increasing number of acute cancer presentations that can be risk assessed for care in an ambulatory emergency setting. Patients with febrile neutropenia are a heterogenous group with a minority developing significant potentially life-threatening complications. Risk assessment tools, such as the Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia scores have been developed to stratify adult patients with febrile neutropenia. Management of patients with low-risk febrile neutropenia in an outpatient setting is safe and effective. Intravenous and oral antibiotic therapies have been proven to be equally effective in patients with low-risk febrile neutropenia. Combined chemotherapy/immune checkpoint inhibitor (ICI) therapy is increasingly standard of care for a range of cancers. Febrile neutropenia is a common emergency presentation in patients treated with chemotherapy/ICI therapy. Patients receiving chemotherapy/ICI therapy could have more severe presentations with febrile neutropenia illustrated by lower MASCC scores, higher NEWS2 scores, and longer lengths of stay. This may necessitate greater caution in ambulatory management for this cohort. ICI-related neutropenia is a rare adverse event. Early recognition of ICI-related neutropenia in patients treated with chemotherapy/ICI therapy is challenging with the vast majority driven by chemotherapy. Modelling of ambulatory emergency oncology services, such as those for low-risk febrile neutropenia, will be dependent on local service deliveries and pathways, but are key for providing high quality, personalized and sustainable emergency oncology care. Bullet Points There are an increasing number of acute cancer presentations that can be risk assessed for care in an ambulatory emergency setting. Patients with neutropenic fever are a heterogenous group with a minority developing potentially life-threatening complications. Management of patients with low-risk febrile neutropenia in an outpatient setting is safe and effective. Patients receiving chemotherapy/ICI therapy could have more severe febrile neutropenia presentations illustrated by lower MASCC and, higher NEWS2 scores, and longer lengths of stay. Modelling of acute ambulatory oncology services are dependent on local service pathways, but are key for providing high quality, personalized and sustainable acute oncology care.
Postgrad Med J
· 2026 May · PMID 42210670
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PURPOSE: Tracheostomy-associated bleeding is an uncommon but potentially fatal complication. This review outlines its incidence, risk factors, diagnostic approach, management, and prevention, emphasizing early recognitio...PURPOSE: Tracheostomy-associated bleeding is an uncommon but potentially fatal complication. This review outlines its incidence, risk factors, diagnostic approach, management, and prevention, emphasizing early recognition of tracheo-innominate artery fistula (TIF). METHODS: Relevant literature from 2000-2025 was reviewed using PubMed and surgical databases, focusing on studies describing tracheostomy-related hemorrhage and TIF. RESULTS: Post-tracheostomy bleeding occurs in 0.6-5% of patients, most often from minor stomal sources. TIF, though rare (<1%), remains the deadliest complication, with mortality over 60%. Major risk factors include low tracheostomy placement, excessive cuff pressure, infection, radiation, and anticoagulant use. Sentinel bleeding precedes 30-50% of TIF events and signals impending catastrophe. Diagnosis relies on prompt bronchoscopy and CT angiography. Management ranges from local control to endovascular or surgical repair. Preventive strategies-meticulous technique, cuff pressure monitoring, and multidisciplinary tracheostomy care-significantly reduce risk. CONCLUSIONS: Early identification of sentinel bleeds, rapid airway control, and adherence to standardized protocols are crucial to prevent fatal hemorrhage. Continuous vigilance and team-based care can markedly improve outcomes in tracheostomy management.
Postgrad Med J
· 2026 May · PMID 42165176
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Modern care is increasingly delivered across multiple teams, settings, and digital systems rather than within stable relationships or places. Responsibility for review, follow-up, and action often passes between clinicia...Modern care is increasingly delivered across multiple teams, settings, and digital systems rather than within stable relationships or places. Responsibility for review, follow-up, and action often passes between clinicians who were not present at the original decision. In that context, time becomes part of the intervention, not merely its backdrop.
Postgrad Med J
· 2026 May · PMID 42165163
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Advances in genomic and epigenetic research are reshaping how disease risk is identified and understood. The recent Mendelian randomization study by Zhang et al. investigating links between circadian rhythm-related genes...Advances in genomic and epigenetic research are reshaping how disease risk is identified and understood. The recent Mendelian randomization study by Zhang et al. investigating links between circadian rhythm-related genes and coronary artery disease highlights how multi-omic approaches can identify plausible pathways linking molecular regulation to clinical pathology. At the same time, our ever-growing understanding of risk markers raises broader questions about how such variables are translated into clinical practice. Genetic or epigenetic indicators of risk may carry psychological and social implications for patients, particularly when their significance remains uncertain. As precision medicine advances, we must become comfortable with the communication of uncertainty and ensure that we remain attuned to the lived experience of the patients we treat.
Postgrad Med J
· 2026 May · PMID 42160214
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Large language models (LLMs) are increasingly used to generate multiple-choice questions (MCQs) in medical education. We conducted a systematic review following PRISMA 2020, searching PubMed, Web of Science, Scopus, and...Large language models (LLMs) are increasingly used to generate multiple-choice questions (MCQs) in medical education. We conducted a systematic review following PRISMA 2020, searching PubMed, Web of Science, Scopus, and ERIC through 15 February 2026. Two reviewers independently screened 1352 records, extracted data and assessed methodological quality using the Joanna Briggs Institute checklist. Findings were synthesized according to Messick's five sources of validity evidence. Seventy-one studies from 24 countries were included. Most relied on expert review rather than learner-based testing. All studies reported content evidence, whereas fewer addressed relations to other variables (40/71), response process (35/71), internal structure (31/71) or consequences (25/71). Error rates ranged from <1% to 45%. Median item difficulty was 0.67 and discrimination 0.28, with reliability between 0.51-0.81. Studies reported substantial efficiency gains, including up to 31-fold time savings. LLMs appear useful drafting tools but current evidence does not yet support unsupervised use in summative assessment.
Postgrad Med J
· 2026 May · PMID 42149647
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BACKGROUND: Competency-Based Medical Education (CBME) relies on frequent, competency-focused assessments, which can be challenging to implement consistently. Artificial Intelligence (AI) holds promise to improve assessme...BACKGROUND: Competency-Based Medical Education (CBME) relies on frequent, competency-focused assessments, which can be challenging to implement consistently. Artificial Intelligence (AI) holds promise to improve assessment efficiency, objectivity, and feedback in CBME, but its use remains in early stages with limited understanding of current practices and evaluation methods. This study aims to map existing AI applications in CBME assessments to guide future work. METHODS: A comprehensive search was performed in MEDLINE (Ovid), EMBASE (Ovid), PsycINFO, and Scopus using tailored keywords and MeSH terms. Included studies focused on the deployment of AI for assessment within CBME, covering applications in generating, analyzing, or interpreting evaluation data across undergraduate, graduate, and continuing professional education. The PRISMA-ScR guidelines were used to ensure transparent reporting, and findings were synthesized following Levac et al.'s approach. RESULTS: Of the 1002 search results, 32 studies met the inclusion criteria. Key findings indicate a wide application of AI from surgical or procedural skill assessment, to clinical note assessment, communication assessment, feedback generation, projected trainee performance, and analysis of narrative feedback from supervisors. CONCLUSION: This review highlights potential advantages, such as timely evaluations, and challenges, such as lack of granularity, of AI integration. In conclusion, thoughtful integration of AI into competency-based medical education can complement traditional assessment methods and enhance learner outcomes, provided it is supported by robust infrastructure, ethical oversight, and collaborative policy development.
Morley E, Woods SA, Baron H
… +1 more, Patterson F
Postgrad Med J
· 2026 May · PMID 42127416
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PURPOSE OF THE STUDY: The Multi-Specialty Recruitment Assessment (MSRA) is a proctored assessment, comprising a clinical problem-solving (CPS) test and a situational judgement test (SJT), often combined with selection in...PURPOSE OF THE STUDY: The Multi-Specialty Recruitment Assessment (MSRA) is a proctored assessment, comprising a clinical problem-solving (CPS) test and a situational judgement test (SJT), often combined with selection interviews, for admission to multiple postgraduate medical specialty training programmes in the UK. The study examined the predictive validity of these selection assessments (i.e. the extent to which they effectively predicted later performance outcomes). STUDY DESIGN: Data were obtained from the UKMED dataset and analyzed for ten UK medical specialties (~13 000 unique applications) to explore relationships between selection data (CPS, SJT, and selection interview) and subsequent performance outcomes; Annual Review of Competence Progression (ARCP) and national professional examination scores, comprising Applied Knowledge Tests (AKTs) and Objective Structured Clinical Examinations (OSCEs). RESULTS: Results supported the predictive validity of the MSRA and interview scores with some evident trends across different criteria. For example, the CPS tended to be most predictive of the AKT performance, and the SJT (which assesses non-academic skills) tended to be more strongly predictive of OSCE than AKT performance. The predictive validity of the selection interviews beyond the MSRA varied by specialty. CONCLUSION: Results provide evidence of the predictive validity for both the MSRA and interviews across a range of specialties, providing insights into how best to design and combine different selection methods to balance key considerations such as reliability, validity, efficiency, and positive candidate feedback. The findings of this research also have implications for other healthcare selection settings. Key messages • What is already known on this topic - Previous research has already demonstrated that the MSRA shows predictive validity in the context of General Practice and Psychiatry selection, and has begun to explore the validity of the MSRA and interviews in further specialties. However, there is a lack of recent research exploring the predictive validity of MSRA in selection processes across other specialties, using a range of criterion measures and longitudinal performance outcomes, such as exam data. • What this study adds - The MSRA demonstrates validity with Annual Review of Competence Progression (ARCP) and national professional examination scores in postgraduate medical specialty training, across a range of different medical specialties. • How this study might affect research, practice, or policy - The results of this study can be used to inform future policy and decision making regarding the use of the MSRA alongside selection interviews and to enhance the reliability, validity, efficiency, and candidate experience for selection in future. Further, results provide valuable insights about the validity of such methods which may be informative to other settings internationally.
Cader FA, Lee WYS, Widodo WA
… +34 more, Shariff RER, Al-Omary MS, Gan G, Lee DPH, Vorn M, Lim F, Singh AO, Faisal H, Salehi N, Chimura M, Honda S, Ting TC, Sukahri SB, Arshad A, Sundran RM, Ulziisaikhan G, Lwin TZ, Thein TH, Tun KT, Maskey A, Wong B, Huma Z, Cuenza L, Cho DH, Hewarathna UI, Chang WT, Surunchupakorn P, Alali JY, Dat PT, Van Chien D, Keh YS, Tan JWC, Sen YM, Yap J
Postgrad Med J
· 2026 May · PMID 42113478
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BACKGROUND: Considerable diversity in cardiology training and credentialing pathways exist within the Asia-Pacific. We aimed to map these variations and report similarities and disparities with a view to understanding ne...BACKGROUND: Considerable diversity in cardiology training and credentialing pathways exist within the Asia-Pacific. We aimed to map these variations and report similarities and disparities with a view to understanding needs in cardiology curricula development in the region. METHODS: A 42-item online questionnaire was distributed to credentialed cardiologists serving as representatives from various regions within the Asia-Pacific, allowing obtainment of region-specific data as of December 2023. Responses were derived from a total of 23 regions. RESULTS: All regions required specialist qualification to practise cardiology. Overall, 69.6% have a single training pathway, while 21.7% and 8.7% have two or three pathways, respectively. Majority (91.3%) had structured cardiology training curricula with assigned supervisor and regular assessments. The majority (91.3%) required mandatory training in internal medicine prior to cardiology. The total training duration inclusive of medicine and cardiology varied across regions (range 3-8 years) with 26.1% lasting 5 years and 43.5% lasting 6 years. All programmes had mandatory clinical cardiology training; 82.6% had interventional cardiology, 73.9% had electrophysiology, 73.9% had cardiac imaging training. However, 47.8% of regions had no training in cardiac computerized tomography (CT) and 56.5% had no cardiac magnetic resonance (CMR) imaging. 73.9% required mandatory research for board certification. In addition, 95.1% had an exit exam at completion of training (local in 95% cases). Board certification was mandatory for general cardiology practise in 69.6% of regions. Separate subspeciality fellowships were mandatory in 73.9% of regions. CONCLUSIONS: Significant regional variations in cardiology training and credentialing pathways exist, presenting opportunities to harmonize and improve training metrics regionally. Key message What is already known on the topic? Cardiology training within the Asia-Pacific region has considerable variation in terms of duration, curriculum, training, and exit requirements. What this study adds? This study outlines the similarities and differences of cardiology training between different countries within the Asia-Pacific region. How this study might affect research, practise or policy? Results from this study provide insights that may inform the development of harmonized and contextually appropriate cardiology curricula in the Asia-Pacific region. Establishing common standards for cardiology training could facilitate a more uniform and coherent curriculum across Asia, ensuring consistency in trainee competencies and clinical practise.
Postgrad Med J
· 2026 May · PMID 42095727
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INTRODUCTION: Diabetic kidney disease (DKD), a chronic microvascular complication is leading cause of End Stage Kidney disease (ESKD). Reduction of ≥30% urinary albumin is recommended to slow ESKD progression. Remote Isc...INTRODUCTION: Diabetic kidney disease (DKD), a chronic microvascular complication is leading cause of End Stage Kidney disease (ESKD). Reduction of ≥30% urinary albumin is recommended to slow ESKD progression. Remote Ischemic conditioning (RIC) induces brief episodes of ischemia and reperfusion and has protective effect on various organs. The current study aims to explore the effects of RIC on albuminuria reduction in adults with type-2 Diabetes Mellitus. MATERIALS AND METHODS: In this double blind, sham controlled, Randomized Clinical Trial, we assigned 40 normotensive Diabetic adults with moderate and severely increased albuminuria to RIC group (n = 20) or Sham group (n = 20) weekly for 8 weeks. Primary outcome was reduction in albuminuria at the end of 8 weeks. Secondary outcomes were changes in serum creatinine, e-Glomerular Filtration Rate (eGFR), and HbA1c levels. RESULTS: The reduction in albuminuria at the end of 8 weeks was 37.9% [Median (IQR): -7.5, 43.9] in the RIC group while it increased by 1.10% (-5.6, 15.2) in the Sham group (P = 0.015). Significant reduction was noted in serum creatinine in RIC group from 1 to 0.83 mg/dl as compared to increase in Sham group from 0.97 to 1.1 mg/dl (P = 0.0004). The mean eGFR in the RIC group improved from 85 to 99 (ml/min/1.73m2) P = 0.0001). No significant change was detected in HbA1C levels. Mild pain was the only adverse effect noted in 10% in the RIC group and none in the Sham group. CONCLUSION: Among adults with DKD, treatment with RIC significantly reduced albuminuria and serum creatinine while improving the eGFR (CTRI/2024/09/074453).
Postgrad Med J
· 2026 May · PMID 42095606
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Chest pain remains one of the most common reasons for emergency department visits and cardiology consultations worldwide. Although structured diagnostic algorithms, such as the European Society of Cardiology, endorsed 0 ...Chest pain remains one of the most common reasons for emergency department visits and cardiology consultations worldwide. Although structured diagnostic algorithms, such as the European Society of Cardiology, endorsed 0 h/1 h approach, have greatly improved the triage of suspected myocardial infarction, they are designed to be applied only after the clinician has determined that the presenting symptoms may be cardiac in origin. This article focuses on that crucial pre-algorithmic step: helping clinicians recognize which symptom presentations truly warrant consideration for myocardial ischemia. By clarifying how clinical features such as symptom duration, electrocardiogram changes, and troponin kinetics relate to pathophysiology, we aim to support the early identification of potentially ischemic chest pain, before structured pathways are applied. Rather than offering an alternative to current algorithms, this work seeks to enhance their precision and applicability by reinforcing the clinical reasoning required to use them appropriately.
INTRODUCTION: Cancer survivors face a high burden of comorbidities which negatively influence long-term outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may augment these outcomes, but their role in this p...INTRODUCTION: Cancer survivors face a high burden of comorbidities which negatively influence long-term outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may augment these outcomes, but their role in this population remains understudied. METHODS: We conducted a literature review of randomized controlled trials, observational studies, retrospective cohort studies, pre-clinical trials, and reviews related to GLP-1 RAs and cancer survivors. RESULTS: We first delineate the GLP-1 RA mechanisms of action in glycemic control, inflammation, cardiovascular protection, neuroprotection, nephroprotection, and cancer proliferation. Then, we highlight the potential clinical benefits that these drugs could have in cancer survivors based on available studies, including metabolism, cardiovascular risk, lymphedema and mortality. Finally, we address ongoing safety concerns for GLP-1 RAs, particularly focusing on their potential use in cancer survivors. DISCUSSION: Given the limited evidence to date, further research is needed to evaluate the long-term benefits and safety of GLP-1 RA use in cancer survivors.