Self-monitoring accuracy does not increase throughout undergraduate medical education

Context: Accurate self-assessment of one's performace on a moment-by-moment basis (ie, accurate self-monitoring) is vital for the self-regulation of practising physicians and indeed for the effective regulation of self-directed learning during medical education. However, little is currently known about the functioning of self-monitoring and its co-development with medical knowledge across medical education. This study is the first to simultaneously investigate a number of relevant aspects and measures that have so far been studied separately: different measures of self-monitoring for a broad area of medical knowledge across 10 different performance levels. Methods: This study assessed the self-monitoring accuracy of medical students (n = 3145) across 10 semesters. Data collected during the administration of the formative Berlin Progress Test Medicine (PTM) were analysed. The PTM comprises 200 multiple-choice questions covering all major medical disciplines and organ systems. A self-report indicator (ie, confidence) and two behavioural indicators of self-monitoring accuracy (ie, response time and the likelihood of changing an initial answer to a correct rather than an incorrect item) were examined for their development over semesters. Results: Analyses of more than 390 000 observations (of approximately 250 students per semester) showed that confidence was higher for correctly than for incorrectly answered items and that 86% of items answered with high confidence were indeed correct. Response time and the likelihood of the initial answer being changed were higher when the initial answer was incorrect than when it was correct. Contrary to expectations, no differences in self-monitoring accuracy were observed across semesters. Conclusions: Convergent evidence from different measures of self-monitoring suggests that medical students self-monitor their knowledge on a question-by-question basis well, although not perfectly, and to the same degree as has been found in studies outside medicine. Despite large differences in performance, no variations in self-monitoring across semesters (with the exception of the first semester) were observed

What does the best interests principle of the convention on the rights of the child mean for paediatric healthcare?

The present review analyses the implications of the best interests of the child principle, which is one of the most widely discussed principles of medical ethics and human rights, for paediatric healthcare. As a starting point, it presents the interpretation of the best interests principle by the United Nations Committee on the Rights of the Child. On this basis, it points out possible fields of application of the best interests principle with regard to paediatric healthcare and discusses the potential difficulties in the application of the best interests principle. Based on this, it illustrates the implications of the best interests principle for paediatric healthcare through four case studies, which look at ethical dilemmas in paediatric gynaecology, end-of-life care, HIV care and genetic testing. Conclusion: The best interests principle requires action, inter alia, by health policymakers, professional associations, hospital managers and medical teams to ensure children receive the best possible healthcare. Whilst the best interests principle does not provide a conclusive solution to all ethical dilemmas in paediatric healthcare (as illustrated by the case studies), it provides children, medical teams, parents and families, and clinical ethicists with an indispensable framework for health care centred on the rights of the child. What is Known: • The best interests principle is one of the most widely discussed principles of medical ethics and human rights and one of the four general principles of the Convention on the Rights of the Child. What is New: • The present review discusses possible fields of application and potential difficulties of the best interests principle with regard to paediatric healthcare. • Based on this, it illustrates the implications of the best interests principle for paediatric healthcare through four case studies, which look at ethical dilemmas in paediatric gynaecology, end-of-life care, HIV care and genetic testing. Keywords: Best interests principle; Children’s rights; Convention on the Rights of the Child; Human rights in paediatrics; Paediatric ethics; Shared decision-making

Benchmark of FEM, Waveguide and FDTD Algorithms for Rigorous Mask Simulation

An extremely fast time-harmonic finite element solver developed for the transmission analysis of photonic crystals was applied to mask simulation problems. The applicability was proven by examining a set of typical problems and by a benchmarking against two established methods (FDTD and a differential method) and an analytical example. The new finite element approach was up to 100 times faster than the competing approaches for moderate target accuracies, and it was the only method which allowed to reach high target accuracies.Comment: 12 pages, 8 figures (see original publication for images with a better resolution

Resource allocation in the Covid-19 health crisis:are Covid-19 preventive measures consistent with the Rule of Rescue?

Abstract The Covid-19 pandemic has led to a health crisis of a scale unprecedented in post-war Europe. In response, a large amount of healthcare resources have been redirected to Covid-19 preventive measures, for instance population-wide vaccination campaigns, large-scale SARS-CoV-2 testing, and the large-scale distribution of protective equipment (e.g., N95 respirators) to high-risk groups and hospitals and nursing homes. Despite the importance of these measures in epidemiological and economic terms, health economists and medical ethicists have been relatively silent about the ethical rationales underlying the large-scale allocation of healthcare resources to these measures. The present paper seeks to encourage this debate by demonstrating how the resource allocation to Covid-19 preventive measures can be understood through the paradigm of the Rule of Rescue, without claiming that the Rule of Rescue is the sole rationale of resource allocation in the Covid-19 pandemic

Blacklisting Health Insurance Premium Defaulters: Is Denial of Medical Care Ethically Justifiable?

Rising health insurance costs and the cost of living crisis are likely leading to an increase in unpaid health insurance bills in many countries. In Switzerland, a particularly drastic measure to sanction defaulting insurance payers is employed. Since 2012, Swiss cantons – who have to cover most of the bills of defaulting payers - are allowed by federal law to blacklist them and to restrict their access to medical care to emergencies.In our paper, we briefly describe blacklisting in the context of the Swiss healthcare system before we examine the ethical issues involved in light of what is known about its social and health impacts. We found no evidence that blacklisting serves as an effective way of recovering unpaid health insurance contributions or of strengthening solidarity within the health insurance system. Furthermore, the ambiguous definitions of what constitutes an emergency treatment and the incompatibility of the denial of medical care with the obligation to provide professional assistance complicate the implementation of blacklists and expose care providers to enormous pressure.Therefore, we conclude that blacklists and the (partial) denial of medical care not only pose profound ethical problems but are also unsuitable for fulfilling the purpose for which they were introduced

Monkeypox, bioethics and the LGBTQI+ community

The COVID-19 pandemic has been a challenging time for different communities, including the LGBTQI+ (lesbian, gay, bisexual, transgender, queer, intersex, and other gender identities and sexual orientations) community, and has sharpened health inequalities already present before the pandemic. In his report to the United Nations General Assembly of 28 July 2020, the United Nations Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity, Victor Madrigal-Borloz, provided a detailed overview of ways in which the COVID-19 pandemic has affected the LGBTQI+ community [1]. Stay-at-home policies, quarantine and isolation, and social stress have severely increased their risk of victimization, particularly in the case of LGBTQI+ people living with unsupportive family members. In several countries, including, e.g., the United States, Turkey, Georgia, Ghana and Malaysia, powerful religious and political leaders have blamed LGBTQI+ persons for the COVID-19 pandemic, which has led to a sharp rise in (online) hate speech. In Uganda, lockdown policies have been instrumentalised for a crackdown on the LGBTQI+ community [1]. The mental health of many LGBTQI+ persons has also significantly deteriorated in many countries; in the US, for example, 50.0% of LGBTQI+ adult respondents in the US Census Bureau’s March – May 2022 Household Pulse Survey reported symptoms of anxiety (compared to 24.3% of non-LGBTQI+ adults) and 41.6% symptoms of depression (compared to 19.4% of non-LGBTQI+ adults) [2]

Association between the A-2518G polymorphism in the monocyte chemoattractant protein-1 gene and insulin resistance and Type 2 diabetes mellitus

Aims/hypothesis: The molecular mechanisms of obesity-related insulin resistance are incompletely understood. Macrophages accumulate in adipose tissue of obese individuals. In obesity, monocyte chemoattractant protein-1 (MCP-1), a key chemokine in the process of macrophage accumulation, is overexpressed in adipose tissue. MCP-1 is an insulin-responsive gene that continues to respond to exogenous insulin in insulin-resistant adipocytes and mice. MCP-1 decreases insulin-stimulated glucose uptake into adipocytes. The A-2518G polymorphism in the distal regulatory region of MCP-1 may regulate gene expression. The aim of this study was to investigate the impact of this gene polymorphism on insulin resistance. Methods: We genotyped the Ludwigshafen Risk and Cardiovascular Health (LURIC) cohort (n=3307). Insulin resistance, estimated by homeostasis model assessment, and Type 2 diabetes were diagnosed in 803 and 635 patients respectively. Results: Univariate analysis revealed that plasma MCP-1 levels were significantly and positively correlated with WHR (p=0.011), insulin resistance (p=0.0097) and diabetes (p<0.0001). Presence of the MCP-1 G-2518 allele was associated with decreased plasma MCP-1 (p=0.017), a decreased prevalence of insulin resistance (odds ratio [OR]=0.82, 95% CI: 0.70-0.97, p=0.021) and a decreased prevalence of diabetes (OR=0.80, 95% CI: 0.67-0.96, p=0.014). In multivariate analysis, the G allele retained statistical significance as a negative predictor of insulin resistance (OR=0.78, 95% CI: 0.65-0.93, p=0.0060) and diabetes (OR=0.80, 95% CI: 0.66-0.96, p=0.018). Conclusions/interpretation: In a large cohort of Caucasians, the MCP-1 G-2518 gene variant was significantly and negatively correlated with plasma MCP-1 levels and the prevalence of insulin resistance and Type 2 diabetes. These results add to recent evidence supporting a role for MCP-1 in pathologies associated with hyperinsulinaemi