Newsletter_Medical_ethics_2023

JUNIOR DOCTORS
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Published by the Junior Doctors Network of the World Medical Association
The information, perspectives, and opinions expressed in this publication do not
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Network. WMA and WMA-JDN do not assume any legal liability or responsibility
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Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
ISSN (print) 2415-1122
ISSN (online) 2312-220X
Junior Doctors Leadership 2022-2023
CHAIRPERSON
DEPUTY
CHAIRPERSON
SECRETARY
SOCIO-MEDICAL
AFFAIRS OFFICER
EDUCATION
DIRECTOR
MEDICAL ETHICS
OFFICER
MEMBERSHIP
DIRECTOR
PUBLICATIONS
DIRECTOR
COMMUNICATIONS
DIRECTOR
IMMEDIATE PAST
CHAIRPERSON
Dr. Yassen Tcholakov
(Canada)
Dr. Marie-Claire Wangari
(Kenya)
Dr. Lekha Rathod
(India/Netherlands)
Dr. Pablo Estrella
(Spain)
Dr. Lwando Maki
(South Africa)
Dr. Uchechukwu Arum
(Nigeria/United Kingdom)
Dr. Sazi Nzama
(South Africa)
Page 2
Dr. Balkiss Abdelmula
(Tunisia/Germany)
Dr. Jihoo Lee
(Korea)
Dr. Jeazul Ponce H.
(Mexico/Spain)
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Editorial Team 2022−2023
Dr. Ireju
(Nigeria)
Dr. Bonnke Arunga
(Kenya)
Dr. Carol Kanghete
(Kenya)
Dr. Fatma
(Tunisia)
Dr. Jamie Colloty
(South Africa)
Dr. Michael Johnson
(UK)
Dr. Po-Chin Li
(Taiwan)
Dr. Parth Patel
(Malawi)
Dr. Rebecca Enejo
(Nigeria)
Dr. Maymona Choudry
(Philippines)
Page 3
Dr. Aqsa Shafique
(Pakistan)
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Table of Contents
TEAM OF OFFICIALS’CONTRIBUTIONS
06 Words from the JDN Chairperson
By Dr. Uchechukwu Arum (Nigeria/United Kingdom)
07 Words from the Medical Ethics Officer
By Dr. Jihoo Lee (Republic of Korea)
08 Words from the Medical Education Director
By Dr. Balkiss Abdelmoula(Tunisia/Germany)
09 Words from the Publications Director
By Dr: Jeazul Ponce Hernandez (Mexico/Spain)
10 Enhancing Holistic End-of-Life Care: Empowering Junior
Doctors through Comprehensive Medical Education and
Training
By Dr. Jihoo Lee (Republic of Korea)
12 Climate Change and Health in Medical Education
By Dr. Balkiss Abdelmoula(Tunisia/Germany)
Page 4
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Table of Contents
16 Revolutionizing Healthcare: The Role of Artificial
Intelligence in Modern Medicine
By Dr. Daniel Andrés Sierra García (Guatemala/Germany)
19 EthicalConsiderationsin the Age of MOOCs: Exploring the Role
of MassiveOpen Online Coursesin MedicalEducation
By Dr. Mahmoud Kamoun (Tunisia)
21 Mental Health of Physicians in Training
By Dr. ImenBouaziz (Tunisia/France)
24 Discrimination of Female Healthcare Workers
during COVID-19: A way forward to defeat this double burden
By Dr. Deena Mariyam (India/UAE)
27 Discrimination in the Workplace
By Manisha Jana and Dr. Dave Shravan (India)
31 Importance of Learning from the Community during Medical
School
By Dr. Chetan Agarwal and Dr. Dave Shravan (India)
33 Quality of Care VS Waiting Time:How Do Young Physiciansin the
Madrid Area Cope with It, and What Is Their BurnoutRate?
By Dr. Rocio Garcia-Gutiérrez Gomez, Dr. Ana Peral Martin and Dr. Sergio
Chamorro Minguez (Spain)
36 Spanish Version of the last Article
Page 5
JUNIOR DOCTORS’CONTRIBUTIONS
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Dear Esteemed Colleagues,
I want to express my sincere appreciation as I take this opportunity to share my thoughts in
this exceptional edition of our newsletter. This edition is dedicated to the critical intersection
of Medical Education and Medical Ethics and is the result of a collaborative effort between
our medical ethics officer and medical education director.
As we embark on our journey as junior healthcare professionals, our foundation is built
upon education, and guided by the fundamental principles of ethics. These principles
collectively serve as the cornerstone of our esteemed profession.
Medical Education is an enduring and lifelong pursuit that molds us into compassionate and
skilled healers. Within this edition, you will discover enlightening articles covering crucial
aspects of medical education. Conversely, Medical Ethics acts as our moral compass,
guiding us through intricate decision-making with unwavering integrity. In this newsletter,
we engage in profound discussions addressing ethical dilemmas that hold paramount
importance in our field.
I wholeheartedly encourage each one of you to actively participate in the discussions
presented here. May our collective wisdom illuminate the path toward a future in medicine
characterized by compassion and excellence. I extend my heartfelt gratitude to all of you
for your steadfast dedication to our noble profession.
Furthermore, I would like to extend my deep appreciation to the publications team for their
tireless efforts in bringing this edition to fruition. I also applaud all the authors who
contributed their valuable insights. I warmly invite you to delve into the enriching content of
this newsletter.
Thank you.
Dr. Uchecheukwu Arum, MD.
Words from the JDN Chairperson
TEAM OF OFFICIALS’CONTRIBUTIONS Page 6
Dr. Uchechukwu Arum, MD.
Chairperson 2022-2023
Junior Doctors Network
World Medical Association
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Words from the Medical Ethics Officer
Dear JDN collagues,
TEAM OF OFFICIALS’CONTRIBUTIONS Page 7
Dr. Jihoo Lee, MD.
Medical Ethics Officer 2022−2023
Junior Doctors Network
World Medical Association
I’m delighted to present JDN’s first-ever Newsletter special edition dedicated to both
Medical Education and Medical Ethics. I want to extend my heartfelt thanks to the JDN
authors who contributed their fantastic articles, as well as to our publication team for
their hard work, and of course my colleague and friend the Medical Education Director.
Medicine is more than just a job; it’s a calling to heal, care, and uphold the highest
ethical standards. Today, ethics is in the spotlight due to complex global issues like
resource allocation during COVID-19, end-of-life decisions, and the use of AI in
healthcare. These topics demand a strong ethical foundation for making the right
decisions, both at the national and global level. In addition, ethical concerns within
medical workplaces, such as discrimination and burnout, are becoming more pressing
matters in these days.
This special edition focuses on the important intersection of medical education and
medical ethics. In our ever-changing healthcare world, these two aspects are crucial for
creating compassionate, skilled, and ethically responsible doctors. Our collaborative
effort, with its insightful articles, aims to shed light on key aspects that will shape the
future of healthcare.
We hope these articles will spark meaningful discussions, drive positive change, and
champion the values that define compassionate and ethical medical practice. We look
forward to your contributions to future JDN activities. Enjoy reading!
Stay connected, and let your voices be heard worldwide!
Best wishes,
Dr. Jihoo Lee, MD.
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Words from the Medical Education Director
TEAM OF OFFICIALS’CONTRIBUTIONS
Dr. Balkiss Abdelmoula, MD. MPH.
Medical Education Director 2022-2023
Junior Doctors Network
World Medical Association
Page 8
Dear colleagues,
I am honored to address you in this special edition of our JDN newsletter, dedicated to
the vital intersection of medical education and ethics. It has been a privilege to
collaborate with my friends and colleagues, the Medical Ethics Officer and the
Publications Director to bring you this insightful edition. This endeavor wouldn’t have
been possible without the invaluable contributions of all our authors, whose dedication
to advancing medical education and ethics shines through in each article.
In this edition, we delve into critical issues shaping contemporary medical practice, and
we address different challenges faced by doctors nowadays, such as workplace
discrimination and mental health struggles. We also explore the intersection of climate
change and health in medical education, as well as Artificial Intelligence’s role in the
medical practice. As our field undergoes significant shifts, it is our collective duty to
remain well-equipped to better navigate such complex issues and address the resulting
health implications while upholding high ethical standards.
As caretakers of human lives, we are in fact entrusted with the extraordinary privilege
of ensuring the dignity, autonomy, and well-being of our patients. The commitment to
continuous learning is thus both a professional duty and an ethical imperative. Staying
abreast of emerging technologies, therapies, and research findings is essential to
providing the best possible care to our patients. As junior doctors, we are both the
torchbearers of this legacy and the shapers of the future of healthcare.
By approaching our medical education and practice with unwavering dedication and
ethical fortitude, we not only honor the noble profession we have chosen but also leave
an indelible mark on the lives of those we serve.
Thank you for your steadfast commitment to improving healthcare.
Warm regards,
Dr. Balkiss Abdelmoula, MD. MPH.
Words from the Publications Director
Dear JDN colleagues,
On behalf of the Publications Team (2022−2023) of the Junior Doctors Network (JDN), we
are honoured to share this first of its kind special edition of the JDN Newsletter on both
Medical Education and Medical Ethics with you all.
Medical ethics and medical education are key to promoting universal healthcare
coverage. Universal health is indispensable for sustainable human development and one of
the factors to achieve it is the adequate availability and distribution of health personnel in
the countries. This is based on medical education with humanistic, holistic approaches,
prioritizing early attention to diseases, their prevention and early detection.
Shortage of health personnel is a factor hindering the achievement of universal
healthcare. Despite the increasing use of prospective methods to plan the training of
physicians in the medium and long term, it has not been possible to solve the deficit and
the availability of physicians is still lower in some regions of the world; Latin America,
Africa, even in certain European countries where there is a talent drain and some areas
remain uncovered. So, we have the obligation to raise our voice in some way, in order to
improve medical education and stop this deficit of health human resources.
I feel very proud to contribute to this special edition with many interesting topics covered,
and I personally encourage more JDN members to continue sharing their insights and
activities worldwide.
I finally would like to thank you all for trusting us again and making this collaborative effort
possible. It is an honour and pleasure to be part of this initiative.
Sincerely yours,
Dr. Jeazul Ponce Hernandez MD. MPH. Msc.
Dr. Jeazul Ponce Hernandez, MD MSc. MPH.
Publications Director 2022−2023
Junior Doctors Network
World Medical Association
TEAM OF OFFICIALS’CONTRIBUTIONS Page 9
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
EnhancingHolistic End-of-Life Care:EmpoweringJuniorDoctors
throughComprehensiveMedicalEducationand Training
TEAM OF OFFICIALS’CONTRIBUTIONS Page 10
Dr. Jihoo Lee, MD.
Medical Ethics Officer 2022−2023
Junior Doctors Network
World Medical Association
I vividly remember persuading a 70-year-old patient with lung cancer to sign his
physician’s orders for life-sustaining treatment (POLST). Despite being in an advanced
stage of the disease, he eagerly wanted to enroll in a clinical trial. However, he was
hospitalized with respiratory failure just before starting the trial. As a new resident, I was
assigned to him without immediate access to his attending physician. With the only help
of a second-year resident, I managed to convince the patient to forgo aggressive
treatments. Regrettably, he passed away that day, leaving me deeply disappointed and
depressed for a while. This incident exposed a critical gap in the medical education
system in the Republic of Korea—a lack of structured support for junior doctors
grappling with life-sustaining treatment decisions. Additionally, there is no mechanism in
place to ease the emotional burdens borne by medical personnel during the process of
making such decisions, further underscoring the need for improvement.
In 2016, Korea implemented the Hospice and Palliative Care and Decisions on Life-
Sustaining Treatment for Patients at the End-of-Life (hereafter referred to as the LST
Decisions Act), which allowed individuals to express their end-of-life care preferences
(1). Since then, medical training has incorporated education on the duties outlined in the
Act. During my residency, my colleagues and I received in-classroom lectures on
Hospice and Palliative care three to four times a year. However, and despite progress in
the legal and cultural aspects of this care, significant challenges remain in ensuring
death with dignity, affecting patients and medical staff, including junior doctors.
A study on the Act conducted in 2020 revealed that resident physicians faced
challenges with complex procedures. The research team carried out a survey targeting
a total of 267 resident physicians, with 139 respondents in the first year of enforcement
and 128 respondents in the second year. In the first-year survey, 67.9% of residents
found procedures challenging, decreasing to 53.9% in the second year. In addition, the
percentage of residents feeling psychological burdens increased from 40.3% to 51.6%.
In the medical field, significant pressure exists in determining the terminal stage of a
patient’s illness, especially for junior doctors with less experience. The study results
thus imply that case-based and practical education in the medical field should be
provided for residents to realize the objectives of the LST Decisions Act (2).
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
EnhancingHolistic End-of-Life Care:EmpoweringJuniorDoctors
throughComprehensiveMedicalEducationand Training
TEAM OF OFFICIALS’CONTRIBUTIONS
Unfortunately, since 2020, the situation of end-of-life care has deteriorated due to the
COVID-19 pandemic. Due to hospital visitation restrictions for infection control, not only
were dying patients unable to spend their last moments with their families, but it also
became extremely challenging for medical staff to engage in discussions about life-
sustaining treatment with the patients and their caregivers. Although discussions on this
topic have been raised in academia and the public, tangled issues such as an
overwhelmed healthcare system in implementing the LST Decisions Act and the social
consensus on life-sustaining treatment are still left far behind to be addressed (3). Even in
this unsettled moment, medical staff oversee critical roles regarding end-of-life care in
initiating advance care planning, facilitating patient-family communication, and alleviating
patient and family suffering (4). The high-quality education and training curriculum on end-
of-life care for junior doctors should be provided.
While the World Medical Association (WMA) has recognized the importance of end-of-life
care (5), it is essential to consider regional contexts, including cultural, religious, and
historical factors when addressing this sensitive topic. Although the global momentum
may have weakened during the pandemic, the necessity for comprehensive end-of-life
care has only strengthened due to the increased risk of death from COVID-19. As
physicians, we must prioritize human dignity and provide appropriate treatment and
medical services. It is crucial to lead junior doctors to be well-trained in both academics
and ethics toward implementing systematic and realistic end-of-life care medical
education.
References
1. Act on decisions on life-sustaining treatment for patients in hospice and palliative care
or at the end of life [Internet] [cited 2023 Jul 11]. Available here
2. KIM YJ, LIM CM, SHIM TS, HONG SB, HUH JW, OH DK, KOH Y. The influence of
new legislation on the withdrawal of life-sustaining treatment on the perceptions and
experiences of residents in a tertiary hospital in Korea. Korean Journal of Medical Ethics.
2020;23(4):279-99.
3. Shin J, Kim Y, Yoo SH, Sim JA, Keam B. Impact of COVID-19 on the End-of-Life Care
of Cancer Patients Who Died in a Korean Tertiary Hospital: A Retrospective Study. The
Korean Journal of Hospice and Palliative Care. 2022;25(4):150-8.
4. Kim Y, Yoo SH, Shin JM, Han HS, Hong J, Kim HJ, Choi W, Kim MS, Park HY, Keam
B. Practical considerations in providing end-of-life care for dying patients and their family
in the era of COVID-19. The Korean Journal of Hospice and Palliative Care.
2021;24(2):130-4.
5. WMA – The World Medical Association-WMA Declaration of Venice on end-of-life
medical care [Internet]. [cited 2023 Jul 11]. Available from: https://www.wma.net/policies-
post/wma-declaration-of-venice/
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October 2023
Climate Change and Health in Medical Education
Introduction
Climate change is one of the 21st century’s most pressing issues and one of the most
significant threats that humanity faces today. Its negative impacts are felt in various
aspects of our lives, including health. These impacts span from increased frequency of
extreme weather events to shortening global food supplies. The changing climate is also
causing a shift in the distribution of diseases, leading to the emergence of new diseases,
and exacerbating existing ones (1). While the intersection between climate change and
health is more and more evident, this paper would explore if medical schools have already
started integrating this thematic into their curricula, why it is important to do so, and which
aspects are relevant to medical students and medical doctors in both their education and
their practice in this regard.
Discussion
According to the World Health Organization (WHO), there is an urgent need for sustained
multidisciplinary climate education to be integrated within medical curricula and across a
continuum of training for healthcare professionals (2). Nevertheless, medical schools have
been slow in adapting their curricula to health-related challenges brought about by climate
change. According to a recent Lancet article, only a minority of medical curricula has
indeed incorporated planetary health and climate change impacts on health (3). This is
mainly due to a lack of recognition of the complex and growing interconnectedness
between environmental changes and human health (4). In absence of comprehensive
medical curricula covering these interlinkages, medical students and thus future healthcare
providers are left without adequate preparations to deal with the challenges arising from the
intersection between climate change and health. That’s why, programs in medical schools
require transformative educational methods that consider such complex thematic including
sustainability, resilience, and related socioeconomic aspects of equity, justice, and human
rights (5). In this regard, only a few universities across the world have started their own
initiatives transforming health professionals’ education in recent years, such as in
Germany, the USA and China (5, 6, 7). In a recent study from Canada (8), climate change
was found to be an important determinant of health according to most medical students
(88%). Many believed that it would affect their future patients’ health (89.6%) and that it
should be incorporated into their medical curricula (85.6%).
Dr. Balkiss Abdelmoula, MD. MPH.
Medical Education Director 2022-2023
Junior Doctors Network
World Medical Association
TEAM OF OFFICIALS’CONTRIBUTIONS Page 12
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Climate Change and Health in Medical Education
While understanding how climate change affects the environment may not be deemed
imperative within the curriculum of healthcare professionals, comprehending the underlying
mechanisms through which climate change influences human health is of paramount
importance. Notably, healthcare professionals must possess a firm grasp of the intricate
interplay between climate change and human health, encompassing factors such as air
pollution, waterborne illnesses, and food insecurity (7).
Of particular significance, air pollution stands out as a predominant health hazard linked to
climate change. The escalation of global temperatures contributes to heightened levels of
air pollutants, thereby precipitating adverse respiratory outcomes including asthma and
bronchitis. Accordingly, medical students must acquire a profound understanding of the
ramifications of air pollution on respiratory well-being, coupled with the ability to proficiently
diagnose and manage respiratory conditions stemming from such pollutants.
Waterborne diseases emerge as another salient health peril entwined with the ramifications
of climate change. The rising global temperatures disrupt the water cycle, engendering
more frequent and intense occurrences of floods, droughts, and storms. Such climatic
perturbations subsequently foster water contamination, serving as a conduit for the
dissemination of waterborne ailments such as cholera, typhoid, and hepatitis A. To this
end, medical students necessitate a comprehensive grasp of the modes of propagation of
waterborne diseases, alongside adeptness in their diagnostic and therapeutic approaches.
Furthermore, the spectrum of substantial health risks stemming from climate change
extends to encompass food insecurity, warranting integral inclusion in the educational
trajectory of medical students. Evidently, climatic fluctuations can precipitate crop failure,
scarcities in food supplies, and a surge in food prices, collectively culminating in
malnutrition, hunger, and even psychosocial well-being challenges. As such, a holistic
understanding of the intricate relationship between climate change-induced food insecurity
and its health ramifications is imperative for future medical practitioners.
To cultivate their capacity to serve as proponents of climate change mitigation and
adaptation, medical students must acquire insights into the involvement of healthcare
providers in combating climate change. This extends beyond patient interactions to
encompass effective communication with policymakers, elucidating the intricate nexus
between climate dynamics and human health (9). A comprehensive educational framework
should encompass the ethical dimensions inherent to these issues, including
considerations of social equity and health parity (10). These pivotal facets must be
integrated into the fabric of medical curricula to foster a profound grasp of the broader
implications. By nurturing an appreciation of the ethical underpinnings, medical students
can more effectively navigate the intricacies of addressing climate change-related health
TEAM OF OFFICIALS’CONTRIBUTIONS Page 13
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Climate Change and Health in Medical Education
disparities. Through comprehensive training, medical students can evolve into proactive
advocates for climate-conscious healthcare delivery, adept at engaging with patients,
policymakers, and ethical considerations alike. This holistic approach not only fortifies the
healthcare sector’s response to climate-related health threats but also instills a sense of
responsibility and foresight in the medical professionals of tomorrow.
Conclusion
The intersection between climate change and health is a fundamental area that needs to
be addressed in medical education so that physicians find themselves adequately prepared
to deal with the health impacts of climate change and become advocates for climate
change mitigation and adaptation. An enriched educational paradigm that encompasses
the multifaceted relationships between climate change and health is imperative for
nurturing competent healthcare providers equipped to confront the multifarious challenges
posed by these global phenomena and safeguard the health of individuals and
communities.
References
1. Semenza JC, Rocklöv J, Ebi KL. Climate Change and Cascading Risks from Infectious
Disease. Infect Diseases and Therapy. May 2022. doi: https://doi.org/10.1007/s40121-
022-00647-3
2. Villalobos Prats E, Neville R, Nadeay KC, et all. WHO Academy education : globally
oriented, multicultural approaches to climate change and health. Lancet Planet Health.
January 2023. doi: https://doi.org/10.1016/S2542-5196(22)00252-2
3. Howard C, McNeil A J, Hughes F, et al. Learning to treat the climate emergency
together: social tipping interventions by the health community. Lancet Planet Health.
2023 March. doi: https://doi.org/10.1016/S2542-5196(23)00022-0
4. Jowell A, Lachenauer A, Lu J, et al. A model for comprehensive climate and medical
education. Lancet Planet Health. January 2023. doi: https://doi.org/10.1016/S2542-
5196(22)00215-7
5. Gepp S, Jung L, Wabnitz K, et al. The Planetary Health Academy – a virtual lecture
series for transformative education in Germany. Lancet Planet Health. 2023 January.
doi: https://doi.org/10.1016/S2542-5196(22)00253-4
6. Teherani A, Nicastro T, St Clair M, et al. Faculty Development for Education for
Sustainable Health Care: A University System-Wide Initiative to Transform Health
Professional Education. Acad Med. 2023 January. doi:
10.1097/ACM.0000000000005137
7. Yang L, Liao W, Liu C, et al. Associations between Knowledge of the Causes and
Perceived Impacts of Climate Change: A Cross-Sectional Survey of Medical, Public
Health and Nursing Students in Universities in China. Int J Environ Res Public Health.
2018 November. doi: https://doi.org/10.3390/ijerph15122650
TEAM OF OFFICIALS’CONTRIBUTIONS Page 14
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October 2023
Climate Change and Health in Medical Education
8. Létourneau S, Roshan A, Kitching GT, et al. Climate change and health in medical
school curricula: A national survey of medical students’ experiences, attitudes and
interests. The Journal of Climate Change and Health, Volume 11. May 2023. doi:
https://doi.org/10.1016/j.joclim.2023.100226
9. Haines A, Ebi K. Health and climate change: policy responses to protect public health.
Lancet. 2021 June. doi: https://doi.org/10.1016/S0140-6736(15)60854-6
10. Bonell A, Badjie J, Faal LB, et al. Equity in planetary health education initiatives.
Lancet Planet Health. 2023 January. doi: https://doi.org/10.1016/S2542-5196(22)00142-5
TEAM OF OFFICIALS’CONTRIBUTIONS Page 15
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Medical Education & Medical Ethics Special Edition
October 2023
Revolutionizing Healthcare: The Role of Artificial
Intelligence in Modern Medicine
Artificial intelligence (AI) is already transforming healthcare! An 82-year-old patient with an
aggressive form of blood cancer, in whom standard chemotherapy failed, entered
remission after a successful personalized medicine approach. AI used a tissue sample to
select a proper drug specific to the patient, which was thought ineffective for that type of
cancer. But it worked. AI saved a patient’s life! This story was recently published by the
MIT Technology Reviews, but there are still many concerns about the use of AI in today’s
medical practice.
What is AI and why is it important for health?
AI is a collection of technologies. As such, some of these technologies are more relevant to
healthcare. Surgical robots are the most known technology, but in fact, AI is broadly
implemented in other fields: early detection of atrial fibrillation, continuous glucose
monitoring, imaging processing and histopathological diagnosis, test interpretation and risk-
predictive tools (1).
The modernization of healthcare has translated into a flood of data from electronic medical
records. This data-driven modernization is leading to the search for synergies between
medicine and AI. In this regard, AI has the potential to analyze piles of data, extract the
important aspects, analyze the information, and draw conclusions.2 AI is evolving rapidly
together with other fields of population health, -omics, telemedicine, and precision medicine
(1,3).
In some medical specialties, AI implementation is already successful. In
precision medicine, which aims to tailor medical treatment to the individual characteristics
of the patients, AI easily allows physicians to determine relevant mutations and identify
ideal medications, increasing diagnostic accuracy, and personalizing treatments tailored-
made for each patient. In diagnostic radiology, AI can input meaningful insights
that support clinical decisions, helping radiologists reach to a conclusion that will be
further discussed with other physicians involved in the case.
JUNIOR DOCTORS’CONTRIBUTIONS Page 16
Dr. Daniel Andrés Sierra García, MD.
Guatemala/Germany
Junior Doctors Network
World Medical Association
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
The same happens in pathology since AI can assist trained pathologists with detecting
certain findings that can lead to a diagnosis. In ophthalmology, AI can help detect early-
stage retinopathies and in cardiology, it can improve cardiovascular risk prediction. AI has
the capacity to use great amounts of data for making precise diagnostics and predicting
disease, exceeding any human capacity and knowledge (2).
“Hello Mr. Doe, your robot doctor will see you now.”
AI can now diagnose skin cancer more accurately than an experienced dermatologist,
faster and more efficiently, without requiring a decade-long intense medical education.4
This progress in AI is leading to a threatening question: will AI displace physicians, or will it
help to make them more effective or a little bit of both? (2)
On this thought, even when AI can take over any medical specialty, it seems that it would
most likely replace those physicians working with digital information, like radiologists and
pathologists. But even these professionals do more than reading and interpreting images
and tissue slides.5 Similarly, a neurological examination in the routine physical exam
requires a high level of patient-physician interaction and critical thinking, a work that
neurologists have perfectioned and are experts on.2 Another constantly debated aspect of
adopting AI is the dehumanization of medicine (1).
AI is still not capable of engaging with patients in a trustful, reassuring or empathic way.2
Some of the crucial skills and characteristics needed for patient-doctor relations are
uniquely human skills, like empathy, persuasion and big-picture integration (5).
Smart medical technologies are thought to support physicians in caring for patients.1 AI
systems will not replace clinicians but will aid them in the process of care for patients (5).
It is better to, instead, understand that AI will augment physicians rather than replace them,
becoming an important routine aid in healthcare (2).
JUNIOR DOCTORS’CONTRIBUTIONS Page 17
Revolutionizing Healthcare: The Role of
Artificial Intelligence in Modern Medicine
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
For or against?
As with any other big change, implementing AI will translate into rejection. This is mainly
due to the lack of basic and continuing education in this regard. To tackle this, medical
curricula are starting to get a stronger approach to hard and computational sciences, in the
search of training augmented doctors, and physicians with both clinical experience and
digital expertise adapted to manage the digital transition. Augmented doctors would be the
drivers of innovation and research, building digital strategies to solve modern health
problems (1).
Final reflections
While right now AI in medicine is still in its early stages, it seems like a promising tool that
will improve healthcare delivery. AI will certainly help to make medicine more accurate,
more comprehensive, and potentially less expensive by preempting disease, preventing
side effects, and reducing unnecessary testing. We can see this change as a threat, or we
can see it as an opportunity. It is on us the choose to learn how to wisely use it.
References
1. Briganti G, Le Moine O. Artificial Intelligence in Medicine: Today and Tomorrow.
Front Med (Lausanne). 2020 Feb 5;7.
2. Ahuja AS. The impact of artificial intelligence in medicine on the future role of the
physician. PeerJ. 2019 Oct 4;7:e7702.
3. Kulkarni S, Seneviratne N, Baig MS, Khan AHA. Artificial Intelligence in Medicine:
Where Are We Now? Acad Radiol. 2020 Jan;27(1):62–70.
4. Rigby M. Ethical Dimensions of Using Artificial Intelligence in Health Care. AMA J
Ethics. 2019 Feb 1;21(2):E121-124.
5. Davenport T, Kalakota R. The potential for artificial intelligence in healthcare. Future
Healthc J. 2019 Jun;6(2):94–8.
JUNIOR DOCTORS’CONTRIBUTIONS Page 18
Revolutionizing Healthcare: The Role of
Artificial Intelligence in Modern Medicine
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
EthicalConsiderations in the Age of MOOCs:Exploring the Role of
MassiveOpen Online Courses in MedicalEducation
In recent years, the use of massive open online courses (MOOCs) in medical education
has gained significant attention due to their ability to provide learners with access to
educational resources and training opportunities worldwide. However, the use of MOOCs in
medical education has also raised ethical concerns that need to be addressed (1). This
article will explore the ethical considerations associated with the use of MOOCs in medical
education and suggest solutions to these issues.
One of the primary ethical concerns associated with the use of MOOCs in medical
education is the quality of education provided. MOOCs may not provide learners with the
same level of quality education as traditional medical education (2). Practical training and
hands-on experience are essential components of medical education that learners may not
have access to through MOOCs. To address this concern, MOOCs can be designed to
incorporate practical training and hands-on experience through virtual simulations and
other innovative technologies. Additionally, MOOCs can provide learners with access to
high-quality educational resources that can supplement traditional medical education. By
combining traditional medical education with MOOCs, learners can receive a well-rounded
education that provide the necessary skills and knowledge to practice medicine (3).
Another ethical consideration associated with the use of MOOCs in medical education is
the issue of certification. Regulatory bodies may not recognize MOOCs, and learners may
not receive the necessary certification to practice medicine (4). To address this concern, a
regulatory framework that recognizes the certification provided by MOOCs should be
established. This framework can be developed in collaboration with regulatory bodies and
medical education institutions to ensure that learners who complete MOOCs receive the
necessary certification to practice medicine. Additionally, MOOCs can be designed to align
with the standards set by regulatory bodies to ensure that the certification provided meets
the required standards.
Dr. Kamoun Mahmoud, MD.
Family Medicine Physician
Sfax, Tunisia
Junior Doctors Network
World Medical Association
Page 19
JUNIOR DOCTORS’CONTRIBUTIONS
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
EthicalConsiderations in the Age of MOOCs:Exploring the Role of
MassiveOpen Online Courses in MedicalEducation
The issue of access is another ethical consideration associated with the use of MOOCs in
medical education. MOOCs may not be accessible to all medical learners, and access to
technology and to internet may be a barrier to learners from disadvantaged socio-
economical settings (5). To address this concern, medical education institutions can
provide learners with the necessary tools and resources to access MOOCs, including
access to computers, internet connectivity, and training on how to use these tools.
Additionally, MOOCs can be designed to be accessible to learners with disabilities,
ensuring that they are not left behind. Another solution is to make MOOCs available in
different languages to cater to learners from different regions.
In conclusion, while MOOCs have the potential to revolutionize medical education, ethical
considerations must be addressed to ensure their effective integration into the medical
education system. Quality education, certification, and accessibility should be considered
when implementing MOOCs in medical education. MOOCs should not replace traditional
medical education but rather complement it. Therefore, medical institutions need to develop
strategies that ensure the proper integration of MOOCs with traditional medical education.
As we continue to navigate the age of MOOCs, it is important to continue exploring and
addressing the ethical considerations of online medical education. This will help ensure that
medical students and junior doctors have access to quality education, regardless of their
location, economic status, or any other limiting factor. MOOCs can be a powerful tool in
democratizing medical education and bridging gaps in healthcare access, but only if used
ethically and responsibly.
References
1. Feitosa de Moura V, Alexandre de Souza C, Noronha Viana AB. The use of Massive
Open Online Courses (MOOCs) in blended learning courses and the functional value
perceived by students. Computers & Education. 2021;161:104077.
2. Masters K. A Brief Guide To Understanding MOOCs. The Internet Journal of Medical
Education. 2011;1(2).
3. Doherty I, Sharma N, Harbutt D. Contemporary and future eLearning trends in medical
education. Medical Teacher. 2015;37(1):1-3.
4. Setia S, Tay JC, Chia YC, Subramaniam K. Massive open online courses (MOOCs) for
continuing medical education – why and how? Advances in Medical Education and
Practice. 2019;10:805-12.
5. Goldberg L, Crocombe L. Advances in medical education and practice: role of massive
open online courses. AMEP. 2017;Volume 8:603-9.
JUNIOR DOCTORS’CONTRIBUTIONS Page 20
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Mental Health of Physicians in Training
Introduction
Medical training is a rigorous and demanding process that can take a significant toll on the
mental health of physicians in training. The stress of long working hours, high-pressure
work environments, and the stigma associated with mental health problems in the medical
community can contribute to the high prevalence of mental health problems among
physicians in training. This article will explore recent research on the mental health of
physicians in training and potential solutions to address this issue.
The Prevalence of Mental Health Problems Among Physicians in Training
Studies suggest that physicians in training are at higher risk for mental health problems
compared to the general population. A systematic review and meta-analysis published in
2021 analyzed data from 37 studies that included a total of 26,678 medical students and
residents. The study found that the prevalence of depression, anxiety, and stress was
significantly higher among medical students and residents than in the general
population (1). Another study published in 2019 found that the prevalence of burnout was
also higher among medical students and residents compared to the general population (2).
Factors Contributing to Mental Health Problems
Several factors contribute to the higher prevalence of mental health problems among
physicians in training. The demanding nature of medical training, including long working
hours, lack of control over workloads, and high-pressure work environments, is a significant
source of stress. A study published in 2020 found that residents working longer shifts
reported higher levels of burnout, depression, and anxiety (3). The isolation and stigma
associated with mental health problems within the medical community can also make it
challenging for physicians in training to seek help. A survey published in 2019 found that
40% of residents reported feeling uncomfortable seeking mental health treatment (4).
Potential Solutions
Several interventions can help address the mental health problems faced by physicians in
training.
Dr. Imene Bouaziz MD. MPH.
Family Medicine Physician
Tunisia/France
Junior Doctors Network
World Medical Association
JUNIOR DOCTORS’CONTRIBUTIONS Page 21
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Mental Health of Physicians in Training
A study published in 2020 found that a mindfulness-based stress reduction program
improved well-being and reduced burnout among residents (5). Another study published in
2021 found that a brief intervention program improved mental health outcomes among
medical students (5). Furthermore, it is essential to address the culture of medicine that
perpetuates the stigma surrounding mental health problems. A study published in
2023 found that residents who perceived their program as supportive of their mental
health reported lower levels of burnout and depression (6). In addition to these
interventions, it is crucial to address the work environment of physicians in training. A study
published in 2022 found that improving work conditions, such as reducing the number of
consecutive work hours, improved mental health outcomes among residents (7). Another
study published in 2022 found that increased supervision and support from attending
physicians reduced the risk of burnout among residents (8).
The Tunisian case
Medical residents in Tunisia face significant mental health challenges, which can have
negative impacts on their well-being and professional development. A cross-sectional study
conducted in Tunisia found that medical residents reported high levels of stress and
symptoms of anxiety and depression, with nearly 40% of participants meeting the criteria
for a depressive disorder. The study also found that long working hours and work overload
were contributing factors to their mental health difficulties. Despite the significant mental
health challenges faced by medical residents in Tunisia, access to mental health services
remains limited. The cultural stigma surrounding mental health and seeking help for mental
health concerns is also prevalent in Tunisia, which may contribute to reluctance to seek
support. These findings highlight the urgent need for interventions to address the mental
health needs of medical residents in Tunisia. Efforts to improve access to mental health
services and reduce the stigma surrounding mental illness could help support the well-
being and professional development of medical trainees in Tunisia (9).
Conclusion
The mental health of physicians in training is a growing concern, with studies showing that
medical students and residents are at higher risk for mental health problems than the
general population. The demanding nature of medical training, isolation, and stigma
surrounding mental health problems are significant factors contributing to this issue.
Implementing mental health support programs, promoting a culture of openness and
support for mental health, addressing the work environment, and providing adequate
supervision and support can help address this problem. By taking steps to improve the
mental health of physicians in training, we can help ensure that they are better equipped to
provide high-quality care to patients while also promoting their own well-being.
JUNIOR DOCTORS’CONTRIBUTIONS Page 22
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Mental Health of Physicians in Training
References
1. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of
Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A
Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214-36. DOI:
10.1001/jama.2016.17324
2. Dyrbye LN, West CP, Sinsky CA, Goeders LE, Satele DV, Shanafelt TD. Medical
Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions.
Mayo Clin Proc. 2017;92(10):1486-93. DOI: 10.1016/j.mayocp.2017.06.020
3. Wang H, Li H, Lv M, Zhou D, Bai L, Du L, et al. Associations between occupation
exposure to Formaldehyde and semen quality, a primary study. Sci Rep. Nature Publishing
Group; 2015;5(1):15874. DOI: 10.1038/srep15874
4. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce
physician burnout: a systematic review and meta-analysis. Lancet Lond Engl.
2016;388(10057):2272-81. DOI: 10.1016/S0140-6736(16)31279-X
5. Ungar P, Schindler A-K, Polujanski S, Rotthoff T. Online programs to strengthen the
mental health of medical students: A systematic review of the literature. Med Educ Online.
27(1):2082909. DOI: 10.1080/10872981.2022.2082909
6. Briciu V, Leucuta D-C, Tőkés GE, Colcear D. Burnout, Depression, and Job Stress
Factors in Healthcare Workers of a Romanian COVID-19 Dedicated Hospital, after Two
Pandemic Years. Int J Environ Res Public Health. 2023;20(5):4118. DOI:
10.3390/ijerph20054118
7. Bondagji D, Fakeerh M, Alwafi H, Khan AA. The Effects of Long Working Hours on
Mental Health Among Resident Physicians in Saudi Arabia. Psychol Res Behav Manag.
2022;15:1545-57. DOI: 10.2147/PRBM.S370642
8. Ju TR, Mikrut EE, Spinelli A, Romain A-M, Brondolo E, Sundaram V, et al. Factors
Associated with Burnout among Resident Physicians Responding to the COVID-19
Pandemic: A 2-Month Longitudinal Observation Study. Int J Environ Res Public Health.
2022;19(15):9714. DOI: 10.3390/ijerph19159714
9. Mejri I, Youssfi I, Znegui T, Mechergui N, El Kefi H, Hammami R, et al. Mental health
status of healthcare workers at a third line Tunisian hospital during COVID-19 pandemic.
Tunis Med. 2022;100(10):670-5.
JUNIOR DOCTORS’CONTRIBUTIONS Page 23
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Discrimination of Female Healthcare Workers during
COVID-19: A way forward to defeat this double burden
The famously known pandemic of this century which I would like to compare to the Black
Death of Europe is the Coronavirus pandemic. Coronavirus created a global havoc during
the year 2020-21, with its multiple waves and unsettling effects on humanity. It startled the
medical community at large, as they were challenged to tackle the increasing number of
deaths. Surely this pandemic has taught a few untold lessons.
Countries regardless of their economic status were affected by this equally. The countries
that survived were those with strong healthcare systems, especially those that handed over
the crisis to the technical experts rather than producing influences through political
agendas. For example, the United Arab Emirates saw cooperation between all relevant t
stakeholders and communities which significantly decreased the number, while it was not
the case globally. As of, 19 April 2023, there have been 763,740,140 confirmed cases of
COVID-19, including 6,908,554 deaths, reported to WHO (1).
The pandemic had a debilitating impact on the social and economic life and health of the
populations worldwide. Lockdowns restricted mobility, social contact, access to healthcare,
and access to education due to closure of schools. The restrictions often resulted in the
loss of jobs combined with existential fears and mental health problems.
Junior doctors worldwide were affected by the increasing demand of healthcare workers
needed to care for patients. They had to do long hours of shifts without food or water in
PEP kits to prevent the spread of the virus. A large proportion of doctors even contracted
the disease and many of them even sacrificed their lives during serving the diseased.
Worldwide, doctors and healthcare professionals were applauded for their work and
commitment. They were termed as frontline workers and were also compared with it
soldiers at war.
JUNIOR DOCTORS’CONTRIBUTIONS Page 24
Dr. Deena Mariyam, MBBS. MPH.
General Practitioner, LSHTM
India/UAE
Junior Doctors Network
World Medical Association
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
However, stakeholder and country-level commitments were limited towards
health professionals as the policies introduced had minimal effectiveness (2). This is even
worse when it comes to young female healthcare workers which includes junior doctors,
nurses, and pharmacists. COVID-19 has disproportionately impacted young women
professionals in healthcare, in academia in terms of research and publishing, also severely
compromised community health workers.
On the personal front added to the professional obligations, unpaid care work increased
among parenting couples working from home; mothers spent an average of 4 hours on
childhood and 3 hours on homeschooling, whereas fathers spent an hour less, on average.
The pandemic reinforced, therefore, re, e.g., unequal sharing of childcare (3).
With the UNGA “High-Level Meeting Pandemic Prevention, Preparedness and Response”
(4). High-Level’s imperative that all member states work on our demands and
recommendations, the impacts of COVID-19 have had detrimental effects on the lives
of Junior Doctors Worldwide specifically on female healthcare workers. Adequate
compensation for their work must be duly given for their commitment and highest sense of
duty. It should be of utmost importance to member states to protect the rights of these
young workers in professional spaces as well as uplift their status in communities. Young
female workers need a seat at the table, we have contributed to fighting the pandemic with
utmost sincerity and our voices need to be heard in the highest decision-making spaces.
The negotiations at these bodies must be percolated down to the lowest level as we just
don’t need an immense amount of literature on paper but also on-ground implementation.
For example, in India, many private medical colleges do not provide interns with a stipend
end which is mandatory as stated by the National Medical Commission and some of them
must even pay for their PPE kits themes even pay for their PPE kits themselves, this was a
mentally challenging time for the young doctors and their families (5).
In my conclusion I would like to highlight the possible solutions for ensuring continued
support to young female health-professionals. The guiding document which countries could
use to help achieve objectives at workplaces is global health and care worker compact
published by the World Health Organization (6). Achieving gender equity is not only the
work of governments but all stakeholder including but not limited to NGOs, Local
Communities, Universities, Academics and Private sector. We all need to work together to
raise the political capital to address the demands of women and girls
worldwide.
JUNIOR DOCTORS’CONTRIBUTIONS Page 25
Discrimination of Female Healthcare Workers during
COVID-19: A way forward to defeat this double burden
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
References
1. World Health Organization. WHO COVID-19 dashboard [Internet]. World
Health Organization. 2023. Available from: https://covid19.who.int/
2. G Williams, G Scarpetti, A Bezzina, K Vincenti, K Grech, I Kowalska-Bobko, C Sowada,
M Furman, M Gałązka-Sobotka, CB Maier, How are countries supporting health
workers? Data from the COVID-19 Health System Response Monitor, European Journal
of Public Health, Volume 31, Issue Supplement_3, October 2021,
ckab164.060, https://doi.org/10.1093/eurpub/ckab164.060
3. Hoffmann C, Schneider T, Wannous C, Nyberger K, Haavardsson I, Gilmore B,
Quigley P, Winkler AS, Ludwig S. Impact of COVID-19 on the private and professional
lives of highly educated women working in global health in Europe—A qualitative study.
Frontiers in Global Women’s Health. 2023;4.
4. Letters 8 F 2023 |. Letter from the President of the General Assembly –
Modalities Resolution for the HLM on Pandemic Prevention, Preparedness and
Response | General Assembly of the United Nations [Internet]. [cited 2023 Apr 22].
Available from: https://www.un.org/pga/77/2023/02/08/letter-from-the-president-of-the-
general-assembly-modalities-resolution-for-the-hlm-on-pandemic-prevention-
preparedness-and-response/
5. Kinder, F., & Harvey, A. (2020). Covid-19: the medical students responding to the
pandemic. bmj, 369.
6. Global health and care worker compact [Internet]. www.who.int. [cited 2023 Apr
22]. Available from: https://www.who.int/publications/m/item/carecompact
JUNIOR DOCTORS’CONTRIBUTIONS Page 26
Discrimination of Female Healthcare Workers during
COVID-19: A way forward to defeat this double burden
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
“It’s about to rain,” I think to myself.
“Nurse, can you please tell me where the surgical ward is?” my thoughts were interrupted,
by a man who seemed to be in a rush. A sliver of annoyance streaks through me, before I
regain my composure.
“He’s in a hurry, maybe that’s why he missed the white coat and stethoscope around my
neck.”
I provide him with the direction, and he rushes away.
“Or… maybe, he’s just one of those people who have difficulty picturing a woman as a
doctor”.
I try to shrug off the thought as I walk into my next posting, however, my thoughts keep
gnawing at me. It hits me how the entire episode was a déjà vu, and that during my five
years at medical school, I have often been mistaken for a nurse.
The voices in my head get the better of me, “Is it that difficult to picture women as
doctors?”
The storm outside mirrors the one in my heart. A storm that often gets the better of those of
us who don’t look like an “ideal doctor”. A fight that is fought by all those that don’t fit the bill
of the “ideal doctor.”
My experience described above is not an isolated experience of prejudice. And while
experiences can be subjective, numbers don’t lie.
JUNIOR DOCTORS’CONTRIBUTIONS Page 27
Manisha Jana, MBBS
Final year
Bhaikaka University
Anand, Gujarat, India
Discrimination in the Workplace
Dr. Shravan Dave, MBBS. MS
General Surgery Resident
Pramukh Swami medical college
Karamsad, Gujarat, India
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Surveys mailed to 1,930 practicing physicians in Massachusetts were asked if they had
encountered discrimination, how significant the discrimination was against a specific
group, the frequency, and the type of discrimination. Factor analysis identified four types of
discrimination: career advancement, punitive behaviors, practice barriers and hiring
barriers. A staggering Sixty-three per cent of respondents had experienced some form of
discrimination. Respondents were women (46%), racial/ethnic minorities (42%) and
international medical graduates (IMGs) (40%) (1).
Similarly, on the other side of the globe, a 2019 study of 2,377,028 outpatient appointments
at one major tertiary care hospital in Delhi revealed that women in India face “extensive
gender discrimination” in access to healthcare, with the situation worse for younger and
older female patients and those residing at increasing distances from the referral hospital.
An estimated 402,722 female outpatient visits were missing, constituting a staggering 49%
of the patient database. Missing female patients for each state measure of the extent of f
gender discrimination was computed as the difference in the actual number of female
patients who came from each state and the number of female patients that should have
visited the tertiary hospital. A key implication of the study is that, relative to men, women in
these states are deprived of quality tertiary healthcare (3).
From temperate to the tropics, landscapes and healthcare systems change, but the general
theme of discrimination stays.
Akin to the practice of medicine to treat a disease, we must understand its etiology
and pathogenesis. Social discrimination is no different, explicit recognition is an essential
step in the elimination of disparities.
Like a kaleidoscope, there is a multifaceted aspect of structural discrimination amongst the
medical community in India. Gender stereotypes aren’t the only malady. Caste inequality,
homophobia and insensitivity towards mental health issues are just a few pillars of
this nefarious institution.
“Don’t be too bold. You want to impress, not scare them.” A maxim that’s drilled into the
psyche of most female doctors in their professional lifespan. While the number of female
residents in medical institutions has been steadily rising, the discrimination reminds us of a
gender gap that might not be absolved by simply outnumbering our male counterparts.
JUNIOR DOCTORS’CONTRIBUTIONS Page 28
Discrimination in the Workplace
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
The implicit insult in the notion that a woman wearing a white coat couldn’t possibly have
gone through the rigorous training required to become a doctor is offensive.
Gender pay gap exists in nearly every profession, but as per 2022 WHO reports, the gap in
healthcare is 24% greater than any other occupation (5). Women account for 70% of the
health workforce but they are mostly concentrated in nursing and midwifery professions,
while far fewer are physicians. According to UN Women, globally, women are concentrated
in service jobs (61.5%) and occupy fewer leadership roles as parliamentarians (23%) or as
chief executive officers (4%) compared to men. A huge implication of this is that although
women deliver the bulk of healthcare globally, men continue to lead it (6).
And while I talk of my experience and those who have come before me, women aren’t the
only sufferers of prejudice. Racial inequality in America has its parallel with caste inequality
in India. According to the Thorat Committee Report (7), there is harrowing evidence of the
systemic denigration that students of certain castes and tribes face in medical institutions.
Resentment against doctors of certain castes stems from several factors such as a sense
of caste prestige, caste endogamy, and belief in religious dogmas. The harassment occurs
in many ways: soon after new students join the college, they are the target of systematic
verbal and, sometimes, physical attacks by higher caste students.
They are frequently told that they are inferior and do not deserve to be in the institute. They
are given very little space in sports and cultural activities. There is very little healthy social
interaction among students of higher castes and these students. Moreover, the sensitive
nature of this topic makes gathering evidence or conducting independent
investigations extremely difficult, hence masking the clandestine.
These factors are entrenched in the minds from the very beginning, and continually
reinforced over the generations.
In conclusion, structural discrimination has numerous forms and, despite being
frequently unintentional, has the potential to limit the opportunities for those who are
subjected to it. Asseveration of this ingrained history and ongoing harm is essential in order
to constructively engage in changing and actively dismantling the status quo.
Compassion, welcoming mindsets, and unlearning societal conditioning is the pioneer
towards defying the age-old iniquitous establishment of discrimination. A thorough
introspection into our own ingrained prejudices and socio-cultural biases will serve as the
seeds that will eventually grow into the idea of diversity, equity, and inclusion.
JUNIOR DOCTORS’CONTRIBUTIONS Page 29
Discrimination in the Workplace
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Everyone graduates with a degree of equal competence. Yet, women, racial minorities,
members of the LGBTQ community, and those in the clutches of mental illness, have
to fight more hurdles in order to be really seen as an analogue. To be ignorant is far more
destructive than to do ill harm.
A world imbalanced, a troubled home, and a lot more broken bones.
References
1. Coombs, A. A. T., & King, R. K. (2005). Workplace discrimination: experiences of
practicing physicians. Journal of the National Medical Association, 97(4), 467.
2. Mehta, H., Bishnoi, A., & Vinay, K. (2022). The multifaceted aspects of structural
discrimination amongst medical community in India. Indian Dermatology Online
Journal, 13(2), 252.
3. Kapoor, M., Agrawal, D., Ravi, S., Roy, A., Subramanian, S. V., & Guleria, R. (2019).
Missing female patients: an observational analysis of sex ratio among outpatients in a
referral tertiary care public hospital in India. BMJ open, 9(8), e026850.
4. Hennein, R., Gorman, H., Chung, V., & Lowe, S. R. (2023). Gender discrimination
among women healthcare workers during the COVID-19 pandemic: Findings from a mixed
methods study. Plos one, 18(2), e0281367.
5. World Health Organization. (2022). Women in the health and care sector earn 24
percent less than men. World Health Organization. https://www.who.int/news/item/13-07-
2022-women-in-the-health-and-care-sector-earn-24-percent-less-than-men
6. World Health Organization. (2019). Delivered by women, led by men: A gender and
equity analysis of the global health and social workforce.
JUNIOR DOCTORS’CONTRIBUTIONS Page 30
Discrimination in the Workplace
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Medical schools are renowned as hubs of extensive knowledge, not only concerning the human
body but also its intricate interactions with the surrounding environment. For healthcare
professionals, it’s imperative to grasp the challenges faced by the communities they serve, a pursuit
that can commence within the early stages of medical education. The well-being of an individual is
invariably intertwined with the overall health of the community. Here, ‘health’ encompasses
physical, mental, social, emotional, and economic dimensions.
Engaging with the community allows students to immerse themselves in real-life predicaments and
comprehend the lifestyles of patients grappling with chronic illnesses. This engagement aids in
identifying requisite transformations for the enhancement of societal health. The experience
cultivates students’ powers of observation and critical analysis, thereby augmenting the learning
journey. Diverse methods of medical education have shown promising outcomes, particularly in
scenarios that necessitate astute observation and immediate response, prompting heightened
alertness among students. In contrast to the typical 30-minute attention span during didactic
lectures, community-based learning sustains interest over more extended periods.
Communication emerges as a quintessential skill for medical professionals. This process is pivotal
in-patient care, involving the extraction of information about their ailments and more—a task
demanding doctors to display empathy. The mastery of communication improves through
interactions with the community, where the art of understanding and addressing diverse concerns is
refined. Given the distinctive ways, individual minds think, feel, and interpret, honing
communication kills remains an ongoing endeavor, fostering psychological rapport between doctors
and patients.
Physicians are recognized as societal leaders due to the wealth of knowledge accrued during their
educational journey, their role in preserving lives, and the cultivated personalities they embody.
Nurturing leadership qualities requires the transition from making rational decisions to habitual
problem-solving. Such growth flourishes within the community, where students pinpoint health-
related issues, proffer solutions, and thereby contribute to the broader well-being. This approach
also hones the medical students’ prowess in resolving complex challenges.
JUNIOR DOCTORS’CONTRIBUTIONS Page 31
Dr. Chetan Agarwal, MBBS.
Intern, Pramukh Swami medical college
Karamsad, Gujarat, India
Importance of Learning from the Community during
Medical School
Dr. Shravan Dave, MBBS. MS
General Surgery Resident
Pramukh Swami medical college
Karamsad, Gujarat, India
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Recent developments within the curriculum of medical education, particularly the Family Adoption
Program initiated by the National Medical Commission in India, have introduced the concept of
adopting families means to immerse students in community health dynamics. Under this initiative,
students undertake the responsibility of overseeing the health and welfare of designated families,
conducting periodic visits to ensure their well-being. This endeavor augments their capacity to
exhibit empathy towards patients, nurturing an essential trait.
Learning from the community emerges as a profoundly enriching experience, shaping students into
more adept, compassionate, understanding, and empathetic doctors
References
1. Rodríguez L, Banks T, Barrett N, Espinoza M, Tierney WM. A Medical School’s Community
Engagement Approach to Improve Population Health. J Community Health. 2021
Apr;46(2):420-427. doi: 10.1007/s10900-021-00972-7. Epub 2021 Feb 19. PMID: 33606137.
2. Claramita, M., Setiawati, E.P., Kristina, T.N. et al. Community-based educational design
for undergraduate medical education: a grounded theory study. BMC Med Educ 19, 258 (2019).
https://doi.org/10.1186/s12909-019-1643-6
3. Yalamanchili VK, Uthakalla VK, Naidana SP, Kalapala A, Venkata PK, Yendapu R. Family
Adoption Programme for Medical Undergraduates in India – The Way Ahead: A Qualitative
Exploration of Stakeholders’ Perceptions. Indian J Community Med. 2023 Jan-Feb;48(1):142-
146. doi: 10.4103/ijcm.ijcm_831_22. Epub 2023 Feb 1. PMID: 37082407; PMCID:
PMC10112757.
4. Circular by National Medical Commission dated 31st March 2022, No.U11026/1/2022-UGMEB
JUNIOR DOCTORS’CONTRIBUTIONS Page 32
Importance of Learning from the Community during
Medical School
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
The situation of young doctors and residents in the health system of the Madrid Community
is precarious due to the excessive workloads they have to bear, in one of the areas of
Spain where the least is invested in healthcare (4). Several politicians have recently
described the Spanish public health system as the “jewel in the crown” (1). However, the
satisfaction of doctors, who have to deal with excellence in their work under conditions of
overload and burnout, and of patients who observe every day how the waiting lists
lengthen, do not reflect this situation.
To provide a more global opinion on how we deal with this situation of stress and overwork,
we conducted a qualitative anonymous and voluntary survey (from April 14th to April
25th 2023) of young doctors and residents of all specialties in the Madrid area to find out
their burnout status and how we can ethically cope with the overflow of our consulting and
services.
Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has
not been successfully managed. Is considered by the World Health Organization as an
occupational disease that causes detriment to the physical and mental health of
individuals.
Of the 156 young physicians and residents surveyed, 21.8% reported a burnout score of 7
out of 10 points overall (on a subjective scale from 0 to 10, with 0 being “nothing” and 10
being “very intense”), which was the most prevalent mark. In addition, 53.9% reported
having between 7 and 10 points of burnout. (FIGURE 1)
JUNIOR DOCTORS’CONTRIBUTIONS Page 33
Dr. Rocio Garcia-Gutierrez Gomez, MD. Ms.C.
Physician Specialist in Primary and Community Care
Exchange Officer European Young Family Doctors Movement
Hospital Universitario Severo Ochoa. Leganés, Madrid (Spain)
Dr. Peral Martin Ana, MD. Ms.C.
Physician Specialist in Primary and Community Care
Centro de Salud Paseo Imperial, Madrid (Spain)
Dr. Sergio Chamorro Mínguez, MD.
Resident in Primary and Community Care
Hospital Universitario Severo Ochoa. Leganés, Madrid (Spain)
Quality of Care VS Waiting Time: How Do Young Physicians in the Madrid
Area Cope with It, and What Is Their BurnoutRate?
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
What degree of burnout do you think you suffer in GENERAL in your day-to-day life as a
physician? (0 to 10, where 0 is “nothing” and 10 is “very intense”)
Regarding the question we asked them to find out how they cope with the great pressure of
care: 67.3% said that they can spend as much time as they consider necessary to attend to
their patients, as long the other patients are waiting. 19.9% said that they never have the
time they need. Only 3.2% commented that they have plenty of time to see their patients,
unhurried and unstressed. (FIGURE 2)
FIGURE 2: Do you consider that you can attend to your patients in the time they need?
.
JUNIOR DOCTORS’CONTRIBUTIONS Page 34
156 answers
19, 9%: No, never
67,3%: Sometimes, as long as the other
patients wait.
9,6%: Normally yes, with no need for other
patients to wait.
3,2%: Yes, I have plenty of time to see my
patients without rushing my patients without
haste and stress
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Finally, we asked them to fill in the Maslach Burnout Inventory
(MBI) questionnaire, consisting of 22 items, which aims to measure the frequency and
intensity with which burnout is suffered. It is composed of three subscales, the first two of
which indicate greater attrition with higher scores. (3).
1. Emotional exhaustion is a chronic state of physical and emotional depletion that results
from excessive work or personal demands or continuous stress. 28.9% of the
respondents scored low on the scale, 16% scored medium and more than half, 55.1%
scored high.
2. Depersonalization can consist of a detachment within the self, regarding one’s mind or
body, or being a detached observer of oneself. Again, most of the respondents scored
high (67.9%), with low and medium scores being much lower (13.5% and 18.6%
respectively).
3. Self-realization is a very broad concept described as psychological growth and
maturation, the awakening and manifestation of latent potentialities of the human being.
This scale works in reverse, with lower scores indicating higher attrition, and we found
similar results: very few respondents showed a high score on this subscale (7%), with
the majority showing a low score (71.2%), and therefore consistent with more burnout.
It should be noted that a high prevalence of burnout is considered to be present if at least
one of the three subscales scores high, even if the other two score low. We rated high in
the three of them.
To sum up, we are highly concerned about the results and perceptions of the burnout level
in our community. The majority of respondents find themselves in the ethical dilemma
of providing a quality medical service at the expense of leaving other patients waiting,
which combined with their own social determinants and inverse care law could lead to
serious time dependent problems, as seen in many studies (5).
We would like to continue our investigation to identify the possible causes and remedies
of this discouraging situation, by comparing our study with new ones in other communities
or even countries, and other years.
JUNIOR DOCTORS’CONTRIBUTIONS Page 34
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
References
1. Redacción. El sistema sanitario español es “la joya de la corona”, según el
nuevo consejero extremeño [Internet]. El médico interactivo. 2012 [cited 2023 Apr
27]. Available from: https://elmedicointeractivo.com/sistema-sanitario-espanhol-joya
corona-nuevo-consejero-extremenho-20120510144624035061/
2. World Health Organization. ICD-11 – Mortality and Morbidity Statistics
[Internet]. Who.int. 2019. Available from: https://icd.who.int/browse11/l
m/en#/http://id.who.int/icd/entity/129180281
3. Maslach, C.; Jackson, S.E. (1981). “The measurement of experienced burnout”. Journal
of Occupational Behavior. 2 (2): 99–113. doi:10.1002/job.4030020205
4. Ministerio de Sanidad, Consumo y Bienestar Social – Portal Estadístico del SNS – Gasto
sanitario público, gestionado por las comunidades autónomas, estructura en porcentaje
según los principales elementos de la clasificación económica y funcional del gasto
sanitario, por comunidad autónoma [Internet]. www.sanidad.gob.es. [cited 2023 Apr 27].
Available from:
https://www.sanidad.gob.es/estadEstudios/sanidadDatos/tablas/tabla31.htm
5. Urbanos-Garrido R. La desigualdad en el acceso a las prestaciones
sanitarias. Propuestas para lograr la equidad. Gac Sanit.2016;30(S1):25–30.
https://doi.org/10.1016/j.gaceta.2016.01.012.
JUNIOR DOCTORS’CONTRIBUTIONS Page 35
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
La situación de los médicos jóvenes y residentes en el sistema sanitario de la Comunidad
Autónoma de Madrid es precaria debido a las excesivas cargas de trabajo que tienen que
soportar, en una de las zonas de España donde menos se invierte en sanidad (4). Varios
políticos han calificado recientemente a la sanidad pública española como la “joya de la
corona” (1). Sin embargo, la satisfacción de los médicos, que tienen que lidiar con la
excelencia en su trabajo en condiciones de sobrecarga y burnout, y de los pacientes, que
observan cada día cómo se alargan las listas de espera, no reflejan esta situación.
Para dar una opinión más global sobre cómo afrontamos esta situación de estrés y
sobrecarga de trabajo, realizamos una encuesta cualitativa anónima y voluntaria (del 14 al
25 de abril de 2023) a médicos jóvenes y residentes de todas las especialidades del área
de Madrid para conocer su estado de burnout y cómo podemos afrontar éticamente el
desbordamiento de nuestras consultas y servicios.
El burnout es un síndrome conceptualizado como el resultado de un estrés laboral crónico
que no ha sido gestionado con éxito. Está considerado por la Organización Mundial de la
Salud como una enfermedad profesional que causa detrimento en la salud física y mental
de las personas. De los 156 médicos jóvenes y residentes encuestados, el 21,8% informó
de una puntuación global de burnout de 7 sobre 10 puntos (en una escala subjetiva de 0 a
10, siendo 0 “nada” y 10 “muy intenso”), que fue la marca más prevalente. Además, el
53,9% declaró tener entre 7 y 10 puntos de burnout. (FIGURA 1)
JUNIOR DOCTORS’CONTRIBUTIONS Page 36
Dra. Rocio Garcia-Gutierrez Gomez
Médica Especialista en Atención Primaria y Comunitaria.
Responsable de Intercambios del Movimiento Europeo de Jóvenes
Médicos de Familia. Hospital Universitario Severo Ochoa.
Leganés, Madrid (España)
Dra. Peral Martin Ana
Médica Especialista en Atención Primaria y Comunitaria.
Centro de Salud Paseo Imperial, Madrid (España)
Dr. Sergio Chamorro Mínguez
Médico Residente en Atención Primaria y Comunitaria.
Hospital Universitario Severo Ochoa. Leganés, Madrid (España)
Calidad de la atenciónmédica VS tiempo de espera:¿cómolo afrontanlos
médicos jóvenes delárea de Madridy cuáles su tasa de burnout?
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
En cuanto a la pregunta que les hicimos para saber cómo afrontan la gran presión
asistencial: el 67,3% dijo que pueden dedicar el tiempo que consideren necesario a
atender a sus pacientes, siempre que los demás pacientes estén esperando. El 19,9%
afirma que nunca dispone del tiempo necesario. Sólo el 3,2% comentó que dispone de
tiempo suficiente para atender a sus pacientes, sin prisas ni agobios. (FIGURA 2)
.
JUNIOR DOCTORS’CONTRIBUTIONS Page 37
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
Por último, les pedimos que cumplimentaran el cuestionario “Maslach Burnout Inventory”
(MBI), compuesto por 22 ítems, que pretende medir la frecuencia e intensidad con la que
se sufre burnout. Se compone de tres subescalas, las dos primeras de las cuales indican
mayor desgaste con puntuaciones más altas. (3).
1. El agotamiento emocional es un estado crónico de agotamiento físico y emocional
que resulta de demandas laborales o personales excesivas o de un estrés continuo.
El 28,9% de los encuestados puntuaron bajo en la escala, el 16% puntuaron medio y
más de la mitad, el 55,1% puntuaron alto.
2. La despersonalización puede consistir en un desapego hacia uno mismo, hacia la
propia mente o el propio cuerpo, o en ser un observador desapegado de uno mismo.
De nuevo, la mayoría de los encuestados puntuaron alto (67,9%), siendo las
puntuaciones bajo y medio mucho más bajas (13,5% y 18,6% respectivamente).
3. La autorrealización es un concepto muy amplio que se describe como el crecimiento y
la maduración psicológicos, el despertar y la manifestación de las potencialidades
latentes del ser humano. Esta escala funciona a la inversa, con puntuaciones más
bajas que indican un mayor desgaste, y encontramos resultados similares: muy pocos
encuestados mostraron una puntuación alta en esta subescala (7%), mostrando la
mayoría una puntuación baja (71,2%), y por lo tanto consistente con un mayor
burnout.
Hay que tener en cuenta que se considera que existe una alta prevalencia de burnout si al
menos una de las tres subescalas puntúa alto, aunque las otras dos puntúen
bajo. Nosotros puntuamos alto en las tres.
En resumen, estamos muy preocupados por los resultados y las percepciones del nivel de
burnout en nuestra comunidad. La mayoría de los encuestados se encuentran en el dilema
ético de prestar un servicio médico de calidad a costa de dejar esperando a otros
pacientes, lo que unido a sus propios determinantes sociales y a la ley de atención inversa
podría provocar graves problemas de dependencia del tiempo, como se ha visto en
muchos estudios (5).
Nos gustaría continuar nuestra investigación para identificar las posibles causas y
remedios de esta desalentadora situación, comparando nuestro estudio con otros nuevos
realizados en otras comunidades o incluso países, y otros años.
JUNIOR DOCTORS’CONTRIBUTIONS Page 38
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023
References
1. Redacción. El sistema sanitario español es “la joya de la corona”, según el
nuevo consejero extremeño [Internet]. El médico interactivo. 2012 [cited 2023 Apr
27]. Available from: https://elmedicointeractivo.com/sistema-sanitario-espanhol-joya
corona-nuevo-consejero-extremenho-20120510144624035061/
2. World Health Organization. ICD-11 – Mortality and Morbidity Statistics
[Internet]. Who.int. 2019. Available from: https://icd.who.int/browse11/l
m/en#/http://id.who.int/icd/entity/129180281
3. Maslach, C.; Jackson, S.E. (1981). “The measurement of experienced burnout”. Journal
of Occupational Behavior. 2 (2): 99–113. doi:10.1002/job.4030020205
4. Ministerio de Sanidad, Consumo y Bienestar Social – Portal Estadístico del SNS – Gasto
sanitario público, gestionado por las comunidades autónomas, estructura en porcentaje
según los principales elementos de la clasificación económica y funcional del gasto
sanitario, por comunidad autónoma [Internet]. www.sanidad.gob.es. [cited 2023 Apr 27].
Available from:
https://www.sanidad.gob.es/estadEstudios/sanidadDatos/tablas/tabla31.htm
5. Urbanos-Garrido R. La desigualdad en el acceso a las prestaciones
sanitarias. Propuestas para lograr la equidad. Gac Sanit.2016;30(S1):25–30.
https://doi.org/10.1016/j.gaceta.2016.01.012.
JUNIOR DOCTORS’CONTRIBUTIONS Page 39
Junior Doctors Network Newsletter
Medical Education & Medical Ethics Special Edition
October 2023