Because the US Medical Licensing Examination Step 1 (Step 1) has transitioned to pass/fail scoring, US Medical Licensing Examination Step 2 has emerged as a primary standardized metric in residency selection. In response, many medical schools have implemented hard deadlines for Step 2 completion before Electronic Residency Application Service (ERAS) submission. Although intended to streamline the application process and ensure timely examination completion, such mandates may unintentionally heighten student stress, jeopardize academic performance, and impair Match outcomes. This perspective offers a medical student's insight into the psychological and professional consequences of Step 2 deadlines and suggests policy recommendations to better align institutional goals with student wellness and success.

Postoperative hand therapy is important for recovery and enhanced functional outcomes following hand surgery. Access to this essential care is limited in Alabama, however, particularly for vulnerable populations in rural areas where public transportation is scarce. These challenges are further amplified for patients who are unable to drive due to their injuries. This study aimed to quantify disparities and barriers to certified hand therapy access in Alabama. Certified hand therapists in Alabama were identified through the Hand Therapy Certification Commission directory. Practice addresses were geocoded and paired with county center coordinates to calculate travel distances from each county center to the nearest certified hand therapist. These distances were then converted into one-way travel costs using Internal Revenue Service standard mileage rates. Counties were categorized by rurality using Rural-Urban Continuum Codes (RUCC) and assessed for social vulnerability using the Social Vulnerability Index (SVI), which considers socioeconomic, housing, and transportation factors. Statistical analyses, including t tests, χ2 tests, and multivariate regression, were used to evaluate patterns and predictors of travel costs. Alabama counties had a mean SVI of 0.67 ± 0.195-significantly higher than the national mean of 0.50 (P<0.0001). More than 80% of Alabama counties rank in the most vulnerable 50% of US counties, with Shelby County being the only county in the least vulnerable quartile (SVI 0.116). In addition, 36 counties (53.7%) are classified as rural (RUCC 4-9). Both SVI and RUCC independently correlated with increased travel costs. Multivariate regression modeling revealed that each unit increase in RUCC was associated with a $3.43 increase in travel costs (P<0.0001), and each 10% increase in SVI corresponded to a $1.64 increase in travel costs (P=0.006). These factors explained 56.4% of the variability in travel costs. Heatmaps visually highlighted higher travel costs in rural, socially vulnerable areas. Rural and socially vulnerable populations in Alabama face significant travel barriers to accessing certified hand therapy. The combined impact of geographic isolation and social vulnerability underscores the need for targeted interventions to ensure equitable access to postoperative care.

Trainee autonomy is a value emphasized by formal governing bodies within graduate medical education, yet prior data demonstrate that pediatric residents perceive less autonomy than attendings report providing. Independent rounding (IR) is one practice that has been demonstrated in qualitative studies to promote autonomy. The objective of our study was to promote graduated trainee autonomy and to understand the interprofessional perspectives on the implementation of IR across various domains. A single-center mixed-methods study was conducted between July 2021 and June 2022 at a quaternary children's hospital. IR was introduced on one inpatient team 1 day/week for the academic year. Postsurveys were sent to participants that included resident trainees, medical students, attendings, and nurses comparing IR with traditional rounding. Attendings and trainees who rotated on one of the inpatient pediatrics teams were automatically enrolled in this study, which included 26 medical students, 41 interns, 22 senior residents, and 15 attending physicians. IR was well received among all participants. All senior residents reported improved perceptions of autonomy. There was overall improved or lack of change in perceptions of patient safety, teaching and feedback, and clinical workflow. All attendings and trainees endorsed that residents should have the opportunity to round independently, with trainees feeling that the opportunity should be more frequent than once per week. IR is a feasible and well-received method of promoting graduated trainee autonomy.

Pregnant women living in rural areas of the United States are not equitably served by healthcare systems and may be disproportionately affected by sexually transmitted infections (STIs). We examined the impact of location of pregnancy care on STI screening and positivity in a statewide health system. Pregnant women seeking care within a statewide health system during 2021-2022 were categorized by location of care at either the main university hospital (urban) or regional (rural) hospitals. We assessed STI screening and positivity for chlamydia, gonorrhea, and trichomoniasis within each setting and by the Social Vulnerability Index (SVI) assigned to the person's census tract (high ≥0.75 vs low <0.75). We identified 12,921 unique pregnancy episodes: 9051 (70%) within the university hospital and 3870 (30%) in regional hospitals. The mean census tract SVI among all women was 0.54 (standard deviation 0.29), and 29% of pregnant women resided in areas with a high SVI. Women in care at a regional hospital were more likely to reside in areas with a high SVI compared with the university hospital (41% v. 23%). In total, 75% of pregnant women were screened for any STI (9727/12,921). Compared with university hospitals, STI screening rates during pregnancy were lower (77% vs 70%) and STI positivity during pregnancy was higher in regional hospitals (chlamydia [3.9% vs 6.4%], gonorrhea [0.6% vs 1.3%], and trichomoniasis [4.6% vs 8%]). In a statewide health system, pregnancy care provided in rural regional hospitals was associated with lower STI screening rates and higher STI positivity.

The rapid evolution of genomic technologies is poised to transform patient care during the next decade, integrating precision medicine with artificial intelligence (AI) to enhance diagnostic accuracy, therapeutic decision making, and personalized healthcare strategies. This review explores key advancements in genomics, including whole-genome sequencing, single-cell genomics, pharmacogenomics, and gene-editing technologies, and their potential impact on clinical practice. AI is emerging as a critical tool in genomic data interpretation, improving disease risk prediction, patient stratification, and drug-response assessments. The synergy between AI and genomics is fostering novel insights into complex diseases such as cancer, cardiovascular conditions, and neurodegenerative disorders. In addition, epigenomics and liquid biopsies are expanding early disease detection capabilities, allowing for minimally invasive diagnostics and real-time treatment monitoring. Despite these promising developments, challenges remain in accessibility, cost, and ethical considerations, particularly regarding genomic data privacy and algorithmic bias. This review highlights ongoing global initiatives, such as the UK Biobank and the 100,000 Genomes Project, as models for integrating genomic data into mainstream health care. Furthermore, the widespread adoption of gene-editing techniques such as CRISPR holds potential for curative interventions in hereditary diseases. By 2030, genomics will likely be embedded in routine clinical practice, shifting medicine toward a predictive, preventive, and personalized model. Equitable access and ethical governance must be prioritized to ensure the responsible implementation of these transformative technologies, however. This review underscores the need for interdisciplinary collaboration to maximize the clinical and societal benefits of genomic innovation.

The Rio Grande Valley (RGV) is a developing clinical research region characterized by its distinctive demographic profile that offers an opportunity to investigate diverse health issues. This pilot investigation sought to evaluate the demographic and clinical characteristics linked to bone metastases and primary malignant bone neoplasms (PMBNs) in patients from the RGV and to compare the frequency of these conditions with the US general population. This was a retrospective chart review in which data were gathered from the University of Texas Rio Grande Valley UTHealth electronic database from January 1, 2018 to September 4, 2024. Various statistical analyses were performed to assess the demographic and clinical data. Individuals in the RGV are more likely to develop a PMBN (P < 0.0163) but less likely to have bone metastasis (P < 0.0015) compared with the general US population. Regarding bone metastases and PMBN, although not statistically significant, patients with bone metastasis were 10 years older on average and exhibited a lower body mass index (-1.7 kg/m2) and weight (-17.6 kg) than those with PMBN. Our initial research indicates age and body weight variations among individuals with bone metastases and PMBN in the RGV, as well as differences in frequency of bone metastases and PMBN in this medically underserved region compared with the general US population. Despite the limited sample size, our results necessitate further exploration in a larger cohort to elucidate any demographic and clinical differences in bone metastases and PMBN subtypes in medically underserved areas.

Female sexual dysfunction (FSD) refers to problems with desire, arousal, orgasm, or pain, affecting approximately 12% of US women. Although FSD can be managed in primary care, most primary care clinicians do not regularly treat it. This survey of primary care clinicians practicing at a large US health system assessed perspectives on managing sexual dysfunction compared with other conditions, knowledge of prevalence of sexual dysfunction, and which specialty should be responsible for treating FSD. We described the distribution of clinicians' survey responses. Of the 527 invited, 80 completed the survey (response rate: 15%). Most were women (68%), physicians (52%), and had >15 years of experience (43%). The majority (88%) reported treating FSD is as important as treating other conditions that affect quality of life. Two-thirds reported disorders of desire, arousal, and orgasm could be managed in primary care, and 64% believed that pain with intercourse, typically addressed by Obstetrics/Gynecology, should be handled in primary care. Most primary care clinicians believed that treating FSD was at least as important as treating other conditions, yet up to one-third believed this responsibility should be left to a different specialty. Educational interventions targeting primary care clinicians may increase the number who take on FSD management.