Stefania Di Gangi

BACKGROUND: Feeling adequately prepared for a career at the end of medical school may impact both career choice and performance. This study investigated medical students’ self-assessed preparedness for various career options, including research and non-clinical roles, on completing their master’s programme and the factors associated with this preparedness. METHODS: This was a cross-sectional online survey of medical students who completed the master’s programme in spring 2025. The students were enrolled at various Swiss medical schools. The survey included Likert-scaled questions. Multivariable regression analysis assessed the factors associated with students’ self-assessed preparedness for each career, including age, gender, medical school, teaching programme, intention to complete a doctoral thesis and career attractiveness. RESULTS: Among the 338 medical students who participated (52% response rate), the majority felt adequately prepared for a career in hospital general internal medicine, 261 (77%), or in general practice, 215 (64%). There was variation in self-assessed preparedness between medical schools, but it was statistically significant only for a career in paediatrics or gynaecology in a practice, with results ranging from 4/26 (15%) to 24/43 (56%), p <0.001. Female students were less likely than male students to feel prepared for an academic career or for general practice (odds ratio: 0.42 [95% confidence interval: 0.25-0.71] and 0.59 [0.35–0.98], respectively). An increase in the attractiveness of careers in general practice or specialised medicine in a hospital was associated with self-assessed preparedness for those careers. CONCLUSION: At the end of the master’s programme, over two-thirds of students from the included medical schools felt that they were adequately prepared to start a career in hospital general internal medicine or in general practice. The dynamics of career attractiveness and the medical school attended were associated with self-assessed preparedness for specific career options. This underscores the pivotal role that medical school plays in shaping career preparedness and the future medical workforce.

Background: Preventive tests and procedures (PTPs) help to reduce disease burden. However, patient expectations often differ from current guidelines, resulting in overuse or underuse of PTPs. Shared decision making can bridge this gap but requires clear, evidence-based information. This study aimed to develop and conduct an initial evaluation of prototype fact sheets designed to support informed decisions about PTPs. Methods: We selected 11 PTPs based on their potential for over- or underuse. For each, we developed a fact sheet following guideline recommendations. These summarised key benefits, risks and relevance using verbal, numerical and graphical formats. User experience and comprehensibility were assessed through a survey among a university population. Participants rated comprehensibility, content and design on a 5-point scale. Approval was defined as the proportion of ‘very good’ or ‘rather good’ ratings. Participants giving poor ratings were invited to provide free-text comments. Subgroup analyses were performed by age and educational level. Results: A total of 2,082 individuals answered all relevant questions to fact sheets. The median fact sheet approval score was 77% (interquartile range: 55%, 91%). Six of the 11 fact sheets received an approval of greater than 80% for comprehensibility in general. Lower approval was reported for risk descriptions, usefulness in doctor–patient conversations and visuals. Cancer screening sheets scored the lowest. Subgroup analyses showed lower approval in younger age groups and among individuals with higher levels of education. Conclusions: Initial user testing of the fact sheets showed generally positive ratings regarding comprehensibility and user experience. However, the presentation of specific risks and the use of visuals needed to be adapted, especially for cancer-related topics. The findings highlighted the importance of tailoring informational materials to effectively support shared decision making.

Managing bodily distress disorder (BDD) requires an interprofessional, holistic therapeutic approach, which can be challenging to implement in routine care. The aim was to evaluate a care pathway for patients with BDD involving general practitioners (GPs) and physiotherapists. Participants were patients aged 18 years or older with BDD symptoms and the PHQ-15 (Patient Health Questionnaire 15-Item) score > 9. The treatment consisted of patient education by GPs about BDD and stress, sleep interventions, physical exercises and support to develop an active lifestyle (> 150 min per week of moderate-intensity physical activity), as measured with the Physical Activity Vital Sign (PAVS). Patient outcomes (PHQ-15 and PAVS) were compared at baseline and after six months. A survey assessed the perspectives of both patients and health professionals about the treatment. A total of 70 patients treated by 11 GPs and 6 physiotherapists were involved. Comparing outcomes at baseline vs. after six months (median [IQR]): PHQ-15 decreased, 14 [11, 17] vs. 8 [5, 12], p < 0.001; PAVS increased, 60 [30, 120] vs. 120 [60, 180], p < 0.001; GP confidence (scale 0-100) in treating BDD increased, 50 [38, 66] vs. 82 [66, 85], p = 0.005. Feedback from patients, GPs and physiotherapists about the intervention was positive. The interprofessional care pathway for patients with BDD had a positive impact on patient outcomes, GP treatment confidence, and was well-received by both patients and health professionals. It can be adapted across primary care systems and tailored to local contexts to improve the quality of care.

Medical career preferences are in focus because the future medical workforce should align with society's needs. The study investigated how medical students' perceptions of the attractiveness of various clinical and non-clinical career options evolved as they approached the end of medical school, and which factors might influence their career choices. This was a cross-sectional online survey of medical students who completed the master's program in spring 2025 in different medical education tracks at different Swiss universities. The survey included both Likert-scaled and open-ended questions. Flow diagrams were used to depict changes in attractiveness throughout medical school. Network visualization mapped the connections between the most important career determinants. Regression analysis assessed the factors associated with career preferences. Among 364 medical students included, the most attractive careers at the end of medical school were the specialized disciplines of inpatient care (37%) and outpatient care (20%). These specialties were preferred due to interest in surgery or specialization. During the master's program, attractiveness of general practice, specialized outpatient care, and specialized inpatient care increased while the attractiveness of outpatient gynecology/pediatrics and inpatient general internal medicine decreased. Career characteristics perceived to be the most important determinants of career choice were primarily performing medical activities, part-time work, and relationships with patients. The most prevalent factors favoring career decisions were experience during the elective year (91%) and clinical courses with patient contact during the studies (70%). Students who found a career more attractive during their studies were more likely to prefer that career at the end of medical school. Career preferences at the end of medical school were associated with specific factors. Among these factors, the most significant was the perceived attractiveness of the career during medical education. This emphasizes the importance of medical education in shaping students' dynamic and multifaceted career decisions.

Purpose: Antibiotic-sparing treatment (ASPT) strategies, such as delayed prescribing and symptomatic treatment, are promising to reduce antimicrobial consumption (AMC) in patients with uncomplicated urinary tract infections (uUTI). The aim of this scoping review was to identify literature reporting on factors that may act as barriers and facilitators to the use of ASPT in order to improve implementation. Methods: MEDLINE (Ovid), Embase, the Cochrane Database, Google Scholar, Proquest Dissertations and Theses, the Clinical Trials Gov Registry and the ICTRP WHO Registry were searched for evidence of health care professionals and/or patients exposed to ASPT in the context of uUTI. We included evidence published between 2000 and 2024, from high-income countries and in any language. Identified factors were grouped into themes and categorized as facilitators or barriers. Results: A total of 6543 unique records were screened for eligibility and 108 records were included in the review. Most evidence was from original research ( n = 50, 46.3%) or reviews ( n = 46, 42.6%). We identified AMC, clinical outcomes, healthcare utilisation, and patient- or prescriber-related factors as main themes. The main facilitator was the expectation of reduced AMC, while prolonged symptom duration and increased risk of disease progression were identified as main barriers. Conclusion: The clinical management of uUTIs is shaped by factors that can facilitate or hinder ASPT use. This scoping review identified key factors and provided a basis for future research in the area of patient-provider decision making for ASPT, with the ultimate goal to inform targeted interventions and promote wider implementation of ASPT.

Objective: This scoping review will explore the evidence on factors influencing the decision to use antibiotic-sparing treatments in women with uncomplicated urinary tract infections. Introduction: Overuse and misuse of antibiotics are the main drivers of antimicrobial resistance. Antibiotic-sparing treatments, such as symptomatic treatment with analgesics and delayed prescriptions, have considerable potential to reduce antibiotic consumption, but the majority of patients still receive antibiotics without delay. The reasons for the poor implementation of these alternative approaches are unknown. A better understanding of the factors influencing treatment decisions is needed. Inclusion criteria: This review will consider the experiences and attitudes of health care professionals and women in outpatient settings in high-income countries, regarding the use of antibiotic-sparing treatments for the diagnosis or suspected diagnosis of uncomplicated urinary tract infections (ie, healthy women aged 18–64 years who are not pregnant, immunosuppressed, and have no functional or structural urinary tract abnormalities). Methods: This review will follow the JBI methodology for scoping reviews. MEDLINE (Ovid), Embase, and the Cochrane Library will be searched to identify peer-reviewed articles: original research (quantitative or qualitative studies, experimental, or observational), reviews, case reports, and case series. Gray literature will also be searched for. Sources in any language from 2000 to 2024 will be included. Three reviewers will screen the sources and extract data using a tool developed by the reviewers. The analysis will use counts and descriptive qualitative content analysis. The results will be presented in visual, tabular, and narrative formats. Review registration: Open Science Framework osf.io/t8y5e/

Introduction: Improving the quality of teaching placements in family medicine practice (FMP) could help to address the shortage of primary care physicians. This study aims to investigate students’ evaluations of first-exposure FMP placements, to identify clusters of FMPs that might need to improve their placement quality, and to analyze students’ perceptions of the FMP as a learning environment. Methods: The design was a cross-sectional survey study, including all fourth-year undergraduate medical students at the University of Zurich, Switzerland, who completed a mandatory placement in FMP during 2019– 2022. The placements consisted of individual teaching and training in the same FMP for 8 half days within an academic year. The primary outcome was the student Likert scale rating of the 14 key questions as indicators of teaching placement quality. Based on these indicators, cluster analysis was used to identify groups of FMPs with the potential for quality improvement. A framework analysis was used to analyze the students’ perceptions. Results: A total of 713 students (response rate 81%) and 249 FMPs (median [interquartile range]: 2 [1,4] students per FMP) were included. Overall, 86% of the students were satisfied with the placement, and 95% reported that the placement gave them realistic insight into FMP work. A cluster of 25 (10%) FMPs that may improve placement quality was identified. Students most liked the opportunity to gain FMP skills, insight into FMP work, and establishment of patient relationships. Conclusion: Our study described students’ experiences with FMP and a method for teaching evaluation to identify FMPs that may benefit from interventions to improve their learning environment. This could upgrade the medical education offered and increase the interest in family medicine as a response to the shortage of primary care physicians.

AIMS OF THE STUDY: Arterial hypertension is a major global health risk. Global surveys indicate that only half of patients with arterial hypertension receive pharmacotherapy, and only a quarter achieve the primary blood pressure target recommended by guidelines. This study aimed to evaluate the achievement of the primary blood pressure target in Swiss general practice, provide insights into arterial hypertension treatment, and identify factors associated with achieving this goal. METHODS: This cross-sectional study utilised data from a large Swiss primary care database. Patients with arterial hypertension, aged ≥18 years, who underwent blood pressure monitoring in 2021 were included. The primary observation was blood pressure control, defined as the achievement of the primary blood pressure target of systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg. Demographic data from physicians and patients, blood pressure measurements, comorbidities, cardiovascular risk factors, and pharmacotherapy were collected, and arterial hypertension stages were calculated. Unadjusted and multivariable-adjusted mixed logistic regression models were used to identify factors associated with blood pressure control. RESULTS: A total of 49,290 patients were included, of whom 23,933 (48.6%) were female. The median patient age was 71 years (interquartile range 61–80). Blood pressure control was observed in 23,022 patients (46.7%), and 36,692 patients (74.4%) had an antihypertensive pharmacotherapy prescription. In multivariable analysis, blood pressure control was positively associated with arterial hypertension stage, antihypertensive pharmacotherapy, the intensity of blood pressure monitoring, and the number of blood pressure-increasing drugs, but negatively associated with a long-standing arterial hypertension, female sex, and old age. CONCLUSIONS: While general practitioners appear to consider arterial hypertension stages in their treatment strategies, there is still room for improvement in arterial hypertension care by prescribing pharmacotherapy, especially in patients with long-standing arterial hypertension, female sex and old age.

Summary: Background: The risk of developing deep vein thrombosis (DVT) after endovenous ablation of varicose veins varies in the literature. Little is known about the characteristics of this complication and associated factors. This study aimed: 1) to study the occurrence of DVT after ultrasound-guided foam sclerotherapy (UGFS) alone or combined with endovenous laser ablation (EVLA) for lower-limb varicose veins; 2) to identify factors associated with DVT. Patients and methods: The study included all outpatients aged 18 years or older who underwent UGFS and EVLA or UGFS alone at the University Hospital of Zurich between 2011 and 2015. Data were extracted from the hospital electronic medical record. Patients were surveyed about their level of pain after the procedure and their level of satisfaction with the procedure. Duplex ultrasound was used to assess the deep venous system 7–10 days and 6–8 months after the procedure. Regression analysis was used to examine the association of patient and procedure characteristics with the development of DVT. Results: A total of 334 patients (561 procedures performed in 393 different sessions) were included: 73% of the patients underwent combined UGFS and EVLA and 27% underwent UGFS alone. DVT occurred in 24 (7.2%) patients, of whom 88% underwent combined procedures and 17% underwent interventions involving both the great and small saphenous veins on the same session. DVT occurred in 8.2% of patients receiving thromboprophylaxis and in 9.5% of patients not receiving thromboprophylaxis. DVT occurred in 5.2% of women and 11.9% of men. No factors associated with a diagnosis of DVT after intervention were identified. Pain and satisfaction levels did not differ between patients with and without DVT. Conclusions: This study adds to the knowledge of the risk of DVT following UGFS alone or combined with EVLA. Further studies are needed to revise thromboprophylaxis.

Background: Monitoring the career intentions of medical students during their undergraduate studies could help to address the shortage of physicians, particularly in general practice. This study aimed to investigate changes in medical students' career openness, attractiveness and determinants of medical career choice during their bachelor’s studies. Methods: The design was cross-sectional, recruiting all medical students who started a bachelor’s program in one of the four different educational tracks in Zurich, Switzerland, in the fall of 2019 (first survey) and completed it in the summer of 2022 (second survey). Students’ perceptions of the attractiveness and determinants of different medical career options were assessed using a structured online questionnaire. Absolute changes between the two-time points were reported in percentage points overall and by educational track. Regression analysis was used to examine the association of student characteristics and determinants of career options with the attractiveness of each option. Results: We surveyed 354 medical students at the beginning and 433 at the end of the bachelor’s program (participation rate: 71.1% and 86.9%, respectively). Overall, the proportion of students open to all proposed medical career options decreased (from 52.8% to 43.8%, p = 0.004). The attractiveness of outpatient gynecology or pediatrics increased (from 27.4% to 43.4%, p < 0.001), whereas the attractiveness of both general and specialized inpatient care decreased (from 47.8% to 40.3%, p = 0.05 and from 71.1% to 61.1%, p = 0.006 respectively). There was an increase in the proportion of students who perceived part-time work, autonomy and relationships with patients as important career determinants (from 47.3% to 64.7%, p < 0.001; from 63.3% to 77.8%, p < 0.001; from 80.8% to 89.3%, p = 0.002 respectively), while the importance of reputation and career opportunities decreased (from 42.6% to 26.2%, p < 0.001; from 79.2% to 63.6%, p < 0.001 respectively). The importance of part-time work and relationships with patients were positively associated with the attractiveness of general practice. Conclusions: During the bachelor’s program, the attractiveness of a career in general practice tended to decrease, but the importance of part-time work, autonomy and relationships with patients as career determinants increased. Helping students understand how these determinants relate to general practice may increase their interest in the profession. Trial registration: Not applicable.