In recent years, medical students have been assuming increasing control over their preclerkship education. According to a survey involving 13 099 US medical students, the percentage of second-year medical students who reported "almost never" attending lectures in person continued to increase, from 26.3% to 37.0% between 2018 and 2020. 1 Concurrently, medical school curricula evolved to promote learner autonomy. Apart and distinct from increased reliance on recorded rather than live lectures, the curricular events allocated to independent learning nearly doubled between 2013 and 2020, from an estimated 3.35% to 6.38%. 2 These trends are unlikely to abate anytime soon. Current medical students accomplish the bulk of their learning outside the classroom, a practice likely solidified by adaptations to the COVID-19 pandemic. As others have noted, the reconfiguration of the preclerkship component of medical education is all but inevitable. 3 In this Viewpoint, we highlight the growing role of medical students in shaping their own education and outline the measures required to ensure that the increase of medical student-directed learning remains aligned with the educational aims of the medical discipline.Since the advent of Accreditation Standard 6.3 of the Liaison Committee on Medical Education (LCME), medical schools have taken to emphasizing selfdirected learning to complement lecture and casebased instruction. The LCME standard in question requires the inclusion of unscheduled time and independent learning components "to allow medical students to develop the skills of lifelong learning." 4 The emphasis on self-directed learning aptly encourages a more active role for medical students in the educational experience. These changes, along with the pressures imposed by the numeric score reporting of the United States Medical Licensing Examination (USMLE) Step 1, led to the emergence of a parallel, medical studentdirected curriculum that is dominated by resources geared toward studying for the USMLE. 5 Contemporary medical students now navigate a vast sea of didactic resources wherein institution-specific materials constitute but one of many sources.
Women suffering from absolute uterine factor infertility (AUFI) had no hope of childbearing until clinical feasibility of uterus transplantation (UTx) was documented in 2014 with the birth of a healthy baby. This landmark accomplishment followed extensive foundational work with a wide range of animal species including higher primates. In the present review, we provide a summary of the animal research and describe the results of cases and clinical trials on UTx. Surgical advances for graft removal from live donors and transplantation to recipients are improving, with a recent trend away from laparotomy to robotic approaches, although challenges persist regarding optimum immunosuppressive therapies and tests for graft rejection. Because UTx does not involve transplantation of the Fallopian tubes, IVF is required as part of the UTx process. We provide a unique focus on the intersection between these two processes, with consideration of when oocyte retrieval should be performed, whether, and for whom, preimplantation genetic testing for aneuploidy should be used, whether oocytes or embryos should be frozen and when the first embryo transfer should be performed post-UTx. We also address the utility of an international society UTx (ISUTx) registry for assessing overall UTx success rates, complications, and live births. The long-term health outcomes of all parties involved—the uterus donor (if live donor), the recipient, her partner and any children born from the transplanted graft—are also reviewed. Unlike traditional solid organ transplantation procedures, UTx is not lifesaving, but is life-giving, although as with traditional types of transplantation, costs, and ethical considerations are inevitable. We discuss the likelihood that costs will decrease as efficiency and efficacy improve, and that ethical complexities for and against acceptability of the procedure sharpen the distinctions between genetic, gestational, and social parenthood. As more programs wish to offer the procedure, we suggest a scheme for setting up a UTx program as well as future directions of this rapidly evolving field. In our 2010 review, we described the future of clinical UTx based on development of the procedure in animal models. This Grand Theme Review offers a closing loop to this previous review of more than a decade ago. The clinical feasibility of UTx has now been proved. Advancements include widening the criteria for acceptance of donors and recipients, improving surgery, shortening time to pregnancy, and improving post-UTx management. Together, these improvements catalyze the transition of UTx from experimental into mainstream clinical practice. The procedure will then represent a realistic and accessible alternative to gestational surrogacy for the treatment of AUFI and should become part of the armamentarium of reproductive specialists worldwide.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.