Israel Medical Association Journal

Background: Recent guidelines have emphasized the importance of the diagnosis and treatment of obesity in all healthcare settings. However, obesity rarely appears as a chronic diagnosis during hospitalization, and there are few reports of targeted interventions.

Objective: To assess obesity-related diagnoses and interventions during pediatric acute hospitalization.

Methods: A retrospective cohort study was conducted in a pediatric ward. Hospitalization records of all patients aged 2–18 years were retrieved during a 30-month period. Weight percentile for patient age was calculated using the U.S. Centers for Disease Control and Prevention (CDC) age- and sex-adjusted charts. Patients with a weight-percentile-for-age of ≥ 95% were classified as suspected obesity. The characteristics of obesity-diagnosed patients were compared to obesity-overlooked patients.

Results: Of the hospitalized patients, 245/2827 (8.6%) had weight-percentile-for-age of ≥ 95%. Of these, 91/245 (37.4%) had obesity-related references in their medical record; 65/245 (26.5%) had a mean body mass index of 97.66% ± 2.6. Only 38/245 (15.5%) were diagnosed with obesity; weight-related recommendations only appeared in the discharge letter for 44/245 (17.9%). Multivariate analysis indicated that obesity was significantly more overlooked in preschoolers than in adolescents (adjusted odds ratio [OR] 11.78, 95% confidence interval [95%CI] 4.71–29.42), P < 0.001) and in patients, regardless of age, whose chief complaint was not abdominal (OR 7.7, 95%CI 1.92–30.8, P = 0.004).

Conclusions: Low rates of obesity-related diagnoses during pediatric acute hospitalization, especially in younger patients, are frequent. Pediatric staff should note obesity in patients and be trained in non-stigmatizing intervention during hospitalization.

Becoming and Being a Physician: A Developmental Journey

Shmuel P. Reis, Adina L. Kalet, W. Wayne Weston. CRC Press, 2025, Boca Raton, London, New York

This book is essentially about the evolution of knowledge regarding the DLC from its seemingly simplistic beginnings to its current extreme complexity. The authors offer a set of lenses to understanding such complexity and discerning what comprises and what may influence the DLC.

The Lancet Commission on Medicine, Nazism and the Holocaust was published in November 2023, recognized the potential dangers for the medical profession that are echoed in this history. The tragic events on 7 October 2023 have revealed just how timely and important the Commission's publication is and have raised the question of the relevance to the Holocaust to this attack. One of the continuities from this past and which has dangerous implications for current medicine, is antisemitism. Examination of the antisemitism inherent to medical education in Nazi Germany raises the question of antisemitism in current academia. Since October 7th there has been a drastic rise in antisemitism and antisemitic actions in both the academy and in medicine. We have seen outright refusal to condemn the brutal perpetrators of the October 7th massacre and continue to observe explicit support for the perpetrators from both faculty and students. Medicine, a profession whose foundational tenet is the well being of humanity–all humanity–and that hallows moral clarity, cannot allow for antisemitic speech and actions to exist within the profession. Awareness and education on this history is crucial for the medical profession so that the tragic events of the past do not happen again.

It is indisputable that internal medicine is the cornerstone of medical activities, including medical education, in hospital clinical activities, and clinical and basic medical research.

The medical landscape in Israel is exceptionally demanding, far exceeding the norms of the countries that are members of the Organisation for Economic Co-operation and Development (OECD). We have fewer hospital beds per capita, a greater workload for each physician, and in the future, we will face the challenge of teaching more medical students across our current clinical fields.

The Israeli Society of Internal Medicine has made it its mission to advance internal medicine across all dimensions of the healthcare system in Israel. As such, for the third consecutive year, we are honored to present an issue of the Israel Medical Association Journal (IMAJ) dedicated to research in the different fields of internal medicine that are conducted by physicians from various departments across the country.

This year, we emphasize even more strongly that research is an integral part of our clinical practice. At a time when the basic sciences phase of residency is under threat, it is crucial to underscore its importance. In this issue of IMAJ, we have chosen to publish various studies that were conducted during the basic sciences phase of the residency in internal medicine, highlighting how this training period can be optimally utilized to advance research while simultaneously progressing and maturing through clinical training.

The Dina Recanati School of Medicine at Reichman University was founded as a testament to the Zionist vision of its founders: Prof. Uriel Reichman, Mr. Oudi Recanati, and prominent leaders from Israel’s foremost medical institutions, including Rabin Medical Center, Schneider Children’s Medical Center, Clalit Health Services, Maccabi Healthcare Services, Edmond and Lily Safra Children's Hospital, and the Sheba Medical Center. United by a shared purpose, they established the school to tackle a critical challenge in Israeli healthcare: the growing need for locally trained physicians.

Among the people who contributed to the idea were the editors of the Israel Medical Association (IMAJ), Prof. Yehuda Shoenfeld, Prof. Joshua Shemer, and Prof. Zvi Spirer who presented the idea to Prof. Reichman, 10 years ago.

The Dina Recanati School of Medicine at Reichman University offers a unique approach to preclinical medical education, combining strong scientific foundations with practical, clinical applications. This 4-year program includes two preclinical years focused on core medical knowledge and two clinical years of rotations. The curriculum emphasizes small-group learning, early clinical exposure, and a system-based block structure. Starting from the first week of the preclinical years, students will participate in biweekly clinical days, using simulations, virtual reality, and patient interactions to develop practical clinical skills. The community clinic mentorship offers real-world experience that complements the clinical program taught in class during the same week. Research is central, with students conducting supervised projects aimed at a medical doctor thesis publication. The teaching model ensures relevance by integrating clinical cases into all courses, guided by practicing physicians. Daily quizzes and block-style assessments replace traditional examination periods, promoting consistent learning. The innovative program balances clinical practice with scientific knowledge, preparing students for the challenges of modern medicine.

Medical educators often find teaching useful findings on physical examination challenging. Important findings must be easy to remember and applied or they will soon be forgotten by students. The use of elegant, thought-provoking art for teaching examination skills makes learning enjoyable and memorable. Physicians need the ability to quickly perform and incorporate a limited useful physical examination into patient encounters to be good diagnosticians.

War is a chaotic situation for most of the public sectors in the countries involved. These sectors also include the medical systems, especially medical education, of which medical communication is often neglected or forgotten due to objective and subjective causes on either side of the involved countries. By planning lessons on various aspects of medicine for countries at war and close mentoring and utilization of modern communications technologies, these difficulties can be minimized without jeopardizing the quality of medical studies nor medical communication. In this perspective article, we describe the objective and subjective measures taken by our team to achieve these goals during the Iron Swords war in our region.

Background: On 7 April 1933, the Nazi Law for the Restoration of the Professional Civil Service was enacted. The law triggered the dismissal of most Jewish medical staff from German universities. A few Jewish professors in Berlin were permitted to continue their academic activity with restrictions. Those professors were gradually dismissed as laws and restrictions were enforced.

Objectives: To identify the last Jewish medical professors who, despite severe restrictions, continued their academic duties and prepared students for their examinations in Berlin after the summer of 1933.

Methods: We reviewed dissertations written by the medical faculty of Berlin from 1933 to 1937 and identified Jewish professors who mentored students during those years.

Results: Thirteen Jewish tutors instructed dissertations for the medical examinations after the Nazi regime seized power. They were employees of different university hospitals, including the Jewish hospitals. We did not identify Aryan students instructed by Jewish professors. The professors were active in different medical disciplines. Half of the reviewed dissertations were in the disciplines of surgery and gynecology. The last Jewish tutors were dismissed in October 1935. However, some of their studies were submitted for examination after that date.

Conclusions: After the Nazi regime seized power, academic activities and medical research by Jewish professors declined but did not stop. However, these professors worked with only Jewish students on their theses. Most dissertations were approved and examined after the Jewish academics were dismissed by the university, in some cases even after they left Germany.

The ancient, Biblical, holy Ten Commandments were presented to humanity to serve as guidelines for relationships between individuals and the deity they worship as well as a benchmark for living in civilized communities, irrespective of religious affiliation. The commandments are also embedded in medical education taught to medical students and other health professions throughout the world. Thus, the Ten Commandments are embedded in the medical communications curriculum at Adelson School of Medicine, Ariel University, Ariel, Israel. Unfortunately, most of these commandments were desecrated during the violent, hostile, merciless, and ruthless attack inflicted by the Hamas terror organization on villages, rural communities, and cities in southern Israel on 7 October 2023. We define the Ten Commandments in terms of medical education and describe their desecration by Hamas terrorists before and during the Iron Swords war.

Internal medicine is no doubt one of the main pillars of modern medicine. For years it has been considered to be the basis and foundation of medical education and proper clinical service. During the recent coronavirus disease 2019 (COVID-19) pandemic, internal medicine departments were recognized worldwide, and clearly in Israel, to be the true Corona Warriors that provided medical care to patients as well as support and comfort to families. Around the globe, the public applauded and appreciated the bravery of our medical staff, who without hesitation and under direct personal danger provided the best medical care possible despite the hardships of the time. The high personal price and even the heavy cost of staff member lives lost in offering medical care to the pubic did not stop our quest for ongoing medical research.

Worldwide, students of healthcare professions attend clinical rotations at medical facilities. Much research, and consequently scientific publications, is produced during their studies, bearing the fruits of student–faculty collaboration. To the best of our knowledge, no previous contract has been proposed detailing the fine print to pre-determine mutual responsibilities and privileges of students and faculty. Our objective was to present such a contract to the relevant students and faculty. We conducted a literature review to study existing proposals and solutions for this dilemma. Appropriate guidelines were also scanned. We included a proposal for a standard contract as the basis for student–faculty agreement for conducting research and publishing collaborative work. Questions regarding the relative contribution of students and subsequent authorship often arise. Vague rules and absent regulations in this realm can, at times, can be disadvantageous to students. We foresee a future role for our proposed agreement.

Background: Coronavirus disease-19 (COVID-19) impacted medical education and led to the significant modification or suspension of clinical clerkships and rotations.

Objectives: To describe a revised surgery clerkship curriculum, in which we divided in-person clinical teaching into smaller groups of students and adopted online-based learning to foster student and patient safety while upholding program standards.

Methods: The third-year surgery core clerkship of a 4-year international English-language program at the Medical School for International Health at Ben Gurion University of the Negev, Beer Sheva, Israel, was adapted by dividing students into smaller capsules for in-person learning and incorporating online learning tools. Specifically, students were divided evenly throughout three surgical departments, each of which followed a different clinical schedule.

Results: National Board of Medical Examiners clerkship scores of third-year medical students who were returning to in-person clinical clerkships after transitioning from 8 weeks of online-based learning showed no significant difference from the previous 2 years.

Conclusions: To manage with the restrictions caused by COVID-19 pandemic, we designed an alternative approach to a traditional surgical clerkship that minimized the risk of exposure and used online learning tools to navigate scheduling challenges. This curriculum enabled students to complete their clinical rotation objectives and outcomes while maintaining program standards. Furthermore, this approach provided a number of benefits, which medical schools should consider adopting the model into practice even in a post-pandemic setting

Background: The effect of extended shift length on pediatric residency is controversial. Israeli residents perform shifts extending up to 26 hours, a practice leading to general dissatisfaction. In early 2020, during the coronavirus disease-2019 (COVID-19) pandemic, many Israeli hospitals transitioned from 26-hour shifts to 13-hour shifts in fixed teams (capsules) followed by a 24-hour rest period at home. The regulation changes enacted by the Israeli government during the COVID-19 pandemic provided a rare opportunity to assess perception by residents regarding length of shifts before and after the change.

Objectives: To assess perception of pediatric residency in three aspects: resident wellness, ability to deliver quality healthcare, and acquisition of medical education following the change to the shorter shifts model.

Methods: We performed a prospective observational study among pediatric residents. Residents completed an online self-assessment questionnaire before and after the COVID-19 emergency regulations changed toward shorter shifts.

Results: Sixty-seven residents answered the questionnaires before (37) and after (30) the shift changes. The average score was significantly better for the 13-hour shifts versus the 26-hour shifts, except for questions regarding available time for research. There was a positive perception regarding the shorter night shifts model among pediatric residents, with an increase in general satisfaction and improvement in perception of general wellness, ability to deliver quality healthcare, and medical education acquisition.

Conclusions: Following the change to shorter shift length, perception of pediatric residents included improvement in wellness, ability to deliver quality healthcare, and availability of medical education