Medical Education Publications

Objective: Using repeated measures, we examined third-year medical students’ perceptions of communication skills training (CST) during clinical rotations, focusing on dimensions of patient-centered communication most salient in each subspecialty. Methods: 273 third-year students at a large Midwestern medical school completed a four-phase longitudinal mixed-methods survey. Results: By the end of their third year, students reported more confidence in their communication skills, particularly question asking and answering. They reported the most direct communication with patients and the most communication training satisfaction during emergency medicine, primary care, and family medicine rotations. These evaluations were lowest during general surgery rotations. Fostering healing relationships and exchanging information were considered the most salient dimensions of patient-centered communication, particularly during primary care rotations. Conversely, during surgical rotations, time management and efficiency were heavily reinforced. Unsuccessful interactions with patients were often attributed to incompatible goals, expectancy violations, unpredictable interactions, and time constraints. Conclusion: Students would benefit from CST related to advanced patient-centered communication skills such as adapting to challenging interactions and remaining patient-centered within clinical time constraints. Future research can use these results to develop communication curricula that is discipline-specific, focuses on multiple dimensions of patient-centered communication, and reinforces the behaviors most salient during students’ current or upcoming clinical tasks. Innovation: This study extends previous work by focusing on student-centered and discipline-specific aspects of CST. Centering the behaviors students consider most relevant is a novel approach to medical education that can increase students’ attitudes toward the value of communication skills training, make them more confident, and improve care for their future patients. © 2024

Since 2022, generative artificial intelligence (AI) use has grown rapidly across many sectors, including medical education. While prior research has explored perceptions of AI, the understanding of AI use amongst medical trainees has been limited. This study surveyed medical trainees to better identify the patterns of generative AI use. Results showed varying patterns based on the phase of training, with ChatGPT emerging as the predominantly used platform across all phases. While awareness of AI policies was limited, the majority reported efforts for responsible use of AI. Implications include understanding of equitable access and onboarding regarding AI use policies. © The Author(s) 2026.

Simulation is an essential component of training in multiple fields, including aviation, and has gained particular interest in medical education, especially within cardiovascular medicine. Societies and institutions have supported the incorporation of simulators in medical education. However, its use has been limited chiefly to individual efforts without clear guidelines on best practices. This article highlights key events in healthcare simulation history and its development. We also discuss recent studies on the effectiveness of simulation training in different cardiovascular disciplines, such as interventional cardiology, cardiac imaging, cardiac electrophysiology, and pericardiocentesis. We review the challenges of simulation training and provide key recommendations to improve the utilization of simulators in training programs, in addition to other roles of simulators in healthcare, from quality improvement initiatives to personalized medicine through preprocedural planning. © 2025 Elsevier B.V., All rights reserved.

Focus groups allow researchers to collect data from multiple participants on a set of questions while simultaneously observing participant interactions during  sessions. Traditionally, researchers conduct focus groups in person, though  online focus groups have been increasingly used as technologies have improved.  The pandemic increased the need for researchers to innovate online focus group  practices. This paper aims to present best practices for using annotation  functions on digital video conference platforms to conduct focus group interviews  in veterinary medicine education research. We explain how Zoom, specifically its  Annotate functions, offers a useful tool to facilitate online focus groups and  assist veterinary medicine education research and practice. This method addresses  many of the challenges that in-person focus groups have-dominant participants,  geographical barriers, and confidential (instead of anonymous)  participation-while still being able to collect quality data during a group  interview. The best practices described here allow for capturing both qualitative  and quantitative data from online participants while preserving their anonymity  and increasing the ease of participation. Based on data we have collected,  participants report being comfortable providing honest and direct responses  across a variety of questions. This practice also allows the collection of  simultaneous or delayed answers, which means that participants have more  flexibility in how and when they respond compared to many in-person focus groups.  This practical approach to online focus group research can assist in conducting  veterinary medicine education research not just during the pandemic but whenever  geographical barriers or a need for increased confidentiality are researcher  concerns.

High school freshman students without documentation of physical examinations and/or vaccination are excluded from school by state-mandated health  requirements. With social determinants impacting student medical compliance,  school nurses lack evidence-based interventions to reduce medical exclusion. This  quality improvement project aims to reduce medical exclusion at the project site  by 25% from the previous year by focusing on meeting the freshman physical  examination requirement. A three-pronged PDSA cycle evaluates each program  intervention [resource guides, phone calls, temporary health clinic] in reducing  medical exclusion. After the distribution of two resource guides, 93 personalized  phone calls were made to families with missing health documentation. On the first  day of school, 28 freshmen remained out of medical compliance. The temporary  on-site health clinic provided physical examinations to 13 of the 28 students.  Through a systematic approach operationalizing community partnerships, school  nurses can reduce barriers to achieving medical compliance and support student  agencies in accessing healthcare.

The American Public Health Association’s Public Health Education and Health Promotion (APHA PHEHP) Section celebrates its 100th anniversary by reflecting on  its humble beginnings and early contributions to the field of health education.  This article highlights the often-unsung history of our field and its fledgling  beginnings, which is important to scholars and students alike. First codified as  the Health Education and Publicity Section in the early 1920s, we trace the  history and challenges of using new modes of publicity such as motion pictures  and innovative exhibits to help curb the spread of infectious diseases (e.g.,  tuberculosis, venereal disease). Evart G. Routzahn, credited as the Section’s  father, worked tirelessly to increase the Section’s visibility (renamed the  Health Education Section in 1927 and the Public Health Education and Health  Promotion Section in 1990) and in advancing the professionalization of health  education during a time when there were no formal professional preparation  programs in health education. Over the years, the Section has played significant  roles in strengthening the practice of health education and communication;  advancing APHA’s overall leadership, infrastructure, and governance; and  contributing to the unified voice and advocacy for the health education  profession and health equity. We conclude by describing contemporary initiatives  that reflect the continued spirit and vibrancy of the Section in setting the  stage for the next 100 years.

BACKGROUND: Grading medical student patient notes (PNs) is resource-intensive. Natural language processing (NLP) offers a promising solution to automatically  grade PNs. We deployed an automated grading system that uses NLP and explored the  perceived value of PN feedback. APPROACH: The automated system graded written  notes after two standardized patient encounters by third-year medical students.  The system generated an individualized report on “items found” and “items not  found” in the history, physical examination, and diagnosis sections, which was  shared with students for feedback via a web-based interface. By rotation, block  students received either the automated case feedback first or the faculty-written  model note feedback first (the pre-intervention baseline). EVALUATION: After  reviewing feedback, students completed surveys for both automated feedback and  model note feedback and participated in follow-up focus groups. In total, 44  students received feedback, 37 completed surveys, and 28 participated in focus  groups. Qualitative themes that emerged suggested the automated feedback was  visually appealing and allowed for easy comparison of items found vs. missing,  which would help improve students’ documentation skills. Model note appeared  trustworthy. IMPLICATIONS: We found automated systems can be a potential tool for  formative feedback on note writing activity although in terms of quality it does  not surpass the pre-existing feedback methods, such as model note feedback used  in our study. Order effects may have influenced these perceptions and the small  sample size limits generalizability. Tested software had occasional errors in  recognizing a phrase or showing a false positive.

Peer coaching is a form of faculty development in which faculty improve their teaching skills through collaborative work or peer observation of teaching. As a  tool grounded in experiential learning, peer coaching promotes targeted feedback,  reflection on action, and collegial exchange to improve teacher self-efficacy and  trainee learning outcomes. Nevertheless, faculty developers face challenges in  creating sustainable, effective peer coaching programs as faculty fear scrutiny  of their teaching practices. Additionally, to promote collegial exchange, faculty  (the person observed and peer coach) must trust one another and accept  vulnerability. Without attending to trust, faculty developers may find themselves  on black ice, designing and implementing ineffective peer coaching programs. In  this Black Ice article, we underscore the role of trust in peer coaching and  present five ways to help faculty developers get a grip by incorporating trust  into the design and implementation of peer coaching programs, optimizing its  efficacy.

INTRODUCTION: Educational research presents unique study design challenges. Novice researchers in health professions education (HPE) frequently misuse the  one-group pretest-posttest design, highlighting the need for improved training in  research design. This workshop aimed to enhance understanding of research design  among novice HPE researchers, specifically addressing the inherent limitations of  the one-group pretest-posttest design and offering alternative approaches.  METHODS: Experienced HPE researchers developed this workshop to address common  misunderstandings of research design. Leaders from the AAMC Medical Education,  Scholarship, Research, and Evaluation section facilitated 60-75-minute workshops  conducted at the four 2024 regional meetings hosted by the AAMC Group on  Educational Affairs (GEA). Workshop activities included large-group discussion,  small-group case-based discussion, and critiques of research designs.  Participants discussed internal validity threats and alternative research designs  and scholarly approaches. RESULTS: Approximately 120 GEA regional meeting  registrants attended, with 74 (61%) completing a feedback questionnaire  immediately after the workshop. Most respondents reported achieving the  workshop’s educational objectives, such as being better able to identify internal  validity threats associated with the one-group pretest-posttest design (100%) and  to discuss alternative approaches to evaluate educational innovations (100%).  Additionally, >95% of respondents agreed that the workshop was well organized,  interactive, and valuable in providing content they could apply to their  educational scholarship. DISCUSSION: The workshop successfully clarified  misconceptions surrounding the one-group pretest-posttest design while  introducing participants to more rigorous research approaches. Facilitator  expertise is essential. Future iterations should consider participants’  experiences to tailor content further and expand offerings about research  methodologies.

BACKGROUND: For many U.S. academic physicians, direct patient care is the primary focus of daily work and the most important professional responsibility.  Concurrently, some degree of scholarly activity is often required for career  advancement. Junior clinical faculty often face challenges that limit their  success in this area such as heavy clinical workloads or other time constraints,  a lack of personal expertise or experience, mentorship, and institutional  infrastructure. Support systems and faculty development interventions may  mitigate these challenges and contribute to increased academic productivity and  promotion. The objective of this study was to perform a scoping review of  literature on strategies which increase scholarly activity among junior clinical  faculty in the United States to determine the extent to which this topic has been  scientifically investigated, the form of the employed strategies for supporting  junior clinical faculty scholarly activity, the types of scholarly activity  measured, and the research methods used. METHODS: An online search of PubMed,  CINAHL, Cochrane Library, Embase, ERIC and APA PsycINFO databases was conducted  and supplemented by a manual search of references and citations. Articles  published between January 1, 2012, and February 7, 2025, that described faculty  development interventions designed to increase scholarly productivity of junior  clinical faculty in the United States were included. We employed a structured  data extraction algorithm, extracted data in dyads, and resolved any  inconsistencies using a third extractor. Included publications were categorized  by the primary intervention strategy they employed. RESULTS: Eighteen  publications are included in this scoping review. The most common primary  strategies for supporting scholarly activity were peer-mentoring (5/18, 28%) and  traditional mentoring (5/18, 28%). Other strategies included grants and funding  (4/18, 22%), faculty development and training (2/18, 11%), and protected time  (1/18, 6%). Two of the 18 publications included a control group. CONCLUSIONS:  Mentoring was the most common strategy to support scholarly activity of junior  clinical faculty followed by faculty development programs. Scholarly activity is  often measured by publications, grant funding, and presentations. A major gap in  the current literature is the absence of any high-quality research demonstrating  a beneficial effect on the scholarly activity of junior clinical faculty.

Dramatization, a teaching method where each student acts out or mimics a cell or body parts while the entire group represents the physiological process was  adapted to produce original teaching videos paired with a pretest that activates  memory and a posttest to prevent misconceptions. Three physiology instructors  collaborated on Zoom to create six DramaZoom videos (Dramatization via Zoom)  focused on hormone signaling with negative feedback in different contexts. In  these videos, each instructor personalizes a different part of an organ system or  a physiological process, which allows the visualization of complex concepts in  endocrinology. DramaZoom videos utilize theater, personification, and humor to  represent physiological processes in a fun and creative way that facilitates  students to learn and remember the content. Our goal was to introduce DramaZoom  videos as an original teaching tool and present evidence of its efficacy on  student learning. We analyzed the impact of DramaZoom videos on students’  knowledge acquisition at three distinct levels (1st year medical students, 3rd  and 4th year undergraduate science students, and 1st year undergraduate nursing  students) and investigated whether the mode of delivery of the videos (face to  face during regular classroom teaching or asynchronous in a virtual classroom)  affected student learning. Our data show that knowledge in all three student  groups improved significantly after viewing DramaZoom videos independently of the  mode of delivery. Our data indicate that DramaZoom videos combined with memory  activation due to the pretest are an effective tool to instruct this cohort of  students regardless of level and delivery mode.NEW & NOTEWORTHY DramaZoom is a  teaching tool paired with a pretest to activate memory. It promotes learning for  both medical students and undergraduate students with different majors in the  study cohort. DramaZoom creates an opportunity for a fun learning experience that  promotes knowledge gain in physiology regardless of whether the teaching setting  is face to face or completely virtual. Future research will be done to  investigate the long-term retention of content.

Veterinarians bridge the critical gap between animal and human health and can alert health agencies to potential health risks in cases of emergencies or  disease outbreaks, making them a crucial ally in the fight against infectious  diseases. Thus, training veterinarians in public health provides them with  additional skills, knowledge, and the necessary tools in disease and hazard  prevention. We conducted a national survey in the United States to determine the  efficacy of doctor of veterinary medicine (DVM)-master of public health (MPH) and  veterinariae medicinae doctoris (VMD)-MPH dual degrees, and we identified gaps  and shortcomings in the curricula in order to improve the career outcomes of  enrolled veterinary students. The survey was sent in 2020 to alumni of all the  DVM-MPH and VMD-MPH programs and administered through Qualtrics. Key findings  include that most participants were women (83.2%), the predominant age group was  30-39 years (61%), and 50.4% considered the MPH beneficial. The majority of  respondents work in veterinary medicine or public health. Qualifications and  veterinary networks were identified as the most useful for securing employment.  About 31.1% felt their program prepared them moderately well for these jobs,  while 68.9% indicated that the MPH did not affect their salary. Respondents also  highlighted areas needing improvement in DVM-MPH programs, such as increased  practical work-skill opportunities, mentoring, career support, and access to  nonveterinary courses and students. These findings can be useful for veterinary  and public health schools in developing curricula and opportunities that  strengthen the preparation of veterinarians in public health.

We developed a generative artificial intelligence (genAI)-assisted tool enabling learners to receive feedback on, revise, and clone multiple-choice questions  aligned with learning objectives. Initially designed as a custom GPT, we adapted  it to a universal prompt for platform-agnostic, equitable access. This innovation  exemplifies readily adaptable genAI-enhanced learning driven by pedagogy.  SUPPLEMENTARY INFORMATION: The online version contains supplementary material  available at 10.1007/s40670-025-02334-7.

Various resources exist for conducting program evaluations, but these resources do not specify features of a scholarly program evaluation. In this commentary, the authors use Glassick’s criteria for scholarship (clear goals, adequate preparation, appropriate methods, significant results, effective presentation, and reflective critique) to define what counts as a scholarly program evaluation. Then they use a hypothetical scenario common in medical education to describe how an educator could design and share program evaluation findings for a Research in Medical Education Research Report submission, an Innovation Report submission to Academic Medicine, and a MedEdPortal submission. © 2025 Elsevier B.V., All rights reserved.

A summary report of student performance on the North American Veterinary Licensing Examination (NAVLE) is shared each year with colleges and schools of  veterinary medicine accredited by the American Veterinary Medical Association  Council on Education. The NAVLE summary report provides valuable outcomes  assessment information that allows an institution to benchmark student clinical  problem-solving ability and to monitor changes in academic performance over time.  A new curriculum was fully implemented at the University of Illinois College of  Veterinary Medicine for the Class of 2013. We conducted a retrospective cohort  study based on annual NAVLE summary reports for 2006 to 2020 as part of a  comprehensive curricular review. A One-Sample Z-test was applied to mean  category-specific NAVLE scale scores or percentage correct values for each year  at the University of Illinois relative to mean values for all students taking the  NAVLE, with subsequent conversion of Z-score values to percentiles. P < 0.05 was  considered significant. The new curriculum improved student performance on the  NAVLE relative to the old curriculum, based on an increased mean yearly pass  percentage (p = .011), and increased Z-score values for 3 of 7 species  categories, 7 of 12 organ system categories, and two quartiles of students  categorized by class rank. Findings also identified areas of weakness in student  learning, which stimulated further curricular review and revision. We suggest  that colleges/schools consider using the One-Sample Z-test to increase the value  of NAVLE summary data as a component of quantitative curricular review and assess  the effectiveness of curricular change.

Educational and psychological research often involves comparing motivation across groups. It is critical to ensure that observed differences in motivation are true  variations by group, not due to measurement biases. With a diverse sample of  undergraduate students (N = 2200), this study measured internal consistency and  gathered validity evidence based on the internal structure of five motivation  scales. To compare motivation for biology between groups of undergraduate  students, this study tested for measurement scalar invariance by group and,  accordingly, conducted latent factor mean comparisons to understand true group  differences. On average, female students held lower expectancy beliefs and  self-efficacy for biology learning than males. Female students perceived higher  attainment value and utility value for biology learning and higher psychological  cost. First-generation college students held lower expectancy beliefs and  self-efficacy but perceived higher attainment value for biology learning than  continuing-generation students. No differences in average motivation for biology  learning were found between underrepresented racial minority (URM) and non-URM  students. The implications of these findings and future research directions are  also discussed.

With recent trends in holistic admissions to medical schools, students from a variety of backgrounds are matriculating. This presents challenges for the curriculum as medical schools assume a baseline foundation of knowledge and skills for those students. Although cognitive load is considered when delivering material, this scoping review aimed to explore the existing literature on cognitive capacity as it relates to academic performance of students in professional degrees. The results were summarized into four constructed themes—cognitive influence on learning and performance, experience and cognitive engagement, adaptive learning environments, and psychological and emotional aspects of learning. These themes can be pieced together to generate a definition of cognitive capacity and its implications on academics. © 2025 Elsevier B.V., All rights reserved.

Like other complex systems, medical education programs require a systematic continuous quality improvement (CQI) approach to drive effective improvement.  Accreditation bodies in both undergraduate medical education (UME) and graduate  medical education (GME) require programs to have effective CQI processes.  Dashboards facilitate visualization and tracking of key metrics that impact  medical education programming, thus driving excellence. Keys to developing useful  dashboards include using existing program evaluation frameworks to identify  desired outputs, determine acceptable evidence, and identify key data sources. In  developing dashboards, it is important to consider data management including  oversight and appropriate sharing of reports. When effectively developed and  delivered to key parties, data dashboards serve as valuable tools to drive  improvement of medical education programing. The purpose of this paper is to  provide guidance for dashboard implementation and use in medical education, with  a focus on UME and GME, based on available literature and experiences in our own  institutions.

This paper explores how Design Thinking methodologies can address UN Sustainable Development Goal 2 (Zero Hunger), emphasizing the transformative role of empathy and emotional engagement in fostering innovative solutions. Through a participatory workshop at an international conference, participants critically examined the systemic, cultural, and emotional dimensions of food insecurity. The workshop integrated experiential learning, guiding attendees from personal emotional responses to collaborative problem-solving. By leveraging interdisciplinary teamwork, participants developed technological, cultural, and community-based strategies for tackling food insecurity. Over 80% of attendees deepened their understanding and felt more confident in addressing food insecurity in their communities. This study underscores the pedagogical value of Design Thinking in food systems education, demonstrating how empathy-driven, participatory approaches can drive systemic change. © 2025 Elsevier B.V., All rights reserved.

The preparedness of health professionals to address the climate crisis is increasingly important for the health and well-being of society at large. As society grapples with mounting health consequences of a changing climate, the crisis also presents an opportunity to emphasize planetary health principles in medicine and care delivery. The preparedness of physicians to address climate change and apply principles of planetary health will shape strategies to optimize individual and population health, healthcare delivery, and the health sector. The Liaison Committee on Medical Education (LCME) accreditation standards do not currently reference climate change nor planetary health explicitly. LCME has a vested interest in improving physician workforce preparedness to meet the needs of patients and society, and consideration of climate change and planetary health in these standards is an important future step for LCME. In the meantime, the current accreditation standards offer some opportunity for students and faculty to align curricular efforts or initiatives on climate change and planetary health at their institution. The authors present practical tools highlighting multiple avenues for integrating planetary health concepts into medical education such as sustainability, resilience, and curriculum. Using existing LCME standards and data collection instruments, the authors showcase how medical students, instructors, and other leaders can incorporate planetary health concepts into the accreditation process. This approach aims to leverage accreditation to advocate for planetary health efforts and build momentum for grassroots policy change within physician training programs. © 2025 Elsevier B.V., All rights reserved.

Genome engineering methods can be utilized to perform complex genetic manipulations in living cells with remarkable efficiency and precision. Given the transformative potential of these enabling technologies, their applications are steadily expanding into most biology and biomedical fields where they play a central role in many experimental frameworks. For these reasons, in order to effectively prepare future generations of biologists and bioengineers for successful careers, there is a high need to incorporate courses teaching genome editing fundamentals into existing curricula. To accomplish this objective, lecture-based courses are rapidly integrating genome editing concepts; however, there are few laboratory courses that teach the practical skills needed to successfully perform genome editing experiments. Here, we describe the development and implementation of a semester-long laboratory course that teaches students not only the techniques needed to perform gene knockout, gene activation, gene repression, and base editing in mammalian cells but also prepares them to design and troubleshoot experiments, write scientific manuscripts, as well as prepare and deliver scientific presentations. Course evaluations demonstrate that this class effectively equips students with the knowledge and hands-on experience needed to succeed in careers related to genome engineering, cell and tissue engineering, and, more broadly, biology. © 2025 Elsevier B.V., All rights reserved.

Medical Functional Experimental Science (MFES) integrates physiology, pathophysiology, and pharmacology laboratory courses into a cohesive laboratory  curriculum in China’s medical education. However, limited research exists on its  implementation and evolution over the past two decades. This cross-sectional  study surveyed experienced teachers from China’s top 100 medical schools. A total  of 89 valid responses were received. A decline in technician numbers was reported  by 62.9% of schools, potentially due to equipment automation and resource  reallocation. The majority of the schools accommodated fewer than 30 students per  laboratory. Over the past 20 years, laboratory sizes increased in 40.5% of the  schools. Regarding the ratio of human experiments to animal experiments, of the  schools surveyed, 60% reported less than 1 to 6, and 12% showed 1 to 5. The study  also highlights the adoption of advanced teaching equipment, such as integrated  signal acquisition systems and wireless human experiment systems, which have  enhanced laboratory efficiency and student engagement. Furthermore, the  integration of innovative and comprehensive experiments has been instrumental in  fostering critical thinking and problem-solving skills among students. Despite  progress, challenges remain, including technician shortages and uneven regional  resource distribution, requiring policy interventions and global benchmarking.

OBJECTIVES: The study aims to explore the workplace learning experiences of medical faculty in critical care specialties at a university hospital, focusing  on how they develop their professional identity and construct the meaning of  their work. DESIGN: Qualitative, phenomenological study. SETTING: The current  study was conducted at a university hospital in South Korea between November 2022  and October 2023. PARTICIPANTS: Five faculty members (two males and three  females) from critical care specialties (eg, emergency medicine) with over 15  years of experience, each having served as faculty at a university hospital for  more than 5 years. RESULTS: Six key themes emerged: cultivating “doctor-ishness”  in the realm of critical care, beacon of inner drive: guiding professional  growth, nexus for leveraging expertise and fostering professional growth, the  challenging reality of becoming an “ideal” faculty, the shifting tides of the  medical profession’s role and weaving workplace learning into a unique rhythm of  practice. These themes collectively highlight that faculty members’ workplace  learning involves a transition from functional professionals to reflective  practitioners. CONCLUSIONS: Workplace learning of faculty members with critical  care specialties is understood as an ongoing, context-dependent and  individualised process in which emotions play a crucial role in determining the  depth and significance of learning and shaping professional identities. This  study highlights their capacity for agency and potential, offering a perspective  beyond previous research that has primarily focused on their hardships. By  shedding light on their workplace learning from an insider’s view and  underscoring the need to support professional development in these high-stakes  fields, our findings suggest theoretical and practical interventions to foster  the mutual growth of faculty and hospital organisations.

BACKGROUND: Managing uncertainty is an essential element of patient-centered communication (PCC) and shared decision making (SDM), yet we know little about  how residents’ reactions to uncertainty are related to their perceptions of their  ability to engage in these important activities. This longitudinal study assesses  whether residents’ self-perceived PCC and SDM skills are associated with their  reactions to uncertainty throughout residency. METHODS: Data were collected using  a three-year, longitudinal survey of two cohorts of pediatric residents. Before  each year of residency, residents self-reported PCC behaviors (information  exchange and socioemotional communication), SDM skills, and general intolerance  of uncertainty, and context-specific reactions to uncertainty in patient care.  100 residents completed Phase I (intern year), 61 residents completed Phase II  (second year), and 53 residents completed Phase III (third year). RESULTS:  Anxiety from uncertainty and reluctance to disclose uncertainty to parents were  significant, negative predictors of SDM perceptions at each phase. Anxiety from  uncertainty negatively predicted PCC information-related behaviors (seeking,  giving, and verifying) at each phase, but not socioemotional communication. At  each phase, concerns for bad outcomes only significantly predicted information  giving. Tolerance of uncertainty was not a significant predictor of SDM  perceptions or any of the four dimensions of PCC. CONCLUSIONS: Residents with  stronger negative reactions to uncertainty reported poorer self-perceptions of  patient-centered communication and shared decision making over the course of  residency. Thus, residency programs should implement training that normalizes  conversations about uncertainty and identifies strategies for PCC and SDM in  situations of clinical uncertainty.

Medical imaging is undergoing a transformation driven by the advent of new, highly effective, machine learning techniques paired with increases in  computational capabilities (Cheng et al. 2021; Gilson et al. 2023; Almeida et al.  2024; Krishna et al. 2024). These advanced algorithms have the potential to  improve disease detection, diagnosis, prognosis, and treatment outcomes. However,  the complexity of machine learning models, the large amounts of curated and  annotated data required by some methods, and the potential for bias and error  make it challenging for individuals to safely and effectively leverage these  methods (Lin et al. 2024; Guo et al. 2024; Xu et al. 2024; Linguraru et al. 2024;  Wood et al. 2019). To address these challenges, the American Association of  Physicists in Medicine (AAPM), American College of Radiology (ACR), Radiological  Society of North America (RSNA), and Society for Imaging Informatics in Medicine  (SIIM) have worked together to develop a syllabus detailing a recommended set of  competencies for medical imaging professionals interacting with these systems.  This guide is aimed at four different personas: users of AI systems, purchasers  of AI systems, individuals who provide clinical expertise during the development  of AI systems (“clinical collaborators”), and developers of AI systems.1 This is  a syllabus, not a curriculum, and is intentional in this scope. Recognizing that  individuals may benefit from different presentations of the same material, this  work enumerates a series of relevant competencies but does not prescribe, nor  offer, a method of instruction (Schuur, Rezazade Mehrizi, and Ranschaert 2021;  Garin et al. 2023). By addressing the task-specific demands of each role, this  guide will enable medical imaging professionals to utilize machine learning  systems more safely and effectively, ultimately improving patient care and  outcomes.

BACKGROUND: Restorative justice (RJ) is an ethical lens that places emphasis on a community’s connection and proliferative impact of actions, promoting  communication and establishing methods for accountability. RJ practices can be  applied on a spectrum, including proactive community-building practices,  community discussions in response to an event, and restorative conferences  addressing specific incidences of harm. This article describes an intervention  that utilized RJ community-building practices within a medical education  environment and evaluates its acceptability and feasibility. APPROACH: During the  summer of 2023, RJ interventions were planned, executed and assessed within two  programmes involving pre-matriculant medical students, physician-assistant  studies students and undergraduate students. The interventions utilized  community-building circles within small group activities. Capacity building  included training for facilitators. Ninety-five students participated in the RJ  circles. EVALUATION: Evaluation included mixed methods pre- and post-intervention  surveys as well as qualitative interviews. Ten students (11%) responded to the  pre-intervention survey, and 17 responded to the post-intervention survey (18%).  Seven responses were obtained from interviews and qualitative surveys. Overall,  participant survey responses indicated increased feelings of connection and  perceptions of mutual understanding and that the programme provided adequate  space to share one’s perspective. Qualitative content analysis emphasized  community building through RJ circles and their ability to promote connection,  meaningful vulnerability, foster peer support and a desire to continue these  activities. IMPLICATIONS: RJ interventions within medical education environments  are feasible and show considerable promise. Participants consistently noted the  benefits of greater connection between peers, feelings of support and a desire  for these practices to continue.

BACKGROUND: Primary care is pivotal to delivering effective healthcare. However, interest in primary care continues to decline; this is compounded by difficulties  recruiting and retaining community-based preceptors to train and inspire trainees  to enter primary care. Prior research explored the perspectives of community  preceptors, but more concerted efforts across primary care specialties need to be  directed upstream to understanding residents’ perceptions on becoming future  preceptors. OBJECTIVE: We aimed to understand the experiences and factors that  shape graduating residents’ attitudes about and desire to serve as outpatient  preceptors. DESIGN: This was a qualitative study, using a narrative inquiry  approach, based on semi-structured interviews. PARTICIPANTS: Graduating Internal  Medicine, Pediatric, and Internal Medicine-Pediatric residents at a single  institution were interviewed. APPROACH: We developed an interview guide based on  researchers’ own experiences as medical educators and a pilot interview. Applying  inductive analysis, we identified common themes that influenced participants’  perspectives on outpatient precepting. With the derived themes, we identified an  existing theory that best explained the results. KEY RESULTS: After interviewing  13 residents, four themes were constructed that influence participants’  perspectives on becoming outpatient preceptors. The Theory of Planned Behavior,  where one’s intention is informed by one’s behavioral beliefs, normative beliefs,  and control beliefs, conceptualized the themes. Witnessed advantages and  disadvantages of precepting informed participants’ behavioral beliefs,  preparedness to practice medicine and teach informed their control beliefs,  physicians’ responsibility to teach contributed to their normative beliefs, and  clinical demands were a secondary determinant that influenced all three beliefs.  CONCLUSIONS: Using identified themes and the Theory of Planned Behavior, we  propose the following recommendations to improve resident outpatient training  with the goal of improving long-term community preceptor recruitment: (1) enrich  the outpatient learning experience, (2) reinforce the teacher identity, (3)  advocate for structural and cultural changes to address current clinical barriers  to teaching.

The Social Determinants of Health significantly impact patient care, and understanding their role in the disease process and patient management is  essential to high-quality healthcare. Several barriers exist to integrating  social determinants of health into medical curricula, including the lack of  consensus on evidence-based teaching methods. In this context, our study  investigated the impact of integrating social determinants of health into  pre-clerkship problem-based learning courses using concept mapping on the  clinical problem-solving process. Fourteen pre-clerkship medical students  voluntarily participated and were randomly assigned to control and experimental  groups. The experimental group education intervention included two problem-based  cases with social determinants of health-informed probes to promote linking those  determinants to the disease process and develop a treatment plan using concept  mapping. The control group participated in the same cases without the education  intervention. Students in both groups completed post-session assignments that  included two new cases, individual concept maps, and recorded reflections.  Concept maps were scored using a scoring rubric. The scores of both groups were  compared using the Mann-Whitney U test. Recorded reflections and concept maps  were analyzed using reflexive thematic analysis coding method. Quantitative data  analysis showed that the experimental group received significantly higher scores  than the control group. Qualitative data analysis highlighted substantial  differences in clinical problem-solving approaches. The control group’s clinical  reasoning approach focused mainly on the clinical aspects of the case. The  experimental group followed a social determinants of health-informed clinical  reasoning approach to patient-centered treatment plans with balanced  therapeutic/nontherapeutic elements.

Background and objective Navigating interprofessional team dynamics is essential for high-quality patient care in pediatric settings. This study involved medical  students on a pediatric clerkship who explored the characteristics of high- and  low-performing clinical teams by considering drivers and barriers to effective  team performance. By analyzing these reflections, the study aimed to identify key  facilitators and barriers to effective team-based care. Methods Survey  evaluations and narrative reflections were completed by third-year students (M3s)  at a single US allopathic medical school during their pediatric clerkship after  receiving training in TeamSTEPPS® and Institute for Healthcare Improvement (IHI)  Open School, two programs that support quality improvement (QI) in healthcare.  Descriptive statistical and inductive thematic analyses were conducted on the  resulting 183 narratives. A valence rating system was employed to quantify  narrative responses as positive/attractive or negative/aversive, with a Cronbach  alpha of 0.958 between two independent reviewers. Results Inductive thematic  analysis generated 40 themes that we grouped under the five TeamSTEPPS® skill  domains (situation monitoring, communication, leadership, team structure, mutual  support) into thematic conceptual models. High-performing teams demonstrated open  communication, role clarity, shared understanding, and organized task delegation.  Low-performing teams displayed a lack of information exchange, uncertain team  roles, unhealthy power dynamics, and disorganized task delegation. Conclusions  After instruction in QI methods, pediatric clerkship students identified  consistent drivers of and barriers to effective team performance. The themes  within the narrative reflections can provide insights into improving patient care  delivery, specifically around situation monitoring, communication, and team  structure.

Escape rooms are used in medical education to encourage teaming and communication skills, but their effectiveness beyond learner satisfaction remains unexplored.  This review evaluated their educational value, focusing on alignment with ACGME  core competencies. Following the PRISMA framework, a scoping review was conducted  in PubMed, Scopus, and ERIC through mid-September 2023, excluding commentaries,  editorials, and letters. The review included 35 studies, mostly  single-institution studies, with various methodologies. Most aligned with  competencies in interpersonal and communication skills and systems-based  practice, with increased virtual formats during COVID-19 pandemic. High learner  satisfaction was noted. Escape rooms effectively foster teamwork and  communication in medical education. Further research is needed on knowledge  retention and application.

While the U.S. Latinx population has rapidly increased in the past 30 years, the number of Latinx physicians has not kept pace. Latinx students are often  motivated to pursue medicine to serve those in their communities, which benefits  Latinx community health outcomes through patient-clinician cultural and  linguistic concordance. However, significant barriers often prevent Latinx people  from successfully navigating the transition to and through medical school. This  study utilized a qualitative, constructivist approach to investigate the  transition to and through medical school and residency to further understand and  prevent leakages for aspiring Latinx physicians. Using an assets-based framework  of Community Cultural Wealth (CCW), we specifically explored navigational  capital, to understand how Latinx learners navigate belonging in medicine.  Through semi-structured interviews with 20 Latinx medical students and 14  residents, we found that learners understood and created belonging by navigating  help-seeking and the imposter phenomenon through their respective pathways in  medicine. Findings from this study may be used to develop support systems and  resources to reduce the structural inequalities, barriers, and challenges Latinx  students and future physicians encounter through medical education pathways.

Aim: We aim to a) offer an overview of eXtended Reality (XR) and intelligent computing; b) present a framework to evaluate XR and intelligent computing in replicating real-world patient care experiences; and c) evaluate the qualities and abilities that XR and intelligent computing meet student’s learning needs and capacity, producing safe, competent patient care and critical thinking skills. Background: Although hands-on simulation has been shown to be comparable to traditional patient care in attaining clinical and critical thinking skills, little is known is known about how well XR and intelligent computing meet the learning styles and preferences of students and attainment of procedural and critical thinking skills necessary to be safe competent health professionals. Design: Design-based research Methods: Identification of gap in use of immersive technology in teaching and generation of theoretical conjecture, reiterative conjecture and reflection on design principles and processes of teaching-learning. Results: XR provides varying levels of immersion, presence, interactivity and causability. XR is well suited for learning processes and procedures. Intelligent computer systems provide immersion, presence, interactivity, causability and adaptability. Intelligent computing may be better suited to support the development of critical thinking. Conclusion: Nursing faculty need to consider which immersive technologies can provide a bridge between didactic and clinical experience that best supports experiential learning. Further research is needed to better understand pedagogical practices and strategies that are best suited for XR and intelligent computing to prepare safe, competent nurses. © 2025 Elsevier B.V., All rights reserved.

Grounded in communication models of cultural competence, this study reports on the development and testing of the first module in a larger virtual reality (VR) implicit bias training for physicians to help them better: (a) recognize implicit bias and its effects on communication, patients, and patient care; (b) identify their own implicit biases and exercise strategies for managing them; and (c) learn and practice communicating with BIPOC patients in a culture-centered manner that demonstrates respect and builds trust. Led by communication faculty, a large, interdisciplinary team of researchers, clinicians, and engineers developed the first module tested herein focused on training goal (a). Within the module, participants observe five scenes between patient Marilyn Hayes (a Black woman) and Dr. Richard Flynn (her obstetrician, a White man) during a postpartum visit. The interaction contains examples of implicit bias, and participants are asked to both identify and consider how implicit bias impacts communication, the patient, and patient care. The team recruited 30 medical students and resident physicians to participate in a lab-based study that included a pretest, a training experience of the module using a head-mounted VR display, and a posttest. Following the training, participants reported improved attitudes toward implicit bias instruction, greater importance of determining patients’ beliefs and perspectives for history-taking, treatment, and providing quality health care; and greater communication efficacy. Participants’ agreement with the importance of assessing patients’ perspectives, opinions, and psychosocial and cultural contexts did not significantly change. Implications for medical education about cultural competency and implicit bias are discussed. © 2025 Elsevier B.V., All rights reserved.

The increasing complexity of medical education requires innovative tools to help students manage cognitive overload. Concept mapping (CM) enhances knowledge  retention and integration by visually organizing information, and has received  positive feedback in various educational contexts. However, the use of CM  combined with interactive 3D courseware to teach the cellular mechanisms of  bacterial sepsis is underexplored. This study evaluated the feasibility and  effectiveness of integrating a 3D computer simulation with CM to improve  understanding of sepsis. Fifty-two second-year medical students were randomized  into three groups (A, B, and C). Each group completed five tasks: a  pre-simulation self-assessment, a scaffolded pre-simulation CM, a computer  simulation, a post-simulation CM, and a post-simulation self-assessment. Group A  completed the tasks at the start of the sepsis case in the medical curriculum,  Group B in the middle, and Group C at the end. A control group completed only the  pre-simulation CM, and third-year students who had previously participated  repeated the CM. Pre-simulation CM scores showed significant improvement in all  three groups compared to the control group (p < 0.05). Post-simulation, Group C  significantly outperformed Groups A and B (p < 0.05). Third-year students scored  15 points higher than Groups A and B (p < 0.001), but their scores were similar  to Group C’s. CM scores improved across all intervention groups, with Group C  showing more than double the increase seen in Groups A and B. This study suggests  that combining 3D simulations with CM is an effective strategy for teaching  complex medical concepts and warrants further exploration of its long-term  impact.

PURPOSE: The purpose of this systematic review of the literature is to build understanding of the key elements and recommendations for the design of mHealth  technology for individuals using wheelchairs and/or scooters and identify key  features associated with the use of mHealth to support healthy behaviour changes  for this population. MATERIALS AND METHODS: Eight major electronic databases were  systematically searched to identify mobile health (mHealth) interventions, which  targeted adult WC/S users. Independent reviewers used Endnote and Covidence to  manage articles meeting review criteria and to exclude duplicates. A quality  assessment was conducted on each included article. RESULTS: Nine articles  describing studies with diverse study designs met criteria to be included in this  review. Several interactive application intervention features, such as  participant collaboration and goal setting, and key technical features to support  mHealth app development and utilisation were identified. Results found intuitive  and simple designs of mHealth apps, with the ability to customise to support  learning styles and preferences, support usability and acceptability by  participants. CONCLUSIONS: More research is needed to evaluate best practices to  support initial training of end-users, mHealth apps’ ability to support long-term  behaviour change and maintenance, and the understanding of active ingredients in  complex interventions that include mHealth apps. Both interactive mHealth  application intervention and technical features support healthy behaviour change  among individuals using wheelchairs and scooters.

Introduction: Sense of belonging is described by Anant as a “personal and contextually mediated experience.” For medical students, their personal characteristics, patient care settings, and interactions with healthcare team members inform their perception of belonging. Students are designated as members of healthcare teams; however, feeling a sense of belonging, while necessary to achieve self-actualization, is not automatic. This study explored senior medical students’ sense of belonging in patient care settings, specifically in their interactions with team members. Methods: In this qualitative study, investigators conducted focus groups with senior medical students at six institutions between February and May 2022. Investigators collected anonymous responses to reflective open-ended questions and demographics from participants at the close of each focus group. Author teams iteratively coded transcripts and written responses to generate themes. Results: Students’ sense of belonging was influenced by interactions with team members that acknowledged shared experiences of stress and suffering, prioritized connection with team members, delineated expectations of students, and supported student autonomy, along with other contributors like physical spaces and team member characteristics. Discussion: This study explores interactions supporting medical students’ sense of belonging in patient care settings. Results highlight the previously underreported contributions that collectively shared experiences of stress and suffering have on medical student belongingness. Participants’ descriptions of experiences that promoted their sense of belonging form the basis for strategies to support a sense of belonging for medical students. These strategies may allow busy clinical teams to positively impact medical student belongingness. © 2025 Elsevier B.V., All rights reserved.

OBJECTIVES: The study examined how physicians’ use of analogies, literal language, or medical jargon influences patient attitudes towards health  recommendations and perceptions of physician trustworthiness by considering  language’s alignment or deviation from patient expectations and subsequent  evaluations. METHODS: A 3 (physician language: analogies, jargon, literal  language) x 2 (health topic: coronary artery disease, influenza vaccine)  experiment tested the role of communication unexpectedness and evaluations on  patient attitudes and physician trustworthiness. Participants (N = 545) recruited  online were instructed to imagine themselves as patients interacting with the  physician in a randomly assigned video, in which the physician explained medical  information and provided a health recommendation. Participants then reported  their attitudes toward the recommended behavior and their perceptions of the  physician’s trustworthiness. RESULTS: The physician’s use of analogies or jargon  was more unexpected than literal language. Jargon was evaluated more negatively,  but analogies were evaluated similarly to literal language. Language type had  significant indirect effects on attitudes and perception of physician through  unexpectedness, moderated by patient evaluation of communication. When  participants evaluated physicians’ communication positively, literal language led  to the best outcomes, while jargon led to the worst outcomes through higher  unexpectedness. When participants evaluated the style neutrally, jargon resulted  in the best outcomes through higher unexpectedness, while literal language led to  the worst outcomes. CONCLUSIONS: This study highlights the crucial and contingent  role of patient expectations and evaluations in shaping the outcomes of physician  language strategies. Our findings underscore the complexity of language choice,  demonstrating that unexpected communication, even when evaluated positively, may  reduce its intended persuasive effect. PRACTICE IMPLICATIONS: Healthcare  professionals should assess patient preferences when making their language  choice. Interventions that train physicians to recognize and respond to patient  expectations should ensure more tailored and effective communication approaches,  ultimately enhancing patient trust, comprehension, and adherence to medical  recommendations.

Introduction The integration of artificial intelligence (AI) into medical education is reshaping how students prepare for standardized examinations. Prior  studies have shown that AI models can achieve high accuracy on United States  Medical Licensing Examination (USMLE) questions, highlighting their potential for  examination preparation. ChatGPT (GPT), especially the 4o model, is one of the  most widely used AI models; however, its accessibility is limited by subscription  costs and regional censorship. DeepSeek (DS), a newer AI model, offers free  access and has demonstrated comparable performance in general tasks. In this  study, we compared the performance of GPT-4o and DS DeepThink R1 on the AMBOSS  medical board preparation question bank to evaluate their potential and  limitations as supplementary tools in medical education. Methods We extracted  1,079 USMLE-style multiple-choice questions from the AMBOSS question bank.  Questions were categorized by USMLE Step 1 and Step 2 examinations and further  grouped by topic, resulting in 36 categories. Each question was assigned a  difficulty level (easy, intermediate, or hard) based on AMBOSS grading criteria.  To ensure balanced representation, we randomly selected 10 questions per  difficulty level per category. Questions and answer choices were copied verbatim  from the AMBOSS website and input into GPT-4o and DS R1 without any modification.  Model responses were scored as correct or incorrect, and correctness rates were  compared across GPT-4o, DS R1, and AMBOSS user performance. Results Both GPT and  DS outperformed AMBOSS users, with overall accuracies of 88.79%, 78.68%, and  56.98%, respectively. Comparing GPT and DS, GPT performed significantly better  overall (t=7.90, p<0.0001). When stratified by examination type, GPT achieved  significantly higher accuracy than DS in both Step 1 (0.89 vs. 0.78, p < 0.0001)  and Step 2 (0.88 vs. 0.80, p < 0.0001). GPT consistently showed higher accuracy  than DS at all three difficulty levels. However, when further stratified by  examination type, statistically significances were only observed in intermediate  (p = 0.0002) and hard (p = 0.0021) questions in both Step 1 and Step 2.  Conclusion Our findings demonstrated that both AI models outperformed human  learners, with GPT-4o showing superior accuracy, particularly in intermediate and  hard questions. While DS underperformed relative to GPT, its free accessibility  and competitive accuracy in easy questions suggest that it may serve as a viable  alternative, particularly in resource-limited settings.

Assessing student mastery is often done by using exams. Inevitably, some students will complete remediation, which may include exam retakes. This method provides  students an additional opportunity to take an exam that assesses the same  objectives as the original exam, while using different questions. Although this  form of remediation increases exam scores, it is also possible that students who  prepare for an exam retake adversely affect preparation for an upcoming exam.  Therefore, the purpose of this study was to determine whether studying for and  taking an exam retake affected preparation for the next exam. We hypothesized  that students who completed an exam retake would have lower than expected scores  on their next exam. This study utilized data collected over five semesters from  467 students enrolled in a 200-level introductory human physiology class; 159  students (34.0%) completed at least one exam retake. Students who retook an exam  increased their original exam score by 6.1% (SD 13.9). These findings suggest  that retaking an exam leads to better outcomes, which could be explained by  students improving their study habits or test-taking skills, which would help  them perform better on future exams.NEW & NOTEWORTHY Exam retakes provide  students with an additional opportunity to demonstrate mastery of learning  objectives. However, this preparation might adversely affect performance on  subsequent exams. This study suggests that students who choose to prepare for and  take an exam retake not only improve their original exam score but show a larger  improvement on subsequent exam performance than those students who did not take  an exam retake.

The Competency-Based Veterinary Education (CBVE) Analyze Working Group of the American Association of Veterinary Medical Colleges (AAVMC) Council on  Outcomes-based Veterinary Education (COVE) has developed a CBVE assessment  toolkit. The toolkit is designed to provide curriculum committees and individual  instructors with an opportune intersection of the CBVE domains of competence and  various assessment techniques. College-wide curriculum committees can use the  toolkit to guide programs of assessment in the larger unit, ensuring that  assessment methods are aligned with intended learning outcomes throughout the  curriculum. On a smaller unit basis, the toolkit allows a single instructor or  team of instructors to identify domains of interest for evaluation and then to  identify various assessment tools appropriate to those domains. For each of 21  different assessment tools, the toolkit provides information that includes: a  description; appropriate CBVE domains and competencies; examples; documented  uses; evidence of efficacy; references; and links to illustrations if available.  Because the toolkit is published online, periodic updates can be made as more  data become available on the efficacy of various assessment tools relative to the  CBVE domains in veterinary education. From programmatic assessment to single  course examinations, the toolkit is intended to assist both administrators and  faculty alike in understanding how different assessment approaches can support a  variety of competency domains.

The clinical experiences, feedback, and assessment that veterinary students receive during final year rotations have a significant impact on whether they  will achieve entry-level competency at the time of graduation. In this study, a  cross-sectional survey was administered to American Association of Veterinary  Medical Colleges (AAVMC) member institutions to collect baseline data about  current feedback and assessment practices to identify key target areas for future  research and educational interventions. Responses were received from 89 faculty  and 155 students distributed across 25 universities. The results indicated that  there are significant gaps between evidence-based approaches for delivering  feedback and assessment and what was being implemented in practice. Most feedback  was provided to students in the form of end-of-rotation evaluations sometimes  several weeks to months after the rotation finished when faculty were unlikely to  remember specific interactions with students and there were limited opportunities  for students to demonstrate progress towards addressing identified concerns.  Although the most valuable type of feedback identified by students was verbal  feedback delivered shortly after clinical experiences, this method was often not  used due to factors such as lack of time, poor learning environments within  veterinary teaching hospitals, and lack of faculty training in delivering  effective feedback. The results also indicated potential challenges with how  non-technical domains of competence within the AAVMC Competency-Based Veterinary  Education (CBVE) Framework are currently evaluated. Finding avenues to improve  feedback and assessment processes in final year clinical settings is essential to  ensure that veterinary students are adequately prepared for practice.

PURPOSE: Exposure to procedures varies in the neonatal intensive care unit (NICU). A method to teach procedures should be available without patient  availability, expert oversight, or simulation laboratories. To fill this need, we  developed a virtual reality (VR) simulation for umbilical vein catheter (UVC)  placement and sought to establish its face and content validity and usability.  METHODS: Engineers, software developers, graphic designers, and neonatologists  developed a VR UVC placement simulator following a participatory design approach.  The software was deployed on the Meta Quest 2 head-mounted display (HMD).  Neonatal nurse practitioners (NNPs) from a level 4 NICU used the simulator and  completed an 11-item questionnaire to establish face and content validity.  Participants also completed the validated simulation task load index and system  usability scale to assess the usability of the simulator. Group 1 tested the VR  simulation, which was optimized based on feedback, prior to Group 2’s  participation. RESULTS: A total of 14 NNPs with 2-37 years of experience  participated in testing. Participants scored the content and face validity of the  simulator highly, with most giving scores ≥ 4/5. Usability was established with  relatively high average system usability scores for both groups (Group 1:  67.14 ± 7.8, Group 2: 71 ± 14.1) and low SIM-TLX scores indicating manageable  load while using the simulator. CONCLUSION: After optimization, Group 2 found the  UVC simulator to be realistic and effective. Both groups felt the simulator was  easy to use and did not cause physical or cognitive strain. All participants felt  the UVC simulator provided a safe environment to make mistakes, and the majority  would recommend this experience to trainees.

BACKGROUND: Over the last decade, there has been growing interest in inverted classroom teaching (ICT) and its various forms within the education sector.  Physiology is a core course that bridges basic and clinical medicine, and ICT in  physiology has been sporadically practiced to different extents globally.  However, students’ and teachers’ responses and feedback to ICT in physiology are  diverse, and the effectiveness of a modified ICT model integrated into regular  teaching practice in physiology courses is difficult to assess objectively and  quantitatively. OBJECTIVE: This study aimed to explore the current status and  development direction of ICT in physiology in basic medical education using  bibliometric visual analysis of the related literature. METHODS: A bibliometric  analysis of the ICT-related literature in physiology published between 2000 and  2023 was performed using CiteSpace, a bibliometric visualization tool, based on  the Web of Science database. Moreover, an in-depth review was performed to  summarize the application of ICT in physiology courses worldwide, along with  identification of research hot spots and development trends. RESULTS: A total of  42 studies were included for this bibliometric analysis, with the year 2013  marking the commencement of the field. University staff and doctors working at  affiliated hospitals represent the core authors of this field, with several  research teams forming cooperative relationships and developing research  networks. The development of ICT in physiology could be divided into several  stages: the introduction stage (2013-2014), extensive practice stage (2015-2019),  and modification and growth stage (2020-2023). Gopalan C is the author with the  highest citation count of 5 cited publications and has published 14 relevant  papers since 2016, with a significant surge from 2019 to 2022. Author  collaboration is generally limited in this field, and most academic work has been  conducted in independent teams, with minimal cross-team communication. Authors  from the United States published the highest number of papers related to ICT in  physiology (18 in total, accounting for over 43% of the total papers), and their  intermediary centrality was 0.24, indicating strong connections both within the  country and internationally. Chinese authors ranked second, publishing 8 papers  in the field, although their intermediary centrality was only 0.02, suggesting  limited international influence and lower overall research quality. The topics of  ICT in physiology research have been multifaceted, covering active learning,  autonomous learning, student performance, teaching effect, blended teaching, and  others. CONCLUSIONS: This bibliometric analysis and literature review provides a  comprehensive overview of the history, development process, and future direction  of the field of ICT in physiology. These findings can help to strengthen academic  exchange and cooperation internationally, while promoting the diversification and  effectiveness of ICT in physiology through building academic communities to  jointly train emerging medical talents.

Background: The acquisition of in-depth medical knowledge, skills, and competencies is of utmost importance when training future medical professionals. This systematic literature review delves into the empirical connection between gamified learning in medical education and the Structure of Observed Learning Outcomes (SOLO) taxonomy. Methods: Following PRISMA guidelines, a systematic literature review was conducted in seven databases to identify empirical studies related to gamification and medical education. The literature search was limited to peer-reviewed articles published between January 2012 and December 2022. Articles focusing on games or learning technologies in a broader sense as well as research focusing on nursing or pharmacy education were excluded. Results: Upon reviewing 23 qualified empirical studies that applied gamified learning strategies in medical education, 18 (78%) studies are associated with the second lowest level (uni-structural) of the SOLO taxonomy. The mid-level (multi-structural) learning outcomes are associated with three (13%) of the reviewed studies. There are five (22%) studies focusing on the second highest (relational) level of the SOLO. Only one study (4%) is associated with the highest SOLO level (extended-abstract). Finally, three (13%) studies were identified with multiple levels of the SOLO. In addition to the SOLO levels, the review found six (26%) studies emphasizing motivational and engagement support of gamified learning strategies in facilitating intended learning outcome attainment. A total of three (13%) studies, across three SOLO levels, suggested that gamified learning strategies can improve students’ soft skills in medical education programs. Conclusion: These findings collectively emphasize the need for future research and development to design gamified learning experiences capable of fostering higher SOLO taxonomy attainment in medical education. Moreover, there is potential to extend the SOLO framework to encompass motivational and affective learning outcomes, providing a comprehensive understanding of the impact of gamified learning on medical students. © 2024 Elsevier B.V., All rights reserved.

On February 6th, 2024, Gynecologic Oncology Reports and the Society of Gynecologic Oncology Education Committee co-hosted a webinar about ways to use social media for career enhancement and for dissemination of research. During the discussion, we reviewed: i. how to identify one’s goals, target audience, and select a social media platform. ii. how to navigate the negatives of social media. iii. how to develop one’s online academic brand. iv. how to use social media for academic promotion and career advancement. v. how to use social media as a research tool. vi. how to use visual tools to bring attention to one’s research.The objective of this report is to review the literature on social media in oncology and review the webinar presentation. © 2024 Elsevier B.V., All rights reserved.

Large language models (LLMs) represent a transformative class of AI tools capable of revolutionizing various aspects of healthcare by generating human-like  responses across diverse contexts and adapting to novel tasks following human  instructions. Their potential application spans a broad range of medical tasks,  such as clinical documentation, matching patients to clinical trials, and  answering medical questions. In this primer paper, we propose an actionable  guideline to help healthcare professionals more efficiently utilize LLMs in their  work, along with a set of best practices. This approach consists of several main  phases, including formulating the task, choosing LLMs, prompt engineering,  fine-tuning, and deployment. We start with the discussion of critical  considerations in identifying healthcare tasks that align with the core  capabilities of LLMs and selecting models based on the selected task and data,  performance requirements, and model interface. We then review the strategies,  such as prompt engineering and fine-tuning, to adapt standard LLMs to specialized  medical tasks. Deployment considerations, including regulatory compliance,  ethical guidelines, and continuous monitoring for fairness and bias, are also  discussed. By providing a structured step-by-step methodology, this tutorial aims  to equip healthcare professionals with the tools necessary to effectively  integrate LLMs into clinical practice, ensuring that these powerful technologies  are applied in a safe, reliable, and impactful manner.

This paper explores the efficacy of Large Language Models (LLMs) in generating dialogues for patient avatars in Virtual Reality (VR) nurse training simulators. With the integration of technology in healthcare education evolving rapidly, the potential of NLP to enhance nurse training through realistic patient interactions presents a significant opportunity. Our study introduces a novel LLM-based dialogue generation system, leveraging models such as ChatGPT, GoogleBard, and ClaudeAI. We detail the development of our script generation system, which was a collaborative endeavor involving nurses, technical artists, and developers. The system, tested on the Meta Quest 2 VR headset, integrates complex dialogues created through a synthesis of clinical expertise and advanced NLP, aimed at simulating real-world nursing scenarios. Through a comprehensive evaluation involving lexical and semantic similarity tests compared to clinical expert-generated scripts, we assess the potential of LLMs as suitable alternatives for script generation. The findings aim to contribute to the development of a more interactive and effective VR nurse training simulator, enhancing communication skills among nursing students for improved patient care outcomes. This research underscores the importance of advanced NLP applications in healthcare education, offering insights into the practicality and limitations of employing LLMs in clinical training environments. © 2024 Elsevier B.V., All rights reserved.

OBJECTIVE: Managing uncertainty is a core competency of pediatric residents. However, discussing uncertainty with attending physicians can be challenging.  Research is needed to understand residents’ goals when communicating about  uncertainty with attending physicians and how residents’ perceptions of  communication change during residency. Therefore, we assessed changes in  residents’ perceptions of their own ability to communicate uncertainty and their  perceptions of attending physicians’ willingness to discuss uncertainty  effectively. We also identify residents’ goals and challenges communicating  uncertainty. METHODS: We conducted a 3-year (2018-2021) survey with 2 cohorts of  residents at a US children’s hospital. Of the 106 eligible residents, 100  enrolled and completed Phase I (94% response rate), 61 of the enrolled residents  completed Phase II (61% response rate), and 53 completed Phase III (53% response  rate). We employed hierarchical linear modeling to account for clustering of the  data (Phases within residents) and to assess changes in communication efficacy  and target efficacy over time. We coded open-ended responses to identify  residents’ communication goals and challenges. RESULTS: Communication efficacy  and target efficacy significantly increased over time. Open-ended responses  indicated that residents managed multiple task, identity, and relational goals.  Residents described persistent challenges related to wanting to appear competent  and working with attending physicians who were unwilling to discuss uncertainty.  CONCLUSIONS: Although residents may grow more confident communicating  uncertainty, such conversations are complex and can present challenges throughout  residency. Our results support the value of training on communication about  uncertainty, not only for residents, but also attending physicians.

BACKGROUND: In 2022 there were only seven pediatric surgeons in Uganda, but approximately 170 are needed. Consequently, Ugandan general surgeons treat most  pediatric surgical problems at regional hospitals. Accordingly, stakeholders  created the Pediatric Emergency Surgery Course, which teaches rural providers  identification, resuscitation, treatment and referral of pediatric surgical  conditions. In order to improve course offerings and better understand pediatric  surgery needs we collected admission and operative logbook data from four  participating sites. One participating site, Lacor Hospital, rarely referred  patients and had a much higher operative volume. Therefore, we sought to  understand the causes of this difference and the resulting economic impact.  METHODS: Over a four-year period, data was collected from logbooks at four  different regional referral hospitals in Uganda. Patients ≤ 18 years old with a  surgical diagnosis were included. Patient LOS, referral volume, age, and case  type were compared between sites and DALYs were calculated and converted into  monetary benefit. RESULTS: Over four sites, 8,615 admissions, and 5,457 cases  were included. Lacor patients were younger, had a longer length of stay, and were  referred less. Additionally, Lacor’s long-term partnerships with a high-income  country institution, a missionary organization, and visiting Ugandan and  international pediatric surgeons were unique. In 2018, the pediatric surgery case  volume was: Lacor (967); Fort Portal (477); Kiwoko (393); and Kabale (153),  resulting in a substantial difference in long-term monetary health benefit.  CONCLUSION: Long-term international partnerships may advance investments in  surgical infrastructure, workforce, and education in low- and middle-income  countries. This collaborative model allows stakeholders to make a greater impact  than any single institution could make alone.

BACKGROUND: Prior literature has demonstrated barriers to successful residency matching, including sex, medical school background, and international medical  graduate status. Our aim is to characterize the recent trends in  successfully-matched residents, with particular attention to geography and  academic productivity. METHODS: Resident information, including demographics and  educational background, was gathered from program websites. Bibliometric analysis  focused on PubMed publications from the top neurosurgery journals. A top 20  medical school was defined using the US News Rankings for research in 2022.  Regression analyses were performed to explore the associations between total and  first-author publications and other relevant factors, correcting for graduate  studies. RESULTS: A total of 114 institutions and 946 residents were included in  the final analysis. Of the 845 with medical school information, 62 (7.3%)  completed medical school internationally and 181 of 783 (23.1%) came from a top  20 medical school. Male residents had a higher proportion of residents with  international undergraduate and international medical school degrees when  compared to female residents [32 (7.5%) vs. 4 (2.4%), P = 0.021; 52 (8.6%) vs. 10  (4.2%), P = 0.026; respectively]. The multivariate regression analysis  demonstrated a significant increase in publications for international medical  school graduates (B = 8.3, P < 0.001), top tier medical school graduate (B = 1.3,  P = 0.022), and male sex (B = 1.20, P = 0.019) for total number of publications.  CONCLUSIONS: Geographical factors, reported sex, and graduation status have  influenced how resident candidates are perceived. Understanding these trends is  vital for future resident matching. Addressing gender and educational diversity  is essential to foster inclusivity and research-driven environments in  neurosurgery residency programs.

Purpose: This review summarizes the current use of extended reality (XR) including virtual reality (VR), mixed reality, and augmented reality (AR) in the medical field, ranging from medical imaging to training to preoperative planning. It covers the integration of these technologies into clinical practice and within medical training while discussing the challenges and future opportunities in this sphere. This will hopefully encourage more physicians to collaborate on integrating medicine and technology. Approach: The review was written by experts in the field based on their knowledge and on recent publications exploring the topic of extended realities in medicine. Results: Based on our findings, XR including VR, mixed reality, and AR are increasingly utilized within surgery both for preoperative planning and intraoperative procedures. These technologies are also promising means for improved education at every level of physician training. However, there are still barriers to the widespread adoption of VR, mixed reality, and AR, including human factors, technological challenges, and regulatory issues. Conclusions: Based on the current use of VR, mixed reality, and AR, it is likely that the use of these technologies will continue to grow over the next decade. To support the development and integration of XR into medicine, it is important for academic groups to collaborate with industrial groups and regulatory agencies in these endeavors. These joint projects will help address the current limitations and mutually benefit both fields. © 2025 Elsevier B.V., All rights reserved.

BACKGROUND: Cognitive integration occurs when trainees make conceptual connections between relevant knowledges and is known to improve learning. While  several experimental studies have demonstrated how text and audio-visual  instruction can be designed to enhance cognitive integration, clinical skills  training in real-world contexts may require alternative educational strategies.  Introducing three-dimensional (3D) printed models during clinical skills  instruction may offer unique learning opportunities to support cognitive  integration. METHODS: Using case study methodology, we explore how learners and  an instructor used 3D printed bones to augment their learning interactions during  a clinical skills laboratory on shoulder on palpation, and to describe the  instructional strategies with 3D printed bones that may support learning.  Students (n = 21) worked in small groups and were given access to a 3D printed  clavicle, scapula, and humerus. Data were collected through observation, a  student focus group, and a semi-structured interview with the instructor.  Thematic analysis to review and code the data and to generate themes. RESULTS: We  developed four themes that describe how 3D printed models were used in the  classroom and how they may support cognitive integration: classroom  interactivity, visualization of anatomy, integrating knowledge, and educational  potential. CONCLUSIONS: The findings demonstrate several ways 3D printed models  can augment how learners, instructors, and educational materials interact with  one another and how readily learners make connections between different sources  and types of knowledge. This research extends previous work by demonstrating how  social learning processes and interactions with physical models can offer unique  affordances that may support cognitive integration.

OBJECTIVE: Women neurosurgeons (WNs) continue to remain a minority in the specialty despite significant initiatives to increase their representation. One  domain less explored is the regional distribution of WNs, facilitated by the  hiring practices of neurosurgical departments across the US. In this analysis,  the authors coupled the stated practice location of WNs with regional geospatial  data to identify hot spots and cold spots of prevalence and examined regional  predictors of increases and decreases in WNs over time. METHODS: The authors  examined the National Provider Identifier (NPI) numbers of all neurosurgeons  obtained via the National Plan and Provider Enumeration System (NPPES),  identifying the percentage of WNs in each county for which data were appended  with data from the US Census Bureau. Change in WN rates was identified by  calculating a regression slope for all years included (2015-2022). Hot spots and  cold spots of WNs were identified through Moran’s clustering analysis. Population  and surgeon features were compared for hot spots and cold spots. RESULTS: WNs  constituted 10.73% of all currently active neurosurgical NPIs, which has  increased from 2015 (8.81%). Three hot spots were found-including the Middle  Atlantic and Pacific divisions-that contrasted with scattered cold spots  throughout the East Central regions that included Memphis as a major city.  Although relatively rapidly growing, hot spots had significant gender inequality,  with a median WN percentage of 11.38% and a median of 0.61 WNs added to each  respective county per year. CONCLUSIONS: The authors analyzed the prevalence of  WNs by using aggregated data from the NPPES and US Census Bureau. The authors  also show regional hot spots of WNs and that the establishment of WNs in a region  is a predictor of additional WNs entering the region. These data suggest that  female neurosurgical mentorship and representation may be a major driver of  acceptance and further gender diversity in a given region.

INTRODUCTION: Medical Spanish courses in US medical schools aim to teach patient-centered communication, yet many existing resources focus on technical  vocabulary and may inadvertently increase jargon use with patients. Graphic  medicine presents an opportunity for interactive learning that centers the  patient experience, yet it has never been explored in medical Spanish education.  METHODS: We developed a Medical Spanish Graphic Activity (MeGA) for medical  student deliberate practice of patient-centered verbal communication focused on  three aspects: diagnosis, treatment, and follow-up care. Each 30-minute activity  included a comics handout depicting a patient with a common problem. Students  used voice-to-text technology to record their explanations in response to  prompts. Transcripts were analyzed for jargon use, including total jargon,  unexplained jargon, and problem words (non-Spanish words plus unexplained  jargon), utilizing a previously published, reliable protocol for Spanish medical  jargon classification. Participants voluntarily provided postactivity feedback.  RESULTS: Twenty-nine fourth-year students with intermediate or greater Spanish  skills participated in a series of 10 MeGA activities between January and April  2022. Unexplained jargon use and problem words progressively decreased for all  transcripts (diagnosis, treatment, and follow-up; all ps < .001). Total jargon  use also decreased, but this was not significant in follow-up transcripts (p =  .38). All students agreed that MeGA helped them enhance communication skills  applicable to patient care and self-identify strengths and limitations.  DISCUSSION: MeGA is realistic to implement, engages students’ active  participation in the speaking domain, and reduces unexplained jargon use. Future  studies should explore the broader application of this model and engage patient  perspectives.

BACKGROUND: The COVID-19 pandemic has prompted a transformation of medical training. Although there were obvious medical education and social interaction  challenges, e-learning presented some advantages, which may have generated  medical curricula innovation and adjustments to novel technological  methodologies. This study aims to generate consensuses among medical students  regarding medical education provided during the pandemic in the resource-limited  context of a Global South university. METHODS: The implementation of a  participatory Delphi method included a recruitment campaign, training,  constitution of Delphi panels and questions, and development of the Delphi  exercises. Students from the second to the sixth year of medicine of a university  in Quito, Ecuador, constituted two Delphi panels, developed questions about the  education received during the pandemic, and answered them over 3.5 rounds.  FINDINGS: Twenty-two medical students participated in the Delphi exercises about  their perception of medical education during the COVID-19 pandemic. The analysis  consisted of a total of 22 Delphi questions divided into five distinct  categories: adaptations and innovations, curriculum and assessment changes,  virtual clinical practice, time management, and mental health. The authors  established high, medium, and low consensuses for analysis. CONCLUSIONS:  Consensuses were reached based on students’ academic year and focused on the  changes in lecture delivery, the usage of new technologies, patient care skills,  the impact of the educational routine, and the mental health of the COVID-19  pandemic. The way the pandemic affected medical education in the Global South set  the stage for the need for a comprehensive review of tools, skills, and curricula  for students from culturally diverse backgrounds. This study offers a highly  replicable methodology to generate consensuses and introduce students to academic  research.

Applications of machine learning in the biomedical sciences are growing rapidly. This growth has been spurred by diverse cross-institutional and interdisciplinary collaborations, public availability of large datasets, an increase in the accessibility of analytic routines, and the availability of powerful computing resources. With this increased access and exposure to machine learning comes a responsibility for education and a deeper understanding of its bases and bounds, borne equally by data scientists seeking to ply their analytic wares in medical research and by biomedical scientists seeking to harness such methods to glean knowledge from data. This article provides an accessible and critical review of machine learning for a biomedically informed audience, as well as its applications in psychiatry. The review covers definitions and expositions of commonly used machine learning methods, and historical trends of their use in psychiatry. We also provide a set of standards, namely Guidelines for REporting Machine Learning Investigations in Neuropsychiatry (GREMLIN), for designing and reporting studies that use machine learning as a primary data-analysis approach. Lastly, we propose the establishment of the Machine Learning in Psychiatry (MLPsych) Consortium, enumerate its objectives, and identify areas of opportunity for future applications of machine learning in biological psychiatry. This review serves as a cautiously optimistic primer on machine learning for those on the precipice as they prepare to dive into the field, either as methodological practitioners or well-informed consumers. © 2024 Elsevier B.V., All rights reserved.

Precision education (PE) systematically leverages data and advanced analytics to inform educational interventions that, in turn, promote meaningful learner outcomes. PE does this by incorporating analytic results back into the education continuum through continuous feedback cycles. These data-informed sequences of planning, learning, assessing, and adjusting foster competence and adaptive expertise. PE cycles occur at individual (micro), program (meso), or system (macro) levels. This article focuses on program- and system-level PE. Data for PE come from a multitude of sources, including learner assessment and program evaluation. The authors describe the link between these data and the vital role evaluation plays in providing evidence of educational effectiveness. By including prior program evaluation research supporting this claim, the authors illustrate the link between training programs and patient outcomes. They also describe existing national reports providing feedback to programs and institutions, as well as 2 emerging, multiorganization program- and system-level PE efforts. The challenges encountered by those implementing PE and the continuing need to advance this work illuminate the necessity for increased cross-disciplinary collaborations and a national cross-organizational data-sharing effort. Finally, the authors propose practical approaches for funding a national initiative in PE as well as potential models for advancing the field of PE. Lessons learned from successes by others illustrate the promise of these recommendations. © 2024 Elsevier B.V., All rights reserved.

In this essay, we review how health communication scholarship has been translated into various communication skills trainings (CSTs), we present four case studies  of how health communication research informed the development and implementation  of specific CSTs, and we reflect on how we can productively define “impact” in  looking back as well as looking forward within this line of research.

Often, nurses new to the school setting find they have more questions than answers about school nursing practice but no mentor to ask. Questions often arise  regarding medication administration, health records, health requirements to  attend school, student illness, school health legislation, and state reporting  requirements in the school setting, plus many more. This article outlines how one  Regional Office of Education (ROE) in central Illinois partnered with a Certified  School Nurse to establish a mentoring and networking program to foster  relationships and information sharing among school nurses.

Medical students’ feedback orientation (their attitudes about and preferences for feedback from preceptors) may change over the course of the third year of medical  school and is likely influenced by identity-related factors. This study proposed  that both how students view themselves personally (i.e., impostor syndrome) and  how they view themselves in relation to the group (i.e., identification with the  profession) are identity factors related to related to feedback orientation  during clinical rotations. 177 third-year medical students enrolled in a  four-phase longitudinal survey study beginning at the start of clinical rotations  and continuing every twelve weeks of the academic year thereafter. Feedback  orientation was conceptualized and measured as comprising aspects of utility  (i.e., feedback is valuable and useful), sensitivity (i.e., feeling intimidated  or threatened by corrective feedback), confidentiality (i.e., public/private  context of feedback), and retention (i.e., feedback remembered). Results  indicated that these aspects of feedback orientation did not significantly change  during the third year. Instead, impostor syndrome was at least marginally,  significantly associated with all aspects of feedback orientation across phases.  Group identity was associated with feedback utility and retention, and  female-identifying students reported significantly greater feedback  confidentiality and feedback retention. Interventions may be needed to improve  medical students’ attitudes about feedback, particularly for those who experience  impostor syndrome. Fostering group cohesion among medical students may influence  how well students remember feedback and find it useful.

OBJECTIVE: We explore relationships between barriers and facilitators experienced by users to understand dynamic interactions in sociotechnical systems and improve  a mobile phone-based augmented reality application that teaches users about the  contents of a standardized pediatric code cart. BACKGROUND: Understanding  interactions between performance obstacles and facilitators can provide guidance  to (re)designing sociotechnical systems to improve system outcomes. Clinicians  should know about contents and organization of code carts, and an augmented  reality mobile application may improve that knowledge but changes the  sociotechnical system in which they learn. Prior work identified barriers and  facilitators impacting the use of this application-participants described  dimensions together, indicating interactions that are explored in the current  study. METHOD: We conducted four focus groups (number of clinicians = 18) and two  interviews with clinicians who used the application. We performed a secondary  analysis of focus group data exploring interactions between previously identified  barriers and facilitators to application use. We used epistemic network analysis  to visualize these interactions. RESULTS: Work system barriers interacted with  barriers and facilitators interacted with facilitators to amplify cumulative  negative or positive impact, respectively. Facilitators balanced barriers,  mitigating negative impact. Facilitators also exacerbated barriers, worsening  negative impact. CONCLUSION: Barriers and facilitators interact and can amplify,  balance, and exacerbate each other-notably, positives are not always positive. To  obtain desired outcomes, interactions must be further considered in  sociotechnical system design, for example, the potential improvements to the  application we identified.

Medical educators are finding it challenging to ensure strong basic sciences knowledge is built in the allocated time assigned in the innovative medical  school curriculum. In this article, we introduce a novel method to vertically  integrate basic sciences knowledge during clinical training.

INTRODUCTION: In 2014, 56 Illinois hospitals came together to form a unique learning collaborative, the Illinois Surgical Quality Improvement Collaborative  (ISQIC). Our objectives are to provide an overview of the first three years of  ISQIC focused on (1) how the collaborative was formed and funded, (2) the 21  strategies implemented to support quality improvement (QI), (3) collaborative  sustainment, and (4) how the collaborative acts as a platform for innovative QI  research. METHODS: ISQIC includes 21 components to facilitate QI that target the  hospital, the surgical QI team, and the peri-operative microsystem. The  components were developed from available evidence, a detailed needs assessment of  the hospitals, reviewing experiences from prior surgical and non-surgical QI  Collaboratives, and interviews with QI experts. The components comprise 5  domains: guided implementation (e.g., mentors, coaches, statewide QI projects),  education (e.g., process improvement (PI) curriculum), hospital- and  surgeon-level comparative performance reports (e.g., process, outcomes, costs),  networking (e.g., forums to share QI experiences and best practices), and funding  (e.g., for the overall program, pilot grants, and bonus payments for  improvement). RESULTS: Through implementation of the 21 novel ISQIC components,  hospitals were equipped to use their data to successfully implement QI  initiatives and improve care. Formal (QI/PI) training, mentoring, and coaching  were undertaken by the hospitals as they worked to implement solutions. Hospitals  received funding for the program and were able to work together on statewide  quality initiatives. Lessons learned at one hospital were shared with all  participating hospitals through conferences, webinars, and toolkits to facilitate  learning from each other with a common goal of making care better and safer for  the surgical patient in Illinois. Over the first three years, surgical outcomes  improved in Illinois. DISCUSSION: The first three years of ISQIC improved care  for surgical patients across Illinois and allowed hospitals to see the value of  participating in a surgical QI learning collaborative without having to make the  initial financial investment themselves. Given the strong support and buy-in from  the hospitals, ISQIC has continued beyond the initial three years and continues  to support QI across Illinois hospitals.

PURPOSE: Scoring postencounter patient notes (PNs) yields significant insights into student performance, but the resource intensity of scoring limits its use.  Recent advances in natural language processing (NLP) and machine learning allow  application of automated short answer grading (ASAG) for this task. This  retrospective study evaluated psychometric characteristics and reliability of an  ASAG system for PNs and factors contributing to implementation, including  feasibility and case-specific phrase annotation required to tune the system for a  new case. METHOD: PNs from standardized patient (SP) cases within a graduation  competency exam were used to train the ASAG system, applying a feed-forward  neural networks algorithm for scoring. Using faculty phrase-level annotation, 10  PNs per case were required to tune the ASAG system. After tuning, ASAG item-level  ratings for 20 notes were compared across ASAG-faculty (4 cases, 80 pairings) and  ASAG-nonfaculty (2 cases, 40 pairings). Psychometric characteristics were  examined using item analysis and Cronbach’s alpha. Inter-rater reliability (IRR)  was examined using kappa. RESULTS: ASAG scores demonstrated sufficient  variability in differentiating learner PN performance and high IRR between  machine and human ratings. Across all items the ASAG-faculty scoring mean kappa  was .83 (SE ± .02). The ASAG-nonfaculty pairings kappa was .83 (SE ± .02). The  ASAG scoring demonstrated high item discrimination. Internal consistency  reliability values at the case level ranged from a Cronbach’s alpha of .65 to  .77. Faculty time cost to train and supervise nonfaculty raters for 4 cases was  approximately $1,856. Faculty cost to tune the ASAG system was approximately  $928. CONCLUSIONS: NLP-based automated scoring of PNs demonstrated a high degree  of reliability and psychometric confidence for use as learner feedback. The small  number of phrase-level annotations required to tune the system to a new case  enhances feasibility. ASAG-enabled PN scoring has broad implications for  improving feedback in case-based learning contexts in medical education.

Phenomenon: Mental shortcuts are commonly used in medical education to facilitate the learning and application of a large volume of information. However, the use  of demographic identifiers such as race, ethnicity, region, and descent from one  of these groups as mental shortcuts in association with disease can perpetuate  misconceptions about the construction of these identities and reinforce  stereotypes. The United States Medical Licensing Exam (USMLE) Step 1 is a major  driver of pre-clinical undergraduate medical education that requires memorization  of a large volume of information and application of this information to clinical  vignettes. This study assesses how demographic identifiers have been used in a  nearly universally used study resource for this exam. Approach: The authors  analyzed First Aid for the USMLE Step 1 2020, Thirtieth Edition, a resource that  contains “high yield facts” and was built and maintained based on experiences  with the USMLE Step 1 for references to race, ethnicity, region, and descent from  one of these groups and the distribution of skin tones used in photos. These  findings were subsequently compared to the changes made in the 2021 edition of  the resource. Findings: The authors found 50 references in the 2020 edition to  race, ethnicity, region, and descent from one of these groups, all in relation to  disease. More than half of these references had an associated heritable  component. Black or African American race was disproportionately represented,  comprising more than half of all racial associations (13/24). Additionally, light  skin tone was used in 170/204 photos (84.2%) in the 2020 edition. In the 2021  edition, only 12/209 photos (5.7%) were new or changed. Insights: These findings  highlight the trend to associate race with disease while also furthering the  misconception that there are innate, heritable differences between socially  constructed groups and establishing light skin tone as the norm. While some  favorable changes were made to the 2021 text, further work within this resource  and across medical education is required to avoid further misuse of race and  challenge existing implicit biases.

Physiology is a critical subject that bridges basic and clinical medicine. The reform of physiology education is crucial to improving the quality of teaching  and supporting student learning; however, there is a lack of comprehensive data  documenting the current state of physiology education in medical programs in  China. This study conducted an online survey among experienced teachers from the  top 100 medical schools in the Chinese mainland in 2022. A total of 89 valid  questionnaires were included in this study. In 57.3% of the surveyed medical  schools, 70% of the physiology teachers have a Ph.D. degree, while the number of  faculty members with a medical background has tended to decrease in 53.9% of the  surveyed medical schools. Of the 89 medical schools, 62 have implemented  physiology course integration, with 69.4% of the respondents believing that  curriculum integration could enhance students’ knowledge acquisition and  application. The lecture hours per term are 50-70 and 71-90 in 49.4% and 42.7% of  the 89 medical schools, respectively. The ratio of course duration of lecture to  laboratory was 2:1 in 47.2% of the surveyed medical schools, while the ratio was  between 1:1 and 2:1 in 47.2% of the surveyed medical schools, and only 5.6% of  medical schools opted for a 1:1 course arrangement. For teaching methods, about  60% of medical schools used problem-based learning, case-based learning, and  task-based learning (PBL/CBL/TBL) for clinical medicine students only, and 25.4%  of medical schools applied PBL/CBL/TBL to all students. This study is conducive  to promoting dialogue and communication among physiology teachers,  administrators, and researchers.NEW & NOTEWORTHY This study conducted a  nationwide survey of the top 100 medical schools in the Chinese mainland in 2022  to provide first-hand data on the current situation and changes in physiology  education and teaching in the Chinese mainland with focuses on the faculty  composition, curriculum integration, teaching methods, and assessment modes,  which is a microcosm of the reform and development of the medical education in  the Chinese mainland, hoping to improve the quality of preclinical medical  education.

Described herein is the synthesis of the Ni(II) complex ((t)BuMe(2)tacn)Ni(II)(cycloneophyl) ((t)BuMe(2)tacn =  1-tert-butyl-4,7-dimethyl-1,4,7-triazacyclononane, cycloneophyl =  -CH(2)CMe(2)-o-C(6)H(4)-) and its reactivity with dioxygen and peroxides. The new  (t)BuMe(2)tacn ligand is designed to enhance the oxidatively induced bond-forming  reactivity of high-valent Ni intermediates. Tunable chemoselectivity for Csp(2)-O  vs Csp(2)-Csp(3) bond formation was achieved by selecting the appropriate solvent  and reaction conditions. Importantly, the use of cumene hydroperoxide and  meta-chloroperbenzoic acid suggests a heterolytic O-O bond cleavage upon reaction  with ((t)BuMe(2)tacn)Ni(II)(cycloneophyl). Mechanistic studies using isotopically  labeled H(2)O(2) support the generation of a high-valent Ni-oxygen species via an  inner-sphere mechanism and subsequent reductive elimination to form the Csp(2)-O  bond. Kinetic studies of the exceptionally fast Csp(2)-O bond-forming reaction  reveal a first-order dependence on both ((t)BuMe(2)tacn)Ni(II)(cycloneophyl) and  H(2)O(2), and thus an overall second-order reaction. Eyring analysis further  suggests that the oxidation of the Ni(II) complex by H(2)O(2) is the  rate-determining step, which can be modulated by the presence of coordinating  solvents. Moreover, computational studies fully support the conclusions drawn  from experimental results. Overall, this study reveals for the first time the  ability to control the oxidatively induced C-C vs C-O bond formation reactions at  a Ni center. Importantly, the described system merges the known organometallic  reactivity of Ni with the biomimetic oxidative transformations resembling  oxygenases and peroxidases, and involving high-valent metal-oxygen intermediates,  which is a novel approach that should lead to unprecedented oxidative catalytic  transformations.

Integration of technology within problem-based learning curricula is expanding; however, information regarding student experiences and attitudes about the integration of such technologies is limited. This study aimed to evaluate pre-clinical medical student perceptions and use patterns of the “Road to Birth” (RtB) software, a novel program designed to support human maternal anatomy and physiology education. Second-year medical students at a large midwestern American university participated in a prospective, mixed-methods study. The RtB software is available as a mobile smartphone/tablet application and in immersive virtual reality. The program was integrated into problem-based learning activities across a three-week obstetrics teaching period. Student visuospatial ability, weekly program usage, weekly user satisfaction, and end-of-course focus group interview data were obtained. Survey data were analyzed and summarized using descriptive statistics. Focus group interview data were analyzed using inductive thematic analysis. Of the eligible students, 66% (19/29) consented to participate in the study with 4 students contributing to the focus group interview. Students reported incremental knowledge increases on weekly surveys (69.2% week one, 71.4% week two, and 78.6% week three). Qualitative results indicated the RtB software was perceived as a useful educational resource; however, its interactive nature could have been further optimized. Students reported increased use of portable devices over time and preferred convenient options when using technology incorporated into the curriculum. This study identifies opportunities to better integrate technology into problem-based learning practices in medical education. Further empirical research is warranted with larger and more diverse student samples. © 2023 Elsevier B.V., All rights reserved.

Recent surveys of Magnet facilities and nurses found low rates of implementation of evidence-based practice in U.S. health care settings. Nursing Experts: Translating the Evidence (NExT) is a collaboration of nurses and librarians providing free online evidence-based practice nursing education benefiting nurses in all settings. The NExT online modules empowered participants to effi-ciently access valuable resources to inform and improve their practice in a convenient, accessible, self-paced for-mat. Quantitative and qualitative evaluation methods and the value of collaboration are discussed. © 2023 Elsevier B.V., All rights reserved.

Student pharmacists can have a positive impact on patient care. The objective of this research was to compare clinical interventions made by Purdue University  College of Pharmacy (PUCOP) student pharmacists completing internal medicine  Advanced Pharmacy Practice Experiences (APPE) in Kenya and the US. A  retrospective analysis of interventions made by PUCOP student pharmacists  participating in either the 8-week global health APPE at Moi Teaching and  Referral Hospital (MTRH-Kenya) or the 4-week adult medicine APPE at the Sydney &  Lois Eskenazi Hospital (SLEH-US) was completed. Twenty-nine students (94%)  documented interventions from the MTRH-Kenya cohort and 23 (82%) from the SLEH-US  cohort. The median number of patients cared for per day was similar between the  MTRH-Kenya (6.98 patients per day, interquartile range [IQR] = 5.75 to 8.15) and  SLEH-US students (6.47 patients per day, IQR = 5.58 to 7.83). MTRH-Kenya students  made a median number of 25.44 interventions per day (IQR = 20.80 to 28.95), while  SLEH-US students made 14.77 (IQR = 9.80 to 17.72). The most common interventions  were medication reconciliation/t-sheet rewrite and patient chart reviews for  MTRH-Kenya and the SLEH-US, respectively. This research highlights how student  pharmacists, supported in a well-designed, location-appropriate learning  environment, can positively impact patient care.

Physicians in residency training experience high levels of medical uncertainty, yet they are often hesitant to discuss uncertainty with parents. Guided by the  theory of motivated information management and a multiple goals perspective, this  mixed-methods longitudinal study examines associations among residents’ tolerance  of and reactions to uncertainty, efficacy communicating about uncertainty, and  perceptions of parents’ trust in them as physicians. To contextualize these  associations, we also examined residents’ task, identity, and relational goals  when communicating about uncertainty with parents. We surveyed 47 pediatric  residents at the beginning of each year of their residency program. As they  progressed through their training, residents’ uncertainty-related anxiety and  reluctance to communicate uncertainty to parents decreased, and their efficacy  communicating uncertainty with parents increased. Residents’ concerns about bad  outcomes remained unchanged. Residents pursued multiple, often conflicting,  conversational goals when communicating uncertainty with parents. Results reveal  important considerations for addressing how residents can manage their  uncertainty in productive ways.

BACKGROUND: Because of the effect of COVID-19 on academic opportunities, as well as limitations on travel, away rotations and in-person interviews,  COVID-19-related changes could impact the neurosurgical resident demographics.  Our aim was to retrospectively review the demographics of the previous 4 years of  neurosurgery residents, provide bibliometric analysis of successful applicants,  and analyze for the effects of COVID-19 on the match cycle. METHODS: All American  Association of Neurological Surgeons’ residency program websites were examined  for a list of demographic characteristics for current postgraduate years 1 to 4.  Gathered information included gender, undergraduate and medical institution and  state, medical degree status, and prior graduate programs. RESULTS: A total of  114 institutions and 946 residents were included in the final review. Most (676,  or 71.5%) of the residents included in the analysis were male. Of the 783 who  studied within the United States, 221 (28.2%) residents stayed within the same  state of his or her medical school. Fewer residents (104 of 555, or 18.7%) stayed  within the same state of his or her undergraduate school. Demographic information  and geographic switching relative to medical school, undergraduate school, and  hometown showed no significant changes between pre-COVID-19 and COVID-19-matched  cohorts overall. The median number of publications per resident significantly  increased for the COVID-19-matched cohort (median, 1; interquartile range [IQR],  0-4.75) when compared with the non-COVID-19-matched cohort (median, 1; IQR, 0-3,  P = 0.004), as did first author publications (median, 1; IQR, 0-1 vs. median, 1;  IQR, 0-1; P = 0.015), respectively. The number of residents matching into the  same region in the Northeast relative to undergraduate degree was significantly  greater after COVID-19 (56 [58%] versus 36 [42%], P = 0.026). The West  demonstrated a significant increase in the mean number of total publications (4.0  ± 8.5 vs. 2.3 ± 4.2, P = 0.02) and first author publications (1.24 ± 2.33 vs.  0.68 ± 1.47, P = 0.02) after COVID-19, with the increase in first author  publications being significant in a test of medians. CONCLUSIONS: Herein we  characterized the most recently matched neurosurgery applicants, paying  particular attention to changes over time in relation to the onset of the  pandemic. Apart from publication volume, characteristics of residents and  geographical preferences did not change with the influence of COVID-19-induced  changes in the application process.

OBJECTIVES: To evaluate suturing skills of veterinary students using 3 common performance assessments (PAs) and to compare findings to data obtained by an  electromyographic armband. SAMPLE: 16 second-year veterinary students.  PROCEDURES: Students performed 4 suturing tasks on synthetic tissue models 1, 3,  and 5 weeks after a surgical skills course. Digital videos were scored by 4  expert surgeons using 3 PAs (an Objective Structured Clinical Examination [OSCE]-  style surgical binary checklist, an Objective Structured Assessment of Technical  Skill [OSATS] checklist, and a surgical Global Rating Scale [GRS]). Surface  electromyography (sEMG) data collected from the dominant forearm were input to  machine learning algorithms. Performance assessment scores were compared between  experts and correlated to task completion times and sEMG data. Inter-rater  reliability was calculated using the intraclass correlation coefficient (ICC).  Inter-rater agreement was calculated using percent agreement with varying levels  of tolerance. RESULTS: Reliability was moderate for the OSCE and OSATS checklists  and poor for the GRS. Agreement was achieved for the checklists when moderate  tolerance was applied but remained poor for the GRS. sEMG signals did not  correlate well with checklist scores or task times, but features extracted from  signals permitted task differentiation by routine statistical comparison and  correct task classification using machine learning algorithms. CLINICAL  RELEVANCE: Reliability and agreement of an OSCE-style checklist, OSATS checklist,  and surgical GRS assessment were insufficient to characterize suturing skills of  veterinary students. To avoid subjectivity associated with PA by raters, further  study of kinematics and EMG data is warranted in the surgical skills evaluation  of veterinary students.

Introduction: Health educators have had difficulty introducing health policy and public health training into an already intensive medical school curriculum.  Although the COVID-19 pandemic may have changed perspectives on the importance of  public health, it may not change educational approaches. Assessment of medical  student opinions and perceptions of health policy and public health might  influence the weight given to these topics in medical education. METHODS: We used  a 39-item instrument to cross-sectionally survey medical students, to assess  their perceptions of the value of public health and health policy within their  professional education. RESULTS: One hundred two students completed the survey  (13% response rate). Most students reported an interest in public health (94.1%)  and health policy (92.2%). Although interested, most students lacked confidence  in their knowledge of public health and health policy on both state (health  policy 34.3% confident; public health 43.1%) and national (health policy 41.0%;  public health 44.1%) levels. Most students perceived that their institution has  not sufficiently prepared them to understand health policy (34% felt prepared)  and most reported insufficient information to participate in policy discussions  (30.3% sufficiently informed). CONCLUSIONS: Medical students reported an interest  in public health and health policy while also reporting a lack of confidence in  their level of preparedness to understand and participate in these fields, thus  demonstrating a need for increased public health and health policy education  within medical school curricula.

OBJECTIVE: The objective of this study is to investigate whether self-disclosed disability and self-reported program access are associated with measures of  empathy and burnout in a national sample of US medical students. METHODS: The  authors obtained data from students who responded to the Association of Medical  Colleges (AAMC) Year 2 Questionnaire (Y2Q) in 2019 and 2020. Data included  demographic characteristics, personal variables, learning environment indicators,  measures of burnout (Oldenburg Burnout Inventory for Medical Students), empathy  (Interpersonal Reactivity Index) and disability-related questions, including  self-reported disability, disability category and program access. Associations  between disability status, program access, empathy and burnout were assessed  using multivariable logistic regression models accounting for YQ2 demographic,  personal-related and learning environment measures. RESULTS: Overall, 23 898  (54.2%) provided disability data and were included. Of those, 2438 (10.2%)  self-reported a disability. Most medical students with disabilities (SWD)  self-reported having program access through accommodations (1215 [49.8%]) or that  accommodations were not required for access (824 [33.8%]). Multivariable models  identified that compared with students without disabilities, SWD with and without  program access presented higher odds of high exhaustion (1.50 [95% CI, 1.34-1.69]  and 2.59 [95% CI, 1.93-3.49], respectively) and lower odds of low empathy (0.75  [95% CI, 0.67-.85] and 0.68 [95% CI, 0.52-0.90], respectively). In contrast,  multivariable models for disengagement identified that SWD reporting lack of  program access presented higher odds of high disengagement compared to students  without disabilities (1.43 [95% CI, 1.09-1.87], whereas SWD with program access  did not (1.09 [95% CI, 0.97-1.22]). CONCLUSIONS: Despite higher odds of high  exhaustion, SWD were less likely to present low empathy regardless of program  access, and SWD with program access did not differ from students without  disabilities in terms of disengagement. These findings add to our understanding  of the characteristics and experiences of SWD including their contributions as  empathic future physicians.

Many medical students use spaced repetition as a study strategy to improve knowledge retention, and there has been growing interest from medical students in  using flashcard software, such as Anki, to implement spaced repetition. Previous  studies have provided insights into the relationship between medical students’  use of spaced repetition and exam performance, but most of these studies have  relied on self-reports. Novel insights about how medical students use spaced  repetition can be gleaned from research that takes advantage of the ability of  digital interfaces to log detailed data about how students use software. This  study is unique in its use of data extracted from students’ digital Anki data  files, and those data are used to compare study patterns over the first year of  medical school. Implementation of spaced repetition was compared between two  groups of students who were retrospectively grouped based on average performance  on three exams throughout the first year of medical school. Results indicate that  students in the higher scoring group studied more total flashcards and  implemented spaced repetition via Anki earlier in the year compared to the lower  scoring group. These findings raise the possibility that implementing spaced  repetition as a study strategy early in medical school may be related to improved  knowledge retention and exam performance. Additional research should be performed  at more sites to further examine the relationship between spaced repetition  implementation and exam performance.

As the COVID-19 pandemic continues, the opioid epidemic has worsened. Opioid-related deaths continue to rise, and many of these deaths can be traced to a prescription opioid. Because veterinarians prescribe opioids, many organizations and federal agencies have called for increased veterinary education on the topic. In this teaching tip, we review the current literature surrounding the veterinary profession’s link to the opioid epidemic and one potential way that educational institutions can successfully and efficiently incorporate safe opioid prescribing training into the curriculum using an online course. © 2023 Elsevier B.V., All rights reserved.

PURPOSE: There are no standardized approaches for communicating with patients discharged from the emergency department with diagnostic uncertainty. This trial  tested efficacy of the Uncertainty Communication Education Module, a  simulation-based mastery learning curriculum designed to establish competency in  communicating diagnostic uncertainty. METHOD: Resident physicians at 2 sites  participated in a 2-arm waitlist randomized controlled trial from September 2019  to June 2020. After baseline (T1) assessment of all participants via a  standardized patient encounter using the Uncertainty Communication Checklist  (UCC), immediate access physicians received training in the Uncertainty  Communication Education Module, which included immediate feedback, online  educational modules, a smartphone-based application, and telehealth deliberate  practice with standardized patients. All physicians were retested 16-19 weeks  later (T2) via in-person standardized patient encounters; delayed access  physicians then received the intervention. A final test of all physicians  occurred 11-15 weeks after T2 (T3). The primary outcome measured the percentage  of physicians in the immediate versus delayed access groups meeting or exceeding  the UCC minimum passing standard at T2. RESULTS: Overall, 109 physicians were  randomized, with mean age 29 years (range 25-46). The majority were male (n = 69,  63%), non-Hispanic/Latino (n = 99, 91%), and White (n = 78, 72%). At T2, when  only immediate access participants had received the curriculum, immediate access  physicians demonstrated increased mastery (n = 29, 52.7%) compared with delayed  access physicians (n = 2, 3.7%, P < .001; estimated adjusted odds ratio of  mastery for the immediate access participants, 31.1 [95% CI, 6.8-143.1]). There  were no significant differences when adjusting for training site or stage of  training. CONCLUSIONS: The Uncertainty Communication Education Module  significantly increased mastery in communicating diagnostic uncertainty at the  first postintervention test among emergency physicians in standardized patient  encounters. Further work should assess the impact of clinical implementation of  these communication skills.

INTRODUCTION: Doctors are trusted voices for communities and can influence lawmakers on climate change. Effective climate policy advocacy requires  awareness, knowledge, and skills not typically taught in medical schools. Such  curriculum additions could help students describe reasons for physicians to  engage in climate policy advocacy and compose advocacy presentations. METHODS: To  empower engagement in climate policies and develop advocacy skills, we deployed  three 90-minute workshops at three institutions for first-, second-, and  fourth-year students. The workshops included background on various climate  policies of concern to health care professionals, advocacy guidance, scripts and  factsheets from physicians’ meetings illustrating advocacy opportunities for  students and physicians, and active learning exercises. The exercises utilized  advocacy templates and actual proposed actions on climate change. Students worked  in small groups on advocacy presentations’ content and format. Each group shared  its work, and facilitators provided feedback. RESULTS: Out of 102 participants,  29 completed a survey (28% response rate). Using a Likert scale and narratives,  students reported significant improvements in readiness to advocate for  legislation or policies to mitigate the health effects of climate change,  awareness of advocacy opportunities, and capability to prepare advocacy  documents. DISCUSSION: Workshops on climate policy advocacy can equip medical  students with important perspectives on their responsibilities and opportunities,  as well as skills to be effective. The physician’s voice is critical to promoting  policies related to the health impacts of climate change. Targeted workshops with  actual examples and exercises on climate advocacy are feasible and important  additions to the curriculum.

INTRODUCTION: Mastery learning orientation, conceptualized as a growth mindset, can be beneficial to learners in medical education and is supported by a  program...s learning environment. Currently, there are no instruments which  reliably assess the learning orientation of a graduate medical education  program...s learning environment. OBJECTIVE: To explore the reliability and  validity of the Graduate Medical Education Learning Environment Inventory  (GME-LEI). METHODS: Leaders of the Education in Pediatrics Across the Continuum  (EPAC) project revised Krupat...s Educational Climate Inventory to create the  GME-LEI. We investigated the GME-LEI...s reliability and validity through  confirmatory factor and parallel factor analyses and calculated Cronbach...s  alpha for each subscale. We compared mean subscale scores between residents in  traditional programs and the EPAC project. As EPAC is known to foster a  mastery-focused learning orientation, we hypothesized differences detected  between resident groups would strengthen the instrument...s validity. RESULTS:  One hundred and twenty-seven pediatric residents completed the GME-LEI. The final  3-factor model was an acceptable fit to the data, and Cronbach...s alpha for each  subscale was acceptable (Centrality: 0.87; Stress: 0.73; Support: 0.77). Mean  scores on each subscale varied by program type (EPAC vs traditional) with EPAC  residents reporting statistically significant higher scores in the Centrality of  Learning subscale (2.03, SD 0.30, vs 1.79, SD 0.42; P.ß=.ß.023; scale of 1...4).  CONCLUSIONS: The GME-LEI reliably measures 3 distinct aspects of the GME learning  environment with respect to learning orientation. The GME-LEI may be used to help  programs better monitor the learning environment and make changes to support  mastery-oriented learning.

OBJECTIVES: Evaluate effectiveness of a multisite program promoting the successful transition of baccalaureate and graduate entry (with a prior degree)  students into pre-licensure curricula. Faculty concern around nursing students’  successful completion of nursing programs and passage of the nursing licensure  exam stems from challenges students encounter in core courses, study habits, and  civility. METHODS: One hundred eighty-five students participated in a  quasi-experimental pre-post-test mixed-methods study. Students completed content  modules and open-ended surveys. RESULTS: Most students found the program helpful.  Statistically significant improvements were shown in medication calculation,  reading comprehension, and medical terminology. No statistically significant  improvement was shown in anatomy and physiology. CONCLUSIONS: Our Transition to  Nursing program shows promise and adds to proactive strategies in preparing  students for a successful transition into nursing programs. Our innovative  approach may serve as a model to nursing schools and colleges around the world to  promote student success.

OBJECTIVE Neurosurgeons frequently move throughout their careers, with moves driven by personal and professional factors. In this study, the authors analyzed these migration trends through a dynamic migratory map and statistical review, with a particular focus on differences in education and practice patterns between male and female neurosurgeons. METHODS A list containing all board-certified and -affiliated US neurosurgeons practicing in 2019 was obtained from the American Association of Neurological Surgeons. The list was augmented to include demographic and location information for medical school, residency, fellowship(s), and current practice for all neurosurgeons with publicly available data. Migration heatmaps were generated, and migration patterns over 10-year intervals were plotted. A web tool was additionally created to allow for dynamic visualization of this database. RESULTS The database included 5307 neurosurgeons with a mean age of 57.2 ± 11.3 years. The female population made up 8.93% of all neurosurgeons, and were found to be more likely to complete fellowships than their male counterparts, at 54.2% and 39.1%, respectively (p < 0.0001). A total of 39.5% of all neurosurgeons completed at least one fellowship. A large proportion of currently practicing US neurosurgeons completed medical school internationally in the 1990s. Recently, there has been a trend in neurosurgeons choosing to practice in the South, emigrating from the Northeast and the Western US Census regions. By population, the Western US region trained the fewest neurosurgeons at 1 per 115,000 residents, and the Northeastern US region trained the most at 1 per 49,000. The web tool provides a simple interface to visualize the database on a world map. CONCLUSIONS Diversity, equity, and inclusion in neurosurgery have been a strong point of discussion in recent literature, with neurosurgeons comprising one of the most gender-disparate workforces in the US medical system. This study provides additional metrics to assess these disparities to help motivate further action toward a larger, more diverse neurosurgical community. © 2023 Elsevier B.V., All rights reserved.

BACKGROUND: Expanding access to workforce training for opioid use disorder (OUD) treatment continues to be a priority. This study explored the use of tiered  mentoring opportunities within an ECHO® model to expand treatment capacity and  develop a statewide network of medications for OUD (MOUD) expertise. ECHO®  engages participants in a virtual community to learn best practices through  case-based learning and interactions with experts. METHODS: We studied two  incentivized Illinois MOUD ECHO® training programs by examining aggregate  demographic and prescribing data across eight training cohorts (n = 199  participants). Participants (n = 51) in the last two cohorts were evaluated with  expanded pre- and post-training surveys. Qualitative interviews were completed  with a subset (n = 13) to examine effects observed in the survey data. RESULTS:  For the whole group, we found a geographic expansion of the participants’  prescribing capacity that reached into rural and other underserved areas in  Illinois. Participants in the last two cohorts reported both increased  self-efficacy for OUD treatment and increased connectedness to the addiction  treatment community in Illinois. Participants who progressed through the tiered  mentorship roles were found to exhibit stepwise increases in reported  self-efficacy and connectedness measures. CONCLUSION: An incentivized ECHO®  program yielded substantive outcomes in terms of increased prescribing capacity  across the state. The use of tiered mentoring opportunities enabled participants  to develop MOUD expertise and support novice providers in a growing statewide  network. There is potential to train professionals to a high level of expertise  when the ECHO® model is combined with a mentorship pathway.

Transgender individuals are an underserved, vulnerable population. They face many inequities including barriers in both accessing and receiving adequate  healthcare. These inequities are proposed here to be rooted in a lack of  education about transgender people and their experiences. We begin by exploring  the existing transgender healthcare research carried out in the USA, examining  client experiences, provider education and attitudes, and the barriers  transgender people face to obtaining proper healthcare. Secondly, we look at the  previous research on educational interventions implemented with medical students  and practitioners in the USA to enhance knowledge about transgender people, and  increase sensitivity and awareness, while also increasing the level of comfort in  working with these clients. The limitations in these fields of study are  discussed in order to understand how to better serve transgender clients in the  USA. We will do this through a narrative review to determine evidence-based best  practices for educational intervention, uncovering gaps in the literature and  highlighting where to focus in future work for researchers and practitioners.

BACKGROUND: An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public  health emergency. The COVID-19 pandemic has been accompanied by an unprecedented  global infodemic that has led to confusion about the benefits of medical and  public health interventions, with substantial impact on risk-taking and  health-seeking behaviors, eroding trust in health authorities and compromising  the effectiveness of public health responses and policies. Standardized measures  are needed to quantify the harmful impacts of the infodemic in a systematic and  methodologically robust manner, as well as harmonizing highly divergent  approaches currently explored for this purpose. This can serve as a foundation  for a systematic, evidence-based approach to monitoring, identifying, and  mitigating future infodemic harms in emergency preparedness and prevention.  OBJECTIVE: In this paper, we summarize the Fifth World Health Organization (WHO)  Infodemic Management Conference structure, proceedings, outcomes, and proposed  actions seeking to identify the interdisciplinary approaches and frameworks  needed to enable the measurement of the burden of infodemics. METHODS: An  iterative human-centered design (HCD) approach and concept mapping were used to  facilitate focused discussions and allow for the generation of actionable  outcomes and recommendations. The discussions included 86 participants  representing diverse scientific disciplines and health authorities from 28  countries across all WHO regions, along with observers from civil society and  global public health-implementing partners. A thematic map capturing the concepts  matching the key contributing factors to the public health burden of infodemics  was used throughout the conference to frame and contextualize discussions. Five  key areas for immediate action were identified. RESULTS: The 5 key areas for the  development of metrics to assess the burden of infodemics and associated  interventions included (1) developing standardized definitions and ensuring the  adoption thereof; (2) improving the map of concepts influencing the burden of  infodemics; (3) conducting a review of evidence, tools, and data sources; (4)  setting up a technical working group; and (5) addressing immediate priorities for  postpandemic recovery and resilience building. The summary report consolidated  group input toward a common vocabulary with standardized terms, concepts, study  designs, measures, and tools to estimate the burden of infodemics and the  effectiveness of infodemic management interventions. CONCLUSIONS: Standardizing  measurement is the basis for documenting the burden of infodemics on health  systems and population health during emergencies. Investment is needed into the  development of practical, affordable, evidence-based, and systematic methods that  are legally and ethically balanced for monitoring infodemics; generating  diagnostics, infodemic insights, and recommendations; and developing  interventions, action-oriented guidance, policies, support options, mechanisms,  and tools for infodemic managers and emergency program managers.

Common medical school practice includes an independent “dedicated preparation period” for the USMLE Step 1 exam during which students have reported  considerable stress and anxiety. Carle Illinois College of Medicine sought to  improve their students’ experience during the dedicated preparation period via a  unique course, Phase 1 Synthesis and Summary, designed to provide support for  academics and wellness. The strengths of the course were elements that maximized  student flexibility, autonomy, wellness, and targeted self-study. The course  design reported here may provide a model for other schools to design courses to  holistically improve students’ preparation for Step 1 and other board exams.  SUPPLEMENTARY INFORMATION: The online version contains supplementary material  available at 10.1007/s40670-023-01791-2.

INTRODUCTION: Medical trainees who participate in global rotations demonstrate improved cultural sensitivity, increased involvement in humanitarian efforts, and  ability to adapt to limited resources. The global coronavirus pandemic halted  global rotations for medical trainees. Domestic rural surgery (DRS) may offer a  unique alternative. We aimed to understand medical students’ perceptions of the  similarities and differences between global surgery and DRS and how students’  priorities impact career choices. METHODS: An electronic survey was administered  at eleven medical training institutions in Indiana, Illinois, and Michigan in  spring 2021. Mixed methods analysis was performed for students who reported an  interest in global surgery. Quantitative analysis was completed using Stata 16.1.  RESULTS: Of the 697 medical student respondents, 202 were interested in global  surgery. Of those, only 18.3% were also interested in DRS. Students interested in  DRS had more rural exposures. Rural exposures associated with DRS interest were  pre-clinical courses (P = 0.002), clinical rotations (P = 0.045), and rural  health interest groups (P < 0.001). Students interested in DRS and those unsure  were less likely to prioritize careers involving teaching or research, program  prestige, perceived career advancement, and well-equipped facilities. The  students who were unsure were willing to utilize DRS exposures. CONCLUSIONS:  Students interested in global surgery express a desire to practice in  low-resource settings. Increased DRS exposures may help students to understand  the overlap between global surgery and DRS when it comes to working with limited  resources, achieving work-life balance and practice location.

PURPOSE: In 2014, the Association of American Medical Colleges defined 13 Core Entrustable Professional Activities (EPAs) that all graduating students should be  ready to do with indirect supervision upon entering residency and commissioned a  10-school, 5-year pilot to test implementing the Core EPAs framework. In 2019,  pilot schools convened trained entrustment groups (TEGs) to review assessment  data and render theoretical summative entrustment decisions for class of 2019  graduates. Results were examined to determine the extent to which entrustment  decisions could be made and the nature of these decisions. METHOD: For each EPA  considered (4-13 per student), TEGs recorded an entrustment determination (ready,  progressing but not yet ready, evidence against student progressing, could not  make a decision); confidence in that determination (none, low, moderate, high);  and the number of workplace-based assessments (WBAs) considered (0->15) per  determination. These individual student-level data were de-identified and merged  into a multischool database; chi-square analysis tested the significance of  associations between variables. RESULTS: The 2,415 EPA-specific determinations  (for 349 students by 4 participating schools) resulted in a decision of ready (n  = 997/2,415; 41.3%), progressing but not yet ready (n = 558/2,415; 23.1%), or  evidence against student progression (n = 175/2,415; 7.2%). No decision could be  made for the remaining 28.4% (685/2,415), generally for lack of data. Entrustment  determinations’ distribution varied across EPAs (chi-square P < .001) and, for  10/13 EPAs, WBA availability was associated with making (vs not making)  entrustment decisions (each chi-square P < .05). CONCLUSIONS: TEGs were able to  make many decisions about readiness for indirect supervision; yet less than half  of determinations resulted in a decision of readiness to perform this EPA with  indirect supervision. More work is needed at the 10 schools to enable authentic  summative entrustment in the Core EPAs framework.

Purpose: To determine the effect of motivational interviewing (MI) to improve recall attendance after dental treatment under general anesthesia (GA). Methods: The sample consisted of parents of randomly selected pediatric patients who had oral rehabilitation under GA at a children’s hospital. An 18-item questionnaire that included demographics, education, language, country of birth and age was administered prior to the GA appointment. A five-minute MI phone call three months after the procedure and a second MI phone call after the first recall was conducted by a standardized interviewer. The primary outcomes were attendance at the six- and 12-month recall visits. Data were compared to a historical control group of participants who did not receive the MI phone call during the same date range. Results: Of 100 patients, 72 participated in the first phone call and 51 participated in the second phone call. All children had public insurance. The estimated odds of a six-month recall visit for parents receiving a single motivational interview was 2.52 times (95 percent confidence interval [95% CI]=1.43 to 4.44, P=0.001) higher compared to the control. The estimated odds of a 12-month recall visit for parents receiving two motivational interviews was 2.40 times greater (95% CI=1.27 to 4.54, P=0.006) compared to the historical control. Conclusion: A brief intervention using MI led to an improvement in attendance at both the six- and 12-month recall visits. © 2023 Elsevier B.V., All rights reserved.

BACKGROUND: Digital education using immersive virtual reality (VR) technology is available in nursing. Evidence of its effectiveness is essential. PURPOSE: This  review analyzed the effectiveness of and barriers to using immersive VR in  nursing education. METHODS: A structured search was performed in PubMed,  Cumulative Index to Nursing and Allied Health Literature, EMBASE, PsycINFO, Web  of Science, and ProQuest Nursing & Allied Health Database. The Medical Education  Research Study Quality Instrument was used to assess the quality of studies.  RESULTS: The final review was composed of 9 studies of moderate to high quality  published between 2018 and 2020. The review indicated that immersive VR increased  learning, cognitive, and psychomotor performance. Most participants of the  studies preferred using immersive VR in education and with a variety of  experiential scenarios. Barriers were associated with technological hardware and  software (eg, simulation sickness, lack of visual comfort). CONCLUSION: The  review supports the viability of immersive VR technology in nursing education.

The welcome development of the veterinary humanities, and veterinary anthropology specifically, raises the question of its potential relationship with the now  well-established field(s) of the medical humanities, and of medical anthropology.  Although there are national variations, the term “medical humanities” generally  refers to either the tapping of the humanities to improve medical education by  developing, through engagement with the humanities like literature and visual  art, skills in empathy, visualization and expressivity, or alternatively, it  refers to the application of humanities approaches of cultural critique to the  presumptions, practices and institutions of the human medical world to  denaturalize the ideologies of knowledge that contemporary human medicine  professions depend upon. This article reflects on the potential impact that the  development of a veterinary medical humanities could have on the field of (human)  medical humanities and vice versa. Could such a development force a re-conception  of notions of agency, of consent, and of the position of “patient” when the  (human based) medical humanities is expanded to include both human and veterinary  medicine? What would the potential usefulness, or limitations, both in conceptual  and in applied terms, be of constructing a multi-species notion of “medical  humanities?” What can such a comparative approach offer to veterinary medicine,  in practice and in terms of the curricula of veterinary training? To reflect on  these questions, this article draws on my multiple years of fieldwork in  veterinary clinics and classrooms to first lay out the constituent components of  the formal practice of contemporary veterinary medicine (at least in the U.S.) in  terms of the roles that species specificity and relations to humans play in the  delivery of care, and then seeks to center the animal in these practices to ask  questions about consent, resistance, veterinary obligation, and the role of  finance in comparison with human medicine. These similarities and differences  will form the basis for a consideration of the effects of enlarging the medical  humanities to encompass more than one species.

The variability in diagnostic imaging caseload, increasing class sizes, high hospital workloads, and the progressive departure of veterinary radiologists from  academia can lead to inconsistent and reduced teaching opportunities. This one  group pretest, posttest study aimed to compare the learning outcomes of students  enrolled in two veterinary radiology clerkship models. Our hypothesis was that  the learning and satisfaction scores of students in a case-based veterinary  radiology clerkship would be higher than those in a clinical veterinary radiology  clerkship. During the spring and summer semesters of 2019, students were assigned  to a clinical (CRC) or case-based (CBRC) radiology clerkship model, respectively.  Prior to starting the clerkship and at the conclusion thereof, all students took  identical radiographic interpretation quizzes. Four major areas of learning were  assessed: knowledge base (KB), diagnostic test interpretation (DTI), problem  prioritization and differential diagnosis (PPDDX), and critical thinking (CrT). A  total of 41 of 48 (CRC) and 130 of 151 (CBRC) students enrolled in this study; 15  and 34, respectively, were off-shore students, while the remainder were in-house  students. In-house students improved their scores with CRC and CBRC, but achieved  better scores in the four areas with CBRC. Off-shore students only improved their  scores with CBRC. In both groups, there was a negative effect of CRC on DTI.  Course satisfaction score was 3.21 on CRC and 4.38 on CBRC (range 1-5). An  intensive, case-based, discussion-focused veterinary radiology clerkship can  improve students’ radiographic interpretation skills and overall course  satisfaction scores.

In this paper, we propose Micro-Scholarship as a new and innovative approach to begin the scholarship journey for Scholarship in Health Professions Education. We  introduce Micro-Scholarship as both an outcome and process, with the iterative  and progressive development of a variety of micro-assets that can be combined and  counted as “traditional” Scholarship. We highlight the core components and  processes that are enabled by a variety of digital technologies and supported by  engagement with a community of practice. We also emphasise the importance of  reflection throughout the entire journey. Our intention is to offer practical  advice that can lower the bar for entry to Scholarship in Health Professions  Education, with the potential to increase the sharing of different viewpoints at  an early stage of the journey and to build a community of scholars.

INTRODUCTION: Evidence-based medicine (EBM) teaching is most successful when integrated with patient care, but finding time for teaching on inpatient  rotations is difficult. Obstetrics (OB)-Newborn TEACH (Teaching Evidence-based  medicine And Clinical topics in the Hospital) Cards is a curricular tool for  efficient teaching sessions on maternity care rotations. We evaluated the impact  of OB-Newborn TEACH Cards on resident EBM attitudes and skills, exposure to  clinical topics, and patient management. METHODS: OB-Newborn TEACH Cards includes  56 cards on obstetrics and newborn topics with background and foreground  discussion questions. Residents on a family medicine maternal-child service  completed pre- and postrotation surveys to assess the cards’ impact on EBM  attitudes and skills. Faculty and residents also completed point-of-care surveys  to assess the self-reported influence on management decisions. RESULTS: Of 24  potential resident participants, 58% completed pre- and postrotation surveys,  which showed significant increase in perceived EBM skills like applying evidence  to a clinical scenario (P=.04), but a decrease in reported attitudes that EBM is  realistic (P=.028) and useful (P=.025). Residents agreed the cards exposed them  to a variety of topics. Point-of-care surveys (n=58) indicated that 57% of the  time respondents used a card to learn about a topic not related to a specific  patient. When used to learn about specific patients, the cards influenced  self-reported patient care 44% of the time. CONCLUSION: OB-Newborn TEACH Cards  are a promising inpatient teaching tool for improving perceived EBM clinical  application, exposing residents to maternal-child topics, and influencing patient  care decisions.

The focus of diagnostic radiology training is on creating competent professionals, whereas confidence and its calibration receive less attention.  Appropriate confidence is critical for patient care both during and after  training. Overconfidence can adversely affect patient care and underconfidence  can create excessive costs. We reviewed the psychology and medical literature  pertaining to confidence and competence to collect insights and best practices  from the psychology and medical literature on confidence and apply them to  radiology training. People are rarely accurate in assessments of their own  competence. Among physicians, the correlation between perceived abilities and  external assessments of those abilities is weak. Overconfidence is more prevalent  than underconfidence, particularly at lower levels of competence. On the  individual level, confidence can be calibrated to a more appropriate level  through efforts to increase competence, including sub-specialization, and by  gaining a better understanding of metacognitive processes. With feedback,  high-fidelity simulation has the potential to improve both competence and  metacognition. On the system level, systems that facilitate access to follow-up  imaging, pathology, and clinical outcomes can help close the gap between  perceived and actual performance. Appropriate matching of trainee confidence and  competence should be a goal of radiology residency and fellowship training to  help mitigate the adverse effects of both overconfidence and underconfidence  during training and independent practice.

BACKGROUND AND OBJECTIVES: Family physicians routinely manage uncertainty in their clinical practice. During their first year of clinical rotations, medical  students learn communication and patient care skills that will influence the care  they provide as future physicians. However, little is known about how their  reactions to uncertainty change during this formative year, and medical education  often fails to teach students how to manage uncertainty effectively. This study  employs a repeated measures analysis of students’ reactions to uncertainty over  the course of their third year. METHODS: We surveyed 273 medical students at four  time points during their third year and employed hierarchical linear modeling to  analyze a series of models in which phase and intolerance of uncertainty were  entered as covariates. We modeled age and gender as control variables. RESULTS:  Analyses revealed that students’ affective reactions to uncertainty did not  significantly change during the third year, but reluctance to disclose  uncertainty to physicians and patients significantly decreased across phases.  Analyses also showed that general intolerance of uncertainty predicted affective  reactions to medical-specific uncertainty. CONCLUSIONS: These findings confirm  that students experience negative reactions to uncertainty during clinical  rotations. Students would benefit from curriculum designed to mitigate  consequences of negative affective reactions to uncertainty, particularly those  students characteristically higher in intolerance of uncertainty. Given that  students demonstrated more willingness to communicate about their uncertainty  over time, medical school should equip students with the communication skills  needed to discuss their uncertainty effectively with patients and preceptors.

OBJECTIVE: We investigated changes in medical students’ communication competence and communication anxiety during their third year of training when they are  immersed in formative clinical experiences that shape their patient-centered care  and communication skills. METHODS: We invited 282 students to complete a  longitudinal, four-phase online survey during their third-year. Our response rate  was 62.8% at Phase I (n = 177), 34.0% at Phase II (n = 96), 37.9% at Phase III  (n = 107), and 48.9% at Phase IV (n = 138). Measures included communication  competence, communication anxiety, and patient-centered attitudes and  orientation. We employed hierarchical linear modeling to analyze the data.  RESULTS: Students’ communication competence and anxiety improved over time.  Female students reported greater communication anxiety and less competence  related to information giving. At each phase, patient-centered attitudes  significantly predicted communication competence and communication anxiety.  CONCLUSION: Students’ competence and anxiety regarding communication during  medical encounters improve during their third year and are significantly  influenced by their attitudes and orientation towards patient-centered care and  communication. PRACTICE IMPLICATIONS: Schools should integrate curriculum that  fosters positive attitudes toward patient-centered communication and provides  opportunities to practice complex communication skills, which may increase  competence and recognition that patient-centered communication is an important  clinical skill.

Rapid Cycle Quality Improvement (RCQI) is often required for behavioral health work force training and evaluation projects supported by the U.S. Health Resources and Services Administration (HRSA). The RCQI process is well established within healthcare but under-utilized in academia to improve teaching and learning. We created and piloted the Friday Feedback (FF) survey tool as part of a HRSA funded training program for weekly completion by MSW interns. Across two semesters of full-time field education, a cohort of 15 MSW students completed 281 weekly FF surveys. Students reported activities such as number of patients seen, observations about integration of behavioral and physical health, patient successes and challenges, and time spent working on interdisciplinary teams. Cumulatively, students reported working with 2,425 patients/clients and in frequent close collaboration with other health professions. A review team comprised of faculty and staff met weekly to discuss students’ FF data and create response plans to promote student learning. The RCQI process was feasible and acceptable to students and the team. It created a feedback loop to improve students’ field experiences, enhanced the curriculum, and enabled effective monitoring and rapid response from team to students. Benefits and challenges of this RCQI approach to enhance field education along with lessons learned for wider adoption are discussed. © 2022 Elsevier B.V., All rights reserved.

Transdisciplinary (TD) graduate training programs are growing in number, yet little is known about their effectiveness or the development of TD attitudes and behaviors among students over time. This prospective longitudinal mixed methods study compares graduate students participating in a federally funded TD training program with non-participating students from the same disciplines and degree programs (n = 26). The Interdisciplinary Perspectives Index (IPI) and Behavior Change Collaborative Activity Index (BCCAI) were used to assess TD attitudes and behaviors at beginning, middle, and end of an MPH/PhD program. Additionally, a multiple case-based approach was used to further analyze changes among the TD students at three time points (n = 10), including a novel sketch protocol to elicit TD student conceptualizations (mental maps) of TD teams. Four assessments were used to construct an overall TD orientation score. Wilcoxon Signed Rank Tests showed TD behaviors increased over time only among TD students, and favorable TD attitudes were high at baseline and did not change for any group. Generalized Estimating Equations showed that TD behaviors were higher among TD students than traditional students at both mid and endpoint, with no difference at baseline. Visual assessments showed TD students’ mental maps of TD research and team science, elicited under a novel sketch protocol, reflected greater integration and organization by endpoint. Two developmental patterns of increasing overall TD orientation emerged among the TD students. This article reports findings and insights applicable to TD graduate education and curriculum design and introduces a novel visual assessment tool. © 2022 Elsevier B.V., All rights reserved.

Background: The number of cases of tick-borne diseases in humans is increasing rapidly within Illinois. The responsibility for increased surveillance of tick-borne disease cases and tick vectors is being placed on local health departments throughout the United States, but they often lack the funding, time, and/or training needed to perform said surveillance. The aims of this study were to develop, deliver, and determine the effectiveness of tick surveillance training workshops for local health department employees within Illinois. Methods: We developed and delivered in-person training at local health department offices in each of six Illinois Department of Public Health Environmental Health Regions between April–May of 2019. Pre-, post-, and six-month follow-up questionnaires on knowledge, attitudes, and practices with regards to tick surveillance were administered to training participants. Paired student’s t-test or Wilcoxon signed-rank test were used to compare knowledge, attitudes, and practices scores between questionnaires with Cohen’s d being used to calculate effect sizes associated with t-tests. McNemar’s and McNemar-Bowker tests were used to evaluate individual questions. Spearman’s rank correlation was used to evaluate the relationship between knowledge, attitudes, and practices at pre-, post-, and six-month follow-up. Results: Seventy-six employees from 40 local health departments that represent 44% (45/102) of Illinois counties attended at least one training workshop. Of these attendees, 81.5% (62/76) participated in at least one survey, 79% (60/76) in the in-person pre-training survey, 74% (56/76) in the in-person post-training survey, and 22% (17/76) in the online six-month follow-up survey. The average knowledge score was significantly increased by 8.21 (95% CI:7.28–9.14) points from pre-training to post-training. The average overall attitude score significantly increased by 5.29 (95% CI: 3.91–6.66) points from pre- to post-training. There were no significant differences in practice scores. Conclusions: Our study found the training was effective in increasing the knowledge of ticks, tick-borne diseases, and surveillance as well as promoting positive attitudes related to surveillance. While the training, by itself, was not associated with increases in surveillance practices, we were able to empower local public health officials with the knowledge and positive attitudes needed to enact change. © 2022 Elsevier B.V., All rights reserved.

BACKGROUND: Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may  provide a useful adjunct to traditional simulation skills training. OBJECTIVE: To  evaluate (1) use of an app for teaching communication skills about diagnostic  uncertainty, (2) feedback on app use, and (3) the association between use and  skill mastery. PATIENT INVOLVEMENT: The app under study is designed to improve  doctor-patient communication. METHODS: The study was a planned sub-analysis of a  randomized controlled waitlist trial with emergency medicine resident physicians  randomized to receive immediate or delayed access to an educational curriculum  focused on diagnostic uncertainty. The curriculum included a web-based  interactive module and the app. Metrics describing participants’ use of the app,  feedback on use, and association of use and achieving mastery in communicating  diagnostic uncertainty are reported. Differences between groups utilizing the app  were analyzed using Chi-squared test; logistic regression assessed the  association between app use and achieving mastery of the communication skill.  RESULTS: Among 109 participants completing the trial, only 34 (31.2%) used the  app. Most participants engaged with the app on one occasion for a median of  50 min (IQR 31, 87). Senior residents were more likely to use the app than junior  residents (41.3% vs 23.8%, p=0.05). Overall reviews were positive; 76% reported  the app helped them learn. There was no significant association between app use  and achieving mastery of the communication skill in the trial [OR 2.1, 95% CI  (0.91-4.84)]. DISCUSSION: Despite positive reviews of app use, overall use was  low and there was no association with achieving mastery. PRACTICAL VALUE:  Offering an app as an auxiliary training opportunity may be beneficial to some  residents, but shouldn’t be planned for use as a primary didactic modality unless  there is evidence for effectiveness and use is mandated. AVAILABILITY OF DATA AND  MATERIALS: The datasets generated and/or analyzed during the current study are  not publicly available since some data may be identifiable but are available from  the corresponding author on reasonable request.

BACKGROUND: One-fifth of the US population lives in rural areas. A record number of rural hospitals have closed, creating increased burdens on regional centers  and delays in care. This study aimed to assess medical student perceptions of  rural surgery and health care, and to elucidate influential factors for future  practice. METHODS: We administered a survey to medical schools throughout  Indiana, Illinois, and Michigan. The survey was designed and evaluated by a  survey content expert and piloted among a group of students. Student and faculty  liaisons disseminated the survey between February and May 2021. Descriptive  analysis of data was completed using Stata v.16.1 (StataCorp, LLC, College  Station, TX). RESULTS: The respondents included 700 medical students; 59.5% were  female, with an equal distribution across medical school classes. More than 98%  of students believe we “lack” or “are in great need of” rural health care  providers, as well as rural surgeons; however, more than half of the students did  not agree that the rural workforce is declining. Only 15.7% of students reported  an interest in “pursuing a future career in a rural setting.” Students with  exposure to rural health care, coming from a rural hometown, or having a  dependent had a positive association with interest in pursuing rural practice.  CONCLUSION: Although students are aware of the lack of rural surgeons and health  care providers, there remains an educational deficit. Expanding exposure to rural  health care and surgery while in medical school may increase the number of  students interested in pursuing a career in a rural setting, potentially  shrinking the rural workforce gap.

Mental health challenges have been rising across college campuses. To destigmatize wellness practices and promote student mental health, we present a  novel technical project in an introductory bioengineering course that explores  stress management techniques through physiology, biosensors, and design. We  hypothesize that if students measure objective, physiologic impacts of stress  management techniques on themselves, they may be more likely to realize the  benefits and use those techniques when needed. Additionally, through this  data-driven project, we aim to appeal to engineers’ critical thinking nature. To  support students in selecting stress management techniques for themselves,  mindfulness is introduced and practiced in the course. Initial student feedback  on the introduction of mindfulness into the classroom is positive. The COVID-19  pandemic has emphasized the need to focus on student wellbeing in addition to  physical health. Integration of wellness into the core curriculum can normalize  the use of these resources within engineering departments and colleges and equip  students with stress management tools for their careers. Ultimately, this  curricular development lays the groundwork for institutional enhancement of  undergraduate STEM education by supporting student wellness through the  engineering curriculum. SUPPLEMENTARY INFORMATION: The online version contains  supplementary material available at 10.1007/s43683-021-00060-1.

The medical curriculum is charged with training medical students who can possess both the technical and contextual abilities to adapt to the transformational  world of medicine. This new objective would require incorporating engineering  principles into the medical curriculum, which was formed by the University of  Illinois as the Carle Illinois College of Medicine. As a fully integrated  engineering based medical school, students partake in active learning modules  that develop their quantitative, innovative, and entrepreneurship skills. An  example of the active learning component of the curriculum is the “Neuroscience  Engineering Challenge Lab.” The purpose of this study was to explore students’  perception of the lab and learn how the active-learning curriculum via the design  thinking labs can be enhanced. Using a paired samples t test of pre- and  post-survey results, we found that the students did not statistically gain a  better understanding of the design thinking process (p = 0.052), which is  expected due to the majority of students having an engineering background.  Contrarily, the lab increased students’ understanding of ideation tools  (p = 0.003), user-centered design concepts (p = 0.004), preparing a business plan  pitch (p = 0.027), and students felt better prepared for their IDEA and Capstone  project (p = 0.010). Based on the results, students are becoming more confident  with understanding, experience, and applying these specific tools and skills.  Therefore, the medical curriculum should provide opportunities for students to  develop and apply their innovation skills through active-learning activities such  as a Neuroscience Engineering Challenge Lab.

Improving care for the older population is a growing clinical need in the United States. Ageism and other attitudes of healthcare professionals can negatively impact care for older adults. This study investigated healthcare professionals’ (N = 140) views towards aging and characterized a confluence of factors influencing ageism perspectives in healthcare workers using path analysis models. These models proposed relationships between aging anxiety, expectations regarding aging, age, ageism, and knowledge. Aging anxiety had a less critical role in the final model than hypothesized and influenced ageism in healthcare workers through its negative effect ((Formula presented.) = −0.27) on expectations regarding aging. In contrast, aging knowledge ((Formula presented.) = −0.23), age ((Formula presented.) = −0.27), and expectations regarding aging ((Formula presented.) = −0.48) directly and inversely influenced ageism. Increased knowledge about the aging process could lower ageism amongst healthcare professionals and improve care for older adults. The results put forth in this study help to characterize and understand healthcare workers’ complex views towards the aging population they often encounter. Moreover, these results highlight the need and utility of leveraging practitioner education for combating ageism in the clinical setting. © 2023 Elsevier B.V., All rights reserved.

Introduction The gender disparity in orthopaedic surgery is well-established. According to our analysis, only 7.4% of practicing orthopaedic  surgeons in the US are female in 2022. While there are several theories  attempting to explain this gender gap, our eight years of data show that limited  female representation is a self-perpetuating cycle as areas without female  representation almost never improve in that regard. It appears that existing  female mentorship is critical to the growth of a female orthopaedic presence in  an area. In the present work, we aim to describe how gender diversity in  orthopaedic surgery differs across the country, how this diversity is changing  over time, and how surgeon gender diversity may be affected by the  sociodemographic characteristics making up the counties where orthopaedic surgery  is practiced. Methods A retrospective study was conducted using publicly  available National Provider Identifier (NPI) data from 2015 to 2022. Orthopaedic  surgeons and their genders were identified using the Provider Type and Gender  data elements associated with an individual NPI. Rural-urban and metro characters  were defined using the USDA Economic Research Reserve’s rural-urban continuum  codes. Python was used for database building and data cleaning. GeoDa, a  statistical map-based graphing software, was used to plot and assess demographic,  geographic, and socioeconomic trends. Trends in gender diversity from 2015 to  2019 were analyzed for each individual year as well as the time period as an  aggregate. Cluster analysis was performed to assess complex spatial patterns of  variables that could not be condensed linearly or logarithmically. Moran’s I was  used to measure the similarity of a Federal Information Processing System (FIPS)  area code to its neighbors. Within the clustering analysis, spatial clusters were  broken down into four groups of spatial outliers (High-High, High-Low, Low-High,  and Low-Low) referencing a given area’s relationship with its neighbors.  Factorial ANOVA between each of the four cluster types was performed using the  variables provided in the article to identify significant demographic variables  within the cluster analysis. Results There are relative hotspots of gender  diversity in the Northwest, Northeast, and Southwest with relative coldspots in  the Midwest and Southern US. In counties that are considered gender diversity  hotspots, the total population of orthopaedic surgeons increases by 0.94 each  year while the population of female orthopaedic surgeons increases by 0.2,  suggesting that in areas with high gender diversity, 4.7 male orthopaedic  surgeons are joining practices for every 1.0 female. In areas with low gender  diversity, the population of orthopaedic surgeons increases by 0.11 surgeons each  year while the slope for an increase in female orthopaedic surgeons is 0.  Conclusions  Orthopaedic surgery lags behind other male-dominated surgical  specialties in gender parity. Our analysis demonstrates that certain areas of the  country including the Northwest, Northeast, and Arizona have improved gender  diversity compared to the rest of the country. We also see that the rate of  increase of female orthopaedic surgeons in the past seven years is highest in  areas with more preexisting female orthopaedic surgeons, suggesting the  importance of a “trailblazer” phenomenon in recruiting female surgeons.

In Fall 2020, universities saw extensive transmission of SARS-CoV-2 among their populations, threatening health of the university and surrounding communities, and viability of in-person instruction. Here we report a case study at the University of Illinois at Urbana-Champaign, where a multimodal “SHIELD: Target, Test, and Tell” program, with other non-pharmaceutical interventions, was employed to keep classrooms and laboratories open. The program included epidemiological modeling and surveillance, fast/frequent testing using a novel low-cost and scalable saliva-based RT-qPCR assay for SARS-CoV-2 that bypasses RNA extraction, called covidSHIELD, and digital tools for communication and compliance. In Fall 2020, we performed >1,000,000 covidSHIELD tests, positivity rates remained low, we had zero COVID-19-related hospitalizations or deaths amongst our university community, and mortality in the surrounding Champaign County was reduced more than 4-fold relative to expected. This case study shows that fast/frequent testing and other interventions mitigated transmission of SARS-CoV-2 at a large public university. © 2022 Elsevier B.V., All rights reserved.

As one of the most severe forms of ocular trauma, open-globe injury (OGI) causes significant vision loss. Timely and meticulous repair of these injuries can improve patient outcomes. This video-based educational curriculum is intended to serve as an efficient yet comprehensive reference for OGI repair. We hope that these video-based articles help surgeons and trainees from around the world find answers to specific surgical questions in OGI management. The curriculum has been divided into six separate review articles, each authored by a different set of authors, to facilitate a systematic and practical approach to the subject of wound types and repair techniques. This third article highlights the use of antibiotics before, during, and after surgery; suture selection; surgical knots, and “ship-to-shore” suturing. © 2023 Elsevier B.V., All rights reserved.

OBJECTIVE: A career in academic neurosurgery is an arduous endeavor. Specific factors influencing physician practice preferences remain unclear. This study  analyzes data from the American Association of Neurological Surgeons membership  identifying the impact of several demographic and educational characteristics  influencing neurosurgical career choices centered on academia, private practice,  or a combination in the United States. METHODS: A list of all current  neurosurgeons was obtained from the American Association of Neurological Surgeons  membership, and information on physician characteristics was collected via  internet searches and institutional databases. The practice type of all  neurosurgeons considered in this study were categorized as follows: private  practice, academic, or a combination of private practice and academic, termed  privademic. These data were subsequently correlated to race, gender, current age,  training at a top 40 National Institutes of Health-funded medical school or  residency program, and current practice. RESULTS: The median age of private  practice and academic neurosurgeons was 58.18 and 53.61 years, respectively (P <  0.001). Age was significantly associated with practicing in an academic setting  (odds ratio 0.96), with younger neurosurgeons pursuing careers in academia. Data  indicated a positive and statistically significant contribution of female gender  (P < 0.001) and training at a top-40 National Institutes of Health-funded  institution to practicing in an academic setting (P < 0.01). CONCLUSIONS:  Neurosurgery as a field has grown significantly over the past century. The  authors recommend that future efforts seek to diversify the neurosurgical  workforce by considering practice setting, demographic characteristics, and  educational background.

BACKGROUND: Integration of clinical skills during graduate training in dual-degree programs remains a challenge. The present study investigated the  availability and self-perceived efficacy of clinical continuity strategies for  dual-degree trainees preparing for clinical training. METHODS: Survey  participants were MD/DO-PhD students enrolled in dual-degree-granting  institutions in the USA. The response rate was 95% of 73 unique institutions  surveyed, representing 56% of the 124 MD-PhD and 7 DO-PhD recognized training  programs. Respondents were asked to indicate the availability and self-perceived  efficacy of each strategy. RESULTS: Reported available clinical continuity  strategies included clinical volunteering (95.6%), medical grand rounds (86.9%),  mentored clinical experiences (84.2%), standardized patients/ practice Objective  Structured Clinical Examinations (OSCEs) (70.3%), clinical case reviews (45.9%),  clinical journal clubs (38.3%), and preclinical courses/review sessions (37.2%).  Trainees rated standardized patients (µ = 6.98 ± 0.356), mentored clinical  experiences (µ = 6.94 ± 0.301), clinical skills review sessions (µ = 6.89 ±  0.384), preclinical courses/review sessions (µ = 6.74 ± 0.482), and clinical  volunteering (µ = 6.60 ± 0.369), significantly (p < 0.050) higher than clinical  case review (µ = 5.34 ± 0.412), clinical journal club (µ = 4.75 ± 0.498), and  medicine grand rounds (µ = 4.45 ± 0.377). Further, 84.4% of respondents stated  they would be willing to devote at least 0.5-1 hour per week to clinical  continuity opportunities during graduate training. CONCLUSION: Less than half of  the institutions surveyed offered strategies perceived as the most efficacious in  preparing trainees for clinical reentry, such as clinical skills review sessions.  Broader implementation of these strategies could help better prepare dual-degree  students for their return to clinical training.

INTRODUCTION: Technical standards document US medical school’s nonacademic criteria necessary for admission, persistence, and graduation and communicate the  school’s commitment to disability inclusion and accommodation but are considered  one of the largest barriers for students with disabilities. Calls for more  inclusive technical standards have increased in recent years, yet the impact of  this work on changing technical standards has not been measured.The establishment  of 15 new US MD- and DO-granting medical schools between 2017 to 2020 offered a  unique opportunity to evaluate differences in the inclusive nature of newly  developed technical standards. METHOD: We conducted a document analysis of 15  newly formed medical schools’ technical standards to determine the availability  and inclusive nature of the standards as they pertain to students with sensory  and mobility disabilities. Technical standards were coded for: ease of obtaining  technical standards, the school’s stated willingness to provide reasonable  accommodations, the origin of responsibility for accommodation request and  implementation, and the school’s openness to intermediaries or auxiliary aids.  RESULTS: Of the 15 schools, 73% of the technical standards were not easy to  locate online. Few (13%) included language that support disability  accommodations. Most (73%) used language that was coded as “restrictive” for  students with physical or sensory disabilities. Coding of the newly accredited US  MD and DO medical schools suggests that newly created technical standards are  more restrictive than those in previous studies. CONCLUSIONS: Efforts to create  more inclusive technical standards have not yet been realized. Newly formed US  MD- and DO-granting medical schools may perpetuate historically restrictive  technical standards that serve as barriers to applicants with disabilities.  Future research should evaluate the role of medical school accrediting bodies to  go beyond simply requiring technical standards to ensuring that the standards are  readily available and appropriately convey the availability of reasonable  accommodations for students with disabilities.