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Problem The COVID-19 pandemic restricted in-person gatherings, including residency conferences. The pressure to quickly reorganize educational conferences and convert content to a remote format overwhelmed many programs. This article describes the pilot event of a large-scale, interactive, virtual educational conference modeled, designed, and implemented by Academic Life in Emergency Medicine (ALiEM), called ALiEM Connect. Approach The pilot ALiEM Connect event was conceptualized and implemented within a 2-week period in March 2020. The pilot was livestreamed via a combination of Zoom and YouTube and was archived by YouTube. Slack was used as a backchannel to allow interaction with other participants and engagement with the speakers (via moderators who posed questions from the backchannel to the speakers live during the videoconference). Outcomes The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used for program evaluation, showing that 64 U.S. Accreditation Council for Graduate Medical Education-accredited emergency medicine residency programs participated in the pilot event, with 1,178 unique users during the event (reach). For effectiveness, 93% (139/149) of trainees reported the pilot as enjoyable and 85% (126/149) reported it was equivalent to or better than their usual academic proceedings. Adoption for ALiEM Connect was fairly good with 64/237 (27%) of invited residency programs registering and participating in the pilot event. Implementation was demonstrated by nearly half of the livestream viewers (47%, 553/1,178) interacting in the backchannel discussion, sending a total of 4,128 messages in the first 4 hours. Next Steps The final component of the RE-AIM framework, maintenance, will take more time to evaluate. Further study is required to measure the educational impact of events like the ALiEM Connect pilot. The ALiEM Connect model could potentially be used to replace educational conferences that have been canceled or to implement and/or augment a large-scale, shared curriculum among residency programs in the future., American Board of Emergency Medicine (ABEM), The American Board of Emergency Medicine (ABEM) provided exclusive financial sponsorship support for ALiEM Connect.

This study aims to compare the attitudes of nursing students in Jordan toward seeking professional psychological help, before and after taking part in a mental health course. A pretest-posttest design was used to assess the attitudes of 205 nursing students attending a state-run university in Zarqa City, Jordan. A significant difference was found in Attitudes Toward Seeking Professional Psychological Help subscales before and after the course, implying that it would be useful for policy makers to provide periodic comprehensive mental health education and courses for practicing health care providers.

One of the complications that patients in need of home healthcare might experience is pressure injury. Given that a significant part of the care of these patients is performed by their family caregivers, they must have sufficient knowledge about prevention and treatment of pressure injuries. We investigated the knowledge related to pressure injuries among family caregivers of patients needing home care who were at risk of pressure injury. Family caregivers of patients in Iran who needed home care services and were at risk of developing pressure injuries based on the Braden scale were invited to participate. A special questionnaire designed by Arboledas and Pancorbo-Hidalgo was used to assess the caregivers' level of knowledge. This questionnaire consists of 23 items, and with total scores between 23 and 46. A higher score indicates a higher level of knowledge about pressure injuries. A total of 323 family caregivers participated, most of whom were female. The mean total score of caregivers' knowledge about pressure injuries was 34.5 ± 3.4 (ranging 23 to 42). Most of the participants (n = 290) stated they did not receive adequate education related to pressure injuries. Among the demographic variables, a significant relationship was observed between the level of caregivers' knowledge with the level of education, younger age, offspring, admission in intensive care units, and male sex (p < 0.005). Family caregivers did not have sufficient knowledge about pressure injuries. Most of them did not receive the necessary education during the time of their patient's hospitalization. This issue should be considered by healthcare providers, and the necessary interventions should be considered to improve the situation.

Entrustable professional activities (EPAs) have been increasingly used as an assessment framework to formally capture the myriad ad hoc entrustment decisions that occur on a daily basis in clinical settings with learners present. Following the definition of Core EPAs for Entering Residency by the Association of American Medical Colleges in 2014, the American Board of Surgery (ABS) began to explore the utility of EPAs as a framework to support competency-based resident education within general surgery in 2016. As the complement of EPAs drafted for a specialty serve to define the core tasks of a professional within that discipline, initial efforts to define the entire scope of general surgery were fraught with difficulty as no commonly accepted definition of a general surgeon currently exists. Opting to prioritize a pilot of the EPA conceptual framework within surgical training rather than defining the entirety of the specialty, ABS leaders identified 5 EPAs that represent a core of general surgery with which to begin. This article details the process of choosing the initial set of EPAs and provides a roadmap for other disciplines interested in testing the feasibility of this assessment framework while garnering buy-in among the community of educators. Future steps, including implementation of the existing 5 EPAs beyond the initial pilot sites and drafting and implementation of the additional complement of EPAs, are also described.

The transition to the assessment of entrustable professional activities as part of competency-based medical education (CBME) has substantially increased the number of assessments completed on each trainee. Many CBME programs are having difficulty synthesizing the increased amount of assessment data. Learning analytics are a way of addressing this by systematically drawing inferences from large datasets to support trainee learning, faculty development, and program evaluation. Early work in this field has tended to emphasize the significant potential of analytics in medical education. However, concerns have been raised regarding data security, data ownership, validity, and other issues that could transform these dreams into nightmares. In this paper, the authors explore these contrasting perspectives by alternately describing utopian and dystopian futures for learning analytics within CBME. Seeing learning analytics as an important way to maximize the value of CBME assessment data for organizational development, they argue that their implementation should continue within the guidance of an ethical framework.

To establish a research and development agenda for Entrustable Professional Activities (EPAs) for the coming decade, the authors, all active in this area of investigation, reviewed recent research papers, seeking recommendations for future research. They pooled their knowledge and experience to identify 3 levels of potential research and development: the micro level of learning and teaching; the meso level of institutions, programs, and specialty domains; and the macro level of regional, national, and international dynamics. Within these levels, the authors categorized their recommendations for research and development. The authors identified 14 discrete themes, each including multiple questions or issues for potential exploration, that range from foundational and conceptual to practical. Much research to date has focused on a variety of issues regarding development and early implementation of EPAs. Future research should focus on large-scale implementation of EPAs to support competency-based medical education (CBME) and on its consequences at the 3 levels. In addition, emerging from the implementation phase, the authors call for rigorous studies focusing on conceptual issues. These issues include the nature of entrustment decisions and their relationship with education and learner progress and the use of EPAs across boundaries of training phases, disciplines and professions, including continuing professional development. International studies evaluating the value of EPAs across countries are another important consideration. Future studies should also remain alert for unintended consequences of the use of EPAs. EPAs were conceptualized to support CBME in its endeavor to improve outcomes of education and patient care, prompting creation of this agenda.

Entrustable professional activities (EPAs) have emerged as a meaningful framework for achieving competency-based medical education (CBME). However, little is known about how to adapt EPAs to large-scale, multispecialty, system-wide implementations. The authors describe the design and experience of creating such a system based on EPAs and the Van Melle Core Components Framework for all accredited training programs under the auspices of the Royal College of Physicians and Surgeons of Canada. The resulting design is a unique configuration and use of EPAs, called Royal College EPAs. Others looking to implement EPAs for large-scale health professions education systems may want to consider this design approach.

The Core EPAs for Entering Residency Pilot project aimed to test the feasibility of implementing 13 entrustable professional activities (EPAs) at 10 U.S. medical schools and to gauge whether the use of the Core EPAs could improve graduates' performance early in residency. In this manuscript, the authors (members of the pilot institutions and Association of American Medical Colleges staff supporting the project evaluation) describe the schools' capacity to collect multimodal evidence about their students' performance in each of the Core EPAs and the ability of faculty committees to use those data to make decisions regarding learners' readiness for entrustment. In reviewing data for each of the Core EPAs, the authors reflected on how each activity performed as an EPA informed by how well it could be assessed and entrusted. For EPAs that did not perform well, the authors examined whether there are underlying practical and/or theoretical issues limiting its utility as a measure of student performance in medical school.

Contains fulltext : 235350.pdf (Publisher’s version ) (Closed access) Postgraduate medical education in the Netherlands has adopted competency-based education since the turn of the century. In 2006, the CanMEDS competency framework was introduced. A 2013 government plan to reduce the length and budgets of training programs led the Dutch Association of Medical Specialists (DAMS) to respond with a proposal to create more flexibility and individualization rather than a blunt cut in the length across all training programs. DAMS launched a government-funded, nation-wide, 4-year project (2014-2018) to blueprint the reform of postgraduate medical education in this direction. To achieve competency-based individualization, the fixed duration of postgraduate programs was abandoned, and entrustable professional activities (EPAs) were introduced in all specialty programs. Implementation of this new generation of programs took place in 2017-2019 in all disciplines. The project focused on EPA-based individualization of all programs, while addressing issues of the continuity of patient care in time-variable programs and the legal and regulatory consequences of individualization. About 30 specialty programs were revised at national, regional, local, and individual levels to incorporate EPAs; portfolio systems were adapted, clinical competency committees were installed for all programs, and procedures for summative entrustment decision making were elaborated. This paper reports on the rationale and the process that led to a more time-variable postgraduate education landscape, and, on average, a shortening of training length by 3 months.

Educators use entrustment, a common framework in competency-based medical education, in multiple ways, including frontline assessment instruments, learner feedback tools, and group decision making within promotions or competence committees. Within these multiple contexts, entrustment decisions can vary in purpose (i.e., intended use), stakes (i.e., perceived risk or consequences), and process (i.e., how entrustment is rendered). Each of these characteristics can be conceptualized as having 2 distinct poles: (1) purpose has formative and summative, (2) stakes has low and high, and (3) process has ad hoc and structured. For each characteristic, entrustment decisions often do not fall squarely at one pole or the other, but rather lie somewhere along a spectrum. While distinct, these continua can, and sometimes should, influence one another, and can be manipulated to optimally integrate entrustment within a program of assessment. In this article, the authors describe each of these continua and depict how key alignments between them can help optimize value when using entrustment in programmatic assessment within competency-based medical education. As they think through these continua, the authors will begin and end with a case study to demonstrate the practical application as it might occur in the clinical learning environment.

The adoption of entrustment ratings in medical education is based on a seemingly simple premise: to align workplace-based supervision with resident assessment. Yet it has been difficult to operationalize this concept. Entrustment rating forms combine numeric scales with comments and are embedded in a programmatic assessment framework, which encourages the collection of a large quantity of data. The implicit assumption that more is better has led to an untamable volume of data that competency committees must grapple with. In this article, the authors explore the roles of numbers and words on entrustment rating forms, focusing on the intended and optimal use(s) of each, with a focus on the words. They also unpack the problematic issue of dual-purposing words for both assessment and feedback. Words have enormous potential to elaborate, to contextualize, and to instruct; to realize this potential, educators must be crystal clear about their use. The authors set forth a number of possible ways to reconcile these tensions by more explicitly aligning words to purpose. For example, educators could focus written comments solely on assessment; create assessment encounters distinct from feedback encounters; or use different words collected from the same encounter to serve distinct feedback and assessment purposes. Finally, the authors address the tyranny of documentation created by programmatic assessment and urge caution in yielding to the temptation to reduce words to numbers to make them manageable. Instead, they encourage educators to preserve some educational encounters purely for feedback, and to consider that not all words need to become data.

Purpose Health care program admission processes utilize multi-faceted approaches to evaluate cognitive and noncognitive attributes of applicants. The multiple mini-interview (MMI) was developed in response to the need for a reliable and validated tool to assess noncognitive factors and has been increasingly incorporated into the admissions process by physician assistant (PA) programs. The study's purpose was to explore the current implementation and utilization of the MMI within PA programs. Methods The study used a mixed-methods exploratory approach including a telephone survey and semi-structured interview of 11 PA programs using the MMI in their admissions process. Quantitative data collected included demographic information, MMI implementation characteristics, station structure, scoring, feasibility, satisfaction with MMI utilization, and MMI evaluation methods. Results During the 2015-2016 admissions cycle, the participating programs used from 5 to 10 stations, averaging 7 minutes per station, requiring 8 faculty, 2 staff, and 7 students per interview session. Despite variation in program size, number of applicants, and years of MMI utilization, all participating programs reported that they were satisfied with the format and would continue to utilize the MMI in the admissions process. Conclusions While there is substantial literature describing the use of the MMI within health care programs globally, this study represents the first characterization of its use within PA programs on a national level. Although there was variation among PA program implementation of the MMI, our results are comparable to studies within other health care professions. Additional studies are necessary to further describe the MMI and its correlation with PA program educational outcomes and the impact on diversity.

While sociopolitical advances have improved the rights of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer [LGBTQ+] persons), they continue to face a health system that discriminates against them and does not provide competent, comprehensive care. Despite calls for advancing research, there remains limited sexual and gender minority health research funding, mentorship, and institutional support. Academic medical centers are best suited to systematically tackle disparities and improve care for all sexual and gender minority people through their tripartite missions of patient care, education, and research. In this article, the authors outline discrimination experienced by LGBTQ+ persons and highlight the unique disparities they experience across access and outcomes. The authors posit that by systematically improving clinical care of, incorporating education and training about, and research with LGBTQ+ people into their core missions, academic medical centers can dramatically change the health care landscape. Academic medical centers can eliminate health disparities, expand necessary research endeavors about sexual and gender minorities, and prepare the health care workforce to address the unique needs of these overlooked populations.

Purpose Evaluation of the medical profession at all levels has exposed episodes of gender-based role misidentification whereby women physicians are disproportionately misidentified as nonphysicians. The authors of this study investigate this phenomenon and its repercussions, quantifying the frequency with which resident physicians experience role misidentification and the effect this has on their experience and behavior. Method In 2018, the authors conducted a cross-sectional survey study of internal medicine, surgical, and emergency medicine residents at a single, large, urban, tertiary academic medical center. The survey tool captured both the self-reported frequency and effect of professional misidentification. The authors used a t test and linear multivariate regression to analyze the results. Results Of the 260 residents who received the survey, 186 (72%) responded, and the authors analyzed the responses of 182. All 85 of the women respondents (100%) reported being misidentified as nonphysicians at least once in their professional experience by patients or staff members, compared with 49% of the 97 men respondents. Of those 182 residents, 35% of women were misidentified more than 8 times per month by patients compared with 1% of men. Of the 85 women physicians responding to the survey, 38% felt angry and 36% felt less satisfied with their jobs as a result of misidentification compared with, respectively, 7% and 9% of men. In response to role misidentification, 51% of women changed their manner of attire and 81% changed their manner of introduction, compared with, respectively, 7% and 37% of men. Conclusions These survey results demonstrate that women physicians are more likely than men physicians to be misidentified as nonphysicians and that role misidentification provokes gender-polarized psychological and behavioral responses that have potentially important professional ramifications.

COVID-19 is a worldwide pandemic, with frontlines that look drastically different than in past conflicts: that is, women now make up a sizeable majority of the health care workforce. American women have a long history of helping in times of hardship, filling positions on the home front vacated by men who enlisted as soldiers during World War I and similarly serving in crucial roles on U.S. military bases, on farms, and in factories during World War II. The COVID-19 pandemic has represented a novel battleground, as the first in which women have taken center stage, not only in their roles as physicians, respiratory therapists, nurses, and the like, but also by serving in leadership positions and facilitating innovations in science, technology, and policy. Yet, the pandemic has exacerbated multiple pain points that have disproportionally impacted women in health care, including shortages in correctly sized personal protective equipment and uniforms, inadequate support for pregnant and breastfeeding providers, and challenges associated with work-life balance and obtaining childcare. While the pandemic has facilitated several positive advancements in addressing these challenges, there is still much work to be done for women to achieve equity and optimal support in their roles on the frontlines.

The National Institutes of Health (NIH) has prioritized efforts to increase diversity in the biomedical research workforce. NIH-funded institutional career development awards may serve as one mechanism to facilitate these efforts. In 2013, the Duke University KL2 program, an internal career development program funded by the National Center for Advancing Translational Sciences, set a goal to increase the number of investigators from underrepresented racial and ethnic groups (UREGs) to ≥ 50% of KL2 awardees. From 2013 to 2019, 133 KL2 applications were received, 38% from UREG investigators. Of the 21 scholars selected, 10 (47.6%) were UREG investigators; all were Black/African American. This represents a threefold increase in the proportion of UREG applications and a sixfold increase in the proportion of UREG KL2 scholars compared with Duke's previous KL2 cycles (2003-2012), during which only 13% of applicants and 8.3% of funded scholars were UREGs. Of the 12 KL2 scholars (7 UREG) who completed the program, 5 have received NIH funding as principal investigators of an external K award or R01, and 4 of them are UREG investigators; this constitutes a post-KL2 NIH funding success rate of 57% (4/7) for UREG scholars. Achieving this programmatic priority was facilitated by institutional support, clear communication of goals to increase the proportion of UREG KL2 awardees, and intentional strategies to identify and support applicants. Strategies included targeted outreach to UREG investigators, partnerships with other institutional entities, structured assistance for investigators with preparing their applications, and a KL2 program structure addressing common barriers to success for UREG investigators, such as lack of consistent mentorship, protected research time, and peer support. The authors' experience suggests that KL2 and other internal career development programs may represent a scalable, national strategy to increase diversity in the biomedical research workforce.

Purpose When the Centers for Medicare and Medicaid Services (CMS) changed policies about medical student documentation, students with proper supervision may now document their history, physical exam, and medical decision-making in the electronic health record (EHR) for billable encounters. Since documentation is a core entrustable professional activity for medical students, the authors sought to evaluate student opportunities for documentation and feedback across and between clerkships. Method In February 2018, a multidisciplinary workgroup was formed to implement student documentation at Duke University Health System, including educating trainees and supervisors, tracking EHR usage, and enforcing CMS compliance. From August 2017 to August 2018, locations and types of student-involved services (student-faculty, or student-resident-faculty) were tracked using billing data from attestation statements. Student end-of-clerkship evaluations included opportunity for documentation and receipt of feedback. Since documentation was not allowed prior to August 2018 it was not possible to compare to prior student experiences. Results In the first half of the academic year, 6,972 patient encounters were billed as student-involved services, 52% (n = 3,612) in the inpatient setting and 47% (n = 3,257) in the outpatient setting. Most (74%) of the inpatient encounters also involved residents and most (92%) of outpatient encounters were student-teaching physician only.Approximately 90% of students indicated having had opportunity to document in the EHR across clerkships, except for procedure-based clerkships such as surgery and obstetrics. Receipt of feedback was present along with opportunity for documentation more than 85% of the time on services using evaluation and management coding. Most students (>90%) viewed their documentation as having a moderate or high impact on patient care. Conclusions Changes to student documentation were successfully implemented and adopted; changes met both compliance and education needs within the health system without resulting in potential abuses of student work for service.

Purpose Socioeconomic and geographic determinants of medical school application and matriculation may help explain the unequal distribution of physicians in the United States. This study describes trends in MD-granting medical school application and matriculation rates and explores the relationship between county median family income, proximity to a medical school, and medical school application and matriculation rates. Method Data were obtained from the Association of American Medical Colleges, including the age, gender, and Federal Information Processing Standards code for county of legal residence for each applicant and matriculant to MD-granting medical schools in the United States from 2001 through 2015. The application and matriculation rates in each county were calculated using the number of applicants and matriculants per 100,000 residents. Counties were classified into 4 groups according to the county median family income (high-income, middle-income, middle-low-income, low-income). The authors performed Chi-square tests to assess trends across the study period and the association of county median family income with application and matriculation rates. Results There were 581,833 applicants and 262,730 (45.2%) matriculants to MD-granting medical schools between 2001 and 2015. The application rate per 100,000 residents during 2001-2005, 2006-2010, and 2011-2015 was 57.2, 62.7, and 69.0, respectively, and the corresponding matriculation rate was 27.5, 28.1, and 29.8, respectively. The ratio of the application rate in high-income counties to that in low-income counties during the 3 time periods was 1.9, 2.4, and 2.8, respectively. Conclusions The application and matriculation rates to MD-granting medical schools increased steadily from 2001 to 2015. Yet, applicants and matriculants disproportionately came from high-income counties. The differences in the application and matriculation rates between low-income and high-income counties grew during this period. Exploring these differences can lead to better understanding of the factors that drive geographic differences in physician access and the associated health disparities across the United States.

BACKGROUND: The COVID-19 pandemic disrupted nursing education and required modification of instructional methods and clinical experiences. Given the variation in education, rapid transition to virtual platforms, and NCLEX-RN testing stressors, this cohort faced unique losses and gains influencing their transition into clinical practice. PURPOSE: This study examined the impact of COVID-19 and preparedness for professional practice of 340 new graduate nurses (NGNs) at an academic medical center. METHODS: This was a mixed-methods descriptive study focusing on how clinical experience loss or gains in the final semester affected the fears, concerns, and recommendations for NGNs. RESULTS: More than half (67.5%, n = 295) of NGNs reported changes to clinical experiences, ranging from 0 to 240 hours transitioned to virtual (n = 187; median, 51; interquartile range, 24-80). NGNs fear missing important details or doing something wrong in providing patient care. They identified the need for preceptor support, guidance, teaching, and continued practice of skills. CONCLUSION: Recommendations are clear communication with leadership, advocacy from the nurse residency program, and targeted clinical and emotional support for NGNs.

Background The unprecedented pandemic presented new stresses and challenges in nursing education impacting the mental health of nursing students. Purpose The purpose of this study was to evaluate the relationship between virtual learning and the mental health of nursing students. Method This study used a descriptive, cross-sectional design with a convenience sample of 256 nursing students enrolled in a baccalaureate program. Data were collected through an online survey using 2 screening tools for stress, anxiety, and depression. Results Mean sum Patient Health Questionnaire-4 scores and subscale scores suggest that more than 40% of students experienced mild to moderate levels of psychological distress. Mean sum Perceived Stress Scale-10 scores indicate 84% of students experienced moderate levels of stress, and 14% experienced high levels of stress. Conclusions During periods of societal crisis, faculty must be hypervigilant to the mental health needs of students.

Shared decision making, a collaborative approach between patient and provider that considers the patient's values and preferences in addition to the scientific evidence, is a complex clinical activity that has not realized its full potential. Gaps in education and training have been cited as barriers to shared decision making, and evidence is inconsistent on effective educational interventions. Because individual agents with their own social and behavioral contexts co-construct a shared decision, the educational approach may need to consider the role of patient agency and sociocultural influences. To address the inherent complexity in shared decision making, the authors identified cultural historical activity theory (CHAT) as a framework for analysis. Although certainly not the only relevant theory, CHAT offers an appropriate lens through which the multivoiced nature of shared decision making can be more clearly appreciated. In this article, the authors demonstrate the application of CHAT as a lens for researchers and educators to examine the complexity of shared decision making. The fictitious case presented in this article describes the use of CHAT with a patient who experiences 2 clinical encounters; during the second, shared decision making takes place. Elements of the case are threaded through the article, demonstrating a sample analysis of the interacting activity systems of the patient and physician and highlighting inherent tensions and contradictions. The authors propose CHAT as a tool for future research around the role of agency in shared decision making and other complex topics and as a framework for design of novel instructional strategies. Although not applicable to all topics and settings, CHAT has significant potential within health professions education.

PURPOSE It has been shown that empathy erodes in the later phases of education of both medical students and physician assistant (PA) students. This brief study assessed compassion in PA students at different levels of training to explore if a similar phenomenon occurs. METHODS Students at entry, midway, and at the end of PA training were surveyed using Pommier's Compassion Scale. RESULTS Although overall compassion scores were lower when comparing students further along in training, differences were not significant. Females scored significantly higher on the kindness subscale overall. Scores for the common humanity subscale declined for both males and females. CONCLUSIONS Unlike scales measuring empathy have shown, scores using a compassion rating scale did not decline with progression through PA school. Further research is needed to elucidate differences in subscales of compassion.

PURPOSE To explore the prevalence of major anxiety and its associated risk factors in residents in China. METHOD This multicenter, cross-sectional study was conducted from December 2019 to February 2020; 1,343 residents from 8 hospitals in Northeast China were included in the final analysis (effective response rate of 86.48%). Demographic characteristics, dietary habits, life-related factors, work-related factors, and psychological characteristics were collected from participants via a self-reported questionnaire. This questionnaire measured sleep quality, physical activity, anxiety, perceived organizational support, psychological capital, and burnout. Adjusted odds ratios (ORs) and 95% confidence intervals were determined using binary logistic regression. Cutoff values and the area under the curve were calculated for risk factors using receiver operating characteristic curve analysis. RESULTS Of participants, 441 (32.80%) reported anxiety symptoms and 133 (9.90%) reported major anxiety symptoms. Four independent risk factors for major anxiety were identified: poor sleep quality (OR = 1.282, P < .001) and 3 dimensions of burnout: higher emotional exhaustion (OR = 1.085, P < .001), higher depersonalization (OR = 1.064, P = .002), and reduced personal accomplishment (OR = 0.951, P < .001). The optimal cutoff values for these risk factors were 7, 10, 9, and 22 scores, respectively. CONCLUSIONS This study found a considerable prevalence of major anxiety symptoms in residents in China and identified poor sleep quality and higher levels of burnout as having a close association with major anxiety. These findings enrich the existing literature on anxiety and demonstrate a critical need for additional studies that investigate intervention strategies to improve sleep quality and combat burnout, which could improve the mental health of residents.

Purpose Physician burnout is endemic across medical education and has numerous deleterious effects. Given the prevalence and negative effects of burnout, there is an urgent need to understand how residents experience and cope with stress and develop explanatory models that inform the development of more effective interventions. Method Using a qualitative, constructivist approach informed by grounded theory, the authors conducted semistructured interviews from March to April 2019, in which psychiatry residents were asked about their experiences of stress and how they coped. First- through fourth-year trainees at Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, were invited. Two authors independently and inductively coded deidentified transcripts. A constant comparative approach was used to analyze data and support construction of themes. Theoretic sufficiency was observed after 14 interviews. Results The authors constructed an explanatory model for how residents cope with stress and whether they tended toward burnout or wholehearted engagement. The model included 3 themes: self-care, work relationships, and meaning making. Self-care, including time spent with others, provided connection and belonging that bolstered physicians' developing identities. Interpersonal relationships at work profoundly influenced the experience of residents. Positive peer and supervisor relationships enhanced confidence and perseverance. Negative role models and conflict engendered feelings of inadequacy. The ability to shift perspective and build meaning through examining moral values in the face of challenges was crucial for residents who reported success at coping with stress. Residents identified personal psychotherapy as an especially important strategy to facilitate meaning making. Conclusions These findings provide guidance for how residency programs may help residents cope with stress and move away from burnout toward wholehearted engagement. Strategies may include reducing barriers to self-care and to accessing help early in training, creating spaces that promote peer connection and providing training in addressing conflict, and facilitating engagement in meaning-making activities.

Aim The purpose of this study was to identify quantitative instruments that measure characteristics that support nurse educator education, specifically social support, motivation, and work opportunity. Background Vacancies in nurse faculty positions have left nursing education unable to increase the number of nurses prepared to enter the workforce. Method A review of education, nursing, and psychological databases was undertaken to identify reported instruments. Identified instruments were analyzed to match three framework-derived concept categories: social support, internal motivators, and work opportunity. Search terms, retrievals, and quality assessments are discussed; identified instruments are ranked by concept categories. Results Of 98 articles retrieved, 85 underwent full review, and 7 met the inclusion criteria. From these reports, 20 unique instruments were identified and analyzed. Conclusions There are quantitative instruments that measure the concepts found in the Nurse Educator Retention Framework.

PROBLEM: There are significant barriers for resident physicians seeking mental health care, including lack of time, cost, and concerns about confidentiality. The authors sought to improve access to mental health resources by addressing these barriers through the development of a confidential opt-out mental health pilot program for interns and to assess the feasibility, acceptability, and resident satisfaction with the program. APPROACH: All internal medicine and internal medicine-pediatrics interns in the 2017–2018 residency class at the University of Colorado were enrolled in the confidential opt-out mental health program. Each intern was provided with an additional half-day off during their continuity clinic week, during which a mental health screening appointment at the campus health center with an in-network mental health provider was scheduled. All costs were covered by the residency program. An anonymous follow-up survey was sent to all interns to assess participation in the program and its perceived impact on their wellness. OUTCOMES: Appointments were made for 80 interns: 23 (29%) attended the appointment, 45 (56%) opted out in advance, and 12 (15%) were no-shows. The total cost of the program was $940 or $11.75 per intern. Of the 41 interns who responded to the survey, 35 (85%) agreed the program should continue next year. The majority of interns felt the program positively affected their wellness regardless of whether they attended the appointment. Of the 16 interns who attended the appointment and completed the survey, 4 (25%) reported receiving additional mental health referrals or follow-up appointments. NEXT STEPS: This confidential opt-out mental health pilot program for interns was feasible, relatively low cost and simple to implement, and had positive impacts on self-reported wellness. Further study of interventions that remove barriers to accessing mental health care for residents is urgently needed.

These are challenging times for physicians. Extensive changes in the practice environment have altered the nature of physicians’ interactions with patients and their role in the health care delivery system. Many physicians feel as if they are “cogs in the wheel” of austere corporations that care more about productivity and finances than compassion or quality. They often do not see how the strategy and plan of their organization align with the values of the profession. Despite their expertise, they frequently do not feel they have a voice or input in the operational plan of their work unit, department, or organization. At their core, the authors believe all of these factors represent leadership issues. Many models of leadership have been proposed, and there are a number of effective philosophies and approaches. Here, the authors propose a new integrative model of Wellness-Centered Leadership (WCL). WCL includes core skills and qualities from the foremost leadership philosophies along with evidence on the relationship between leadership and physician well-being and distills them into a single framework designed to cultivate leadership behaviors that promote engagement and professional fulfillment. The 3 elements of WCL are: care about people always, cultivate individual and team relationships, and inspire change. A summary of the mindset, behaviors, and outcomes of the elements of the WCL model is presented, and the application of the elements for physician leaders is discussed. The authors believe that learning and developing the skills that advance these elements should be the aspiration of all health care leaders and a foundational focus of leadership development programs. If cultivated, the authors believe that WCL will empower individual and team performance to address the current problems faced by health care organizations as well as the iterative innovation needed to address challenges that may arise in the decades to come.

Professional burnout has reached epidemic levels among U.S. medical providers. One key driver is the burden of clinical documentation in the electronic health record, which has given rise to medical scribes. Despite the demonstrated benefits of scribes, many providers-especially those in academic health systems-have been unable to make an economic case for them. With the aim of creating a cost-effective scribe program in which premedical students gain skills that better position them for professional schooling, while providers at risk of burnout obtain documentation support, the authors launched the Clinical Observation and Medical Transcription (COMET) Program in June 2015 at Stanford University School of Medicine. COMET is a new type of postbaccalaureate premedical program that combines an apprenticeship-like scribing experience and a package of teaching, advising, application support, and mentored scholarship that is supported by student tuition. Driven by strong demand from both participants and faculty, the program grew rapidly during its first 5 years (2015-2020). Program evaluations indicated high levels of satisfaction among participants and faculty with their mentors and mentees, respectively; that participants felt the experience better positioned them for professional schooling; and that faculty reported improved joy of practice. In summary, tuition-supported medical scribe programs, like COMET, appear to be feasible and cost-effective. The COMET model may have the potential to help shape future health professions students, while simultaneously combating provider burnout. While scalability and generalizability remain uncertain, this model may be worth exploring at other institutions.

Aim The aim of this scoping review was to map teaching strategies incorporating Quality and Safety Education for Nurses (QSEN) competencies and assessment tools based on the QSEN framework. Method The search was conducted through MEDLINE, Embase, Scopus, and Web of Science databases and carried out through the framework developed by Arksey and O'Malley and revised by Levac et al. Results Thirty-one studies were included. Among QSEN competences, patient-centered care, safety, and teamwork and collaboration were most frequently incorporated into teaching strategies. Most assessment tools aimed at capturing the achievement of QSEN competencies after a classroom learning experience. Conclusion The scoping review made it possible to identify various teaching strategies and assessment tools developed on the QSEN framework. Further studies are needed to test teaching strategies to facilitate students' acquisition of QSEN competencies in clinical environments.

Given the complex health and social needs of older adults, the rapid growth of the aging population, and the increasing use of information technology in healthcare, there is a critical need for informatics solutions that advance gerontological nursing care and knowledge discovery. This article illustrates the value of standardized data for healthcare quality improvement throughout the life cycle of data capture and reuse. One such informatics solution is the MyStrengths+MyHealth app, which incorporates a whole-person perspective through the Simplified Omaha System Terms assessment, including the social and behavioral determinants of health, as well as resilience. The data describe whole-person health of older adults from MyStrengths+MyHealth for use in clinical encounters and as raw data for research. There is potential to use such standardized data to improve gerontological nursing care at the bedside and for population health management and research.

Aim This two-group feasibility study tested the efficacy of a four-scenario simulation program to improve clinical judgment and clinical competence among graduate nurses. Background Clinical judgment and clinical competence are underdeveloped among new-to-practice nurses. Method Clinical judgment was compared between the intervention group (n = 17) and a control group (n = 26) in the practice setting at two time points. Results The simulation program had a large effect on the intervention group's clinical judgment (η2 = .143) and clinical competence (η2 = .153). There were no statistically significant differences for each outcome at baseline as compared to the final scenario for the intervention group. There was no statistical significance between the intervention and control groups in clinical judgment in the practice setting at each measurement time. Conclusion Replication of the study with a randomized controlled trial and large sample size is warranted.

Supplemental Digital Content is available in the text., Purpose This qualitative study examined fiscal and administrative (i.e., pre- and post-award grants process) barriers and facilitators to community-engaged research among stakeholders across 4 Clinical and Translational Science Awards (CTSA) institutions. Method A purposive sample of 24 key informants from 3 stakeholder groups—community partners, academic researchers, and research administrators—from the CTSA institutions at the University of North Carolina at Chapel Hill, Medical University of South Carolina, Vanderbilt University Medical Center, and Yale University participated. Semistructured interviews were conducted in March–July 2018, including questions about perceived challenges and best practices in fiscal and administrative processes in community-engaged research. Transcribed interviews were independently reviewed and analyzed using the Rapid Assessment Process to facilitate key theme and quote identification. Results Community partners were predominantly Black, academic researchers and research administrators were predominantly White, and women made up two-thirds of the overall sample. Five key themes were identified: level of partnership equity, partnership collaboration and communication, institutional policies and procedures, level of familiarity with varying fiscal and administrative processes, and financial management expectations. No stakeholders reported best practices for the institutional policies and procedures theme. Cross-cutting challenges included communication gaps between stakeholder groups; lack of or limits in supporting community partners’ fiscal capacity; and lack of collective awareness of each stakeholder group’s processes, procedures, and needs. Cross-cutting best practices centered on shared decision making and early and timely communication between all stakeholder groups in both pre- and post-award processes. Conclusions Findings highlight the importance of equitable processes, triangulated communication, transparency, and recognizing and respecting different financial management cultures within community-engaged research. This work can be a springboard used by CTSA institutions to build on available resources that facilitate co-learning and discussions between community partners, academic researchers, and research administrators on fiscal readiness and administrative processes for improved community-engaged research partnerships.

SUMMARY STATEMENT Culture influences how we communicate, teach, and learn. Debriefings are laden with cultural influences. Without attention to cultural considerations, accepted debriefing techniques might not reach the desired outcome and, in certain cultures, may even harm teacher-learner relationships. We explore cultural considerations in healthcare simulation debriefing and offer guidance for debriefers to gain awareness of potential cultural biases.

The COVID-19 pandemic has disrupted medical research, pushing mentors and mentees to decide if COVID-19 research would be germane to the early career investigator's developing research portfolio. With COVID-19 halting hundreds of federal trials involving non-COVID-19 research, mentors and mentees must also consider the broader moral calling of contributing to COVID-19 research. At the time of writing, the National Institutes of Health had responded to the pandemic with significant funding for COVID-19 research. However, because this pandemic is a new phenomenon, few mentors have expertise in the disease and relevant established resources. As a result, many mentors are unable to provide insight on COVID-19 research to early career investigators considering a pivot toward research related to this disease. The authors suggest 4 ways for mentees and mentors to respond to the changes the pandemic has brought to research funding and opportunities: (1) include COVID-19 research in existing portfolios to diversify intellectual opportunities and reduce funding risks; (2) negotiate the mentor-mentee relationship and roles and expectations early in project discussions-considering, as relevant, the disproportionate burden of home responsibilities often borne by early career faculty members who are women and/or from a minority group; (3) address any mentor limitations in content expertise; and (4) if the decision is to pivot to COVID-19 research, select projects with implications generalizable beyond this pandemic to other infectious outbreaks or to the redesign of health care delivery. Mentors and mentees must weigh the relevance of COVID-19 research projects to the postpandemic world and the amount of available funding against the developing interests of early career investigators. Academic medical centers nationwide must enable seasoned and early career researchers to contribute meaningfully to COVID-19 and non-COVID-19 research.

BACKGROUND: Elevated levels of stress, anxiety, and depression are common symptoms in graduate students pursuing a degree in the health care professions. The onset of the COVID-19 pandemic likely complicated these existing issues. PURPOSE: To confirm this hypothesis, researchers created a survey to examine the experiences of graduate nursing students during COVID-19. METHODS: Graduate nursing students (n = 222) completed the survey, which included 2 instruments: the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Events Scale (IES-R). RESULTS: Nearly 25% of students expressed moderate to extremely severe levels of negative emotional states on the DASS-21, and 23.8% of students scored within the area of clinical concern for the presence of posttraumatic stress disorder on the IES-R. CONCLUSIONS: Understanding levels of mental health and associated factors that may contribute to changes can assist administration, faculty, and staff in targeting resources and interventions to support graduate nursing students to continue their education.

Aim The aim of this study was to explore facilitators and barriers to conducting a multisite national study in nursing academia unsupported by grant funding. Background Scholarship focused on the Quality and Safety Education for Nurses (QSEN) competencies stimulates opportunities for research and collaboration among nurse educators and clinicians. Twelve members of the QSEN Academic Task Force collaborated on a multisite study of the effectiveness of a QSEN teaching strategy and published the findings. Method A descriptive phenomenological reflective approach using Kim's critical reflective inquiry model was used to explore the lived experiences of the original study investigators. Data were analyzed using Colaizzi's phenomenological reduction. Results Findings revealed seven facilitators and one overarching barrier to conducting academic research projects of this scope. Conclusion Participants found that strong leadership, a commitment to teamwork and collaboration, and a shared interest were critical to conducting a successful national study across academic settings.

Aim The aim of the study was to better understand the scholarship requirements and support for nursing faculty as they work to advance their scholarship and careers. Background Nursing faculty are often required to participate in teaching, service, and scholarship. New faculty often struggle with the scholarship component. Method A nationwide Delphi study was conducted, surveying deans and/or associate deans for research at master's and doctoral degree-granting institutions. Results Scholarly requirements provided for faculty to enable development of scholarship were well defined: having a dedicated leader; funding support; a culture of scholarship; publications, presentations, and grant writing expectations; formal programs; mentors; and support. Conclusion This study provided a beginning understanding of important aspects of faculty support for scholarship and career development. More information is needed to determine if the support structures and activities described reach faculty and enhance career development.

Purpose The purpose of this study was to assess holistic review use in physician assistant (PA) programs and determine whether a relationship between holistic review and underrepresented minority (URM) matriculation exists. Methods Using data from the 2016-2017 Physician Assistant Education Association annual survey of PA programs, we examined the frequency of holistic review use across PA programs. Bivariate correlation analyses and binary logistic regression were used to examine relationships between holistic review practices and program percentages of first-year underrepresented racial and ethnic minority students. Results Most PA programs (169/219 [77.2%]) reported using holistic review, and its use modestly correlated with percentage of students who were underrepresented racial minorities (rho = 0.16, 95% confidence interval [CI] = 0.02-0.30) or Hispanic (rho = 0.20, 95% CI = 0.06-0.33). Using several holistic review elements related to program commitment to diversity modestly correlated with percentage of students who were underrepresented racial minorities (rho = 0.25, 95% CI = 0.10-0.39) or African American (rho = 0.20, 95% CI = 0.04-0.34). Additionally, the odds of a first-year student being an underrepresented racial or ethnic minority were slightly higher in PA programs using holistic review (OR = 1.56, 95% CI = 1.23-1.99 and OR 1.33, 95% CI = 1.09-1.62, respectively). Conclusions PA program use of holistic review practices was modestly associated with percentage of URM students. Further research is needed to identify elements that are most effective.

Standardized entrance exams are used in many health professions as one way to objectively measure knowledge and facilitate comparisons across student groups. The physician assistant (PA) profession has historically not employed a profession-specific entrance exam, and the idea was never seriously explored until the Physician Assistant College Admissions Test was developed recently by a commercial assessment publisher, with field testing in some volunteer programs in 2018 and the exam's first administration in May of 2020. The 2020 Physician Assistant Education Association Presidents Commission chose to investigate the issues raised by a consensus-derived, PA-specific entrance exam to stimulate more informed discussion on the efficacy of such an exam. While it may have the potential to enhance efficiency in PA admissions and reduce variability in admissions requirements, a PA entrance exam would also likely introduce new challenges, including increased costs, impact on the diversity of the applicant pool, and incongruence with an increasingly holistic admissions process. The biggest barrier would likely be the lack of current consensus on the knowledge, skills, and attributes that matriculants need to be successful in the program and in clinical practice. Development of a consensus-derived PA entrance exam would be a complex, expensive, and time-consuming endeavor, requiring considerable attention to technical issues of psychometric quality, process transparency, and legal defensibility. Changes being made to health professions admissions practices due to the COVID-19 pandemic, including the dropping of test scores as a requirement by some institutions, may make some of the issues raised in this paper more timely than ever.

The development of physician assistants (PAs) in the Republic of Bulgaria began in 2014 with the inauguration of the first class at Trakia University, Stara Zagora, and at Faculty of Public Health, Sofia. Modeled after North American and European education systems, the preparation of PAs complies with state requirements for higher medical education from the Bulgarian Ministry of Health. As of 2020, the PA training program is in the state's register of regulated professions. Three programs, in Ruse, Burgas, and Plovdiv, will start in the early 2020s, building on the success of the initial programs in Sofia and Stara Zagora. In the Bulgarian PA education system, a bachelor's degree includes 8 semesters and nearly 5000 combined classroom and clinical hours (254 credits). Accreditation is through the state system, and graduation is achieved by passing 3 national examinations, after which the PA is awarded a diploma. The quality of PA education is guaranteed by the Ordinance of Unified State Requirements for the acquisition of higher education with a bachelor's degree in the PA specialty. As of 2020, 2 PA cohorts have graduated and serve in ambulatory medical roles throughout the state. Newer roles in curative (hospital) centers are being explored. This new medical workforce is designed to contribute to the national health system as a cost-effective medical resource that replaces an older feldsher system.

After a medical student prompted medical faculty to tell their stories of depression and related mental health issues, the author wrote this article with the aim of decreasing the stigma of mental illness and encouraging treatment, as needed, in the medical profession. The professional culture of the house of medicine not only mimics society in attributing stigma to people with mental health issues but may also contribute to high rates of suicide in the ranks of health care professionals by leading to a delay in seeking treatment. Acculturation accelerates in the first year of medical school such that medical students experience an increase in burnout and depressive symptoms from prematriculation levels. It follows that faculty have a responsibility to improve the learning environment. Survey data from medical faculty at the author's institution showed that depression decreased respondents' willingness to seek mental health treatment because of the stigma and issues of access to help. Faculty attitudes toward mental health issues, including reluctance to admit having such issues, may be conveyed to medical students in the hidden curriculum that teaches them to keep depression hidden. Moreover, the fear of mental disorders is manifested in licensing and privileging applications under the guise of patient safety, contributing to a culture of shame and silence. As creators and guardians of this professional culture, medical faculty and other physicians must be the ones who change it. The same faculty who play a part in causing and perpetuating stigma related to mental health issues have the power to derive and enact some of the solutions. In addition to giving voice to a personal experience of mental health issues, this article offers suggestions for normalizing moderate to severe depression as a medical disorder, decreasing the stigma of mental health issues, and encouraging faculty to seek treatment.

BACKGROUND: As the landscape of medical education evolves with emerging technologies and the COVID-19 pandemic, e-learning platforms continue to gain popularity. Orthopaedic podcasts, a burgeoning e-learning platform, continue to gain traction; however, there is a paucity of information regarding their coverage of topics and their distribution over time. Therefore, our analysis sought to (1) characterize podcast content related to orthopaedic surgery, and (2) evaluate the changes in the prevalence of orthopaedic podcasts over the past 15 years. METHODS: Three common podcasting platforms (Apple Podcasts, Google Podcasts, and Spotify) were queried using the key terms "orthopaedic," "orthopedic," and "ortho" in order to identify a list of podcasts that are related to orthopaedic surgery. For each unique orthopaedic podcast, the title, the show description, the number of episodes, the date of the first episode, the date of the most recent episode, and episode frequency were collected. Podcasts were then classified based on a predetermined list of podcast domains. The number of existing active (released within the last 3 months) orthopaedic podcasts was then trended on a monthly basis from 2011 to 2020. RESULTS: Ninety-four unique podcasts met inclusion criteria, 62 of which remained active as of October 25, 2020. The most common podcast domains were "general" (38 [40.4%]) and "clinical knowledge" (20 [21.3%]). Among the assessed podcasts, 90 (95.7%) utilized an exclusively audio format. The majority of podcasts were based in the United States (89.4%), included introductory music (72.3%), and included interviews (63.8%). Most podcast hosts were practicing orthopaedic surgeons (52.1%). Between January 2016 and October 2020, the number of active orthopaedic surgery podcasts grew more than twelvefold (1,240%) at an average rate of roughly 1 new podcast each month (average, 1.0 podcast; standard deviation, 1.8). DISCUSSION: The past decade has seen sizable growth in the number of readily available podcasts related to orthopaedic surgery. Additional research is required to independently assess the quality of these resources and their implications for remote trainee education.

BACKGROUND: The need for faculty to educate prospective nurses is urgent: without sufficient nursing faculty, schools regularly reject qualified applicants, despite an increasing need for nurses. At the same time, many graduate-prepared nurses lack preparation in teaching and pedagogical frameworks. PROBLEM: Literature on how PhD programs in nursing prepare graduates for teaching indicates that there is typically more emphasis on research than pedagogical learning. APPROACH: With the shift to remote learning under the COVID-19 pandemic, the University of California Irvine created a Graduate Fellows program to provide support to faculty while offering graduate students education in pedagogy and remote learning. OUTCOMES: Fellows were satisfied and reported increased understanding of challenges in teaching and increasing comfort with nurse faculty roles. CONCLUSIONS: The collaborative efforts of fellows and faculty provided important resources at a critical time, and insights gained can inform similar projects in nursing faculty development.

Purpose To describe the prevalence and scope of wellness programs at U.S. and Canadian medical schools. Method In July 2019, the authors surveyed 159 U.S. and Canadian medical schools regarding the prevalence, structure, and scope of their wellness programs. They inquired about the scope of programming, mental health initiatives, and evaluation strategies. Results Of the 159 schools, 104 responded (65%). Ninety schools (93%, 90/97) had a formal wellness program, and across 75 schools, the mean full-time equivalent (FTE) support for leadership was 0.77 (standard deviation [SD] 0.76). The wellness budget did not correlate with school type or size (respectively, P = .24 and P = .88). Most schools reported adequate preventative programming (62%, 53/85), reactive programming (86%, 73/85), and cultural programming (52%, 44/85), but most reported too little focus on structural programming (56%, 48/85). The most commonly reported barrier was lack of financial support (52%, 45/86), followed by lack of administrative support (35%, 30/86). Most schools (65%, 55/84) reported in-house mental health professionals with dedicated time to see medical students; across 43 schools, overall mean FTE for mental health professions was 1.62 (SD 1.41) and mean FTE per student enrolled was 0.0024 (SD 0.0019). Most schools (62%, 52/84) evaluated their wellness programs; they used the Association of American Medical Colleges Graduation Questionnaire (83%, 43/52) and/or annual student surveys (62%, 32/52). The most commonly reported barrier to evaluation was lack of time (54%, 45/84), followed by lack of administrative support (43%, 36/84). Conclusions Wellness programs are widely established at U.S. and Canadian medical schools, and most focus on preventative and reactive programming, as opposed to structural programming. Rigorous evaluation of the effectiveness of programs on student well-being is needed to inform resource allocation and program development. Schools should ensure adequate financial and administrative support to promote students' well-being and success.

Clerkship grades (like money) are a social construct that function as the currency through which value exchanges in medical education are negotiated between the system’s various stakeholders. They provide a widely recognizable and efficient medium through which learner development can be assessed, tracked, compared, and demonstrated and are commonly used to make decisions regarding progression, distinction, and selection for residency. However, substantial literature has demonstrated how grades imprecisely and unreliably reflect the value of learners. In this article, the authors suggest that challenges with clerkship grades are fundamentally tied to their role as currency in the medical education system. Associations are drawn between clerkship grades and the history of the U.S. economy; 2 major concepts are highlighted: regulation and stock prices. The authors describe the history of these economic concepts and how they relate to challenges in clerkship grading. Using lessons learned from the history of the U.S. economy, the authors then propose a 2-step solution to improve upon grading for future generations of medical students: (1) transition from grades to a federally regulated competency-based assessment model and (2) development of a departmental competency letter that incorporates competency-based assessments rather than letter grades and meets the needs of program directors.

AIM The purpose of this study was to develop and pilot an instrument to assess group synergy and team-based learning among nursing students. BACKGROUND Little is known on how to evaluate soft nursing skills such as synergy. METHOD Nurse faculty were recruited through purposive and snowball sampling to serve on an expert panel. Using the DeVillis framework, three rounds of data were collected using semistructured online surveys. The resulting scale of 34 items was piloted with teams of undergraduate nursing students taking part in a simulation experience. RESULTS Item-content validity index ranged from .8 to 1.0 for each item. Scale-content validity index average was .93; scale-content validity index universal was .62. Exploratory factor analysis identified three factors. CONCLUSION This study suggests that synergy is multifactorial and can be assessed by faculty. However, further testing of the scale is needed.

Problem Distress, depression, and burnout are common during medical training. Stigma surrounding seeking help for mental illness during medical training may involve fear of negative peer perceptions, academic jeopardy, and adverse future career consequences. Faculty disclosure of personal mental health illness may reduce stigma surrounding mental health disorders and reassure and encourage trainees to seek help when needed. Approach The authors aimed to assess the impact of faculty disclosure of mental health issues on stigma toward help-seeking during training, self-reflection about mental health, and resident physician awareness of mental health resources. Three self-selected faculty members shared their personal experiences with depression and mental health during a confidential noon conference intended for internal medicine residents at Mayo Clinic Rochester as part of their core curriculum in December 2016. Institutional and community mental health resources were provided. After the conference, attendees completed an anonymous survey assessing self-reported knowledge, attitudes, and behaviors surrounding mental health during medical training. Outcomes One hundred percent of residents (39/39) agreed that they enjoyed the conference. Thirty-five of 39 (89.7%) respondents agreed that their knowledge of available mental health resources increased and 33/39 (84.6%) agreed they were more likely to pursue mental health resources after attending the conference. Thirty-eight of 39 (97.4%) residents agreed that faculty sharing their personal struggles destigmatizes mental health issues during training, and the same percentage reported engaging in postconference self-reflection regarding their own mental health and well-being. Next steps Resident conference sessions during which faculty self-disclose personal mental health experiences may help decrease the stigma of mental health issues during medical training and increase the likelihood residents will seek assistance when needed. The authors encourage further study of longer-term outcomes and actual help-seeking behaviors across learner levels and training environments.

Background and purpose Prelicensure nursing students lack the situational awareness to promote timely intervention with a patient in septic shock. This study evaluated a multifaceted educational project that determined the impact on nursing students' knowledge retention and time to task (TTT). Methods A quasi-experimental, repeated-measures design was used to evaluate students' knowledge retention and TTT. Eighty-four prelicensure nursing students participated in groups of 4 students to participate in a high-fidelity simulation. Results Results show knowledge retention was significant between the pretest scores and 2 repeated assessment scores. The repeated-measures analysis of variance time effect P value was .02. The overall TTT group response suggested most (64/84, 76%) students responded within 5 minutes of patient deterioration. Conclusions A multifaceted approach was effective to influence knowledge of septic shock over time and demonstrate students' ability to intervene with a septic shock patient in a timely manner.

Background Telehealth is a rapidly growing health care delivery modality with advanced practice nurses as key providers. This growth has occurred without critical consideration of provider training. Training requires the development of competencies situated within a framework. Problem Standardized telehealth competencies for advanced practice nursing are missing. The purpose of this article is to describe the development of telehealth competencies for education and practice. Approach Using the Four P's of Telehealth framework (planning, preparing, providing, and performance evaluation), a modified Delphi technique was used to identify, develop, and evaluate telehealth competencies. Outcomes Competencies were arranged around telehealth domains, expected activities, and outcomes. Effective use of the competencies to guide curriculum development, practice, and future research related to telehealth was identified. Conclusions Providing education with competencies aligned to the Four P's Telehealth framework will provide learners with tools to assume leadership roles in all phases of telehealth implementation, delivery, and refinement.

Purpose Assessment of the Core Entrustable Professional Activities for Entering Residency (Core EPAs) requires direct observation of learners in the workplace to support entrustment decisions. The purpose of this study was to examine the internal structure validity evidence of the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) scale when used to assess medical student performance in the Core EPAs across clinical clerkships. Method During the 2018-2019 academic year, the Virginia Commonwealth University School of Medicine implemented a mobile-friendly, student-initiated workplace-based assessment (WBA) system to provide formative feedback for the Core EPAs across all clinical clerkships. Students were required to request a specified number of Core EPA assessments in each clerkship. A modified O-SCORE scale (1= "I had to do" to 4 = "I needed to be in room just in case") was used to rate learner performance. Generalizability theory was applied to assess the generalizability (or reliability) of the assessments. Decision studies were then conducted to determine the number of assessments needed to achieve a reasonable reliability. Results A total of 10,680 WBAs were completed on 220 medical students. The majority of ratings were completed on EPA 1 (history and physical) (n = 3,129; 29%) and EPA 6 (oral presentation) (n = 2,830; 26%). Mean scores were similar (3.5-3.6 out of 4) across EPAs. Variance due to the student ranged from 3.5% to 8%, with the majority of the variation due to the rater (29.6%-50.3%) and other unexplained factors. A range of 25 to 63 assessments were required to achieve reasonable reliability (Phi > 0.70). Conclusions The O-SCORE demonstrated modest reliability when used across clerkships. These findings highlight specific challenges for implementing WBAs for the Core EPAs including the process for requesting WBAs, rater training, and application of the O-SCORE scale in medical student assessment.