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Objective: The purpose of this study was to examine differences between American and Chinese students in their perceptions of school climate and engagement in school, and in the relation between school climate and engagement. Method: Confirmatory factor analyses were used to support the factor structure and measurement invariance of the two measures administered: The Delaware School Climate Survey-Student and the Delaware Student Engagement Scale. Differences in latent means were tested, and differences in relations between variables were examined using multilevel hierarchical linear modeling. Participants consisted of 3,176 Chinese and 4,085 American students, Grades 3-5, 7-8, and 10-12. Results: Chinese students perceived school climate more favorably than American students, particularly beyond elementary school. Findings were more complex for student engagement. In elementary school, American students reported greater cognitive--behavioral and emotional engagement, and especially the former. In middle school and high school, Chinese students reported greater emotional engagement; however, no significant differences were found for cognitive-behavioral engagement. Most intriguing were results of multilevel hierarchical modeling that examined associations between school climate and student engagement: They were significant in American schools but not Chinese schools. Conclusion: Chinese students, compared with American students, perceived the climate of their schools more favorably, especially after elementary school. However, among Chinese students, their perceptions of school climate were unrelated to their self-reported engagement in school--school climate did not seem to matter as much.

Background: The purpose of this study was to evaluate relationships between demographics, professional characteristics, and perceived challenges facing the specialty of anesthesiology among physicians who entered a fellowship and those who started independent practice immediately after finishing a U.S. anesthesiology residency. Methods: Anesthesiologists in the year after their residency graduation were invited to take an online survey during the academic years of 2016–2017, 2017–2018, and 2018–2019, with questions about their personal characteristics, the nature of their professional lives, and their perceptions of the greatest challenge facing the profession of anesthesiology. Results: A total of 884 fellows-in-training and 735 anesthesiologists starting independent practice right after the completion of their residency responded. Fellows were slightly younger (mean = 33.2 vs. 34.0 years old, p < 0.001), were more likely to have a spouse who works outside the home (63.9% vs. 57.0%, p = 0.002), had fewer children (mean = 0.69 vs. 0.88, p < 0.001), worked more hours per week (mean = 56.2 vs. 52.4, p < 0.001), and were less likely to report a personal and professional life balance (66.4% vs. 72.3% positive, p = 0.005) than direct-entry anesthesiologists. Fellows and direct-entry anesthesiologists identified similar challenges in three broad themes – workforce competition (80.3% and 71.8%), healthcare system changes (30.0% and 37.9%), and personal challenges (6.4% and 8.8%). Employment security issues posed by non-physician anesthesia providers and perceived lack of appreciation of anesthesiologists' value were commonly cited. Relative weighting of challenge concerns varied between fellows and direct-entry physicians, as well as within these groups based on gender, fellowship subspecialty, location or size of practice, and frequency of supervisory roles. Conclusions: Anesthesiology fellows and direct-entry anesthesiologists had largely similar demographics and perspectives on the challenges facing anesthesiology in the United States. Group differences found in some demographics and perspectives may reflect different motivations for choosing their professional paths and their diverse professional experiences. [ABSTRACT FROM AUTHOR]

Several previous studies have found that Chinese students perceive teacher-student relationships and student-student relationships more favorably than American students. In this study we examined if the same holds true with respect to teachers' perceptions. Also examined were both students' and teachers' perceptions of conduct problems. The sample included 3,253 students and 345 teachers in China and 2,192 students and 540 teachers in the United States. Results of a multivariate analysis of variance revealed the greatest differences in mean scores between countries were in teachers' and students' perceptions of student-student relationships and student conduct problems. American students perceived their schools much less favorably, and particularly so in middle school and high school. Students tended to report less favorable relationships and greater conduct problems than their teachers, especially in the United States compared with China. Cultural differences are discussed that may account for the findings, including differences in the valuing of education, filial piety, social harmony, self and peer regulation of behavior, classroom management, and the socialization of cultural values.

The local‐scale precipitation (LSP) is mainly driven by thermal convection. Here we reveal a decreasing trend in the summertime LSP frequency over both China and the United States by utilizing the hourly rain gauge data from 1981 to 2012. The contrasting aerosol trend likely contributes to this same declining trend of LSP in both countries. As aerosol optical depth (AOD) goes beyond the turning zone of 0.25–0.30, the impact of aerosol on precipitation changes from invigoration to suppression. The mean AOD is generally less and larger than this range and of opposite trends in China and United States, respectively, which likely accounts for the same declining trend of LSP hours in the two countries. The observed boomerang shape points to the importance of aerosol loading, which matters as much as, if not more than the AOD trend, thereby potentially serving as a constraint for climate model evaluation. Plain Language Summary: Local‐scale precipitation (LSP) is an integral part of the freshwater cycle. Here, we show that summer LSP hours have significantly declined in the United States and China over the past three decades, a phenomenon that cannot be well explained by global warming. The relationship between LSP hours and aerosol loading is a boomerang shape; a turning zone exists for the shifting effect of aerosols from enhancing to suppressing rainfall as aerosol loading increases. China is above this zone with an increasing aerosol trend, and the United States is below it with a decreasing trend, but they have similar reductions in LSP hours. This disparate role of aerosols in the rainfall process requires holistic thinking about air pollution and climate change. Key Points: The summer LSP hours have significantly declined in the United States and China over the past three decadesThe boomerang shape revealing the response of LSP frequency to aerosols points to the importance of aerosol loading rather than AOD trendThis disparate role of aerosols in the rainfall process requires holistic thinking about air pollution and climate change [ABSTRACT FROM AUTHOR]

This study sought to understand the timing and important factors identified by residents regarding their decision to pursue a career in anesthesiology, training areas deemed important to their future success, perceived greatest challenges facing the profession of anesthesiology, and their post-residency plans. The American Board of Anesthesiology administered voluntary, anonymous, repeated cross-sectional surveys to residents who began clinical anesthesia training in the U.S. from 2013 to 2016 and were subsequently followed up yearly until the completion of their residency. The analyses included data from 12 surveys (4 cohorts from clinical anesthesia years 1 to 3), including multiple-choice questions, rankings, Likert scales, and free text responses. Free responses were analyzed using an iterative inductive coding process to determine the main themes. The overall response rate was 36% (6480 responses to 17,793 invitations). Forty-five percent of residents chose anesthesiology during the 3rd year of medical school. "Nature of the clinical practice of anesthesiology" was the most important factor influencing their decision (average ranking of 5.93 out of 8 factors, 1 [least important] to 8 [most important]), followed by "ability to use pharmacology to acutely manipulate physiology" (5.75) and "favorable lifestyle" (5.22). "Practice management" and "political advocacy for anesthesiologists" (average rating 4.46 and 4.42, respectively, on a scale of 1 [very unimportant] to 5 [very important]) were considered the most important non-traditional training areas, followed by "anesthesiologists as leaders of the perioperative surgical home" (4.32), "structure and financing of the healthcare system" (4.27), and "principles of quality improvement" (4.26). Three out of 5 residents desired to pursue a fellowship; pain medicine, pediatric anesthesiology, and cardiac anesthesiology were the most popular choices, each accounting for approximately 20% of prospective fellows. Perceived greatest challenges facing the profession of anesthesiology included workforce competition from non-physician anesthesia providers and lack of advocacy for anesthesiologist values (referenced by 96% of respondents), changes and uncertainty in healthcare systems (30%), and personal challenges such as psychological well-being (3%). Most residents identified anesthesiology as their career choice during medical school. Interest in non-traditional subjects and fellowship training was common. Competition from non-physician providers, healthcare system changes, and compromised psychological well-being were perceived concerns. • 80% anesthesiology residents decided to pursue the specialty during medical school. • Nature of clinical practice was most important to choose anesthesiology specialty. • Competition from non-physician anesthesia providers considered greatest challenge. • Practice management & political advocacy were most important novel training areas. • Pain medicine, pediatric, & cardiac anesthesiology were most popular fellowships. [ABSTRACT FROM AUTHOR]

Study Objective: To describe how the introduction of an Objective Structured Clinical Examination (OSCE) by the American Board of Anesthesiology (ABA) to its initial certification impacted anesthesiology residencies in the United States.Design and Setting: A sequential mixed-methods design with focus groups and online survey among program directors of Accreditation Council for Graduate Medical Education-accredited anesthesiology residencies.Patients: No patients were included.Intervention: None.Measurements: A convenience sample of 34 program directors were interviewed to understand their perceptions of the ABA OSCE. Subsequently, an online survey, based on major themes identified from the focus groups, was sent to all 156 program directors.Main Results: Several themes emerged from the focus group discussions: (1) a mock OSCE was most common for preparing residents for the ABA OSCE; 2) the ABA OSCE led to changes in residency curriculum; 3) the ABA OSCE assessed communication and professionalism skills well, and how well it assessed technical skills was less agreed on. Survey results from 87 program directors (response rate = 56%) were mostly consistent with the themes generated by the focus groups. Eight-one out of 87 programs (93%) specifically prepared their residents for the ABA OSCE. Fifty-two out of 81 program directors (64%) reported the introduction of the ABA OSCE led to curricular changes. Out of 79 program directors, 45 (57%) agreed the ABA OSCE assesses skills essential to anesthesiology practice, and 40 (51%) considered it added value to board certification.Conclusions: The introduction of the OSCE by the ABA for board certification has affected the curriculum of many residencies. Approximately 3 in 5 program directors perceived the ABA OSCE measures skills essential to anesthesiologists' practice. Future studies should assess residency graduates' perspective on the usefulness of both mock OSCE preparation and the ABA OSCE, and whether the ABA OSCE performance predicts future clinical practice. [ABSTRACT FROM AUTHOR]

Background: The American Board of Anesthesiology piloted 3-option multiple-choice items (MCIs) for its 2020 administration of 150-item subspecialty in-training examinations for Critical Care Medicine (ITE-CCM) and Pediatric Anesthesiology (ITE-PA). The 3-option MCIs were transformed from their 4-option counterparts, which were administered in 2019, by removing the least effective distractor. The purpose of this study was to compare physician performance, response time, and item and exam characteristics between the 4-option and 3-option exams., Methods: Independent-samples t-test was used to examine the differences in physician percent-correct score; paired t-test was used to examine the differences in response time and item characteristics. The Kuder and Richardson Formula 20 was used to calculate the reliability of each exam form. Both the traditional (distractor being selected by fewer than 5% of examinees and/or showing a positive correlation with total score) and sliding scale (adjusting the frequency threshold of distractor being chosen by item difficulty) methods were used to identify non-functioning distractors (NFDs)., Results: Physicians who took the 3-option ITE-CCM (mean = 67.7%) scored 2.1 percent correct higher than those who took the 4-option ITE-CCM (65.7%). Accordingly, 3-option ITE-CCM items were significantly easier than their 4-option counterparts. No such differences were found between the 4-option and 3-option ITE-PAs (71.8% versus 71.7%). Item discrimination (4-option ITE-CCM [an average of 0.13], 3-option ITE-CCM [0.12]; 4-option ITE-PA [0.08], 3-option ITE-PA [0.09]) and exam reliability (0.75 and 0.74 for 4- and 3-option ITE-CCMs, respectively; 0.62 and 0.67 for 4-option and 3-option ITE-PAs, respectively) were similar between these two formats for both ITEs. On average, physicians spent 3.4 (55.5 versus 58.9) and 1.3 (46.2 versus 47.5) seconds less per item on 3-option items than 4-option items for ITE-CCM and ITE-PA, respectively. Using the traditional method, the percentage of NFDs dropped from 51.3% in the 4-option ITE-CCM to 37.0% in the 3-option ITE-CCM and from 62.7% to 46.0% for the ITE-PA; using the sliding scale method, the percentage of NFDs dropped from 36.0% to 21.7% for the ITE-CCM and from 44.9% to 27.7% for the ITE-PA., Conclusions: Three-option MCIs function as robustly as their 4-option counterparts. The efficiency achieved by spending less time on each item poses opportunities to increase content coverage for a fixed testing period. The results should be interpreted in the context of exam content and distribution of examinee abilities., (© 2023. The Author(s).)