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The national or local lockdowns in response to COVID-19 forced education systems to rapidly shift from in-person to distance learning. The hasty transition undoubtedly imposed tremendous challenges on teachers, students and distance learning infrastructure. The purpose of this study was to investigate how high school science teachers who had previously been trained in flipped-learning and advanced educational technology through the Science Teaching Excites Medical Interest (STEMI) program perceived their transition to distance learning during this pandemic. In this study eleven teachers were interviewed with a semi-structured interview guide. Data were analyzed using the deductive-inductive content analytic approach. Our results indicated that teachers reported having more confidence in using technology for teaching online due in part to their participation in the STEMI program. They also reported internet access as one of the most significant barriers, both for students and teachers. While some teachers thought that students may feel more in control of learning due to absence of time and place limits with distance learning, others may struggle to stay engaged without the classroom support they would normally have received. Teachers generally experienced increased workloads and harder work--life balance with online teaching. In spite of the unforeseen challenges, the pandemic situation afforded teachers with opportunities to adopt different technology in teaching and foresee the need for technology integration in order to better prepare for the unexpected in the future.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has been shown to increase levels of psychological distress among healthcare workers. Little is known, however, about specific positive and negative individual and organizational factors that affect the mental health of emergency physicians (EP) during COVID-19. Our objective was to assess these factors in a broad geographic sample of EPs in the United States.  Methods: We conducted an electronic, prospective, cross-sectional national survey of EPs from October 6–December 29, 2020. Measures assessed negative mental health outcomes (depression, anxiety, post-traumatic stress, and insomnia), positive work-related outcomes, and strategies used to cope with COVID-19. After preliminary analyses and internal reliability testing, we performed four separate three-stage hierarchical multiple regression analyses to examine individual and organizational predictive factors for psychological distress.  Results: Response rate was 50%, with 517 EPs completing the survey from 11 different sites. Overall, 85% of respondents reported negative psychological effects due to COVID-19. Participants reported feeling more stressed (31%), lonelier (26%), more anxious (25%), more irritable (24%) and sadder (17.5%). Prevalence of mental health conditions was 17% for depression, 13% for anxiety, 7.5% for post-traumatic stress disorder (PTSD), and 18% for insomnia. Regular exercise decreased from 69% to 56%, while daily alcohol use increased from 8% to 15%. Coping strategies of behavioral disengagement, self-blame, and venting were significant predictors of psychological distress, while humor and positive reframing were negatively associated with psychological distress.  Conclusion: Emergency physicians have experienced high levels of psychological distress during the COVID-19 pandemic. Those using avoidant coping strategies were most likely to experience depression, anxiety, insomnia, and PTSD, while humor and positive reframing were effective coping strategies.

ObjectiveLack of empathic communication between providers and patients may contribute to low value diagnostic testing in emergency care. Accordingly, we measured the perception of physician empathy and trust in patients undergoing low-value computed tomography (CT) in the emergency department (ED).MethodsMulticenter study of ED patients undergoing CT scanning, acknowledged by ordering physicians as unlikely to show an emergent condition. Near the end of their visit, patients completed the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE), Trust in Physicians Survey (TIPS), and the Group Based Medical Mistrust Scale (GBMMS). We stratified results by patient demographics including gender, race, and education.ResultsWe enrolled 305 participants across 9 sites with diverse geographic, racial, and ethnic representation. The median scores (interquartile ranges) for the JSPPPE, TIPS, and GBMMS for all patients were 29 (24-33.5), 55 (47-62), and 18 (12-29). Compared with white patients, nonwhite patients had similar JSPPPE and TIPS scores but had higher (worse) GBMMS scores. Females had significantly lower JSPPPE and TIPS scores than males, and scores were lower (worse) in females with college degrees. Patients in the lowest tier of educational status had the highest (better) JSPPPE and TIPS scores. Scores were invariant with physician characteristics.ConclusionAmong patients undergoing low-value CT scanning in the ED, the degree of patient perception of physician empathy and trust varied based on the patients' level of education and gender. Given this variation, an intervention to increase patient perception of physician empathy should contain individualized strategies to address these subgroups, rather than a one-size-fits-all approach.

The Science Teaching Excites Medical Interest (STEMI) program is an evolving collaboration of academic health science center-based biomedical clinical and research experts, graduate students in clinical anatomy, and Mississippi K-12 schools that seeks to develop a technologically-enhanced teacher-centered community of health learners. The present description of the STEMI community highlights development, implementation, and initial dissemination of high school learning products utilizing contemporary technological approaches and the flipped classroom pedagogical model. The goal is to better engage students within a context of exploring relationships between health literacy, the state's epidemic of obesity, and ensuing anatomic and functional pathophysiology. An evaluation team utilizes a robust mixed-methods approach to examine the program goals and the potential for program expansion and replication. The community is growing, in part through a robust collaboration with the Mississippi INBRE (IDeA Network of Biomedical Research Excellence) at the University of Southern Mississippi.

Cadaveric dissection offers an important opportunity for students to develop their ideas about death and dying. However, it remains largely unknown how this experience impacts medical students' fear of death. The current study aimed to address this gap by describing how fear of death changed during a medical gross anatomy dissection course and how fear of death was associated with examination performance. Fear of death was surveyed at the beginning of the course and at each of the four block examinations using three of the eight subscales from the Multidimensional Fear of Death Scale: Fear of the Dead, Fear of Being Destroyed, and Fear for the Body After Death. One hundred forty-three of 165 medical students (86.7%) completed the initial survey. Repeated measures ANOVA showed no significant changes in Fear of the Dead (F (4, 108) = 1.45, P = 0.222) or Fear for the Body After Death (F (4, 108) = 1.83, P = 0.129). There was a significant increase in students' Fear of Being Destroyed (F (4, 108) = 6.86, P < 0.0005) after beginning dissection. This increase was primarily related to students' decreased willingness to donate their body. Concerning performance, there was one significant correlation between Fear for the Body After Death and the laboratory examination score at examination 1. Students with higher fears may be able to structure their experience in a way that does not negatively impact their performance, but educators should still seek ways to support these students and encourage body donation.

Many professional development programs aim to improve student outcomes by enhancing teacher competencies. Effective evaluation of these programs requires a clear delineation of the competencies to be gained. A competency model was developed to evaluate the impact of a teacher professional program that aimed to improve teachers' ability to effectively implement technologically engaged modules in a flipped classroom setting. Competencies were identified via participatory evaluation techniques and assessments were aligned to the competencies. The competency of teachers in the knowledge, skills, and abilities needed for creation and delivery of effective flipped lessons can be tracked using a radar graph to guide tailored professional development.

Introduction: Formative evaluations of clinical teaching for emergency medicine (EM) faculty are limited. The goal of this study was to develop a behaviorally-based tool for evaluating and providing feedback to EM faculty based on their clinical teaching skills during a shift.  Methods: We used a three-phase structured development process. Phase 1 used the nominal group technique with a group of faculty first and then with residents to generate potential evaluation items. Phase 2 included separate focus groups and used a modified Delphi technique with faculty and residents, as well as a group of experts to evaluate the items generated in Phase 1. Following this, residents classified the items into novice, intermediate, and advanced educator skills. Once items were determined for inclusion and subsequently ranked they were built into the tool by the investigators (Phase 3).  Results: The final instrument, the “Faculty Shift Card,” is a behaviorally-anchored evaluation and feedback tool used to facilitate feedback to EM faculty about their teaching skills during a shift. The tool has four domains: teaching clinical decision-making; teaching interpersonal skills; teaching procedural skills; and general teaching strategies. Each domain contains novice, intermediate, and advanced sections with 2-5 concrete examples for each level of performance.  Conclusion: This structured process resulted in a well-grounded and systematically developed evaluation tool for EM faculty that can provide real-time actionable feedback to faculty and support improved clinical teaching.

Physician well-being is a complex and multifactorial issue. A large number of tools have been developed in an attempt to measure the nature, severity, and impact of both burnout and well-being in a range of clinical populations. This two-article series provides a review of relevant tools and offers guidance to clinical mentors and researchers in choosing the appropriate instrument to suit their needs, whether assessing mentees or testing interventions in the research setting. Part One begins with a discussion of burnout and focuses on assessment tools to measure burnout and other negative states. Part Two of the series examines the assessment of well-being, coping skills, and other positive states.

Introduction: Formative evaluations of clinical teaching for emergency medicine (EM) faculty are limited. The goal of this study was to develop a behaviorally-based tool for evaluating and providing feedback to EM faculty based on their clinical teaching skills during a shift. Methods: We used a three-phase structured development process. Phase 1 used the nominal group technique with a group of faculty first and then with residents to generate potential evaluation items. Phase 2 included separate focus groups and used a modified Delphi technique with faculty and residents, as well as a group of experts to evaluate the items generated in Phase 1. Following this, residents classified the items into novice, intermediate, and advanced educator skills. Once items were determined for inclusion and subsequently ranked they were built into the tool by the investigators (Phase 3). Results: The final instrument, the “Faculty Shift Card,” is a behaviorally-anchored evaluation and feedback tool used to facilitate feedback to EM faculty about their teaching skills during a shift. The tool has four domains: teaching clinical decision-making; teaching interpersonal skills; teaching procedural skills; and general teaching strategies. Each domain contains novice, intermediate, and advanced sections with 2-5 concrete examples for each level of performance. Conclusion: This structured process resulted in a well-grounded and systematically developed evaluation tool for EM faculty that can provide real-time actionable feedback to faculty and support improved clinical teaching. There was an error on Figure 1. Faculty Shift Card. The top card originally stated, “What should this faculty member do to improve their procedural teaching skills? Select all that apply.” This should be revised to, “What should this faculty member do to improve their clinical decision making teaching skills?  Select all that apply.”

Introduction: Few studies have documented the value of mentoring for medical students, and research has been limited to more subjective (e.g., job satisfaction, perceived career preparation) rather than objective outcomes. This study examined whether having a mentor is associated with match outcome (where a student matched based on their rank order list [ROL]).Methods: We sent a survey link to all emergency medicine (EM) program coordinators to distribute to their residents. EM residents were surveyed about whether they had a mentor during medical school. Match outcome was assessed by asking residents where they matched on their ROL (e.g., first choice, fifth choice). They were also asked about rank in medical school, type of degree (MD vs. DO), and performance on standardized tests. Residents who indicated having a mentor completed the Mentorship Effectiveness Scale (MES), which evaluates behavioral characteristics of the mentor and yields a total score. We assessed correlations among these variables using Pearson’s correlation coefficient. Post-hoc analysis using independent sample t-test was conducted to compare differences in the MES score between those who matched to their first or second choice vs. third or higher choice.Results: Participants were a convenience sample of 297 EM residents. Of those, 199 (67%) reported having a mentor during medical school. Contrary to our hypothesis, there was no significant correlation between having a mentor and match outcome (r=0.06, p=0.29). Match outcome was associated with class rank (r=0.13, p=0.03), satisfaction with match outcome (r= -0.37, p

In this article, the determinants of "time to dropout" from doctoral studies and "time to PhD completion" are studied using a discrete-time competing risks survival analysis for a sample of 3092 doctoral candidates from the Université libre de Bruxelles. Not surprisingly, results show that students supported with research fellowships have much higher PhD completion hazards than teaching assistants or unfinanced students. Concerning dropout, students with no financing showed the highest withdrawal rate, while students with selective research fellowships showed the lowest one. Dropout is also influenced by the ability of the student, which is correlated to their success in the fellowship allocation procedure. However, the type of financial support influences time to dropout from doctoral studies even when controlling for the ability of the student. Finally, our findings suggest that there are no significant differences in dropout and degree completion between fields of study, except for unfinanced students.

In this paper we study the factors that influence both dropout and (4-year) degree completion throughout university by applying the set of discrete-time methods for competing risks in event history analysis, as described in Scott and Kennedy (2005). In the French-speaking Belgian community, participation rates are very high given that higher education is largely financed through public funds, but at the same time, the system performs very poorly in terms of degree completion. In this particular context, we explore two main questions. First, to what extent is socioeconomic background still a determinant of success for academic careers in a system that, by construction, aims to eliminate economic barriers to higher education? Second, given the high proportion of students who fail their first year and are unable to move to their second year, can authorities promote degree completion and decrease dropout among students who have already experienced a failure? Using the competing risks model, we show that in spite of low entry barriers, students coming from lower socioeconomic background are more vulnerable to dropout along the whole academic path because of financial constraints that prevent them from re-enrolling. Also, our results reveal that, after a failed year, a significantly higher proportion of students who re-enroll in a different field obtain a degree compared to those that re-enroll in the same field, suggesting that universities should rethink the mechanisms available to manage failure and guide student choices.

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