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Background: Academic emergency medicine (EM) communities have viewed anonymous online communities (AOC) such as Reddit or specialty-specific “applicant spreadsheets” as poor advising resources. Despite this, robust EM AOCs exist, with large user bases and heavy readership. Insights about applicants’ authentic experiences can be critical for applicants and program leadership decision-making. To date, there are no EM studies to qualitatively assess EM AOC narratives during the application cycle. Our goal was to perform a qualitative analysis of students’ EM program experiences through a publicly available AOC. Methods: This was a qualitative analysis of a publicly available, time-stamped, user-locked AOC dataset: “Official 2020–2021 Emergency Medicine Applicant Spreadsheet.” We extracted and then de-identified all data from selected sub-sheets entitled “Virtual Interview Impressions” and “Rotation Impressions.” Four investigators used constant comparative method to analyze the data inductively, and they subsequently met to generate common themes discussed by students. Preliminary thematic analysis was conducted on a random sample of 37/183 (20%) independent narratives to create the initial codebook. This was used and updated iteratively to analyze the entire narrative set consisting of 841 discrete statements. Finally, two unique codes were created to distinguish whether the identified sub-themes, or program attributes, were likely “modifiable” or “non-modifiable.” Results: We identified six major themes: living and working conditions; interpersonal relationships; learning experiences, postgraduate readiness, and online/virtual supplements. Common sub-themes included patient population (13%); resident personality (7%); program leadership personality (7%); relationship with faculty/leadership (6%); geography (4%); practice setting (4%); program reputation (4%), and postgraduate year-3 experiences (4%). Modifiable sub-themes outnumbered non-modifiable sub-themes, 60.7% to 39.3%. Conclusion: In this analysis of selected medical students’ narratives in an AOC, the majority of identified themes represented topics that may serve as external feedback for EM residency programs and their clerkships. Selective use of AOCs may set a precedent for future program assessments by applicants and inform program leadership of important programmatic elements in the eyes of applicants. It elucidates important themes in their interactions or learning experiences with programs and creates opportunities for learner-centric program improvement.

Abstract Background Positive psychology interventions are known to have an impact on mental health as well as on a number of beneficial characteristics like optimism, gratitude and self-efficacy. The Positive Emotions Training (PoET) is one of the first holistic training programs covering eleven positive psychology constructs. The goal of this study was to test PoET’s feasibility in the general population and to assess possible effects on positive and negative mental health factors. Additionally, possible effects on optimism, gratitude, happiness, resilience, and self-efficacy were examined. Methods The sample (n = 101) was not randomized. Participants were allocated to PoET (n = 55) or control group (n = 46) that did not receive treatment initially. The PoET group completed two training sessions (3.5 h each) that were conducted in an online format with groups of about 30 people. All participants completed positive and negative mental health measures at the beginning of the first training session and at the beginning of the second one as well as 30 days after the second session. Two-factorial repeated measures ANOVAs were conducted to test for possible effects of PoET on mental health. Results The results showed that the contents were comprehensible and that the conduction of the training was feasible overall. In addition, a significant decrease of depression and anxiety symptoms as well as a significant increase of optimism were found in the PoET group. No significant changes were found in the control group. Conclusions Results indicate that PoET is an applicable intervention for improving mental health in the general population. Trial registration Retrospectively registered at ClinicalTrials.gov on 21/02/2023 (Identifier/Trial registration number: NCT05737251).

Background The desire to have children has been declining globally, especially in industrialized nations. This study examines the physical health correlates, and positive and negative mental health correlates of the wish to have a child across time and in two countries. Method Questionnaire data were obtained from large-scale university samples of 12,574 participants in Germany and China. Results The wish to have a child (child wish) is related to positive and negative mental health in China and, to a lesser degree, in Germany. Child wish is positively related to some aspects of mental and somatic health for Chinese women and men, negatively to depression for Chinese and German men and Chinese women, and positively to stress for German men, with generally small effects. Effects hold when controlling for age, partnership status, and family affluence. Most relationships were almost equal between women and men (in both China and Germany), and between countries with the exception of two different paths in each gender group. That is, having a partner is associated with a higher child wish in both Chinese and German female students. In China, older female students are more likely to want to have a child, while older female students in Germany are less likely to want to have a child. Neither partnership nor age predict child wish for the next year. Conclusion In sum, Chinese students reported feeling more positively about having children when they were happy and healthy, with the exception that highly satisfied Chinese males report lower child wish in the next year. More depressed Chinese and German men and Chinese women reported lowered child wish, and stressed German men reported more child wish. Older students reported more (Chinese) or less (German) child wish depending on country.

Low self-efficacy for threatening stimuli and situations has been proposed as an important etiological factor in the development and maintenance of specific phobias. The present study examined the relationships between general self-efficacy (GSE), specific self-efficacy (SSE) and specific fears in a representative sample (n = 717). While GSE was associated with higher self-reported fear and avoidance, SSE (e.g. SSE in the presence of animal-related fear) was more related to specific fears. SSE turned out to be a significant predictor of specific fear even after controlling for trait anxiety, age and gender. Interestingly, the association between SSE and specific fear differed across the different fear categories. Fear and avoidance of blood/injection/injuries showed the highest associations with SSE. In contrast, the association between natural environment-related fear and avoidance and GSE or SSE together was only modest. Exploratory analyses revealed a gender-specific effect on the strength of the association between SSE and specific fears. Women scored higher in animal-related fears and SSE. Our findings support the self-efficacy hypothesis of anxiety disorder development and provide a more detailed insight into the role of GSE and SSE in specific fears and phobias.

Abstract Health professions education has benefitted from standardized patient (SP) programs to develop and refine communication and interpersonal skills in trainees. Effective case design is essential to ensure an SP encounter successfully meets learning objectives that are focused on communication skills. Creative, well-designed case scenarios offer learners the opportunity to engage in complex patient encounters, while challenging them to address the personal and emotional contexts in which their patients are situated. Therefore, prior to considering the practical execution of the patient encounter, educators will first need a clear and structured strategy for writing, organizing, and developing cases. The authors reflect on lessons learned in developing standardized patient-based cases to train learners to communicate to patients during times of diagnostic uncertainty, and provide suggestions to develop a set of simulation cases that are both standardized and diverse. Key steps and workflow processes that can assist educators with case design are introduced. The authors review the need to increase awareness of and mitigate existing norms and implicit biases, while maximizing variation in patient diversity. Opportunities to leverage the breadth of emotional dispositions of the SP and the affective domain of a clinical encounter are also discussed as a means to guide future case development and maximize the value of a case for its respective learning outcomes.

Introduction: Students worldwide are at marked risk of suicidal ideation/behavior, depression, and low positive mental health (PMH). Medical students are suspected to be a particularly burdened group. On this background, the aim of the present study was to determine prevalence rates of suicidal ideation/behavior, depression and PMH, among Chinese medical students compared to students from other disciplines. Methods: A total of 2,695 Chinese students (41.2% women; age: M = 18.86, SD = .60, range: 18–21), including 461 medical students, filled out self-report measures on suicidal ideation/behavior, depression, and PMH. Results: Twelve-month suicidal ideation was reported by 10.2% of the medical students and by 11.5% of the other students. Medical students had significantly lower levels of depression symptoms and significantly higher levels of PMH than students from other disciplines. Complete mental health – according to the dual-factor model of mental health – was reported by more than 84% of the total sample. Limitations: Data were assessed by a self-report survey that is prone to social desirability. Conclusions: Students in the present study displayed high rates of complete mental health – although the survey was conducted in the midst of the Corona pandemic. No evidence was found that medical students are particularly stressed.

Reduced physical activity is considered a key feature of major depressive disorder (MDD). However, research directly comparing non-depressed controls and patients yielded mixed findings. In contrast to most previous research, this study compared objective as well as subjective activity levels of individuals with MDD with non-depressed controls and used an ambulatory assessment method. Moreover, we investigated whether objective and subjective measures of activity could predict mood. On two consecutive days, physical activity of 35 MDD patients and 36 non-depressed control participants were assessed objectively using an accelerometer and subjectively with hourly ecological momentary assessments. During the same assessment, participants mood was monitored. No significant differences between MDD patients and control participants in objective and most of the subjective activity measures were observed. We found significant associations between objective and subjective measures of activity in non-depressed as well as in MDD patients. Objective but not subjective measures of activity predicted subsequent mood. Our results support the notion that the association between MDD and activity level is complex and depends on moderating factors.

Abstract Background The objective of this study was to determine the advising and emergency medicine (EM) residency selection practices for special population applicant groups for whom traditional advice may not apply. Methods A survey was distributed on the Council of Residency Directors in EM and Clerkship Directors in EM Academy listservs. Multiple choice, Likert-type scale, and fill-in-the-blank questions addressed the average EM applicant and special population groups (osteopathic; international medical graduate (IMG); couples; at-risk; re-applicant; dual-accreditation applicant; and military). Percentages and 95% confidence intervals [CI] were calculated. Results One hundred four surveys were completed. Of respondents involved in the interview process, 2 or more standardized letters of evaluation (SLOEs) were recommended for osteopathic (90.1% [95% CI 84–96]), IMG (82.5% [73–92]), dual-accreditation (46% [19–73]), and average applicants (48.5% [39–58]). Recommendations for numbers of residency applications to submit were 21–30 (50.5% [40.7–60.3]) for the average applicant, 31–40 (41.6% [31.3–51.8]) for osteopathic, and > 50 (50.9% [37.5–64.4]) for IMG. For below-average Step 1 performance, 56.0% [46.3–65.7] were more likely to interview with an average Step 2 score. 88.1% [81.8–94.4] will consider matching an EM-EM couple. The majority were more likely to interview a military applicant with similar competitiveness to a traditional applicant. Respondents felt the best option for re-applicants was to pursue the Supplemental Offer and Acceptance Program (SOAP) for a preliminary residency position. Conclusion Advising and residency selection practices for special population applicants differ from those of traditional EM applicants. These data serve as an important foundation for advising these distinct applicant groups in ways that were previously only speculative. While respondents agree on many advising recommendations, outliers exist.

The present study examines the relationship between smoking and panic, depression, and anxiety over time and across two cultures, using data from the BOOM studies. The relationship between smoking and anxiety disorders, including panic requires further exploration, in order to reconcile inconsistent, contradictory findings and cross-cultural differences. Participants in the present study included 5,416 Chinese university students and 282 German university students. Participants completed surveys assessing smoking, panic, depression, and anxiety. Multiple logistic regressions were used to examine predict later mental health from smoking, as well as later smoking from mental health. In sum, across the regressions, smoking at baseline did not predict higher panic or depression at follow-up in either German or Chinese students. It did predict lower anxiety in German students. Anxiety at baseline, but not depression, predicted increased likelihood of smoking at follow-up in German students. The relationship between smoking and anxiety disorders is one that will require further exploration, in order to reconcile inconsistent, contradictory findings and cross-cultural differences. The present data point to a relationship between anxiety and later smoking, and also to a negative, though small, relationship between smoking and later anxiety in German students, and no prospective relationship in either direction in Chinese students.

The present study examines the relationship between obesity and mental health using longitudinal data. Participants with data at baseline and one-year follow-up were included from two countries: Germany (364) and China (9007). A series of structural equation models with three mediators and one moderator were conducted separately for female and male students in Germany and China. Zero-order correlations indicated that overweight/obesity was significantly related to later depression and anxiety in Chinese males. Additional effects of obesity on later mental health flowed through effects on attractiveness (Chinese and German females, and Chinese males), physical health (Chinese males), and life satisfaction (German females). Though overweight/obesity is related to mental health across many other studies, results in this study yield total effects between overweight/obesity and follow-up mental health only in Chinese males. The relationship between overweight/obesity and follow-up mental health was significantly mediated by follow-up attractiveness, or health state, or life satisfaction in German females, Chinese females, and Chinese male students, with no significant indirect effects found in German male students. This highlights the possible importance of culture in examining these effects.

Abstract Resuscitative hysterotomy is a daunting and rarely performed procedure in the emergency department (ED). Given the paucity of clinical exposure to this intervention, resuscitative hysterotomy is an ideal opportunity for simulation-mediated deliberate practice. The authors propose a novel training program using a homegrown, realistic, simulation device as a means to practice resuscitative hysterotomy. Two high-fidelity, tissue-based task-trainer models were constructed and tested on a convenience sample of 14 emergency medicine (EM) residents. The simulated human placenta, bladder, amniotic sac, and uterus were constructed through the use of porcine skin, porcine stomach, transparent plastic bag, Foley tubing, and squid mantle, all secured with nylon sutures. A Gaumard S500 Articulating Newborn was inserted in the simulated uterus, and the entire model was placed into a Gaumard S500 Childbirth Simulator. Each model required less than 1 h for assembly. Emergent hysterotomy was first demonstrated by an EM faculty facilitator, followed by hands-on deliberate practice. Formal feedback on the learners’ self-reported confidence and satisfaction levels was solicited at the end of the workshop through a survey previously cited for use with a low-fidelity resuscitative hysterotomy. Quantitative evaluation of the simulated training session was extracted through a 5-item questionnaire using a 5-point Likert-type scale (i.e., from 1, strongly disagree, to 5, strongly agree). Item scores were added for a cumulative total score, with a possible maximum score of 25 and minimum score of 5. Responses were overwhelmingly positive [24.13 (± 1.36)]. Qualitative feedback was extracted from the survey through open-ended questions; these responses highlighted learners’ appreciation for hands-on practice and the development of a novel, tissue-based simulation task trainer. All participants recommended the training session be available to future learners. Resuscitative hysterotomy is a high-stakes, low-frequency procedure that demands provider practice and confidence. Our hybrid, tissue-based hysterotomy model represents a feasible opportunity for training. The model is cost conscious, easily reproducible, and portable and allows for ample deliberate practice.

Ocular trauma is one of the most common and vision-threatening ophthalmic presentations with a wide spectrum of complications, such as bleeding, infection, vision loss, and enucleation. A 64-year-old-male presented to the emergency department (ED) with a self-inflicted orbital penetrating injury with a hair comb. Computed tomography showed the comb traversed the medial orbit inferior to the medial rectus but did not damage the optic nerve; there were no globe or orbital wall fractures. His ocular exam was significant for a right eye afferent pupillary defect and decreased visual acuity 20/800, consistent with optic neuropathy. Primary concerns were stabilizing and removing the foreign body without causing further damage in the setting of an uncooperative patient. The comb was removed with the aid of local and systemic analgesia using gentle traction and normal saline irrigation. The patient was admitted for systemic and topical antibiotics and showed improvement in visual acuity and resolution of his optic neuropathy. This case illustrates the importance of rapid ED assessment and management of complex penetrating ocular trauma. Examination should specifically look for signs of globe rupture and optic nerve injury. Expedited foreign body removal should be managed together with an ophthalmologist with procedural sedation and broad-spectrum antibiotics to avoid further visual and infectious complications.

The present study examines a broad range of longitudinal predictors of dimensional positive mental health (PMH) and negative mental health (NMH), using data from the BOOM study. Participants were drawn from university student samples in Germany (1,608), Russia (677) and China (12,057). A structural equation model was conducted with four groups of predictors and PMH/NMH as criteria (outcomes). Five of the six salutogenic predictors were predictive of both positive mental health (positively) and negative mental health, as measured by depression (negatively). Pathogenic predictors anxiety and depression were related to future depression, but not to positive mental health. Stress at baseline was related to both future positive mental health (negatively) and future depression (positively). Being male in this study was associated with increased future depression. Results hold across Germany, Russia, and China. Results support the conceptualization of positive and negative mental health as related, but independent dimensions across three cultures.

Introduction Although residents are on the front lines of patient care, they enter few formal patient safety reports on the adverse events and near misses they witness. Demonstrating the rationale and mechanics of reporting may improve this. Methods We designed and implemented an escape room patient safety simulation to incorporate active learning, gamification, and adult learning theory into intern patient safety onboarding. Interns from all sponsoring institution programs participated, identifying, mitigating, and reporting a range of patient safety hazards. Props and faculty time were the major resources required. Results One hundred twenty interns participated in this simulation in June 2018. Forty-one percent reported previous training on reporting errors, and only 5% had previously entered an event report. Average confidence in ability to identify patient safety hazards improved after the simulation from 6.35 to 8.00 on a 10-point rating scale. The simulation was rated as relevant or highly relevant to practice by 96% of interns. Discussion Several factors contribute to a low error-reporting rate among house staff. We developed a simulation modeled on popular escape room activities to increase awareness of safety hazards and ensure familiarity with the actual online reporting system our interns will use in the clinical environment.

AVATAR therapy offers a unique therapeutic context that uses virtual reality technology to create a virtual embodiment of the voice-hearing experience, enabling the person to visualize their persecutory voice and engage in real-time “face-to-face” dialogue. The present study explores, for the first time, the contribution of sense of voice presence, together with session-by-session reduction of anxiety and paranoid attributions about the avatar, to changes in primary outcomes following AVATAR therapy. Data from 39 participants, who completed AVATAR therapy and attended a 12-week follow-up assessment, were analysed. Mid- to high-levels of sense of voice presence were reported across the therapy sessions, along with significant reductions of anxiety levels and paranoid attributions about the avatar. The interaction of sense of voice presence and reduction of anxiety was associated with two of the significant therapy outcomes: PSYRATS total and frequency of voices. The findings suggest that improvements in voice severity and frequency at post AVATAR therapy may be influenced by the combination of feeling less anxious in the context of a realistic simulation of the voice, while voice-related distress may involve additional cognitive and relational processes.

El estrés cotidiano, en comparación con acontecimientos traumáticos, es reconocidocada vez más como un importante factor de riesgo para la salud mental. El papel de laautoeficacia general en la relación entre estrés diario y aspectos de la salud mental todavíano se ha examinado. Teniendo en cuenta el modelo de dos factores, que postula que la saludmental es más que la ausencia de síntomas psicopatológicos, examinamos la mediación de la autoeficacia separadamente para la salud mental positiva y negativa. Efectos totales, directose indirectos fueron evaluados, utilizando datos de una muestra de la población alemana representativa(N = 1.031). La autoeficacia es un mediador de los efectos del estrés cotidiano, conefectos superiores para la salud mental positiva. Los resultados fueron replicados en muestrasde estudiantes de Alemania (N = 394), Rusia (N = 604) y China (N = 8.669). La autoeficacia actúacomo un búfer para el estrés cotidiano. Un modelo de mediación completo no fue apoyado conmúltiples recursos psicológicos que pueden tener efectos protectores. Es la primera evidenciatransnacional para diferentes efectos del búfer-estrés para las dos dimensiones de saludmental.

Introduction Augmented reality (AR), mixed reality (MR), and virtual reality devices are enabling technologies that may facilitate effective communication in healthcare between those with information and knowledge (clinician/specialist; expert; educator) and those seeking understanding and insight (patient/family; non-expert; learner). Investigators initiated an exploratory program to enable the study of AR/MR use-cases in acute care clinical and instructional settings. Methods Academic clinician educators, computer scientists, and diagnostic imaging specialists conducted a proof-of-concept project to 1) implement a core holoimaging pipeline infrastructure and open-access repository at the study institution, and 2) use novel AR/MR techniques on off-the-shelf devices with holoimages generated by the infrastructure to demonstrate their potential role in the instructive communication of complex medical information. Results The study team successfully developed a medical holoimaging infrastructure methodology to identify, retrieve, and manipulate real patients’ de-identified computed tomography and magnetic resonance imagesets for rendering, packaging, transfer, and display of modular holoimages onto AR/MR headset devices and connected displays. Holoimages containing key segmentations of cervical and thoracic anatomic structures and pathology were overlaid and registered onto physical task trainers for simulation-based “blind insertion” invasive procedural training. During the session, learners experienced and used task-relevant anatomic holoimages for central venous catheter and tube thoracostomy insertion training with enhanced visual cues and haptic feedback. Direct instructor access into the learner’s AR/MR headset view of the task trainer was achieved for visual-axis interactive instructional guidance. Conclusion Investigators implemented a core holoimaging pipeline infrastructure and modular open-access repository to generate and enable access to modular holoimages during exploratory pilot stage applications for invasive procedure training that featured innovative AR/MR techniques on off-the-shelf headset devices.

Estudios previos sobre orientaciones de valores tradicionales y modernos encontraron relaciones predictivas mediadas con trastornos mentales particulares. El objetivo de este estudio con muestras procedentes de tres países (Alemania, Rusia y China) es ampliar los resultados indicadores más amplios de salud mental (SM) y dos tipos de mediadores (apoyo social y resiliencia), de acuerdo a la teoría de los valores y la modernización/postmodernización. Se probó en los tres países un path-model con valores tradicionales prediciendo la SM mediada por el apoyo social y valores modernos prediciendo la SM mediada por la resiliencia. Como era de esperar, las orientaciones de valores eran en su mayor parte más fuertes en China, seguido por Rusia y Alemania. Modelos de ecuaciones estructurales apoyaron la hipótesis de la predicción de la SM mediada por las orientaciones de valores en general. La benevolencia de valores tradicionales predice el apoyo social, mientras que el valor autodirección moderna predice la resiliencia. Las orientaciones de valores constituyen una herramienta sensible para describir empíricamente las diferencias interculturales. Los resultados indican que las orientaciones de valores personales son predictores significativos de la SM. El análisis de los valores personales se muestra prometedor en la salud pública transcultural y cuestiones de modernización.

Social rhythm refers to the general regularity of engaging in basic social activities during the week, and was found to be associated with individuals’ positive mental health. The present study investigated the relationship between social rhythm and emotional well-being in a cohort of 2,031 college students over 3 years with a cross-lagged longitudinal panel design. Results revealed that regularity of social rhythm positively predicted emotional well-being in the following year, and vice versa, when the level of both factors in the previous year was controlled. Our study provides evidence of a longitudinal positive reciprocal relationship between social rhythm and positive mental health in younger adult populations.

Abstract Introduction Opiate overdose is a dangerous but common chief complaint to the emergency department. While many patients with opiate intoxication respond well to opiate reversal agents and noninvasive airway management, some cases involve persistent respiratory failure, hemodynamic instability, and unintentional head trauma that may necessitate airway management. This simulation allows emergency medicine residents to explore an unusual but high-risk disease process: persistent hypoxia in an intubated patient with severe acute respiratory disease syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO). Methods This case ran for four separate iterations at a simulation center, with a Laerdal 3G Sim Man, respiratory therapist, actor, residents, and attending physician acting as specific confederates for their respective roles. Following each case, learners were debriefed at bedside, discussed a PowerPoint presentation, and underwent a question-and-answer session. Results Both junior and senior resident groups recognized esophageal intubation, diagnosed ARDS, and proposed treatment goals. Although junior residents recognized that optimal ventilation had not been achieved, they were unable to specifically direct ventilator recruitment maneuvers. Senior residents were more likely to articulate treatment orders, to instruct junior residents to address family members, and to recognize severe ARDS requiring early consultation of the intensive care unit and discussion of disposition. After case completion and debriefing, all learners demonstrated achievement of learning objectives, as well as managing acute dyspnea, treating opiate overdoses, and understanding the role of ECMO in severe ARDS patients. Discussion Overall, we noted this case worked well for junior EM residents with senior resident backup for supervision and guidance. The presence of a certified respiratory therapist was invaluable and was greatly appreciated by both learner groups, especially during the debriefing section where they discussed various ventilator optimization techniques in conjunction with case instructors.

Background: The desire to have children has been declining globally, especially in industrialized nations. This study examines the physical health correlates, and positive and negative mental health correlates of the wish to have a child across time and in two countries.Method: Questionnaire data were obtained from large-scale university samples of 12,574 participants in Germany and China.Results: The wish to have a child (child wish) is related to positive and negative mental health in China and, to a lesser degree, in Germany. Child wish is positively related to some aspects of mental and somatic health for Chinese women and men, negatively to depression for Chinese and German men and Chinese women, and positively to stress for German men, with generally small effects. Effects hold when controlling for age, partnership status, and family affluence. Most relationships were almost equal between women and men (in both China and Germany), and between countries with the exception of two different paths in each gender group. That is, having a partner is associated with a higher child wish in both Chinese and German female students. In China, older female students are more likely to want to have a child, while older female students in Germany are less likely to want to have a child. Neither partnership nor age predict child wish for the next year.Conclusion: In sum, Chinese students reported feeling more positively about having children when they were happy and healthy, with the exception that highly satisfied Chinese males report lower child wish in the next year. More depressed Chinese and German men and Chinese women reported lowered child wish, and stressed German men reported more child wish. Older students reported more (Chinese) or less (German) child wish depending on country. [ABSTRACT FROM AUTHOR]