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Background Engaging and motivating busy trainees to work on reducing the climate impact of their clinical practice is challenging. To our knowledge, there are no published studies of graduate medical education (GME)-wide, institutional efforts to engage residents in implementing climate sustainability improvement projects. Objective We piloted a novel, institution-wide, pay-for-performance (P4P) sustainability quality improvement (SusQI) program in 2023-2024 that enabled residents from all GME programs to implement SusQI projects with practice-changing improvement goals for a financial incentive. Methods Project leaders were provided an opportunity to implement a project by identifying a SusQI problem and collaborating with stakeholders toward meeting environmentally friendly monthly improvement goals for an incentive payment. Eligible residents who reached their monthly goal for 6 months of the academic year would receive $400. Results Of the 4 SusQI projects approved for the P4P program, 3 remained active after 6 months. One project stalled because of institutional barriers. Two hundred and ten residents participated. Environmental impacts included an increase in low anesthetic gas flow use in operating room cases (mean [SD] 25% to 53% [0.1]), increase of radiology workroom waste sorting into recycling and composting bins (mean [SD] 20% to 58% [0.1]), and increase in emergency department instruments recycled (mean [SD] 9% to 24% [0.2]). Two hundred and ten residents are set to receive $84,000 at the end of the year for meeting their SusQI goals. Conclusions We were able to integrate sustainability into QI programs by implementing an institution-wide pay-for-performance SusQI program that encouraged residents to develop and implement environmentally friendly practice projects.

BACKGROUND AND OBJECTIVES: Musculoskeletal (MSK) complaints comprise more than 20% of all visits to health care providers each year. Despite required experiences in MSK care, family physicians report low confidence in diagnosing and treating MSK conditions. The purpose of this study was to analyze the effects of early and longitudinal exposure to MSK education on residents confidence in and likelihood of performing MSK physical exams and injections in future practice. METHODS: From 2017 to 2019, residents completed an annual survey assessing confidence in, frequency of, and future intentions to perform exams and injections for MSK conditions. We compared responses between family medicine residents who completed a 176-hour longitudinal sports medicine (LSM) curriculum distributed over all 3 years of residency and a comparable cohort of family medicine residents who completed a 188-hour concentrated MSK curriculum primarily in the final year of residency. We made comparisons using the Fisher exact test for categorical variables and an independent samples t test for numeric variables. RESULTS: We analyzed the 98 total responses from 50 residents. The proportion of residents reporting high ratings of their residency MSK education (26% to 60%), performing >5 injections (38% to 73%), reporting confidence in performing injections (12% to 40%), and indicating likelihood to perform MSK injections in the future (52% to 65%) were all greater in the LSM versus concentrated MSK curriculum cohorts (P

OBJECTIVE: An expert panel made recommendations to optimize surgical education and training based on the effects of contemporary challenges. BACKGROUND: The inaugural Blue Ribbon Committee (BRC I) proposed sweeping recommendations for surgical education and training in 2004. In light of those findings, a second BRC (BRC II) was convened to make recommendations to optimize surgical training considering the current landscape in medical education. METHODS: BRC II was a panel of 67 experts selected on the basis of experience and leadership in surgical education and training. It was organized into subcommittees which met virtually over the course of a year. They developed recommendations, along with the Steering Committee, based on areas of focus and then presented them to the entire BRC II. The Delphi method was chosen to obtain consensus, defined as ≥80% agreement among the panel. Cronbach α was computed to assess the internal consistency of 3 Delphi rounds. RESULTS: Of the 50 recommendations, 31 obtained consensus in the following aspects of surgical training (# of consensus recommendation/# of proposed): Workforce (1/5); Medical Student Education (3/8); Work Life Integration (4/6); Resident Education (5/7); Goals, Structure, and Financing of Training (5/8); Education Support and Faculty Development (5/6); Research Training (7/9); and Educational Technology and Assessment (1/1). The internal consistency was good in Rounds 1 and 2 and acceptable in Round 3. CONCLUSIONS: BRC II used the Delphi approach to identify and recommend 31 priorities for surgical education in 2024. We advise establishing a multidisciplinary surgical educational group to oversee, monitor, and facilitate implementation of these recommendations.

The Healthcare Improvement and Innovation in Quality (THINQ) Collaborative is a uniquely designed program that engages undergraduate and postgraduate students to participate in improving health care and addressing important clinical problems. In 9 years, over 120 THINQ Fellows have been trained in quality improvement (QI) frameworks and methodologies focusing on research skills, social justice, leadership development, and problem-solving. Program evaluation has included surveying current and former THINQ Fellows about their experiences with the program and its subsequent impact on their careers. THINQs research and outreach initiatives have contributed to improvements in workflows and clinical care on topics such as interdisciplinary team communication, discharge and care transition, sepsis management, and physician burnout. The THINQ Program has equipped future health care leaders to engage with and address QI issues in clinical practice. The structures, processes, and outcomes discussed here can guide other institutions in creating similar QI programs.

A 7-session narrative medicine (NM) curriculum was designed and facilitated by pediatrics residents for pediatrics residents in order to unpack challenging experiences during clinical training and strengthen relationships with colleagues and patients. The primary facilitator, a resident with a masters degree in NM, provided facilitator training to her co-residents with whom she co-led the workshops in the curriculum. We conducted, transcribed, and analyzed individual interviews of 15 residents, with three resultant themes: reflection on personal and professional identity; connection to others and community building; and reconceptualization of medical practice. Residents shared that they experienced greater solidarity, professional fulfillment, appreciation for multiple facets of their identities, recognition of holding space for vulnerability, and advocacy for marginalized populations. Our study highlights the feasibility and effectiveness of peer-led NM workshops to enhance clinical training through self-reflection, inclusion of persons from underrecognized backgrounds, and promotion of values consistent with humanistic care. IMPACT: A novel narrative medicine curriculum was designed and facilitated by pediatrics residents for pediatrics residents. The curriculum was feasible and acceptable to pediatrics residents and required a facilitator with content and methodology expertise in narrative medicine to train additional facilitators. Three themes emerged from resident interviews: reflection on personal and professional identity; connection to others and community building; and reconceptualization of medical practice on individual and global levels.

Purpose: Dental students learn knowledge and practical skills to provide oral health care to the population. Practical skills must be maintained or continuously developed throughout a professional career. This cross-sectional survey aimed to evaluate the perception of practical skills of dental students and dental-school graduates by national dental associations (NDAs) in international comparison in the European Regional Organization of the FDI World Dental Federation (ERO-FDI) zone. Materials and Methods: A questionnaire of 14 items collected information on pre-/postgraduate areas. Results: A total of 25 countries participated (response rate: 69.4%), with 80.0% having minimum requirements for practical skills acquisition and 64.0% starting practical training in the 3rd year of study. In countries where clinical practical work on patients begins in the 2nd year of study, practical skills of graduates are perceived as average, starting in the 3rd year of study as mainly good, starting in the 4th as varying widely from poor to very good. In total, 76.0% of respondents feel that improvements are needed before entering dental practice. Improvements could be reached by treating more patients in dental school (32.0%), increasing the quantity of clinical training (20.0%), or having more clinical instructors (12.0%). In 56.0% of the countries, it is possible to open one’s own dental practice immediately after graduation, and in 16.0%, prior vocational training is mandatory. Conclusions: All participating countries in the ERO-FDI zone reported practical training in dental school, most starting in the 3rd year of study. The perception of practical skills of dental students and dental-school graduates among NDAs is very hetero geneous. Reasons for the perceived deficiencies should be further explored. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although women comprise the majority of medical students, gender disparities emerge early and remain at the highest levels of academia. Most leadership courses focus on faculty or students rather than women graduate medical education (GME) trainees. AIM: To promote the leadership development of women GME trainees through empowerment, community building, networking and mentorship, and concrete leadership skills development. SETTING: University of California, San Francisco. PARTICIPANTS: 359 women residents and fellows from 41 specialties. PROGRAM DESCRIPTION: A longitudinal curriculum of monthly workshops designed to support leadership development for women trainees. Sessions and learning objectives were designed via needs assessments and literature review. PROGRAM EVALUATION: A mixed-methods evaluation was performed for 3 years of WILD programming. Quantitative surveys assessed participant satisfaction and fulfillment of learning objectives. Structured interview questions were asked in focus groups and analyzed qualitatively. DISCUSSION: 23% of invited participants attended at least one session from 2018 to 2021, despite challenging trainee schedules. Surveys demonstrated acceptability and satisfaction of all sessions, and learning objectives were met at 100% of matched sessions. Focus groups highlighted positive impact in domains of community-building, leadership skills, mentorship, and empowerment. This program has demonstrated WILDs longitudinal sustainability and impact for women trainees.

BACKGROUND: Incorporation of the rapid advances in ophthalmologic surgical and diagnostic techniques inherent in the field poses a challenge to residency training programs. This study investigates exposure to new technologies during residency and perception of its impact on practice patterns. METHODS: Ophthalmology residents at various training levels and practicing ophthalmologists who had completed their training were invited to participate in a survey study assessing exposure to various technologies in residency and in practice. Data collection occurred from December 2022 to June 2023. Descriptive statistics were performed. RESULTS: The study received 132 unique responses, including 63 ophthalmology residents and 69 practicing ophthalmologists. 65.2% (n = 45) of practicing ophthalmologists and 47.6% (n = 30) of current residents reported discussion/training on newly developed products on the market (e.g. premium IOLS, MIGS), was minimally discussed but not emphasized or not discussed at all in residency. 55.1% (n = 38) of practicing ophthalmologists reported that exposure to new technologies during residency did influence types of technologies employed during practice. The majority resident physicians reported enjoying being trained on newer technology and feeling more prepared for future changes in the field (95.2%, n = 60) and felt that having industry partnerships in residency enhances education and training (90.5%, n = 57). CONCLUSIONS: Considering how to maximize exposure to newer technologies/devices during residency training is important, and may contribute to training more confident, adaptable surgeons, who are more likely to critically consider new technologies and adopt promising ones into their future clinical practice.

BACKGROUND: Assessment of the ocular fundus, traditionally by direct ophthalmoscopy (DO), is essential to evaluate many neurologic diseases. However, the status of DO training in neurology residencies is unknown. We conducted a needs assessment to determine current attitudes, curricula, and gaps in DO training. METHODS: A survey was developed and administered to residents and program directors (PDs) at ACGME accredited neurology residencies in the United States. The survey assessed factors such as current DO curricula, perceived importance of DO, confidence of skills, and need for improvement. Data analysis was performed using the Mann Whitney U test and Fisher Exact Test. RESULTS: Nineteen PDs (11.6%) and 74 (41.1%) residents responded to the survey. 97.1% of residents and 100.0% of PDs believe DO is an important skill to learn. 29.4% of PDs expected graduating residents to have completed > 10 supervised DO exams, while 0.0% of graduating fourth year residents reported doing so (p = 0.03). 35.7% of graduating residents had never correctly identified an abnormal finding on DO. The number of times residents practiced DO unsupervised correlated with increasing confidence in all components of the DO exam (p

BACKGROUND: Institutional Graduate Medical Education (GME) Well-being Director (WBD) roles have recently emerged in the United States to support resident and fellow well-being. However, with a standard position description lacking, the current scope and responsibilities of such roles is unknown. This study describes the scope of work, salary support, and opportunities for role definition for those holding institutional leadership positions for GME well-being. METHODS: In November 2021, 43 members of a national network of GME WBDs in the United States were invited to complete a cross-sectional survey that included questions about job responsibilities, percent effort, and dedicated budget, and a free text response question about unique leadership challenges for GME WBDs. The survey was analyzed using descriptive statistics for quantitative data and thematic analysis for qualitative data. RESULTS: 26 members (60%) responded. Most were physicians, and the majority identified as female and White. Median percent effort salary support was 40%. A small minority reported overseeing an allocated budget. Most respondents worked to improve access to mental health services, oversaw institution-wide well-being programs, designed or delivered well-being content, provided consultations to individual programs, met with trainees, and partnered with diversity, equity, and inclusion (DEI) efforts. GME WBDs described unique challenges that had implications for perceived effectiveness related to resources, culture, institutional structure, and regulatory requirements in GME. DISCUSSION: There was high concordance for several key responsibilities, which may represent a set of core priorities for this role. Other reported responsibilities may reflect institution-specific needs or opportunities for role definition. A wide scope of responsibilities, coupled with limited defined budgetary support described by many GME Well-being Directors, could limit effective role execution. Future efforts to better define the role, optimize organizational reporting structures and provide funding commensurate with the scope of work may allow the GME Well-being Director to more effectively develop and execute strategic interventions.

IntroductionUrology residency prepares trainees for independent practice. The optimal operative chief resident year experience to prepare for practice is undefined. We analyzed the temporal arc of cases residents complete during their residency compared to their chief year in a multi-institutional cohort.MethodsAccreditation Council for Graduate Medical Education case logs of graduating residents from 2010 to 2022 from participating urology residency programs were aggregated. Resident data for 5 categorized index procedures were recorded: (1) general urology, (2) endourology, (3) reconstructive urology, (4) urologic oncology, and (5) pediatric urology. Interactions were tested between the trends for total case exposure in residency training relative to the chief resident year.ResultsFrom a sample of 479 resident graduates, a total of 1,287,433 total cases were logged, including 375,703 during the chief year (29%). Urologic oncology cases had the highest median percentage completed during chief year (56%) followed by reconstructive urology (27%), general urology (24%), endourology (17%), and pediatric urology (2%). Across the study period, all categories of cases had a downward trend in median percentage completed during chief year except for urologic oncology. However, only trends in general urology (slope of -0.68, P = .013) and endourology (slope of -1.71, P ≤ .001) were significant.ConclusionsOver 50% of cases completed by chief residents are urologic oncology procedures. Current declining trends indicate that residents are being exposed to proportionally fewer general urology and endourology cases during their chief year prior to entering independent practice.

ObjectiveWe aimed to describe pediatric program directors' perceptions of existing mentorship programs in pediatric residencies, to assess whether characteristics used for mentor-mentee assignments impact mentoring outcomes, and to identify barriers to success in mentorship programs.MethodsWith the support of the Association of Pediatric Program Directors (APPD) Research Task Force, we conducted a cross-sectional survey study of all associate pediatric program directors in the United States in March 2022.ResultsNearly half (82 of 197, 41.6%) of programs responded. Most (87.8%) report having a formal mentoring program. Half of programs (51.4%) do not provide training to residents on how to be a mentee, and only slightly more than half (62.5%) provide training to faculty mentors. Most programs (80.6%) do not provide protected time for faculty mentors. There were no meaningful associations with characteristics used for mentorship matches and perceived successful mentorship. Top barriers from the program leadership perspective included faculty and residents lacking time, residents lacking skills to be proactive mentees, and inadequate funding.ConclusionsWhile a majority of programs have formal mentorship programs, many do not provide training to mentors or mentees. Barriers to mentorship include a lack of funding and time. National organizations, such as APPD and the Accreditation Council for Graduate Medical Education, have an opportunity to provide guidance and support for protected time, funding, and training for mentors and mentees.

Background Medical trainees must learn how to provide effective feedback as an essential communication skill, yet few models exist for training and assessing these skills. Objective To develop an observed structured feedback examination (OSFE) to provide feedback training to pediatric fellows and assess changes in skills and self-reported confidence. Methods This educational study was conducted from 2019 to 2020 at an academic childrens hospital. Our team developed the OSFE and trained standardized feedback recipients and faculty. Fellows completed baseline self-assessments (31 items) on prior exposure to feedback training, application of skills, and confidence. They then participated in the OSFE, giving feedback to a standardized recipient using a standardized scenario, and were scored by faculty and recipients using a 15-item checklist for performance. Next, fellows participated in feedback training and received individualized feedback, after which they repeated the OSFE and confidence self-assessment. Three months later, fellows completed self-assessments on confidence and application of skills and another OSFE to assess retention. Descriptive statistics and signed rank sum test were used for analysis. Results Of 60 eligible fellows, 19 participated (32%), with 100% follow-up. After training and individualized feedback, all fellows improved feedback skills as measured by OSFE performance (mean change +0.89). All items, measured on a 5-point Likert scale, were sustained 3 months later (mean change +0.92). All fellows reported improved confidence in feedback knowledge (mean change +2.07 post, +1.67 3 months post). Conclusions Feedback training using simulation and individualized feedback moderately improved fellows performance, confidence, and 3-month retention of feedback skills.

Background: Clinical teachers often struggle to record trainee underperformance due to lacking evidence-based remediation options. Objectives: To provide updated evidence-based recommendations for addressing academic difficulties among undergraduate and postgraduate medical learners. Methods: A systematic review searched databases including MEDLINE, CINAHL, EMBASE, ERIC, Education Source, and PsycINFO (2016–2021), replicating the original Best Evidence Medical Education 56 review strategy. Original research/innovation reports describing intervention(s) for medical learners with academic difficulties were included. Data extraction used Michie's Behaviour Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraised used the Mixed Methods Appraisal Tool (MMAT). Authors synthesized extracted evidence by adapting GRADE approach to formulate recommendations. Results: Eighteen articles met the inclusion criteria, primarily addressing knowledge (66.7%), skills (66.7%), attitudinal problems (50%) and learner's personal challenges (27.8%). Feedback and monitoring was the most frequently employed BCT. Study quality varied (MMAT 0–100%). We identified nineteen interventions (UG: n = 9, PG: n = 12), introducing twelve new thematic content. Newly thematic content addressed contemporary learning challenges such as academic procrastination, and use of technology-enhanced learning resources. Combined with previous interventions, the review offers a total dataset of 121 interventions. Conclusion: This review offers additional evidence-based interventions for learners with academic difficulties, supporting teaching, learning, faculty development, and research efforts. [ABSTRACT FROM AUTHOR]

Objective: Pediatric emergency medicine (PEM) fellowship directors can interview candidates from either pediatric or EM residency programs. Currently, most candidates are pediatricians; however, because emergency physicians have attributes that could benefit PEM, our goal was to investigate facilitators and barriers to training more of them to become PEM physicians. Methods: We surveyed U.S. PEM fellowship program directors (PDs) about their program's recruitment practices: Do they recruit only pediatricians or mostly pediatricians with an occasional emergency physician or do they actively recruit both? We solicited volunteers from each recruitment group for interviews. These were recorded, transcribed, and thematically coded using summative content analysis. Comments were cataloged into themes that were philosophical or logistic in nature and those that might facilitate (drivers) or serve as barriers (restrainers) to the inclusion of emergency physicians in PEM. Results: We received 50 of 86 (58%) survey responses, 29 (34%) of whom volunteered for interviews. The 17 volunteers we selected for interviews generated 13 themes that fell into the four major theme categories: four philosophical drivers, three logistic drivers, two philosophical restrainers, and four logistic restrainers. Program groups differed with regard to the inclusion of emergency physicians. Most limiting were the impact of variable program length and the implicit belief that pediatricians are best suited to treat children. Most beneficial is the recognized value of EM graduates to the field of PEM. Conclusions: While PDs acknowledged a growing need for PEM physicians, particularly in community hospitals, and that emergency physicians would contribute to PEM, they also identified the logistical burden of including them in programs primarily designed for pediatricians. This burden involves maintaining separate curricula for EM graduates and finding emergency physician faculty to serve as mentors. PDs also expressed a desire for resources to guide the integration of more emergency physicians into their programs. [ABSTRACT FROM AUTHOR]

Clinical education for nurse practitioner (NP) students is increasingly challenging. With fewer preceptors, lack of resources and time burden, finding clinical placements is a burdensome responsibility. Also, when students have multiple preceptors, there may be inconsistencies when evaluating students. With the change to competency-based education, consistency is crucial when evaluating NP students. Typical preceptorship with students is a 1:1:1 ratio: one student with one preceptor for one semester. The Dyad/Precepting to Optimize Development (POD) model has potential to improve clinical precepting. Precepting to optimize development refers to a consistent team of students, preceptors, and faculty over the course of the students' education. Dyad refers to two students with one preceptor. Students rotate in dyad pairs every 4–8 weeks with a consistent group of preceptors, and see these same preceptors again over the course of their educational journey. Preceptors met monthly to collaborate, discuss, and learn. This article reports on the outcomes of a mixed-methods feasibility study that occurred over a year. The students, preceptors, and faculty report satisfaction with the model. Several themes arose during analysis of focus group sessions. Those themes were as follows: safe learning environment; everyone teaches, everyone learns; growth mindset; teaming culture and the POD structure is essential to the dyad. In conclusion, developing a different approach to precepting is essential to meet national provider needs. The Dyad/POD model provides consistency for development and evaluation of the NP student. [ABSTRACT FROM AUTHOR]

Preclinical simulation is an evidence-based method for nurse practitioner (NP) students to improve clinical communication and disease management competency. During simulation, students may receive feedback from multiple sources, including standardized patients (SPs), faculty, peers, and themselves. Although evidence supports simulation with multisource feedback, its impact on clinical knowledge and communication has yet to be evaluated among NP students. We designed, implemented, and evaluated a preclinical simulation program with structured multisource feedback integrated into a disease management course within a Doctor of Nursing Practice curriculum. Differences in communication self-efficacy and disease management knowledge before and after participation, as well as perceptions of learning and importance of varying feedback sources, were evaluated using a single group pre–post mixed-methods design. On average, clinical communication self-efficacy was significantly higher, and disease management knowledge scores were significantly higher after participation. Learners rated feedback sources as important or very important and described varying feedback sources as complementary. Feedback from SPs, peers, learners themselves, and faculty was complementary and important to learning. This preclinical simulation program with purposeful integration of multisource feedback provides an evidence-based foundation for scaffolding multidomain competency development into curriculums to meet updated standards of advanced nursing education. [ABSTRACT FROM AUTHOR]

Chile is a South American country that spans 4,300 km from north to south. Population density and access to critical care are highly concentrated in Santiago's metropolitan region. After the educational challenges posed by the 2009 H1N1 influenza pandemic, our critical care department at the Pontificia Universidad Católica de Chile in Santiago created the Respiratory Therapy Postgraduate Certificate as an educational intervention to address the shortage of healthcare professionals with knowledge and skills in performing respiratory support in critically ill patients. Throughout this Perspective, we aim to delineate the program design, major educational results, implementation of educational innovations that allowed us to adapt to the geographical challenges of the country and those imposed by the coronavirus disease (COVID-19) pandemic, and future challenges identified for the next decade. [ABSTRACT FROM AUTHOR]

Background: In Australia, a government insurance scheme (Medicare) pays set rebates for a range of distinct general practitioner (GP) services. GPs may ‘bulk-bill’ and accept the Medicare rebate fee directly, or ‘privately-bill’ by charging the patient a higher fee that is partially reimbursed by Medicare. The billing behaviour of Australian GP registrars (trainees) and their decision to bulk- or privately-bill patients is an evidence gap. This study aimed to establish the prevalence and associations of registrars’ bulk-billing versus private-billing. Methods: A cross-sectional analysis of data from the ReCEnT study, 2010–2021. The primary analysis used univariable and multivariable logistic regression, with the outcome factor being whether a consultation was bulk-billed versus privately-billed. The primary analysis excluded practices that universally bulk-bill or universally privately-bill all patients. A secondary analysis included all practices regardless of billing policy to provide an overall perspective of billing across the breadth of GP vocational training. Results: For the primary analysis, 3,086 GP registrars recorded details of 316,141 consultations. Bulk-billing accounted for 61.8%, [95% CI:61.6%, 62.0%] of consultations. Significant positive associations of bulk-billing included: younger and older patient age (compared to patients aged 15–34 years, aOR 5.45; CI: [5.06, 5.87] for patients aged 0–14 years, aOR 2.36; 95% CI: [2.24, 2.49] for patients aged 65–74 years, and aOR 4.48; CI: [4.13, 4.85] for 75 years-and-older). Significant negative associations of bulk-billing included patients new to the practice (aOR 0.39; CI: [0.37, 0.41]) and patients new to the registrar (aOR 0.56; CI: [0.55, 0.58]), compared to existing patients of the registrar and practice; and practices with lesser socio-economic disadvantage (aOR 0.91; CI: [0.89, 0.93] per decile decrease in socioeconomic disadvantage). Bulk-billed consultations were positively associated with arranging patient follow-up (with the registrar aOR 1.06; CI: [1.03, 1.09]; or with another GP in the practice aOR 1.40; CI: [1.33, 1.46]). Conclusions: Registrar billing decisions may, in part, reflect government bulk-billing incentives but our findings suggest other factors may contribute, including the provision of affordable care recognising patient need (children and elderly, and those living in areas of greater socioeconomic disadvantage) and continuity of care. Further research is needed to better understand how, and why, registrars make billing decisions. [ABSTRACT FROM AUTHOR]

Introduction Ventral hernia repair cost the U.S. healthcare system nearly 3 billion dollars annually. Surgical repair is a critical competency for residents yet hernia recurrence rates following mesh-based repair range from 0.8% to 24%. Improving surgical techniques using cadavers is often cost-prohibited for many education programs and limited research exists using simulation models with a corresponding hernia repair curriculum in the graduate medical education setting. This pilot project aimed to develop a low cost, easily reproducible novel abdominal wall reconstruction model and pilot-test the ventral hernia repair curriculum to inform further refinement prior to formal evaluation. Material and Methods This descriptive study pilot-tested the newly refined Abdominal Wall Surgical Skills Operative Model (AWSSOM) simulator for ventral hernia repair with mesh and its corresponding 2-h training curriculum for use at all levels of general surgery graduate medical education. The AWSSOM is a 3D printed synthetic anatomically realistic abdominal wall model consisting of silicone cured layers of skin, fat, rectus abdominis and a posterior rectus sheath fascia, and silicone tubules to simulate lateral neurovascular bundles. The curriculum incorporated didactic content reflecting surgical practice guidelines, hands-on practice, and faculty guidance promoting interactive critical thinking development during task performance. A pre-/post-assessment included a 10-item knowledge test, a 19-item psychomotor assessment, and 4-items confidence survey to examine changes in performance, knowledge, and confidence in competently completing the ventral hernia repair technique. Descriptive statistics were used to report the limited results of six military surgical resident participants and inform further model and curriculum refinement prior to formal evaluation. Results The five-layer AWSSOM model was manufactured in 65 h at a material cost of $87 per model frame, is reusable model, and secure base. Six surgical residents were recruited; only four completed both pre- and post-tests due to resident schedule conflicts. The average increase in knowledge was 25%, although variable changes in confidence were observed over the four program year participants. A larger sample size and a control group are needed to demonstrate curriculum effectiveness at improving knowledge, performance, and confidence in ventral hernia repair with mesh and better delineate if high scores translate to better operative skills. A key improvement requested by residents was a more secure model base for dissection and performance of the hernia repair. Conclusions The novel abdominal wall surgical skills operative model fills an important proof of concept gap in simulation training. It is low cost with the potential to improve cognitive and psychomotor skills, as well as confidence to competently complete ventral hernia repair with mesh in the graduate medical education setting. Prior to formal effectiveness testing, our lessons learned should be addressed in both the model and curriculum. Future studies must include an adequately powered statistical evaluation with a larger sample across all levels of training. [ABSTRACT FROM AUTHOR]

Prior to the COVID-19 pandemic, the University of San Francisco (UCSF) School of Nursing (SON) is a historically in person graduate program that immediately transitioned to remote learning at the start of the pandemic. In 2022, upon emerging from the pandemic, the need to intentionally determine the teaching and learning modality of the UCSF SON became apparent. This is a report of the process of our institutions transition from an in person to a hybrid school. A task force was formed and charged with identifying the school's approach to the teaching and learning modality moving forward. A group think activity identified needs assessment for the task force's approach. The task force agreed upon definitions for in person, hybrid, online and hyflex learning, conducted a literature review, re-examined internal survey results from both faculty and learners regarding teaching and learning modality preferences and compared top graduate nursing programs teaching and learning modalities. The literature review revealed that hybrid learning was not inferior to in person learning and may improve educational outcomes. The faculty and learner survey results identified a preference toward hybrid learning and teaching. The task force recommended that the school change its public-facing information to identify as a hybrid school with specialty specific flexible design. This transition allows the school to carry out the mission of educating diverse health leaders. • Needs assessment of faculty and students • Using a consensus definition for hybrid teaching and learning delivery • Literature review of outcomes from different teaching and learning modalities • Data review of literature and internal survey results • Outcome measures from different types of teaching and learning modalities [ABSTRACT FROM AUTHOR]

Purpose: The proliferation of digital tools and instant access to information has diversified reading habits among Generation Z (Gen Z) students. The primary objective of this study is to examine the reading habits of Gen Z students at Dhaka University. Design/methodology/approach: A survey questionnaire method was employed to collect data from 354 university students. We collected research data through printed questionnaires, and randomly selected students to answer survey questions. A total of 500 printed questionnaires were distributed to the seminar library, university hall library and Dhaka University library. Additional efforts made to engage students in classrooms. Findings: Students prefer printed materials, particularly fiction and enjoy reading at home. The majority have emerged as dormant readers and prefer using mobile phones for reading. Hobbies and interests have been identified as significant influencers in shaping reading habits. Promoting a reading culture, improving access to books, integrating technology, expanding fiction collections, creating engaging content and tailoring outreach strategies are key steps to enhancing the reading habits of the Gen Z students in Bangladesh. Social implications: These findings provide valuable guidance for policymakers and educators seeking to foster effective reading habits among students by aligning strategies with their preferences and needs. Originality/value: This study offers original insights into the reading habits of Gen Z students at Dhaka University, focus on enhancing library collections, particularly in fiction literature, addresses challenges such as space constraints and reflects innovative approaches to fostering improved reading habits among students. [ABSTRACT FROM AUTHOR]

Introduction: The quality of nursing education depends on the availability of faculty members with great professional knowledge and clinical work experience. Thus, novice faculty may face challenges in providing quality education. The aim of this study was to explore the experience of transition to a faculty role among a sample of Iranian nursing faculty.Methods: This qualitative study was conducted in 2022. A total of fifteen faculty members of the nursing and midwifery schools participated in this study. Participants were recruited through purposeful sampling. Data were collected through semistructured interviews and analyzed through Graneheim and Lundman’s conventional content analysis approach.Results: 704 primary codes were generated and grouped into 35 subcategories, nine main categories, and three main themes, namely unpreparedness for the faculty role, abandonment in anon-empathetic workplace, and a road to resilience.Conclusion: Nursing faculty members with limited work experience are unprepared for the transition to faculty roles, receive limited support at work, and rely on personal resources and support networks to facilitate their transition to the faculty role. Further studies are needed to assess the effects of preparation and support programs on the transition to faculty roles among the faculty members with no previous clinical work experience.

ImportanceProcedural proficiency is a core competency for graduate medical education; however, procedural reporting often relies on manual workflows that are duplicative and generate data whose validity and accuracy are difficult to assess. Failure to accurately gather these data can impede learner progression, delay procedures, and negatively impact patient safety.ObjectiveTo examine accuracy and procedure logging completeness of a system that extracts procedural data from an electronic health record system and uploads these data securely to an application used by many residency programs for accreditation.Design, setting, and participantsThis quality improvement study of all emergency medicine resident physicians at University of California, San Diego Health was performed from May 23, 2023, to June 25, 2023.ExposuresAutomated system for procedure data extraction and upload to a residency management software application.Main outcomes and measuresThe number of procedures captured by the automated system when running silently compared with manually logged procedures in the same timeframe, as well as accuracy of the data upload.ResultsForty-seven residents participated in the initial silent assessment of the extraction component of the system. During a 1-year period (May 23, 2022, to May 7, 2023), 4291 procedures were manually logged by residents, compared with 7617 procedures captured by the automated system during the same period, representing a 78% increase. During assessment of the upload component of the system (May 8, 2023, to June 25, 2023), a total of 1353 procedures and patient encounters were evaluated, with the system operating with a sensitivity of 97.4%, specificity of 100%, and overall accuracy of 99.5%.Conclusions and relevanceIn this quality improvement study of emergency medicine resident physicians, an automated system demonstrated that reliance on self-reported procedure logging resulted in significant procedural underreporting compared with the use of data obtained at the point of performance. Additionally, this system afforded a degree of reliability and validity heretofore absent from the usual after-the-fact procedure logging workflows while using a novel application programming interface-based approach. To our knowledge, this system constitutes the first generalizable implementation of an automated solution to a problem that has existed in graduate medical education for decades.

Regional and global environmental challenges have become increasingly complex and require broader solutions than a single discipline can provide. Although there is a growing need for interdisciplinary research, many graduate education programs still train students within the confines of a particular discipline or specialty. The Ridge 2 Reef research traineeship program at the University of California, Irvine, aimed to provide transferable and interdisciplinary skill training to prepare graduate students from different disciplines to address current and future environmental challenges. The program achieved its goals through a 'culture of improvement' that ensured trainee needs shaped program management and curriculum. Due to trainee feedback and leaders dedicated to program improvement, there was a complete course overhaul during the first two years of the program, resulting in a final curriculum structure that was more effective and aligned with revised program goals. Program evaluations suggest that the flexibility of the program, diversity of training, overhauled courses offered, and partnership-focused opportunities contributed to more confident graduate students who were more broadly trained and better prepared in their chosen environmental career paths. Based on evaluation surveys, graduate students reported significant gains in scientific, technical, and career knowledge as well as transferrable skills in communication, data analysis, leadership, mentoring, and interdisciplinary collaboration. The structure and evolution of the Ridge 2 Reef traineeship can provide a framework for other graduate education programs to better incorporate interdisciplinary training and student feedback, ultimately improving programs and preparing scientists for the 21st century workforce.

Background: African research capacity is challenged by insufficient infrastructure to solicit and manage grants from local and international funding agencies. Objective: The manuscript provides an overview and discusses lessons learned about the pioneering role of the Mozambique Institute for Health Education and Research (MIHER) as the first research support center (RSC) in supporting the management of research grants in Mozambique, emphasizing its impact on research capacity development. Methods: Using mixed methods, data were comprehensively collected to identify MIHERs primary achievements from 2010 to 2023. The activities took place in four public universities, five training institutions for healthcare workers, and 40 public healthcare units in Mozambique. Findings: MIHER had partnership contracts with over 35 external institutions, and supported the design and implementation of one doctoral program and five masters degree programs at three public universities. Over 70% of the 128 MSc and three Ph.D. degree recipients have gone on to become lecturers at Mozambiques public universities or are working in Mozambiques public health system. Over 9,000 lecturers and healthcare workers participated in MIHERs 261 research capacity development workshops. MIHER assisted in writing and implementing 98 research grants, amassing $29,923,197 in extramural support. Of 170 publications generated, 89% were indexed in PubMed. African researchers served as first or last author in 55% and 34% of these publications, respectively; Mozambicans were first and last authors in 44% and 23% of the articles, respectively. Two research laboratories were rehabilitated. Investments in information and communication technology also fostered training and mentorship. Conclusions: MIHER has emerged as a leading RSC of Excellence, fostering synergies and promoting a quality research culture in Mozambique, fueled in part, by its ability to identify and incorporate key collaborations. MIHER is a successful example of an RSC that can make the difference in resource‑limited settings to enable research resource mobilization, evidence-based health care delivery and policy design.

Despite practice guidelines for multiculturally competent care, including spiritual/religious diversity, most mental health graduate training programs do not formally address spiritual/religious competencies. Thus, we enhanced the Spiritual Competency Training in Mental Health (SCT-MH) course curriculum to train graduate students in foundational attitudes, knowledge, and skills for addressing clients spirituality and/or religion (S/R). The hybrid (online and in-person) SCT-MH course curriculum was integrated into existing required graduate clinical courses (replacing 15% of a courses curriculum) and taught to 309 students by 20 instructors in 20 different graduate training programs across counseling, psychology, and social work disciplines. Using a multiple baseline waitlist control design in which students served as their own controls, students completed validated assessments at three timepoints evaluating their spiritual/religious competencies for understanding the intersection between S/R and mental health. We also collected qualitative data from the students to evaluate acceptability of the content and format of the training program. Students scores on all seven measures of spiritual/religious competencies had a statistically significant positive increase after engaging with the SCT-MH curriculum compared to the control period. At the end of the course, 97% of the students envisioned using spiritually integrated therapy techniques with their clients at least some of the time, 92% or more rated the materials as helpful and relevant, and 96% were satisfied with the training modules. Results demonstrate that dedicating a small (i.e., 6 hours of class time; 10 hours outside class time) but intentional amount of course time to teaching spiritual/religious competencies increases students attitudes, knowledge, and skills for attending to clients S/R in clinical practice. The SCT-MH hybrid course content is freely available to all graduate programs on our website. https://www.spiritualandreligiouscompetenciesproject.com/resources/sct-mh.

INTRODUCTION: Laparoscopic surgery requires significant training, and prior studies have shown that surgical residents lack key laparoscopic skills. Many educators have implemented simulation curricula to improve laparoscopic training. Given limited time for dedicated, in-person simulation center practice, at-home training has emerged as a possible mechanism by which to expand training and promote practice. There remains a gap in published at-home laparoscopic curricula employing embedded feedback mechanisms. METHODS: We developed a nine-task at-home laparoscopic curriculum and an end-of-curriculum assessment following Kerns six-step approach. We implemented the curriculum over 4 months with first- to third-year residents. RESULTS: Of 47 invited residents from general surgery, obstetrics/gynecology, and urology, 37 (79%) participated in the at-home curriculum, and 25 (53%) participated in the end-of-curriculum assessment. Residents who participated in the at-home curriculum completed a median of six of nine tasks (interquartile range: 3-8). Twenty-two residents (47%) responded to a postcurriculum survey. Of these, 19 (86%) reported that their laparoscopic skills improved through completion of the curriculum, and the same 19 (86%) felt that the curriculum should be continued for future residents. Residents who completed more at-home curriculum tasks scored higher on the end-of-curriculum assessment (p = .009 with adjusted R 2 of .28) and performed assessment tasks in less time (p = .004 with adjusted R 2 of .28). DISCUSSION: This learner-centered laparoscopic curriculum provides guiding examples, spaced practice, feedback, and graduated skill development to enable junior residents to improve their laparoscopic skills in a low-stakes, at-home environment.

INTRODUCTION: As surgical technologies grow, so too do demands on surgical trainees to master increasing numbers of skill sets. With the rise of endovascular surgery, trainees have fewer opportunities to practice open vascular techniques in the operating room. Simulation can bridge this gap. However, existing published open vascular simulation curricula are basic or based on expensive models. METHODS: We iteratively developed an open vascular skills curriculum for second-year surgery residents comprising six 2-hour sessions. We refined the curriculum based on feedback from learners and faculty. The curriculum required skilled facilitators, vascular instruments, and tissue models. We evaluated the latest iteration with a survey and by assessing participants technical skills using the Objective Structured Assessment of Technical Skills (OSATS) form. RESULTS: Over the past 10 years, 101 residents have participated in the curriculum. Nine of 13 residents who participated in the latest curricular iteration completed the survey. All respondents rated the sessions as excellent and strongly agreed that they had improved their abilities to perform anastomoses with tissue and prosthetic. Facilitators completed 18 OSATS forms for residents in the fifth and sixth sessions of the latest iteration. Residents scored well overall, with a median 26.5 (interquartile range: 24-29) out of a possible score of 35, with highest scores on knowledge of instruments. DISCUSSION: This simulation-based curriculum facilitates open vascular surgical skill acquisition among surgery residents. The curriculum allows residents to acquire critical vascular skills that are challenging to learn in an increasingly demanding operative setting.

BackgroundIn 2011, the American Board of Medical Specialties established clinical informatics (CI) as a subspecialty in medicine, jointly administered by the American Board of Pathology and the American Board of Preventive Medicine. Subsequently, many institutions created CI fellowship training programs to meet the growing need for informaticists. Although many programs share similar features, there is considerable variation in program funding and administrative structures.ObjectivesThe aim of our study was to characterize CI fellowship program features, including governance structures, funding sources, and expenses.MethodsWe created a cross-sectional online REDCap survey with 44 items requesting information on program administration, fellows, administrative support, funding sources, and expenses. We surveyed program directors of programs accredited by the Accreditation Council for Graduate Medical Education between 2014 and 2021.ResultsWe invited 54 program directors, of which 41 (76%) completed the survey. The average administrative support received was $27,732/year. Most programs (85.4%) were accredited to have two or more fellows per year. Programs were administratively housed under six departments: Internal Medicine (17; 41.5%), Pediatrics (7; 17.1%), Pathology (6; 14.6%), Family Medicine (6; 14.6%), Emergency Medicine (4; 9.8%), and Anesthesiology (1; 2.4%). Funding sources for CI fellowship program directors included: hospital or health systems (28.3%), clinical departments (28.3%), graduate medical education office (13.2%), biomedical informatics department (9.4%), hospital information technology (9.4%), research and grants (7.5%), and other sources (3.8%) that included philanthropy and external entities.ConclusionCI fellowships have been established in leading academic and community health care systems across the country. Due to their unique training requirements, these programs require significant resources for education, administration, and recruitment. There continues to be considerable heterogeneity in funding models between programs. Our survey findings reinforce the need for reformed federal funding models for informatics practice and training.

In response to concerns regarding numerous complex issues facing the veterinary specialty profession, several organizations, including the American College of Veterinary Internal Medicine, have made a clarion call to the American Veterinary Medical Association to begin discussions surrounding the formation of an accrediting body for internships, residencies, and fellowships. A proposed name for such a body is the Accreditation Council on Graduate Veterinary Medical Education, in alignment with the Accreditation Council on Graduate Medical Education (ACGME); the term graduate refers to specialty education that occurs after the first 4 years of the MD or DVM degree. Although the structure and financing of graduate education differ between the human medical and veterinary professions, we can nevertheless learn much from the history of evolution of human medical specialization as we navigate the path ahead.

BACKGROUND: Substance use increasingly contributes to early morbidity and mortality, which necessitates greater preparation of the healthcare workforce to mitigate its harm. The purpose of this systematic scoping review is to: 1) review published curricula on harm reduction for substance use implemented by undergraduate (UME) and graduate medical education (GME) in the United States and Canada, 2) develop a framework to describe a comprehensive approach to harm reduction medical education, and 3) propose additional content topics for future consideration. METHODS: PubMed, Scopus, ERIC: Education Resources Information Center (Ovid), and MedEdPORTAL were searched. Studies included any English language curricula about harm reduction within UME or GME in the United States or Canada from 1993 until Nov 22, 2021. Two authors independently reviewed and screened records for data extraction. Data were analyzed on trainee population, curricula objectives, format, content, and evaluation. RESULTS: Twenty-three articles describing 19 distinct educational programs across the United States were included in the final sample, most of which created their own curricula (n = 17). Data on educational content were categorized by content and approach. Most programs (85%) focused on introductory substance use knowledge and skills without an understanding of harm reduction principles. Based on our synthesis of the educational content in these curricula, we iteratively developed a Harm Reduction Educational Spectrum (HRES) framework to describe curricula and identified 17 discrete content topics grouped into 6 themes based on their reliance on harm reduction principles. CONCLUSIONS: Harm reduction is under-represented in published medical curricula. Because the drug supply market changes rapidly, the content of medical curricula may be quickly outmoded thus curricula that include foundational knowledge of harm reduction principles may be more enduring. Students should be grounded in harm reduction principles to develop the advanced skills necessary to reduce the physical harm associated with drugs while still simultaneously recognizing the possibility of patients ongoing substance use. We present the Harm Reduction Educational Spectrum as a new framework to guide future healthcare workforce development and to ultimately provide the highest-quality care for patients who use drugs.

Background Best practices to improve diversity, equity, and inclusion (DEI) in the biomedical workforce remain poorly understood. The Accreditation Council for Graduate Medical Education launched the Barbara Ross-Lee, DO, Diversity, Equity, and Inclusion award for sponsoring institutions to celebrate efforts to improve DEI in graduate medical education (GME). Objective To identify themes in practices used by award applicants to improve DEI efforts at their institutions, using a qualitative design. Methods This qualitative study employed an exploratory, inductive approach and constant comparative method to analyze award applications from 2 submission cycles (2020, 2021). Data analysis involved the use of a preliminary codebook of 29 program applications used in a previous study, which was modified and expanded, to perform a subsequent analysis of 12 sponsoring institution applications. Seven adjudication sessions were conducted to ensure coding consistency and resolve disagreements, resulting in the identification of final themes. Results Institutions approaches to advancing DEI resulted from work within 5 themes and 10 subthemes. The themes encompassed organizational commitment (policies that reflect DEI mission), data infrastructure (tracking recruitment, retention, and inclusion efforts), community connection (service-learning opportunities), diverse team engagement (coproduction with residents), and systematic strategies for DEI support throughout the educational continuum. Consistent across themes was the importance of collaboration, avoiding silos, and the need for a comprehensive longitudinal approach to DEI to achieve a diverse GME workforce. Conclusions This qualitative study identified 5 themes that can inform and guide sponsoring institutions in promoting DEI.

Background: In many countries, nurses serve as prescribers in the healthcare system to manage acute and chronic diseases. Nurse prescribing can be affected by specific variables, one of which is the nurses' self-efficacy. This study aimed to determine Iranian postgraduate nursing students’ attitudes and readiness for prescribing and its relationship with their self-efficacy in patient care. Methods: This correlational study was conducted on 220 postgraduate nursing students of Tabriz Faculty of Nursing and Midwifery, Iran, from Dec 2022 to Mar 2023. The total population sampling method was employed to include all students, and data were collected using a three-part questionnaire: demographics, nurse prescribing (attitude, and readiness), and self-efficacy questionnaire. The collected data were analyzed using SPSS-26 software. Descriptive statistics were used to analyze demographics. ANOVA and t-tests were employed to compare mean scores, while the Pearson correlation coefficient measured the linear correlation between data sets. The significance level for all tests was determined to be p

Amaç: Bu sistematik derlemede Türkiye’de, hemşirelik alanında kuram veya model kullanılarak yapılan lisansüstü tezlerin sistematik olarak incelenmesi amaçlandı.Yöntemler: Yapılan sistematik derlemede, Ulusal Tez Merkezine kayıtlı tezler 25 Nisan-15 Mayıs 2023 tarihleri arasında Türkçe “model, kuram, teori, hemşirelik” sözcükleri kullanılarak tarandı. Veri tabanına kayıtlı 78 lisansüstü teze ulaşıldı. Dâhil edilme kriterlerine uyan 67 tez yıl, kuram veya model, örneklem, yöntem, araştırma türü, sonuç yönünden incelendi.Bulgular: Türkiye’de hemşirelik alanında 67 tezde kuram veya model kullanıldı. Tezlerin %13.43’ü yüksek lisans tezi, %86.56’ı doktora tezidir, %53,73’ü randomize kontrollü araştırma tipindedir. Kullanılan kuram ve modellere bakıldığında, tezlerin %10.44’ü Watson İnsan Bakım Kuramı'nı, %10.44’ü Kolcaba'nın Konfor Kuramı'nı, %8.95’i Dorothea Orem Öz Bakım Eksikliği Kuramı'nı ve %7.46’sı Meleis’in Geçiş Modeli'ni kullanmıştır.Sonuç: Hemşirelikte 2018-2023 yılları arasında ülkemizde en sık kullanılan modeller Watson İnsan Bakım Kuramı ve Kolcabo’nın Konfor Kuramı’dır. Kuram veya model kullanımı geçmiş yıllara göre karşılaştırıldığında kullanımı yaygınlaşmasına rağmen, günümüzde sınırlı sayıda kullanılmaktadır.

Background: Midwifery emergencies can be managed by providing effective and quality care through a skilled workforce. Improving the quality of midwifery care requires the professional development of midwives, especially those who are novice, to maintain their capabilities and enhance their performance. This study was designed to develop a professional development program in the management of midwifery emergencies for midwifery graduates. Materials and Methods: This mixed-method study was conducted in two phases. In the first phase, a qualitative study was conducted to investigate the program needs, facilitators, and barriers to the management of midwifery emergencies in midwifery graduates. Further, the initial version of the program was developed based on the results of the qualitative study and literature review. The Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model was used to develop a professional development program for the management of midwifery emergencies. The developed program was then evaluated and approved by a panel of experts. In the second phase, the developed professional development program is implemented, and its impacts are evaluated. Finally, the final professional development program in the management of midwifery emergencies for midwifery graduates is provided. Results: In total, 2,360 primary codes were extracted and merged into 210 codes. After extracting the sub-categories and categories, a review of the texts was conducted, and the final program was developed. Conclusions: Using a professional development program for newly graduated midwives is an effort to improve the health of mothers and infants who receive these services.

Interprofessional education (IPE) aims to prepare health professional students with the knowledge, attitudes and skills required for collaborative healthcare practice. Although positive outcomes have been documented at the completion of university-based IPE experiences, or longitudinally across health care degrees, the literature is unclear on how university-based IPE influences graduate practice. This study therefore explores how health professional graduates experience interprofessional interactions in practice and how these may be connected to their university-based IPE experiences. Interviews with seven health professional graduates who had participated in an 11-week IPE course as part of their pre-licensure degrees were analyzed using interpretative phenomenological analysis. The participants were able to articulate instances of effective and less effective collaboration from their professional experiences, making sense of these experiences with explicit reference to the themes of role understanding, collaborative working relationships, interprofessional communication, patient-centered care and contextual influences; all ideas introduced in their university-based IPE. They connected their understanding of roles, collaborative working relationships and interprofessional communication explicitly to their prior university-based IPE, identifying these learnings as foundational knowledge. This connection was not as explicit for patient-centered care and contextual issues. These findings highlight the critical importance of IPE in preparing health professionals for high-quality contemporary practice. [ABSTRACT FROM AUTHOR]

Steeped in both critical race feminism (Wing, 1997) and social cognitive career theory (Lent et al., 2002), the present study intentionally centered the voices of 11 Women of Color graduate students and early career professionals to understand how graduate advisors mitigated or exacerbated the structural barriers Women of Color navigate during their science, technology, engineering, and mathematics (STEM) doctoral programs. Using thematic analysis grounded in the social constructivist paradigm, researchers identified four emergent themes: (a) unsupportive advising behaviors as a contextual barrier, (b) debilitating impact on mental health, (c) shared gender identity but mismatch racial/ethnic identity, and (d) advocacy-centered instrumental support and psychosocial support as key contextual supports. Results indicated that graduate advisors' behaviors served as both contextual barriers that exacerbated the structural barriers Women of Color navigated in STEM, as well as contextual supports that enhanced the doctoral experience and mitigated the adverse toll of marginalizing encounters in STEM. Three recommendations that stem from this work include: (a) adopt an intersectional approach to advising that values students as whole beings, (b) commit to antioppressive advocacy as part of the advising role, and (c) recognize the toll that unsupportive advising behaviors have on Women of Color's mental health. [ABSTRACT FROM AUTHOR]

Community placements among trainee doctors have proven beneficial in understanding community problems, the role of primary care in health, and increasing the likelihood of pursuing a primary care career, albeit with some challenges. In 2020, Kenya started community rotations as part of the mandatory internship programme. This study aimed to describe the experiences among medical interns and their educational supervisors during the rotation from which insights on how to improve the community rotation may be drawn. A qualitative analysis of 13 in-depth interviews carried out among medical interns and their supervisors was undertaken in the first year of the implementation of the community rotation. Factors that enabled a successful rotation were an increased awareness amongst interns about patient health in the context of the community, presence of existing primary care structures, and the use of technology for patient follow-up during the COVID-19 pandemic. Conversely, challenges experienced by participants included insufficient communication prior to implementing the community health rotation, limited community health exposure among medical graduates before the internship, and fear of contracting or spreading COVID-19. The study identified opportunities to improve the community rotation through stakeholder engagement, timely government communication, and strengthening undergraduate medical training in community health competencies. [ABSTRACT FROM AUTHOR]

The development of international trade and logistics has brought the training of qualified individuals with knowledge of these subjects to the agenda. For this reason, global trade and logistics departments have begun to open rapidly in Turkey. For employees to be knowledgeable, they must obtain information about their jobs throughout their training. At this point, it is important to get the opinions of all shareholders regarding the department while preparing the curriculum. One of these shareholders is graduate students. Therefore, the purpose of this research is to reveal how people who graduated from the International Trade and Logistics undergraduate program and work in a job related to their field evaluate the education they received, the activities they did during their education, and the impact of the education they received on finding a job.The sample of the research consists of 18 people who graduated from the Department of International Trade and Logistics and work in a job related to their field. The data collection method of the research is the in-depth interview. Content and descriptive analysis methods were used to analyze the data. According to the results of the research, the participants stated that there was a lack of practice in the education they received, a course containing logistics documents should be included in the curriculum, English preparation and internship are very important in finding a job. [ABSTRACT FROM AUTHOR]

Introduction Developing the clinical reasoning skills necessary to becoming an astute diagnostician is essential for medical students. While some medical schools offer longitudinal opportunities for students to practice clinical reasoning during the preclinical curriculum, there remains a paucity of literature fully describing what that curriculum looks like. As a result, medical educators struggle to know what an effective clinical reasoning curriculum should look like, how it should be delivered, how it should be assessed, or what faculty development is necessary to be successful. We present our Introduction to Clinical Reasoning course that is offered throughout the preclinical curriculum of the Uniformed Services University of the Health Sciences. The course introduces clinical reasoning through interactive lectures and 28 case-based small group activities over 15 months. The curriculum is grounded in script theory with a focus on diagnostic reasoning. Specific emphasis is placed on building the student's semantic competence, constructing problem lists, comparing and contrasting similar diagnoses, constructing a summary statement, and formulating a prioritized differential diagnosis the student can defend. Several complementary methods of assessment are utilized across the curriculum. These include assessments of participation, knowledge, and application. The course leverages clinical faculty, graduate medical education trainees, and senior medical students as small group facilitators. Feedback from students and faculty consistently identifies the course as a highly effective and engaging way to teach clinical reasoning. Conclusion Our Introduction to Clinical Reasoning course offers students repeated exposure to well-selected cases to promote their development of clinical reasoning. The course is an example of how clinical reasoning can be taught across the preclinical curriculum without extensive faculty training in medical education or clinical reasoning theory. The course can be adapted into different instructional formats to cover a variety of topics to provide the early learner with sequential exposure and practice in diagnostic reasoning. [ABSTRACT FROM AUTHOR]

The study explored the experiences of unemployed graduates at Vleifontein Village Elim in Makhado Local Municipality in Limpopo Province, South Africa. To achieve the mandate of the study, the researcher adopted a unique qualitative research approach, which gathered in-depth data from the participants. This approach, distinct in its focus on understanding the experiences of unemployed graduates, aided in the elevated understanding of the research problem. The study adopted an exploratory qualitative research design to gather or collect data from the participants, and the researcher used semi-structured interviews consisting of open-ended questions administered face-to-face to observe gestures, emotions, feelings, or even how they react to the questions. Furthermore, purposive sampling was used to select the sample that formed part of the interviews. Additionally, the study adopted the Conflict theory by Karl Marx to integrate with the study. Therefore, the findings of the study deduced that most of the participants understood the meaning of unemployment as their current socio-economic state, both from a financial and psychological perspective. Moreover, on the issue of the challenges, the findings deduced that they are not experienced and skilled enough for the jobs they are applying for. In that light, the study emphasizes the need for increased employment opportunities to minimize the negative impacts faced by unemployed graduates, which includes specialized training of graduates to render services that would make it easier for the graduates to find employment. [ABSTRACT FROM AUTHOR]

Background: Midwifery emergencies can be managed by providing effective and quality care through a skilled workforce. Improving the quality of midwifery care requires the professional development of midwives, especially those who are novice, to maintain their capabilities and enhance their performance. This study was designed to develop a professional development program in the management of midwifery emergencies for midwifery graduates. Materials and Methods: This mixed-method study was conducted in two phases. In the first phase, a qualitative study was conducted to investigate the program needs, facilitators, and barriers to the management of midwifery emergencies in midwifery graduates. Further, the initial version of the program was developed based on the results of the qualitative study and literature review. The Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model was used to develop a professional development program for the management of midwifery emergencies. The developed program was then evaluated and approved by a panel of experts. In the second phase, the developed professional development program is implemented, and its impacts are evaluated. Finally, the final professional development program in the management of midwifery emergencies for midwifery graduates is provided. Results: In total, 2,360 primary codes were extracted and merged into 210 codes. After extracting the sub-categories and categories, a review of the texts was conducted, and the final program was developed. Conclusions: Using a professional development program for newly graduated midwives is an effort to improve the health of mothers and infants who receive these services. [ABSTRACT FROM AUTHOR]

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Copyright of Journal of Midwifery & Health Sciences is the property of Ataturk University Coordinatorship of Scientific Journals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)