Psychometric Testing of the Debriefing Assessment for Simulation in Healthcare (DASH) for Trainee-led, In Situ Simulations in the Pediatric Emergency Department Context.

OBJECTIVES: Effective trainee-led debriefing after critical events in the pediatric emergency department has potential to improve patient care, but debriefing assessments for this context have not been developed. This study gathers preliminary validity and reliability evidence for the Debriefing Assessment for Simulation in Healthcare (DASH) as an assessment of trainee-led post-critical event debriefing. METHODS: Eight fellows led teams in three simulated critical events, each followed by a video-recorded discussion of performance mimicking impromptu debriefings occurring after real clinical events. Three raters assessed the recorded debriefings using the DASH, and their feedback was collated. Data were analyzed using generalizability theory, Gwet's AC2, intraclass correlation coefficient (ICC), and coefficient alpha. Validity was examined using Messick's framework. RESULTS: The DASH instrument had relatively low traditional inter-rater reliability (Gwet's AC2 = 0.24, single-rater ICC range = 0.16-0.35), with 30% fellow, 19% rater, and 23% rater by fellow variance. DASH generalizability (G) coefficient was 0.72, confirming inadequate reliability for research purposes. Decision (D) study results suggest the DASH can attain a G coefficient of 0.8 with five or more raters. Coefficient alpha was 0.95 for the DASH. A total of 90 and 40% of items from Elements 1 and 4, respectively, were deemed "not applicable" or left blank. CONCLUSIONS: Our results suggest that the DASH does not have sufficient validity and reliability to rigorously assess debriefing in the post-critical event environment but may be amenable to modification. Further development of the tool will be needed for optimal use in this context.

Burnout and Resiliency Trends in Pediatric Emergency Medicine Fellows.

OBJECTIVE: Burnout is a problem among physicians. Debriefing may be a tool to decrease burnout and increase resiliency in pediatric emergency medicine (PEM) providers. The objective of this study was to determine rates of burnout and resiliency in PEM fellows and their experience with debriefing. METHODS: A validated survey was administered to PEM fellows during their first and then third years of fellowship. The survey included the abbreviated Maslach Burnout Index (MBI), the Brief Resilience Scale (BRS), and debriefing experience. The percent of respondents with moderate to high burnout was determined by their scores in each of 3 MBI categories. Their resilience was determined by the BRS score. The effect of debriefing on resiliency scores was analyzed. RESULTS: There were 47 first-year respondents (of 148 first-year PEM fellows) and 34 third-year respondents (of 118 third-year PEM fellows). There were burnout scores in at least 1 MBI category in 80.9% of first years and 65% of third years. In first years, 42.6% showed burnout in personal accomplishment, 38.3% in depersonalization, and 55.3% in emotional exhaustion. By third year, they were 35.3%, 29.4%, and 52.9%, respectively. About 59% of first and third years had low resiliency scores. Fifty-five percent of first year respondents felt comfortable with debriefing compared with 67.6% of third years. The fellows' comfort and experience with debriefing did not significantly affect their BRS score. CONCLUSIONS: This study shows that many first-year PEM fellows already have signs of burnout and low resiliency. However, by third year, there was improvement in burnout scores. Additional tools provided in fellowship may help prevent burnout in PEM fellows.

Sexual Harassment during Residency Training: A Cross-Sectional Analysis.

The reality of sexual harassment is unmasking in many fields, and medical trainees constitute a vulnerable and at-risk group. We report the prevalence of sexual harassment among GI, internal medicine, and pediatric residents, with a focus on identifying underlying reasons for lack of victim reporting. A modified previously validated Department of Defense survey on sexual harassment was e-mailed to 261 GI, 132 pediatric, and 271 internal medicine program directors. Three hundred eighty-one residents responded to the survey. Female trainees were more likely to be subject to sexual harassment (83% vs 44%, P <0 .0001). Offensive and/or suggestive jokes and comments were the most common type of harassment experienced. Most residents were unlikely to report the offender (87% females, 93% males). Although 77 per cent of residents believed they would be supported by their program if they reported a sexual harassment event, only 43 per cent were aware of institutional support in place for victims at their program. Although there is a persistently high incidence of harassment in training, the avenues in which to report it are largely unknown and underused. Further research should focus on evidence-based interventions to encourage reporting and to design institutional programs for victims of sexual harassment.

Evolution of mating isolation between populations of Drosophila ananassae.

Prezygotic mating isolation has been a major interest of evolutionary biologists during the past several decades because it is likely to represent one of the first stages in the transition from populations to species. Mate discrimination is one of the most commonly measured forms of prezygotic isolation and appears to be relatively common among closely related species. In some cases, it has been used as a measure to distinguish populations from subspecies, races, and sister species, yet the influences of various evolutionary mechanisms that may generate mate discrimination are largely unknown. In this study, we measured the level and pattern of mate discrimination among 18 populations of a cosmopolitan drosophilid species, Drosophila ananassae, from throughout its geographical range and its sister species, Drosophila pallidosa, which has a restricted geographical distribution in the South Pacific Islands. In addition, we measured genetic differentiation between all 18 populations using mitochondrial DNA polymorphism data. Mate discrimination varies considerably throughout the species range, being higher among populations outside the ancestral Indonesian range, and highest in the South Pacific. Our results suggest that colonization and genetic differentiation may have an influence on the evolutionary origin of mate discrimination. Our phylogeographical approach clarifies the ancestral relationships of several populations from the South Pacific that show particularly strong mate discrimination and suggests that they may be in the early stages of speciation. Furthermore, both the genetic and behavioral results cast doubt on the status of D. pallidosa as a good species.