Undergraduate College Pathway Programs Designed to Attract and Matriculate Students from Underrepresented Groups into Medicine.

OBJECTIVES: Undergraduate college pathway (or pipeline) programs support students' interests as they explore advanced degree and career pathways. Many programs aim to diversify the medical workforce by reducing barriers that may have otherwise prevented desired academic and career goals; however, variability in structure, expectations, benefits, and outcome data exist. This systematic review was conducted to identify and evaluate undergraduate college pathway programs designed to increase the diversity of medical school matriculants. METHODS: We searched Ovid Medline, PsycInfo, Scopus, and the Education Resources Information Center for peer-reviewed, original research publications (1996-2019) describing US pathway/pipeline programs designed for undergraduate-level college students from underrepresented groups to apply and enter medical school. Data extraction included application processes, participant demographics, curricular components, social support systems, mentorship, funding, and program/participant outcomes. We reviewed the journal impact factor to inform us about where articles are being published. RESULTS: Our full-text review included 137 articles; 25 articles met the inclusion criteria. All of the papers were descriptive, requiring an application, minimum grade point average, letters of recommendation, and personal statements. All of the programs aimed to diversify medicine, yet some could not request identification of race/ethnicity because of changes in affirmative action or legal restrictions when reporting demographics. Women represented the majority of enrollees. The program length varied; all reported having one or a combination of academic enrichment, research, field observation/experience, and mentorship. All of the programs included career development and various supplemental social supports. Only two programs provided comparison data; four reported no outcomes. CONCLUSIONS: Pathway programs support the acquisition and enhancement of professional skills. Lacking longitudinal or comparison data leads to questions of the long-term impact on diversifying the medical workforce. This article highlights a need for rigorous data collection methods and transparent reporting of participant outcomes to inform programmatic efficacy.

E-mail as the Appropriate Method of Communication for the Decision-Maker When Soliciting Advice for an Intellective Decision Task.

For many problems in operating room and anesthesia group management, there are tasks with optimal decisions, and yet experienced personnel tend to make decisions that are worse or no better than random chance. Such decisions include staff scheduling, case scheduling, moving cases among operating rooms, and choosing patient arrival times. In such settings, operating room management leadership decision-making should typically be autocratic rather than participative. Autocratic-style decision-making calls for managers to solicit and consider feedback from stakeholders in the decision outcome but to make the decision themselves using their expert knowledge and the facts received. For this to be effective, often the manager will obtain expert advice from outside the organization (e.g., health system). In this narrative review, we evaluate the advantages and disadvantages of using prompt asynchronous written communication (i.e., e-mail) as a communication channel for such interaction between a decision-maker (manager) and advisor. A detailed Appendix (Supplemental Digital Content, http://links.lww.com/AA/B72) lists each observational and experimental result. We find that the current ubiquitous role of e-mail for such communication is appropriate. Its benefits include improved time management via asynchronicity, low cognitive load (e.g., relative to Web conferencing), the ability to hide undesirable and irrelevant cues (e.g., physical appearance), the appropriateness of adding desirable cues (e.g., titles and degrees), the opportunity to provide written expression of confidence, and the ability for the advisor to demonstrate the answer for the decision-maker. Given that the manager is e-mailing an advisor whose competence the manager trusts, it is unnecessary to use a richer communication channel to develop trust. Finally, many of the limitations of e-mail can be rectified through training. We expect that decades from now, e-mail (i.e., asynchronous writing) between an expert and decision-maker will remain the dominant means of communication for intellective tasks.

Review of experimental studies in social psychology of small groups when an optimal choice exists and application to operating room management decision-making.

Because operating room (OR) management decisions with optimal choices are made with ubiquitous biases, decisions are improved with decision-support systems. We reviewed experimental social-psychology studies to explore what an OR leader can do when working with stakeholders lacking interest in learning the OR management science but expressing opinions about decisions, nonetheless. We considered shared information to include the rules-of-thumb (heuristics) that make intuitive sense and often seem "close enough" (e.g., staffing is planned based on the average workload). We considered unshared information to include the relevant mathematics (e.g., staffing calculations). Multiple studies have shown that group discussions focus more on shared than unshared information. Quality decisions are more likely when all group participants share knowledge (e.g., have taken a course in OR management science). Several biases in OR management are caused by humans' limited abilities to estimate tails of probability distributions in their heads. Groups are more susceptible to analogous biases than are educated individuals. Since optimal solutions are not demonstrable without groups sharing common language, only with education of most group members can a knowledgeable individual influence the group. The appropriate model of decision-making is autocratic, with information obtained from stakeholders. Although such decisions are good quality, the leaders often are disliked and the decisions considered unjust. In conclusion, leaders will find the most success if they do not bring OR management operational decisions to groups, but instead act autocratically while obtaining necessary information in 1:1 conversations. The only known route for the leader making such decisions to be considered likable and for the decisions to be considered fair is through colleagues and subordinates learning the management science.

Increase in Sharing of Stressful Situations by Medical Trainees through Drawing Comics.

INTRODUCTION: Medical trainees fear disclosing psychological distress and rarely seek help. Social sharing of difficult experiences can reduce stress and burnout. Drawing comics is one way that has been used to help trainees express themselves. The authors explore reasons why some medical trainees chose to draw comics depicting stressful situations that they had never shared with anyone before. METHODS: Trainees participated in a comic drawing session on stressors in medicine. Participants were asked if they had ever shared the drawn situation with anyone. Participants who had not previously shared were asked what prevented them and why they shared it now. The authors performed content analysis of the responses. RESULTS: Of two hundred forty participants, forty-six (19.2%) indicated sharing an experience for the first time. Analysis of the responses revealed dedicated time and space was essential to sharing, trainee insecurity was a barrier, and comics were perceived as a safe way to communicate. DISCUSSION: Depicting a stressful situation may be beneficial for trainees who drew an experience they had never shared before. Providing trainees with the opportunity to externalize their experience and create a community for sharing tough experiences may be one way to reduce trainee stress and burnout.

Exploratory regression analysis: a tool for selecting models and determining predictor importance.

Linear regression analysis is one of the most important tools in a researcher's toolbox for creating and testing predictive models. Although linear regression analysis indicates how strongly a set of predictor variables, taken together, will predict a relevant criterion (i.e., the multiple R), the analysis cannot indicate which predictors are the most important. Although there is no definitive or unambiguous method for establishing predictor variable importance, there are several accepted methods. This article reviews those methods for establishing predictor importance and provides a program (in Excel) for implementing them (available for direct download at http://dl.dropbox.com/u/2480715/ERA.xlsm?dl=1) . The program investigates all 2(p) - 1 submodels and produces several indices of predictor importance. This exploratory approach to linear regression, similar to other exploratory data analysis techniques, has the potential to yield both theoretical and practical benefits.

Workplace Lactation Support: Using Implementation Climate to Inform a New Model.

Introduction: Breastfeeding (BF) duration remains problematic, especially among women returning to work. Given that use of workplace lactation support programs has not gained traction in improving BF duration, there appears to be elements missing from lactation support initiatives that need further exploration. The field of Implementation Science, in explaining organizational behavior, provides an opportunity to inform a better model for workplace BF support. Materials and Methods: To inform a new model for workplace lactation support, data from the Breastfeeding and Employment Study (BESt) were combined with Implementation Climate theory. BESt surveyed companies on their BF supports, and used hierarchical linear modeling to determine the association of those supports with company employee perceptions of and manager attitudes toward BF supports. Results: Employee scores were not associated with any company scores. Total company scores were associated with more positive manager attitudes (p < 0.01), due to structural supports, or those supports most visible to managers. Considering these results along with other studies, it is proposed that employees and managers are influenced by tangible (physical) as well as intangible (people) workplace lactation supports. Furthermore, strategies are needed to design and implement approaches to these components to increase workplace lactation support and improve BF durations. Conclusions: Implementation strategies will vary with the diversity of workplaces and how they function. A better understanding of the application of implementation climate for workplace lactation support will help tailor programs and their implementation to improve BF duration in employed women.

The accuracy of dominance analysis as a metric to assess relative importance: The joint impact of sampling error variance and measurement unreliability.

Dominance analysis (DA) has been established as a useful tool for practitioners and researchers to identify the relative importance of predictors in a linear regression. This article examines the joint impact of two common and pervasive artifacts-sampling error variance and measurement unreliability-on the accuracy of DA. We present Monte Carlo simulations that detail the decrease in the accuracy of DA in the presence of these artifacts, highlighting the practical extent of the inferential mistakes that can be made. Then, we detail and provide a user-friendly program in R (R Core Team, 2017) for estimating the effects of sampling error variance and unreliability on DA. Finally, by way of a detailed example, we provide specific recommendations for how researchers and practitioners should more appropriately interpret and report results of DA. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The dynamics of team cognition: A process-oriented theory of knowledge emergence in teams.

Team cognition has been identified as a critical component of team performance and decision-making. However, theory and research in this domain continues to remain largely static; articulation and examination of the dynamic processes through which collectively held knowledge emerges from the individual- to the team-level is lacking. To address this gap, we advance and systematically evaluate a process-oriented theory of team knowledge emergence. First, we summarize the core concepts and dynamic mechanisms that underlie team knowledge-building and represent our theory of team knowledge emergence (Step 1). We then translate this narrative theory into a formal computational model that provides an explicit specification of how these core concepts and mechanisms interact to produce emergent team knowledge (Step 2). The computational model is next instantiated into an agent-based simulation to explore how the key generative process mechanisms described in our theory contribute to improved knowledge emergence in teams (Step 3). Results from the simulations demonstrate that agent teams generate collectively shared knowledge more effectively when members are capable of processing information more efficiently and when teams follow communication strategies that promote equal rates of information sharing across members. Lastly, we conduct an empirical experiment with real teams participating in a collective knowledge-building task to verify that promoting these processes in human teams also leads to improved team knowledge emergence (Step 4). Discussion focuses on implications of the theory for examining team cognition processes and dynamics as well as directions for future research. (PsycINFO Database Record

Social network approaches to leadership: an integrative conceptual review.

Contemporary definitions of leadership advance a view of the phenomenon as relational, situated in specific social contexts, involving patterned emergent processes, and encompassing both formal and informal influence. Paralleling these views is a growing interest in leveraging social network approaches to study leadership. Social network approaches provide a set of theories and methods with which to articulate and investigate, with greater precision and rigor, the wide variety of relational perspectives implied by contemporary leadership theories. Our goal is to advance this domain through an integrative conceptual review. We begin by answering the question of why-Why adopt a network approach to study leadership? Then, we offer a framework for organizing prior research. Our review reveals 3 areas of research, which we term: (a) leadership in networks, (b) leadership as networks, and (c) leadership in and as networks. By clarifying the conceptual underpinnings, key findings, and themes within each area, this review serves as a foundation for future inquiry that capitalizes on, and programmatically builds upon, the insights of prior work. Our final contribution is to advance an agenda for future research that harnesses the confluent ideas at the intersection of leadership in and as networks. Leadership in and as networks represents a paradigm shift in leadership research-from an emphasis on the static traits and behaviors of formal leaders whose actions are contingent upon situational constraints, toward an emphasis on the complex and patterned relational processes that interact with the embedding social context to jointly constitute leadership emergence and effectiveness.

A cautionary note on modeling growth trends in longitudinal data.

Random coefficient and latent growth curve modeling are currently the dominant approaches to the analysis of longitudinal data in psychology. The application of these models to longitudinal data assumes that the data-generating mechanism behind the psychological process under investigation contains only a deterministic trend. However, if a process, at least partially, contains a stochastic trend, then random coefficient regression results are likely to be spurious. This problem is demonstrated via a data example, previous research on simple regression models, and Monte Carlo simulations. A data analytic strategy is proposed to help researchers avoid making inaccurate inferences when observed trends may be due to stochastic processes.