Evaluation of a Radiation Oncology Microclerkship as a Component of Medical Student Education.

Compared to most oncologic subspecialties, radiation oncology (RO) lacks a natural pathway for incorporation into the clinical clerkships, and few students ever complete a formal rotation in RO. The feasibility, and perceived value, of a 1-day "microclerkship" exposure in RO during other related clerkships was evaluated in this study. At a single institution, the RO clerkship director partnered with clerkship directors in medical oncology, palliative care, and radiology so that every 3rd or 4th year student would spend 1 day in RO during those clerkships. Afterwards, students completed an electronic survey containing multiple choice and 5-point Likert-type questions describing their experience. Descriptive statistics are reported. Ninety-seven students completed the RO microclerkship over 2 years, and 81 completed the survey (response rate 84%). Only 8 students (10%) had ever been in a RO department previously. During the microclerkship, 73 students (90%) saw at least one new patient consultation; 77 (95%) were involved in contouring or treatment planning; 76 (94%) saw treatment delivery; and 38 (47%) saw a brachytherapy procedure. Seventy-nine students (98%) felt that the microclerkship was at least moderately valuable (mean Likert-type rating 4.01, SD 0.73). Forty students (49%) were either somewhat or much more interested in participating in a longer (2-4 week) rotation in radiation oncology (mean Likert-type rating 3.59, SD 0.83). This study demonstrated the feasibility of incorporating a 1-day RO microclerkship into other related elective clerkships. Students viewed the experience favorably and found it valuable in their education.

A Randomized Trial Comparing NeoLight Skylife and Blanket Phototherapy in Newborn Indirect Hyperbilirubinemia.

This investigation aimed to assess the safety and efficacy of NeoLight's Skylife phototherapy device for the treatment of hyperbilirubinemia. A prospective, two-arm, randomized, unblinded controlled investigation compared total serum bilirubin (TSB) levels at baseline and discharge for a new phototherapy device (Skylife) with an existing phototherapy treatment in newborn infants. The repeated-measures analysis of variance (RM-ANOVA) indicated a significant main effect for the treatment condition, F(1, 54) = 4.041, P = .049. Post hoc findings showed that the Skylife group had significantly lower TSB levels following treatment (n = 28, Mean = 11.36, SD = 1.69) compared with the standard of care group (n = 28, Mean = 12.37, SD = 2.08), t(54) = 2.01, P = .049). The Skylife phototherapy device was as effective as the currently used therapy, with a shift toward a more rapid decline in bilirubin levels. Using this device may potentially decrease the length of therapy and hospitalization.Clinical Trial Registration Comparison of Phototherapy Using Neolight Skylife Versus Standardized Phototherapy for Hyperbilirubinemia in Newborns is registered at clinicaltrials.gov as NCT03599258.

Thematic Analysis of State Medicaid Buprenorphine Prior Authorization Requirements.

Importance: Prior authorization (PA) requirements for buprenorphine are associated with lower provision of the medication for the treatment of opioid use disorder (OUD). While Medicare plans have eliminated PA requirements for buprenorphine, many Medicaid plans continue to require them. Objective: To describe and classify buprenorphine coverage requirements based on thematic analysis of state Medicaid PA forms. Design, Setting, and Participants: This qualitative study used a thematic analysis of 50 states' Medicaid PA forms for buprenorphine between November 2020 and March 2021. Forms were obtained from the jurisdiction's Medicaid websites and assessed for features suggesting barriers to buprenorphine access. A coding tool was developed based on a review of a sample of forms, including fields for behavioral health treatment recommendations or mandates, drug screening requirements, and dosage limitations. Main Outcomes and Measures: Outcomes included PA requirements for different buprenorphine formulations. Additionally, PA forms were evaluated for various criteria such as behavioral health, drug screenings, dose-related recommendations or mandates or patient education. Results: Among the total of 50 US states in the analysis, most states' Medicaid plans required PA for at least 1 formulation of buprenorphine. However, the majority did not require a PA for buprenorphine-naloxone. Four key themes of coverage requirements were identified: restrictive surveillance (eg, requirements for urine drug screenings, random drug screenings, pill counts), behavioral health treatment recommendations or mandates (eg, mandatory counseling or 12-step meeting attendance), interfering with or restricting medical decision-making (eg, maximum daily dosages of 16 mg, requiring additional steps for dosages higher than 16 mg), and patient education (eg, information about adverse effects and interactions with other medications). Eleven states (22%) required urine drug screenings, 6 states (12%) required random urine drug screenings, and 4 states (8%) required pill counts. Fourteen states' forms (28%) recommended therapy, and 7 (14%) required therapy, counseling, or participation in group sessions. Eighteen states (36%) specified dosage maximums; among them, 11 (22%) required additional steps for a daily dosage higher than 16 mg. Conclusion: In this qualitative study of state Medicaid PA requirements for buprenorphine, themes were identified that included patient surveillance with drug screenings and pill counts, behavioral health treatment recommendations or mandates, patient education, and dosing guidance. These results suggest that state Medicaid plans' buprenorphine PA requirements for OUD are in conflict with existing evidence and may negatively affect states' efforts to address the opioid overdose crisis.

"I wouldn't need Narcan for myself, but I can have it for somebody else:" perceptions of harm reduction among hospitalized patients with OUD.

BACKGROUND: Extant literature is limited on adoption of evidence-based harm reduction strategies in hospitals. We explored patient perceptions of incorporating harm reduction supplies and education in hospital care with patients with opioid use disorder (OUD). METHODS: Qualitative descriptive study of hospitalized patients with OUD in Philadelphia, PA using semi-structured interviews conducted between April and August of 2022. RESULTS: Three major themes emerged from 21 interviews with hospitalized patients with OUD: (1) Applicability and Acceptability of Harm Reduction Practices for Oneself; (2) Applicability and Acceptability of Harm Reduction Practices for Others; (3) Perceptions of Harm Reduction Conversations. Most participants were familiar with harm reduction but varied in their perceptions of its relevance for their lives. We noted differences in how participants viewed the applicability and acceptably of harm reduction practices that they perceived as intended to help others (e.g., naloxone) versus intended to help themselves (e.g., syringes). Most participants reported that meaningful conversations about drug use did not happen with their care team but that these conversations would have been acceptable if they were conducted in a way consistent with their individual substance use goals. CONCLUSIONS: Patients' interest and perceived acceptability of harm reduction services during hospitalization varied by individual patient factors and the perceived user of specific interventions. Given their positive potential, harm reduction practices should be incorporated in hospitals, but this must be done in a way that is acceptable to patients. Our findings reveal ways to integrate concepts from a harm reduction approach within a traditional medical model. More work is needed to understand the impact of such integration.

"Come try it out. Get your foot in the door:" Exploring patient perspectives on low-barrier treatment for opioid use disorder.

PURPOSE: Low-barrier treatment is an emerging strategy for opioid use disorder (OUD) care that prioritizes access to evidence-based medication while minimizing requirements that may limit treatment access in more traditional delivery models, particularly for marginalized patients. Our objective was to explore patient perspectives about low-barrier approaches, with a focus on understanding barriers to and facilitators of engagement from the patient point of view. METHODS: We conducted semi-structured interviews with patients accessing buprenorphine treatment from a multi-site, low-barrier mobile treatment program in Philadelphia, PA from July-December 2021. We analyzed interview data using thematic content analysis and identified key themes. RESULTS: The 36 participants were 58% male, 64% Black, 28% White, and 31% Latinx. 89% were enrolled in Medicaid, and 47% were unstably housed. Our analysis revealed three main facilitators of treatment in the low-barrier model. These included 1) program structure that met participant needs, such as flexibility, rapid medication access and robust case management services; 2) harm reduction approach that included acceptance of patient goals other than abstinence and provision of harm reduction services on-site; and 3) strong interpersonal connections with team members, including those with lived experience. Participants contrasted these experiences with other care they had received in the past. Barriers related to lack of structure, limitations of street-based care, and limited support for co-occurring needs, particularly mental health. CONCLUSIONS: This study provides key patient perspectives on low-barrier approaches for OUD treatment. Our findings can inform future program design to increase treatment access and engagement for individuals poorly served by traditional delivery models.

State and Federal Legislators' Responses on Social Media to the Mental Health and Burnout of Health Care Workers Throughout the COVID-19 Pandemic: Natural Language Processing and Sentiment Analysis.

Background: Burnout and the mental health burden of the COVID-19 pandemic have disproportionately impacted health care workers. The links between state policies, federal regulations, COVID-19 case counts, strains on health care systems, and the mental health of health care workers continue to evolve. The language used by state and federal legislators in public-facing venues such as social media is important, as it impacts public opinion and behavior, and it also reflects current policy-leader opinions and planned legislation. Objective: The objective of this study was to examine legislators' social media content on Twitter and Facebook throughout the COVID-19 pandemic to thematically characterize policy makers' attitudes and perspectives related to mental health and burnout in the health care workforce. Methods: Legislators' social media posts about mental health and burnout in the health care workforce were collected from January 2020 to November 2021 using Quorum, a digital database of policy-related documents. The total number of relevant social media posts per state legislator per calendar month was calculated and compared with COVID-19 case volume. Differences between themes expressed in Democratic and Republican posts were estimated using the Pearson chi-square test. Words within social media posts most associated with each political party were determined. Machine-learning was used to evaluate naturally occurring themes in the burnout- and mental health-related social media posts. Results: A total of 4165 social media posts (1400 tweets and 2765 Facebook posts) were generated by 2047 unique state and federal legislators and 38 government entities. The majority of posts (n=2319, 55.68%) were generated by Democrats, followed by Republicans (n=1600, 40.34%). Among both parties, the volume of burnout-related posts was greatest during the initial COVID-19 surge. However, there was significant variation in the themes expressed by the 2 major political parties. Themes most correlated with Democratic posts were (1) frontline care and burnout, (2) vaccines, (3) COVID-19 outbreaks, and (4) mental health services. Themes most correlated with Republican social media posts were (1) legislation, (2) call for local action, (3) government support, and (4) health care worker testing and mental health. Conclusions: State and federal legislators use social media to share opinions and thoughts on key topics, including burnout and mental health strain among health care workers. Variations in the volume of posts indicated that a focus on burnout and the mental health of the health care workforce existed early in the pandemic but has waned. Significant differences emerged in the content posted by the 2 major US political parties, underscoring how each prioritized different aspects of the crisis.

"The new normal has become a nonstop crisis": a qualitative study of burnout among Philadelphia's harm reduction and substance use disorder treatment workers during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic worsened the ongoing overdose crisis in the United States (US) and caused significant mental health strain and burnout among health care workers (HCW). Harm reduction, overdose prevention, and substance use disorder (SUD) workers may be especially impacted due to underfunding, resources shortages, and chaotic working environments. Existing research on HCW burnout primarily focuses on licensed HCWs in traditional environments and fails to account for the unique experiences of harm reduction workers, community organizers, and SUD treatment clinicians. METHODS: We conducted a qualitative secondary analysis descriptive study of 30 Philadelphia-based harm reduction workers, community organizers, and SUD treatment clinicians about their experiences working in their roles during the COVID-19 pandemic in July-August 2020. Our analysis was guided by Shanafelt and Noseworthy's model of key drivers of burnout and engagement. We aimed to assess the applicability of this model to the experiences of SUD and harm reduction workers in non-traditional settings. RESULTS: We deductively coded our data in alignment with Shanafelt and Noseworthy's key drivers of burnout and engagement: (1) workload and job demands, (2) meaning in work, (3) control and flexibility, (4) work-life integration, (5) organizational culture and values, (6) efficiency and resources and (7) social support and community at work. While Shanafelt and Noseworthy's model broadly encompassed the experiences of our participants, it did not fully account for their concerns about safety at work, lack of control over the work environment, and experiences of task-shifting. CONCLUSIONS: Burnout among healthcare providers is receiving increasing attention nationally. Much of this coverage and the existing research have focused on workers in traditional healthcare spaces and often do not consider the experiences of community-based SUD treatment, overdose prevention, and harm reduction providers. Our findings indicate a gap in existing frameworks for burnout and a need for models that encompass the full range of the harm reduction, overdose prevention, and SUD treatment workforce. As the US overdose crisis continues, it is vital that we address and mitigate experiences of burnout among harm reduction workers, community organizers, and SUD treatment clinicians to protect their wellbeing and to ensure the sustainability of their invaluable work.

On, With, By-Advancing Transgender Health Research and Clinical Practice.

To advance the fields of transgender health research and clinical care and center trans-led scholarship, there must be an acknowledgment of the consolidated power in cisgender hands and the subsequent need to redistribute such power to trans experts and burgeoning trans leaders. To redress the social structures that cause harm and limit opportunities for trans persons to lead, current cisgender leaders can take actions including deferring opportunities to trans persons to ensure a redistribution of power and resources to trans experts. This article presents necessary steps to recruit, collaborate, and elevate trans experts.

Reddit language indicates changes associated with diet, physical activity, substance use, and smoking during COVID-19.

COVID-19 has adversely impacted the health behaviors of billions of people across the globe, modifying their former trends in health and lifestyle. In this paper, we compare the psychosocial language markers associated with diet, physical activity, substance use, and smoking before and after the onset of COVID-19 pandemic. We leverage the popular social media platform Reddit to analyze 1 million posts between January 6, 2019, to January 5, 2021, from 22 different communities (i.e., subreddits) that belong to four broader groups-diet, physical activity, substance use, and smoking. We identified that before the COVID-19 pandemic, posts involved sharing information about vacation, international travel, work, family, consumption of illicit substances, vaping, and alcohol, whereas during the pandemic, posts contained emotional content associated with quarantine, withdrawal symptoms, anxiety, attempts to quit smoking, cravings, weight loss, and physical fitness. Prevalent topic analysis showed that the pandemic was associated with discussions about nutrition, physical fitness, and outdoor activities such as backpacking and biking, suggesting users' focus shifted toward their physical health during the pandemic. Starting from the week of March 23, 2020, when several stay-at-home policies were enacted, users wrote more about coping with stress and anxiety, alcohol misuse and abuse, and harm-reduction strategies like switching from hard liquor to beer/wine after people were socially isolated. In addition, posts related to use of substances such as benzodiazepines (valium, xanax, clonazepam), nootropics (kratom, phenibut), and opioids peaked around March 23, 2020, followed by a decline. Of note, unlike the general decline observed, the volume of posts related to alternatives to heroin (e.g., fentanyl) increased during the COVID-19 pandemic. Posts about quitting smoking gained momentum after late March 2020, and there was a sharp decline in posts about craving to smoke. This study highlights the significance of studying social media discussions on platforms like Reddit which are a rich ecological source of human experiences and provide insights to inform targeted messaging and mitigation strategies, and further complement ongoing traditional primary data collection methods.

A Call for Reform: Variability and Insufficiency in Radiation Oncology Resident Didactics-a Brief Report and National Survey of Program Directors.

An informal needs assessment and lack of a national standardized curriculum suggest that there is tremendous variability in the formal teaching of radiation oncology resident throughout the USA. The goal of this study was to characterize formal radiation oncology resident education, in order to identify knowledge gaps and areas for improvement. We developed a 14-item survey consisting of the following domains: program characteristics, teaching faculty, formal teaching time, instructional approaches for formal teaching, curricular topics, and satisfaction with didactics. All 91 accredited US-based radiation oncology program directors received an invitation to complete the survey anonymously by email. Twenty-four (26% response rate) program directors responded. Programs used a variety of instructional methods; all programs reported using lecture-based teaching and only a minority using simulation (38%) or flipped classroom techniques (17%). Other than PowerPoint, the most common electronic resource utilized was quizzing/polling (67%), webinar (33%), and econtour.org (13%). The lack of a national, standardized, radiation oncology residency didactic curriculum promotes variability and insufficiency in resident training. Themes for improvement were diversity in didactic topics, incorporation of evidence-based teaching practices, increased faculty involvement, and sharing of resources across programs. Development of a national curriculum and increased electronic resource sharing may help address some of these areas of improvement.

Association Between Online Reviews of Substance Use Disorder Treatment Facilities and Drug-Induced Mortality Rates: Cross-Sectional Analysis.

BACKGROUND: Drug-induced mortality across the United States has continued to rise. To date, there are limited measures to evaluate patient preferences and priorities regarding substance use disorder (SUD) treatment, and many patients do not have access to evidence-based treatment options. Patients and their families seeking SUD treatment may begin their search for an SUD treatment facility online, where they can find information about individual facilities, as well as a summary of patient-generated web-based reviews via popular platforms such as Google or Yelp. Web-based reviews of health care facilities may reflect information about factors associated with positive or negative patient satisfaction. The association between patient satisfaction with SUD treatment and drug-induced mortality is not well understood. OBJECTIVE: The objective of this study was to examine the association between online review content of SUD treatment facilities and drug-induced state mortality. METHODS: A cross-sectional analysis of online reviews and ratings of Substance Abuse and Mental Health Services Administration (SAMHSA)-designated SUD treatment facilities listed between September 2005 and October 2021 was conducted. The primary outcomes were (1) mean online rating of SUD treatment facilities from 1 star (worst) to 5 stars (best) and (2) average drug-induced mortality rates from the Centers for Disease Control and Prevention (CDC) WONDER Database (2006-2019). Clusters of words with differential frequencies within reviews were identified. A 3-level linear model was used to estimate the association between online review ratings and drug-induced mortality. RESULTS: A total of 589 SAMHSA-designated facilities (n=9597 reviews) were included in this study. Drug-induced mortality was compared with the average. Approximately half (24/47, 51%) of states had below average ("low") mortality rates (mean 13.40, SD 2.45 deaths per 100,000 people), and half (23/47, 49%) had above average ("high") drug-induced mortality rates (mean 21.92, SD 3.69 deaths per 100,000 people). The top 5 themes associated with low drug-induced mortality included detoxification and addiction rehabilitation services (r=0.26), gratitude for recovery (r=-0.25), thankful for treatment (r=-0.32), caring staff and amazing experience (r=-0.23), and individualized recovery programs (r=-0.20). The top 5 themes associated with high mortality were care from doctors or providers (r=0.24), rude and insensitive care (r=0.23), medication and prescriptions (r=0.22), front desk and reception experience (r=0.22), and dissatisfaction with communication (r=0.21). In the multilevel linear model, a state with a 10 deaths per 100,000 people increase in mortality was associated with a 0.30 lower average Yelp rating (P=.005). CONCLUSIONS: Lower online ratings of SUD treatment facilities were associated with higher drug-induced mortality at the state level. Elements of patient experience may be associated with state-level mortality. Identified themes from online, organically derived patient content can inform efforts to improve high-quality and patient-centered SUD care.

Translating and disseminating a localised economic model to support implementation of the 'Ending the HIV Epidemic' initiative to public health policymakers.

Background: Despite significant progress in HIV treatment and prevention, the US remains far from its goal of 'Ending the HIV Epidemic' by 2030. Economic models using local data can synthesise the evidence to help policymakers allocate HIV resources efficiently, but persistent research-to-practice gaps remain. Little is known about how to facilitate the use of economic modelling data among local public health policymakers in real-world settings. Aims and objectives: To explore the dissemination of results from a locally-calibrated economic model for HIV prevention and treatment and identify the factors influencing potential uptake of the model for public health decision making at the local level. Methods: Four virtual focus groups with 26 local health department policymakers in Baltimore, Miami, Seattle, and New York City were held between July 2020 and May 2021. Qualitative content analysis of transcripts identified key themes around using the localised economic model in policy decisions. Results: Participants were interested in using local data in their decisions to allocate resources for HIV prevention/treatment. Six themes emerged: 1) importance of understanding local policy context; 2) health equity considerations; 3) using evidence to support current priorities; 4) difficulty of changing strategies, even incrementally; 5) bang for the incremental buck (efficiency) vs. previous impact; and 6) community values. Conclusion and relevance: To optimise acceptance and use of results from economic models, researchers should engage with local community members and public health decision makers early to understand budgetary and community priorities. Participants prioritised evidence that supports their existing strategies, considers budgets and funding streams, and improves health equity; however, real-world budget constraints and conflicting interests serve as barriers to implementing model recommendations and reaching national goals.

Fractured families and social networks: Identifying risk and resilience factors for supporting positive mental health in Venezuelan immigrant groups.

OBJECTIVES: Language barriers, isolation, and challenges related to social integration, acculturative stress, and systemic discrimination are correlated with poor physical and mental health outcomes among immigrant populations. Emerging literature highlights the importance of social networks for resiliency and well-being. This study explores the experiences of Venezuelan immigrants in central Florida, factors that have promoted resilience, and considerations for mental health providers to meet the needs of this population. METHOD: A phenomenological approach was used to engage Venezuelan immigrants who had been in the United States for at least 6 months (n = 48) in dialogue about forced migration, identity, and adaptation. Five focus groups using a semistructured format were conducted to explore aspects of the experience before, during, and after migration. Recruitment was done through word of mouth and community gatekeepers. RESULTS: Participants were 54% female with an average age of 45, 85% had at least 1 college degree, and more than half left Venezuela since 2011. Themes were identified from the focus group transcripts and clustered into three broad areas: characteristics and individual experiences, mental health, and family and social context. Major findings included the need for culturally responsive mental health support, which appeared to mitigate distress and the centrality of social networks in support of resiliency. CONCLUSIONS: Findings from the present study suggest that community context, support for ethnic identity, and the ability to foster meaningful connections to others with similar experience and identity are critical factors in resilience. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Patient Perceptions About Opioid Risk Communications Within the Context of a Randomized Clinical Trial.

Importance: Opioid overdose rates continue to increase, and extant literature suggests that many individuals who use heroin were first introduced to opioids through a medical prescription. Objective: To explore patient experiences related to decisions regarding analgesia after an emergency department visit within the context of a randomized clinical trial aimed to test the efficacy of risk communication interventions on treatment preference, risk recall, and use of opioids. Design, Setting, and Participants: This qualitative study of 36 patients making decisions regarding analgesia included qualitative interviews with participants in 2 risk intervention groups. Interviews were audio recorded, transcribed, and edited to remove identifying information to protect the confidentiality of participants. Interviews were conducted from June 4, 2019, to August 6, 2019. We conducted thematic analysis from August to December 2019 using a mixed inductive and deductive approach. Participants received $20 in compensation. The study was conducted in 4 geographically diverse emergency departments in the United States. Participants were adults presenting to the emergency department with either musculoskeletal back or neck pain or kidney stone-related pain. Eligibility criteria included being aged 18 to 70 years, capable of providing informed consent, English speaking or having English comprehension, eligible for emergency department discharge within 24 hours of enrollment, and able to access email or a smartphone. Interventions: Participants enrolled from the main randomized clinical trial received 1 of 2 risk interventions: a probabilistic opioid risk tool or a narrative-enhanced probabilistic risk tool (ie, participants viewed eight 1- to 3-minute short videos of patients discussing their experiences with pain treatment and positive and negative experiences with opioid use). Main Outcomes and Measures: Factors reported by participants to have influenced their decision-making regarding acute pain and treatment. Results: Thirty-six participants were interviewed, 18 in the group who received the probabilistic risk tool alone and 18 in the group who received the additional narrative-enhanced probabilistic risk tool intervention. The median age was 38 years (range, 21-67 years), 22 individuals were female (61%), 14 were Black or African American (39%), and 14 were White (39%). Five themes emerged from the analysis in the following domains: the factors associated with the risk interventions; clinician paternalism; analgesia attributes and previous experiences; individual self-identity, attitudes, and values; and perceptions of clinician bias. Conclusions and Relevance: Most participants commented on the powerful lessons they learned from the risk interventions. More research is needed to understand how patients incorporate risk information into their decision-making process.

Evaluating ACGME-accredited addiction psychiatry fellowship online content: A critical analysis of addiction psychiatry fellowship program websites in the US.

Introduction: There is an extreme shortage of addiction psychiatrists and a lack of representation of addiction psychiatry (ADP) fellows from racial/ethnic minoritized backgrounds. ADP fellowship websites are integral in engaging potential applicants. It is therefore critical to understand the quality of engagement that trainees are having with ADP fellowship websites. The aim of this study was to investigate the accessibility and content of ADP fellowship program websites in the U.S. Methods: A list of ADP Fellowship programs was obtained from the Accreditation Council for Graduate Medical Education. A critical textual analysis of 42 unique factors within four categories (accessibility, recruitment, education, and health equity) was performed for each ADP fellowship website. Results: Of 51 ADP fellowships, 47 (92.2%) had websites. Information about social media accounts was largely missing from ADP fellowship websites. For recruitment, program description (95.7%) and program director name (76.6%) were most readily available, while interview day (0.00%) and vacation details (10.6%) were least available. For education, a list of rotations (55.3%) and didactics/lectures (40.4%) were most readily available, while post fellowship placement (6.4%), call schedule (4.3%), and responsibility progression (2.1%) were least available. The most prevalent health equity factors were gender-inclusive language (100%) and an absence of stigmatizing addiction language (100%). The least listed were statements of commitment to health equity (0.0%), antiracism training (2.1%), and harm-reduction strategies (4.3%). Conclusions: There are considerable gaps in the amount and types of information provided by ADP fellowship websites. Many existing websites are poorly interfacing with potential leaders in the field. The development of ADP fellowship websites could serve as a low-cost recruitment tool to engage potential addiction specialists. Our findings underscore the need for ADP fellowships to optimize their websites to engage bourgeoning leaders in addiction and optimize access to more comprehensive information.

Syndemic relationship of depressive symptoms, substance use, and suicidality in transgender youth: a cross-sectional study using the U.S. youth risk behavior surveillance system.

PURPOSE: Syndemics are co-occurring epidemics that cluster within populations due to shared socio-structural factors and are often in populations with intersecting forms of vulnerability. Suicide, depression, and substance use all disproportionately affect transgender and gender diverse (TGD) youth. In this study, we test a syndemic model of the relationship between these three mental health conditions in the context of economic deprivation and interpersonal discrimination. METHODS: We used data on substance use, depressive symptoms, suicidality, and social-structural factors from 2680 TGD youth captured in the 2017 and 2019 survey waves of the Youth Risk Behavior Surveillance System. We used a latent class analysis (LCA) to identify groups with distinct patterns of self-reported substance use and depressive symptoms, and regression models to characterize the relationship between substance-use, depressive symptoms, class membership, social-structural factors, and suicidality. RESULTS: A three-class LCA solution identified a subset of student respondents in a "high use" latent class characterized by high self-reported substance use frequency and depressive symptoms compared with other classes. Online bullying (aOR: 1.58; 95% CI: 1.28-1.95) and housing insecurity (aOR: 8.78; 95% CI: 4.35-17.71) were associated with increased odds of "high use" class membership relative to the "no use" class membership. "High use" class membership was associated with increased odds of suicidal ideation (aOR: 2.26; 95% CI: 1.75-2.94), plans (aOR: 2.59; 95% CI: 2.01-3.36), and attempts (aOR: 6.85; 95% CI: 3.17-15.68). CONCLUSION: The co-occurrence of substance use and depressive symptoms is associated with socio-structural factors and may drive risk for suicidality among TGD youth. Meaningful suicide prevention efforts that address disproportionate risk in this population must be attentive to and mitigate the shared determinants of mood symptoms and substance use behavior.

Impact of Providing Peer Support on Medical Students' Empathy, Self-Efficacy, and Mental Health Stigma.

BACKGROUND: Peer-support programs in medical school can buffer feelings of inadequacy, anxiety, social isolation, and burnout, drawing upon the benefits of near-peer-support resources. This study examined the effects of providing support to students in a medical school peer-support program. METHODS: Using a pre-post, quasi-experimental study design, the investigators surveyed medical students who were peer supporters in their second through fourth years of medical school with four measures assessing (1) empathy, (2) self-efficacy, (3) mental health stigma, and (4) likelihood to assist peers with mental health problems to examine if serving as a volunteer peer supporter had any effect. Participants included 38 medical students that were actively enrolled peer supporters during the 2020-2021 year at a United States allopathic medical school. RESULTS: Medical students who participated as peer supporters were found to have higher ratings of empathy scores (Z = -1.964, p = 0.050, r = 0.34) and self-efficacy scores (Z = -2.060, p = 0.039, r = 0.35) after participation in the program. No significant changes were noted for mental health stigma or likelihood to assist peers with mental health problems. DISCUSSION: Peer-support programs present a low-cost, sustainable modality to promote wellbeing in medical students. There is a growing body of literature documenting the benefits of peer-support services. This brief, novel study examined the effects of providing peer support on the peer supporters and found higher self-reported ratings of empathy and self-efficacy after participation. These findings underscore peer-support programs as a valuable wellness resource not only for medical students who use the services but for those who provide them as well.

Aligning Medical Student Workplace-Based Assessments with Entrustable Professional Activities and the RIME Model in a Psychiatry Clerkship.

OBJECTIVE: The authors piloted use of workplace-based assessments of students during the psychiatry clerkship utilizing both entrustable professional activities (EPAs) and the reporter, interpreter, manager, and educator (RIME) model. METHODS: After supervising clinicians conducted assessments of medical students (N=109) during the psychiatry clerkship using a supervisory scale aligned with both EPA and RIME models, each student received individualized formative feedback. Students were then surveyed on the usefulness of this feedback, and participating faculty/residents were surveyed on the ease of completion of the supervisory scale. RESULTS: Students' mean skill profile suggested they no longer needed direct supervision on EPA1 and EPA6. Mean scores on other studied EPAs suggested students were well on their way toward performing these EPAs without direct supervision. Students had mean RIME scores that exceeded the suggested levels identified for a Reporter to start clerkships, for an Interpreter to start clerkships, and for a Manager to transition to the fourth year. Close to half of the students found the feedback helpful in their development as a clinician but most felt their performance should not be shared with residency program directors, either before or after the Match. Almost all responding preceptors felt the supervisory ratings were easy to complete. CONCLUSIONS: This pilot RIME/EPA framework served as a successful step toward a more competency-based medical education in the psychiatry clerkship with relatively little additional faculty time commitment by using workplace-based assessments already in place and a supervisory scale based on EPAs and RIME.

Perceptions on navigating ACGME-accredited addiction psychiatry fellowship program websites: A thematic analysis across a race- and gender-diverse pool of potential applicants.

Background: There is an alarming shortage of addiction psychiatrists in the United States. To promote interest in addiction psychiatry (ADP), it is essential to maximize resources available through ADP fellowship websites. The aim of this study was to investigate the perceived adequacy and accessibility of content on ADP fellowship websites and discover what further information is considered important among trainees interested in becoming addiction specialists. Methods: Three virtual focus groups were conducted between January and February 2021 among medical students and residents in diverse geographic regions. Participants were asked about the availability of information on ADP fellowship program websites and other material they would like to see available. Focus groups were recorded, with data transcribed and coded using NVivo 11 and Dedoose. A coding scheme was deductively developed based on the core research questions. Results: The majority of participants (N = 27) identified areas of dissatisfaction with the content currently available on ADP websites. The sample was highly representative of racial and ethnic minoritized trainees (n = 12) and genderqueer/non-binary participants (n = 3). Three major themes were identified and durable across all focus groups: lack of emphasis on diversity/health equity, lack of portrayal of everyday life and activities of fellows, and inadequate representation of curricula. Overwhelmingly, participants identified a dedication to health equity (for example, working with minoritized populations) as a key deciding factor in whether to apply to a particular ADP fellowship. Conclusions: ADP fellowship websites are perceived to have considerable variability in the amount and quality of information. Many do not appear to provide the full spectrum of content desired by diverse potential applicants, such as information regarding current fellows and community-centered initiatives. This is concerning, as it suggests ADP fellowships may be interfacing poorly with burgeoning leaders, especially those from race and gender minoritized backgrounds, neglecting potential opportunities to develop future addiction specialists.