Well-being in trainee and faculty physicians.

Background: Physician well-being remains a critical topic with limited information concerning the impact of the progression of training and duty hours. To date, our knowledge and interventions have not adequately addressed these issues. We assessed differences in well-being across the USA: (1) between all post-graduate trainees and their academic core faculty; (2) between all obstetrics and gynecology trainees and their academic core faculty and (3) during the progression of training within obstetrics and gynecology (OB/GYN).Methods: A cross-sectional study analyzing responses to well-being questions included in the 2017-2018 Accreditation Council for Graduate Medical Education (ACGME) surveys given to all U.S. trainees and core faculty. Results: More than 85% of all U.S. physician-trainees and faculty surveyed responded. Respondents included 128,443 trainees from all specialties combined, 5,206 OB/GYN residents and 799 OB/GYN subspecialty fellows. A total of 94,557 faculty from all specialties combined, 4,082 general OB/GYN faculty and 1,432 sub-specialty OB/GYN faculty responded. Trainees were more negative than faculty for the majority of questions for both all trainees combined and within OB/GYN when progressing from resident to subspecialty fellow to subspecialty faculty (p ≤ 0.05). Questions focusing on work satisfaction (e.g., pride in work) were more negative for residents compared to fellows and for fellows compared to faculty. In contrast to work satisfaction, responses to the question 'Felt the amount of work you were expected to complete in a day was reasonable' showed either no difference or higher scores for trainees compared to their faculty. Conclusions: Although an issue for all physicians, well-being impacts trainees more, and differently, than faculty and well-being improves during training from resident to fellow to faculty. Survey responses suggest that interventions should focus on workplace satisfaction over workplace environment areas and further limitations in duty hours are unlikely to improve physician well-being.

Preparing historically underrepresented trainees for biomedical cancer research careers at Huntsman Cancer Institute/University of Utah Health.

Given the well-documented inequities in health care outcomes by race, ethnicity, and gender, many health career pipeline programs have focused on supporting the development of a diverse and inclusive workforce. The State of Utah, is vast, but sparsely populated outside the Salt Lake City metropolitan area. More than 96% of our nearly 85,000 square miles is designated rural (<100 people/square mile) or frontier (<7 people/square mile). The Salt Lake City area is home to the Hunsman Cancer Institute, the only NCI-designated Comprehensive Cancer Center in the region, also noted the limited diversity in the biomedical cancer research workforce. Our primary objective was to increase the number of underrepresented trainees who pursue higher education with the goal of a career in cancer research. PathMaker is a regional, competitive pipeline program that nurtures high school or undergraduate trainees from historically underrepresented backgrounds towards a career in cancer research. Our faculty and staff team collaboratively developed a cohort model curriculum that increased student awareness of research career options; provided academic and professional development, cultural and social support, evolutionary success strategies, active mentorship, and leadership skill development; and fostered an environment of continuous evaluation and improvement. Since pilot program initiation in May 2016, the PathMaker Research Program (PathMaker) has engaged a total of 44 underrepresented trainees in cancer research labs at Huntsman Cancer Institute, the majority still in college. Eleven trainees graduated college: five employed in STEM, one pursuing a PhD in STEM; two in medical school, and three are lost to follow-up. Alumni report high levels of satisfaction with PathMaker and will be followed and supported for academic success. PathMaker is a replicable model to increase diversity and inclusion in the biomedical cancer research workforce.

Communication as a High-Stakes Clinical Skill: "Just-in-Time" Simulation and Vicarious Observational Learning to Promote Patient- and Family-Centered Care and to Improve Trainee Skill.

Patient-provider communication is a hallmark of high-quality care and patient safety; however, the pace and increasingly complex challenges that face overextended teams strain even the most dedicated clinicians. The COVID-19 pandemic has further disrupted communication between clinicians and their patients and families. The dependence on phone communication and the physical barriers of protective gear limit nonverbal communication and diminish clinicians' ability to recognize and respond to emotion. Developing new approaches to teach communication skills to trainees who are often responsible for communicating with patients and their families is challenging, especially during a pandemic or other crisis. "Just-in-time" simulation-simulation-based training immediately before an intervention-provides the scaffolding and support trainees need for conducting difficult conversations, and it enhances patients' and families' experiences. Using a realistic scenario, the author illustrates key steps for effectively using just-in-time simulation-based communication training: assessing the learner's understanding of the situation; determining what aspects of the encounter may prove most challenging; providing a script as a cognitive aid; refreshing or teaching a specific skill; preparing learners emotionally through reflection and mental rehearsal; coaching on the approach, pace, and tone for a delivery that conveys empathy and meaning; and providing specific, honest, and curious feedback to close a performance gap. Additionally, the author acknowledges that clinical conditions sometimes require learning by observing rather than doing and has thus provided guidance for making the most of vicarious observational learning: identify potential challenges in the encounter and explicitly connect them to trainee learning goals, explain why a more advanced member of the team is conducting the conversation, ask the trainee to observe and prepare feedback, choose the location carefully, identify everyone's role at the beginning of the conversation, debrief, share reactions, and thank the trainee for their feedback and observations.

Mitigating Global Oral Health Inequalities: Research Training Programs in Low- and Middle-Income Countries.

Although oral diseases are largely preventable, they are among the most non-communicable diseases globally, and they disproportionately burden disadvantaged communities, specially within low- and middle-income nations. The COVID-19 pandemic has highlighted the social, economic, and health inequalities in our society, including the existing global oral health inequalities. There is a shortage of dentist-scientist all around the world, especially in developing countries, such as Thailand. The National Institute of Dental and Craniofacial Research (NIDCR) and Fogarty International Center (FIC), joined efforts on creating research capacity in oral health in South East Asia through the Fogarty International Center Training Program in Clinical, Public Health and Behavioral Oral Health Research for Thailand (2006-2016). The University of Washington (USA), Thammasat University (Thailand) and Khon Kaen University (Thailand) partnered to conduct short-, medium- and long-term training programs to build regional oral health research capabilities. Investing in research has not only impacted trainees' career development but enhanced advancement of oral health research of South East Asia. The success of partnership calls for expanding oral health research training in other low-income countries.

Transformative medical education: must community-based traineeship experiences be part of the curriculum? A qualitative study.

BACKGROUND: There are shortcomings in medical practitioners' capacity to adapt to the particular needs of people experiencing circumstances of social vulnerability. Clinical traineeships create opportunities for the acquisition of knowledge, competencies, attitudes, and behaviors. However, some authors question the learnings to be made through classical clinical training pathways. This article explores the learnings gained from a traineeship experience within a community-based clinical setting intended for patients experiencing social vulnerability and operating under an alternative paradigm of care. To our knowledge, there is little research intended to identify and understand what medical trainees gain from their experience in such contexts. METHODS: This exploratory qualitative study is based on twelve interviews with practicing physicians who completed a traineeship at La Maison Bleue (Montreal, Canada) and three interviews conducted with key informants involved in traineeship management. Based on Mezirow's theory of transformational learning, data were analyzed according to L'Écuyer's principles of qualitative content analysis. NVivo software was used. RESULTS: The main learnings gained through the traineeship are related to (1) greater awareness of beliefs, assumptions and biases through prejudice deconstruction, cultural humility and critical reflection on own limitations, power and privileges; (2) the development of critical perspectives regarding the health care system; (3) a renewed vision of medical practice involving a less stigmatizing approach, advocacy, empowerment, interdisciplinarity and intersectorality; and (4) strengthened professional identity and future practice orientation including confirmation of interest for community-based practice, the identification of criteria for choosing a future practice setting, and commitment to becoming an actor of social change. Certain characteristics of the setting, the patients and the learner's individual profile are shown to be factors that promote these learnings. CONCLUSIONS: This article highlights how a traineeship experience within a clinical setting intended for a clientele experiencing circumstances of social vulnerability and operating under an alternative paradigm presents an opportunity for transformative learning and health practice transformation toward renewed values of health equity and social justice. Our findings suggest medical traineeships in community-based clinical settings are a promising lead to foster the development of fundamental learnings that are conducive to acceptable and equitable care for people experiencing social vulnerability.

Examining Psychological Self-Sufficiency among African American Low-Income Jobseekers in a Health Profession Career Pathways Program.

The aim of this study was to explore the experiences and perceptions of low-income African American jobseekers participating in the Health Profession Opportunity Grants (HPOG) program by employing a mixed method (Qual-Quant) approach. For qualitative data, two in-depth focus groups were conducted with a total of 12 participants who either completed one program or graduated from the HPOG program. With quantitative data, amediation path analysis was conducted using Model 4 of the PROCESS macro (3.1) with a total of 386 participants. The qualitative content analysis of the focus groups generated an overarching theme of the relationship influence on generating hope that included four phenomenological categories: (a) staff and instructors' approach to engagement and support with on-going accessibility and close follow-up; (b) experience-based career motivation; (c) hope as the core driver to overcoming perceived barriers; and (d) supportive relationships as key to instilling hope. In addition, the quantitative analysis confirmed a full mediation model with the path from perceived employment barriers to economic self-sufficiency being mediated by employment hope. The model suggested that the psychological self-sufficiency (PSS) process is key to increasing the economic self-sufficiency (ESS) outcome. Findings supported the importance ofa relationship-based, culturally competent practice to strengthen the PSS process in health profession workforce development among low-income African American jobseekers.

Dynamically generating T32 training documents using structured data.

BACKGROUND: The US National Institutes of Health (NIH) funds academic institutions for training doctoral (PhD) students and postdoctoral fellows. These training grants, known as T32 grants, require schools to create, in a particular format, seven or eight Word documents describing the program and its participants. Weill Cornell Medicine aimed to use structured name and citation data to dynamically generate tables, thus saving administrators time. CASE PRESENTATION: The author's team collected identity and publication metadata from existing systems of record, including our student information system and previous T32 submissions. These data were fed into our ReCiter author disambiguation engine. Well-structured bibliographic metadata, including the rank of the target author, were output and stored in a MySQL database. We then ran a database query that output a Word extensible markup (XML) document according to NIH's specifications. We generated the T32 training document using a query that ties faculty listed on a grant submission with publications that they and their mentees authored, bolding author names as required. Because our source data are well-structured and well-defined, the only parameter needed in the query is a single identifier for the grant itself. The open source code for producing this document is at http://dx.doi.org/10.5281/zenodo.2593545. CONCLUSIONS: Manually writing a table for T32 grant submissions is a substantial administrative burden; some documents generated in this manner exceed 150 pages. Provided they have a source for structured identity and publication data, administrators can use the T32 Table Generator to readily output a table.

Creative Strengths-Based Approaches to Health Promotion: Perspectives From Graduate Training Experiences.

The authors met during a career development experience where they discussed the commonalities of their successes and challenges conducting creative strengths-based health promotion research with underserved communities during their graduate and postgraduate training. They identified changes to health promotion pedagogy that they would like to see in the future. These include understanding both the strengths and the challenges of creative strengths-based health promotion research conducted with underserved communities, ensuring that reflexivity and flexibility is a component of the process, developing support networks for trainees, understanding personal limitations to effect change, and supporting self-care. They hope that trainees and health education programs will learn from their experiences.

Where Do Pediatric Dental Residents Intend to Practice? Exploring the Influence of Loan Repayment Programs and Other Factors.

The high cost of dental education and consequent loan burdens contribute to the shortage of pediatric dental providers in rural areas (RAs). Economic incentives are meant to recruit practitioners to RAs. The aim of this study was to assess the ability of government subsidized loan repayment programs (GSLRPs) to recruit pediatric specialists to practice in RAs. A 26-item questionnaire was emailed to all 921 pediatric dental residents across the U.S. in 2015 for a cross-sectional study of factors influencing their choice of practice location. The instrument included information about GSLRPs, enabling the study to serve as a quasi-experiment on the level of funding needed to make GSLRPs effective. A total of 169 residents responded, for an 18% response rate; 74% of respondents were women and 86% had student loan debt. Among the respondents, 40.6% said they would like to practice in RAs, but only 4.1% actually intended to do so. Over one-third initially reported interest in GSLRPs for practicing in RAs. However, after being informed that the average GSLRP is $30,000 annually, one-third of those lost interest. Although 14.2% said no amount would convince them to consider practice in an RA, over half (53.3%) indicated willingness to consider it if the GSLRP were $40,000-$60,000. These results suggest that current GSLRP levels are insufficient to induce pediatric dentists to practice in RAs.

Development of a Vertically Integrated Trainee Program: Linking Future and Young Physicians.

Supplemental digital content is available in the text.

Educational Value of Surgical Multidisciplinary Team Meetings for Learning Non-Technical Skills - A Pilot Survey of Trainees From Two UK Deaneries.

OBJECTIVE: This prospective survey study aimed to identify trainee surgeons' views on the educational potential of multi-disciplinary team (MDT) meetings for learning non-technical skills and relevant issues around using MDT meetings as an educational instrument. DESIGN: An online survey questionnaire containing eight closed and three open-ended questions; was developed based on established educational theories. Responses were anonymous. SETTING: This survey study was designed as professional project for masters in medical education degree at Warwick University. The study received ethical approval from the Biomedical Science Research and Ethics Committee of Warwick University. PARTICIPANTS: Trainee surgeons and non-trainee junior surgical doctors within two regions (Health Education Kent Surrey and Sussex, Health Education Wessex) in the UK were invited through an email to take the survey with the help of regional heads of surgery and coordinators. RESULTS: Twenty eight (28) out of 420 invitees completed the survey. High internal consistency was observed for questionnaire (Cronbach's α = 0.924). 71.42% (20/28) respondents attended MDT at least once a week. 75.9% of participants indicated the importance of attendance to MDT meetings with any level of involvement; passive attendance considered the least important (5/28, 17.9%, p=0.005). Trainees felt included in the team by attendance to MDT meetings (Median score 5, p=0.027). MDT meetings were considered important for learning all domains of non-technical skills for surgeons taxonomy (cumulative mean score 2.4, p=001). Respondents considered MDT as a valuable tool for learning non-technical skills for surgeons on Miller's pyramid for learning (Cumulative mean 5.6, p=0.025). Free text answers indicated agreement to the learning opportunity provided by MDT meetings. Consistent suggestions of increasing trainee participation were obtained. CONCLUSION: Results indicate consistently positive views from trainees about the educational value of MDT meeting in general and for non-technical skills. Trainee participation, in the form of case-preparation, presentation, and discussion are recommended by respondents.

Twenty-five-Year Follow-up of Short-term Cancer Research Trainees at the University of Alabama at Birmingham: a Brief Report.

Long-term follow-up is needed to evaluate the impact of short-term cancer research programs on the career trajectories of medical and graduate students. Participation in these programs may be crucial in fostering the next generation of cancer research scientists. This report presents the career outcomes and research productivity of 77 medical and public health students with 25 years of tracking data following their participation in a summer cancer research training program at the University of Alabama at Birmingham (UAB) in 1990-1998. Of 64 summer trainees with contact information, complete survey responses were received from 55 (86.0%) individuals. Over half reported clinical care of cancer patients and 18.2% stated that they were engaged in cancer research. Literature searches confirmed that 23.4% (18/77) of trainees have published cancer research papers. Future studies should explore the optimal timing of short-term post-baccalaureate academic cancer training experiences to identify participant characteristics and institutional factors that influence career choices and determine research productivity.