Has telemedicine come to fruition? Parents' and pediatricians' perceptions and preferences regarding telemedicine.

BACKGROUND: Telemedicine has increasingly become a viable option for patient care and may increase access to care. The aim of our study was to evaluate both parent and pediatrician perceptions, preferences, and acceptability regarding the use of different telemedicine modalities. METHODS: We conducted a cross-sectional survey of both parents and pediatricians in Geneva, Switzerland in 2021. The questionnaire focused on digital literacy, preferences, acceptability, advantages, and disadvantages regarding telemedicine (phone, email, video, and instant message). Descriptive statistics and comparisons of preferences and perceptions (Pearson Chi2 and logistic regression) were performed. RESULTS: Two hundred and twenty-two parents and 45 pediatricians participated. After face-to-face consultations, parents and pediatricians preferred the phone for simple medical advice, discussion of parameters, acute or chronic problems, and psychological support. Email was preferred for communication of results and prescription renewal. Main reasons for using telemedicine were avoiding travel and saving time. Disadvantages were lack of physical examination, technical problems, and unsuitability of the reason for consultation. CONCLUSIONS: Understanding the factors that influence acceptance and satisfaction with telemedicine is vital for its successful implementation. Convenience, quality of care, trust, strong pediatrician-parent relationships, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping parent and pediatrician attitudes toward telemedicine. IMPACT: The COVID-19 pandemic spurred the expansion of the use of telemedicine in pediatric care. Few studies have addressed parent and pediatrician perceptions and preferences regarding telemedicine. Both parents and pediatricians consider certain telemedicine modalities (phone, email, video, and instant message) pertinent in only specific clinical situations. Advantages of telemedicine outweigh disadvantages with parents and pediatricians appreciating the increased access to care, time savings, and avoiding transport. However, the lack of a physical examination remains a significant disadvantage. Convenience, quality of care, trust, strong pediatrician-parent relationship, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping attitudes towards telemedicine.

Validity Evidence of A Screening Tool for Early Detection of Clinical Crisis-Related Anxiety Amongst Medical Students.

Construct: Psychological distress among students is a growing concern in medical education, even more so with the advent of COVID-19 pandemic. Anxiety is among students' mental health issues. High and persistent anxiety has many negative impacts on students' academic and personal life. Early detection is essential for timely intervention. Background: Currently, medical student anxiety is assessed using tools primarily designed for psychiatric purposes. Despite their excellent validity evidence, these tools contain sensitive items and do not explore stressors related to clinical activities. There is a need for contextualized tools to better identify anxiety-provoking factors specific to the medical education environment. Approach: We previously developed the Crisis Experience Rating Scale (CERS-7), a short screening tool to identify early on anxious students participating in clinical activities during the first wave of the COVID-19 pandemic. The present study sought to produce further validity evidence for the CERS-7. Medical students in their clinical years at two Swiss and one French medical school, all involved in COVID-19 clinical activity during the second wave of the pandemic, completed the CERS-7 and the State Anxiety Inventory (STAI-A), the best known and widely used tool to measure for general anxiety. We evaluated internal structure using confirmatory factor analysis (CFA) and relation to other variables using linear regression (LR) and receiver operating characteristic (ROC) curves with thresholds defined using the Youden index. Findings: There were 372 participants. CFA confirmed the two-factor structure of the CERS-7 scale from first-wave dataset. The CERS-7 total scale and subscales demonstrated validity evidence in relationship to the STAI-A scores and categories. A CERS-7 total scale score < 27.5 identified 93% of severely anxious students. Conclusion: The CERS-7 produces reliable scores to use for monitoring anxiety status when assigning students to clinical settings as well as for improving training conditions during clinical crisis.

Towards equitable learning environments for medical education: Bias and the intersection of social identities.

CONTEXT: Medical educators are increasingly paying attention to how bias creates inequities that affect learners across the medical education continuum. Such bias arises from learners' social identities. However, studies examining bias and social identities in medical education tend to focus on one identity at a time, even though multiple identities often interact to shape individuals' experiences. METHODS: This article examines prior studies on bias and social identity in medical education, focusing on three social identities that commonly elicit bias: race, gender and profession. By applying the lens of intersectionality, we aimed to generate new insights into intergroup relations and identify strategies that may be employed to mitigate bias and inequities across all social identities. RESULTS: Although different social identities can be more or less salient at different stages of medical training, they intersect and impact learners' experiences. Bias towards racial and gender identities affect learners' ability to reach different stages of medical education and influence the specialties they train in. Bias also makes it difficult for learners to develop their professional identities as they are not perceived as legitimate members of their professional groups, which influences interprofessional relations. To mitigate bias across all identities, three main sets of strategies can be adopted. These strategies include equipping individuals with skills to reflect upon their own and others' social identities; fostering in-group cohesion in ways that recognise intersecting social identities and challenges stereotypes through mentorship; and addressing intergroup boundaries through promotion of allyship, team reflexivity and conflict management. CONCLUSIONS: Examining how different social identities intersect and lead to bias and inequities in medical education provides insights into ways to address these problems. This article proposes a vision for how existing strategies to mitigate bias towards different social identities may be combined to embrace intersectionality and develop equitable learning environments for all.

[Career and family projects: determinants of medical students' choices]. / Carrière et projets de famille : déterminants des choix des étudiantes et étudiants en médecine.

Society is changing and students' career choices have evolved compared to those of previous generations. This observation motivated a survey of Master's students at the Faculty of Medicine in Geneva. The results reveal that among the respondents (108 students), 85% consider working part-time to take care of their family and 56% feel they have to choose between an ideal career and a family life. During internships and lessons, female students were significantly more likely than their male peers to be encouraged or discouraged to make career choices based on their compatibility with family life. These findings provide useful information about the changing perspectives of students and should be acknowledged by clinical and academic settings to adjust the framework to these changes.

La société change et les choix de carrière des étudiant-e-s évoluent. Ce constat a motivé la réalisation d'une enquête auprès des étudiant-e-s en Master à la Faculté de médecine de Genève. Les résultats révèlent que parmi les répondant-e-s (108 étudiant-e-s), 85 % envisagent un temps partiel pour s'occuper de leur famille et 56 % ont l'impression de devoir faire un choix entre carrière idéale et vie de famille. Lors de leurs stages et de leurs cours, les étudiantes sont significativement plus orientées vers certains choix de carrière en fonction de leur compatibilité avec une vie familiale que leurs pairs. Ces résultats donnent des informations utiles sur l'évolution des mentalités des étudiant-e-s et devraient être considérés par les milieux cliniques et universitaires afin d'ajuster le cadre à ces changements.

Medical students' perceptions and coping strategies during the first wave of the COVID-19 pandemic: studies, clinical implication, and professional identity.

BACKGROUND: The unfolding of the COVID-19 pandemic during spring 2020 has disrupted medical education worldwide. The University of Geneva decided to shift on-site classwork to online learning; many exams were transformed from summative to formative evaluations and most clinical activities were suspended. We aimed to investigate the perceived impact of those adaptations by the students at the Faculty of Medicine. METHODS: We sent an online self-administered survey to medical students from years 2 to 6 of the University of Geneva, three months after the beginning of the pandemic. The survey explored students' main activities during the first three months of the pandemic, the impact of the crisis on their personal life, on their training and on their professional identity, the level of stress they experienced and which coping strategies they developed. The survey consisted of open-ended and closed questions and was administered in French. RESULTS: A total of 58.8% of students responded (n = 467) and were homogeneously distributed across gender. At the time of the survey, two thirds of the participants were involved in COVID-19-related activities; 72.5% voluntarily participated, mainly fueled by a desire to help and feel useful. Many participants (58.8%) reported a feeling of isolation encountered since the start of the pandemic. Main coping strategies reported were physical activity and increased telecommunications with their loved ones. Most students described a negative impact of the imposed restrictions on their training, reporting decreased motivation and concentration in an unusual or distraction-prone study environment at home and missing interactions with peers and teachers. Students recruited to help at the hospital in the context of increasing staff needs reported a positive impact due to the enriched clinical exposure. Perceived stress levels were manageable across the surveyed population. If changed, the crisis had a largely positive impact on students' professional identity; most highlighted the importance of the health care profession for society and confirmed their career choice. CONCLUSION: Through this comprehensive picture, our study describes the perceived impact of the pandemic on University of Geneva medical students, their training and their professional identity three months after the start of the pandemic. These results allowed us to gain valuable insight that reinforced the relevance of assessing the evolution of the situation in the long run and the importance of developing institutional support tools for medical students throughout their studies.

Motivational factors influencing student intentions to practise in underserved areas.

CONTEXT: Exploring student intentions to practise in underserved areas (UAs) is necessary to inform the planning and training of the future medical workforce in order to increase effectiveness and fulfil societal needs. However, little is known about the motivational factors influencing these intentions. This paper explores medical students' intentions to practise in UAs and the motivational factors predicting these intentions. METHODS: Eligible participants included graduating medical students from four of the five Swiss medical schools, who self-reported specialty choice, intentions to practise in UAs, and motives that explained their career choices. Chi-squared analysis was used to compare site, gender, specialty choice and UA practice intention. Motives were aggregated to obtain motivational factors using a principal component analysis with varimax rotation. Logistic regression was used to predict the effects of these motivational factors and of gender on UA practice intention. RESULTS: Of 1749 students included in the study, 240 (13.7%) expressed an intention to practise in UAs (62.1% of whom intended to practise in rural areas) and 719 (41.1%) were undecided. In those who wished to practise in UAs, general practice (21.6%) was the most preferred specialty. Motivational factors influencing specialty choice were intellectual challenge, work variety, work conditions and enthusiasm (Kaiser-Meyer-Olkin index 0.79, P < .001, 49.0% of variance explained). Students motivated by work variety (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.2-1.7) and by work conditions (OR 1.3, 95% CI 1.1-1.6) were more likely to choose UAs and those motivated by intellectual challenge (OR 0.4, 95% CI 0.3-0.5) were less likely. Undecided students' motivations were very similar to those of students interested in working in UAs. CONCLUSIONS: The actual number of Swiss students interested in working in UAs is low and is probably insufficient to meet current societal needs. Work variety and work conditions appear to be factors that might attract interested and undecided students towards working in UAs.

Learning to manage uncertainty: supervision, trust and autonomy in residency training.

Sociologists have debated whether and how medical trainees are socialised to deal with uncertainty for decades. Recent changes in the structure of medical education, however, have likely affected the ways that resident physicians learn to manage uncertainty. Through ethnographic case studies of academic medical centres in Switzerland and the United States, this article provides new insights into the processes through which residents learnt to manage uncertainty. These processes included working under supervision, developing relationships of trust with supervisors and gaining autonomy to practise independently. As a result, residents developed different attitudes towards uncertainty. Residents at the Swiss medical centre tended to develop a more pragmatic attitude and viewed uncertainty as something to be addressed and controlled. On the other hand, residents at the American medical centre tended to develop an acceptive attitude towards uncertainty. More broadly, residents learnt to reproduce their supervisors' attitudes towards uncertainty. This article therefore provides new perspectives on continuity and the reproduction of social phenomena in medical education.

Training junior faculty to become clinical teachers: The value of personalized coaching.

Background: Junior clinical faculty require institutional support in the acquisition of feedback and clinical supervision skills of trainees. We tested the effectiveness of a personalized coaching versus guided self-reflection format of a faculty development program at improving faculty skills and self-efficacy.Methods: Participants were evaluated both before and after the program using a four-station Objective Structured Teaching Exercise (OSTE). A gain-score analysis, one-way ANOVA, and paired t-tests were used to evaluate both groups. The impact on the learning environment was measured by resident ratings of the Maastricht Clinical Teaching Questionnaire.Results: One hundred and twenty-seven participants completed the study over a three-year period. Both groups had significant improvements in self-efficacy. Participants in the coaching group demonstrated superior performance in encouraging learner self-reflection, teaching effectiveness, verifying learner understanding, exploring feelings/needs, and defining learning objectives. Over a 5-year period, the overall institutional learning climate significantly improved concerning faculty role-modeling, coaching, articulation, and explorations skills.Conclusion: Offering a contextualized faculty-development program using OSTEs that provides multiple opportunities for feedback and is focused on creating a community of practice is an effective method to facilitate the transfer of skills to the clinical environment, supports teacher identity development, and favorably impacts the learning climate.

Intra versus interprofessional conflicts: implications for conflict management training.

Interprofessional collaboration and conflict management training are necessary in health sciences curricula. Characteristics of conflicts occurring within intraprofessional or between interprofessional teams can vary and are poorly understood. We sought to compare and contrast characteristics of intra- versus interprofessional conflicts to inform future training programs. An exploratory study was conducted through semi-structured interviews with 82 healthcare professionals working in a tertiary hospital. Interviews focused on sources, consequences, and responses to conflicts. Conflict situations were analyzed with conventional content analysis. Participants shared more intra- than interprofessional situations. Intraprofessional conflicts were caused by poor relationships, whereas interprofessional conflicts were associated with patient-related tasks and social representations. Avoiding and forcing were the most commonly mentioned responses to intraprofessional conflicts. The theme of power impacted all aspects of conflict both intra- and interprofessional. Intraprofessional conflicts were found to be as important as interprofessional conflicts. Differences in the sources of conflict and similarities regarding consequences of and responses to conflicts support integration of authentic clinical situations in interprofessional training. Understanding similarities and differences between intra- and interprofessional conflicts may help educators develop conflict management training that addresses the sources, consequences, and responses to conflicts in clinical settings.

Exploring group boundaries and conflicts: a social identity theory perspective.

CONTEXT: In the clinical environment, health care professionals self-categorise into different groups towards which they develop positive attitudes, whereas they view other groups less favourably. Social identity theory purports that these attitudes influence group processes and may foster conflicts that impede collaborative practice, although this relationship is poorly understood. This study used concepts from social identity theory to examine the interplay between group processes and conflicts, as well as the consequences of these conflicts, with the goal of identifying educational strategies to favour teamwork. METHODS: Semi-structured interviews with 82 randomly selected physicians and nursing professionals working at a Swiss academic medical centre explored participants' experiences of conflicts. Data analysis was informed by social identity theory and focused on interviews where group processes were highlighted by participants. The analysis sought to uncover how group processes were intertwined with conflicts and how they affected health care professionals. RESULTS: A total of 42 participants out of the initial pool of 82 interviews shared 52 stories of conflicts involving group processes. Most of these stories were shared by physicians and involved groups of physicians at different hierarchical levels. Conflicts and group processes were linked in two ways: (i) through processes of group membership when individuals struggled to join a relevant group, and (ii) through intergroup boundaries, such as when participants perceived that power differentials disadvantaged their own groups. Conflicts could lead to difficult experiences for clinicians who questioned their abilities, became disillusioned with their professional ideals and developed negative perceptions of other groups. CONCLUSIONS: This study suggests that conflicts involving group processes may lead to stronger intergroup boundaries, challenging current educational efforts to favour teamwork in health care. Taking steps to create more inclusive groups and to encourage perspective taking may help manage intergroup conflict.

Validity Evidence for a Residency Admissions Standardized Assessment Letter for Pediatrics.

Construct: This study aims to provide validity evidence for the standardized Assessment Letter for Pediatrics as a measure of competencies expected of a 1st-year pediatrics resident as part of a pediatric residency admissions process. BACKGROUND: The Narrative Letter of Recommendation is a frequently used tool in the residency admissions process even though it has poor interrater reliability, lacks pertinent content, and does not correlate with residency performance. A newer tool, the Standardized Letter, has shown validity evidence for content and interrater reliability in other specialties. We sought to develop and provide validity evidence for the standardized Assessment Letter for Pediatrics. APPROACH: All 2012 and 2013 applicants invited to interview at the University of Geneva Pediatrics Residency Program provided 2 standardized Assessment Letters. Content for the letter was based on CanMEDS roles and ratings of 6 desired competencies and an overall assessment. Validity evidence was gathered for internal structure (Cronbach's alpha and generalizability), response process (interrater reliability with intraclass correlation), relations to other variables (Pearson's correlation coefficient), and consequences (logistic regression to predict admission). RESULTS: One hundred fourteen faculty completed 142 standardized Assessment Letters for 71 applicants. Average overall assessment was 3.0 of 4 (SD = 0.59). Cronbach's alpha was 0.93. The G-coefficient was 0.59. The decision study projected that four Assessment Letters are needed to attain a G-coefficient of 0.73. Applicant variance (28.5%) indicated high applicant differentiation. The Assessment Letter intraclass coefficient was 0.51, 95% confidence interval (CI) [0.43, 0.59]. Assessment Letter scores were correlated with the structured interview (r = .28), 95% CI [0.05, 0.51]; global rating (r = .36), 95% CI [0.13, 0.58]; and admissions decision (r = .25), 95% CI [0.02, 0.46]. Assessment Letter scores did not predict the admissions decision (odds ratio = 1.67, p = .37) after controlling for the unique contribution of the structured interview and global rating scores. CONCLUSION: Validity evidence supports use of the Assessment Letter for Pediatrics; future studies should refine items to improve predictive validity and explore how to best integrate the Assessment Letter into the residency admissions process.

Medical students' professional identity development from being actors in an objective structured teaching exercise.

INTRODUCTION: Medical students develop professional identity through structured activities and impromptu interactions in various settings. We explored if contributing to an Objective Structured Teaching Exercise (OSTE) influenced students' professional identity development. METHODS: University clinical faculty members participated in a faculty development program on clinical supervision. Medical students who participated in OSTEs as simulated residents were interviewed in focus groups about what they learnt from the experience and how the experience influenced their vision of learning and teaching. Transcripts were analyzed using the Goldie's personality and social structure perspective model. RESULTS: Twenty-five medical students out of 32 students involved in OSTEs participated. On an institutional level, students developed a feeling of belonging to the institution. At an interactional level, students realized they could influence the teaching interaction by actively seeking or giving feedback. On the personal level, students realized that errors could become sources of learning and felt better prepared to receive faculty feedback. CONCLUSION: Taking part in OSTEs as a simulated resident has a positive impact on students' vision regarding the institution as a learning environment and their own role by actively seeking or giving feedback. OSTEs support their professional identity development regarding learning and teaching while sustaining faculty development.

Improving the residency admissions process by integrating a professionalism assessment: a validity and feasibility study.

The purpose of this study was to provide validity and feasibility evidence in measuring professionalism using the Professionalism Mini-Evaluation Exercise (P-MEX) scores as part of a residency admissions process. In 2012 and 2013, three standardized-patient-based P-MEX encounters were administered to applicants invited for an interview at the University of Geneva Pediatrics Residency Program. Validity evidence was gathered for P-MEX content (item analysis); response process (qualitative feedback); internal structure (inter-rater reliability with intraclass correlation and Generalizability); relations to other variables (correlations); and consequences (logistic regression to predict admission). To improve reliability, Kane's formula was used to create an applicant composite score using P-MEX, structured letter of recommendation (SLR), and structured interview (SI) scores. Applicant rank lists using composite scores versus faculty global ratings were compared using the Wilcoxon signed-rank test. Seventy applicants were assessed. Moderate associations were found between pairwise correlations of P-MEX scores and SLR (r = 0.25, P = .036), SI (r = 0.34, P = .004), and global ratings (r = 0.48, P < .001). Generalizability of the P-MEX using three cases was moderate (G-coefficient = 0.45). P-MEX scores had the greatest correlation with acceptance (r = 0.56, P < .001), were the strongest predictor of acceptance (OR 4.37, P < .001), and increased pseudo R-squared by 0.20 points. Including P-MEX scores increased composite score reliability from 0.51 to 0.74. Rank lists of applicants using composite score versus global rating differed significantly (z = 5.41, P < .001). Validity evidence supports the use of P-MEX scores to improve the reliability of the residency admissions process by improving applicant composite score reliability.

The impact of gendered experiences on the career choice of swiss medical students: A qualitative study protocol.

The problem of gender discrimination and sexual harassment in medicine is long-standing and widespread. This project aims to document and understand how gendered experiences encountered by final-year medical students in Switzerland are experienced by these individuals and how they influence their career choice. It also aims to identify representations and stereotypes linked to the different specialties. The project will take place at all Swiss universities offering a master's degree in human medicine, for a total of 9 programs. Around 36 participants will be recruited. Semi-structured qualitative individual interviews will be conducted. Analysis will be based on Grounded Theory principles.

Exploring Medical Career Choice to Better Inform Swiss Physician Workforce Planning: Protocol for a National Cohort Study.

BACKGROUND: A medical student's career choice directly influences the physician workforce shortage and the misdistribution of resources. First, individual and contextual factors related to career choice have been evaluated separately, but their interaction over time is unclear. Second, actual career choice, reasons for this choice, and the influence of national political strategies are currently unknown in Switzerland. OBJECTIVE: The overall objective of this study is to better understand the process of Swiss medical students' career choice and to predict this choice. Our specific aims will be to examine the predominately static (ie, sociodemographic and personality traits) and predominately dynamic (ie, learning context perceptions, anxiety state, motivation, and motives for career choice) variables that predict the career choice of Swiss medical school students, as well as their interaction, and to examine the evolution of Swiss medical students' career choice and their ultimate career path, including an international comparison with French medical students. METHODS: The Swiss Medical Career Choice study is a national, multi-institution, and longitudinal study in which all medical students at all medical schools in Switzerland are eligible to participate. Data will be collected over 4 years for 4 cohorts of medical students using questionnaires in years 4 and 6. We will perform a follow-up during postgraduate training year 2 for medical graduates between 2018 and 2022. We will compare the different Swiss medical schools and a French medical school (the University of Strasbourg Faculty of Medicine). We will also examine the effect of new medical master's programs in terms of career choice and location of practice. For aim 2, in collaboration with the Swiss Institute for Medical Education, we will implement a national career choice tracking system and identify the final career choice of 2 cohorts of medical students who graduated from 4 Swiss medical schools from 2010 to 2012. We will also develop a model to predict their final career choice. Data analysis will be conducted using inferential statistics, and machine learning approaches will be used to refine the predictive model. RESULTS: This study was funded by the Swiss National Science Foundation in January 2023. Recruitment began in May 2023. Data analysis will begin after the completion of the first cohort data collection. CONCLUSIONS: Our research will inform national stakeholders and medical schools on the prediction of students' future career choice and on key aspects of physician workforce planning. We will identify targeted actions that may be implemented during medical school and may ultimately influence career choice and encourage the correct number of physicians in the right specialties to fulfill the needs of currently underserved regions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53138.

Physicians' Perceptions and Experiences Regarding Leadership: A Link Between Beliefs and Identity Formation.

Introduction: Despite the development of national recommendations and training programs for effective leadership, junior and senior medical leaders often find themselves ill-prepared to take on these new responsibilities. This study aimed to explore physicians' perceptions, feelings, and beliefs regarding leadership and to provide recommendations regarding appropriate training and institutional post-training support. Methods: We conducted a qualitative study at the Geneva University Hospitals. A purposeful sample of residents (R), fellows (F), attending physicians (A), and chairpersons (CP) were invited to participate in focus groups (or semi-structured interviews) between April and June 2021. We investigated their understanding of leadership, self-perception as leaders, difficulties, and paths to improvement in their leadership skills. Focus groups were transcribed verbatim and analyzed both inductively and deductively using Fishbein's model of behavior prediction and Irby's professional identity formation framework. Results: We conducted ten focus groups (R=3; F=4, A=2, and CP=1) and one interview (CP). Physicians expressed poor self-efficacy at all hierarchical levels: feelings of insecurity and confusion (R and F), frustration (A), and feeling stuck between divisional and institutional governance (CP). Such negative feelings were nurtured by personal beliefs with an intuitive and idealized representation of leadership. Beliefs focused more on personal characteristics rather than on skills, processes, or perceived institutional norms. Unclear expectations regarding physicians' role as leaders, overemphasis on academic achievement, and silo professional organizations fueled their feelings. Participants reported developing their leadership through trial and error, observing role models, and turning to personal resources rather than formal training. Conclusion: Our results show that physicians' leadership skills are still mainly acquired intuitively and that institutional norms do not encourage clarification of leadership roles and processes. Physician training in leadership skills, together with more explicit and clear institutional processes, may help to improve physicians' self-efficacy and develop their identity as leaders.

Development and validity evidence for the intraprofessional conflict exercise: An assessment tool to support collaboration.

BACKGROUND: Effective collaboration is the foundation for delivering safe, high quality patient care. Health sciences curricula often include interprofessional collaboration training but may neglect conflicts that occur within a profession (intraprofessional). We describe the development of and validity evidence for an assessment of intraprofessional conflict management. METHODS AND FINDINGS: We designed a 22-item assessment, the Intraprofessional Conflict Exercise, to evaluate skills in managing intraprofessional conflicts based on a literature review of conflict management. Using Messick's validity framework, we collected evidence for content, response process, and internal structure during a simulated intraprofessional conflict from 2018 to 2019. We performed descriptive statistics, inter-rater reliability, Cronbach's alpha, generalizability theory, and factor analysis to gather validity evidence. Two trained faculty examiners rated 82 trainees resulting in 164 observations. Inter-rater reliability was fair, weighted kappa of 0.33 (SE = 0.03). Cronbach's alpha was 0.87. The generalizability study showed differentiation among trainees (19.7% person variance) and was highly reliable, G-coefficient 0.88, Phi-coefficient 0.88. The decision study predicted that using one rater would have high reliability, G-coefficient 0.80. Exploratory factor analysis demonstrated three factors: communication skills, recognition of limits, and demonstration of respect for others. Based on qualitative observations, we found all items to be applicable, highly relevant, and helpful in identifying how trainees managed intraprofessional conflict. CONCLUSIONS: The Intraprofessional Conflict Exercise provides a useful and reliable way to evaluate intraprofessional conflict management skills. It provides meaningful and actionable feedback to trainees and may help health educators in preparing trainees to manage intraprofessional conflict.

Patients preferences for communication during video consultations.

Objective The aim of our simulation-based study was to explore patient preferences for physician behaviours in video consultations METHODS: We conducted an exploratory study in outpatient setting in Geneva, Switzerland.Patients were invited to watch two variations videos of six simulated physician communication behaviours (camera framing, gaze orientation, initial talk at the opening phase, privacy reminder, pauses, empathy)and to indicate which one they preferred RESULTS: 417 patients watched three different video-recorded encounters. Most patients preferred framing with both face and bust (50.7 %) versus face alone (21.8 %). They valued eye gazing towards the camera (42.9 %) versus eye gazing shifting between screen and camera (13 %). The social talk related to the connection quality was appreciated (43.1 % vs 17.1 %) as well as the privacy reminder (80.8 % vs 6.5 %). Patients preferred short rather than long pauses after physician's statements (63.9 vs 14.9 %) as well as expressive rather than neutral nonverbal behaviour (46.7 % vs 17.6 %). CONCLUSION: Our results confirm that patients prefer the use of video specific communication behaviours recommended by experts except for shifting eye gaze and long pauses after physician's statements. PRACTICE IMPLICATIONS: Given the increasing use of video consultations, video communication "best practices"should be systematically addressed in physician training.