Mistreatment in Residency: Intervening With the REWIND Communication Tool.

Introduction: There is a lack of curricula addressing the alarming rates of resident physician mistreatment. As the ACGME works to address diversity, equity, and inclusion in GME, there has been increasing attention paid to the issue of mistreatment. Previous studies have noted a high prevalence of mistreatment within GME. Despite this, there are few published interventions to address the mistreatment of residents. We developed a workshop for residents to provide an overview of mistreatment in residency and teach them REWIND (relax, express, why, inquire, negotiate, determine), a communication tool to address mistreatment directly. Methods: We designed a 60-minute workshop for residents with didactics on mistreatment in GME, followed by three case discussions. Four case scenarios were developed to represent different types of mistreatment and situations. We implemented the workshop twice and asked participants to self-rate proficiency around the workshop objectives with pre- and postsurveys. Results: A total of 11 GME learners completed both the pre- and postsurveys between the two workshop implementations. GME learners who responded demonstrated significantly higher self-rated proficiency on each objective postworkshop compared to preworkshop (p < .05). Free responses on the survey demonstrated that participants particularly enjoyed the case discussions and wanted more practice with REWIND. Discussion: Our workshop improved participant self-rated proficiency around the mistreatment of resident physicians. The workshop can be used in the future as part of a multifaceted institutional response to mistreatment.

Crown preparations by undergraduate dental students: A comparison of conventional versus digital assessment via an intraoral scanner.

PURPOSE: This study aims to assess the effectiveness of the 3Shape TRIOS intraoral scanner (IOS) in student crown preparation evaluation. DESIGN: Students were tasked to perform a full metal crown preparation on the upper left first molar on a patient simulator within 45 minutes. Marginal Width, Occlusal Reduction, Presence of Undercuts, Taper, Planes of Reduction, Line Angles, Conformity to Gingival Contour, and Smoothness were evaluated via 3 assessment modes: (a) Conventional assessment by 2 supervisors; (b) Conventional assessment by students; (c) Digital assessment by students. Agreement between assessment modes was investigated using Kappa (κ), with a threshold set at κ > 0.4. Effectiveness of IOS for objective parameters was determined via physical verification, while that for subjective parameters was defined by agreement with the stricter supervisor grade. RESULTS: Substantial agreement (κ = 0.631) was found between IOS measurement of Marginal Width and physical verification. Two of 5 subjective parameters met κ > 0.4 for agreement between IOS and the stricter supervisor grade. Agreement between supervisors ranged from slight (κ = 0.103) for Occlusal Reduction to Fair (κ = 0.399) for Marginal Width. Agreement between conventional assessments of supervisors and students ranged from less than chance (κ = -0.142) for Occlusal Reduction to moderate (κ = 0.577) for Line Angles. Agreement between conventional assessments of supervisors and digital assessments of students ranged from slight (κ = 0.130) for Planes of Reduction to moderate (κ = 0.538) for Line Angles. CONCLUSIONS: IOS may be used to overcome limitations in conventional assessment of objective parameters and some subjective parameters. Digital assessment of crown preparations cannot completely replace conventional assessment.

Patterns of Change Over Time in Knee Bone Shape Are Associated with Sex.

BACKGROUND: Knee osteoarthritis (OA) is more common in females than in males; however, the biological mechanisms for the difference in sex in patients with knee OA are not well understood. Knee shape is associated with OA and with sex, but the patterns of change in the bone's shape over time and their relation to sex and OA are unknown and may help inform how sex is associated with shape and OA and whether the effect is exerted early or later in life.Questions/purposes (1) Does knee shape segregate stably into different groups of trajectories of change (groups of knees that share similar patterns of changes in bone shape over time)? (2) Do females and males have different trajectories of bone shape changes? (3) Is radiographic OA at baseline associated with trajectories of bone shape changes? METHODS: We used data collected from the NIH-funded Osteoarthritis Initiative (OAI) to evaluate a cohort of people aged 45 to 79 years at baseline who had either symptomatic knee OA or were at high risk of having it. The OAI cohort included 4796 participants (58% females; n = 2804) at baseline who either had symptomatic knee OA (defined as having radiographic tibiofemoral knee OA and answering positively to the question "have you had pain, aching or stiffness around the knee on most days for at least one month during the past 12 months") or were at high risk of symptomatic knee OA (defined as having knee symptoms during the prior 12 months along with any of the following: overweight; knee injury; knee surgery other than replacement; family history of total knee replacement for OA; presence of Heberden's nodes; daily knee bending activity) or were part of a small nonexposed subcohort. From these participants, we limited the eligible group to those with radiographs available and read at baseline, 2 years, and 4 years, and randomly selected participants from each OAI subcohort in a manner to enrich representation in the study of the progression and nonexposed subcohorts, which were smaller in number than the OA incidence subcohort. From these patients, we randomly sampled 473 knees with radiographs available at baseline, 2 years, and 4 years. We outlined the shape of the distal femur and proximal tibia on radiographs at all three timepoints using statistical shape modelling. Five modes (each mode represents a particular type of knee bone shape variation) were derived for the proximal tibia and distal femur's shape, accounting for 78% of the total variance in shape. Group-based trajectory modelling (a statistical approach to identify the clusters of participants following a similar progression of change of bone shape over time, that is, trajectory group) was used to identify distinctive patterns of change in the bone shape for each mode. We examined the association of sex and radiographic OA at baseline with the trajectories of each bone shape mode using a multivariable polytomous regression model while adjusting for age, BMI, and race. RESULTS: Knee bone shape change trajectories segregated stably into different groups. In all modes, three distinct trajectory groups were derived, with the mean posterior probabilities (a measure of an individual's probability of being in a particular group and often used to characterize how well the trajectory model is working to describe the population) ranging from 84% to 99%, indicating excellent model fitting. For most of the modes of both the femur and tibia, the intercepts for the three trajectory groups were different; however, the rates of change were generally similar in each mode. Females and males had different trajectories of bone shape change. For Mode 1 in the femur, females were more likely to be in trajectory Groups 3 (odds ratio 30.2 [95% CI 12.2 to 75.0]; p < 0.001) and 2 than males (OR 4.1 [95% CI 2.3 to 7.1]; p < 0.001); thus, females had increased depth of the intercondylar fossa and broader shaft width relative to epicondylar width compared with males. For Mode 1 in the tibia, females were less likely to be in trajectory Group 2 (OR 0.5 [95% CI 0.3 to 0.9]; p = 0.01) than males (that is, knees of females were less likely to display superior elevation of tibial plateau or decreased shaft width relative to head width). Radiographic OA at baseline was associated with specific shape-change trajectory groups. For Mode 1 in the femur, knees with OA were less likely to be in trajectory Groups 3 (OR 0.4 [95% CI 0.2 to 0.8]; p = 0.008) and 2 (OR 0.6 [95% CI 0.3 to 1.0]; p = 0.03) than knees without OA; thus, knees with OA had decreased depth of the intercondylar fossa and narrower shaft width relative to epicondylar width compared with knees without OA. For Mode 1 in the tibia, knees with OA were not associated with trajectory. CONCLUSIONS: The shapes of the distal femur and proximal tibia did not change much over time. Sex and baseline knee radiographic OA status are associated with the trajectory of change in the bone's shape, suggesting that both may contribute earlier in life to the associations among trajectories observed in older individuals. Future studies might explore sex-related bone shape change earlier in life to help determine when the sex-specific shapes arise and also the degree to which these sex-related shapes are alterable by injury or other events. LEVEL OF EVIDENCE: Level III, prognostic study.

Socioeconomic status, frailty, and subjective well-being: A moderated mediation analysis in elderly Chinese.

The study examined the mechanisms underlying the link between socioeconomic status and subjective well-being and explored the role of social activities using a representative sample of older adults ( N = 2773) in Shanghai, China. Results show that frailty mediated the relationship between socioeconomic status and subjective well-being, and social activities moderated the model, such that the mediation effect of frailty was significant only when social activities were lower. Moreover, the moderated mediation model was significant only for women, not for men. Findings highlight the importance of addressing frailty of older adults and promoting social activities (especially for elderly women) in future interventions.