Evaluation of Gender-Identity Inclusive Language Used in U.S. Hospital Breastfeeding Education Materials.

Purpose: To assess the use of gender-identity inclusive language in breastfeeding education materials publicly available on U.S. Hospital websites. Methods: Hospitals were identified through the American College of Obstetricians and Gynecologists website. Breastfeeding education materials were searched online at each hospital. The first breastfeeding material on each website was used for our evaluation. Gender-identity inclusive versus traditional sexed language terms were curated a priori by referencing the National Institutes of Health and American Psychological Associations' guidelines. Education materials were categorized into: (1) "gender-identity inclusive language," (2) "mix of inclusive and traditional sexed language," or (3) "traditional sexed language." Frequencies of the type of language and specific gender-related terms were calculated. Results: In total, n = 112 hospitals with publicly available breastfeeding education materials were included. Most hospitals used both traditional sexed and inclusive language (69%, n = 77), followed by only traditional language (31%, n = 35). None of the hospitals used solely gender-identity inclusive language. One hospital provided material "intended for LGBTQI+" populations. Conclusion: Education materials provided by hospitals for breastfeeding do not utilize gender-identity inclusive language As such, there remains uncertainty and hesitancy on how to provide appropriate breastfeeding education for all persons who identify as transgender and/or non-binary, yet choose or are able to breastfeed. Further research in this area could ascertain the impacts of using gender-identity inclusive language in breastfeeding education materials for the general, transgender, or non-binary populations.

Hungry for nutrition information: Undergraduate students' engagement with nutrition social media nutrition content.

Background: Social media is a fast-changing, normalized way through which youth access health and nutrition information. Yet, social media content that lacks expertise or altruistic motives can negatively impact this vulnerable population through mis- or disinformation. Aim: The aims of this study were to 1) assess how adolescents and young adults engage with nutrition information across social media platforms and account types, and 2) describe their preferences for nutrition social media content. Methods: We conducted an exploratory mixed methods study with 57 undergraduate students enrolled in an introductory public health nutrition course. First, we calculated descriptive statistics on close-ended survey data on social media use and sociodemographic variables. Then, we performed thematic analysis on open-ended survey data regarding social media use, preferences, and experiences. Results: The median age of participants was 20 years old; 70% of participants identified as female and 11% identified as male. We found that TikTok and Instagram were highly preferred by participants for weight loss, wellness, diet promotion, and sports and fitness topics. In general, participants reported wanting personalized content that conveys positive nutrition messages that are supported by credible expertise. Conclusion: These findings suggest that the nutrition community can engage adolescents and young adults by presenting information as image- and video-based content on social media. Social media content related to weight loss, wellness, diet promotion, and sports and fitness topics should establish credibility using visible markers and embrace body positive messaging for maximum uptake.

Does Box Height Matter? A Comparative Analysis of Box Height on Box Jump Performance in Men and Women.

This study aimed to analyze the effect of box height on box jump performance among recreationally active college students. Fourteen males (age = 20.8 ± 4.1 years, height = 178.3 ± 6.3 cm, weight = 82.3 ± 13.0 kg) and seventeen females (age = 20.8 ± 2.1 years, height = 167.1 ± 5.5 cm, weight = 64.5 ± 7.4 kg) completed box jumps at five different box heights that corresponded to 0, 20, 40, 60, and 80% of their maximal box jump height. Variables of interest included peak force, rate of force development, peak rate of force development, peak power, velocity at peak power, jump height, time to take-off, and reactive strength index modified. Peak force at 80% maximal box jump was significantly higher than 0% in the female cohort (p = 0.001). No significant differences for any of the other variables were observed in males, or at any other height lower than the 80% maximal box jump height for females (p > 0.05). Overall, variations in box height did not influence box jump performance in recreationally trained individuals when the intent to perform a maximal-effort jump was emphasized. This is important for strength and conditioning coaches and trainers, as they can utilize boxes of varied heights when teaching proper landing techniques to novice athletes with no decrements in propulsive performance.

Perceptions of Breastfeeding Among Adolescents and Young Adults.

Purpose: We aimed to understand adolescents' and young adults' perceptions and the extent of their knowledge about breastfeeding. Methods: Participants (adolescents and young adults in the United States, 14-24 years of age) were texted five open-ended questions about their perceptions of various aspects of breastfeeding including their initial reaction to breastfeeding, the impact on the infant and parent, how it compares with formula, and whether they were breastfed. The responses were analyzed for themes using an inductive content analysis approach. Responses were compared using χ2 tests to assess if knowledge and education about breastfeeding differed according to gender identity and age. Results: Among 1,283 participants, 829 responded (response rate = 64.4%). The average age was 18.8 (standard deviation [SD] = 2.9), with 53% female and 10% Black. Most adolescents and young adults understand there are health benefits of breastfeeding for the breastfeeding dyad (n = 589; 78.8%), yet also indicate an awareness of negative aspects (n = 256; 36.1%). Participants who identified as female or gender-variant and those who were older were more likely to refer to the emotional and bonding connections breastfeeding creates (p = 0.0011 and p = 0.0002). Males were more likely to have less knowledge about breastfeeding effects on the breastfeeding person but have more negative attitudes toward formula (p = 0.0298 and p = 0.0543). Younger respondents tended to indicate that formula was better than breast milk (p = 0.0534). Conclusion: We found a mix of positive and negative perceptions of breastfeeding among adolescents and young adults. Understanding how youth view breastfeeding can inform targeted education for this population that includes all genders and can begin before pregnancy.

Complete genome sequences of microbacterium phages Tedro and BAjuniper.

We purified two novel bacteriophages from soil collected in Sioux County, Iowa: BAjuniper and Tedro. These bacteriophages were isolated from the host, Microbacterium foliorum. BAjuniper was assigned to cluster EB, and Tedro was assigned to cluster EF. Both phages display genomes typical of other phages in their clusters.

Public Health Graduate Students' Longitudinal Perceptions of Remote Learning Challenges and Career Goals During an Ongoing Public Health Crisis.

The ongoing COVID-19 pandemic created a shift from traditional face-to-face learning toward remote learning, resulting in students experiencing unforeseen challenges and benefits through participation in a non-traditional mode of education. Little is known regarding the impact that a shift to remote learning may have had on the learning experiences and the career goals of Master of Public Health (MPH) students. A qualitative study was conducted among a convenience sample of MPH students in the US from January to April 2021. The primary aims were (1) to describe salient challenges or benefits of learning that persisted throughout a semester of remote learning and (2) to describe how being in graduate school during the pandemic impacted students' career goals in public health. A secondary aim was to describe students' general feelings regarding their public health education, given their lived experience of remote learning during the COVID-19 pandemic. Study findings demonstrated that MPH students had mixed perceptions of how a shift to remote learning during a public health crisis impacted their learning experiences and career goals in public health over one semester. Understanding students' responses can guide public health instructors to best prepare trainees to join the workforce during ongoing and future unforeseen public health crises that continue or have the potential to disrupt learning modalities.

Experiential Interprofessional Education Rooted in the Social Determinants of Health and Ecological Model Fosters Interprofessional Socialization.

OBJECTIVE: Experiential interprofessional education (IPE) fostering socialization to interprofessional teams is essential to clinical practice. Inclusion of authentic patient voices cultivates an understanding of social factors that patients face. We qualitatively assessed how experiential IPE framed around social determinants of health (SDH) and socioecological model (SEM) influenced early health profession students' development of interprofessional socialization while working with patients. Secondarily, we explored how students shifted their mindsets for future interactions. METHODS: Fifty-one health profession students participated in the Longitudinal Interprofessional Family-based Experience (LIFE), a virtual, 13-week experiential IPE opportunity during which students interacted with patients living with chronic illnesses through two interviews. Prompts representing aspects of working on an interprofessional team while interacting with a patient framed around social factors affecting healthcare were coded using the constant comparative method of analysis. Themes were derived and tallied for frequencies. RESULTS: Themes from prompt related to working with an interprofessional team included: 1) perspectives, 2) informative, and 3) collaboration. Themes related to patients as a team member included: 1) active listening, 2) patients of similar/dissimilar back¬grounds, 3) person-centered care, and 4) awareness. Themes derived from prompt about future collaborations included: 1) collaboration, 2) awareness, and 3) person-centered care. CONCLUSIONS: This SDH-focused experiential IPE advanced the understanding among early learners of how social factors that patients experience are barriers to how care is delivered and interprofessional teams must collaborate to consider factors to support patients.

Dipping Your Toes in the Water: An Experiential Strategy to Recruit and Engage New Faculty in Interprofessional Education.

AIMS: Engaged and trained faculty to support and role-model interprofessional education (IPE)-related concepts and behaviors are vital in the development, implementation, and sustainability of IPE academic teaching and training programs. Thus, recruitment of engaged faculty is essential for effective IPE expansion, scalability innovation, and sustainability across a variety of schools, programs, and students. The primary aim of this descriptive study was to implement a strategy to recruit and engage new IPE faculty and determine the strategy's effectiveness in increasing faculty's intent to participate in future IPE. A secondary aim was to identify implementation recommendations for this strategy as a first step of IPE faculty engagement. METHODS: An introductory experiential recruitment and engagement strategy for new Faculty Observers was developed. The project used a descriptive study design and data were gathered through pre- and post-program online self-administered surveys completed by Faculty Observer participants. The surveys included questions about demographics, rating usefulness of activities, engagement motivators, and willingness to facilitate in the future. RESULTS: Fifteen faculty with no or limited IPE experience participated. Post-survey results indicated that 85% of the participants expressed willingness to participate in this program in the future, and 100% would recommend using this experiential recruitment and engagement strategy. DISCUSSION: A "dip your toes in the water" experiential strategy for IPE faculty recruitment and engagement was effective in recruitment of new IPE faculty.

Training in Residency and Provision of Reproductive Health Services Among Family Medicine Physicians.

Importance: Contraception and abortion services are essential health care, and family medicine (FM) physicians are an important part of the workforce providing this care. Residency could inform the reproductive health services FM physicians provide. Objective: To determine which residency training factors are associated with FM physicians' provision of reproductive health services to Medicaid beneficiaries. Design, Setting, and Participants: This cross-sectional, population-based observational study of inpatient and outpatient FM physicians who completed residency between 2008 and 2018 and treated at least 1 Medicaid beneficiary in 2019 was conducted from November 2022 to March 2023. The study used 2019 American Medical Association Masterfile and Historical Residency file, as well as the 2019 Transformed Medicaid Statistical Information System claims. Exposures: Residency training in community-based or reproductive health-focused programs. Main Outcomes and Measures: The outcomes were providing the following to at least 1 Medicaid beneficiary in 2019: prescription contraception (pill, patch, and/or ring), intrauterine device (IUD) and/or contraceptive implant, and dilation and curettage (D&C). Odds of providing each outcome were measured using correlated random-effects regression models adjusted for physician, residency program, and county characteristics. Results: In the sample of 21 904 FM physician graduates from 410 FM residency programs, 12 307 were female (56.3%). More than half prescribed contraception to Medicaid beneficiaries (13 373 physicians [61.1%]), with lower proportions providing IUD or implant (4059 physicians [18.5%]) and D&C (152 physicians [.7%]). FM physicians who graduated from a Reproductive Health Education in Family Medicine program, which fully integrates family planning into residency training, had significantly greater odds of providing prescription contraception (odds ratio [OR], 1.23; 95% CI, 1.07-1.42), IUD or implant (OR, 1.79; 95% CI, 1.28-2.48), and D&C (OR, 3.61; 95% CI, 2.02-6.44). Physicians who completed residency at a Teaching Health Center, which emphasizes community-based care, had higher odds of providing an IUD or implant (OR, 1.51; 95% CI, 1.19-1.91). Conclusions and Relevance: In this cross-sectional study of FM physicians providing Medicaid service, characteristics of residency training including community-based care and integration of family planning training are associated with greater odds of providing reproductive health services. With growing reproductive health policy restrictions, providing adequate training in reproductive health is critical to maintaining access to care, especially for underserved populations.

The influence of extreme water levels on coastal wetland extent across the Laurentian Great Lakes.

Laurentian Great Lakes coastal wetlands (GLCW) are ecological hotspots and their integrity depends upon dynamic hydrologic regimes of the Great Lakes. GLCW naturally adjust to changes in hydrologic regimes via migration, but Great Lakes water levels may be shifting faster than wetlands can manage: 2000-2015 marked an extended low water level period and was followed by record highs in 2017-2020. Our objective was to quantify how Great Lakes water levels impact GLCW linear extent (from the shoreline to open water). We calculated wetland extent and migration from 2011 to 2019 using data from 1538 vegetation transects at 342 sites across the U.S. shoreline of the Great Lakes. Mediated multiple linear regression with Bayesian hierarchical modeling investigated the relationship between water levels and wetland extent. We employed Bayesian hierarchical modeling because (1) the dataset was spatially nested, with sampling points within wetlands within Great Lakes and (2) Bayesian statistics offer flexibility for environmental modeling, such as the inclusion of mediation in models, where we can assess both direct influences of Great Lake water levels on wetland extent and indirect (i.e., mediated) influences of water levels via the presence of vegetation zones on thus wetland extent. Results showed that, overall, there was a landward migration from 2011 to 2019 (although 38 % of wetlands had lakeward migration of the wetland-upland border). Wetland length and inundation length decreased with increased water levels, as mediated by the presence of certain vegetation zones. This decrease in wetland extent is of concern because it likely relates to a decrease in wetland function and habitat. A better understanding of how GLCW migrate with shifts in water levels enables decision makers to better predict where Great Lakes coastal wetlands are at risk of being lost and thus where to prioritize management efforts.

Analysis of spatiotemporal variation in dissolved organic carbon concentrations for streams with cropland-dominated watersheds.

It remains a challenge to understand how dissolved organic carbon (DOC) is cycled from farmlands to rivers due to the complex interaction between farming practices, the baseflow hydrology of predominantly flat lowlands, and seasonal environmental influences such as snowpack. To address this, field DOC concentrations were measured monthly throughout the year at sub-basin scales across the Chippewa River Watershed, which falls within the Corn Belt of the Midwestern United States. These DOC dynamics in stream water from croplands were benchmarked against the data sampled from hilly forested areas in the Connecticut River Watershed. The Soil Water Assessment Tool (SWAT) simulation was applied to provide potential predictive variables associated with daily baseflow. Our study outlines a framework using the combination of primary field data, hydrological modeling, and knowledge-based reclassification of Land Use/Land Cover (LULC) data to analyze the viability of modeling the spatial and temporal variations of cropland stream DOC concentrations. Calibration of the SWAT model resulted in the overall daily Nash-Sutcliffe model efficiency coefficient (NSE) of 0.67 and the corresponding R2 = 0.89. Our main results show: 1) baseflow DOC concentrations from croplands were substantially higher throughout the year relative to other landcover areas, especially for spring runoff/snowmelt scenarios, 2) an empirical analysis explained ~82 % of the spatial gradient of annual mean observed DOC concentrations, and 3) with the addition of hydrological simulated variables, a linear model explained ~81 % of monthly and 54 % of daily variations of observed DOC concentrations for cropland sub-basins. Our study identified key factors regulating the spatiotemporal DOC concentrations in cropland streamflow; the contribution here promotes to strengthen future analytical models that link watershed characteristics to carbon cycling processes in a large freshwater ecosystem.

Affective and Perceptual Responses During an 8-Week Resistance Training to Failure Intervention at Low vs. High Loads in Untrained Women.

ABSTRACT: Anderson, AlOK, Voskuil, CC, Byrd, MT, Garver, MJ, Rickard, AJ, Miller, WM, Bergstrom, HC, and Dinyer McNeely, TK. Affective and perceptual responses during an 8-week resistance training to failure intervention at low vs. high loads in untrained women. J Strength Cond Res 37(3): 546-554, 2023-This study examined the effects of resistance training (RT) to failure on the perceptual and affective responses, intent-to-continue RT to failure in a self-initiated session, and affect-intent relationship. Twenty-three untrained women (mean ± SD : age 21.2 ± 2.2 years; height 167 ± 5.7 cm; body mass, 62.3 ± 16.2 kg) completed an 8-week, full-body RT to failure intervention at a low (30% 1RM; n = 11) or high (80% 1RM; n = 12) load. The Borg's rating of perceived exertion (RPE) scale was used to assess the acute (aRPE) and session (sRPE) RPE immediately after repetition failure and each training session, respectively. Immediately, 15-minute, and 60-minute postsession affective responses were assessed using the feeling scale (FS; -5 to +5), and intent to continue to RT was assessed on a scale of 0-100% intention. During week 4 (W4) and week 8 (W8), aRPE (W4: 18 ± 2, W8: 18 ± 2; p ≤ 0.032) and sRPE (W4: 17 ± 2, W8: 18 ± 1; p ≤ 0.018) were greater than that during week 1 (W1; aRPE: 17 ± 2; sRPE: 16 ± 2). The FS responses increased from immediately to 60-minute postsession during W4 ( p ≤ 0.019) and W8 ( p ≤ 0.049). The correlation between affect and intent-to-continue RT increased from W1 ( r = 0.416) to W8 ( r = 0.777). Regardless of load, untrained women reported similar perceptual, affective, and intention responses. These variables should be considered to improve RT program adoption and adherence in women.

Effects of Nitrate Supplementation on Muscle Strength and Mass: A Systematic Review.

ABSTRACT: Anderson, OK, Martinez-Ferran, M, Lorenzo-Calvo, J, Jiménez, SL, and Pareja-Galeano, H. Effects of nitrate supplementation on muscle strength and mass: a systematic review. J Strength Cond Res 36(12): 3562-3570, 2022-This systematic review examines the effect of dietary nitrate supplementation (SUP) on muscle strength and hypertrophy when combined with physical exercise. The databases PubMed, Web of Science, and MEDLINE were searched for full-text articles published between January 2000 and June 2020. For inclusion, studies had to report on the effects of SUP administered as acute or chronic doses together with a standardized exercise protocol on muscle strength and hypertrophy compared with placebo in healthy adults who were sedentary, physically active, or professional athletes. Twelve studies (1,571 subjects) were finally selected. In 5 studies, the SUP regime was acute, and in 7, it was chronic. SUP was nitrate-rich beetroot juice in 9 studies, a potassium nitrate capsule in 1, and increased dietary nitrate in 2. Ingested nitrate was 64-1,200 mg. Of the 12 studies, 6 observed an ergogenic effect of SUP compared with placebo. These findings indicate that muscle strength gains are possible provided the dose, format, frequency, period, and exercise test are appropriate. Best results were observed with a minimum acute dose of 400 mg of nitrate provided as beetroot juice/shot taken 2-2.5 hours before exercise involving low- and high-intensity muscle contractions. This SUP regime seems to improve muscle efficiency in terms of reduced phosphocreatine and energy costs (P-magnetic resonance spectroscopy) and improved time to exhaustion.

A Description of Breast Models Used to Teach Clinical Skills.

Background: Health care trainees lack opportunities to practice breast assessment and clinical skills with patients, making breast models significant for hands-on training. Insufficient training leads to low competence across practitioners in breast health areas of practice, including clinical lactation. The aim of this review was to describe types of breast models used to teach clinical skills of the breast across breast health areas. The secondary aims were to describe education interventions that included each model and identify whether multiple skin tones were available in models. Methods: Authors conducted a scoping review to identify which types of breast models are used to teach clinical skills across breast health areas of practice and determine gaps in literature regarding how clinical lactation skills are taught. The literature search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, MedLine, and ProQuest. Inclusion criteria were students/professionals engaging in breast model simulation. Eighteen studies were reviewed. Authors extracted data on participants, breast health area, breast model, intervention, evaluation, general outcomes, skin tone, and research design. Results: The most common skill area was clinical breast exam (n = 7), while least was breastfeeding education (n = 1). Most models were commercial (n = 12). Zero studies described skin tone. Generally, breast model simulations were correlated with increased clinical skills and confidence regardless of model used. Conclusions: Despite demonstrated gain of skills, this review reveals inconsistent use of breast models and evaluation, exclusion of diverse skin tones, and lack of breast models reported to teach clinical lactation skills.

Development of Team Behavior Skills and Clinical Lactation Competence Among Medical Students Engaging in Telesimulations with Standardized Patients.

Objective: The aims of this pilot feasibility study were to determine if telesimulations with standardized patients (SPs) wearing high-fidelity breast models impact students' team behavior and clinical competence in lactation support. Materials and Methods: Medical students (N = 19) completed five telesimulations: Cases 1, 2, 5 in a team, 3 as individual, and 4 randomized. SPs used the Formative Assessment Rubric (FAR) to evaluate interpersonal and clinical competence. Collaboration skills within team-based telesimulations (Cases 2 and 4) were rated using the Interprofessional Collaborator Assessment Rubric (ICAR). Satisfaction data were collected from a focus group and written evaluation. Descriptive statistics were calculated for FAR, ICAR, and written evaluations. Appropriate nonparametric tests were used to measure FAR and ICAR differences over time or between team and individual telesimulations and the relationship between FAR and ICAR scores. Content analysis was used to generate themes from focus group data. Results: Learners' interpersonal and lactation-specific competence improved over time (p = 0.003 and 0.009, respectively). Learners were able "to accept responsibility for their actions" more but spent less time "seeking perspectives from peers" in Case 4 compared with Case 2 (p = 0.01 and p < 0.001, respectively). Themes from the focus group related to the value of team telesimulations to learn clinical lactation skills and learn about one's role in a team. Learners agreed they developed clinical lactation skills (>4.5/5-pt). Conclusions: Opportunities to work collaboratively in telesimulations with a SP prepare learners for professional collaborations to effectively care for breast/chestfeeding dyads.

An Application of Kane's Validity Framework to Evaluate Formative and Summative Assessment Instruments for Telesimulations in Clinical Lactation.

INTRODUCTION: Health professional learners have limited exposure to breastfeeding patients from diverse backgrounds in clinical rotations. Instead, simulation-based training is used for lactation skills training. There are no validated or standardized simulations and assessment rubrics for lactation. In this pilot, breastfeeding telesimulations with standardized patients (SPs) wearing a high-fidelity breast model matching their skin tone were developed. The validity of Formative and Summative Assessment Rubrics (FAR, SAR) were assessed following Kane's validity framework. The objective was to provide initial evidence for the validity of the FAR and SAR as constructs of competence in lactation support at the entry to practice or practice level. METHODS: Three breastfeeding case scenarios, FAR, and SAR were developed and evaluated with clinical lactation specialists (evaluators, n = 17) and SPs. The FAR was used in practice telesimulations where SPs' (n = 14) performance and telesimulation feasibility were assessed. The FAR was updated in preparation for a pilot study where medical students (n = 13) completed the 3 telesimulations. In the pilot, the updated FAR was used by SPs (n = 6) to assess medical students' performance of clinical skills. After the pilot, rubrics were updated after focus groups with SPs and discussions with evaluators. Evaluators (n = 3) graded students' posttelesimulation documentations using the SAR. Cronbach ɑ level and the intraclass correlation coefficient were assessed iteratively to collect evidence for the scoring, generalizability, and extrapolation of the FAR and SAR according to Kane's framework. RESULTS: The FAR and SAR were found to have acceptable internal consistency and moderate to high interrater reliability (intraclass correlation coefficient, 0.55-0.94), which provided evidence for scoring and generalizability of the instruments. Evaluators agreed that SPs' performances were realistic (5.6/6), and SPs' feedback was organized (5.5/6) and helpful (5.6/6), which provided evidence for extrapolation. CONCLUSIONS: Initial evidence for validity of scoring, generalization, and extrapolation FAR and SAR (according to Kane's framework) in assessing health professional learner's performance of clinical lactation skills has been presented. These results from a pilot study suggest that the FAR and SAR are reliable instruments for assessing learners' clinical performance in a breastfeeding-focused telesimulation where the SP wears a high-fidelity breast model matching their skin tone. Additional studies will be required to collect evidence according to all 4 categories of Kane's framework for the validity of the FAR and SAR.

What Does It Mean to Be a Clinical Track Faculty Member in Public Health? A Survey of Clinical Track Faculty Across the United States.

OBJECTIVES: The clinical professor track has expanded and reflects a trend toward hiring non-tenure-track faculty in public health; however, little is known about this track. We documented characteristics of clinical faculty at US schools of public health. METHODS: We surveyed clinical faculty at Council on Education for Public Health-accredited schools of public health in the United States in 2019, identified via each school's website. We invited faculty (n = 264) who had the word clinical in their title (ie, apparently eligible faculty), had a working email address, and were not authors of this article to provide information about their rank, degree credentials, expectations for teaching, service, research and practice, and promotion criteria at their institution. In addition, we used open-ended responses to explain and contextualize quantitative data. RESULTS: Of 264 apparently eligible faculty surveyed, 88 (33.3%) responded. We included 81 eligible clinical faculty in our final sample, of whom 46 (56.8%) were assistant professors and 72 (88.9%) had a terminal degree; 57 of 80 (71.3%) had an initial contract of ≤2 years or no contract. Most clinical faculty listed service (96.2%), teaching (95.0%), and student advising/mentoring (86.3%) as duties; fewer clinical faculty reported research (55.0%), practice (33.8%), or clinic (7.5%) duties. Only 37.1% of respondents agreed or strongly agreed that promotion policies for clinical track faculty were clear. CONCLUSIONS: If most clinical faculty are at the lowest academic rank, with short contracts and unclear expectations, it will be difficult for clinical faculty to advance and challenging for schools of public health to benefit from this track. Clear institutional expectations for scope of work and promotion may enhance the contribution of clinical faculty to schools of public health and help define this track.

A pilot study to evaluate the effect of classroom-based high-fidelity simulation on midwifery students' self-efficacy in clinical lactation and perceived translation of skills to the care of the breastfeeding mother-infant dyad.

BACKGROUND: Midwives are expected to provide timely and skilled support to breastfeeding mothers, yet it is not clear whether and how midwifery students receive training in clinical lactation. The primary objective of this pilot study was to evaluate the impact of a classroom-based breastfeeding simulation on nurse-midwifery students' self-efficacy in lactation skills. The secondary objective was to describe students' exposure to breastfeeding patients in the classroom and in clinical settings. METHODS: A pilot study using a prospective cohort study design and convenience sampling was completed between September 2017 and April 2018. Two simulation-based workshops were developed for the classroom setting in alignment with breastfeeding-focused competencies for midwives and lactation professionals. The workshops were integrated into the nurse-midwifery curriculum at a US-based program. Two Self-Efficacy Surveys (defined, 7-point Likert Scale) were developed and used to measure baseline and continuing self-efficacy in breastfeeding skills among students. Two Practice Patterns instruments, adapted from the American Academy of Pediatrics breastfeeding curriculum, were used to define the setting, quantity, and types of nurse-midwifery students' breastfeeding-related exposures. Students participated in a one-hour focus group upon completion of the study. RESULTS: In this pilot study, nurse-midwifery student participants (N = 9) reported a 14% increase (P < .0001) in their perceived self-efficacy in basic and advanced clinical lactation skills after completing both workshops. The nurse-midwifery students reported dozens of encounters with diverse breastfeeding patients over a six-month period during which they performed a wide variety of clinical lactation skills. The focus group revealed most students (n = 5/9) would like more time to practice clinical lactation skills in a simulated environment and some indicated a desire to have more exposure to challenging versus common (n = 2/9) of breastfeeding concerns. CONCLUSIONS: In this work, we demonstrate the first high-fidelity lactation simulation in a classroom setting in a healthcare professional training program. Midwifery educators and researchers can adapt the framework and instruments presented in this pilot study to determine the effect of educational interventions on students' translation of skills to breastfeeding mother-infant dyads. Likewise, this is the first study to define the number and type of breastfeeding-related clinical exposures among nurse-midwifery students.