Not all 'impostors' are created equal: A dimensional, person-centered, and theory-based analysis of medical students.

PURPOSE: Research on the impostor phenomenon (IP) is rapidly growing in medical education due to its relationship with distress and burnout. How IP is theoretically conceptualized and analyzed has been inconsistent, however, which limits our understanding of results and how to act on them. We hypothesized that a person-centered analysis, in combination with a robust theoretical framework, would provide a more specific 'profile' of medical student IP and help to optimize supports for their well-being. MATERIALS & METHODS: We used exploratory factor analysis to assess the factor structure of the Clance Impostor Phenomenon Scale (CIPS) in medical students, followed by cluster analysis to identify distinct 'impostor' profiles, based on the identified factors. We then used self-determination theory's (SDT) framework of motivation to explore how students in each profile differed in their general causality orientation, autonomous motivation towards going to medical school, and psychological need satisfaction in the medical program - factors that SDT identifies as predictors of engagement, performance, and well-being. RESULTS: Factor analysis yielded three main IP factors - feeling like a fake, attributing success to luck, and discounting achievement - in line with Clance's original definition of IP. The cluster analysis then identified four distinct IP profiles based on individual differences in these factors, each varying in aspects of their self-determination. CONCLUSIONS: This study sheds light on the ways that medical students may experience IP, further reinforcing the notion that not all 'impostors' are created equal. Findings support the three-factor structure of the CIPS among medical students, and that most students will fall into one of four IP profiles. These profiles and their implications are discussed.

Workplace Causality Orientations Moderate Impostorism and Burnout: New Insights for Wellness Interventions in Graduate Medical Education.

Theory: Impostor phenomenon (IP) is strongly linked to physician burnout, but the nature of this association is not well understood. A better grasp of the mechanism between these constructs could shed new light on ways to mitigate physician IP and burnout. Grounded in self-determination theory (SDT), the present study explores whether and how residents' general causality orientations at work-impersonal, controlled, and autonomous-each moderate the effect of IP on physician burnout. Hypotheses: We theorized that the autonomous orientation would buffer the facilitative effect of IP on burnout, while the controlled and impersonal orientations would each enhance it to varying degrees. Method: Two hundred forty-three residents from the Universities of Saskatchewan, Calgary, and Alberta, across various programs, specialties, and years of training, completed a survey containing demographic questions and three previously validated instruments: the Clance Impostor Phenomenon Scale, Causality Orientations at Work Scale, and Oldenburg Burnout Inventory. We used partial correlation analyses to test our moderation hypotheses. Results: In line with what we expected, the autonomous causality orientation buffered the facilitative effect of IP on burnout, while the controlled and impersonal causality orientations each enhanced it. Conclusions: Results suggest that possessing a stronger autonomous causality orientation (and creating learning/work environments that prime it) will dampen the effect of IP on burnout, while possessing a stronger controlled or impersonal causality orientation (and creating learning/work environments that prime them) will each augment it. Findings and their implications are discussed in terms of instigating theory-informed, system-level wellness interventions in graduate medical education.

Family Physician Motivation and Well-Being in the Digital Era.

PURPOSE: Family physicians rapidly shifted to using virtual care during the COVID-19 pandemic, yet it is largely unknown if this change has impacted their workplace motivation. A better understanding of this matter is essential for optimizing the integration of virtual care into standard practice and for supporting family physician well-being. Using a self-determination theory lens, we examined if family physicians experienced autonomous (vs controlled) motivation toward using virtual care, how this related to their subjective well-being, and whether satisfaction (vs frustration) of their basic psychological needs at work mediated that relationship. METHODS: Using cross-sectional survey methodology, quantitative data was collected from 156 family physicians in Alberta, Canada. The questionnaire contained validated scales for measuring motivational quality, workplace need fulfillment, and subjective well-being. Descriptive, correlational, and mediation analyses were performed. RESULTS: Family physicians varied significantly in their quality of motivation towards using virtual care. Controlled motivation toward using virtual care was associated with lower well-being, and workplace need frustration fully mediated that relationship. Conversely, workplace need satisfaction, but not autonomous motivation toward using virtual care, was associated with higher well-being. CONCLUSIONS: In line with self-determination theory, findings suggest that when family physicians' motivation toward using virtual care is less self-determined, it will lead to poorer subjective well-being, because of basic psychological need frustration. Potential implications of the findings are discussed within the contexts of virtual health and primary care.

Profiles of physician motivation towards using virtual care: differences in workplace need fulfillment.

BACKGROUND: Physicians appear to vary in their motivation towards using virtual care, but to what extent is unclear. To better understand this variance, which is important for supporting physician wellbeing and therefore patient care, the authors used self-determination theory's (SDT) framework. According to SDT, different types of motivation exist, ranging from controlled to autonomous, that lend to differences in engagement, performance, and wellbeing. The authors aimed to determine: (a) if there were distinct groups of physicians based on their quality of motivation towards using virtual care, and if so, (b) how these groups varied in fulfillment of basic psychological needs (autonomy, competence, and relatedness) in the workplace. METHODS: In March-August 2022, the authors collected quantitative, survey-based data from a cross-section of 156 family physicians in Alberta, Canada. The survey contained existing scales that measure types of motivation (autonomous vs. controlled) and basic psychological need satisfaction/frustration at work. Cluster analysis was used to explore profiles of physician motivation towards using virtual care, and analysis of variance was used to determine how each profile differed with respect to workplace need fulfillment. RESULTS: With motivation towards using virtual care, three higher-order profiles of physician motivation were identified: autonomous (19% family physicians), controlled (16% of family physicians), and ambivalent (66% of family physicians). The three profiles differed significantly in terms of psychological need fulfillment at work. CONCLUSIONS: This study identifies specific profiles that family physicians currently fall into when it comes to motivation towards using virtual care. In line with SDT, findings suggest that basic psychological needs are fundamental nutrients for physicians to internalize and endorse the value of using virtual care in their practices. Implications for physician wellbeing are discussed.

Why Do We Feel Like Intellectual Frauds? A Self-Determination Theory Perspective on the Impostor Phenomenon in Medical Students.

Theory: Impostor phenomenon (IP) refers to people's feelings of intellectual fraudulence and fear of being "discovered," despite contradicting evidence of success. Due to its association with burnout and distress, it is progressively being studied in medicine. While various explanations for IP have been discussed in the literature, the role of motivation has largely been neglected. Hypotheses: Using self-determination theory (SDT) as a lens, it was hypothesized that different general causality orientations (impersonal, control, autonomy), domain-specific types of motivation (autonomous vs. controlled) toward going to medical school, and levels of satisfaction of basic psychological needs (autonomy, competence, relatedness) in the medical program, would each predict severity of IP symptoms. Method: A total of 1,450 medical students from three Canadian institutions were invited to complete a survey containing the Clance Impostor Phenomenon Scale and scales derived from SDT's mini theories: basic psychological needs theory, causality orientations theory, and organismic integration theory. We explored the prevalence of IP among the students and used regression to capture variable relationships, accounting for gender effects. Results: Data from 277 (19.1%) students were assessed, 73% of whom reported moderate or worse IP symptoms. Having an impersonal general causality orientation, more controlled motivation toward going to medical school, and lower need satisfaction in the medical program, each related to increased IP severity. Together, these motivational factors accounted for 30.3%, 13.6%, and 21.8% of the variance in students' IP severity, respectively. Conclusions: Findings from this study suggest that students who are more self-determined (both in general and in medical school), and whose basic psychological needs are more supported in their medical program, will experience less frequent and severe IP symptoms. Preliminary explanations and implications of these findings are discussed within the medical education context.

Attitudes Toward Human Papillomavirus Self-Sampling in Regularly Screened Women in Edmonton, Canada: A Cross-Sectional Study.

OBJECTIVE/PURPOSE: The aim of the study was to determine the level of interest in human papillomavirus (HPV) self-sampling as a method of cervical cancer screening in a population of women affiliated with a primary care clinic. MATERIALS AND METHODS: A survey was given to women (N = 182) between the ages of 25 and 69 years attending a family medicine clinic in Edmonton, Canada. Primary outcome measures include (1) the percentage of women who feel that HPV self-sampling should be available and (2) the percentage of women who would prefer HPV self-sampling to the Pap test. Secondary outcomes include the percentage of women aware of HPV self-sampling and factors associated with a preference for HPV self-sampling using logistic regression. RESULTS: Most women (84%) were up-to-date on Pap testing, and most (85%) had had postsecondary education (either completed or in progress). The percentage of the women who moderately or strongly felt that HPV self-sampling should be available was 60%; the percentage of the women who would prefer HPV self-sampling was 24%. Only 7% of the women reported being previously aware of HPV self-sampling. The factor associated with a preference for HPV self-sampling was the Pap comfort score, with an odds ratio of 1.51 (95% CI = 1.05-2.16, p = .026). CONCLUSIONS: In this population of well-educated women who were mostly up-to-date on cervical screening, there was a clear interest to have the option of HPV self-sampling. It is important for cancer screening programs to take this into account, given that women are the ultimate beneficiaries of these programs.

Development of the Inner City attitudinal assessment tool (ICAAT) for learners across Health care professions.

BACKGROUND: Many health professions learners report feeling uncomfortable and underprepared for professional interactions with inner city populations. These learners may hold preconceptions which affect therapeutic relationships and provision of care. Few tools exist to measure learner attitudes towards these populations. This article describes the development and validity evidence behind a new tool measuring health professions learner attitudes toward inner city populations. METHODS: Tool development consisted of four phases: 1) Item identification and generation informed by a scoping review of the literature; 2) Item refinement involving a two stage modified Delphi process with a national multidisciplinary team (n = 8), followed by evaluation of readability and response process validity with a focus group of medical and nursing students (n = 13); 3) Pilot testing with a cohort of medical and nursing students; and 4) Analysis of psychometric properties through factor analysis and reliability. RESULTS: A 36-item online version of the Inner City Attitudinal Assessment Tool (ICAAT) was completed by 214 of 1452 undergraduate students (67.7% from medicine; 32.3% from nursing; response rate 15%). The resulting tool consists of 24 items within a three-factor model - affective, behavioural, and cognitive. Reliability (internal consistency) values using Cronbach alpha were 0.87, 0.82, and 0.82 respectively. The reliability of the whole 24-item ICAAT was 0.90. CONCLUSIONS: The Inner City Attitudinal Assessment Tool (ICAAT) is a novel tool with evidence to support its use in assessing health care learners' attitudes towards caring for inner city populations. This tool has potential to help guide curricula in inner city health.

The Influence of Students' Perceptions of Learning Environment on Coping with Academic Challenges: A Structural Equation Modeling Study.

Theory: Self-compassion has been identified as a promising interventional target enabling medical learners to respond effectively to stressors and challenges of medical training. Determining factors in the learning environment that support self-compassion is critical for developing such interventions. What is already known in terms of environmental or contextual factors is that learning environments that are supportive of students' basic psychological needs for autonomy, competence, and relatedness result in better learning and wellbeing outcomes. As such, satisfaction of basic psychological needs in the learning environment was tested for potential effects on self-compassion among medical students. Hypothesis: It was hypothesized that medical students who perceived their needs for autonomy, competence, and relatedness were supported in the learning environment would be more likely to respond to stressors and challenges by means of positive processes of self-compassion (common humanity, mindfulness, self-kindness) and less likely by means of negative processes of self-compassion (isolation, over-identification, self-judgment). Two models were tested: Model 1 contained the effects of the needs for autonomy, competence, and relatedness on two factors of self-compassion that comprise three positive and three negative processes, respectively. Model 2 contained the direct effects of the psychological needs on six individual processes of self-compassion. Method: Using two online surveys, authors collected data from medical students (n = 195) at a large Canadian university. The authors used the 12-item basic psychological needs scale to measure the degree of satisfaction of students' needs for autonomy, competence, and relatedness in the learning environment, as perceived by students. The 12-item self-compassion scale was used to measure the degree of compassion students exhibited toward themselves in challenging times in the medical program. The authors used structural equation modeling (SEM) to test the hypothesized relationships between basic psychological needs satisfaction and self-compassion. Results: The SEM results for Model 2 indicated an improved model fit over Model 1; however, not all the hypothesized effects were determined to be significant in the two models. In the better fitting model (Model 2), significant effects were observed between the needs for competence and relatedness and the three negative processes of self-compassion (isolation, over-identification, self-judgement). Specifically, the need for relatedness had comparable effects on all three negative processes of self-compassion. The need for competence had a significant effect only on isolation. The need for autonomy had no effects on self-compassion processes. None of the effects involving the positive processes of self-compassion (common humanity, mindfulness, self-kindness) were significant. Conclusions: Satisfaction of medical students' needs for competence and relatedness in the learning environment appears to reduce the negative processes of self-compassion. Future research is needed to determine why basic psychological needs satisfaction appears to have no effects on the positive processes of self-compassion and what factors are likely to foster these beneficial processes among medical students.

The roles of basic psychological needs, self-compassion, and self-efficacy in the development of mastery goals among medical students.

Aim: Competency-based medical education aims to foster mastery goals in learners. We examined medical students' mastery approach (beneficial) and mastery avoidance (maladaptive) goals and their associations with students' basic psychological needs, self-compassion, and self-efficacy. Methods: This was a cross-sectional study employing an online questionnaire. Two hundred medical students in all four years of the medical program completed the questionnaire, containing measures of mastery goals, basic psychological needs (autonomy, competence, relatedness), self-compassion, and self-efficacy. Regression analyses were performed. Results: Of the three basic psychological needs, the need for competence was significant in explaining both types of mastery goals. Self-efficacy and self-compassion were significant in explaining mastery approach and mastery avoidance goals, respectively. Conclusions: Creating learning environments that are supportive of students' need for competence, raising students' awareness of the value of learning from mistakes in competency acquisition, and providing opportunities for students to experience self-efficacy may foster beneficial mastery approach goals in medical students.

Medical student well-being and lifelong learning: A motivational perspective.

Background: Medical school poses many pressures and challenges for individuals aspiring to health careers. Only some students, however, experience high stress and exhaustion, whereas others adaptively respond to schooling demands and engage in lifelong learning practices. By drawing on three motivation theories - self-determination theory, self-theories of ability, and achievement goal theory - this study examined the relations among motivational constructs, stress, exhaustion, and lifelong learning in medical students. Methods: All medical students in a 4-year program were invited to complete a questionnaire containing measures of psychological need satisfaction, self-theories of ability, achievement goals, stress, exhaustion, lifelong learning, and background characteristics. Using structural equation modeling, we tested a structural model that combined the three motivation theories to explain stress, exhaustion, and lifelong learning in medical students. Results: A total of 267 medical students participated in the study (response rate 42%). The results largely confirmed the hypothesized relations, revealing that unmet psychological needs and a fixed mind-set were associated with maladaptive cognitions (i.e., the pursuit of avoidance goals) and psychological distress (i.e., high stress and exhaustion). In contrast, psychological need satisfaction and a growth mind-set had distinct pathways to beneficial cognitions (i.e., mastery approach goals) and lifelong learning practices in medical students. Discussion: Adaptive motivations, cultivated through personal and environmental factors, may help to protect medical students from psychological distress and enhance their growth as lifelong learners. Understanding the mechanisms and pathways to desirable and undesirable outcomes in medical students is critical for creating learning environments that will serve these students well.

Measuring Self-Compassion in Medical Students: Factorial Validation of the Self-Compassion Scale-Short Form (SCS-SF).

OBJECTIVE: The primary purpose of this study was to evaluate the factorial structure of the short-form version of the self-compassion scale (SCS-SF) and validate its use with medical students. METHODS: Two hundred medical students completed an electronic questionnaire containing the 12-item SCS-SF and the 16-item Oldenburg burnout inventory. The authors performed reliability and confirmatory factor analyses (CFA) to evaluate the internal consistency and factorial structure of the SCS-SF scores, and correlational analyses to examine relationships of self-compassion with student engagement and exhaustion. RESULTS: The internal consistency of the SCS-SF was 0.86. Self-compassion scores were positively correlated with engagement scores (r = 0.24; p < 0.01) and negatively correlated with exhaustion scores (r = - 0.44; p < 0.001). The CFA results for the two-factor model (formed by three positive and three negative components) indicated an improved fit over the single-factor model. The positive factor (self-compassion) was positively correlated with engagement scores (r = 0.17; p < 0.05) and negatively correlated with exhaustion scores (r = - 0.32; p < 0.001). The negative factor (self-criticism) was negatively correlated with engagement scores (r = - 0.25; p < 0.001) and positively correlated with exhaustion scores (r = 0.44; p < 0.001). CONCLUSIONS: The SCS-SF scores had good internal consistency and expected relations with student engagement and exhaustion. Although the single, general self-compassion factorial structure had an acceptable fit with the data, the hierarchical two-factor structure of the SCS-SF provides support for the idea that distinguishing between self-compassion and self-criticism in medical students may be important.

Unexpected result of competency-based medical education: 9-year application trends to enhanced skills programs by family medicine residents at a single institution in Canada.

In Canada, family physicians may pursue extended training for added competence in areas such as Palliative Care or Emergency Medicine by applying to Enhanced Skills (ES) programmes. Despite the increasing popularity of ES programmes, there are no studies that examine trends in applications to ES programmes before and after the introduction of family medicine focused competency-based curricula at individual universities. Additionally, there is a scarcity of research examining factors common among applicants to ES programmes. We undertook a retrospective observational study using secondary data analysis of archived resident files from a large Canadian family medicine residency programme. The proportion of applicants to ES programmes decreased since implementation of a competency-based curriculum in the subject programme. Older, male, and Canadian medical graduates (CMGs) applied to ES programmes more often than their respective counterparts. Residents in a family medicine competency-based curriculum may be less inclined to extend their training by applying to ES programmes. This is remarkable considering that the Canadian residency programme is the shortest among high-income countries. Further studies are needed to investigate the role of competency-based medical education programmes in enabling shortening residency training around the world.

Alberta Family Physician Electronic Endoscopy study: Quality of 1769 colonoscopies performed by rural Canadian family physicians.

OBJECTIVE: To determine whether rural FP colonoscopists in Alberta are achieving benchmarks in colonoscopy quality. DESIGN: Prospective, multicentre observational study. SETTING: Alberta. PARTICIPANTS: Nine FP colonoscopists. MAIN OUTCOME MEASURES: Proportion of successful cecal intubations; proportion of patients aged 50 and older with pathologically confirmed adenomas; mean number of adenomas per colonoscopy; and serious adverse events related to colonoscopy. RESULTS: In this 6-month study, 9 rural FPs in Alberta performed 1769 colonoscopies. Overall, all key colonoscopy quality benchmarks were met or exceeded. The proportion of successful cecal intubations was 97.9% (95% CI 97.2% to 98.6%). The proportion of male and female patients aged 50 and older whose first-time colonoscopy results revealed an adenoma was 67.4% (95% CI 62.4% to 72.7%) and 51.1% (95% CI 45.5% to 56.7%), respectively. There were 120 adenomas, 36 advanced adenomas, and 1 colon cancer case per 100 colonoscopies. There were 2 postpolypectomy bleeds and no other serious complications. CONCLUSION: Alberta rural FP colonoscopists are meeting benchmarks in colonoscopy quality. Ongoing electronic collection of endoscopy quality markers should be encouraged. Supporting and training rural FPs who perform endoscopy might help alleviate current wait times and improve access for rural Canadian patients.

Motivations for learning of family medicine residents trained in competency-based education.

BACKGROUND AND OBJECTIVE: Family physicians regularly encounter clinical uncertainty and ambiguity and thus, are expected to engage in on-going learning to respond to changing needs of family practice. Using Achievement Goal Theory, the objective of this study was to examine motivations for learning of family medicine residents in a competency-based program. METHOD: This was a cross-sectional study, employing a survey methodology with family medicine residents at the mid-point of training at a Canadian university. Multivariate analyses of variance and covariance were used to examine residents' goal orientations (performance approach, mastery approach, performance avoidance, mastery avoidance) for the group as a whole and to test for the effects of residents' gender and program stream (urban/rural), respectively. RESULTS: A total of 52 (67%) residents completed the survey. Overall, residents scored highest on mastery approach and lowest on performance avoidance, thus, exhibiting adaptive motivations for learning. Male residents demonstrated higher levels of performance approach, performance avoidance, and mastery avoidance than female residents. No significant differences in goal orientations were found between urban and rural residents. CONCLUSIONS: Family medicine residents trained in the culture of competency-based education appear to be mastery approach oriented. This motivation orientation is critical in the dynamic practice of family medicine and is consistent with the life-long learning mandate of the medical profession.

Are potentially clinically meaningful benefits misinterpreted in cardiovascular randomized trials? A systematic examination of statistical significance, clinical significance, and authors' conclusions.

BACKGROUND: While journals and reporting guidelines recommend the presentation of confidence intervals, many authors adhere strictly to statistically significant testing. Our objective was to determine what proportions of not statistically significant (NSS) cardiovascular trials include potentially clinically meaningful effects in primary outcomes and if these are associated with authors' conclusions. METHODS: Cardiovascular studies published in six high-impact journals between 1 January 2010 and 31 December 2014 were identified via PubMed. Two independent reviewers selected trials with major adverse cardiovascular events (stroke, myocardial infarction, or cardiovascular death) as primary outcomes and extracted data on trial characteristics, quality, and primary outcome. Potentially clinically meaningful effects were defined broadly as a relative risk point estimate ≤0.94 (based on the effects of ezetimibe) and/or a lower confidence interval ≤0.75 (based on the effects of statins). RESULTS: We identified 127 randomized trial comparisons from 3200 articles. The primary outcomes were statistically significant (SS) favoring treatment in 21% (27/127), NSS in 72% (92/127), and SS favoring control in 6% (8/127). In 61% of NSS trials (56/92), the point estimate and/or lower confidence interval included potentially meaningful effects. Both point estimate and confidence interval included potentially meaningful effects in 67% of trials (12/18) in which authors' concluded that treatment was superior, in 28% (16/58) with a neutral conclusion, and in 6% (1/16) in which authors' concluded that control was superior. In a sensitivity analysis, 26% of NSS trials would include potential meaningful effects with relative risk thresholds of point estimate ≤0.85 and/or a lower confidence interval ≤0.65. CONCLUSIONS: Point estimates and/or confidence intervals included potentially clinically meaningful effects in up to 61% of NSS cardiovascular trials. Authors' conclusions often reflect potentially meaningful results of NSS cardiovascular trials. Given the frequency of potentially clinical meaningful effects in NSS trials, authors should be encouraged to continue to look beyond significance testing to a broader interpretation of trial results.

Evaluation of thyroid test utilization through analysis of population-level data.

BACKGROUND: Inappropriate laboratory test utilization can result in unnecessary patient testing and increased healthcare costs. While several thyroid function tests are available, thyroid-stimulating hormone (TSH) is recommended as the first-line test for investigating and monitoring thyroid dysfunction. We evaluate thyroid test utilization in Northern Alberta in terms of testing patterns, frequencies, and reflex cutpoints. METHODS: This retrospective study analyzed thyroid test requests from January to December 2014. Each request was designated as appropriate or potentially inappropriate as per clinical practice guidelines and Choosing Wisely recommendations, and the frequencies of each testing pattern were calculated. Sub-analysis was performed to categorize testing patterns based on physician specialty. The number of test requests per patient was determined to assess the appropriateness of testing frequency. Receiver operating characteristic (ROC) curves were generated to define optimal TSH cutpoints for automatic reflex to FT4 testing. RESULTS: Of 752,217 test requests, approximately 10% were potentially inappropriate in terms of testing patterns. Free thyroxine (FT4) and free triiodothyronine (FT3) requested with TSH accounted for 59% of all potentially inappropriate test requests, and 49% of requests from endocrinologists (ENDO) were potentially inappropriate, occurring most frequently among those with less experience. Excessive testing frequencies were observed in 869 patients, accounting for 9382 test requests. Adjustment of our TSH reflex cutpoint would significantly increase specificity for identifying a low FT4 without compromising sensitivity. CONCLUSIONS: This study suggests that questionable testing patterns, excessive testing frequencies, and suboptimal reflexive testing cutpoints contribute to inappropriate thyroid test utilization.

Examining gender bias in the feedback shared with family medicine residents.

OBJECTIVES: Competency-based education places increasing emphasis on formative feedback to learners as part of the assessment process. We wished to determine if gender bias was present in the feedback shared with post-graduate medical trainees (residents) in a two-year family medicine residency program at a Canadian university. METHODS: We performed secondary data analyses of documented feedback (FieldNotes) extracted from the Competency-Based Achievement System database. Between 2012 and 2016, 464 preceptors (188 female (F); 276 male (M)) wrote in total 7316 FieldNotes for 192 residents (104 F; 88 M), forming four gender dyads. Descriptive statistics were used to examine trends in FieldNotes frequencies, competencies (Sentinel Habits; SH), progress levels (PL), and the use of adjectives (agentic/competency-based; communal/warmth-based) by preceptors in the FieldNotes. RESULTS: Male and female preceptors wrote on average 7 and 14 FieldNotes, respectively. Female residents received on average more feedback comments from female preceptors (7 notes) than from male preceptors (4 notes). The M-M and M-F resident-preceptor dyads had, respectively, the least and the most 'Stop, Important correction' FieldNotes in both the PGY1 and PGY2 groups. Although preceptors used agentic adjectives more frequently than communal adjectives overall, the F-M resident-preceptor dyad contained the highest proportion of communal adjectives and the lowest proportion of agentic adjectives. CONCLUSIONS: Residents would benefit from multiple opportunities for feedback from both male and female preceptors throughout their residency training. Faculty development to bring attention to potential gender bias may be useful to ensure equitable teaching and quality feedback for learners.

Influence of School Year on Seasonality of Norovirus Outbreaks in Developed Countries.

Factors affecting the seasonal distribution of norovirus outbreaks are not well understood. This study examined whether grade school settings at the start of the school year may be a factor. We searched Ovid Medline from January 2002 to June 2014 for studies that provided all reported norovirus outbreaks in a developed country by month for a minimum of three years. Historical school years were obtained from verifiable sources. The start of the norovirus seasonal outbreak peak and peak outbreak month were determined for each study and compared to the start month of school. Northern hemisphere and southern hemisphere countries had a different norovirus seasonality and different school year structures (traditional compared to year round). In the two studies that provided outbreaks by age, outbreaks among children started several months before outbreaks in the adult population. The median number of months between school start and start of the seasonal outbreak peak was two months (interquartile range [IQR] = 2.0-3.0), while the median number of months between school start and peak outbreak month was four months (IQR = 3.0-4.0). These findings suggest the possibility the school setting at the start of the school year may be a factor in the seasonality of norovirus.

Virtual Care Integration: Balancing Physician Well-Being.

Background and Objectives: According to self-determination theory (SDT), fulfillment of three basic psychological needs-autonomy, competence, and relatedness-positively impacts people's health and well-being. Amid the COVID-19 pandemic, an accelerated adoption of virtual care practices coincided with a decline in the well-being of physicians. Taking into account the frequency of virtual care use, we examined the relationship between workplace need fulfillment and physician well-being. Methods: Using online survey methodology, in March through June 2022, we collected data from 156 family physicians (FPs) in Alberta, Canada. The survey contained scales that measured workplace need satisfaction and frustration, subjective well-being (physical, psychological, and relational), and frequency of virtual care use. We performed correlational and regression analyses of the data. Results: More frequent use of virtual care was associated with lower relatedness satisfaction among FPs. Controlling for the frequency of virtual care use, frustration of autonomy and competence needs negatively related to FPs' physical well-being; frustration of competence and relatedness needs negatively related to their psychological and relational well-being. Conclusions: Findings from this study align with SDT and underscore the importance of supporting FPs' basic psychological needs, while we work to integrate virtual care into clinical practice. In their day-to-day work, we encourage physicians to reflect on their own sense of autonomy, competence, and relatedness, and consider how using virtual care aligns with these basic needs.