How Does a Junior Faculty Development Program Affect Burnout? A Mixed Methods Assessment.

OBJECTIVES: Burnout is common among junior faculty. Professional development has been proposed as a method to improve engagement and reduce burnout among academic physicians. The Penn State College of Medicine Junior Faculty Development Program (JFDP) is a well-established, interdisciplinary program. However, an increase in burnout was noted among participants during the program. The authors sought to quantify the change in burnout seen among JFDP participants across 3 cohorts, and to explore sources of well-being and burnout among participants. METHODS: Through a sequential explanatory mixed methods approach, participants in the 2018/19, 2019/20, and 2020/21 cohorts took a survey assessing burnout (Copenhagen Burnout Inventory), quality of life (QoL), job satisfaction, and work-home conflict at the start and end of the course. Descriptive statistics were generated as well as Pearson χ2 test/Fisher exact test for categorical variables and Wilcoxon rank sum tests for continuous variables for group comparisons. To better understand the outcome, past participants were invited to interviews regarding their experience of burnout during the course. Inductive thematic analysis (kappa = 0.86) was used to derive themes. RESULTS: Start- and end-of-course surveys were completed by 84 and 75 participants, respectively (response rates: 95.5% and 85.2%). Burnout associated with patient/learner/client/colleague increased (P = .005) and QoL decreased (P = .02) at the end compared with the start. Nonsignificant trends toward worsening in other burnout categories, work-home conflict, and job satisfaction were also observed. Nineteen interviews yielded themes related to risks and protective factors for burnout including competing demands, benefits of networking, professional growth, and challenges related to diverse faculty roles. CONCLUSION: Junior Faculty Development Program participants demonstrated worsening of burnout and QoL during the program while benefiting from opportunities including skill building and networking. The impact of Junior Faculty Development Programs on the well-being of participants should be considered as an element of their design, evaluation, and refinement over time.

Determinants of influenza vaccine uptake among pregnant women: Demographics and medical care access.

OBJECTIVE: To investigate how sociodemographic and medical care access variables are associated with influenza vaccine uptake among pregnant women in the USA. METHODS: This is an observational study using 2015-2019 data from the US Behavioral Risk Factor Surveillance System. Pregnant women aged 18-49 years were included. Weighted χ2 tests and weighted logistic regression models were performed using the software SAS. RESULTS: A total of 9149 pregnant women were included, of whom 39.9% received the influenza vaccine. Age, income, education and race/ethnicity were significantly associated with influenza vaccination. The following medical access factors were associated with a higher likelihood of receiving the influenza vaccine: having insurance (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.04-1.97), having had a checkup in the past year (OR 1.69, 95% CI 1.40-2.03), and having a primary care provider (OR 1.45, 95% CI 1.18-1.78). In subgroup analysis by race/ethnicity, non-Hispanic black women had the least difference in influenza vaccine uptake between those with medical care access and those without. CONCLUSION: Our findings suggest that the influenza vaccine uptake level was far from optimal among pregnant women. Influenza vaccine uptake was associated with social demographics and medical care access among pregnant women.

Gynaecological care of women with chronic pelvic pain: Patient perspectives and care preferences.

OBJECTIVE: To explore the experiences and care preferences of women with chronic pelvic pain, with or without a history of sexual trauma, seeking gynaecological care. DESIGN: Qualitative study. SETTING: Ambulatory endometriosis centre. POPULATION OR SAMPLE: Women aged 18-55 years with chronic pelvic pain. METHODS: Baseline demographics and sexual trauma history were obtained, and participants were assigned to focus groups according to a positive (four groups, 13 participants) or negative (two groups, nine participants) screen for a history of sexual trauma. The focus groups were led by a clinical psychologist and a gynaecological surgeon and consisted of semi-structured interviews. The interviews were audio-recorded and transcribed, and the transcripts were coded in NVivo 12. MAIN OUTCOME MEASURES: Content analysis was used to derive themes according to the participants' own words. RESULTS: Participants with chronic pelvic pain, with or without a history of sexual trauma, experienced delay in diagnosis and repetitive dismissals by clinicians. Participants' experiences of dismissals included: clinicians not listening, insufficient allocation of time to appointments and perceived redundant medical testing (i.e. sexually transmitted infection testing, urine cultures, ultrasounds). Participants identified clinician interactions as pivotal in coping with both pelvic pain and sexual abuse. Participants also provided feedback regarding trauma-informed practices and care delivery specific to patients with chronic pelvic pain. CONCLUSION: Patients with chronic pelvic pain, with or without a history of sexual trauma, report negative experiences when interacting with the healthcare system. They have clear needs and preferences regarding gynaecological care and provide feasible suggestions for improving care delivery.

A Graphic Transformation: A Qualitative Study of Transformative Learning in Medical Trainees during COVID-19 Using Comics as Data Presentation.

Phenomenon: Transformative learning is a theory in which individuals construct new or revised interpretations of the meaning of an experience. COVID-19 offers a rare opportunity to better understand how individuals respond to and make meaning within the shared context of an extraordinary event. We aimed to examine if and how residents and fellows engaged in transformative learning when caring for COVID-19 positive patients during the initial peak of the pandemic (Spring 2020).Approach: We conducted an interpretive qualitative study to identify themes pertaining to transformative learning. We used semi-structured interviews of residents and fellows who were directly or indirectly involved in the care of COVID-19 positive patients admitted to the inpatient wards or the intensive care units during the first peak of the pandemic (defined as March 11th - May 28th, 2020) at our Mid-Atlantic academic health system. We used the medium of comics to depict select interviewees' experiences during the pandemic as a novel way to represent themes from the interviews.Findings: Three main themes arose from our qualitative analysis. These included "a sense of guilt," "the impact on training," and "venues and processes for reflection." In comparing their experiences with colleagues and friends at other institutions with higher COVID-19 case volume, trainees reflected on how they felt lucky, and this led to guilt, although not necessarily transformation. The impact of COVID-19 on the training environment had transformative potential. Trainees challenged their previously held assumptions on the necessity of various surgeries, in-person visits, and physical examination maneuvers when COVID-19 posed a barrier. Finally, while trainees recalled multiple situations throughout the pandemic when they believed they were engaging in reflection, such reflection did not appear to reach so deep as to alter participants' underlying assumptions until the research interview itself, suggesting that transformation was incomplete.Insights: Our purposive sample of residents and fellows who cared for COVID-19 positive patients during the initial peak of the pandemic made meaning of their experience in multiple ways. The largest shift in worldview due to the pandemic appeared to be related to the instrumental utility of certain common medical practices or procedures. This, in turn, was the most prominent influence on how these trainees felt they would practice in the future, and translated to a shift in how they appraised evidence. However, lack of opportunity for reflection may have adversely impacted the ability for transformation to take place. Given that multiple trainees showed appreciation for the critical reflection venue that was the research interview, academic leadership should ensure similar venues exist during training, even after the pandemic ends.

Transformative learning of medical trainees during the COVID-19 pandemic: A mixed methods study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a transformative effect on individuals across the world, including those in healthcare. Transformative learning is an educational theory in which an individual's worldview is fundamentally altered through conscious reflection (Cognitive Rational), insights (Extrarational), or social reform (Social Critique). We utilized transformative learning theory to characterize the experiences of medical trainees during the pandemic. METHODS: We used the Transformative Learning Survey in September and October 2020 to evaluate the processes and outcomes of transformative learning in health professions students and housestaff at an academic medical center during the pandemic. We analyzed survey scores for three process domains and four outcome subdomains. We inductively coded the survey's two open-ended questions and performed qualitative and mixed-methods analyses. RESULTS: The most prominent TL outcome was Self-Awareness, Acting Differently was intermediate, and Openness and Worldview Shifts were lowest. Cognitive Rational and Social Critique processes were more prominent than Extrarational processes. Students were more likely than housestaff to undergo transformative learning through the Social Critique process (p = 0.025), in particular the sub-processes of Social Action (p = 0.023) and Ideology Critique (p = 0.010). Qualitative analysis via the aggregation of codes identified four responses to the pandemic: negative change, positive change, existential change, or no change. Negative changes (67.7%) were most common, with students reporting more of these changes than housestaff (74.8% vs 53.6%; p < 0.01). Only 8.4% of reported changes could be defined as transformative. CONCLUSIONS: Through the theoretical lens of transformative learning, our study provides insight into the lives of learners during the pandemic. Our finding that medical students were more likely to use Social Critique processes has multiple parallels in the literature. If leaders in academic medicine desire to create enlightened change agents through transformative learning, such education must continue throughout graduate medical education and beyond.

The influence of patriarchy on Nepali-speaking Bhutanese women's diabetes self-management.

INTRODUCTION: The Nepali-speaking Bhutanese (NSB) community is a rapidly growing population in Central Pennsylvania. A community-based diabetes education pilot program found a large gender disparity with fewer women in attendance; participants reported that primary household cooks and caretakers were women. This may be an indication of women's status in the NSB community, their healthcare access, autonomy, and ability to manage their diabetes. Hence, this study aims to understand the manifestations of patriarchy and its impact on NSB women's diabetes self-management employing a conceptual framework based on Walby's structures of patriarchy. METHODS: An exploratory feminist qualitative inquiry was conducted. Fifteen NSB women with Type 2 Diabetes were interviewed about their diabetes self-management. Transcripts were coded for key concepts that emerged from the data. A thematic analysis was conducted. Themes were developed inductively through those categories as well as through an a priori approach using the conceptual framework. RESULTS: Cultural influences such as family structure, religious beliefs, traditional healthcare and gender roles determined NSB women's patriarchal upbringing and lifestyle. Unpaid household production was largely dependent on women. Multiple immigrations led to poor socioeconomic indicators and marginalization of NSB women. Women's access to healthcare (including diabetes) was entirely reliant on other family members due to poor autonomy. Women experienced adverse physical and emotional symptoms related to diabetes and their ability and attempts to maintain a healthy diabetes lifestyle was determined by their physical health condition, knowledge regarding good dietary practices and self-efficacy. CONCLUSION: Patriarchal practices that start early on within women's lives, such as child marriage, religious restrictions as well as women's access to education and autonomy impacted NSB women's access to healthcare, knowledge regarding their diabetes and self-efficacy. Future interventions tailored for diabetes prevention and self-management among NSB women should factor in patriarchy as an important social determinant of health.

Recent Intimate Partner Violence and Oral Contraceptive Pill Adherence in a Cohort of Reproductive-Aged Women.

Objective: Intimate partner violence (IPV) is an important public health problem that impacts reproductive decision-making. Although previous literature has reported a negative impact on contraceptive adherence overall, this study specifically aims to investigate the association between IPV and oral contraceptive pill (OCP) adherence. Methods: We analyzed baseline survey data from 373 OCP users participating in the MyNewOptions study. Recent IPV was defined as any positive response to HARK, a 4-question tool assessing emotional, sexual, and physical abuse in the past year, or self-report of sexual coercion in the past 6 months. High OCP adherence was defined by self-report of missing ≤1 pill per month, which was then corroborated by pharmacy claims data. Multivariable regression analyses were performed to assess the influence of recent IPV history and patient-level variables on OCP adherence. Results: Just over half of our participants were highly adherent to OCPs (53.6%), and approximately one-quarter reported recent IPV exposure (25.2%). Women with recent IPV were significantly less likely to be OCP adherent than those without IPV (adjusted odds ratio (AOR) 0.54, 95% confidence interval (CI): 0.32-0.92). Protestant religion was also associated with high OCP adherence (AOR 2.41, 95% CI: 1.24-4.65, compared with no religious affiliation), while younger age groups (18-25 and 26-33 years) were less likely to have high OCP adherence compared with the 34-40 age group (AOR 0.45, 95% CI: 0.20-1.00 and AOR 0.40, 95% CI: 0.18-0.91, respectively). Conclusion: Recent IPV exposure is associated with low OCP adherence among women of reproductive age. ClinicalTrials.gov identifier: NCT02100124.

Association of human papillomavirus vaccination with cervical cancer screening: A systematic review and meta-analysis.

INTRODUCTION: Prophylactic vaccination and routine screening are effective at preventing most cases of cervical cancer. Globally, cervical cancer is the fourth most frequently diagnosed cancer among women. The aim of this study was to investigate the association between human papillomavirus virus (HPV) vaccination (1, 2, or 3 doses) and cervical cancer screening. METHODS: PubMed (MEDLINE), Scopus, Web of Science, and Cochrane Library electronic databases were systematically searched from July 1, 2006, up to September 30, 2021. We pooled estimates using random-effects models. Heterogeneity between studies was quantified using Cochran Q test and I2 statistics. In total, 12 studies involving 2.4 million individuals were included in the meta-analysis. RESULTS: In the adjusted estimates, uptake of HPV vaccination was associated with increased cervical cancer screening (pooled relative risk [RR]: 1.35; 95% confidence interval [CI]: 1.21, 1.50; n = 12). Between-study heterogeneity was large (I2 = 99%). Compared to unvaccinated, those who received 3 doses of HPV vaccine had the highest uptake of cervical cancer screening (RR: 1.85; 95% CI: 1.58, 2.17), followed by those who received 2 doses (RR: 1.34; 95% CI: 1.21, 1.47). No statistically significant association with screening was found for those who received a single dose of the HPV vaccine. CONCLUSION: In this meta-analysis, uptake of HPV vaccination was associated with higher cervical cancer screening. It is plausible that vaccinated individuals are more likely to engage in preventive health behaviors. Healthcare providers should remind patients to continue with routine screening for cervical cancer regardless of their HPV vaccine status since vaccination does not protect against all HPV types.

Systematic review of menstrual health and hygiene in Nepal employing a social ecological model.

Menstrual health and hygiene are a major public health and social issues in Nepal. Due to inadequate infrastructure to provide education, healthcare, and communication as well as religious teachings, women and girls are excluded from participation in many activities of daily living and community activities during menstruation. Evidence based research addressing menstrual health and hygiene in Nepal is scares. The objective of this paper is to review the current state of knowledge on menstrual health and hygiene in Nepal through a socio-ecological perspective. This systematic review identifies knowledge gaps and targets for future research and interventions. Studies from Nepal that examined factors contributing to menstrual health and hygiene were identified through searches across six databases (Medline, CINAHL, Web of Science, PsychInfo, Nepal Journals Online and Kathmandu University Medical Journal) in January 2019. The SEM is a public health framework that describes how health is impacted at multiple levels including the individual, interpersonal, community, organizational and policy levels. Key themes were identified, and factors contributing to menstrual health and hygiene were categorized as per the level of socio-ecological model (SEM). After a comprehensive literature review, twenty peer-reviewed publications, published between 2003 and January 2019 were included in this review. Eighteen studies were descriptive and two were interventional. The main outcomes reported were reproductive health concerns and menstrual hygiene practices. Nine studies focused on knowledge, attitude, and practices regarding menstruation, seven studies highlighted reproductive health issues, three studies focused on prevalence of culturally restrictive practices, and one on school absenteeism and intimate partner violence. Lack of awareness regarding menstrual health and hygiene, inadequate WASH facilities, no sex education and culturally restrictive practices makes menstruation a challenge for Nepali women. These challenges have negative implications on women and girls' reproductive as well as mental health and school attendance among adolescent girls. There are gaps in the evidence for high quality interventions to improve menstrual health and hygiene in Nepal. Future research and interventions should address needs identified at all levels of the SEM.

Menstrual health and hygiene are major public health and social issues in Nepal, due to a lack of health and education infrastructure, gender-based disparities and restrictive cultural and social norms. This study reviewed the current state of research on menstrual health and hygiene in Nepal. The socio-ecological model (SEM)­a public health framework that examines individual, interpersonal, community, organizational, and policy impacts on health­was employed to describe impacts on menstrual health and hygiene. After a comprehensive literature review, 20 papers were included in this analysis, of which 18 were descriptive and two were interventional. The primary menstrual health and hygiene outcomes reported were reproductive health concerns and menstrual hygiene practices. Key themes identified were knowledge, attitude, and practices regarding menstruation, reproductive health issues, prevalence of culturally restrictive practices, school absenteeism and intimate partner violence. The study results indicated lower menstrual health and hygiene challenges arose from lack of education around menstruation, lack of proper water, sanitation, and hygiene (WASH) facilities, poor sex education, and culturally restrictive practices. These challenges negatively impact women and girls' reproductive health as well as mental health and school attendance. There is need for high quality, effective interventions to improve menstrual health and hygiene in Nepal. Future research and interventions should address improvements in menstrual health and hygiene at all levels of the socio-ecological model.

Cervical cancer screening varies by HPV vaccination status among a National Cohort of privately insured young women in the United States 2006-2016.

ABSTRACT: Human papillomavirus (HPV) vaccination in young women is low. Women aged 21 to 65 years in the United States (U.S.) have not reached the Healthy People 2020 objective of 93% for cervical cancer screening. The main aim of this study was to investigate the association between HPV vaccination status and cervical cancer screening among privately insured women aged 21 to 26 years in the U.S.This was a retrospective cohort study using the IBM MarketScan database (2006-2016). The study population included 190,982 HPV-vaccinated women and 763,928 matched unvaccinated women. Adjusted incidence rate ratio (IRR) and the 95% confidence intervals (CIs) were obtained using the generalized estimating equations models with a Poisson distribution.Among a total of 954,910 women included in the analysis, age (mean [SD]) was 23.3 [1.6] years. During 967,317 person-years of follow-up, a total of 475,702 incidents of cervical cancer screening were identified. The incidence density rates of cervical cancer screening were 461 per 1000 person-years (PY) for unvaccinated women and 787 per 1000 PY for those who received 3 doses of the HPV vaccine. After adjusting for other covariates, the IRR of cervical cancer screening was 34% higher among HPV-vaccinated women with at least one vaccine dose than unvaccinated women (adjusted IRR = 1.34, 95% CI: 1.33-1.35; P < .0001). The IRR of cervical cancer screening varied by the dose of HPV vaccination. There was evidence of a linear dose-response relationship between the number of HPV vaccine doses and cervical cancer screening (P-trend < .0001). Compared with unvaccinated women, the IRR of cervical cancer screening were 14%, 39%, and 60% higher among those who received 1, 2, and 3 doses of the HPV vaccine, respectively.In this large retrospective cohort study of privately insured women, HPV-vaccinated women were more likely to be screened for cervical cancer compared with unvaccinated women.

Gun violence incidence during the COVID-19 pandemic is higher than before the pandemic in the United States.

During the coronavirus disease 2019 (COVID-19) pandemic, gun violence (GV) in the United States (U.S.) was postulated to increase strain on already taxed healthcare resources, such as blood products, intensive care beds, personal protective equipment, and even hospital staff. This report aims to estimate the relative risk of GV in the U.S. during the pandemic compared to before the pandemic. Daily police reports corresponding to gun-related injuries and deaths in the 50 states and the District of Columbia from February 1st, 2019, to March 31st, 2021 were obtained from the GV Archive. Generalized linear mixed-effects models in the form of Poisson regression analysis were utilized to estimate the state-specific rates of GV. Nationally, GV rates were 30% higher between March 01, 2020, and March 31, 2021 (during the pandemic), compared to the same period in 2019 (before the pandemic) [intensity ratio (IR) = 1.30; 95% CI 1.29, 1.32; p < 0.0001]. The risk of GV was significantly higher in 28 states and significantly lower in only one state. National and state-specific rates of GV were higher during the COVID-19 pandemic compared to the same timeframe 1 year prior. State-specific steps to mitigate violence, or at a minimum adequately prepare for its toll during the COVID-19 pandemic, should be taken.

Perceptions of firearms in a cohort of women exposed to intimate partner violence (IPV) in Central Pennsylvania.

BACKGROUND: Almost one-half of U.S. women will experience intimate partner violence (IPV), defined as physical, sexual, or psychological harm by a current or former partner. IPV is associated with an increased risk of homicide, with firearms as the most commonly used weapon. We designed this study to better understand the correlation of interpersonal trauma exposures and demographic factors on firearm perceptions among a cohort of IPV-exposed women. METHODS: Two hundred sixty-seven women in central Pennsylvania with exposure to IPV were surveyed about perceptions of gun access, safety, and gun presence in the home. Trauma variables included IPV type, IPV recency, unwanted sexual exposure, and adverse childhood experiences (ACEs). Multivariable analyses examined three questions examining firearm perceptions controlling for trauma exposures and demographics. RESULTS: Ease of firearm acquisition: Women who were older (mean 44.92 years +/- SD 12.05), compared to women who were younger (40.91 +/- SD 11.81 years) were more likely to describe it as easy or very easy to acquire a gun (aOR 1.05, 95%CI 1.004, 1.10). Perceived safety in the proximity of a gun: Women with the highest ACE score were less likely to feel safe with a gun nearby (aOR 0.31, 95%CI 0.14, 0.67). Odds of guns in the home: Women who were divorced or separated (aOR 0.22, 95%CI 0.09, 0.54), women were widowed or single (aOR0.23, 95%CI 0.08, 0.67), and women who were partnered (aOR 0.45 95%CI 0.20, 0.97) had lower odds of having a gun in the home, compared to married women. There was no significant effect of the trauma variables on the odds of having a gun at home. CONCLUSIONS: Women with more severe childhood trauma felt less safe around firearms, but trauma exposures did not predict the perception of gun prevalence in the local community or gun ownership. Instead, demographic factors of marriage predicted presence of a gun in the home.

Transformative Learning in Graduate Medical Education: A Scoping Review.

BACKGROUND: Transformative learning (TL) is an educational theory focused on deep fundamental shifts in an individual's worldview. Such shifts are well known to occur within graduate medical education (GME). However, TL in GME has yet to be formally explored. OBJECTIVE: We performed a scoping review of the literature on TL within GME to identify areas where trainees currently experience or have potential to experience TL, and to explore areas where fostering TL has been used as a pedagogical tool. METHODS: In January 2020, we searched 7 databases to identify literature on TL in GME. Additional articles were identified by hand-searching the Journal of Graduate Medical Education. RESULTS: A total of 956 articles were identified through database search with 3 unique articles found via hand-searching. Abstracts and manuscripts were screened by 2 authors and disagreements arbitrated by a third, yielding 28 articles for our analysis. The main components of TL (disorienting dilemma, reflection, discourse, action) took various forms. TL was closely linked with professionalism training and professional identity formation. Training programs in primary care fields were most frequently referenced. Often, trainees were experiencing TL without recognition of the theory by their educators. Gaps in the graduate medical education literature exist pertaining to TL in venues such as diversity, equity, and inclusion. CONCLUSIONS: Our scoping review uncovered the following themes: TL and professionalism, TL and primary care, and TL by other names. TL is likely occurring but going unrecognized in some settings.

Correction to: Remediation Through Transformation: Applying Educational Theory to the Struggling Resident.

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Remediation Through Transformation: Applying Educational Theory to the Struggling Resident.

The struggling medical resident is faced with many adaptive challenges that may require change in mindset. However, formal remediation within graduate medical education (GME) often employs overly structured technical solutions to address trainee deficiencies. These strategies may ultimately fail to result in sustained improvement. Transformative learning (TL) is an educational theory that has recently been explored as a teaching modality in health professions education. In 2013, Cranton published a three-part framework for TL. This framework, composed of the cognitive perspective, beyond rational TL, and TL for social change, has potential applications to GME remediation, specifically in helping individuals to overcome adaptive challenges. These strategies may be particularly useful within the traditionally difficult-to-remediate competencies of systems-based practice, practice-based learning and improvement, and professionalism. The authors provide a descriptive overview of each of Cranton's perspectives, introducing concrete examples drawn from the medical literature. This article will contrast current remediation strategies with those using TL theory in order to assist graduate medical educators in applying these principles to the remediation of their own struggling residents.

Actions Taken by Women in Response to Intimate Partner Violence and Intimate Partner Violence Status at 1-Year Follow-Up.

BACKGROUND: Intimate partner violence (IPV) is a pervasive public health issue with significant physical and mental health sequelae. A longer duration and greater severity of abuse are associated with adverse health outcomes and increased risk of revictimization. Current research has identified a variety of strategies used by women in response to abuse, but has not established whether the use of these strategies is associated with decreased IPV over time. For this study, we analyzed the associations between the use of specific actions in response to abuse-placating, resistance, informal or formal network help-seeking, safety planning, and substance use-and IPV victimization at the 1-year follow-up. METHODS: Ninety-five women with past-year IPV at baseline participated in a 1-year follow-up survey measuring their use of specific actions in response to IPV and subsequent IPV status. IPV victimization at the 1-year follow-up was analyzed as a function of types of actions taken and sociodemographic variables. RESULTS: Among women with past-year IPV at baseline (N = 95), 53% reported no further IPV victimization at the 1-year follow-up. In bivariate analysis, social support was associated with decreased risk of IPV victimization (odds ratio, 0.43; 95% confidence interval [CI], 0.18-0.99). In multivariable analyses, high use of placating (adjusted odds ratio, 9.40; 95% CI, 2.53-34.9), formal network help-seeking (adjusted odds ratio, 7.26; 95% CI, 1.97-26.74), and safety planning (adjusted odds ratio, 2.98; 95% CI, 1.02-8.69) strategies were associated with an increased risk of IPV victimization at the 1-year follow-up. CONCLUSIONS: Our data demonstrate that IPV exposure can change over time and that the use of specific actions in response to IPV can be indicators of risk of subsequent victimization. Abuse severity is an important potential confounder of action efficacy.

COVID-19 has united patients and providers against institutional betrayal in health care: A battle to be heard, believed, and protected.

In this commentary, researchers, health care consumers, and medical providers reflect on institutional betrayal during the COVID-19 pandemic in American and Canadian health care systems. Examples of institutional betrayal experienced by patients and their family members, as well as medical providers, are described. Although such examples may be more evident to the general public during the current pandemic, they do not represent new problems. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A Developmental Approach to Internal Medicine Residency Education: Lessons Learned from the Design and Implementation of a Novel Longitudinal Coaching Program.

BACKGROUND: Resident physicians' achievement of professional competencies requires reflective practice skills and faculty coaching. Graduate medical education programs, however, struggle to operationalize these activities. OBJECTIVE: To (1) describe the process and strategies for implementing an Internal Medicine (IM) resident coaching program that evolved in response to challenges, (2) characterize residents' professional learning plans (PLPs) and their alignment with EPAs, and, (3) examine key lessons learned. DESIGN: The program began in 2013 and involved all postgraduate years (PGY) residents (n = 60, 100%), and 20 faculty coaches who were all IM trained and practicing in an IM-related specialty. One coach was linked with 3-4 residents for three years. Through 1:1 meetings, resident-coach pairs identified professional challenges ('disorienting dilemmas' or 'worst days'), reviewed successes ('best days'), and co-created professional learning plans. Typed summaries were requested following meetings. Coaches met monthly for professional development and to discuss program challenges/successes, which informed programmatic improvements; additionally, a survey was distributed after three program years. Data were analyzed using quantitative and qualitative methodologies. RESULTS: Disorienting dilemmas and professional learning plans mapped to all 16 EPAs and four additional themes: work-life balance, career planning, teaching skills, and research/scholarship. The most-frequently mapped topics included: PGY1 - leading and working within interprofessional care teams (EPA 10), research and scholarship, and work-life balance; PGY2 - improving quality of care (EPA 13), demonstrating personal habits of lifelong learning (EPA15), and research and scholarship; PGY3 - lifelong learning (EPA15); career planning was common across all years. CONCLUSIONS: Lessons learned included challenges in coordination of observations, identifying disorienting dilemmas, and creating a shared mental model between residents, faculty, and program leadership. The coaching program resulted in professional learning plans aligned with IM EPAs, in addition to other professional development topics. Operationalization of aspects of these results can inform the development of similar programs in residency education.

Intimate partner violence discussions in the healthcare setting: A cross-sectional study.

In 2013, the United States Preventive Services Task Force recommended routine intimate partner violence (IPV) screening for reproductive-age women. Given the increased attention paid to IPV on a national scale, and broader recognition of its social and physical implications, we sought to characterize the discussions resulting from routine IPV screening-specifically regarding provider response and patient perceptions. In a cross-sectional analysis, we implemented a survey to examine outcomes of IPV screening, including use of guideline-concordant discussion topics and interventions, as well as patient perception of the encounters. Women aged 18-65 with lifetime history of IPV and a past-year healthcare appointment were recruited from clinics and women's shelters in Pennsylvania. Data collection took place from May 2014-January 2015. Of 253 women, 39% were screened for IPV at a healthcare visit in the year prior to survey administration. Of women who were screened, guideline-concordant discussion topics were employed in 70% of encounters and guideline-concordant interventions were offered in 72% of encounters. 58% of women reported being "extremely" or "very satisfied," and 53% reported being "extremely" or "very comfortable" with IPV-related discussions. The low rate of screening in this population reiterates the importance of focusing efforts on educating providers on the importance of screening, promoting the availability of community resources, and developing systems-based practices that foster IPV screening, discussion, and referral following disclosure.

Trajectories of Depressive Symptoms Throughout the Peri- and Postpartum Period: Results from the First Baby Study.

BACKGROUND: Postpartum depression (PPD) is a common complication of childbearing, but the course of PPD is not well understood. We analyze trajectories of depression and key risk factors associated with these trajectories in the peripartum and postpartum period. METHODS: Women in The First Baby Study, a cohort of 3006 women pregnant with their first baby, completed telephone surveys measuring depression during the mother's third trimester, and at 1, 6, and 12 months postpartum. Depression was assessed using the Edinburgh Postnatal Depression Scale. A semiparametric mixture model was used to estimate distinct group-based developmental trajectories of depression and determine whether trajectory group membership varied according to maternal characteristics. RESULTS: A total of 2802 (93%) of mothers completed interviews through 12 months. The mixture model indicated six distinct depression trajectories. A history of anxiety or depression, unattached marital status, and inadequate social support were significantly associated with higher odds of belonging to trajectory groups with greater depression. Most of the depression trajectories were stable or slightly decreased over time, but one depression trajectory, encompassing 1.7% of the mothers, showed women who were nondepressed at the third trimester, but became depressed at 6 months postpartum and were increasingly depressed at 12 months after birth. CONCLUSIONS: This trajectory study indicates that women who are depressed during pregnancy tend to remain depressed during the first year postpartum or improve slightly, but an important minority of women become newly and increasingly depressed over the course of the first year after first childbirth.